House of God

by Samuel Shem

  ‘LAW NUMBER ONE: GOMERS DON’T DIE,’ said Fats.

  ‘Hooper, what the hell is it with you and those posts?’ I asked.

  ‘The Black Crow Award,’ said Hooper.

  ‘That was a joke,’ I said.

  ‘It was not. The postmortem is the flower—no, the red rose—of medicine.’

  As Hooper went on down the corridor, I thought how happy he’d gotten, now that he’d lodged his M firmly OR, and now that he had his Israeli Path Resident doing autopsies for him on a ‘same-day’ basis. Racing for the Black Crow, Hooper hated the seemingly immortal gomers, and sought out younger patients, the ones who could die. In particular, he cherished the upper socioeconomic young, who, according to a recent J. Path. article, were most likely to sign for their own posts. Occasionally someone would mention to Hooper that maybe he was a little too heavy into death, but he’d just smile his boyish California smile hop up and down like a Mouseketeer, and say, ‘Hey, it’s where we’re all headed, right?’ Death had become a lifeline for the perky little Sausalitan.

  Fats had gone straight from the stench of the Rose Room to breakfast, and Eddie and I were left alone. He turned his tense eyes to me and said, ‘I can’t take it—they’re all gomers.’

  ‘It’s a tremendous opportunity to utilize your twenty-six years of education and maturity to procure the delivery of medical care for a needy geriatric population.’

  ‘They’re all gomers, every one of them.’

  Neck and neck for the Black Crow with Hooper, Eddie had gotten deep into sadomasochism, in particular grooving on patients ‘hurting’ him or on his ‘hurting’ them. I tried to change the subject, and said, ‘Say, I hear your wife’s having a baby.’

  ‘A what?’

  ‘A baby. Your wife. Sarah, remember?’

  ‘Yeah, the wife is having her baby. Soon.’

  ‘It’s not just hers, it’s yours too!’ I shouted.

  ‘Yeah. Say, did you see ’em? All gomers. If three of them were seen in California they’d close up the state. They smell, and I hate smells. Gomers and gomers and more gomers. And’—he looked at me with a puzzled and almost pleading expression and said, ‘. . . and gomers. I mean, do you know what I mean?’

  ‘Yeah I do,’ I said. ‘Don’t worry, we’ll help each other through.’

  ‘I mean . . . gomers is all there is here is gomers.’

  ‘Sweetheart,’ I said, giving up, ‘it’s Gomer City.’

  The Fish was remarkable. Hands in his pockets, head in the clouds, he was so bananas in his own way that almost every time you had a conversation with him you wanted to run and tell someone about it because it did strange things to your brain, as if someone had unrolled a few convolutions, and if it hadn’t come from the Chief Resident you’d swear it had come from a lunatic. That first day as our Visit, he strolled up and was greeted by Fats in between Harry the Horse and Jane Doe and said, ‘Hi, guys, how’s it going?’ and avoided our eyes and didn’t wait to hear how it had been going and said, ‘Let’s see the patients, huh?’

  ‘Welcome, Fish,’ said Fats. ‘We’re both GI men, and is there ver good GI material here, eh?’

  Jane Doe cut a long, drawn-out, liquid fart.

  ‘What’d I tell you, Fish?’ said Fats. ‘The Gee Eye Tract!’

  ‘The GI Tract is a special interest of mine,’ said the Fish ‘as is flatulence. I’ve recently had the opportunity to review the world literature on flatulence in liver disease. Why, flatulence in liver disease would make a very interesting research project. Perhaps the House Staff would be interested in undertaking such a research project?’

  No one said he was interested.

  ‘Let me ask you this,’ said the Fish, looking at Hooper. ‘What enzyme is missing in liver disease to produce flatulence?

  ‘I don’t know,’ said Hooper.

  ‘Good,’ said the Fish. ‘You know, it’s so easy to answer a question. Why, quite often it’s harder, here on rounds, to say frankly “I don’t know.” In some hospitals, like the MBH, it would be frowned on to say “I don’t know.” But I want the House of God to be the kind of place where an intern can be proud to say “I don’t know.” Good, Hooper. Eddie? What’s the enzyme?’

  ‘I don’t know,’ said Eat My Dust.

  ‘Roy?’

  ‘I don’t know,’ I said.

  ‘Fats?’ asked the Fish, with trepidation.

  After a tense pause Fats said, ‘I don’t know.’

  The Fish looked a little perturbed that everyone had said ‘I don’t know,’ Jane Doe broke wind again, and the Fish, irritated, said, ‘I love the GI Tract as much as anyone, but it’s not professional to have someone with that kind of looseness of bowel control sitting in the middle of the corridor. Too loose. Put her in her room.’

  ‘Oh, we can’t do that,’ said Fats, ‘she gets real violent in her room. But don’t worry, I’m working on something special to stop the farting. Part of the TBC.’

  ‘TBC? What’s TBC?’

  ‘Total Bowel Control. Part of the Research Project at the VA.

  ‘Excuse me, Fish,’ said Eddie, ‘but maybe you could tell us the answer to that question about the enzyme?’

  ‘Oh? Why, I don’t know.’

  ‘You don’t know either?’ asked Eddie.

  ‘Why, no, and I’m proud to say it. I was hoping one of you would. But I’ll say one thing: I’ll know by tomorrow on rounds.’

  Since the placement of the gomers was hot stuff in Gomer City, so was the Sociable Cervix. Soon after our sexual carnival in the fall, my thing with Premarin Selma had cooled. On Social Service rounds that first day, both Selma and Rosalie Cohen were cordial but wary. I didn’t mind. I was preoccupied by what I’d already seen of ‘the worst’ ward, and I had a hard time concentrating on the meeting. I caught Eddie muttering something about ‘I looked up, and all I saw was gomers,’ and the nurses demanding we go over the three-part placement form, poring over questions like ‘Anointed: Yes No Date’ and ‘Incontinence: Bladder Bowel Date of Last Enema.’ By the end of rounds I found myself zeroed in on a young blond guy with a terrific tan, sitting in a corner giving his forelock an occasional flick up out of his baby-blue eyes.

  Later Hooper and Eddie and I were sitting in the oncall room, finding new ways to play with our stethoscopes without sucking on them outright. I raised the question: ‘Why are there only gomers on this ward?’ Hooper and Eddie looked at each other, puzzled. No one knew.

  ‘Why don’t you dial HELP and find out?’ Hooper suggested.

  ‘Dial what?’

  ‘H-E-L-P. The guy in the Blue Blazer. It’s a new House concept: if you need help with anything, you dial HELP.’

  I dialed HELP and said, ‘Hello I need help . . . No, I’m not a patient, I’m on the opposing team, the doctors, and I need one of those Blue Blazers . . . Which? Damn! Yeah, floor four . . . ‘Bye.’ I turned to the others and said, ‘Each floor has a Blazer of its very own, and ours is named Lionel.’

  ‘Amazing,’ said Eddie. ‘I wonder how much those jokers get paid?’

  The Blue Blazer arrived. He was the same Blazer as in rounds, and he looked just as terrific as before. We welcomed him and invited him to sit down. With a dynamite aristocratic flick of the wrist and forelock, he did. He crossed his legs in a slick way that showed that here was a guy, finally, who really knew how to sit down and cross his legs.

  A strange thing happened. We asked the Blazer all kinds of questions about what he and HELP was and did and how much HELP got paid, and ‘Why are there only gomers here on this ward?’ Lionel answered each question in a sincere and soothing voice, and seemed to be a storehouse of information that he was glad to disseminate to us hardworking terns ‘without whom the House of God would fall like a house of cards.’ Yet each soothing answer was cotton candy, ‘cause after it was, it wasn’t. Lionel had said nothing. It was crucial to our survival in Gomer City that we get answers, since even if we TURFED every gomer out, if somehow each TURFED-out gomer was to be r
eplaced with a fresh one, why the hell bother at all? We got angry, and our questions turned nasty. This did even less good, and just as the three of us were beginning to boil, in walked Fats. Sizing up the situation, he said a few soothing things to Lionel, who scurried out, and then Fats turned to us and asked, ‘What are you guys doing?’

  We told him.

  ‘So?’ asked Fats, sitting down and smiling. ‘So what?’

  ‘So the prick never did tell us what HELP did or how much they get paid. Where I come from, they pay help what they’re worth, they pay ’em shit,’ said Eddie.

  ‘Take it easy,’ said Fats. ‘Go with it. Getting pissed at jerks like that is useless.’

  ‘I want to know how come there are only gomers here,’ I said.

  ‘Yeah? Well, so do I and so does everyone else, and you know what? You’ll never find out. Why get angry, eh?’

  ‘I’m not getting angry,’ I said, ‘I am angry.’

  ‘So? So what good does that do? Finesse, Basch, finesse.’

  Gracie from Dietary and Food poked her head into the room, carrying an IV bottle filled with yellow liquid, and holding it up, announced, ‘The extract is ready, dear.’

  ‘Hey, great,’ said Fats, ‘let’s try her out.’

  We followed Fats and Gracie down the corridor, and we watched Gracie replace Jane Doe’s IV bottle with the bottle of ‘the extract.’ Fats, using the reverse stethoscope technique, shouted into Jane’s ears: ‘THIS WILL MAKE YOUR BOWELS STOP RUNNING, JANIE. THIS WILL BIND YOU UP!’

  ‘What is this extract?’ I asked.

  ‘Oh, it’s something I invented and Gracie prepared, and it’s part of the TBC, part of the VA Research that’s gonna make the fortoona.’

  ‘Fresh fruit is God’s own cathartic,’ said Gracie, ‘and we hope that this is the opposite. It’s completely organic. Like laetrile.’

  I asked Fats about this research at the VA, and he told me that some ‘shyster’ there had gotten ‘a big government grant’ to try out a new antibiotic on those eternal guinea pigs, the shell-shocked dereliot vets. The Fat Man had contracted with the shyster to get a percentage for every vet he’d put on the antibiotic, and so Fats had put them all on it.

  ‘How’d it work?’ I asked, realizing as soon as I said it that it was a dumb question, since it hadn’t been given to work on anything.

  ‘Great,’ said Fats, ‘except for one thing: the side effect.’

  ‘Side effect?’

  ‘Yeah, see, it wiped out the intestinal flora, and one of the latent intestinal viruses took over and produced an incredible diarrhea that nothing can control. Nothing yet, that is. So we’ve got high hopes for this extract, see?’

  ‘Yeah, but what’s a little diarrhea?’ Hooper asked.

  ‘A little diarrhea?’ said Fats, eyes widening. ‘A little . . .’ And he dissolved into laughter, jolly chubby gusts of laughter that got bigger and bigger until he was holding onto his gut as if it would break apart and slop all over the tile floor, and Gracie and I and Eddie and Hooper laughed, and with tears in his eyes Fats finally took us aside and said, ‘Not a little diarrhea, men, a big diarrhea. A big contagious diarrhea. This first half of TBC, this VA antibiotic, can produce a diarrhea in anyone’s bowels. If I had known how bad the side effect would be, I never would have done it. That’s why I gotta find the second half, the cure. You see, this diarrhea’s the most contagious and uncontrollable son of a bitch in the whole wide GI world.’

  At the end of the day I went to sign out to EMD, who was on call. I asked how it was going.

  ‘Compared to California, it sucks. My third admission is on her way. I’m already on my knees.’

  ‘Why?’

  ‘She’s on her way from Albany. Three hundred miles. In a taxi.’

  In a taxi?’

  ‘In a taxi. A totally demented wiped-out gomere who, according to the scouting report, has not urinated in weeks and is too demented to sign her informed consent for dialysis, who tormented her family to the point where they surreptitiously TURFED her into a slow-moving cab in Albany and who’s been making her way here since noon. She’s being sent here for dialysis.’

  ‘If she won’t sign there, what makes them think she’d sign here?’

  ‘’Cause like you said: “Sweetheart, here it’s Gomer City.” She’s gonna be a special private patient of the Leggo’s. It’s the greatest day of her life.’

  On my drive home, the sun wore that harsh steely look of tired midwinter, slashing and aslant, enraged at the gray of the ice. I felt cold, unsheltered, perplexed. I had high hopes that the Fat Man would save me, and yet here he was telling me not to get angry at the Blazer.

  ‘He told me to cool it, and I don’t feel like cooling it,’ I told Berry. ‘I mean, you’re always telling me to express my feelings, and I worry that if I cool it I’ll go nuts. How can I listen to both of you?’

  ‘Maybe there’s some common ground,’ said Berry. ‘But I can see how you’d be scared to try and survive there if you and he are at odds. What does he say about all the gomers?’

  Realizing with sadness that now even Berry had been sucked into calling these pitiful old ones ‘gomers,’ I said, ‘He says he loves ’em.’

  ‘That’s just being counterphobic. Secondary narcisissm.’

  ‘What’s all that?’

  ‘Counter phobic is when you do what you’re most scared of doing, the guy who’s afraid of heights becoming a bridge painter. Primary narcissism, like with Narcissus at the Pool, is when he tries to love himself, but he can’t embrace his own reflection, and he fails. Secondary narcissism is where he embraces others, and they love him for it, and he loves himself even more. The Fat Man is embracing the gomers.’

  ‘He’s embracing the gomers?’

  ‘And everybody loves him for it.’

  . . . Everybody loves the doctor and I’m sure by now your patients do love you. Hope you are busy and know you are doing a terrific job. Watched the Knicks on cable TV and they prove that basketball is essentially a team game . . .

  Fats had called us his ‘A Team.’ And yet what kind of team would it be if its * * * MVI * * * began questioning its coach?

  15

  ‘I want to eat,’ said Tina, the woman sent in the taxi.

  ‘You can’t eat,’ said Eat My Dust Eddie.

  ‘I want to eat.’

  ‘You can’t eat.’

  ‘Why can’t I eat?’

  ‘Your kidneys don’t work.’

  ‘They do.’

  ‘They don’t.’

  ‘They do.’

  ‘They don’t. When was the last time you peed?’

  ‘I don’t remember.’

  ‘See? They don’t.’

  ‘I want to eat.’

  ‘If your kidneys don’t work, you can’t eat! You’re gonna sign up for dialysis and have a rotten life.’

  ‘Then I want to die.’

  ‘Now you are talkin’, lady, now you are talkin’!’ said EMD, and slipping past the Albany cabbie, who was trying to collect his two-hundred-dollar-plus-tip fare, Eddie and I left Tina and sat down to the Fat Man’s cardflip.

  ‘Card one,’ said Fats, ‘Golda M.?’

  ‘Great case,’ said Eddie, ‘the Lady of the Lice. Seventy-nine-year-old admitted from the floor of her room; found grimacing like The Exorcist version of a Barbie Doll. Plum-sized lymph nodes all over her body, thinks she’s on the T-line in St. Louis, and has lice.’

  ‘Lice?’

  ‘Right. The creeping cooties. Nurses refuse to enter her room.’

  ‘OK,’ said Fats, ‘no problem. The way to TURF her is to find the cancer or find the allergy. We need skin tests: TB, monilia, strep, flyshit, egg foo yong, the works. One positive skin test explains the nodes, and it’s a TURF back to the floor of her room.’

  ‘Putzel, her Private, says he won’t let this poor old lady go back there. He demands that we find placement.’

  ‘Swell,’ said Fats, ‘I’ll call Selma. Next? Sam Levin?’r />
  ‘By the way,’ said EMD, ‘I didn’t have a chance to tell Putzel about the cooties. He’s in there now.’

  A creeping coup.

  ‘Sam’s an eighty-two-year-old demented derelict living alone in a rooming house, picked up by the police for loitering. When the cops asked him where he lived, he said “Jerusalem,” and then he pretended to faint, so they TURFED him here. Severe diabetes. He’s a wellknown pervert. Chief complaint is, “I’m hungry.”’

  ‘Of course he’s hungry,’ said Fats, ‘his diabetes is burning his own body for fuel. Lice and perversion? What are the Jews coming to?’

  ‘To the Black Crow,’ said Hooper.

  ‘Insulin City,’ said Fats. ‘Rough TURF. Next?’

  ‘You should know,’ said Eddie, ‘that Sam Levin is a man who eats everything. Watch your food, Fats.’

  Fats got up and locked his locker, in which he kept a stash of food, including several prized Hebrew National salamis.

  ‘Next is Fast Tina the Taxi Woman,’ said Eddie, ‘a private patient of the Leggo’s.’ At that the cabbie started yelling about his fare, and Fats TURFED him to HELP. He left, cursing, and in walked Bonni and said to Eddie: ‘Your patient Tina Tokerman’s IV bottle has run out. What do you want me to hang next?’

  ‘Tina,’ said Eddie.

  ‘That’s inappropriate. Now, about the lice: it’s not our job to delouse, it is the intern’s.’

  ‘Crap,’ said EMD, ‘it’s a nursing job, ‘cause nurses already got lice.’

  ‘What?! Well! I’m calling my supervisor! And as for the lice, I’m dialing HELP! We’re having problems in communication, good-bye.’

  ‘Anyway,’ Eddie went on, ‘there was Tina, and I thought, Hmm dementia, I’ll go right for the money and invade. So first I did the LP.’

  ‘You did the LP first? Did you ask the Leggo before you did it?’

  ‘Nope.’

  ‘A private patient of the Leggo’s sent three hundred miles in a cab and you started with a painful invasive procedure without asking him first? Why?’