House of God

by Samuel Shem

  ‘I don’t know.’

  ‘Ten minutes, Basch, and Jane Doe didn’t fart.’

  ‘So?’

  ‘So her bowel is completely turned off, for the first time in House memory. That extract might just be the cure for that VA diarrhea. A good deed; a fortoona. Just what I and the world need. Use ’em, Basch, use ’em.’

  ‘Did you and the Fat Man get along any better?’ asked Berry.

  ‘Worse,’ I said, ‘not only does he love the gomers, but he’s acting like a Boy Scout. He keeps telling us not to fight back, he makes me search the whole place for a demented ninety-seven-year-old’s eyeglasses, and then he spends the whole night sitting up with a woman with terminal cancer after he’s told her she’s gonna die.’

  ‘He did that?’

  ‘Yeah, why?’

  ‘I never pictured him doing things like that. The way you described him, he seemed so cynical, so sick. Now I’m not sure.’

  ‘He’s not cynical enough. He’s turned into a patsy. It’s almost like he’s deserting me.’

  ‘He seems more reasonable now. You’re the one who’s acting sick.’

  ‘Thanks a lot.’

  ‘I’m concerned, Roy. This acting out is dangerous. Maybe the Fat Man is right: someone’s gonna get burned.’

  I lay awake chewing on Berry’s concern. It had been fun to say ‘I don’t know’ to get the Fish, to get Lionel, to race around laughing and sarcastic, but there was a bud of bitterness in it that might blossom into savageness and make me sad enough to kill myself or mad enough to bite. I tried to get my worry in my hand, but I was a child grasping a sunbeam, opening my hand to find the light turned dark, the warmth gone. I drifted toward dream, finding myself ringside at a circus and seeing an elephant, yes, an elephant, and seeing a busty girl on a musty elephant puffing dusty sawdust under the roustabustybout and lusty really big and bustyredhot tent of a bighot top—WAIT!—with some alarm I realized that Hyper Hooper had been sitting in the on-call room reading my manual with his finger as his needle pointing—no, it couldn’t have been, but yes it was—pointing in a straight shot right toward Rose Budz the LOL in NAD’s heart.

  16

  ‘OK, Hooper, let’s hear about the postmortem on Rose Budz. Let’s hear what you with your one little needle shot have done.’

  Fats was flipping cards as we lay in the icy ventricle of dead February as it lay in the corpse of the year. There was no question that Eddie and Hooper and I were on our knees and that they were breaking us. Most of the House hierarchies hated us. Gomer City was turning out to be the worst. Far from taking care of it, it was beginning to take care of us.

  ‘The post on Rose Budz confirmed what we thought from when they sectioned the needle I used,’ said Hooper in a tone of contrition mixed with a certain professional satisfaction. ‘I got spleen, lung, stomach, heart, and . . . and liver.’ Hooper paused, watching the Fat Man drum his fingers on the desk, and then went on, ‘In other words, Fats, all the organs you named the other day, plus a helping of liver and stomach as well. I think it’s a new world record for most organs hit with a single needle shot.’

  ‘Liver? The liver’s nowhere near where you went in.’

  I thought back to that day when Hyper Hooper had presented his attempt to tap the chest of Rose Budz, and had told us that ‘there had been a little bleeding.’ If a Californian isn’t enthusiastic, it means a disaster has occurred, and Hooper meant that Rose was dying. He’d sent her to the MICU, and Fats, concerned and thinking malpractice, brought his Gomer City A Team to the MICU to see where the needle had gone in. The hole in Rose’s chest was in the front, right over her heart. Fats had said, ‘Come on, Hooper, you didn’t really put your needle in there, did you?’ and Hooper had said, ‘Yup, that’s what Roy’s manual said, unless I had it upside down.’ Although Hooper had seemed a bit contrite when the Fat Man had said, ‘You never tap a chest from the front because things like the heart get in the way,’ Hooper had brightened right up and said, ‘It’s OK, Fats, it’s a great family for the post.’

  ‘I know there’s usually no liver,’ said Hooper, ‘but it seems as how in this case there was an aberrant lobe.’

  ‘Messy TURF, Hooper, messy TURF,’ said Fats solemnly, slowly ripping Rose Budz to shreds. Again Hooper had managed to snatch defeat from the jaws of victory. Holding up another card, Fats called out, ‘Tina? Eddie?’

  ‘Dead,’ said Eat My Dust.

  ‘What?!’ shouted Fats. ‘Tina too? How? Who killed her?’

  ‘Not me,’ said Eddie, ‘all I did was get her to sign for dialysis. The Leggo’s crack dialysis team did the rest.’

  Tina had died by being inadvertently murdered by a nurse in dialysis who’d mixed up the bottles. Instead of diluting Fast Tina’s blood, the machine had concentrated it further, and all the water had been pulled out of Tina’s body and her brain had shrunk and rattled around in her skull like a pea while the nurse sat and read Cosmopolitan. Tina’s pea-brain had rattled and stretched until one of the arteries straining between her neck and thalamus burst and she had hemorrhaged to death.

  ‘Sorry to say this, Hooper,’ said Eddie, ‘but since Tina was my patient, it’s another postmortem for the kid.’

  ‘Stop!’ said Fats. ‘Tina was the Leggo’s patient. No post.’

  ‘But the Leggo loves posts. He called them the flower—’

  ‘Not when they prove malpractice!’ said Fats in a tone that would hear no answer, all the while ripping Tina’s cards to pieces. ‘Next? Jane Doe?’

  ‘Hey, doin’ great;’ said Hooper. ‘I coulda sworn that today she sat up and gave me a big hello—’

  ‘Never mind,’ said Fats, irritated. ‘That woman’s never given any intern a big hello and she’s not gonna start with an intern like you, slobbering after her corpse. Any bowel activity yet?’

  ‘Nope. No bowel sounds at all. Bowel might be dead. No nuthin’ since you slipped her that “extract” of yours last month.’

  ‘That stuff is dynamite,’ said Fats. ‘Keep running in the VA antibiotic, Hooper. We’ve got to turn her on again. Next.’

  We waded through all the rest and ended with the Lady of the Lice, and Fats asked Eat My Dust if he’d found the cancer or the allergy.

  ‘Who knows?’ said Eddie. ‘I’m OTC.’

  ‘OTC? What the hell’s OTC?’

  ‘Off The Case,’ said Eddie. ‘New concept.’

  ‘Stop it. Pull yourself together. You can’t be OTC.’

  ‘Why not?’

  ‘Because you’re her doctor, that’s why, get it?’ said Fats, mopping his brow. ‘Jesus. Did you ever find the cancer or the allergy?’

  ‘Nope,’ said Eddie’s BMS, ‘the only thing we found was the sperm. Her last three urinalyses have come back “sperm.”’

  ‘Sperm? SPERM? In a demented seventy-nine-year-old gomere?’

  ‘Sperm. We think it’s from Sam Levin, your pervert with diabetes.’

  That morning, the Fish was taking us on a field trip. Hooper had gotten paged to see the Leggo, and while we waited for him, wondering whether the Leggo had paged Hooper to castigate him for killing poor Rose Budz or to congratulate him for obtaining Rose’s tricky postmortem, Eddie and I continued to torment the Fish in our usual ways until, eyeing us suspiciously, he left to make final arrangements. When Hooper reappeared, the Fish loaded us into his station wagon for our field trip. On the way, he talked sincerely about Hooper killing Rose Budz: ‘You know, you can’t possibly learn medicine without killing a few patients. Why, I myself have killed patients. Yes, every time I killed a patient, I learned a little something from it.’

  It was hard to believe that he was actually saying that, and I drifted off, imagining the Fish saying, ‘Killing patients is a special interest of mine. I have recently had the opportunity to review the world literature on killing patients. Why, it would make a very interesting research project . . .’ and by the time I snapped out of it, we were in the office of the Pearl.

  This was o
ur second field trip. The Fish took us on field trips to get us out of the House, to minimize the damage we were doing to his Chief Residency year and his career. The first field trip had been a ghetto health center, where the Fish had seemed ill at ease. This was the opposite. The Pearl had risen up through the House Slurpers as easily as the Fish might have wished, and by this time had become the richest Private in the House, the city, perhaps the world. In his office all was automated and set to Muzak. The Muzak played Fiddler on the Roof. The place was jam-packed: LOLs in NAD getting their blood drawn humming in tune with SUNRISE SUNSET, waiting to move on around the corner where the tech and the LOL in NAD could hum TRADISHUNNNN as the EKG was done, and then, further along past the sign that said ‘This way to Annatevka,’ sure enough, there where the LOL in NAD had to give a urine sample wouldn’t she be bathed in the rippling bittersweet strains of ANNATEVKA, the song about the Fiddler’s lost home. Lastly, we and the LOLs in NAD got a personal guest appearance by the Pearl in his private office, where he sat perusing the computer-processed results of the tests. Muzak played IF I WERE A RICH MAN, and there, behind a dual flagholder in which were both Israel and the USA, sat Pearl, surrounded by original Chagalls and what looked like the original Hippocratic Oath. He was sweet and kind and generous and seemed like the best damn doc and he told us he was seeing an average of one hundred and nineteen LOLs in NAD per day. No gomers. On the ride back I calculated that the Pearl made my yearly intern’s salary in two days. Turning to the Fat Mound next to me on the back seat, I said, ‘Fats, that was Money City.’

  ‘Of course. Even in the bowels of the nonstars, one can find the big fortoonas.’

  After the ten-o’clock meal I went to see Molly on floor six. She was mad at me for forgetting it was Valentine’s Day and not getting her a gift. She yelled at me and I felt guilty because I did like her and I even found myself dreaming about her, which must have meant that I sort of loved her, and I really loved making love to her because she still moaned like a moist Mesopotamian every damn time. Theoretically I had just as much interest in her, and I still saw her as a short-skirted majorette from St. Mesopotamia High marching along throwing her tan kneecaps first at one curb and then at the other and masturbating the longest baton in the band between those far-flung thighs, producing MIs in the senile Legionnaires lining the route, but I had been bombed on Gomer City and my sexual stride had been broken. I knew I’d been screwing her partly to affirm life, and the uneasy thought occurred to me, syllogistically, that since now I was not screwing her much, did that mean I’d ceased affirming life? I listened to her telling me I was getting dull and acting thirty, and I realized that in some ways I was, because it seemed like such an effort to go out in the razored wind and blasting cold to see her, despite my desire when I was with her and my jealousy that maybe some other guy was wearing gold cleats and getting the hot oil and myrrh all over him. I began to warm to her, and see her as sexy and loving right then and there, and I reached out and put both my hands under her boobs all tight-lifted and beruffled in her cute nursing costume and I flashed on her blond pubic hair in which I’d nuzzled and laid my head and I levered her to me and kissed her and remembered the round-the-town movements of her hips and lips and we began to get as excited as we used to get in bed. I began to ask myself where that part of me that was willing to make the effort had gone, and I began to scheme about sleeping with her that night, but she pulled away and asked me to do her a favor, to check out a patient having agonal respirations.

  ‘Agonal respirations mean death. Is he supposed to die?’

  ‘That’s just it: I’m not sure. He’s got end-stage multiple myeloma and renal failure and he’s been in coma for weeks, but Dr. Putzel has never told the family and there’s an argument about his dialysis continuing and about when he’s supposed to die. It’s all confused.’

  I went and saw him. It was too much. Young man, gray and dying, filling the room with his stale ammonium breath. His human centers of respiration were dead and phylogenetically he was breathing like a stranded fish. I went back to Molly and said, ‘He’ll be dead in fifteen minutes. He’s not in any pain?’

  ‘No. The Runt’s been giving him morphine all night.’

  ‘Good.’ Overcome with tenderness because she and I were young and not dying but one day would die, filled to our gills with morphine if we were lucky, I said, ‘Go draw his curtain, love, and come sit down with me and talk.’

  The House of God found it difficult to let some young terminal guy die without pain, in peace. Even though Putzel and the Runt had agreed to let the Man With Agonal Respirations die that night, his kidney consult, a House red-hot Slurper named Mickey who’d been a football star in college, came along, went to see the Agonal Man, roared back to us and paged the Runt STAT. Mickey was foaming at the mouth, mad as hell that his ‘case’ was dying. I mentioned the end-stage bone cancer, and Mickey said, ‘Yeah, but we’ve got an eight-grand dialysis shunt in his arm and every three days the dialysis team gets all his blood numbers smack back into line perfect.’ Knowing there was going to be a mess, I left. The Runt came out of the elevator, fuming, and ran down the long corridor, his stethoscope swinging side to side like an elephant’s trunk. I thought of the bones in multiple myeloma: eaten away by the cancer until they’re as brittle as Rice Krispies. In a few minutes the Man With Agonal Respirations would have a cardiac arrest. If Mickey tried to pump his chest, his bones would crunch into little bitty bits. Not even Mickey, seduced into the Leggo’s philosophy of doing everything always for every patient forever, would dare call a cardiac arrest.

  Mickey called a cardiac arrest. From all over the House, terns and residents stormed into the room to save the Man With Agonal Respirations from a painless peaceful death. I entered the room and saw an even bigger mess than I’d imagined: Mickey was pumping up and down on the chest and you could hear the brittle bones snap, crackle, and pop under his meaty hands: a Hindu anesthesiologist pumped oxygen at the head of the bed, looking over the mess with a compassionate disdain, perhaps thinking back to the dead beggars littering dawn in Bombay; Molly was in tears, trying to follow orders, with the Runt shouting, ‘Stop! Don’t resuscitate him!’ and Mickey cracking and crunching and shouting, ‘Go all-out! Every three days his blood numbers are perfect!’

  And yet the most sickening part of it was when Howard, pipe clenched like a bit between his teeth, ran into the room, with a nervous smile decided to take charge, and just like the tern in the How I Saved the World book, shouted out, ‘Gotta get a big line into this guy, STAT!’ grabbed a homungus big needle, saw a pulsating vessel in the forearm, which happened to be the surgically constructed, meticulously protected shunt between artery and vein, which was Mickey’s dialysis team’s pride and joy, and, eyes glittering with big-time-intern excitement, Howie rammed the needle home, destroying forever Mickey’s continued attainment of perfection every three days. When Mickey saw this, he stopped crunching, his eyes got fierce as a linebacker’s, and he went bananas, screaming, ‘That’s my shunt! You asshole, that’s my shunt! Eight grand to make it, and you wrecked my shunt!’ That was it for me, and I left, thinking to myself, Well, at least they’ll end it here and not transfer the Man With Agonal Respirations And Crushed Bones to the MICU.

  They transferred him to the MICU, where Chuck was the tern on call. When I went to see Chuck, I saw the family outside the MICU, weeping as Mickey explained things to them. Chuck was drenched in blood, bent over the residual mess of the Man With Agonal Respirations, who now had no respirations at all except those generated by a respirator. Chuck looked up from the mess and said, ‘Hey, man, great case, eh?’

  ‘How are you doing?’

  ‘Pitiful. You know what Mickey said to me? “Just keep him alive till tomorrow, for the family.” Sumthin’ else.’

  ‘What the hell are we doing this for?’

  ‘Money. Man, I want to be so rich! Black Fleetwood with gangster whitewalls and a funeral wreaff in the back winda.’

  We sa
t down in the staff room and nipped at Chuck’s Jack Daniels. He leaned back in his chair and crooned his falsetto ‘There’s a . . . moone out too-nahht . . .’ and as I listened, I thought about how our friendship was becoming as wispy as Chuck’s dream of being a singer. Chuck had been having a terrible time adjusting to his new city, one reason being he couldn’t figure out where the graft was. Stopped for speeding and using the standard Chicago practice of handing the cop his driver’s license with a ten-dollar bill had gotten him a stern lecture about ‘bribing an officer of the law’ and the maximum fine. Puzzled, displaced, he spent his time at home sleeping and eating and drinking and watching TV. His suffering showed in his waistline and his hangovers. I’d tried to talk with him about it, but he’d get that blank look on his face and say to me—to me!—‘Fine, fine.’ Each of us was becoming more isolated. The more we needed support, the more shallow were our friendships; the more we needed sincerity, the more sarcastic we became. It had become an unwritten law among the terns: don’t tell what you feel, ‘cause if you show a crack, you’ll shatter. We imagined that our feelings could ruin us, like the great silent film stars had been ruined by sound.

  The Runt came into the room, apologizing to Chuck for TURFING the Man With Agonal Respirations, but Mickey stormed in and asked how the Man was.

  ‘Oh, fine,’ said Chuck, ‘jes’ fine.’

  ‘Right. He never should have gotten that morphine,’ said Mickey.

  ‘He was terminal and in pain,’ said Runt, getting mad, ‘he—’

  ‘Never mind. I’m leaving. Just keep him alive till morning.’

  ‘Till what time?’ I asked nonchalantly.

  ‘Till about eight-thirty, quarter to . . .’ Mickey began, and then, realizing what a fool he looked, he stopped, cursed us, and left.