by Samuel Shem
‘Really?’
‘Yes. Look: if you’re not fit, your heart beats like this,’ and Pinkus made a motion with his fist, slowly moving his fingers toward his palm as if he were in slow motion waving someone good-bye. ‘But if you run, your cardiac output goes up dramatically, and you really pump and I mean PUMP! Like this!’ Pinkus clasped and unclasped his fist so hard that his knuckles turned white and his forearm musculature bulged. It was dramatic. I would be converted. I grasped his hand and asked, ‘What do I have to do to start?’ Pinkus was pleased, and went right to shoe size. Instead of viruses and atherosclerosis, my mind filled with New Balance 320s, anaerobic glycolytic muscle metabolism, and a subscription to Runner’s World. We planned out a schedule with which to begin, which would get me to Marathon distance within a year. Pinkus was one great American.
Except for frolicking in the occasional erotic fondle, I spent the rest of the day avoiding Jo and running scared. Jo wanted to teach me everything about everything so that when she left that night, my first night alone, I would be able to handle things. Apprehensive about turning her Unit over to me, she loitered around, and telling me ‘I never turn off my beeper,’ she finally left. As usual in my medical training, knowing little, I was put in charge of all. I needed someone who knew the nuts and bolts of the Unit. I ran to the night nurse, and made it clear that I was her pawn. Pleased, she used me, and began teaching me things never mentioned in my four rarefied BMS years filled with enzyme kinetics and zebraic diseases. I became a technician, getting off on how to set a respirator’s dials.
Just before the ten-o’clock meal, I was called to the E.W. for my first admission, a forty-two-year-old man named Bloom, with his first MI. He was coming to the Unit because of his age. If he had been sixty-two, he would have been fending for himself on the wards, his chances of immediate survival halved. Bloom was lying on his stretcher in the E.W., white as a sheet, puffing with anxiety and cardiac pain. His eyes showed the terrified longing of a dying man wishing he’d spent his last days differently. He and his wife turned to me, their hope. Uncomfortable, I was surprised to find myself thinking of Pinkus, and asking Bloom if he had a hobby.
‘No,’ he gasped, ‘I don’t have a hobby.’
‘Well, after this you might think of developing one. I’m taking up running, for fitness. And there’s always fishing for calm.’
The risk factors were weighted against Bloom. He’d suffered a serious MI, and for a period of four days he’d camp on death’s door, courtesy of the Unit. I wheeled him into the MICU, where the nurses swarmed over him, wiring him for sound, light, and whatever else they could grab onto. Ollie’s face lit up with Bloom’s ratty EKG. What was I doing for poor Bloom’s heart? Not much. Watching for when Bloom stopped.
The Runt and Chuck, knowing what a strain my first night on call in the Unit would be, stopped by to talk. Even though it had gotten increasingly hard to make contact with each other, what had happened to Eddie and Potts had made us try to be with each other more. I said to the Runt, ‘I always meant to ask you, Runt, what’s the matter with Angel’s language centers. I mean, she starts to talk, fades out, and waves her hands around. What’s it all about?’
‘I never noticed,’ said the Runt. ‘She seems to talk fine, to me.’
‘You mean you still haven’t talked about anything?’
Thinking it over, the Runt paused, and then broke out in a wide grin, walloped his knee, and said, ‘Nope! Never! HA!’
‘Damn,’ said Chuck, ‘you sure come a long way from that poet.’
‘I think I do love Angie, but I don’t think I’ll marry her. See, she hates Jews and she hates doctors and she says I whistle too loud and that I follow her around too much when we’re not in bed. I think I might . . . Oh, hi, Angie-Wangle, I was just tell—’
‘Runt,’ said Angie, ‘you know what’—gesture toward self—’I think?’ Gesture toward Runt. ‘You talk too’—gesture toward cosmos—’Goddamn much. Roy, Mr. Bloom wants to’—gesture toward mouth—‘talk to you. We need’—gesture toward heaven—‘help.’
Chuck and the Runt left, and left me to the shocks and thrills of my first solo night in space. Walking a tightrope with Bloom and the other patients, balancing over their catastrophies, I passed the evening. At eleven came the striptease, the nursing change of shift: smooth leading thighs, a black lace panty rolling down as the tight dungarees came off, flashing pubic hair, the side slope of a jiggly breast, the full frontal of two firm ones, errant nipples, the works. Testosterone storm. Who had each been abed with, how had each been abed with, before coming to work, to me? When I’d calmed down, I went to bed. A nurse awoke me at four A.M.: new admission, age eighty-nine; small MI; no complications.
‘We don’t take them that old,’ I said, ‘she goes to the ward.’
‘Not if her name’s Zock. Not if it’s Old Lady Zock.’
Old Lady Zock turned out to be a typical gomere except for her money, which was three bags full. I was impressed. I would be nice to this Zock, she would give me a bag of money, I would leave medicine and marry the Thunderous Thigh and promise not to whistle, ever, or follow her around. I wheeled Old Lady Zock—whose shriek was MOO-ELL MOO-ELL—up to the Unit. If Bloom and Zock were to have clamored over the last intensive-care bed, who would have gotten it? No contest.
When a Zock gets admitted to the House of God, the whole ice-cream cone of Slurpers shakes and shimmers like a belly dancer in a hall of mirrors. The Leggo gets a call, and he calls on down the cone to the lower Slurpers, and as the nurses were settling Old Lady Zock into her bed, in trotted Pinkus. I looked at him and said, ‘Great case, eh?’
‘Does she have a hobby?’
‘Sure does. Moo-elling.’
‘Never heard of that one,’ said Pinkus, ‘what is it?’
‘Ask her.’
‘Hello, dearie. What’s your hobby?’
‘MOO-ELL MOO-ELL!’
‘What a funny joke, Roy,’ said Pinkus. ‘Say, look at this.’ Pinkus unbuttoned his shirt, revealing a running shirt on which was a giant-sized full-color healthy heart. He took off his trousers, revealing pink shorts on which, in blood red, was the slogan YOU GOTTA HAVE HEART. PINKUS. HOUSE OF GOD. ‘Here,’ he said, motioning the nurses’ and my attention to his calves, ‘just feel these.’
We fondled the steel cords that were his gastrocs and soleus. Pinkus reached into his tote bag and produced a pair of running shoes and said, ‘Roy, these are for you, a pair of my shoes that I don’t use anymore. Already broken in, so you can start right away. Here, I’ll teach you the stretching exercises. I’m on my way out for my A.M. six miles.’
Pinkus and I performed the ritualized stretching of the muscles from the pelvis to the toes. Warmed up, he began to walk out of the Unit as dawn was beginning to break. He passed the room with the lights on, Bloom’s, and asked. ‘Who’s that?’
‘New admission. Name’s Bloom. No hobbies. None at all.’
‘Figures. So long.’
The next day I was surprised that I was not tired. I felt excited. I’d been in control of the sickest, deadest patients alive. By watching the numbers and occasionally giving a med or turning a dial, I’d averted disaster all night long. Bloom had made it through the night. My biggest thrill that morning was Pinkus turning to me at the end of rounds and saying, much to Jo’s chagrin: ‘Roy, good job on your first night on call. And not just good job, no, I mean darn good job, Roy. Darn good job indeed.’
For the rest of the day I rode the backs of the rolling waves of intoxication at my competence. Before I left, I went to ‘M and M Rounds,’ which stood for ‘Morbidity and Mortality.’ At this conference, mistakes were aired, with the idea of not repeating them. In practice, it was a chance for the higher-ups to shit on the lower-downs. Given the propensity for mistakes on the part of some of the terns, the same terns would appear over and over again. That day, again it was Howie, being shat on for mismanaging someone with disease in his future specialty, renal medicine. Unfor
tunately, Howie had missed the diagnosis, and had treated the man for arthritis until he died from renal failure. I entered at Howie pronouncing the death.
‘Did you get the post?’ asked the Leggo.
‘Of course,’ said Howie, ‘but I’d made a mistake—the patient was not dead after all.’
Covering his eyes with his hand, the Leggo said, ‘Oh. Well, what happened next?’
‘I called the resident,’ said Howie, as the audience laughed.
‘Yes?’ asked the Chief.
‘Then the patient really died and we got the post. The dying words were something like “the nurse is incompetent” or “the nurse is incontinent.”’
‘What difference does that make?’ asked the Leggo harshly.
‘Why, I don’t know,’ said Howie.
And Molly loves that asshole? I dozed off, and awakened to the Leggo discussing the case, saying, ‘Most people who have glomerulonephritis and spit blood have glomerulonephritis and spit blood.’ I thought I’d been dreaming until, awakening again, I heard the Leggo’s next pearl: ‘There is a tendency for healing in this fatal disease.’ How pedestrian. Poodling around with kidney disease, and I was doing high-powered medicine with exact regulation of every known body parameter, in the Unit. I left M and Ms, signed out, drove home. I was surprised to find myself whistling, happy, thinking of the musculature of the leg. I would become like Pinkus. The deadness I’d felt in Gomer City was being replaced by the excitement of the Unit. Like the E.W., it was not a place where the gomers could come to linger and outlast me, no. From the Unit, unless they were rich or young, they would be TURFED elsewhere. The thrill of handling the complexity of disease, of running the show well and with power, on top of the pile, the elite of the profession. I was king. Hotcha.
I couldn’t wait to slip into my shorts and Pinkus’ old shoes. Well-worn, they cradled my feet. Tired as I was, I put myself through the Pinkus stretching maneuvers, and trotted out to the street, and with the sun lowering in front of my eyes, with the soothing PLONKA PLONKA of the wide cushioned soles against the asphalt, I was carried a few miles farther toward the land of dilated coronary arteries, patent to rich red well-oxygenated blood. I was a child, free after supper, floating on Icarus wings in the first warm evening breeze of Daylight Saving Time, of spring.
I came back with chest pain, worried that I had angina pectoris and that I had started exercising too late in life. I would die from an MI while running. Pinkus would view my corpse and say wistfully, ‘Too bad. Too late.’
Berry was waiting for me at home, and given my usual sedentary life, she couldn’t believe her eyes.
Taking her hands, I put them on my gastrocnemius and said, ‘Here, feel, that.’
‘Yeah?’
‘That’s BEFORE. I want you to form a clear mental image of that, for when you get to feel AFTER.’
20
By the end of the first two weeks I was doing four miles a day. To my relief, what I’d feared was anginal pain was, according to Pinkus, pain referred from the stretching of the intercostal ligaments as the rib cage expanded, common to beginning runners. I began to run the four miles to work, floating along the cycle path—named in honor of a famous marathoning cardiologist who’d died of old age—next to the river, the dawn breaking over the awakening city, my PLONKA PLONKA a soothing affirmation of my lifebeat.
But all was not Pinkus yet. Unlike him, I had yet to come to terms with the Unit. One side of me was filled with the horror of human misery and helplessness; the other was exhilarated, king in an erotic diseased kingdom, competent to run machines. Being on call every other night meant that there was never time to think about the world outside the House, and the conflicts of the Unit became the main conflicts of life. The nurses? Like the background in Vermeer’s Lady with a Guitar, the empty black highlighting the glow of candle on lithe fingers, the disease highlighted the sex.
Often I’d find myself entwined in variants on the same erotic theme: late at night, the eerie artificial Unit light punctured only by the green-flashing BLEEP BLEEP of the cardiac monitors. The nurse calls me from my bed to see a comatose patient whose body is being run by machine, one parameter of which had gone awry. Following her to the bedside, I notice her bralessness, that she wears no pantyhose. I put a stethoscope on the body. I need to listen to the chest, and ask the nurse to help me. She bends over, the two of us hoist the body to sitting, tubes dangling down. I listen to the clogged lungs, inflated by respirator, my fingers on the waxy skin, fighting the stench of chronic disease. I smell her perfume—coconut. Our heads are close together. I drop my stethoscope, put my free hand around her neck, kiss her. Her tongue and my tongue slither together. I lean my shoulder against the patient’s body, freeing the other hand. The kiss prolonged, I fondle her breast through her cotton dress, feeling the coarse fabric scratching against the skin, pulling the nipple erect. We part, the body falls back—THUMP—on the bed. Later, on her break, she comes to the on-call bunk bed, hoisting up her green surgical skirt because there isn’t time to undress. We two begin to take out our hatred, our loneliness, our horror with human suffering and our despair at human endings in the most tender of human acts, making love. Knowing that she hates me for being a doctor, for forgetting her name three times that shift, for being a Jew who views her eunuch Pope’s pronouncements on ‘Human Life’ as comical at best, for running her Unit, for her being trammeled on by men like me, for my always being the smarter one in the class, for all those hates and for the arousal bred by hates, we bash away at each other savagely, skin on skin, cock in cunt, with the desperation of two space travelers on a journey of light-years, with death at the far end and no way back, imprisoned in a spacecraft of chrome and lights and computers and MUZAK. She will not talk to me about her hatred, she will not even gesture to me about her hatred, she will only fuck me for her hatred, and let it go at that. Groaning, we rattle the springs of the bunk bed, secured by the vigilance of two machines: her IUD; and each of our abilities, the next morning, to forget. California, here I come! We finish. Blushing from the clitoris and not from the heart, she goes back to work.
In tune with this spring theme of sex and death, like eight vultures, the days of Passover swooped down upon the House of God. Despite the false hope offered by Good Friday and Easter Sunday, with the coming of Passover there was no question of God’s intent: death. Despite the technocratic thrust toward life, God flexed his biceps and triceps and, for all we knew, infiniomniceps, and began to mock us, with death. During Passover, patients began to drop like flies.
It was eerie. We’d work like hell on someone, who’d appear to have made it, and then—BLEEP—a cardiac arrest and death. I’d pick up a patient in the E.W., and as I put my stethoscope on him, he’d clutch his chest, turn blue, and die. I’d be sleeping peacefully, and—BUZZ—the arrest button would sound and I would run, blinking and trying to hide my sleep erection, into the bright neon and MUZAK searching out the room with the panic, and sure enough God had made his move and another had cooled on us. Afterward, looking back over the recordings stored by Ollie, we’d find that despite our preparations, an aberrant beat would have landed at the vulnerable period and—BLEEP—ranting, arrogant, in strutted death.
All of us were shocked. The families of the dead, set up with hope and then smashed with despair, suffered beyond words. Blitzed, their own hearts cut from their moorings and rolling and floating in their chests like balls of wool in empty bags they washed us with their tears. Jo, the perfectionist, was hard hit. By Day Four of Passover, she was frantic. Fighting the specter of what she took as a personal failure to keep her patients alive, Jo adopted a sort of phlogiston theory, deciding that there was something contaminated somewhere in the Unit. When Pinkus arrived, she assaulted him with this idea and insisted that the Unit be torn apart, top to bottom, to find the noxious agent that was killing her patients. Pinkus, phlegmatic, told her she could do as she wished, although he didn’t think that was it. He asked me to feel his legs, and I
did, and said, ‘Amazing.’
‘The Marathon’s only six days away. Carbohydrate loading starts today.’
‘Pinkus,’ said Jo with great intensity, the circles under her eyes even blacker, ‘I want to make one thing perfectly clear: we are going to win this war against death.’
The penultimate setback for Jo was at four o’clock in the middle of the Fifth Night. Jo usually stayed up most of the night, but the stress of being the first woman resident to wrestle directly with the Angel of Death had worn her out, and with things seemingly under control, she’d gone to bed for an hour. Shortly thereafter, all hell broke loose, with a man named Gogarty, a spanking-fresh virgin MI, having a cardiac arrest. Jo was called, and with a fanaticism hardly ever seen in the Unit, spent an hour 4-plussing the victim back toward life. Unfortunately, Gogarty turned out to be a smokescreen, for as Jo and the nurses left his room what sight should greet their eyes but Old Lady Zock spread-eagled nose-down on the tiled Unit floor, stone dead. It turned out that, having heard the commotion in Gogarty’s room, Old Lady Zock, in a final philanthropic gesture, had wished to pitch in at the arrest, and following the most heartrending of House LAWS: GOMERS GO TO GROUND, had done so, in the process dislodging the cardiac pacemaker which was prodding her generous heart, and had died. The final irony, of course—the story of Jo’s life—was that Jo’s insisting all nurses tend to Gogarty had caused the neglect of Zock. When a Zock gets neglected, it shakes God’s House.
The next morning, there was much commotion. It was Zocks versus Medicine. Recrimination City. Although in the confrontation the Leggo restrained himself from asking for a postmortem, Jo did not, and things got sticky. The Leggo told Jo to ‘get the hell back inside,’ and we watched as the caravan led the flock of Zocks away to one of the green plush ‘function rooms’ donated by the Zocks and used only for the stroking of philanthropists of the House of God.
