by Samuel Shem
Fed up with Jo’s ‘contamination’ theory, I announced that I was going another route. Jo asked what it was, and I said, ‘Fight fire with fire.’ I picked up the phone and told the operator to page the Rabbi on call, STAT. Alarmed that his beeper had gone off, and STAT at that, huffing and puffing, young Rabbi Fuchs arrived. I told him about the Reign of Death, and about my conviction that this was, in some way, a Visitation of the Lord God, over Passover, mistaking us for Egyptians.
‘I don’t understand,’ said Rabbi Fuchs.
‘Isn’t it just possible that God is punishing us with these deaths, and that we should do everything within our power to follow his Passover Laws? Like paint the doorposts of the Unit, use special Passover dishes, leave a cup of wine for Elijah the Prophet, and so on?’
The black-bearded intellectual Fuchs looked puzzled, peered through his granny glasses at Ollie’s sempiternal flickering console, and said, ‘The Haggadah, the Passover Story to which you refer, is not literal, it’s homiletic. Yes, that’s it: the exigesis of the Haggadah, since the eleventh century, has produced commentaries that are mostly homiletic, although sometimes mystical, in character.’
‘Did you understand that, Pinkus?’ I asked.
‘Nope.’
‘Me neither. What do you mean, Rabbi?’
‘Don’t take it literally. It is myth. God doesn’t work that way anymore. These deaths have to do with physiological fact, not with the whims of Deity. Body, not soul, is what’s dying here.’
Leave it to the House of God to produce some red-hot Theology student as its Rabbi. I turned to him and asked, ‘What denomination are you anyway, Rabbi Fuchs?’
‘Me? Why, Reform.’
‘Figures,’ I said, picking up the phone. ‘Thank you very much. I’m calling the Orthodox boys, the Hassidim.’
The Orthodox Rabbi was an aged, white-bearded patriarch from a half-abandoned synagogue in the black ghetto. Excited by my idea, he quoted cabalistic writings about ‘the homes of the sick during the Exodus,’ telling me about the timeliness of the Passover teachings, as in the Mishnah: ‘In every generation let each man look on himself as if he came forth out of Egypt.’ Unfortunately, this Rabbi suffered from congestive heart failure, and before we could get on with the chanting and painting, he wanted some gratis medical advice. This took us up to lunchtime, and the Rabbi said he must stop and eat. He produced a small screwtop jar, sat down with the nurses and me, and as he opened it, I knew what it was.
‘Herring,’ he said to the nurses, ‘piece herring.’
‘I thought you were low salt?’ I asked.
‘Yeh, I em. Would you believe: the whole low salt for one day is in this tiny piece herring?’
Finally, Maintenance delivered the can of bloodred paint, and with the Rabbi belching herring, beginning to pray, chanting and dovening back and forth, I slapped the red paint around. I wished the Rabbi well, made a small donation to his shul, and reentered the space lab. That evening, as I listened to the Runt blather on about his ecumenical fornications with Angel, befittingly menstrual during Easter and Passover both, I listened also for the wingbeats of the Angel of Death passing over my Unit.
For a night it worked. The main threat that night was Dr. Binsky, a middle-aged Private, who’d suffered a serious MI. I knew that he knew he might die, and despite the pull of being colleagues, my fear of getting involved pulled me away from him. During the night Dr. Binsky served up most of the cardiac arrythmias known to man. Luckily, miraculously, each responded to my efforts, and dawn saw Binsky, and vice versa. The Orthodox boys had come through.
The next morning, the Seventh Day, Jo was ecstatic. Seeing none dead, she beamed from ear to ear, clasped my hand, and affirmed that, ‘by God, we’re going to win, and if it takes painting the doorposts, why of course we’ll paint the doorposts, in the interest of patient care.’ We went to see Dr. Binsky, and Pinkus, his old friend, said, ‘Hi, Morris. How’s Morris today?’
‘I feel OK, Pinkus. What’s it been now, forty hours?’
‘Just about.’
‘How’s my rhythm strip today?’ asked Morris.
‘Dr. Binsky,’ said Jo, putting her hand in an older-brother fashion on his shoulder, and with a crinkle in her voice, ‘it’s normal sinus rhythm again. NSR, at last.’
‘What a relief,’ said Dr. Binsky, ‘what a gigantic relief.’
Ten seconds later he had a cardiac arrest and despite our efforts, within the half-hour he was dead.
Jo broke. She sat in the staff room with Pinkus and me, crying, repeating over and over, ‘He couldn’t have died, he was in normal sinus. Normal sinus rhythm and now he’s dead? It doesn’t make any sense, statistically. I can’t take this absurdity anymore.’
‘People do die in NSF,’ said Pinkus calmly. ‘It shows that we did all we could, right, Roy?’
I nodded my agreement. Of course Pinkus was right.
‘Look, Jo,’ said Pinkus, ‘he went out in perfect, normal sinus rhythm. With class. Yes, he went out the House of God way.’
I thought of a House LAW: THE PATIENT IS THE ONE WITH THE DISEASE. It was his heart, not mine. I was immune from responsibility or concern. My world was for running, eating right, and staying calm. I left Jo to puzzle it out, and tended to the others of the Unit. Later that afternoon I said good-bye, wished Jo good luck, and on the four-mile run home filled my mind with Pinkus and God. I had done all I could, and Dr. Binsky had died. To get anxious about it, to eat away at myself, would only increase my stress, and boy did I know about the risk factor, stress. Personality Type A, the cardiac grenade. No thanks.
After dinner that night, Berry and I were walking home. She was surprised at my energy, given the fact that I’d been averaging only three hours’ sleep a night since I’d begun in the Unit.
‘Pinkus says that within limits, fatigue is mental, not physiological. Every other night is not bad. I kind of like it.’
‘Like it? I thought you hated being in the House at night.’
‘Outside the Unit, I did. Inside the Unit, I like it. In fact, I almost could say I love it. Like the surgeons say: “The only drawback to being on call every other night is that you only get to admit half the patients.” That’s how I feel too. I might become a cardiologist.’
Berry stopped, grabbed me by the shoulders, and forced me to look at her. She seemed far away as she said, ‘Roy, what’s the matter with you? For nine months you’ve been telling me how the internship is wrecking your life—your creativity, your humanness, your passion. What the hell is going on with this Unit, anyway?’
‘Don’t know. Lotta deaths. Jo cracked. Cried. High anxiety level. Type A. Even with estrogens, bad news for her.’
‘Jo cracked? And what about the effect of these deaths on you?’
‘These deaths? So what?’
‘So what?’ asked Berry, in a tone that came from the bottom of a well, far off, ringing of dismay and regret, ‘I’ll tell you what—the more deaths, the less human you become.’
‘You shouldn’t worry. Like Pinkus says, “anxiety’s a killer.”’
That night in bed, as I turned to her and touched her shoulder, I could feel her tension. She stopped me and said, ‘Roy, I’m worried. I could understand your shutting yourself off from grieving Potts’s death, but this is too much. You’re isolated. You never see your friends, you never even mention Fats or Chuck or the policemen anymore.’
‘Yeah. I think I’ve left them all behind.’
‘Listen to me: you don’t love the Unit, it’s a defense. You don’t love Pinkus, it’s a defense. You’re hypomanic, identifying with the aggressor, idolizing Pinkus to save yourself from falling apart. It may work in the House, but it won’t work with me. For me, tonight, you’re a dead man. There’s no spark of life.’
‘Gee, I dunno, Berry. I feel healthy and alive.’ Thinking of Hal, the computer in 2001, I said, ‘Things are going extremely well.’
‘How much longer does this MICU rotation last?’
&n
bsp; ‘Ten days,’ I said, and caressed her hair, thinking calmly of our supreme primeval exercise, sex. She pulled away, and I asked why.
‘I can’t make love to you if there’s this distance between us.’
‘You mean you can’t stand the thought of another woman? Because that’s all ov—’
‘NO! I can’t stand you! I’ve just about had it with trying to get through to you. I’ve got to start thinking of myself. I’ll give you the benefit of time, let you finish the Unit, to see if you can snap out of this. Otherwise, it’s all over. After all this time, we’re through. In your terms, it’s ROR, Roy, ROR.’
As if from far off, I heard myself saying, ‘Better ROR than anxiety, Berry. Better that than Type A.’
‘Goddamn you, Roy!’ she screamed, in tears. ‘You are a jerk! Don’t you realize what’s happening to you? Answer me!’
‘At this point in time,’ I said, trying remain calm in the face of all this turmoil of emotion and stress, ‘that’s all I have to say.’
Berry let out a hissing sound, like a train makes braking into a station, and she said, ‘You’re not a jerk, Roy. You’re a machine.’
‘A machine?’
‘A machine.’
‘So what?’
21
She was wrong. I was not a machine. I was not dead. I was alive. I was doing extremely well. My life was full. The PLONKA PLONKA of my feet on the bicycle path beside the river basin helped to beat out an affirmation of these reassuring thoughts. My head felt clear, like a sleek coronary artery lumen, a sleek woman in a maillot bathing suit, wet from a tropical sea.
That night was my masterpiece. A nurse and I had been told to do a marvelously difficult and intricate medical procedure. A young mother of two had been lingering toward death for months. Now, with end-stage liver disease, she was finally about to die of massive infection and failure of her heart, liver, kidney, brain, and lung. She had been sent to the Unit, and we had been told to drain the infected fluid out of her belly and replace fluid in her circulation. Since the fluid that we put back into her circulation would, because of the low serum protein, soon migrate back into her belly, this procedure, if successful, would do no good. So what? Long ago I’d given up the idea that what I did to these bodies had any relevance to whether it did any good. I would do it well. Why should I mind being the final expiation for the failure of House medical care?
I put in big lines everywhere, monitored everything, and the nurse and I got ourselves rigged up, ready to launch. This would be my moon landing, my techno-Lisa, my grenade. Over the orange belly of the young mother of two we slaved away in eroticosynch, taking fluid out, putting fluid back, watching numbers, setting dials, bathed in the eerie space light of the Unit, humming the melodies dished up by MUZAK. Hushed admiring others, doctors and nurses, dropped in to observe. Time turned timeless. The husband, having suffered the treatment and having lived with the death that the House red-hots had been denying his wife, informed us that he wanted us to stop, to do no more. Knowing that this last prolongation of life was worthless, done out of collective impotence and guilt, I convinced the husband to let us continue, assuring him—falsely?—that her suffering would not be prolonged. Too enraged to cry, he left. I watched him go, hugging his little boy and little girl. They had quizzical looks in their eyes.
At about midnight the arrest alarm sounded in room 5, where a pithed-frog woman died. In confirmation, Ollie spewed forth a flat-line EKG. I walked into her room. Her husband sat there, content with the illusion of life provided by the respirator inflating and deflating the corpse that had been his wife. I asked him to let me see her. He looked at me and began to weep. I helped him up and led him out to a cup of coffee. A nurse asked me what to do. Heading back into the young mother’s room, I told the nurse to turn off the pithed woman’s respirator.
‘I don’t turn off respirators,’ said the nurse.
I was puzzled. Why not? She’s dead. I looked at the nurse in silence, trying to understand. I went into the room with the body. I looked at it, a female, now turned a waxy death-white, without heartbeat or blood flow, dead-brained with a skull filled with clotted blood, the lungs rippled by machine. I searched through the wired undergrowth in back of the bed for the respirator plug. I paused. Bona fide dead. Saul the tailor flashed through. It was easy enough. I did it. Time turned timeless again.
The pleasing symmetry of the shape of that night continued through the next day, the day of the Marathon. I was doing extremely well. I felt extremely good for Pinkus, and planned to get off work early to watch him run up the worst hill, the Humbler. On rounds that morning, things went as smoothly as the MUZAK. A single incident, with the hepatitis woman, made it hard for me to do extremely well for a minute or two. Having spent much of the night completing the tricky hyro-digitotechnics of the Unit’s equivalent of the moon walk, at about noon the nurse and I—she working a double shift out of compassion for this poor ‘salvageable’ woman—were accosted by the husband, who got real red in the face and said, ‘I think you’re both incredibly callous for keeping my poor wife alive!’ The nurse burst into tears. I, in agreement with the husband, fell silent. The nurse and I stood there with the dying woman who stank of disinfectant and infection and bilirubin and ammonia, until the husband had done his punch-drunk catharting and left. For a few minutes I felt as if I were on the edge of some disaster, some abyss that seemed familiar from a nightmare. Then it passed, and again I felt calm.
From noon until I left, I was to work in my Outpatient Clinic downstairs. With some apprehension I left my Unit and entered the hopelessly inefficient world of the rest of the House of God. As I was going into my office, I ran into Chuck going into his. He looked even worse than usual.
‘Well, man,’ he said, ‘bad news. I been found out.’
‘Found out? Found out what?’
‘Well, you know how I always had the amazin’ luck that the old ladies would never seem to show up at my Clinic, no matter what appointments they made?’
‘Yeah, it was amazing,’ I said.
‘Well, the reason they never showed up was that they was daid.’
‘Dead?’
‘Un-hun, daid. See, I used to go over to the record room and pull charts, use daid names for appointments. Hardly any of ’em showed.’
My own Clinic was ridiculous. I employed a useful anatomical concept for Clinic medicine, called Scruffy’s Rhomboid Space, which was formed by unbuttoning the fourth button down on the shirt or blouse, forming a diamond-shaped opening for my stethoscope. With clever wrist action, the stethoscope could be rotated and pushed in such a way that all major organs could be examined without having the patient undress. Using this technique, I waded through my familiar patients with their trivial complaints, my mind filled with the precision and elegance of the techniques of the Unit, like popping a steel needle into a virginal radial artery. My outpatients seemed wary of me, and many of them kept asking me if I was sure I felt all right. I told them I was feeling extremely well. One in particular, my basket-balling Jehovah’s Witness, was insistent: ‘Why, Dr. Basch, you nevah for months used that stethelscope on me. We allas used to jes’ talk. I knows in mah heart that there’s sumpin’ gone wrong. What is it?’ I told her there was nothing wrong, and finished examining her. Shaking her head, she left.
I muttered to myself as I walked through the fresh April afternoon toward the Humbler, all this education just to write prescriptions for padded bras with pockets? What the hell was I in, anyway, ladies’ lingerie?
The gaily colored marathoners began to pass. The first, the leaders looked fit and eager even after these twenty miles, even facing the terror of the Humbler. The build of the leaders, was like that of Pinkus: thin to the waist, solid below. They ran through waves of applause. How jealous I was! The blur of color went on and on and after about five hundred had gone by, there came Pinkus, in a determined sure style that might well bring him in under three hours. I shouted, ‘Go get ’em, Pinkus!’ and he looke
d up, without waving or smiling, and trudged on up the Humbler, with calm, deliberate strides. He looked good. He was doing extremely well, and I watched him go wistfully, the GOTTA HAVE HEART on his rear end disappearing over the crest. My man Pinkus hadn’t even broken stride. The Humbler? Ha!
Later that evening, at the high-school gym after playing some hoop, I ran into a Unit nurse, whose name I’d always forgotten and couldn’t recall then. Wearing a tight black Danskin, she was working out with weights. I was surprised and delighted with her body and with her interest in her body. Dripping sweat, we chatted. I asked her out for a drink. In the bar, we watched Nixon, who, even though Haig thought that Nixon ‘didn’t sell on TV anymore,’ had gone ahead with a prime-time TV address from the Oval Office, something about ‘edited transcripts’ of the tapes. The packaging was terrific! On a side table to which the camera intermittently panned were shiny black vinyl binders, each embossed with a gold presidential seal. ‘I am placing my trust in the basic fairness of the American people.’
Nuzzling the nurse’s sweaty neck, I said, ‘Damn good idea. It’s about time. Get the goddamn thing straightened out, once and for all.’ To me, the locker-room aroma of this tough nurse was more enticing than perfume. I loved it.
After the drink, before the bedding, she went with me to an all-night sporting-goods store, where I bought myself my first ever fishing rod and reel.
22
Having done extremely well in the Unit, it was difficult for me to say good-bye. I felt sad. I wanted to stay on. How do astronauts say good-bye? As befit a pro, my good-byes were unemotional. Neal Armstrong saying good-bye to Frank Borman. John Ehrlichman saying good-bye to Robert ‘Bob’ Haldeman. Good-bye to Pinkus, my hero, who had run two hours fifty-seven minutes thirty-four seconds and who said, ‘Cardiology can be very rewarding in financial and personal terms, and with the implementation of hobbies, a very healthful life. Think about it, Roy, you’re a young man with a bright future.’ I left.
