House of God (7 page)

It didn't last. I got more and more tired, more and more caught up in the multitudinous bowel runs and lab tests. The jackhammers of the Wing of Zock had been wiggling my ossicles for twelve hours. I hadn't had time for breakfast, lunch, or dinner and there was still more work to do. I hadn't even had time for the toilet, for each time I'd gone in, the grim beeper had routed me out. I felt discouraged, worn. Before he left for the day, the Fat Man came by and asked if there was anything else I wanted to talk about.

‘I don't get it,' I said. ‘This isn't medicine, this isn't what I signed up for. Not writing orders for cleanouts for the bowel run.'

‘Bowel runs are important,' said Fats.

‘But aren't there any normal medical patients?'

‘These are normal medical patients.'

‘They can't be. Hardly any of them are young.'

‘Sophie's young; she's sixty-eight.'

‘Between the old people and the bowel runs, it's crazy. It's not at all what I expected when I walked in here this morning.'

‘I know. It's not what I expected either. We all expect the American Medical Dream—the whites, the cures, the works. Modern medicine's different: it's Potts being socked by Ina. Ina, who should have been allowed to die eight years ago, when she asked, in writing, in her New Masada chart. Medicine is “bedrest until complications,” Blue Cross payments for holding hands, and all the rest you've seen today, with the odd Leo thrown in to die.'

Thinking of the Rokitansky girls, I said, ‘You're too cynical.'

‘Did Potts get socked by Ina, or did he not?'

‘He did, but all of medicine isn't like that.'

‘Right. In the teeth of our expertise, the ones our age die.'

‘Cynic.'

‘Ah, yes,' said Fats, eyes twinkling, ‘no one wants you to know all this yet. That's why they wanted you to start with Jo, and not me. I wish I could lie. Doesn't matter, ‘cause I can't discourage you yet. Like sex, you gotta find it out for yourself. So why don't you go home?'

‘I've got some more work to do.'

‘Well, you won't believe this either, but most of the work you do doesn't matter. For the care of these gomers, it doesn't matter a damn. But do you know to whom you're saying goodbye?'

I did not.

‘To the potential father of the Great American Medical Invention. Dr. Jung's. More money than in the bowel run of the stars.'

‘What the hell is this invention, anyway?'

‘You'll see,' said Fats, ‘you will see.'

He left. I felt scared without him, and troubled by what he'd said. Got to find it out for myself? In fifth grade, when I'd asked an Italian kid why he liked having sex, he'd said, ‘ 'Cause it feels good.' I couldn't understand someone doing something because it felt good. What sense was there in that?

Just before I left I wanted to say good-bye to Molly. I found her carrying a bedpan toward the disposal. I walked with her, the shit sloshing in the pan, and said, ‘It's not a very romantic way to meet someone.'

‘The romantic way has gotten me into all kinds of trouble in the past,' she said. ‘This is much more realistic.'

I said good night and drove home. The sun was a foreign diseased thing, glowering down a hot red contagion on the city. I was so tired that I had a hard time driving, the white lines weaving back and forth across the road like the visual aura to an epileptic's seizure. The people I saw seemed strange, as if they should have some disease that I should be able to diagnose. No one had a right to be healthy, for my world was only disease. Even the braless women, sweat collecting in the hollows of their breasts, nipples poking out with the full expectation of a lush and sultry summer night, their eroticism magnified by the scents of the July blossoms and of their aroused bodies, were less the stuff of sex and more the specimens of anatomy. Diseases of the breast. I hummed, of all things, a bossanova: ‘Blame it on the carcinoma, hey hey hey . . .'

In my mailbox was a note: ‘I think of you all night, I think of you in white. It's hard to be an intern, but I know you will return. Love, Berry.' Undressing, I thought of Berry. I thought of Molly, I thought of Potts and his bluesteel throbber, but my own blue steel was throbless that night, for they had started in on me and I was through with feeling anything more for that day, including sex, including love. I lay down on top of the cool sheets, which felt soft as the sole of a baby's foot, soft as the inside of a baby's mouth, and I thought of this puzzling Fat Man and that even if summer is green, death is an odd number, an odd odd number.

4

As I walked onto ward 6-South the next morning, my fear tempered by expectation, I saw a bizarre sight: Potts sat at the nursing station, looking like he'd been shot out of a cannon, his whites filthy, his straight blond hair tangled, blood under his fingernails and vomit on his shoes, his eyes pink, a sick rabbit's eyes. Next to him, strapped to a chair and still wearing the Rams football helmet, was Ina. Potts was writing in her chart. Ina freed herself, screamed: GO AVAY GO AVAY GO AVAY . . . and took a swing at him with her left fist. Enraged, Potts—gentle Molière-perusing Potts of the Legare Street Pottses—screamed: ‘Goddamnit, Ina, shut the hell up and behave!' and shoved her back down in her chair. I couldn't believe it. One night on call, and a Southern gentleman had become a sadist.

‘Hi, Potts, how'd it go last night?'

Raising his head, with tears in his eyes, he said, ‘How'd it go? Terrible. The Fat Man said to me “Don't worry, the Privates know the new terns are here, and they're only admitting emergencies.” So what happened? I get five and a half emergencies.'

‘What's a half?'

‘A transfer from another service to medicine. I asked the Fat Man about that, too, and he said, “Since you only get half credit for the admission, you only do half an exam.”'

‘Which half?'

‘You do whichever half you want. With these patients, Roy, I'd suggest the top.'

Ina rose again, and as Potts pushed her back down in the chair, the Fat Man and Chuck arrived, and Fats said, ‘I see you went ahead against my advice and hydrated Ina, eh?'

‘Yessir,' said Potts sheepishly. ‘I hydrated her, and you were right, she got violent. She acted psychotic, so I gave her an antipsychotic, Thorazine.'

‘You gave her what?' asked Fats.

‘Thorazine.'

Fats burst into laughter. Big juicy laughs rolled down from his eyes to his cheeks to his chins to his bellies, and he said, ‘Thorazine! That's why she's acting like a chimp. Her blood pressure can't be more than sixty. Get a cuff. Potts, you're terrific. First day of internship, and you try to kill a gomere with Thorazine. I've heard of the militant South, but this is the limit.'

‘I wasn't trying to kill her—'

‘Blood pressure fifty-five systolic,' said Levy, the BMS.

‘Get her head down in her bed,' said Fats. ‘Get some blood into it.' As Levy and the nurse carried Ina to her room, the Fat Man informed us that Thorazine in gomers lowers the blood pressure so that the higher human levels don't get perfused. ‘Ina was struggling to get up so she could lie down. You almost did her in.'

‘But last night she went crazy—'

‘Sundowning,' said Fats. ‘Happens all the time with gomers in the House. They don't have much sensory input to begin with, and when the sun goes down, it gets dark, they go bananas. Come on, let's do the cardflip, eh? Thorazine? I love it.'

The Fat Man did the cardflip, beginning with the five and a half admissions that had turned Potts into a sadist. Again, like the day before, most of what I'd learned at the BMS about medicine either was irrelevant or wrong. Thus, for a dehydrated Ina, hydration made her worse. The treatment for depression was to order a barium enema, and the treatment for Potts's third admission, a man with pain in his abdomen but who ‘knew all of you doctors are Nazis but I'm not quite sure just yet which one of you is Himmler,' was not a barium enema and bowel run, but what the Fat Man called a ‘TURF TO PSYCHIATRY.'

‘What's a TURF?' asked Potts.

‘To TURF is to get rid of, to get off your service and onto another, or out of the House altogether. Key concept. It's the main form of treatment in medicine. Just call up psychiatry, tell them about the Nazi stuff, don't mention the gut pain, and presto—TURF TO PSYCHIATRY.' Ripping up the index card containing the Nazi-seeker and throwing the bits over his shoulder, the Fat Man said, ‘The TURF, I love it. Let's go. Next?'

Potts presented his last admission, a man of our age who'd been playing baseball with his son, and who, while trying to beat out a hard screaming line drive, had dropped down in the base path unconscious.

‘What do you think it is?' asked Fats.

‘Intracranial bleed,' said Potts. ‘He's in rough shape.'

‘He's gonna die,' said Fats. ‘Do you want him to have the benefit of a neurosurgical procedure first?'

‘I've already arranged it.'

‘Great,' said Fats, ripping up the man our age and sowing him on the floor. ‘Potts, you're doing great—a TURF TO NEUROSURG. Two TURFS outa three patients.'

Potts and I looked at each other. We felt sad that someone our age who'd been playing ball with his six-year-old son on one of the super twilights of summer was now a vegetable with a head full of blood, about to have his skull cracked by the surgeons.

‘Sure it's sad,' said Fats, ‘but there's nothing we can do. The ones our age are the ones who die. Period. The kind of diseases we get, no medico-surgico-bullshitology can cure. Next?'

‘Well, the next is the worst,' said Potts in a husky voice.

‘What's that?'

‘The Czech, the Yellow Man, Lazlow. Last night about ten o'clock he had a convulsion, and no matter what I did, he wouldn't stop convulsing. I tried everything. His liver function tests late last night were off the scale. He . . .' Potts looked at Chuck and me, and then, ashamed, looked down into his lap and said, ‘He's got fulminant necrotic hepatitis. I transferred him to the isolation ward on the other service. He's not my patient—our patient—anymore.'

Fats asked Potts in a kind voice if he'd given the Yellow Man steroids. Potts said that he'd thought about it, but had not.

‘Why didn't you tell me the lab results? Why didn't you ask me for help?' asked Fats.

‘Well I . . . I thought I ought to be able to make the decision alone.'

A somber quiet floated down over us, the quiet of sadness and grief. Fats reached over and put his thick arm around Potts's shoulder and said, ‘I know how shitty you feel. There's no feeling like it in the world. If you don't feel it at least once, Potts, you'll never be a good doc. It's all right. Steroids never help anyway. So he's TURFED to 6-North, eh? Tell you what: after breakfast, since we've got so many TURFS, I'll demonstrate the electric gomer bed.'

On the way to the electric gomer bed, whatever that was, Potts, despondent, turned to Chuck and said, ‘You were right, I should have given him the roids. He's gonna die for sure.'

‘Wouldn't have helped him none,' said Chuck, ‘he was too far gone.'

‘I feel so bad,' said Potts, ‘I want Otis.'

‘Who's Otis?' I asked.

‘My dog. I want my dog.'

The Fat Man gathered us around the electric gomer bed containing my patient, Mr. Rokitansky. Fats explained how the goal of the tern was to have as few patients as possible. This was opposite the goal of the Privates, the Slurpers, and the House Administration. Since, according to LAW NUMBER ONE: GOMERS DON'T DIE, the gomers would not be leaving the tern's service by way of death, the tern had to find other ways to TURF them. The delivery of medical care consisted of a patient coming in and being TURFED out. It was the concept of the revolving door. The problem with the TURF was that the patient might BOUNCE, i.e., get TURFED back. For example, a gomer who was TURFED TO UROLOGY because he couldn't urinate past his swollen prostate might BOUNCE back to medicine after the urology intern with his filiform probes and flexible followers had managed to produce a total body septicemia, requiring medical care. The secret of the professional TURF that did not BOUNCE, said the Fat Man, was the BUFF.

We asked what was a BUFF.

‘Like BUFFING a car,' said Fats. ‘You gotta BUFF the gomers, so that when you TURF them elsewhere, they don't BOUNCE back. Because you gotta always remember: you're not the only one trying to TURF. Every tern and resident in the House of God is lying awake at night thinking about how to BUFF and TURF these gomers somewhere else. Gath, the surgical resident downstairs, is probably giving his terns the same lecture at this very moment, about how to produce heart attacks in gomers to TURF TO MEDICINE. But one of the key medical tools to TURF gomers elsewhere is the electric gomer bed. I'll demonstrate on Mr. Rokitansky. Mr. R., how you doing today?'

PURRTY GUD.

‘Good. We're going on a little trip, OK?'

PURRTY GUD.

‘Good. Now, the first thing to notice is that the electric gomer bed has side rails. They don't matter. LAW NUMBER TWO:—repeat after me—GOMERS GO TO GROUND.

Responsively we repeated: GOMERS GO TO GROUND.

‘Side rails up, side rails down,' Fats said, ‘no matter how securely restrained, no matter how demented, no matter how seemingly incapacitated, GOMERS GO TO GROUND. The next thing about the gomer bed is this foot pedal. Gomers don't have good blood pressures, and when, like Ina, they stop perfusing the newer parts of their brains, they go crazy, start yelling, and try to GO TO GROUND. In the middle of the night, when you get called for the fact that your gomer now has a blood pressure the same as an amoeba, you kick this pedal. Basic, like knowing C major. OK, Maxine, take the blood pressure for a baseline reading.'