House of God (32 page)

I knew for sure that he was going into a GI Fellowship, that he was the only graduate of Brooklyn College ever to make it to the House of God, and that he was the only true genius I'd ever met. Now, fat and snappy and with a small gold ring on a fat finger of a fat hand and a sparkling gold chain around a huge rubbery neck that barely existed at all, given the way the fat, sleek, black-haired head seemed to rest entirely upon the rolling mound of shoulder, now the Fat Man's good cheer seemed a strange contrast to the searing winter that held the city in its frozen tongs from January until the thaw. I knew from what other terns had said that this ward—ward 4-North—would be the worst. With Fats as our resident, I hoped that it would not be the worst.

‘This ward will be the worst,' said Fats, chalk in chubby fingers scrawling THE WORST on the black-board of the on-call room. ‘This ward has taken fine young men and broken them.' BROKEN THEM went up. ‘And yet, last year, I made it through, and this year, with me for these three months, you guys will make it through OK.'

Hyper Hooper, one of the other terns, asked, ‘What makes this ward the worst?'

‘Name it,' said Fats.

‘The patients?'

‘The worst.'

‘The nurses?'

‘Salli and Bonni—they both wear caps and tin nursing-school badges like meter maids—who say things to the gomers like, “Now we eat our custard, sport.” The worst.'

‘The Visit?'

‘The Fish.'

The third tern, Eat My Dust Eddie, let out a long slow groan of despair. ‘I can't stand it,' he said, ‘I can't stand having the Fish. He's a gastroenterologist and I can't stand any more talk of shit.'

‘To hear you,' said Fats, ‘you'd think no one ever shits in California.' Then, getting serious, he leaned forward and said, ‘That reminds me—my Fellowship Application. I'm trying to get my GI Fellowship for July the first. The Leggo still hasn't written the crucial letter of recommendation. He says he's waiting to see how I run this ward. Don't screw me on that letter, hear? This is a “Protect the Fat Man's Fellowship” ward rotation, see?'

‘Where do you want to go for your fellowship?' asked Hooper.

‘Where? L.A. Hollywood.'

Eat My Dust groaned and covered his face with his hands.

‘“The Bowel Run of the Stars,” ' said Fats, stars sparkling in his dark eyes.

Fats was into money. He'd grown up poor. His mother, during the High Holy Days, even though there wasn't anything to make soup from, had put pots of water on the stove to boil, so that if anyone dropped in, the illusion of soup would be there. Nourished by his family as being a true genius, he'd shot up like a Flatbush meteor, barreled through Brooklyn College in science, cutthroated through Einstein Med, and arrived at the best internship of the Best Medical School, the House of God. Now, as he said, he was ‘going all the way to the top,' and it seemed that from Flatbush, the top was Hollywood: ‘Imagine doing a sigmoidoscopy on Groucho Marx?' he'd said, ‘on Mae West, on Fay Wray, on Kong! On all those stars who think that the colon is filled with cologne.'

I tuned back in as Fats was saying, ‘This ward is a GI Man's Heaven, and even for a GI man, it's Hell. How are you terns going to survive?'

‘By killing ourselves,' said Eddie.

‘Wrong,' said Fats seriously, ‘you are not going to kill yourselves. You are my A Team, you all know what you're doing by now. You will survive by going with it.'

‘Going with it?' I asked.

‘Right. Like in the card game: finesse, men, finesse.'

Finesse? I driffed off, thinking that this was a little bit different from what Fats had said before. How would this ward be the worst? There would be no hiding our doing nothing from Fats, and after what I'd been through on the wards and in the E.W., there would be no doubts about my ability to handle just about anything. I guessed it would be the worst because the gomers would try to torment us by holding up their end of the delivery of medical care by camping in the House, and the Slurpers and the Privates would try to torment us as well, each in his own fail-safe way. It would be the worst precisely because there would be no duplicity or pretense, but only the eternal, almost ecological struggle to do revolving-door medicine the House of God way.

‘Remember,' said Fats, finishing, ‘if you don't do anything, they can't do anything to you. Believe it or not, guys, we're gonna have a ball. OK, now we're ready to go on out there. Let's break!'

We broke with all the enthusiasm of a high-school football team breaking from the locker room knowing they were going to get creamed and leaving their guts in the toilet bowls behind. Ward 4-North was yellow-tiled, smelly, and contorted like a gomer. We went from room to room, and in each there were four beds and on each bed was a horizontal human being who showed few signs of being a human being except being on a bed. No longer did I think it crazy or cruel to call these sad ones gomers. Yet part of me thought it was both crazy and cruel that I no longer thought so. In one male room a gomer was spasmodically tugging at his catheter and moaning something like PAZTRAMI PAZTRAMI PAZTRAAAH—MI and at that, Eat My Dust began making dog-vomiting noises in my ear. We went into the hallway and saw two more males, side by side, the only difference being their mouths, which were:

The Fat Man asked the BMSs—the terrified, eager, and idealistic BMSs—what the inspection of these two men would produce as diagnoses, and they had no idea. Fats said, ‘These are classic signs: the O SIGN on the left and the Q SIGN on the right. The O SIGN is reversible, but once they get to the Q SIGN, they never come back.'

We proceeded down the corridor. Suddenly there they were: side by side in armchair recliners sat two patients, the same two patients Chuck and I had turned back from that first day, Harry the Horse (HEY DOC WAIT HEY DOC WAIT) and Jane Doe (OOOO-AYYY-EEEE-IYYYY-UUUU). Still there! We stood in front of them, mesmerized.

‘Come on, come on,' said Fats, dragging us away down the corridor. ‘This is the worst, the Rose Room. This room has taken fine young men and broken them. There should be an antidepressant dispenser at the door. Always remember, when you leave the Rose Room and feel like killing yourself, remember that it is they of the Rose Room, and not you, who are ill. THE PATIENT IS THE ONE WITH THE DISEASE.'

‘Why is it called the Rose Room?' we asked.

‘It is called the Rose Room because it invariably happens that the four female beds contain gomeres named Rose.'

In hushed silence we stood in the middle of the dimly lit Rose Room. All Was still, spectral, the four Roses horizontal, at peace, barely dimpling their swaddling sheets. It was all very nice, until the smell hit, and then it was disgusting. The smell was shit. I couldn't stand it. I left. From the corridor I could hear Fats continue to lecture. Out came EMD, gagging. Still Fats talked on. Out came Hyper Hooper, snorting. On and on Fats talked. The three fresh BMSs, holding to the fantasy that if they left the Rose Room before the Fat Man, their grade would plunge down toward that deadhouse, middle C, stayed. Fats droned on. Yelping and retching, handkerchiefs to their mouths, out ran the BMSs. As Fats rattled on to himself and to the gomertose Roses, the BMSs threw open a window and hung out their heads, and the burly construction workers who were riveting together the Wing of Zock pointed to them and laughed, and the laughter seemed to come from far away. I wished I could have been a robust hardhat, far from the smell of shit. Fats droned on to himself. The next one out, I mused, would be a Rose. Finally, out came our leader, asking, ‘What's the matter, guys?'

We told him the matter was the aroma.

‘Yeah, well, you can learn a lot from that aroma. With luck, in three months you'll be able to stand in the middle of that room and give the four diagnoses as the different bowel odors smack your olfactory lobes. Why, just today there was a steatorrheac malabsorption, a bowel carcinoma, a superior mesenteric insufficiency giving rise to bowel ischemia and diarrhea, and last? . . . yes! Little packets of gas slipping past a longstanding fecal impaction.'

‘Hey, Fats,' said Hooper, ‘how about having a box with postmortem permission slips here at the doorway of the Rose Room?'

‘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.'