Samuel Shem: The house of God

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 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 blue?steel 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.

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 AWAY GO AVAY GO AVAY . . . and took a swing at him with her left fist. Enraged, Potts?gentle Moliere?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.