Samuel Shem - The house of God

"That's the straight bendover." It was the Fat Man. He sat down beside me, unrolling the Journal.

"Huh?"

"That nursing maneuver, where they bend from the waist and flash their ass. Called the Straight Bendover Nursing Maneuver. Learn it in nursing school. What are you going to do about TURFING Sophie? She's settling in, and I'm warning you, she's really getting Putzeled this time. She could be here for months."

"Putzeled?"

"Bob Putzel, her Private, remember? He uses the standard method: admit the LOL in NAD, do a test, produce a complication, do another test to diagnose the complication, get another complication, and so on until they're gomertose and non?TURFABLE. Do you want that nice LOL in NAD to become an Ina Goober? Nip it in the bud. Do something now. You gotta get her to leave."

"How?"

"Do a painful procedure. She doesn't like painful procedures."

"I can't think of anything that's indicated."

"Oh. Well, she has a headache, and her noon temp is a degree high. No matter that it's almost a hundred Fahrenheit up here and all the temps are a degree high, no matter, 'cause the chart is BUFFED with a recorded noon temp a degree high. Oh, and she has a stiff neck too. So: headache, fever, stiff neck; diagnosis?"

"Meningitis."

"Procedure?"

"Lumbar puncture, LP. But she doesn't really have meningitis."

"She might. If you don't LP her, you might miss it, like Potts missed with Mellow Yellow. And don't worry about hurting Sophie, she's tough. A Gray Panther. Get Molly to help." Looking in the paper, Fats mumbled, "The Dow Jones is up, baby, up. Good. Good climate for the Invention now, for sure."

"For what?"

"The Invention, the Invention! The Great American Medical Invention!"

With the Dow Jones rising up over America's colorful ass, how could I not enjoy doing an LP on Sophie? Molly had never before assisted at an LP and was glad to help. Together we walked into Sophie's room. Levy the Lost, my BMS, was sitting on Sophie's bed Putzeling her hand, "taking a history." He was still at the beginning, asking her "What brought you to the hospital?"

"What brought me? Dr. Putzel, in his white Continental."

I stopped Levy, and instructed Molly in how to hold Sophie curled up in a fetal position on her side, exposing her back to me. As Molly bent down over Sophie, grabbing her behind the knees and neck, arms spread apart like Christ on the Cross, I noticed that the two top buttons of her ruffled blouse were undone, and I was staring into an enticing cleft between Molly's breasts, bubbling up out of lacy bra cups. She noticed me noticing, and said, smiling, "Go ahead." How bizarre, ' the contrast between these two women. I had an urge to slip my penis into Molly's cleft. Potts popped his head in, and asked us if we knew where a Bible could be found.

"A Bible? What on earth for?" asked Molly.

"For pronouncing a patient dead," said Potts, vanishing again.

I tried to recall how to do an LP. At BMS I had been particularly bad at these, and to do an LP on an old person was more difficult, for the ligaments in between the vertebrae are calcified, like guano on an old rock. And then there was the fat. Fat is death to a tern. All the anatomical landmarks get obliterated in fat, and as I tried to locate Sophie's midline, with my ill?fitting rubber gloves and the rolling fat, it was impossible. I thought I had it, and as I put the needle in, Sophie screamed and leaped, and as I advanced the needle further, she yelped and leaped again. Molly's hair came loose, a blond cascade over Sophie's old and sweaty torso. Every time I looked into Molly's cleavage I got aroused, and every time Levy said something I got mad and wanted to slug him, and every time I advanced the needle Sophie leaped up in pain. I began to sweat. I tried another spot on Sophie's fat back. No luck. Another. Nothing. I noticed that blood was coming out of the spinal needle, so I knew it wasn't where it was supposed to be. Where was it? Lubricated by the sweat, my glasses fell off and contaminated the sterile field. Molly let go at the same time, Sophie uncoiled and looked like she was about to GO TO GROUND from just below the Orthopedic Height but we caught her in time. Embarrassed, my cockiness splattered in sweat all over Sophie, I told Levy to stop smirking and get the Fat Man. Fats came in, in two shakes had Molly expose herself and Sophie's porcine back, and, humming a TV commercial that sounded like "I Wish I were an Oscar Weiner weiner," with a smooth and effortless Sam Snead stroke sliced through the fat and popped into the subarachnoid space. I was amazed at his virtuosity. We watched the clear spinal fluid drip out. Fats took me aside, and like a coach put his arm around my shoulders and whispered:

"You were way off the midline. You hit either kidney or gut. Pray kidney, 'cause if it's gut, it's Infection City, and she may suffer the ultimate TURF, to Pathology."

"Pathology?"

"The morgue. No BOUNCE. But I think it worked. Listen."

"I WANT TO GO HOME I WANT TO GO HOME I WANT TO . . ."

I began to feel scared that I had started an infection that would send Sophie home for good. As if in confirmation, from the next bed, behind the curtain, Potts was dealing with his first death. His patient, the young father who'd dropped on the first?base line the day before, had died. Potts had been called to pronounce the patient dead, as required by law. We peeked through the curtain: Potts was standing at the foot of the bed, his BMS beside him holding a Bible, on which rested Potts's hand. His other hand was raised toward the body, which was lying there as white as a corpse, which was what it was. As we watched, Potts intoned:

"By the power vested in me by this great state and nation I hereby pronounce you, Elliot Reginald Needleman, dead."

Molly, snuggling up to me so that her left breast brushed my arm, asked, "Is that really necessary?" and I said I didn't know, and I asked Fats, who said, "Of course not. The only federal regulation is that you take the two pennies out of your loafers and put them over the dead man's eyes."

Potts, decimated, sat with us at the nursing station. Slurring his words, his eyes bloodshot, he said, "He's dead. Maybe I shoulda shipped him to surgery sooner. I shoulda done something. But I was so tired when he came in, I couldn't even think."

"You did all you could," I said. "He popped an aneurysm, nothing would have helped. The surgeons refused to operate."

"Yeah, they said it was too late. If I had moved faster, maybe?"

"Enough of that," said the Fat Man. "Potts, you listen to me. There's a LAW you've gotta learn, LAW NUMBER FOUR: THE PATIENT IS THE ONE WITH THE DISEASE. Understand?"

Before he had a chance to understand, we were interrupted by the Chief Resident, the Fish. He had a concerned look on his face. It turned out that both Needleman and the Yellow Man were not Private patients, but House patients, and the Fish was partially responsible.

"Liver disease is a special interest of mine," said the Fish, "I've recently had the opportunity to review the world literature on fulminant necrotic hepatitis. Why, the case of Lazlow would make a very interesting research project. Perhaps the House Staff would wish at some point to undertake such a project?"

No one said he wanted to undertake such a project.

"However, both the Leggo and I feel, Dr. Potts, that you waited too long without giving steroids. Do you understand?"

Stabbed, Potts said, "Yes, you're right. I understand."

"I'm on my way to an impromptu colloquium on Lazlow. We've brought in the Australian, the world's expert on this disease. It does not look good. You waited too long. Oh, and one more thing," said the Fish, looking at Chuck's dirty whites and unbuttoned shirt without a tie, "the way you dress, Chuck. Not professional. Not enough for the House. Clean whites here, and a tie. Understand?"