Samuel Shem: The house of God

On the Sunday afternoon before the B?M Deli Monday before the horrific Tuesday July the first, I was in bed. June was ending with a final sunny flash, but my shades were drawn. Nixon was off on yet another summit junket to masturbate Kosygin, "Mo" Dean was breathless in her agony over what dress to wear to the Watergate hearings, and I was, in pain. My pain was not even the modern pain of alienation or ennui, the kind that many Americans currently felt while watching the TV documentary on "The California Family: The Louds," with their expensive ranch house, three cars, kidney?shaped pool, and no books. My pain was fear. Despite always having been a red?hot, I was scared out of my mind. I was terrified of being an intern in the House of God.

I was not alone in bed. I was with Berry. Our relationship, having survived the trauma of my years at the Best Medical School, was blossoming, rich in color, woven with liveliness, laughter, risk, and love. Also in bed with me were two books: the first, a gift from my father the dentist, an "internship" book, something called How I Saved the World Without Dirtying My Whites, all about this intern rushing in at the last minute, taking over, crisply barking orders which saved lives in the nick of time; the second book I'd bought for myself, something called How to Do It for the New Intern, a manual that told you everything you needed to know. While I ransacked this manual, Berry, a Clinical Psychologist, was curled up with Freud. After a few minutes of silence, I groaned, let the manual drop, and pulled the sheet over my head.

"Help, heIlllp," I said.

"Roy, you really are in terrible shape."

"How bad is it?"

"Bad. Last week I hospitalized a patient who was found curled up under the covers just like that, and he was less anxious than you"

"Can you hospitalize me?"

"Do you have insurance?"

"Not till I start the internship."

"Then you'd have to go to the State Facility."

"What should I do? I've tried everything, and I'm still scared to death."

"Try denial."

"Denial?"

"Yes. A primitive defense. Deny that it exists"

So I tried to deny that it exists. Although I didn't get very far with this denial, Berry helped me through the night, and the next morning, B?M Deli Monday, she helped me to shave, dress, and she drove me downtown to the House of God. Something stopped me from getting out of the car, and so Berry opened my door, coaxed me out, and pressed a note into my hand that said "Meet you here at five P.M. Good luck. Love, Berry." She kissed me on the cheek and left.

I stood in the steamy heat outside a huge urine-colored building which a sign said was THE HOUSE OF GOD. A ball and chain were demolishing one wing, to make way, a sign said, for THE WING OF ZOCK. Feeling like the ball and chain were swinging back and forth inside my skull, I entered the House and searched out the "function room." I sat down as the Chief Resident, named Fishberg and nicknamed the Fish, was giving a welcoming speech. Short, chubby, scrubbed to a shine, the Fish had just completed his training in Gastroenterology, the specialty of the House. The position of Chief Resident was smack in the middle of the ice?cream cone, and the Fish knew that if he did a good job that year he'd be rewarded by the higher?up Slurpers with a permanent job and become a permanent Slurper. He was the liaison between the interns and everyone else, and he "hoped that you will come to me with any problems you might have." As he said this, his eyes slithered over to the higher?up Slurpers arrayed at the head table. Shifty, slimy, he oozed. Too cheerful. Not in touch with our dread. My concentration waned, and I looked around the room at the other new terns: a smooth black guy slouched down in his chair with his hand wearily shading his eyes; more striking was a giant of a guy with a bushy red beard, wearing a black leather jacket and wraparound sunglasses, twirling a black motorcycle hat on his finger. Far?out.

" . . and so, day or night, I'm available. And now it gives me great pleasure to present the Chief of Medicine, Dr. Leggo."

From the corner where he'd been standing, a thin, dry?looking little man with a horrific purple birthmark on the side of his face walked stiffly to the center of the speaker's table. He wore a butcher?length white coat and a long old?fashioned stethoscope wended its way across his chest and abdomen and disappeared mysteriously into his pants. A question flickered across my mind: WHERE DID THAT STETHOSCOPE GO? He was a renologist: kidneys, ureters, bladders, urethras, and stagnant urine's best friend, the Foley catheter.

"The House is special," said the Chief. "Part of its being special is its affiliation with the BMS. I want to tell you a story about the BMS, that showed me how special the BMS and the House are. It's a story about a BMS doctor and a BMS nurse named Peg. It showed me what it is like to be affiliated with the . . : "

My mind wandered. The Leggo was a less chubby version of the Fish, as if, given the fact that the Leggo had published rather than perished to become Chief, all the human juice had been sucked out of him, and he had been left drained, dehydrated, even uremic. So this was the top of the cone, when finally, and with all men, as Chief, one was perpetually more slurped against than slurping.

" . and so Peg came up to me with a surprised look on her face and said 'Doctor Leggo, how could you wonder whether that order had been done? When a BMS doctor tells a BMS nurse to do something, you can be sure it will be done, and it will be done right."'

He paused, as if expecting applause. He was met with silence. I yawned, and realized that my mind had gone straight to fucking.

". . and you'll be glad to hear that Peg will be coming?"

WHIZAAAK! HHRAAAK!"

An explosion of coughing from the tern in the black leather jacket, doubling him over, gasping, at his seat, interrupted the Leggo.

"?coming from the City Hospital to join us here at the House later in the year."

The Leggo went on to make a statement about the Sanctity of Life. Like the Pope's statements, the emphasis was on doing everything always for everyone forever to keep the patient alive. At the time, we couldn't have known how destructive this nuncio would be. Finishing, the Leggo returned to his corner, where he remained standing. Neither the Fish nor the Leggo seemed to have a firm grasp on what went into being a human being.

The other speakers were more human. A House Administration type in a blue blazer with gold buttons gave us some advice on how "the patients' charts are legal documents" and told us that the House had gotten sued recently because some tern, as a joke, had written in the chart that the Nursing Home had left the patient on the?bed pan so long that stasis ulcers developed, which led to death on transfer to the House; an emaciated young cardiologist named Pinkus remarked on the importance of hobbies in preventing cardiac disease, his two hobbies being "running for fitness and fishing for calm," and then went on to say that every patient we would see during the year would seem to have a rumbling systolic heart murmur which in fact would turn out to be the jackhammers from the Wing of Zock and we might as well throw our stethoscopes away now; the House Psychiatrist, a sad?looking man with a goatee, turned his pleading eyes on us and told us that he was available to help. Then he shocked us all by saying:

"Internship is not like law school, where they say look to your right and look to your left and one of you will not be here at the end of the year, but it is a strain, and everyone has a hard time. If you let it go too far, well . . . Each year the graduating class of at least one medical school?maybe two or three schools?must step into the ranks just to replace colleagues who commit suicide?"