Samuel Shem: The house of God

"In internal medicine, there is virtually no need to see patients. Almost all patients are better off unseen. See these fingers?"

We looked carefully at the Fat Man's stubby fingers.

"These fingers do not touch bodies unless they have to. You want to see bodies, go see bodies. I've seen enough bodies, and especially bodies of gomers, to last me the rest of my life."

"What's a gomer?" I asked.

"What's a gomer?" said the Fat Man. With a little smile he spelled out "G?O . . ."

He stopped, his mouth still set in the "O," and stared at the doorway. There stood Chuck, wearing a collar?to?toes?length brown leather coat with tan fur ruffles at the edges, sunglasses, and a brown leather hat with a broad rim and a red feather. He walked clumsily on platform heels, and looked as if he'd been up dancing the night away.

"Hey, man, what's happenin'?" said Chuck, and slid into the nearest chair, slouching down, covering his eyes with a weary hand. As a token gesture, he unbuttoned his coat and threw his stethoscope on the table. It was broken. He looked at it and said, "Well, I guess I broke my scope, eh? Rough day."

"You look like some kind of mugger," said a BMS.

"That's right, man, 'cause you see, in Chicago where I come from, there are only two kinds of dudes?the muggers and the mugged. Now, if you don't dress like a mugger, man, you automatically gets youseff mugged. You dig?"

"Never mind dig," said the Fat Man, "pay attention. I was not supposed to be your resident today. A woman named Jo was, but her father jumped off a bridge and killed himself yesterday. The House switched our assignments, and I'll be your resident for the first three weeks. After what I did as an intern last year, they didn't want to expose the fresh terns to me today, but they had no choice. Why didn't they want you to meet me, your first day as a doctor? Because I tell things as they are?no bullshitology?and the Fish and the Leggo don't want you to get discouraged too soon. They're right?if you start to get as depressed now as you'll be in February, in February you'll jump off a bridge like Jo's pop. The Leggo and the Fish want you to cuddle with your illusions, so you don't give in to your panic. 'Cause I know how scared you three new terns are today."

I loved him. He was the first person to tell us he knew about our terror.

"What's there to be depressed about?" asked Potts.

"The gomers," said the Fat Man.

"What's a gomer?"

From outside the room there came a high?pitched, insistent cry: GO AVAY GO AVAY GO AVAY . . .

"Who's on call today? You three interns rotate days on call, and you only admit patients on your on?call day. Who's admitting today?"

"I am," said Potts.

"Good, 'cause that awful sound comes from a gomer. If I'm not mistaken, it's from one Ira Goober, whom I admitted six times last year. A gomer, or rather, the feminine, gomere. Gomer is an acronym: Get Out of My Emergency Room?it's what you want to say when one's sent in from the nursing home at three A.M."

"I think that's kind of crass," said Potts. "Some of us don't feel that way about old people."

"You think I don't have a grandmother?" asked Fats indignantly. "I do, and she's the cutest dearest, most wonderful old lady. Her matzoh balls float?you have to pin them down to eat them up. Under their force the soup levitates. We eat on ladders, scraping the food off the ceiling. I love . . ." The Fat Man had to stop, and dabbed the tears from his eyes, and then went on in a soft voice, "I love her very much."

I thought of my grandfather. I loved him too.

"But gomers are not just dear old people," said Fats. "Gomers are human beings who have lost what goes into being human beings. They want to die, and we will not let them. We're cruel to the gomers, by saving them, and they're cruel to us, by fighting tooth and nail against our trying to save them. They hurt us, we hurt them."

"I don't get it," said Potts.

"After Ira you'll get it. But listen?even though I said I don't see patients, when you need me, I'm here with you. If you're smart, you'll use me. Like those dolled?up jets that cargo the gomers to Miami: 'I'm Fats, fly me'. Now, let's get on to the cardflip."

The efficiency of the Fat Man's world rested on the concept of the three?by?five index card. He loved three-by?five cards. Announcing that "there is no human being whose medical characteristics cannot be listed on a three?by?five index card," he laid out two thick decks on the table. The one on the right was his. The duplicate deck on the left he split in three, and handed a stack to each of the new terns. On each card was a patient, our patients, my patients. The Fat Man explained how on his work rounds he would flip a card, pause, and expect that tern to comment on the progress being made. Not that he expected progress to have been made, but he had to have some data, so that at the next cardflip, a condensed version later in the morning with the Fish and the Leggo, he could relate "some bullshit or other" to them. The first cards flipped every day would be the new admissions from the tern who'd been on call the night before. The Fat Man made it clear that he was not interested in fancy elaborations of academic theories of disease. Not that he was anti-academic. To the contrary, he was the only resident to have his own reference file on every disease there was, on three?by?five cards. He loved references on three-by?five cards. He loved everything that was on a three-by?five card. But the Fat Man had strict priorities, and at the top was food. Until that awesome tank of a mind had been fueled via that eager nozzle of a mouth, Fats had a low tolerance for medicine, academic or otherwise, and for anything else.

Rounds over, Fats headed to breakfast, and we headed out to the ward to get to know the patients on our cards. Potts, looking green, said, "Roy, I'm as nervous as a whore in church." My BMS, Levy, wanted to go see my patients with me, but I shooed him away to the library, where BMSs love to be. Chuck and Potts and I stood at the nursing station, and the hairy-armed nurse told Potts that the woman on the stretcher was his first admission of the day, named Ina Goober. Ina was a great mass of flesh sitting upright on a stretcher, wearing, like a uniform, a gown that had blazoned across its front, "The New Masada Nursing Home." Glowering, Ina clutched her purse. She was yelling a high?pitched: GO AVAY GO AVAY GO AVAY…

Potts did what the textbooks said to do: introduced himself, saying, "Hello, Mrs. Goober, I'm Dr. Potts. I'll be taking care of you."

Upping her volume, Ina screamed: GO AVAY GO AVAY GO AVAY . . .

Potts next tried to engage her using the other textbook method, grasping her right hand. Quick as lightning Ina struck him a southpaw blow with her purse, knocking him back against the counter. The sinister violence of it shocked us. Potts, rubbing his head, asked Maxine, the nurse, whether Ina had a private doctor who could provide information.

"Yes," said Maxine, "Dr. Kreinberg. Little Otto Kreinberg. That's him over there, writing Ina's orders in her chart."

"The private doctors are not supposed to write orders," said Potts, "that's a rule. Only interns and residents write orders"

"Little Otto is different. He doesn't want you writing orders on his patients."

"I'll talk to him about that right now."

"You can't. Little Otto won't talk to interns. He hates you."

"He hates me?"

"He hates everyone. See, he invented something having to do with the heart thirty years ago, and he expected to get the Nobel Prize, but he hasn't, so he's bitter. He hates everyone, especially interns.

"Well, man," said Chuck, "sure is a great case. See you later."

I was so scared at the thought of seeing patients that I had an attack of diarrhea, and sat in the toilet with my How to Do It manual spread on my knees. My beeper went off: DR. BASCH CALL WARD 6SOUTH RIGHT AWAY DR. BASCH . . .