Samuel Shem: The house of God

This scored a direct hit on my anal sphincter. Now I had no choice. I could no longer run. I went out onto the ward and tried to go see my patients. In my doctor costume, I took my black bag and entered their rooms. With my black bag I came out of their rooms. All was chaos. They were patients and all I knew was in libraries, in print. I tried to read their charts. The words blurred, and my mind bounced from How to Do cardiac arrests to Berry to this strange Fat Man to Ina's vicious attack on poor Potts and to Little Otto, whose name rang no bell in Stockholm. Running through my mind, over and over like Muzak, was a mnemonic for the branches of the external carotid artery: As She Lay Extended Olaf's Potato Slipped In. And even there, the only one I could remember was Olaf's, which stood for Occipital. And what the hell use was that?

I started to panic. And then finally the cries coming from the various rooms saved me. All of a sudden I thought "zoo," that this was a zoo and that these patients were the animals. A little old man with a tuft of white hair, standing on one leg with a crutch and making sharp worried chirps, was an egret; and a huge Polish woman of the peasant variety with sledgehammer hands and two lower molars protruding from her cavernous mouth became a hippo. Many different species of monkey appeared, and sows were represented in force. In my zoo, however, neither were there any majestic lions, nor any cuddly koalas, or bunnies, or swans.

Two stand out. First, a heifer named Sophie, who'd been admitted by her Private Doctor with a chief complaint of "I'm depressed, I've got headaches all the time." For some reason her Private, Dr. Putzel, had ordered the complete Gastrointestinal workup, consisting of barium enema, upper GI series, small?bowel follow?through, sigmoidoscopy, and liver scan. I didn't know what this had to do with depression and headache. I entered her room and found the old lady with a balding little man who was sitting on her bed patting her hand affectionately. How sweet, I thought, her son has come to visit. It was not her son, it was Dr. Bob Putzel, whom Fats described as "the hand?holder from the suburbs." I introduced myself, and when I asked Putzel about the reason for the GI workup for depression, he looked sheepish, straightened his bowtie, murmured "flatulence," and, kissing Sophie, hurried out. Confused, I called in the Fat Man.

"What is it with this GI workup?" I asked. "She says she's depressed and has a headache."

"It's the specialty of the House," said Fats, "the bowel run. TTB?Therapeutic Trial of Barium."

"There's nothing therapeutic about barium. It's inert."

"Of course it is. But the bowel run is the great equalizer."

"She's depressed. There's nothing wrong with her bowels."

"Of course there's not. There's nothing wrong with her, either. It's just that she got tired of going to Putzel's office, and he got tired of calling at her house, so they both pile into his white Continental and come to our House. She's fine, she's a LOL in NAD?a Little Old Lady in No Apparent Distress. You don't think Putzel knows that too? And every time he holds Sophie's hand, it's forty of your Blue Cross dollars. Millions. You know that new building, the Wing of Zock? Know what it's for? The bowel run of the rich. Carpets, individual changing rooms in radiology with color TV and quadraphonic sound. There's a lotta money in shit. I'm searching for a GI fellowship, myself."

"But with Sophie it's fraud."

"Of course it is. Not only that, it means work for you, and Putzel is the one making the money. It sucks."

"It's crazy," I said.

"It's doing medicine the House of God way."

"So what can I do about it?"

"Start by not talking to her. If you talk to these patients, you'll never get rid of them. Then sic your BMS on her. She'll hate that."

"Is she a gomer?"

"Does she act human?"

"Of course she does. She's a nice old lady."

"Right. A LOL in NAD. Not a gomere. But you're sure to have a gomer on your service. Here, let's see. Rokitansky. Come on."

Rokitansky was an old bassett. He'd been a college professor and had suffered a severe stroke. He lay on his bed, strapped down, IV's going in, catheter coming out. Motionless, paralyzed, eyes closed, breathing comfortably, perhaps dreaming of a bone, or a boy, or of a boy throwing a bone.

"Mr. Rokitansky, how are you doing?" I asked.

Without opening his eyes, after fifteen seconds, in a husky slurred growl from deep down in his smushed brain he said: PURRTY GUD.

Pleased, I asked, "Mr. Rokitansky, what date is it today?"

PURRTY GUD. .

To all my questions, his answer was always the same. I felt sad. A professor, now a vegetable. Again I thought of my grandfather, and got a lump in my throat. Turning to Fats, I said, "This is too sad. He's going to die."

"No, he's not," said Fats. "He wants to, but he won't."

"He can't go on like this."

"Sure he can. Listen, Basch, there are a number of LAWS OF THE HOUSE OF GOD. LAW NUMBER ONE: GOMERS DON'T DIE."

"That's ridiculous. Of course they die."

"I've never seen it, in a whole year here," said Fats.

"They have to."

"They don't. They go on and on. Young people-like you and me?die, but not the gomers. Never seen it. Not once."

"Why not?"

"I don't know. Nobody knows. It's amazing. Maybe they get past it. It's pitiful. The worst."

Potts came in, looking puzzled and concerned. He wanted the Fat Man's help with Ina Goober. They left, and I turned back to Rokitansky. In the dim half-light I thought I saw tears trickling down the old man's cheeks. Shame swept over me. My stomach churned. Had he heard what we'd said?

"Mr. Rokitansky, are you crying?" I asked, and I waited, as the long seconds ticked away, my guilt moaning inside me.

PURRTY GUD.

"But did you hear what we said about gomers?"

PURRTY GUD.

I left, and stopped by to listen to Fats on Ina Goober.

"But there's no indication for the bowel run," Potts was saying.

"No medical indication," said Fats.

"What else is there?"

"For the House Privates, a big one. Tell him, Basch. tell him."

"Money," I said, "there's a lotta money in shit:"

"And no matter what you do, Potts," said the Fat Man, "Ina will be here for weeks. See you on Visit Rounds in fifteen."

"This is the most depressing thing I've ever done," said Potts. lifting up a pendulous breast as Ina continued to shriek and attempt to whack him with her tied-down left hand.

Under the breast was greeny scumlike material, and as the foul aroma hit us, I thought that this first day must be even worse for Potts. He was a displaced person, from Charleston, South Carolina, to the North. He came from a rich Old Family who owned a dream house on Legare Street amidst the magnolias and yellow jasmine, a summerhouse on Pawley's Island, where the only competition was between waves and winds, and an upriver plantation, where he and his brothers would sit out on the porch of a cool summer night and peruse Moliere. Potts had made the fatal mistake of coming north to Princeton, and then compounded his mistake by coming to the BMS. There, over the stiffs in the Path course, he'd met a classy female BMS from Boston, and since up till that time Potts's sexual experience had consisted only of "an occasional recreational encounter with a schoolteacher from North Charleston who was fond of my blue?steel throbber," he'd been assaulted by the female BMS in both intellectual and sexual terms, and, like a false spring in February when all the bees hatch and are killed by the next frost, there had blossomed in these two BMSs something each called "love." The wedding had been held just prior to both internships, his in medicine at the House, hers in surgery at the MBH?Man's Best Hospital?the prestigious BMS?affiliated WASP hospital across town. Their on?call schedules would rarely coincide, and their joy of sex would curdle to their job of sex, for what erectile tissue could stand two internships? Poor Potts. Goldfish in the wrong bowl. Even at BMS he'd seemed depressed, and each choice since then had served only to deepen his depression.