The house of God

10

". . . floozy."

"Huh?" I asked.

"Roy, don't you ever listen to me?"

It was Berry. Where were we, who knew? I was eating an oyster. I hoped I was in France, in Bordeaux, eating a Marenne oyster, or in England, in London, eating a Wheeler's oyster, but feared that I was in the United States, eating a Long Island oyster, fearing America because America contained the House of God, and most of the time the House of God contained me, and the times I was out of the House were more unbearable now, for their succulence, than the times I was in. I said to Berry that I did ever listen to her.

"I saw Judy the other day, and she said that whenever she sees you out with anyone else, it's with some floozy."

An American floozy, an American oyster.

"What the hell," I said, "they're American oysters, aren't they?"

"What?" asked Berry, looking at me strangely, and then, realizing I was elsewhere, turning sympathetic eyes on me, saying, "Roy, you've developed loose associations."

"Not only that, but according to Judy, I've got floozies, too."

"It's all right," said Berry, putting the tines of her fork through the juiciest part of an oyster, "I understand. It's all primary process stuff."

"What's primary process?"

"Infantile pleasure. The pleasure principle. The floozies, the oysters, even me?any pleasures at all, and all pleasures at once. It's all pre?Oedipal, a regression from the Oedipal struggle with your father for your mother, to earlier, infantile concerns. I just hope there's enough of the secondary?process Roy left to include me in his narcissism. Otherwise, it's curtains for us, for sure. See?"

"Not really," I said, wondering if she meant that she knew about Molly. Should I bring that up? Things with Berry had reached an uneasy equilibrium bound by what she called "limits," and floating on an unspoken shared acceptance of the other one's freedom, for now. I wouldn't say anything. Why should I?

"Where do you work next? What's your next rotation?"

"Next rotation?" I asked, seeing myself as an asteroid, rotating around Venus. "The Emergency Ward, tomorrow. From November first until New Year's Day."

"What will that be like?"

At that, my mind turned back to England, to one of the heightened moments in my formless "loitering years" at Oxford. That first summer of Mary Quant's miniskirt, I was idling on a busy street corner when suddenly there was a flurry and then the WEE?AWW of an ambulance approaching. The world stopped, curious and apprehensive, as the ambulance raced by, giving each of us a glimpse of the drama inside. Life or death. Chilling. And I'd thought, "Wouldn't it be great to be the one at the end of the ambulance ride?" That thought had turned me around and had gotten me back to America with its oysters and Mollys and BMSs. And Houses of Gods. Although that thought remained intact, to Berry's question I could only.say, "In the E.W., I don't think they can hurt you as bad."

"Poor Roy, afraid to hope. Go ahead, have as many as you want."

With each new Watergate bombshell, Americans were realizing that Nixon's "Operation Candor" was one terrific lie. On the day that Leon Jaworski was appointed special prosecutor to replace Archibald Cox, just about the time that Ron Ziegler was rejecting Kissinger's suggestion that Nixon make a speech of contrition by saying "Contrition is bullshit," I entered the House through the E.W. automatic doors. The waiting room was empty but for a sharp?eyed old buzzard standing in one?corner rocking, a bulging shopping bag at his feet. Good. Only one patient to see. The stillness of the circular tiled E.W. was peaceful but ominous. A happy buzz, sprinkled with laughter, was coming from the central nursing station, where several people sat: the Head Nurse, named Dini; a black nurse named Sylvia; two surgeons, the uppermore, the resident, a gum?chewing Alabama native named Gath, and the lowermore, the intern, named Elihu, a tall beak?nosed Sephardic Jew with a frizzy Isro?Afro, rumored to be the worst surgical intern in the history of the House.

Gilheeny and Quick, the two policemen, also sat, and as they saw me come in, the redhead boomed out, "Welcome! Welcome to this little bit of Ireland in the heart of the Hebrew House. Your track record for the naughty upstairs ward has preceded you, and we know that you will amuse all of us with stories of passion in the long chill nights to come."

"Am I about to hear another story about the Irish and the Jews?"

"And with the High Holy Days just past, I heard a wonderful tale," said Gilheeny, "a story about the Irish maid coming to work in the Jewish household, do you know?"

I did not.

"Ha! Well, this fine Irish woman sought employment at this Jewish household about the time of the Rosh Hashonah, the New Year, and asked the doorman what the employment in the house was like. Well, said your man, it's all right, my darlin', and they celebrate all the holidays, for instance during the New Year there's a large family dinner, and the head of the household gets up in front of them all, and in gratitude blows the shofar. So your woman the maid's eyes light up and she says, He blows the chauffeur! Ach, mon, but they do treat the help well here, now, don't they?"

When the laughter had died down, I asked whether the patient with the shopping bag in the waiting room was surgical or medical.

"Patient? What patient?" asked Dini.

"Oh, he means Abe," said Flash, the E.W. orderly. Flash was a dwarfish young man with a harelip and a scar that started at his lip and disappeared down into parts unknown. He looked as if he had suffered severe chromosomal damage as a child. "That ain't no patient, that's Crazy Abe. He lives out there, that's all."

"He lives in the waiting room?"

"More or less," said Dini. "His family gave big bucks to the House years ago when they died off, and now he doesn't have a home, so we let him stay here. He's OK, except that he doesn't like the waiting room to get too crowded, and he goes a little apeshit around Christmas."

How kind, to let a poor old man live in the waiting room. The two policemen, their tour of duty over for the night, arose to leave.

"Being policemen of the night," said Quick, "spending much of the dark cold night in this light warm room drinking coffee, safe from the dangers of the night, when our shifts coincide, we will meet again. Good morning and God bless:"

Leaving, Gilheeny said. "Soon you will meet the resident in psychiatry, Cohen. A Freudian."

"A textbook in himself," said Quick as the door closed behind them.

Dini took me and Elihu on a tour of the premises. Although she was attractive, there was something disturbing about her. What was it? Her eyes. Her eyes were hard blank disks showing nothing in back of them. She had worked this beachhead for twelve years. She showed us the different rooms: gynecology, surgery, medicine, and then, last, room 116, which she affectionately called "The Grenade Room."

"Dubler named it, years ago. Grenade Room Dubler. The worst of the screaming gomers get put there. One night, with three of them in there, Dubler called us around, took a grenade from his pocket, opened the door, pulled the pin, tossed in the grenade, and waited for the explosion." .

Elihu and I looked at each other, incredulous.

"Relax," said Dini, "it was a dud grenade."

We returned to the nursing station, where there were many clipboards containing the names and complaints of many patients. Having had a hearty breakfast and a second cup of coffee, the "emergencies" had begun to amble in. The waiting room was full. Crazy Abe, feeling crowded, was getting more agitated. There was no telling what would happen when Abe got really agitated. Gath had gone to the front line to triage those crowding Abe. The nurses had turned the people into patients in their hospital costumes, had taken their vital signs, and were once again sitting down. Dini turned her hard blank disks toward Elihu and me and said "So you're all set now. Do it." Elihu and I went to do it.

I stood outside the gynecology room and read first clipboard: Princess Hope, sixteen, black, pain the stomach. I went blank, like during the first week of the ternship. What did I know about pain in stomach? I'd had pain in my stomach, yes, but in woman it's different: too many organs, and the same pain can stand for a decomposing tuna sandwich or a decomposing ectopic pregnancy that will kill in an hour. I paused outside the door.

"Go on in there," yelled Sylvia. "she ain't got nuthin'."

I went in. Nine times out of ten in that room it would be small?time: V.D., vagitch, urinary, or tuna. This time, I thought it was big?time: appendicitis. I went back out to the nursing station and Sylvia said, "If you take that long with one, you'll only see about ten a day, and Abe will kill you."

"I think she's got appendicitis"

"Damn! Would you listen to this? Get me my scalpal, honey."

Hearing the word "scalpel," Gath was at my elbow. Eager yet skeptical, he listened to my diagnosis, and walked into the room. Nervous about my reputation, I retreated to the toilet. After a few minutes an Alabama?cracker voice outside the door yelled:

"Basch, boah? Hey, boah, you in theah?"

"Yes"

"Can we'all come in theah, boah?"

"What for?"

"To congratulate you. In the opinion of Dr. Dwayne Gath, surgical resident in this E.W., we got a keeper. Hotcha!"

"What's a keeper?"

"Keeper? 'Pendix. You go in theah with the steel blade, find 'er, and keep 'er. Listen heah: THE ONLY WAY TO HEAL IS WITH COLD STEEL. Basch , you gave some hungry surgeon a chance to cut, and A CHANCE TO CUT IS A CHANCE TO CURE. We gunner cut on ole Princess, quicker'n yesterday."

Wiping the sweat off my brow, I opened the bathroom door to the beaming eyes of a Good Ole Boy who'd just given a surgical buddy of his a chance to cut on human flesh.

Feeling better, I began to see other patients. I began to get bogged down with the lonely horrendomas, the LOLs in NAD and the gomers with multisystem disease, often the severity of which, according to textbooks, was "incompatible with life." I began poring over them, doing things I'd done on the wards?taking a history, doing a physical, putting in IVs, feeding tubes, Foley catheters, beginning to treat, to start them on their way back to dementia. After I'd seen about three of them, I came back to the nursing station to find the clipboards wrist?deep on my desk. I was overcome with a sense of futility. I saw no way that I would be able to dent the collection of bodies. How could I take care of all of them? How could I survive?

"You wanna survive here?" asked Dini, pulling me aside.

"Yes."

"Good. Two rules: one, treat only the life?threatening emergencies; two, everything else, TURF. You know TURF?"

"Yes, the Fat Man taught me."

"Oh? Great. So you're all set. Like he says, BUFF 'n' TURF.' It's not easy to separate emergencies from turkeys, especially in the Holiday Season, and it's even harder to TURF so they don't BOUNCE. It's an art. If they're not emergencies, we don't handle 'em. Now, get back in there and BUFF 'n' TURF like crazy!"

What a relief. Familiar Fat Man ground. These bodies, seeking rest, would get none here: They'd either get TURFED back out to the street, TURFED up into the wards, or, if dead, TURFED down to the morgue. The most grotesque screaming gomer might arrive, and I could attack the case with the calm assurance that soon he would be TURFED elsewhere. A mind?boggling thought: the delivery of medical care consisted of BUFFING and TURFING the seeker of care somewhere else. The revolving door, with that eternally revolving door always waiting in the end.

The task was to separate disease from hypochondria. With the waiting room jammed with lonely, hungry bodies seeking a warm place to spend the winter night, complete with clean linen, good food, and attention of a spanking fresh round?assed nurse and a real doctor, to MEET 'EM AND STREET 'EM was not easy. Having had years of experience with the House of God, many of the alleged ill had developed sophisticated methods to get in. I'd been a tern for less than six months; they'd been getting admitted to the House for up to ninety years. All it would take, often, was to have fooled one tern, years before, and thus to have documentation in the old chart, for with the increased threat of litigation, none of us could ignore documented disease. Using the local library, these people had BUFFED their own charts, and knew more about their diseases than me. A particular symptom of a given documented old disease could be revved up on any given night, and the sufferer admitted to be hugged and suckled at the bazooms of the House of God.

I began to work through the multiglomerate experienced ill. At one point, as I was BUFFING a gomer, I felt a tap on the back of my leg, low down. I turned and saw Chuck and the Runt, kneeling on the tile floor, looking up at me like cockerspaniel pups in the window of a pet shop. The Fat Man stood behind them:

"Don't tell me," I said, "let me guess what you're on."

They told me anyway. They were on their knees.

"Man, do you know why?" asked Chuck.

"Because the last twelve weeks," said the Runt, "Howard has been in the E.W., and he's so scared of missing something by sending the patient back home that he admits them all. He's a SIEVE."

"A SIEVE?" I asked.

"Right," said Fats, "he lets everyone through. At Bellevue half the ones Howie admitted would have been TURFED out by the receptionist. Or they would have been too embarrassed to come in. New Yorkers have some pride, especially when it comes to degradation. Howie's been letting through six admissions per tern per day. These poor boys are on their knees. They were your friends, remember?"

"They still are," I said. "What can I do?"

"Man," said Chuck, "be a WALL. Don't let anyone in."

"In New York once," said Fats, "we had a contest to see how long the medical service could go without an admission. Thirty?seven hours. You shoulda seen what we sent outta there. Roy, help them. Be a WALL."

"You can count on me," I said, and watched them leave.

Later that afternoon I was sitting at the nursing station, 'musing on SIEVES AND WALLS .

"There's a cardiac case in the car!"

A woman stood inside the automatic doors, screaming. My first thought was that she was crazy, my second was why would a cardiac case be in a car and not an ambulance and that she was joking, and then I panicked. Before I could move, Gath and the nurses were running out the door to the car, wheeling a crash-cart. By the time I was standing, they had slammed the guy on the chest, were breathing him and pumping his chest, Gath was sticking an IV into the big vessels in his neck, and all were barreling into the major?medfr ical emergency room. Shaking, I flashed on a LAW … AT A CARDIAC ARREST THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE. That helped, and I went into the room. He was a youngish man, coated with the pale blue?white skin of the dead. Gath was threading the line into the heart, Dini was taking a blood pressure, Flash was breathing him, any Sylvia was starting the EKG. I was standing there with my, finger up my ass, woozy. And then the concept of the EKG saved me. As soon as I saw the little pink strip of paper with its blue?lined grid, I started function. He no longer was a man five years older me who was going to die, he was "a patient with anterior MI having runs of V Tach which were compromising his pulmonary circulation and extending his MI." He became a series of concepts and that might just respond to the right treatment. His rhythm fed into my head and CLICK out came a slogan LIVE BETTER ELECTRICALLY and I said, "Let's defibrillate him," arid we did. He went into normal sinus rhythm, the deathly blue of his lips turned pink, he regained consciousness, the MICU resident came down, he was TURFED there, and I sat down again, shaking all over.

"Not bad for your first," said Dini clinically.

"I was panicked," I said, "and I don't understand it. I mean, I've been at lots of arrests before."

"On the wards," she said, "it's different. Up there, you have information about the patient and you know what to expect. Down here, all you've got is the body barreling through those doors. It's all fresh, not preprocessed. That's why I love it."

"You love it?"

"Yeah. It's a real thrill to have anything at all come through those doors and to be able to handle it. You better go talk to his wife. It's easier when they make it. Talk to her, and then you'll be all set."

Covered in vomit and blood, I walked out of the room into which the wife had seen her husband disappear, dying. She had a hungry, pleading look in her eyes, trying to read what I was about to say. Alive or dead? When I told her he was alive and in the MICU, she burst into tears. She grabbed my shoulders and hugged me and sobbed, thanking me for saving his life. Choked up, I looked past her and saw Abe, who'd stopped rocking and was staring at us with a lasersharp buzzing beam in his eye. I went back through the automatic doors, imagining those times I'd have to say, "He's dead." I didn't tell her that if she waited another five minutes I'd have had to say that. End of the ambulance ride was exactly what it was.

Things were going well. I continued to wade through the unprocessed nonemergent, trying to be a good WALL. In the early evening, Gath sat down next to me and said, "Hey, boah, got sumpin' for ya. A soo?prise. Close your eyes and hold out youah hand. Want ya to guess what it is"

I felt a wet, soft, smooth, wormy thing nestled in the palm of my hand, and guessed, "A skinny hot dog?"

"Nope. A keeper."

I opened my eyes, and sure enough it was nothing but, and Gath said, "A hot one, ready to pop. OPERATIONS ARE GOOD FOR PEOPLE, heah? And for he'pin' me, dahlia, I'm gonna he'p you. Jes call, y'heah?"

This was new. To have a good time in the House of God? To look forward to whatever flowed through the doors. To save a life? Two lives? I felt proud. The burden of treating the intractable, untreatable, unplaceable, unwanted, had been replaced by the fantasy of being a real doctor, dealing with real disease. Before midnight, waiting for my replacement, Eat My Dust Eddie, I was sitting in the nursing station talking to the two policemen, who'd stopped in for their first cup of coffee before braving the terror of the night.

"You have been vomited upon," said Gilheeny.

"Your baptism under fire," said Quick, "if you will I excuse a metaphor from Roman Catholicism."

"It's been enough to snap my socks, that's for sure."

The night nurse came up with a final request. Pointing to a worried couple standing inside the doors, she said that they had been told that their daughter had been brought to the House, an overdose…

"There was no overdose who came in here," I said.

"I know, I checked, but you'd better go talk to them."

I did. Well?off, Jewish, he an engineer and she a housewife, they were concerned about their daughter, a student at the women's college across the street. I told them I'd call MBH?Man's Best Hospital?to check if she'd been taken there. I did so. MBH: checked. Yes, she had been brought in: dead on arrival.

The two policemen looked at me. Again I felt choked up. I went back to the parents, not knowing what to say. "She was taken to the MBH. You'd better go there."

"Thank God," said the woman. "Sheldon, let's go"

"OK. Thanks, doe. Maybe, when she's better, they can transfer her back here. This is our hospital, if you know what I mean."

"Yeah," I said, unable to tell it to them straight, "maybe they can."

I went back to the nursing station and sat, feeling guilty about my cowardice, and thinking of the people I'd known who'd been alive and who now were dead, whatever that was.

"How hard to deal honestly with death," said Gilheeny.

"Harder than the hard elbow of a gomere," said Quick.

"And yet that hardness brings out the softness in us all," said the redhead, "the soul in us that makes us cry at births and weddings and wakes and those sad times when the pebbles of the gravedigger dance upon the coffin lid. Sure, and it makes us more human. Yes, this emergency room is not a mean bad place, now, is it?" '

"Not a mean bad place at all," said Quick.

Eat My Dust arrived, to the policeman's booming "Welcome!" I said good night and walked out through the waiting room. Crazy Abe stopped rocking and pinned me with his gaze, buzzing with electric current.

"Are you Jewish?" he asked.

"Yes, I am."

"So far you did good. Watch out driving it's slippery with rain good night."

He was right, about the good job, the Jewishness, the rain, the slipperiness. How could I not be glad? I felt human. For the first time I had spent a human sixteen hours in the House of God.