The house of God

18

I was ready to be taken over by machines. On the morning of April Fool's Day, I found myself just outside the hermetically sealed double doors of the MICU, the Medical Intensive Care Unit, what the Fat Man had called "that mausoleum down the hall." Like a suburbanite in a fugue state who starts out heading for Wall Street and turns up three days later, blank, in Detroit, I had no past or future, I was merely there. I felt scared. For the next month I would have to take responsibility for the intensive care of those perched precariously on the edge of that slick bobsled ride down to death. I would be on call every other night, alternating with the resident. A bronze wall plaque caught my eye: THROUGH THE MUNIFICENCE OF MR. AND MRS. G. L. ZOCK, 1957. Zock, of the Wing of Zock? When would I meet a real Zock? With the technocratic dispassion of an astronaut, I pushed through the double doors, sealing myself hermetically in.

The inside was ultraquiet, ultraclean, ultraunbusy. MUZAK shirred the crisp atmosphere as gently as a French chef might shir a sleepy egg for an early-rising guest. I wandered through the deserted eight-bed unit, searching for intensive care. The patients were in their beds, quiet, at peace, at home with all they touched in this calm sea, happy fishes floating, floating. I found myself happily humming along with the MUZAK:

Some enchanted eeee-veniiiinng . . ." and stopped in front of a computer console, which filled me with a mixture of awed childhood memories of Cape Canaveral and adolescent fears stirred up by 2001. I watched the bright lights blink, the oscilloscope flicker with what looked like something like rows of heartbeats. As I watched, there was an unpleasant buzz from the console, lights flashed, one of the rows of beats froze in space and time, and like ticker tape, out spewed the pink blue?gridded tongue of an EKG strip. At that, from a nearby room, out spewed a nurse. She looked at the EKG, looked at the oscilloscope screen, did not look at the patient, and with a mixture of pique and cajolery said to the console, "Shit, Ollie, wake up and get it together, will you, for Chrissakes?" As if for punishment, she poked a few keys fortissimo, which sent the thing humming along again, almost in syncopation with the fresh aria from MUZAK, a samba: "When they begin, the bee?geeene . . :'

Relieved to see a warm?blooded being in this freaky reptilian lab, I turned to her and said, "Hi, I'm Roy Basch."

"The new tern?" she asked suspiciously.

"Right. What's this thing?"

"Thing? Not hardly. He's Ollie, the Computer. Ollie, say hi to Roy Basch, the new tern here," and with a few prompting punches in the vital parts, Ollie spewed out a pink blue?gridded tongue of an EKG strip, on which was printed: HI, ROY, AND WELCOME, I'M OLLIE. I asked the nurse where I could put my things and she said to follow her. She was dressed in a cotton operating?room wraparound, open in the back from neck ?nape to lumbar?4, that region of the back where the spine begins to make a delicious contra-punto curve into what used to be a tail, and what now begins the beegeeene of the fullness of the upper insertion of the gluteus maximus, the ass. As she walked her spine traced imaginary curves in the MICU space. How fitting, I thought, that these firm young muscles, bathed in MUZAK, should dance together so perfectly in neurophysiological synch.

. . . There's nothing more magnificent than the human body and by now you are an expert in dealing with it . . .

The small staff room was filled with nurses, doughnuts, and gossip. My arrival punctured the bubble of chat, and out leaked silence. Then Angel, the Angel of the Runt, stood up, came over to me, gave me a hug, and said, "I want to"?gesture toward me?"introduce Roy Basch, the medical intern. I told"?gesture toward nurses?"them about"?gesture toward me-"you. We're"?gesture toward heaven?"glad you're" ?gesture toward earth?"here. Wanna"?gesture toward doughnuts?"doughnut?"

I chose cream?filled. Forgetting work, I eased into this friendly group, relieved that things were so relaxed. I flipped my mind?flop to OFF.

The gossip was about the resident in charge of the Unit, Jo. In the weeks she'd been there, Jo had amazed, frightened, and ultimately antagonized the nurses, in that archaic pattern still so familiar when women doctors worked with women nurses. Although Jo usually started her own pre?rounds rounds before usual, on this particular day she was nowhere to be seen.

"She spent all last night?her night off?here," said a nurse. "She sat up with Mrs. Pedley, wondering why Pedley was still alive. And the only thing wrong with Pedley, really, is Jo's treatment of her. She must have have overslept. Will she be mad!"

Jo came in sizzling. She looked at me suspiciously, remembering our debacle when Chuck and the Runt and I had tormented her on the upstairs ward, but she stuck out her jaw and stuck out her hand and said, "Hi, Roy. Welcome aboard. Never mind what happened upstairs, you'll like it here. It's high-powered medicine. Tight ship, the tightest ship in the whole House. Fresh start. No gripes, no hard feelings, eh?"

"No hard feelings, Jo," I said.

"Good. Cardiology's my specialty, I'm going on my Fellowship to the NIH in Bethesda in July, so stick with me and you'll learn an incredible amount. In the Unit, we've got total control of all cardiac parameters. It's high?pressure, but if we work hard, we save lives, and we have good fun. Let's go."

Just as Jo, the head nurse, and I were wheeling the chart rack to the first room, in skipped Pinkus, the Consultant to the Unit, ready to start his teaching rounds. Pinkus was a tall, emaciated?looking Staff cardiologist, heading toward forty. A TURF from the U. of Arizona to the BMS and the House of God, Pinkus was a legend, fanatic in his personal and professional life. Pinkus, it was said, rarely left the House. I myself had seen him, night after night, prowling the corridors, in the guise of following up consults on cardiac patients. Whatever the hour, I had found him patient, helpful, courteous, ready to produce an article, ready to put in a pacemaker, ready to chat. Such was his dedication to being in the House that an apocrypha had arisen about his home life: married, with three daughters, it was rumored that the only way that his, wife or daughters knew he'd been home was to notice the toilet seat flipped to the UP mode.

The other part of Pinkus's fanaticism was his obsession with cardiac?risk factors. Smoking, coffee, obesity high blood pressure, saturated fats, cholesterol, and lack of exercise were like death to him. Rumored one time to have been sedentary, anxious, overweight stuffing doughnuts and slurping coffee, Pinkus now through much effort, was on the verge of emaciation, was phobic to cholesterol, and had run himself into incredible shape, for the past two years finishing close to the time of three hours in the April Marathon. Somehow Pinkus had managed to reduce the final risk factor variable, personality type. In a total turnabout he'd gone from Type A (anxious) to Type B (calm).

Pinkus and Jo, in a short excoriation of the fuck-up of rounds times, had reached the decision that on this day all rounds would be one rounds, beginning at once.

Despite more pressing problems, both Pinkus and Jo were interested in the woman Jo had spent the night with, Pedley. A pleasant seventy?five, Pedley had been TURFED into the House by Putzel, for the usual, the bowel run, for complaints of burping and farting after Chinese food. The bowel run had been negative. Unfortunately, some red?hot noticed on the screening EKG that Pedley was walking around in V Tach, according to the textbooks, a "lethal arrythmia." Whisked by a nervous tern in the MICU, Pedley had fallen prey to Jo, who'd taken one look at the EKG, decided Pedley was dying, and had hooked up the electrodes of the cardioverter, and without anesthetic had burned the skin off Pedley's chest. Pedley's heart, affronted at having been jolted into normal sinus rhythm, stayed there for only a few minutes and reverted to the beat of its own drummer, V Tach. Frantic, Jo scorched Pedley's chest four more times before Pinkus arrived and stopped the barbecue. For the past week Pedley had remained in V Tach. Except for the festering. burns on her chest, she was fine, a LOL in NAD. Pinkus and Jo, sniffing a publishable article, had employed Pinkus's fund of expertise: cardio?pharmaco?therapeutics. Pedley had been put on every cardiac drug, to no avail, and by the time I arrived Pinkus was into drugs only he would dare use, ranging from remedies for such noncardiac diseases as systemic lupus erythrematosis (an autoimmune disorder) to tinea pedis (athlete's foot). Pedley, held prisoner and suffering the side effects of these meds, wanted out. Daily, Pinkus and Jo would coerce Pedley into a trial of something new. That day it was "Norplace," a derivative of the grease used to stick Ollie's EKG monitor leads to a patient's thorax.

"Hello, dearie, how's the gal today?" asked Pinkus.

"I want to go home. I feel fine, young man. Let me go."

"Do you have a hobby, dear?" asked Pinkus

"You ask me that every day," said Pedley, "and every day I tell you: my hobby is my life outside of here. If I had known that Chinese food would lead to this, I'd never have called Putzel. Wait'll I get my hands on him?he won't visit me, you know. He's scared of me."

"My hobbies are running and fishing," said Pinkus. "Running for fitness and fishing for calm. I heard you had Jo worried last night."

"She's worried, I'm not. Let me go."

"There's a new medicine I wish you'd try today, dear," said Pinkus.

"No more medicines! That last one had me thinking; I was a fourteen-year-old girl again in Billings, Montana. I came in here in good faith, and you're giving me trips to Montana! No more meds for Pedley!"

"This one will work."

"There's nothing wrong with me for it to work on!"

"Please, Mrs. Pedley, try it for us," pleaded Jo sincerely.

"Only if you get me some fish chowder for lunch."

"Done," said Jo, and we left.

In the hallway, Pinkus turned to me and said, "It's important to have a hobby, what's yours, Roy?"

Before I had a chance to answer, Jo whipped our caravan forward again. Of the other five patients, none could speak. Each suffered in the throes of some horrible, incurable, lingering disease that would almost certainly kill, usually involving major organs like heart, lung, liver, kidney, brain. The most pathetic was a man who'd started with a pimple on his knee. Without culturing it, his House Private, Duck's Ass Donowitz, had given him the wrong antibiotic, which had eradicated the bacteria that were containing the spread of the resistant staph in the pimple, allowing the staph to spread, producing total body sepsis, and turning a happy forty-five-year-old successful broker into an epileptic, mute, debilitated skeleton who could not speak because of the hole that had rotted through the cartilage of his trachea from his months on a respirator. In our rounds, he looked at me, dumbfounded and terrified, pleading to be saved. His only hope now would be the hope of a dream, his only solace, dream-solace, a time when his dream of his voice, of his full life, would comfort him until the daily awakening to the nightmare of his crushed life. It was obvious malpractice by Donowitz. No one had told the man who'd started with the pimple on his knee that he could sue for millions. At his doorway, I heard his story from Jo in clipped dispassionate argot like Ollie's. I saw his eyes fasten on me, a newcomer, someone who might bring a miracle, asking me to give him back his voice, his Saturday?afternoon game of squash, his piggyback rides under his kids. I was overwhelmed. As if by fate, with a little help from an incompetent and lazy doc, a man's life had taken a sharp permanent turn down. I turned my head away. I never wanted to look into those mute eyes again.

He was not alone. Four more times I was shaken by the horror of ruined life. One after the other, totally immobilized, lungs run by respirators, hearts run by pacemakers, kidneys run by machines, brains run barely, if at all. It was terrible. The smell was that of lingering death: sickly-sour, feverish, sliding away far off on a horizon I could barely see. I didn't want any part of it. I would not touch these putrid ones, no. It was all too sad for me.

Not for Jo. At each room she riffled her three-by-five cards and rattled off numbers, and then had the nurse hoist the body up to sitting, so she could listen to the chest. Pinkus looked distractedly out the window, unable to ask or tell about hobbies, and I felt dead inside. Jo asked me didn't I want to listen to their chests, and reflexively, I did. The last was a second-year BMS student who, while on a pediatrics rotation, had caught a cold from a kid, which turned into a cough, then a flu, then a something beyond the realm of the known or the treatable that had hit his lungs, heart, liver, and kidneys and left him driven by respirator, pacemaker, and kidney machine. Despite this, despite the MICU's "4?plussing" him?going all out?he was dying. The stubble on his cheeks was blond. Jo had the nurse hoist him up, put her stethoscope on him, and motioned for me to join in. I said I'd pass.

"What?" asked Jo, surprised. "Why?"

"I'm afraid of catching what he caught," I said, leaving.

"What? You're a physician, you've got to. Come back here."

"Jo, get off my back, huh?"

Later, Pinkus and I went down to lunch, leaving Jo to tend to the Unit. Pinkus always "brown?bagged" it brought his own?so he could regulate his diet while in the House. As he picked gently at his cottage cheese, alfalfa, and fresh fruit, he inquired first about my hobbies, telling me his were running for fitness and fishing for calm, and second about my attitude toward the cardiac?risk factors. In one lunch-time I learned more about how I was destroying my life, narrowing my coronary arteries, falling prey to the endemic atherosclerosis sweeping America, than I'd learned in four years at the BMS. Pinkus suggested that, given my clear family history, I had an obligation to exert as much control as possible over my cardiac destiny, by refraining from eating what I liked (doughnuts, ice cream, coffee), smoking what I liked (cigarettes, cigars), doing what I liked (lazing. around), and feeling what I felt (anxious).

"Even coffee?" I asked, not aware of this risk faotor.

"Cardiac irritant. Latest Green Journal. Work done right here at the BMS by intern Howard Greenspoon."

Finally, after a lengthy discussion of running, informing me that he was up to sixty miles a week at present in preparation for the Marathon in three weeks, Pinkus invited me to his office to feel his legs. We adjourned there, where he directed my examination.

From the waist up, he was toothpickoid; from the waist down, Mr. Olympia. His quadriceps, hamstrings, and calves were sleek and rippling, fastened to tendons of steel.

Returning to the MICU, repulsed by the disease and boggled by the machines, I had an urge to escape. Jo cornered me, insisting that I learn how to pop a big needle into the radial artery of the wrist, a brutal, dangerous, and more or less unnecessary procedure. After that, I escaped as far as the staff room, saying I had to read up on the patients. I picked up the chart of the BMS with the total body wipe?out of unknown etiology, and started to read. He'd started with a sore throat, a cough, a cold, a slight fever. I had a sore throat, a cough, a cold, a slight fever. My red throat was a plowed field, getting a viral seeding from the BMS. I would catch what he had. I would die. I looked around me and realized it was the nursing change of shift. The nurses came in in their street clothes and used an alcove off the staff room, where there were lockers, to change. Since there was a mad crush at about three, when everyone rushed in, there were too many nurses for the alcove, and with a nonchalance, a few spilled out into the room, slipping out of their blouses and skirts or jeans, radiating the light of their bras and panties and other undies into the staff room, and then wrapping around the green cotton MICU uniform. Even the braless ones would spill out and change in my sight, smiling at my gawking, and I was thrilled with that ease of body I'd grown to know so well, that was somehow connected with doctors and nurses who dealt, day after day, with the decay of other human flesh.

I left. As I drove through the chill April rain, my mind stuck on the Unit. What about it had been so different?

Quintessence. That was it. The Unit was the quintessence. There, after all the sorting had been done, lay the closest representation, in living terms, of death.

That was to have been expected. That was the bronze Zock plaque on the wall. And there, also, lay the closest representation, in living terms, of sex. I could not fail to notice. I did not pretend to understand. Amidst the dying, these nurses were flaunting life.

Berry asked me how it had been, and I told her that it had been different, high?powered, kind of like being part of the manned space program, but that it was also like being in a vegetable garden, only the vegetables were human. I was down about it because of course they were young and would die, but that didn't matter because I too was going to die from whatever tropical virus had attacked the little BMS. Berry suggested that my fear of dying was yet another "medical?student disease" and that she was more worried about my heart. Thinking of Pinkus, I said, "Oh, yeah, how'd you know I was going to key more on controlling my cardiac-risk factors?"

"No, I don't mean the mechanics, I mean the feelings. It's been weeks since Potts's suicide, and you haven't said anything about it. It's as if it didn't happen."

"It happened. So?"

"So he was a damn good friend of yours and now he's dead."

"I can't think about it I got a new job to do, in the Unit."

"Amazing. In spite of everything that happens, there's no past."

"What's that supposed to mean?"

"You and the other interns obliterate each day, in order to start the next one. Forget today today. Total denial. Instant repression."

"Big deal. So what about it?"

"So nothing ever changes. Personal history and experience mean nothing. There's no growth. Unbelievable: all across the country, interns are going through this, and going on each day as if nothing had happened the day before. 'Forget it; all is forgiven; come home; love, the Medical Hierarchy.' It rolls on, greater than anyone's suicide. That's what makes a doctor. Terrific."

"I don't see what's so wrong with that."

"I know you don't. That's what's so wrong. It isn't the medical skills you learn, it's the ability to wake up the next day as if nothing had happened the day before, even if what happened is a friend killing himself."

"There's a helluva lot new to learn in the Unit. I can't afford to think about Potts."

"Stop it, Roy?you're not some dumb clod, you're a person."

"Look, I'm not your red?hot intellectual anymore. I'm just a guy out to learn a trade and make a buck, OK?"

"Wonderful. All the shadows have been taken from your sun."

"How can you ask me to think, when tomorrow I'm gonna die?"