The house of God

23

"What are you going to do on July the first?" I asked Chuck.

"Who knows, man, who knows? All I know is I don't want to do no more of this."

It was May Day. I was in the on?call room of my final ward rotation, 4?South. I was lying in the top bunk. This was unusual. The tern always used the bottom bunk so that he wasn't at risk of GOING TO GROUND from the Orthopedic Height and breaking his hip. For some reason I'd had the urge to lie in the top bunk, up under the ceiling, far back from the leading edge. I'd gathered pillows, climbed the ladder, and settled into a peaceful horizontality, snuggled up against the back wall, staring at the pea?green, sea?green ceiling. Very nice. I wished that the top bunk had side rails, like a gomer bed or crib. I wished food, a breast, a nipple, why not?

There I was to stay. Others would try to move me, and at times, others would succeed, but I had work to do. Having recognized the doctor's disease, I wasn't sure that I could escape. Oh, yes, I had work to do, on compassion, on love. Like a park attendant with a steel-tipped stick, I had to patrol the darkening seaside summer park, browsing around the bandstand in the wake of the wedding, stabbing, collecting the shredded scraps of self scattered among the rainbow of confetti, ruffled in the breezes from the bay. From my top bunk I could see in through the windows of the fleshed-out Wing of Zock. With the spring, the workers seemed renewed, and in the plush GI radiology suite across from me, imitation gold toilet fixtures lay scattered on the thick green carpet like mushrooms. This pristine Wing of Zock offered hope, for the House of God, for the People. My hope was to finish the year in one piece.

On July the first, the medical profession acknowledged its only game, musical jobs. You had to play this game in advance. All of us terns in the House of God had tacitly agreed not only to the one?year ternship, but to the second year as residents. For some of us, like Howie, this was terrific, two years of being "a real doc" being twice as good as one. Smiling, puffing, Howie seemed to love the ternship. Cautious, indecisive, Howie was acknowledged to be the worst tern. Terrified of harming patients or of taking risks, he practiced a homeopathic, almost phantom medicine.

"You know," I said to Chuck, "that dose of antibiotic Howie was giving that woman downstairs is like giving a millionth of an aspirin."

"It's like pissin' in the wind, man, is what it is. It's amazin, though, he's still happy in Gomer City."

"Impossible."

"No, it ain't. I came in this mornin' and Howie was whistlin'. He went there a month ago, whistlin', and he's still whistlin', Puffin' that pipe and whistlin'. They won't break that dude, no way. He loves it."

Others of us felt differently. Hooper, Eddie, the Runt, Chuck, and I clung together in our disillusionment. Having agreed to do another year come July the first, we were sure of one thing: we did not want to do another year in the House of God. None of us knew what to do. What would we say to Leggo when he called us in to ask us-thinking he already knew the answer-what were our plans for July the first?

The two months to decide were to be spent on ward 4-South with Chuck and the resident, a shade named Leon. Leon, finishing two years in the House, had perfected the technique of the LP-Low Profile. Leon's profile was so low that no one saw him, ever. Having watched people screw up their life plans at the House by being visible, Leon had perfected invisibility. Slim, common?featured, commonly and neatly dressed, Leon reckoned on only two more months of LP?ing it until musical jobs and the ultimate city, Phoenix, the ultimate Fellowship, Dermatology. On 4?South, outside myself, only the most extraordinary could hold my interest. The extraordinary took shape in 789 and Olive O.

789 was my new BMS. A mathematician who'd gone to Princeton, and who'd done his senior honors thesis on the numeral 789, he'd been nicknamed by Chuck and me "789" or, for short, "Sev:" A bepimpled intellectual prodigy with few social skills?just the kind of draft pick the BMS adored?789 always had a scared?rabbit look in his eyes. A rare genius for numbers, he was a dullard in common sense. His body coordination was beneath contempt, and all but the most foxed?out gomers soon banished him from doing any procedure upon their bodies.

Olive O. was just as rare. Olive O. was a gomere extraordinaire, who'd been TURFED to the House in some secrecy by her family. Told by flunky Marvin in Admitting that there was a TURF from Orthopedics, I'd sent Sev to investigate. Sev had looked through Olive's chart, had talked to the surgical resident, and had found out that for some godforsaken reason the surgeons, overcome with an early?summer rutting zeal, had made Olive the proud recipient of a hemipelvectomy?they had ripped off half her pelvis?which had left her with only one leg. They had used the orthodox TURF?tool from surgery?replacing too little blood?which had made Olive the proud recipient of MI, and in need of medical care. Proudly showing a series of EKG traces, Sev explained to me, with vector diagrams and with herds of those imaginary numbers that had outgrazed my IQ in grade eleven, how he had succeeded in obtaining an electrophysiologically sound EKG using three of Olive's extremities, the fourth being in a can in the morgue. How could I fail to have been impressed? Sev and I, proud son, proud father, went on down to Ortho.

Tied down in her personal Ortho jungle gym of rods, poles, bells, and chains lay our Olive. A nest of white hair cradled her balding head. Eyes shut, breathing calmly, whitely, she was reveling in her penultimate stillness. From the top of her head to the tip of her ten toes, she was at peace. Ten toes? I uncovered her feet further and counted toes. Ten. I counted feet. Two. Legs? Two. I brought Sev to the bedside, and together the little polymath and I counted: "All right, now we count legs: one?"

"I don't think that's funny," said Sev. "I know how to count."

"Well, then, what happened?"

"I got the wrong chart."

"You didn't look at this patient?"

"Yes, I did," said Sev. "I looked, I just didn't see the other leg, that's all. My cognitive set was for one leg, not for two."

"Terrific," I said. "Reminds me of a very famous House LAW: SHOW ME A BMS WHO ONLY TRIPLES MY WORK, AND I WILL KISS HIS FEET."

The rareness of Olive was her humps. As I did my brief incursion into the realm of her body, I noticed, under the bedsheets, two protrusions from the vicinity of her chest?belly. Curious, I fantasized about what they might be. Breasts? Hardly. Supranumerary growths? No. I rolled down the sheet and rolled up her nightie, and there they were. Sprouting from her abdomen, below her low?slung flat breasts, were two humps.

Sev, at the foot of the bed, enjoying the luxury of putting EKG leads on both legs, glanced up, and his eyes lit up with horror, and he blurted out, "Ugh! What are those . . . those things?"

"What do they look like?"

"Humps."

"Good, Sev, good. That's what they are"

"I've never heard of humps in humans. What's in ,em?"

"Don't know," I said, seeing my own disgust mirrored in 789's eyes, "but by God we're gonna find out," and I began to examine them.

"UGGGHhhh!" said Sev. "Excuse me, but I feel . . . I fee?ecch?"

I watched him rush out of the room. I too felt repulsed, vomitoid. And that, Basch, is what you've learned this year in the House of God: when you feel like vomiting, you don't.

Later, in the on?call room, Sev had come up to me and apologized for getting sick, and I told him it was understandable and that he never had to confront the humps again. I was surprised to hear him say, "Yes, but I'd like to work them up:"

"The humps? I thought they made you sick?"

"They did, but I'll take an antiemetic if I have to. Doggone it, Dr. Basch, I'm going to work up those humps, you just wait and see."

"Suit yourself," I said. "In spite of the fact that you couldn't tell how many legs or toes she had, Sev, from this day on she's all yours."

"I don't know how to say this, Dr. Basch, but, well, thanks, thanks a lot. I'll need a prescription for Compazine."

And who were we, anyway, to imagine we knew what these gomers felt, to be so hot on saving them. Wasn't it ridiculous for us to imagine that they felt as we did? As ridiculous as it would be for us to try to imagine what a child felt? We were putting in these gomers our fear of death, but who knew if they feared death? Perhaps they welcomed death like a dear long?lost cousin, grown old but still known, coming to visit, relieving the loneliness, the failing of the senses, the fury of the half?blind looking into the mirror and not recognizing who is looking back, a dear friend, a dear reliever, a healer who would be with them for an eternity, the same eternity as the long ago, before birth. Wouldn't that be death, for them?

"You know, Roy, I wanna be so rich!" said Chuck. "That's it! Maybe in July I'll start one of them equal opportunity foundations to find out why we're such good guys and nobody else is, huh?"

"Do you really hate medicine?" I asked.

"Well, man, put it this way: I know I hated this."

A sloth from Transportation poked his nose in, delivering the mail. I picked up a throwaway journal called Doctor's Wife, addressed to "Mrs. Roy G. Basch." Chuck looked at his mail, his eyes lit up, and he said, "Damn! It just happened again!"

"What did?"

"The postcards. Here, look," he said, and handed me a postcard: WANT TO HAVE A LUCRATIVE PRACTICE ON NOB HILL, SAN FRANCISCO? IF SO, FILL OUT AND RETURN THIS CARD.

I left the House of God and drove to the suburbs. I stopped in front of a large turreted Victorian house, opened the door, and suddenly realized why the Fat Man had never let me see his house before: I was in a crowded waiting room; the first floor was his office; the Fat Man had a booming private practice in general medicine! The receptionist greeted me, said that Fats was a little behind schedule, and led me past a lab and an examining room to what seemed to be a workshop. There I sat, waiting. I couldn't help noticing the signs of many abandoned projects, and in one corner was a pile of lenses and stainless?steel tubing, and hand?lettered slogans: OWN YOUR OWN ASSHOLE; GAY ASSHOLES, GRAY ASSHOLES, ASSHOLES OF FOREIGN WARS; and finally, the conundrumical: SOME OF MY BEST FRIENDS ARE ASSHOLES.

"How goes the Anal Mirror?" I asked as he came in.

"Ah, yes," said Fats dreamily, "Dr. Jung's. An idea whose time might just have come, eh, Basch? If only I had the time."

"What's keeping you so busy?"

"Diarrhea."

"I'm sorry to hear that."

"Not mine, the Vets'. Haven't you heard?"

"No," I said, thinking this would be a way to introduce what I'd planned to say. "No, we've been out of touch. That's why I insisted on-"

"Yeah, over a month. So much has happened! Back then, I was on the ropes, not knowing if I'd get my Fellowship Letter from the Leggo."

"Yeah," I said, trying to stick with my feelings, "I want to tell-"

"Wait'll you hear what's been going on, Basch. Oh, Christ, wait'll you hear about this!" Settling in, he began telling me how?like one of those weighted clowns that you punch down and watch bob back up, he'd rebounded with a smile, but then he noticed the anxious look on my face and stopped. "You've come to say you're sorry? Is that it?"

How had he known? Looking into those familiar dark eyes, I felt choked up. Ashamed, I blushed. face twisted toward sadness.

"I know, I know," said Fats quietly. "There'll time to talk about it. But hey?a guy like me can't wait on telling an old?friend?new?protege about latest fortoona, can he? Basch, stop sniveling and tune in to this: right now, at this very moment, that diarrhea I inadvertently unleashed is going through God only knows how many hundreds of thousands of U.S. Vet's colons, ripping off the mucosal linings, anf sluicing the villae out through the anus. The worst! Remember that colonel who cornered you in the Unit, snooping around about me?"

"Yeah," I said, hearing again the Colonel me all kinds of questions about Fats and Jane Doe's diarrhea, and whether the Fat Man's extract had cured it. In the midst of our conversation the Colonel had gotten a painful look in his eyes and asked for the Men's Room. "Yeah, I remember the Colonel?the one with diarrhea himself?"

"Exactly. It's all over: NATO, SEATO, they say even Tito's caught the goddamn stuff. See, it's a virus. To date, there's only one cure. And the one inventor of the one cure is Fats."

"You invented a cure?"

"I invented the disease, so I had to: the extract. A cure not only for the diarrhea but also for the Fat Man's GI career." Musing, he picked up a lens and, toying with it, asked playfully, "Will I, like Lincoln. be the one to bind up our nation's bowels? I ask you, Basch, as a citizen, is it not time to put this Watergate of diarrhea behind us and go on with the great task of world peace?"

"How is it a cure for your career?"

"Oh. Well, the Leggo is a military man, right? And what military man wouldn't jump when a higher?up military man says 'Jump'? Why no one, Basch, no one wouldn't jump at all. You should have seen it! Beautiful! Last week, the Leggo and I walk down the corridor together, and there's an arm around my shoulder. There's also an arm around his shoulder, Basch, because in between us is a six?foot?three two?sixty?pound gorilla of a Four Star General of the U.S. Army. Made me feel like I'm in a parade in a Banana Republic: the Colonels had won."

"And so he wrote you a good Fellowship Letter after all?"

"Not exactly. Delighted as he was by the promise to the House of a big GI Research grant, the Leggo has some pride. He told me to write my own letter. He signed it. My Fellowship is assured."

"Not Hollywood?"

"Yes, Hollywood. The bowel run of the stars!"

I was overwhelmed. Never before had I encountered such sustained application of genius. I felt small. "Fats, it's mind?boggling. And you've had this private practice going all year?"

"Sure. Ever since I got my license last July. What's the sense of being a licensed doc if you don't use it. 'to relieve pain and suffering'? This GP work is terrific?these are my neighbors, my people. JFK said it: 'Ask not what your country can do for you, ask what you can do for your country's bowels"'

"So it all worked out just as you planned?"

"My life story, Basch: everything always works out:

"Fats, you might think it's stupid, but I did come here to say I'm sorry for fighting with you. And . . . and to say thanks."

"It's OK, Basch, you don't have to say?"

"Shut up, you fatso, and listen!" I said, smiling, watching him curl down into his roly?polyness smile sheepishly. "You got me through it?"

"Berry got you through it. Marvelous woman: I wish I had?"

"SHUT UP, FATS!" I shouted, hurling a piece an Anal Mirror at him. "Gradually, over the year, I threw away all the others, until you were the one left. When I threw you away last month, I just fell apart."

"No, Roy," said Fats seriously, "things fell apart when Eddie cracked and Potts jumped. None of stayed on our feet after that."

"True. But you showed me that a guy can stay in medicine and still be himself, that besides the Leggo and Putzel, there's another way." I paused, gathered myself up, and said, "Fats, you're fantastic. Thanks. Thanks for everything." I fell silent and watch steady eyes show their happiness. We sat together for a while in silence. Then I sighed and said, "The only problem is that your way is not for me. I can't do GI medicine. I doubt if I can stay in medicine at all. It's not for me."

"You mean you can't think of an organ you can see yourself dealing with every day for the rest of your life?" Fats asked sarcastically. "Kidney? Spleen? Rectum? Tooth?"

My father the dentist. Unimaginable. Even my grandfather, an immigrant, hadn't stuck himself into anything particular. I remembered my mother telling me about the time her mother took her and my aunt Lil to watch him, their father, at work: like a bee in a golden metal honeycomb high up in the sky, they saw him etch the sparkling arcs and curved sunbursts on the spire of the Chrysler Building, at the time the tallest in the City, maybe the world. And now, after all these years, I should choose a tooth?

Feeling hopeless, I said, "I can't see it."

"I know. It's clear that it's not for you."

"Well, then, what is?"

"You think I know? Big deal. Fly high. Have a blast, Basch. Great minds?like ours?can't be just one thing."

"Yeah, but I've got to decide soon," I said, feeling lost, cast out alone after so many programmed years. "I don't know what to do."

"Do? Well, in Brooklyn we always did this," said Fats, and reached out and hooked my pinkie in his. "Linking pinkies."

"Linking pinkies?"

"Sure. That's what we did in Brooklyn whenever we didn't know what to do."

A joke? No, his face was serious, sincere. I felt his fat pinkie hugging mine. Suddenly I knew what he meant. It was perfect, a magical moment. A tingling current of feeling zinged through me. He'd sensed my emptiness, and he'd responded. His touch meant I wasn't alone. He and I were connected. I squeezed back. It was love. No matter what, Fats and I would be friends.

Laughing, I said, "You know,' for a fat kid, you don't sweat much."

"Right. Life's tough, but even a fat kid can fast on Yom Kippur."

Berry and I were laughing over the lead article in Doctor's Wife, a tribute to a terrific doctor's wife who; "becoming aware of the depth charges in a doctor's' dinner" such as her terrific doctor hubby getting called out on an emergency case that might keep him away: until his food gets cold, had learned "a foolproof operation to keep roast beef deliciously rare for hours," namely, wrapping it in aluminum foil and warming it on a hot plate. I told Berry about my top?bunk posture and asked if she thought it was another regression

"No, I think it's integration, working out what to do with yourself. Now that you know you can be doctor, you've got the option of discarding medicine and moving on. What are you thinking of doing?"

"Going on vacation to France with you. Maybe to taking a year off."

"But what are you going to tell the Leggo about July?"

"I don't know. I hated this. The whole year sucked."

"Not true. Fats, the policemen, your buddies?you liked them. And you liked listening to your patients in the Clinic, right?"

"As long as I didn't have to do anything medical, it was fun."

"In the E.W., you were fascinated by the psych resident, Cohen." Tantalizingly she asked, "Why not become a psychiatrist?"

"Me?" I said, surprised. "A shrink?"

"You." Looking me squarely in the eyes, she said, "Being with people was all that kept you going this year, Roy. And 'being with' is the essence of psychiatry."

CLICK. In my head, CLICK. I asked her to repeat what she'd said.

" 'Being with' is the essence of psychiatry. You've always perched yourself at a slight angle to the universe. Psychiatry might be perfect for you."

Being with. CLICK. Dr. Sanders, dying, telling me that what doctors did was to "be with" patients. "You mean 'being with' patients?"

"I mean being with," she said. "Even being with your family."

Family? My grandfather, TURFED to rot in a home, never again to be with anyone: my father?

. . There is nothing more comforting during illness than a loved one to be with you and a good physician can serve that role .

"You're saying that psychiatry really offers something to patients? That it's different from medicine in that you can cure?"

"Sometimes. If you catch a life early, yes."

"So the big thing is that you can offer something to patients?" '

"No. You can offer something to yourself."

Stunned, I asked her: "What can you offer to yourself?"

"Growth. Instead of forgetting, you'd try to remember. Instead of defensive, obsessive superficiality, you'd try to become open, looser, deep. You'd create. Your only tool as a therapist is who you are and who you might become."

It was hard for me to think. Somehow, in the chaos, something was clearing. I might become someone I might not despise? Escape being strapped into the rocker of past, culling my memories for trinkets? Be rid of my avoiding, my exploding, my contempt? Trembling, I asked her if there was anything I could start to read.

"Freud. Start with Mourning and Melancholia. In it Freud says, 'The shadow of the lost object falls across the ego.' You've been under that shadow for a solid Year."

"What shadow?"

"You. The shadow of yourself:"

My lacuna of humanity, my Berry. How I'd grown to love her, my accepting, caring, clear?sighted soft one, during this abrasive year.

"I love you," I said. "I lived through this nightmare because you were with me."

"Yes, partly. And you're right: this internship has been like the stuff of dreams, like the overpowering nightmares of childhood: aggression, fear of retaliation, and then the resolution, where you don't win, you live. It's the straight Oedipal theme: mother, father, child."

. . Hope you are finishing up well and glad to be finished with your experience. Could not understand your premise that now you can handle all medical problems and there is so much to know. I am very worried over the worldwide economic situation meaning the inability of the brains of the world to solve inflation and the monetary crisis and it is not even worth having money the bank. I don't know what mother told you but I know it was basic and true. I know you care for us as a son and that will never change. Distance and circumstance have interfered with our keeping close, and that is inevitable in this day and age. Would love to play golf with my son number one again and that is just a hope. Mom really has such a short controlled swing and it is a picture. My passion for the game is unlimited and I do enjoy it . . .