The house of God

3

It must have been the Fat Man who first showed me what a gomer was. The Fat Man was my first resident, easing my transition from BMS student to intern in the House of God. He was wonderful, and a wonder. Brooklyn?born, New York City?trained, expansive, impervious, brilliant, efficient, from his sleek black hair and sharp black eyes and bulging chins through his enormous middle that forced his belt buckle to roll over on its belly like a shiny fish, to his wide black shoes, the Fat Man was fantastic. Only New York City could have bounced back from his birth to nourish him. In return, the Fat Man was skeptical of whatever wild country existed to the west of that great frontier, Riverside Drive. The only exception to this urbane provincialism was, of course, Hollywood, the Hollywood of the Stars.

At six?thirty in the morning of July the first, I was swallowed by the House of God and found myself walking down an endless bile?colored corridor on the sixth floor. This was ward 6?South, where I was to begin. A nurse with magnificently hairy forearms pointed me to the. House Officer's On?Call Room, where rounds were in progress. I opened the door and went in. I felt pure terror. As Freud had said via Berry, my terror was "a straight shot from the id."

Around the table were five people: the Fat Man; an intern named Wayne Potts, a Southerner whom I'd known at BMS, a nice guy but depressed, repressed, and kind of compressed, dressed in crisp white, pockets bulging with instruments; the three others seemed eager, and this told me they were BMS students doing their medicine clerkship. Each intern was to be saddled with a BMS, each day of the year.

"It's about time," said the Fat Man, biting a bagel. "Where's the other turkey?"

Assuming he meant Chuck, I said, "I don't know."

"Turkeys," said Fats, "he'll make me late for breakfast."

A beeper went off, and Potts and I froze. It was the Fat Man's: FAT MAN CALL THE OPERATOR FOR AN OUTSIDE CALL, THE OPERATOR FOR AN OUTSIDE CALL, FAT MAN, RIGHT AWAY.

"Hi, Murray, what's new?" said Fats into the phone. "Hey, great. What? A name? Sure sure yeah no problem hang on." Turning to us, Fats asked, "OK, you turkeys, what's a catchy doctor's name?"

Thinking of Berry, I said, "Freud."

"Freud? Nah. Gimmee another. Stat "

"Jung."

"Jung? Jung. Murray? I got it. Call it Dr. Jung's. Great. Remember, Murray, we're gonna be rich. Millions. Bye?bye:" Turning back to us with a pleased smile, Fats said, "A fortoona. Ha. OK, we'll start rounds without the other tern."

"Great," said one of the BMSs, leaping to his feet. "I'll get the chart rack. Which end of the ward do we start on?"

"Sit down!" said Fats. "What are you talking about, chart rack?"

"Aren't we going on work rounds?" asked the BMS.

"We are, right here"

"But . . . but we're not going to see the patients?"

"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 . . .

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.

"Oh, and by the way," said the Fat Man, poking his head in again, "I've written an order for this."

In his hand was a Los Angeles Rams football helmet.

"What's that for?" asked Potts.

"It's for Ina," Fats said, strapping it on her head. "LAW NUMBER TWO: GOMERS GO TO GROUND."

"What does that mean?" I asked.

"Fall out of bed. I know Ina from last year. She's a totally demented foxed?out gomere, and no matter how securely restrained, she'll go to ground every time. She cracked her skull twice last year, and was here for months. Till we thought of the helmet. Oh, and by the way?even though she's dehydrated, whatever you do, do not hydrate her. Her dehydration's got nothing to do with her dementia, even though the textbooks say it does. If you hydrate her, she stays demented, but she gets incredibly abusive."

Potts's head turned to watch the Fat Man go, and somehow, her left hand free, Ina slugged him again. Reflexively Potts raised his hand to hit her, and then stopped himself. The Fat Man nearly keeled over with laughter.

"Ho ho, did you see that? I love 'em, I love these gomers I do . . ." And he laughed his way out the door.

The manipulation of her head intensified Ina's screams: GO AVAY GO AVAY GO AVAY . . .

And so, leaving her tied down six ways from Sunday, the ram horns curling around her ears, we proceeded to Visit Rounds.

Being an academic House affiliated with the BMS, the House of God had a Visit for each ward team: a member of the Privates or the Slurpers, who held teaching rounds every day. Our Visit was George Donowitz, a Private who'd been pretty good in the pre-penicillin era. The patient presented was a generally healthy young man who'd been admitted for routine tests of his renal function. My BMS, Levy, presented the case, and when Donowitz grilled him about diagnoses, the BMS, straight from the library of obscure diagnoses, said "amyloidosis."

"Typical," muttered the Fat Man as we gathered around the patient's bed, "typical BMS. A BMS hears hoofbeats outside his window, the first thing he thinks of is a zebra. This guy's uremic from his recurrent childhood infections that damaged his kidneys. Besides, there's no treatment for amyloid, anyway."

"Amyloid?" asked Donowitz. "Good thought. Let me show you a bedside test for amyloid. As you know, people with the disease bruise easily, very easily indeed."

Donowitz reached down and twisted the skin on the patient's forearm. Nothing happened. Puzzled, he said something about "sometimes you have to 'do it a bit harder" and took hold of the skin, wadded it up, and gave it a tremendous twist. The patient gave a yelp, leaped up off the mattress, and began to cry with pain. Donowitz looked down and found that he'd ripped a big chunk of flesh from the guy's arm. Blood was squirting from the wound. Donowitz turned pale and didn't know what to do. Embarrassed, he took the piece of flesh and tried to put it back, patting it down as if he could make it stay in place. Finally, mumbling, "I . . . I'm so sorry," he ran out of the room. With a cool expertise the Fat Man put a gauze compression bandage on the wound. We left.

"So what did you learn?" asked Fats. "You learned that uremic skin is brittle, and that the House Privates stink. What else? What do we have to look out for in this poor bastard now?"

The BMSs ventured several zebras, and Fats told them to shut up. Potts and I went blank.

"Infection," said Chuck. "In uremia you gotta watch for infection."

"Exactly,' said Fats. "Bacteria City. We'll culture for everything. If it hadn't been for Donowitz that guy would be going home tomorrow. Now, if he lives, it'll be weeks. And if he knew about this, it would be Malpractice City."

At this thought the BMSs perked up again. The BMS now comprised a majority of minority groups, and "Social Medicine" was a hot ticket. The BMSs wanted to tell the patient so he could sue.

"It won't work," said Fats, "'cause the worse the Private, the better the bedside manner, and the higher the patient's regard. If a doctor buys the TV illusion of 'the doctor,' so does the patient. How can the patient know which are the 'Double O'Privates? No way."

" 'Double O'?" I asked.

"Licensed to kill," said Fats. "Time for lunch. We'll see from the cultures where Donowitz last stuck his finger before trying to murder that poor uremic schlump."

The Fat Man was right. Colorful and esoteric bacteria grew out of the wound, including one species that was native only to the rectum of the domestic duck. Fats got excited about this, wanting to publish "The Case of Duck's Ass Donowitz." The patient flirted with death but pulled through. He was discharged a month later, thinking it usual, even a necessary part of his successful course of treatment in the House, for the skin to have been ripped off his arm by his dear and glorious physician.

When the Fat Man went to lunch and we did not, the terror returned. Maxine asked me to write an order for aspirin for Sophie's headache, and as I started to sign my name, I realized I was responsible for any complications, and I stopped. Had I asked Sophie if she was allergic to aspirin? Nope. I did. She was not. I started to sign the order, and stopped. Aspirin causes ulcers. Did I want to have this poor LOL in NAD bleed out and die from an ulcer? I would wait for the Fat Man and ask him if it was all right. He returned.

"I've got a question for you, Fats."

"I've got an answer. I've always got an answer:"

"Is it all right to give Sophie two aspirin for her headache?"

Looking at me as if I were from another planet, Fats said, "Did you hear what you just asked me?"

"Yes."

"Roy, listen. Mothers give aspirin to babies. You give aspirin to yourself. What is this, anyway?"

"I guess I'm just afraid to sign my name to the order."

"She's indestructible. Relax. I'm sitting right here, OK?"

He put his feet up on the counter and opened The Wall Street Journal. I wrote the order for the aspirin, and feeling dumb, went to see a gorilla named Zeiss.

Forty?two, mean, with bad heart disease, Zeiss needed a new IV put in. I introduced myself, and tried. My hand shook, and in the hot room I got sweaty, and the drops of sweat plopped onto the sterile field. I missed the vein, and Zeiss yelped. The second time, I went in more slowly, and Zeiss squirmed, moaned, and cried out:

"Help, nurse! Chest pain! Get me my nitroglycerin!"

Terrific, Basch?your first cardiac patient and you are about to give him a heart attack.

"I'm having a heart attack!"

Wonderful. Call a doctor. Wait you are a doctor.

"Are you a real doctor or what? My nitros! Fast!"

I put a tablet under his tongue. He told me to get lost. Crushed, I wished I could.

Filled with great moments in medicine, the day wore on. Potts and I clustered around the Fat Man like ducklings around a mother duck. Fats sat there, feet up, reading, ostensibly into the world of stocks and bonds and commodities, and yet, like a king who knows his kingdom as well as he knows his own body, who feels the rages of a distant flood in the pulsating of his own kidneys, and the bounty of a harvest in his own full gut, he seemed to have a sense for any problem on the ward, instructing us, forewarning us, helping Potts and me. And once, only once, he moved?fast, unashamedly a hero.

A scheduled admission, named Leo, had arrived for Potts. Gaunt, white?haired, friendly, a little breathless, Leo stood at the nursing station, suitcase at his feet. Potts and I introduced ourselves and chatted with him. Potts was relieved that here at last was a patient who could talk to him, who was not deathly sick, and who would not slug him. What Potts and I didn't know was that Leo was about to attempt to die. In the midst of a chuckle at one of Potts's jokes, Leo turned blue and fell down on the floor. Potts and I stood there mute, still, frozen, unable to move. My one thought was "How embarrassing for poor Leo." Fats glanced over, leaped to his feet, yelled out "Thump him!" which we were too panicked to do and which I thought would be rather melodramatic, ran over to us, thumped Leo, breathed Leo, closed?chest?cardiac?massaged Leo, IV'd Leo, and organized with a cool virtuosity Leo's cardiac arrest and Leo's return from the world of the dead. A large crowd had arrived to assist in the arrest, and Potts and I had been pushed out of the action. I felt embarrassed and inept. Leo had been laughing at our jokes, his attempt to die was surreal, and I had denied that it existed. Fats was marvelous, his handling of the arrest a work of art.

When Leo had returned to life, Fats walked us back to the nursing station, put his feet back up, opened the paper again, and said, "All right all right so you panicked and you feel like shit. I know. It's awful and it's not the last time neither. Just don't forget what you saw. LAW NUMBER THREE: AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE."

"I guess I wasn't worried about him because he was an elective admission and not an emergency," said Potts.

"Elective doesn't mean shit around here," said Fats. "Leo would have died. He's young enough to die, you know."

"Young?" I asked. "He looks seventy?five."

"Fifty?two. Congestive heart failure's worse than most cancers. It's ones his age that die. There's no way he'll become a gomer, not with a disease like that. And that's the challenge of medicine: gomers gomers gomers where you can't do anything for them, and then, suddenly?WHAM!?in comes Leo, a lovely guy who can die, and you gotta move fast to save him. It's like what Joe Garagiola said last night about Luis Tiant: 'He gives you all his herky?jerky stuff and then, when he comes in with his heater, it looks a whole yard faster.' "

"His heater?" asked Potts.

"Oh, Jesus," said Fats. "His fast ball?HIS FAST BALL!?where did they get you guys, anyway?"

By that time I was wondering the same thing, and so was Potts. Both of us felt incompetent. For some reason, Chuck was different. He didn't need help. He knew what to do. Later that afternoon I asked him about how he seemed so competent already.

"Easy, man. See, I never read nuthin'. I just did it all"

"You never read anything?"

"Just about them red ants. But I know how to put in a big line, tap a chest?you name it, I done it. Ain't you?"

"Nope. None of that," I said, thinking about my piddling around with Sophie's aspirin.

"Well, man, what all did you do at the BMS?"

"Books. I know all there is to know about medicine in books."

"Well, it looks like that was your failing, man, that right there. Like my not joinin' the army. Maybe I still . . ."

Standing in the streaming July light was a nurse, the afternoon and evening nurse. She stood with her hands on her hips, reading the med cards, legs apart, rocking first one foot on its lateral edge, and then the other. The sharp sunlight made her costume almost transparent, and her legs flowed in smooth lines from her thin ankles and calves all the way up to where all seams meet. She wore no slip, and through her starched white dress I could see the bright patterns on her panties. She knew they would show through. Through her dress showed her bra strap, with its pleading unhookable hook. Her back was to us. Who could know about the front? I half?wished she would never turn around, never spoil the imagined breasts, the imagined face.

"Hey, man, that's somethin' else."

"I love nurses," I said.

"Well, man, what is it about nurses?"

"It must be all that white."

She turned around. I gasped. I blushed. From her ruffled front unbuttoned down past her clavicular notch showing her cleavage, to her full tightly held breasts, from the red of her nail polish and lipstick to the blue of her lids and the black of her lashes and even the twinkly gold of the little cross from her Catholic nursing school, she was a rainbow in a waterfall. After a day in the hot smelly House, after a day of being whacked by the Privates and the Slurpers and the gomers, she was a succulent chilled wedge of an orange squirting in my mouth. She came over to us.

"I'm Molly."

"Gurl, the name's Chuck"

Thinking to myself is it true what they say about interns and nurses, I said, "I'm Roy."

"This your first day, guys?"

"Yeah. I was just thinkin' of joinin' the army instead."

"I'm new too," Molly said. "Started just last month. Scary, eh?"

"No foolin'," said Chuck.

"Hang in there, guys, we'll make it. See ya round the campus, eh?"

Chuck looked at me and I looked at him, and he said, "Sure does make you glad to be spendin' time in here makin' it with the gomers, don't it?"

We watched Molly disappear down the corridor. She stopped to say hello to Potts, who was talking to a young Czech patient, a man yellow from liver disease. The Yellow Man flirted with Molly, and then ogled her as she, giggling, wiggled down the corridor. Potts came over to us and picked up the lab results from the morning.

"Lazlow's liver functions are getting worse," he said.

"He looks mighty yellow," said Chuck. "Lemmee see. Too high. If I was you, Potts, I'd give him some roids."

"Roids?"

"Steroids, man, steroids. Whose patient is he, anyhow?"

"He's mine. He's too poor to afford a Private doctor"

"Well, I'd give him the roids. Never know if he don't have fulminant necrotic hepatitis. If'n he does, unless you hit him with the roids now, he's gonna die."

"Yeah," said Potts, "but the tests aren't that high, and steroids have a lot of side effects. I'd just as soon wait a day."

"Suit yourself. Looks awful yellow, though, don't he?"

Thinking about what the Fat Man said about the young dying, I got up to do some work. When. I returned to the nursing station I saw two LOLs in NAD peering through their thick cataract?defying glasses at the blackboard on which were written the names of the new interns on the ward. They mentioned my name, and I asked them if they were looking for me. Tiny, a foot below me, huddled together, they peered up at me. "Oh, yes," said one.

"Oh, aren't you the tall young doctor."

"Handsome and tall," said the other. "Yes, we want to hear the news about our brother Itzak."

"Itzak Rokitansky. The professor. Brilliant, he was."

"How is he, Dr. Basch?"

I felt trapped, not knowing what to say. Fighting the impulse to say PURRTY GUD, I said, "Well . . . I've only been here a day. It's too early to tell. We'll wait and see."

"It's his brain," said one. "His marvelous brain. We're glad you'll be taking care of him, and we'll look for you tomorrow. We visit every day."

"We spend much of our time now visiting the ones who are ill. Good?bye, Dr. Basch. Thank you so much."

I left them, and noticed them pointing at me to each other, pleased that I would be their brother's doctor. I was moved. I was a doctor. For the first time that day, I felt excited, proud. They believed in me, in my art. I would take care of their brother, and them. Take care of the whole world, why not? I marched down the hallway with pride. I fingered the chrome of my stethoscope with a certain expertise. Like I knew what I was doing. Far?out.

It didn't last. I got more and more tired, more and more caught up in the multitudinous bowel runs and lab tests. The jackhammers of the Wing of Zock had been wiggling my ossicles for twelve hours. I hadn't had time for breakfast, lunch, or dinner and there was still more work to do. I hadn't even had time for the toilet, for each time I'd gone in, the grim beeper had routed me out. I felt discouraged, worn. Before he left for the day, the Fat Man came by and asked if there was anything else I wanted to talk about.

"I don't get it," I said. "This isn't medicine, this isn't what I signed up for. Not writing orders for cleanouts for the bowel run."

"Bowel runs are important," said Fats.

"But aren't there any normal medical patients?"

"These are normal medical patients."

"They can't be. Hardly any of them are young:"

"Sophie's young; she's sixty?eight."

"Between the old people and the bowel runs, it's crazy. It's not at all what I expected when I walked in here this morning."

"I know. It's not what I expected either. We all expect the American Medical Dream?the whites, the cures, the works. Modern medicine's different: it's Potts being socked by Ina. Ina, who should have been allowed to die eight years ago, when she asked, in writing, in her New Masada chart. Medicine is 'bedrest until complications,' Blue Cross payments for holding hands, and all the rest you've seen today, with the odd Leo thrown in to die."

Thinking of the Rokitansky girls, I said, "You're too cynical."

"Did Potts get socked by Ina, or did he not?"

"He did, but all of medicine isn't like that."

"Right. In the teeth of our expertise, the ones our age die."

Cynic.

"Ah, yes," said Fats, eyes twinkling, "no one wants you to know all this yet. That's why they wanted you to start with Jo, and not me. I wish I could lie. Doesn't matter, 'cause I can't discourage you yet. Like sex, you gotta find it out for yourself. So why don't you go home?"

"I've got some work to do"

"Well, you won't believe this either, but most of the work you do doesn't matter. For the care of these gomers, it doesn't matter a damn. But do you know to whom you're saying goodbye?"

I did not.

"To the potential father of the Great American Medical Invention. Dr. Jung's. More money than in the bowel run of the stars."

"What the hell is this invention, anyway?"

"You'll see," said Fats, "you will see." '

He left. I felt scared without him, and troubled by what he'd said. Got to find it out for myself? In fifth grade, when I'd asked an Italian kid why he liked having sex, he'd said, "'Cause it feels good." I couldn't understand someone doing something because it felt good. What sense was there in that?

Just before I left I wanted to say good?bye to Molly. I found her carrying a bedpan toward the disposal. I walked with her, the shit sloshing in the pan, and said, "It's not a very romantic way to meet someone."

"The romantic way has gotten me into all kinds of trouble in the past," she said. "This is much more realistic."

I said good night and drove home. The sun was a foreign diseased thing, glowering down a hot red contagion on the city. I was so tired that I had a hard time driving, the white lines weaving back and forth across the road like the visual aura to an epileptic's seizure. The people I saw seemed strange, as if they should have some disease that I should be able to diagnose. No one had a right to be healthy, for my world was only disease. Even the braless women, sweat collecting in the hollows of their breasts, nipples poking out with the full expectation of a lush and sultry summer night, their eroticism magnified by the scents of the July blossoms and of their aroused bodies, were less the stuff of sex and more the specimens of anatomy. Diseases of the breast. I hummed, of all things, a bossanova: "Blame it on the carcinoma, hey hey hey . . :"

In my mailbox was a note: "I think of you all night, I think of you in white. It's hard to be an intern, but I know you will return. Love, Berry." Undressing, I thought of Berry. I thought of Molly, I thought of Potts and his blue?steel throbber, but my own blue steel was throbless that night, for they had started in on me and I was through with feeling anything more for that day, including sex, including love. I lay down on top of the cool sheets, which felt soft as the sole of a baby's foot, soft as the inside of a baby's mouth, and I thought of this puzzling Fat Man and that even if summer is green, death is an odd number, an odd odd number.