The house of God

4

As I walked onto ward 6?South the next morning, my fear tempered by expectation, I saw a bizarre sight: Potts sat at the nursing station, looking like he'd been shot out of a cannon, his whites filthy, his straight blond hair tangled, blood under his fingernails and vomit on his shoes, his eyes pink, a sick rabbit's eyes. Next to him, strapped to a chair and still wearing the Rams football helmet, was Ina. Potts was writing in her chart. Ina freed herself, screamed: GO AWAY GO AVAY GO AVAY . . . and took a swing at him with her left fist. Enraged, Potts?gentle Moliere?perusing Potts of the Legare Street Pottses?screamed: "Goddamnit, Ina, shut the hell up and behave!" and shoved her back down in her chair. I couldn't believe it. One night on call, and a Southern gentleman had become a sadist.

"Hi, Potts, how'd it go last night?"

Raising his head, with tears in his eyes, he said, "How'd it go? Terrible. The Fat Man said to me 'Don't worry, the Privates know the new terns are here, and they're only admitting emergencies.' So what happened? I get five and a half emergencies."

"What's a half?"

"A transfer from another service to medicine. I asked the Fat Man about that, too, and he said, 'Since you only get half credit for the admission, you only do half an exam.'"

"Which half?"

"You do whichever half you want. With these patients, Roy, I'd suggest the top."

Ina rose again, and as Potts pushed her back down in the chair, the Fat Man and Chuck arrived, and Fats said, "I see you went ahead against my advice and hydrated Ina, eh?"

"Yessir," said Potts sheepishly. "I hydrated her, and you were right, she got violent. She acted psychotic, so I gave her an antipsychotic, Thorazine."

"You gave her what?" asked Fats.

"Thorazine."

Fats burst into laughter. Big juicy laughs rolled down from his eyes to his cheeks to his chins to his bellies, and he said, "Thorazine! That's why she's acting like a chimp. Her blood pressure can't be more than sixty. Get a cuff. Potts, you're terrific. First day of internship, and you try to kill a gomere with Thorazine. I've heard of the militant South, but this is the limit."

"I wasn't trying to kill her?"

"Blood pressure fifty?five systolic," said Levy, the BMS.

"Get her head down in her bed," said Fats. "Get some blood into it." As Levy and the nurse carried Ina to her room, the Fat Man informed us that Thorazine in gomers lowers the blood pressure so that the higher human levels don't get perfused. "Ina was struggling to get up so she could lie down. You almost did her in."

"But last night she went crazy?"

"Sundowning," said Fats. "Happens all the time with gomers in the House. They don't have much sensory input to begin with, and when the sun goes down, it gets dark, they go bananas. Come on, let's do the cardflip, eh? Thorazine? I love it."

The Fat Man did the cardflip, beginning with the five and a half admissions that had turned Potts into a sadist. Again, like the day before, most of what I'd learned at the BMS about medicine either was irrelevant or wrong. Thus, for a dehydrated Ina, hydration made her worse. The treatment for depression was to order a barium enema, and the treatment for Potts's third admission, a man with pain in his abdomen but who "knew all of you doctors are Nazis but I'm not quite sure just yet which one of you is Himmler," was not a barium enema and bowel run, but what the Fat Man called a "TURF TO PSYCHIATRY:"

"What's a TURF?" asked Potts.

"To TURF is to get rid of, to get off your service and onto another, or out of the House altogether. Key concept. It's the main form of treatment in medicine. Just call up psychiatry, tell them about the Nazi stuff, don't mention the gut pain, and presto?TURF TO PSYCHIATRY." Ripping up the index card containing the Nazi?seeker and throwing the bits over his shoulder, the Fat Man said, "The TURF, I love it. Let's go. Next?"

Potts presented his last admission, a man of our age who'd been playing baseball with his son, and who, while trying to beat out a hard screaming line drive, had dropped down in the base path unconscious.

"What do you think it is?" asked Fats.

"Intracranial bleed," said Potts. "He's in rough shape:"

"He's gonna die," said Fats. "Do you want him to have the benefit of a neurosurgical procedure first?"

"I've already arranged it."

"Great," said Fats, ripping up the man our age and sowing him on the floor. "Potts, you're doing great-a TURF TO NEUROSURG. Two TURFS outa three patients."

Potts and I looked at each other. We felt sad that someone our age who'd been playing ball with his six?year?old son on one of the super twilights of summer was now a vegetable with a head full of blood, about to have his skull cracked by the surgeons.

"Sure it's sad," said Fats, "but there's nothing we can do. The ones our age are the ones who die. Period. The kind of diseases we get, no medico?surgicobullshitology can cure. Next?"

"Well, the next is the worst," said Potts in a husky voice.

"What's that?"

"The Czech, the Yellow Man, Lazlow. Last night about ten o'clock he had a convulsion, and no matter what I did, he wouldn't stop convulsing. I tried everything. His liver function tests late last night were off the scale. He . . ." Potts looked at Chuck and me, and then, ashamed, looked down into his lap and said, "He's got fulminant necrotic hepatitis. I transferred him to the isolation ward on the other service. He's not my patient?our patient?anymore."

Fats asked Potts in a kind voice if he'd given the Yellow Man steroids. Potts said that he'd thought about it, but had not.

"Why didn't you tell me the lab results? Why didn't you ask me for help?" asked Fats.

"Well I . . . I thought I ought to be able to make the decision alone."

A somber quiet floated down over us, the quiet of sadness and grief. Fats reached over and put his thick arm around Potts's shoulder and said, "I know how shitty you feel. There's no feeling like it in the world. If you don't feel it at least once, Potts, you'll never be a good doc. It's all right. Steroids never help anyway. So he's TURFED to 6?North, eh? Tell you what: after breakfast, since we've got so many TURFS, I'll demonstrate the electric gomer bed."

On the way to the electric gomer bed, whatever that was, Potts, despondent, turned to Chuck and said, "You were right, I should have given him the roids. He's gonna die for sure."

"Wouldn't have helped him none," said Chuck, "he was too far gone."

"I feel so bad," said Potts, "I want Otis."

"Who's Otis?" I asked.

"My dog. I want my dog."

The Fat Man gathered us around the electric gomer bed containing my patient, Mr. Rokitansky. Fats explained how the goal of the tern was to have as few patients as possible. This was opposite the goal of the Privates, the Slurpers, and the House Administration: Since, according to LAW NUMBER ONE: GOMERS DON'T DIE, the gomers would not be leaving the tern's service by way of death, the tern had to find other ways to TURF them. The delivery of medical care consisted of a patient coming in and being TURFED out. It was the concept of the revolving door. The problem with the TURF was that the patient might BOUNCE, i.e., get TURFED back. For example, a gomer who was TURFED TO UROLOGY because he couldn't urinate past his swollen prostate might BOUNCE back to medicine after the urology intern with his filiform probes and flexible followers had managed to produce a total body septicemia, requiring medical care. The secret of the professional TURF that did not BOUNCE, said the Fat Man, was the BUFF.

We asked what was a BUFF.

"Like BUFFING a car," said Fats. "You gotta BUFF the gomers, so that when you TURF them elsewhere, they don't BOUNCE back. Because you gotta always remember: you're not the only one trying to TURF. Every tern and resident in the House of God is lying awake at night thinking about how to BUFF and TURF these gomers somewhere else. Gath, the surgical resident downstairs, is probably giving his terns the same lecture at this very moment, about how to produce heart attacks in gomers to TURF TO MEDICINE. But one of the key medical tools to TURF gomers elsewhere is the electric gomer bed. I'll demonstrate on Mr. Rokitansky. Mr. R., how you doing today?"

PURRTY GUD.

"Good. We're going on a little trip, OK?"

PURRTY GUD.

"Good. Now, the first thing to notice is that the electric gomer bed has side rails. They don't matter. LAW NUMBER TWO:?repeat after me?GOMERS GO TO GROUND."

Responsively, we repeated: GOMERS GO TO GROUND.

"Side rails up, side rails down," Fats said, "no matter how securely restrained, no matter how demented, no matter how seemingly incapacitated, GOMERS GO TO GROUND. The next thing about the gomer bed is this foot pedal. Gomers don't have good blood pressures, and when, like Ina, they stop perfusing the newer parts of their brains, they go crazy, start yelling, and try to GO TO GROUND. In the middle of the night, when you get called for the fact that your gomer now has a blood pressure the same as an amoeba, you kick this pedal. Basic, like knowing C major. OK, Maxine, take the blood pressure for a baseline reading."

"Seventy over forty," said Maxine.

"Good," said Fats, and kicked the pedal. The electric gomer bed roared into action. In less than thirty seconds Mr. Rokitansky was virtually upside down on his noggin, his feet pointing at forty?five degrees and his head jammed against the headboard, down below at the other end.

"Blood pressure, Max? Mr. Rokitansky, how ya doin'?"

Although Mr. Rokitansky didn't look like he was doing too good, as Maxine tried to read his BP?blood pressure?from his nearly vertical arm, he said:

PURRTY GUD.

A trouper.

"One hundred and ninety over one hundred," said Maxine.

"This position," said Fats, "is called Trendelenberg. You can get any blood pressure you want out of your gomer, depending on how much Trendelenberg you order. The reverse of Trendelenberg is what?"

Nobody knew.

"Reverse Trendelenberg," said Fats. "Since most gomers have trouble making a BP, you don't put a gomer in reverse too often."

Next the Fat Man showed us how to get just the head of the bed up, for pulmonary edema; the foot of the bed up, for stasis ulcers of the foot; the middle of the bed up, for disorders of the middle. Finally, after he'd done everything with the gomer bed but twist it into a pretzel, using Rokitansky for the holes, he became solemn and said in an excited voice, "I've saved the most important control for last. This button controls the height. Mr. Rokitansky, are you ready?"

PURRTY GUD.

"Good, 'cause here we go," and pushing the button, which sent the bed going down, Fats said, "This is the up?down button and we are going down. Given LAW NUMBER TWO, which is . . ."

"GOMERS GO TO GROUND," we said automatically.

". . . the only way to prevent them from hurting themselves is to have the mattresses on the floor. The nurses hate this position 'cause they have to go around searching for the bedpans on their hands and knees. We tried it last year and it didn't work?the traffic in bedpans went down and the place started to smell like the cattle yards in Topeka. However, now we are going up." Fats shouted out, "Going up!" pushed the button, and Rokitansky began to rise. During the smooth journey Fats called out, "Vacuum cleaners, ladies' lingerie, appliances, toys," and finally, when Rokitansky was five feet off the ground chest?level with us all, the Fat Man said, "This is one of the most important positions. From this height, if a gomer goes to ground it is an automatic intertrochanteric fracture of a hip, and a TURF TO ORTHOPEDICS. This height," said Fats, beaming, "is called "The Orthopedic.' The penultimate. And now, the ultimate." Again Fats hit the button, and Mr. Rokitansky floated on up, coming to rest at the level of our heads. "This height is called 'The Neurosurgical.' Going to ground from here results in the TURF TO NEUROSURGERY. And from there, they rarely BOUNCE back. Thank you, gentlemen, see you at lunch."

"Wait," said Levy, the BMS. "You're being cruel to Mr. Rokitansky."

"Whaddaya mean? Mr. Rokitansky, how are you doin'?"

PURRTY GUD.

"But he always says that."

"Oh, yeah? Hey, Mr. Rokitansky, hey, you up there, you got anything else you want to tell us?"

We waited with bated breath. From the Neurosurgical Height the word floated down to us: YEAH.

"What?"

KEEP THE LOWDOWN LOW.

"Gentlemen, thank you again. You will find that if you push the down button, Mr. Rokitansky will come down. Lunch."

"Of course he wasn't serious," said Potts. "No one could be that sadistic. It was a perverted way to try to cheer me up."

"I think he was," I said. "I think he meant it."

"That's crazy," said Potts. "You mean he wants us to use that bed to get old people to break their hips? That's sick."

"What do you think, Chuck?"

"Who knows, man, who knows?"

Potts and I sat at lunch, watching the Fat Man shovel food into his mouth. Chuck, on call that night, had been called away to admit his first patients. All Potts could talk about was how he should have hit the Yellow Man with steroids, and how he wanted to be with Otis, his dog. I felt more confused than scared, puzzled by the Fat Man's version of "the delivery of medical care." We were joined by the three terns on another ward, 6?North. Supported by Eat My Dust Eddie and Hyper Hooper was the Runt, with that same shot?out?of?a?cannon look as Potts. Chuck had seen the Runt earlier in the day and had told me how nervous the Runt was: "Man, he's goin' around with a big gigantic box of Vay?li?um tablets, and about every five minutes he's walkin' around and poppin' one into his mouth." Harold "the Runt" Runtsky had been a friend of mine through the four years at the BMS. A short, stocky product of two red?hot psychoanalysts, the Runt seemed to have had something analyzed out of him, and although he was as smart as anyone in the class, he'd been left shy and quiet, with a little too much slack in his strings, a reactive rather than an active guy, his raucous laugh usually being at someone else's jokes. The Runt had trouble standing up to women sexually. Saddled all through BMS with a roommate who was the most promiscuous guy in the class and who allowed him at times to peek through the keyhole at what was going on, the Runt had gotten into "two?dimensional" sex, magazines and movies. After much prodding, shortly before the internship he'd begun a relationship with an intellectual poet named June. The poems were sexless, asensual, bonedry.

The Runt looked defused. His mustache drooped. As he sat down, he took out a pillbox, put a pill on his hamburger, and munched it down. When I asked what it was, he said, "Valium, Vitamin V. I've never been so nervous in my life."

"Were you on call last night?"

"Nape. Tonight. Hooper was on call last night."

When I asked Hooper how it had been, he got that same gleam in his eye that he'd gotten at the B?M Deli when the Pearl told the story about doing the autopsy in secret, and he giggled and said, "Great, just great. Two deaths. One permission for the postmortem. Watched it myself this morning. Fantastic"

"Does the Valium help?" Potts asked the Runt.

"It makes me feel kinds sleepy, but I feel pretty unflappable. I'm writing orders for it for all my patients."

"What?" I asked. "You're putting them on Valium too?"

"Why not? They're all very nervous, having me as their doc. By the way, Potts, thanks a lot for that transfer last night, the Yellow Man," said the Runt sarcastically. "Terrific."

"I'm sorry," said Potts, "I should have given him the steroids. Has he stopped convulsing?"

"Nope. Not yet."

I got beeped to go back to the ward, and as I left I asked Eat My Dust how it was going for him.

"How's it going? Compared to California, it sucks."

When the Rokitansky girls asked to speak with me again, I felt grand. Their hearing aids turned up full blast, they asked for the latest bulletin from "our brother's doctor." I felt like I was in command, like I had something to give. They hung on my every word. When my beeper called me away, they said they were sorry they'd bothered me and that I must have more important things to do, and as I left them to go down to my first Outpatient Clinic, I felt a real thrill. When I stepped into the elevator, people looked at me, tried to read my name tag, knowing I was a doc. I was proud of my stethoscope, of the blood on my sleeve. The Fat Man was a burnt?out case. Being a doc was a thrill. You could do things for people. They had faith in you. You couldn't let them down. Rokitansky would get well.

Cocky, seduced by the illusion of somehow getting Rokitansky to regenerate his brain, I entered the Outpatient Clinic. Chuck and I had our Clinics on the same day, and, side by side, listened as the Clinic was explained. We'd be functioning just like General Practitioners, except we wouldn't get paid. We each were given an office, to use once every two weeks. The final seduction was when they presented each of us with our cards:

ROY G. BASCH, M.D. OUTPATIENT CLINIC, HOUSE OF GOD.

Bolstered by pride, pretending to know what I was doing, I waded through my first Clinic. Too poor to afford a House Private, Clinic patients would turn out to be of two types: fifty?two?year?old husbandless black mothers with high blood pressure, and seventy?two year?old husbandless Jewish LOLs in NAD with high blood pressure. I would hardly ever see a male, and to see someone below the age of fifty?two, except for "mental disturbance" or venereal disease, would be publishable. My first very own patient was a LOL in NAD in need of a checkup and a prescription for a new artificial breast and padded bra with fillable pockets. Who knew how to write a prescription? Not me. She wrote it, I signed it, and, grateful, she left. Next was a Portuguese woman who wanted me to do something about her corns. Who knew about corns? I toyed with the idea of writing her a prescription for an artificial foot and a padded shoe with finable socks, but then I remembered the Fat Man and TURFED her to Podiatry. The next LOL in NAD was seventy?five, Jewish, and came in with her upper eyelids, Scotchtaped to her forehead. Reading her old chart, I found out that this was a case of "drooping lids of unknown etiology" and that her previous Clinic tern had TURFED her to Ophthalmology, where the resident had told her to "tape them up or I operate" and she'd chosen the tape and had been TURFED back to Medicine. This was a BOUNCE.

"Oh, I love meeting all you nice young doctors," she said.

"How long have you had this tape on your lids?"

"Eight years. How much longer do I have to wear it?"

"What happens if you take it off?"

"My eyelids fall down."

I wrote her a prescription for more tape. She grasped my hand and began to chatter about how glad she was to have me as her doctor. It was hard for me to listen because her taped?up lids made her eyes bulge out like a monster of the deep, and the only thing that stopped her life story from pouring out was that the nurse brought in my next patient, the last of the afternoon. This was a hypertensive black woman of fiftyfour named Mae, with no chief complaint except "my joints hurt when I play basketball with my kids" and a request for a pelvic exam. When she was up in the stirrups Mae started spouting Jehovah's Witness gospel, and after she got dressed, chattering all the while a mixture of religion, family history, and history of her previous terns at the House Clinic, she spewed out some Witness pamphlets and left. These women loved coining to the doctor. I walked into Chuck's office and found him with a LOL in NAD too. He was doing something I'd never seen done before in medicine, something with a tape measure and a breast.

"Well, you see, man, this lady says her breast is growing."

"Just one of them?"

"Right. So I thought I'd better measure and see if it gets any bigger in the next two weeks."

Back on the ward, I felt grand. I was excited, thrilled at being a doctor. Having been a red?hot in my academic career, there was no reason not to be a House red?hot too. Hadn't the Pearl himself, earlier in the day, congratulated me on the way I'd cleaned out his patient for the bowel run? Feeling Dr. Kildarish, I sat in the warm sunlight of the nursing station. Looking into the room across the hallway, I saw Molly, perky transparent Molly, bending over the bed, fiddling with the sheet. She kept her legs straight, so her miniskirt rode up her thighs, and with a final reach over to the far side of the bed, she hiked the hem up over her ass, showering me with the rainbow?and?flower pattern of her little?girl panties, snug against the firm full gluteal folds that formed an awning over the juicy female thing that grew up there. I could feel a half?chub mumbling and squirming in my whites.

"That's the straight bendover." It was the Fat Man. He sat down beside me, unrolling the Journal.

"Huh?"

"That nursing maneuver, where they bend from the waist and flash their ass. Called the Straight Bendover Nursing Maneuver. Learn it in nursing school. What are you going to do about TURFING Sophie? She's settling in, and I'm warning you, she's really getting Putzeled this time. She could be here for months."

"Putzeled?"

"Bob Putzel, her Private, remember? He uses the standard method: admit the LOL in NAD, do a test, produce a complication, do another test to diagnose the complication, get another complication, and so on until they're gomertose and non?TURFABLE. Do you want that nice LOL in NAD to become an Ina Goober? Nip it in the bud. Do something now. You gotta get her to leave."

"How?"

"Do a painful procedure. She doesn't like painful procedures."

"I can't think of anything that's indicated."

"Oh. Well, she has a headache, and her noon temp is a degree high. No matter that it's almost a hundred Fahrenheit up here and all the temps are a degree high, no matter, 'cause the chart is BUFFED with a recorded noon temp a degree high. Oh, and she has a stiff neck too. So: headache, fever, stiff neck; diagnosis?"

"Meningitis."

"Procedure?"

"Lumbar puncture, LP. But she doesn't really have meningitis."

"She might. If you don't LP her, you might miss it, like Potts missed with Mellow Yellow. And don't worry about hurting Sophie, she's tough. A Gray Panther. Get Molly to help." Looking in the paper, Fats mumbled, "The Dow Jones is up, baby, up. Good. Good climate for the Invention now, for sure."

"For what?"

"The Invention, the Invention! The Great American Medical Invention!"

With the Dow Jones rising up over America's colorful ass, how could I not enjoy doing an LP on Sophie? Molly had never before assisted at an LP and was glad to help. Together we walked into Sophie's room. Levy the Lost, my BMS, was sitting on Sophie's bed Putzeling her hand, "taking a history." He was still at the beginning, asking her "What brought you to the hospital?"

"What brought me? Dr. Putzel, in his white Continental."

I stopped Levy, and instructed Molly in how to hold Sophie curled up in a fetal position on her side, exposing her back to me. As Molly bent down over Sophie, grabbing her behind the knees and neck, arms spread apart like Christ on the Cross, I noticed that the two top buttons of her ruffled blouse were undone, and I was staring into an enticing cleft between Molly's breasts, bubbling up out of lacy bra cups. She noticed me noticing, and said, smiling, "Go ahead." How bizarre, ' the contrast between these two women. I had an urge to slip my penis into Molly's cleft. Potts popped his head in, and asked us if we knew where a Bible could be found.

"A Bible? What on earth for?" asked Molly.

"For pronouncing a patient dead," said Potts, vanishing again.

I tried to recall how to do an LP. At BMS I had been particularly bad at these, and to do an LP on an old person was more difficult, for the ligaments in between the vertebrae are calcified, like guano on an old rock. And then there was the fat. Fat is death to a tern. All the anatomical landmarks get obliterated in fat, and as I tried to locate Sophie's midline, with my ill?fitting rubber gloves and the rolling fat, it was impossible. I thought I had it, and as I put the needle in, Sophie screamed and leaped, and as I advanced the needle further, she yelped and leaped again. Molly's hair came loose, a blond cascade over Sophie's old and sweaty torso. Every time I looked into Molly's cleavage I got aroused, and every time Levy said something I got mad and wanted to slug him, and every time I advanced the needle Sophie leaped up in pain. I began to sweat. I tried another spot on Sophie's fat back. No luck. Another. Nothing. I noticed that blood was coming out of the spinal needle, so I knew it wasn't where it was supposed to be. Where was it? Lubricated by the sweat, my glasses fell off and contaminated the sterile field. Molly let go at the same time, Sophie uncoiled and looked like she was about to GO TO GROUND from just below the Orthopedic Height but we caught her in time. Embarrassed, my cockiness splattered in sweat all over Sophie, I told Levy to stop smirking and get the Fat Man. Fats came in, in two shakes had Molly expose herself and Sophie's porcine back, and, humming a TV commercial that sounded like "I Wish I were an Oscar Weiner weiner," with a smooth and effortless Sam Snead stroke sliced through the fat and popped into the subarachnoid space. I was amazed at his virtuosity. We watched the clear spinal fluid drip out. Fats took me aside, and like a coach put his arm around my shoulders and whispered:

"You were way off the midline. You hit either kidney or gut. Pray kidney, 'cause if it's gut, it's Infection City, and she may suffer the ultimate TURF, to Pathology."

"Pathology?"

"The morgue. No BOUNCE. But I think it worked. Listen."

"I WANT TO GO HOME I WANT TO GO HOME I WANT TO . . ."

I began to feel scared that I had started an infection that would send Sophie home for good. As if in confirmation, from the next bed, behind the curtain, Potts was dealing with his first death. His patient, the young father who'd dropped on the first?base line the day before, had died. Potts had been called to pronounce the patient dead, as required by law. We peeked through the curtain: Potts was standing at the foot of the bed, his BMS beside him holding a Bible, on which rested Potts's hand. His other hand was raised toward the body, which was lying there as white as a corpse, which was what it was. As we watched, Potts intoned:

"By the power vested in me by this great state and nation I hereby pronounce you, Elliot Reginald Needleman, dead."

Molly, snuggling up to me so that her left breast brushed my arm, asked, "Is that really necessary?" and I said I didn't know, and I asked Fats, who said, "Of course not. The only federal regulation is that you take the two pennies out of your loafers and put them over the dead man's eyes."

Potts, decimated, sat with us at the nursing station. Slurring his words, his eyes bloodshot, he said, "He's dead. Maybe I shoulda shipped him to surgery sooner. I shoulda done something. But I was so tired when he came in, I couldn't even think."

"You did all you could," I said. "He popped an aneurysm, nothing would have helped. The surgeons refused to operate."

"Yeah, they said it was too late. If I had moved faster, maybe?"

"Enough of that," said the Fat Man. "Potts, you listen to me. There's a LAW you've gotta learn, LAW NUMBER FOUR: THE PATIENT IS THE ONE WITH THE DISEASE. Understand?"

Before he had a chance to understand, we were interrupted by the Chief Resident, the Fish. He had a concerned look on his face. It turned out that both Needleman and the Yellow Man were not Private patients, but House patients, and the Fish was partially responsible.

"Liver disease is a special interest of mine," said the Fish, "I've recently had the opportunity to review the world literature on fulminant necrotic hepatitis. Why, the case of Lazlow would make a very interesting research project. Perhaps the House Staff would wish at some point to undertake such a project?"

No one said he wanted to undertake such a project.

"However, both the Leggo and I feel, Dr. Potts, that you waited too long without giving steroids. Do you understand?"

Stabbed, Potts said, "Yes, you're right. I understand."

"I'm on my way to an impromptu colloquium on Lazlow. We've brought in the Australian, the world's expert on this disease. It does not look good. You waited too long. Oh, and one more thing," said the Fish, looking at Chuck's dirty whites and unbuttoned shirt without a tie, "the way you dress, Chuck. Not professional. Not enough for the House. Clean whites here, and a tie. Understand?"

"Fine, fine," said Chuck.

"And you, Roy," said the Fish, pointing to the cigarette I'd just lit up, "enjoy that, because it will prove to be three minutes off your life."

I saw red. The Fish slid off down the corridor to the colloquium. A morbid silence coated us. The Fat Man broke it, spitting out, "Jerk! Now, just remember this, Potts, if you want to end up like that jerk, you'll believe him. If not, you'll listen to me: THE PATIENT IS THE ONE WITH THE DISEASE."

"Are you really going to dress better?" I asked Chuck.

"'Course not, man, 'course not. In Memphis, we don't even wear neckties to funerals. Man, these gomers are sumpthin' else. None of my four admissions so far believes I'm really their doctor. They all think am the hep."

"Hep?"

"H?e?1?p. Hep. The colored hep. See you later."

Staring out the window, Potts muttered to himself something about how he should have given the Yellow Man the roids, but the Fat Man stopped him, saying, "Potts, go home."

"Home? Charleston? You know, right now my brother?he's in construction?he's probably lying out in a hammock on Pawley's Island, sipping a fizz. Or maybe upcountry, where it's all green and cool. I never should have left. The Fish is right in what he said, but if this was the South, he never would have said it. Not like that. My mother has a word for him: 'common.' Guess I made my choice, though, didn't I? Well, I will go home. Thank God Otis is at home."

"Where's your wife?"

"She's on call tonight at the MBH. It'll be just Otis and me. That's just fine, 'cause he loves me, too. He'll be lying there on the bed with his balls up in the air, snoring. It'll be good to go home to him. See you tomorrow."

We watched Potts stumble on down the hallway. He came to the colloquium, outside the room containing the Yellow Man. Without looking in, as if ashamed, Potts slunk past them and out the door.

"This is crazy," I said to the Fat Man, "this internship is nothing like what I thought it would be. What do we do for these patients anyway? They either die or we BUFF and TURF them to some other part of the House."

"That's not crazy, that's modern medicine."

"I don't believe it. Not yet." "Of course you don't. You'd be crazy to. It's only

your second day. Wait till tomorrow, when you and

me are on call together. Well, I'm going home. Pray

for the Dow Jones, Basch, pray the fucker stays on up"

Who cared?

I finished my work and walked down the corridor toward the elevator. The crowd around the Australian expert was breaking up, and out of it rolled the Runt. He looked a lot worse. I asked him what was going on, and he said, "The Australian said we should do an exchange transfusion, where you take all the old blood out and replace it with new."

"That never works. The blood still has to go through the liver, and there is no liver. He's going to die."

"Yeah, that's what they all said too, but since he's young and was walking around yesterday, they think it's worth a try. They said I had to do it, tonight, and I'm scared stiff."

Screams came from the room. The Yellow Man was flopping up and down on the bed like a hooked tuna, screaming. A member of Housekeeping ambled up, pushing two huge carts laden with linen, gowns, operating?room garb, and large polyethylene bags labeled "Danger?Contaminated." The head nurse told the Runt that the blood would be ready in half an hour and that there was only one nurse to assist, since the others were scared of sticking themselves with a needle and catching the fatal disease. They refused to work in the room. The Runt and I watched the nurse walk away, and watched Housekeeping, whistling, disappear into the down elevator. The Runt looked up at me with terror in his eyes; and then put his head on my shoulder and cried. I didn't know what to do. I would have volunteered to help, but I was scared of catching whatever bad thing it was that had you walking around chatting up the Tit one day and convulsing like a hooked tuna the next.

"Do one thing for me," said the Runt. "If I die, take the money in my trust fund and donate it to the BMS. Make a prize for the member of the class, who first realizes the insanity of this business and drops out to do something else."

I helped him on with his sterile operating?room garb, his gloves, face mask, hat. Like an astronaut, he launched himself with an awkward shuffle into the room, up to the bed, and started the procedure. The bags of fresh blood began to arrive. With a lump in my throat I walked out, down the corridor. The cries, smells, bizarre sights riddled my head like bullets in a nightmare war. Even though I hadn't touched the Yellow Man, I went to the bathroom and gave myself a long surgical scrub. I felt terrible. I liked the Runt, and he was going to poke himself with a contaminated needle, catch this liver?ripping hepatitis, turn yellow, flip like a gaffed fish, and die. And for what?

As if in a tankful of water, I listened to Berry while I read my father's latest letter:

. . By now you must be in the middle of your work and it will settle down to a routine. I know that there is so much to learn and you will be immersed in it. Medicine is a great profession and it is a wonderful thing to be able to heal the sick. I played eighteen on Saturday in the heat and it was made bearable by a gallon of iced tea and a birdie on number . . .

Unlike my father, Berry was not as interested in preserving an illusion of medicine as she was in understanding my experience. She asked me what it had been like, and although I tried to tell her, I realized that it had not been like anything, and I could not.

"But what made it so hard? The fatigue?"

"Nope. I think what made it hard was the gomers and the Fat Man."

"Tell me about it, love"

I told her how I couldn't decide whether or not what the Fat Man taught about medicine was crazy. The more I saw, the more sense the Fat Man made. I had begun to think I was crazy for thinking he was crazy. As an example, I told Berry about the gomers and about how we'd laughed at Ina in her Rams helmet socking Potts with her purse.

"Calling old people gomers sounds like a defense."

"Gomers aren't just old people. The Fat Man says he loves old people and I believe him, because he gets tears in his eyes when he talks about his grandmother and her matzoh balls that you eat sitting on ladders scraping them off the ceiling."

"Laughing at this Ina is sick."

"It does seem sick right now, but it didn't then."

"Why did you laugh at her?"

"I don't know. It was hilarious at the time."

"I'd like to understand. Try again."

"Nope. I can't."

"Try to snap out of it, Roy, please?"

"No! I don't want to think about it anymore."

I shut up. She got mad. She couldn't have known that all I wanted then was to be taken care of. Things had moved fast. Two days, and already, like swimming in a strong current, I'd looked up and found my life an eternity farther downstream, the near bank far gone. A rift had opened. Up until then, Berry and I had been in the same world, outside the House of God. Now, for me, the world was inside the House, with the Yellow Man my age and the Runt both about to Grump, with the dead father my age who'd popped an aneurysm playing baseball, with the Privates, the Slurpers, and the gomers. And with Molly. Molly knew what a gomer was, and why we'd laughed. With Molly, so far, there had been no talk, there'd been only the straight bendovers, the clefts and the round full hollows, the red nails and blue lids and panties splashed with flowers and rainbows, and the laughter amidst the gomers and the dead. Molly was the promise of a breast against an arm. Molly was recess.

Yet Molly was recess from much that I loved. I didn't want to laugh at patients. If it really were as hopeless as the Fat Man said, I'd give up now. I didn't like this rift with Berry, and so, thinking to myself that the Fat Man really was bananas after all and that, somehow, if I believed him I'd lose Berry, I said, "You're right. It's sick to laugh at the old people. I'm sorry." For an instant I saw myself as a real doc rushing in and saving lives, and Berry and I sighed together and snuggled together and got undressed together and were together in love together tight and warm?wet, and that portending rift sealed over again.

She slept. I lay awake, afraid of my tomorrow, my upcoming first night on call.