THE HOUSE OF GOD
We came here to serve God, And also to get rich.
History of the Conquest of Mexico
The House of God had been founded in 1913 by the American People of Israel when their medically qualified Sons and Daughters could not get good internships in good hospitals because of discrimination. A great tribute to the dedication of the founders, it soon attracted red hot doctors, and was blessed with an affiliation with the BMS?the Best Medical School?in the world. Built up to this status, internally it had broken down into many hierarchies, at the bottom of which now lay the very people for whom it had been constructed, the House Staff. Consistently, at the bottom of the House Staff lay an intern.
While the straight shot down from the top of the medical hierarchy got the intern, the intern was at the bottom of the other hierarchies only indirectly. In many tricky ways he had the opportunity to be abused at any time by Private Doctors, House Administration, Nursing, Patients, Social Service, Telephone and Beeper Operators, and Housekeeping. The latter made the beds and regulated the heat, cold, toilets, linen, and general repairs. The interns were completely at their mercy.
The House medical hierarchy was a pyramid ?a lot at the bottom and one at the top. Given the mentality required to climb it, it was more like an ice-cream cone?you had to lick your way up. From constant application of tongue to next uppermost ass, those few toward the top were all tongue. A mapping of each sensory cortex would show a homunculus with a mammoth tongue overlapping an enormous portion of brain. The nice thing about the ice?cream cone was that from the bottom, you got a clear view of the slurping going on. There they were, the Slurpers, greedy optimistic kids in an ice?cream parlor in July, tonguing and tonguing and tonguing away. It was quite a sight.
The house of God was known for its progressiveness, especially in relation to the way it treated its House Staff. It was one of the first hospitals to offer free marital counseling, and when that failed, to encourage divorce. On average, during their stay, about eighty percent of the married medically qualified Sons and Daughters would make use of this suggestion, separate from their spouses, and take up with some bombshell from Private Doctors, House Administration, Nursing, Patients, Social Service, Telephone and Beeper Operators, and Housekeeping. In a further progressive gesture, the House believed in introducing its incoming interns to the horrors of the year in a gentle fashion, inviting us to an all?day talk session broken by a lunch catered by the B?M Deli, taking place on Monday June the thirtieth, the day before we were to start. At this meeting we were to be exposed to representative members of each hierarchy.
On the Sunday afternoon before the B?M Deli Monday before the horrific Tuesday July the first, I was in bed. June was ending with a final sunny flash, but my shades were drawn. Nixon was off on yet another summit junket to masturbate Kosygin, "Mo" Dean was breathless in her agony over what dress to wear to the Watergate hearings, and I was, in pain. My pain was not even the modern pain of alienation or ennui, the kind that many Americans currently felt while watching the TV documentary on "The California Family: The Louds," with their expensive ranch house, three cars, kidney?shaped pool, and no books. My pain was fear. Despite always having been a red?hot, I was scared out of my mind. I was terrified of being an intern in the House of God.
I was not alone in bed. I was with Berry. Our relationship, having survived the trauma of my years at the Best Medical School, was blossoming, rich in color, woven with liveliness, laughter, risk, and love. Also in bed with me were two books: the first, a gift from my father the dentist, an "internship" book, something called How I Saved the World Without Dirtying My Whites, all about this intern rushing in at the last minute, taking over, crisply barking orders which saved lives in the nick of time; the second book I'd bought for myself, something called How to Do It for the New Intern, a manual that told you everything you needed to know. While I ransacked this manual, Berry, a Clinical Psychologist, was curled up with Freud. After a few minutes of silence, I groaned, let the manual drop, and pulled the sheet over my head.
"Help, heIlllp," I said.
"Roy, you really are in terrible shape."
"How bad is it?"
"Bad. Last week I hospitalized a patient who was found curled up under the covers just like that, and he was less anxious than you"
"Can you hospitalize me?"
"Do you have insurance?"
"Not till I start the internship."
"Then you'd have to go to the State Facility."
"What should I do? I've tried everything, and I'm still scared to death."
"Yes. A primitive defense. Deny that it exists"
So I tried to deny that it exists. Although I didn't get very far with this denial, Berry helped me through the night, and the next morning, B?M Deli Monday, she helped me to shave, dress, and she drove me downtown to the House of God. Something stopped me from getting out of the car, and so Berry opened my door, coaxed me out, and pressed a note into my hand that said "Meet you here at five P.M. Good luck. Love, Berry." She kissed me on the cheek and left.
I stood in the steamy heat outside a huge urine-colored building which a sign said was THE HOUSE OF GOD. A ball and chain were demolishing one wing, to make way, a sign said, for THE WING OF ZOCK. Feeling like the ball and chain were swinging back and forth inside my skull, I entered the House and searched out the "function room." I sat down as the Chief Resident, named Fishberg and nicknamed the Fish, was giving a welcoming speech. Short, chubby, scrubbed to a shine, the Fish had just completed his training in Gastroenterology, the specialty of the House. The position of Chief Resident was smack in the middle of the ice?cream cone, and the Fish knew that if he did a good job that year he'd be rewarded by the higher?up Slurpers with a permanent job and become a permanent Slurper. He was the liaison between the interns and everyone else, and he "hoped that you will come to me with any problems you might have." As he said this, his eyes slithered over to the higher?up Slurpers arrayed at the head table. Shifty, slimy, he oozed. Too cheerful. Not in touch with our dread. My concentration waned, and I looked around the room at the other new terns: a smooth black guy slouched down in his chair with his hand wearily shading his eyes; more striking was a giant of a guy with a bushy red beard, wearing a black leather jacket and wraparound sunglasses, twirling a black motorcycle hat on his finger. Far?out.
" . . and so, day or night, I'm available. And now it gives me great pleasure to present the Chief of Medicine, Dr. Leggo."
From the corner where he'd been standing, a thin, dry?looking little man with a horrific purple birthmark on the side of his face walked stiffly to the center of the speaker's table. He wore a butcher?length white coat and a long old?fashioned stethoscope wended its way across his chest and abdomen and disappeared mysteriously into his pants. A question flickered across my mind: WHERE DID THAT STETHOSCOPE GO? He was a renologist: kidneys, ureters, bladders, urethras, and stagnant urine's best friend, the Foley catheter.
"The House is special," said the Chief. "Part of its being special is its affiliation with the BMS. I want to tell you a story about the BMS, that showed me how special the BMS and the House are. It's a story about a BMS doctor and a BMS nurse named Peg. It showed me what it is like to be affiliated with the . . : "
My mind wandered. The Leggo was a less chubby version of the Fish, as if, given the fact that the Leggo had published rather than perished to become Chief, all the human juice had been sucked out of him, and he had been left drained, dehydrated, even uremic. So this was the top of the cone, when finally, and with all men, as Chief, one was perpetually more slurped against than slurping.
" . and so Peg came up to me with a surprised look on her face and said 'Doctor Leggo, how could you wonder whether that order had been done? When a BMS doctor tells a BMS nurse to do something, you can be sure it will be done, and it will be done right."'
He paused, as if expecting applause. He was met with silence. I yawned, and realized that my mind had gone straight to fucking.
". . and you'll be glad to hear that Peg will be coming?"
An explosion of coughing from the tern in the black leather jacket, doubling him over, gasping, at his seat, interrupted the Leggo.
"?coming from the City Hospital to join us here at the House later in the year."
The Leggo went on to make a statement about the Sanctity of Life. Like the Pope's statements, the emphasis was on doing everything always for everyone forever to keep the patient alive. At the time, we couldn't have known how destructive this nuncio would be. Finishing, the Leggo returned to his corner, where he remained standing. Neither the Fish nor the Leggo seemed to have a firm grasp on what went into being a human being.
The other speakers were more human. A House Administration type in a blue blazer with gold buttons gave us some advice on how "the patients' charts are legal documents" and told us that the House had gotten sued recently because some tern, as a joke, had written in the chart that the Nursing Home had left the patient on the?bed pan so long that stasis ulcers developed, which led to death on transfer to the House; an emaciated young cardiologist named Pinkus remarked on the importance of hobbies in preventing cardiac disease, his two hobbies being "running for fitness and fishing for calm," and then went on to say that every patient we would see during the year would seem to have a rumbling systolic heart murmur which in fact would turn out to be the jackhammers from the Wing of Zock and we might as well throw our stethoscopes away now; the House Psychiatrist, a sad?looking man with a goatee, turned his pleading eyes on us and told us that he was available to help. Then he shocked us all by saying:
"Internship is not like law school, where they say look to your right and look to your left and one of you will not be here at the end of the year, but it is a strain, and everyone has a hard time. If you let it go too far, well . . . Each year the graduating class of at least one medical school?maybe two or three schools?must step into the ranks just to replace colleagues who commit suicide?"
The Fish was clearing his throat. He did not like this talk about suicide and was clearing his throat of it.
"?and even year after year right here in the House of God we do see suicides="
"Thank you, Dr. Frank," said the Fish, taking over, greasing the wheels of the meeting again so that it could roll on to the last medical speaker, a representative of the House Private Doctors, the Attendings, Dr. Pearlstein.
Even at the BMS, I'd heard of the Pearl. Once the Chief Resident, he had soon abandoned academics in pursuit of cash, had snatched the beginnings of his own practice from his older partner when the latter was away on a Florida vacation, and with a quick entry into computer technology that fully automated his office, the Pearl had become the richest of the rich House Privates. A gastroenterologist with his personal X?Ray machine in his office, he serviced the wealthiest bowels in town. He was the retained physician of the Family of Zock, whose Wing of Zock jackhammers would make us throw our stethoscopes away. Well?groomed, glittering with gems, in a handsome suit, he was a master with people, and in a few seconds he had us in the palm of his hand:
"Every intern makes mistakes. The important thing is neither to make the same mistakes twice nor to make a whole bunch of mistakes all at once. During my internship, right here at the House, a fellow intern, eager for academic success, had had a patient die, and the family had refused permission for the postmortem. In the dead of night, this intern wheeled the body down to the morgue and did the autopsy himself. He was caught and punished severely, being sent to the Deep South, where he practices in obscurity to this day. So remember: don't let your enthusiasm for medicine get in the way of your feeling for people. It can be a great year. It started me on the way to what I am and what I have today. I look forward to working with each and every one of you. Best of luck, boys, best of luck."
Given my aversion to dead bodies, he needn't have bothered to warn me. Others felt differently. Sitting beside me, Hooper, a hyperactive tern whom I'd known as a classmate at the BMS, seemed to get off on the idea of doing the autopsy himself. His eyes gleamed, he rocked back and forth in his chair, almost quivering. Well, I mused, whatever turns you on.
The token humanitarian statement having been made, we turned to computers, the Fish passing out our day?by?day schedules for the year. A large?breasted adolescent stood up to guide us through the maze of paperwork. She spoke of "the major problem you will face in your internship: parking." After going over several complex diagrams of the parking in the House, she passed out parking stickers and said, "Remember: we do tow, and we love it. With the Wing of Zock going up, you'd better put your stickers on the inside of your windshield, because the past few months the construction workers have ripped off all the stickers they could find. And if you're thinking of riding your bikes, forget it. Every night the teen gangs rip through this place with bolt cutters. No bike is safe. Now we fill in our computer forms, so we can get paid. You all brought your number?two pencils, right?"
Damn. I'd forgot. My whole life has been trying to remember to bring those two number?two pencils. I couldn't remember when I'd ever remembered. And yet someone else always did. I filled in the circles of the forms.
The meeting ended with the Fish suggesting "you might want to go to your respective wards to get acquainted with your patients before tomorrow." Although this sent a shiver through me, since I wanted to continue to deny that it exists, I filed out of the room with the others. Lagging behind, I found myself on the fourth floor walking from one end of the corridor to the other. Ten yards down the corridor were two armchair recliners, in which sat two patients. One, a woman with bright yellow skin signifying severe liver disease, sat with her mouth open to the fluorescent lights, her legs spread apart, her ankles puffed and her cheeks gaunt. There was a bow in her hair. Next to her was a decrepit old man with a frantic thatch of white hair spilling over his veined skull, who was yelling over and over:
HEY DOC WAIT HEY DOC WAIT HEY DOC …
An intravenous bottle was running yellow stuff into his arm, and a Foley catheter was running yellow stuff out of his vermilion?tipped schlong, which lay across his lap like a pet snake. The caravan of new terns had to wend its way single file past these two lost ones, and by the time I got to them there was a traffic jam and I had to stop and wait. The black guy and the black motorcycle guy waited with me. The man, whose name tag said "Harry the Horse," kept yelling: HEY DOC WAIT HEY DOC WAIT HEY DOC . . .
I turned to the woman, whose name tag said "Jane Doe." She was singing, a chromatic phonetic scale of increasing intensity:
0000?AYYY?EEEE?IYYY?UUUU. . .
In response to our attention Jane Doe made motions as if to touch us, and I thought "No, don't touch me!" and she didn't but what she did do was squeeze out a long liquid fart. Smells had always gotten to me, and that smell did then, and I felt like vomiting. Nope, they weren't going to get me to see my patients yet. I turned around. The black guy, whose name was Chuck, looked at me.
"What do you think of this?" I asked.
"Man, it's pitiful."
Looming over us was the giant with the black motorcycle gear. He put on his black jacket again and said to us: "Guys, in my medical school in California, I never saw anyone as old as this. I'm going home to my wife."
He turned, walked back down the corridor, and disappeared into the down elevator. On the back of his black motorcycle jacket was spelled out in shiny brass studs:
***EAT MY DUST***
Jane Doe farted again.
"Do you have a wife?" I asked Chuck.
"Me neither. But I can't take this yet. No way."
"Well, man, let's go have a drink."
Chuck and I had poured a good deal of bourbon and beer into our bodies, and had gotten to the point of laughing at the farting Jane Doe and the insistent Harry the Horse asking us to HEY DOC WAIT. Having started by sharing our disgust, we proceeded through sharing our fear, and were in the process of sharing our pasts. Chuck had grown up dirt?poor in Memphis. I inquired as to how from this humble beginning he'd gotten to the pinnacle of academic medicine, the BMS?affiliated House of God.
"Well, man, you see, it was like this. One day when I was a senior in high school in Memphis, I got this postcard from Oberlin College, and it said: WANT TO GO TO COLLEGE AT OBERLIN? IF SO, FILL OUT AND RETURN THIS CARD. That was it, man, that was all. No College Board tests, no application, no nothin'. And so I did it. Next thing I know, I get this letter saying I'd been accepted, full scholarship, four years. And here the white guys in my class were all trying like crazy to get in. Now, I'd never been out of Tennessee in my life, I didn't know anything about this Oberlin, 'cept I asked somebody and he told me they had a music school there."
"Did you play a musical instrument?"
"You gotta be kiddin'. My old man read cowboy novels as a night janitor, and my old lady cleaned floors. Only thing I played was roundball. The day I was supposed to leave, my old man says, 'Son, you'd be better off joinin' the army.' So I take the bus to Cleveland and then I was supposed to change for Oberlin, and I didn't know if I was in the right place but then I see all these dudes with musical instruments and I say yup this must be the right bus. So I went to Oberlin. Majored in premed 'cause you didn't have to do nothing, read two books?the Iliad, which I didn't dig, and then this great book about these red killer ants. See, there was this dude trapped, tied down, and this army of red killer ants came marchin' and marchin'. Great."
"What made you decide to go to medical school?"
"Same thing, man, same ezact thing. In my senior year, I got this postcard from the University of Chicago: WANT TO GO TO MEDICAL SCHOOL AT CHICAGO? IF SO, FILL OUT AND RETURN THIS CARD. That was all. No Medical Board tests, no application, no nothing. Full scholarship, four years. So there it is, and here I am."
"And what about the House of God?"
"Same thing, man, same exact thing. Senior year, postcard: WANT TO BE AN INTERN AT THE HOUSE OF GOD? IF SO, FILL OUT AND RETURN THIS CARD. There it is. Sumthin' else, huh?"
"Well, you sure put one over on them."
"I thought I did, but you know, seeing these pitiful patients and all, I think those guys sending me the postcards knew all along I was tryin' to fool them by gettin' all this, so they fooled me by givin' it all to me. My old man was right: that first postcard was my downfall. I shoulda joined the army."
"Well, you got to read a good story about the killer ants."
"Yeah, I can't deny that. What about you?"
"Me? I look great on paper. For three years after college I was on a Rhodes Scholarship to England."
"Damn! You must be some ath?a?lete. What's your sport?"
"You gotta be kiddin'. With those little white balls?"
"Right. Oxford got fed up with the dumb Rhodes jocks, so they went in more for brains my year. One guy's sport was bridge."
"Well, man, how old are you, anyway?"
"I'll be thirty on the Fourth of July."
"Damn, you're older than all of us. You're as old as dirt."
"I should have known better than to come to the House. My whole life has been those goddamn number-two pencils. You'd think I'd learn."
"Well, man, what I really want to be is a singer. I got a great voice. Listen to this."
In falsetto, shaping the tones and words with his hands, Chuck sang: "There's a . . . moone out toonight, wo?o?o?ooow, and I know . . . if you held me tight, wo?o?o?owww . . ."
It was a lovely song and he had a lovely voice and it was lovely, all of it, and I told him so. We both were real happy. In the face of what faced us, it was almost like falling in love. After a few more drinks we decided we were happy enough to leave. I reached into my pocket to pay, and came out with Berry's note.
"Oh, shit," I said, "I'm late. Let's go."
We paid and walked out. The heat had disappeared under an umbrella of summer rain. Soaking wet, with the thunder blasting and the lightning rattling, Chuck and I sang through the car window to Berry. He kissed her good?bye, and as we left him, walking toward his car, I yelled out: "Hey, I forgot to ask you?where are you starting tomorrow?"
"Who knows, man, who knows?"
"Wait?I'll look," and I fished out my computer schedule and saw that Chuck and I would be together for our first ward rotation. "Hey, we're gonna work together."
"That's cool, man, that's cool. So long."
I liked him. He was black and he had endured. With him I would endure. July the first seemed less frightening than before.
Berry was concerned about my lacing my denial with bourbon. I was silly and she was serious, and she said that this first forgetting to meet her was an example of the problems we might have during the year. I tried to tell her something about the B?M Deli, and could not. When I, laughing, told her about Harry the Horse and the farting Jane Doe, she didn't laugh.
"How can you laugh at that? They sound pathetic."
"They are. I guess denial didn't work:"
"It did. That's what your laughter's about."
In my mailbox was a letter from my father. An optimist, he was a master of the conjunction, his letters patterned in the grammar of: (phrase) conjunction (phrase):
I know there is so much to learn about medicine and it is all new. It is fascinating all the time and there is nothing more amazing than the human body. The hard physical part of the job will soon become usual and you must watch your health. I had an eighty on Wednesday afternoon and am putting better . . .
Berry put me to bed early and went back to her place, and I was soon wrapped in the velvet robe of sleep, heading toward the kaleidoscope of dream. Pleased, happy, no longer scared, with a smile I murmured "Hiya, dream," and I was soon in Oxford, England, at lunch in the Senior Common Room of Balliol College, a Septcentenary Fellow at each elbow, eating dull food off bone china, discussing how the screwy Germans, after fifty years' work on their vast Dictionary compiling all the Latin words ever used, had gotten only up to the letter K, and then I was a kid running out into the summer dusk after supper, baseball mitt in my hand, leaping up and up in the warm twilight, and then, in a whirlwind of dread, I sighted a traveling circus falling from a cliff into the sea, the sharks savaging the succulent marsupials as the drowned clown's painted face dissolved in the cold inhuman pickling brine . . .