I had high hopes that the Fat Man would save me.
Chubby, pumped up, bubbling with all the fresh optimism of a baby rocking in the cradle of the New Year, the Fat Man was back, ward resident in the House of God. During his long swing through the various Mt. St. Elsewheres and the Veterans Administration Hospital, I had missed him. Of course he had loomed large always, and in frantic times, his teachings had pulled me through. For months we had been in touch mostly through rumor. According to Fats, things were going great. Yet, the more I got to know him, the more contradictions there seemed to be. While laughing at a system that cherished Jo and the Fish and Little Otto and the Leggo, Fats seemed not only to be able to survive but also to use it for himself and even to enjoy it.
Among the rumors that had floated in from Fats's long road trip were several about Dr. Jung's Anal Mirror, including one that allegedly had Esquire publishing its listing of "The Ten Most Beautiful Assholes of the World." Yet whenever the Fat Man talked about his invention, it was always in the subjunctive tense, "would" and "could," not "will" and "can." Gregarious inside the House, when Fats left it, he disappeared. In spite of my offers, I never saw him outside. Although inside the House he was doing something erotic with Gracie from Dietary and Food, there was no word of female relationships outside. Ambitious, Fats wouldn't let women stand in his way. Even his goal in life, to "make a big fortoona," was complicated: whenever I'd ask him how it was going, he'd get a wistful look in his eye and say, "I'm just not crooked enough," and tell me that he'd passed up opportunities that would have made ten fortoonas in the past year alone. "If only I had the hearts and minds of the Watergate Boys," he'd sigh, "if only I was G. Gordon Liddy."
I knew for sure that he was going into a GI Fellowship, that he was the only graduate of Brooklyn College ever to make it to the House of God, and that he was the only true genius I'd ever met. Now, fat and snappy and with a small gold ring on a fat finger of a fat hand and a sparkling gold chain around a huge rubbery neck that barely existed at all, given the way the fat, sleek, black?haired head seemed to rest entirely upon the rolling mound of shoulder, now the Fat Man's good cheer seemed a strange contrast to the searing winter that held the city in its frozen tongs from January until the thaw. I knew from what other terns had said that this ward?ward 4?North?would be the worst. With Fats as our resident, I hoped that it would not be the worst.
"This ward will be the worst," said Fats, chalk in chubby fingers scrawling THE WORST on the blackboard of the on?call room. "This ward has taken fine young men and broken them." BROKEN THEM went up. "And yet, last year, I made it through, and this year, with me for these three months, you guys will make it through OK."
Hyper Hooper one of the other terns, asked, "What makes this ward the worst?"
"Name it," said Fats.
"Salli and Bonni?they both wear caps and tin nursing?school badges like meter maids?who say to the gomers like, 'Now we eat our custard, sport.' The worst."
The third tern, Eat My Dust Eddie, let out a long slow groan of despair. "I can't stand it," he said, "I can't stand having the Fish. He's a gastroenterologist and I can't stand anymore talk of shit."
"To hear you," said Fats, "you'd think no one ever shits in California." Then, getting serious, he leaned forward and said, "That reminds me?my Fellowship Application. I'm trying to get my GI Fellowship for July the first. The Leggo still hasn't written the crucial letter of recommendation. He says he's waiting to see how I run this ward. Don't screw me on that letter, hear? This is a 'Protect the Fat Man's Fellowship' ward rotation, see?"
"Where do you want to go for your fellowship?" asked Hooper.
"Where? L.A. Hollywood."
Eat My Dust groaned and covered his face with his hands.
"The Bowel Run of the Stars," said Fats, stars sparkling in his dark eyes.
Fats was into money. He'd grown up poor. His mother, during the High Holy Days, even though there wasn't anything to make soup from, had put pots of water on the stove to boil, so that if anyone dropped in, the illusion of soup would be there. Nourished by his family as being a true genius, he'd shot up like a Flatbush meteor, barreled through Brooklyn College in science, cutthroated through Einstein Med, and arrived at the best internship of the Best Medical School, the House of God. Now, as he said, he was "going all the way to the top," and it seemed that from Flatbush, the top was Hollywood: "Imagine doing a sigmoidoscopy on Groucho Marx?" he'd said, "on Mae West, on Fay Wray, on Kong! On all those stars who think that the colon is filled with cologne."
I tuned back in as Fats was saying, "This ward is a GI Man's Heaven, and even for a GI man, it's Hell. How are you terns going to survive?"
"By killing ourselves," said Eddie.
"Wrong," said Fats seriously, "you are not going to kill yourselves. You are my A Team, you all know what you're doing by now. You will survive by going with it."
"Going with it?" I asked.
"Right. Like in the card game: finesse, men, finesse." Finesse? I drifted off, thinking that this was a little bit different from what Fats had said before. How could this ward be the worst? There would be no hiding our doing nothing from Fats, and after what I'd been through on the wards and in the E.W., there would be no doubts about my ability to handle just about anything. I guessed it would be the worst because the gomers would try to torment us by holding up their end of the delivery of medical care by camping in the House, and the Slurpers and the Privates; would try to torment us as well, each in his own failsafe way. It would be the worst precisely because them would be no duplicity or pretense, but only the eternal, almost ecological struggle to do revolving?door medicine the House of God way.
"Remember," said Fats, finishing, "if you don't anything, they can't do anything to you. Believe it not, guys, we're gonna have a ball. OK, now we're ready to go on out there. Let's break!"
We broke with all the enthusiasm of a high?school football team breaking from the locker room knowing they were going to get creamed and leaving their guts in the toilet bowls behind. Ward 4?North was yellow-tiled, smelly, and contorted like a gomer. We went from room to room, and in each there were four beds and on each bed was a horizontal human being who showed few signs of being a human being except being on a bed: No longer did I think it crazy or cruel to call these sad ones gomers. Yet part of me thought it was both crazy and cruel that I no longer thought so.
In one male room a gomer was spasmodically tugging at his catheter and moaning something like PAZTRAMI PAZTRAMI PAZTRAAAH?MI and at that, Eat My Dust began making dog?vomiting noises in my ear. We went into the hallway and saw two more males, side by side, the only difference being their mouths, which were:
[one gaping open, the other gaping open with the tongue hanging out of the lower corner]
The Fat Man asked the BMSs?the terrified, eager, and idealistic BMSs?what the inspection of these two men would produce as diagnoses, and they had no idea. Fats said, "These are classic signs: the O SIGN on the left and the Q SIGN on the right. The O SIGN is reversible, but once they get to the Q SIGN, they never come back."
We proceeded down the corridor. Suddenly there they were: side by side in armchair recliners sat two patients, the same two patients Chuck and I had turned back from that first day, Harry the Horse (HEY DOC WAIT HEY DOC WAIT) and Jane Doe (OOOO?AYYY?EEEE?IYYY?UUUU). Still there! We stood in front of them, mesmerized.
"Come on, come on," said Fats, dragging us away down the corridor. "This is the worst, the Rose Room. This room has taken fine young men and broken them. There should be an antidepressant dispenser at the door. Always remember, when you leave the Rose Room and feel like killing yourself, remember that it is they of the Rose Room, and not you, who are ill. THE PATIENT IS THE ONE WITH THE DISEASE."
"Why is it called the Rose Room?" we asked.
"It is called the Rose Room because it invariably happens that the four female beds contain gomeres named Rose."
In hushed silence we stood in the middle of the dimly lit Rose Room. All was still, spectral, the four Roses horizontal, at peace, barely dimpling their swaddling sheets. It was all very nice, until the smell hit, and then it was disgusting. The smell was shit. I couldn't stand it. I left. From the corridor I could hear Fats continue to lecture. Out came EMD, gagging. Still Fats talked on. Out came Hyper Hooper, snorting. On and on Fats talked. The three fresh BMSs, holding to the fantasy that if they left the Rose Room before the Fat Man, their grade would plunge down toward that deadhouse, middle C, stayed. Fats droned on. Yelping and retching, handkerchiefs to their mouths, out ran the BMSs As Fats rattled on to himself and to the gomertose Roses, the BMSs threw open a window and hung out their heads, and the burly construction workers who were riveting together the Wing of Zock pointed, to them and laughed, and the laughter seemed to come, from far away. I wished I could have been a robust hardhat, far from the smell of shit. Fats droned on to himself. The next one out, I mused, would be a Rose. Finally, out came our leader, asking, "What's the matter, guys?"
We told him the matter was the aroma.
"Yeah, well, you can learn a lot from that aroma. With luck, in three months you'll be able to stand the middle of that room and give the four diagnoses as the different bowel odors smack your olfactory lobes. Why, just today there was a steatorrheac malabsorbtion, a bowel carcinoma, a superior mesenteric insufficiency giving rise to bowel ischemia and diarrhea, and last? . . . yes! Little packets of gas. slipping past a long?standing fecal impaction."
"Hey, Fats," said Hooper, "how about having a box with postmortem permission slips here at the doorway of the Rose Room?"
"LAW NUMBER ONE: GOMERS DON'T DIE," said Fats.
"Hooper, what the hell is it with you and those posts?" I asked.
"The Black Crow Award," said Hooper.
"That was a joke," I said.
"It was not. The postmortem is the flower?no, the red rose?of medicine."
As Hooper went on down the corridor, I thought how happy he'd gotten, now that he'd lodged his M firmly OR, and now that he had his Israeli Path Resident doing autopsies for him on a "same?day" basis. Racing for the Black Crow, Hooper hated the seemingly immortal gomers, and sought out younger patients, the ones who could die. In particular, he cherished the upper socioeconomic young, who, according to a recent J. Path. article, were most likely to sign for their own posts. Occasionally someone would mention to Hooper that maybe he was a little too heavy into death, but he'd just smile his boyish California smile, hop up and down like a Mouseketeer, and say, "Hey, it's where we're all headed, right?" Death had become a lifeline for the perky little Sausalitan.
Fats had gone straight from the stench of the Rose Room to breakfast, and Eddie and I were left alone. He turned his tense eyes to me and said, "I can't take it?they're all gomers."
"It's a tremendous opportunity to utilize your twenty-six years of education and maturity to procure the delivery of medical care for a needy geriatric population."
Neck and neck for the Black Crow with Hooper, Eddie had gotten deep into sadomasochism, in particular grooving on patients "hurting" him or on he "hurting" them. I tried to change the subject, and said "Say, I hear your wife's having a baby."
"A baby. Your wife. Sarah, remember?"
"Yeah, the wife is having her baby. Soon."
"It's not just hers, it's yours too!" I shouted.
"Yeah. Say, did you see 'em? All gomers. If three of them were seen in California they'd close up the state. They smell, and I hate smells. Gomers and gomers and more gomers. And"?he looked at me with puzzled and almost pleading expression and said, " and gomers. I mean, do you know what I mean?"
"Yeah, I do." I said. "Don't worry, we'll help each other through."
"I mean . . . gomers is all there is here is gomers."
"Sweetheart," I said, giving up, "it's Gomer City:
The Fish was remarkable. Hands in his pool; head in the clouds, he was so bananas in his own way that almost every time you had a conversation with him you wanted to run and tell someone about it, because it did strange things to your brain, as if someone had unrolled a few convolutions, and if it hadn't come from the Chief Resident you'd swear it had come from a lunatic. That first day as our Visit, he strolled up and was greeted by Fats in between Harry the Horse and Jane Doe and said, "Hi, guys, how's it going?" and avoided our eyes and didn't wait to hear how it had been going and said, "Let's see the patients, huh?"
"Welcome, Fish," said Fats. "We're both GI, and is there ever good GI material here, eh?"
Jane Doe cut a long, drawn?out, liquid fart.
"What'd I tell you, Fish?" said Fats. "The Gee Eye tract!"
"The GI tract is a special interest of mine," said the Fish," as is flatulence. I've recently had the opportunity to review the world literature on flatulence in liver disease. Why, flatulence in liver disease would make a very interesting research project. Perhaps the House Staff would be interested in undertaking such a research project?"
No one said he was interested.
"Let me ask you this," said the Fish, looking at Hooper. "What enzyme is missing in liver disease to produce flatulence?"
"I don't know," said Hooper.
"Good," said the Fish. "You know, it's so easy to answer a question. Why, quite often it's harder, here on rounds, to say frankly 'I don't know.' In some hospitals like the MBH, it would be frowned on to say 'I don't know.' But I want the House of God to be the kind of place where an intern can be proud to say 'I don't know.' Good, Hooper. Eddie? What's the enzyme?"
"I don't know," said Eat My Dust.
"I don't know," I said.
"Fats?" asked the Fish, with trepididation.
After a tense pause Fats said, "I don’t know."
The Fish looked a little perturbed that everyone had said "I don't know," Jane Doe broke wind again, and the Fish, irritated, said, "I love the GI Tract as much as anyone, but it's not professional to have someone with that kind of looseness of bowel control sitting in the middle of the corridor. Too loose. Put her in her room."
"Oh, we can't do that," said Fats, "she gets real violent in her room. But don't worry, I'm working on something special to stop the farting. Part of the TBC."
"TBC? What's TBC?"
"Total Bowel Control. Part of the Research Project at the VA."
"Excuse me, Fish." said Eddie, "but maybe you could tell us the answer to that question about the enzyme?"
"Oh? Why, I don't know"
"You don't know either?" asked Eddie.
"Why, no, and I'm proud to say it. I was hoping one of you would. But I'll say one thing: I'll know by tomorrow on rounds."
Since the placement of the gomers was hot stuff in Gomer City, so was the Sociable Cervix. Soon after our sexual carnival in the fall, my thing with Premarin Selma had cooled. On Social Service rounds that first day, both Selma and Rosalie Cohen were cordial but wary. I didn't mind. I was preoccupied by what I'd already seen of "the worst" ward, and I had a hard time concentrating on the meeting. I caught Eddie muttering something about "I looked up, and all I saw was gomers," and the nurses demanding we go over the three?part placement form, poring over questions like "Anointed: Yes No Date" and "Incontinence: Bladder Bowel Date of Last Enema." By the end of rounds I found myself zeroed in on a young blond; guy with a terrific tan, sitting in a corner giving hid forelock an occasional flick up out of his baby?blue eyes.
Later Hooper and Eddie and I were sitting in the on?call room, finding new ways to play with our stethoscopes without sucking on them outright. I raised question: "Why are there only gomers on this ward?" Hooper and Eddie looked at each other, puzzled. No one knew.
"Why don't you dial HELP and find out?" Hooper suggested.
"H?E?L?P. The guy in the Blue Blazer., It's a new House concept: if you need help with anything, dial HELP."
I dialed HELP and said, "Hello, I need help . . . No, I'm not a patient, I'm on the opposing team, the doctors, and I need one of those Blue Blazers . . . Which? Damn! Yeah, floor four . . . 'Bye." I turned to the others and said, "Each floor has a Blazer of its very own, and ours is named Lionel."
"Amazing," said Eddie. "I wonder how much those jokers get paid?"
The Blue Blazer arrived. He was the same Blazer as in rounds, and he looked just as terrific as before. We welcomed him and invited him to sit down. Witha dynamite aristocratic flick of the wrist and forelock, he did. He crossed his legs in a slick way that showed that here was a guy, finally, who really knew how to sit down and cross his legs.
A strange thing happened. We asked the Blazer all kinds of questions about what he and HELP was and did and how much HELP got paid, and "Why are there only gomers here on this ward?" Lionel answered each question in a sincere and soothing voice, and seemed to be a storehouse of information that he was glad to disseminate to us hardworking terns "without whom the House of God would fall like a house of cards." Yet each soothing answer was cotton candy, 'cause after it was, it wasn't. Lionel had said nothing. It was crucial to our survival in Gomer City that we get answers, since even if we TURFED every gomer out, if somehow each TURFED?out gomer was to be replaced with a fresh one, why the hell bother at all? We got angry, and our questions turned nasty. This did even less good, and just as the three of us were beginning to boil, in walked Fats. Sizing up the situation, he said a few soothing things to Lionel, who scurried out, and then Fats turned to us and asked, "What are you guys doing?"
We told him.
"So?" asked Fats, sitting down and smiling. "So what?"
"So the prick never did tell us what HELP did or how much they get paid. Where I come from, they pay help what they're worth, they pay 'em shit," said Eddie.
"Take it easy," said Fats. "Go with it. Getting pissed at jerks like that is useless"
"I want to know how come there are only gomers in here," I said.
"Yeah? Well, so do I and so does everyone else, and you know what? You'll never find out. Why get angry, eh?"
"I'm not getting angry," I said. "I am angry."
"So? So what good does that do? Finesse, Basch, finesse."
Gracie from Dietary and Food poked her head into the room, carrying an IV bottle filled with yellow liquid, and holding it up, announced, "The extract is ready, dear."
"Hey, great," said Fats, "let's try her out."
We followed Fats and Gracie down the corridor and we watched Gracie replace Jane Doe's IV bot with the bottle of "the extract." Fats, using the reverse stethoscope technique, shouted into Jane's ears: "THIS WILL MAKE YOUR BOWELS STOP RUNNIN JANIE. THIS WILL BIND YOU UP!"
"What is this extract?" I asked.
"Oh, it's something I invented and Gracie prepared and it's part of the TBC, part of the VA Research that's gonna make the fortoona."
"Fresh fruit is God's own cathartic," said Gra "and we hope that this is the opposite. It's completely organic. Like laetrile."
I asked Fats about this research at the VA, and he told me that some "shyster" there had gotten "a government grant" to try out a new antibiotic on eternal guinea pigs, the shell?shocked derelict vets. The Fat Man had contracted with the shyster to get a percentage for every vet he'd put on the antibiotic, so Fats had put them all on it.
"How'd it work?" I asked, realizing as soon said it that it was a dumb question, since it hadn't been given to work on anything.
"Great," said Fats, "except for one thing: the side effect."
"Yeah, see, it wiped out the intestinal flora, and one of the latent intestinal viruses took over and produced an incredible diarrhea that nothing can control. Nothing yet, that is. So we've got high hopes for this extract, see?"
"Yeah, but what's a little diarrhea?" Hooper asked.
"A little diarrhea?" said Fats, eyes widening. "A little . . ." And he dissolved into laughter, jolly chubby gusts of laughter that got bigger and bigger until he was holding onto his gut as if it would break apart and slop all over the tile floor, and Gracie and I and Eddie and Hooper laughed, and with tears in his eyes Fats finally took us aside and said, "Not a little diarrhea, men, a big diarrhea. A big contagious diarrhea. This first half of TBC, this VA antibiotic, can produce a diarrhea in anyone's bowels. If I had known how bad the side effect would be, I never would have done it. That's why I gotta find the second half, the cure. You see, this diarrhea's the most contagious and uncontrollable son of a bitch in the whole wide GI world."
At the end of the day I went to sign out to EMD, who was on call. I asked how it was going.
"Compared to California, it sucks. My third admission is on her way. I'm already on my knees."
"She's on her way from Albany. Three hundred miles. In a taxi."
"In a taxi?"
"In a taxi. A totally demented wiped?out gomere who, according to the scouting report, has not urinated in weeks and is too demented to sign her informed consent for dialysis, who tormented her family to the point where they surreptitiously TURFED her into a slow?moving cab in Albany and who's been making her way here since noon. She's being sent here for dialysis."
"If she won't sign there, what makes them think she'd sign here?"
"'Cause like you said: 'Sweetheart, here it's Gomer City.' She's gonna be a special private patient of the Leggo's. It's the greatest day of her life."
On my drive home, the sun wore that harsh steely look of tired midwinter, slashing and aslant, enraged at the gray of the ice. I felt cold, unsheltered, perplexed. I had high hopes that the Fat Man would save me, and yet here he was telling me not to get angry at the Blazer.
"He told me to cool it, and I don't feel like cooling it," I told Berry. "I mean, you're always telling me to express my feelings, and I worry that if I cool it I'll it I'll go nuts. How can I listen to both of you?"
"Maybe there's some common ground," said Berry, "But I can see how you'd be scared to try and survive there if you and he are at odds. What does he say about all the gomers?"
Realizing with sadness that now even Berry had sucked into calling these pitiful old ones "gomers," said, "He says he loves 'em."
"That's just being counterphobic. Secondary narcissism."
"What's all that?"
"Counterphobic is when you do what you're most scared of doing, the guy who's afraid of heights becoming a bridge painter. Primary narcissism, like with Narcissus at the Pool, is when he tries to love himself but he can't embrace his own refection, and he fails. Secondary narcissism is where he embraces others; they love him for it, and he loves himself even more. The Fat Man is embracing the gomers:"
"He's embracing the gomers?"
"And everybody loves him for it."
. . . Everybody loves the doctor and I'm by now your patients do love you. Hope you busy and know you are doing a terrific job. Watched the Knicks on cable TV and they prove that basketball is essentially a team game . . .
Fats had called us his "A Team." And yet what kind of team would it be if its ***MVI*** began questioning its coach?