Having been pushed around for five steaming weeks with Jo, Chuck and I had learned a lot. One of our main skills was how to put a terrific BUFF on any chart to satisfy Jo, who could thus satisfy the Fish, who could thus satisfy the Leggo, who could thus satisfy whomever he had to satisfy. In addition, Chuck and I had learned to hide what we were actually doing with the gomers from Jo, since what we were actually doing was doing nothing, more intensely than any other terns in the House. Time and again, reading about our prodigious efforts on the gomers in their charts and then seeing how well the actual gomers were doing, Jo would turn to Chuck and me with pride and say, "Good job. By God, that's a damn good job. I told you that the Fat Man was nuts about patient care, didn't I?"
Without realizing it, Chuck and I were hanging ourselves. On our rounds with Jo, our charts looked so terrifically BUFFED that when Jo on her rounds with 'the Fish displayed them to him, and when the Fish on his rounds with the Leggo displayed them to him, all were amazed. This was it: the delivery of medical care. These footnotes! These cures! And so the Leggo decided that Chuck and I should be rewarded.
"How will they be rewarded?" the Fish asked the Leggo.
"We'll give them the greatest reward any intern could wish," said the Leggo. "When I was an intern, we used to fight to get the toughest cases, to show our Chief what we could do. That will be their reward, to let them show me what they can do. We'll give them the toughies. Tell them that."
"We'll give them the toughies," said the Fish to Jo.
"They're giving you the toughies," said Jo to us.
"The toughies?" I asked. "What are they?"
"The toughest admissions to the House."
"Yeah, man, what all did we do wrong?"
"That's just it," said Jo, "Nothing. It's the Leggo's way of saying thanks, to challenge you with the toughies. I think it's great. You should see the cases we're going to get now."
Soon we saw the cases we were going to get then. They were the worst. They were the House of God disasters, mostly young men and women with horrible diseases just past cure and just our side of death, diseases with rotting names like leukemia, melanoma, hepatoma, lymphoma, carcinoma, and all the other horrendomas for which there was no cure in this world or in any other. And so Chuck and I hung ourselves, and created, in 6?South, the toughest ward in the House. Without realizing it, without choosing it, and in fact choosing the opposite at every turn, we had to learn to handle the worst disease the House could dish up. We sweated and we cursed and we hated it, but we used each other?him using me for the facts and the numbers and me using him for the nuts and bolts?and we risked, and we learned. Given the increasing concentration of the dying young, the number of bowel runs for headache decreased, and the traffic in gomers went down, with Rokitansky getting sent back to his nursing home and Sophie getting driven back to her house in Putzel's Continental. Ina and Anna, the residua of our mistakenly aggressive approach, were still on the ward, slowly returning to their cradling dementia. Dr. Sanders turned out to have Hodgkin's disease, advanced and incurable, and had been started on chemotherapy and sent home to arrange his last fishing trip with his brother in West Virginia. The Yellow Man lay in his bed, flat and still, as withered as the first yellowing leaf of the fall.
When Chuck and I found out how much we each loved basketball, we began playing every chance we got.Two out of every three nights Chuck and I would be off call together, and we'd help each other finish our work, evade Jo, sign out to Potts, shove our black bags into our lockers and take out our jointly owned regulation basketball and our black low?cut sneakers, which, as we laced them, sent hot memories of the times before the big games racing through us, change into our green surgical scrub suits, jog down the corridor of the House and out into the street with that "school's out!" feeling that we'd known for a quarter of a century. At the public playground, if it was just the two of us we'd go oneon?one, caught up in that electric moment of making the slick move that would fake your best friend out of his jock. At times, in pickup games, we'd play on the same team, and we'd have that thrill of playing together with just the right blend of dazzle and unselfishness, playing against a strange mixture of strabismic Jewish BMSs and tough ghetto kids, running and yelling and breathing hard and worrying about chest pain meaning heart attack, throwing sharp elbows and playing dirty under the boards and getting into all?out screaming arguments with fifteen?year?olds about disputed calls, the elbows in fact thrown at Jo and the Fish and the Leggo and the deaths and diseases and wasted healthy moments spent cooped up in the House of Gad. Afterward we'd go to bars or to Chuck's apartment, which looked, with its garish furniture, like a TV commercial, and we'd sit and drink bourbon and beer and watch the ballgame or, with the tube sound off and stereo playing Chicago soul, watch a movie. We began to understand each other. Turned into ten?year?olds by the pressures of the House, we became friends as only ten?year?olds can, and one day something happened that made me realize what I'd always suspected: my new friend's studied indifference was only and all an act.
Chuck and I found ourselves in a basketball game with some BMSs who thought they were hot?shit ballplayers. With the same kind of ferocious competitiveness that had gotten them into the BMS, these guys started to play rough?hand?checking, fouling, calling us for the slightest foul and disputing calls?as if they were making an A in surgery if they won. Chuck's opponent was the worst, the kind of kid whose arrogance had oozed through the umbilical cord and breast and had always been the part of him that his mother loved, the kind of kid whom everybody hated and who played for the fans and not for the game, even when there weren't any fans to play for. Every time Chuck had the ball, this kid would foul, him, and every shot the kid took, he'd call a foul on Chuck. Despite the fact that Chuck was taking a beating, he never called a foul. Finally, on one outrageous call that even had his own team telling the wiseass to "jest play ball, Ernie, all right?" Ernie said to Chuck, "Hey if you didn't foul me, why don't you say so?" and all Chuck said was, "Fine, fine, let's play," and he handed over the ball.
Something in that "Fine, fine" was ominous, and from then on Chuck began to play. He'd stay outside and bomb for hoops, and he'd take Ernie inside and overpower him despite the fouls, and he'd fake the shot from outside and slip past, and he'd fake the drive and stop and pop, and as he did all this, scoring point after point, wise Ernie got madder and madder and fouled more and more, but it had about as much effect as a fly on a racehorse. It became a ballet of strength and smarts and finesse. The game turned into a one-on?one, played out in a raging intense silence. Chuck made a fool of Ernie until finally somebody said it had gotten too dark to see the rim. Chuck asked Ernie for our ball, and Ernie threw it into some bushes. A hush fell. I wanted to smash Ernie in the teeth. Chuck said, "Well, Roy, I guess I better go get our ball, now that we won this game," and, smiling, arms around each other's sweaty shoulders, proud of winning, we left.
Later, drinking with him, I said, "Damn, you are some ballplayer. Did you play in college?"
"Yup. Small College All?American, my senior year. First team."
"Well, I found you out," I said. "Your indifference is all an act. You care about everything you do:"
"'Course it is, man, 'course I care."
"Well, why do you pretend that you don't?"
"On the street, it's the only way to be. If'n you let on what you are and who you are and what you got and how someone can use you, you get yourself used worse. Like Potts with Jo. I may be painin', man, but nobody's gonna know it. Being cool is the only way of stayin' alive."
"Amazing. Where I come from, it's just the opposite?you keep showing your pain so that people will lay off you. What do you think about that?"
"What do I think? I think, fine, man, fine."
On those rare days when Potts came out to play ball, it was embarrassing. He was clumsy and shy, scared of hurting someone and scared of standing out. Open for a shot, he'd pass. In a dispute, the other guy was right. He rarely yelled. As the maples began to do their reddening, as the touch?football games sprouted on the browning fields and as the dawn dew got more and more chill, Potts got worse and worse. Left out of Chuck's and my lives, left for weeks on end by his wife, worried about his golden retriever's growing whine, hounded by the Yellow Man and by 70, Potts became scared of taking any risks. Since the only way to learn medicine was to take risks in those hard times when you were alone with your patient, Potts had trouble learning. Ashamed and afraid, in the computer rotation handed us on our first day. Potts moved on to his next assignment and left our ward.
His replacement was the Runt. On the day of his arrival, Chuck and I were sitting at the nursing station, our feet up, drinking ginger ale from large House ice buckets. Knowing how nervous he would be, Chuck and I had filled a syringe with Valium and taped it under his name on the blackboard, with a prescription: "to be injected into right buttock upon arrival" The blackboard was the standard way that the House Privates communicated with the terns about their patients. Under my name was an insignia:
*** MVI ***
This cryptic insignia had begun to appear throughout the House. It was always the same, always only associated with my name, and no one knew who was writing it. Recently it had become known that it stood for Most Valuable Intern. The rumor was that there was a competition among the interns, sponsored by the Fish and the Leggo, for this award, the ***MVI***. Since this insignia was associated only with my name, people began to address me as "the ***MVI***" and often I was greeted with "here comes the ***MVI***." I asked the Fish whether I really was the front?runner for the ***MVI***. He said he hadn't known there was an award. I told him that I'd heard the Leggo say that there was an award and that it was "part of the special tradition of the House." I then asked the Leggo, who said he hadn't known there was an award, and I told him that I'd heard the Fish say that there was and that it was "part of the special tradition of the House." I began to protest to the Fish that I didn't enjoy having my name plastered with ***MVI*** all over the House, and the Fish said he'd get House Security on the case, and for the past few days I'd glimpsed a bouncer dressed in fake West Point peering out from a corner, hoping to catch whoever was putting up ***MVI*** under my name.
And yet the ones most irritated by the ***MVI*** were the Privates, and of the Privates the most irritated of all was Little Otto Kreinberg, the Private whose name still rang no bell in Stockholm. Since Otto wouldn't talk to the terns, and since the blackboard was the only way of communicating with the terns, and since the ***MVI*** left no room for communication, it drove Little Otto wild. As Chuck and I sat, we watched Otto march in, curse, erase the ***MVI***, write a note to me, and depart. Almost as soon as he was gone, when the bouncer's back was turned, there appeared under my name on the blackboard:
*** MVI ***
As the insignias continued to multiply, gnomes like Otto spent a greater and greater amount of time manning the erasers. And when the erasers disappeared, Little Otto got big in anger. As Otto got angrier, I got more and more angry with the Fish and the Leggo, protesting the abuse of my name. With my protests, they employed more and more bouncers to peer around more and more corners, and with all this attention given to the award, the other terns began to protest to the Fish and the Leggo that Basch, who spent so much time sitting with low?cut black?sneakered feet up drinking ginger ale, could not possibly be the front?runner for the ***MVI***, which award may not have existed at all, ever, anywhere, except on the blackboards of the House.
"Hey, hey, Hazel," said Chuck. "Come on in, gurl."
Hazel from Housekeeping stood in the doorway. I'd seen her pushing mops and emptying trash, but I'd never seen her look like this: she wore tight white tights and a green uniform stretched tautly over her chest so that the buttons were tugging at the fabric, which parted to reveal enticing bits of black breast in white bra. Her face was marvelous: ruby?red lipstick on black lip, light?brown afro on head, mascara, eye shadow, false lashes, and a carnival of bangles. Her tongue lay like a cushion on the couch of her mouth. Her teeth were moonstones.
"You got your hot water and clean sheets, Chuck?"
"Great, Hazel, just great, gurl. Thanks."
"And your car? Maybe it needs some fixing?"
"Oh, yeah, Hazel, my car's not runnin' well. Needs a lotta work. Gotta get my car fixed for sure, soon. See, my front end needs some looking at. Yeah, that's it, my front end."
"Front end? Ho! You bad boy! And when do you want to put your car in the garage?"
"Well, let's see?tomorrow, gurl, how about tomorrow?"
"OIL," said Hazel, giggling. "Tomorrow. Front end? Ba' boy. Adios."
I was astounded. I'd known that Chuck had been interested in Hazel, but I'd had no idea that things had progressed this far. Even after the Cuban Firecracker had left, her afterburner?afterimage seemed to remain in the air around us, real hot and red.
"But Hazel's not a Spanish name," I said.
"Well, man, you know how it is. That's not her name."
"What's her name?"
"Jesulita. And we ain't talkie' no auto mechanics, neither:"
Jesulita. And that was the other thing that had started to happen: the sexualization of the ternship. Without realizing it, perniciously, hand in hand with our growing competence and rising resentment at the way we were beng drilled by Jo and the Slurpers, we had begun to, almost without knowing it, as Chuck said, "get it on" with those erotic ones of the House of God.
I thought about Molly, a beautiful woman who happened to have been disappointed in romantic love and who happened to have made an A in the straight bendover in her Catholic nursing school, and about how I'd begun to get involved. It had started innocently enough with my finding her in tears one day at the nursing station, and when I'd asked her why, she'd said that she was scared she was going to die because she had this mole on her thigh?her upper thigh?that had started to grow, and I said Let me have a look and so we went into the on?call room like naughty kids and on the lower bunk bed she pulled down her pantyhose and let me have a look and Christ it was a marvelous thigh and of course I saw those wonderful garden?flowered panties on that bulging blond mops but sure enough it was a bad black mole and she was gonna die. But I didn't know anything about moles, and so I pretended to be a big shot and used my "Dr. Basch" title to get her to the dean clinic that morning, and the resident in dean slobbered all over himself because he would get to look at her mops and panties instead of the usual excoriated psoriatic lesions of the gomers and he took a little biopsy of it and within twenty?four hours he told her it was just a mole and completely benign and she was not going to die. Being saved from death by me made her grateful, and she had invited me to dinner. Dinner was a terrible casserole and I had tried to get her into bed that night but had managed only to get into her, bed with her and with my hands on her almost little?girl breasts and long nipples and to hear the NO NO NO without the final scrumptious YES and to hear also the religious IF I GAVE YOU THAT I'LL HAVE GIVEN YOU EVERYTHING and so that was where the damn thing stood so far, perched erotically amidst the gomers and yet on that age?old and tantalizing ledge called the affair, the new lover versus the steady, the only one who could understand the pull to the lover being the steady, and yet to tell the steady before she found out would wreck it all. Inside the House of God Berry did not seem to exist, and even outside, when I was with Molly she didn't seem to exist either. And so it had become clear to Chuck and me that one way to survive was sexually. This was terribly puzzling and threatening to our sexual dud of a resident, Jo, for the only time she had dropped much below the top of the class at BMS had been in "Medical Aspects of Human Sexuality." Her limbic was out to lunch. Our trump card with Jo could always be sex.
When the Runt showed up, he was so nervous?from having spent eight weeks with a Double O Resident named Mad Dog and with Hyper Hooper and Eat My Dust Eddie, from having heard about "the toughies" awaiting him on our ward, from living with the fear that he was gonna die from being stuck with a needle from the Yellow Man's groin, and also from his intellectual poet June, who was furious at him for spending time, away from her?he was so nervous that he seemed to be flying, living three inches above the floor. His hair was frazzled and his mustache seemed to be alive, and he tugged first at one end and then at the other. Chuck and I tried to talk him down, but it was no use, and so we called for Molly to get the syringe of Valium.
"OK, man," said Chuck, "pull down your pants:"
"Here? Are you crazy?"
"Go ahead," I said, "we've got things all ready for you.
The Runt pulled down his pants and bent over the nursing?station desk. In walked Molly, with a friend of hers, a nurse from the MICU?Medical Intensive Care Unit?named Angel. Angel was redheaded, buxom, Irish, with wraparound muscular thighs and a creamy complexion. Working in Intensive Care, the Death Row of the House, was rumored to have intensified her sexuality, and it was said that year after year Angel gave intensive care not only to the sick, but also to the male tern. This talent, perhaps apocryphal, had at any rate yet to be experienced by anyone in our group.
"Molly," I said, "I'd like you to meet the new tern, the Runt."
"Pleased to meet you," said Molly. "This is Angel."
Craning his neck around, the Runt blushed, his bulbococcygeals tightened, causing his testes to leap up in his scrotum like startled fish in an electrified pond, and he said, "Pleased to meet you. I . . . I've never met anyone in this position before. It's their idea, not mine."
"Oh it's"?gesturing up toward the thin air?"nothing new for a"?gesturing toward herself?"nurse," said Angel.
How strange that Angel had difficulty putting words together without gesturing, but it must have had something to do with her nervousness at meeting the Runt from the rear. Angel seemed to be having a hard time resisting the impulse to go to the Runt and run her creamy hands over his leering lumpy rump, his cheeks, his testicles, even the crenellations of his anus, why not? We settled on Angel delivering the dose of Valium, which she did with professional skill, finishing by planting a kiss on the spot. The nurses left, and we asked the Runt how he felt and he said fine and in love with Angel but that he was still scared stiff about starting with the toughies on the ward.
"Man, there's nothing to worry about," said Chuck. "Even though you inherit Potts's disasters, you inherit Towl too."
"Who is Towl?"
"Towl? Towl, boy, you get in here stat!" yelled Chuck. "Towl is the best damn BMS you ever saw."
He was. In he walked: four feet tall with thick black glasses and thick black skin, with a voice gruff as a drill sergeant's and a vocabulary that was short and tough like him. The words Towl knew, he slurred, and his main gift was action, not talk. He was a locomotive from Georgia.
"Towl," said Chuck, "this is the Runt. He's gonna be your new tern, starting tomorrow."
"Rhhmmmmm rhmmmm hi the Runt," growled Towl.
"Boy," said Chuck, "you gotta run the Runt's service, just like you did Potts's. OK? Now, you tell him about it."
"Rhhmmmmm rhmmmm twenty?two patients: eleven gomers, five sickees, and six turkeys who nevah shoulda been heah in the foist place. All in all, nine of 'em are on da rolla coasta."
"Right," said Towl, making a motion with his hand like a car on a roller coaster, up and down, up and down, and finally up and flying out into space.
"He means TURFED out of the House," I said.
"But what about the sickees?" asked the Runt. "I'd better start seeing them right away?"
"Rhhmmmmm rhmmmm, nope. You don't have to. Ah takes care of 'em. I nevah lets the new tern touch 'em, not till I'm sure he knows what he's on about."
"But you can't write orders," said the Runt.
"Oh, I can write 'em, I jes cain't sign 'em. Go home, Runt, and come on back in tamarra. Well, gotta go finish mah shit on the ward so I can take off early."
Despite our preparations, Jo and ward 6-South began to destroy the Runt. Jo, on call with him, took up where Mad Dog had left off, making the Runt feel that he never could do enough and that he never should do anything without first consulting her. Afraid to risk, the Runt didn't learn. Jo's aggressive approach to the gomers soon created for the Runt the sickest, most pitiful service on the ward. The Runt was completely disorganized, and, worse, if a patient did poorly, he thought it was his fault. If Lazarus bled, it was his fault. If a birdlike woman with intransigent bowels hadn't had a bowel movement, it was his fault. He began spending more time talking to his patients, and formed such an attachment to one old man that whenever the Runt showed up, the old fellow would grasp his hand, start to cry, kiss his hand, say that the Runt was his only friend, and when the Runt would try to leave, the old fellow would kiss his hand again, start to cry, and offer him, over and over, the same present, a used bowtie. Despite Chuck, Towl, and me, the Runt was being eaten up by guilt. We'd seen it happen to Potts and we didn't want it to happen again. Chuck and I decided that if the Runt could only get something going with Angel, he might gain some confidence. His poet, fed up with his being too preoccupied with medicine to read her runes, now demanded that he sleep out on the living?room couch. Yet the Runt was too unsure of himself to ask Angel out.
"Why don't you ask her out?" I'd ask. "Don't you like her?"
"Like her? I'm nuts about her. I dream about her. She's beautiful. She's the kind of woman my mother would never let me go out with. She's what I watched my roommate Norman screw for four years at BMS. A centerfold."
"So why don't you ask her out?"
"I'm scared she won't like me and say no."
"So what? What have you got to lose?"
"The possibility-if she says no-that she might have said yes. Whatever I do, I don't want to lose that possibility."
"Look, man," said Chuck, "you know unless you get your dick moving a little faster, you never gonna learn medicine at all."
"What the hell does that have to do with it?"
"Who knows, man, who knows?"
And instead of asking her out, the Runt kept floundering in guilt on the ward and kept tossing and turning fitfully on the couch in the living room of the poet and kept going to the funerals of his dead young patients and kept letting Jo lop a bit off his schlong daily by telling him what he'd failed to do, and on top of all that, at his poet's suggestion, she being deep into the anal sadistic stages of her psychoanalysis, the Runt followed the path of cure that had warped his organ in the first place in his hyper-analyzed family and went back to the therapist he'd had throughout BMS to work out the torment he'd felt from his promiscuous roommate, Norman, who had had an electric organ and played only one song: "If You Knew Suzie Like I Know Suzie"; that song because all of his girlfriends were named Suzie and each was oh so delighted when she knocked on Norman's door and he leaped to his organ, yelled, "Come on in, Suzie," and in the words of each Suzie, "played my song."
One horrendously hot and steamy night I was on call, and the Runt, working late, refused to leave a patient of his who was in serious trouble. I urged the Runt to go home, and then I urged him to call up Angel and ask her out, and he would do neither. Towl had gone home and so the Runt was at a loss about what to do with his patients, a particular problem being Risenshein, a LOL in NAD whose bone marrow had been wiped out by our cytotoxic agents and had failed to regenerate blood cells, which meant that she was bound to die. The Runt kept asking me what to do with her. Since I was busy with my admissions and with keeping track of the decompensating ward of "toughies," I blew my cool and said, "Get out of here, damnit! I'll take care of things. Go home!"
"I don't want to go home. June's at home. If I go back there, we'll get into some argument about her anal sadism."
"So long," I said, walking off.
"Where are you going?"
"To the bathroom," I said, "I've got the flu." I retreated to the sanctuary of the toilet, wrapped in the latest graffiti: WAS ST. FRANCIS ASSISI?
"What should I do?" wailed the Runt outside the door.
"Call up Angel."
"I'm afraid. Why should I call her, anyway?" Receiving no answer, he struggled with the silence, and said, "All right. Damn! I almost forgot?I'm late for therapy. I'll call her when I get back:"
"Nope. Call her now, and don't come back. I'm on call here, see?"
So he finally called her and asked her out and rushed off to talk it all over with the therapist, whom he was paying fifty an hour to take the starch out of his penis. I sat at the nursing station, worn out by a nagging influenza that had me shitting on the hour, and overcome with gloom at the work I had to do. The sun was setting over the changing leaves, and even though it was a boiling?hot Indian?summer night, I knew that soon the days would turn crisp and clear and bright, football weather, when you huddled with a sweatered woman under a blanket and got drunk to avoid getting cold and kissed her lips and shivered . . .
Mrs. Biles is back from her cardiac catheterization," said my BMS, Bruce Levy the Lost. "The cath fellows wrote in the chart that 'Mrs. Biles had excessive bleeding from the site of needle puncture in the groin.' I'd better work it up, Dr. Basch. She might have a bleeding disorder."
Mrs. Biles had no bleeding disorder. The cath boys always wrote "excessive bleeding" to BUFF the charts in case of litigation. In fact, Mrs. Biles, Little Otto's patient, didn't even have cardiac disease at all, but, as everyone including Otto knew?bursitis. Little Ottowas after the big bucks. Bruce Levy, the BMS, was after playing the invent?an?obscure?disease?to?make?an-A?in?medicine game. Who was I to stand in his way?
"Sounds interesting, Bruce. How ya gonna work it up?
Bruce rattled off several blood tests he was about to order.
"Wait a sec," said Jo, who'd been on her way out but who had stopped back in to make sure all was OK before she went back out to where she was just another lonely single woman and not an admiral of the gomers in the House of God. "Those tests cost a fortune. What evidence do you have that she has a bleeding disorder? For example, did you ask her if she suffers from nosebleeds?"
"Hey, great idea!" said Bruce, and ripped off down the hall to ask. Returning, he said, "Yeah, she suffers from nosebleeds. Great!"
"Wait a sec," I said, "everybody will say that when you ask, right?"
"Yeah, right," said Brucie, looking crestfallen.
"Did you ask her if she bleeds after tooth extraction?" asked Jo.
"Hey, terrific idea!" said Bruce, and ran out again. "Yup, she bleeds like crazy after tooth extractions."
"Brucie, everyone bleeds like crazy after extractions," I said.
"Damnit, Dr. Basch, you're right," said the BMS, and he looked sad, since to become an intern in the BMS system he had to make an A, and to do that he had to make a disease so he could make a cure and make a lecture, and he saw his grade fluttering down toward low C and his internship moving west of the Hudson River.
"Say, Brucie," I said nonchalantly, "what about bruising?"
"Bruising? Hey, fantastic idea?"
"WAIT! Save yourself a trip. She's gonna say yes, that she bruises easily, right?"
"Right, Dr. Basch. Who wouldn't say that?"
"No one," I said. "But how can you test it out for sure?" '
"I don't know," said Brucie, his fist furrowing his brow.
"Too bad," I said. "Bleeding disorders are fascinating."
All of a sudden Brucie lit up, shouted, "I got it!" and ran down the hallway, and a few seconds later there echoed back up to us a scream YEEE?OWWWW! and in a moment Brucie was back, grinning from ear to ear, and he said, "Well, I did it," and reached for the hematology slips.
"You did it? You did what?" asked Jo, eyes popping.
"I bruised her."
"WHAT? YOU DID WHAT?"
"Just like you suggested, Jo, I bruised Mrs. Biles. Punched her in the arm. You were right, I shouldn't have gone ahead with this expensive work?up until I'd bruised her with my own two hands."
Just before the Runt returned from his therapy, a forty?two?year?old patient of his had a cardiac arrest, and as the Runt came down the hallway, he was passed by the intubated patient being wheeled to the MICU by Eat My Dust Eddie, the tern on rotation here. The Runt looked horrified and said, "I'm sure it was something I did wrong."
"Don't be silly," I said, "it's a good TURF. Now, get out of here?you'll be late for your date with Thunder Thighs."
"I'm not going."
"You are. Think of those red pubic hairs:"
"I can't. I better go see Mrs. Risenshein. I feel terrible that these young patients are all dying."
"LAW NUMBER FOUR: THE PATIENT IS THE ONE WITH THE DISEASE. Get the hell out of here," I said, pushing him out the door. "Scram."
"I'll call you from the Chinese restaurant."
"Call me from the saddle or don't call me at all"
"But why? Why?" he screamed, his foot jamming the door like a salesman. "Why am I doing this?"
"Because it's limp."
"Because what's limp?"
"The whole goddamn shooting gallery. So long."
He left. As usual, all hell broke loose on the ward, mostly with the Runt's patients. The Runt had learned to be aggressive with the gomers and cautious with the dying young, and since Chuck and I had begun to believe the Fat Man's idea that the reverse was the essence of medical care, the Runt's patients were disasters, and the first part of each night on call had to be spent BUFFING the Runt's service, in secret, hidden from Jo, the Runt, and the charts. Surreptitiously I'd slip into the room containing the young asthmatic who would die without the steroids that the Runt was afraid to give her and BAM BAM hit her with a big secret dose that would get her through the night; next it would be his nice leukemic lady, whom Towl was keeping alive, and secretly I'd transfuse her six more units of platelets without which she'd bleed out before sunrise; and the final horrendoma was Lazarus, the alcoholic janitor, who was always in shock, always infected, and whom the Runt was always treating with homeopathic doses of meds for fear of doing something bad. Each day, Lazarus made a determined effort to die, usually by bleeding out, from nose or lip or gut or balls, and each night Chuck or I in a clandestine and almost religious operation would BUFF the shit out of him for his next day's thrilling adventures with a tern who was limp and unstrung and scared to death of doing anything active, anything active at all. That night I remembered that I'd forgotten what the Runt had told me just before he'd left the first time, when I'd asked him if he'd tapped the infection in Lazarus' ascitic belly:
"He's all right," the Runt had said, looking away.
"Wait a sec," I'd said, "did you tag his belly or not?"
"Jesus Christ! Why the hell not?"
"I never learned how. You need to use a big needle and I . . . I was scared I'd hurt him."
Limp. Cursing, I went into Lazarus' room, where he was dying again in earnest, and since I'd been in this situation with him every other night on call, I knew what to do, and got busy raising him up yet again:
Molly came up and said I had a phone call. It was the Runt.
"How's Mrs. Risenshein?" he asked.
"Fine, but Lazarus just started to go down the tubes," I said, telling myself I won't yell at him for not having tapped his belly.
"I should have tapped his belly:"
"Where are you?"
"Chinatown. But how's Lazarus?"
"What did you have?"
"Lo mein, moo goo gai pan, and a lotta rice, but how is he?"
"Sounds delicious, he went down the tubes," I said. "Oh, no! I'm coming in!"
"But I saved him."
"Hang on," I said, watching Molly gesture from Lazarus' room, "he's trying to go down the tubes again."
"I'm coming in!"
"What are you doing after dinner?"
"I thought I'd take her back to my place."
"What? With June there, are you nuts?"
"Never mind. I gotta go, but listen, whatever you do, do not take her back to your place. Go to her place. Remember: FAKE HIGH, GO LOW. So long:"
For some reason, admission diagnoses in the House of God ran in spurts: three cardiac, two renal, four pulmonary. That hot and dismal night, the disease matched the oppression?it was cancer night at the House. First it was a little tailor named Saul. As I read his chart in the E.W., Howard?the tern who seemed to love every aspect of the ternship and whom I hated for that?bubbling with excitement at "really being a doc," told me that Saul had pneumonia. The blood smear told me that Saul had acute leukemia, his pneumonia being part of his generalized sepsis because his white cells didn't work. Saul knew he was sick, although he didn't know yet how sick, and when I wheeled him to X-Ray for his chest film, I asked him if he could stand up by himself.
"Stand up? I could peech a full game," said Saul, and fell down. I propped him up, this little bony just-young?enough?to?die old man, whom I'd just told he had leukemia. As I left him to himself in front of the X?ray beam, his boxer shorts fell down.
"Saul," I said, "you're losing your shorts."
"Yeh. So? Here I'm losing my life, and you tell me I'm losing my shorts?"
I was moved. He was all of our grandfathers. With the laconic resignation of a Diasporic Jew he was watching the latest Nazi?leukemia?force him from his only real home, his life. Leukemia was the epitome of my helplessness, for the treatment was to bomb the bone marrow with cell poisons called cytotoxins until it looked, under the microscope, like Hiroshima, all black, empty, and scorched. And then you waited to see whether the marrow regenerated any healthy cells, or the same old cancer. Since there was a period of time when there were no blood cells?no whites to fight infection and no reds to carry oxygen and no platelets to stop bleeding?to deliver care was to fight: the infection and transfuse red cells for oxygen ands platelets to control bleeding, all the time creating more bleeding and anemia by drawing blood for countless' tests. Terrific. I'd gone through it with Dr. Sanders,: and I hated it. The start of this horrific treatment was to inject modified rat poison, nicknamed the Red Death for its color and the way it eroded your skin if you splashed it around; directly into Saul's veins. Thinking "so long, marrow," I did so, brimming with disgust.
The second E.W. admission: Jimmy the name, cancer the game. Young enough to die for sure. Howard, smiling, chubby, smoking his chubby pipe like a TV doc, presented the case to me: pneumonia, and Howard thought he might have leukemia. One look at Jimmy's chest X Ray showed that Howie had missed a homungus lung cancer that would kill Jimmy pretty quick. As I worked on him in the E.W., trying to shoo away the hovering Howie, I heard Hooper battling a gomere behind the next curtain. The gomere, his third admission of the night, was trying to kick him in the nuts. I asked Hooper how it was going.
"Terrible. MOR, Roy, MOR."
"Marriage On Rocks. We're both doing everything we can?joined a California?style sauna where they whip you with hot eucalyptus leaves and give you some aquanude group psychotherapy but I don't think it's going to work. The little woman is mad as hell that I'm here all the time, and that I'm into death."
"You're into death?"
"Who isn't? It's where we're all headed, you know."
"I can't deny that, but I guess I just don't get the charge out of it that you do. I'm sorry about the MOR," I said, wondering if my R?for Relationship?would get to the point of ROR during the internship.
"Doesn't matter," said the hyperactive tern, "no kids. In California, being married two years means you've hit the median. Hey, I got a question for you: do you think it's legal to have this woman sign her own postmortem permission slip along with her insurance voucher?"
"It's probably legal, but I'm not sure it's ethical."
"Great," said Hooper, "another post coming up. In Sausalito nobody's heard of ethics. Hey, thanks. I didn't want to stay married to that bitch anyway. You should see what I've got simmering down in the morgue."
"In the morgue?"
"A female pathology resident from Israel. Dynamite. Grooves on thanatos, like me. Romeo and Juliet, man, so long."
I sat in the E.W. nursing station thinking about how the Leggo and the Fish had blessed our ward with "the toughies," the dying young, like Jimmy, like my friend Dr. Sanders, out there on his last fishing trip before his last autumn?
"That's tough to do, to face the dying and the dead"
I looked up. It was one of the policemen, the fat one, Gilheeny.
"Strength of character," said the other one, Quick, "it doesn't grow on trees."
"Nor can one buy it in any store," said the redhead. "It's the toilet training that does it, I do believe. So said Freud and Cohen."
"Where did an Irish cop learn about Freud?" I asked.
"Where? Why, here, man, here, from spending the last twenty years here, five nights a week; in trialogues of discussion with fine young overeducated men like: you: Better than night school, more broad and useful.' And we get paid to attend."
"Not only that," said Quick, "but all the different viewpoints contribute. Over twenty years one learns a good deal. Currently a surgeon named Gath brings?the news from the Southern Rim, and with Cohen we are in the middle of a gold mine of psychoanalytical thought."
"Who is Cohen?"
"A sophisticated, jocular, and unrestrained resident in psychiatry," said Quick. "A textbook in himself."
"You must make his acquaintance," said Gilheeng Twitching his red eyebrows so that they coerced the rest of his fat face into a gap?toothed smile, he went on, "We can hardly wait to hear from a Rhodes Scholar like yourself, a man with high qualities of body mind, with experience gleaned from corners of the round globe, like England, France, and the Emerald Isle, which I have visited only twice."
"A textbook in yourself," said Quick.
Upstairs, I had just finished working Jimmy over, putting in lines and tubes and starting to treat his untreatable diseases, when Mrs. Risenshein arrested and I was surprised to hear myself cursing under my breath as I resuscitated her, "I wish she would die so I could just go to sleep," and I was shocked when I realized that I'd just wished a human being dead so I could go to sleep. Animal. Eat My Dust rolled up from the MICU to take Risenshein away and I asked how he was.
"Glad you asked. It's going just great. Here, Bob," he said, nodding to his BMS, "wheel this stretcher on down to the Unit, will you, pal? Keep pumping the oxygen and keep the lines open, I'm just going up to floor eight for a minute to jump off and kill myself."
He left, and Molly?clean and pretty and sexy and off duty left, and I was desolate watching her go.
I should have been going with her. The Runt called back again.
"How's Lazarus?" he asked.
"Stable. Where are you?"
"At Angel's. I'm scared. How's Risenshein?"
"There's nothing to be scared about. Risenshein's had a cardiac arrest and is in the MICU:"
"Oh, no! I'm coming in right away!"
"You do and I'll kill you. Put Angel on"
"Hi, Roy," said a healthy drunk voice, "I'm"?gesture?"drunk."
"Fine. Listen, Angel, I'm worried about the Runt. He's not going to make it unless he gets some confidence in himself. He's a great guy, but he needs some confidence. Chuck and I are really concerned?suicide?that's how concerned we are"
"Sruicide!" Gesture. "Wow! WhatcanIdo?"
I told Angel exactly what she could do to prevent the Runt's suicide.
"Sruicide!" Gesture. "You mean he's freee?"
"Not yet, Angie. Right now, he's still a bird in a cage. Open it up, Angel, set him free, let him fly."
"Flyfly his"?gesture?"fly bye?bye," and the phone went dead.
Hot, sweaty, with the dried sweat salt like sand on my eyelids, with my flu declaring itself in malaise, photophobia, myalgia, nausea, and diarrhea, cursing being in the House while Molly was out and Berry was out where and with whom??and while the Runt was getting seduced out of "sruicide," I tried to finish my write?up of young and soon?to?be?dead Jimmy. Chubby, grinning, puffing his pipe, Howard appeared.
"What the hell are you doing up here?"
"Oh, I just thought I'd do some follow?up on Jimmy. Great case. Guess he's had it, huh? Oh, and I wanted to ask, you about that nurse in the MICU, Angel. Very fine girl, and I thought I might ask her out."
I watched him puff his pipe, and, hating him because his happy life even in the House was a puff on his pipe, I said, "Oh, so you haven't heard about the Runt and Angel?"
"No. You don't mean?"
"Exactly. At this very moment. And, Howard, listen carefully: you should see what she does with her mouth."
"With her . . . her what?"
"Her mouth," I said, knowing that by morning Howard would have puffed what Angel did with her mouth all over God's House. "See, she takes her lips and she puts them around his?"
"Well, I don't want to hear about that, and I'm glad you warned me before I asked her out. But I want to know why when I took Jimmy's blood pressure just now it was only forty systolic."
"It's what?" I said, rushing into Jimmy's room, where I found that it was forty systolic and Jimmy was trying to die right away. I panicked. I didn't know where to start, to save him. I looked at Howard leaning casually against the doorway lighting his pipe and smiling, and I said, "Howard, help me with this."
"Oh, yes? And what might I do?"
I didn't know what he might do or what I might do either, but then I thought of the Fat Man and I said, "Page the Fat Man, stat."
"Oh? Do you think you need him? No, you can handle it, Roy. Besides, they say you can't become a real doctor without killing a few patients at the least."
"Do something to help me," I said, trying to think clearly.
"What might I do?"
The Fat Man arrived, puffing from the race up the stairs, and sensing my panic, ordered me to take my own pulse. As I did so, he began to get Jimmy organized so he would not die right then. Fats attacked Jimmy with that fantastic smooth expertise of his, and you could almost hear the click click click of each essential procedure. Fats chattered as he worked, addressing comments to us all, including the nurse and a woman named Gracie from Dietary and Food Services who somehow at that late hour had been with him in bed?!-
"What's wrong with Jimmy?" asked Fats, putting in a big needle.
"Cancer of the lung," I said.
"Christ," said Fats, "and he's young enough to die."
"If I were you, I'd try laetrile," said Gracie from Dietary and Food Services.
"Try what?" asked Fats, stopping trying to save Jimmy.
"Laetrile. A cure for cancer," said Gracie.
"A what for what?" shot out Fats, standing up stockstill.
"The Mexicans have found that an extract from apricot pits, called laetrile, can cure cancer. Controversial, but—"
"But worth a big fortoona," said Fats, eyes aglitter: "Hey, listen, I gotta hear more about this, Roy," he said, starting to leave.
"Fats, wait!" I said. "Don't leave me yet!"
"Did you hear what Gracie said, Roy? A cure for cancer. Come on, Gracie, I want you to tell me more."
"It's bullshit," I said. "There's no cure for cancer, it's a hoax."
"It's not," said Gracie from Dietary and Food indignantly, "it worked on my cousin's husband. He was dying and now he's fine."
"Dying and now he's fine," said Fats, and then, walking toward the door, he murmured, as if in a trance, "dying and now he's fine."
"Please, Fats," I said, "don't leave me alone yet," as Jimmy began once again to die and I began once again to panic.
"Why not?" asked Fats, puzzled.
"Still? You still need some help?"
"Yes, I do."
"Well, then, you're going to get it. Let's get to work."
We got to work, but soon I realized that Fats had slipped away, and I was left alone with Jimmy and Howie and Maxine, the night nurse. And then I knew that Fats's slipping away and leaving me in charge meant that he knew I could handle it, and I felt a warm rush go through me. I could handle it, and although all I wanted to do was to beat the shit out of Howard, I worked on Jimmy until it was clear that he needed to be breathed by a respirator, which meant a TURF to the SICU-Surgical Intensive Care Unit-and as I watched the cheery sadistic surgical resident wheel Jimmy off, Jimmy, who by now was surrounded by so much tubing that he looked like a meat ball in the middle of a plate of spaghetti, I felt great relief, and I heard Howard say, "Impressive job on a tough case," and he left and I was filled to my eyeballs with hate.
With the sweat dripping from my brow onto Jimmy's chart and the flu dripping through every muscle and bowel villas in my body, I finished my write-up and sent the Bruiser along with it to the SICU. I sat for a moment musing: Well, this has been the worst night of my life, but now it's over, and now I can go to sleep. They can't get me now. Through the open window came that comforting smell of fresh rain on hot asphalt. The nurse came in and said, "Mr. Lazarus has just had a bowel movement that is all blood:"
"Hey, that's really funny, Maxine. You got a great sense of humor."
"No, I'm serious. The bed is solid blood."
They wanted me to go on, and I could not. The world became the world just before the head?on crash. It could not be what it was. "I can't do anything more tonight," I heard myself say. "I'll see you in the morning."
"Look, Roy, don't you understand? He's just bled out a gallon of blood. He's lying in it. You're the doctor, and you have to do something for him."
Filled with hate, trying to get rid of thoughts that Lazarus wanted to die and I wanted him to die and I had to break my ass to stop him from dying, I went into his room and was face to face with black putrid sticky wet blood. On autopilot, I went to work. My last clear memory was putting a naso-gastric tube down into Lazarus' stomach and having the bloody vomit spew up and out and all over me, as Lazarus rolled his death-defying eyes.
Just after Lazarus, just before dawn, Dr. Sanders came back in, bald from the chemotherapy, infected and bleeding, having had to cut short his fishing trip.
"1'm glad you'll be taking care of me again," he said weakly.
"So am I," I said, wondering if this admission would be his last, and realizing how attached to him I felt.
"Just remember: no whispering behind my back, Roy. And as for heroic measures-we'll talk about that, together."
I put him in the same room with Saul the leukemic tailor, thinking that while Sanders would die, Saul might be just old enough to survive. How crazy was that? As I lay down in my spewed clothes for my hour's sleep, I found myself wondering where Molly was, more than where Berry was, and wondered if that meant that it was the beginning of the ROR?Romance On Rocks?and then I thought with pleasure of the phone call I'd gotten at about one A.M. from June, the Runt's poet, wondering if I knew where he was, and I chuckled at that and composed a letter in my head to give the Runt in the morning: "Congratulations on your bravo three?dimensional night of love. You are herewith charged with rape. Red pubic hairs, I might warn you, will stand up in court." But then I realized that, Goddamn! the Runt was seeing what Angel did with her mouth while I still hadn't gotten past Molly's long nipples, and then finally I recalled that no one yet knew what Angel did with her mouth because I'd just made that up to torment that optimist Howard, who knew that being a doc really was the cat's balls after all. And I realized that they could never hurt me more than they had just hurt me that night, and that out of chaos like this had to come confidence and skill. Something had happened when I was with Saul and Jimmy and Lazarus and Dr. Sanders, and I didn't know for sure what, but I knew that from taking the risks and learning and remembering Fats, I had pinned down my terror and exploded it to bits. From that night on, I might be everything else, but I'd never again be panicked in the House of God. It was a thrilling thought?almost like in the intern novels and in the inside of Howard's skull and in my father's letters?until I realized with alarm that I hadn't learned how to save anyone at all, not Dr. Sanders or Lazarus or Jimmy or Saul or Anna O., and that what I was thrilled about was learning how to save myself.