The house of God

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

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

"What's that?"

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

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

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

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

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

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

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

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

"Who's Otis?" I asked.

"My dog. I want my dog."

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

We asked what was a BUFF.

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

PURRTY GUD.

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

PURRTY GUD.

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

Responsively, we repeated: GOMERS GO TO GROUND.

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

"Seventy over forty," said Maxine.

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

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

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

PURRTY GUD.

A trouper.

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

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

Nobody knew.

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

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

PURRTY GUD.

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

"GOMERS GO TO GROUND," we said automatically.

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

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

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

PURRTY GUD.

"But he always says that."

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

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

"What?"

KEEP THE LOWDOWN LOW.

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