The house of God

"Roy, this is the greatest day of this woman's life, 'cause she's finally had a bona fide heart attack"

I tried to pursuade the intensive?care resident to take her off my service, but taking one look and saying, "Are you for real?" he refused the TURF. Sheepishly, trying to avoid the family, I slunk down the hallway. The Fat Man pointed out a valuable House LAW, NUMBER EIGHT: THEY CAN ALWAYS HURT YOU MORE. I finished my work for the day, and, woozy, paged Potts, to sign out to him for the night. I asked him how it was going.

"Bad. Ina's on some kind of rampage, stealing shoes and pissing in them. I never should have given her the Valium."

"Yeah. To try to control her violence. Worked with the Runt, so I thought I'd try it on her. Made her worse."

Walking to the elevator with the Fat Man, I said, "You know, I think these gomers are trying to hurt me."

"Of course they are. They try to hurt everyone."

"What difference does that make? I never did anything to hurt them, and they're trying to hurt me."

"Exactly, that's modern medicine."

"You're crazy."

"You have to be crazy to do this."

"But if that's all there is, I can't take it. No way."

"Of course you can, Roy. Trash your illusions, and the world will beat a pathway to your door."

"And he was gone. I waited for Berry to pick me up outside the House. When she saw me, her face twisted in disgust.

"Roy! You're green! Phew! Stinky! Green and stinky! What happened?"

"They got me."

"Got you?"

"Yeah. They killed me."

"Who did?"

"The gomers. But the Fat Man just told me that they hurt everybody and that's modern medicine so I don't know what to think anymore. He said to trash my illusions and the world would beat a pathway to my door."

"That sounds bizarre."

"That's what I said too, but now I'm not so sure."

"I could make you feel better," said Berry.

"Just tuck me in."

"What?"

"Just put me in my bed and tuck me in"

"But today's your birthday. We're going out to di

"I forgot."

"Your own birthday and you forgot?"

"Yup. I'm green and stinky, and just tuck me in."

She tucked me in, and green and smelly as I was said she loved me all the same and I said I loved her too but it was a lie because they had destroyed something in me and it was some lush thing that had to do with love and I was asleep before she closed the door.

The phone went off, and out of it came two-part harmony: "Happy birthday to you, happy birthday to you, happy birthday dear Roy-oiy, happy birthday to you." My birthday, forgotten, then remembered, then forgotten again. My parents. My father said, "I hope that you're not too tired and it must be great to have patients of your very own at last," and I knew he thought modern medicine was the greatest invention since the high-speed dental drill, and as I hung up I thought of Dr. Sanders, who would die, and of the gomers, who would not, and I tried to figure out what was illusion and what was not. I had expected, just like in the How 1 Saved the World Without Dirtying My Whiter book, to have been rushing in and saving people at the last moments, and here I had been observing a wrecked Southerner being socked in the puss by a gomere wearing a ram-horned football helmet, all the time being told by a fat wizard who was a wonderful doc and also something phantasmagorical like either a madman or a genius that doing nothing except BUFFING and TURFING was the essence of the delivery of medical care. If there had been the feeling of power in the empty corridor at night and in the crowded elevator during the day, there had also been the awesome powerlessness in the face of the gomers and the helpless incurable young. Sure there had been the clean whites, and the clean white of Putzel's Continental, but the clean whites had gotten spewed with vomit and blood and piss and shit, and the dirty sheets had bred bugs that went right for the finger and the eye, and Putzel was a jerk. In months, Dr. Sanders would be dead. If I knew that I were to die in months, would. I spend my time like this? Nope. My mortal healthy body, my ridiculous diseased life. Waiting for the hard screaming line?drive ball, for the aneurysm straining in my brain stem to pop and squirt blood all over my cortex, draining it dry. And now there was no way out. I'd become a tern in the stinky tern in the green house in the House of God.

6

At the end of three weeks, the Fat Man was TURFED out of the House of God to do a rotation at one of the neighboring community hospitals, what he had called one of "The Mt. St. Elsewheres." Although he would still be the resident on call with me every third night, in his fat wake came the new ward resident, the woman named Jo, whose pop had just leaped to his death off a bridge. Like so many of us in medicine, Jo was a victim of success. Growing up short and wiry, plain and tough, in adolescence Jo had ignored her mother's invitations to come out as a deb and had concentrated instead on biology, dissecting rather than attending balls. She first became a victim of success when she successfully a

From the first day that Jo stood before us, feet apart and hands on hips like the captain of a ship and said, "Welcome aboard," it was clear that she was so different from the Fat Man that she would be a threat to all he'd taught us. A short, trim woman with clipped black hair, a jutting jaw, and dark circles under her eyes, she wore a white skirt and a white jacket, and in a special holster fastened to her belt was a two?inch-thick black ring notebook filled with her own transcription of the three?thousand?page Principles of Internal Medicine. If it wasn't in her head, it was on her hip. She spoke strangely, in a monotone devoid of feeling. If it wasn't fact, she didn't handle it. She recognized no humor. "Sorry I couldn't be here when I was scheduled to," she said to Chuck and Potts and me and the BMSs that first day, "but I had personal reasons for being away."

"Yes, we heard," said Potts. "How are things now?"

"They're fine. These things do happen. I took it in stride. I'm glad to be back at work to get my mind off it. I know you had the Fat Man for the first three weeks, and I want you to know that I do things differently. Do things my way and we'll get along swell. There's nothing sloppy about the way I run a ward. No loose ends. OK, gang, let's go make rounds. Get the chart rack, eh?"

Delighted, Levy the Lost leaped up to get the chart rack.

"With Fats," I said, "we sat here for rounds. It was relaxing and efficient?"

"And sloppy. I see every patient every day. There's a no excuse for not seeing every patient every day. You'll soon find out that the more you do in medicine, the better care you give. I do as much as possible. It takes, a little longer, but it's worth it. Oh, by the way, that means that rounds will start earlier?mix?thirty. Got it? Swell. I run a tight ship. No slop. My career interest is cardiology. I've got an NIH Fellowship next year..: We'll be listening to a lot of hearts. But listen: if there are any complaints, I want to hear 'em. Out in the open, got it? OK, gang, let's cast off."