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There was no way that Chuck or I would show up for rounds an hour earlier than we had been showing up for rounds. We followed Jo as she marched out of the room with that fanaticism known only to an overachiever, one who lives with the eternal fear that soma lurking underachiever will, in a flash of brilliance, achieve more. As we wheeled the chart rack into and out of the room of every one of the forty?five patients on the ward, with Jo examining each one and then shooting off a lecture from the transcription holstered on her hip, telling each of the terns what he had forgotten to do, I felt a growing apprehension. How could we survive her? She went against everything Fats had taught. She would work us into the ground.
We came to the room containing A
ROODLE ROODLE ROOOOO?DLE!
After she'd finished, Jo asked me what the most important part of A
Thinking of the Fat Man's LAWS, I said, "Placement."
"What?"
"PLACEMENT COMES FIRST."
"Who taught you that?"
"The Fat Man."
"That is baloney," said Jo. "This woman is suffering from a severe senile dementia. She's oriented neither to place, time, nor person, all she says is ROODLE, she's incontinent, and confused. There are several treatable causes for dementia, one of which is operable brain tumor. We've got to work it up completely. Let me tell you about it."
Jo shot off a lecture on the treatable causes of dementia, filled with obscure neuro-anatomical references that brought back to me a story I'd heard about her and an anatomy exam at the BMS. The exam had been impossible, the average score forty?two, and Jo had made ninety?nine. The one question she'd missed was to "identify the Circle of Polgi," which turned out to be a trick question, the said Circle being the traffic island situated just outside the front door of the BMS dorm. Jo's lecture on A
"Start ordering the tests," said Jo to me, "we're really going to work this up. Completely. No, one's going to be able to say that we do sloppy work."
"But the Fat Man said that A
"Dementia's never normal," said Jo, "never."
"Maybe not," I said, "but the Fat Man said that the way to treat her is to do nothing except try like hell to find a new bed at the nursing home."
"I never do nothing. I'm a doctor, I deliver medical care."
"The Fat Man said that for gomers, doing nothing is the delivery of medical care. If you do something, he said, you make everything worse. Like Potts hydrating Ina Goober?she's never recovered from that."
"And you believed him?" asked Jo.
"Well, it seems to be working with A
"You listen to me, smartass," said Jo, amazed and threatened. "One?the Fat Man is nuts; two?if you don't believe me, ask anyone else in the House; three?that's why they wouldn't let him start with the new terns; four?I'm the captain of this ship, and I deliver medical care, which, for your information, means not doing nothing, but doing something. In fact, doing everything you can, see?"
"Sort of. But Fats said that was the worst—"
"Stop! I don't want to hear it. Do the work?up for treatable causes of dementia: LP, brain scan, bloodwork, skull films. Do it all, and then if it's negative, then talk to me about placement. Ridiculous. All right, gang, let's shove off and move on. Next?"
We sailed through Rokitansky, Sophie, Ina with her football helmet that Jo removed, the sick Dr. Sanders, and all the rest, almost all of whom wound up with some hitherto undetected cardiac disease, Jo's specialty. We finished just outside the door of the Yellow Man, at the border of the domain of 6?North. Even though he was not our patient, Jo had to have a look at him. Coming out, she turned to Potts and said, "I heard about this case. Fulminant necrotic hepatitis. Fatal unless you catch it early and use steroids. Let me tell you about it."
She blasted off with her lecture on the disease, oblivious to the pain on Potts's face. She finished, said she would photocopy references for us, and left to tell the Fish and the Leggo, on their rounds, about our rounds. Somehow she'd managed to deflate each of us. She'd left something in the air, something tight and heavy and gray, a stomach churning in the leap down toward the water from the bridge.
"Well, she sure is something else than Fats," said Chuck.
"I miss him already," I said.
"Seems like everybody knows about the Yellow Man," said Potts.
"Do you think I should do the dementia work?up on A
"Don't look like you got much choice, man."
"The Fat Man was never wrong, not once," I said.
"I don't think there's anybody in the whole worl' who knows more about the gomers than Fats," said Chuck. "He was a cool dude about these gomers. Be cool, Roy, be cool."
Prodded by my fear of missing something and being haunted by it as Potts was haunted by the Yellow Man, in the first weeks with Jo I did what she suggested. I ordered every test I could think of on every patient I had, and I wrote down everything in the charts. With Jo's help, I even wrote down references, in footnotes. The charts soon looked terrific, BUFFED to a fine shine. The House Slurpers like the Fish and the Leggo took a look at the shiny BUFFED charts and their faces lit up with fine and shiny smiles. BUFF the chart, you automatically BUFF the Slurpers. Not only that, but I soon found out that the more tests I ordered, the more complications there were, the longer the House kept the patients, and the more money the Privates collected. BUFF the chart, you automatically BUFF the Privates. Jo was right: the.more you did, the more you BUFFED the doctors.
The hooker was the patients, especially the gomers. About the gomers Jo was dead wrong. The more I did, the worse they got. A
"What the hell are you doing?" he asked.