The house of God

"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?"

"Nope."

"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."

"Hey, great!"

"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 di

"I thought I'd take her back to my place."

"What? With June there, are you nuts?"

"Why not?"

"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."

"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."