The house of God

I stood outside the gynecology room and read first clipboard: Princess Hope, sixteen, black, pain the stomach. I went blank, like during the first week of the ternship. What did I know about pain in stomach? I'd had pain in my stomach, yes, but in woman it's different: too many organs, and the same pain can stand for a decomposing tuna sandwich or a decomposing ectopic pregnancy that will kill in an hour. I paused outside the door.

"Go on in there," yelled Sylvia. "she ain't got nuthin'."

I went in. Nine times out of ten in that room it would be small?time: V.D., vagitch, urinary, or tuna. This time, I thought it was big?time: appendicitis. I went back out to the nursing station and Sylvia said, "If you take that long with one, you'll only see about ten a day, and Abe will kill you."

"I think she's got appendicitis"

"Damn! Would you listen to this? Get me my scalpal, honey."

Hearing the word "scalpel," Gath was at my elbow. Eager yet skeptical, he listened to my diagnosis, and walked into the room. Nervous about my reputation, I retreated to the toilet. After a few minutes an Alabama?cracker voice outside the door yelled:

"Basch, boah? Hey, boah, you in theah?"

"Yes"

"Can we'all come in theah, boah?"

"What for?"

"To congratulate you. In the opinion of Dr. Dwayne Gath, surgical resident in this E.W., we got a keeper. Hotcha!"

"What's a keeper?"

"Keeper? 'Pendix. You go in theah with the steel blade, find 'er, and keep 'er. Listen heah: THE ONLY WAY TO HEAL IS WITH COLD STEEL. Basch , you gave some hungry surgeon a chance to cut, and A CHANCE TO CUT IS A CHANCE TO CURE. We gu

Wiping the sweat off my brow, I opened the bathroom door to the beaming eyes of a Good Ole Boy who'd just given a surgical buddy of his a chance to cut on human flesh.

Feeling better, I began to see other patients. I began to get bogged down with the lonely horrendomas, the LOLs in NAD and the gomers with multisystem disease, often the severity of which, according to textbooks, was "incompatible with life." I began poring over them, doing things I'd done on the wards?taking a history, doing a physical, putting in IVs, feeding tubes, Foley catheters, begi

"You wa

"Yes."

"Good. Two rules: one, treat only the life?threatening emergencies; two, everything else, TURF. You know TURF?"

"Yes, the Fat Man taught me."

"Oh? Great. So you're all set. Like he says, BUFF 'n' TURF.' It's not easy to separate emergencies from turkeys, especially in the Holiday Season, and it's even harder to TURF so they don't BOUNCE. It's an art. If they're not emergencies, we don't handle 'em. Now, get back in there and BUFF 'n' TURF like crazy!"

What a relief. Familiar Fat Man ground. These bodies, seeking rest, would get none here: They'd either get TURFED back out to the street, TURFED up into the wards, or, if dead, TURFED down to the morgue. The most grotesque screaming gomer might arrive, and I could attack the case with the calm assurance that soon he would be TURFED elsewhere. A mind?boggling thought: the delivery of medical care consisted of BUFFING and TURFING the seeker of care somewhere else. The revolving door, with that eternally revolving door always waiting in the end.

The task was to separate disease from hypochondria. With the waiting room jammed with lonely, hungry bodies seeking a warm place to spend the winter night, complete with clean linen, good food, and attention of a spanking fresh round?assed nurse and a real doctor, to MEET 'EM AND STREET 'EM was not easy. Having had years of experience with the House of God, many of the alleged ill had developed sophisticated methods to get in. I'd been a tern for less than six months; they'd been getting admitted to the House for up to ninety years. All it would take, often, was to have fooled one tern, years before, and thus to have documentation in the old chart, for with the increased threat of litigation, none of us could ignore documented disease. Using the local library, these people had BUFFED their own charts, and knew more about their diseases than me. A particular symptom of a given documented old disease could be revved up on any given night, and the sufferer admitted to be hugged and suckled at the bazooms of the House of God.

I began to work through the multiglomerate experienced ill. At one point, as I was BUFFING a gomer, I felt a tap on the back of my leg, low down. I turned and saw Chuck and the Runt, kneeling on the tile floor, looking up at me like cockerspaniel pups in the window of a pet shop. The Fat Man stood behind them:

"Don't tell me," I said, "let me guess what you're on."

They told me anyway. They were on their knees.

"Man, do you know why?" asked Chuck.

"Because the last twelve weeks," said the Runt, "Howard has been in the E.W., and he's so scared of missing something by sending the patient back home that he admits them all. He's a SIEVE."

"A SIEVE?" I asked.

"Right," said Fats, "he lets everyone through. At Bellevue half the ones Howie admitted would have been TURFED out by the receptionist. Or they would have been too embarrassed to come in. New Yorkers have some pride, especially when it comes to degradation. Howie's been letting through six admissions per tern per day. These poor boys are on their knees. They were your friends, remember?"

"They still are," I said. "What can I do?"

"Man," said Chuck, "be a WALL. Don't let anyone in."

"In New York once," said Fats, "we had a contest to see how long the medical service could go without an admission. Thirty?seven hours. You shoulda seen what we sent outta there. Roy, help them. Be a WALL."

"You can count on me," I said, and watched them leave.

Later that afternoon I was sitting at the nursing station, 'musing on SIEVES AND WALLS .

"There's a cardiac case in the car!"

A woman stood inside the automatic doors, screaming. My first thought was that she was crazy, my second was why would a cardiac case be in a car and not an ambulance and that she was joking, and then I panicked. Before I could move, Gath and the nurses were ru