The house of God

This was our second field trip: The Fish took us on field trips to get us out of the House, to minimize the damage we were doing to his Chief Residency year and his career. The first field trip had been a ghetto health center, where the Fish had seemed ill at ease. This was the opposite. The Pearl had risen up through the House Slurpers as easily as the Fish might have wished, and by this time had become the richest Private in the House, the city, perhaps the world. In his office all was automated and set to Muzak. The Muzak played Fiddler on the Roof. The place was jam?packed: LOLs in NAD getting their blood drawn humming in tune with SUNRISE SUNSET, waiting to move on around the corner where the tech and the LOL in NAD could hum TRADISHUNNNN as the EKG was done, and then, further along past the sign that said "This way to A

"Of course. Even in the bowels of the nonstars, one can find the big fortoonas."

After the ten?o'clock meal I went to see Molly on floor six. She was mad at me for forgetting it was Valentine's Day and not getting her a gift. She yelled at me and I felt guilty because I did like her and I even found myself dreaming about her, which must have meant that I sort of loved her, and I really loved making love to her because she still moaned like a moist Mesopotamian every damn time. Theoretically I had just as much interest in her, and I still saw her as a short?skirted majorette from St. Mesopotamia High marching along throwing her tan kneecaps first at one curb and then at the other and masturbating the longest baton in the band between those far?flung thighs producing MIS in the senile Legio

"Agonal respirations mean death. Is he supposed to die?"

"That's just it: I'm not sure. He's got end-stage multiple myeloma and renal failure and he's been in coma for weeks, but Dr. Putzel has never told the family and there's an argument about his dialysis continuing and about when he's supposed to die. It's all confused."

I went and saw him. It was too much. Young man, gray and dying, filling the room with his stale ammonium breath, His human centers of respiration were dead and phylogenetically he was breathing like a stranded fish. I went back to Molly and said, "He'll be dead in fifteen minutes. He's not in any pain?"

"No. The Runt's been giving him morphine all night."

"Good." Overcome with tenderness because she and I were young and not dying but one day would die, filled to our gills with morphine if we were lucky, I said, "Go draw his curtain, love, and come sit down with me and talk.

The House of God found it difficult to let some young terminal guy die without pain, in peace. Even though Putzel and the Runt had agreed to let the Man With Agonal Respirations die that night, his kidney consult, a House red?hot Slurper named Mickey who'd been a football star in college, came along, went to see the Agonal Man, roared back to us and paged the Runt STAT. Mickey was foaming at the mouth, mad as hell that his "case", was dying. I mentioned the end?stage bone cancer, and Mickey said, "Yeah, but we've got an eight?grand dialysis shunt in his arm and every three days the dialysis team gets all his blood numbers smack back into line perfect." Knowing there was going to be a mess, I left. The Runt came out of the elevator, fuming, and ran down the long corridor, his stethoscope swinging side to side like an elephant's trunk. I thought of the bones in multiple myeloma: eaten away by the cancer until they're as brittle as Rice Krispies. In a few minutes the Man With Agonal Respirations would have a cardiac arrest. If Mickey tried to pump his chest, his bones would crunch into little bitty bits. Not even Mickey, seduced into the Leggo's philosophy of doing everything always for every patient forever, would dare call a cardiac arrest.

Mickey called a cardiac arrest. From all over the House, terns and residents stormed into the room to save the Man With Agonal Respirations from a painless peaceful death. I entered the room and saw an even bigger mess than I'd imagined: Mickey was pumping up and down on the chest and you could hear the brittle bones snap, crackle, and pop under his meaty hands: a Hindu anesthesiologist pumped oxygen at the head of the bed, looking over the mess with a compassionate disdain, perhaps thinking back to the dead beggars littering dawn in Bombay; Molly was in tears, trying to follow orders, with the Runt shouting, "Stop! Don't resuscitate him!" and Mickey cracking and crunching and shouting, "Go all?out! Every three days his blood numbers are perfect!"

And yet the most sickening part of it was when Howard, pipe clenched like a bit between his teeth, ran into the room, with a nervous smile decided to take charge, and just like the tern in the How I Saved the World book, shouted out, "Gotta get a big line into this guy; STAT!" grabbed a homungus big needle, saw a pulsating vessel in the forearm, which happened to be the surgically constructed, meticulously protected shunt between artery and vein, which was Mickey's dialysis team's pride and joy, and, eyes glittering with big?time?intern excitement, Howie rammed the needle home, destroying forever Mickey's continued attainment of perfection every three days. When Mickey saw this, he stopped crunching, his eyes got fierce as a linebacker's, and he went bananas, screaming, "That's my shunt! You asshole, that's my shunt! Eight grand to make it, and you wrecked my shunt!" That was it for me, and I left, thinking to myself, Well, at least they'll end it here and not transfer the Man With Agonal Respirations And Crushed Bones to the MICU.

They transferred him to the MICU, where Chuck was the tern on call. When I went to see Chuck, I saw the family outside the MICU, weeping as Mickey explained things to them. Chuck was drenched in blood, bent over the residual mess of the Man With Agonal Respirations, who now had no respirations at all except those generated by a respirator. Chuck looked from the mess and said, "Hey, man, great case, eh?"