The house of God

Berry and I were laughing over the lead article in Doctor's Wife, a tribute to a terrific doctor's wife who; "becoming aware of the depth charges in a doctor's' di

"No, I think it's integration, working out what to do with yourself. Now that you know you can be doctor, you've got the option of discarding medicine and moving on. What are you thinking of doing?"

"Going on vacation to France with you. Maybe to taking a year off."

"But what are you going to tell the Leggo about July?"

"I don't know. I hated this. The whole year sucked."

"Not true. Fats, the policemen, your buddies?you liked them. And you liked listening to your patients in the Clinic, right?"

"As long as I didn't have to do anything medical, it was fun."

"In the E.W., you were fascinated by the psych resident, Cohen." Tantalizingly she asked, "Why not become a psychiatrist?"

"Me?" I said, surprised. "A shrink?"

"You." Looking me squarely in the eyes, she said, "Being with people was all that kept you going this year, Roy. And 'being with' is the essence of psychiatry."

CLICK. In my head, CLICK. I asked her to repeat what she'd said.

" 'Being with' is the essence of psychiatry. You've always perched yourself at a slight angle to the universe. Psychiatry might be perfect for you."

Being with. CLICK. Dr. Sanders, dying, telling me that what doctors did was to "be with" patients. "You mean 'being with' patients?"

"I mean being with," she said. "Even being with your family."

Family? My grandfather, TURFED to rot in a home, never again to be with anyone: my father?

. . There is nothing more comforting during illness than a loved one to be with you and a good physician can serve that role .

"You're saying that psychiatry really offers something to patients? That it's different from medicine in that you can cure?"

"Sometimes. If you catch a life early, yes."

"So the big thing is that you can offer something to patients?" '

"No. You can offer something to yourself."

Stu

"Growth. Instead of forgetting, you'd try to remember. Instead of defensive, obsessive superficiality, you'd try to become open, looser, deep. You'd create. Your only tool as a therapist is who you are and who you might become."

It was hard for me to think. Somehow, in the chaos, something was clearing. I might become someone I might not despise? Escape being strapped into the rocker of past, culling my memories for trinkets? Be rid of my avoiding, my exploding, my contempt? Trembling, I asked her if there was anything I could start to read.

"Freud. Start with Mourning and Melancholia. In it Freud says, 'The shadow of the lost object falls across the ego.' You've been under that shadow for a solid Year."

"What shadow?"

"You. The shadow of yourself:"

My lacuna of humanity, my Berry. How I'd grown to love her, my accepting, caring, clear?sighted soft one, during this abrasive year.

"I love you," I said. "I lived through this nightmare because you were with me."

"Yes, partly. And you're right: this internship has been like the stuff of dreams, like the overpowering nightmares of childhood: aggression, fear of retaliation, and then the resolution, where you don't win, you live. It's the straight Oedipal theme: mother, father, child."

. . Hope you are finishing up well and glad to be finished with your experience. Could not understand your premise that now you can handle all medical problems and there is so much to know. I am very worried over the worldwide economic situation meaning the inability of the brains of the world to solve inflation and the monetary crisis and it is not even worth having money the bank. I don't know what mother told you but I know it was basic and true. I know you care for us as a son and that will never change. Distance and circumstance have interfered with our keeping close, and that is inevitable in this day and age. Would love to play golf with my son number one again and that is just a hope. Mom really has such a short controlled swing and it is a picture. My passion for the game is unlimited and I do enjoy it . . .

24

Disillusioned, not wanting to go on as House residents but not knowing what to do, we needed help. We turned to Fats. At the ten?o'clock meal, we asked him what we should do.

"About what?"

"About what specialty to go into on July the first."

"Do what's always done nowadays," said Fats, "do a colloquium. Never fails."

"What on?" asked Eddie, his eyes a bit dull, tranquilized.

"On 'How to Choose a Specialty,' what else?"

"Who the hell's go

"Who?" asked Fats. smiling. "Me. The star of the bowel run of the stars."

Word spread rapidly. On the day, from all over the House of God, terns and BMSs appeared. Even Gilheeny and Quick were there. The crowded room hushed, and the Fat Man began: "The whole pattern of medical education is backwards: by the time we realize we're not going to be TV docs undressing ripe-titted beauties, but rather House docs disimpacting gomers, we've invested too much to quit, and we wind up like you poor slobs: stuck. The sequence of training should be reversed: on day one, bring the puking BMSs right into the House of God and rub their noses in Olive O.: turn off potential surgeons with her humps, potential internal?medicine red?hots with her numbers incompatible with life and her inability to be cured or dead; even potential gynecologists will take one look at the terrain of their future speciality and transfer into dentistry. And then?and only then?let the ones who still have the stomach for it start on the preclinical years."

It was brilliant, as expected. But how did it help us now?

"But that doesn't help you now, 'cause now you've invested, and now you're trapped. So? So there are many different specialties you could choose. Most of them involve the same close contact you've had with patients all this year?touching, being tortured, killing yourself with night call. These are the 'PC?Patient Care' specialties. PC specialties will not be considered, here. The masochists may leave."

No one left.

"I myself am going into a PC specialty, Gastroenterology. I have my reasons. I am a very special case. Where I'm headed, GI is what's best for me. A rare gift, eh? Right. But the NPC?No Patient Care specialties number six and only six: Rays, Gas, Path, Derm, Ophthalmology, and Psychiatry."

The Fat Man listed these six on the blackboard and told us he would list, with our suggestions, the advantages and disadvantages of each. "Game theory," he called it. This chart would "optimize" our specialty choice.

"First," said Fats, "is Rays. Advantages of Radiology?"

"Money," said Chuck. "Big money."

"Exactly," said Fats, "a veritable fortoona. Other advantages?"

Aside from the assumed "No Patient Care," no, no one could think of any other advantages, and Fats asked for disadvantages.

"Gomers," I said. "You do bowel runs on gomers.

"Narcolepsy," said Hooper, "you're always in the dark."

"Gonads," said the Runt. "X rays can fry your sperm. Your first kid comes out with one eye, two teeth, and eight fingers to a hand.

"Terrific!" said Fats, writing them down. "Men, we're on our way!"

We proceeded to construct a table of the NPC Specialties: