inside the chest cavity and beats?'
'The heart.'
'Good. So the gomere has congestive heart failure. What else?'
'The lungs.'
'Terrific. You're really cooking now. Pneumonia. Your gomere has CHF and pneumonia, she's septic from her indwelling catheter, refuses to eat, wants to die, is demented, and has an unobtainable BP. What's the first thing?the crucial thing?to do?'
I thought of the diagnosis of septic shock, and suggested an LP.
'Nope. That's BMS textbook. Forget textbook. I am your textbook. Nothing you learned at the BMS will help you tonight. Listen?key concept?LAW NUMBER FIVE: PLACEMENT COMES FIRST.'
'I think that's going a little too far. I mean, you're making all kinds of assumptions about this person. You're treating a human being like a piece of baggage.'
'Oh? I'm crass; cruel, and cynical again, am I? I don't feel anything for the ill? Well, I do. I cry at movies. I've spent twenty?seven Passovers being pampered by the sweetest grandma any Brooklyn boy ever had. But a gomere in the House of God is something else. You'll find out for yourself tonight.'
We stood at the nursing station of the E.W. Several others were sitting there: Howard Grinspoon, who was the new tern on call in the E.W., and two policemen. Howard I'd known from the BMS. He was blessed with two traits which were to prove to be so useful to him in medicine: unawareness of self, and unawareness of others. Not smart, Howard had slurped his way through BMS and into the House by doing something with urine, either putting urine through computers or running computers on urine. This had endeared him to that other man of little urine, the Leggo. A plodder and a planner, Howard was also into using IBM computer cards to aid in medical decision?making. By the start of the ternship, he already had developed a terrific bedside manner, to hide his rampant indecisiveness. Although Howard wanted to 'present the case' to Fats and me, Fats ignored him, focusing on the policemen. One policeman was huge, barrel?shaped, with red hair growing out of and into most of the slitty features on his fat red face. The other policeman was a matchstick, decked out, facially, in white of skin and black of hair, with vigilant eyes and a large and worrisome mouth , filled with many disparate teeth.
'I'm Sergeant Gilheeny,' said the red, barrel?shaped one, 'Finton GiIheeny, and this is Officer Quick. Dr. Roy G. Basch, we wish you hello and Shalom.'
'You don't look Jewish,' I said.
'You don't have to be Jewish to love a hot pumpernickel bagel, and besides, the Jews and the Irish are similar in one respect.'
'What respect is that?'
'In their respect for the family unit, and the concomitant fucked?up nature of their lives.'
Howard, irritated at being ignored, tried to tell us again about my admission. The Fat Man silenced him at once.
'But you don't know anything about her,' said Howard.
'Tell me her shriek, and I'll know it all.'
'Her what?'
'Her shriek. Whatever sound she makes'
'Well,' said Howard, 'she does shriek. She makes a ROO?DLE.'
'Anna O.,' said Fats. 'Hebrew House for the Incurables. This admission will be approximately number eighty?six. You start with a hundred sixty milligrams of the diuretic Lasix and you go up from there.'
'How'd you know all that?' asked Howard.
Ignoring him, Fats turned to the policemen and said, 'It's obvious that Howard has failed to do the most important things in the case. I trust that you two gentlemen have?'
'Even in our role as policemen who patrol the city and environs of the House of God and often sit and chat and drink coffee with the brilliant young medicos,' said Gilheeny, 'we do sometimes intervene in emergency patient care.'
'We are men of the law,' said Quick, 'and we followed the House LAW: PLACEMENT COMES FIRST, and called the Hebrew House. Alas, during the ambulance ride here, Anna O.'s bed was sold.'
'Too bad,' said the Fat Man. 'Well, at least Anna O. is a great one to learn on. She's taught countless House terns medicine. Roy, go see her. You've got twenty minutes till the ten?o'clock meal. I'll wait here and jabber with our friends the cops.'
'Magnificent!' said the redheaded policeman, beaming a grand sunny smile, 'for twenty minutes of Fat Man chat is a gift horse we shall look everywhere but in the mouth.'
I asked Gilheeny why he and Quick were so well-informed about this medical emergency, and his reply puzzled me:
'Would we be policemen if we were not?'
I left the Fat Man and the two policemen huddling together, intensifying their chatter. I went to the door of room 116, and once again I felt alone and afraid. Taking a deep breath, I went in. The walls were covered with green tile, and the bright neon light glittered off the stainless?steel equipment. It was as if I had stepped into a tomb, for there was no doubt that here, somehow, I was in touch with that poor thing, death. In the center of the room was a stretcher. In the center of the stretcher was Anna O. She lay motionless, her knees bent up toward the ceiling, her shoulders curved around toward her knees, so that her head, unsupported and rigid, almost touched her thighs. From the side she looked like the letter W. Was she dead? I called to her. No answer. I felt for a pulse: No pulse. Heartbeat? None. Breath? No. She was dead. How fitting, that in her death her entire body should have hooked around in mimicry of her persecuted Jewish nose. I felt relieved that she was dead, that the pressure to care for her was off. I saw her little tuft of white hair, and I remembered my grandmother lying in her coffin, and I was filled with sadness for that loss. A lump formed in my midsection, tugged at the tip of my heart, and pulled itself up into my throat. I felt that strange sensation of gritty warmth that comes just before tears. My lower lip curled down. To control myself, I sat.
The Fat Man rushed in and said, 'All right, Basch, blintzes and . . . hey, what's the matter with you?'
'She's dead'
'Who's dead?'
'This poor woman. Anna O'
'Baloney. Have you lost your mind?'
I said nothing to this. Perhaps I had lost my mind and the strange policemen and the gomere were all a hallucination. Sensing my sadness, the Fat Man sat down next to me.
'Have I steered you wrong so far?'
'You're too cynical, but whatever you say seems to be true. Even though it's crazy.'
'Exactly. So listen to me, and I'll tell you when to cry, 'cause there are times during this ternship when you'll have to cry, and if you don't cry then, you'll jump off this building and they'll scrape you up from the parking lot and drip you into a plastic bag. You'll wind up a bagful of goo. Get it?'
I said I did.
'But I'm felling you that now is not the time, 'cause this Anna O. is a true gomere, and LAW NUMBER ONE: GOMERS DON'T DIE.'
'But she's dead. Just look at her.'
'Oh, she looks dead, sure. I'll give you that.'
'She is dead. I called to her and felt for a pulse and listened for a heartbeat and looked for a breath. Nothing. Dead.'
'With Anna, you need the reverse stethoscope technique. Watch.'
The Fat Man took off his stethoscope, plugged the earpiece into Anna O.'s ears, and then, using the bell like a megaphone, shouted into it: 'Cochlea come in, cochlea come in, do you read me, cochlea come . . :'
Suddenly the room exploded. Anna O. was rocketing up and down on the stretcher, shrieking at great pitch and intensity: ROODLE ROODLE ROOOOOO . . . DLE!
The Fat Man plucked his stethoscope from her ears, snatched my hand, and pulled me out of the room. The shrieks echoed through the E.W., and Howard, at the nursing station, stared at us. Seeing him, Fats yelled: 'Cardiac arrest! Room 116!' and as Howard jumped up and came running, the Fat Man, laughing, pulled me into the elevator and punched the cafeteria button. Beaming, he said, 'Repeat after me: GOMERS DON'T DIE.'
