The phone went off, and out of it came two-part harmony: 'Happy birthday to you, happy birthday to you, happy birthday dear Roy-oiy, happy birthday to you.' My birthday, forgotten, then remembered, then forgotten again. My parents. My father said, 'I hope that you're not too tired and it must be great to have patients of your very own at last,' and I knew he thought modern medicine was the greatest invention since the high-speed dental drill, and as I hung up I thought of Dr. Sanders, who would die, and of the gomers, who would not, and I tried to figure out what was illusion and what was not. I had expected, just like in the How 1 Saved the World Without Dirtying My Whiter book, to have been rushing in and saving people at the last moments, and here I had been observing a wrecked Southerner being socked in the puss by a gomere wearing a ram-horned football helmet, all the time being told by a fat wizard who was a wonderful doc and also something phantasmagorical like either a madman or a genius that doing nothing except BUFFING and TURFING was the essence of the delivery of medical care. If there had been the feeling of power in the empty corridor at night and in the crowded elevator during the day, there had also been the awesome powerlessness in the face of the gomers and the helpless incurable young. Sure there had been the clean whites, and the clean white of Putzel's Continental, but the clean whites had gotten spewed with vomit and blood and piss and shit, and the dirty sheets had bred bugs that went right for the finger and the eye, and Putzel was a jerk. In months, Dr. Sanders would be dead. If I knew that I were to die in months, would. I spend my time like this? Nope. My mortal healthy body, my ridiculous diseased life. Waiting for the hard screaming line?drive ball, for the aneurysm straining in my brain stem to pop and squirt blood all over my cortex, draining it dry. And now there was no way out. I'd become a tern in the stinky tern in the green house in the House of God.
6
At the end of three weeks, the Fat Man was TURFED out of the House of God to do a rotation at one of the neighboring community hospitals, what he had called one of 'The Mt. St. Elsewheres.' Although he would still be the resident on call with me every third night, in his fat wake came the new ward resident, the woman named Jo, whose pop had just leaped to his death off a bridge. Like so many of us in medicine, Jo was a victim of success. Growing up short and wiry, plain and tough, in adolescence Jo had ignored her mother's invitations to come out as a deb and had concentrated instead on biology, dissecting rather than attending balls. She first became a victim of success when she successfully annihilated her twin brother by getting into Radcliffe while he went off to some beerswilling football factory in the Midwest, a trombonist in the marching band. Her academic performance continued to accelerate through college, rocketing her into BMS at a barely pubescent age, her meteoric rise halted only slightly by her mother's all?American involutional psychotic break, which had had the effect of reducing her pop to a quivering jellylike mass. The disintegration of her family had intensified her medical achievement, as if by learning how to do a stellar rectal exam she could detect her family's psychological cancer. And so Jo had come to the House of God, and had become its most ruthless and competitive resident.
From the first day that Jo stood before us, feet apart and hands on hips like the captain of a ship and said, 'Welcome aboard,' it was clear that she was so different from the Fat Man that she would be a threat to all he'd taught us. A short, trim woman with clipped black hair, a jutting jaw, and dark circles under her eyes, she wore a white skirt and a white jacket, and in a special holster fastened to her belt was a two?inch-thick black ring notebook filled with her own transcription of the three?thousand?page
'Yes, we heard,' said Potts. 'How are things now?'
'They're fine. These things do happen. I took it in stride. I'm glad to be back at work to get my mind off it. I know you had the Fat Man for the first three weeks, and I want you to know that I do things differently. Do things my way and we'll get along swell. There's nothing sloppy about the way I run a ward. No loose ends. OK, gang, let's go make rounds. Get the chart rack, eh?'
Delighted, Levy the Lost leaped up to get the chart rack.
'With Fats,' I said, 'we sat here for rounds. It was relaxing and efficient?'
'And sloppy. I see every patient every day. There's a no excuse for not seeing every patient every day. You'll soon find out that the more you do in medicine, the better care you give. I do as much as possible. It takes, a little longer, but it's worth it. Oh, by the way, that means that rounds will start earlier?mix?thirty. Got it? Swell. I run a tight ship. No slop. My career interest is cardiology. I've got an NIH Fellowship next year..: We'll be listening to a lot of hearts. But listen: if there are any complaints, I want to hear 'em. Out in the open, got it? OK, gang, let's cast off.'
There was no way that Chuck or I would show up for rounds an hour earlier than we had been showing up for rounds. We followed Jo as she marched out of the room with that fanaticism known only to an overachiever, one who lives with the eternal fear that soma lurking underachiever will, in a flash of brilliance, achieve more. As we wheeled the chart rack into and out of the room of every one of the forty?five patients on the ward, with Jo examining each one and then shooting off a lecture from the transcription holstered on her hip, telling each of the terns what he had forgotten to do, I felt a growing apprehension. How could we survive her? She went against everything Fats had taught. She would work us into the ground.
We came to the room containing Anna O. Looking through the chart, Jo went in and examined Anna, despite the Wing of Zock jackhammers, focusing on Anna's heart. As Jo listened and poked and prodded, Anna grew more and more resentful and cried out:
ROODLE ROODLE ROOOOO?DLE!
After she'd finished, Jo asked me what the most important part of Anna's care was.
Thinking of the Fat Man's LAWS, I said, 'Placement.'
'What?'
'PLACEMENT COMES FIRST.'
'Who taught you that?'
'The Fat Man.'
'That is baloney,' said Jo. 'This woman is suffering from a severe senile dementia. She's oriented neither to place, time, nor person, all she says is ROODLE, she's incontinent, and confused. There are several treatable causes for dementia, one of which is operable brain tumor. We've got to work it up completely. Let me tell you about it.'
Jo shot off a lecture on the treatable causes of dementia, filled with obscure neuro-anatomical references that brought back to me a story I'd heard about her and an anatomy exam at the BMS. The exam had been impossible, the average score forty?two, and Jo had made ninety?nine. The one question she'd missed was to 'identify the Circle of Polgi,' which turned out to be a trick question, the said Circle being the traffic island situated just outside the front door of the BMS dorm. Jo's lecture on Anna was crisp, complete, coherent, and cohesive. She finished, looking as if she'd just had a satisfying bowel movement.
'Start ordering the tests,' said Jo to me, 'we're really going to work this up. Completely. No, one's going to be able to say that we do sloppy work.'
'But the Fat Man said that Anna O. is always like this, and that in a ninety?five?year?old, dementia is normal.'
'Dementia's never normal,' said Jo, 'never.'
'Maybe not,' I said, 'but the Fat Man said that the way to treat her is to do nothing except try like hell to find a new bed at the nursing home.'
'I never do nothing. I'm a doctor, I deliver medical care.'
'The Fat Man said that for gomers, doing nothing is the delivery of medical care. If you do something, he said, you make everything worse. Like Potts hydrating Ina Goober?she's never recovered from that.'
'And you believed him?' asked Jo.
'Well, it seems to be working with Anna,' I said.
'You listen to me, smartass,' said Jo, amazed and threatened. 'One?the Fat Man is nuts; two?if you don't
