that had me shitting on the hour, and overcome with gloom at the work I had to do. The sun was setting over the changing leaves, and even though it was a boiling?hot Indian?summer night, I knew that soon the days would turn crisp and clear and bright, football weather, when you huddled with a sweatered woman under a blanket and got drunk to avoid getting cold and kissed her lips and shivered . . .
Mrs. Biles is back from her cardiac catheterization,' said my BMS, Bruce Levy the Lost. 'The cath fellows wrote in the chart that 'Mrs. Biles had excessive bleeding from the site of needle puncture in the groin.' I'd better work it up, Dr. Basch. She might have a bleeding disorder.'
Mrs. Biles had no bleeding disorder. The cath boys always wrote 'excessive bleeding' to BUFF the charts in case of litigation. In fact, Mrs. Biles, Little Otto's patient, didn't even have cardiac disease at all, but, as everyone including Otto knew?bursitis. Little Ottowas after the big bucks. Bruce Levy, the BMS, was after playing the invent? an?obscure?disease?to?make?an-A?in?medicine game. Who was I to stand in his way?
'Sounds interesting, Bruce. How ya gonna work it up?
Bruce rattled off several blood tests he was about to order.
'Wait a sec,' said Jo, who'd been on her way out but who had stopped back in to make sure all was OK before she went back out to where she was just another lonely single woman and not an admiral of the gomers in the House of God. 'Those tests cost a fortune. What evidence do you have that she has a bleeding disorder? For example, did you ask her if she suffers from nosebleeds?'
'Hey, great idea!' said Bruce, and ripped off down the hall to ask. Returning, he said, 'Yeah, she suffers from nosebleeds. Great!'
'Wait a sec,' I said, 'everybody will say that when you ask, right?'
'Yeah, right,' said Brucie, looking crestfallen.
'Did you ask her if she bleeds after tooth extraction?' asked Jo.
'Hey, terrific idea!' said Bruce, and ran out again. 'Yup, she bleeds like crazy after tooth extractions.'
'Brucie, everyone bleeds like crazy after extractions,' I said.
'Damnit, Dr. Basch, you're right,' said the BMS, and he looked sad, since to become an intern in the BMS system he had to make an A, and to do that he had to make a disease so he could make a cure and make a lecture, and he saw his grade fluttering down toward low C and his internship moving west of the Hudson River.
'Say, Brucie,' I said nonchalantly, 'what about bruising?'
'Bruising? Hey, fantastic idea?'
'WAIT! Save yourself a trip. She's gonna say yes, that she bruises easily, right?'
'Right, Dr. Basch. Who wouldn't say that?'
'No one,' I said. 'But how can you test it out for sure?' '
'I don't know,' said Brucie, his fist furrowing his brow.
'Too bad,' I said. 'Bleeding disorders are fascinating.'
All of a sudden Brucie lit up, shouted, 'I got it!' and ran down the hallway, and a few seconds later there echoed back up to us a scream YEEE?OWWWW! and in a moment Brucie was back, grinning from ear to ear, and he said, 'Well, I did it,' and reached for the hematology slips.
'You did it? You did what?' asked Jo, eyes popping.
'I bruised her.'
'WHAT? YOU DID WHAT?'
'Just like you suggested, Jo, I bruised Mrs. Biles. Punched her in the arm. You were right, I shouldn't have gone ahead with this expensive work?up until I'd bruised her with my own two hands.'
Just before the Runt returned from his therapy, a forty?two?year?old patient of his had a cardiac arrest, and as the Runt came down the hallway, he was passed by the intubated patient being wheeled to the MICU by Eat My Dust Eddie, the tern on rotation here. The Runt looked horrified and said, 'I'm sure it was something I did wrong.'
'Don't be silly,' I said, 'it's a good TURF. Now, get out of here?you'll be late for your date with Thunder Thighs.'
'I'm not going.'
'You are. Think of those red pubic hairs:'
'I can't. I better go see Mrs. Risenshein. I feel terrible that these young patients are all dying.'
'LAW NUMBER FOUR: THE PATIENT IS THE ONE WITH THE DISEASE. Get the hell out of here,' I said, pushing him out the door. 'Scram.'
'I'll call you from the Chinese restaurant.'
'Call me from the saddle or don't call me at all'
'But why? Why?' he screamed, his foot jamming the door like a salesman. 'Why am I doing this?'
'Because it's limp.'
'Because what's limp?'
'The whole goddamn shooting gallery. So long.'
He left. As usual, all hell broke loose on the ward, mostly with the Runt's patients. The Runt had learned to be aggressive with the gomers and cautious with the dying young, and since Chuck and I had begun to believe the Fat Man's idea that the reverse was the essence of medical care, the Runt's patients were disasters, and the first part of each night on call had to be spent BUFFING the Runt's service, in secret, hidden from Jo, the Runt, and the charts. Surreptitiously I'd slip into the room containing the young asthmatic who would die without the steroids that the Runt was afraid to give her and BAM BAM hit her with a big secret dose that would get her through the night; next it would be his nice leukemic lady, whom Towl was keeping alive, and secretly I'd transfuse her six more units of platelets without which she'd bleed out before sunrise; and the final horrendoma was Lazarus, the alcoholic janitor, who was always in shock, always infected, and whom the Runt was always treating with homeopathic doses of meds for fear of doing something bad. Each day, Lazarus made a determined effort to die, usually by bleeding out, from nose or lip or gut or balls, and each night Chuck or I in a clandestine and almost religious operation would BUFF the shit out of him for his next day's thrilling adventures with a tern who was limp and unstrung and scared to death of doing anything active, anything active at all. That night I remembered that I'd forgotten what the Runt had told me just before he'd left the first time, when I'd asked him if he'd tapped the infection in Lazarus' ascitic belly:
'He's all right,' the Runt had said, looking away.
'Wait a sec,' I'd said, 'did you tag his belly or not?'
'Nope.'
'Jesus Christ! Why the hell not?'
'I never learned how. You need to use a big needle and I . . . I was scared I'd hurt him.'
Limp. Cursing, I went into Lazarus' room, where he was dying again in earnest, and since I'd been in this situation with him every other night on call, I knew what to do, and got busy raising him up yet again:
Molly came up and said I had a phone call. It was the Runt.
'How's Mrs. Risenshein?' he asked.
'Fine, but Lazarus just started to go down the tubes,' I said, telling myself I won't yell at him for not having tapped his belly.
'I should have tapped his belly:'
'Where are you?'
'Chinatown. But how's Lazarus?'
'What did you have?'
'Lo mein, moo goo gai pan, and a lotta rice, but how is he?'
'Sounds delicious, he went down the tubes,' I said. 'Oh, no! I'm coming in!'
'But I saved him.'
'Hey, great!'
'Hang on,' I said, watching Molly gesture from Lazarus' room, 'he's trying to go down the tubes again.'
'I'm coming in!'
'What are you doing after dinner?'
'I thought I'd take her back to my place.'
'What? With June there, are you nuts?'
