'Yes'
'Can we'all come in theah, boah?'
'What for?'
'To congratulate you. In the opinion of Dr. Dwayne Gath, surgical resident in this E.W., we got a keeper. Hotcha!'
'What's a keeper?'
'Keeper? 'Pendix. You go in theah with the steel blade, find 'er, and keep 'er. Listen heah: THE ONLY WAY TO HEAL IS WITH COLD STEEL. Basch , you gave some hungry surgeon a chance to cut, and A CHANCE TO CUT IS A CHANCE TO CURE. We gunner cut on ole Princess, quicker'n yesterday.'
Wiping the sweat off my brow, I opened the bathroom door to the beaming eyes of a Good Ole Boy who'd just given a surgical buddy of his a chance to cut on human flesh.
Feeling better, I began to see other patients. I began to get bogged down with the lonely horrendomas, the LOLs in NAD and the gomers with multisystem disease, often the severity of which, according to textbooks, was 'incompatible with life.' I began poring over them, doing things I'd done on the wards?taking a history, doing a physical, putting in IVs, feeding tubes, Foley catheters, beginning to treat, to start them on their way back to dementia. After I'd seen about three of them, I came back to the nursing station to find the clipboards wrist?deep on my desk. I was overcome with a sense of futility. I saw no way that I would be able to dent the collection of bodies. How could I take care of all of them? How could I survive?
'You wanna survive here?' asked Dini, pulling me aside.
'Yes.'
'Good. Two rules: one, treat only the life?threatening emergencies; two, everything else, TURF. You know TURF?'
'Yes, the Fat Man taught me.'
'Oh? Great. So you're all set. Like he says, BUFF 'n' TURF.' It's not easy to separate emergencies from turkeys, especially in the Holiday Season, and it's even harder to TURF so they don't BOUNCE. It's an art. If they're not emergencies, we don't handle 'em. Now, get back in there and BUFF 'n' TURF like crazy!'
What a relief. Familiar Fat Man ground. These bodies, seeking rest, would get none here: They'd either get TURFED back out to the street, TURFED up into the wards, or, if dead, TURFED down to the morgue. The most grotesque screaming gomer might arrive, and I could attack the case with the calm assurance that soon he would be TURFED elsewhere. A mind?boggling thought: the delivery of medical care consisted of BUFFING and TURFING the seeker of care somewhere else. The revolving door, with that eternally revolving door always waiting in the end.
The task was to separate disease from hypochondria. With the waiting room jammed with lonely, hungry bodies seeking a warm place to spend the winter night, complete with clean linen, good food, and attention of a spanking fresh round?assed nurse and a real doctor, to MEET 'EM AND STREET 'EM was not easy. Having had years of experience with the House of God, many of the alleged ill had developed sophisticated methods to get in. I'd been a tern for less than six months; they'd been getting admitted to the House for up to ninety years. All it would take, often, was to have fooled one tern, years before, and thus to have documentation in the old chart, for with the increased threat of litigation, none of us could ignore documented disease. Using the local library, these people had BUFFED their own charts, and knew more about their diseases than me. A particular symptom of a given documented old disease could be revved up on any given night, and the sufferer admitted to be hugged and suckled at the bazooms of the House of God.
I began to work through the multiglomerate experienced ill. At one point, as I was BUFFING a gomer, I felt a tap on the back of my leg, low down. I turned and saw Chuck and the Runt, kneeling on the tile floor, looking up at me like cockerspaniel pups in the window of a pet shop. The Fat Man stood behind them:
'Don't tell me,' I said, 'let me guess what you're on.'
They told me anyway. They were on their knees.
'Man, do you know why?' asked Chuck.
'Because the last twelve weeks,' said the Runt, 'Howard has been in the E.W., and he's so scared of missing something by sending the patient back home that he admits them all. He's a SIEVE.'
'A SIEVE?' I asked.
'Right,' said Fats, 'he lets everyone through. At Bellevue half the ones Howie admitted would have been TURFED out by the receptionist. Or they would have been too embarrassed to come in. New Yorkers have some pride, especially when it comes to degradation. Howie's been letting through six admissions per tern per day. These poor boys are on their knees. They were your friends, remember?'
'They still are,' I said. 'What can I do?'
'Man,' said Chuck, 'be a WALL. Don't let anyone in.'
'In New York once,' said Fats, 'we had a contest to see how long the medical service could go without an admission. Thirty?seven hours. You shoulda seen what we sent outta there. Roy, help them. Be a WALL.'
'You can count on me,' I said, and watched them leave.
Later that afternoon I was sitting at the nursing station, 'musing on SIEVES AND WALLS .
'There's a cardiac case in the car!'
A woman stood inside the automatic doors, screaming. My first thought was that she was crazy, my second was why would a cardiac case be in a car and not an ambulance and that she was joking, and then I panicked. Before I could move, Gath and the nurses were running out the door to the car, wheeling a crash-cart. By the time I was standing, they had slammed the guy on the chest, were breathing him and pumping his chest, Gath was sticking an IV into the big vessels in his neck, and all were barreling into the major?medfr ical emergency room. Shaking, I flashed on a LAW … AT A CARDIAC ARREST THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE. That helped, and I went into the room. He was a youngish man, coated with the pale blue?white skin of the dead. Gath was threading the line into the heart, Dini was taking a blood pressure, Flash was breathing him, any Sylvia was starting the EKG. I was standing there with my, finger up my ass, woozy. And then the concept of the EKG saved me. As soon as I saw the little pink strip of paper with its blue?lined grid, I started function. He no longer was a man five years older me who was going to die, he was 'a patient with anterior MI having runs of V Tach which were compromising his pulmonary circulation and extending his MI.' He became a series of concepts and that might just respond to the right treatment. His rhythm fed into my head and CLICK out came a slogan LIVE BETTER ELECTRICALLY and I said, 'Let's defibrillate him,' arid we did. He went into normal sinus rhythm, the deathly blue of his lips turned pink, he regained consciousness, the MICU resident came down, he was TURFED there, and I sat down again, shaking all over.
'Not bad for your first,' said Dini clinically.
'I was panicked,' I said, 'and I don't understand it. I mean, I've been at lots of arrests before.'
'On the wards,' she said, 'it's different. Up there, you have information about the patient and you know what to expect. Down here, all you've got is the body barreling through those doors. It's all fresh, not preprocessed. That's why I love it.'
'You love it?'
'Yeah. It's a real thrill to have anything at all come through those doors and to be able to handle it. You better go talk to his wife. It's easier when they make it. Talk to her, and then you'll be all set.'
Covered in vomit and blood, I walked out of the room into which the wife had seen her husband disappear, dying. She had a hungry, pleading look in her eyes, trying to read what I was about to say. Alive or dead? When I told her he was alive and in the MICU, she burst into tears. She grabbed my shoulders and hugged me and sobbed, thanking me for saving his life. Choked up, I looked past her and saw Abe, who'd stopped rocking and was staring at us with a lasersharp buzzing beam in his eye. I went back through the automatic doors, imagining those times I'd have to say, 'He's dead.' I didn't tell her that if she waited another five minutes I'd have had to say that. End of the ambulance ride was exactly what it was.
Things were going well. I continued to wade through the unprocessed nonemergent, trying to be a good WALL. In the early evening, Gath sat down next to me and said, 'Hey, boah, got sumpin' for ya. A soo?prise. Close your eyes and hold out youah hand. Want ya to guess what it is'
I felt a wet, soft, smooth, wormy thing nestled in the palm of my hand, and guessed, 'A skinny hot dog?'
'Nope. A keeper.'
