The house of God

'The Fish.'

The third tern, Eat My Dust Eddie, let out a long slow groan of despair. 'I can't stand it,' he said, 'I can't stand having the Fish. He's a gastroenterologist and I can't stand anymore talk of shit.'

'To hear you,' said Fats, 'you'd think no one ever shits in California.' Then, getting serious, he leaned forward and said, 'That reminds me?my Fellowship Application. I'm trying to get my GI Fellowship for July the first. The Leggo still hasn't written the crucial letter of recommendation. He says he's waiting to see how I run this ward. Don't screw me on that letter, hear? This is a 'Protect the Fat Man's Fellowship' ward rotation, see?'

'Where do you want to go for your fellowship?' asked Hooper.

'Where? L.A. Hollywood.'

Eat My Dust groaned and covered his face with his hands.

'The Bowel Run of the Stars,' said Fats, stars sparkling in his dark eyes.

Fats was into money. He'd grown up poor. His mother, during the High Holy Days, even though there wasn't anything to make soup from, had put pots of water on the stove to boil, so that if anyone dropped in, the illusion of soup would be there. Nourished by his family as being a true genius, he'd shot up like a Flatbush meteor, barreled through Brooklyn College in science, cutthroated through Einstein Med, and arrived at the best internship of the Best Medical School, the House of God. Now, as he said, he was 'going all the way to the top,' and it seemed that from Flatbush, the top was Hollywood: 'Imagine doing a sigmoidoscopy on Groucho Marx?' he'd said, 'on Mae West, on Fay Wray, on Kong! On all those stars who think that the colon is filled with cologne.'

I tuned back in as Fats was saying, 'This ward is a GI Man's Heaven, and even for a GI man, it's Hell. How are you terns going to survive?'

'By killing ourselves,' said Eddie.

'Wrong,' said Fats seriously, 'you are not going to kill yourselves. You are my A Team, you all know what you're doing by now. You will survive by going with it.'

'Going with it?' I asked.

'Right. Like in the card game: finesse, men, finesse.' Finesse? I drifted off, thinking that this was a little bit different from what Fats had said before. How could this ward be the worst? There would be no hiding our doing nothing from Fats, and after what I'd been through on the wards and in the E.W., there would be no doubts about my ability to handle just about anything. I guessed it would be the worst because the gomers would try to torment us by holding up their end of the delivery of medical care by camping in the House, and the Slurpers and the Privates; would try to torment us as well, each in his own failsafe way. It would be the worst precisely because them would be no duplicity or pretense, but only the eternal, almost ecological struggle to do revolving?door medicine the House of God way.

'Remember,' said Fats, finishing, 'if you don't anything, they can't do anything to you. Believe it not, guys, we're gonna have a ball. OK, now we're ready to go on out there. Let's break!'

We broke with all the enthusiasm of a high?school football team breaking from the locker room knowing they were going to get creamed and leaving their guts in the toilet bowls behind. Ward 4?North was yellow-tiled, smelly, and contorted like a gomer. We went from room to room, and in each there were four beds and on each bed was a horizontal human being who showed few signs of being a human being except being on a bed: No longer did I think it crazy or cruel to call these sad ones gomers. Yet part of me thought it was both crazy and cruel that I no longer thought so.

In one male room a gomer was spasmodically tugging at his catheter and moaning something like PAZTRAMI PAZTRAMI PAZTRAAAH?MI and at that, Eat My Dust began making dog?vomiting noises in my ear. We went into the hallway and saw two more males, side by side, the only difference being their mouths, which were:

[one gaping open, the other gaping open with the tongue hanging out of the lower corner]

The Fat Man asked the BMSs?the terrified, eager, and idealistic BMSs?what the inspection of these two men would produce as diagnoses, and they had no idea. Fats said, 'These are classic signs: the O SIGN on the left and the Q SIGN on the right. The O SIGN is reversible, but once they get to the Q SIGN, they never come back.'

We proceeded down the corridor. Suddenly there they were: side by side in armchair recliners sat two patients, the same two patients Chuck and I had turned back from that first day, Harry the Horse (HEY DOC WAIT HEY DOC WAIT) and Jane Doe (OOOO?AYYY?EEEE?IYYY?UUUU). Still there! We stood in front of them, mesmerized.

'Come on, come on,' said Fats, dragging us away down the corridor. 'This is the worst, the Rose Room. This room has taken fine young men and broken them. There should be an antidepressant dispenser at the door. Always remember, when you leave the Rose Room and feel like killing yourself, remember that it is they of the Rose Room, and not you, who are ill. THE PATIENT IS THE ONE WITH THE DISEASE.'

'Why is it called the Rose Room?' we asked.

'It is called the Rose Room because it invariably happens that the four female beds contain gomeres named Rose.'

In hushed silence we stood in the middle of the dimly lit Rose Room. All was still, spectral, the four Roses horizontal, at peace, barely dimpling their swaddling sheets. It was all very nice, until the smell hit, and then it was disgusting. The smell was shit. I couldn't stand it. I left. From the corridor I could hear Fats continue to lecture. Out came EMD, gagging. Still Fats talked on. Out came Hyper Hooper, snorting. On and on Fats talked. The three fresh BMSs, holding to the fantasy that if they left the Rose Room before the Fat Man, their grade would plunge down toward that deadhouse, middle C, stayed. Fats droned on. Yelping and retching, handkerchiefs to their mouths, out ran the BMSs As Fats rattled on to himself and to the gomertose Roses, the BMSs threw open a window and hung out their heads, and the burly construction workers who were riveting together the Wing of Zock pointed, to them and laughed, and the laughter seemed to come, from far away. I wished I could have been a robust hardhat, far from the smell of shit. Fats droned on to himself. The next one out, I mused, would be a Rose. Finally, out came our leader, asking, 'What's the matter, guys?'

We told him the matter was the aroma.

'Yeah, well, you can learn a lot from that aroma. With luck, in three months you'll be able to stand the middle of that room and give the four diagnoses as the different bowel odors smack your olfactory lobes. Why, just today there was a steatorrheac malabsorbtion, a bowel carcinoma, a superior mesenteric insufficiency giving rise to bowel ischemia and diarrhea, and last? . . . yes! Little packets of gas. slipping past a long?standing fecal impaction.'

'Hey, Fats,' said Hooper, 'how about having a box with postmortem permission slips here at the doorway of the Rose Room?'

'LAW NUMBER ONE: GOMERS DON'T DIE,' said Fats.

'Hooper, what the hell is it with you and those posts?' I asked.

'The Black Crow Award,' said Hooper.

'That was a joke,' I said.

'It was not. The postmortem is the flower?no, the red rose?of medicine.'

As Hooper went on down the corridor, I thought how happy he'd gotten, now that he'd lodged his M firmly OR, and now that he had his Israeli Path Resident doing autopsies for him on a 'same?day' basis. Racing for the Black Crow, Hooper hated the seemingly immortal gomers, and sought out younger patients, the ones who could die. In particular, he cherished the upper socioeconomic young, who, according to a recent J. Path. article, were most likely to sign for their own posts. Occasionally someone would mention to Hooper that maybe he was a little too heavy into death, but he'd just smile his boyish California smile, hop up and down like a Mouseketeer, and say, 'Hey, it's where we're all headed, right?' Death had become a lifeline for the perky little Sausalitan.

Fats had gone straight from the stench of the Rose Room to breakfast, and Eddie and I were left alone. He turned his tense eyes to me and said, 'I can't take it?they're all gomers.'

'It's a tremendous opportunity to utilize your twenty-six years of education and maturity to procure the delivery of medical care for a needy geriatric population.'

Neck and neck for the Black Crow with Hooper, Eddie had gotten deep into sadomasochism, in particular grooving on patients 'hurting' him or on he 'hurting' them. I tried to change the subject, and said 'Say, I hear your wife's having a baby.'