POLITICAL FICTION What It's Really Like: An Intern's First Day
Shem, Samuel
POLITICAL FICTION What It’s Really Like: An Intern's First Day by Samuel Shem It was the Fat Man who first showed me what a gomer was. The Fat Man was my first resident, easing my...
...See, he invented something having to do with the heart 30 years ago, and he expected to get the Nobel Prize, but he hasn’t, so he’s bitter...
...the three others seemed eager, and this told me they were BMS students doing their medicine clerkship...
...I drove home...
...And once, only once, he moved-fast, unashamedly a hero...
...Oharen’t you the tall young doctor...
...No way...
...You dig...
...I’m sitting right here...
...And that’s the challenge of medicine: gomers gomers gomers where you can’t do anything for them and then, suddenly-Wham!-in comes Leo, a lovely guy who can die, and you gotta move fast to save him...
...Crushed, I wished I could...
...On each card was a patient...
...PURRTY GUD...
...Not only that, it means work for you, and Putzel is the one making the money...
...Upping her volume, Ina screamed: Potts next tried to engage her using the other textbook method, grasping her right hand...
...Fighting the impulse to say PURRTY GUD, I said, “Well...
...At 6:30 in the morning of July the First, I was swallowed by the House of God and found myselfwalkingdown an endless bile-colored corridor on the sixth floor...
...Bowel runs are important,” said Fats...
...He wanted the Fat Man’s help with Ina Goober...
...With a little smile he spelled out “G-0-” He stopped, his mouth still set in the “0,” and stared at the doorway...
...Itzak Rokitansky...
...OK, we’ll start rounds without him...
...For some reason, Chuck was different...
...Potts had made the fatal mistake of coming North to Princeton and then compounded his mistake by coming to the BMS...
...which we were too panicked to do, and which I thought would be rather melodramatic, and ran over to us, thumped Leo, breathed Leo, closed-chest cardiac massaged Leo, IV’d Leo, and organized with a cool virtuosity Leo’s cardiac arrest, and Leo’s return from theworldofthedead...
...I know...
...I’ll be taking care of you...
...I did...
...asked Potts...
...I hummed, of all things, a bossanova: “Blame it on the carcinoma, hey hey hey...
...Thank you so much...
...She’s a totally demented loxedout gomere, and no matter how securely restrained, she’ll go ‘to ground every time...
...We are, right here...
...We’re glad you’ll be taking care of him, and we’ll look for you tomorrow...
...Law Number One: Comers Don’t Die...
...Fats sat there, feet up, reading, ostensibly into the world of stocks and bonds and commodities, and yet, like a king who knows his kingdom as well as he knows his own body, who feels the rages of a distant flood in the pulsating of his own kidneys, and the bounty of a harvest in his own full gut, he seemed to have a sense for any problem on the ward, instructing us, forewarning us, helping Potts and me...
...I felt trapped, not knowing what to say...
...Around the table were five people: the Fat Man...
...In internal medicine, there is virtually no need to seepatients...
...He was wonderful, and a wonder...
...What does that mean...
...But the tests aren’t that high, and steroids have a lot of side effects...
...Handsome and tal1,”said the other...
...My beeper went off: DR...
...Nope...
...He knew what to do...
...But listeneven though I said I don’t see patients, when you need me, I’m herewith you...
...said Fats...
...They hurt us, we hurt them...
...Roy, listen...
...We eat on ladders, scraping the food off the ceiling...
...If you’re smart, you’ll use me...
...For the first timethat day, I felt excited, proud...
...Millions...
...The gomers,”said the Fat Man...
...At this thought the BMSs perked up again...
...He was a displaced person, from Charleston, South Carolina, to the North...
...They mentioned my name, and I asked themifthey werelookingfor me...
...I lay down on top of the cool sheets, which felt as soft as the sole of a baby’s foot, soft as the inside of a baby’s mouth, and I thought of this puzzling Fat Man and that even if summer is green, death is an odd number, an odd, odd number...
...Whose patient is he, anyhow...
...What is this, anyway...
...I asked...
...The first cards flipped each day would be the new admissions from the tern who’d beenoncall thenight before...
...Just that story about them red ants...
...1 asked, and I waited, as the long seconds ticked away, my guilt moaning inside me...
...This guy’s uremic from his recurrent childhood infections that damaged his kidneys...
...And no matter what you do, Potts,” said the Fat Man, “Ina will be here for weeks...
...And every time he holds Sophie’s hand, it’s 40 of your Blue Cross dollars...
...I’ve seen enough bodies and especially bodies of gomers to last me the rest of my life...
...It’s crazy,” I said...
...Ho, ho, did youseethat?I love’em, 1 love these gomers, I d o . . . .” and he laughed his way out the door...
...What sense was there in that...
...Fast...
...He’s too poor to afford a Private Doctor...
...Without opening his eyes, after 15 seconds, in a husky slurred growl from deep down in his smushed brain hesaid: PURRTY CUD...
...These fingers do not touch bodies unless they have to...
...We visit every day...
...In my mailbox was a note: “I thinkof you all night, I think ofyou in white...
...I was not supposed to be your resident today...
...Aspirin causes ulcers...
...Assuming he meant Chuck, the black intern from Memphis, I said, “I don’t know...
...I think that’s kind of crass,” said Potts...
...Like those dolled-up jets that cargo the gomers to Miami: ‘I’m Fats, fly me.’Now let’s get on to the cardflip...
...Kreinberg...
...With a cool expertise the Fat Man put a gauze compression bandage on the wound...
...As you know, people with the disease bruise easily, very easily indeed...
...You think I don’t have a grandmother...
...He put his feet up on the counter and opened The Wall Street Journal...
...Books...
...They believed in me, in my art...
...I couldn’t understand someone doing it because it felt good...
...I introduced myself, and tried...
...I left, and stopped by to listen to Fats “But there’s no indication for the “No medical indication,” said Fats...
...Til we thought of the helmet...
...I’ve got some more work to do...
...Well you won’t believer this either, but most of the work you do doesn’t matter...
...Oh and by the way-even though she’s dehydrated, whatever you do, do not hydrate her...
...It’s not at all what I expected when 1 walked in here this morning...
...Are you a real doctor or what...
...If it hadn’t been for Donowitz, that guy would be going home tomorrow...
...He returned...
...What are you talking about, chart rack...
...He’s going to die...
...I didn’t know what this had t o d o with depression and headache...
...So what did you learn...
...The people I saw seemed strange, as if they should have some disease that I should be able to diagnose...
...Only New York City could have bounced back from his birth to nourish him...
...Law Number Three: At An Arrest, The First Procedure Is To Take Your Own Pulse...
...Oh Jesus,” said Fats...
...an intern named Wayne Potts, a Southerner whom I’d knownat BMS, a nice guy but depressed, repressed, and kind of compressed, dressed in crisp white, pockets bulging with instruments...
...Thinking about what the Fat Man said about the young dying, I got up to do some work...
...Potts, rubbing his head, asked Maxine the nurse whether Ina had a Private Doctor who could provide information...
...Never seen it...
...Glowering, Ina clutched her purse...
...He didn’t need help...
...My stomach churned...
...The BMS now comprised a majority of minority groups, and “social medicine” was a hot ticket...
...I left them, and noticed them pointing at me to each other, pleased that I would be their brother’s doctor...
...I asked...
...What is it with this GI workup...
...Of course there’s not...
...A nurse with magnificently hairy forearms pointed me to the House Officer’s On Call Room, where rounds were in progress...
...The day wore on...
...I thought of my grandfather...
...We’ll have to wait and see...
...Potts and I introduced ourselves and chatted with him...
...Nobody knows...
...For some reason her Private, Dr...
...In the midst of a chuckle at one of Potts’ jokes, Leo turned blue and fell down on the floor...
...Amyloid...
...A gomer, or rather, the feminine, gomere...
...What’s a gomer...
...Well, man, what all did you do at the BMS...
...Rounds over, Fats headed to breakfast, and we headed out to the ward to get to know the patients on our cards...
...Take care of the whole world, why not...
...Suit yourself, Looks awful yellow, though, don’t he...
...She says she’s depressed and has a headache...
...Double O...
...A woman named Jo was, but her father jumped off a bridge and killed himselfyesterday...
...He’s mine...
...It’sawfuland it’s not the last timeeither...
...We looked carefully at the Fat Man’s stubby fingers...
...Ifn he does, unless you hit him with the roids now, he’s gonna die...
...Right...
...For the care of these gomers, it doesn’t matter a damn...
...Now, if he lives, it’ll be weeks...
...They left, and I turned back to Rokitansky...
...Because I tell things as they are-no bullshitology-and they don’t want you to get discouraged too soon...
...Sit down...
...Never know if he don’t have fulminant necrotic hepatitis...
...It’s like what Joe Garagiola said last night about Luis Tiant: ‘He gives you all his herky-jerky stuff and then, when he comes in with his heater, it looks a whole yard faster.’ ” “His heater...
...Terrific, Basch-your first cardiac patient and you are about to give him a heart attack...
...After what I did as an intern last year, they didn’t want to expose the fresh terns to me today, but they hadno choice...
...BASCH...
...We spend much of our time now visiting the ones who are ill...
...I would wait for the Fat Man and ask him if it was all right...
...The sun was a foreign diseased thing, glowering down a hot red contagion on the city...
...If you hydrate her, shestaysdemented, but she gets incredibly abusive...
...she’s 68 .” “Between the old people and the bowel runs, it’s crazy...
...When Leo had returned to life, Fats walked us back to the nursing station, put his feet back up, opened the paper again, and said, “All right, all right, so you panicked...
...It’s not what I expected either...
...See you on Visit Rounds in 15...
...By that time I was wondering the same thing, and sowas Potts...
...Gomers are human beings who have lost what goes into being human beings...
...I’ll get the chart rack...
...asked the BMS...
...Little Otto Kreinberg...
...His fast ball-HIS FAST BALL!-where did they get you guys, anyway...
...flatulence,” and, kissing Sophie, hurried out...
...I just did it all.’’ “You never read anything...
...With my black bag I came out of their rooms...
...Samuel Shem is the pseudonym of a young physician, novelist...
...Potts came over to us and picked up the lab results from the morning...
...Cynic...
...Of course it is...
...He looks 75...
...Forty-two, mean, with bad heart disease, Zeiss needed anew IV put in...
...But the Fat Man had strict priorities, and at thetopwas food...
...Relax...
...Oh, and by the way,” said the Fat Man, poking his head in again, “I’ve written an order for this.’’ In his hand was a Los Angeles Rams football helmet...
...The Fat Manexplained how on his work rounds he would flip a card, pause, and expect that tern to comment on the progress being made...
...Brooklyn born, New York Citytrained, expansive, impervious, brilliant, efficient, from his sleek black hair and sharp black eyes and bulging chins through his enormous middle that forced his belt buckle to roll over on its belly like a shiny fish to his wide black shoes, the Fat Man was fantastic...
...Typical,” muttered the Fat Man as we gathered round the patient’s bed...
...I could no longer run...
...I got more and more tired, more and more caught up in the multitudinous bowel runs and labtests...
...Fifty-two...
...I was so scared at the thought of seeing patients that I had an attack of diarrhea and sat in the toilet with my How To Do It manual spread on my knees...
...They don’t...
...Easy, man...
...I asked...
...Not that he expected progress to have been made, but he had to have some data so that at the next cardflip, a condensed version later in the morning with the Chief Resident and the Chief of Medicine, he could relate “some bullshit or otherl’to them...
...Typical BMS...
...gomers...
...I don’t get it,” said Potts...
...Time for lunch...
...Is it all right to give Sophie two aspirin for her headache...
...What’s a gomer...
...Goober, I’m Dr...
...Turning to Fats, I said, “This is too sad...
...Gaunt, whitehaired, friendly, a little breathless, Leo stood at the nursing station, suitcase at his feet...
...We’ll see from the cultures where Donowitz last stuck his finger before trying to murder that poor uremic schlump...
...See I never read nuthin...
...Listen, Basch, thereare a number of Laws of the House of God...
...Like I knew what I was doing...
...RIGHT AWAY DR...
...From outside the room came a highpitched, insistent cry: GO AVAY GO AVAY GO AVAY “Who’s on call today...
...The Fat Man made it clear that he was not interested in fancy elaborations of academic theories of disease...
...Who’s admitting today...
...PURRTY CUD...
...How can a patient know which are the ‘Double 0’ Privates...
...But I know howtoputinabigline,tapa chest-you name it, I done it...
...What else...
...Tell him, Basch, tell him...
...Leo would have died...
...said the Fat Man...
...I wrote the order for the aspirin and, feeling dumb, went to see a gorilla named Zeiss...
...Cause I know how scared you three new terns are today...
...Tiny, a foot below me, huddled together, they peered up at me...
...Thinking of the Rokitansky girls, I said, “You’re too cynical...
...The patient gave a yelp, leapt up off the mattress, and began to cry with pain...
...A BMS hears hoofbeats outside his window, the first thing he thinks of is a zebra...
...They want to die, and we will not let them...
...You give aspirin to yourself...
...But . . . but we’re not going to see the patients...
...Licensed to kill,” said Fats...
...Fats was marvelous, his handling of the arrest a work of art...
...Her matzoh balls float-you havetopinthemdowntoeat them up...
...I’ve got a question for you, Fats...
...He’s young enough to die, you know...
...He wants to, but he won’t...
...Gomer is an acronym: Get Out of My Emergency Room-it’s what you want to say when one’s sent in from the nursing home at 3 a.m...
...Basch...
...Money,” I said...
...Diseases of the breast...
...I’m searching for a GI fellowship, myself...
...She cracked her skull twice last year and was here for months...
...The manipulation of her head intensified Ina’s screams: GO AVAY GO AVAY GO AVAY Leaving her tied down six ways from Sunday, the ram horns curling round her ears, we proceeded to Visit Rounds...
...My hand shook, and in the hot room, I got sweaty, and the drops of sweat plopped onto the sterile field...
...Now I had no choice...
...Infection,” said Chuck...
...I do, and she’s the cutest, dearest, most wonderful old lady...
...I asked...
...But with Sophie, it’s fraud...
...Donowitz looked down and found that he’d ripped a big chunk of flesh from the guy’s arm...
...The Fat Man was my first resident, easing my transition from BMS (Best Medical School) student to intern in the House of God...
...You know that new building, the Wing of Zock...
...Hardly any of them are young...
...You three interns rotate days on call, and you only admit patients on your call day...
...Not writing orders for cleanouts for the bowel run...
...Donowitz reached down and twisted the skin on the patient’s forearm...
...The professor...
...Call a doctor...
...Rokitansky, are you crying...
...Being an academic House affiliated with the BMS, the House of God had a Visit for each ward team: a member of the Privates or Academic Slurpers who held teaching rounds every day...
...He hates you...
...Mr...
...I’ve only been here a day...
...Before he left for the day, the Fat Man came by and asked if there was anything else I wanted to talk about...
...I missed the vein, and Zeiss yelped...
...A scheduled admission, named Leo, had arrived for Potts...
...It’s too early to tell...
...Sophie’s young...
...andplaywright, who trained at and now practices near “me House of God...
...Maxine asked me to write an order for an aspirin for Sophie’s headache, and as I started to sign my name, I realized I was responsible for any complications, and I stop.ped...
...Pleased, I asked “Mr...
...1 felt sad...
...Chest pain...
...Why didn’t they want you to meet me your first day as a doctor...
...I fingered the chrome of my stethoscope with a certain expertise...
...This was ward 6-South, where I was to begin...
...That’s right, man, ’cause you see in Chicago where I come from there are only two kinds of dudes-the muggers and the mugged...
...He walked clumsily on platform heels, and looked as if he’d been up dancing the night away...
...Quick as lightning Ina struck him a southpaw blow with her purse, knocking him back against the counter...
...He can’t go on like this...
...Potts, looking green, said, “Roy, I’m as nervous as a whore in church...
...He hates everyone, especially interns...
...Puzzled, he said, “Sometimes you have to do it a bit harder...
...I hadn’t had time for breakfast, lunch, or dinner, and there was still more work to do...
...It was not her son, it was Dr...
...If I’m not mistaken, it’s from one Ina Goober, whom I admitted six times last year...
...He loved three-by-five cards...
...asked Fats, indignantly...
...It’s for h a , ” Fats said, strapping it on her head...
...Mothers give aspirin to babies...
...Later that afternoon, I asked him about how he seemed so competent already...
...It won’t work,” said Fats, “ ’cause the worse the Private, the better the bedside manner, and the higher the patient’s regard...
...They go on and on...
...It sucks...
...This isn’t medicine, this isn’t what I signed up for...
...She’s depressed...
...But did you hear what wesaid about PURRTY GUD...
...Young people-like you and me-die, but not the gomers...
...I went out onto the ward and tried to go see my patients...
...Steroids, man, steroids...
...asked Donowitz...
...All of a sudden, I thought “zoo...
...He lay on his bed, strapped down, IVs going in, catheter coming out...
...Looking at me as if I were from another planet, Fats said, “Did you hear what you just asked me...
...I tried to read their charts...
...Donowitz turned pale and didn’t know what to do...
...I’ll talk to him about that right now...
...Exactly,” said Fats...
...Goodbye Dr...
...See you later...
...Brilliant, he was...
...Ina who should have been allowed to die eight years ago, when she asked, in writing, in her New Masada chart...
...Doesn’t matter, ’cause I can’t discourage you yet...
...The only exception to this urbane provincialism was, of course, Hollywood, the Hollywood of the Stars...
...You don’t think Putzel knows that too...
...We all expect the American Medical Dream-the whites, the cures, the works...
...Mr...
...But aren’t there any normalmedical patients...
...There’s nothing wrong with her either...
...I felt scared without him and troubled by what he’d said...
...My nitros...
...I introduced myself, and when I asked Putzel about the reason for the GI workup for depression, he looked sheepish, straightened his bow tie, murmured...
...As a token gesture, he unbuttoned his coat, and threw his stethoscope on the table...
...The sinister violence of it shocked us...
...on Ina Goober...
...Good, ’cause that awful sound comes from a gomer...
...Besides, there’s no treatment for amyloid anyway...
...How is he, Dr...
...I’ve got an answer...
...Fats glanced over, leapt to his feet, yelled out, “Thump him...
...What else is there...
...The Fat Man had to stop, and dabbed the tears from his eyes, and then went on in a soft voice, “I love her very much...
...mis story is excerpted from his novel, The House of God, to be published in August by Richard Marek Publishers, Inc...
...Under their force the soup levitates...
...It was broken...
...No one wants you to know all this yet...
...He took hold of the skin, wadded it up, and gave it a tremendous twist...
...I opened the door and went in...
...Get me my nitroglycerin...
...When I returned to the nursing station, I saw two Little Old Ladies peering through their thick cataract-defying glasses at the blackboard on which were written the names of the new interns on the ward...
...I’ve never seen it, in a whole year here,” said Fats...
...In uremia you gotta watch for infection...
...What’s that for...
...Lemmee see...
...Little Otto is different...
...Well, I’d give him the roids...
...It’s his brain,” said one...
...Little Otto won’t talk to interns...
...The duplicate deck on the left he split in three and handed a stack to each of the new terns...
...In fifth grade, when I’d asked an Italian kid why heliked having sex, he’d said, “’Cause it feels good...
...Too high...
...I started to sign the order, and stopped...
...Some of us don’t feel that way about old people...
...Oh yes,”said one...
...Great,” said one of the BMSs, leaping to his feet...
...That’s a rule...
...It’s about time,” said the Fat Man, biting a bagel, “where’s the other turkey...
...Law Number Two: Gomers Go To Ground...
...Rough day...
...My one thought was, “How embarrassing for poor Leo...
...Yes,” said Maxine, “Dr...
...The BMSs wanted to tell the patient so he could sue...
...Two stand out...
...Shame swept over me...
...Of course it is...
...Good thought...
...It’s inert...
...He loved everythingthat was on a three-byfive card...
...The jackhammers of the Wing of Zock had been wiggling my ossicles for 12 hours...
...Of course they die...
...I asked...
...Chuck and Potts and I stood at the nursing station, and the hairy-armed nurse told Potts that the woman on the stretcher was his first admission of the day, named Ina Goober...
...I am,” said Potts...
...Embarrassed, he took the piece of flesh and tried to put it back, patting it down as if he could make it stay in place...
...That’s why they wanted you to start with Jo, and not me...
...Announcing that “there is no human being whose medical characteristics cannot be listed on a three-by-five index card,” he laid out two thick decks on the table...
...He was also, according to the Fat Man, a gomer...
...I’ve always got an answer...
...I would take care of their brother, and them...
...And if he knew about this, it would be Malpractice City...
...When the Fat Man went to lunchand we did not, the terror returned...
...A professor, now avegetable...
...Many different species of monkey appeared, and sows were represented in force...
...Finally, mumbling “I . . . I’m so sorry,” he ran out of the room...
...He looks mighty yellow,” said Chuck...
...In my doctor BASCH CALL WARD 6-SOUTH costume, I took my black bag and entered their rooms...
...His marvelous brain...
...Never mind dig,” said the Fat Man...
...asked Fats...
...Yeah,” said Potts...
...I asked...
...I was moved...
...They’re right-if you start to get as depressed now as you’ll be in February, in February you’ll jump off a bridge like Jo’s pop...
...I know all there is to know about medicine in books...
...Wonderful...
...Know what it’s for...
...Bothofus felt incompetent...
...We left...
...Did I want to have her bleed out and die from an ulcer...
...Far out...
...Now if you don’t dress like a mugger, man, you automatically get yourself mugged...
...Even the braless women, sweat collecting in the hollows of their breasts, nipples poking out with the full expectation ofalushand sultrysummer night, their eroticism magnified by the scents of the July blossoms and of their aroused bodies, were less thestuff ofsex and more the specimens of anatomy...
...First, a heifer named Sophie, who’d been admitted by her Private Doctor with a chief complaint of “I’m depressed, I’vegot headaches all the time...
...I was so tired that I had a hard time driving, the white lines weaving back and forth across the road, like the visual aura to an epileptic’s seizure...
...Her dehydration’s got nothing to do whatever with her dementia, even though the textbooks say it does...
...So what can I do about it...
...Yes, we want to hear the news about our brother Itzak...
...I started to panic...
...Under the breast was greeny scumlike material, and as the foul aroma hit us, I thought that this first day must be even worse for Potts...
...Well, man,” said Chuck, “sure is a great case...
...There’s nothing wrong with her bowels...
...Not once...
...And then finally the cries coming from the various rooms saved me...
...Turkeys,” said Fats, “he’ll make me late for breakfast...
...I loved him too...
...Rokitansky, what date is it today...
...Which end of the ward dowestart on...
...Aren’t we going on work rounds...
...I entered her room and found the old lady with a balding little man who was sitting on her bed, patting her hand affectionately...
...I wish I could lie...
...The patient presented was a generally healthy young man who’d been admitted for routine tests of his renal function...
...I guess I’m just afraid to sign my name to the order...
...Until that awesome tank of a mind had been fueled via that eager nozzle of a mouth, Fats had a low tolerance for medicine, academic or otherwise, and for anything else...
...If adoctorbuystheTV illusion of ‘the doctor,’ so does the patient...
...The efficiency ofthe Fat Man’s world rested on the concept of the three-byfive index card...
...bowel run,” Potts was saying...
...TheFat Man nearly keeled over with laughter...
...Our Visit was George Donowitz, a Private who’d been pretty good in the prepenicillin era...
...You can’t...
...I loved him...
...In the dim half-light, I thought I saw tears trickling down the old man’s cheeks...
...Waityou are a doctor...
...I felt pure terror...
...Had he heard what we’d said...
...Love, Berry...
...Noneofthat,”I said, thinking about my piddling around with you...
...It’s doing medicine the House of God way...
...And even there, the only one I could remember was Olafs, which stood for Occipital...
...There’s no way he’ll become a gomer, not with adisease like that...
...He looked at it and said, “Well, I guess I broke my scope, eh...
...Motionless, paralyzed, eyes closed, breathing comfortably, perhaps dreaming of a bone, or a boy, or a boy throwing a bone...
...He doesn’t want you writing orders on his patients...
...There stood Chuck, wearing a collar-to-toelength brown leather coat with tan fur ruffles at the edges, sunglasses, and a brown leather hat with a broad rim and a red feather...
...asked Potts...
...Medicine is ‘bedrest until complications,’ Blue Cross payments for holding hands, and all the rest you’ve seen today, with the odd Leo thrown in to die...
...0 1978 by Samuel Shem...
...Hewas the first personto tell us he knew about our terror...
...Start by not talking to her...
...Let me show youa bedsidetest for amyloid...
...She was not...
...He loved references on three-by-five cards...
...A little old man with a tuft of white hair standing on one leg with a crutch and making sharp worried chirps was an egret, and a huge Polish woman of the peasant variety with sledgehammer hands and two lower molars protruding from her cavernous mouth became a hippo...
...My BMS, Levy, wanted to go see my patients with me, but I shooed him away to the library, where BMSs love to be...
...This was azooand these patients were the animals...
...This is the most depressingthing I’ve ever done,” said Potts, lifting up a pendulous breast as Ina continued to shriek and attempt to whack him with her tied-down left hand...
...They can’t be...
...Fall out of bed...
...What’s there to be depressed about...
...He told me to get lost...
...Almost all patients are better off unseen...
...That’s ridiculous...
...What’s a gomer...
...They have to...
...Basch...
...Ina wasagreat mass of flesh sitting upright on a stretcher, wearing, like a uniform, a gown that had blazoned across its front The New Masada Nursing Home...
...These are normal medical patients...
...Why not...
...Like my not joining the army...
...You learned that uremic skin is brittle, andthattheHousePrivatesstink...
...The one on the right was his...
...Justdon’t forget what you saw...
...Running through my mind, over and over like Muzak, was a mnemonic for the branches of the external carotid artery: As She Lay Extended Olafs Potato Slipped In...
...He left...
...She was yelling a high-pitched: GO AVAY GO AVAY GOAVAYPotts did what the textbooks said to do: introduced himself, saying, “Hello, Mrs...
...I was a doctor...
...She’s fine-she’s a LOL in NAD, a Little Old Lady in No Apparent Distress...
...She’s indestructible...
...No he’s not,” said Fats...
...Congestive heart failure’s worse than most cancers...
...What do we have to look out for in this poor bastard now...
...Only interns and residents write orders...
...He hates everyone...
...Bacteria City...
...Young...
...To the contrary, he was the only resident to have his own reference file on every disease there was, on three-by-five cards...
...It’s the specialty of the House,”said F a t s , “ t h e bowel r u n . TTBTherapeutic Trial of Barium...
...But gomers are not just dear old people,”said Fats...
...I felt discouraged, worn...
...He came from a rich Old Family who owned a dreamhouse on Legare Street amidst the magnolias and yellow jasmine, a summerhouse on Pawley’s Island, where the only competition was between waves and winds, and an upriver plantation, where he and his brothers would sit out on the porch of a cool summer night and peruse Moliere...
...Sure he can...
...He hates me...
...The Private Doctors are not supposed to write orders,” said Potts...
...Carpets, individual changing rooms in radiology with color TV and quadraphonic sound...
...Ain’t “Nope...
...In the teeth of our expertise, the ones our age die...
...They were patients, and all I knew was in libraries, in print...
...Got to find out for myself...
...There’s nothing therapeutic about barium...
...Hey, man, what’s happenin...
...After Ina you’ll get it...
...We’re cruel to the gomers, by saving them, and they’re cruel to us, by fighting tooth and nail against our trying to save them...
...Undressing, I thought of Berry, but they had started in on me, and I was through with feeling anything more for that day, including sex, including love...
...Potts was relieved that here, at last, was a patient who could talk to him, who was not deathly sick, and who would not slug him...
...Rokitansky, how are you doing...
...Potts came in, looking puzzled and concerned...
...He’d been a college professor aQd had suffered a severe stroke...
...For the House Privates, a big one...
...You want to see bodies, go see bodies...
...Not that he was anti-academic...
...I hadn’t even had time for the toilet, for each time I’d gone in, the grim beeper had routed me out...
...I marched down the hallway with pride...
...Did Pottsget socked by Ina or did he not...
...In return, the Fat Man was skeptical of whatever wild country existed to the west of that great frontier, Riverside Drive...
...I know Inafromlast year...
...Putzel, had ordered the complete gastrointestinal workup, consisting of barium enema, upper GI series, small bowel followthrough, sigmoidoscopy, and liver scan...
...Pay attention...
...Yes...
...And what the hell use was that...
...Had I asked Sophie if she was allergic to aspirin...
...Like sex,,you gotta find it out for yourself...
...They want you to cuddle with your illusions, so you don’t give in to your panic...
...A large crowd had arrived to assist in the arrest, and Potts and I had been pushed out of the action...
...To all my questions, his answer was always the same...
...In my zoo, however, neitherwere there any majestic lions, nor any cuddly koalas, nor bunnies, nor swans...
...It didn’t last...
...If you talktothesepatients, you’llneverget rid of them...
...Potts’ head turned to watch the Fat Man go, and somehow, her left hand free, Ina slugged him again...
...Ah yes,” said Fats, eyes twinkling...
...If1 was you, Potts, I’d give him some roids...
...Potts and I stood there, mute, still, frozen, unable to move...
...I guess I wasn’t worried about him because he was an elective admission and not an emergency,” said Potts...
...Roids...
...It’s hard to be an intern, but I know you will return...
...The bowel run of the rich...
...It’s just that she got tired of going to Putzel’s office, and he got tired of calling at her house, so they both pile into his white Continental and come to our House...
...asked Potts...
...Each intern was to be saddled with a BMS, each day of the year...
...But the bowel run is the great equalizer...
...Confused, I called in the Fat Man...
...Blood was squirting from the wound...
...So why don’t you go home...
...said Chuck, and slid into the nearest chair, slouching down, covering his eyes with a weary hand...
...Potts and I clustered around the Fat Man like ducklings round a mother duck...
...Nothing happened...
...Bob Putzel, whom Fats described as “the handholder from the suburbs...
...The House switched our assignments, and I’ll be your resident for the first three weeks...
...I’m having a heart attack...
...Potts...
...He did, but all of medicine isn’t like that...
...My BMS, Levy, presented the case, and when Donowitz grilled him about diagnoses, the BMS, straight from the library of obscure diagnoses, said, “amyloidosis...
...What Potts and I didn’t know was that Leo was about to attempt to die...
...Again I thought of my grandfather and got a lump in my throat...
...Reflexively, Potts raised his hand to hit her and then stopped himself...
...No one had a right to be healthy, for my world was only disease...
...How sweet, I thought, her son has come to visit...
...The BMSs ventured several zebras, and Fats toldthemtoshutup...
...Lazlow’s liver functions are getting worse,” he said...
...I know...
...I love...
...I put a tablet under his tongue...
...Pottsand I went blank...
...Well it looks like that was your failing, man, that right there...
...The second time, I went in more slowly, and Zeiss squirmed, moaned, and cried out: “Help, nurse...
...Elective doesn’t mean shit around here,” said Fats...
...It’s ones his age that die...
...Modern medicine’s different: it’s Potts being socked by Ina...
...Rokitansky was an old basset...
...We’ll culture for everything...
...I don’t get it,” I said...
...The words blurred, and my mind bounced from How To Do cardiac arrests to this strange Fat Man to Ina’s vicious attack on poor Potts and to Little Otto whose name rang no bell in Stockholm...
...I’d just as soon wait a day...
...That’s him over there, writing Ina’s orders in her chart...
...See these fingers...
...You look like some kind of mugger,” said a BMS...
Vol. 10 • July 1978 • No. 5
