The House of God

by Samuel Shem

For before the House of God, I had loved old people. Now they were no longer old people, they were gomers, and I did not, I could not love them anymore. I struggle to rest, and cannot, and I struggle to love, and cannot for I’m all leached out, like a man’s shirt washed too many times.

The House of God had been founded in 1913 by the American People of Israel when their medically qualified Sons and Daughters could not get good internships in good hospitals because of discrimination. A great tribute to the dedication of the founders, it soon attracted red-hot doctors, and was blessed with an affiliation with the BMS—the Best Medical School—in the world. Built up to this status, internally it had broken down into many hierarchies, at the bottom of which now lay the very people for whom it had been constructed, the House Staff. Consistently, at the bottom of the House Staff lay an intern. While the straight shot down from the top of the medical hierarchy got the intern, the intern was at the bottom of the other hierarchies only indirectly. In many tricky ways he had the opportunity to be abused at any time by Private Doctors, House Administration, Nursing, Patients, Social Service, Telephone and Beeper Operators, and Housekeeping. The latter made the beds and regulated the heat, cold, toilets, linen, and general repairs. The interns were completely at their mercy.

The House of God was known for its progressiveness, especially in relation to the way it treated its House Staff. It was one of the first hospitals to offer free marital counseling, and when that failed, to encourage divorce. On average, during their stay, about eighty percent of the married medically qualified Sons and Daughters would make use of this suggestion, separate from their spouses, and take up with some bombshell from Private Doctors, House Administration, Nursing, Patients, Social Service, Telephone and Beeper Operators, and Housekeeping.

“I’ll get the chart rack. Which end of the ward do we start on?” “Sit down!” said Fats. “What are you talking about, chart rack?” “Aren’t we going on work rounds?” asked the BMS. “We are, right here.” “But . . . but we’re not going to see the patients?” “In internal medicine, there is virtually no need to see patients. Almost all patients are better off unseen.

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 three A.M.” “I think that’s kind of crass,” said Potts. “Some of us don’t feel that way about old people.” “You think I don’t have a grandmother?” asked Fats indignantly. “I do, and she’s the cutest, dearest, most wonderful old lady. Her matzoh balls float—you have to pin them down to eat them up. Under their force the soup levitates. We eat on ladders, scraping the food off the ceiling. I love . . .” 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.” I thought of my grandfather. I loved him too. “But gomers are not just dear old people,” said Fats. “Gomers are human beings who have lost what goes into being human beings. They want to die, and we will not let them. 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. They hurt us, we hurt them.”

She’s fine, she’s a LOL in NAD—a Little Old Lady in No Apparent Distress.

“Sure he can. Listen, Basch, there are a number of LAWS OF THE HOUSE OF GOD. LAW NUMBER ONE: GOMERS DON’T DIE.” “That’s ridiculous. Of course they die.” “I’ve never seen it, in a whole year here,” said Fats. “They have to.” “They don’t. They go on and on. Young people—like you and me—die, but not the gomers. Never seen it. Not once.” “Why not?” “I don’t know. Nobody knows. It’s amazing. Maybe they get past it. It’s pitiful. The worst.”

said, “How’d it go? Terrible. The Fat Man said to me ‘Don’t worry, the Privates know the new terns are here, and they’re only admitting emergencies.’ So what happened? I get five and a half emergencies.” “What’s a half ?” “A transfer from another service to medicine. I asked the Fat Man about that too, and he said, ‘Since you only get half credit for the admission, you only do half an exam.’ ” “Which half ?”

Again, like the day before, most of what I’d learned at the BMS about medicine either was irrelevant or wrong. Thus, for a dehydrated Ina, hydration made her worse. The treatment for depression was to order a barium enema, and the treatment for Potts’s third admission, a man with pain in his abdomen but who “knew all of you doctors are Nazis but I’m not quite sure just yet which one of you is Himmler,” was not a barium enema and bowel run, but what the Fat Man called a “TURF TO PSYCHIATRY.” “What’s a TURF?” asked Potts. “To TURF is to get rid of, to get off your service and onto another, or out of the House altogether. Key concept. It’s the main form of treatment in medicine. Just call up psychiatry, tell them about the Nazi stuff, don’t mention the gut pain, and presto—TURF TO PSYCHIATRY.” Ripping up the index card containing the Nazi-seeker and throwing the bits over his shoulder, the Fat Man said, “The TURF, I love it. Let’s go. Next?”

The Fat Man gathered us around the electric gomer bed containing my patient, Mr. Rokitansky. Fats explained how the goal of the tern was to have as few patients as possible. This was opposite the goal of the Privates, the Slurpers, and the House Administration. Since, according to LAW NUMBER ONE: GOMERS DON’T DIE, the gomers would not be leaving the tern’s service by way of death, the tern had to find other ways to TURF them. The delivery of medical care consisted of a patient coming in and being TURFED out. It was the concept of the revolving door. The problem with the TURF was that the patient might BOUNCE, i.e., get TURFED back. For example, a gomer who was TURFED TO UROLOGY because he couldn’t urinate past his swollen prostate might BOUNCE back to medicine after the urology intern with his filiform probes and flexible followers had managed to produce a total body septicemia, requiring medical care. The secret of the professional TURF that did not BOUNCE, said the Fat Man, was the BUFF. We asked what a BUFF was. “Like BUFFING a car,” said Fats. “You gotta BUFF the gomers, so that when you TURF them elsewhere, they don’t BOUNCE back. Because you gotta always remember: you’re not the only one trying to TURF. Every tern and resident in the House of God is lying awake at night thinking about how to BUFF and TURF these gomers somewhere else. Gath, the surgical resident downstairs, is probably giving his terns the same lecture at this very moment, about how to produce heart a...

remember? He uses the standard method: admit the LOL in NAD, do a test, produce a complication, do another test to diagnose the complication, get another complication, and so on until they’re gomertose and non-TURFABLE.

The more I did, the worse they got. Anna O. had started out on Jo’s service in perfect electrolyte balance, with each organ system working as perfectly as an 1878 model could. This, to my mind, included the brain, for wasn’t dementia a fail-safe and soothing oblivion of the machine to its own decay? From being on the verge of a TURF back to the Hebrew House for the Incurables, as Anna knocked around the House of God in the steaming weeks of August, getting a skull film here and an LP there, she got worse, much worse. Given the stress of the dementia workup, every organ system crumpled: in a domino progression the injection of radioactive dye for her brain scan shut down her kidneys, and the dye study of her kidneys overloaded her heart, and the medication for her heart made her vomit, which altered her electrolyte balance in a life-threatening way, which increased her dementia and shut down her bowel, which made her eligible for the bowel run, the cleanout for which dehydrated her and really shut down her tormented kidneys, which led to infection, the need for dialysis, and big-time complications of these big-time diseases. She and I both became exhausted, and she became very sick. Like the Yellow Man, she went through a phase of convulsing like a hooked tuna, and then went through a phase that was even more awesome, lying in bed deathly still, perhaps dying.

“What the hell are you doing?” he asked. I told him. “Anna was on her way back to the Hebrew House, what happened—wait, don’t tell me. Jo decided to go all-out on her dementia, right?” “Right. She looks like she’s going to die.” “The only way she’ll die is if you murder her by doing what Jo says.” “Yeah, but how can I do otherwise, with Jo breathing down my neck?” “Easy. Do nothing with Anna, and hide it from Jo.” “Hide it from Jo?” “Sure. Continue the workup in purely imaginary terms, BUFF the chart with the imaginary results of the imaginary tests, Anna will recover to her demented state, the workup will show no treatable cause for it, and everybody’s happy. Nothing to it.” “I’m not sure it’s ethical.” “Is it ethical to murder this sweet gomere with your workup?”

Finally, one day, as I passed by her room I heard a healthy demented ROODLE! and my heart swung around on its apex with pride and I knew that Anna was back and that I had proved scienterrifically that, just as Fats had said, to do nothing for the gomers was to do something, and the more conscientiously I did nothing the better they got, and I resolved that from that time on I would do more nothing on the gomers than any other tern in the House of God.

Lazarus’s liver disease was not classy, it was just the standard sure-death brand of cirrhosis seen sucking the end of bottles wrapped in paper bags on every street corner of the world.

his attention shifted to my cigarette until he couldn’t stand it any longer and said, “I don’t understand how, knowing what you know about lung cancer, you continue to smoke. Maybe you don’t inhale?” I did not inhale, and so I said, “I inhale.” “Why do you do it?” “It feels good.” “If everyone did what feels good, where would we all be?” “Feeling good.”

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 the 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.

The policemen say I’ve become paranoid. They’ve seen it happen to interns before. It comes from working in the E.W.” “I thought you liked the E.W.” “I used to. It had been fun. It wasn’t all gomers. There were people whose lives I saved, I actually saved.” “What happened?” “I got competent to handle the big stuff, and the other stuff is just one abusive person after another. It shits. Addicts trying to dupe you for dope, drunks, the poor, the clap, the lonelies—I hate ’em all. I don’t trust anyone. It comes from being vomited on and spit at and yelled at and conned. Everyone’s out to get me to do something for them, for their fake disease.