The House of God

by Samuel Shem

The patient flirted with death but pulled through. He was discharged a month later, thinking it usual, even a necessary part of his successful course of treatment in the House, for the skin to have been ripped off his arm by his dear and glorious physician.

One night on call, and a Southern gentleman had become a sadist.

“By the power vested in me by this great state and nation I hereby pronounce you, Elliot Reginald Needleman, dead.” Molly, snuggling up to me so that her left breast brushed my arm, asked, “Is that really necessary?” and I said I didn’t know, and I asked Fats, who said, “Of course not. The only federal regulation is that you take the two pennies out of your loafers and put them over the dead man’s eyes.”

Things had moved fast. Two days, and already, like swimming in a strong current, I’d looked up and found my life an eternity farther downstream, the near bank far gone. A rift had opened.

“Key concept,” said the Fat Man, “to think that you’re doing a shitty job. If you resign yourself to doing a shitty job, you go ahead and get the job done,

By the start of the ternship, he already had developed a terrific bedside manner, to hide his rampant indecisiveness.

A warmth filled the room, a trust, a plea to help, a promise to try. It was what medicine might be.

Trash your illusions, and the world will beat a pathway to your door.”

the helpless incurable young.

The House needed us. The House thought it needed us to do something for the gomers and for the dying young. What the House really needed us for was to do nothing for the gomers and to bear the helplessness of caring for the dying young.

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.

I make them feel like they’re still part of life, part of some grand nutty scheme instead of alone with their diseases, which, most of the time and especially in the Clinic, don’t hardly exist at all. With me, they feel they’re still part of the human race.”

The main source of illness in this world is the doctor’s own illness: his compulsion to try to cure and his fraudulent belief that he can.

It’s our job to tell them that imperfect health is and always has been perfect health, and that most of the things that go wrong with their bodies we can’t do much about. So maybe we do make diagnoses; big deal. We hardly ever cure.”

Relieved to think that my compulsion to try to cure was the only real disease in my patients, I sat back and let them, as people, bring me into their lives. What a difference! My basketball-playing arthritic black woman, when I ignored her aching knees and asked about her kids, opened up, chatted happily, and brought her kids in to meet me.

“you never outgrow your need for neurosis.”

It was awful. A scoliotic wreck of a woman, bent into an ungodly shape, demented from the spread of the cancer to her brain, fighting like an animal in pain against my doing anything for her. Two sisters hovered, demanding I do everything. The disease was disgusting and painful. These sisters were irritating in their absurd hope. This was no live thing, no hope. This was death.

“You two are drunk,” she said, “and I can see why. I’d get drunk too if I had to deal with these schmucks. It’s not transference, it’s obsessive-compulsive neurosis. You spill something, they have an attack of diarrhea. No wonder doctors have the highest rate of suicide, divorce, addiction, alcoholism, and premature death. And probably premature ejaculation too. In two hours here, nobody asked me anything about me. It’s as if I were only an appendix to you.” A keeper, I thought to myself.

They were gonna get me. The question was how, and how bad.

This TV show had served the primary purpose of confusing the American male about anatomy, since none of the chest pain was chest pain, but stomach pain, arm pain, back pain, groin pain, and one valid pain in a big toe, which turned out to be gout. Wading through these normal EKGs, I felt a deep contempt for “educating the public” about disease. Some TV evangelist was trying to hock “heart attacks”; terns across the country were being broken. The only MI I did see that day was a man my age, Dead on Arrival. My age. And here I was spending my few remaining pre-MI years trying to deaden myself, to survive.

took her in my arms and let her cry, and I was crying too. After she’d quieted some, I asked for her husband’s number, and after I did the workup for rape, I called him. He’d been worried stiff, and was glad she was not dead. He couldn’t know, yet, that part of her had died.

And yet neither friendship nor a weekend away from the House could contain my rage. Feeling free, more like a person, made the contrast even more painful. I carried my suspicion and contempt with me.

what I had to live with, the rest of the world must never see, for it separated me from them, as it had just done with my former best friends and with my one long love, Berry. There was rage and rage and rage, coating all like crude oil coating gulls. They had hurt me, bad. For now, I had no faith in the others of the world. And the delivery of medical care? Farce. BUFF ’n’ TURF. Revolving door. I wasn’t sitting at the end of the ambulance ride, no. There was no glamour in this. My first patient of the New Year was a five-year-old found in a clothes dryer, face bloodied. She had been hit by her pregnant mother, hit over and over with a bludgeon of pantyhose stuffed with shards of broken glass. How could I survive?

He crossed his legs in a slick way that showed that here was a guy, finally, who really knew how to sit down and cross his legs.

haha, finally!

Realizing with sadness that now even Berry had been sucked into calling these pitiful old ones “gomers,” I said, “He says he loves ’em.” “That’s just being counterphobic. Secondary narcissism.” “What’s all that?” “Counterphobic is when you do what you’re most scared of doing, the guy who’s afraid of heights becoming a bridge painter. Primary narcissism, like with Narcissus at the Pool, is when he tries to love himself, but he can’t embrace his own reflection, and he fails. Secondary narcissism is where he embraces others, and they love him for it, and he loves himself even more. The Fat Man is embracing the gomers.”

Ah, it’s a tough case: the only relief for her dementia is dialysis, but the thing that keeps her from signing for dialysis is her dementia. A real tough TURF.”

“Nah, I’ll just read this manual and then go tap Rose Budz’s chest.” I left him poring over the book and pointing his own finger at his own chest in the imaginary needle track he was going to take on Rose Budz.

WAIT!—with some alarm I realized that Hyper Hooper had been sitting in the on-call room reading my manual with his finger as his needle pointing—no, it couldn’t have been, but yes it was—pointing in a straight shot right toward Rose Budz the LOL in NAD’s heart.

If Mickey tried to pump his chest, his bones would crunch into little bitty bits. Not even Mickey, seduced into the Leggo’s philosophy of doing everything always for every patient forever, would dare call a cardiac arrest. Mickey called a cardiac arrest. From all over the House, terns and residents stormed into the room to save the Man With Agonal Respirations from a painless peaceful death.

Each of us was becoming more isolated. The more we needed support, the more shallow were our friendships; the more we needed sincerity, the more sarcastic we became. It had become an unwritten law among the terns: don’t tell what you feel, ’cause if you show a crack, you’ll shatter.

On the way back to bed I passed the room with Saul the leukemic tailor. My tormenting him with my attempt, against his will, for a second remission had made him much worse. Comatose, by most legal criteria he was dead. He would not recover and yet I could keep him alive for a long time.

When I asked him if he thought I’d gone off the deep end he said, “Deep end? Ha! Roy, I think you were giving that elevator just what the fucker always deserved!”

“Not them, you. They make me sad, but the way you treat them, making fun of them, like they were animals, is sick. You guys are sick.”

“Hurt your feelings, Fats?” “No, but it hurts hers. You can’t use our inside jokes with the ones outside all this, the ones like her.” “Sure you can,” I said, “they need to see—” “THEY DON’T!” yelled Fats. “They don’t need to, and they don’t want to. Some things have to be kept private, Basch. You think parents want to hear schoolteachers making fun of their kids? Use your damn head.

“It’s the strangest thing,” said the Leggo, as I sat in his office, which was the only place they’d decided it was safe to send me, “yes, the strangest . . .” and he drifted off into that place out his window where the answers to strange things might be found.

found myself thinking of Potts as a tragic figure, a guy who’d been a happy towheaded kid you’d love to take fishing with you, who’d mistakenly invested in academic medicine when he’d have been happy in his family business, and who’d become a splattered mess on the parking lot of a hospital in a city he’d despised. What had been the seductiveness of medicine? Why? “They killed him.”

Pedley had fallen prey to Jo, who’d taken one look at the EKG, decided Pedley was dying, and had hooked up the electrodes of the cardioverter, and without anesthetic had burned the skin off Pedley’s chest. Pedley’s heart, affronted at having been jolted into normal sinus rhythm, stayed there for only a few minutes and reverted to the beat of its own drummer, V Tach. Frantic, Jo scorched Pedley’s chest four more times before Pinkus arrived and stopped the barbecue. For the past week Pedley had remained in V Tach. Except for the festering burns on her chest, she was fine, a LOL in NAD.

Without culturing it, his House Private, Duck’s Ass Donowitz, had given him the wrong antibiotic, which had eradicated the bacteria that were containing the spread of the resistant staph in the pimple, allowing the staph to spread, producing total body sepsis, and turning a happy forty-five-year-old successful broker into an epileptic, mute, debilitated skeleton who could not speak because of the hole that had rotted through the cartilage of his trachea from his months on a respirator.

Pinkus suggested that, given my clear family history, I had an obligation to exert as much control as possible over my cardiac destiny, by refraining from eating what I liked (doughnuts, ice cream, coffee), smoking what I liked (cigarettes, cigars), doing what I liked (lazing around), and feeling what I felt (anxious).

I got my hand around the back of the young lifeless heart and squeezed. Tough, slippery, the sinewy muscle was a leather bag, filled with blood, rolling in the steamy chest cavity, tied to the tubes of the major vessels. Why was I doing this? My hand hurt. I gave up. The heart lay like a grayish-blue fruit on a tree of bones. Sickening.

As usual in my medical training, knowing little, I was put in charge of all.

“Does she have a hobby?” “Sure does. Moo-elling.” “Never heard of that one,” said Pinkus, “what is it?” “Ask her.” “Hello, dearie. What’s your hobby?” “MOO-ELL MOO-ELL!” “What a funny joke, Roy,” said Pinkus. “Say, look at this.” Pinkus unbuttoned his shirt, revealing a running shirt on which was a giant-sized full-color healthy heart. He took off his trousers, revealing pink shorts on which, in blood red, was the slogan YOU GOTTA HAVE HEART. PINKUS. HOUSE OF GOD.

Is Chris Trager from Parks and Rec modeled after Pinkus?

“Pinkus,” said Jo with great intensity, the circles under her eyes even blacker, “I want to make one thing perfectly clear: we are going to win this war against death.”

Long ago I’d given up the idea that what I did to these bodies had any relevance to whether it did any good. I would do it well. Why should I mind being the final expiation for the failure of House medical care?

The husband, having suffered the treatment and having lived with the death that the House red-hots had been denying his wife, informed us that he wanted us to stop, to do no more. Knowing that this last prolongation of life was worthless, done out of collective impotence and guilt, I convinced the husband to let us continue, assuring him—falsely?—that her suffering would not be prolonged. Too enraged to cry, he left.

Denying hope and fear, ritualized defenses pulled up around ears like turtlenecks, these doctors, to survive, had become machines, sealed off from humans—from wives, kids, parents—from the warmth of compassion and the thrill of love.

I brought Sev to the bedside, and together the little polymath and I counted: “All right, now we count legs: one—” “I don’t think that’s funny,” said Sev. “I know how to count.” “Well, then, what happened?” “I got the wrong chart.” “You didn’t look at this patient?” “Yes, I did,” said Sev. “I looked, I just didn’t see the other leg, that’s all. My cognitive set was for one leg, not for two.” “Terrific,” I said. “Reminds me of a very famous House LAW: SHOW ME A BMS WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.”

We were putting into these gomers our fear of death, but who knew if they feared death? Perhaps they welcomed death like a dear long-lost cousin, grown old but still known, coming to visit, relieving the loneliness, the failing of the senses, the fury of the half-blind looking into the mirror and not recognizing who is looking back, a dear friend, a dear reliever, a healer who would be with them for an eternity, the same eternity as the long ago, before birth. Wouldn’t that be death, for them?

The sequence of training should be reversed: on day one, bring the puking BMSs right into the House of God and rub their noses in Olive O.: turn off potential surgeons with her humps; potential internal-medicine red-hots with her numbers incompatible with life and her inability to be cured or dead; even potential gynecologists will take one look at the terrain of their future specialty and transfer into dentistry. And then—and only then—let the ones who still have the stomach for it start on the preclinical years.”

“Dr. Basch, I’ve got several hours’ more work to do tonight, and you don’t. How come you’re always going to sleep, and I’m always staying awake?” “Simple. You’re a mathematician, right? Now, I get paid a fixed salary by the BMS, no matter how many hours I’m awake. You pay a fixed tuition to the BMS, no matter how many hours you’re awake. Therefore, the more I sleep, the more I earn per waking hour, and the more you stay awake, the less you pay per waking hour. Got it?”