"I don't know," I said as we walked to the elevator.
"You don't know? Damn. They've probably already sold her bed, so we won't be able to TURF her back there. One of the true medical emergencies, when the nursing home sells the gomere's bed."
"How do you know it will be a gomere?"
"The odds, just playing the odds."
The elevator opened, and there was the 6?North tern, Eat My Dust Eddie, standing with a stretcher on which was piled his very own first E.W. admission: three hundred pounds of flesh, naked but for dirty underpants, huge herniations of his abdominal wall, a great medicine hall of a head with little slots for eyes, nose, and mouth, and a bald skull covered with purplish crisscrossing neurosurgical scars so it looked like a box of Purina dog chow. And all of it was convulsing.
"Roy," said Eat My Dust, "meet Max."
"Hi, Max," I said.
"HI JON HI JON HI JON," said Max.
"Max perseverates," said E.M.D. "They unhooked his frontal lobe."
"Parkinson's disease for sixty?three years," said Fats, "a House record. Max comes in when his bowels get blocked. See that intestine pushing its way out through the scars in his belly? Those lumps?"
We did.
"If you X?ray it, you'll find it's feces. Last time Max was here, it took nine weeks to clean him out, and the only thing that finally worked was a small?handed female Japanese cellist who was also a BMS student, equipped with special long?armed gynecological gloves, and promised the internship of her choice if she would disimpact Max manually. Wanna hear 'Fix the lump'?"
We did.
"Max," said Fats, "what do you want us to do?"
"FIX THE LUMP FIX THE LUMP FIX THE LUMP," said Max.
Eat My Dust Eddie and his BMS put their shoulders to the wheels of the stretcher, and Max, gathering momentum, rolled off into the n8on sunset. Yoked together, the three looked like they were trudging around a ring of the mountain of Purgatory. Coming back to my senses as we rode the elevator down, I asked the Fat Man how come he seemed to know all the patients, like Max, Ina, and Mr. Rakitansky.
"There is a finite number of House gomers," said Fats, "and since GOMERS DON'T DIE, they rotate through the House several times a year. It's almost as if they get their yearly schedules in July, just like us. You get to know them by their particular shrieks. But what diseases does your gomere have?"
"I don't know. I haven't seen her yet."
"Doesn't matter. Pick an organ, any organ"
I fell silent, so scared that I was having trouble thinking of an organ.
"What is this? Where did they get you from? On quota? Is there affirmative action for Jews? What lies inside the chest cavity and beats?"
"The heart."
"Good. So the gomere has congestive heart failure. What else?"
"The lungs."
"Terrific. You're really cooking now. Pneumonia. Your gomere has CHF and pneumonia, she's septic from her indwelling catheter, refuses to eat, wants to die, is demented, and has an unobtainable BP. What's the first thing?the crucial thing?to do?"
I thought of the diagnosis of septic shock, and suggested an LP.
"Nope. That's BMS textbook. Forget textbook. I am your textbook. Nothing you learned at the BMS will help you tonight. Listen?key concept?LAW NUMBER FIVE: PLACEMENT COMES FIRST."
"I think that's going a little too far. I mean, you're making all kinds of assumptions about this person. You're treating a human being like a piece of baggage."
"Oh? I'm crass; cruel, and cynical again, am I? I don't feel anything for the ill? Well, I do. I cry at movies. I've spent twenty?seven Passovers being pampered by the sweetest grandma any Brooklyn boy ever had. But a gomere in the House of God is something else. You'll find out for yourself tonight."
We stood at the nursing station of the E.W. Several others were sitting there: Howard Grinspoon, who was the new tern on call in the E.W., and two policemen. Howard I'd known from the BMS. He was blessed with two traits which were to prove to be so useful to him in medicine: unawareness of self, and unawareness of others. Not smart, Howard had slurped his way through BMS and into the House by doing something with urine, either putting urine through computers or running computers on urine. This had endeared him to that other man of little urine, the Leggo. A plodder and a planner, Howard was also into using IBM computer cards to aid in medical decision?making. By the start of the ternship, he already had developed a terrific bedside manner, to hide his rampant indecisiveness. Although Howard wanted to "present the case" to Fats and me, Fats ignored him, focusing on the policemen. One policeman was huge, barrel?shaped, with red hair growing out of and into most of the slitty features on his fat red face. The other policeman was a matchstick, decked out, facially, in white of skin and black of hair, with vigilant eyes and a large and worrisome mouth , filled with many disparate teeth.
"I'm Sergeant Gilheeny," said the red, barrel?shaped one, "Finton GiIheeny, and this is Officer Quick. Dr. Roy G. Basch, we wish you hello and Shalom."
"You don't look Jewish," I said.
"You don't have to be Jewish to love a hot pumpernickel bagel, and besides, the Jews and the Irish are similar in one respect."
"What respect is that?"
"In their respect for the family unit, and the concomitant fucked?up nature of their lives."
Howard, irritated at being ignored, tried to tell us again about my admission. The Fat Man silenced him at once.
"But you don't know anything about her," said Howard.
"Tell me her shriek, and I'll know it all."
"Her what?"
"Her shriek. Whatever sound she makes"
"Well," said Howard, "she does shriek. She makes a ROO?DLE."
"Anna O.," said Fats. "Hebrew House for the Incurables. This admission will be approximately number eighty?six. You start with a hundred sixty milligrams of the diuretic Lasix and you go up from there."
"How'd you know all that?" asked Howard.
Ignoring him, Fats turned to the policemen and said, "It's obvious that Howard has failed to do the most important things in the case. I trust that you two gentlemen have?"
"Even in our role as policemen who patrol the city and environs of the House of God and often sit and chat and drink coffee with the brilliant young medicos," said Gilheeny, "we do sometimes intervene in emergency patient care."
"We are men of the law," said Quick, "and we followed the House LAW: PLACEMENT COMES FIRST, and called the Hebrew House. Alas, during the ambulance ride here, Anna O.'s bed was sold."
"Too bad," said the Fat Man. "Well, at least Anna O. is a great one to learn on. She's taught countless House terns medicine. Roy, go see her. You've got twenty minutes till the ten?o'clock meal. I'll wait here and jabber with our friends the cops."
"Magnificent!" said the redheaded policeman, beaming a grand sunny smile, "for twenty minutes of Fat Man chat is a gift horse we shall look everywhere but in the mouth."
I asked Gilheeny why he and Quick were so well-informed about this medical emergency, and his reply puzzled me:
"Would we be policemen if we were not?"
I left the Fat Man and the two policemen huddling together, intensifying their chatter. I went to the door of room 116, and once again I felt alone and afraid. Taking a deep breath, I went in. The walls were covered with green tile, and the bright neon light glittered off the stainless?steel equipment. It was as if I had stepped into a tomb, for there was no doubt that here, somehow, I was in touch with that poor thing, death. In the center of the room was a stretcher. In the center of the stretcher was Anna O. She lay motionless, her knees bent up toward the ceiling, her shoulders curved around toward her knees, so that her head, unsupported and rigid, almost touched her thighs. From the side she looked like the letter W. Was she dead? I called to her. No answer. I felt for a pulse: No pulse. Heartbeat? None. Breath? No. She was dead. How fitting, that in her death her entire body should have hooked around in mimicry of her persecuted Jewish nose. I felt relieved that she was dead, that the pressure to care for her was off. I saw her little tuft of white hair, and I remembered my grandmother lying in her coffin, and I was filled with sadness for that loss. A lump formed in my midsection, tugged at the tip of my heart, and pulled itself up into my throat. I felt that strange sensation of gritty warmth that comes just before tears. My lower lip curled down. To control myself, I sat.