This story contains the Ten Rules of Engagement in The House of God—a delightfully black humor satirical look at the life of a doctor during hospital residency. It's written by Samuel Shem. Because of that, the humor in this story is rather dark and seemingly a bit callous. Readers should be warned that there are M*A*S*H style jokes. This is not mean to be insensitive or uncaring to anyone who has a loved one being treated or an insult to the hard working people in the ER. Rather, I hope this reflects a bit of what it takes to make it in the ER and come out the other side caring about your patients.
There are days when it's not even worth chewing through the leather restraints. That's most days in the ER and I work the night shift, so it's even worse. I thought this place was bad when I was a resident, then I got planted here full time—my cup runneth over, mostly with bodily fluids. I know what you are thinking. If I don't like it, I should just leave. Yeah, well, I got bills and they pay me well here. Another place might not be quite as generous with their cash. So, I'm a slave to the all-mighty dollar, at least until I get medical school loans paid off.
It was a typical Friday night, the sort of Friday night that you know no good will come of. I'd nearly called in sick for my shift, but either a twinge of guilt or gas from a burrito stopped me.
We'd already had one knifing and a DOA from the gang fight on 53rd, when lo and behold the ambulance drones brought in the rest of the injured gang members, from both sides. In these moments, I cite Rule Number Nine—the only good admission is a dead admission. These guys continued pounding on each other until half of them were dead and the other half were unconscious. We pretty much stood back while the knife demonstration continued in the ambulance breeze-through, then waited for security to sort out the winners from the losers. Remembering Rule Number Eight, "They can only hurt you more", none of us were anxious to get a stab injury courtesy of the local gangs, at least not that night. That's why they paid security the big bucks.
Later, a LOL in NAD (little old lady in no acute distress), aside from the fact she looked more dead than alive, was wheeled in by her "nephew" who was loudly insisting that she needed to have her Valium script renewed. Giving her Valium would have been like taking coals to Newcastle. If she was any more relaxed, grey matter would be oozing out of her ears. Nephew, too, was given an escort by our friendly security guards to the nearest police station. Auntie Gomere, the female derivative of Get Outta My Emergency Room, was gently hydrated once we found the one usable vein left in her tiny body, then turfed upstairs to a nice warm bed. The Gen Med admitting resident was having a stroke that I was not adhering to the Residents' after-hours credo, "treat and street," but I told him to just pull up his panty hose because Auntie needed to be admitted and reminded him that if he ran in the IV too fast, Auntie G would go into fluid overload, Rule Number Four: Age plus BUN (blood urea nitrogen—it's one of the chemicals that indicated kidney function) equals Lasix dose.
I figured it couldn't get worse, so, of course, that's when I saw them. Two guys, a blond and a dark haired guy, each one practically holding the other up, staggered in. There was so much blood I wasn't sure which one was the patient or if both of them were splitting the tab. Then I caught a flash of cold blue eyes and knew.
"Gurney," I shouted and rushed to them, reaching for the dark-haired guy. "What happened?"
"Zigged, didn't zag," the dark haired guy muttered and coughed. He doubled up and I caught him before he hit the ground. The orderlies were there and one muttered, "Hold on, Gomer."
"His name is Napoleon," the blond snapped and there was something in that voice that told you that you would address him as Napoleon and by no other name.
"Okay, what happened to Napoleon?" I asked as I followed the gurney. The blond guy was looking a little shocky and with all that blood, I wasn't sure he wasn't hurt as well. The orderlies pulled the curtain and he jumped a mile. He moved his hand and that's when I saw the shoulder holster.
I started to say something, but instead of a gun, he pulled out a wallet with blood crusted fingers and flipped it open to an ID card. U.N.C.L.E.—An honest-to -God UNCLE agent! I'd heard of these guys, but it was sort of like a yeti or Bigfoot, until you see one for yourself, you never really quite believe these guys are real. But they were real and were currently dripping all over the floor.
"I didn't know you guys really existed."
"We exist, at times painfully," Napoleon muttered and I was amazed that someone in his condition could still joke. Glancing over at the blond, I took a step toward him. He took a step back.
"Help Napoleon. I'm fine."
I stared at him for a minute, decided he could wait and turned back to Napoleon.
"Let's get you fixed up." I reached for a pair of scissors and a hand caught my wrist. It was amazing how strong Napoleon's grip was considering the blood pool he was adrift in. I made up my mind then and there to not get into an Indian wrestling match with him after this.
"This is..."
"Garbage," the blond guy snapped and pulled the hand off my arm. "Let the man do his job."
"Illya..." Napoleon's voice was not happy.
"Allow the doctor to cut the pants or I shall rip them off myself..."
I liked the way this little guy worked and there were telltale buldges which proclaimed that he was quite capable carrying through with his threat. With a groan, Napoleon sunk back to the gurney and I began to cut things off. I got to his belt. It was around his thigh and holding a square of cloth in place, a handkerchief I was guessing. I went to cut it off and, again, the hand reached out.
"Don't."
"I have to take it off so I can check your wound. What is it, designer leather? Exotic hide?"
"Explosive."
Chanting Rule Number Eight—they can always hurt you more—I backed away from the gurney and handed the blond... Illya... the scissors. "You want to finish up for me, pal?"
There was a hint of a smile as he took the scissors from me. He fiddled with the belt for a moment, then he quickly divested Napoleon of his coat, shirt and shoulder holster. He gathered everything up in a neat, if bloody, bundle and set it aside.
Now I got my first look at Napoleon. He had about a half dozen knife wounds, some of them were shallow enough to just need steri-strips, some were scratches just needing to be cleansed and Bactroban'ed. Looked like the only thing that would need sutures was the laceration to his upper thigh. The more I examined him, the more I couldn't believe this guy's luck.
"What's wrong?" Napoleon asked as I shook my head.
"Were you conceived on a bed of four leaf clovers? I've never seen anything like this!"
"I prefer to think he was kicked by a horse at an early age," Illya had found a chair and settled into it, his eyes never leaving my hands. "Will he be all right?"
"Of course, Rule Number. Six, 'There is no part of the body that can't be repaired with a #14 gauge needle and a strong right arm." Okay, so I fudged a bit, but if I had said body cavity, I have a feeling both men would have been gone before I finished speaking. And Napoleon did need patching up. I turned to the nurse, "I'm going to need..." I rumbled through the list, observing Illya out of the corner of my eye. I still wasn't convinced that he was as fine as he kept insisting he was.
So, the nurse started an IV on Napoleon and slipped in a bit of happy juice, just enough to relax him. He kept glancing over at his partner, as if he desperately wanted to say something, but didn't quite know how to say it.
I took a hypo from the tray and squirted out a bit. People give you all this song and dance about air bubbles and the lot, but honestly we do this because nine times out of ten it freaks the hell out of the patient. Hey, I ain't just here for my good looks and charm, you know.
Napoleon didn't even flinch and I spared him the 'you may feel a pinch' speech. There were enough scars on this guy to tell me he'd been around or else danced with a barbed wire fence at some point in his life.
I started to clean up some of the scratches while I waited for the local to kick in.
"Aren't you even going to ask how this happened?" Napoleon's voice was starting to get soft around the edges.
"Nope, I figure it wouldn't do me any good to and, besides, the delivery of good medical care is to do as much nothing as possible." That's Rule Number 10, by the way. "And that means no asking when it's none of my business." Then, just on an off chance, I muttered, "Is your friend really okay?"
"Doubtful," Napoleon murmured. "Illya, since I'm not going anywhere for the next few minutes, maybe you could let Uncle Alex know what is going on."
"I wondered when you were going to stick me with that." He got up, took two steps and went to ground, adhering to Rule Number 2—gomers don't die; gomers go to ground.
"Motherpussbucket! Gurney!"
Things got a little intense after that, but surprisingly, I got him stable enough to turf upstairs and pissed off the Gen Surg admitting resident by sending him up without authorization. I kicked myself because I forgot Rule Number. Three -the patient is the one with the disease,' or in this case, a nice little air- conditioned spleen. At least he didn't kack in the ER.
Life continued at The Knife and Gun Club. About a month later, it was another stupid, God-awful Friday night. I'd been arguing with Radiology that the Gomer behind Curtain Three did not have a pulmonary infiltrate ... the freaking medical student had spewed on the film and hadn't cleaned it all off. I'd turfed about five other patients and was just about to break for a well earned cup of disgusting coffee and to address the death threats from the Gen Med and Gen Surg admitting residents. I looked up and, quietly, this guy walked up to the Triage desk. He looked seriously lost, but he wasn't bleeding or staggering or barfing.
"What can I do for you?"
"I'm looking for a Doctor Gladstone."
"That would be me." I flipped my lapel over to display my name tag.
"This is for you." He handed me an envelope and scurried away before I could even offer him a tip. Not that waiting would have done him any good. My wallet was in my locker—you only get held up twice by some drug-crazed freak to learn that lesson.
I took the envelope into the staff lounge and got myself some coffee. I used someone else's cup just to piss her off and collapsed on the lumpy couch. I set the cup down so I could tear open the envelope and pulled out a sheet of paper.
Due to my outstanding treatment of a Mr. Napoleon Solo and Mr. Illya Kuryakin, I was being offered a staff physician job at U.N.C.L.E. The salary was nearly double what I was currently getting. The location was better, the hours were better, everything was better. And I thought about it for a long time before I sent them back a nice little 'thanks but no thanks' letter.
It's not that I'm crazy, stupid, or loyal, don't get me wrong. It's just if I hadn't been in the ER when those two staggered in, I wouldn't be reading this letter now. Everyone has a place and mine's here, with the crappy coffee, the crabby nurses and a BMS, Best Medical Student, who is only tripling my work this time around.
You know what they say, home is where the Gomers are...
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