The Tower: A Novel

by Uwe Tellkamp

  9

  Everyday life with Asclepius. The sorrow of a houseman

  ‘Knife.’

  The operating-theatre nurse handed Wernstein the scalpel.

  ‘Adjust light, please.’

  Richard was enjoying himself: he had handed this operation over to Wernstein and taken the role of assistant himself and now he was actually treating him as a junior physician. If you’re going to do something, you might as well do it properly. He reached up and focused the light of the lamp on the operating area that was framed in green cloths. ‘There you are, sir.’

  Wernstein cut open the fascia. He didn’t respond to the joke; his tension was evident as he tried to widen the cut with his finger. The houseman, Herr Grefe, who was standing at the other side of the operating table holding the retractors, grinned behind his mask; the movement of his mouth that stretched the material of his mask and the wrinkles at the corners of his eyes indicated it.

  ‘I bet you anything you won’t manage the fascia with just your finger.’

  ‘We’ll see.’ Wernstein took a deep breath, asked the anaesthetist to add the antibiotic drop by drop.

  ‘Which fascia are we actually talking about here?’

  Grefe, whom Richard had asked, started. ‘Fascia … er … the fascia …’

  ‘Lata,’ Wernstein said after a while. ‘The fascia lata. But that’s not the entire truth. What I’m trying to force apart here with my fingers but am never going to manage to open like a can of beans is … the tractus iliotibialis. Where did you do your preliminary study?’

  ‘In Leipzig.’

  ‘There’s a motto over the entrance to the anatomical lecture theatre there.’

  You had to know that if you were working under Dr Hoffmann. The anaesthetist, who was just looking over the edge of the guard cloth, smirked.

  ‘Anatomia – clavis et clavus medicinae.’

  ‘The key and the rudder of medicine,’ Nurse Elfriede, who handed the operator the instruments, translated in a dry voice. ‘Young man, for the last fifteen years all Leipzig students have been asked that question in this operating theatre.’

  ‘Are you suggesting I’m starting to bore you?’

  Nurse Elfriede rolled her eyes. ‘I’ll give Dr Wernstein the scissors rather than answer that. You know that you’re our guiding light, Dr Hoffmann.’

  Muttering, Wernstein got down to work and started to cut open the fibrous tissue. – How difficult he finds it to admit I was right. Now he’s sawing away at it after all. But, dammit, I was just the same. Smiling to himself, Richard staunched the flow of blood. At the same time he was irritated by the houseman. These young people, they came to an operation and had no idea! If we’d dared do that in the old days … He thought of a few of the surgeons under whom he’d developed his technique, eruptive characters inclined to outbursts of rage if things didn’t go precisely the way they expected; most of them came from the operating bunkers and field hospitals of the war, from the mills of unimaginable carnage. With Grosse the assistants had to prepare everything; once they’d finished he would make his way, godlike, eyes half closed, unapproachable, as if in a trance, gently waving his hands still moist from disinfection, to the operating table, have someone help him into his gown and gloves before silently holding out his hand for the scalpel that the operating-theatre nurse placed in it with due reverence. Woe to any assistant who was unable to answer one of the questions he would suddenly fire off into the silence. The boss wouldn’t look at him again, his career with him was over.

  ‘Thread.’ Richard tied off a bleeding vessel. With decisively made cuts Wernstein deepened the incision, felt for the fracture. His every movement, the elegance and assurance with which he handled the instruments, his finely gauged sense of when it was necessary to proceed with caution and when he could work more purposefully, his feeling for the hidden dangers of an operation, for all the deviations from operational and anatomical theory when, suddenly reduced to a blind man in a pitch-dark tunnel, you had to rely on instinct alone – all that spoke of the talent, intuition and outstanding technical ability of a born surgeon. Richard had always been surprised at how varied things could be in his profession. As a student he had assumed there was no difference between one doctor and another, more specifically between one surgeon and another. Everything was done according to the textbooks and surgery seemed to be something like ticking off boxes in a catalogue: every patient was a human being and what the human being the surgeon was interested in was could be seen in the meticulous drawings in Spalteholz’s and Waldeyer’s handbooks of anatomy. That’s where the problem lies, these are the anatomical conditions, off we go. Practice had taught him otherwise. There were surgeons who worked incredibly slowly, who were afraid of every vessel, every little mucous membrane and, as they operated, transmitted this sense of fear to all those around them and who yet, for all their caution, had no better, sometimes even worse results than their apparently more casual colleagues. Richard remembered Albertsheim, his fellow assistant with Uebermuth in Leipzig. Albertsheim, whom they called Guarneri, for when he had a good day his intuition and his speed combined with perfect technique were as astonishing as a Guarneri violin. At such times Albertsheim would reach heights that Richard never reached, and presumably never would reach, and that had drawn cries of admiration even from Uebermuth. If he had a bad day, however, he operated ‘like a drayman’ and it was said that on his bad days Guarneri had also made ‘drayman’s violins’, which had led to the nickname, which didn’t even annoy Albertsheim – on the contrary, he cultivated his artist’s pose. On the other hand he had never managed to develop even an average feel for diagnosis, he could hardly distinguish crepitations in the lung from a pleural effusion, the slightly metallic rasp over a tubercular cavity from the wheeze of an asthmatic lung. But those were clinical skills, they were the business of the Internal Medicine specialist, of whom he would speak, like many a surgeon, with mild condescension – as if clinical knowledge were superfluous for a surgeon. Nor was he interested in further developments. ‘Great surgeons make great incisions,’ Albertsheim had said, mocking Richard, who had his doubts about this absolute principle of these surgical monarchs, since he had found that great incisions can also cause great infections. Wernstein was not like that. What was it Albert Fromme, the first rector of the Medical Academy, had said? A surgeon has the heart of a lion and the hands of a woman. And now the houseman was moving the retractors of his own accord. Wernstein and Richard looked up simultaneously.

  ‘It’s the operating surgeon who moves the retractors, not you,’ Wernstein growled indignantly. ‘Now I can’t see anything. You must tell us if you can’t hold them any longer.’

  Richard felt angry. The young man was far away from them in age and training, and certainly they ought to remain matter-of-fact, treat him like a colleague, but … The truth was, he couldn’t stand this houseman. He knew that that was connected with the fact that Grefe was the son of Müller’s sister and the Professor had, in an embarrassingly formal conversation, ‘asked’ Richard to send a houseman who had already been given the post to another clinic. True, Grefe could do nothing about these machinations, probably didn’t even know about them; one had to try to remain objective. And the lack of specialist knowledge would sort itself out. If he was honest, as a houseman he himself had paid more attention to the nurses than to surgery; moreover the idea of housemen was for them to acquire practical experience. Despite that, the pedagogue inside him broke through: ‘What characterizes pertrochanteric fractures?’ Again Grefe started to hum and haw. ‘I … er … I’ve only been with you for two days …’

  ‘But you did a degree in surgery; did you skip trauma surgery?’

  ‘Should I get them to put a little music on, Dr Hoffmann?’

  Nurse Elfriede was well acquainted with her senior traumatologist’s angry outbursts. But he didn’t feel like music. This fellow might perhaps tell his uncle that the trauma surgeons were listening to music during an operation again,
which, for his uncle, was an expression of a casual attitude and the Professor had no time for ‘bohemian’ surgeons. ‘That’s for Herr Wernstein to decide, he’s performing the operation. Let me have the retractors.’ He took the retractors out of Grefe’s hands and with a curt nod ordered him to come round to his side. ‘Be careful you don’t touch the image intensifier and make yourself unsterile. Let him feel it,’ he said to Wernstein, using the familiar ‘du’ without thinking, as if he were an equal colleague. ‘Can you feel the fracture?’ Grefe poked about in the wound.

  ‘The fracture line is between the greater and the lesser trochanter, almost directly on the neck of the femur. You do know where we’re operating here?’

  ‘Oh, yes, I’ve got it now. Basically at the hip joint, I thought?’

  Wernstein had stepped back and was waiting, hands dripping with blood raised.

  ‘Good. We’ll change over again. In grown-ups at what angle are the femur and the neck of the femur to each other?’

  Grefe, who was back on the other side and raised the retractors, gave the wrong angle.

  ‘Fractures of the neck of the femur – how are they classified and why?’

  His knowledge was sketchy.

  ‘Five wrong answers to my questions, Herr Grefe. We have a rule here. For each wrong answer the person asked has to cut a hundred swabs or fold a hundred compresses. That’s five hundred swabs for you. Report to the duty operating-theatre sister after we’ve finished.’

  That hit home. Wernstein was continuing his preparations in silence. Richard’s anger subsided as quickly as it had arisen. He sensed that he had reacted too harshly and that he was punishing Grefe for his uncle’s methods. Now he felt sorry for the young guy. You’re doing just the same as the communists! he told himself. That reminded him that in Grefe’s file he had discovered a request to be accepted as a member of the Socialist Unity Party … So what, he decided. If something was to be made of them, you had to be hard on them. The plus side was that Sister Elfriede had 500 more swabs in her sterilization unit, swabs that the run-down socialist economy couldn’t manage to manufacture. If he wants to join the Party that determines all our lives, he should get to know the kind of world that it has produced.

  ‘Spherical cutter,’ Wernstein demanded, reamed the bone. ‘A Lezius nail on the handle grip. – Who was Lezius?’ This time it was Wernstein who asked. But Grefe knew the answer and proudly gave a little lecture. There was no addition to his 500 swabs.

  After the operation Richard went to the Academy Administration. He took the route through the hospital. Wernstein had taken just three-quarters of an hour to perform the operation on the patient, a woman of sixty who had slipped while cleaning the stairs and broken her femur as she fell. The atmosphere in the clinic was something that had been familiar to Richard since he had started to study medicine, when, after his apprenticeship as a fitter, he had got to know the work of the hospital from the bottom upwards, first of all as a nursing auxiliary, then during the university vacations, as a student and a professor’s assistant: the morning rounds had finished in the wards on the north side, nurses were rushing to and fro, doctors were bent over patients’ notes or X-rays. ‘Morning, Dr Hoffmann.’ – ‘Morning, Nurse Gertrud.’ – ‘Morning, Dr Hoffmann.’ – ‘Morning, Nurse Renate.’ Familiar faces, some he had known for twenty years; he knew the people behind their routine masks, knew about their major and minor worries that you didn’t hear about during the day, in the hectic rush of the wards, but during night shifts when the city was asleep and the acute cases had been settled for the night. Nurse Renate, who, even after twenty-two years, still trembled like a schoolgirl when faced with the senior nurse and whose first husband had died in this ward, the surgical cancer ward. Richard sidestepped a mop that a nursing auxiliary was swinging across the PVC floor-covering in vigorous semicircles. The smell of disinfectant – Wofasept – how familiar it was; how it brought everything back: the nurses with their blood-pressure gauges and intravenous-drip stands, the clatter of scissors and glass syringes in kidney dishes which were just being put into the sterilizer in the ward he was passing. He went into the vestibule. Food carts clattered by the lifts, a haze of voices came from the swing doors of South I, Müller’s powerful, precisely articulating voice: the consultant was doing his round of the private ward. Richard hurried out past the bust of Carl Thiersch. He had actually intended, before going over to Administration, to look in at his own ward to check on things, but he would probably have run into the gaggle of doctors, and he wasn’t in the mood for that, especially not for an encounter with Müller. Wernstein had done North II and Trautson, Richard’s fellow senior doctor, North III, together with Dreyssiger, who had been on duty and would see the outpatients. He could rely on Wernstein and anyway, when he’d done the round of North II today everything had been in order. With Dreyssiger you had to be more careful; he was good as a scientist, and as a teacher the students liked him; but in general the senior nurse knew better than he what was going on in his ward, North III, as the young houseman Richard would have liked to have kept often did as well.

  He left the clinic and set off for the old Academy section where the Administration building was. The air, fresh after the snow, did him good, he took deep breaths. He had an uneasy feeling about the meeting he was about to attend. The eternal struggles for dressings, swabs, drip-feed bottles, plaster. Trifles. On the one hand. On the other, Administration had asked him to hand in his Christmas lecture to be checked. He had deliberately not brought it with him. How had Wernstein put it just now? We’ll see. Although he was freezing, he didn’t regret having taken this route and not the one through the subterranean tunnel system that appealed to his old sense of adventure and that he had known like the back of his hand since his days as a nursing auxiliary, but he preferred not to breathe its air, which was stale with the smell of cigarettes and rats’ urine, after an operation. A few electric carts were bumping along the Academy road; far ahead, by the porter at the kiosk beside the Augsburger Strasse entrance, which was flanked by frosted-glass cubes with the red cross, patients were queuing for newspapers. A few doctors were coming from Radiology, which was in sight of the massive block of the Surgical Clinic. Richard went across the park, past the Dermatology Clinic and the equipment store, where thermophores were being loaded. Taking cover behind a hedge, he did a few jump squats to warm up.

  10

  Veins of ore. The Old Man of the Mountain

  ‘Dear Herr Rohde, I can’t get our discussion out of my mind. I became agitated and you, or so it seemed to me, remained unimpressed in a way that disturbed me because I am familiar with it from situations that make me seem powerless and the person facing me fairly powerful. You had to reject my pieces, you said, and left it to me to read, between the lines and behind the reason that was clear to both of us, a different one, less edifying for the modicum of author’s vanity that remains to me, for you did not state it expressly and, on the one hand, I don’t know you well enough to see your restraint as other than reserve, on the other you are an author yourself; and an author who, as far as I am aware, works precisely, so you know how, at this sensitive stage – the book is finished but not yet out – one weighs every word. I would like to tell you again, this time in writing, what your ability to listen at our meeting instigated (I apologize that that turned it largely into a monologue); it is important to me that it should not remain in the transient medium of the spoken word. A story that I, rather presumptuously, do not call my own for the sole reason that, with variations, it applies to so many people of my age. – No. I must break off. Please excuse me. I will not continue this letter … I’m so tired, I find all this so exhausting … Yet I will still post this letter to you; I know that sounds confused but, to be honest, I hope you will visit me again … Do you really consider the book a failure?’

  Meno lowered the letter. He thought. The Old Man of the Mountain had not had a fit of anger, Meno hadn’t noticed the agitation he mentioned or it had arisen a
fter he’d left. On the contrary, the old man had nodded and put on a dreamy smile which had given his face with the high, Slav cheekbones a mischievous touch; the parchment-pale skin, creased with many wrinkles, had even started to glow as if the old man had not merely expected but had hoped for Meno’s restraint. Yes, Meno thought, it was as if he had hoped for Schiffner’s shake of the head – like an accolade, an honour. ‘You … don’t regret that a year’s work has been for nothing?’