by Daniel Mason
If he loved Medicine—yes, this was the word, this giddiness, this jealous guarding against fellow suitors, this pursuit of increasingly delicate secrets to be indulged—if he loved Medicine, what he had not expected was for Her to return his affections. In the beginning, he noticed only this: when he spoke of Her, his stutter vanished. There were no exams until the end of his second year, and so it was only one cold day in December, during his third semester, that there came the first hint that he possessed, in the words of that year’s assessment, “an unusual aptitude for the perception of things that lie beneath the skin.”
The lecturer that day, Grieperkandl, the great anatomist, was of that species of emeriti who believed that most modern medical innovations (such as handwashing) were emasculating. It was in a state of general terror that the students attended his classes, for each week Grieperkandl would call a Praktikant before him, take down his name in a little notebook (always a his; there were but seven women in the class, and Grieperkandl treated them all as nurses), and proceed to submit him to an inquisition of such clinically irreverent arcana that most of their professors would have failed.
It was during a lecture of the anatomy of the hand that Lucius was called to the front of the class. Grieperkandl asked if he had studied for that day—he had—and whether he knew the name of the bones—he did—and whether he would like to recite them. The old professor was standing so close that Lucius could smell the naphthalene on his coat. Grieperkandl rattled his pocket. Inside he had some bones. Would Lucius like to select one and name it? Lucius hesitated; there was nervous laughter in the tiers. Then cautiously, he slid his hand in, his fingers settling on the longest and thinnest of the bones. As he went to remove it, the professor grabbed his wrist. “Any fool can look,” he said. And Lucius, closing his eyes, said scaphoid, and withdrew it, and Grieperkandl said, “Another,” and Lucius said capitate and withdrew it, and Grieperkandl said, “Those are the two largest—that is easy,” and Lucius said lunate, and Grieperkandl, “Another,” and Lucius said hamate, triquetrum, metacarpal, removing each in turn until at last a tiny bone remained, peculiar, too stubby to be a distal phalange, even that of the thumb.
“Toe,” said Lucius, realizing he had sweated through his shirt. “It’s the pinkie toe.”
A hush had come over the class.
And Grieperkandl, unable to prevent a yellow smile from spreading across his face (for, he would say later, he had been waiting twenty-seven years to make the joke), said, “Very good, my son. But whose?”
An unusual aptitude for the perception of things that lie beneath the skin. He copied out these words into his journal, in Polish, German, and Latin, as if he’d found his epitaph. It was a bracing thought for a boy who had grown up mystified by the simplest manners of other people. What if his mother’s pronouncements were false? What if all along he had been simply seeing deeper? When the first Rigorosum came after two years, he scored the highest in the class on all his subjects but physics, where Feuermann edged him out. It seemed impossible. With his governess, he had nearly given up on Greek, cared nothing for the causes of the War of the Austrian Succession, confused Kaiser Friedrich Wilhelm with Kaiser Wilhelm and Kaiser Friedrich, and thought philosophy stirred up problems where there were no problems before.
He entered his fifth semester with great anticipation. He had enrolled in Pathology, Bacteriology, and Clinical Diagnosis, and the summer would bring the first lectures in Surgery. But his hopes to leave his books and treat a real, living patient were premature. Instead, in the same vast halls where he had once attended lectures on organic chemistry, he watched his professors from the same great distance. If a patient was brought before them—and even this was rare in the introductory classes—Lucius could scarcely see them, let alone learn how to percuss the liver or palpate swollen nodes.
Sometimes he was called forth as Praktikant. In Neurology, he stood next to the day’s patient, a seventy-two-year-old locksmith from the Italian Tyrol, with such severe aphasia that he could only mutter “Da.” His daughter translated the doctor’s questions into Italian. As the man tried to answer, his mouth opened and closed like a baby bird. “Da. Da!” he said, face red with frustration, as murmurs of fascination and approval filled the hall. Driven on by the lecturer’s aggressive questioning, Lucius diagnosed a tumor of the temporal lobe, trying to keep his thoughts on the science and away from how miserable he was making the old man’s daughter. She had begun to cry, and she kept reaching for her father’s hand. “You will stop that!” his professor shouted at her, slapping her fingers. “You will disturb the learning!” Lucius’s face was burning. He hated the doctor for asking such questions before the daughter, and he hated himself for answering. But he also did not like feeling that he was on the side of the patient, who was inarticulate and weak. So he answered forcefully, with no compassion. His diagnosis of early brainstem herniation and the relentless destruction of the breathing centers and death, was met by rising, even thunderous, applause.
Following his performance, some of the other students approached him and asked him to join their groups. But he had no time for their inadequacies. He couldn’t understand the laziness of those who hired artists to help them remember the anatomy of their cadavers. He was ready to move on, to touch his patients, to cut them open and take out their disease. Even the clinics frustrated him—crowds of eighty would follow their renowned instructor, and merely ten or twenty of them would be allowed to probe a hernia or examine a tumor in a breast. Once, and only once, he was left alone with a patient, a wispy-haired Dalmatian from whose ear canals he extracted enough wax to make a small but working votive candle. The man, who had been diagnosed as deaf for fifteen years, stared at Lucius as if Christ himself had just returned. But the praise, the blessings, the lachrymose kissing of Lucius’s hand embarrassed him. This was what he had trained for? Mining? That his esteemed professor had attributed the deafness to dementia only left him more depressed.
He returned to his books.
By then, only Feuermann could keep up with him. Soon they left the others and studied alone, pushing each other to ever finer diagnostic feats. They memorized poisoning syndromes, the manifestations of obscure tropical parasites, and mischievously applied defunct physical classification systems (phrenology, humoralism) to the other members of their class. When Feuermann said that he could diagnose a dozen conditions by watching a patient’s gait, Lucius countered that he could do so by listening to the gait, and so the two sought out an empty corridor, and Lucius turned to face the wall. Feuermann walked back and forth behind him. Slap went his feet, and slap slap and slide-thump and slide-slide and plop plop. The answers were: sensory ataxia, spastic hemiplegia, Parkinson’s, and fallen arches.
“And this?” asked Feuermann, and his feet went pitter-pitter plop.
But that was easy.
“Dancing, wretched type, chronic, most likely terminal.”
“I have been defeated!” roared Feuermann, as Lucius, utterly pleased with himself, began to tap as well.
He felt at times that Feuermann was the only person who could understand him, and around Feuermann alone, he felt at ease. It was his friend, handsome, already with a bit of a reputation for flirtation among the lay nurses, who persuaded him to go to the brothel on Alserstrasse by arguing that it had once been frequented by the legendary doctors Billroth and Rokitansky; Feuermann, who taught him, with reference to Structure and Function of the Genitalia of the Female (Leipzig, 1824), the principle of titillatio clitoridis. And yet never in the past two years had they spoken of anything that wasn’t at least partially related to medicine. Not once had Feuermann accepted an invitation to Lucius’s palatial home on Cranachgasse. And Lucius never asked what had happened to Feuermann’s parents that led them to flee their village near the Russian border when his friend was still a baby, or why he had no mother. He knew only that his father was a tailor, outfitting his son with suits assembled impeccably from scrap.
Billroth, said Feuerm
ann, would dine on gherkins after coitus; Rokitansky never took his lab coat off. Titillatio had once been prescribed by the great van Swieten to treat the frigidity of Empress Maria Theresa; it was what saved the Empire. Once, from nowhere, Feuermann said, “Perhaps one day we might marry sisters.” Lucius said he thought this was a fine idea and asked if he had read Klamm’s paper on bromides for palpitations of unknown cause.
But of all the cases he studied, it was the neurological ones that fascinated him the most. How extraordinary was the mind! To sense a limb years after amputation! To see ghosts at one’s bedside! To create all the symptoms of pregnancy (swollen abdomen, amenorrhea) by wish alone! The thrill he felt when he solved the most difficult cases was almost sexual. There was a beautiful clarity in the patterns, the possibility of locating a tumor simply by whether it destroyed language or vision, the opportunity to reduce the complexity of other people to the architecture of their cells.
At the university was a professor called Zimmer, famous for his dissections of the thalamus done back in the ’70s, who had later published a book called Radiological Diagnosis of Diseases of the Head. It was Feuermann who found it, Lucius who couldn’t put it away. Soon he was spending so many hours with the library’s copy that he purchased one himself.
Page after page showed radiographs of the head and face. Little arrows illustrated the growths of cancers and subtle hairline fractures. He learned to make out the thin, twisting courses of the sutures, the “Turkish saddle” that held the pituitary, and the darker swirlings of the skull base. But his eyes kept traveling to the smooth dome of the calvarium. There, the light was hazy, like puffs of smoke blown into the skull. Nothing to see…just cloudy shades of grey and lighter grey, tricks of shadow that played upon the eye and yielded nothing. And yet! Thought was there, he told himself, astounded. In that grey haze lay Fear and Love and Memory, the countenances of loved ones, the smell of the wet cellulose, even the vision of the technician the moment the film was shot. Doctor Macewen of Glasgow, one of his gods, had called the brain the dark continent. Before the radiograph, one could only see the living brain in the tiny pearl of optic nerve inside the eye.
He approached Zimmer unannounced in the Department of Neurology.
What was lacking in his book, said Lucius, seated before the old professor, in a room piled high with specimens and slide boxes, What was lacking, with all due respect, Herr Professor Doktor, were images of the vessels. If one could invent an elixir that could be picked up by the radiograph, if one could inject it into arteries and veins and show the twisting tributaries…if one could just resolve this haze…
Zimmer, with the stringy hair and overgrown muttonchops of a professor long sent to pasture, licked something off his monocle before polishing it and placing it before his eye. He squinted as if in disbelief at the student’s impudence. On the wall behind him were portraits of Zimmer’s professor, and his professor’s professor, and his professor’s professor’s professor, as much a royal line as any in medicine, thought Lucius, who prepared himself to be dismissed. But something in the boy’s gangly tactlessness must have intrigued the old man. “We inject mercury to show the vessels in cadavers,” he said at last. “But with live patients, it can’t be done.”
“What of calcium?” asked Lucius a bit vertiginously, but pressing on, “Iodine, bromine . . . I’ve been reading . . . If you could see the vessels, you could watch blood flow, you could see the outlines of tumors, strokes, the narrowing of arteries—”
“I know what you could see,” said Zimmer sharply.
“Thoughts,” said Lucius as the old man marked the end of the visit with an arch of his eyebrow, releasing the monocle and catching it in his hand.
But two weeks later Zimmer called him back.
“We will begin in dogs. We can prepare the solution here and inject it at the X-ray machine in the School of Radiology.”
“Dogs?”
Zimmer must have read the unease on the student’s face. “Well, we can’t just use Professor Grieperkandl, can we?”
“Professor Grieperkandl? Well, no, Herr Professor.”
“Our findings would not be generalizable, would they?”
Lucius hesitated. The possibility that a professor of Zimmer’s stature was making a joke about a professor of Grieperkandl’s stature was so far beyond contemplation that Lucius took the question literally at first. But what to answer? Yes, and he would be agreeing to vivisect his old instructor. No, and he would imply that the great anatomist was so abnormal…
“We are not going to experiment on Professor Grieperkandl,” said Zimmer.
“Of course not, Herr Professor!”
His hands twisted. Then Zimmer, clearly amused, opened a tin on his desk and popped a candy inside his mouth. He held another out across the desk.
“Caramel?”
His fingers were dark with tobacco and smelled of chloroform; now Lucius noticed an open jar containing what appeared to be a brainstem on his desk.
For a moment Lucius hesitated, eyes darting to the jar and back.
“Of course, Professor. Thank you, Herr Professor Doktor, sir.”
The main hospital was nearly a kilometer from Zimmer’s lab. For two weeks Lucius brought the dogs there. As none of the fiacres would stop to take the animals, he had to push them in a cart. In the streets, the dogs—those that had survived the procedure—were prone to seizures. On the crowded sidewalks, people turned to watch the pale young man in his loose-fitting suit, wheeling the twitching animals along. He steered far away from children.
The X-ray machine was often broken, and the lines to use it were long. One day he had to wait five hours while the Royal Family had themselves radiographed with their decorations.
He returned to his professor. “How much is an X-ray machine?” he asked.
“To purchase? Ha! Far beyond the budget of this laboratory.”
“I understand, Herr Professor Doktor,” said Lucius, his eyes cast down. “What if it were purchased with a donation, from a family of means?”
For the following weeks, he returned home only to sleep, taking the grand staircase three steps at a time. Past the bust of Chopin and portrait of Sobieski, down the grand hall, with the medieval tapestries and the gilded, Lucius-less Klimt.
He rose before dawn. He injected mercury salts and solutions of calcium, but the images were poor. Oil suspensions provided brilliant images of the veins, but they formed emboli. Iodine and bromine showed more promise, but too much killed the animal, while lesser quantities didn’t show up on the films. His increasing frustration was equaled only by the enthusiasm of his advisor. Zimmer’s elixir, the old man took to calling the substance that was yet to be, and he began to speculate whether minute increases of blood flow could be detected in areas of greatest activity. Ask them to move an arm, said Zimmer, and we might see a corresponding flood of light within the motor cortex, while speech would illuminate the temporal lobe. One day, with men.
And Lucius thought, I said that the very first day we met.
The dream of being able to see another person’s thinking was all that retained him.
Soon it was clear that they were far from any discovery. The few images they had were too blurry to be of much use, and Zimmer refused to publish them out of fear that another professor would steal his research. Now Lucius regretted having ever proposed the idea. He was sick of killing the poor dogs—eight by spring. At home, Puszek (VII) fled him, as if he knew. He had wasted time. Now Feuermann teased Lucius that it reminded him of the days when, slipping brain sections into their microscopes, the two of them pretended to see the snakelike curl of envy, or desire’s glimmering curve.
“A lovely idea, Krzelewski. But you must know when to stop.”
Still, Lucius would not relent.
Most classmates made up for limited clinical training by spending their vacations volunteering in provincial hospitals. Lancing milkmaids’ boils, his mother called it, so Feuermann went alone, set brok
en legs, repaired a pitchfork wound, pronounced a man dead from rabies, and delivered nine babies to fertile country girls so robust they sometimes walked in from the fields in labor. Three weeks later, back at their table at Café Landtmann, Lucius listened as his friend described each case in detail, his tan, child-birthing forearms waving his confident, child-birthing fingers in the air. He didn’t know what made him more jealous: the meals the peasants prepared in gratitude or the sunburnt girls who kissed Feuermann’s palm. Or the chance to deliver a baby using procedures he had only practiced on the satin vagina of a manikin. He had spent the month chasing a mix of iodine and bromine, only to find that Zimmer had switched the labels on the flasks.
“I can’t describe it, truly, words can’t do it justice,” said Feuermann, flipping a coin onto the silver platter of the waiter. “Next summer, we’ll go together. You haven’t lived until you’ve held one in your arms.”
“A milkmaid?” Lucius joked weakly.
“A baby, a real live baby. Pink and lusty. Screaming with life.”
The last straw came in May 1914.
That afternoon, Zimmer called him conspiratorially to his office. He needed Lucius’s help, he said. He had a very peculiar case.
For a moment, Lucius felt that old excitement. “What sort of case, Herr Professor?”
“A perplexing condition.”
“Indeed.”
“Very mysterious.”
“Herr Professor is being youthfully playful.”
“A case of severe coccygeal ichthyoidization.”
“Sorry, Herr Professor?”
Now Zimmer could not control his giggling. “Mermaids, Krzelewski. In the Medical Museum.”
Since beginning medical school, Lucius had heard the rumor. The museum, with objects from the famous Cabinet of Wonders of Rudolf II, was said to contain, among its centuries of priceless artifacts, a pair of dwarfs, three formalin-preserved angels, and several mermaids gifted to the Emperor after washing up on foreign shores. But no student had ever been inside.
