A Fight in Silence

by Melanie Metzenthin

  ‘I don’t envy you that job,’ said Leonie. ‘I’d almost prefer dismissal to doing that.’

  ‘You can’t be serious!’

  ‘No,’ conceded Leonie, ‘not completely, but I’m trying to look on the bright side.’ She let out a huge sigh. ‘Maybe my father’s idea of emigrating to Switzerland isn’t so crazy when I think about what’s happened here in just the last six months.’

  ‘Try not to get too down about it,’ said Paula. ‘It can’t get any worse, surely.’

  Richard raised his eyebrows at that. ‘No? And what if Leonie’s father loses access to the health insurance scheme?’

  ‘Don’t say that! Do you really think the Medical Council would allow respected colleagues to be treated like that? I know they have no influence over state hospitals but surely eligibility for the scheme can’t suddenly be declared invalid.’

  ‘Why on earth not?’ Richard persisted.

  ‘Oh, stop it. I don’t want always to fear the worst, like you do.’

  ‘Nor do I,’ said Leonie. ‘And if we’re desperate, there’s always Switzerland.’ She managed a smile in spite of her despondent state.

  Richard said nothing more, but his sense of unease was growing.

  Chapter 25

  When Richard found the initial pile of registration forms on his desk and saw that one of the first patients he had to assess was Herbert, he felt as though he’d been punched in the belly. This wasn’t because of the case itself – he accepted that Herbert would never be able to support a family. His shock and disappointment owed more to the fact that dear, naive Herbert still dreamt of leading a normal life in spite of his perpetual failure to get transferred to an open country house. Richard also knew that Herbert could never be talked into agreeing to sterilisation, but then he started to wonder why Herbert of all people should even be considered, because he never left the secure unit and had no contact with women.

  He reflected for some time as to how he might best complete the form in order to protect Herbert’s dignity and integrity. Eventually, he put a cross beside the statement that sterilisation was not required, and gave as the reason the unlikelihood of such a seriously ill patient ever being released, given his repeated failures to be transferred to an open house and therefore being at no risk of fathering a child.

  Next he addressed the forms relating to births of the ‘feeble-minded’. This included Julius, the older Downs’ syndrome patient who tended to the cows. Why sterilise Julius? Most men with his condition were in any case infertile and Julius had never shown any particular interest in women. Again he marked the statement that sterilisation was not indicated and gave some thought as to how he could best justify this. The simplest would be to state that Julius was infertile, although such an assertion would mean he was breaking the rules of medical conduct, as he would be quite deliberately falsifying an official document. Under certain circumstances this could cost him his job. He took a deep breath and put Julius’s form on the pile for resubmission.

  The next case was comparatively straightforward. The subject was a mentally deficient, or ‘feeble-minded’, man, already father to one illegitimate child, who had inherited his father’s hydrocephalus and was so deficient that he couldn’t even benefit from attending a special school. In this case sterilisation would be a blessing for the patient and for the women who for some inexplicable reason allowed him into their beds. Richard marked the statement that sterilisation was indicated on medical grounds provided that the patient was in agreement with the explanation given him.

  By evening Richard had worked through the first half of his cases and continued to avoid the pile of resubmissions – a very different approach to that of his colleague Krüger, who he encountered with his own stack of forms tucked under his arm as he made his way over to the secretariat.

  ‘Oh, did you get caught up in an emergency?’ he asked Richard, giving his small batch of papers a hard look. ‘How can a hard-working expert like you have done so few in a day?’

  ‘In my view, the wording of the questions is highly complex and has far-reaching implications.’

  ‘Is it now?’ Krüger said with a smile. ‘It’s very simple, actually. Can you imagine any one of our inmates in the role of father?’

  ‘No,’ Richard conceded.

  ‘There you are, then. Why take so much trouble? It’s a waste of time for specialists to have to give thought to this, but on the other hand, sterilisation costs money and is not necessary for those who are already infertile. The way I consider a case is whether reproduction could occur.’

  ‘Aha,’ observed Richard.

  ‘And how do you go about it?’

  ‘I scrutinise whether sterilisation is necessary in each individual case. In my estimation, it’s not necessary for patients whose discharge will be in the distant future because they have no contact with women. And as you yourself have said, a sterilisation operation is expensive. We should consider the indications very carefully.’

  Krüger muttered something under his breath, while Richard suddenly realised that he had hit upon the crucial solution in getting around any blanket compulsory sterilisation for his patients. It was all about cost – an unbeatable argument both before and since the economic crisis.

  As soon as he returned to his desk, Richard phoned Fritz. He was lucky to find his friend in the office and not stuck in the operating theatre, as was more usually the case when he tried to contact him.

  ‘Richard, what a pleasant distraction!’ Fritz greeted his friend effusively. ‘And perfect timing – I’ve got some excellent news!’

  ‘Tell me!’

  ‘Dorothea is pregnant. We found out yesterday and she’s so excited about the baby.’

  ‘That’s fantastic! I hope Rudi won’t be jealous!’

  Fritz laughed. ‘Never – he’s as pleased as we are! Isn’t it magnificent news, though? So fingers crossed that everything goes OK and we have a lovely healthy baby.’

  ‘When’s it due?’

  ‘That’s the only thing that’s bothering Dorothea,’ Fritz conceded. ‘End of January – same as Gottlieb. But that doesn’t mean anything. We’re just quietly looking forward to it all.’

  ‘I’m really pleased for you both. How about a celebratory beer?’

  ‘I might run late today; I’ve still got two operations to go. But tomorrow’s fine, so I’ll take you up on that! Now, what can I do for you?’

  ‘Have you heard about this new Law for the Prevention of Progeny with Hereditary Diseases?’

  ‘Only in passing. Something about sterilisation being permitted as a matter of course.’

  ‘Have you ever carried one out?’

  ‘That’s been prohibited for years, so why are you asking me?’

  ‘So you’ve never carried out a male sterilisation procedure?’

  ‘I have.’

  ‘Even though it’s prohibited?’

  ‘It was last year, when I was at a conference in London. I got to know an English doctor – nice chap. Max Cooper had been very keen on my research publications on operative care for bullet wounds to the skull. I seem to have become rather well known in British medical circles as a result.’ He chuckled with pleasure at this. ‘Maxwell is a consultant neurologist and showed me his operating theatre. There happened to be a sterilisation scheduled for that day and because it’s so rare here in Germany I took up his offer of lending him a hand.’

  ‘Can you give me an idea of what a sterilisation procedure like that costs?’

  ‘No idea. Why do you want to know?’

  Richard explained.

  ‘That’s bad,’ Fritz agreed. ‘You know how much I love surgery, but we should avoid unnecessary operations like the plague. You only need to tot up the hourly cost of the surgeon, theatre nurse, anaesthetist, then add on the equipment, so I’d say around thirty marks for the operation alone. Then, with post-operative care, you’re probably looking at fifty marks, and that’s without complications.’

  Richard g
ave a low whistle. ‘A tidy sum – half the monthly wage of an ordinary worker. I can see how to work that into my argument. Thanks, Fritz. Shall we meet at The Green Man tomorrow? Six o’clock?’

  ‘I’ll be there,’ Fritz promised.

  After a consultants’ meeting a fortnight later, Dr Harms praised the argument Richard had put forward regarding the costs incurred by serial sterilisation without critical analysis of need. ‘Did you see Krüger’s face?’

  Richard smiled. ‘When obvious resistance is useless, then we have to fall back on our own resources. Your advice about looking at Mein Kampf was worth its weight in gold. It’s only by seeing what’s behind their thinking that you can come up with an effective countermeasure.’

  This was only one small triumph, but Richard relished it, because over the next few months it allowed him to stay true to his moral ideals in spite of the difficult times in which they lived.

  Chapter 26

  One sunny Friday afternoon in May 1934, Richard was at his desk as usual, signing letters and going through files, but his mind wasn’t fully on his work. He had the next day off and was already looking forward to spending the weekend at Travemünde with Paula and the children. Fritz also had the weekend off and planned to join them, together with Dorothea, their daughter, Henriette, now four months, as well as their dachsie, Rudi, who was adored by Richard and Paula’s twins. Emilia could already say a few words and had learned quite a few sign language gestures, as had Georg. Fräulein Felber continued to come to their home every Tuesday to teach Richard and Paula. In addition, Paula had become good friends with Fräulein Felber’s deaf and dumb mother and often went to see her with the children to perfect her knowledge of sign language. Richard was quite relaxed about the fact that his wife had long surpassed him in that regard.

  As he sat thinking about the Baltic coast, there was a knock on his door.

  ‘Come in!’

  It was Dr Krüger. ‘This case landed on my desk, but I think you’d better review it as it’s concerning your expert statement of two years back.’ He placed a brown folder on Richard’s desk. The name on the front was Johannes Mönicke. Richard remembered the case straight away: it was the man who had developed schizophrenia after being buried alive in the trenches.

  ‘Thank you,’ said Richard. ‘I’ll take care of that.’

  He expected Krüger to leave, but the man stayed where he was, in front of his desk.

  ‘Was there something else?’

  ‘I’d be very interested to know what you think of the argument put forward by this expert statement in which Dr Brockmann no longer sees this patient as meeting the eligibility criteria for continuing to draw the invalidity pension.’

  ‘I shall tell you as soon as I have read the statement. Anything else?’

  ‘No, not at all. May I wish you a pleasant afternoon and an enjoyable weekend, sir?’

  ‘And the same to you.’

  The name Dr Marius Brockmann didn’t mean anything to him. But no sooner had Krüger left the office than Richard picked up the file. Krüger’s smugness had made him fear the worst:

  My colleague Dr Hellmer argues in his preliminary statement that the patient has a particularly strong psychological constitution in comparison with others suffering wartime trauma because prior to his burial alive he had been deployed to the Front without demonstrating any distinctive mental condition. Taking this fact into consideration, it cannot be concluded from a medical point of view precisely why the experience of being buried alive, without any innate disposition to the condition, should have led to the onset of schizophrenia. On the other hand, the patient was twenty-five years old at the time, the peak age for the early manifestation of this hereditary illness. Even under more desirable conditions the onset of this illness could have been expected at precisely this time. Scientific literature finds no reference to a hereditary illness being brought on by war trauma. This would be medically impossible because the genes are determined at conception. The argument put forward by the writer of the preliminary statement suffers from a lack of specialist analysis of the given facts, using instead an embellished writing style to try to arouse sympathy, something more suited to light romantic fiction.

  Being buried alive is, of course, a traumatic event, but there are numerous examples in scientific literature which show that a man who is hereditarily sound and of pure blood can withstand this without damage. Where, however, inferior stock comes into play, then the sick genome will always prevail. From a human standpoint, it is understandable that Dr Hellmer has let himself be ruled by sympathy in writing this statement, but such sentiment should never take priority in the preparation of expert statements.

  An expert who allows his feelings to dominate has failed in his profession. With regard to the proven hereditary nature of the illness in this patient, as well as his previously recognised strong mental state, the onset of schizophrenia can be explained uniquely by the fact that the patient had reached the age at which the sick gene prevails. The connection with being buried alive is of a merely temporal nature. The preconditions for further payment of the invalidity pension are therefore not met.

  ‘Arrogant idiot!’ hissed Richard to himself. He took a few deep breaths. He could usually easily spot weak arguments in statements of this kind. But this one didn’t read like an expert statement. More like a pamphlet in the style of Hitler’s Mein Kampf.

  While he mulled over how to respond, a thought came to him. If schizophrenia was considered hereditary, then there had to be a transparent line to follow in Mönicke’s family. However, if Mönicke was the only sufferer, there would be the opportunity to question the diagnosis and in its place put forward an organically conditioned psychosis with parallels to schizophrenia.

  Mönicke’s wife had no telephone so Richard wrote her a letter asking her to let him have a statement on any mental anomalies in her husband’s family. He then placed the folder on the pile of resubmissions and resolved not to let this case spoil the weekend he’d been looking forward to so much.

  The drive to Travemünde was enjoyed by all, even though Paula complained loudly about Richard and Fritz repeatedly overtaking each other on the empty country road.

  ‘Slow down! You boys always want see whose car goes faster.’

  ‘What the heck! Fritz knows it’s ours. He only wants to show me how well his car accelerates! We’re saving ourselves for the real contest, when the motorway to Lübeck’s ready.’

  ‘Which motorway’s that, then?’

  ‘I read about it in the paper a few days ago. Work’s due to start in May 1937 and the second section between Lübeck and Travemünde should come in 1938. If you really put your foot down, you could do Hamburg to Travemünde in an hour and a half.’

  ‘So that’s what you’re both practising for,’ Paula said with a sigh. ‘I’d still rather you didn’t drive like this! It’s not as if Fritz urgently needs any new patients.’

  Richard laughed, but relented and moderated his driving to a more sedate pace.

  They had booked rooms at the Emperor Hotel, along with two beach chairs, which Fritz and Richard immediately surrounded with a suitably grand wall of sand. Meanwhile, Paula collected shells with the twins while Dorothea was busy with Henriette and Rudi. They’d smuggled their little dog on to the beach in a basket and put a towel over him whenever the beach supervisor hove into view.

  The sea was still very cold, but the twins splashed happily at the water’s edge. Anyone looking at Emilia and Georg would never have guessed that the little boy was deaf as he shrieked with delight just as much as she did, although he couldn’t use words in the way she had started to.

  Baby Henriette lay content on a woollen rug with Rudi obligingly acting as a pillow of sorts. Richard had brought along his camera and took around twelve photos of their group, especially the children and the dog.

  ‘Times are not nearly as bad as we feared,’ confided Fritz as he and Richard lingered over a beer in the hotel bar that evening.
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br />   ‘Apart from public hospitals dismissing all our Jewish colleagues and my patients having to battle even more repressive treatment than before, things couldn’t be better,’ retorted Richard, barely able to conceal his bitterness.

  ‘Of course, yes, I’m really sorry about Leonie,’ said Fritz quietly. ‘Is she still working with her father?’

  Richard nodded. ‘Yes, and he’s been allowed to keep his access to the health insurance system because of his status as a war veteran. Dr Stamm’s only allowed to treat private patients now.’

  ‘That’s absurd.’ Fritz said, taking a gulp of his beer. ‘Although one thing you have to hand to the Nazis: there is order on the streets now. I haven’t had a single gunshot case in the last six months.’

  ‘There is that at least,’ said Richard, a harshly ironic edge to his voice. ‘All you need to add to the list now is stable prices, a fall in unemployment and Germany having the fastest recovery in Europe from the economic crisis.’

  ‘Yes, that’s really something. But as for the other things . . . if they overdo this business with the Jews and the sick, they’ll get taught a lesson at the next elections.’

  ‘For God’s sake, Fritz, haven’t you realised that the SPD and many other parties were banned last year? And then there’s this new Law Against the Founding of New Parties.’

  Fritz stared at Richard in amazement. ‘I didn’t know that. I don’t really follow politics, like you do. So if there are no other parties, why bother to vote at all?’

  ‘I’m wondering how more than why. A ballot paper with just NSDAP on it? And they can win with a single vote in their favour?’

  ‘That would be grotesque!’

  ‘As grotesque as dismissing Jewish doctors, as replacing our black, red and gold flag with the black, white and red German Empire one with a swastika stuck on it, and then there’s this laughable “Heil Hitler” business being used as the national form of greeting.’