For the first time since childhood I’m in hospital for more than a night. My relative good health in the intervening decades has perhaps proven to be a curse, because I ignored signs of something going wrong in my body. I’ve been treated here in the Rudolf Virchow Clinic of Berlin’s Charité Hospital for ten days now, had two operations within a week on my spine at the neck. Through the window to my left, I see the upper stories of a row of grey, nondescript tenements, beyond them the chimney of a power station, and on clear days the tip and blinking light of the East Berlin TV tower. Every morning, every second morning at latest – Visite.
The professor makes an entry with attendant staff, doctors, duty nurses, Chinese students, the room hardly big enough to contain them all. There are rings under the professor’s eyes, strands of curly hair are plastered across his forehead, where they have been pressed down under the operating cap. A Hungarian, Professor -czy switches effortlessly between barely accented German and English. How’s it going? asks the professor. The question and my replies are taken down by the duty doctor, as by a nurse. I mention a weakness in my upper arm. Do we know what might be the cause of that? The professor half turns to one side of the semi-circle around him. Prescribe cortizone, snaps the professor, turns now to the other bed in the room, its occupant a young man with a brain tumour which drags down one side of his face. The exchange is briefer, the operation not yet imminent. White coats flapping, the “visite” sweeps out and on to the next room.
The professor neuro-surgeon is barely in his 40’s, almost a Bonaparte of the trade (thrust, cut, remove, substitute, reinforce). And it was in the era of the Revolutionary and Napoleonic Wars that the rules and procedures of the operation of both the modern army and the modern hospital began to be laid down, though undoubtedly there are antecedents as far back as Classical Antiquity. Napoleon on the mound, standing or on horseback, surrounded by marshals, generals of reserves, adjutants, couriers. Cannonfire, regiments, columns taking up position below or already engaging with the enemy. The swift noting of instructions in the most summary form possible, coded for brevity and speed. The hillock, the commander-in-chief with his staff around him, is also a pedagogical location. What would you do, captain?, a glance at the map, favour and promotion dependent on the right answers. Decisions to be made, arrived at without hesitation, appropriate orders dispatched. Procedures formalised and professionalised later in the 19th century and embodied in the Prussian General Staff. Procedures also deployed at the Charité, for much of its history, since its foundation in the early 18th century, the place where the surgeons of the Prussian army were trained. Professionalisation, specialisation, the reward of merit, the routine of staff consultation in the preparation for and administration of emergency.
But here in the hospital, as in the army, the greatest time is spent waiting. Time weighs heavy in barracks, in the bivouac, the guns point silently. In the late afternoon, the corridors of the ward are almost deserted, a patient wearing a combination of pyjamas and street clothes shuffles to the tea and coffee trolley, others doze after sleepless nights, a book, a newspaper slipped from their hand, the hum of invisible machinery, air conditioning, strip lighting, computers, a single nurse in the control room, files, paper work. And then, just after the changeover from day to evening shift: a patient has a seizure (a surprise attack!), two new patients are brought in by para-medics (the enemy has appeared in strength from an unexpected direction, not predicted by scouts or reconnaissance). A crisis: barely enough nurses on duty to cope (no reserves immediately available). The patient with the seizure is rushed to intensive care, the bed surrounded by six or seven helpers, doctors, nurses, orderlies, infusion bottles held aloft; plastic sheeting is tugged off beds, the new patients are pushed to rooms, lugged from stretchers, duty doctors appear, cursory questions, nurses measure blood pressure, pulse, temperature; swift decisions, brief words of reassurance, injections. For half an hour there’s not enough care to go round, one sees how physically demanding the work of the nurses can be. But there is no question of defeat. Defeat would be synonymous with catastrophe. The sound of battle recedes, calm returns, the hum is audible again, the attacks were not the main engagement, only skirmishes after all, though casualties are always possible. The evening meal can be served now. In an hour the professor-surgeon will be here to review the situation, setting priorities, times for the morning operations.
And there’s this too: The ranks, uniforms, and distinctions here on the ward are often opaque to the layperson or visitor, to the observer from another land. Many of the doctors – though not all – wear jeans and boots under their white coats. The nurses are in white or blue or white and blue. Do the colours also signify grade or are they merely the result of chance wardrobe decisions? There are special units at any rate: Polish nurses always in white, the company of gay orderlies (always in green) and the nutritionists, physiotherapists, the welfare workers and the talkative volunteer counsellors, constituting a kind of baggage train.
Absent here in the hospital: At least since the time of the Ottoman Janissaries, whose example spread through the European armies, marching and drilling has been accompanied by the music of bands. There is no music in the ward (or its enclosed by headphones), no bandsmen pace out the hospital grounds with brass, woodwind and drum, only the faint sound of Radio Eins, old hits and traffic news, leaks from the physiotherapists’ room.
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Of course, what I’ve written here is no more than an observation, a minor footnote to a Foucauldian history of institutions and the discourses linking them. But perhaps here at the Charité a certain tradition, a practice deriving from the military genesis of the modern hospital, has survived in less dilute form than in other hospitals.
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