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.
The Whole Dingle-Dangle (Highlander)
I’m looking at myself naked for the first time since the operation to remove the main tumour. Except that, reflected in the wall-to-wall mirror of the shower room, waiting for the nurse to come to soap and rub me down, I’m not so naked at all. From neck to knees I’m splashed in fading orange-red iodine paint. I’ve lost a lot of weight, I raise and bend my arm and the skin wrinkles and folds; at my right shoulder there’s a hollow where there should be muscle. My two week-old beard hasn’t grown in evenly, there are white tufts amidst the peppery grey stubble. I’m holding on to the infusion stand, perhaps would have to anyway to remain upright. To the right of my groin, the elastoplast-coloured colostomy bag. Dressings cover the operation incisions. My penis hangs down, shrinks back, rather, a catheter emerging from the urethra, the tube leading to a bag of pale lemony urine attached to the stand. Another bag holds dark red liquid waste collecting from the internal operating wounds. High up on the stand an infusion bag from which mineral-enriched fluid is fed into me a via a port on my hand, while a tube from a smaller bottle containing pain-killer leads directly to my lower back. I feel no pain at all except when I cough or laugh.
But if I half-shut my eyes then all these attachments and stick-ons assume a decorative, even magical aspect. I see myself as a missing white man, gone native in one of the last lost valleys of the Papua-New Guinea Highlands. The stand my spear – a sheaf of spears! – or a bow taller than a man, the colostomy bag a gourd strung from my waist, containing seeds or perhaps spear or arrow heads, the dressings an arrangement of signs, meaningful, as is the body paint; the catheter a penis adornment. Squinting more I see my beard begin to straggle down to my chest, see my hair growing, matted now, a shell protruding from the caked mass, a horn piercing my nostril.
It’s quiet in the Chemo Room of the Oncology Clinic at Oskar Helene Heim. Eight or nine big club chairs whose high backs and footrests can be adjusted by a remote control. Mobile phones aren’t banned, but even when a patient uses his, he murmurs rather than speaks. The chairs are scattered across the room but all more or less directly face the long strip of window on one side. Through the window: Trees beginning to turn green, their tops and bottoms truncated; sparrows, blackbirds, finches soundlessly alighting, hopping, flying off again. The nurses have a pop hit radio station playing just audibly beside the computers, but that too hardly impinges on the peacefulness of the room. We read, doze, look at the trees again, read, heads nod forward. There are five infusion bags and bottles suspended from the stand beside my easy chair. One infusion to combat nausea, one to deal with the cancer cells and so on. The tubes from the bags pass through an electronic counter before reaching the port inserted at the front of my right shoulder. A repeated bleeping whenever a bag is empty, a nurse comes to close off the tube from the now drained container and open the tube from the next one. A mother, sitting on a stool, talks to her son, around his head a bandana, which at once covers and draws attention to his hairless skull. I read again, nod off, stare out the window, shafts of sunlight falling across the leaves, at the bags on the stand above me, willing them to empty more swiftly into my body. At the end of the afternoon, when my last bag is drained, I’m the only remaining patient. Even Herr Hille (You’re Herr Hille? – Jawoll) left a few minutes ago. But even when it’s time to leave the chemo room the infusions continue. I get a little barrel-like jar, still attached to the port, containing a pump and more fluid to take home with me. I have to carry the jar with me for the next 48 hours, hanging from my belt or around my neck as if I were my own St. Bernard, while it dribbles 4800 mg Fluorouracil plus 13 ml Isoton (i.e. salt solution) into me. After two days, needle, tube and empty pump barrel are removed. And in two weeks the whole business again. Arrival at the clinic at 11, needle through the skin into the port, blood sample (I never look), infusion bottles attached, reading, dozing, the trees grown greener, the foliage thicker in the overgrown grounds of Oskar Helene Heim.
The Day Franz Didn’t Come Back
In the end he did what he always did. Went off by himself, rooted around, came back later, a day, two days later, old leaves sticking to his fur. Just appeared at the front door or came through the cat flap and began eating, wolfing the food in the bowl as if he hadn’t eaten for a day or two, which he probably hadn’t. We never really found out where he went on his wanderings – this was in Kentish Town in London – as a young cat. At weekends and during the long holidays I think he liked the playground of the school opposite the house. There was even a mulberry tree there. (The main building had originally been an asylum for elderly governesses) And he must have gone to the lane along the railway viaduct with its workshops, shuttered or in use. A little, not so little black cat with very bright eyes.
Of the two boys of Kalman’s litter who survived (Kalman was likewise black, but smaller and with longer hair), Franz was his father’s true son. The Wailer, as we called him, was one of the few unneutered cats in the neighbourhood and his agonised cries echoed round the nighttime streets and backyards of Kentish Town. The Wailer was a Bombay Cat, large and black and short-haired, with a powerful head and high hind legs, and the cries of the Bombay Cat do sound agonised, are no domestic mewing, except that Franz neither cried nor mewed, instead emitting almost silent pleas. Franz was neutered when he was a few months old, but he seemed to have inherited the wandering inclinations of his father, even if they were not pursued with the same dramatic urgency.
Later, in Hungary, in calmer middle age, Franz would lie by the little pond in the garden in Battonya, ready to pounce at the first sight of frog movement. But it was no more than a little game in the summer heat of the Hungarian plain, because I never saw him catch one.
We had called him Franz, after Kafka. As a sort of joke I liked to call him Frank or Frankie, just as I sometimes referred to Frank or Frankie Kafka. (Franz’s brother was called Schwartz or Schwartzie and I sometimes call him the Big Black – he’s bigger than Franz and has the Wailer’s massive head – and in my mind I’m thinking of the Big Lebowski.)
He did what he always did, wandered off, rooted among the leaves, did his lone cat thing. Before we went to market in the afternoon I saw him among the damp brown fallen leaves and scrubby grass of the next yard. I called to him through the mesh fence, but he didn’t turn his head, eased forward a little on his stomach. I knew then, really, that he was drifting away.
Franz had been diagnosed with a thyroid problem months before and as it got worse had stopped eating as he should. Now water had got onto his lungs which caused breathing difficulties and he hadn’t eaten at all for two or three days and no longer wanted to be touched. It must have been with his very last strength that he jumped onto the windowsill, dropped down into the garden and pushed under the wire fence.
When he hadn’t come in after nightfall and it began to snow, we looked for him and found him in the other back yard, though not in the same place where I had seen him earlier. His eyes were open, the pupils dark, deep and motionless, the mouth stiff and agape from the effort of breathing in the cold air. He lay stretched out, the first snowflakes of winter on his fur. (In sunlight it showed shades of dark honey, it wasn’t a uniform black.) There was still a little warmth in the body, but his claws were extended, he had become thinner, smaller, was no longer Franz or Frankie.
He did what he always did, went off alone, rooted among the leaves, but this time he didn’t go far and went as far as anyone does, man or beast. He was fourteen years and nine months.