by Uwe Tellkamp
‘Have you seen any of the technical guys?’ Nurse Wolfgang called to Dreyssiger. ‘It’d help if they got a cable laid.’
‘X-rays possible?’
‘No. No CAT scanner either.’
‘Then close down,’ said Richard. ‘We can’t deal with all this. We can’t operate.’
‘I’ve called regional headquarters, Herr Hoffmann. They say all the Dresden hospitals want to close down.’
‘But not all of them can have a power cut?’
‘They’re not sending us any multiple traumas, that’s all I managed to get out of them.’
‘Who’s coordinating things?’
‘Grefe. But he can’t get out of the plaster room.’
‘Are there any beds at all?’
‘No.’
Dreyssiger went into a treatment room. Richard picked up the phone. ‘I’m sure the boss will turn up soon, until then I’ll coordinate the surgical clinics. – The line’s busy.’
‘Eddi!’ Wolfgang shouted, waving vigorously to a brawny man in the blue overalls of Technical Services. Eddi was its head, he was a former boxer, there was a punchbag in his office and on the walls, between bunches of boxing gloves, were photos of famous welter- and heavyweights. Eddi panted, ‘The diesel! Someone’s siphoned off the diesel from the emergency generator.’
‘Nonsense.’
‘I’m telling you, Wolfgang. And there’s no reserve, it’s enough to drive me mad.’
‘There must be a few fuckin’ litres of diesel somewhere in the hospital! People are stuck in the lift.’
‘It’s being seen to. We’ll have to jack it up. Internal and Gynaecological’ve got diesel but they need it for their own generators.’
‘Dad,’ Robert said, he’d squeezed himself into a corner behind the desk, ‘there’s some people from the Western Channel 2 out in the car park. Four big diesel lorries, I saw them when I came up to your ward.’
Eddi said, ‘Touch wood’, and he and Robert ran off.
‘Are you just standing around or is someone going to see to us?’ a man in a leather hat said in a querulous voice through the sliding window of the enquiry desk. ‘Oh, Herr Hoffmann.’ Griesel took a step back. ‘I’d no idea it was you, neighbour. I can’t believe how long we have to wait here.’ Suddenly his expression changed. ‘Wouldn’t it be possible …’
‘All patients have equal rights,’ Richard said, a bit too loud for Griesel’s liking.
‘It caught me out on the way home from work, you see …’ Griesel went on in placatory tones and bowing in an ingratiating manner. ‘Our house hasn’t been hit, by the way.’
Emotions a doctor couldn’t afford to permit himself bubbled up like boiling milk inside him as he watched Griesel push his way through the patients back to his chair; hatred and contempt for that man, the conditions, the whole system. To pay them back in their own kind, to be able, just once, to retaliate to power with power, to have an outlet for the impotent rage piling up inside him day after day! He goes to the back of the queue, Richard felt like saying, Wolfgang would have understood and probably approved. The deep-rooted, feared esprit de corps of health professionals. Richard didn’t say it. All patients have equal rights. The welfare of the sick is the final law, that was what was written in Latin on a board in the entrance to Accident and Emergency: Salus aegroti suprema lex.
A commotion outside the entrance, floodlight beams flashing to and fro, powdery snow coming in through the door. Eddi and an auxiliary brought in Robert, who was holding his arm.
‘I slipped and fell. Stupid.’ Robert shrugged his shoulders. ‘It’s all frozen outside. But we’ve got the diesel.’
His wrist was swollen but his hand didn’t show a bayonet deformity, as with a fracture in a typical position. Robert gave a quiet cry when Richard examined it.
‘Volar radial fracture, the non-typical type.’
‘Meaning?’ Robert asked in a deliberately calm voice.
‘Prickling in your fingers? Any numbness?’
‘A bit, yes. It’s cold outside.’
‘We’ll have to X-ray it. If that confirms what I think, it means an operation. You can wait in there.’ Richard pointed behind the desk. Once Robert had gone, Richard couldn’t control himself any more and swore. If the lad had fallen with his arm outstretched a plaster cast would have done the job.
‘Smith-Thomas?’ Wolfgang, who’d watched Richard examine him through the desk window, asked, using the technical term for the fracture.
‘It’ll need an operation, yes.’ Richard stamped his foot in his fury, a ridiculous sight and, for the patients waiting, not one to inspire confidence.
Müller came in, behind him the man with the floodlight, followed by one carrying a microphone on a long boom like a fishing rod; three other men, in sharply creased trousers and bomber jackets, had overpowered the cameraman and were dragging him out of the flurries of snow, where a second cameraman was coolly filming the scene, into the crowded waiting area. They stopped short for a moment when they saw all the patients. The cameraman who’d been detained took advantage of that to free himself and protest loudly. The floodlight dug a dazzling white tunnel though A&E.
‘There will be no filming in my clinic and certainly not by your lying station,’ Müller cried angrily.
‘But you take our fuel!’
‘The diesel has been confiscated,’ announced one of the three men in bomber jackets. ‘This is an emergency, as we’ve already explained to you.’
‘The fuel taken will, of course, be replaced, Citizen Capitalist,’ shouted the second of the three in the silence that had arisen all around; even the two women beside the young girl had broken off their lamentations.
‘We need everyone we can get.’ Müller pointed to the three in bomber jackets. ‘You are to help charging the room sterilizers. No, gentlemen, we have no time for discussion. You will do what I, as head of this clinic and of the emergency team, tell you until the Rector and your immediate superiors arrive. No sterile material means no operations. The central sterilizer isn’t working. You’ – he pointed to the West German television men – ‘can make yourselves useful transporting patients and clearing paths. Have them shown what to do, Nurse Wolfgang. Will you please come with me, Herr Hoffmann.’ Müller waved Richard out through the swing door into the corridor to the vestibule and wards. ‘A word in your ear. A difficult situation within a difficult situation. I’ve just had a phone call.’
When Richard said nothing, he went on, ‘A call from the top, Barsano himself. His daughter is on her way to us, he claims. With these African conditions out there … He’s asked me to have our most experienced trauma surgeon operate on his daughter, should an operation be necessary.’
‘My son’s been injured, Herr Professor.’
‘Oh.’
‘Volar radial fracture, the nerve has probably been compressed.’
‘Hm. But you can reset it and put it in plaster, Herr Hoffmann. I know it’s not a permanent solution but it’ll do until the morning and then you can take your time over it.’
‘I’d prefer not to wait until the morning. The results don’t get better if you leave it.’
‘I know that,’ Müller, exasperated, replied with a sweeping gesture. ‘I have a suggestion: when the generator starts, we’ll at least have power in the ICU again and then Herr Kohler can join us. Never operate on a relative, you know that. And you’ve trained up Herr Kohler very well.’
Richard, alarmed, didn’t reply. That possibility had never occurred to him. The maxim he had followed in training Kohler was not in the Hippocratic Oath: If you have to instruct your enemy, teach him just enough to make sure he won’t harm the patients, but not enough that he can replace you.
‘All patients have equal rights,’ Richard muttered. There were sounds of the jacking-up operation from the lift shaft, metal on metal, someone calling for pliers.
‘I can understand you, believe me. But Barsano has protected you. There are those, and not only here in
the clinic, who are unhappy with the opinions on certain things you often express quite openly.’ A fragment of the pocket-torch light from South I slipped into the stone in Müller’s signet ring. Beautifully cut, Richard thought. Does he take it off when he’s doing an operation? It wouldn’t fit under the gloves and disinfection to a surgical level wouldn’t be possible either. Why not operate on Robert, take the reprimand and resign?
‘And suggest you have to prove yourself. Nonsense, if you ask me. As if you hadn’t proved yourself here.’
Not a threat, more a plea for understanding. Richard sensed he was getting nowhere the way things were. ‘So far we’ve no power, no X-ray, we can only use one room, if any at all.’
‘The CAT scanner’s working again. Tellkamp has been informed, he’s waiting. The technicians are running a cable from Admin and Nuclear Medicine to us. We’ll be able to operate and X-ray again, even if we don’t have mains current very soon – which I reckon we will. For the moment the generator ought to be enough for the ICU. I’m only halfway through my operation too.’ Müller suddenly spoke in an unusually understanding tone: ‘We’ll manage. You never know, Fräulein Barsano might arrive immediately and you’ll be able to operate on both. Lord alone knows what’s wrong with her: sent with multiple traumas, arrives with athlete’s foot.’
‘But why here, of all places. Can’t she be treated up there in Friedrich Wolf?’
Müller nodded. ‘I’m sure they won’t have a power cut up there, but I’ve no idea, Herr Hoffmann. – Thank you for your cooperation.’
Accident and Emergency did not empty. The doctors from the various surgical areas had formed teams (no one there said ‘collectives’ any more, Richard thought), those from Internal Medicine went to and fro between the wards, Endoscopy and Outpatients. Whenever Richard thought the stream of patients was slackening off, the outside door would swing open and Rapid Medical Assistance, a taxi driver or a relation would bring more people with injuries. They also brought news of how things were in the city outside. From what they said, which was immediately passed on by the nurses rushing in and out, by doctors, porters, waiting patients, the situation outside must be chaotic. Trams were stuck on Platz der Einheit, the power was off there too, passengers had forced open the doors, the people who lived in Neustadt didn’t have far to go and could trudge home through the snow; anyone who wanted to get across Marienbrücke to the city centre tried to hitch a lift from one of the cars crawling past; worst off of all were those who had to go up to the high residential area: with no possibility of hitching a lift, they were faced with several kilometres on foot. The Elbe was covered with a sheet of ice, a Czech tug had been squeezed against the Blue Miracle, the bridge had had to be closed. None of the ferries between the north and south bank were running any more. When Richard went out to get a breath of fresh air, the Academy looked like a darkened honeycomb: the roofs waxy with ice, the snow on the paths and roads knee-deep. In many of the ten-storey buildings in Johannstadt, in the new developments of Prohlis and Gorbitz, the central heating wasn’t working; the people there were shivering in their beds, envious of those on the slopes of the Elbe with their tiled stoves that devoured coal and produced ash but also – and that was the important thing – warmth.
In Outpatients no one seemed to know who had already been treated and who still needed treatment, who could be transferred to a ward and where which of their colleagues was occupied with which case. Wolfgang was still ensconced behind the desk, flanked by sheets of paper on which he tried to provisionally record the details of the arriving and departing patients, telephones were ringing, always someone wanting to know something: patients when they’d be treated, family members where their relations had got to, staff where there were supplies of syringes, bandages, admission forms – and couldn’t someone finally make a decent cup of coffee, after all the emergency generator was working now!
‘Yes, in the ICU and the patient lift to the operating theatre, clever Dick.’
‘Clever Dick yourself! Then they can just make the coffee up there and send it down to us!’
‘And when’s the light going on here again? Oh, sorry, nurse, missed again. But you can hardly see anything here.’
‘I’m sorry to have to put it so frankly, but you’re an old goat.’
‘You’ve completely misunderstood me, nurse. It must be this pitch darkness. Goats have two horns.’
‘Where’s the testicle?’ Frau Doktor Roppe, a urologist, called across Outpatients, arms akimbo. ‘The strangulated one. – You’ve called me away from a septic catheter, Wolfgang, you’ll be sorry if it’s a false alarm.’
‘Here,’ a faint voice said shyly, ‘here, Herr Doktor.’
A National People’s Army tanker was expected but still hadn’t arrived. Scheffler, the Rector, had formed a crisis committee and inspected the clinics. Walkie-talkies were taken out of the Administration safe, important telephone calls, listed in a sealed plan, were made in the prescribed order. The Intensive Care Unit in Internal Medicine was supplied by the emergency generator there, the one in Gynaecology was working too. The idea of transferring urgent surgical cases there was dropped: moving there with all the equipment would be too much of an upheaval, and beside that Eddi and his men were already in the process of laying cables through the Academy’s system of tunnels to supply Outpatients and the operating section. A simultaneous ‘Ah!’ rang out when the lights flickered back on. The heavy X-ray machines started to hum again, the coffee maker in the rest-room sputtered water over the coffee powder, X-rays appeared on the lightboxes, nurses who had been holding torches over lacerations and scalp cuts in Minor Surgery could return to other tasks. Richard helped Grefe with the resetting of broken bones and subsequently putting them in plaster, between the cases (a wearying, mildly comic coming and going between fractures of the radius on the left, fractures of the radius on the right) he went to the enquiry desk, impatiently looking for Alexandra Barsano, telephoned Intensive Care but Kohler couldn’t be spared yet.
Richard had aspirated the haematoma on Robert’s wrist himself and given the anaesthetic that made resetting bearable for the patient. But that he had asked Dreyssiger to do, that brutal-seeming bending up and down over the broken wrist; then they’d put it in plaster, done an X-ray (Dreyssiger had done the resetting excellently, but Richard insisted on the operation; that type of fracture mostly did not stay stable), and put Robert in the duty doctors’ room. Kohler arrived an hour later.
‘I will not operate on your son, at least not immediately.’ Kohler didn’t wait for Richard to respond. ‘All patients have equal rights, you’ve always told me that, Herr Hoffmann, should we disregard it today of all days?’
‘He’s my son, he wants to be a doctor … his hand, he needs his hand.’ Richard was so taken aback by Kohler’s attitude that he didn’t ask him but Müller, who came over, ‘Would you not give your son preferential treatment?’
‘My father’s sitting out there,’ Kohler said calmly. ‘Wolfgang gave me the patients’ names in order of arrival. Others come before him, I don’t want to give anyone an unfair advantage, nor put them at a disadvantage.’
Richard flew into a rage. ‘Strictly according to the rules … like a blockhead!’ How dare the fellow, he’d given him a formal order! ‘Head down and follow the plan, head down whatever the cost, that’s the way it goes … You’re leaving your own father sitting there for the sake of your convictions?’ Richard asked, suddenly interested.
‘I give others the same rights as him. And do you know what?’ Kohler adopted an impatient, hostile tone. ‘He even approves of it. That’s the way he taught me to be. As a convinced communist. Which you are not.’
‘Gentlemen.’ Müller stepped between the two of them, for a moment Richard was surprised he wasn’t furious, that he seemed to have ignored Kohler’s open refusal. ‘Gentlemen,’ he repeated, a pointless, plaintive request, ‘gentlemen!’
‘It is against my beliefs as a doctor to give anyone preferential trea
tment.’
‘Herr Kohler –’ Müller ushered him out.
‘Herr Hoffmann,’ Wolfgang called from behind the desk, ‘Frau Barsano’s here.’
But it wasn’t Alexandra Barsano coming towards Richard as he went out, but the wife of the Regional Secretary. She was standing, very upright, by the door of her Wartburg. Richard plodded over to her, the blizzard had died down a little, beyond the entrance to the Academy snow-clearing teams could be seen, a lorry, perhaps the impatiently awaited army tanker, was flashing its indicators. The even blanket of fine powder snow seemed to gather the light and reflect it back onto the paths as high as the hips of the passers-by. Frau Barsano’s expression looked reserved when Richard shook her hand. The interior light flickered, he could see Alexandra Barsano, she was staring into space and holding a discoloured bandage round her left wrist.
‘We’re colleagues, of course,’ Frau Barsano said, getting straight down to business, ‘and you have problems here. My husband tells me they’re pulling all the stops out to resolve it and you should have power again in one hour, at the latest two.’ She lit a cigarette, blew out the smoke, looked at the glowing tip that lit up her face when she drew on it. ‘I suggest I treat my daughter in our place, I mean at the Friedrich Wolf Hospital. Herr Müller –’