Unfortunately, when I finished medical school, Ilse wanted to get married, but I felt I was too young and wanted to see the world. “Don’t go,” she said. “We have everything we need and are so happy doing things here.”
But her desire to remain in Eschwege bothered me, since I was looking for a girlfriend who could share my goals. Since she was not enthusiastic about my plans for the future, the romance soon ended. Meanwhile, as my relationship with Ilse wound down, on some weekends when she was busy with other activities I joined several of my old school friends to visit the taverns and cafes in town and get tipsy.
While the ending of a relationship is never pleasant or easy, and I found it hard to break up with Ilse since I still had strong feelings for her, I knew it was time to end things. I was very young and so was she, and I felt we both had a lot of life to live before committing to marriage. So I flung myself back into my studies, since for now that was my first priority—getting the education I needed to become a doctor.
Chapter 12
Clinical Training
After the physicum, which I completed in 1953, we began our clinical studies to get practical clinical training, starting at the hospital of our choice. This shift from theory to practice reminded me of Goethe’s lines in Faust, “Gray, dear friend, is theory, and green is the golden tree of life.” It’s the statement Mephistopheles makes when he offers the scholar Faust the gift of experience in exchange for his soul. It’s the basis for the Faustian bargain that has reappeared in literature since then, when anyone seeks to gain something deeply desired in return for a bargain with strings attached from the devil.
I certainly longed for experience, and it was a great gift after the arid years of scholarship, but at least we didn’t have to give up our souls. In fact, gaining experience was a breath of fresh air, and my years of clinical training helped me reaffirm that I had chosen the right path in life.
To get this experience, I returned to the University Clinic in Göttingen, where I had done my earlier practical training. It was a hospital where no patient needing treatment was refused admission, much like a modern emergency room. On my time off, I returned to Eschwege to visit my family and continue my amorous life with Ilse, since we had not yet broken up.
To begin my clinical training, I was attached to a dozen different medical specialties, including surgery, internal medicine, pediatrics, ophthalmology, dermatology, and obstetrics, so I could learn more about the everyday practice of each discipline. We were assigned to the specialist of each division in turn, and we followed the doctors as they went about their rounds. We did their work-ups on each patient, from the moment the patients arrived until they were discharged.
Some of the doctors were the same physicians who had gained experience on the battleground during the war, where they had dealt with patients who were severely injured in battle and in many cases near death. Now they showed a great deal of empathy for the patients, seemingly heartened to treat patients who were not so severely injured and had the hope of a good recovery. They greeted each new patient with some reassurance that they would soon be well.
In a typical day, we followed the doctors around with only a short break for lunch. We were expected to spend the night in the hospital and were on call at all hours, assisting whichever doctor we were following on a rotation. At night, when we went on rounds on our own, checking on the status of the patients much like nurses, we were expected to contact the attending physician if we noticed a change in one of the patients, for example if he or she was suddenly breathing heavily, coughing, or complained about a new pain.
My priority on my first day of this training with a doctor of internal medicine was to make sure I made a good appearance. Accordingly, as I dressed in front of the mirror, I carefully put on my suit, making sure that it was well pressed and I was neatly dressed. When I got to the hospital, I proudly put a white coat over my suit, the symbol that I was a doctor. As I reported to the doctor I was assigned to, underneath the white coat my heart beat like mad.
Soon four other interns joined me in standing around the doctor, since usually five interns followed each attending physician from bed to bed, as he went about his daily rounds. “You will interview the patients,” the doctor told us. “You want to take each patient’s vital signs and ask the patient questions to find out how he or she is doing.” After we walked into the ward, which was divided into two rows of four beds each, we fanned out to the beds, so we each stood beside a different patient and began interviewing them.
Like the other interns, I first took the patient’s vital signs, using a stethoscope to listen for a heartbeat and pulse. Then I took the patient’s temperature. I also noticed if the patient had a strong heartbeat or excellent blood pressure. Generally, we kept our opinions to ourselves and simply described what we observed, so the attending physician could make the final determination about the patient’s condition. After we noted each person’s level of health from the physical assessment, we asked the patient questions about day-to-day experiences, as we had been taught. “What symptoms brought you here?” “Are you currently in pain?” “Can you eat?” “Are your bladder and bowels regular?” As the patients answered, we carefully noted their responses in our notebooks to help us make our own diagnosis. Later we would have a discussion with the supervising doctor and other interns about what we learned from our observations and each patient’s answers.
Next, like the other students, I observed each patient carefully for signs of a hidden illness. For example, did his eyes protrude abnormally, so they looked a little like small popping balls, which indicated thyroid problems? I paid particular attention to the patient’s skin color, which could be a clue to liver failure if it was a yellowish color, or it might be an indication of scarlet fever if it was abnormally reddish in color.
The supervising doctor came around observing us, and as we observed and talked to each patient, the doctor gave us tips on what to do. Later, when we discussed this experience, he explained what else we should look for in the future to learn even more about a patient. “Use your noses too,” he told us. “Notice whether the patient’s breath seems normal, or if there is an odd heavy or musky odor. If there’s any abnormality, an unusual odor could mean diabetes or stomach ailments.”
The doctor then asked us to gather around a patient who had unusually large legs, which reminded me of legs of mutton. “He has a swelling in the legs,” the doctor explained. “When you notice this, it could indicate that this patient’s heart is weak, not just that he is overweight.”
“Aren’t those two things connected?” I asked. “If a patient is too heavy, doesn’t that put pressure on the heart?”
“Yes, that’s right. Very good,” the doctor said, and I felt delighted to be praised for my observation and recognized in front of my peers.
We continued our rounds, testing out our skills with still more patients. This time, after the interviews, we palpated the patients, which means that we put pressure on their chest and back and thumped up and down with the palms of our hands. The purpose of these actions was to see how they affected the patients’ breathing and the operation of their organs.
As we moved from bed to bed in each room with eight beds, we discussed possible diagnoses for both adult and juvenile patients. Frequently, we saw examples of heart failure, appendicitis, and liver and kidney disease in both adults and children, as well as scarlet fever in children.
Yet, as much as the other interns and I wanted to show how much we knew, the supervising doctors often had to gently prompt us to ask the right questions or arrive at the right diagnoses. For example, when I was examining one patient, I thought he probably had a cardiac weakness because of his swollen legs and heavy breathing, only to learn this was a misdiagnosis. “That’s not correct,” the doctor told me. “Since the patient has heavy breathing and sometimes gasps for breath, have you considered emphysema? He has been a heavy smoker his whole life.”
I had jumped on the diagnosis
of heart disease, because due to the scarcity of antibiotics, which were fairly new at the time, untreated infections sometimes led to heart disease in young men. But no, he had no heart disease, just a serious case of emphysema that was destroying his lungs.
I appreciated such corrections and was determined to be even more observant and precise the next time. I also was glad that the doctors were very kind and helpful, and not at all arrogant. Again and again, they showed us with their gentle corrections that they wanted to help us do even better in the future, rather than show off how much more they knew than we did. At the same time, their careful precision as they guided us made me appreciate how much they knew, so I respected them even more. Moreover, I thought about their difficult experiences at the front during the war, and perhaps that helped to make them more humble and sympathetic to both the patients and us. I felt no one could come away from such an ordeal the same as before. After all, the war years had certainly affected me, as I learned to savor being alive each day and appreciated the camaraderie from many soldiers I met in those years, especially when I was a prisoner in a camp.
One day we encountered a man in his fifties with increased heart activity. He was sweating, and his eyes sagged and bulged. His hands shook, and he complained of insomnia. His voice was also croaky, since his enlarged thyroid constricted his voice box. “I can’t sleep at night,” he told the intern who asked how he was feeling. “I keep waking up, because I feel so hot and sweaty. It’s like being in a furnace, and I have to wake up to get away from it.”
The intern who questioned him took down some notes and joined us in a small circle near his bed. “I think he has a case of hyperthyroidism or Grave’s disease,” the intern said. “That means his thyroid is enlarged.”
I never forgot that exchange. Years later when my wife and I vacationed in Paris, we went to an out-of-the-way bistro, acclaimed for the best aioli, a wonderful garlic mayonnaise, in Paris. When we arrived, after a complicated journey on the Metro, we found the owner, a tall heavy-set man, with a gray brush-cut hairdo, who was wearing a white shirt, gray pants, and suspenders and acting as the maître d’. He appeared to be in his late sixties, had a croaky voice, and looked amazingly like the patient from the ward with beads of sweat on his forehead and the same sagging, popping eyes.
“He’s got Grave’s disease,” I whispered to my wife, as the owner showed us to our table and we sat down. “Do you think he knows? Should I tell him?”
“No!” she said. “I’m sure he knows.”
“But maybe he doesn’t, so I should tell him,” I said.
“Fine,” she said. “Tell him. But it’s not our place to say this to him. So if you say anything to him, I’m out of here, and you’ll have to find your way back home!”
Since I have absolutely no sense of direction, I felt going home by myself was not an option. Besides, my wife was right. We were out for a night enjoying Paris, and this restaurant was famed for its aioli. So I said nothing, leaving the master aioli maker to his own doctors, and we simply ordered. However, as he bustled about, bringing us the steaming platters of fish covered with aioli, I kept reflecting back on those days when I was first learning to be a doctor, and it seemed like those days had just happened yesterday, since the memory of them was still very vivid in my mind.
I also had a chance to observe the labor and delivery department, popularly called the Stork’s Nest. I liked it best because there were always contented patients around: the babies, the mothers, and the fathers. Everyone was happy.
In those days, the fathers waited anxiously in the waiting room, often pacing back and forth, just like in cartoons of expectant dads, rather than being invited to observe the birth in the delivery room, as is common today. Back then we invited the dads into the delivery room once the baby was safely nestled in its mother’s arms. However, sometimes we asked them in too soon, before the after-delivery mess had been cleaned up, so more than one father passed out cold from the sight of the blood.
We had to deliver at least three babies in our obstetrics rotation, but the attending physicians did the C-sections. Occasionally, walking through town, a woman pushing a carriage would wave me over to say, “This is the baby you delivered!” She was happy, and so was I.
I found my clinical studies, with the direct hands-on interaction with patients, to be much better than the academic study of medicine. Seeing patients cured by our efforts was exhilarating, no matter what discipline of medicine I observed.
I especially liked working with dying patients. I had always worried about death and dying, from earliest childhood, and I hoped to find out how people coped with imminent death. Back then we did not use the term “palliative care,” though we did provide the same kind of care and compassion. If a patient was dying, and particularly if he was suffering, we would administer pain medication. We tried to provide a comfortable and quiet place so the patient could die in peace.
I had one very touching experience during the Christmas holidays. A boy of twelve had been riding his toboggan on a snowy, icy road. All he wore on his head was a woolen pom-pom hat, since there were no helmets in those days. He couldn’t stop in time and ran into a truck. The surgeons examined him, but his injuries were so extensive that they determined they could do nothing for him. They brought him into a private room, where he lay in front of me as I held his hand.
He asked me plaintively, “Will I become an angel now?”
“Yes, you will,” I told him.
This encounter shook me up, and I have always remembered it. His injuries were too great, and he died that night. I talked to his mother, who was a refugee from East Germany and was a single mother. She told me, “My husband was in a prison camp in Russia, and I don’t know when or if he will come home.”
“I’m so sorry,” I said. “It must be especially painful for you to deal with your son’s accident by yourself.”
She nodded and then asked, “Did my son say anything?”
“Yes,” I said, and told her about our conversation and his question about becoming an angel. She began weeping. “But he did not suffer,” I assured her.
Then she told me, “I have two other children to care for. We’ve been fleeing the Russians, and we ended up here.” At least I felt better when she seemed relieved that her son hadn’t suffered, and I had told her the truth, since he died peacefully.
But not all children or other families did die in peace, and I did not always tell families the truth. I asked myself, “How would it help them to know that their loved ones died in agony?” I didn’t feel it would help to tell them the truth under those circumstances. I don’t know if this was right or wrong, but it’s what I did.
Visits Home
When I had time off from my clinical training I often visited my mother. She and I were now on our own, since my grandmother, aunt, and two small cousins had moved to their own place, and my father was still in a Russian prison camp. My mother now worked in a pharmaceutical company, filling bottles with pills. She had been raised to be a wife and mother, with servants to do a lot of the housework. She had volunteered with the Red Cross during the war and found it very fulfilling. Then circumstances were such that she had to get a job. She found she liked it, and kept working after the war ended. It didn’t bother her that the work was routine, since she was happy to be making money of her own.
I was still seeing Ilse. Yet, while I was very fond of her and she was the last woman I dated to meet with my mother’s approval, I knew I was not ready for marriage. So one day I told her, “I really do love you, but I’m still in medical school. I’m not ready to get married yet.” Ilse nodded that she understood, and in the end, she married someone else, though she was my first real love.
Everything changed in 1955, when my father returned home from the prison camp. The Russians had held him in Sverdlovsk, in the Ural Mountains, which divided Russia between Europe and Asia. After holding the prisoners in horrendous conditions for ten years, the Russians released them to the
Red Cross. They put the prisoners on trains that arrived in East Germany, then under Russian rule. Since the Russians let the Germans know the prisoners were coming, the city of Eschwege sent Red Cross cars to the train station in East Germany to collect the prisoners from that area and bring them to their homes. It was a relatively short trip, as Eschwege is on the border of the former East and West Germany.
The local paper announced that the prisoners would be coming, so the citizens of Eschwege gathered in the streets to greet them. As the Red Cross car entered the city, sirens sounded and the people of the town began to cheer. They threw flowers at the car as it passed. My father had always been an intensely private and modest man, and he was deeply embarrassed by this show of affection from the townspeople. But he must have felt gratitude as well, knowing the people were out there to support him and cheer him for his bravery in enduring ten years in the camps. Later we heard that all the POWs who returned at that time received the same sort of celebratory welcome.
After the parade, the Red Cross car delivered my father to our house. He must have felt both ecstatic and relieved to walk through that familiar door into the arms of his wife. I wanted to rush home from Saarbrücken where I was working as soon I heard of his imminent arrival, though it took me a couple of weeks to get to Eschwege. I was overcome with joy when I finally saw him. Though he was tired, older, sicker, and weaker, he was still my father, and I felt the same love I had always had for him. The last time he had seen me I was still a boy wearing my Hitler Jugend outfit. Now I was a grown man, a doctor.
“I’m so proud of you,” he told me. “You have done so well, and now you can help others.” I beamed with pride, hearing him speak, and I was glad to finally see him again.
Unfortunately, it turned out that he had developed a heart condition in the camp from the rigors of the work, climate, food, and poor treatment. His age contributed to his hard time at the camp, since he was now fifty-seven, the oldest of the POWs released from that camp.
From School to War: Growing Up in Hitler’s Germany (Contemporary Nonfiction) Page 18