Steinhof The asylum had existed as a concept long before she saw it with her own eyes. In the Steinhof, one would say. This or that individual was in the Steinhof. And this would always be said quietly, almost in a whisper, with a distant look in one’s eyes. Her grandfather had been a Steinhof patient for many years and when she was nine or ten and, as they thought, old enough, she was taken along to visit him. She remembers narrow lobbies full of men in the institutional uniform; how the staring, oddly bright eyes in their coarse, unshaven faces would fix on her and follow every step she took. She remembers the screaming, high-pitched and repulsive, as if from animals taken to slaughter, that would rise suddenly from behind the open doors of the wards and which often triggered frenetic activity, sending staff along the corridors at a run, with the long, effective strides of trained athletes. But just as often, the screams would be completely ignored. A mat of sound was ever present beneath these frightening outbursts, woven from thousands of mumbling voices, incessantly muttering and whispering. Somewhere far inside this huge cathedral of sound, her granddad lay quietly in bed. Dad, don’t you recognise me? her father would ask every time, on a sliding scale of anxiety. Her grandfather didn’t recognise anyone, it seemed, but now and then he would reach out and touch Anna’s head the way you tentatively touch an object you would like but don’t dare to hold. Her mother, who never came with them, opined that her father-in-law was paying the price of a life of drunkenness and she missed no opportunity to tell them about all the sacrifices her husband had been forced to make for his alcoholic father. However, for the son, these visits were no sacrifice. Afterwards, father and daughter would walk for a while in the hospital park and maybe climb the hill to Otto Wagner’s lovely church with its copper dome, green with verdigris, and its great gate guarded by four angels with raised, golden wings. Anna remembers the hospital site as always thronged with people of all ages. Some of the strolling groups would include a patient in his pyjama-style daywear but there would also be people dressed for a picnic, or entire families, the boys in knee-length shorts and the little girls with bows like small propellers in their hair. The trams taking you away from Steinhof would always be crowded. It felt as if the whole city had enacted a communal pilgrimage and happily went home in unison. A few years later, Anna’s granddad was moved to the Ybbs hospital and no more visits were made, at least not by her. The family would sum up what happened as: the old man was lucky to die in good time. What that was supposed to mean, no one cared to explain.
Has Sister Anna Worked with Idiots Before? When she starts work, she discovers that Steinhof has changed and no longer has anything but the walls and the façade ornamentation in common with the hospital site she once visited with her father. It is January 1941. The day is overcast and still. Near the imperial clock by the main entrance, the Nazi flag droops, as if glued to the flagpole. Set among the bare trees in the park, the pavilions look like bunkers with their high, solid walls and window grilles. Anna Katschenka presents herself to the administrative office in pavilion 1 and is given instructions about where to go next, but she is soon met by the matron, Klara Bertha, who comes walking briskly down the wide drive. Bertha is a strongly built, middle-aged woman with, in some people’s eyes, striking good looks. Arguably she would have been respected, whatever profession she had taken up. In conversation (with patients or colleagues) she comes across as slightly reserved, someone waiting patiently if a little irritably for what the others have to say before finally delivering her response, distinctly and explicitly. On the way towards their pavilion, she points and describes with pedagogic clarity which of the pavilions still belong to the ‘old’ Steinhof establishment and which to the new institution for children and adolescents. She explains that the odd numbers, as in 3, 5, 7, 9, 11 and 13, are ‘theirs’. We have tried to avoid mixing former inmates with, for instance, the children from Lustkandlgasse who have been placed in pavilions 3, 5 and 9, and those from Juchgasse in number 7. Pavilions 15 and 17 hold only psychopaths of both sexes and also younger children who are very ill or malformed, which means that they don’t just need specialised care but also constant supervision. And that is where Sister Anna will be nursing. Anna Katschenka points out her previous experience of dealing with severely ill children and takes the opportunity to mention her many years in Professor Knöpfelmacher’s unit. Matron smiles patiently, almost sadly, as she waits for Sister Katschenka to finish and then says: I’m afraid that there’s very little hope for these young lives. By then, they have reached the right place and the door is opened by a young nurse who introduces herself as Nurse Hedwig. Behind her, several other members of staff emerge from doors along a narrow corridor. Bertha introduces some of them by name and qualifications: Emilie Kragulj, Hildegard Mayer and Cläre Kleinschmittger. Kragulj and Mayer had worked before as psychiatric nurses at Steinhof but had been seconded to the children’s wards and had to relearn on the job. Same difference, Mayer says. Her tongue is as quick as her body is heavy. Nurse Kleinschmittger, Bertha continues, is the charge nurse for one of the wards for very young children. There are three types of patient in pavilion 15: infants, children aged less than three, and slightly older children, up to the age of six or seven. We employ tutors who are meant to instruct the third age group but, regrettably, most of the children lack the ability to learn even the simplest things. When Bertha has completed the sentence, Kleinschmittger turns to Katschenka and smiles. Her smile is meant to please but is tinged with nervousness. One might even read jealousy in it, a keenness to guard some spoken-for territory. Or else it is simply that she has no idea what she is supposed to say or doesn’t dare to speak at all. Meanwhile, Doctor Gross has descended the stairs, apologising loudly for having been delayed by a telephone call, and quickly takes the lead in what turns out to be an improvised tour of the premises. Like most of the pavilions on the site, number 15 is constructed around a central flight of stairs, which makes for an easy subdivision of each floor into two wards. Two doctors, Gross and Marianne Türk, who used to work at Steinhof, share the medical responsibility. Anna Katschenka is due to meet Doctor Türk later. She is a short, slim, middle-aged woman with something tense and withdrawn about her that marks her out as one of those doctors who set about their daily work with the kind of goal-oriented persistence that leaves no room for anything else – neither errors of judgement nor moments of compassion. Quite unlike Doctor Gross, who speaks with many vague but big gestures and who has already acquired the apparent distractedness often displayed by men conscious of their own importance, a manner that entails constantly changing subject and register and seems ultimately intended to make everyone they talk to feel insecure. Has Sister Anna worked with idiots before? he suddenly asks without stopping to listen to her answer. He moves on, as if the question had been quite beside the point, and instead opens wide the door to one of the wards and steps inside, immediately followed by Bertha, Kleinschmittger and Mayer, who seem to be swept along in his wake. The wards are not that large. Each long wall has room for five to ten beds, and the changing tables and basins. The bedsteads with their high end-rails are made of white-painted metal. Along the short walls, some beds enclosed in metal netting stand a little apart, presumably to make it easier to keep an eye on them. In one of the netted beds, a nearly grown-up girl is crouching, leaning a little forward. Oblivious of the staff, her jaws are grinding like millstones while her gaze makes helpless attempts to hang on to objects within her field of vision: a blanket, a pillow, the inside of the bed rails, which her fingertips explore intently as if investigating an enigmatic script. All the children, not only the infants, are in their beds. Gross walks from bed to bed, pointing this way and that. He could be demonstrating objects in a museum. She only catches fragments of what he says: idiocy … spastic diplegia … we have cages for epileptics as you can see here! He indicates the girl in the netted bed. For Anna Katschenka, the children are still nameless and suffer from nameless diseases. She sees bodies: bodies just lying there, the already exhausted attachments to gigantic skulls that sometimes look absurdly beautiful, the distended cranial bones covered with blond baby hair and fragile networks of pale-blue blood vessels. Some bodies have been preyed on by tumours until so emaciated that the skeleton is about to pierce the skin, the ribcage protruding through the loose skin-folds over chest and abdomen, the sharp edges of forehead, cheek and jaw bones stretching the weakened sphincter muscles around eyes and mouth. The bodies emit shrieks and odd noises which are everywhere, the alien sounds ranging from hoarse shouting to gurgling and cooing. A little boy with cleft palate groans like a rutting animal when they are about to pass him, and Doctor Gross stops and points: Cheilognathopalatoschisis. Alcoholic mother who abandoned the infant when she saw what it looked like. One can’t entirely blame her! With an exaggeratedly caring gesture, the doctor helps the malformed child to stand by supporting his right arm. The split in the boy’s palate is wide enough for them to see straight into the moist membranes of his gullet. When Gross touches him, the boy’s coarse, wild groans change into helpless gurgles and she finds herself looking into a pair of shiny blue eyes that express a lucid awareness more alarming than any scream. But most of the children are silent as they sit or lie on the beds, their fingers spread out or stuck between wet lips, their gazes dull or absently following the white-clad procession, and it seems as if the incessant sobs and moans that fill the large room from floor to ceiling don’t come from anyone in it but from somewhere far away, like a vast, distant wave of discordant noise that has taken tens of thousands of years to reach this place but is finally breaking through the dams and is about to swallow everyone and everything on the ward, the children in their beds and the professionals bending over them. But a slightly older child, whose skin has a doll-like pallor, lies on her back deep below the uproar, her face turned indifferently towards the murky surface high above her where space and voices blend. Her face has grown and suggests five or six years of age, a much too large head in relation to her short torso and thin but shapely limbs. Looking more closely, her every feature seems chiselled with extraordinary precision. Her hands, which rest on the coverlet, have slender fingers and pink, half-moon-shaped nails, and her doll’s face with its porcelain skin and pointed chin is given distinction by her small, lovely mouth that has a slight, almost ironic twist. Her eyes are a deep blue beneath their heavy, aristocratic lids, the sweep of her high forehead ends where a mane of thin blonde hair with a reddish shimmer grows from what Anna Katschenka’s mother would describe as ‘a perfect hairline’. And it is perfect. The thin, exactly delineated roots run like a neatly stitched seam across the forehead, along a line that is reminiscent of a Cupid’s bow. (Anna Katschenka has had to learn these finer points, as her own hairline is less than perfect.) This child is Sophie Althofer, Nurse Kleinschmittger explains as she stops by the girl’s bed and draws attention to her presence next to Katschenka by pretending to tidy the coverlet. Her mother comes in almost daily, she adds, at which Doctor Gross, who patently disapproves of nurses chattering while he is prepared to hold forth, clears his throat and loudly announces the diagnosis: Achondroplasia, combined with imbecility of the worst order. Not even the mother has managed to get a single, sensible word from this girl, he says as he turns to Anna Katschenka with a smile, as if to advise her against even trying. And then the performance is over. Matron instantly picks up the change of tone and addresses the group of nurses: Sister Cläre, will you show Sister Anna the practical side of things. Anna Katschenka follows Cläre Kleinschmittger into the corridor and then into the lavatories and shower rooms. Sister Cläre also demonstrates the sluice room and the correct places for washbasins and bedpans, then shows her where the first aid cupboard and the linen stores are, and goes through the order of towels and bed-linen items on the shelves. Anna stays in the sluice room afterwards and watches as Hedwig Blei, the young woman who opened the door when she arrived, busies herself with rinsing out bedpans. Nurse Hedwig is young and vital. Her arms are broad and strong, and there is a band of freckles across her nose. She seems unfazed as she upsets the hierarchical order, speaking to a superior without being spoken to first. Pointing to a jar of hand cream that she has put next to the sink, she says that people from the countryside know how to look after themselves and then explains that it is the same cream she learnt to use when she was younger and was asked to treat the inflamed sores on cows’ udders. Then, in reply to Anna’s question, she says, yes, well, I’m from Grünbach in Mühlviertel. You know, this cream is good for chapped skin on the hands as well. For a moment, the two pairs of hands are placed side by side on the workbench and young Miss Blei can’t refrain from asking, I can’t help seeing that Sister Anna perhaps isn’t married? And carries on, now energetically rinsing off bottles and glasses, so she doesn’t notice how Anna stiffens. Instead, Nurse Blei adds that a job like this is simply impossible to combine with having a husband and children, that’s what I‘ve always thought. Much wiser to wait! On their way out, they pass little Sophie with her pretty doll’s-house face that looks too mature, too clever for a child. Anna feels that the girl’s gaze follows her but Sophie’s pupils shelter below her elegantly curved eyelids. Her exquisite lips curl disdainfully.
Conditions of Service She did not know what exactly she had hoped for as she took up her new post because her expectations had been more linked to the person of Doctor Jekelius than to the work, but nothing had prepared her for having to nurse such badly afflicted children. It was not that she was unused to caring for ill children or, of course, for physically and mentally debilitated old people. The patients they were responsible for here were, however, so severely disturbed by neurological and other malformations that they fell outside the normal range. Her training had taught her to deal with injuries and common illnesses, but little or nothing about how to nurse children who had no control whatsoever over their limbs, who any second might attack her with wildly flailing arms, hissing and spitting and biting, or children whose inner torment was so terrible that they screamed all the time, unending ululations without any apparent relationship to the cause of their pain, let alone how they could be made better or even soothed in any way other than the morphine-based medication that was routinely prescribed in quantities that frightened her. She also felt that she was being constantly watched, which didn’t help at all. Every hesitation was recorded, every hint of her being ill at ease or put off by something interpreted as being unable to cope. Nurse Mayer especially seemed to see it as her duty to keep an eye on the new recruit. Even though she was formally Katschenka’s inferior, she had ways of showing that she disliked how she had been told to do something, or simply disliked being told anything at all, and indicated her displeasure by perhaps a raised eyebrow or a faint smile, before going about her tasks with studied slowness. Mayer was an old hand, as she put it, and like many of the other ex-psychiatric nurses, she handled the children in her charge as if they were insensate, pulling the screaming little bundles out of bed and carrying them under her arm like parcels, or perhaps more like small animals on their way to slaughter. Meanwhile, Cläre Kleinschmittger would hover in some doorway, her eyes flickering anxiously while her gaze stayed fixed on Anna’s every move. Their eyes never met and they never exchanged more than a few words, but Kleinschmittger seemed always to be surrounded by one or several colleagues such as Nurse Sikora, Erna Storch and Emilie Kragulj, and Katschenka saw them together more than once in a corridor or the corner of a ward, standing in tight little clusters, whispering together only to fall silent the moment she came past. Finally, her concern had become an incessant, deep-seated ache and, one afternoon, she knocked on the matron’s door and asked leave to take half an hour off work in order to speak with Doctor Jekelius. Doctor Jekelius is away on business, Matron Bertha replied curtly, and her tone suggested that it was an unheard-of impertinence even to mention his name. Sister Anna can of course talk to me if the matter is a practical one, or refer it to the personnel department. Anna Katschenka had by then realised that Doctor Jekelius’s role was not only that of medical director of the Spiegelgrund institution but that he also acted as the right hand of Councillor Max Gundel, who was in charge of the new department of public health. It had been Gundel who drove the decision to merge the city’s many children’s homes and reform schools into one institution: Spiegelgrund was his creation. Jekelius had been charged with overseeing that all children ‘who required special treatment’ were taken to Spiegelgrund, a responsibility that led to much arduous travelling. When Jekelius was not on site, the administrative side of his work was handled by Doctor Margarethe Hübsch. Doctor Hübsch was a robustly built, middle-aged woman with severe features. She wore her blonde hair pulled back into a strict bun, dressed for work in two-piece suits with the NS-Frauenschaft pin ostentatiously placed on the lapel, and greeted people with the German Heil, as was the rule by then but which Anna Katschenka found awkward. Anna was of course used to working within a framework of discipline that meant employees knew what was expected of them and what the limitations of their rights were. She had always been content with the clarity of this. However, she had now joined an institution run on militaristic lines, as if the hospital had turned into barracks, and it made her feel ill at ease. She was unused to the way her superiors addressed the staff. Doctor Knöpfelmacher had been firm and decisive but often ready with a kind, encouraging smile. Doctor Hübsch, on the other hand, was either formal, bordering on brusque, or else given to ice-cold sarcasm. Katschenka felt insecure and, always, there was Nurse Kleinschmittger, lingering in a doorway, as if looking forward to when Katschenka would make some mistake or annoy one of the doctors. Anna lay awake night after night, arguing with herself. She couldn’t afford the risks entailed in resigning. For instance, returning to Lainz would be out of the question. There was just one way out, as far as she could see. She told her mother one evening that she would be going out after supper to meet a friend, and set out to catch the 8 tram. That was the line she travelled on to work every morning but, this time, she stayed on board until the Alser Strasse stop and then walked briskly up the hill to Michelbeuern. It was only when she stood in front of the wide iron gate on Martinstrasse that it dawned on her quite the enormity of what she was about to do. It wasn’t just that she was being pushy (which was completely out of character, of course) but also that she clung to the belief that he would be able to put a stop to, or at least mitigate the effects of, the choice he had himself suggested that she should make when she had consulted him. The healer of souls needed no eyes. Would he be able to see that this particular post did not suit her? But she doesn’t get round to ringing the bell. Standing on the pavement opposite the gate, she is as incapable of stepping forward as of walking away. A few cars pass by. When the noise of the last one dies away she hears footsteps on the cobbled pavement. She turns. It is he. She recognises his light, vigorous gait immediately, despite the darkness. Suddenly terrified that he might catch sight of her, she slips into a gateway, the sound of footsteps grows fainter and when she dares to look he is gone. He must have turned the corner already. She runs the same way, well aware of what a pathetic figure she makes. The street in front of her is deserted. Did the ground open up and swallow him? And then she hears a car engine start. Just some fifty metres away, two powerful headlamps light up. The car glides out of the garage and, as it reaches the street, the light falls on a woman waiting on the pavement. The car stops near her, the window comes down and she bends forward to say something. It is Jekelius in the driver’s seat, Anna is certain of that. She has no idea who the woman is. Anyway, with a laugh, a small affected giggle, the woman gets into the car. They drive past Anna but neither one pays any attention to her. As she walks back to the Alser Strasse tram stop, she doesn’t feel disappointed, only empty. Her mother doesn’t ask where she has been. She knows that her daughter doesn’t have any friends and especially not anyone whom she might like to visit at this time of night.
Mother and Daughter Only a few days later, she meets Mrs Althofer in the office in pavilion 1. Sophie’s mother wants to speak to Doctor Jekelius and, when she learns that he is away, asks to see Doctor Hübsch. Mrs Althofer is in many ways the spitting image of her dwarf child. The same reddish-blonde hair springing from the same perfect hairline. Their curving eyelids are similar, too, but the mother’s eyes look so heavy that she can’t lift them enough to see Anna Katschenka’s face. A meeting was arranged for today at nine o’clock but it would appear that Doctor Hübsch has preferred to be unavailable, she says as her gaze slides past Katschenka to follow the stair rail. Sister Katschenka says that this is not a matter she can deal with and suggests that the office staff could set up a new appointment. But Mrs Althofer insists that the agreed meeting should take place and eventually becomes very loud on her daughter’s behalf. Apparently Doctor Hübsch had personally assured her that her daughter would get well and now, what’s happened to that promise? You’re keeping my little girl locked up day and night! You don’t give her anything to eat or drink! You treat her worse than a base animal! Next, Anna Katschenka is baffled to find herself holding Mrs Althofer’s small, clenched fists in her hands. For a brief moment, the surprise they both feel at the prevented exchange of blows dampens the underlying fury and the two of them, the ward sister and the mother, stand on the stairs with their faces close together. Then a door slams a little further upstairs and a white-coated Doctor Gross bends over the railing to speak to them:
Doctor Hübsch is off sick today,
but if you wish, Mrs Althofer, you can speak with me…!
Later that day, Doctor Gross will enlighten Katschenka and her new colleagues about exactly what type of woman they are dealing with in Mrs Althofer and, particularly, what kind of mother. One of those who can’t make up her mind: will she or won’t she let go of her child? And because she is incapable of squaring her conscience, she continues to haunt the periphery of the institution where her child is being cared for, all the while complaining loudly about how appallingly the little girl is looked after and how unpleasant the staff are to her mother. Nothing but a charade, from beginning to end, Doctor Gross emphasises, because in her rational moments, Mrs Althofer knows that she can have her child back any time she so decides. Against medical advice, that goes without saying, but no matter. That right belongs to her in this situation, as it would to all mothers. The problem is that, in her heart of hearts, Mrs Althofer doesn’t want to. She is aware that if she ever were to hug Sophie’s shrunken, malformed body to her breast again, she would be at an utter loss as to how to handle this new burden. It is a fact that she doesn’t have the time to look after her child. She has to work. Food is hard to come by. Who would look after little Sophie while her mother carries out her office duties? As Mrs Althofer has repeatedly pointed out herself, she has a responsible post as the trusted secretary of a large legal firm. And Mrs Althofer’s own mother, who selflessly used to care for her granddaughter while her daughter was at work; well, the old lady has spent the last few weeks in hospital with an attack of gallstones. And Mr Althofer has been called up. So typical of how families live nowadays. There’s a war on, after all. Each and every one of us must be prepared to make sacrifices. We can only conclude that Mrs Althofer’s stubborn meanderings amount to nothing more than her way of quieting a constantly nagging, very uneasy conscience. Because, by coming here and badgering members of staff and complaining, Mrs Althofer at least gives the pretence of doing something even though she knows deep down, as does everyone else, exactly what a repulsive and miserable condition this child is in, how depressingly feeble and unworthy it has become. Yes, Mrs Althofer knows full well but cannot bring herself to state it in so many words, Doctor Gross says. She would really be so endlessly grateful if we could only lift this burden off her shoulders but is unable to put that into words, as well; like all these mothers who keep accusing us of stealing their children.
Decursus Morbi In the evening, Sophie runs a high temperature. Anna Katschenka is not on duty at the time but one of the day nurses had made an entry in the case notes: before the onset of the fever, the girl had been very restless for several hours, first noted early that afternoon. The child twists and turns, also emits short, almost inaudible shrieks. The following morning, the perfect hairline is edged with a ribbon of small, shiny drops of sweat. The child is febrile. Temp. 38.5. During the months and years that follow, Anna Katschenka, as the ward sister, will be responsible for keeping case notes up to date. Back then, another hand is making entries in Sophie Althofer’s notes. The writing is stronger than Katschenka’s, with neat rows of sloping letters. The notes include something of the patient’s earlier history. She was a much longed-for girl, born to two apparently perfectly normal parents. Their only child. At birth, it was noted that the baby had shorter than normal limbs, with hands and feet especially reduced in size, and a protruding breastbone – one of the so-called pectus anomalies, the ‘pigeon chest’ or pectus carinatum. The misshapen thorax is associated with narrowing of the ribcage and sharp-edged ribs that threaten to compress the internal organs. Various treatments were used at an early stage, beginning with a cradle designed to straighten the limbs. On the family doctor’s advice, Mrs Althofer gave the infant a nightly bath in rock-salt brine. All available nutritional supplements were purchased, including Vigantol oil, Bio Malt and cod liver oil. At the age of three and a half, the child suffered from severe headaches in connection with a cold, and later fell ill with a high fever and strong muscular pains. The tentative diagnosis was polio. The child’s mental development, which had been normal, became affected and she stopped speaking or in any other way communicating with others.
21/01/1941
[…] the child was admitted to Spiegelgrund as her mother stated ‘I cannot cope any more’.
22/01
[notes in Doctor Gross’s writing]
[…] The child is well nourished, overall status good. Deep tendon reflexes elicited bilaterally and at normal power. Babinski reflex and Rossolimo’s sign negative.
The child tends to lie on its back, hardly ever moves its pathetic stumps of arms and legs. Cannot sit upright without support, the head falls backwards due to an apparent lack of muscle power.
Pupils fix on stationary objects but she does not reach or grasp. No real eye contact possible.
On examination, the child gives an impression of a marked degree of idiocy.
02/02
[notes alternately in Doctor Gross’s and Doctor Türk’s writing, with added entries made by the day duty nurse]
[…] Sophie appears not to suffer from any physical pain but will emit an incessant low, wailing sound (especially on days when her mother has visited).
Sophie is calm and biddable but will not eat unless spoon-fed & seems not to feel hunger in the ordinary sense.
Weight reduction: 800g. […]
08/02
Strong epileptiform convulsions. The girl is tied down to prevent self-inflicted injuries. She still refuses nourishment. Luminal prescr.
09/02
Continued muscular spasms, less extensive.
As the restlessness is not reduced by the evening, administration of Luminal.
11/02
Condition not improved. Visible decline in the child’s overall status.
Further weight loss recorded: 800g.
Generally weakened. Apathetic.
At this point, Mrs Althofer writes a letter to the board of the institution and demands that they should let her have her child back. Her stated reason is that she felt unable to establish contact with her daughter on her latest visit, an experience she describes as ‘something completely new’. Even though Sophie has chosen not to communicate ‘as people normally do’, Mrs Althofer insists that mother and daughter had developed ‘their own language’ and that they could speak fluently with each other. The girl had been happy and often laughed. When I held her by her waist and lifted her high in the air she would choke with laughter and whisper in her tiny voice, ‘Thank you, Mummy!’ It is with deep distress that I have been forced to realise that my girl is no longer herself. You have written [Mrs Althofer refers to a letter from Doctor Jekelius] that no amount of wishful thinking can make my daughter well again and that at Spiegelgrund she will receive all the care and attention a child needs. Are you telling me to be grateful that my daughter seems no longer able to recognise her own mother?
16/02
[…] Fever 39.0o. Suspected viral bronchitis. Decongestant prescr.
When Katschenka checks on her that evening, Sophie seems to be sleeping peacefully for the first time in weeks. Her smooth features show no sign of the earlier distortion. Anna would like to stop and place a hand on her face. But there are so many children. Soon afterwards, she is called to pavilion 17, where a boy is banging his head against the wall. He has to be restrained. In the other ward, a boy has come down with scarlet fever and must be isolated at once. Hildegard Mayer is bullying a girl, she shouts and hits the child. Nurse Mayer really has an awful temper. By the time Katschenka returns to pavilion 15, Sophie has been moved to the gallery wing. Her temperature has gone up again and she is breathing irregularly. Each breath seems to be ejected separately, one by one, from her misshapen chest. The pallor of her face has turned grey, and her skin is unnaturally glossy, like a sheet of shiny, thick paper. There might well have been glimpses of awareness in her eyes before but now they are empty beneath their heavy lids. Anna thinks that her face shuts you out, like a blank wall. Later that day, a so-called Schlechtmeldung, a bad news announcement, is put in the mail.
Wien, 16 February 1941
For the attention of Mrs Althofer
I regret to have to inform you that your daughter’s health has undergone a severe decline. Her condition must now be regarded as worrying.
Professor, Dr E Jekelius
Medical Director
The following morning, two of them wash Sophie Althofer’s body. Katschenka props the corpse upright while one of the nursing assistants pulls the mattress and sheets off the bed. The child’s body is lighter than Anna had imagined and easy to hold: the strongly arched pigeon chest fits into the bend of her left arm. They suddenly hear a shrill, piercing scream from the corridor, and Anna briefly fears that Mrs Althofer has arrived and that she is to be the one who hands the dead girl over to her mother. But it is a child who screams. The note about Sophie’s declining health had been put in the post after a deliberate delay to make it too late for Mrs Althofer in case she decided to come along. But she might not come at all, just as Doctor Gross had explained earlier: the mothers may well be tremendously loud and pushy while their children are here, but once the little ones have died, they’ll write and ask us to ‘look after the practical issues’ and that they’ll pay us for our expenses, thank you kindly.
The Procedure A few days after the death of Sophie Althofer, the office finally informs Anna Katschenka that Doctor Jekelius wishes to see her. Does a child have to die before she is offered the reward of an audience with him? The Jekelius she meets in his study isn’t the humorous, pleasantly jovial doctor she remembers, or believes that she remembers. He doesn’t get up to greet her, and carries on leafing through documents while taking occasional notes. She is left to stand there. When he finally turns to her, he moves in the old, relaxed, carefully controlled way but his face is like a stone wall. There is no way to get through. He slowly places one hand on top of the other and asks if she is becoming familiar with the routines and pace of the ward work. She says yes, since that is obviously what he expects. This unchanging face of his frightens her. He goes on to say that he assumes she has by now observed the miserable condition of most of the children, taken on board the fact that many of them are incurable and also understood how the institution deals with this type of case. She thinks of Sophie, and the far too high dose of phenobarbital she was given, and of how strangely light, almost weightless the child’s body had felt in her arms. Tears fill her eyes. There is nothing she can do to stop them. She feels in her uniform pockets for a handkerchief, can’t find one and tries to turn her head away. Weeping is so undignified but Jekelius doesn’t seem to have noticed that her feelings have got the better of her. His face is still rigid as he leans forward over the desk. I shall now have to remind Sister Anna about the professional oath that binds you and the pledge of confidentiality that you will have made at the same time. As you know, you are, under no circumstances, to communicate any details whatsoever with respect to any individual case to anyone outside the institution. And you are not to ask any unnecessary questions. Has Sister Anna grasped these implications? She nods. The corners of her eyes have almost dried and now she thinks that maybe Doctor Jekelius’s stiffness is related to the message he is trying to convey to her. He sits back in his chair to unlock one of the drawers in his desk, finds a thin sheet of typescript and hands it to her. It is some kind of certificate with a signature at the bottom and the Nazi emblem in the upper left-hand corner. She is far too tense to get a grip on what the lines of typescript actually say. As Sister Anna can see, this circular carries the Führer’s own personal signature, Doctor Jekelius points out. It means that legally, this document has the same status as an already enacted piece of legislation. He pauses to give her time to take in the overwhelming significance of this but, somehow, she is struck mute and also feels unable to grasp what he is trying to tell her and what the circular has to do with any new laws and regulations. She stares at the piece of paper in her hands. So, that’s what Hitler’s signature looks like? Doctor Jekelius continues to speak but in a gentler voice, as if he has sensed her confusion. What we do in certain circumstances, he says, is confined to extreme cases only. And our interventions aren’t crimes, neither morally nor legally, as you can see now. On the contrary, the measures we take should be seen as acts of mercy in the spirit that has always guided medical science, that is to ameliorate or remove sources of pain and suffering. Then he explains the practical aspects of the procedure, how for each patient certain forms are to be completed and sent to the Ministry for Internal Affairs in Berlin, where a dedicated medical committee scrutinises the submissions with great care and sees to it that every individual case is tested before their decision is made and which it is our duty to carry out. But, by now, she has ceased taking in what he says. She gets up, politely excuses herself, but she really must leave. They are waiting for her down in the pavilion. Presumably, he believes that she is upset because of the information he has just entrusted her with and his gloss on the words in that document. She is upset but that isn’t why. Often that day, as well as during many of the days and nights that follow, she returned to the thought of how differently she would have reacted if he had taken her into his confidence rather than laying on that performance. How she would then have understood not only the words he used but, with a will, embraced the meaning of it all. However repellent the new legislation he had spoken of appeared to her, she would nonetheless have been completely loyal to it. Now, it seemed as cold and abstract and impersonal as Jekelius himself. And what of those monstrous children, was there nothing for them except the law? No mercy, no love, no life? She lay awake all night in her old girlhood bedroom in her parents’ flat on Fendigasse. Although their area was usually calm and quiet at night, she seemed to hear a chorus of voices rising from the street: loud, high-pitched voices speaking across each other and then yet cut through by other ones, as sharp and shrill as officers’ commands. The ultimate decisions are not made by us, but by them, in Berlin. All we can do is knuckle under and do as we’re told. None of us can be regarded as personally responsible. We are obliged to obey current legislation. We have no reason to feel guilty.
Two Lives From that time, she seems to lead two lives. With her parents, she chats contentedly about her new, secure post at Steinhof and the remarkable Doctor Jekelius who looks after his staff so well. Sometimes, she also tells them about the children she cares for at the institution, the poor little things – that’s how Hilde Mayer describes them – with their comical notions, and about the games the nurses think up to amuse and distract the few who have enough sense to be distracted. She never says a word about the circumstances that have led to the children’s institutionalisation or gives the slightest hint of any of the repulsive defects and health problems they suffer from, but instead manages to suggest that these are quite normal children, though maybe a little slow to develop. Doctor Jekelius had assured her that euthanasia would be considered only in extreme cases. He expanded on this theme: only when we are one hundred per cent certain that being cared for in this institution will never lead to anything better than conditioned responses that please the staff; only when the child is so retarded or afflicted by such grave defects of hereditary or racial biological origin that the only predictable outcome is endlessly drawn-up pain and degradation; only then will we choose to abandon attempts to extend artificially the tormented existence of such children and instead end its life, something we will do, as instructed, in the most humane way possible. However, Anna Katschenka had no doubt at all that the committee in Berlin had been notified of just about all of the children in pavilion 15 and that new patients were routinely referred on admission. Nor had it taken long for her to understand that most of the children on the ward had already been prescribed the ‘treatment’ but some were still there only because it was due start later. She never grasped the logic of the timing. On her daily rounds, all she knew was that some of the children were ‘sentenced’ but not whether they had weeks or months to live. However strange and distressing she found it, nothing stopped her from carrying out the necessary day-to-day work. Children rated as unfit to live still had to be washed and changed regularly, and fed with solid or liquid food as required. Those who couldn’t swallow must somehow be made to in the end, and those who were immobile had to be turned to prevent bedsores developing. And all ought to be talked to and cared for, perhaps even sung to, as Anna found herself doing to a little girl whom no one and nothing could comfort. She sang the same songs she had once sung to the children in Professor Knöpfelmacher’s infection wards. They were childish verses and riddles, like the one about the fox who stole all the hens in the coop. Then the knotted, hard muscles in the little girl’s face relaxed slowly and the large, infantile mouth began sucking on its own tongue, then two fingers went into her mouth and she fell asleep. A few hours later that same girl woke and convulsed badly. They had to tie her hands to bars at the head end of the bed to stop her from scratching her face. While Nurse Sikora tried to bottle-feed her, Anna Katschenka phoned for Doctor Türk who came at once, as tight-lipped and focused as ever, inspected the girl’s throat and prescribed scopolamine injections since the child clearly could no longer chew and swallow on her own. A week later, the girl had to be moved to the gallery wing where the most severely ill children were cared for or, more to the point, where they kept the children whose ‘treatment’ had advanced to the last stage and who had only a few hours left to live. Along the wall, opposite the row of tall windows with the ventilator panels always open to let the persistent stench of Lysol and faeces escape, the febrile children were bedded down under thick white duvets. It looked like a line-up of little mummies. Some might cough, making rough, painful sounds as if a spoon was scraping the inside of their frail chests. Most of them lay quite still, their lids half closed over cloudy eyes. The hardly audible breathing of one child after another would cease and all that was left of them was the mess on the sheets. The alkaloid agent that was pumped into their bodies to dull their restlessness and convulsions seemed, at least in these huge quantities, to affect the mucous lining of the intestines and cause the faeces to become semi-liquid and stained with blood. The bitter stench of shit mixed with medication was so overpowering that nothing you washed the floors with could remove it, and however often you cleaned and aired the place, it was still there. The smell would never go away. Outside, the corpse-porters were waiting with their covered carts to take the bodies to the mortuary, where they were washed and made ready for the post-mortem examination. The soiled bed linen was bundled up and the packages taken on the little train to the laundry. And that was it. A casual visitor might have been surprised at how quiet and orderly the procedure was. No one struggled to save lives here. No dashing about, as Nurse Mayer might have put it. The two ward medics, doctors Türk and Gross, came and went at their own serene pace. If some especially interesting case had been admitted, the doctors might all turn up and cluster around the bed. Their discussions could become lively but rarely loud. Doctor Jekelius never joined these case conferences. Often, it was Doctor Gross who took the lead with his usual pompous authority. And it was also Doctor Gross who usually decided about whether to carry out encephalographic examinations on the children, or any other investigations. The young patients who had been subjected to lumbar puncture, and especially those who had to have several punctures, which of course took much longer, were often in terrible shape when they were returned to the ward. It took just a few hours for some of them to fall ill with nausea, vomiting and severe spasticity. And then it was time for scopolamine injections again. Instinctively, Katschenka knew that it was wrong to up the dosage of pain-reducing and tranquillising agents to this extent, especially for very sick children. But what right did she have to express medical opinions? She assumed anyway that the cases that were selected for cranial X-rays were already so ill that the child’s relatives would have given their consent, and she also hoped that these investigations were carried out in order to reach the high scientific goals that Doctor Jekelius always invoked. Besides, it was a comfort to see that in the end the children became calm and somnolent after all their pain, although it was impossible to make them take any nourishment afterwards. What was truly hard to deal with was the way all these interventions were undertaken without a word being exchanged about them, and in an atmosphere of gloom and mutual distrust. She would sometimes catch Nurse Kleinschmittger watching her as she stood in front of the drug cupboard with her list of prescribed medications, as if weighing up what Katschenka might know of all that was unsaid and simply taken as read when it came to the running of the ward. Would she reach a stage at which what was left unsaid would become unbearable? But, no, of course there was no such stage. Rather, it was a relief when one of the members of staff turned what they all knew into a joke; someone like Nurse Mayer, whose uncaring, coarse manner could feel liberating. Isn’t it soon time for little Fritzl to have his next shot? she might say, all mock innocence. Or Emilie Kragulj, who was simply thoughtless, would lift one of the most malnourished children and say the doctor will come soon, unintentionally making Nurse Kleinschmittger smile even as her restless eyes nervously flickered across the room to check on Katschenka. All this meant that they formed a collective after all, without trying to and without any real understanding between then. What they were not allowed to talk about or even mention in front of the others made them bond more tightly than anything else they might have in common. The shadow of all that was unsaid would never disappear. It was no ordinary shadow because somehow those on whom it fell were induced to lean further into it. Katschenka has that darkness inside her. She can’t explain her awareness of the shadow in any other way. When she went home in the evenings, she sat in the tram and all around her people would crowd in, with the workaday briefcases squashed under the arm or between their knees. They were all pure, spotless, and it showed. She paid attention to how she dressed but avoided anything startling, and carried out her duties flawlessly; the shadow grew as flawlessly. She realised that it would soon invade her so thoroughly that none of it would show anymore, inside or outside her. Then, not even the fact that it existed would seem remarkable.
Existence and Will One May morning, she is again told that Doctor Jekelius wishes to see her. This will be the first time he has spoken to her since he showed her that circular but, to her relief, he seems to be in a gentler mood, even expressing regret that he has so little time to spend at Spiegelgrund, since when he is not with Councillor Gundel to discuss urgent matters, he often has to attend medical conferences. And then there’s the problem with all the provincial hospitals under Wien City Council’s control, where local clinics look after children who should be transferred to Spiegelgrund and which he is duty bound to visit. These last few weeks, he has carried out numerous inspection-tours of such clinics. And herein lies the reason why he has asked her to come to his office today. A journey to the Bruckhof hospital in Totzenbach has been scheduled and the plan was that Doctor Hübsch would accompany him, but now she has informed him that she is ill and cannot travel, so he wonders if Sister Anna might be prepared to assist him instead? Of course it is to be seen as an in-service duty. He adds that he will drive an official car and that expenses will be paid.
Sister Anna could perhaps see it as a change from her routine?
They set out early in the morning, on a Monday in July. It must have rained the night before because afterwards she clearly remembers the sloshing sound made by the tyres as the car sped through the quiet streets. The air had a fresh saltiness about it, as always after rain. Doctor Jekelius had offered to collect her at her door but she had declined. She had no wish to be observed from inside the house. In that case, she would have to go to the trouble of coming to his home; she knew the Martinstrasse address, of course, he added with a little smile. She recognised at once the car she had seen that night when a strange woman had been waiting for him. In daylight, the glossy new Opel Kapitän convertible is if anything even more impressive. Jekelius looks suitably sporting in his plus fours, matched by a checked tweed jacket and a cap of the same material. The cap makes his face look more angular than usual, which both attracts and alarms her. She feels a twinge of fear because he suddenly seems a stranger, as if she were landed with an unknown companion. They drive with the top down along Hernalser Gürtel, where the rumbling traffic is already building up to the morning rush, then past Westbahnhof towards Linzer Strasse. He is at ease behind the steering wheel and chats about how pressed he is for time, what with all these inspections and, of course, all the administrative work. She finds it more and more difficult to keep her mind on what he is saying. The sun, still low above the horizon, is dazzling. As they speed along, the wind makes her eyes fill with tears (he clearly has no intention to raise the hood). She congratulates herself that she put her hair up properly and used a scarf to keep it in place. Her mother always went on about how only prostitutes let their hair hang loose. And would add that such girls of course want to hide their faces. (She wonders, why suddenly think about all that?) Jekelius carries on talking but has moved on to the necessity of advancement in medical research and how the profession, despite all the progress during the last few decades, still persists in holding positively medieval views on what constitutes illness. So, what is illness? he asks her. It is probably a rhetorical question, because he only glances fleetingly at her where she sits picking at the ends of her scarf. Illness, he says, is something that afflicts people blindly. Or so it is believed. A punishment sent by God whose hand reaches out from heaven and singles someone out for no rhyme or reason. But, on the contrary, nothing to do with the body happens at random. The biology of heredity has demonstrated with unassailable clarity that there is no disease of the organism; no, not even ordinary infections, which cannot be explained in terms of inherited factors. The causes of damage are already lodged within the body, long before we see the first symptoms of disease. It follows that medical science must adopt a different perspective of time. Taking a patient’s history should not only entail asking if Mr A has had symptoms of this or that illness before. A useful, goal-oriented examination must include the patient’s entire medical history as well as his social and racial background. Sister Anna surely understands that we should learn to see time as a space, but above all learn how to make the art of healing more fit for purpose. How many dimensions would you say there are, Mrs Katschenka? (The question is so abruptly asked that at first she doesn’t take on board that she is supposed to say something. But when she turns towards him, his eyes still look straight ahead and both his hands grip the steering wheel.) Most people would reply that there are three, he goes on without pausing. Three dimensions that define space and then, perhaps, time as well. However, personally, I would answer that there are only two. The first dimension is existence. Most people live in it. And in existence, only the most base and trivial needs are recognised. When someone who simply exists falls ill, he experiences a base, animalistic need to be cured. He doesn’t for a moment consider why he fell ill, why the illness afflicted just him or what would be the use or sense of curing him. The other dimension is the will, which is outside the reach of most. Your will enables you to prove that you, in yourself, feel free to rule over the material and physical contingencies of your own life and the lives of others. Duty and law both derive from the will. Likewise, the freedom to sacrifice yourself for a higher cause. Likewise, the ability to think in categories such as lifetimes rather than just lives, or in terms such as peoples or races rather than individuals who are either well or ill. For as long as medical science operates only at the level of human existence it will never truly heal, only remove or mitigate the symptoms and, even so, only temporarily. Medicine acts, as it were, blindfolded. It remains unaware of precisely whose symptoms are removed or, worse still, if such a removal has any significance or is useful in a wider context. The enlightened form of medical science that encompasses both dimensions always intervenes with some defined intention. This is when it becomes possible to treat also in order to cure. That is, you remove not only the external symptoms of the disease but also clarify its fundamental causation, and can hope to eliminate the factors that have allowed it to emerge and take hold. This might sound strange, coming from the mouth of a medical man, but it is my whole-hearted, firm belief that even the most severe conditions can be cured by the action of the will alone. Our Führer is the sovereign incarnation of the will, of course, he adds quickly. It is actually said unemphatically, as a dutiful afterthought. He is driving very fast by now. It occurs to her (and it might well be the effect he wanted) that they are leaving mere existence behind and are travelling exclusively in the dimension of the will. She quite enjoyed the speed at first but she is beginning to feel sick. It scares her that she has no sense of where she is, whether the countryside is spreading wide and open around them or, on the contrary, if they are hurtling so fast through a narrow tunnel that its walls can’t be made out, and suddenly the old nausea overwhelms her, taking her over as brutally as it did that time in the sports ground on the day she met Hauslich.
Please, I have to ask you to stop for just a moment, Doctor Jekelius …
She didn’t mean to, but she has touched his arm. He turns to her and his eyes look dismissive and stern. In the shade of the brim of his tweed cap, his jawline looks hard, even threatening. But he does slow down and then stops outside a rustic building that seems to be some kind of inn. He stares at it for a while before, in a sudden rush, he says that he must make a phone call, leaves her and slams the car door shut. After a while, the engine sounds in her head die down and, with them, the dizziness and nausea. All is quiet around her now. The sun shines in a cloudless sky. It is baking hot. She sticks her arm out and touches the car door. The sensation of hot metal against her skin is pleasurable with just a hint of pain. The realisation of how quickly feeling sick can give way to feeling so wonderfully well makes her a little ashamed. She closes her eyes. In the silence, she hears the chirping of grasshoppers and smells the rough odour of decaying grass from the roadside ditch. When she opens her eyes again, she sees larks swirling high above the ripening cornfields. She turns to look for Jekelius and catches sight of cardboard boxes on the rear seat. The boxes are packed full of tins and jars of preserves. She can’t resist taking a closer look. Cured ham, asparagus, champignons; desirable luxury goods in these deprived times. Who are they meant for? They are travelling on duty, after all, so all this can hardly be intended for the staff or the patients at the hospital they are going to inspect. She quickly straightens up when she sees him walking towards the car. The sun is behind him and his slim body seems to dissolve and reform in the heat haze that rises from the tarmac. She waits, ashamed again, with lowered head and thumping heart. They’re waiting for us at Bruckhof now, is all he says before starting the engine.
The Boy Pelikan and the Fourteen Holy Helpers The Bruckhof hospital is not in Totzenbach as she had assumed but stands surrounded by fields and meadows about a kilometre outside the village. Apart from the main building and a chapel, there is also a long, wooden building on the hospital site: a barn, perhaps, or stables, or a tool shed. The hospital building is three storeys tall, with a splendid Baroque gable and a high, sharply sloping roof topped with an onion-domed turret. Jekelius parks in the narrow shade in front of it, removes his cap, takes a white coat from his doctor’s bag and pulls it on over his jacket. The institution’s director, a red-cheeked, elderly man, is already waiting on the steps to receive them. Accompanied by two nurses in neatly ironed, white uniforms, he leads the way in a nervous, slightly affected manner. The doors to the wards open into long corridors and the whole scene reminds her of Steinhof as it looked in the 1920s, when her grandfather was a patient there. It smells the same, as stale as if the place hadn’t been properly aired for decades. There is something almost sculptural about the bright sunlight that enters through the windows high above the heads of the few patients who have dared to step outside the wards. They are ushered into a smallish room with bare stone walls and a single tall window looking out over the garden. Someone has put a vase full of fresh wild flowers in the window alcove, a gesture that seems somehow touching. The staff has already picked the children to be examined. She can hear their voices on the other side of the door, excited and angry as children always are when jostling for a place in a queue. The director invites them to sit down at a desk in the middle of the room. On it, patient records and case-note folders are tidily arranged and opened for the inspector and his assistant. The two nurses stand by the door, ready to assist as required. Looking indifferent, Doctor Jekelius leafs through the list of patients and then agrees with the director that the children will not be called in alphabetical order (the records are not consistently sorted that way) but according to the ward and room where the child’s bed is. The voices outside suddenly fall silent, and one by one (as their names are called) the boys and girls come in to stand in front of them, like little actors at an audition, looking confident or scared or trying their luck with frankly ingratiating smiles. Some are obviously imbecile, with protruding lips, wet with saliva. Most of them seem to find it difficult to stand still in the same spot, or to speak coherently enough to string together more than a few sentences at one time, or to speak at all without constantly becoming distracted. They are not intimidated, though, and look curious and intently interested in what is going on. One of the boys tries to grab hold of the spatula used to examine the inside of his mouth and then becomes intrigued by the doctor’s little reflex hammer. Jekelius works calmly, with that thoughtful concentration she has come to think is typical of him. His expression fascinates her, withdrawn and distant but very alert at the same time. He is sparing with comment, but now and then uses a Latin term or some short description, for instance of the appearance of the limbs, or of skin rashes and scars. She makes a note in the margin of the patient’s record of the remarks she has understood. Finally, the room is empty, no one waits in the corridor and the hospital director, visibly relieved, comes over to them. She looks through the list of children again. All names have been ticked apart from one.
Someone called Pelikan is missing, she says. Karl Pelikan.
Jekelius looks hard at her for a long moment. The director is pressing the palms of his hands together in front of his chest, almost as if praying.
Why haven’t you had Pelikan called? Jekelius asks. The director closes his eyes and Jekelius turns to one of the nurses: this Pelikan, is he not here any longer?
The nurse, oh, yes, Doctor … Doctor —
Doctor Jekelius, Please, would you bring the child to us immediately.
Pelikan is brought. He is a thin, gangly boy of about thirteen or fourteen. Two men support his shoulders but he can walk on his own, though in an odd, jerky, foot-dragging way. Instead of stepping straight into the room, he drags his body along the whole of the short wall next to the door and the two men follow him obediently. She thinks: like royalty. His long, narrow face seems as strangely twisted as his body. His eyes are screwed up below sternly pulled-together eyebrows, as if observing Jekelius with profound distrust, possibly even contempt. Briefly, confused embarrassment fills the room. The two men who support Pelikan are unsure whether to keep propping him up or to set him down, and Doctor Jekelius offers them no instructions. He just stands there, intently scrutinising the boy’s face until the hospital director clears his throat and says, clearly still troubled:
Master Pelikan here works for us in the office, he’s …
Doctor Jekelius waves impatiently at him to shut up:
Sister Anna will read to us from his hospital record instead.
Pelikan, Karl (Karel). Born 1927. The youngest child of four.
Father: Forest ranger. Mother: Schoolteacher.
K initially developed normally; learnt reading and arithmetic early. Joined in children’s play but worried because he was unable to run as fast as the others. At the age of eight, complained that he found it hard to raise his arms or to carry heavy objects.
She looks up and sees Pelikan staring at her, from his throne of supportive arms. His gaze is so penetrating that she gets lost in the text she is reading. The room is very silent. Then, a new conversation starts up between Doctor Jekelius and the institution’s director, in a different, more factual tone:
DIRECTOR: Pelikan walked normally until he was ten.
DOCTOR JEKELIUS: This looks like a severe case of muscular dystrophy. It usually starts distally in the limbs. Can he raise his hands?
DIRECTOR: He can read and write, he’s …
DOCTOR JEKELIUS: What about his speech?
DIRECTOR: His speech is perfectly normal. Like you or me.
DOCTOR JEKELIUS: [to Pelikan] Say something…!
KARL PELIKAN: [stutters] J-j-j …
DOCTOR JEKELIUS: And what is the nature of the work he carries out?
DIRECTOR: He works in the office. He stamps letters, Doctor Jekelius.
DOCTOR JEKELIUS: Stamps letters?
DIRECTOR: He is a great help to us in the office, where he undertakes many other practical tasks in addition to stamping letters.
DOCTOR JEKELIUS: But all this is of course completely beside the point. It’s clear for everyone to see that this boy is subject to progressive atrophy and, as you will understand yourself, this is not the right place for keeping cripples. Young Pelikan ought to be transferred to the kind of institution where he will receive appropriate care. His future capacity for work is something you, Doctor, and I should discuss in private, if there is an opportunity?
The two medical men leave the room together. Young Pelikan, too, leaves in his mobile throne, followed by the two nurses who both turn in the doorway and curtsey to Anna, as if to some superior. Because she doesn’t know what to do next, she returns to the car. Soon afterwards, Jekelius comes along and insists that they must drive into Totzenbach. Someone lives there whom he must visit. But first, he has a couple of phone calls to make in the hospital. Sister Anna can go ahead into the village to pass the time, he says. It sounds like an order and she obeys. There is a cemetery on the village side of the hospital. It is surrounded by tall poplar trees that cast a basketwork of swiftly changing shadows over the gravestones. Some of those buried here must have been patients who died in the hospital, but most of the graves are for staff, all female. The tall headstones have the same year chiselled into them: 1918. The year of the Spanish flu. She recalls Jekelius’s long lecture on the way here: were these nurses themselves the cause of the infection that killed them? A narrow path runs from the wooded burial ground between broad fields towards the village. For a while, she follows a slow stream with wooded banks until houses and farms close in around her and she is in Totzenbach. She has arrived at a ruined castle with a moat that looks more like an overgrown ditch. The castle seems to have been recruited as an army base: parked military trucks and troop-transport vehicles are parked everywhere along the moat. It is midday. The heat encloses her like a bell jar. She feels dizzy again and recognises the spasms at her temples that announce a headache. When ten minutes have passed without any sign of Jekelius, she walks slowly towards the church at the far end of the village main street. There are hardly any men around, only women and children. Yet another sign of the war’s silent presence. A flock of boys and girls come running from the school building and set off, shouting and laughing, down a road lined by flowering pear trees with large flower clusters far out along their branches. She is looking for cool places where she can settle down to rest, and when she sees the door to the church transept standing open she walks inside, then stops in front of a low stone relief on the wall of the porch. It is a triptych and the central panel is crowded with allegorical figures. She stares vacantly at the scene for a long time before she suddenly recognises two of the Fourteen Holy Helpers in Need: Saint Christopher holding the infant Jesus in his arms and Saint Catherine with the wheel. And then she realises that they are all there: Saint Barbara with the tower, Saint Blaise with the crossed candles, Saint Margaret with the dragon. When she was little, she had to learn about them in school, the fourteen names and attributes of each saint. Irrespective of where you were or what affliction you suffered from, there was always a Holy Helper to pray to and the hope of a pair of protective or supportive hands, like those escorting young Pelikan from his hiding place. There should have been a helper for her mother, too, someone to save her from the insane time warp that made everything seem to slip out of her hands. Perhaps Saint Florian would serve, he who blessed and secured the sanctity of the home when fire and warfare lay waste the land? She notices next that the two worshippers kneeling on either side of the frieze’s central panel, a man and a woman in prayer, have had their heads knocked off. But the vandals have spared the saintly helpers. Only time has worn their bodies smooth. There is the sound of a car engine in the distance, and from inside the gloomy transept she sees Jekelius’s large Opel Kapitän slowly approach along the tree-lined street. Some of the children have climbed up into the pear tree closest to the church but one little boy is too small to follow them on his own. He stands around on the ground below while excited voices call from inside the canopy and then go silent when Jekelius gets out of the car and stops near the tree. He first looks up, then at the boy, who tries his luck by expectantly stretching both arms into the air. Jekelius grabs hold of him and lifts him up into the anxiously waiting tree. Then, he walks to the passenger side of the car and silently holds the door open for her. She climbs in. He stays silent all the way back to the city. Even though he has not commented on the day’s events, she feels that he all the time wanted her to be there, not exactly as an assistant but more as a witness. He intended her to watch his assured, decisive examination and evaluation of the children of Bruckhof, and liked her to see the affectionate firmness with which he lifted the little boy up into the tree. And then she recalls the scene in Martinstrasse, when that woman was impatiently waiting while Jekelius manoeuvred the car out into the street. It has struck her that she is now taking the woman’s place. She briefly wonders if he, too, is aware of that, only to push the thought right out of her mind. It is too absurd and irrelevant to follow up. Instead, she leans back, allows herself to be dazzled by the setting sun and thinks of nothing else until they drive into suburban Wien.