Winemakers
ON TUESDAY, OCTOBER 10, 1967, the day the surgical resident advertised him as the German who just came down from McGill, Dr Josef Bernhardt realized he had been in a depression since the end of the war. Not a clinical depression—he was functional—but in an emptiness lasting twenty-two years.
“Who is he?” the circulating nurse had whispered to the surgical resident.
“He’s the German who just came down from McGill.”
His patient was asleep and already paralyzed, and Dr Bernhardt was preparing to insert the endotracheal tube before turning him over for surgery, when he noticed that the resident was folding down the sheet.
“He’s not intubated yet. Cover him, please.”
But the resident, preoccupied with the pretty circulating nurse, continued to fold down the sheet, exposing the naked body of the patient, an elderly black man. Dr Bernhardt kicked at the tripod stand holding the unwrapped sterile water basin. The empty stainless steel container clattered on the tile floor. All looked at him: the surgical resident and the circulating nurse, the intern, the orderly, the scrub nurse, and the surgeon.
“Cover him!” Dr Bernhardt shouted, voice shaking, body trembling with rage. His large, dark eyes above the white mask were half closed with pain. He could see his pulse, rhythmic, making waves, distorting his vision, and feel his diffuse headache throbbing in tune.
The reflexes of the resident and the circulating nurse were a jump and a rush to pull up the sheet. Hands met. Heads bumped. They covered him.
“This is Mr LaRivière,” said Dr Bernhardt, extending his arm. “If he were awake and in control, would he wish to expose his genitals to you in such a way?”
The resident and the nurse shook their heads, faces drained of color.
“Then while he sleeps, you will treat him with the same consideration as you would if he were awake. And if I hear again of such indignity to a patient in this hospital, the wrath of the Lord will descend upon you, and it will come through me.” He bowed slightly to the surgeon. “I beg your pardon, doctor.”
“Thank you, doctor, very much,” said the surgeon.
“Who is he?” hissed the nurse.
“He’s the German who just came down from McGill.”
The operating room was small; Dr Bernhardt could not help but hear. He, at the head of the table, hemmed in by the anesthesia machine with its gas cylinders, valves, and meters, could not escape, for LaRivière was asleep and already paralyzed.
The anesthesiologist must interview his patients while they are fully conscious. Josef Bernhardt visited LaRivière on his rounds the afternoon before surgery, having no idea that this would be his final case. At the station on Four North, a nurse handed him his chart.
“Thank you,” he said mechanically, without seeing her. He leaned heavily against the counter and opened his second pack of cigarettes for the day, feeling so tired that any movement was extraordinary effort.
“Dr Bernhardt? May I get you a cup of coffee?”
“I beg your pardon?” He glanced at her face—young, late twenties or so. The name tag on her left breast read Susan Ingram, R.N.
“Coffee? May I get you a cup?”
“No, thank you. Miss Ingram. But if you have an ashtray?”
She turned away and was back in an instant.
“Thank you very much.” He extended the pack of Camels. “Would you like a cigarette?”
She shook her head. “I think you smoke too much.”
Her face was even-featured and pleasant, her dark hair pulled back neatly behind the stiff white cap.
“You are right.” He leafed through the chart, several pages on a clipboard. “Are there any old charts?”
“No. He hasn’t been in a hospital for thirty years, and that was in France and was some kind of fracture.”
Dr Bernhardt lit his cigarette.
“I’ll see if I can get the lab reports up before you leave the floor.”
“If you would be so kind. I would really appreciate that.”
She addressed a student nurse who sat at a desk at the rear of the station. “Telephone the lab, please, and see if you can get the results on Mr LaRivière before Dr Bernhardt leaves the floor.”
“That’s the pilondial cyst in four-oh-nine North,” said the student.
“His name is Auguste LaRivière.”
“He’s the cranky old colored guy in four-oh-nine North.”
“His name,” repeated Miss Ingram, “is Auguste LaRivière.”
Auguste LaRivière, 72, Professor of Chemistry, retired. R.C. No Last Rites. The nurses’ notes listed many complaints: that the nurses would not let him sleep; that they awakened him to give him a sleeping pill he did not want; that they would not tell him the name of the sleeping pill; that they restricted him to his room and would not let him go down to the cafeteria; that they took away his bottle of wine. All in all, the patient seemed crotchety but fit.
Dr Bernhardt extinguished his cigarette and was about to walk down the hallway.
“Wait a minute, Dr Bernhardt.” The student nurse was waving a piece of paper and moving toward him. “I’ve got the lab tests.” She came out from behind the counter to hand it to him. “How do you like it so far in Iowa City?”
“Fine, thank you.” He looked at the paper: routine preoperative lab work was well within normal limits. No obvious problems.
“Do you mind if I ask you a personal question?”
Reluctantly, he looked up. “I can’t promise to answer.”
“Are all the anesthesiologists up at McGill like you and Dr Borbon? He came from up there too, didn’t he?”
“Yes.”
“Do you want to know what the girls are saying about the two of you?” She giggled and leaned provocatively close. “They say you’re good-looking enough to be obstetricians.” She was a blandly pretty blond, typical of the region, corn-fed and bursting with health. “Dr Borbon says that obstetrics is the only specialty chosen while standing in front of a mirror.”
“I’ve known it to happen, Miss . . .”
“Burke. Debby Burke: 555-4765. And I’m partial to older men.”
The station nurse, Susan Ingram, was still at the counter. Dr Bernhardt looked at her; they exchanged smiles. She was a small woman, full-bosomed. Her crisp white uniform was buttoned to the throat, and she wore a thin gold chain under the collar with a small peace symbol resting between her breasts.
“And I like your accent.”
“You’ll have to excuse me, Miss Burke.”
He clipped the lab report onto the chart, walked down the hallway to 409 North and knocked on the door.
“C’est ouvert.” The voice informed, curtly, in French, that the door was open.
Dr Bernhardt entered and scrutinized the patient: LaRivière sat up in bed reading, a red plaid robe over his pajamas. Magazines and newspapers were stacked neatly on his bedside table. His slippers were so placed on the stool beside the bed that one could assume he walked freely about. He was in no obvious distress: if anything, he was at ease and fully in control of himself. He was a Negro, so dark that Dr Bernhardt could not tell whether or not his color was good, but there was no obvious breathing difficulty and no evidence that he smoked. Although his hair was gray, he looked younger than seventy-two.
“Good afternoon, sir. Are you Mr Auguste LaRivière?”
“It is I.” The patient spoke English with a pronounced French accent.
“Excusez-moi, Monsieur LaRivière. Je m’appelle Josef Bernhardt. Je suis votre docteur, votre anesthèsiste.” Their conversations, thereafter were in French. “I will be putting you to sleep before your surgery tomorrow.”
“You’ll be administering anesthesia, you mean. Contrary to your opinion, monsieur le docteur, not all of us with dark skin are in want of education. I have a doctorate from the Sorbonne. But I should not correct you. At least your French is perfect. Nevertheless, you will forgive my hopefully incorrect assumption that you are like the rest of them and won’t tell me what you are going to give me.”
“What kind of anesthetics have you had before, monsieur?”
“Ether! Once!”
“Have you any allergies?”
“They asked that before. It should be written.”
Dr Bernhardt looked at him without speaking.
LaRivière glared fiercely, but the doctor remained silent.
“All right, doctor, there’s not a thing in the State of Iowa I’m allergic to but the racial bigots and being wakened in the middle of the night to be given a sleeping pill they won’t tell me the name of.”
“How much alcohol do you drink?”
“Do you mean here in this prison, or when I’m a man?”
The doctor waited.
“You’re not a talker, are you?”
Dr Bernhardt shook his head.
“Hmpff! Every night at home—with my dinner—I drink a small bit of my own homemade wine. One glass or two. I brought some with me, but the nurses made my wife take it away. Then at night, when I get into bed, I sip a little Scotch whisky with the ten o’clock news before I go to sleep.”
“How do you take your whisky?”
“I used to take it pure, but my stomach can’t stand that now, so I mix it with a little water. Are you going to tell me what you are giving me in the morning?”
“Laughing gas.” Dr Bernhardt smiled.
“Nitrous oxide? That won’t even touch me, much less put me to sleep.”
“It will be combined with other drugs.”
“What other drugs? Sacrè coeur, doctor, if you would look at my chart as you are supposed to, you would see I’m a chemist!”
“Sodium thiopental to put you to sleep. Succinylcholine to paralyze you and small doses of meperidine, nitrous oxide plus oxygen for sleep and analgesia.”
LaRivière was startled. “Succinylcholine. That’s a muscle relaxant.”
Dr Bernhardt nodded. “It blocks the nerve impulse to the muscle by keeping the neuromuscular junction in a state of depolarization.”
“But why would you want to paralyze me? I won’t be able to breathe!”
“I do so that the level of sleep need not be very deep. One needs less of the drugs. And I am there to breathe for you.”
“Artificial respiration,” he said quietly.
“Yes. In the morning before they take you up to surgery, you will be given shots of meperidine and Nembutal, and also some Bellafoline to reduce secretions. I see from your chart you prefer not to have a sleeping pill at night.”
LaRivière nodded.
“I’ll leave an order for a glass of wine with your dinner and at eight o’clock or so a shot of Scotch whisky and water. After that, please, nothing by mouth until after your surgery.”
“I thank you, doctor.”
“You’re welcome.” LaRivière seemed shaken, chastened. Dr Bernhardt had not intended that. “I would like to apologize in advance for the wine they will bring you. It will not be like your own.”
“You’re damned right it won’t,” LaRivière exploded in English; and then, in French, “It’s those nurses. And my wife—she took mine away. Did you ever make your own wine, doctor?”
“No. But I remember that my uncle did.” For an instant the image surfaced in Dr Bernhardt’s mind of the bulging cheesecloth, stained wine-red, dripping over the bucket in the cellar of his uncle’s apartment house in Berlin. Passover wine. “It was for sacramental purposes. Very, very sweet. As a child I loved it.”
“He must have used sugar. I add no sugar! Only the grape. I add no yeast! My hands and the grape, which I grow myself.”
“And what of the happy little winemakers, the first winemakers, the Drosophila, who are kind enough to walk about on your grapes with yeast on their tiny feet and start the process of fermentation?”
“Ah, yes, the little fruit flies; we couldn’t do it without them, could we? They wrote the book.” He smiled. “You’re different, doctor. Where are you from? You’re not like the rest of them.”
This classical cliché of bigotry brought Dr Bernhardt back to his usual feeling of extreme fatigue. “Berlin. I was born in Berlin. I will see you in the morning, Monsieur LaRivière. I will put you to sleep and stay with you until your own protective reflexes are present again.”
The trolley or the train, he couldn’t remember which, rammed into a brick wall. His propulsion was cushioned by the bodies of the other passengers, whom he was on the verge of knowing but could not identify. He smashed them to bits. The trolley or the train was cut open with a carpenter’s ax, and he was lifted out. Saved. But the unremembered others, mashed and broken by the impact of his body, lay in pools of their own gore—crushed, dismembered, beheaded.
Dizzy, nauseated, Dr Bernhardt swung his feet over the side of the bed and reached for a cigarette. This horror had not surfaced since near the end of the war, and he could not understand why after so many years the dream returned that morning. He lit up and inhaled deeply. He was exhausted—more exhausted—more exhausted than when he’d gone to bed—and he had to get up; he was due in surgery at seven.
Auguste LaRivière was wheeled into surgery at seven-thirty, groggy from the meperidine and Nembutal. The intern and the orderly helped him move from the cart to the operating table, then covered him with a sheet, removed his hospital gown, and secured him with a strap about his hips.
Dr Bernhardt was wedged in at the head of the table checking his equipment. “Good morning. Monsieur LaRivière. Do you remember me?” They spoke in French.
“Morning, doctor. The wine was terrible.”
They both smiled.
Dr Bernhardt asked the orderly, “Would you be so kind as to stay until we have turned Mr LaRivière?”
The orderly nodded and continued talking with the intern. The surgical resident was talking to the pretty circulating nurse.
“Is the surgeon here?” Dr Bernhardt asked the scrub nurse.
“He’s already scrubbing up.”
Dr Bernhardt pushed the operating table forward and came out from behind it on the right of the patient. “Monsieur LaRivière, I’m going to put a blood pressure cuff on your arm. Will you give me your right arm, please?” He put the cuff on the right arm, then lifted the left from beneath the sheet and laid it in an arc above LaRivière’s head, straightened the sheet, moved back to the head of the table, and pulled it into place, locking himself into the small space. His chest felt constricted; he was having difficulty breathing and experienced a momentary vertigo. He had felt particularly unwell since awakening that morning and now was experiencing the disquieting sensation that his arms and legs were asleep and that any movement was an effort of supreme will. He sat on his high stool to rest for a moment. Dr Bernhardt couldn’t remember; it was either a trolley or a train. The image came to the edge and receded. He rose and said, “I have to start an intravenous drip. Monsieur LaRivière, so you’ll feel a needle prick.” His hand trembled as he inserted the needle in the patient’s arm. “Monsieur LaRivière, you will be getting sleepy.”
“This stuff tastes . . .” and Auguste LaRivere was asleep.
The surgeon came in and said, “Good morning, doctor, is he ready for turning?”
“No. You still have a few minutes.”
“Fine. No hurry.” He turned to the scrub nurse, standing across the table from him, and asked if she had the 3-0 silk and his own needle holder.
Dr Bernhardt put the mask in place, watched LaRivière breathe the oxygen—his airway was fine—and injected the paralyzing agent, succinylcholine. Within seconds LaRivière’s muscles began twitching; then he lay still, paralyzed. Dr Bernhardt gave him a few breaths of oxygen, his hand squeezing the breathing bag, and then, in order to see the expansion of his chest in breathing, he pushed down the sheet enough to bare the chest. The resident, talking with the circulating nurse, must have noticed that movement out of the corner of his eye and without thinking loosened the strap around the hips and folded down the sheet. Ignoring Dr Bernhardt’s first admonition to cover LaRivière, he exposed the naked body.
In an astonishing rage, Dr Bernhardt kicked over the tripod stand and shouted, “Cover him!”
The empty sterile water basin clattered to the floor; Dr Bernhardt squeezed the breathing bag; they covered him; Dr Bernhardt, all the while watching LaRivière’s chest, loudly pounding and vision wavy, began inserting the endotracheal tube through which he would give the nitrous oxide and oxygen. It was then that he heard the surgical resident bruit it about the operating room that he was a German.
All the while ventilating the patient, Dr Bernhardt secured the endotracheal tube and bite block with tape, checked the blood pressure, and began the nitrous oxide and oxygen. After checking the dials on the machine, he announced the blood pressure and pulse. The patient began to show movement: a feeble attempt to cough. The muscle relaxant was wearing off. Dr Bernhardt started the intravenous drip containing succinylcholine and injected a dose of meperidine before reporting, “One hundred fifty over ninety and pulse eighty. Ready to turn.” He was saved, but the others were smashed by the propulsion of his own body. Their identity was on the edge of his memory, but he could not bring it forward—like a name on the tip of the tongue: one knows it but cannot remember. Dr Bernhardt’s lips were numb; he felt faint and nauseated. He knew that his blood pressure was quite high but he could not succumb to it. He must continue to breathe for LaRivière until he was turned and attached to the ventilator. He detached the anesthesia machine and assisted those who were not scrubbed—the orderly and the circulating nurse—with the turning: a fast and gentle flip onto his stomach. With shaking hands, he reattached the anesthesia machine, ventilated the patient, checked the vital signs, then looked to be certain that LaRivière rested so that there were no pressure points. He asked the orderly to place a pillow to lift the legs, and he rearranged the donut under the face.
They were almost ready. The circulating nurse handed Dr Bernhardt the metal arc for the screen, and he put it in place. The scrub nurse threw the first drapes over the screen, separating the surgical field from that of the anesthesiologist, and he was finally secure in his tiny space at the head of the patient. He asked the surgeon, “Is the position all right?”
“I want the patient a little higher and the table flexed. I don’t think I need a kidney bar.”
The orderly pumped up the table with a foot pedal.
“Wait,” said the surgeon, “too high.”
All was adjusted and flexed. The unscrubbed tightened the straps so that LaRivière would not slip down. The surgeon asked Dr Bernhardt, “How is the patient?”
“Pulse is ninety, blood pressure one sixty over one hundred. He reacted a little to the change in position; I’m going to deepen anesthesia slightly, and the patient will be ready for you by the time he is prepped and draped.”
The intern began the prepping. Dr Bernhardt put LaRivière on the ventilator, then in a cold sweat, palsied, he perched on the high stool. The unremembered others buffered his propulsion so that he was saved. But they, crushed by the impact of his body, lay smashed in pools of their own blood. The incision had begun. Dr Bernhardt forced his mind away from the nightmare that had come back to haunt him after twenty-two years, forced his mind away from his own symptoms, for he, Josef Bernhardt, was his patient’s pulse, his heartbeat, the guarantor of his homeostasis. That is what he would tell his residents during their training, and he would say that being an anesthesiologist is a secret wish fulfillment. One becomes a guardian angel watching over the sleep of a being who has given up his will, is totally defenseless, for not only is his monitoring system anesthetized, but also his motor system is paralyzed. The technical skill makes one omnipotent, with the power to gas another human being into a deep and dreamless sleep. And what could be more pleasant than that? But after the cutting was done, one must see that the being awakens again. Mother. One becomes in his tenderness and love as a mother to her unborn child—its very life and breath.
The surgeon removed the pilonidal cyst from LaRivière’s back, and since there were no complications, it was only ten minutes before the intern leaned over the screen and said to Dr Bernhardt, “Ready to close.” Then, blinking at him in his tiny isolation behind the arc, he added, “Don’t you have claustrophobia?” And he disappeared from view.
The implication that one should feel claustrophobic in such a confined space acted on Dr Bernhardt like a posthypnotic suggestion. He broke out in a cold sweat and began to wheeze: bronchospasms. When he glanced at the blood pressure gauge to see how LaRivière was doing, he could not read it: double vision, two gauges instead of one. He was drenched, suffocating, and his impulse was to flee. But he was unable to escape without shoving the table forward, or crouching and crawling underneath it, or without pushing past the surgeon. The complicated defense system that had allowed him to function since the war, already weakened, blew apart. It was as though an electrically indifferent neutron was introduced into a mass of fissionable material. Nuclear fission is a process of structural simplification. Dr Bernhardt became simple. He could no longer force unwelcome thoughts from his mind, nor could he control his physical symptoms. He was ajangle. Through the din, memory imposed itself counterpoint to the mangled and bloody dismembered bodies, and his will was unable to silence the invasion: Berlin. He, sixteen and a half, locked into the tiny control booth in the corner of the Radiation Laboratory monitoring the linear accelerator, a small atom smasher, used in genetic experiments on Drosophila—fruit flies. He irradiated them with fast neutrons to produce mutations. The little booth was supposed to have been protected from the radiation by the half meter of paraffin blocks, twenty-five centimeters of concrete, sheet of lead, and windows only fifteen centimeters in which the contractor had put one pane of lead glass, a vacuum, then another pane of lead glass. Years later, of course, he realized that even after the Chief and the physicist, Dr Maximilian Kreutzer, filled the vacuum with water, one was not protected. But at that time, he looked through the aquarium of glass and water into the Radiation Laboratory and felt safe. Even when the in-house Gestapo—the Security Officer for the Institute—was brought in each day for his x-ray treatment, he had felt protected, never considering that one should feel claustrophobic in such a confined space.
He did not know how long he had been abstracted when he heard the surgeon tell the intern to do the dressing. The operation was over, and during the moments of the depth of his anxiety, he had left LaRivière unguarded. This is inexcusable. He heard the surgeon asking if the patient was all right.
Dr Bernhardt was shocked by the sound of his own voice. “Just fine. No problems.” He looked again at the gauge and he could read it. LaRivière was all right. But he had left him unprotected. This could not be forgiven.
“Then I’ll grab a cup of coffee and see you in the lounge.” The surgeon left with his resident.
The intern and the scrub nurse dressed the incision; the circulating nurse left to find the orderly and a stretcher; Dr Bernhardt lightened anesthesia but did not bring LaRivière out of it yet, because he still must be turned.
It was not that he had ever forgotten the Institute, but that he tried not to think about it and had steadfastly refused to discuss his two years there with anyone, even with his wife, Tatiana, who had been there, too. But then they never had discussed anything.
The orderly came with the stretcher. Dr Bernhardt, in a trance, on the verge of his own reality, was able to care for LaRivière automatically. The years of medical training and practice taught one to seem controlled under almost any circumstance.
“Will you straighten the table please,” he heard himself say to the orderly, his voice hollow and distant. And then, to all, “Let’s push these instrument trays and stands away.” The intern, the orderly, and the scrub nurse helped him. “I prefer to turn the patient on the table and move him onto the stretcher only when he is extubated and has his own protective reflexes.”
The period of awakening is a critical one. Feeling returns, muscle power is restored, and protective reflexes: coughing, sneezing, vomiting. This is where the art comes in—removing the endotracheal tube one second before the patient coughs or before he awakens enough to try to pull it out with his own hand but not before he can take care of his own airway—breathe on his own and protect himself against the aspiration of vomitus. One had to make certain that the return again to life was not so great a shock that it induced a violent reaction.
Dr Bernhardt stopped all medication but continued to give LaRivière pure oxygen. They turned him and strapped him down again, which was very important now, for he might try to jump when he first awakened. Dr Bernhardt checked the vital signs and watched the patient for eye movements, twitching, slight movement of head, and the slight elevation in pulse rate which should come as he awakened. One of LaRivière’s fingers moved. A small shaking of his head. Dr Bernhardt removed all secretions from the airway with suction, turned off the respirator, and had to wait five long seconds before LaRivière took a breath on his own; then, with the next exhalation, he swiftly, smoothly removed the endotracheal tube. LaRivière reacted with a slight gagging but kept on breathing regularly. Dr Bernhardt checked the vital signs: pulse 90, blood pressure 160 over 95. LaRivière opened his eyes.
“Monsieur LaRivière, the operation is over. You are fine. We are going to move you onto the stretcher, and you will remain in the Recovery Room until you feel ready to go back to your own room.”
LaRivière looked bewildered and made a grunting noise.
A loving circle for the moving: the intern on one side, the scrub nurse at his feet, and the orderly on the side by the stretcher. The orderly bore most of the weight, leaning over the stretcher and pulling LaRivière onto it. Dr Bernhardt held LaRivière’s head and kept talking quietly as he was moved so that the continuity of his life would not be broken. Then he and the intern wheeled him to Recovery, where Dr Bernhardt completed the anesthesia record and attached it to the chart before leaning over and touching LaRivière’s arm. “Is there anything I can do for you?”
LaRivière opened his eyes.
He repeated, “Is there anything I can do for you? The operation is over, Monsieur LaRivière. You are fine. I will tell the surgeon you are awake, and he will come to see you.”
“Monsieur le docteur, by now you know me so intimately, can we not use the familiar tu instead of the formal vous?”
Dr Bernhardt was so touched by this, he felt tears rising. He had not felt like crying since the war. “I am honored.” Then, using the familiar tu, “Are you comfortable? Can I do anything for you before I leave?”
“No, thank you, Josef.” Auguste LaRivière closed his eyes.
In the dressing room, the surgeon was sprawled on a chair smoking a cigarette. He offered one to Josef Bernhardt.
“Thank you, no. Mr LaRivière is awake. I told him you’d be in to see him.”
“How is he?”
“Fine. He’s in remarkable health for his age.”
“Thank you, doctor. It’s a pleasure to work with you.”
“Thank you.” A slight bow to him. “And good-bye.”
In the scrub room, Josef found the resident in charge of scheduling.
“You’ll have to cancel my other cases for this morning,” he said. “I am unwell.”
“Oh, Christ,” said the resident. “What’s wrong? Are you sure you can’t get through the morning?”
“I’m sure.”
“Oi vey,” said the resident, picking up his scheduling list and tearing from the room.
Josef showered, put on his charcoal gray suit and black tie, and headed down the corridor to his office in the Anesthesiology Suite.
It was in chaos, unpacked cartons randomly stacked, papers and journals covering every surface. The Department of Anesthesiology was so understaffed that he had begun working the day after his arrival in Iowa City, leaving no time to make order of his office or house. Carlos’s housekeeper, Camila, and her two daughters had been kind enough to unpack the kitchen and arrange the furniture, but his clothes and his papers and books were still in suitcases and boxes.
He dropped into the swivel chair behind his desk. If one resigns, one must, he supposed, write a letter about it. He rummaged through the desk drawers for stationary. He found it and also a sphygmomanometer and decided to take his blood pressure. Leaving it untended was a stupid form of suicide. He didn’t want to have a stroke or a heart attack unless it would kill him. In any case, he would need time to get to his safety box at the First National.
Josef stood, removed his jacket, rolled up his left sleeve, and attached the cuff: 200 over 110. Higher than he’d estimated. Actually, he was feeling better, although, curiously, since the intimate scene with LaRivière, he was on the verge of shedding tears. The severe physical symptoms had abated, but his head still throbbed, he was nauseated, and there was that fatigue he’d had for months—an almost irresistible urge to sleep; yet when he would lie down, he was unable to sleep. He was tired. Josef had allowed himself no holidays, had worked steadily since he entered the Institute in April 1943, when he was sixteen. He was forty-one, now, and too tired.
Jacket on again, Josef sat behind his desk and telephoned the office of Dr Elizabeth Duncan in Student Health. Her nurse said she was over at Mercy. He dialed Mercy and had her paged. While waiting, he removed the opened pack of Camels from his pocket and dropped it into the wastebasket. Over two packs a day now. He had begun smoking in earnest when he went to the Institute. But then he began all his vices in earnest there. Everyone smoked. It was a wonder they didn’t blow themselves up, with all the fumes from the ether and the alcohol. There were signs all over, warning of the danger: DO NOT SMOKE. CAUTION: DANGER OF FIRE AND EXPLOSION.
He could picture the signs—and himself, so young, so thin—emaciated, really—in the Biology Lab, leaning into his microscope and puffing away on those dreadful cigarettes they rolled from tobacco grown in the greenhouse and cured in the basement of the Institute, each scientist with his own nauseating recipe. One could not buy tobacco in Berlin during those last years of the war. The Chief, who was director of the entire operation, cured his leaf with prune juice and extract of dried figs. All Josef’s co-workers in the lab were able to do the tedious sorting of the fruit flies and smoke simultaneously because of his famous little invention, a metal cigarette holder attached at mouth level to the body of the binocular lenses. He could not breathe. A recrudescence of his phobic symptoms. Josef’s noisy lungs had lost all compliance. He began to sweat profusely, and the incipient tears let go and rolled freely down his face.
“Dr Duncan here.” Elizabeth’s warm voice brought him to, but he could not answer her immediately. He mopped his face with a handkerchief, took a shallow breath, and exhaled.
“Hello?” she said.
“Elizabeth.” His voice was hoarse and shaking. “How are you?”
“Josef? Is that you? I can hardly hear you. Can you talk a little louder?”
“Yes.” He was calmer. “Can you hear me now?”
“Yes, yes, that’s better. How good to hear your voice. Just last night John and I were lamenting that we haven’t seen you since you came down. We saw more of you when you were in Montréal. How have you been?”
“Just fine, thank you. And how is your family? John? The boys?”
“We’re plugging along. What can I do for you?”
“I wonder if you might have time to see me today?”
“Of course. What’s the problem?”
“My blood pressure has been a little high.”
She hesitated before answering. “You know I’m always happy to see you, but you should go to a good internist. I hardly think you need a doctor who takes care of all the young ones around here.”
“Elizabeth, I . . . I want to talk to you.”
“Of course, my dear. Your blood pressure. How high is it?”
“Fairly high.”
“Right now it’s about two hundred over one hundred and ten.”
“How long has that been going on?”
“Three quarters of a year or so.”
“That high?”
“It’s usually around one seventy over just below a hundred.”
“Did it go up all at once?”
“I think so. I checked it one day last spring—in Montréal. It was up, and it hasn’t come down since.”
“What are you taking?”
“Nothing.”
“Not even a diuretic?”
“No.”
“Good God, Seff, there are more efficient ways to commit suicide.” Josef was silent.
“Can you come over to Student Health in about an hour? Around ten?”
“Ten. Yes, that would be fine. And thank you.”
He hung up and, feeling calmer, began to compose the letter of resignation. The facts were simple. He was not competent; therefore, he could not work. But how much detail must he convey? They would be displeased no matter what he said, so he might as well keep it brief. He pivoted his chair to face the typewriter on the small table beside his desk, inserted the University of Iowa letterhead, and glanced up at the wall calendar: Tuesday, October tenth.
UNIVERSITY OF IOWA
COLLEGE OF MEDICINE
IOWA CITY, IOWA 52242
Department of Anesthesiology
October 10, 1967
George M. Jenkins, M.D., Head Department of Anesthesiology
I resign, for reasons of health, effective immediately.
Yours truly,
Josef L. Bernhardt, M.D.
It was thin. Joseph did not want Jenkins to think he meant to be rude, for he did not. But what more should one say? Some “deeply regrets,” or “sincerely sorrys”? That had never been his style. His high school composition teacher had always complained that although Josef’s essays were mechanically correct and to the point, they lacked embellishment. His papers were forever decorated in red ink with “embellish” or “invent.” The Nazis were quite good at that kind of thing, at taking a so-called fact, usually an invalid premise, and building it to a conclusion with loaded language.
Biological science has shown that only the pure race will survive and that mixed-bloods inherit only the worst characteristics of their ancestors. Therefore, the bastardizing of pure German Aryan blood with degenerate Jew-infested blood has to be outlawed.
In math he could invent—elegant proofs. Out of the depths of his memory emerged the image of his high school math professor, a very old man, retired from the University of Berlin, called back to teach at the Collège Français de Berlin because of the shortage of teachers in Germany during the war.
With this recollection, Josef’s symptoms once again returned: shallow, fast inhalations through his mouth; he was unable to exhale. He tried to think of anything else: the mechanics of the remainder of the day; the walk to the bank so he could empty his safety box, destroy some memorabilia of no concern to Tatiana, and send the rest of the money to her in Berlin. The bank would seal the box and their joint accounts as soon as they read his obituary. He had a little tuft of white hair above each ear. He was the most marvelous and exciting teacher. He saved Josef’s life. The other classes were so boring. Josef jumped to his feet, put his hands firmly on his desk, and bent over, hunching his back, mouth open, straining his neck and abdominal muscles, trying to pull the air out of his noisy lungs until, finally, the chest constrictions eased and his breathing became easier. Drenched with sweat, exhausted, Josef dropped in his chair and, elbows on desk, rested his face in his hands. Bronchodilators would raise his blood pressure, and he didn’t want to have a stroke or a heart attack unless he could be assured it would kill him. He could breathe now and felt calm enough to sign his letter and type the envelope.
He knew Jenkins would be outraged by his resignation. Josef had been on the job a little over two weeks after over a year of intensive manipulation on the part of Jenkins and Carlos Borbon to get the Bernhardts’ residents’ visas and to secure a position for Tatiana in Biochemistry, which, after all their effort, she refused. He’d wanted to stop the damn thing after the first delays, begged Carlos to stop pushing it. And Tatiana never had wanted to go to Iowa. Her family was alive in Berlin. All she ever wanted, she said over and over, was to return to Berlin.
He inserted the envelope into the typewriter. There was a knock on his office door. Carlos. Josef grimaced as he removed the envelope and shoved it and the letter into the center drawer of his desk. A second knock; the door opened and Carlos Borbon, in wrinkled surgical greens, unshaven, his mask dangling, entered the office, stood by the door, and stared critically at Josef.
“You can come in, Charley, if you’ll stop examining me.”
“I’ve just got a minute. Do you have a cigarette?”
Josef recovered the pack of Camels from the waste-basket.
Carlos raised an eyebrow. “You file them in the trash can?”
“I stopped smoking.” Josef handed him the pack and ashtray. “Keep them.”
“I heard you’re sick.” Carlos leaned over and retrieved the lighter he kept tucked in his left sock. “What’s wrong?”
“I suppose it’s just an advanced case of la grippe. I’ll be all right.” Annoyed by his friend’s scrutiny, Josef swiveled his chair to face the window, and, looking out, was shocked to discover that it was one of those rare and brilliant October days, the yellow oak, the red maple against emerald lawn and deep sky.
Carlos lit up and inhaled deeply. “Surgeon said you blew up at his resident this morning.”
“That has nothing to do with it.” The day reminded him of an image in a poem by some American author: white geese against green lawn—and apples. Elizabeth had sent him the anthology when he was interning in Montréal: When you can understand the metaphors, then you’ll know you know English, she had written. It was “Requiem for . . .” No, that didn’t ring a bell. It was a little elegy, a condolence letter for the death of a child, and he was annoyed he couldn’t remember it. He had always prided himself on his memory. He would have to ask Elizabeth.
“In the five years I worked with you at McGill, I never knew you to miss a day. You’re the only person I know who’s more obsessive and compulsive about work than I am.”
Josef sighed and turned to face his friend. “Did it ever occur to you to mind your own business?”
“This is my business. If it weren’t for me you wouldn’t be here.”
“Look, Charley, I was going to write you a note. I . . . I can’t make it to dinner tonight. Tell Matsumoto I’m sorry to miss him.”
“He’ll be sorry too. He’s just had a break-through on that pituitary hormone. I wouldn’t be surprised if he’s nominated for the Nobel prize.” Carlos snuffed out his cigarette, took the pack of Camels and his lighter from Josef’s desk, shoved them into his left sock, and stood. “I’ve got to go,” he said. “You’re one of the few people Matsumoto enjoys talking to.”
“I’ve enjoyed talking with him, and always with you. Those Tuesday night dinners—in Montréal and now here—were the one thing I did look forward to.” He choked on the words. The tears were rising again, and Josef, mortified by his loss of control, jumped to his feet and walked to the window. His lips were quivering; he leaned his forehead against the cool glass to recover himself.
Carlos strode to the window and tried to put an arm around him, but Josef shrugged him away.
“Why don’t you let me find a bed for you, and we’ll give you a thorough going over.”
Josef shook his head. “I’m going to see Elizabeth. I’ll be all right.”
“Elizabeth! You need an internist, not somebody who takes care of the healthy young kids around here.”
“She’s a good physician.”
“That’s not the point, Seff. She sees nothing but students who’ve caught a dose of the clap or—” He stopped mid-sentence. “What time are you seeing her?”
“Ten.”
“Over in Student Health?”
Josef turned from the window to say, “Never mind where. Don’t call her. I mean that.”
“This move has been too much for you,” Carlos said. “First the hassle over the visa, and then we didn’t give you time to unpack and settle before digging in.” Carlos looked around the cluttered office at the cardboard cartons. “Maybe I shouldn’t have hounded you so to come down here—especially after that damned visa came a year late. I suppose you worked in Montréal right up to the last minute?”
“Yes.”
“You need a rest. Do you have the time?”
Josef looked at his wristwatch. “Nine thirty.”
“I’ve got to go.” Carlos strode to the door, stopped, and faced Josef. “Isn’t there anything I can do for you?”
Josef turned again to the window. “You’ve done quite enough already.”
“I’ll drop by after surgery.”
“I won’t be here.”
“Then I’ll call you later this afternoon.” Carlos left, closing the office door behind him.
Forehead pressed against the cool glass, eyes closed against the beauty of the October day, Josef, on the verge of tears, laboring for each breath, felt that he was drowning. Why had he told that intrusive bastard he was going to see Elizabeth? And the visa, it was not one year late. It was twenty-two years too late. He pushed himself away from the window. There was just enough time to hand in his resignation and pick up the succinylcholine before meeting Elizabeth at ten. It was a punishing death, a suffocating death, but the insurance companies would not be able to prove suicide. The heart continues to pump the blood, but all voluntary functions stop—he would have to take enough for five minutes or so—one cannot breathe or even blink, so if the eyes are open, they remain open, or if they are closed, they remain so. He would lie down, and he must remember to close his eyes. The corpse looks as though it suffered a heart attack or a stroke. The autopsy, of course, would disprove this. It was not a bad idea to take a little tranquilizer or barbiturate to control vomiting and to throw them off the track. But the succinylcholine they would never find. It gets broken down by metabolism into normal constituents of the blood or serum, even after death. He would put it into enteric-coated capsules that don’t get dissolved in the stomach but in the guts.