[March 19-23, 2008]
Winterschnee (Wednesday)
Snow is forecast, although it is Easter weekend (admittedly a very early Easter, tribute to the peculiarly arcane calculations the Church goes through to establish the date – look it up some time, the formula is nothing short of bizarre); and here it is – rich, heavy snow, very wet, but falling beautifully in the small park outside my room.
This hotel room is tiny but outrageously efficient: this is, in fact, a Germany that I’ve always liked a great deal – well-made, well-designed, excellent heating and lighting, wonderful bread, a vast range of Schinken und Käse at the deli next door. Perhaps I like it so much, not only because everything is so dependable, so neat, so functional, but because this is the Germany I first saw in 1993 – my first trip to Europe, the eight or nine months I spent in Kiel and Darmstadt. Like those small cities, Stuttgart was bombed flat in the war; so everything is post-war design, what Joyce has called ‘very seventies’; but Stuttgart does this kind of thing distinctly better than Kiel or Darmstadt, as it is both small and quite wealthy, because of the local Mercedes/Daimler-Benz money. I remember the city tram lines, which had a charming toylike quality – I wonder if they’ll still look that way to me….
Nachtschmerzen
Rather horribly, the night before my flight today, my digestion became acutely painful, endlessly, miserably so; I slept very little, and was a wan, frustrated ghost by the time I took a taxi to the airport. Impossible to change my flight, of course, impossible to handle being on the plane, impossible to handle the unreasonably bad planning at Schiphol where, as I’d been warned, transfers have become outrageously slow and difficult: a weird contrast to the rationalist pleasantness of the architecture of the new airport, which is purely rational urban Dutch, as though the entire place were a Helvetica font.
My dear friend Joyce, whom I am visiting here in Stuttgart, is in so many ways a blessing, and is happy to spend time helping me try to feel better: some Heilpraktiker tea, some pills at the Apotheke, a couple of Brötchen at the delicatessen by my hotel. I can do no work today, although the whole point in this trip is to put together this book that should have been finished ten years ago: but she is forgiving about that, and when we have done what we can to generate some symptomatic cures she takes me back to the hotel, we sneak various teas and a hot-water kettle into my room, and I sleep all evening.
But I’m not really better, and from around midnight that becomes all too clear: tonight, I am still in pain – and, increasingly obviously, real and serious pain. For months I’ve been assuming that my digestive problems were a kind of irritable bowel syndrome, something that requires managing my diet and avoiding coffee (why, in that burst of writing I did before I left, did I drink coffee three days in a row? – such foolishness); but of course last night and tonight I can’t help thinking: is this a different, a worse, problem than that? If I had an X-ray now, would it perhaps show some kind of awful dark shadow on my left side, where the colon is – where the pain is constant now?
Madness. Somewhere between the trivial pleasantries of Stuttgart, the valiant attempt to banish the ancient demons of not finishing this book, Joyce’s kindness, and my long reading of a novel by Nicholas Mosley – a book whose dark, thoughtful confusion is making perhaps too much sense to me right now – I can’t really find my balance. And I need to find it, because I’m not at home, because that damned book must get finished – and because, maybe, I really, really need to go to a doctor: and brace myself for something real – something non-trivial.
Mosley (Thursday)
And how strange: because of the pain, sleep is impossible; instead I have read this dense, wonderful novel – Nicholas Mosley’s Hopeful Monsters – five and a half hundred pages, entirely between getting on the flight at 10 am yesterday and 6 am today.
It would be so wonderful to sleep: but if I can’t sleep, at least this novel was the best of distractions. The density and darkness of so much of it – the tangled politics, ideas, and increasingly demented behaviors of 1920s and 1930s Germany and England, seen through the eyes very intelligent young people who are at a loss to understand what’s going on… and a happy-ish ending, which brings me great peace, something I could use right now.
Of course, now I have only one other book left to read, a professional and depressing one on the cultural theory of AIDS… I hope the local Buchladen has books in English.
But I think, more importantly, that I need to call Joyce as soon as I think she’s awake, and go see a doctor.
Krankenhäuser (Thursday)
Joyce responds quickly and practically to the situation – she really is a marvel – calling around to see what the best choice of hospitals would be, then telling me to dress and stand outside (I can’t button my pants, but hold them up inside my long coat) while she drives over to get me. The first hospital is a mistake, we are misled by confusing signs and two different hospitals with similar names; but we finally reach the correct one and take a gleaming elevator up to Internal Medicine. Many questions, many explanations, about insurance, citizenship, pain, age, date of birth, previous conditions; Joyce calls me, repeatedly, Herr Doktor Professor, and mentions to me later in an undertone that that ought to get me better attention. It’s like when I was living in Hong Kong: I used my titles like social weapons, and they worked – but I’m out of practice doing that, Brits tend to be somewhat ashamed of professional titles and avoid using them. Joyce points out that, on the top of the check-in sheet that is now the beginning of my medical chart here, it says clearly: Professor….
A charming, businesslike young woman doctor examines me, takes blood, enters me into the hospital: but what is wrong? They don’t seem to know….
Joyce comes with me up to my room, which I share with a very old man (it seems that almost all the other patients are in their seventies or eighties – Joyce says, well, Germany has a negative birth rate). He is not exactly charming – slurping food and moaning occasionally – but his wife and daughter are very pleasant, and I settle down, expectant that someone will now take care of me, and I can stop worrying.
In ernst (Friday)
I am not happy.
Friday morning, and although they are kind to me they have done nothing definite yet, and I am definitely not well – Bauch bloated, Magenschmerzen, Fieber. I point these things out to the nurse, in no uncertain terms; there is some bustling around, and I am taken in a wheelchair down several elevators, across and around several halls in different colors, almost entirely across the hospital to the surgical wing – to be seen, as though I was led through tunnels to consult with a sort of master wizard, by the Chefarzt (senior doctor, far senior to the ones I’ve had contact with so far). He is a big, hearty, country man; in the next few days, when he is out of the room, the younger doctors will tell me he’s known as a sort of Landarzt (country doctor), bluff and strong-willed. He examines me, then turns to me and says: I’m not sure what’s wrong, but we’re going to operate – now – so good-night, because you’re going to have general anesthesia.
I am taken into a room where a young man and woman bustle about, arranging me on a specially designed bed that has blue plastic gel supports for the feet and head – very high-tech, very well-made, very German – and prepare the anesthesia. They joke, I joke – I’m actually relieved that something is being done. And perhaps a bit relieved to being made unconscious.
But, of course, also a bit anxious….
Afterwards
It was a burst appendix: full surgery, eight-inch incision down the middle of my belly – later in the week I will read that when an appendectomy is done before the appendix bursts, it is done with a small incision, a camera, and two or three days in the hospital. Or when they already know it’s a burst appendix, the incision isn’t much bigger – but because they were going in blind, they did a great big exploratory incision. Ah well, I wasn’t so lucky: I will be here for at least ten days or so. I also read that it’s not their fault – although so many people have appendicitis, symptoms vary so confusingly that thirty per cent of appendectomies are misdiagnoses….
But, thank God, I am no longer in pain… morphine… intensive care. Feeling much better. Actually quite comfortable, rather happy. Morphine…. There are five connections to me – catheter, a tube down my nose into my stomach to carry away bile, a drip in my arm with saline, Schmerzmittel – morphine… – and antibiotics, whatever. Intensive care is fairly strange, constantly busy but at a low hum. Many machines, blinking lights, a sense of constant watchfulness. Intensive Care has not only Krankenschwestern – nurses – but also the supposedly stronger Krankenpflegern – male nurses: gender divisions are unsubtle in German hospitals. The lights are never turned off, the lights are never bright. Morphine…. there is a little tube attached to one finger, checking my pulse. Joyce says that the battery of screens behind me has all sorts of moving numbers – she tries to figure out what they mean – she can see what must be pulse and temperature, the rest are mysteries.
I am not uncomfortable. Morphine….
Nadel (Saturday)
A catastrophe: but not for me – because of me. The Chefarzt – I am gradually absorbing the information that he isn’t merely head doctor for a division or something, he is literally the chief surgeon for this entire large hospital – stuck himself with a needle during my surgery.
The dreaded needlestick injury: infection with HIV, with HCV, through accidental blood contact with a patient… one hears so much about it, it’s even been a long-term semi-tragic subplot in ER, House, and other television hospital dramas. It’s quite different when it happens during your own operation – now I feel, well, like a threat, like an unconscionable danger to others: as though those old Republican plans to put us all into quarantine in Utah were not such a bad idea….
I learn, also, that the Chefarzt is a month and a half away from retirement. He is widely feared, and as widely respected – the younger doctors (especially the meticulous young Turkish one who is slightly pompous, slightly grandiose, when he is alone in my room giving me instructions) often look panic-stricken when he is in the room, as though they’re about to pee their pants.
This is all upsetting. A plump, red-cheeked young doctor, sort of a young German teddy bear, asks me for information on my HIV viral load, my doctors, everything – I give it all to him, fax numbers, whatever I can. I am anxious, and say so: at one point I tell the Chefarzt himself, I’m very, very sorry – he simply raises his hand and says: this is not your fault, this is our job and our responsibility, don’t worry about it. And it is clear that he means it.
Of course, one must imagine: this bluff, strong man, retiring in six weeks – a moment of clumsiness in surgery: is one reason for his retirement that he no longer feels quite sure of his hands? How awful, then, that they should betray him in a moment, that they might betray his own health, his own immune system….
That day, a fax is received from England with my most recent test results; everyone is reassured that my HIV viral load is undetectable (as it has been for several years); I’d told them this, but of course doctors are always happier with information that comes in directly and officially from their own kind. Just to make sure, they send my blood to Heidelberg for testing… the next day the results are back (speedy service for a Chefarzt), and there is indeed no detectable virus.
So the Chefarzt is happy, he won’t have to do any kind of prophylaxis. Of course my HCV viral load is not low at all – but there’s no prophylaxis for that, and in any case HCV infection is exasperatingly mysterious. He seems unworried – and more than that: he seems pleased with me, that I made such a fuss about it – and this will have some very positive repercussions: because although I have not paid for a single room, I notice in the ensuing days, the ten days I will still be kept here, that I am practically always alone in a nice room.
The advantages of being a Herr Doktor Professor: and a favorite of the Chief’s….
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