Berlin Wild Page 2

  “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 monito
ring 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 b
lack 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.