Uwe Tellkamp - The Tower

‘It’s the operating surgeon who moves the retractors, not you,’ Wernstein growled indignantly. ‘Now I can’t see anything. You must tell us if you can’t hold them any longer.’

Richard felt angry. The young man was far away from them in age and training, and certainly they ought to remain matter-of-fact, treat him like a colleague, but … The truth was, he couldn’t stand this houseman. He knew that that was connected with the fact that Grefe was the son of Müller’s sister and the Professor had, in an embarrassingly formal conversation, ‘asked’ Richard to send a houseman who had already been given the post to another clinic. True, Grefe could do nothing about these machinations, probably didn’t even know about them; one had to try to remain objective. And the lack of specialist knowledge would sort itself out. If he was honest, as a houseman he himself had paid more attention to the nurses than to surgery; moreover the idea of housemen was for them to acquire practical experience. Despite that, the pedagogue inside him broke through: ‘What characterizes pertrochanteric fractures?’ Again Grefe started to hum and haw. ‘I … er … I’ve only been with you for two days …’

‘But you did a degree in surgery; did you skip trauma surgery?’

‘Should I get them to put a little music on, Dr Hoffmann?’

Nurse Elfriede was well acquainted with her senior traumatologist’s angry outbursts. But he didn’t feel like music. This fellow might perhaps tell his uncle that the trauma surgeons were listening to music during an operation again, which, for his uncle, was an expression of a casual attitude and the Professor had no time for ‘bohemian’ surgeons. ‘That’s for Herr Wernstein to decide, he’s performing the operation. Let me have the retractors.’ He took the retractors out of Grefe’s hands and with a curt nod ordered him to come round to his side. ‘Be careful you don’t touch the image intensifier and make yourself unsterile. Let him feel it,’ he said to Wernstein, using the familiar ‘du’ without thinking, as if he were an equal colleague. ‘Can you feel the fracture?’ Grefe poked about in the wound.

‘The fracture line is between the greater and the lesser trochanter, almost directly on the neck of the femur. You do know where we’re operating here?’

‘Oh, yes, I’ve got it now. Basically at the hip joint, I thought?’

Wernstein had stepped back and was waiting, hands dripping with blood raised.

‘Good. We’ll change over again. In grown-ups at what angle are the femur and the neck of the femur to each other?’

Grefe, who was back on the other side and raised the retractors, gave the wrong angle.

‘Fractures of the neck of the femur — how are they classified and why?’

His knowledge was sketchy.

‘Five wrong answers to my questions, Herr Grefe. We have a rule here. For each wrong answer the person asked has to cut a hundred swabs or fold a hundred compresses. That’s five hundred swabs for you. Report to the duty operating-theatre sister after we’ve finished.’

That hit home. Wernstein was continuing his preparations in silence. Richard’s anger subsided as quickly as it had arisen. He sensed that he had reacted too harshly and that he was punishing Grefe for his uncle’s methods. Now he felt sorry for the young guy. You’re doing just the same as the communists! he told himself. That reminded him that in Grefe’s file he had discovered a request to be accepted as a member of the Socialist Unity Party … So what, he decided. If something was to be made of them, you had to be hard on them. The plus side was that Sister Elfriede had 500 more swabs in her sterilization unit, swabs that the run-down socialist economy couldn’t manage to manufacture. If he wants to join the Party that determines all our lives, he should get to know the kind of world that it has produced.

‘Spherical cutter,’ Wernstein demanded, reamed the bone. ‘A Lezius nail on the handle grip. — Who was Lezius?’ This time it was Wernstein who asked. But Grefe knew the answer and proudly gave a little lecture. There was no addition to his 500 swabs.

After the operation Richard went to the Academy Administration. He took the route through the hospital. Wernstein had taken just three-quarters of an hour to perform the operation on the patient, a woman of sixty who had slipped while cleaning the stairs and broken her femur as she fell. The atmosphere in the clinic was something that had been familiar to Richard since he had started to study medicine, when, after his apprenticeship as a fitter, he had got to know the work of the hospital from the bottom upwards, first of all as a nursing auxiliary, then during the university vacations, as a student and a professor’s assistant: the morning rounds had finished in the wards on the north side, nurses were rushing to and fro, doctors were bent over patients’ notes or X-rays. ‘Morning, Dr Hoffmann.’ — ‘Morning, Nurse Gertrud.’ — ‘Morning, Dr Hoffmann.’ — ‘Morning, Nurse Renate.’ Familiar faces, some he had known for twenty years; he knew the people behind their routine masks, knew about their major and minor worries that you didn’t hear about during the day, in the hectic rush of the wards, but during night shifts when the city was asleep and the acute cases had been settled for the night. Nurse Renate, who, even after twenty-two years, still trembled like a schoolgirl when faced with the senior nurse and whose first husband had died in this ward, the surgical cancer ward. Richard sidestepped a mop that a nursing auxiliary was swinging across the PVC floor-covering in vigorous semicircles. The smell of disinfectant — Wofasept — how familiar it was; how it brought everything back: the nurses with their blood-pressure gauges and intravenous-drip stands, the clatter of scissors and glass syringes in kidney dishes which were just being put into the sterilizer in the ward he was passing. He went into the vestibule. Food carts clattered by the lifts, a haze of voices came from the swing doors of South I, Müller’s powerful, precisely articulating voice: the consultant was doing his round of the private ward. Richard hurried out past the bust of Carl Thiersch. He had actually intended, before going over to Administration, to look in at his own ward to check on things, but he would probably have run into the gaggle of doctors, and he wasn’t in the mood for that, especially not for an encounter with Müller. Wernstein had done North II and Trautson, Richard’s fellow senior doctor, North III, together with Dreyssiger, who had been on duty and would see the outpatients. He could rely on Wernstein and anyway, when he’d done the round of North II today everything had been in order. With Dreyssiger you had to be more careful; he was good as a scientist, and as a teacher the students liked him; but in general the senior nurse knew better than he what was going on in his ward, North III, as the young houseman Richard would have liked to have kept often did as well.

He left the clinic and set off for the old Academy section where the Administration building was. The air, fresh after the snow, did him good, he took deep breaths. He had an uneasy feeling about the meeting he was about to attend. The eternal struggles for dressings, swabs, drip-feed bottles, plaster. Trifles. On the one hand. On the other, Administration had asked him to hand in his Christmas lecture to be checked. He had deliberately not brought it with him. How had Wernstein put it just now? We’ll see. Although he was freezing, he didn’t regret having taken this route and not the one through the subterranean tunnel system that appealed to his old sense of adventure and that he had known like the back of his hand since his days as a nursing auxiliary, but he preferred not to breathe its air, which was stale with the smell of cigarettes and rats’ urine, after an operation. A few electric carts were bumping along the Academy road; far ahead, by the porter at the kiosk beside the Augsburger Strasse entrance, which was flanked by frosted-glass cubes with the red cross, patients were queuing for newspapers. A few doctors were coming from Radiology, which was in sight of the massive block of the Surgical Clinic. Richard went across the park, past the Dermatology Clinic and the equipment store, where thermophores were being loaded. Taking cover behind a hedge, he did a few jump squats to warm up.