Summer House with Swimming Pool: A Novel (2 page)

I have, until now, been assuming that the patient is a man. In the example we are dealing with, a man is lying on the table with his pants and underwear pulled down. Women are a different story; I’ll get to women later. The man in question turns his head slightly in my direction but, as I’ve mentioned, he can no longer get a good look at me. Just relax your head now, I say. All you have to do is relax. Unbeknownst to the patient, I now turn my gaze to the naked lower back. I’ve already told him that what follows may be a bit unpleasant. Between that remark and the unpleasant feeling itself, there is nothing. This is the empty moment. The emptiest moment in the entire examination. The seconds tick by silently, like a metronome
with the sound turned off. A metronome on a piano in a silent movie. No physical contact has yet taken place. The bare back bears the mark of the underwear. Red bands left on the skin by the elastic. Sometimes there are pimples or moles. The skin itself is often abnormally pale—it’s one of those places where sunlight rarely reaches. There is, however, almost always hair. Lower down, along the back, the hair only increases. I’m left-handed. I place my right hand on the patient’s shoulder. Through the rubber glove I feel the body stiffen. The entire body tenses and contracts. It would like to relax, but instinct is more powerful. It braces itself. It readies itself to resist invasion from the outside.

By then my left hand is already where it has to be. The patient’s mouth falls open, his lips part, a sigh escapes as my middle finger goes in. Something between a sigh and a groan. Take it easy, I say. It will be over in a moment. I try to think about nothing, but that’s always difficult. So I think about the night when I dropped my bicycle key in the mud in the middle of a football field. It was a patch of mud no bigger than one square yard, and I knew for sure my key was there. Does this hurt at all? I ask. Now my index finger joins my middle finger. Using both of them will make it easier to find the key. A little … Where? Here …? Or here? It was raining out, a few lights were on around the field, but it was still a bit too dark to see well. Usually it’s the prostate. Cancer, or just an enlargement. Usually there’s not much you can say about it after the first examination. I could have walked home and come back the next day, once it got light. But my fingers were already in there, the mud was already up under my nails, there wasn’t much sense in stopping now. Ow! There, Doctor! Fucking hell!
Excuse me … Oh, fucking hell! And then there was that one fraction of a second, my fingers feeling something hard amid the goo. Careful, it could also be a piece of glass … I hold it up to the light, the dim light from a lamppost beside the field, but in fact I already know what it is. It glistens, it gleams, I won’t have to walk home after all. Without looking at my hands, I pull off the gloves and toss them in the step-on trash can. You can sit up now. You can get dressed. It’s too early to draw conclusions, I say.

It was eighteen months ago when Ralph Meier suddenly appeared in my waiting room. I recognized him right away, of course. He asked whether he could talk to me for just a moment? … It … was nothing urgent, he said. Once we were in my office, he came straight to the point. He wanted to know whether it was true, what so-and-so had told him, that I was fairly accommodating with prescriptions for—Here he looked around somewhat skittishly, as though the place might be bugged. “So-and-so” was a regular patient of mine. In the long run they all tell one another everything, which is how Ralph Meier ended up in my practice. It sort of depends, I said. I’ll have to ask you a few questions about your general health, so we don’t run into any unpleasant surprises later on. But if we do that? he insisted. If everything is okay, would you be willing … I nodded. Yes, I said. That can be arranged.

Now we’re eighteen months down the road and Ralph Meier is dead. And tomorrow morning I have to appear before the Board of Medical Examiners. Not for what I helped him out with that time, but for something else, about six months later. Something you might describe as a “medical error.” I’m not so worried about the Board of Examiners; in the medical
profession we all know one another. Often enough, we even went to school together. It’s not like in the States, where a lawyer can ruin a doctor after a misdiagnosis. In this country you really have to have gone too far. And even then: a warning, a few months’ suspension, no more than that.

All I have to do is make sure the members of the board actually see it as a medical error. I’ll have to keep my wits about me. I have to keep believing in it, one hundred percent—in the medical error.

The funeral was a couple of days ago. At that lovely, rustic cemetery by the bend in the river. Big old trees, the wind blowing through the branches, rustling the leaves. Birds were twittering. I stayed as far to the back as I could, which seemed prudent enough, but nothing could have prepared me for what happened next.

“How dare you show your face here!”

A brief moment of absolute silence, as though even the wind had suddenly died down. The birds went quiet, too, from one moment to the next.

“You piece of shit! How dare you! How
dare
you!”

Judith Meier had a voice like a trained opera singer, a voice that could reach the audience in the very last row of a concert hall. All eyes turned in my direction. She was standing beside the open back of the hearse, into which the pallbearers had just shouldered the coffin containing her husband’s body.

Then she was trotting toward me, elbowing her way through hundreds of mourners, who stepped aside to let her through. For the next thirty seconds, her high heels on the gravel drive were the only sound in an otherwise breathless silence.

Right in front of me, she stopped. I was actually expecting
her to slap me. Or to start pounding her fists against my lapels. To make, in other words, a scene; something she had always been good at.

But she didn’t.

She looked at me. The whites of her eyes were laced with red.

“Piece of shit,” she said again, much more quietly now.

Then she spat in my face.

A general practitioner’s task is simple. He doesn’t have to heal people, he only has to make sure they don’t sidestep him and make it to the specialists and the hospitals. His office is an outpost. The more people who can be stopped at the outpost, the better the practitioner is at what he does. It’s simple arithmetic. If we family doctors were to let through everyone with an itch, a spot, or a cough to a specialist or a hospital, the system would collapse entirely. Entirely. Someone did the arithmetic on that once. The conclusion was that the collapse would come more quickly than anyone expected. If every general practitioner referred more than one-third of his patients for further care from a specialist, the system would begin to creak and buckle within two days. Within a week it would collapse. The general practitioner mans the outpost. Just a common cold, he says. Take it easy for a week, and if it’s not over by then, well, don’t hesitate to come back. Three days later, in the middle of the
night, the patient suffocates on his own mucus. That can happen, you say, but it’s a fluke. A rare combination of factors. We see it in no more than one out of every ten thousand patients.

Patients don’t realize that there’s strength in numbers. They let themselves be ushered into my office one by one. There I spend twenty minutes with them, convincing them that there’s nothing wrong. My office hours are from eight-thirty to one. That adds up to three patients an hour, twelve to thirteen a day. For the system, I’m the ideal family doctor. General practitioners who think they can make do with half the time per visit see twenty-four patients in a working day. When there are twenty-four of them, there’s more of a chance of a few slipping through the cracks than there is when there are only twelve. It has to do with how they feel. A patient who gets only ten minutes’ attention feels shortchanged sooner than a patient who gets the same song and dance for twenty minutes. The patient gets the impression that his complaints are being taken seriously. A patient like that is less likely to insist on further examination.

Mistakes happen, of course. Our system couldn’t exist without mistakes. In fact, a system like ours thrives on its mistakes. Even a misdiagnosis, after all, can lead to the desired result. But usually a misdiagnosis isn’t even necessary. The most important weapon we general practitioners have at our disposal is the waiting list. The mere mention of the waiting list tends to do the job. For this examination there’s a waiting list of six to eight months, I say. With that treatment your symptoms might be a little less acute, but there’s a waiting list … Half the patients give up as soon as the waiting list is mentioned. I can see it in their faces: relief. One of these days is none of these days, they figure. No one wants to have
a tube the size of a garden hose pushed down their throat. It’s not a particularly comfortable procedure, I say. You could also decide to wait and see whether it goes away with a combination of rest and medication. Then we’ll take another look in six months’ time.

How can there be waiting lists, you might ask yourself, in a wealthy country like the Netherlands? For me, the association is always with the gas bubble. With our reserves of natural gas. I brought it up once during an informal gathering with colleagues. The waiting list for hip operations: How many cubic yards of gas would you have to sell in order to do away with that list within a week? I asked. How, for Christ’s sake, is it possible that in a civilized country like ours people die before they reach the top of the waiting list? You can’t look at it that way, my colleagues said. You can’t tally gas reserves against the number of postponed hip operations.

The gas bubble is huge. Even worst-case scenarios predict that there will be enough natural gas for the next sixty years. Sixty years! That’s bigger than the oil reserves in the Persian Gulf. This is a wealthy country. We’re as rich as Saudi Arabia, as Kuwait, as Qatar—but still, people die here because they have to wait too long for a new kidney, infants die because the ambulance that’s rushing them to the hospital gets stuck in traffic, mothers’ lives are endangered because we, we general practitioners, convince them that home-birthing is safe. While what we should actually say is that it’s only
cheaper
—here, too, it’s clear that if every mother claimed the right to give birth in a hospital, the system would collapse within a week. The risks of babies dying, of babies suffering brain damage because no oxygen can be administered during a home birth are simply factored into the equation. Every once in a
great while an article appears in a medical journal, and sometimes a summary of that article will actually make the Dutch papers, but even those summaries show that infant mortality in the Netherlands is the highest in all of Europe and indeed the Western world. But no one has ever acted on those figures.

In fact, the family doctor is powerless in the face of all this. He can put a patient’s mind at ease. He can see to it, for the time being at least, that a patient doesn’t seek the assistance of a specialist. He can convince a woman that home-birthing poses no risks whatsoever. That it’s all much more “natural.” Whereas it’s only more natural in the sense that dying is natural, too. We can give them salves or sleeping pills, we can burn away moles with acid, we can remove ingrown toenails. Nasty chores, usually. Like cleaning the kitchen, using a scouring pad to remove the goo from between the burners.

I lie awake at night sometimes. I think about the gas bubble. Sometimes it resembles a bubble like the ones you blow with soapsuds, only it’s right under the earth’s crust; all you have to do is poke a hole in it and it deflates—or blows up in your face. At other times the gas is spread out over a much greater area. It has permeated into the loose earth. The natural-gas molecules have mixed invisibly with the soil. You can’t smell it. You hold a match up to it and it explodes. The little fire becomes an inferno that spreads within seconds across hundreds of square miles. Underground. The earth’s surface becomes hollowed out, there is no more support for bridges and buildings, not enough solid ground beneath the feet of humans and animals, entire cities sink into the burning depths. I lie there with my eyes open in the dark. Sometimes our country’s undoing takes the form of a documentary. A documentary on the National Geographic Channel, with charts and
computer animations, the kind of documentary they’re so good at: documentaries about dam bursts and tsunamis, about avalanches and mudslides that wipe whole towns and villages off the map, about the entire side of a volcano that breaks off from an island and slides into the sea, causing a tidal wave, which, eight hours later and thousands of miles away, reaches a height of almost four thousand feet.
The Disappearance of a Country
, tomorrow night at nine-thirty, on this channel. Our country. Our country consumed by its own reserves of natural gas.

On rare occasions, lying awake at night like this, I think about Ralph Meier. About his role as the Emperor Augustus in the television series of the same name. The role suits him to a tee; both his fans and his detractors are in total agreement about that. First of all, of course, because of his build, the corpulence he nurtured through the years. An obesity achieved exclusively by means of systematic pig-outs in restaurants with one or more Michelin stars. By lavish barbecues in his yard: sausages from Germany, hams from Bulgaria, entire suckling lambs roasted on a spit. I remember those barbecues as though they were yesterday: his hulking frame beside the smoking fire, single-handedly flipping the hamburgers, steaks, and drumsticks. His unshaven, flushed face, the barbecue fork in one hand, a sixteen-ounce can of Jupiler in the other. His voice, which always carried right across the lawn. A voice like a foghorn. A voice that tankers and container vessels might use to find their bearings in distant estuaries and foreign ports. The last barbecue wasn’t even that long ago, it occurs to me now, only about five months. He was already ill by then. It was still he who flipped the meat, but now he had pulled up
a plastic lawn chair—he had to sit while he did it. It’s always fascinating, how an illness—an illness like his—attacks the human body. It’s a war. The bad cells turn against the good. At first they attack the body from the sides, a flanking maneuver. An orderly little attack is all it is, a glancing blow, designed only to divert attention from the main force. You think you’ve won: You have, after all, repelled this first minor assault. But the main force is still in hiding, deeper inside the body, in a dark place where the X-rays, the ultrasounds, and the MRI scans can’t find it. The main force is patient. It waits until it has reached full strength. Until victory is assured.