Authors: Steve Sem-Sandberg
*
Blood
Anna loses blood. Warm, sticky, dark blood. When she pushes her hand between her legs, it fills her cupped palm. It is menstrual blood, as she knows perfectly well. What she can’t understand is why such a lot of it pours out of her. Headaches and nausea follow in its wake and she, usually such a good pupil at school, who hangs on the teachers’ every word and is diligence personified, has to ask
leave to go to the lavatory too often during lessons and must walk out while everyone in the class giggles and looks the other way. To tell her mother about this affliction is unthinkable. To her father, she says it is just nerves. But, in the end, it is the ageing printer, a shy and inhibited man with little idea of women’s health problems, who takes his young daughter to see the doctor. They learn that Anna is anaemic and needs to take the prescribed tablets. At school, she gets called Woodlouse because of her greyish, unnaturally pale skin, set off by greasy hair and teenage pimples. How she
hates
this physical self that grows and swells and wants nothing more than to wallow, languid and bland. She hides behind a wall of chilly self-control. She has few friends at school but stays top of the class. The healthy body that she never before felt ashamed to see in full sunlight has changed irrevocably into an alien continent. That is how she sees it. Like the school’s wall maps of Africa or South America. Her skin is like a coastline, long and thin. Beyond it, there are endless forests through which the blood flows, in narrow winding streams or in huge glossy rivers, only to end in internal lakes in cavities enclosed on all sides by the vault of a sky that has no inner or outer surface but exists only as the boundary of the truly boundless inner world. This childlike idea of the body stays with her even much later, when she has learnt so much more about human anatomy. When the migraines come, the headaches establish a hold over this alien continent, and when she sleeps, her dreams are inner seas and skies in which she travels. Unlike the world out there, it is pleasingly easy to move from one internal place to the next. Her feelings, which she is quite capable of concealing from everyone, can in moments transport her mind from the black bog of despond and self-contempt onto the high plateau of willingness to forgive herself. Pain, she soon learns, is another way of travelling.
*
The Healthy Don’t Shun the Light
To be a nurse is no longer her vocation. Training has become a compulsion: the only way to make the alien continent her own while at the same time keep it at bay. Control it. She follows her father’s advice and takes a three-year course in domestic science and then gets a poorly paid job as nursery nurse at the children’s hospital in Leopoldstadt. If your background is ordinary, it is hard to land a good traineeship. It was only in May 1924 that she found an opening. Wien had been a federated state in its own right for a couple of years and the city council was under Social Democratic control. Now, the hospital in Lainz offers a three-year course leading to registered nurse status. Anna Katschenka sails through the preliminary exam. The training also includes voluntary work, and the following year Anna’s class is recruited to run the first aid station at the large sports championships held by the Austrian labour organisations at Trabrennbahn – the trotting course – in the Prater. Her period is due just then and, in the morning, dizziness overwhelms her as usual despite her attempt to deal with it by lying in bed with her feet higher than her head to force the blood to run back into her head. (But there’s nothing else for it. This is her baptism of fire. And she wouldn’t miss it for anything in the world.) Here they are! Twenty-odd dutiful nursing students,
Pflegeschülerinnen
in freshly starched uniforms. In front of them, out on the race track, thousands of young male and female athletes are marching in perfect formations behind their colourful club standards, while above them the span of the sky is as high and deep and blue as it can be on a summer’s day, and a light breeze toys with the pennants on the packed terraces. Afterwards, she remembers the conductor in his absurd tailcoat, leading the orchestra from his podium with amusingly snappy baton movements while the music emerged from the laughter of the audience and the noise of marching feet: the
crisp bleating of the brass section, the twittering of the flutes and the heavy, rhythmic, but somehow distracted
thump-thump-thump
of the percussion. Once the athletes’ walk-past was completed, the procession swung round and, led by the standard bearers, marched towards the exit and she craned her neck to spot her brother among them when, in an instant, nausea hit her again. Her next memory is of lying flat on her back in the grass with some of the other trainee nurses bending over her, so many of them that their faces screened the sun, and black night seemed to envelop her. It was in this shame-filled darkness that she heard the voice of her husband-to-be for the first time:
Let me through. I’m a doctor.
She later said to Doctor Jekelius that, from that day on, she took to heart that a vocation like hers was not a call coming out of the blue, not a gift from a merciful God, but something you must struggle for all your life.
He introduced himself as Hauslich, Siegfried Hauslich, she went on to explain. All that about being a medical man was just something he said to make an impression. He told her, much later and with not a trace of shame, that he had been watching her at a distance for months and waiting for the right moment to make himself known to her. They had gone walking together after that first encounter, up and down the Prater Hauptallee to ‘let her get some air’ and, during that short time, he had not only harangued her with fussy medical advice but also made her tell him what her parents’ names were and where they lived. Only a few days later, a letter addressed to her father arrived in which Mr Hauslich introduced himself as the holder of pre-clinical degree, claimed to have grand ambitions and also to enjoy the patronage of Julius Tandler, presumably because Anna had let slip, against her better judgement, that her father was a great admirer
of Professor Tandler, who as a leading city councillor had done so much to improve the health and social services for the working classes of Wien. Hauslich explained to Anna’s father that Professor Tandler had helped out with bursaries from his personal funds and that he would surely also support Anna’s studies. One believes what one would like to be true. Is that not so? Afterwards, her father happily overlooked the fact that everything Hauslich said was empty chatter and meaningless boasts, and yes, even that he was a Jew …
And Doctor Jekelius,
are you telling me that Hauslich was a Jew …?
She said,
yes, what did you think?
Doctor Jekelius,
if he was a Jew, why did you agree to marry him?
She looked straight into his large face with its receding hairline, powerful hawk nose and the clear, sincere eyes below dark, dense eyebrows (he seemed relaxed and deep in thought but his eyes were alert) and knew that she had confided too much to back out now. Doctor Jekelius had already learnt all there was to know about her dead sister and how her family had attempted to recover from the defeat of their inability to keep her alive. And now, about
the shadow
, the shaming black mark in her past that was the man she had had the misfortune to marry and who was a curse she still had to live with. It was my father who insisted that we should marry, she told him. My father was very serious about not making distinctions between people. It’s the
character
that matters, not someone’s faith or blood, he used to say without realising that in this case it was precisely Hauslich’s character that was the problem. By then, it should have been blindingly obvious that he would never do the right thing by anyone, let alone complete his medical training. He was a charlatan. Who could tell how many people he had already deceived with his pretty talk? Before the wedding, she had already started in her first post as a nurse in the maternity unit at the Brigitta-Spital on
Stromstrasse. So it was
she
who supported
him
while he lived in a rented room in the neighbourhood but expected any time soon to move into the large flat that his wealthy uncle was renovating for them both. The flat, falsehood like all his promises, never materialised. One evening she decided to confront him, went to his shabby room and told him that if he did not qualify as a doctor, start paying off his debts and find a decent home for them both, she would divorce him. The pathetic man had burst into tears, kneeled before her and begged her to stay with him, insisting that ever since that day in the Prater he had loved her madly, blindly. She stuck to her guns. Her father, who rarely allowed anything to upset him, was furious with her. But he was no longer her guardian, she had made up her mind and nothing could stop her. There were jobs going at the unit for infectious diseases at Karolinenspital and she applied happily, even though she knew how demanding the work would be. Her years at the Karolinenspital under Professor Knöpfelmacher would provide her experience of nursing children. Her first two years at the unit coincided with one of Wien’s worst-ever epidemics of diphtheria. She was the charge nurse in a ward with beds for forty-five children and, within one month, thirty of them had died. Can you imagine what it was like, Doctor? What it was like to hold a four- or five-year-old child in your arms and watch, powerless, as the small life slipped between your fingers? The one factor that made the years in the unit bearable was Professor Knöpfelmacher’s personality, his courage and strength of character. But 1934 brought changes that turned absolutely everything upside down. Professor Knöpfelmacher was forced to leave, as were many of the doctors. I worried, too, through nights of desperation. The Patriotic Front was in power and one of the things they did was send my father to prison because of a rumour going around that he had embezzled money belonging
to WAT. They suspected that the money had been spent on arming the Socialists. My father was freed in the end and I had meantime managed to arrange for a transfer to Lainz, so all could have turned out well in the end if the Nazis hadn’t come to power. And this time, they had of course found out about everything.
Doctor Jekelius,
sorry? Who? What had they found out?
She said,
they said that of course they couldn’t have an employee who had previously married a Jew.
Doctor Jekelius,
aha, that man Hauslich, yet again …!
There was something about the indifferent, uncaring way he pronounced the hated name that made exasperation suddenly explode inside her:
Can you have the slightest sense of how I felt, Doctor Jekelius? What it was like to have fought all my life to stay sane and well and so escape from the suffocating influence of this man and then, when I had succeeded after years of faithful service, to be told that my work had been in vain?
Jekelius’s face remained unmoved:
Nothing you have done is in vain, Mrs Katschenka.
And, much later, when the war had ended, when Spiegelgrund stood shut and empty after the discovery of what happened to the interned children, she would be able to recall, almost word for word, what they had said to each other that day, which was to be the last time she came to him for treatment. How she had tearfully confessed to him that it was work that kept her well, nothing but the good, self-sacrificing work, and he found a handkerchief for her in his jacket pocket, unfolding it in his calm, measured way.
I understand your predicament very well
, he said. And then,
you are in the front line.
And,
you have nothing whatsoever to be ashamed of.
A few months later, she learnt that Jekelius had been appointed medical director at the clinic for children and adolescents that had opened
in the old Steinhof asylum. The Wien city council’s new department of health was advertising for staff at the recently established Wiener Städtische Jugendfürsorgeanstalt, ‘Am Spiegelgrund’. After hesitating for a while, she took her courage in both hands and phoned them. Later, this would be held against her because, by then, she had surely realised whose interests Jekelius served and what they were up to at Spiegelgrund, though this was something she would consistently deny. Again and again, she would repeat what she had told Doctor Jekelius the first time they met: that all she wished for was to be allowed to work with children again. And this time, her application was not returned as it usually was, with a covering letter to the effect that her qualifications were ‘insufficient’ or even ‘unsuitable’, but instead she was called to a face-to-face interview in the personnel department and found to her great surprise that the long conversation never touched on subjects such as her previous marriage or her father and brother’s illegal political activities. When she, just one week later, received written confirmation that the post was hers, she wept with happiness. She felt certain that in the future, too, Doctor Jekelius would hold out his hand to support her.
Steinhof
The asylum had existed as a concept long before she saw it with her own eyes. In the Steinhof, one would say. This or that individual was in the Steinhof. And this would always be said quietly, almost in a whisper, with a distant look in one’s eyes. Her grandfather had been a Steinhof patient for many years and when she was nine or ten and, as they thought, old enough, she was taken along to visit him. She remembers narrow lobbies full of men in the institutional uniform; how the staring, oddly bright eyes in their coarse, unshaven faces would fix on her and follow every step she took. She remembers the screaming, high-pitched and repulsive, as if from animals taken to slaughter, that would rise suddenly from behind the open doors of the wards and which often triggered frenetic activity, sending staff along the corridors at a run, with the long, effective strides of trained athletes. But just as often, the screams would be completely ignored. A mat of sound was ever present beneath these frightening outbursts, woven from thousands of mumbling voices, incessantly muttering and whispering. Somewhere far inside this huge cathedral of sound, her granddad lay quietly in bed. Dad, don’t you recognise me? her father would ask every time, on a sliding scale of anxiety. Her grandfather didn’t recognise anyone, it seemed, but now and then he would reach out and touch Anna’s head the way you tentatively touch an object you would like but don’t dare to hold. Her mother, who never came with them, opined that her father-in-law was paying the price of a life of drunkenness and she missed no opportunity to tell them about all
the sacrifices her husband had been forced to make for his alcoholic father. However, for the son, these visits were no sacrifice. Afterwards, father and daughter would walk for a while in the hospital park and maybe climb the hill to Otto Wagner’s lovely church with its copper dome, green with verdigris, and its great gate guarded by four angels with raised, golden wings. Anna remembers the hospital site as always thronged with people of all ages. Some of the strolling groups would include a patient in his pyjama-style daywear but there would also be people dressed for a picnic, or entire families, the boys in knee-length shorts and the little girls with bows like small propellers in their hair. The trams taking you away from Steinhof would always be crowded. It felt as if the whole city had enacted a communal pilgrimage and happily went home in unison. A few years later, Anna’s granddad was moved to the Ybbs hospital and no more visits were made, at least not by her. The family would sum up what happened as: the old man was lucky to die in good time. What that was supposed to mean, no one cared to explain.
*
Has Sister Anna Worked with Idiots Before?
When she starts work, she discovers that Steinhof has changed and no longer has anything but the walls and the façade ornamentation in common with the hospital site she once visited with her father. It is January 1941. The day is overcast and still. Near the imperial clock by the main entrance, the Nazi flag droops, as if glued to the flagpole. Set among the bare trees in the park, the pavilions look like bunkers with their high, solid walls and window grilles. Anna Katschenka presents herself to the administrative office in pavilion 1 and is given instructions about where to go next, but she is soon met by the matron, Klara Bertha, who comes walking briskly down the wide drive. Bertha is a strongly built, middle-aged woman with, in some people’s eyes,
striking good looks. Arguably she would have been respected, whatever profession she had taken up. In conversation (with patients or colleagues) she comes across as slightly reserved, someone waiting patiently if a little irritably for what the others have to say before finally delivering her response, distinctly and explicitly. On the way towards
their
pavilion, she points and describes with pedagogic clarity which of the pavilions still belong to the ‘old’ Steinhof establishment and which to the new institution for children and adolescents. She explains that the odd numbers, as in 3, 5, 7, 9, 11 and 13, are ‘theirs’. We have tried to avoid mixing former inmates with, for instance, the children from Lustkandlgasse who have been placed in pavilions 3, 5 and 9, and those from Juchgasse in number 7. Pavilions 15 and 17 hold only psychopaths of both sexes and also younger children who are very ill or malformed, which means that they don’t just need specialised care but also constant supervision. And that is where Sister Anna will be nursing. Anna Katschenka points out her previous experience of dealing with severely ill children and takes the opportunity to mention her many years in Professor Knöpfelmacher’s unit. Matron smiles patiently, almost sadly, as she waits for Sister Katschenka to finish and then says: I’m afraid that there’s very little hope for these young lives. By then, they have reached the right place and the door is opened by a young nurse who introduces herself as Nurse Hedwig. Behind her, several other members of staff emerge from doors along a narrow corridor. Bertha introduces some of them by name and qualifications: Emilie Kragulj, Hildegard Mayer and Cläre Kleinschmittger. Kragulj and Mayer had worked before as psychiatric nurses at Steinhof but had been seconded to the children’s wards and had to relearn on the job. Same difference, Mayer says. Her tongue is as quick as her body is heavy. Nurse Kleinschmittger, Bertha continues, is the charge nurse for one of the wards for very young children. There are three
types of patient in pavilion 15: infants, children aged less than three, and slightly older children, up to the age of six or seven. We employ tutors who are meant to instruct the third age group but, regrettably, most of the children lack the ability to learn even the simplest things. When Bertha has completed the sentence, Kleinschmittger turns to Katschenka and smiles. Her smile is meant to please but is tinged with nervousness. One might even read jealousy in it, a keenness to guard some spoken-for territory. Or else it is simply that she has no idea what she is supposed to say or doesn’t dare to speak at all. Meanwhile, Doctor Gross has descended the stairs, apologising loudly for having been delayed by a telephone call, and quickly takes the lead in what turns out to be an improvised tour of the premises. Like most of the pavilions on the site, number 15 is constructed around a central flight of stairs, which makes for an easy subdivision of each floor into two wards. Two doctors, Gross and Marianne Türk, who used to work at Steinhof, share the medical responsibility. Anna Katschenka is due to meet Doctor Türk later. She is a short, slim, middle-aged woman with something tense and withdrawn about her that marks her out as one of those doctors who set about their daily work with the kind of goal-oriented persistence that leaves no room for anything else – neither errors of judgement nor moments of compassion. Quite unlike Doctor Gross, who speaks with many vague but big gestures and who has already acquired the apparent distractedness often displayed by men conscious of their own importance, a manner that entails constantly changing subject and register and seems ultimately intended to make everyone they talk to feel insecure.
Has Sister Anna worked with idiots before?
he suddenly asks without stopping to listen to her answer. He moves on, as if the question had been quite beside the point, and instead opens wide the door to one of the wards and steps inside, immediately followed by Bertha, Kleinschmittger and
Mayer, who seem to be swept along in his wake. The wards are not that large. Each long wall has room for five to ten beds, and the changing tables and basins. The bedsteads with their high end-rails are made of white-painted metal. Along the short walls, some beds enclosed in metal netting stand a little apart, presumably to make it easier to keep an eye on them. In one of the netted beds, a nearly grown-up girl is crouching, leaning a little forward. Oblivious of the staff, her jaws are grinding like millstones while her gaze makes helpless attempts to hang on to objects within her field of vision: a blanket, a pillow, the inside of the bed rails, which her fingertips explore intently as if investigating an enigmatic script. All the children, not only the infants, are in their beds. Gross walks from bed to bed, pointing this way and that. He could be demonstrating objects in a museum. She only catches fragments of what he says:
idiocy … spastic diplegia … we have cages for epileptics as you can see here!
He indicates the girl in the netted bed. For Anna Katschenka, the children are still nameless and suffer from nameless diseases. She sees bodies: bodies just lying there, the already exhausted attachments to gigantic skulls that sometimes look absurdly beautiful, the distended cranial bones covered with blond baby hair and fragile networks of pale-blue blood vessels. Some bodies have been preyed on by tumours until so emaciated that the skeleton is about to pierce the skin, the ribcage protruding through the loose skin-folds over chest and abdomen, the sharp edges of forehead, cheek and jaw bones stretching the weakened sphincter muscles around eyes and mouth. The bodies emit shrieks and odd noises which are everywhere, the alien sounds ranging from hoarse shouting to gurgling and cooing. A little boy with cleft palate groans like a rutting animal when they are about to pass him, and Doctor Gross stops and points:
Cheilognathopalatoschisis. Alcoholic mother who abandoned the infant when she saw what it looked
like. One can’t entirely blame her!
With an exaggeratedly caring gesture, the doctor helps the malformed child to stand by supporting his right arm. The split in the boy’s palate is wide enough for them to see straight into the moist membranes of his gullet. When Gross touches him, the boy’s coarse, wild groans change into helpless gurgles and she finds herself looking into a pair of shiny blue eyes that express a lucid awareness more alarming than any scream. But most of the children are silent as they sit or lie on the beds, their fingers spread out or stuck between wet lips, their gazes dull or absently following the white-clad procession, and it seems as if the incessant sobs and moans that fill the large room from floor to ceiling don’t come from anyone in it but from somewhere far away, like a vast, distant wave of discordant noise that has taken tens of thousands of years to reach this place but is finally breaking through the dams and is about to swallow everyone and everything on the ward, the children in their beds and the professionals bending over them. But a slightly older child, whose skin has a doll-like pallor, lies on her back deep below the uproar, her face turned indifferently towards the murky surface high above her where space and voices blend. Her face has grown and suggests five or six years of age, a much too large head in relation to her short torso and thin but shapely limbs. Looking more closely, her every feature seems chiselled with extraordinary precision. Her hands, which rest on the coverlet, have slender fingers and pink, half-moon-shaped nails, and her doll’s face with its porcelain skin and pointed chin is given distinction by her small, lovely mouth that has a slight, almost ironic twist. Her eyes are a deep blue beneath their heavy, aristocratic lids, the sweep of her high forehead ends where a mane of thin blonde hair with a reddish shimmer grows from what Anna Katschenka’s mother would describe as ‘a perfect hairline’. And it is perfect. The thin, exactly delineated roots run like a neatly stitched seam across the
forehead, along a line that is reminiscent of a Cupid’s bow. (Anna Katschenka has had to learn these finer points, as her own hairline is less than perfect.) This child is Sophie Althofer, Nurse Kleinschmittger explains as she stops by the girl’s bed and draws attention to her presence next to Katschenka by pretending to tidy the coverlet. Her mother comes in almost daily, she adds, at which Doctor Gross, who patently disapproves of nurses chattering while he is prepared to hold forth, clears his throat and loudly announces the diagnosis:
Achondroplasia, combined with imbecility of the worst order.
Not even the mother has managed to get a single, sensible word from this girl, he says as he turns to Anna Katschenka with a smile, as if to advise her against even trying. And then the performance is over. Matron instantly picks up the change of tone and addresses the group of nurses:
Sister Cläre, will you show Sister Anna the practical side of things.
Anna Katschenka follows Cläre Kleinschmittger into the corridor and then into the lavatories and shower rooms. Sister Cläre also demonstrates the sluice room and the correct places for washbasins and bedpans, then shows her where the first aid cupboard and the linen stores are, and goes through the order of towels and bed-linen items on the shelves. Anna stays in the sluice room afterwards and watches as Hedwig Blei, the young woman who opened the door when she arrived, busies herself with rinsing out bedpans. Nurse Hedwig is young and vital. Her arms are broad and strong, and there is a band of freckles across her nose. She seems unfazed as she upsets the hierarchical order, speaking to a superior without being spoken to first. Pointing to a jar of hand cream that she has put next to the sink, she says that
people from the countryside know how to look after themselves
and then explains that it is the same cream she learnt to use when she was younger and was asked to treat the inflamed sores on cows’ udders. Then, in reply to Anna’s question, she says,
yes, well, I’m
from Grünbach in Mühlviertel. You know, this cream is good for chapped skin on the hands as well.
For a moment, the two pairs of hands are placed side by side on the workbench and young Miss Blei can’t refrain from asking,
I can’t help seeing that Sister Anna perhaps isn’t married?
And carries on, now energetically rinsing off bottles and glasses, so she doesn’t notice how Anna stiffens. Instead, Nurse Blei adds that
a job like this is simply impossible to combine with having a husband and children, that’s what I‘ve always thought. Much wiser to wait!
On their way out, they pass little Sophie with her pretty doll’shouse face that looks too mature, too clever for a child. Anna feels that the girl’s gaze follows her but Sophie’s pupils shelter below her elegantly curved eyelids. Her exquisite lips curl disdainfully.