Bestsuburban

By Axel Zander

You feel transported back in time to the 1970s and immediately plunged in young doctor Fritz Blücher’s life. The author vibrantly describes the years that are perhaps the most significant for the main character, who has just decided to undertake his one-year internship in the distant USA. He parts from his fiancée Leni. However, he wants to use this opportunity together with his best friend Chris and gain important experience overseas. At the Westsuburban Hospital in Oak Park, near Chicago, the two comrades finally find a good teaching hospital, where they learn many new lessons - among other things, the young doctor faces his first experiences with chemotherapy. They make friends and take an interest in the socio-political events of the United States. After almost a year, he returns to Germany for a short period, for a job interview at a pulmonary clinic near Hamburg and to meet his girlfriend again. What will Fritz decide to do: a future in Germany or in the USA, at the University of Illinois?

Axel Zander, born in 1943, completed his medical studies in Munich and Lübeck, his medical assistantship in Berlin and later in Oak Park, Illinois. His American career led him, for 20 years, from Chicago to San Francisco, via Houston; then the Hamburg native doctor decided to return to Germany. His medical interests focus on stem cell transplants, leukaemia, and cancer treatment.

• Language: English
• Publisher: Europa Edizioni
• Release date: Feb 28, 2023
• ISBN: 9791220138239

Book preview

Chapter 1

It was a beautiful morning of May in 1969. I was sitting at my desk in my rented room in Berlin Zehlendorf. The window was wide open. The sun was shining outside. An unsuitable time to study. I had taken a few days off to prepare for the American state exam. In front of me there was a questionnaire from ECFMG, the Educational Commission for Foreign Medical Graduates. The answers to the multiple-choice questions were almost all schematically the same: correct is a, b, c, d, all of the above or none of the above, all or none of the possible options. This was equally valid for real life, where our decisionmaking patterns are not always unambiguous, yes or no. The wording a, b, c, d, all of the above and none of the above accompanied me throughout the day and in my dreams. Physiology, biochemistry, anatomy, and all the clinical subjects were stuffed here as if they were sausages. Many of the clinical questions brought back memories of the lectures they had been discussed in or clinical decisions I had to make myself. When in doubt, I often consulted my textbooks and then continued working on the questionnaire.

A, b, c, d, all of the above...

Yesterday I moved away from the straight and narrow, attracted by a pair of brown eyes, long brown hair, a melodious voice, and a female body with extraordinarily long legs: Leni = Helen and I = Paris, aka Fritz, aka Laurel (Oliver Hardy's partner). Leni had finished the night shift when I met her. A walk along the wall to a Turkish café and a jazz bar. Eventually, we found ourselves at the

other end of the city, on the Pfaueninsel. Leni was taking a nursing internship at the Rittberg Hospital to keep herself busy while waiting to enter medical school. Leni had questions that pervaded me like pouring rain: medicine, studies, travel, feelings. We remained trapped in the balmy Berlin night until daybreak.

All of the above...

The open window and warm spring air let my thoughts wander.

My earliest medical experiences date back to my childhood, when I was occasionally allowed to accompany my grandfather on visits to patients in surrounding villages, such as Theesen and Vilsendorf. Not that I always understood the meaning of my grandfather's actions. But I noticed how he touched the patients, how he addressed them, explained their situation, and gave them hope.

I believe that the doctor/patient relationship has remained similar over the centuries, despite the evolution of medical theories and treatments.

A, b, c, d, all of the above, none of the above...

The surgical department in the hospital on Drontheimerstrasse in the Wedding neighborhood of Berlin, a grey building next to a factory. I had chosen this rather small facility because I hoped to do more surgical practice here during my residency. The building was timeworn: an allpowerful chief surgeon named Dietrich Faeger, who talked to the head nurse using a Walkie Talkie and at the same time managed everything, admissions, operations, discharges, pharmacy purchases. He was the supreme commander, as in a war movie about the fall of Stalingrad. His senior physician Mahlke was in his fifties, very overweight, power-hungry, and arrogant. He knew how to defend his middle position of power by assigning surgeries. Assistant physicians Kessler and Gehrken were his age, but not yet in his position. Gehrken had been a licensed gynecologist but had lost his license for violating the abortion law. Here he was embarking on a new career on probation. When he had a weekend duty shift, every three weeks, from Friday afternoon to Monday morning, he needed plenty of beer. To be on the safe side, there were three chests in the night duty room, each containing twenty-four bottles. Rarely there were more than a dozen bottles left. Surprisingly, no one had ever seen him drunk. He functioned automatically, like a soldier in snowy Stalingrad. Kessler, a small, taciturn man, did not drink when on duty. He did everything silently and smoothly. In all important decisions, the senior physician Mahlke was consulted, who made feel his superiority.

The work morning began every weekday at seven o'clock with a radiology meeting. The residents and the senior physician used to meet at five to seven and exchange the latest news reports.

At seven o'clock, a blast of cold air swept through the room as the chief physician walked in. The group, including me, leapt to their feet, and said, Good morning, Mr. Chief Physician!

Good morning gentlemen, what's new?

This was followed briefly by a list of hospitalizations and deaths, commented on synthetically by the senior physician, and interventions to be performed.

I had been working the night shift. An elderly patient, Mrs. Holzhausen, had come to the ward at 2 a.m. with back pain. The x-ray technician, at my request, had taken an image of her lower spine and then showed it to me. I had looked at it and, apart from a general weakening of all the bones in the context of general osteoporosis, I had not noticed any vertebral fractures. The chief physician asked me why the patient had developed this sudden pain in her back. No trauma. She bent over and the pain appeared, I said.

The chief physician took off his glasses and approached the X-ray image.

Then he announced with a serious expression, Hairline fracture, as Americans call this bone crack. Now it was my turn to evaluate the x-ray a second time. I still could not see a fracture line. Body of the third thoracic vertebra on the left. Here, pointing to the body of the third thoracic vertebra with his ruler, which he used for demonstration purposes. On the image with low-contrast I still could not see anything resembling a fracture. I searched desperately as if to find a piece of white chalk in a blizzard. Then I withdrew quietly, leaving the handling of the presentation area to the senior physician. Mahlke nodded in confirmation. Then it was Kessler and Gehrken’s turn. Kessler seemed to immediately understand what the chief physician meant; Gehrken had to be prompted further by the chief physician and his senior physician. Where is the patient? asked the chief physician.

I prescribed painkillers, let her go home and advised her to see her family doctor if the pain returned, I said.

It can't be done that way. Too risky. We must admit her. Mr. Gehrken, would you please visit the patient together with your colleague Blücher and inform her of the need for hospitalization. Thank you, gentlemen!

Since it was a day without surgery, immediately after the morning rounds, we went to Mrs. Holzhausen’s home, the patient with the hairline fracture. The patient lived on Ritterlandweg, in a grey tenement house, just a few minutes from the hospital on Drontheimer Street. She opened to us only after we had rung the doorbell three times and we had started knocking at the door. 

Sven Gehrken introduced us. Mrs. Holzhausen recognized me. She invited us in, and we sat at the living room table with a lace tablecloth. Gehrken explained to her that her back problem was difficult to diagnose and that I, a young colleague, had missed it. However, it was a dangerous condition that could lead to paraplegia if strict bed rest were not adhered to and, in my experience, this would only be possible in a hospital with professional care. The hospital had reserved a bed especially for her.

Mrs. Holzhausen asked in amazement how long the period of treatment would last.

One to two months. The chief physician will determine that. Can we help you pack? We can call an ambulance right away, Gehrken said.

Mrs. Holzhausen looked at him shocked and muttered, I really need to talk to my daughter for her to take care of the cat. Can you please give me a few more hours?

Then I will schedule the ambulance for five o'clock this afternoon.

Before returning I had no choice but to apologize for my mistake. I was still not convinced that a crack was present.

This blizzard in the X-ray image did not leave me calm. Why could I not see what was so obvious to others? Mrs. Holzhausen had a pronounced osteoporosis. Two months of strict bed rest would aggravate the osteoporosis.

I remained silent as we walked the few hundred meters that separated us from the clinic.

Gehrken stopped just before he reached the entrance and looked at me, This crack is hard to see. What can you do when the chief physician has seen it so clearly? He shrugged his shoulders. Well, at least the clinic will have a bed occupied for 60 days and primum nil nocere, the vertebra will not be damaged.

When I left the clinic, eight weeks later, Mrs. Holzhausen was still in the women's ward, taking care of her roommates during the day and night as the ward senior.

...None of the above...

Shortly before the end of my surgical rotation at the German Red Cross hospital, two interns joined the group: a doctor from Persia and Jacob Katumba, a Congolese doctor who had abandoned his internship in Perm, Soviet Union, to move to West Germany. He had come to Berlin with his Russian wife Svetlana. When I asked Jacob Katumba how he had managed to transfer his work beyond the Iron Curtain, he simply replied, No problem, and laughed. Dr. Katumba was a competent expert surgeon. He was initially designated as the second clamp holder, then he had slowly worked his way up the operating room hierarchy, stepping in when one of the main team members was absent. 

For Katumba, I had become a point of contact for everything that was new and unexplainable to him in the Western world. 

On Svetlana's pressing request, we visited the KDW, the Kaufhaus des Westens, the Department Store of the West, the German counterpart of Moscow's GUM department store, to look, not to buy, as Jacob told his wife before we went. For Svetlana, the visit to the KDW was like a walk in paradise. KDW had exceeded all her expectations: much better than GUM.

We visited all the departments, from food to kitchen utensils, to women's fashion. I noticed that she circled several times a table with beautifully draped leather belts. A black belt with a gold buckle seemed to have won her over. She looked at me dumbfounded when I took the belt in my hand for a moment. Jacob, Svetlana, may I give this belt to Svetlana? A parting gift. You may, Fritz, why do you ask me - she is an independent Soviet citizen. We are sorry to see you go - let us hear from you. 

Thank you very much - I wish you wouldn't leave, Svetlana said.

Svetlana, you have moved west. I'm moving west, too, I tried to downplay the parting moment. In silence, we walked through the Berlin sleet to the subway.

The second intern, Armin Tavassoli, was an aspiring internist from Iran, scion of a family of traders scattered all over the world, with lots of money and the best connections. For some inexplicable reason, he had been assigned to the surgical department of the Drontheimer Straße Hospital, and here he appeared like a peacock in a henhouse. Armin was eloquent and intelligent, so he understood the hierarchy of the place in no time. He spoke perfect English and tolerable German and had a flair for irony and satire. He was horrified when he saw me jump up with the others to greet the chief physician during the x-ray round. Fritz, mold under the gown, with such ready obsequiousness.

He, too, had jumped to his feet instinctively, but he immediately sat back down, an attitude that irritated the senior physician and made me think.

And after the Good morning, Mr. Chief Physician!, admissions, deaths, upcoming surgeries, and X-ray diagnoses had also faded. Armin took me aside after the meeting. What would Rudi Dutschke say, if he saw all this and think back to the men of July 20! 

I understood his point of view, but I pointed out to him that the comparison with the July 20 men was exaggerated and refrained from asking him what he himself would do about the shah.

The next morning, Armin and I remained seated, and Jacob also followed our example. The chief physician treated us with disdain and went on with his work according to his custom. The next day they all remained seated wishing the chief physician good morning, a practice that continued until I left the German Red Cross hospital. Armin left Berlin two weeks after our rebellion and took up service at a university hospital in Paris. 

A, b, c, d, all of the above, none of the above...

My next destination was the Rittberg Hospital in BerlinLichterfelde, an old building with the charm of a castle and a park-like garden for patients and staff. I was assigned to the women's internal medicine department as intern. My ward supervisor was the fly, Dr. Fliege, a small, energetic, and witty woman with curly brown hair and oversized glasses, who ran the women's ward with 25 beds available. The average stay of the inpatients was four weeks, so I was daily plagued by the tedious task of writing discharge letters, or rather dictating them. Once a week, the chief physician, Dr. Schuhmacher, a jovial, good-looking man with a mane of wavy grey hair crowning a partially bald head that gave him the dignified appearance of a State Actor, used to make the rounds of one of the four sections of his ward. After the rounds, the ward's chief physician, doctors and head nurse were served a breakfast, the so-called chief's breakfast. The individual sections competed to make it as inviting and tasty as possible. The chief physician spared no praise when he stuffed egg rolls with mayonnaise and ham tartlets into his mouth. Administrative matters were discussed on the side lines. Each time I had to resolutely remove myself from that lively bustle to complete my work of taking blood samples and measuring blood pressure.

In addition to the blood sample, some drugs also had to be administered intravenously. The fly was an enthusiastic advocate of intravenous administration: What's in, is in. Too often she had seen or heard that patients hid the tablets in the bedside drawer or flushed them directly down the toilet. I was particularly astonished when it was necessary to visit an elderly patient in the garden, who had made an excellent recovery from a heart attack in the past three weeks, and then inject her with a minimal dose of Strophantine on the ward. Even the fly was aware that this therapy did not rest on any scientific foundation, but she reiterated, The patient feels better this way. It has been proven. This allowed me to gain more practice in vein search, a skill that I hoped would be useful in the future.

Back to multiple-choice questions: a 39-year-old woman with a rash and fever, elevated liver enzymes.

That evening I was going to pick up Leni from the hospital after the evening shift.

Chapter 2

On May 26, 1969, I, Becquer Benalcazar, a resident of Cali, Colombia, received the long-awaited but unwanted letter from the Secretary of the Ministry of Health in Bogota. 

A year's practice as a country doctor is a demanding mandatory fulfilment in Colombia, after the state medical exam, to obtain a certificate of license. It is in a sense the price one must pay to hang the licensed physician plaque outside one's residence in Cali, Medellin, or Bogota. Country doctor positions are filled on an annual rotation and only rarely do young doctors stay beyond the mandatory period. I had ended up in Esperanza, a small town of 800 souls, somewhere between Pasto and Popayan. I had not chosen Esperanza. Once again, I had been busy with other matters and had missed the beginning of the country doctor selection process.

The country doctor lottery had been established for those doctors without recommendations. After colleagues with the so-called vitamin R had grabbed positions as tutorial assistants at the University of Bogotá, at the Santa Marta spa hotel or as interns at the quarantine department in Cartagena, our turn came, of those without recommendations.

I did not know Esperanza and had never been there, since it is not on the main road between Popayan and Pasto. But the name Esperanza, Hope, had intrigued me. I had been in contact with my predecessor Esteban Pena, a colleague at the University of Valle Del Cauca. Pena had not expressed great enthusiasm for the opportunities offered by this practice. A meeting room, a small operating room, and a trauma room. Patients with the usual seasonal infections, home and work accidents, allergies, and depression. An elderly housekeeper named Dona Blanca was on staff and an excellent cook. Morena, a younger nurse, assisted in the outpatient clinic.

Esperanza seemed to me the junction to eventually reach the Mecca of psychiatry and analysis, Topeka, Kansas, via an internship near Chicago. 

It was like crossing a stream with dry feet, hopping on two stones.

Accompanied by my suitcase I had travelled by bus from Cali to Popayan, and from there by cab to Esperanza. A market square with a grey neo-Gothic church from the last century, a dozen stone houses on the main street, and a hundred houses and wooden huts on the outskirts. This was Esperanza.

The doctor's office was housed in a venerable turn-of-thecentury, three-story house with two bow windows on the second floor. The taxi driver told me that at one time, about half a century ago, the town had been a thriving mining centre, until the gold mines proved unproductive, and the wealth seekers and their middle-class retinue moved to Pasto or Popayan. Now the inhabitants lived by farming, raising dairy cattle and goats.

I paid the taxi driver and gave him a generous tip.

Good luck, doctor. There doesn't seem to be much work for you. Everything seems to be dead. May God protect you! and drove back toward the bustling Popayan.

The house door opened, and a chubby, friendly person greeted me, Dr. Becquer Benalcazar. Welcome to Esperanza!

Donna Blanca. I guess.

Yes, thanks to St. Anthony, that is indeed me.

Great. Then I'll take my suitcase into the house, freshen up, and then talk to Dr. Pena.

"Please come in. Dr. Pena is no longer here. He took leave as soon as you signed the contract.

Urgent family matter in Cartagena. He left you a letter and patient records."

What about the patients?, I asked in a hurry. Pena's demeanour was tantamount to a slap in the face. For any young doctor, the year as country doctor represents a leap into the void, a daunting task that can only be overcome with the right mix of naiveté and arrogance and a dash of medical knowledge. A simple handover and a few kind words would have made the beginning more bearable.

Nurse Morena, the study assistant, took care of the patients. Now take a seat for a moment. I'll make you a nice breakfast and then we'll see.

The late breakfast had everything one could want. Omelets, goat cheese, sausage, ham, and roasted plantain slices.

I read the letter from colleague Pena. He apologized profusely for not being able to wait for me. But pressing family business made his presence in Cartagena necessary. Nurse Morena knew everything about the patients and was able to run the practice in her absence.

I had to take care of myself. That year would also pass.

Sincerely... That letter revealed more puzzles than information. 

After a deserved siesta, it was time to take a look at the outpatient clinic. Nurse Morena, a dark-eyed brunette beauty, greeted me with reserved friendliness and showed me around the modest rooms, including the operating room. 

Then we sat down at the desk and Morena described the patients and their pathologies to me in brief. Some with chronic bronchitis with the usual exacerbation of symptoms in the cold season, diabetes mellitus with and without insulin treatment, chronic heart failure, mostly treated with digital drugs, some hernias treated conservatively with pressure bandages. Some alcohol intoxications during the holidays. More rarely, children with diarrhoea and abdominal cramps. Half a dozen work injuries per year: loss of a finger in the shredder, radius fracture from a fall from a horse, and a dislocated shoulder during haying. 

That's all; in one year is not much. Dr. Benalcazar, you will have plenty of time to read. I hope you have brought enough books with you. Otherwise, you can play chess against yourself as your predecessor did. 

I brought my preparation books for the U.S. state exam. That will keep me pretty busy.

Do you also want to go to the United States? It's so sad. This huge octopus is capturing all the best doctors in Latin America and taking them to American hospitals to devour them. I knew a doctor who wanted to go to the United States just for a year and then continue working in Popayan. After a year, residency came, and then lucrative job offers. He is still in the United States. It will be the same for you, Dr. Benalcazar.

Call me Becquer, Dr. Benalcazar is too formal. After all, we are a team. May I call you Morena?

Please continue with Nurse Morena, Dr. Benalcazar. You are the doctor, and I am the assistant. She looked at me sadly and then let her gaze wander out the window to the dusty, grey church square.

I sensed that her refusal of my offer to call each other by name concealed a tragic story or unhappy affair behind it and decided to let it go for the time being. Her sincere sadness made her seem even more desirable to me.

A couple of patients are expected tomorrow morning.

Thank you for the summary and presentation, Nurse Morena. And there is one more thing I wanted to ask you: Why did my colleague, Dr. Pena, leave without waiting for my arrival?

Nurse Morena shrugged her shoulders. I don't know. Presumably, business in Cartagena that could not be delayed. He was in a big hurry. That was a month ago. The news must have reached him at night. The next morning, he had already packed his bags, then informed Donna Blanca and me and took a cab to Cali.

The year as a country doctor was for me, as for all my colleagues, a challenge to finally put into practice, independently, what I had learned at the university. However, I soon realized that reality had little to do with what I had learned in books. It was like having to learn a whole new trade.

My experience at Esperanza turned out to be positive. Nurse Morena helped me make decisions: she had a down-to-earth mindset and a great deal of experience. Patients were seen, counselled, treated and usually left the practice relieved. Difficult cases that needed special therapies or more complex surgery were sent to Popayan for further treatments. I had enough time to devote to the ECFMG questionnaires.

All medicine was compressed into sausage-like problems to be answered with A, b, c, d or all of the above or none of the above. 

For example: a woman presents to the clinic with a fever for two weeks and a rash on her cheeks... I couldn't help but think of Morena's octopus’ image for ECFMG. Not a bad business model for U.S. medicine: being able to recruit the best and most