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The Physician From Vienna

2017; Elsevier BV; Volume: 131; Issue: 4 Linguagem: Inglês

10.1016/j.amjmed.2017.11.012

1555-7162

Leonard J. Hoenig, Beatrix I. Thom,

Medical History and Innovations

On March 12, 1938, Nazi troops invaded Austria. Three days later, in Vienna, a nearly 80-year-old physician named Ismar Boas (1858-1938) (Figure) committed suicide. Thus ended the life of a pioneering founder of gastroenterology.1Hoenig L.J. Boyle J.D. The life and death of Ismar Boas.J Clin Gastroenterol. 1988; 10: 16-24Crossref PubMed Scopus (10) Google Scholar In 1886, Boas opened the first specialty clinic for digestive diseases in Berlin. In 1895, he founded the first gastroenterology journal, presently entitled Digestion. Boas was also Jewish, and his story reflected the fate of all Jewish physicians within the Third Reich: their careers were destroyed as they endured Nazi intimidation and terror. Many Jewish physicians would perish during the Holocaust. In 1936, Boas fled to Vienna after he was forced to close his Berlin practice. In 1938, following the Anschluss, Boas refused to fall again under Nazi rule. He preferred to end his life with a drug overdose. In November 1938, Boas' death became the theme of a short drama (Appendix, available online) written in German by the Jewish Austrian-Bohemian novelist Franz Werfel (1890-1945). It is called “The Physician From Vienna” (Der Arzt Von Wien), and it is a fictional account of Ismar Boas' final hours. It was published in Pariser Tageszeitung (Parisian Daily Newspaper). The work is a monodrama, featuring one character: the Physician. The action occurs from dusk to nightfall, with darkness symbolizing death. The scene is an old-fashioned doctor's office, where the Physician has practiced for 40 years. In a corner rests a bust of Professor Hermann Nothnagel (1841-1905), the Physician's deceased mentor. Nothnagel was a German internist who in 1882 became a Professor of Medicine in Vienna. He was famous for his stirring words: “Only a good man can be a good physician.” The Physician has seen his last patient when the phone rings. A voice warns him that he was denounced as a Jew and will be arrested soon. The Physician, stunned, is urged to pack up quickly so that he can escape across the border. He will be contacted again at 6 pm. The Physician gathers his clothes and books. Suddenly, the bust of Dr Nothnagel is illuminated by the street lights. The statue is imagined to be saying “Only a good person can be a good physician.” The Physician tells the bust that going into exile means “I'll be waking up someplace, without a name, without any means, without people, without possibility…in my seventies, when other professors are celebrating their honorable retirement…”. The Physician decides not to run. He will die on his own terms. The noise on the street has grown louder with shouts of Sieg-Heil. The Physician looks out the window, wondering “The hate! Why this hate??? What did we do to you?” The Physician injects himself with strophanthus, as the clock tolls 6 pm. He slumps into his chair, immobile. The Physician From Vienna is an anti-Nazi drama written to protest Hitler's brutal oppression of European Jewry, one of several authored by Werfel on anti-Semitism and genocide. Following the Anchluss, Werfel settled in France. When France fell to the Nazis in June 1940, Werfel and his wife Alma were in danger of being sent to a concentration camp. They were rescued by an American journalist, Varian Fry (1907-1967), who had volunteered to go to Marseilles, France, to save endangered persons. On September 13, 1940, Fry arranged a secret crossing that took the Werfels over the Pyrenees mountains into Spain, then to Lisbon, Portugal, where they boarded a ship bound to New York. In September of 1941, the Vichy government forced Fry out of France after he had saved 4000 Jews. The Physician From Vienna is a remembrance of Ismar Boas, a great physician who tragically committed suicide 80 years ago, amidst the Holocaust. It is a reminder that it is important to stand up to hatred and inhumanity, so that no one will ever again experience the horrors of genocide. It is noteworthy that looming over this drama is the image of Hermann Nothnagel with his inspiring words “Only a good man can be a good physician.” This maxim, timeless in its wisdom, can serve all physicians as a moral guide to help overcome any obstacle, whether economic, regulatory, or bureaucratic, that challenges our ability to give patients our finest medical care. English translation of Franz Werfel's The Physician From Vienna by Beatrix Thom.Franz WerfelTales from Two WorldsVolume IIIThe Physician From ViennaEnglish Translation by Beatrix I. Thom BA, MSN, RNOriginal Title:Der Arzt Von WienBy Franz WerfelErzӓhlungen Aus Zwei WeltenDritter BandHerausgegeben von Adolf D. KlarmannS. Fischer Verlag 1954, pages 40-45Frankfurt am Main An old-fashioned doctor's office, displaying none of the modern shiny nickel, or glass furnishings. In this dimly lit room this physician has received and treated his patients for 40 years (1). In the center of the room is a large desk. Library cupboards against the surrounding walls. To the left, a door exits into a waiting room. Through a draped portal, towards the back, another room can be seen. A window to the right. In a corner, on a portal covered with a red drape, stands a bust of Professor Nothnagels; this professor was a founding father of (medical college) and integral to the fame garnered by this Vienna medical faculty. He served as our physician's mentor. In the corner of one of the book cupboards is an open gramophone, a frivolous object in a serious (non-frivolous) environment; but our doctor loves music, even in this modality (2). This tragedy is set mid-March, 1938; it is dusk and the night is approaching, ultimately, becoming pitch black. The physician from Vienna is in his 70's, with a ruddy face and a lively demeanor. He is escorting his last patient to the door. He impatiently begins to open his white lab coat. Physician: (calling out the door) My honorarium? You wouldn't be able to afford my bill if I added everything together. So, don't worry about it…everything turned out great, nothing went wrong, and it could have ended badly…even six weeks ago…that in itself is an honorarium for a doctor… (3). Woman's voice: whispering, intense and urgently. Physician: Your husband joined the party….? Oh therefore…but Mrs. Eberseder, who would even be concerned (care) about me…I'm almost 70 and I've been practicing for 45 years…in this room (office)…I have no interest in politics, I don't read newspapers, and I haven't assisted any more people into the hereafter than any other doctor….No, no Mrs. Eberseder, I've already lived through too many “great” times, I'll pass up this one, for a change…very nice of you, Bye, Adieu, say hello to your husband at home, the party-member, convalescing… tell him to drop by some time so that I can take a peek at him…he nods, and closes the door. A grandfather clock strikes 5:30. Physician: pulls his pocket watch: finally. 5:30….once more, again, 5:30. How many more times? He yawns and stretches. Ambles to the window where the last of the sunbeams of early spring are collecting; He gazes quietly out of the window. As he turns around, the anticipation of a relaxing evening is reflected in his body language. He exchanges his lab coat for a silken evening robe. Next he pours himself coffee from a thermos and lights up a Virginia-cigar; his face reflects pleasure. Wait again…suddenly he is startled…maybe Eberseder sent his wife because he himself is afraid….Ah no…this is paranoia… He walks over to the library, sorts through his books, pulls out one, then another, then puts them back, until he finds the one he wants to enjoy for his solitary “downtime”. Stroking the book's cover, he gently sighs and smiles in anticipation, because one of his favorite authors will help him escape into tried and true worlds, where he feels more at home than in the strange world of today. Still standing, he begins eagerly to leaf through the book, sampling the familiar and exquisite enjoyment inherent to this activity. He moves an armchair next to the window, takes a seat, dons his reading glasses, sips his coffee, puffs a couple of times on his cigar, and becomes more and more engrossed in his book. In the rosiness of the setting sun, his face almost appears youthful. Suddenly the shrill and demanding sound of the telephone The Physician angrily slams shut the book. Now, there you go. Another evening ruined. He gets up and somewhat heavily treads to the desk, and picks up the receiver. Yes…it's you, dear friend?…not in a long time…what did you say?…someone is eavesdropping on my calls?…ok, a high ranking personality like you, even today…only in my best interest?…He sinks into the office chair behind his desk The voice of the caller creaks out of the phone for a while… The physician interrupts: Stop! Slow down, please…I can't even comprehend everything that you are saying!…Did I understand you correctly?…My house is going to be searched? Tomorrow, at 4 am?…And then they want to take me away with them (arrest)?…and why?…You're right…Only kids ask “why” in this day and age…It says in the newspaper that I'm a poisonous pest of the human race? Because I treated a government official? (4) I have treated thousands of people, kings, millionaires, poor persons, Christians, Jews, Maharajas, and even Nazis. Before God and the physician, all human beings are equal…. Oh it's different now…Judaism, sharpened through life long success now it reads concentration camp (5)…Oh please! I won't beleaguer my beloved Vienna any longer through my medical successes…today still, I'll remove my office sign, it's been an old dream of mine (6). Unfortunately you all prevented me from closing my practice before…Excuse me?…It's too late you say… The voice on the phone creaks emphatically The Physician has lost his self-possession. He speaks quietly with controlled vehemence: From the horse's mouth (an undeniable source)? Still tonight across the border, absolutely…otherwise…what do you mean “the worst consequences”?…They have that much hateful vengeance against a doctor?…You yourself want to…in your car…that is fabulous of you…but…but this is happening too quickly…before I make such a big decision I have to give it a little bit of thought…I'm old and pedantic and this ultimately affects the rest of my life…no time to consider…absolutely none…Hello…What's going on?…Hello…Are you still there? We briefly lost contact… The voice on the phone is creaking emphatically now, agitated, commanding The Physician: Resigned and de moralized: Fine…I will immediately pack the necessities…and I won't rethink this…Yes, I'm alone… I gave my housekeeper the evening off. You are calling me back at 6? Ok. I'll be ready. Count on it. I'll anticipate your call…and I'm ready…he lays down the receiver and remains motionless. The evening's darkness has progressed. The Physician reaches for his forehead and mumbles to himself…Well, there isn't anything one can do…anything's better than that…well, let's go then (dialect)…stands up abruptly and disappears in the other room, hurries back. He is carrying an old-fashioned carryall as well as some clothes. Hurriedly and unfocused he begins to pack. Suddenly he stops and hurries to the library, fervently, with shaking hands, he withdraws books and piles them up. What should I take with me? Emotionally choked up he mutters: My books…he rushes back to his desk, pulls open the desk drawer, and pulls out a large roll of paper. At least my Diploma from Medical School, then returns it…it won't hold any value in a foreign country (there is no point in taking it along)… In that moment the streetlights flicker on; bright beams of light strike the walls of the room and reflect brightly (uncomfortably bright light) the bust of Dr. Nothnagels. The Physician stares at the bust for a long time, and then formally bows to the icon: And you, Mr. Hofrat (7)…How many times did I consult with you in bygone days, my respected (honored) teacher? Any comments (8) regarding this situation? Nothnagel's venerable, sonorous, and still a little dry- throat—voice is audible near the statue: “Only a noble (good) person can be a good (effective healer) physician”. Physician: Those guiding words (9) brought you and our Vienna-school fame, Mr. Hofrat. I however, in the best moments in my practice, almost believed that only a good doctor (a competent doctor with integrity) can be a good person…and now, now…I'm a poisonous pest, simply because I'm a Jew… Nothnagel's voice: From a medical point of view, antisemitism is a cyclical psychosis from which a manic-depressive people occasionally suffer. Physician: It's easy for you, Mr. Hofrat, to render diagnoses, because, first of all, you are not a Jew, and to the second point, you are dead. Nothnagel's voice: The incomparable heights of our profession necessitate for us, Mr. Colleague, to identify world history to be comparable to pathology (sickness-history). Physician: Mr. Hofrat, you are an icon composed of plaster. You are completely out of danger; I, however, within the hour, will have left this room, this house, this city, my entire life with its few victories, and the many defeats of our incomparable lofty profession…and all that decade after decade, will have been less than nothing…and then comes the border, with its dangers and depravities, which frighten me terribly, disgusting and without honor…and if everything goes well, I'll be in a foreign land, and tomorrow, I'll be waking up someplace, without a name, without any means, without people, without possibility…in my seventies, when other professors are celebrating their honorable retirement…However, if I should dare to check some poor slob's (devil's) throat, my incomparable highly placed colleagues will promptly deliver me to the police…So, Mr. Hofrat, advise me…what would you do in my place? Nothnagel's voice: Obtain an unobstructed point of view, Mr. Colleague, like you would at the bedside…and then consider all the possibilities. Physician: But that is the terrible thing…my kind can't (is not allowed to) take a stand, have a point of view, …and the 2 alternatives are equally troubling. Nothnagel's voice: you only need to turn up the light if you are seeking enlightenment (clarity). Physician: Mr. Hofrat, believe me, … life is too difficult for me, I can barely lift my legs and I'm unable to drag myself to the to the light switch. Nothnagel's voice: One is unable to derive conclusions in the darkness (void), Mr. Colleague… Physician: Are you referring to the third alternative? A dull roar is audible in the street, and approaching closer and closer….The physician pulls a nickel plated container out of his pocket and shows it to the bust. Look here, Mr. Professor, this here is very practical. Everything a doctor needs in an emergency; a sterile syringe for 50 cc's caffeine, strophantus, camphor, etc. With a painful nod to the window: So it goes day after day; I force myself not to listen, in spite of nausea and rapid pulse….Please, Mr. Hofrat, please look over here…this ampule here, now I know why I always have it with me, it is a serum that quickly achieves drunkenness (loss of consciousness?)…Did you say something? Nothnagel's voice is silent The Physician prepares the injection: So you agree with me… The roar on the street is very close now; goose stepping on the street is audible; The Horst-Wessel song; crowd noises, with intermittent Sieg Heil, Sieg Heil, Sieg Heil! The physician, stiffly walks toward the window: The hate! Why this hate??? What did we do to you? (that justifies this hate) …it is not possible here anymore for a person to be a good physician…he has pulled back his sleeve, places the needle, after a short pause he turns to the side…The grandfather clock loudly tolls six, audible in spite of the noise outside; Physician: It's done, Mr. Hofrat…intravenous…nothing to be done anymore. Nothnagel's voice: doctor like, with compassion, softly reassuring…So, Mr. Colleague now sit down; and breathe deeply. Physician: pummels his head with his fists…do I have to listen to this until the end?! (10). Dr. Nothnagel's voice: We still have other music here, right Mr. Colleague? Physician: Yes, right…these new records…how much I enjoyed them, even yesterday…he slowly feels his way over to the phonograph and starts up the record…A waltz, from Strauss… philharmonica…Vienna's life-blood… (a remembrance) back from our good times, Mr. Hofrat…The waltz crescendos and fills the room (stage) and then decrescendos and ceases as the Hitler music and noises begins to crescendo and drown out the waltz. The Physician, bent over, with a dreamy smiling expression, slowly advances back to the desk. Now the call will be coming… if I finished packing…If I'm ready… He slumps into the “patient's” chair, with his back to the audience…Across the border…A loud crescendo with the waltz is audible with the shrill repeatedly ringing of the phone The physician remains immobile, the stage lighting diminishes and ultimately blackens out. (1)It was common back then for physicians to house their practice in their homes.(2)Back when people predominantly attended live musical performances, the gramophone must have been a poor second in tonality.(3)He is talking in Viennese dialect; apparently this patient can't begin to pay the fees and the fact that he was able to heal the patient is a reward in itself.(4)The implication is that he treated someone at one point who is now an enemy of the State, ie, is not a party member.(5)Alternate translation: “Judaism intensified by success means concentration camp.”(6)Retirement is implied.(7)An honorary title in bygone days bestowed by the government to distinguished physicians meaning “court (royal) counselor.”(8)“Words of wisdom” would be the idiom.(9)This “maxim,” was the foundation, the philosophy of our school.(10)Presumably the singing from the streets.