White Is Black

By Zann Karlé-Schmitt

A patient’s journey in intensive care always starts like a tennis ball landing on top of the net, at the tipping point. Not only for the one in the bed.

Doctor Apfelstein, a specialist in the field, recounts his rise and fall; from flamboyance to custody; from the sleaziest north-east suburb of Paris where he may have killed some of his guests, to the jungle of Harley Street, and finally the flatlands of Norfolk.

He portrays the darkest recesses of his trade, the fleeting nature of life and love, and the blessings of all sorts of music: the soothing drug he needs.

When his own tennis ball lands on top of the net that separates oblivion from memories, at the tipping point, he has chosen his side. Memories. His way.

Translated from French by Brigid Purcell, PhD in European Literature, assisted by Philippe Grunstein, Fellow of the Royal College of Physicians (London), Associate Professor of Medicine, for specific vocabulary of Respiratory Medicine and Intensive care.

• Language: English
• Publisher: Austin Macauley Publishers
• Release date: Jun 23, 2023
• ISBN: 9781035812509

Zann Karlé-Schmitt

Zann Karlé-Schmitt 1951–2019 Born in Mazuria (Poland), a region of lakes and wolves. Translated from French by Brigid Purcell, PhD in European Literature, assisted by Philippe Grünstein, Fellow of the Royal College of Physicians, Associate Professor of Medicine

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About the Author

Zann Karlé-Schmitt 1951–2019

Born in Mazuria (Poland), a region of lakes and wolves.

Translated from French by Brigid Purcell, PhD in

European Literature, assisted by Philippe Grünstein, Fellow of the Royal College of Physicians, Associate Professor

of Medicine

Dedication

This biography is dedicated to Doctor William R (PhD). Difficult to be certain that he would have appreciated it for two reasons: he did not speak French and he was living under the threat of two cancers, removed indeed, yet with a poor prognosis.

We worked together in the same respiratory department for eight years at the hospital in N. The day after his first operation, I left for a holiday in the Tyrol. When I returned, I did not go to visit him. My colleagues told me that he had lost a lot of weight; he walked with a stick, he was very depressed and very lonely back in his big house.

I was paralysed by the fear of confronting his decline. I admired him at work. His medical and scientific talents were way above ours. And what to say about his sense of humour, his culture and his infectious enthusiasm? He was at one and the same time the lighthouse of our department and its tireless adventurer.

His office looked like an explorer’s cabin on board a dubious cargo ship. Worm-eaten apples from his orchard and his mouldering home-made rye bread gave off a chaos of smells that floated over a clutter of books, magazines and medical articles read, re-read and annotated, dossiers under study and boxes of hibernating folders, photos of snow-covered trees and one empty bench in the sun at Kew Gardens…the life of an artist flavoured the place. I thought of him every day. Nobody touched his office.

We had all been waiting for him to return. He did not.

This biography is a novel.

Copyright Information ©

Zann Karlé-Schmitt 2023

The right of Zann Karlé-Schmitt to be identified as author of this work has been asserted by the author in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publishers.

Any person who commits any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages.

All of the events in this memoir are true to the best of author’s memory. The views expressed in this memoir are solely those of the author. All personal names and surnames have been changed.

A CIP catalogue record for this title is available from the British Library.

ISBN 9781035812493 (Paperback)

ISBN 9781035812509 (ePub e-book)

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I did not know other things. He often repeated this sentence. I had been his patient for a long time. Fortunately, he did not kill me. Our meetings quickly drifted away from my respiratory condition. He confided in me, lavishly. Nobody else seemed to be deeply interested in him. All is true. He repeated that as well, but he was certainly exaggerating. He liked to make up a story, to blow it up, to embellish; that was his childish side. He did not try to hide his mediocrity. He coated it a little, out of self-consciousness and out of shame. I am not sure he ever played on the piano any of the pieces he sprinkled over his memories. He led the life of an ordinary physician who dreamt of being better than he was. Was it proper and useful to pay attention to this rambling chronicle and, according to his wish, to translate it (my mother was French)? As a construction engineer by trade, I could not add any literary dimension, which he would probably have appreciated. Amiens Hospital informed me of his passing and sent his exercise books and a green notebook to my address in N, the city where he practised. What follows is a debt of trust, a blend of friendship, compassion and—an endangered feeling—pity.

Barry

People of the profession who might recognise themselves in this account, rest assured that you are beyond words.

1. Memory Jumble

I would have preferred to avoid all that, the scandal, the hatred, the stigma, but it was stronger than me. I was born a coward and a warrior, inoffensive and venomous. Aren’t we all? I had pondered this story for a long time, perhaps too long. Should it have been forgotten? It was a Sunday in autumn, a day of respite, a blank in my diary, no goal, no dream, nearly extinct. I came to a decision. The sky was clear after three days and three nights of drizzle. I was sitting in front of a steaming cup of black coffee in a bar overlooking the market place. The tarpaulins were down.

I was ending my career in a cold city in the east of England. I had already spent fifteen years in this hole. Long enough to judge the place. The general hospital, the girls, the London train and the Theatre Royal: everything was antiquated, like me.

My cup was almost empty. My memories were as clear as the blue of the sky. Had it been raining; I would not have started writing.

I was taught the arts of respiratory support in a venerable hospital in Paris, in the 20th arrondissement. After my training, I spent fifteen years roaming the wastelands of the living dead, sporting my white coat like a would-be Don Quixote in his tin can armour. During most of that time, I used to sleep well. I always managed to get back on my feet the next day until that early morning, I lost my last fight. I understood. I limped back to the locker-room, battered. I stopped all that. I accepted.

A forty-year-old woman who slogged away in a kitchen foil factory had been transferred to our unit. Within a couple of weeks, she had become more and more breathless because of a rare condition; a viscous, pearly-grey matter was flooding her lungs. In an attempt to cure her, we washed the lungs via the bronchi with a tepid saline solution. The daily procedure, under general anaesthetic, lasted about forty minutes, until we could bring back a clear, transparent liquid. Well, at the time we knew of no other treatment. One or two weeks of this management would decide the matter-it was 50/50.

Before being sedated for the first session, she whispered to me with an apprehensive smile: I hope I’ll see you again when I wake up. Except for her first name, Henriette, I cannot remember anything physically specific about her. A self-effacing woman whose passing never stopped haunting me. She died of septic shock at the end of the fifth session, at 6 am on the last day of winter. It had dropped to freezing during the night. Outside the sky was made of ice, indifferent. I was sitting on the lino opposite the bed, facing our useless machines. Her small feet were sticking out of the rumpled sheets. The pipes and wires of our devices looked like the arms of a resting octopus, sated.

Our team had worked flawlessly. Alveolar Proteinosis (the medical term for this condition) is not easily vanquished.

The nurse and the care assistant tidied the room. They prepared the dead. They combed her hair. Their sadness and their compassion imbued each gesture. I had a coffee in the nursing staff office. I phoned her husband around nine. He arrived quickly with their seven-year-old son, the same age as mine. Father and son merged into a single person. They wept silently.

Would another team have succeeded? I had heard of a centre in Oregon…I lost confidence in myself, in everything, profoundly. It was becoming much too personal.

During my training at the hôpital de Ménilmontant, as the old residents of this populous area called it, we used to work Saturdays: market day along the pavement opposite the administrative block and A&E. Rue de la Chine was almost always sunny on those days. I would often buy a slice of custard tart before going up to the department. I had three mistresses: a sister, a nurse, and an assistant nurse, a balanced representation of the Health Service. The first one brought me her exotic perfection. She carried me off to the West Indies without leaving Paris, until the day when a certain Roland, a Belgian jeweller she had met on a train, diverted her with a pair of emerald earrings. The second one, a slightly plump nurse with frog-green eyes, carried me over the roofs of the 11th arrondissement hanging from her breasts that were like two hot-air balloons. Her blonde hair was a shower of gold. The third, Michèle, was more ordinary in appearance but I was crazy about her cherry-juice. She had passed forty. I had to climb over dustbins to visit her in her tiny one-room attic flat on the corner of Rue d’Aboukir and Rue Réaumur. Her skin was sweet and sticky like the icing on a coffee profiterole. Her hair was short, black, and coarse, and she had a pointed nose. On a humid spring evening, I complained about the dinner. If you were Mickey Rourke, I’d have prepared quail with grapes for you, was her cutting reply.

On Bastille Day, it was her turn to complain about my lack of enthusiasm in bed. Saved by the growing rumbling of the fighter jets that crowned the military parade, I ripped off the sheet that was covering us, ran to the window, opened it wide and hollered in the pilots’ direction: Fly to my rescue, lads! This woman needs you! She chucked me out, but that was not the last word. She still wanted me to take her to a particular restaurant in the Stock Exchange district to eat carp. We never set foot there because I am stingy, I do not like carp and I did not like her enough.

Michèle—or Mimi, after her Bohemian lodging—was addicted to a creamy cake called ‘The Well of Love’ that you could only get in a certain pâtisserie on a seedy street. The whole of the quartier was seedy. I have forgotten the first names of the two other mistresses. My memory has not respected the Parisian Health Service hierarchy. When I was not on call, I would leave the department where I was learning so much around 9 pm. I used to walk from Place Gambetta to Place de la Nation (a couple of miles), just for the pleasure of it. I never dreamed of restaurants or of life as a couple. I was discovering my life as a man. My selfishness was limitless.

***********

At nine years old, I saw myself dying soon in the Algerian war, or from TB or polio. My first encounter with the science of medicine happened during that alarming time by virtue of an illustrated family encyclopaedia in two volumes with a dark green embossed leather binding. My mother had purchased it. She did not trust our local doctors. Two pages of the chapter on mental illness regularly commanded my attention. In a Spanish asylum, a hirsute dwarf repeatedly made drawings in pen of elaborate hearses drawn by four plumed horses. A reproduction of one fascinated me in its disturbing beauty. On the next page, a black-and-white photo of the unfortunate inmate showed a panic-stricken buffoon who inspired more pity than fright. Why was he locked up? Was he not an artist? Was medicine a conspiracy? Did mental illness exist?

Finally, I only felt comfortable barricaded in my bed, underneath a fortress of blankets, with my pocket-torch, my music-hall, my imaginary audience, and my one and only lead soldier, Henri IV. We won all our nightly duels. Sometimes, I dreamt of the dwarf. He had escaped from his monstrous doctors. We were riding one of his hearses. The horses were strawberry roans. We were roving desolate plains, at dawn. He was smiling. We were the same size. It was difficult to say who was who.

***********

My past is coming back in such a mess, like an unmade jigsaw. The rain sneaks in between the roof tiles of the bungalow. My joints groan. I must not let the season wash away my memories.

***********

A long time ago, between Christmas and New Year, I left the bosom of my old Parisian hospital with some little glory. I had been entitled to my ‘burial’. I submitted to this ritual with a mixture of joy and sadness. I had completed my training and I was proud of having won the recognition of my peers, for this ceremony was only granted to the most distinctive of the trainees.

After a shaming speech, an edifying parody of my pitiful techniques of flirtation, my quirks, and my failures, by the colleague who knew me best, a drinker but a bright doctor, deceptively distant and as observant as hell, I had to strip naked in the middle of our refectory. I felt less embarrassed at displaying myself naked than I did during the catalogue that had preceded it. A pine coffin adorned with four lighted candles awaited me, mounted on chocks. Getting stretched out in it without rocking the whole thing was another tricky and ridiculous moment awaited impatiently by the audience. The box wobbled, the chocks trembled, the candles flickered, the audience hooted louder and louder, but I installed myself without damage and was rewarded with a round of applause.

Lots of colleagues came to piss down on me, including on my face, before the procession to the ‘Court of Dishonour’ and across the wards where I had worked. A girl placed a kiss on my forehead, but I did not recognise her in the confusion. The pharmacists’ orchestra struck up and played the Danse Macabre very competently on three violins, a trumpet, a clarinet, a drum, and a pair of cymbals accompanied by a choir of the senior registrars. I was soaking in the cooling piss. I looked at the stars and was transported towards my new life. I was king. My pallbearers in white coats threw the coffin up in the air to the clash of cymbals. The mingled piss spattered me like little pieces of gold, all sorts of coins, coins of all sorts of currencies.

I was on duty the Christmas Eve preceding my wonderful ‘burial’. We had hung garlands all over the intensive care unit, even above the patients, between the drip-stands and the ventilators. Our ten beds were occupied by HIV-positive patients. The epidemic was raging. In 1986, they were all condemned. We had reduced the sedation, raised the heads of the beds. A Polish nurse, Tomasz, had brought a Paderewski record and we played it in the background. The Ménilmontant Hospital was a very musical place in my time. We circulated among the beds sketching out dance steps, we entertained our hosts with party-horns, confetti and pulling funny faces under our false moustaches and garishly coloured pointed hats. Those who were least unconscious smiled. We danced; we shared a bottle of Rosé de Provence. Tomasz turned the music down at the end of the Andante of the piano concerto. A gentle atmosphere reigned. Nobody died that Christmas Eve. At midnight, we presented each other with trinkets. At two o’clock, everything was cleared away. The intensive care unit looked like the intensive care unit again, paradoxically, because none of our hosts would pull through.

***********

And why do so many of us cling desperately to our dog’s life if the hereafter is the land of everlasting wonders, as our religions suggest? Because nobody really believes it. The arts of forced life support still have many days to go.

***********

My memories are dancing in my head. I am recalling a bit of everything at once. Which route shall I follow?

***********

Five years later, I had set up my own unit. I was living my heroic times. First of May, end of the morning: we had admitted a fellow of seventy, cachectic, his skin greenish-grey, his eyes white, he seemed dead already. I could feel a faint irregular pulse. Retired electrician, active smoker of thirty roll-ups a day, indefatigable drinker of plonk, a widower. A large left-sided pleurisy darkened half of the chest X-Ray. I insert a drain into the thorax, no sedation, minimal local anaesthesia, beneath the armpit. A stinking pus gushes out. The pasty brown fluid keeps flowing, spills over the kidney dish on the bed before I have time to connect the drain to the container on the floor. The nurse is on the verge of passing out. The stench of that fluid is hardly bearable. We try not to breathe. We tighten our stomachs. The assistant nurse opens the window as wide as possible. Her name is Juliette; a short middle-aged steely blonde with a nice figure, the strength of an elephant, the softness of a woman and the readiness always to make the right move. View over the bungalows, a few treetops and the housing estates, the sky is white and blue, the spring is glorious. Somewhere, some normal people are selling and buying lilies of the valley on street corners. It’s mid-day. The dying pensioner recovered. He returned two months later to give us a box of chocolates and a bouquet of flowers. I did not immediately recognise Amédée in his suit. He had put on six kilos. Sometimes, respiratory medicine is beautiful.

During August, in the same side-room, we treated a cor anglais player from the National Orchestra. A handsome man, with sparkling eyes: forget-me-not blue with silvery glints. He had consulted surgeon after surgeon in an effort to find a cure for his laryngeal cancer. Too much tobacco, alcohol and bad genes had destroyed this forty-four-year-old musician, one of the rare male blonds on the Plateau, the dilapidated Moorish suburb of the City of Light.

Tracheostomised, the dressing of his cannula bloodstained, the skin of his neck, burnt and hardened by radiotherapy, changed into three flaps of cardboard, his clear bright eyes simply asked: why me? On