Summer House with Swimming Pool: A Novel

ALSO BY HERMAN KOCH

The Dinner

I am a doctor. My office hours are from eight-thirty in the morning to one in the afternoon. I take my time. Twenty minutes for each patient. Those twenty minutes are my unique selling point. Where else these days, people say, can you find a family doctor who gives you twenty minutes?—and they pass it along. He doesn’t take on too many patients, they say. He makes time for each individual case. I have a waiting list. When a patient dies or moves away, all I have to do is pick up the phone and I have five new ones to take their place.

Patients can’t tell the difference between time and attention. They think I give them more attention than other doctors. But all I give them is more time. By the end of the first sixty seconds I’ve seen all I need to know. The remaining nineteen minutes I fill with attention. Or, I should say, with the illusion of attention. I ask all the usual questions. How is your son/daughter getting along? Are you sleeping better these days?
Are you sure you’re not getting too much/too little to eat? I hold the stethoscope to their chests, then to their backs. Take a deep breath, I say. Now breathe out nice and slow. I don’t really listen. Or at least I try not to. On the inside, all human bodies sound the same. First of all, of course, there’s the heartbeat. The heart is blind. The heart pumps. The heart is the engine room. The engine room only keeps the ship going, it doesn’t keep it on course. And then there are the sounds of the intestines. Of the vital organs. An overburdened liver sounds different from a healthy one. An overburdened liver groans. It groans and begs. It begs for a day off. A day to deal with the worst of the garbage. The way things are now, it’s always in a hurry, trying to catch up with itself. The overburdened liver is like the kitchen in a restaurant that’s open around the clock. The dishes pile up. The dishwashers are working full tilt. But the dirty dishes and caked-on pans only pile up higher and higher. The overburdened liver hopes for that one day off that never comes. Every afternoon at four-thirty, five o’clock (sometimes earlier), the hope of that one day off is dashed again. If the liver’s lucky, at first it’s only beer. Beer passes most of the work along to the kidneys. But you always have those for whom beer alone isn’t enough. They order something on the side: a shot of gin, vodka, or whisky. Something they can knock back. The overburdened liver braces itself, then finally ruptures. First it grows rigid, like an overinflated tire. All it takes then is one little bump in the road for it to blow wide open.

I listen with my stethoscope. I press against the hard spot, just beneath the skin. Does this hurt? If I press any harder, it will burst open right there in my office. Can’t have that. It makes an incredible mess. Blood gushes out in a huge wave. No general practitioner is keen to have someone die in his
office. At home, that’s a different story. In the privacy of their own homes, in the middle of the night, in their own beds. With a ruptured liver, they usually don’t even make it to the phone. The ambulance would get there too late, anyway.

My patients file into my practice at twenty-minute intervals. The office is on the ground floor of my home. They come in on crutches and in wheelchairs. Some of them are too fat, others are short of breath. They are, in any case, no longer able to climb stairs. One flight of stairs would kill them for sure. Others only imagine it would: that their final hour would sound on the first step. Most of the patients are like that. Most of them have nothing wrong with them. They moan and groan, make noises that would make you think they found death staring them in the face every moment of the day, they sink into the chair across from my desk with a sigh—but there’s nothing wrong with them. I let them reel off their complaints. It hurts here, and here; sometimes it spasms down to here … I do my best to act interested. Meanwhile, I doodle on a scrap of paper. I ask them to get up, to follow me to the examination room. Occasionally I’ll ask someone to undress behind the screen, but most of the time I don’t. Human bodies are horrible enough as it is, even with their clothes on. I don’t want to see them, those parts where the sun never shines. Not the folds of fat in which it is always too warm and the bacteria have free rein, not the fungal growths and infections between the toes, beneath the nails, not the fingers that scratch here, the fingers that rub there until it starts to bleed … Here, Doctor, here’s where it itches really badly … No, I don’t want to see. I pretend to look, but I’m thinking about something else. About a roller coaster in an amusement park. The car at the front has a green dragon’s head mounted on it. The people throw their hands in
the air and scream their lungs out. From the corner of my eye I see moist tufts of pubic hair, or red, infected bald spots where no hair will ever grow again, and I think about a plane exploding in the air. The passengers still belted to their seats as they begin a mile-long tumble into eternity: It’s cold, the air is thin, far below the ocean awaits. It burns when I pee, Doctor. Like there are needles coming out … A train explodes just before it enters the station. The space shuttle
Columbia
shatters into millions of little pieces. The second jet slams into the South Tower. It burns, here, Doctor. Here …

You can get dressed now, I say. I’ve seen enough. I’ll write you a prescription. Some of the patients can barely conceal their disappointment: a prescription? They stand there for a few seconds, staring blankly, their underwear down around their knees. They took a morning off from work, and now they want value for their money, even if that money has actually been coughed up by the community of the healthy. They want the doctor to poke at them at least; they want him to pull on his rubber gloves and take something—some body part—between his knowing fingers. For him to stick at least
one
finger into something. They want to be
examined
. They aren’t content only with his years of experience, his clinical gaze that registers at a single glance what’s wrong with a person. Because he’s seen it all 100,000 times before. Because experience tells him that there’s no need on occasion 100,001 to suddenly pull the rubber gloves on.

Sometimes, though, there’s no getting around it. Sometimes you have to get in there. Usually with one or two fingers, sometimes with your whole hand. I pull on my rubber gloves. If you would just roll onto your side … For the patient, this is the point of no return. Finally, he is being taken seriously,
he is about to receive an internal examination, but his gaze is no longer fixed on my face. All he can look at now are my hands. My hands as they pull on the rubber gloves. He wonders why he ever let things get this far. Whether this is really what he wants. Before putting on the gloves, I wash my hands. The sink is across from the exam table, so I stand with my back to him as I soap up. I take my time. I roll up my sleeves. I can feel the patient’s eyes at my back. I let the tap water flow over my wrists. First I wash my hands thoroughly, then my lower arms, all the way up to the elbows. The sound of running water blocks out all other sounds, but I know that once I’ve reached the elbows, the patient’s breathing has quickened. It quickens for a few seconds, or stops altogether. An internal examination is about to take place. The patient—consciously or unconsciously—has insisted on this. He had no intention of letting himself be fobbed off with a prescription, not this time. Meanwhile, though, the doubts arise. Why is the doctor washing and disinfecting his hands and arms
all the way up to the elbows
? Something in the patient’s body contracts. Even though what he should be doing is relaxing as much as possible. Relaxation is the key to a smooth internal examination.

Meanwhile, I have turned around and am drying my hands, my forearms,
my elbows
. Still without looking at the patient, I take a pair of plastic-packed gloves from a drawer. I tear open the bag, press the pedal of the trash can with my foot, and throw the bag away. Only now, as I pull on the gloves, do I look at the patient. The look in his eyes is—how shall I put it—
different
from what it was before I started washing my hands. Lie down on your side, I say, before he has a chance to express his misgivings. Facing the wall. A naked body is less disgraceful than a body with pants and underwear down around
its ankles. Less helpless. Two legs with the shoes and socks still on, and bound together at the ankles by pants and underwear. Like a prisoner in a chain gang. A person with his pants around his ankles can’t run away. You can submit someone like that to an internal examination, but you could also punch him right in the side of the head. Or take a pistol and empty the clip into the ceiling. I’ve listened to these fucking lies long enough! I’m going to count to three … One … two … Try to relax, I say again. Turn on your side. I pull the rubber gloves tighter over my fingers and farther over my wrists. The sound of snapping rubber always reminds me of party balloons. Balloons for a birthday party. You blew them up last night in order to surprise the birthday boy. This may be a little unpleasant, I say. The important thing is to just keep breathing calmly. The patient is all too aware of my presence, right behind his half-naked body, but he can’t see me anymore. This is the moment when I take time to submit that body, or at least the naked part of it, to a further look.