THE DOCTOR IN THE AGE
the hand that holds the scalpel
Dr. Lenz is received by two helpful nurses at the entrance to the operating theater. The doctor in the Age of Technique is looked upon as though he was a skillful driver. The car waits serenely for the arrival of its owner—just like a pet dog, except that machines don’t entertain themselves or sink into existential crises when their boss isn’t around. Nothing of the sort, from either extreme: machinery understands neither the playful nor the tragic, it understands direction, a certain force, a certain movement. A movement that is, as it were, intellectual, and deliberate—there is nothing in a machine that is as stupid as a dog who, with no sense of timing, salivates when there’s no food anywhere in sight, merely because it’s ill, or as an animal who limps and despite having only three available legs still tries to attack or run away. Machines are far more sensible.
Lenz is a surgeon, Dr. Lenz B., and his skill contained, concentrated in his right hand, well supported by a left hand that plays the role of specialist observer, didn’t take many years to earn its reputation. His right hand has an aura, an unscientific glimmer about it: an extra finger, as it were, an invisible finger whose touch—that final touch—can, in extreme cases, save. Dr. Lenz B. has already saved many men and many women.
In his right hand the scalpel gleams; there is a certain something extra about the combination of this medical instrument with Lenz’s hand that provokes those in attendance at any operation to keep their eyes fixed only on the area immediately surrounding them. In a situation of extreme cold, that hand, holding the scalpel, would be fire.
Some have even likened the spectacle to sessions of hypnosis: the absolute, convincing slowness of Lenz’s right hand transformed into a fairground hypnotist: all the attendant nurses and the younger doctors focus their worthier instincts of observation and hold their breaths, as though watching the climax of a film. Lenz’s wrist holds steady as though supported by a length of metal rather than an arm. All that moves are the fingers; the scalpel an instrument able to affect us far more deeply than a musical instrument: whatever feelings of tragedy or celebration are born from this instrument are acute in the extreme. Precise and profound, this right hand, with its scalpel, expressed the various degrees of intensity one could have, in the world: here, music really could kill or save. The scalpel came into contact with the body and went right into it, it didn’t circle it, or edge around it.
“We’re not dealing with feelings here,” Lenz said once, “we’re dealing with veins and arteries, with vessels that have broken and which we must repair, with swellings that release substances that seem—though they have come from within—that seem nonetheless to be alien to the body.”
Inside a body, the scalpel sought to reinstate lost order. It brought back laws: knowing the cause, the effects could be guessed at; it was a matter—and Lenz would sometimes say this—of installing a new monarchy; the scalpel proclaimed a new Kingdom: it repaired the organism’s roads, straightened up whatever ruins needed straightening up, or, on the contrary, knocked down once and for all anything that was still standing but that had lost its foundations, and through this knocking-down constructed a new horizontal plane; if everything had been knocked down and nothing could be raised up again, then we would come to accept this new state of being: “We would lie down, and observe,” said Lenz.
In turn, illness was clearly a form of cellular anarchy, a disorder, an internal disrespect for the rules that some people even call divine, as they preceded any human arrangement. A body is not a city. There may have been a pre-existing map, but humans were not given the privilege of examining it and suggesting amendments.
Of course, a new world was beginning now. A more powerful action would bring the Gods down; the gleam of things was already the only gleam in things, a bonfire cast light thanks to its concrete matter alone, the divine was no longer an element that illuminates even further, it was simply another thing, beyond the opposition between dark and light. Electricity, Lenz used to say, had made certain assumptions about the divine ridiculous. It is impossible to feel fear and respect toward something that could be mistaken for nothing more than a powerful electrical discharge.
explosion and precision
The most amazing thing about Lenz’s operations was that at a certain moment the scalpel, and even his right hand, seemed to dissolve into the body of the patient being operated on. The scalpel entered the body like a dagger, and seemed to be seeking something far more amazing than just a particular artery; the scalpel marked the first point of attack; an attack that, in this case, aimed to save the one being attacked.
Lenz occasionally had a feeling that was almost magical, soberly irrational—he saw his scalpel searching not for some poorly functioning artery or vessel but for something less material, more (the word does apply) spiritual. As though his scalpel were even able to detect the patient’s individual guilt, a guilt that wasn’t necessarily moral but which was certainly organic. A sick organism seemed to Lenz materially guilty; he had constructed, in his mind, a morality of tissues, a morality composed of black cells or white cells, burned cells or intact ones, and in this context immorality was simply a failure to function.
In not many years’ practice, Lenz had learned that, in medicine, two opposing, equally astonishing technical forces struggled for dominance: explosion and precision. The two extremes were each other’s adversaries. His scalpel, it was quite clear, was the messenger of precision and rightness. The sick organism, or a part of it, had blundered down a cul-de-sac, and with its strength the scalpel would provide material aid in reminding it which was the correct track, which the main road.
Which was why Lenz always found it strange when surgical interventions were the result of an explosion—as had happened in a factory some months earlier. A machine whose insides were in a state of disorder had exploded and this had provoked a similar state of disorder on the insides of an individual. Lenz had managed to save the man’s life, and during the operation had felt with unusual intensity the struggle between the two extremes of medical technique: his scalpel embodying precision, morality, the legality that this facet of technique both establishes and requires, and, on the other hand, on the sick man’s side, there were the clear results of an explosion likewise provoked by technique; the explosion that instantly establishes disorder—whether on a large scale (a battlefield of soldiers) or a personal one—and cellular panic, which is simply the temporary establishment of a marked immorality: there isn’t a single straight line left in a body that has just experienced the effects of an explosion. A bomb, deep down, from a schematic point of view—just as a photocopier is a machine designed to produce photocopies—is simply a machine designed to explode.
Lenz’s scalpel was therefore the material voice of human ethics, and a bomb the material voice of perversion and the deregulation of habits. However, the two opposing sides were made of exactly the same substance. They were sons, not of the same God, but of the same man, which Lenz found fascinating.
And just as he found these two worlds fascinating, Lenz never forgot, when he was operating on someone, that the slightest diversion of his scalpel, through accident or error, could lead to the death of the organism being operated upon.
When his right hand—exact and magical—was acting, the decision to go left or to go right was not simply a question of traffic, it didn’t mean progressing via a shorter or longer route. It was, rather, a matter of living or not living, of remaining alive or not. It wasn’t the length of the journey, the time that this or that path took. A wrong decision on the scalpel’s part—turning left when you ought to have turned right—wasn’t equivalent to some minor annoyance provoked by a delay due to a poor choice while navigating the space of the city. No, a diversion of a few millimeters on the part of his right hand could take a body to one of two opposing worlds: the world of a living body—albeit a sick one, or one with its capabilities diminished—or the world of a corpse, which is something else entirely.
As he steered his scalpel, Lenz saw the operation as he might see a stereo—something that could be turned off or kept on, depending on his decision. To the right—always to the right, a straight line, the side where the Lord (Lenz joked) had placed moral men—moving to the right kept the human system switched on, while turning left—the side of the devil or of those movements we do not understand—turned off the system, cut off the electricity. And it was Lenz who was in charge of the crucial switch.
competence is not determined by the heart
Up to that point he had always gone the right way, but each time he took up his scalpel for another operation Dr. Lenz Buchmann couldn’t stop himself thinking about that other possibility, which yet again he had available to him: he could turn the switch in the wrong direction, deliberately turning the mechanism off. And however much it shocked him—as his profession was the one moral stronghold he still maintained in a life he knew to be utterly disordered—in spite of this, Lenz always felt attracted to the second possibility, to the negative path he would never choose to take.
Yes, his profession would always be protected from his unvarying refusal to have any truck with virtue: he was alive, he was strong and rich; he only toyed with virtue out of playfulness, for pleasure, never out of necessity. When he operated, however, he was transformed into a respecter of the laws of the city and of all generally-held convictions about good and evil. He accepted them just like a soldier, an animal that had learned its lesson well. And that was why he saved the sick men he operated on: his scalpel fought against the forces of explosion and re-established precision and order. He felt worthy because his right hand was “in combat” (when he operated), and his hand was worthy too. But with each day that passed, the praise and the admiration of technique that his patients, his medical colleagues, and the hospital staff directed at him became intolerable. He didn’t mind being considered competent, but that this competence should be confused with a sort of goodness—a sentiment he utterly despised—was unacceptable. And their confusion—unable to see the difference between goodness and technical competence—began to erode the barrier Lenz had built between his profession and his private life, in which the total dissolution of moral values was absolutely obvious. The pleasure he took in humiliating prostitutes, weak women, adolescents, beggars who knocked on his door, even his own wife, couldn’t stand in starker contrast to the holy aura with which some of the relatives of the sick people he’d operated on had enveloped him.
This was why, on that afternoon, when that ingenuous woman, thanking him for having operated successfully on her mother, said to him,
“You’re a good man!”
he felt the need (right there in front of the hospital staff) to reply, roughly,
“Sorry, I’m nothing of the sort. I’m a doctor.”