The Case of Dr. Sachs (review)

Martin Winckler. The Case of Dr. Sachs. Translated by Linda Asher. New York: Seven Stories Press, 2000. 432 pp. Hardcover, $27.95.

"Whatever the trouble is, there is always something we can do. . . ."

These are the words of Bruno Sachs, the slight, stooped, and somewhat unkempt general practitioner whose "case" this novel is. In this particular case, the words are filtered through the memory of Monsieur Deshoulieres (p. 155), whose wife lies in bed, "stuffed with painkillers" and terminally ill. Dr. Sachs has come to the house to see her. The man recalls his wife's previous physician, who had responded to her anguished plea--"I can't stand it, it's too painful"--with dismissal; there was nothing he could do. Yet Sachs had been able to provide her with remarkable pain relief. Meanwhile, the weary Sachs, who has been up most of the night on call, seems stunned and perplexed by the older man's open expression of gratitude.

This incident takes place in number 38 of the 112 short chapters in Martin Winkler's The Case of Dr. Sachs. In fact, Sachs's case history is presented through the eyes of many different narrators--patients, colleagues, friends, and passing acquaintances--each of whom speaks in the first person, with Sachs himself appearing throughout as "he" or "you," the object, the other. Thus, the reader comes to know the "real" Dr. Sachs gradually by facets and reflections, by inference and deduction, much as we develop our understanding of, or empathy with, any new acquaintance.

Bruno Sachs is a reserved and rather solitary doctor who practices in a small French village. His life is taken up with office hours, house calls, telephone calls, night calls--indeed, this unmarried physician appears to be married to his practice. Sure, he steals a few moments to stop in the butcher shop, to phone his mother, or to read a magazine, but all in all, he has little in the way of a personal life. Nonetheless, Bruno responds to his patients in a very personal way, with respect and compassion. These are not skills he learned in medical school:

During ten years of studies, I learned to palpate, manipulate, cut, suture, bandage, set casts, take out foreign bodies with tweezers, put my fingers up or thread tubes into every possible orifice, inject, perfuse, percuss, shake, do a "good diagnosis," give nurses orders, write out an observation as per the rules of the art, and make a few prescriptions, but during all those years no one ever taught me how to relieve pain, or how to keep it from occurring. No one ever told me that I could sit by the bedside of a dying person and hold his hand and talk with him. (P. 390)

At the center of the novel is a simple love story. In addition to his private practice, Bruno Sachs works part-time at an abortion clinic, where he performs an abortion on a distraught young woman named Pauline Kasser. At a follow-up visit, Bruno finds himself attracted to Pauline and spends the better part of an hour with her, while other patients wait. Soon the doctor and his patient fall in love. She moves in with him, begins to tend his garden, and becomes pregnant. An editor by profession, Pauline also encourages and assists Sachs to complete the book he is writing.

Sexual intimacy with a patient, especially one in such a vulnerable situation, is a serious violation of professional ethics. Sachs initially makes some weak attempts to acknowledge this fact. He decides not to schedule another follow-up appointment for Pauline (thus making her less of a "patient") and later observes that "some people offer you their bodies, but you mustn't touch" (p. 197). Yet they do, in fact, touch. Thus, this good doctor finds fulfillment through what looks, at least initially, like an abuse of Hippocratic power.

But what about Bruno's writing? At another...