When Nietzsche Wept by Irvin D. Yalom
“What next?” Breuer shivered. The cold was seeping into his marrow. However irritating Herr Schlegel was, Breuer nonetheless liked hearing that others had found Nietzsche difficult.
“I offered to get a doctor, but he got very agitated at that! You should have seen him. ‘No! No! No doctors! They only make things worse! No doctors!’ He wasn’t exactly rude—he never is, you know—just frosty! Always well mannered. You can see he’s well born. Good private school, I’d bet. Travels in good circles. At first I couldn’t figure out why he didn’t stay at a more expensive hotel. But I checked his clothes—you can tell a lot from clothes, you know—good labels, good cloth, well tailored, good Italian leather shoes. But everything, even underclothing, is well worn, very well worn, often mended, and jackets haven’t been that length in ten years. I said to my wife yesterday that he’s a poor aristocrat with no idea of how to get along in today’s world. Earlier in the week I took the liberty of asking him about the origin of the name Nietzsche, and he mumbled something about old Polish nobility.”
“What happened then, after he refused a doctor?”
“He continued to insist he’d be all right if he were left alone. In his well-mannered way, he got the message across I should mind my own damn business. He’s the silent-suffering type—or he’s got something to hide. And stubborn! If he hadn’t been so stubborn, I could have summoned you yesterday, before the snow started, and not have to get you up at this hour.”
“What else did you notice?”
Herr Schlegel brightened at the question. “Well, for one thing he refused to leave a forwarding address, and the previous address was suspicious: General Delivery, Rapallo, Italy. I’ve never heard of Rapallo, and when I asked where it was, he just said, ‘On the coast.’ Naturally the police must be notified: his secrecy, sneaking about with no umbrella, no address, and that letter—Russian trouble, deportation, the police. Naturally, I searched for the letter when we cleaned his room, but I never found it. Burned it, I think, or hidden it.”
“You haven’t called in the police?” Breuer asked anxiously.
“Not yet. Best wait for daybreak. Bad for business. Don’t want the police disturbing my other clients in the middle of the night. And, then, on top of everything else, he gets this sudden illness! You want to know what I think? Poison!”
“Good God, no!” Breuer almost shouted. “No, I’m sure not. Please, Herr Schlegel, forget about the police! I assure you, there’s nothing to be concerned about. I know this man. I’ll speak for him. He is not a spy. He is exactly what the card says, a university professor. And he does have these headaches often; that’s why he came to see me. Please relax your suspicions.”
In the flickering light of the fiacre’s candle, Breuer could see that Herr Schlegel was not relaxing, and added, “However, I can understand how an acute observer could reach that conclusion. But trust me on this matter. The responsibility will be mine.” He tried to get the innkeeper back to Nietzsche’s illness. “Tell me, after you saw him in the afternoon, what else happened?”
“I check back twice more to see if he needs anything—you know, tea or something to eat. Each time he thanks me and refuses, not even turning his head. He seemed weak, and his face was pale.”
Herr Schlegel paused for a minute, then—unable to stop himself from commentary—added, “No gratitude at all for my or my Frau’s looking in on him—he’s not a warm person, you know. He actually seemed annoyed at our kindness. We help him, and he gets annoyed! That didn’t sit well with my Frau. She got annoyed back and won’t have anything more to do with him—she wants him out tomorrow.”
Ignoring his complaint, Breuer asked, “What happened next?”
“The next time I saw him was about three in the morning. Herr Spitz, the guest in the room next to him, was awakened—the noise of furniture being knocked over, he said, then moaning, even screaming. Getting no response to his knock and finding the door locked, Herr Spitz woke me up. He’s a timid soul and kept apologizing for waking me. But he did the right thing. I told him that immediately.
“The professor had locked the door from inside. I had to break the lock—and I have to insist on his paying for a new one. When I entered, I found him unconscious, moaning and lying in his underwear on the bare mattress. All his clothes and all the bed coverings had been thrown about. My guess is he hadn’t moved from the bed but had undressed and thrown everything on the floor—nothing was more than two or three feet from the bed. It was out of character for him, all out of character, Doctor. He’s usually a tidy man. The Frau was shocked at the mess—vomit everywhere, it’ll take a week before the room is rentable, before the stink clears out. He should, by rights, pay for that week. And bloodstains on the sheet, too—I rolled him over and looked, but no wound—the blood must have been in the vomit.”
Herr Schlegel shook his head. “That’s when I searched his pockets, found your address, and came to get you. My wife said to wait for dawn, but I thought he might die by then. I don’t have to tell you what that means—undertaker, formal inquest, the police around all day. I’ve seen it many times—the other guests will clear out in twenty-four hours. In my brother-in-law’s Gasthaus in the Schwarzwald, two guests died in one week. Do you know that, ten years later, people still refuse to take those death rooms? And he’s completely redone them—curtains, paint, wallpaper. And people avoid them still. Word just gets around, the villagers talk, they never forget.”
Herr Schlegel put his head out the window, looked around, and shouted to Fischmann: “Right turn—coming up, next block!” He turned back to Breuer. “Here we are! Next building, Doctor!”
Telling Fischmann to wait, Breuer followed Herr Schlegel into the Gasthaus and up four narrow flights of stairs. The stark landscape of the stairwells bore witness to Nietzsche’s claim of being concerned only about sheer subsistence: Spartan clean; a threadbare carpet runner, with a different faded pattern on each flight; no bannisters; no furniture on the landings. Recently whitewashed walls softened by neither picture nor ornament—not even an official certificate of inspection.
Breathing hard from the climb, Breuer followed Herr Schlegel into Nietzsche’s room. He took a moment to accommodate to the lush, acrid-sweet smell of vomit, then quickly scanned the scene. It was as Herr Schlegel had described. In fact, precisely so—the innkeeper not only being an accurate observer, but also having left everything untouched so as not to disturb some precious clue.
On a small bed in one corner of the room lay Nietzsche, clad only in his underwear, deeply asleep, perhaps in coma. Certainly he didn’t stir in response to the sounds of their entering the room. Breuer gave Herr Schlegel leave to collect Nietzsche’s strewn clothes and vomit-soaked and bloodstained bedsheets.
Once they were gone, the brutal bareness of the room emerged. It was not unlike a prison cell, Breuer thought: along one wall was a flimsy wooden table on which rested only a lantern and a half-filled water pitcher. Before the table stood a straight wooden chair, and under the table sat Nietzsche’s suitcase and briefcase—both wrapped with a light chain and padlocked. Over the bed was a small grimy window with pathetic, faded and streaked yellow curtains, the room’s sole concession to aesthetics.
Breuer asked to be left alone with his patient. His curiosity being stronger than his fatigue, Herr Schlegel protested, then acquiesced when Breuer reminded him of his obligations to his other guests: to be a good host, he would have to salvage some sleep.
Once alone, Breuer turned up the gaslight and surveyed the scene more carefully. The enamel basin on the floor next to the bed was half filled with blood-tinged, light green vomitus. The mattress and Nietzsche’s face and chest glistened with drying vomitus—no doubt he had become too ill, or too stuporous, to reach for the basin. Next to the basin was a glass half filled with water, and next to that a small bottle three quarters filled with large oval tablets. Breuer inspected and then tasted a tablet. Most likely chloral hydrate—that would account for his stupor; but he couldn’t be
Nietzsche looked moribund: face gray; eyes shrunken; his entire body cold, pallid, and pockmarked with goose pimples. His breathing was labored, and his pulse feeble and racing at one hundred fifty-six per minute. Now Nietzsche shivered, but when Breuer tried to cover him with one of the blankets Frau Schlegel had left, he moaned and kicked it away. Probably extreme hyperesthesia, Breuer thought: everything feels painful to him, even the merest touch of a blanket.
“Professor Nietzsche, Professor Nietzsche,” he called. No response. Nor did Nietzsche stir when he, more loudly, called, “Friedrich, Friedrich.” Then, “Fritz, Fritz.” Nietzsche flinched at the sound, and flinched yet again as Breuer tried to lift his eyelids. Hyperesthesia even to sound and light, Breuer noted, and rose to turn the light down and the gas heater up.
Closer inspection confirmed Breuer’s diagnosis of bilateral spastic migraine: Nietzsche’s face, especially his forehead and ears, was cool and pale; his pupils were dilated; and both temporal arteries were so constricted they felt like two slender frozen cords in his temple.
Breuer’s first concern, however, was not the migraine but the life-threatening tachycardia; and he proceeded, despite Nietzsche’s thrashing, to apply firm thumb pressure to the left carotid artery. In less than a minute, his patient’s pulse slowed to eighty. After closely observing his cardiac status for about fifteen minutes, Breuer felt satisfied and turned his attention to the migraine.
Reaching into his medical bag for nitroglycerine troches, he asked Nietzsche to open his mouth, but got no response. When he tried to pry open his mouth, Nietzsche clenched his teeth so hard that Breuer abandoned the effort. Perhaps amyl nitrate will do it, Breuer thought. He poured four drops on a cloth and held it under Nietzsche’s nose. Nietzsche took a breath, flinched, and turned away. Resistive to the end, even in unconsciousness, thought Breuer.
He placed both hands on Nietzsche’s temples and began, lightly at first and then with gradual increasing pressure, to massage his entire head and neck. He concentrated particularly on those areas that seemed, from his patient’s reactions, to be most tender. As he proceeded, Nietzsche screamed and frantically shook his head. But Breuer persisted and calmly held his position, all the while whispering gently in his ear, “Take the pain, Fritz, take the pain—this will help.” Nietzsche thrashed less, but continued to moan—deep, agonized, guttural “Noooos.”
Ten, fifteen minutes passed. Breuer continued to massage. After twenty minutes, the moans softened and then became inaudible, but Nietzsche’s lips were working, muttering something inaudible. Breuer bent his ear to Nietzsche’s mouth but still could not make out the words. Was it “Leave me, leave me, leave me”? Or perhaps “Let me, let me”? He couldn’t be certain.
Thirty, thirty-five minutes passed. Breuer continued to massage. Nietzsche’s face felt warmer, and his color was returning. Perhaps the spasm was ending. Even though he was still stuporous, Nietzsche seemed to be resting easier. The mumbling continued, a little louder, a little clearer. Again, Breuer bent his ear close to Nietzsche’s lips. He could distinguish the words now, though at first doubted his ears. Nietzsche was saying, “Help me, help me, help me, help me!”
A wave of compassion swept over Breuer. “Help me!” So, he thought, all along that’s what he’s been asking of me. Lou Salomé was wrong: her friend is capable of asking for help, but this is another Nietzsche, one I am meeting for the first time.
Breuer rested his hands and paced for a few minutes around Nietzsche’s small cell. Then he soaked a towel in the cool water in the pitcher, placed the compress to his sleeping patient’s brow, and whispered, “Yes, I will help you, Fritz. Count on me.”
Nietzsche winced. Perhaps touch is still painful, Breuer thought, but held the compress in place nonetheless. Nietzsche opened his eyes slightly, looked at Breuer, and raised his hand to his brow. Perhaps he intended simply to remove the compress, but his hand approached Breuer’s and for a moment, just for a moment, their hands touched.
Another hour passed. Daylight was breaking, almost seven thirty. Nietzsche’s condition seemed stable. There was little more to be done at this time, Breuer thought. It was best now to attend to his other patients and return later when Nietzsche had slept off the chloral. After covering his patient with a light blanket, Breuer wrote a note saying he would return before noon, moved a chair next to the bed, and left the note on the chair in plain view. Descending the stairs, he directed Herr Schlegel, who was at his post at the front desk, to look in on Nietzsche every thirty minutes. Breuer woke Fischmann, who had been napping on a stool in the vestibule, and together they went out into the snowy morning to begin their round of house calls.
When he returned four hours later, he was greeted by Herr Schlegel, sitting at his post at the front desk. No, there had been no new developments: Nietzsche had been sleeping continuously. Yes, he seemed more comfortable, and he had behaved better—an occasional moan, but no screaming, thrashing, or vomiting.
Nietzsche’s eyelids fluttered when Breuer entered his room, but he continued to sleep deeply even when Breuer addressed him. “Professor Nietzsche, can you hear me?” No response. “Fritz,” Breuer called. He knew he was justified in addressing his patient informally—often stuporous patients will respond to younger, earlier names—but he still felt guilty, knowing he was also doing it for himself: he enjoyed calling Nietzsche by the familiar “Fritz.” “Fritz! Breuer here. Can you hear me? Can you open your eyes?”
Almost immediately, Nietzsche’s eyes opened. Did they contain a look of reproach? Breuer reverted at once to formal address.
“Professor Nietzsche. Back among the living, I am pleased to see. How do you feel?”
“Not pleased”—Nietzsche’s voice was soft, and his words slurred—“to be living. Not pleased. No fear of darkness. Awful, feel awful.”
Breuer put his hand on Nietzsche’s brow, partly to feel his temperature, but also to offer comfort. Nietzsche recoiled, jerking his head back several inches. Perhaps he still has hyperesthesia, Breuer thought. But later, when he made a cold compress and held it to Nietzsche’s brow, the latter, in a weak, weary voice, said, “I can do that,” and, taking the compress from Breuer, comforted himself.
The rest of Breuer’s examination was encouraging: his patient’s pulse was now seventy-six, his complexion was ruddier, and the temporal arteries were no longer in spasm.
“My skull feels shattered,” Nietzsche said. “My pain has changed—no longer sharp, more now like a deep, aching brain bruise.”
Though his nausea was still too extreme for him to swallow medication, he was now able to accept the nitroglycerine troche Breuer placed under his tongue.
Over the next hour, Breuer sat and conversed with his patient, who gradually grew more responsive.
“I was concerned about you. You might have died. That much chloral is more poison than cure. You need a drug that will either attack the headache at its source or attenuate the pain. Chloral does neither—it’s a sedative, and to render yourself unconscious in the face of that much pain requires a dose that might well be fatal. It almost was, you know. And your pulse was dangerously irregular.”
Nietzsche shook his head. “I don’t share your concern.”
“Meaning——?”
“About outcome,” Nietzsche whispered.
“About it’s being fatal, you mean?”
“No, about anything—about anything.??
Nietzsche’s voice was almost plaintive. Breuer gentled his voice as well.
“Were you hoping to die?”
“Am I living? Dying? Who cares? No slot. No slot.”
“What do you mean?” Breuer asked. “That there’s no slot, or place, for you? That you’d not be missed? That no one would care?”
A long silence. The two men remained together quietly, and soon Nietzsche was breathing deeply as he lapsed back into sleep. Breuer watched him for another few minutes, then left a note on the chair saying he would return later that afternoon or early evening. Once again, he instructed Herr Schlegel to check on his patient frequently, but not to bother offering food—perhaps hot water, but the professor would not be able to stomach anything solid for another day.
When he returned at seven o’clock, Breuer shuddered as he entered Nietzsche’s room. The plaintive light of a single candle cast flickering shadows on the walls and revealed his patient lying in the darkness, eyes closed, hands folded on his chest, fully dressed in his black suit and heavy black shoes. Was this, Breuer wondered, a prevision of Nietzsche lying in state, alone and unmourned?
But he was neither dead nor asleep. He quickened at the sound of Breuer’s voice and, with effort and in obvious pain, raised himself to a sitting position, with his head in his hands and his legs hanging over the side of the bed. He motioned to Breuer to seat himself.
“How are you feeling now?”
“My head is still squeezed by a steel vise. My stomach hopes it will never again encounter food. My neck and back—here”—Nietzsche pointed to the back of his neck and to the upper margins of his scapulae—“ are excruciatingly tender. Aside from these things, however, I feel dreadful.”
Breuer was slow to smile. Nietzsche’s unexpected irony caught up with him only a minute later, when he noticed his patient’s grin.