فصل 11

CHAPTER 11

BREUER, LAY IN BED that night still thinking about the queen’s gambit and Max’s commentary on beautiful women and tired men. His troubled feelings about Nietzsche had diminished. Somehow the talk with Max had helped. Perhaps, all these years, he had underestimated Max. Now Mathilde, returning from the children, climbed into bed, moved close to him, and whispered, “Good night, Josef.” He pretended to be asleep.

Rap! Rap! Rap! A pounding on the front door. Breuer looked at the clock. Four forty-five. He roused himself quickly—he never slept deeply—grabbed his robe, and started down the hall. Louis came out of her room, but he waved her back. As long as he was awake, he would answer the door.

The Portier, apologizing for waking him, said there was a man outside who wanted him for an emergency. Downstairs Breuer found an elderly man standing in the vestibule. He wore no hat and had obviously walked a long way—his breath came quickly, his hair was covered with snow, and the mucus leaking from his nose had frozen his thick mustache into a great icy broom.

“Doctor Breuer?” he asked, his voice trembling with agitation.

At Breuer’s nod, he introduced himself as Herr Schlegel, bowing his head and touching the fingers of his right hand to his forehead in an atavistic remnant of what undoubtedly had been, in better times, a smart salute. “A patient of yours in my Gasthaus is sick, very sick,” he said. “He cannot talk, but I found this card in his pocket.” Examining the formal card Herr Schlegel handed him, Breuer found his own name and address written on one side and on the reverse:

PROFESSOR FRIEDRICH NIETZSCHE

Professor of Philology

University of Basel

His decision was instantaneous. He gave Herr Schlegel explicit instructions for fetching Fischmann and the fiacre. “And when you get back here, I’ll be dressed. You can tell me about my patient on the way to the Gasthaus.”

Twenty minutes later, Herr Schlegel and Breuer were wrapped in blankets and being driven through the cold, snowy streets. The innkeeper explained that Professor Nietzsche had been at the Gasthaus since the beginning of the week. “A very good guest. Never any problems.”

“Tell me about his sickness.”

“All week he spends most days in his room. I don’t know what he does up there. Whenever I bring his tea in the morning he’s sitting at his table scribbling. That puzzled me because, you know, I’d found out he can’t see well enough to read. Two or three days ago, a letter came for him postmarked Basel. I took it up to him, and a few minutes later he came downstairs squinting and blinking. He said he was having some eye trouble and asked if I’d read it to him. Said it was from his sister. I started, but after the first couple of lines—something about a Russian scandal—he seemed upset and asked for it back. I tried to catch a glimpse of the rest before handing it over but had time only to see the words ‘deportation’ and ‘police.’ “He takes his meals out, though my wife offered to cook for him. I don’t know where he eats—he didn’t ask me for advice. He scarcely talked, though one night he said he was going to a free concert. But he wasn’t shy, that’s not why he was quiet. I observed several things about his quietness———” The innkeeper, who had once served ten years in military intelligence, missed his old trade and amused himself by regarding his guests as mysteries and attempting to construct a character profile from small housekeeping details. On his long walk to Breuer’s home, he had gathered together all his clues about Professor Nietzsche and rehearsed his presentation to the doctor. It was a rare opportunity: ordinarily he had no suitable audience, his wife and the other Gasthaus owners being too lumpish to appreciate real inductive skill.

But the doctor interrupted him. “His sickness, Herr Schlegel?”

“Yes, yes, Doctor.” And swallowing his disappointment, Herr Schlegel reported how around nine on Friday morning Nietzsche had paid his bill and gone out, saying he would be leaving that afternoon and would come back before noon to collect his baggage. “I must have been away from my desk for a bit because I didn’t see him come back. He walks very softly, you know, as if he doesn’t want to be followed. And he doesn’t use an umbrella, so I can’t tell from the downstairs umbrella stand if he’s in or not. I don’t think he wants anyone to know where he is, when he’s in, when he’s out. He’s good, he is—suspiciously good—at getting in and out without attracting notice.” “And his sickness?”

“Yes, yes, Doctor. I only thought some of these points might be important for diagnosis. Well, later in the afternoon, around three o’clock, my Frau, like always, went in to clean his room, and there he was—he hadn’t left on the train at all! He was stretched out on his bed moaning, his hand on his head. She called me, and I told her to replace me at the desk—I never leave it unguarded. That’s why, you see my point, I was surprised that he got back into the room without my seeing him.” “And then?” Breuer was impatient now—Herr Schlegel had, he decided, read one too many pulp mystery stories. Yet there was still plenty of time to indulge his companion’s obvious wish to tell all he knew. The Gasthaus in the third, or Landstrasse, district was still a mile or so ahead, and in the thickening snow visibility was so poor that Fischmann had climbed down and was now walking his horse slowly through the frozen streets.

“I went into his room and asked if he was sick. He said he wasn’t feeling well, a little headache—he’d pay for another day and leave tomorrow. He told me he often had headaches like this, and it was best if he didn’t talk or move. Nothing to be done, he said, but wait it out. He was quite frosty—he usually is, you know, but today more so, icy. No doubt about it, he wanted to be left alone.” “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 certain because he did not know when Nietzsche had taken the tablets. Had he time to absorb them into his bloodstream before he vomited all the contents of his stomach? Calculating the number of tablets missing from the jar, Breuer rapidly concluded that even had Nietzsche taken all the tablets that evening, and his stomach absorbed all the chloral, he had consumed a dangerous, but not lethal, dose. Had it been larger, Breuer knew there was little he could have done: gastric lavage was pointless, since Nietzsche’s stomach was now empty, and he was far too stuporous—and probably too nauseated—to ingest any stimulant Breuer might give him.

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.

“But at least I am in familiar waters. I have visited this pain many times before.”

“This was a typical attack, then?”

“Typical? Typical? Let me think. For sheer intensity, I’d say this was a strong attack. Of my last hundred attacks, perhaps only fifteen or twenty were more severe. Still, there were many worse attacks.”

“How so?”

“They lasted much longer, the pain often continuing for two days. That’s rare, I know, as other doctors have said.”

“How do you explain the brevity of this one?” Breuer was fishing, trying to discover how much of the last sixteen hours Nietzsche remembered.

“We both know the answer to that question, Doctor Breuer. I am grateful to you. I know I’d still be writhing in pain on this bed if not for you. I wish there were some meaningful way I could repay you. That failing, we must rely on the currency of the realm. My feelings about debts and payment are unchanged, and I expect a bill from you commensurate with the time you have devoted to me. According to Herr Schlegel’s account—which does not suffer from lack of precision—the bill should be considerable.” Though dismayed to hear Nietzsche return to his formal, distancing voice, Breuer said he would instruct Frau Becker to prepare the bill on Monday.

But Nietzsche shook his head. “Ach, I forgot your office is not open on Sunday, but tomorrow I plan to take the train to Basel. Is there no way we can settle my account now?”

“To Basel? Tomorrow! Surely not, Professor Nietzsche, not till this crisis is over. Despite our disagreements this past week, allow me now to function properly as your physician. Only a few hours ago, you were comatose and in a dangerous heart arrhythmia. It is more than unwise for you to travel tomorrow, it is perilous. And there’s another factor: many migraines may recur immediately if sufficient rest is not taken. Surely you have made that observation.” Nietzsche was silent for a moment, obviously thinking over Breuer’s words. Then he nodded. “Your advice will be heeded. I agree to stay over another day and leave on Monday. May I see you on Monday morning?”

Breuer nodded. “For the bill, you mean?”

“For that, and I’d be grateful also for your consultation note and a description of the clinical measures you employed to abort this attack. Your methods should be useful to your successors, primarily Italian physicians, since I will be spending the next several months in the south. Surely the power of this attack proscribes another winter in Central Europe.” “This is a time for rest and tranquillity, Professor Nietzsche, not for us to engage in further disputation. But please permit me to make two or three observations for you to mull over until we meet on Monday.”

“After what you have done for me this day, I am bound to listen carefully.”

Breuer weighed his words. He knew this would be his last chance. If he failed now, Nietzsche would be on the Basel train Monday afternoon. He quickly reminded himself not to repeat any of his previous mistakes with Nietzsche. Stay calm, he told himself. Don’t try to outwit him; he’s too clever by half. Don’t argue: you will lose, and even if you win, you lose. And that other Nietzsche, the one who wants to die but pleads for help, the one you promised to help—that Nietzsche is not here now. Don’t try to speak to him.

“Professor Nietzsche, let me begin by underscoring how critically ill you were last night. Your heartbeat was dangerously irregular and could have failed at any time. I don’t know the cause, I need time to evaluate it. But it was not the migraine, nor do I believe it was the overdose of chloral. I have never seen chloral produce this effect before.

“That’s the first point I want to make. The second is the chloral. The amount you took could have been fatal. It’s possible the vomiting from the migraine saved your life. I, as your physician, must be concerned about your self-destructive behavior.”

“Doctor Breuer, forgive me.” Nietzsche spoke with his head cupped in his hands and his eyes closed. “I’d resolved to hear you out entirely without interrupting, but I fear my mind is too sluggish to retain thoughts. I had best speak when ideas are still fresh. I was unwise about the chloral and should have known better from similar previous experiences. I intended to take only a single chloral tablet—it does dull the blade of the pain—and then put the bottle back in my suitcase. What undoubtedly occurred last night was that I took one pill and forgot to put the bottle away. Then as the chloral took effect, I became confused, forgot I had already taken one tablet, and took another. I must have gone through this sequence several times. This has happened before. It was foolish behavior, but not suicidal—if that’s what you mean to imply.” A plausible hypothesis, thought Breuer. The same thing had happened to many of his elderly, forgetful patients, and he always instructed their children to dispense medications. But he did not believe the explanation sufficiently accounted for Nietzsche’s behavior. For one thing, why, even in his pain, did he forget to put the chloral back in his suitcase? Doesn’t one have responsibility even for one’s forgetfulness. No, Breuer thought, this patient’s behavior is more malignantly self-destructive than he claims. In fact, there was proof: the soft voice that said, “Living or dying—who cares?” Yet it was proof that he could not use. He had to let Nietzsche’s comment stand unchallenged.

“Even so, Professor Nietzsche, even if that were the explanation, it does not mitigate the risk. You must have a complete evaluation of your medication regime. But permit me another observation—this one about the onset of your attack. You attribute it to the weather. Without doubt that played a role: you have been a keen observer of the influence of atmospheric conditions on your migraine. But several factors are likely to act in concert to initiate a migraine attack, and for this episode I believe I bear a responsibility: it was shortly after I confronted you in a rude and aggressive fashion that your headache began.” “Again, Doctor Breuer, I must interject. You said nothing that a good physician should not have said, that other physicians would not have said earlier and with less tact than you. You do not deserve the blame for this attack. I sensed it coming long before our last talk. In fact, I had a premonition of it even on my way to Vienna.” Breuer hated to yield on this point. But this was not time for debate.

“I don’t want to tax you further, Professor Nietzsche. Let me merely say, then, that on the basis of your overall medical condition, I feel even more strongly than before that an extended period of thorough observation and treatment is necessary. Even though I was called in hours after its onset, I was still successful in shortening this particular attack. Had you been under observation in a clinic, I feel confident that I could have developed a regimen to abort your attacks even more completely. I urge you to accept my recommendation to enter the Lauzon Clinic.” Breuer stopped. He had said all that was possible. He had been temperate, lucid, clinical. He could do no more. There was a long silence. He waited it out, listening to the sounds in the tiny room: Nietzsche’s breathing, his own, the whining of the wind, a footstep and a creaking board in the room above.

Then Nietzsche responded in a gentle, almost inviting, voice. “I have never met a physician like you, not one as capable, not one as concerned. Nor as personal. Perhaps you could teach me much. When it comes to learning how to live with people, I believe I must start from scratch. I am indebted to you, and believe me, I know how indebted.” Nietzsche paused—“I’m tired and must lie down”—and stretched out on his back, his hands folded on his chest, his eyes fixed on the ceiling. “Being so indebted, I am distressed to go against your recommendation. But the reasons I gave you yesterday—was it just yesterday? It seems we’ve talked for months—those reasons were not frivolous, not simply dreamed up on the spot to oppose you. If you choose to read further in my books, you’ll see how my reasons are rooted in the very ground of my thinking, hence of my being.

“These reasons feel even stronger now—stronger today than yesterday. I don’t know why that should be. I cannot understand much about myself today. Doubtless you are right, chloral is not good for me, certainly not a tonic for my cerebration—I’m not thinking clearly even yet. But those reasons I offered you, they feel tenfold stronger now, a hundredfold stronger.” He turned his head to look at Breuer. “I urge you, Doctor, to cease your efforts on my behalf! To refuse your advice and your offer now, and to continue to refuse you again and again, only increases the humiliation of being so indebted to you.

“Please”—and he turned his head away again—“it is best for me to rest now—and perhaps best for you to return home. You mentioned once you have a family—I fear they will resent me, and with good cause. I know you have spent more time this day with me than with them. Until Monday, Doctor Breuer.” Nietzsche closed his eyes.

Before departing, Breuer said that should Nietzsche require him, a messenger from Herr Schlegel would bring him within the hour, even on Sunday. Nietzsche thanked him, but did not open his eyes.

As Breuer walked down the stairs of the Gasthaus, he marveled at Nietzsche’s control and resilience. Even from a sickbed, in a tawdry room still reeking with the odors of the violent upheaval of only hours ago, at a time when most migraine sufferers would be grateful simply to sit in a corner and breathe, Nietzsche was thinking and functioning: concealing his despair, planning his departure, defending his principles, urging his physician to return to his family, requesting a consultation report and a bill that was fair to his physician.

When he got to the waiting fiacre, Breuer decided that an hour’s walk home would clear his head. He dismissed Fischmann, handing him a gold florin for a hot supper—waiting in the cold was hard work—and set off through the snow-covered streets.

Nietzsche would leave for Basel on Monday, he knew. Why did that matter so much? No matter how hard he pondered this question, it seemed beyond understanding. He knew only that Nietzsche mattered to him, that he was drawn to him in some preternatural way. Perhaps, he wondered, I see something of myself in Nietzsche. But what? We differ in every fundamental way—background, culture, life design. Do I envy his life? What is there to envy in that cold, lonely existence?

Certainly, Breuer thought, my feelings about Nietzsche have nothing to do with guilt. As a physician, I have done all that duty calls for; I cannot fault myself in that regard. Frau Becker and Max were right: What other physician would have put up for any length of time with such an arrogant, abrasive, and exasperating patient?

And vain! How naturally he had said en passant—and not in empty boasting but out of full conviction—that he was the best lecturer in the history of Basel, or that perhaps people might have the courage, might dare, to read his work by the year two thousand! Yet Breuer took offense at none of this. Perhaps Nietzsche was right! Certainly his speech and his prose were compelling, and his thoughts powerfully luminous—even his wrong thoughts.

Whatever the reasons, Breuer did not object to Nietzsche’s mattering so much. Compared with the invasive, pillaging Bertha fantasies, his preoccupation with Nietzsche seemed benign, even benevolent. In fact, Breuer had a premonition that his encounter with this bizarre man might lead to something redemptive for himself.

Breuer walked on. That other man housed and hidden in Nietzsche, that man who pleaded for help: Where was he now? “That man who touched my hand,” Breuer kept saying to himself, “how can I reach him? There must be a way! But he’s determined to leave Vienna on Monday. Is there no stopping him? There must be a way!” He gave up. He stopped thinking. His legs took over, and continued walking, toward a warm, well-lit home, toward his children and loving, unloved Mathilde. He concentrated only on breathing in the cold, cold air, warming it in the cradle of his lungs, and then releasing it in steamy clouds. He listened to the wind, to his steps, to the bursting of the fragile icy crust of snow underfoot. And suddenly, he knew a way—the only way!

His pace quickened. All the way home, he crunched the snow and, with every step, chanted to himself, “I know a way! I know a way!”