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THE GOLDWYN DIARY OF NOVEMBER AND DECEMBER 1960, AT THE ALBERT
SCHWEITZER HOSPITAL, LAMBARENE, GABON
Robert M. Goldwyn, MD
Clinical Professor of Surgery, Harvard Medical School
Edited and Forword by
Mark B. Constantian, MD
Active Staff, Department of Surgery, Saint Joseph Hospital, Nashua, NH,
and the Division of Plastic Surgery, University of Wisconsin Medical Center,
Madison, WI
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DR. SCHWEITZER’S BACKGROUND
Dr. Albert Schweitzer was born on January 14, 1875 in Kaysersberg, a town near
Strasbourg in Alsace, then German, now French. The older son (he had also three
sisters) of a Lutheran pastor and studied at the University of Strasbourg, where
he took his doctorates in philosophy and theology. In 1910 he wrote an unusual
book that gained him fame: The Quest of the Historical Jesus. In addition to
these achievements he was a brilliant organist and had a doctorate in music also
from Strasbourg.
Despite his many activities and accolades he was struggling to make his life
worthwhile by his own standards. “It struck me as incomprehensible that I
should be allowed to lead such a happy life.” In 1904 he read the bulletin of the
Paris Missionary Society: “I quietly began my work. My search was over.” He
was 39.
The following year Dr. Schweitzer announced his intention to become a mission
doctor in Africa. The Dean of the University, in fact, thought his decision so
bizarre that he suggested that Schweitzer seek a psychiatrist. Nobody and
nothing could deter him then and never would.
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DR. SCHWEITZER’S LIFE IN AFRICA
In 1913 Dr. Schweitzer officially received his Medical Degree. With his wife,
Hélène Bresslau they sailed from Bordeaux to Lambaréné. Mrs. Schweitzer had
received training as a nurse and was to be an invaluable helper.
He went not to convert but to serve medically all who needed him. With the help
of the natives, he built his hospital, even to supervising the felling of trees. Dr.
Schweitzer equipped this rudimentary hospital and maintained it at first with
earnings from his concerts and writings. A unit for those afflicted with leprosy
and their families was added later with the money ($33,000) that he received
from the Nobel Peace Prize in 1952.
During World War I, he was interned in Gabon as an enemy alien because he was
German. He was later transferred to France as a prisoner of war. While in Africa
and able to continue his hospital work only sporadically, he constructed a
simulated organ with foot pedals so he could practice his beloved Bach.
After WWI ended, he wrote Kulturphilosophie (1923) “Philosophy of Civilization”,
in which he expressed his belief in “reverence for life,” an ethical principle that he
had conceived in 1913 while on a boat on the Ogowe River. Schweitzer believed
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“reverence for life” was essential for the survival of civilization. In 1924 he
returned to Africa to rebuild the hospital.
GOLDWYN AND SCHWEITZER AFTER LAMBARÉNÉ
After I had left Lambaréné, I corresponded with Dr. Schweitzer but was
concerned I was burdening him because he would feel an obligation to answer
me. Nevertheless, I could not resist maintaining my connection with him. He
was extremely gracious and prompt in replying. Dr. Schweitzer had the amazing
ability of making those who visited and especially those who worked with him in
Lambaréné feel a special affinity to him.
Dr. Schweitzer died at 90 and was buried next to his wife at the hospital. He had
spent 52 years in Gabon.
This diary I can honestly say I never thought would become public. The years
have passed; I am now 77. I realize that not many of those who served in a
medical capacity at his hospital are still alive and not everyone will share his or
her experiences.
I want to make clear that I was with Dr. Schweitzer only two months. I would not
want anyone to think that I played a strategic role at the hospital. I did not but I
helped as best I could.
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Although I have traveled throughout the world and have been a surgeon in many
out-of-the-way places, I have not returned to Lambaréné. The reason, I confess,
is that I wanted it to remain in my mind as it was. For Dr. Schweitzer and those
who served there, his hospital was a way of life. It was a world of its own and,
though small, it came into being because of the arching ideals and unflagging
dedication of a remarkable man. His example should inspire us to enlarge our
personal horizons, not just to recognize the less fortunate but to act without
delay on their behalf. For each of us there is an Ogowe waiting to be crossed.
THE GOLDWYN DIARY: THE FIRST MONTH
Day 1 at Lambaréné – November 2, 1960
I was taken to lunch and, as the most recent arrival, placed opposite Dr.
Schweitzer, with whom I conversed in French. His voice surprised me by being
slightly high pitched. At dinner we sat around an enormous table and the lighting
was by kerosene lamps. The food was abundant and tasty: fried bananas, tuna
fish salad, cheese soufflé, stewed mangoes, and cold (boiled) water. Dr.
Schweitzer (as I later learned would be his custom) then read the Bible in German
and gave a two hour lecture on the rise of Luther. I had taken enough German in
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college to understand most but not all of what he said. He then played a hymn
(sometimes he played two hymns) on the piano that was against the wall of the
dining room to the left as one entered. Dr. Schweitzer quickly stood up,
announced: “To work (in German)” took his hat off the hook, and left to return to
his room, as did we to our own quarters.
There is a Leper Colony with about 170 patients, and if one includes families, the
total is about 400 people. The average stay is about 3.5 years. Sulfones have
been introduced within the past few years and are now being used routinely. The
larger hospital has about 350 other patients as well as their families. Routine
upon admission: CBC, urinalysis, and there is a native who reads urine and stool
for ova and parasites. Almost 100% have amebiasis as well as ascariais and 80%
have filariasis. Because of these parasites and other ailments, an average of one
to two weeks is required to prepare the patient who might also need a
transfusion. Many come here with uterine fibroids, one of the most common
problems, and supracervical hysterectomy is a frequent procedure.
Herniorrhaphies, unilateral or bilateral, occupy most of the schedule. Patients do
not seemingly mind (but probably did) pelvic and rectal examinations which are
done without chaperones. Total operations were about 500 for the year 19591960 and can be as high as 50 a month.
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Clinic days are Monday, Wednesday and Friday. Operations are scheduled on
Tuesday, Thursday and Saturday mornings. Dr. Schweitzer sits in the Pharmacie
(called formally La Grande Pharmacie) at his desk. Patient beds are close together
and each bed can accommodate 2 or 3 of the same family. There is no separation
of males and females, and families are never divided. The sick person with his
family entourage surrounds him. Beds are high enough to allow storage of
cooking utensils. There is no common kitchen. Each family prepares its own food
because of fear of poisoning. Promiscuity is high with fights. At eight PM the bell
sounds for bedtime and peace.
The Ogowe River has no crocodiles but electric eels and hippopotami. A “casque”
(sun helmet) is worn at the request (demand) of Dr. Schweitzer to prevent injury
from a falling coconut. We wear white (for me a white shirt ad yellow chinos)
and one can see the mosquitoes or tsetse flies better against that color.
The natives in this area are Fang (a bantu speaking people of North Gabon,
Equatorial Guinea and Southern Cameroon). They are said to have been warlike,
now jovial but quick tempered. They originally came to Gabon through Port
Gentil, which had a large slave trade.
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Snake bites are rare although vipers are common. Wild boars are said to be
common also and occasionally a goat is a victim of a boar. However, only one
boar has been seen by one nurse during her stay here of 5 years.
Dr. Schweitzer is not liked by all the natives, who consider him too autocratic, but
he and the hospital are respected. Because of him, it has a large reputation with
troupes of patients coming here from the jungles.
Dr. Schweitzer’s ether device (for anesthesia) sometime ago resulted in two
patients being lost since there was no monitoring (of vital signs) involved. No
pure oxygen exists.
Day 2 at Lambaréné - November 3, 1960
In the operating room equipment is adequate but anesthesia spotty. Local
anesthesia is used whenever possible. For general anesthesia open drop ether or
a bellows with an endotracheal tube is employed. For very short cases
intravenous muscle relaxant is given and ethyl chloride administered.
In general the nurses are attractive, strong, German, Swiss or Dutch and seem to
have no fear. They are good diagnosticians and are good with the natives’ family.
There are formal rounds to see patients, especially those who have had a recent
operation. Rest hour is from 12 to 2 with breakfast at 7:30 AM and lunch at
12:20 PM and dinner at 7:00 PM, bells sound the events.
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The dinner table is massive, solid, covered with a white table cloth. It usually
seats 25 to 28 people although it can accommodate more. Dr. Schweitzer is
always at the center facing the dining room entrance. A nurse and 2 cooks who
have been with him for decades prepare food for the white staff, visitors of color
and guests. Thursdays we had spaghetti and meatballs, plain bread, no butter,
dessert of apple sauce from local orchards. On Saturdays a special meal with
bread and butter, cheese, salami, coco (We ate well). Dr. Schweitzer occasionally
has special portions. Mlles Mathilde and Ali help serve him. Mlle Ali handles a
tremendous amount of his correspondence. She has had only one vacation in 10
days.
Occasionally Dr. Schweitzer drums his fingers on the table and practices on his
organ in the morning and at night. He can work in the Pharmacie (outpatient
department, dispensary, operating room) through all noises, interruptions and
without adequate lighting – always writing letters.
More pets of Dr. Schweitzer include many goats, two chimps, and the pelican
called Parsifal, named after the Opera by Richard Wagner, whose works
Schweitzer admired. He knew Wagner’s second wife, Cosima, who has helped
him raise money for the hospital.
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We could use more x-ray equipment and do more chest x-rays and flat films of
the abdomen. We could have better care if we had more nurses (the nurses in
Lambaréné were extremely hard working, totally dedicated, unbelievably
efficient and resourceful).
Day 3 at Lambaréné – November 4, 1960
It is amazing that Dr. Schweitzer built all this from practically scratch – that he
can still write books on philosophy, plays the organ superbly and maintains his
great knowledge of their construction, and is a master of the compositions of
Bach. He works continuously and did so when he used to operate. He treats
disease in very practical ways and carriers on an immense correspondence.
I note that the native women’s posture is amazingly good perhaps from always
carrying things on their head.
Dr. Schweitzer is informed about a lady who had a cataract operation and the
diagnosis of pneumonia was missed. Dr. Schweitzer said “All our life we doctors
learn. In old patients, always examine more carefully, always try to avoid
surgery.”
It is reassuring to see Dr. Schweitzer walk around the hospital, sometimes in deep
thought, with his hands clasped behind his back but nevertheless managing to
observe almost everything and stopping to pay attention to his pets or to give an
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order whenever he thinks it is necessary. This hospital is his domain and will
always be his as long as he is here. Continually we have visitors and journalists,
bags of mail, reporters and new books arrive all the time with dedication to Dr.
Schweitzer. I look at the stamps to see from what country they were sent.
When patients have a cough we obtain a chest film and since it may be
pneumonia, penicillin is given, which serves also to treat gonorrhea if it happens
to be present. For tuberculosis, we use streptomycin which has been employed
here for many years. We do not see evidence of vestibular damage, such as
dizziness.
When a patient is hospitalized, usually the whole family comes: sister, wife (or
wives) daughters serve as nurses; brothers, husbands and sons work around the
hospital and this is the way the patient earns his keep.
Treatment for worms is always paid for even if it is a token amount – something
that would correspond to ten or twenty cents or maybe even eighty cents;
otherwise every native would come for treatment even if they do not have the
disease because they like the idea of going to the hospital and of receiving pills.
The wards, about 26 of them, are called Cases and may bear in addition the name
of a nurse or philanthropist – always a friend – can accommodate 30 with
families. Besides the bed there are bananas, grass mats, stools to squat upon – a
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piece of wood, bidet, water basin, roots for eating, occasionally even chickens.
The proximity of the patient to his family and their emotional support and even
physical help in the care is something we can in so called developed countries
learn from. Dr. Schweitzer asked me at the end of an operation: “You like this
learning experience?” I replied in the affirmative enthusiastically and thanked
him for the opportunity.
With so many visitors, to protect oneself and get the work done, doctors have to
maintain some routine. Visitors themselves display their own weaknesses. Many
do not know tropical diseases and occasionally the other doctors here generalize
this weakness into the visitor’s sphere of knowledge where he is proficient. I am
glad to have few distractions – no paper (except for this diary), TV, or radio. I am
here to observe, to do and I am able to think clearly. At home, previous
associations except for Roberta (wife) and parents seem alarmingly distant.
Many poisonings occur in the villages, I am told, often over women, property,
reasons also for violence in the USA.
Day 4 at Lambaréné – November 5, 1960
Patients say they have a venereal disease to get injections but usually they do
have it. We seldom treat partners; the male will often bring in 4 women. Natives
buy wives; a man likes to marry a woman with daughters. He gets money when
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they are married. Patients like the doctor who gives pills and often a family will
feign illness to stay on so that they can get a food ration as well.
Today I read Men of Music, chapters on Bach and pre-Bach composers. Saturday
night, suppers are special. The nurses come more dressy. Cheese, butter, sugar
balls and then a concert of Sibelius’ 7th. To see Dr. Schweitzer’s face and hands
folded in a darkened room listening to Sibelius is really moving.
[Dr. Schweitzer] feels he has revised Christian thinking. He wrote a book on Bach
trying to see how Bach felt at the time he composed – to deduce his frame of
mind from his musical scores. Dr. Schweitzer read through and has not forgotten
six volumes of tropical medicine. He once looked 7 hours for trypanosomes in
the spinal fluid. Dr. Schweitzer’s attention to detail is fantastic. Dr. Friedman
told me of mental disease here – mostly among African Christian preachers. They
feel guilty about deserting their old religion and think evil spirits chase them.
Also some wives of these preachers have gone into the marriage to benefit them
socioeconomically but do not really believe that Christ will protect them. No real
witch doctors left; now there are only imposters. There is a directory of witch
doctors’ drugs published two years ago by the government. Last night I heard
dance drums in the village and often the dance is done after a death. We are not
allowed to visit the village at night although sometimes nurses go along with
some doctors.
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Day 6 at Lambaréné – November 7, 1960
In the dining room there are two pianos, one old and one new. Dr. Schweitzer
uses the old. I finished Dr. Schweitzer’s Memoirs of Childhood and Youth (1924),
which I had read a few times before and Christianity and the Religions of the
World (1923).
This evening I delivered a talk on cardiac surgery in English. It was based on my
relatively recent experience on Dr. Harkin’s service. They were fascinated by not
only Dr. Harkin’s personality but by his pioneering feats, particularly with respect
to mitral valve stenosis and replacement of valves with open surgery.
Today we had to amputate the leg (above knee) of a patient. This patient had
elephantiasis. In honor of Dr. Lindner’s (a surgeon) departure, Dr. Takahashi and
his wife invited us to the Leper Village. There was singing, dancing and an iron tin
was heard being played with fantastic drumming. People of all ages – both sexes
joined – extremely rhythmic and really African – against the tropical foliage.
Today I walked toward the Leper Village and took photos as the sun was setting.
Gertrude, a nurse, who has been here 16 months said the climate was “dur”
(harsh). She is a nature lover and pointed out avocados, grapefruit, and mangoes
as well as the breadfruit tree. I also saw butterflies. One resembles our tiger
swallowtail and another is like the viceroy and another one is brown in flight and
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has the wing shape of the morning cloak. I would like to find a book about the
fauna and flora. At 9:00 PM I tried on the radio to get election results but no
luck. I am sure Kennedy will be elected.
Day 8 at Lambaréné – November 9, 1960
The Election news came at 3:00 AM (9:00 AM) here in Dr. Schweitzer’s time via
the Voice of America from Washington, DC, Kennedy leading by a substantial
margin. Later I took the radio from where I was staying and went down to the
river to hear the results. I did this at the rest hours. A native was astonished to
hear music from this small box.
A word about the operating room. It is adequate in size and in equipment and it
is screened. The renovations were from money given to Dr. Schweitzer by Prince
Rainier of Monaco. A remarkable feature is a swinging small segment of screen
that lets out insects – obviously in deference to Dr. Schweitzer’s reverence for
life. However, the nurses do use an insecticide but they are careful to employ it
after checking that Dr. Schweitzer is not around to witness it. Our surgical gloves
are not disposable and soaked in alcohol after every procedure. (There was no
air conditioning in the operating room and on very hot, humid days, we male
surgeon stripped to the waist before putting on our gowns).
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I finished The Philosophy of Civilization by Dr. Schweitzer (1949). It is a very
provocative work in which he develops his own system of ethics. His transitions
are not sufficiently worked out.
Day 10 at Lambaréné – November 11, 1960
Birth of twins is interpreted by the Africans as a curse – one must die, usually the
weaker. Therefore, they are kept a long time until allegedly one two is poisoned.
First twin male or female – wora, second twin male or female, teno. Later in life
if one twin gets ill, the other receives treatment.
Dr. Friedman and I will write an article in the New England Journal of Medicine
about problems at Lambaréné (Goldwyn, R.M. and Friedman, R.L. Surgery at the
Albert Schweitzer Hospital, Lambaréné, Gabon. N. Eng. J. Med. 264:1031-1033,
1961).
I reviewed an old operative log book – 450 operations:
Herniorrhaphy and Hydrocelectomy:
260 (about 1/3 bilateral)
Head and Neck operations:
30
Eye operations:
30
Correction of Urethral Stenosis:
25
Cesarean Sections:
22
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Total Hysterectomies:
3
Colostomy:
1
Procedures for Elephantiasis:
3
Exploratory laparotomies:
4
Oophorectomies:
5
Friday night I can hear drums in the village. The road to the village is flooded.
Day 11 at Lambaréné - November 12, 1960
In the dry season, when the water level is lower and the sandbars emerge,
hippotomi can be seen. They are dangerous – never travel by pirogue at night.
Hippos may overturn the boat. Today I operated (took over) for cancer of the
right ovary with extension to the uterus. I amputated the large mass and put in
retention sutures of heavy nylon; they had never seen retentions used.
I got rid of my drum today – its maker was a leper who is serious ill – the
transmissibility of the disease has not been definitely established. I doubt that
there is a danger but I am taking no chances. Some people here have urged me
to do this.
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One of Dr. Schweitzer’s pets – a parrot, likes men – “Jackie” – he continually
alights on my shoulder. I frankly do not like it. He is very eerie but probably
harmless. He is everywhere.
Anesthesia here is either too light or too deep. I have controlled myself fairly
well (from expressing any criticism). Postoperative mortality 4 of 450 patients
and 85 “accidents” recorded from June ’59 to June ’60.
Dr. Schweitzer last operated in 1950. He was a slow, meticulous surgeon. I
finished E.N. Mozley’s The Theology of Albert Schweitzer with an Epilogue by
Albert Schweitzer. I do not have the background for this. I read it only dutifully.
The price for a wife, I understand, is between $15 and $100 – more for someone
with children because she has proven fertility. Tribe members do not help others
in tasks especially caring for children. If a child gets a fever during the night, they
will feel that a curse has been cast by the other tribe members. As Dr. Schweitzer
has written, Africans are not happy – they are continuously disturbed by curses,
evil spirits, etc.
Day 12 at Lambaréné – November 13, 1960 Sunday
I was told last night that one should never tell a patient here that she has cancer.
The tribe may harm her if they think she is “doomed to die.”
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People give medical books to Dr. Schweitzer but they do not circulate. Dr.
Schweitzer considers them as private property. I have begun and finished today
Joy’s Music in the Life of Albert Schweitzer (1951), an excellent book, one to
secure for my library.
Day 13 at Lambaréné – November 14, 1960
My herniorrhaphy patient developed retention. He had a urethral stricture (from
gonorrhea). Dr. Adler instituted sondinage (passing cylindrical curves of metal of
progressive sizes). His temperature went to 104.
My patient with ovarian cancer was distended and I inserted a gastric tube with
good return. I have to fight against clysis (intravenous solution is given
subcutaneously). This practice should be discontinued here.
Nurses bring me babies to see orthopedically. I carefully apply casts. Nurses
think I am much older than I am – more like 40 or 45 when I do an operation or a
procedure they have never seen. Certainly more could be improved here:
1) Weekly medical and surgical conferences
2) Nurse-doctor conferences
3) Separate aseptic ward for critically ill patients with oxygen available
4) No animals should be allowed in the ward
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5) Screens to be placed in all wards
6) More use of x-ray
7) Bacteriology lab
8) Chemistry lab
9) Better anesthesia set-up
10) Surgical rounds daily together nurses, doctors and orderlies. There is a
special ward for Fang patients-because of tribal rivalry
11) Less petty politics among staff
12) Library available and a journal club especially necessary here
Emphasis should be more on sanitation. Being picturesque is not sufficient for
good medicine. Every Thursday afternoon, however, the operating room and
the wards are scoured with some strong soap. Dr. Schweitzer is really
unaware of certain basic faults here. It really needs just a few changes and a
basic one would be to insist on cleanliness and get rid of the animals.
Why should the Negroes get second rate medicine? Note the difference in
cleanliness for the white patients; yet both feel the effects of sepsis equally,
especially postoperatively.
Day 14 at Lambaréné – November 15, 1960
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When I arrived here, I was told to eat a lot. This was advice contrary to what I
had heard. However, this advice is helpful and one can become extremely
weak from only drinking and not eating.
Dr. Schweitzer came here from a position of strength; so many who come
here do so from a position of weakness. Over the years hundreds of staff and
maybe more hundreds of visitors have renewed their purpose in life by
coming here, to see the hospital and Dr. Schweitzer and to be inspired by him.
They have literally changed their ways and have expanded their purpose in
life to include the wellbeing of others. Dr. Schweitzer has probably changed
more lives in a positive direction than have 500 or more psychotherapists. To
borrow a phrase from Winston Churchill (really to distort it), Dr. Schweitzer
has “replenished the well” of others or encouraged them to dig new ones.
He is remarkably tolerant of others. Wise and gracious he does not judge
other people by the very high standards he has set for himself. He says
“There is good in everyone” but does avoid discussing the problem of how a
person can actualize that potential. He believes that “reverence for life” is
available to anyone.
Day 16 at Lambaréné – November 17, 1960
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Today I saw Dr. Friedman do a psychiatric interview – really fascinating. The
chief complaint was rage against family and villagers. Many patients are
psychotic and the interpreters work hard to understand their questions and
answers.
Day 17 at Lambaréné – November18, 1960
If children do not eat, mothers say, “The crocodile is coming.” They eat.
Day 18 at Lambaréné – November19, 1960
I read Paul du Chaillu’s Adventures in the Great Forest of Equatorial Africa
(1890). On pages 56 and 57, he mentions, as does Schweitzer, the saddened,
embittered lives of the natives, afraid of evil spirits. He describes the Fans
(Fangs) who push seaward, were cannibals, fierce warriors, and used iron
weapons and poisoned arrows.
Day 19 at Lambaréné – November20, 1960
One of my favorite hymns was sung last night: “Zums Stille sich braiten um mir
sorgen.” Today Marie-Louise, Rolf Adler and I took an afternoon trip to
Lambaréné. We took the piroque to the Catholic Mission and then walked
about one half hour to the village. The road was flooded in spots. We went
through the jungle to avoid the puddles. The small stone stores are run by
handsome African Muslims wearing fezzes and white robes. My feet were
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soaked but I washed and dried them at the Relais owned by Air France and
run by a wonderfully obliging couple with two lovely children, who took us
back to the mission in a jeep. The river was limpid and calm. The sky, red at
sunset. At the Relais I had ice cream (powdered milk) and orangeade.
Europeans are very gracious to other whites and form bonds of fellowship.
They also are petty. I notice they all have dogs, which bark at the blacks, but
these are the best protection for the women and children. These whites
furnish very interesting material for novels set in this unusual part of the
world. It was a delightful day.
Day 21 at Lambaréné – November 22, 1960
When you ask a native “Ca va?” (“How are things going?”- he says almost
always “un peu” – (literally “a little,” “so so”). Today I helped with two
patients who had inguinal hernias and tried to teach others to be gentle in
handling tissues. Dr. Friedman and I will report a series of seven patients with
lumbar hernias with strangulation in four. Today my patient with the hernia
and the rectal abscess gave me a pineapple.
Day 22 at Lambaréné – November 23, 1960
Dr. Friedman had a patient he wanted me to see. He told me that from the
symptoms it seems like polio. The patient had minimal chest excursion. We
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planned a tracheotomy for noon but his condition worsened. The diagnosis
was “bulbar polio with anoxia.” I quickly performed an indelicate tracheotomy
but soon he died. His wife (one of his wives) wailed, rolled on the ground,
shrieked and went into a trance, especially as they brought the body to the
river. They kept his face uncovered. He was the chief of the neighboring
village. Dr. Schweitzer said he never saw polio here and believed that he was
poisoned. Dr. Schweitzer failed to get an autopsy but did not press the issue.
A respirator is needed badly here.
I was offered a 14 foot boar skin about 10 inches across. I refused. It is
ghastly. Medicine in the jungle is a humbling experience. One should always
suspect poison and treat for it and then look for other causes.
Day 24 at Lambaréné – November 25, 1960
Today I saw an elderly patient with an inguinal hernia and high blood
pressure. I felt surgery should be delayed; Müller did not. Dr. Schweitzer saw
the patient and canceled the case and sent him home despite the patient’s
protestation that he could die. Dr. Schweitzer says surgery should be avoided
in all old people as they often get depressed and die postoperatively. I could
believe anything here although I would still favor surgery in the elderly.
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Pfizer and others send him old drugs that are out of date when they reach him
so Pfizer can deduct it from income taxes. They often get the throw-aways.
Dr. Schweitzer, however, is humbly grateful for them, although I think this is
shameful – like a philanthropist today giving away Confederate money.
Marie-Louise has malaria and is being mistreated by being given Paladrine and
the nurses want me to take over the case. I refuse. She is another doctor’s
patient. Some here thought at first we had a romantic relationship, both
being American. There are malicious gossips here and our relationship is
strictly at the dinner table and conversations outside. I sit next to her and I
wish Roberta (my wife) were here to stop vile tongues from wagging. I have
always become irate when accused of things I never have done. Here
everybody is so worried about his own sexuality that he or she displaces their
desires on others. This aspect of Lambaréné is detestable and it is a shame
that with Dr. Schweitzer as a symbol it occurs here and cheapens life here.
Day 26 at Lambaréné – November 27, 1960
Dr. Edgar Berman, physician and confidant to Vice President Hubert
Humphrey, General Surgeon at the Mount Sinai Hospital in Baltimore and his
wife, Phoebe, arrived. He is President of Medico and unknown to Dr.
Schweitzer. He plans to stay a month or so. It makes things slightly awkward
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– two chiefs, both Americans and little surgery. Dr. Schweitzer spoke to me
and said that I was still his chief surgeon (Dr. Schweitzer really is). He will
assign cases and give Dr. Berman an occasional one. I felt sorrier for him than
for myself because he feels useless.
Dr. Schweitzer and I talked tonight. He really seemed glad to talk to me. I
think he and I get along well. I cause him no trouble. He apologized for
moving me at the dining room table. I told him I was one of the “anciens” (old
timers). Also he asked me whether I wanted to see more of the country. I
said all I wish to see is here. He said “tu me ressembles” (“you are like me”).
He is very conscious of people’s feelings and senses jealousies which are
frequent; petty but get magnified in this close community.
After each operation, the patient’s family usually cleans the operating room.
THE GOLDWYN DIARY: THE SECOND MONTH
Day 30 at Lambaréné – December 1, 1960
The crazy turkey still attacks me. He is male and has two wives. Perhaps he
has the fantasy that I am vying for their favors. I read Dr. Berman’s report to
Senator Hubert Humphrey urging International Health project as a main focus
for American doctors, as the USSR is doing. The USSR graduates 25,000 MDs
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and we 8,000. Dr. Berman told me that for $17,000 one could build a 300 bed
(the Schweitzer Hospital had 350 beds) army hospital with an operating room
having electricity and that will probably last 8 years. There is no doubt that
this is our future responsibility – ours meaning the United States – and I
should like to shoulder some of this.
I’ve been told that resecting a bowel never works in Gabon and so tonight a
patient came in who has had a hernia for some time but last night it became
incarcerated and was reduced in three hours by an orderly elsewhere. Today
he presented with signs of peritonitis. I thought he needed an exploratory
laparotomy so did Dr. Schweitzer and Dr. Berman. Dr. Weisberg and Dr.
Friedman advised against resection of the compromised bowel. At 5:00 pm I
operated and found that the ileum had perforated and there was gangrene
and I did a resection with Dr. Berman’s help. All watched, especially Dr.
Schweitzer, who stood for 2 hours and observed. He was dressed in a gown
and mask. What a moving sight! I felt like Morton demonstrating ether
(1846). Dr. Schweitzer at 85 still learning. Life seems good tonight. I am very
glad I came. I hope that the patient does well. I will feel that I truly saved
somebody.
Day 31 at Lambaréné – December 2, 1960
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I feel that esprit de corps is sorely lacking. In the long run it is more
detrimental to the care of patients than an ignorance of a particular
technique. When one gets all these people in this small hospital, difficulties
arise. Like Livingstone, my policy has been to do the best possible job every
day. I think my performance here has been consistent in honesty, diligence,
good judgment and good surgical results – all hernias went well. Even my
lady with incontinence is now repaired satisfactorily beyond my wildest
hopes.
Day 33 at Lambaréné – December 4, 1960
Finished Dr. Schweitzer’s The Mystery of the Kingdom of God (1901) written
when he was 26. A brilliant work about the life of Jesus.
Ed Berman observed, as have I, that hernias here have much bigger sacs and
smaller rings than we see in the United States and they cannot be easily
separated from the cord (spermatic) without opening the sac – often the
bladder is in them.
I took my first shower in a month at an equivalent cost of $.50 – well worth it!
We then went by the small boat to a village across the way where tom-toms
were playing and witnessed a small tribal dance with masks and costumes on
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the excellent dancers. I snapped a picture and was ready to do another but
the dancers said no and that this was not a wise thing to do.
Day 35 at Lambaréné – December 6, 1960
I wish now to write certain observations about the relationship of Dr.
Schweitzer to the Africans. The natives respect Dr. Schweitzer and feel that
he did good work but they resent his treatment of them as inferiors. They do
not like their poor board, dirty dwelling, and their low pay - $2 a month. They
feel he is living as if it were 30 years ago and Noël looks forward to a
revolution to get rid of him (“not kill him”). They have already appointed a
black orderly as Minister of Health.
A few thoughts about Dr. Schweitzer’s psychological make-up: He had a
strong father figure and has some signs of rejecting him – his criticism of
Christ, his preoccupation with avoiding pain to others suggests preoccupation
with aggression and guilt arising therefrom, his necessity to atone to go to
Africa. Ed Berman feels he is very conscious of being well-liked and loved like
Christ and the attempt to win followers. As Schweitzer de-deified Christ, he
became more accessible to Schweitzer and easier to emulate.
A miracle has happened: my patient with dysgerminoma (malignant tumor of
the ovary) suddenly became unobstructed and has begun to eat. Suddenly
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after a witch doctor walked by her, she had two bowel movements tonight. I
was called to be told that she was in a coma. I went to the Case Bouka, the
postoperative recovery ward, and in the lamplight amidst frightened, half
naked women, I saw she was all right. I hope she goes home well.
Day 39 at Lambaréné – December 10, 1960
After watching Drs. Adler and Friedman repair a strangulated hernia until I
was satisfied that there was no bad bowel, I took a pirogue (the lepers rowed
me) and went to the Protestant Mission where the house in which Dr.
Schweitzer first lived from 1913 was being commemorated. Behind is the old
kitchen, where he boiled his instruments and kept his medicines. His eyes lit
up as he told us of the “old days” (he did not stress the hardships). He is a
wonderful man – “a god among men” – a giant. He seemed such an
inspiration as he stood in a coat jacket – high on a hill overlooking the Ogowe
– alert, vigorous and as his pirogue swept into the evening clouded river, it
seemed almost unbelievable that I was with him. This has been an incredible
experience.
Day 40 at Lambaréné – December 11, 1960
Dr. Schweitzer played the organ for us and explained how Bach used pedals
which at first the French did not have. He explained “the continuous
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freedom” of this piano-organ (really the Bach organ). The piano-organ was
made in Paris – Gaveau – and is zinc lined. Schweitzer played selections from
Widor, Bach, and some French composers. I asked him why he did not
compose, he said “When I saw what Bach had done, I thought composing for
the organ was finished.”
Dr. Schweitzer frequently plays the organ very early in the morning or late at
night and when I hear him begin, I leave whatever I am doing, if possible, to
wait under a tree outside his bedroom for this unique privilege of hearing him
– and Bach.
Day 45 at Lambaréné – December 16, 1960
I was walking near the hospital and a native jumped from the trees while
brandishing a machete. He asked whether I was the doctor who operated
upon him. I feared the worst and thought that medical malpractice, though
far from ideal in the United States, could not match the situation in which I
now found myself. I told him to show me the scar and he did: a hernia repair.
He wanted to know when he could resume physical relations with his wife. I
looked at my watch and told him that it would have to be done with fifteen
minutes; we both ran as fast as we could in opposite directions.
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Day 48 at Lambaréné – December 19, 1960
Dr. Schweitzer had his first Coca Cola.
Day 49 at Lambaréné – December 20, 1960
Today was hot, excessively. A forgotten genius is the parrot who has been
here for about 4 years and speaks in French and says “Bon jour, Zolo, mettre le
chapeau” (“put on your hat”) and says people’s names also and will reply
“oui” to questions and say “Bien dormez” (“sleep well”)
Day 51 at Lambaréné – December 22, 1960
One jet plane costs about 8 million dollars and this is the cost for WHO to
meet its responsibilities in a world needing malaria eradication.
Today a man came allegedly attacked by a gorilla. The wounds were
obviously inflicted by a knife. The orderlies say he probably attacked
someone who got the better of him in a palaver. Three killings occurred last
week - possibly by the so-called leopard men or other killers. This patient may
be taken away and killed some night.
Day 53 at Lambaréné – December 24, 1960
I feel the need after being with Dr. Schweitzer to write a book about creativity
in others. The emphasis would be on doing good for others and not simply
writing a novel – doing something unusual that would not necessarily ensure
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happiness for people but it would urge people to think differently and
hopefully ethically.
Light morning – watched the natives receive their Christmas gifts. Had lunch
but first I photographed Dr. Schweitzer with the natives at the “Pharmacie.”
At 4 PM we gathered (the staff, orderlies, etc.) before his rooms and read the
Bible after two hymns (by the orderlies, staff and by the nurses in German).
Then presents were distributed to those attending and also to patients,
practical items such as plates, cups, soap, and clothes
I was about to return to the rooms when a patient who entered two days ago
with a bullet wound (skull grazed) entered and now was convulsing. Müller
and I examined him. He had a subdural and an extradural hematoma. I told
Dr. Schweitzer that we had to explore the subdural area in each a clot was
there too. He was impressed by the operation (burr holes with evacuation of
the clots) which took two and half hours and stayed the entire time. I came
late to Christmas dinner. Then after dinner German and French incomplete
quotations were passed out. One had to match the proverb and gift with the
missing part (passed around). Dr. Schweitzer got three or four right away. He
was very good as expected and also joking but slightly tired. At 85 earlier that
day he stood for more than two hours to watch an operation – Quel homme!
(What a man!).
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For my gifts, I received a coconut (a symbol of long lift), three pictures of
Lambaréné (one of my room), cologne, napkin holder, pencils, and a clothes
brush. It was a beautiful evening, replete with carols and good cheer. I was
very happy this Christmas Eve.
Day 57 at Lambaréné – December 28, 1960
Maria left today – honest, simple, religious, I felt as if I were watching my own
departure. My friend, the German economist, said “The German army had a
saying: ‘Leave the thinking to the horses, they have bigger heads.’”
Day 58 at Lambaréné – December 29, 1960
Today was a busy medical day. The operating room schedule was:
1- An emergency Cesarean section
2- Tumor of the hand with general anesthesia (? fibroma)
3- Exploratory laparotomy – really scheduled as a hysterectomy but no
fibroids. Perhaps it was a pregnancy. (I was not the surgeon).
4- A hysterectomy
5- An emergency resection of a strangulated hernia.
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Day 59 at Lambaréné – December 30, 1960
Volvulus is common in Africans with the lower ileum in knot involving the pelvic
colon. In Europeans this condition is usually associated with bands but my patient
today had none.
My patient with cancer of the ovary (dysgerminoma), metastatic, went into a
sudden coma, and then died. ? cerebral metastases. Was it poisoning? I doubt it.
Sadly the last day. I said goodbye to some patients. I gave Faustin (interpreter)
toothpaste; Noël (orderly), shoes; Frederique (technician), soap.
I took a long walk. I savored each last moment here. With Ali, I talked and told
her I purposely avoided bothering Dr. Schweitzer. She said he was grateful not to
have to worry about surgery and knew me “more for your not coming (to disturb
him) than my coming.” Too many bother him not to learn but to be able to say
that they had spoken to him. I feel he knows me through my work as do I, him.
Ah! Last minutes at Lambaréné; the hourglass empties; time has run out. Dr.
Schweitzer posed with me today. Today the conversation with Dr. Schweitzer at
8:15 pm in his fantastic room (fantastic in terms of its being so small and
crowded). He stroked the parrot and talked with it and it went to bed – both
signaled each other by thumping and finally there was quiet. Dr. Schweitzer then
offered to pay my expenses and I refused. He seemed touched. I asked him:
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“This century overemphasized Freud but he still has shown why people who
know right from wrong fail to act but why do they? We have the Ten
Commandments but why do we not follow them?” Dr. Schweitzer said that
people lack courage and added that politicians lack courage. He admitted that
courage comes with maturity. I said “When you were young …” He interrupted
and said “I am still young”--touché--and I said “When you were younger, did you
not fear the dark and later with reasoning outgrow it?” He said “Yes.” I asked Dr.
Schweitzer, “Why then, can we not outgrow childish ways?” He said “I do not
know.” I told him I learned much here.
Dr. Schweitzer, referring to himself, said “I was lucky and my fortune was
unbelievable. Every time I needed someone, somebody came.” Again he thanked
me for coming and together we looked at pictures in a large book he had,
identifying natives and chuckling as he saw their faces. He offered me an oil
painting. I refused first but later accepted it with gratitude. What a wonderful
evening! Two hours – all in French. Ali said Dr. Schweitzer remarked I was very
modest and did not seek photographs. He said I had taken care of the surgery
and he had time to do his work. He has no questions about my ability. I was
happy as I left his room but also said because I would likely never see him again.
My happiness was from this rich immense experience that has given a new
direction to my life.
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Day 60 at Lambaréné – December 31, 1960
Dr. Schweitzer escorted me down to bank of the Ogowe and Mrs. Urquart said
goodbye. Dr. Schweitzer said: “Allez, allez” (go, go) – the last goodbyes. All the
nurses and many natives and Dr. Schweitzer waved and watched me depart. His
last question not unexpectedly a practical one from him, was “Did you leave the
key,” “Oui, elle est dans la serrure” (Yes, it is in the lock”).
As the pirogue headed to the little airport, I saw Marie-Louise in her ever-present
white casque waving furiously and then no more of the Hospital could be seen as
we rounded the bend. I hoped that this would be au revoir not adieu (regrettably
it was).
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ACKNOWLEGEMENTS
The editor gratefully acknowledges the expert technical assistance of Mrs. Anita
A. Serian, and the assistance and encouragement of Mrs. Robert M. (Tanya)
Goldwyn.