"the frost of this most unfortunate age"

Reflections on Kafka's "A Country Doctor"

In October, I was asked to give a lecture to a group of American dental students, who were coming to Prague as part of a dental leadership program. The topic of the lecture was Franz Kafka. When I met with the program director, he issued a more specific request: Could I connect Kafka’s work to oral health? Unsurprisingly, I’d never considered Kafka’s work through this particular lens. It happened that I was reading Kafka’s letters on the following day for work on a different piece and came to the series of letters Kafka wrote in early 1921 from a sanatorium in Matliary, where he was undergoing treatment for tuberculosis (the treatment seemed to consist mainly of gaining weight). In a couple of these letters, Kafka complains about noise—nothing new for Kafka—and specifically about the especially annoying source of noise coming from the balcony above him: a dental technician studying “half out loud.” Kafka and dentistry, for perhaps the first and only time, had come together in my life. I agreed to give the talk.

Franz Kafka (sitting in front, second to the right) among guests at the Matliary sanatorium in the High Tatras (1920-1921)

The program director had assigned his students the short story “In the Penal Colony”  to read before the program. In our conversation, he justified the choice by offering two thoughts. The first was that the famous apparatus in the story—the torture machine—had something in common with the dental chair. Who among us doesn’t dread the dentist’s final pronouncement on the state of our teeth—the dental sentence—at the end of our yearly exam? Brush better! Floss! The program director’s second notion had to do with the way the colony’s system of justice related to the American private health insurance industry, especially as the senselessly complex insurance system attempts to hold out against a clearly more rational (and humane) process.

The director’s ideas, however instrumentalizing, impressed me. I liked them because they demonstrated what I have long considered one of the great gifts of Kafka’s work: the ability to be stretched by creative encounter such that they become relevant for even distant and unlikely contexts or subjects like American dentistry in the twenty-first century. I felt warmed by the director’s creative approach to interpretation. I felt happy that in a program about global dental policy and international dental practice students would intersect with Kafka. These twenty or thirty students who came to Prague to learn about Czech and European dentistry would also be compelled to think for an hour about Kafka, and through Kafka to think not about “practical” matters but about ideas, concepts, and philosophy.

When the request to give the lecture came in, I had just read Mark Harman’s new book of translations of stories by Kafka. Harman is an accomplished translator, best known for the fantastic edition of Kafka’s The Castle he completed from the German critical edition. The new book, Selected Stories, has garnered the most attention because of Harman’s choice to break with convention and change the title of Kafka’s most famous work, “Die Verwandlung” (“The Metamorphosis”) to the more quotidian “The Transformation,” a similar mini-controversy to when Sandra Smith changed Camus’s The Stranger to The Outsider in 2012. This particular issue—the shift from metamorphosis to transformation—didn’t (and doesn’t) provoke me that much. I think both choices can be justified, and Harman provides a clear rationale for his decision in a wonderful introduction to the volume. What interested me quite a bit more was Harman’s choice to include the story “A Country Doctor” (“Ein Landarzt”).

I’d read “A Country Doctor” many times before encountering it in Harman’s book, but it never became a focal point for me. I hadn’t paused over it or truly contemplated it. It could be because I’d found the story incomprehensible—that the surreal elements made it less uncanny and more magically bizarre. Symbols abounded, but for whatever reason I didn’t feel compelled to try to interpret them, to translate them into readable concepts. The text, more than Kafka’s others, had become for me somehow illegible. When I encountered it, I’d feel like the explorer in Kafka’s “In the Penal Colony” looking down on the punishments drawn by the old commandant, seeing only lines, crosshatching, and scribbles where the attending officer saw a clear statement of judgment, of command—“Honor your superiors!” The dental lecture was the perfect opportunity, I thought, to overcome my resistance. “A Country Doctor” wasn’t about oral health but it did concern a doctor, and it was explicitly about healthcare and treatment. It seemed like the most fitting of Kafka’s texts for the occasion. I asked the program director to add it to the students’ list of required readings for the program. I would end my lecture, I said to him, with a discussion of the story.

There are four great periods of literary production in Kafka’s tragically short life between when he famously composed “The Judgment” in his September 1912 “breakthrough” and when he died in June 1924. The first is the time around 1914 when Kafka wrote both “In the Penal Colony” and the unfinished novel The Trial. The second came in late 1916 and throughout 1917, when he set up his writing practice in a room his sister Ottla rented in a tiny house on Alchemistengasse just below Prague Castle. There, Kafka composed stories and prose fragments in blue octavo notebooks, which included “A Report to an Academy,” “The Great Wall of China,” “Jackals and Arabs,” and “A Country Doctor.” This period of incredible literary depth was followed by Kafka’s time with Ottla in Zürau, where he wrote a series of complex, beautiful, and paradoxical aphorisms. The third period is the one I’ve spent the most time with, the one that forms the basis for my latest novel. It began in the winter of 1922 in the mountain town of Spindelmühle (Špindlerův Mlýn), where Kafka started to develop the manuscript for what is now known as the novel The Castle—his longest and most complex work. The final burst of writing came in Berlin in 1923 and early 1924. There, living with Dora Diamant, finally having escaped Prague, he produced a set of startling stories: “The Burrow,” “A Hunger Artist,” “Josephine the Singer, or The Mouse Folk.”

During this past year, the centenary of Kafka’s death, I’ve felt drawn to the second period, to the work Kafka did in the basement room on Alchemistengasse, to his writings in those blue octavo notebooks. The stories in this period feel less constrained than the earlier work and are largely free of the framing of the domestic drama found in “The Judgment” and “The Metamorphosis.” While “In the Penal Colony” and The Trial move far beyond the domestic space, they still contain easily recognizable narrative structures—they know themselves as stories. Can the same be said of the prose fragment “The Great Wall of China” or the published story “Jackals and Arabs”? The pieces that formed in the blue octavo notebooks are less structured. They are often hybridized texts. They are questions without resolutions.

“A Country Doctor” begins with a scene of action and suspense. A country doctor has been called to visit a gravely ill patient in a town ten miles away. It’s night. It’s winter. The doctor has everything he needs to start out—fur coat, bag of medical equipment, a suitable carriage—but he doesn’t have a horse. His horse had died the previous day from overexertion, and nobody in town will lend him one for his journey. “What do you think it means,” I asked the dental students, “for the doctor to lack a horse?”

It turns out the doctor has a horse—two horses. Frustrated by his maid Rosa’s failure to borrow a horse, the doctor kicks at the door of his long-neglected pigsty. The door swings open and a man calls out, “Should I harness up?” Rosa jokes—an example of Kafka’s dark, foreboding humor—“One never knows what’s stored in one’s own house.” It’s a joke intended for the doctor and the reader. The house is the house. The house is the psyche. The house is the self. The house is what’s beyond the self. The house is…  

At this point, the story rapidly increases in strangeness. Two strong horses emerge from the pigsty with a stable-hand. When Rosa moves over to help the man deal with the horses, as the doctor has instructed her to do, the stable-hand grabs her aggressively and bites her cheek. The stable-hand is animalistic, bestial. He possesses a devouring lust unbridled by social or moral constraints, and immediately asserts his dominance of the scene. He readies the horses and commands the doctor to get into the carriage. The doctor obeys. The doctor, in an attempt to reassert himself, tells the stable-hand he’s driving, that the stable-hand doesn’t know the way. To this the stable-hand replies, “I’m not coming along, I’m staying with Rosa.” The horses, it becomes clear, are being exchanged for the girl—and the doctor, despite his verbal protestations, is powerless to stop it. Upon the stable-hand’s word, the horses sweep the doctor away. The last sound the doctor hears until his eyes and ears are overcome with “a whooshing that penetrates all my senses” is the crack and split of his door giving way to the stable-hand’s attack. Rosa’s rape is assured. What has the doctor’s house become now? Is it still his house?   

The doctor doesn’t drive the horses through the winter nighttime landscape to his patient’s house, he is driven by them. Both the spatial and the temporal relationship between his house and the patient’s has collapsed, for as soon as he sets out, he arrives. When he gets to the house the patient’s parents and sister pull him from the carriage and basically carry him to the sickbed, continuing the theme of the doctor’s passivity.

The atmosphere is oppressive—“the air in the sick room is hardly breathable.” Cramped and crowded, there is nothing hygienic about this space. There are no signs of the family’s attempt to heal the boy or even to alleviate his suffering.

Skinny, not feverish, neither cold nor warm, blank-eyed, shirtless, the boy raises himself under the featherbed, puts his arms around my neck, and whispers in my ear: “Doctor, let me die.”

The boy’s request shifts the terms of the doctor’s visit. The doctor, an agent of healing, is called on to prepare the boy for death. But to prepare him in what way? The doctor, at first ignoring the boy’s plea, reverts to his routine. He opens his medical bag, rummages for a tool, draws out a tweezers, recognizes the tool’s inadequacy in the face of the boy’s predicament, and puts it down. The doctor’s mind drifts momentarily away from science to another register:

“Yes,” I think blasphemously, “in cases like this the gods help out, send the missing horse, add a second because of the urgency, and for good measure throw in a stable-hand.”    

The doctor’s fleeting thought about “the gods” and their power to shape fate is laced with irony. He mocks “the gods”—which itself implies the dismissal of the notion of God in the singular, monotheistic sense. More than that, the dismissal of the monotheistic God is a tacit rejection of the relationship between God and the world. Without God overseeing history and fate, there is no divine order. There is no such thing as goodness. There is no transcendent meaning in life—and this includes a meaning for death. If one of the central purposes of religion is to provide a ritualized vision of a threshold between life and death, without this concept, there is no clear way to relate the two states of being other than in the direct materialist sense of death as the negation of life. It would seem that Nietzsche’s view of God-is-dead has prevailed.

The doctor undertakes a cursory examination of the sick boy. On the surface, which is as far as the doctor’s attention takes him, the boy appears fundamentally healthy, if slightly weakened (a condition the doctor attributes with no evidence to the mother’s officious care). The family, in the meantime, pours the doctor a glass of rum, as the scene of doctor-at-sickbed transforms into a kind of ceremony. When the doctor shuts his medical bag, symbolically ending the scientific examination with the conclusion of the boy’s healthiness, the sister displays the “blood-soaked towel.” Not only is this material proof of the boy’s disastrous condition, it is a powerful rebuke of the doctor’s methods. The blood-soaked towel is a grotesque version of a shroud.

The doctor now probes again and finds the source of the suffering. There is a large open wound in the region of the boy’s right hip. It’s a deep wound, revealing a flowered layering of pinkish flesh—the pink and the floral description a linguistic link to the maid, Rosa. Worse: the wound is infested with worms. It’s a shocking discovery, both because of the wound’s grotesque nature and because it went totally unnoticed by the doctor during his initial examination. The doctor, powerless at the beginning of the story (de-horsed) is now unmasked as incompetent. If he first curses the trip as a waste of time when he thinks the boy is healthy, now he must contend with his own uselessness to treat an affliction of this magnitude. The doctor is helpless not against the surface conditions of the wound but against what the worms indicate about its depth, about the interior.

The juxtaposition of surface and depth, of exterior and interior, suggest a metaphorical relationship between the material world and the existence of a spiritual dimension. The boy’s disease is too deep for the doctor to treat, seemingly even to contemplate. The external wound is the symbolic flower. Internal decay lies within.

The boy’s family has known the whole time that the boy’s condition is bleak, that the decay is not treatable. They have called the doctor out at night not to treat or to cure but to administer the boy’s death. But the doctor is not the appropriate figure for such a task. He is the wrong character for this particular play, and yet at the same time must act the role—a role without a usable script. The confusion of roles, the absence of clear scripts, indicates that we are dealing with a broader cultural collapse. This is a culture that still must prepare an individual for death, a family and a village for death; it is a culture that must make sense of death. Yet, it is a culture that cannot connect death to a transcendental order. It is a culture with withered rituals and traditions—ones that exist piecemeal or as decontextualized elements but which are not integrated into a unified whole.

The family’s makeshift ritual is the poor substitute for authentic ritual. The doctor is a pathetic stand-in—the ill-chosen replacement—for a man of faith. The doctor understands this cultural confusion, and blames the villagers for it:

That’s how people are in my region. Always asking the impossible of the doctor. They have lost the old faith; the priest sits at home, shredding his vestments one by one; yet the doctor is supposed to accomplish everything with his delicate surgical hand. Well, as you wish: I did not put myself forward for this; if you misuse me for sacred purposes I shall also let that happen; what more could I want, I, an old country doctor, robbed of my maid!

The family of the dying boy needs ritual—or ritualized performance—to connect life and death; they desire, in other words, a meaning-making apparatus. The traditional apparatus might have decayed to the point of becoming something close to farce, but it hasn’t disappeared entirely. It hasn’t been totally abandoned. The priest is absent, but the role of the priest has transferred to the doctor.

The doctor, however, is a man of surfaces, a man of materiality. In a semi-feverish state, he reproaches the sick boy, assuring him his wound isn’t so bad: “‘Young friend… your mistake is that you lack perspective [dein Fehler ist: du hast keinen Überblick].’” It is Überblick, literally the view from above, that is the only type of vision possible for the country doctor. It is his greatest asset and his greatest limitation. He cannot possibly, as a man of science, stand at the great gate between life and death and usher the boy into the realm of a meaningful beyond.

When it comes to Kafka, it’s always easier to identify what he isn’t, what he’s not doing, rather than to say with confidence who he is and what he is doing. I’m reasonably confident in the following negations: First, “A Country Doctor” is not an anti-modern, nostalgic call for a return to a society governed by traditional religious culture. The traditions in the world of the story are too degraded for any possible resurrection. Second, the story is not a celebration of the scientific worldview, nor is it an optimistic statement about the power of empiricism. The doctor is far from heroic. He is not a man of progress. He is rather the paragon of uselessness, helplessness, and impotence. Third, the piece is not a Romantic reading of sickness and disease. There is nothing ennobling about the boy’s condition. There is no grander meaning in the “flower” of his wound or in his approaching death.

The story occupies the shadowy space between interpretative paradigms. The liminality or in-betweenness of “A Country Doctor” exists on thematic and narrative levels. The story hovers between life and death. It exists between the real and the surreal. The mundane framing of a country doctor being called out at night to treat a seriously ill boy is contrasted with a host of uncanny elements: the horses and stable-hand in the pigsty, the stable-hand’s bestiality, the collapse of an orderly experience of time, the grotesque abundance of worms in the wound, the intrusion of the horses into the sickroom, the stripping of the doctor and the placing of him on the sickbed next to the patient, the singing of the village’s school chorus. Other details add to the liminal strangeness: the blinding snow, the wintry expanse.

One might say that the final bulwark against the intolerable state of liminality is the existence of the individual, the cohesiveness of the self, however internally or psychologically divided. This is partly what, I think, animates the powerful interpretive desire to formulate a psychological or psychoanalytic reading of Kafka’s texts—it’s about his father; it’s about his relationship to women; it’s about homosexuality. The character of the doctor pushes the reader in another direction, not toward the coherence of a self but toward its disintegration. The doctor can be read as a collage (and mirror) of otherness—the stable-hand’s lust and violence, the potency and agency of the horses, the boy’s inner decay, the family’s degraded ritual, and so on. The doctor, struggling against this diffusion into the liminal, ends up consumed by it. At the end of the story, he is neither here nor there, neither self nor other, neither alive nor dead:

I shall never reach home like this; my flourishing practice is doomed; a successor steals from me, but in vain, for he cannot replace me; the repulsive stable-hand wreaks havoc in my house; Rosa is his victim; I do not want to think it through. Naked, exposed to the frost of this most unfortunate age, with an earthly carriage, unearthly horses, I, an old man, drift about. My coat hangs on the carriage behind me, but I cannot reach it; and nobody among the able riff-raff of my patients lifts a finger. Betrayed! Betrayed! Once one has followed the mis-ringing of the night bell—it can never be made good.

To read “A Country Doctor” as liminal fiction is to eschew a definitive reading and to embrace its grayness, strangeness, and instability. But what can such a liminal text provide for the reader? What could the dental students take away from my session with them? They, like most of us, seek clarity. They—we—find none. We seek meaning, definitive meaning, but this is precisely what liminal fiction denies us. We seek to build arguments based on evidence, but the evidence cannot hold the weight of the argument. The structure collapses. The mis-ringing of the night bell chimes for all of us.

“How do we live in a world like this?” I asked the dental students. “How do we move through our snowy, wintry nighttime without sight, without the power to rein in or steer our horses?”

“What happens to a culture,” I asked, “that demands meaning but struggles to find its way below life’s surface, and when it does penetrate the surface discovers decay and rot, not answers, not meaning, not hope?”

For some tense minutes, the dental students gazed at me in silence from their orderly rows. They were dressed in business casual attire. They had identical black faux-leather portfolios on their laps, stamped, as I later found out when the program director gifted me one, with the phrase “Leadership: Learning it, Living it” on the front. Inside the case was a legal notepad, though nobody was taking notes.

Finally, a hand went up, half-raised in a tentative manner. It belonged to a young woman sitting to my left in the second row. She was wearing a blue pantsuit, brown shoes with no visible socks, had long black hair. I called on her.

“In a case like that,” she said, “I guess it’s time to drill to the root.”

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Translation: Mark Harman, Selected Stories (Harvard UP/Belnap 2024).