Not in Kansas Anymore

By Emily Berns
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"Please make underneath free," the nurse said, pointing to a semiprivate nook in the spotless, modern gynecology office. I looked around, locating a mirror and a hook for my clothes, but no hospital gowns. After a few moments of confusion, I realized this was no oversight on the nurse's part: There were no hospital gowns. Gritting my teeth, I emerged bottomless from the dressing area for my examination, feeling exposed and slightly ridiculous. Dimly I recognized that, to paraphrase Dorothy in The Wizard of Oz, I was not in Kansas anymore.

It was the end of my very first week as a resident of Munich, home of my German husband, Uwe. The conclusion of that examination--a confirmed pregnancy--left me stunned. I had just started to meet Uwe's friends; I was learning where the food stores were and familiarizing myself with the comparatively limited product choice and with German coins and bills; I'd even lined up a freelance job. But my pregnancy was to derail any additional plans to adapt gradually to my new surroundings. Instead of taking lessons in the German language, I would be thrust into German society through a crash course in German medicine. Uwe pointed out that there is rarely a convenient time for a baby to arrive, and his philosophical attitude helped me adjust to my condition. If he, who a few months before had been a carefree, sociable bachelor, could accept this sudden new responsibility without a murmur, I could but follow his lead.

Meanwhile, without half trying, I picked up a specialized vocabulary--one heavily weighted with prenatal terms. Schwangerschaft. Gebärmutter. Fruchtwasserprobe. (Pregnancy. Uterus. Amniocentesis.) The fact of my pregnancy soon acquainted me with Germany's vaunted system of medical insurance (which provides, for a price, generous coverage for all) and its successful variation on socialized medicine. I learned that I must choose a hospital in which to undergo certain required pregnancy tests and eventually give birth. With some trepidation I discovered that the doctor who delivered my baby would be whoever was on duty at the time.

I chose a huge, turn-of-the-century hospital in our neighborhood that had been recommended by several young mothers Uwe knew. Though its wide corridors, 20-foot ceilings, crucifixes, and occasional shrouded religious sculptures were old-fashioned and somewhat intimidating, I came to have confidence in the skill and efficiency of the doctors, and their anonymity ceased to bother me. As my gynecologist and the hospital doctors carefully noted the progress of my pregnancy in my Mutterpass, or "mother's passport," I realized that I was part of a well-run, well-thought-out system. Yet I was puzzled when, after several mysterious but apparently benign bleeding episodes, the doctors saw no need to explain what could have caused them. "Wouldn't you want an explanation if you were me?" I asked Uwe. "No," he replied, "as long as I knew nothing serious was wrong." (Years later, an ear-nose-throat specialist who operated on both my sons responded to a query of mine in this fashion: "If I were to tell you how I operate, you might as well become a surgeon yourself.")

German patients' more resigned attitude, less insistent on what Americans would see as their right to know, is a further indication of something I had sensed during that first visit with the gynecologist: the direct connection between a country's culture and its approach to medicine. In what other country but this home of superb chocolate would a pediatrician describe it as Nature's healthy relaxant? And where else but in Germany would beer be considered not an alcoholic beverage but food?

As any trip to a public swimming pool in Germany demonstrates, Germans have an accepting, no-nonsense attitude toward the human body and a lack of understanding of what Americans would call modesty. Topless women of all ages and shapes, often with unshaven legs and armpits, men in the briefest of swimming trunks, and open-air changing are the norm.

Eventually I would learn that I was not the only foreign woman who gritted her teeth in German gynecologists' offices. A few months after I arrived in Munich, I met a British-educated but partially German-raised Indian woman at a birth-preparation class. Sonu became my class translator and my friend, and her fluency in not only the German language but the ways of German society was a frequent help to me. She sympathized with my discomfort in the examination room, telling me of her gynecologist's disdain when she asked to be draped for her examination because her two-year-old was present. "You Asians should get over your prudishness," he said. Such self-righteous contempt for other cultures' mores is, of course, unattractive. But the Germans' lack of prudery, their natural approach to all things natural, also has a positive effect on the way their doctors practice medicine.