The Real Hospital, The Imaginary Hospice. On Maria Gerhardt’s Der bor Hollywoodstjerner på vejen (2014) and Transfervindue (2017)

1 Previous Research on Gerhardt and Generic Attribution of the Works

It is worth noting that some scholars have already conducted inquiries into Gerhardt’s literary oeuvre. Even though the research has not been extensive so far, the approaches employed by the scholars are remarkably diverse, and their observations are insightful. In what follows, I also attempt to identify the generic features of both of Gerhardt’s works, not in order to pigeonhole them, but rather to encourage particular modes of reading.

Although the plot of the two books revolves around the same topic, their generic attribution is somewhat different. Der bor Hollywoodstjerner på vejen is an autobiographical piece of literature, and can be perceived as a pathography – a literary genre defined by Ann Hunsaker Hawkins as “a form of autobiography or biography that describes personal experiences of illness, treatment, and sometimes death” (Hawkins 1993, 1). However, the definition of Hawkins may be overly broad in the present era of ubiquitous testimonies of the ill and their next of kin. Therefore Linda Nesby suggests a more inclusive approach to the genre, so that it encompasses both actual (auto-)biographies and works of fiction, as – she claims – it is the mediation of the illness experience, not the connection to the extratextual reality, that is pivotal in a pathography (Nesby 2019, 57). Transfer Window, in turn, is a work that is “situated between fiction and non-fiction,” in Pernille Meyer’s words (Meyer 2022, 27), and it is set in an imaginary, luxurious hospice located in Danish North Zealand. Since the plot is set in a fictional place, the work can be classified as a utopian or dystopian narrative. The ambiguity of the hospice’s status as both a utopian and dystopian place is also expressed by Niels Dalgaard, whose observations situate the plot’s location somewhere between a refuge (tilflugt) and exclusion (eksklusion) (Dalgaard 2023, 21). It is also noteworthy that Transfer Window employs the first-person narrative, but the text’s addressee, the protagonist’s wife, is present here in form of the ubiquitous “you”. This topic is discussed in detail by the aforementioned Pernille Meyer who investigates the matter of the second person narrative in the text (2022).

The list of the relevant publications can be supplemented by Per Krogh Hansen’s “llness and Heroics” (2018), in which the master metaphor “the war against cancer” is discussed, along with its impact on people’s lives and its political and cultural repercussions, in relation to Transfer Window. Yet another approach is employed by Linda Nesby, who investigates illness in the context of the sick person’s social class and prominent address in a number of Scandinavian narratives, including Der bor Hollywoodstjerner på vejen (Nesby 2021). Last but not least, Camilla Schwartz’s short contribution should also be mentioned in this list, as the author’s observations on the patient narratives, including Maria Gerhardt’s book debut, introduce an alternative to the strictly medical discourse (Schwartz 2016). Nevertheless, none of the research published so far has openly addressed the places of hospital and hospice in Gerhardt’s works as non-places or/and heterotopias, which is the main objective of the present article.

The aim of the essay is twofold: I intend to investigate whether the two places in question actually display the hallmarks of non-places and heterotopias, and, subsequently, if they affect the protagonist in the same fashion – specifically, if and how they contribute to her alienation and exclusion from the outside world, i.e., the world of the healthy individuals, and from the fellow patients. In order to do this, I have selected Marc Augé’s theory of places and non-places and Michel Foucault’s concept of heterotopias and utopias as a theoretical frame of my investigation. It is my conviction that they help shed light on the particular relation between places and the individuals who inhabit them, often involuntarily.

2 Augéan Non-Places, Foucaultian Heterotopias and Utopias

The fact of alienation and exclusion of the sick from the healthy seems to be crucial in my investigation, as it is inherent in the spatial theories of Augé and Foucault, whose concepts of non-places (Augé) and heterotopias (Foucault) partly coincide. Both scholars employ the concept of norm (in Foucault’s case “normality”), which they contrast with the concept of deviation from the norm, or aberration. Following this line of thought, in Foucault’s understanding, the healthy will represent the norm and standard, while the sick will embody deviation and “abnormality”. Such a division inevitably leads to the alienation of the sick, and their stigmatization as persons diverging from the norm. Augé, in turn, does not involve the concepts of health and illness in his research on spatiality, but his distinction between places and non-places seems indicative of his binary thinking that validates one (places) over the other (non-places). Since hospitals and hospices display several traits of non-places, they can therefore be perceived as places of lesser value, which affects their (temporary) inhabitants.

In Marc Augé’s theory, hospitals can be described as non-places, as opposed to places. This is how Augé explains the difference between the two phenomena:

If a place can be defined as relational, historical and concerned with identity, then a space which cannot be defined as relational, or historical, or concerned with identity will be a non-place. […] Supermodernity produces non-places, meaning places which are not themselves anthropological places and which […] do not integrate the earlier places. (Augé 1992, 77–78)

Hence, places in Augé’s understanding are intimate, complex and ambiguous; they are essentially unchangeable, and they establish a relation with the past. Conversely, non-places are “transit points and temporary abodes, such as hotel chains, holiday clubs, refugee camps” (78), but also airports, motorways, supermarkets or factories. The editors of the anthology Non-Place. Representing Placelessness in Literature, Media and Culture additionally argue that non-places in Augé’s understanding “do not allow for their user to satisfy important human needs” (Gebauer et al. 2015, 5), including communication with a “unique fellow human being” (5).

Augé’s places and non-places remind to some extent of Michel Foucault’s distinction between two types of spaces: utopias, which constitute a part of the society’s collective imagination, and heterotopias, which are real. The French philosopher and historian defines utopias as follows: “Utopias are sites with no real place. They are sites that have a general relation of direct or inverted analogy with the real space of Society. They present society itself in a perfected form, or else society turned upside down, but in any case these utopias are fundamentally unreal spaces” (Foucault 1986, 24). As for heterotopias, Foucault distinguishes between two types: “heterotopias of crisis”, which he defines as “privileged or sacred or forbidden places, reserved for individuals who are, in relation to society and to the human environment in which they live, in a state of crisis: adolescents, menstruating women, pregnant women, the elderly, etc.” (Foucault 1986, 24). The other type of heterotopia is a “heterotopia of deviation”, which is a site where the society allocates individuals whose condition or behaviour diverge from the required norm. Heterotopias of deviation encompass prisons, rest homes and psychiatric hospitals (Foucault 1986, 25), but the notion can also be applied to regular hospitals, since they house patients whose condition and appearance tend to alienate and exclude them from the general public. Accordingly, both hospitals and hospices can be seen (at least hypothetically) as non-places or heterotopias of deviation. In her texts, Maria Gerhardt describes a real place – a hospital, and a fictitious one – the hospice. In what follows, I am going to inspect closer the features of these two places, and try to establish, whether they represent the same category in terms of Augé’s and Foucault’s observations.

3 Hospital in Der bor Hollywoodstjerner på vejen

In Der bor Hollywoodstjerner på vejen, the hospital appears already in the first chapter, where Maria arrives to examine a lump in her breast. As she steps inside the Royal Hospital in Copenhagen, she enters an Augéan non-place, i.e., a site that is non-residential, transitional and efficient. The distinction between the “normal” outside world and the “abnormal” hospital is tremendous. The common rules of behaviour and communication are suspended there in order to deliver as good medical treatment as possible, and to dispose of the (cured) patient, so that her place can be taken by another. The narrator is immediately confronted with the rules and procedures governing the non-place. After undergoing an ultrasound examination and a biopsy, she learns that her life is going to change drastically, even though initially it is more of a premonition than certainty: “Da han tager en biopsi, bruger han noget, der ligner en hæftepistol med en stor nål med indbyggede modhager for enden. Den gør ondt, og den larmer, og jeg begynder at kunne mærke det hele” (Gerhardt 2014, 9).

The initial chapter depicts Maria’s visit to the hospital as a game-changer. The life as she knows it is ending, and her holiday plans in a faraway country have to be set on hold. Few chapters into the book the oncological department becomes the narrator’s new reality. When admitted as a patient, she becomes dependant on the medical personnel, and feels humiliated by the medical procedures she needs to be submitted to:

Afdeling 4262, mit nye hjem. 2013, min skæbne. […] Der sidder en læge og en sygeplejerske over for os. […] Lægen afleverer beskeden og forlader så lokalet, videre, som en anden stjerne, som en hoven elsker.

Du har en kræftknude på otte cm i diameter i dit venstre bryst, siger han og fortsætter: Du kommer til at miste brystet, du kommer til at miste håret. Du kommer til at få mere kemoterapi end normalt, fordi knuden er så stor. (Gerhardt 2014, 13)

The description of the oncological department and the unempathic doctor, along with the degrading experience of undergoing mammography, contribute to rendering the hospital a disquieting and hostile place where the rules of the outside world do not apply. The usual communication between people is limited to the doctor’s straightforward and patronizing monologue, and his immediate desertion after delivering the diagnosis to the patient seems symptomatic of the rules governing non-places. The presented scene leaves no doubt as to the agents who control the narrative: it is the doctors and other representatives of the medical care system who exert their power. The patient, i.e., Maria, is voiceless and not even expected to react, as the communication model between the doctor and the patient does not accommodate such a reaction. Hence, a clear association with Augé’s non-places comes to mind. According to Augé, non-places do not encourage spontaneous communication between individuals, because they are not even perceived as ones. Augéan agents ascribed to a certain non-place tend to be functionalized as respectively the doctor and the patient, and restricted to the roles the two sides are bound to play. This is how the French scholar puts it: “non-places mediate a whole mass of relations, with the self and with others, which are only indirectly connected with their purposes” (Augé 1992, 94).

Further into the narrative, the negative perception of the hospital becomes reinforced by a series of adverse sensory impressions and the protagonist’s feeling of isolation. The narrator describes, for example, the contrast agent she has to drink before her MRI as “the most disgusting she has ever drunk” (Gerhardt 2014, 19), and the preparation to her first chemotherapy session as very painful:

Der er små båse, adskilt af lange hvide gardiner. Der sidder ikke nogen andre, da vi kommer derind. Jeg skal have kemoterapien i drop, og sygeplejersken tager tilløb til at sætte droppet fast i min højre hånd. Hun har problemer med at få nålen rigtigt ind, mine vener sidder åbenbart dybt. Fire gange forsøger hun, inden den sidder rigtigt, og det gør ondt. (Gerhardt 2014, 37)

However the medical procedures which Maria has to be submitted to are part of her treatment, and as such are not questioned by her, one of the worst experiences she describes is the necessity of wearing the hospital gown, and being incorporated in the hospital healthcare system. This thought appears in several scenes of Der bor Hollywoodstjerner på vejen, for example in the scene where the narrator descends to the so-called Atomkælderen to undergo a MRI scanning, and is demanded to change into the hospital gown.

The institutional character of the hospital in Gerhardt’s pathography is one of the factors which alienate the ill protagonist from herself, and excludes her from the outside world. The Royal Hospital from the book is undoubtedly a non-place, since it does not create singular identity, nor does it encourage communication. The ill person feels incapacitated and passive, being humilitated by both the illness, and the predominant discourse of power which situates doctors and patients on two opposing poles. Meeting other patients does not alleviate the suffering, because they are merely a reflection of the narrator’s own condition, and make one realise one’s own plight, even though it could be assumed that the solidarity of common fate facilitates mutual understanding and communication.

Jeg sidder i venteværelset og bryder mig ikke om det. […] Den gode patient er gået. Den skaldede dame med Billedbladet er ikke min ven i dag. Hun er ikke min søster, ikke Jeanne D’Arc. De ligner Gollum. Alle sammen. Afpillede og savlende holder de fast i de åndssvage ugeblade, mimer, at de læser, lider i angst. […] Døden findes her. (Gerhardt 2014, 158)

In Maria’s eyes, the other patients are revolting in their uniformity. They do not even resemble people, but remind her of Gollum, a human-like creature from Tolkien’s universe.

It is also worth noticing that the narrator does not perceive her fellow patients as “Jeanne D’Arc”, which pertains to the discourse of heroism versus failure in battle against cancer. Hansen (2018) observes in his aforementioned study devoted to counter-metaphors on illness in Transfer Window that the protagonist seeks seclusion in her exile because she is tired of the dominant base metaphor of illness as a battle which must be fought by the patient. He perceives the metaphor as ambivalent since, on the one hand, it offers hope of recovery, but on the other hand, it unintentionally marks the ill person as a loser, if he or she fails to recover. Hansen’s observations are equally relevant in Der bor Hollywoodstjerner på vejen The discourse on illness is governed by healthy individuals, whose expectations of the ill can be a burden, and as a result, contribute to further alienation and exclusion of the ill.

The concepts of heterotopia and non-place can beyond doubt be applied to the oncological department from Gerhardt’s narrative. Not only does it alienate the ill persons from the ‘normal’ world, but it also deprives them of individual traits. The emotional description of the terminally ill patients recalls the inhabitants of Foucaultian heterotopias of deviation, places where individuals are separated from the society due to their subversive behaviour, condition or/and appearance. These processes, described as “processes of exclusion and standardization in modernity” (Gebauer et al. 2015, 15), seem unavoidable. In Gerhardt’s narrative, the fellow patients lack identity; they are mere representations of the illness which has reduced them to a subject position.

4 Hospice in Transfer Window

The question arises, whether the hospice from Gerhardt’s other book, Transfer Window, affects the protagonist in the same manner, and contributes to her alienation and feeling of incapacitation.

As mentioned before, the plot of Transfer Window is set in a non-existent, luxurious hospice in North Zealand where terminal cancer patients are located. The title “transfer window” denotes a liminal place – a limbo between life and death – where the ill reside before entering the ultimate stage of fate. This notion aligns with Foucault’s concept of heterotopias. One could therefore argue that the terminal condition of hospice inhabitants could make the hospice even more heterotopian than the hospital. Surprisingly, in Gerhardt’s description the hospice is humorously depicted as an idyllic place where nuns grow cannabis to relieve the patients’ suffering, and where each patient has plenty of space, room service and access to the sea.

This enormous Hospice, unparalleled anywhere in the world, starts at the gateway on Strandvejen […]. We have been granted the entire coastline from Tuborg Harbour to Bellevue Beach. […] The eldest residents live in villas on the waterfront. The physicians live in the white building that Arne Jacobsen designed in the 30s. […] Café Jorden Rundt is a 24-hour raw juice bar with recipes from around the globe. […] We own high-end restaurants. And Bakken amusement park, of course. You can win a range of expensive medical treatments at the Sommerfest Tombola. (Gerhardt 2017, 33)

The whole description resembles a tourist resort, and only the presence of doctors and the tombola with expensive medical procedures signals that the narrative refers to the realm of terminal illness. The restrictions which apply here are unrelated to medicine, as such; rather they exist to cater to the needs of the ill. For example, listening to music “is prohibited. It wakes too many feelings” (15), but it would be incorrect to assume that expression of emotion is frowned upon in the Hospice, as “there were days allocated to tears from 9.00 to circa 3.30 pm. There was so much water. I had to apply another coating of face cream after tea” (26). Visits of the healthy are only allowed on Sundays, but after two visits of her family, Maria refuses to meet with them, and chooses to frequent the Virtual Reality Shop, if needed. The entire storyline of the book is undoubtedly imaginary, apart from another track in the narrative that contains memories from the time of illness in the outside, ‘normal’ world.

It is not a coincidence that Transfer Window bears the disquieting subtitle Tales of the Mistakes of the Healthy. I describe it as disquieting because it clearly challenges the unwritten rule, as well as Foucault’s concept of heterotopias, which posits that health is the norm, and illness is a deviation that should therefore be removed from the centre of attention. Paradoxically, in Gerhardt’s Transfer Window the order is reversed, and it is the healthy who are to be blamed for making mistakes. It is worth noticing that the majority of the locations mentioned by Gerhardt actually exist in North Zealand in Denmark, and that the coastal environment is synonymous with luxury and wealth. Hence, the idea of placing the terminally ill in the Arcadian refuge of peace and quiet is both symbolic and subversive, as it highlights the reversed order governing the narrative. The standpoint of Gerhardt’s narrative is clearly that of a terminally ill person, not of a healthy one, and the ill narrator has had to retreat from the world of the healthy for various reasons.

Firstly, she does not want to inconvenience the healthy with her illness, or to cause them any discomfort. The narrator keeps track of friends who cannot endure being in her presence because they cannot address the problem of terminal illness (28), or who cannot resist the temptation of giving her unsolicited advice, or repeatedly ask the same questions (36). But the most noteworthy remark of the dying Maria is connected with the lack of communication between the two worlds: the sick and the healthy. This is expressed in her painfully ironic statement: “The sick are sent stacks of emojis” (30). The absence of an appropriate language to express the experience of illness and to communicate it across to ‘the other side’ seems pivotal here, leading the healthy to resort to the more primitive language of pictures, as the codified ideograms of emojis replace words. One cannot fail to notice that Augé regards the presence of ideograms as one of the tenets of non-places (Augé 1992, 96), making the term “non-place” applicable to Gerhardt’s hospice in this respect.

Secondly, the narrator does not want to be a burden to anyone, let alone her family, so she considers moving into a hospice the best solution for everybody, including herself:

It’s easier, if you stay away. It is easier, if he gets used to me not being around. It is easier to think it’s okay that you’ll love someone else one day. (Gerhardt 2017, 42)

Everyone, who does anything for me, is paid one-hundred-and-fifty kroner an hour: No one has to call me up voluntarily, or come for a visit and get a bad conscience about all the things they cannot change. (43)

I simply disappeared to here, after all. I didn’t run. I just vanished. […] I wanted to spare you from witnessing any further destruction. Of my body, of memories, of the person I used to be. The person I will never be again. (86)

Being an obstacle in both communication and personal contact, the terminal illness symbolizes both (self-)exclusion, and a pass to a zone with restricted access.

Last but not least, Maria chooses to retreat to the hospice to reclaim her own voice – the voice of the ill – who cannot communicate with those “on the other side of the wall”, because they are unable to understand the condition she has found herself in. She voluntarily withdraws from the world of the healthy, reclaiming the agency which eluded her in her earlier, more vulnerable state as a patient navigating the external medical discourse.

Communication and understanding are possible only with other terminally ill people, those who also reside in the hospice and who share the narrator’s standpoint. In contrast to the fellow patients described in the previous book as lacking individual traits, Maria’s fellow patients from Transfer Window are distinctly individuals with their own life and story of illness, and are referred to by name in the narrative. Being around others who share similar experiences in illness, is a relief for the protagonist, who ironically remarks: “How eighties can you be; pick out the friends in a circle who are going to die” (53).

The question arises whether Gerhardt’s hospice can actually be regarded as a utopia, in the Foucaultian understanding of the concept. It seems that the imaginary hospice from Transfer Window possesses many tenets of a utopia: it is a fictitious place, even though the locations are recognizable to an inhabitant of Zealand, it presents an image of the ideal society (for the ill) and it is a society whose order has been reversed, since ‘the abnormal’ (the ill) dictate the rules. On the other hand, the restrictions and rules governing the place may cast doubt on the utopian provenance of the imaginary hospice, as idyllic spaces are usually associated with unlimited freedom. Nevertheless, it is worth remembering that the narrator enters the hospice of her own volition, and has therefore accepted the terms of her stay. There is, however, one disquieting element of the narrative that can question the ‘purely’ utopian character of the place. In the book’s final scene Maria escapes from the hospice, chased by German shepherds; it is the day 500 of her stay, and it is supposedly her last attempt at returning to her old life. She succeeds in her pursuit, and takes a pause at a supermarket:

I must look like a homeless person, for a man comes up to me and puts a coin in my hand. I snatch it to my chest, horrified. […] I stand in the queue, and when my items have been scanned the tired shop assistant looks up in confusion, and I realize that I’m trying to pay her with a miracle. (92)

Is the narrator trying to escape the ‘paradise’ after all, and could her voluntary confinement be a self-deceptive strategy? Yet, the odd gesture of handing her a coin by a random passer-by bears an eerie resemblance to the mythological obol which needs to be paid to Charon in order for his ferry to convey a dead person’s soul to the other bank of the river Styx. The passer-by apparently recognizes Maria’s needs before she does herself, as she realizes the coin’s worthlessness only after she attempts at paying with it in the realm of the living. The last scene of the book complicates the idyllic representation of the hospice, but even so, the utopian traits seem to prevail over the heterotopian in Foucault’s understanding. After all, Maria’s escape, though unsuccessful, demonstrates the protagonist’s agency and independence.

5 Conclusions

The above reflections lead me to sum up the conclusions of my investigation into two works by Gerhardt that explore her terminal illness. The question has been whether the two places – the real and the imagined – can indeed be classified as non-places and heterotopias, and whether they affect the protagonist in the same way, i.e., if they alienate and exclude her from the environment of the healthy individuals in a similar fashion. I hope that I have succeeded in proving that the two places differ significantly in terms of the autonomy and agency of the ill person, which influences her overall perception of the two institutions. The Royal Hospital depicted in Der bor Hollywoodstjerner på vejen fulfils various requirements of a heterotopia and a non-place: it is a transit place where all communication between people is limited to a minimum level, it is clearly divided into two groups of people: the normal (the healthy) and abnormal (the ill), and it is the healthy (i.e., the norm) who are in control of the narrative on the patients’ condition and illness. No wonder that Maria finds the necessity to identify herself as a patient – deprived of her own voice and autonomy – as oppressive and incapacitating. This oppressive master narrative of the healthy is, in turn, absent in Transfer Window, where the hospice is surprisingly depicted as an idyllic place, displaying only to a little extent the characteristics of a non-place and heterotopia. Moreover, being an idyllic, imaginary place, situates Gerhardt’s hospice in the vicinity of Foucault’s utopia, rather than a heterotopia, even though its image does not emerge from collective imagination, as one might expect according to the author of Of Other Spaces. During her stay in the fictitious hospice, Maria establishes meaningful contacts with other patients who are individuals of flesh and blood. The alienation and exclusion from the outside world are also present here, but the protagonist isolates herself from it of her own accord. It can therefore be concluded that the discourse dominating in a particular place determines its level of heterotopia.

I would also like to emphasize the metaphorical potential that the two places hold in Gerhardt’s narratives. While the heterotopian hospital is real, the idyllic, utopian hospice is merely an idea of an ideal place this can be interpreted as an important voice in the discourse on places of illness, which explicitly expresses the needs of the ill and the shortcomings of the healthcare system, including the absence of patient-oriented discourse. It does, indeed, matter “hvor man ligger og har det dårligt” (Gerhardt 2014, 80), and how one is treated in the process.