Goethe's Erlköenig: A poetic 
drama at the close of day

Legend has it that Goethe penned his poem Der Erlköenig shortly after visiting a friend in the country one winter night. While the two men sat by the kitchen fire, a horseman passed by on the road outside, clutching a small bundle to his breast. Goethe later learned that the horseman was a neighboring farmer carrying his feverish son to the town doctor for emergency care. In Goethe's mind, these events congealed in a poetic drama where, despite the father's attempted reassurance, the young boy shudders at the whispers of death in the misty night.


It was late winter, the height of RSV season that year. I stepped in to see my last patient of the afternoon, a 6-week-old baby girl brought in by her father for cough and congestion. "She's not breathing right," the father said, dispensing with formalities. "Her mother and I are worried."


"Let's get her undressed," I said, helping the father pull off the infant's clothing.


I clocked her respiratory rate at 66. She lay on the exam table in obvious distress, chest and abdomen seesawing back and forth, retractions defining each rib with every short, rapid breath. Beneath the flaring nostrils I noted two rivulets of clear mucus.


Still, she was pink; her petite nail beds flushed immediately after gentle pressure was applied and released. I popped the stethoscope into my ears and listened intently to the slight wheezes scattered over her lung fields. The tiny heart ticked away at 140 beats per minute.


I stood up, draped the stethoscope over my shoulders like an ancient prayer shawl, and took a deep breath myself.


"She is breathing hard," I explained to the father, "although she seems to be taking in enough oxygen."


"What do we do?" he asked.


"It looks as though she's got bronchiolitis, a respiratory viral infection that causes cold symptoms and difficulty breathing in young babies. Until things settle down, she needs to be monitored more closely. Let's have you take her to the hospital, where we can check her oxygen levels and get a chest x-ray."


The father nodded his head. "You want me to take her down now?"


"That would be best. We can call an ambulance—"


"Ambulance? I can get her there myself in 20 minutes. You think she's going to be okay?"


"Most babies do fine. It may take some time, but she'll fight off the virus. The important thing is to have her monitored closely in the meantime."


The father had begun to dress the baby. Gently, he placed her into the infant car seat. I walked him out to the exit. Outside the window tiny white flakes were falling; the parking lot was dusted with snow.


"It might be better to call for that ambulance," I said, my hand on the door latch.


"Thanks—but we're out of here." He draped the bulky bundle beneath his heavy coat and walked quickly to his car.


"You think that baby will be okay?" our receptionist asked.


"They usually do fine," I muttered, recalling another infant in another time that didn't.


I retreated to my office and picked up the phone to call triage at the hospital emergency department. Methodically, I reported the objective findings on physical exam: low-grade fever, tachypnea, tachycardia, substernal and intercostal retractions, flaring of the alae nasi, scattered wheezes throughout lung fields, adequate capillary refill. The triage nurse said they would call back after the child was evaluated by one of the ED physicians.


I hung up the phone and swiveled my chair to watch the snow swirling outside in the twilight. The wind had picked up a bit.


I thought of Goethe's Erlköenig calling to the small child held tightly in the father's arms. The child fears the foreign voice, the cold night wind. While the father tries to reassure, the Erlköenig persists in beckoning the boy.


My darling boy, won't you come with me?


I have daughters in whose care you'll be.


My daughters dance round the fairy ring.


Each night they'll cradle you, dance and sing.


I looked at the clock on the credenza and noted the time. I elected to wait in the office. Soon the plows would be out, lumbering down the snow-covered streets. Traffic would grind down. Perhaps I should have called an ambulance. At least they had supplemental oxygen and airway support.


Suddenly I shuddered, recalling the last of Goethe's lines.


Dread grips the father, he spurs the roan,


In loving arms he feels the boy moan.


At last, the courtyard, with fear and dread,


He looks at the child; the boy is dead.


That evening, the next 20 minutes would stretch out into a small eternity, but this time round the Erlköenig would be denied his persistent request. JAAPA