I had been made to suffer unbelievable rigours. No matter how delicate or complex the case—usually surgical—I had had to set my unshaven face squarely to it and conquer it. And if I failed, as now, then I was not only flung from bump to bump but tormented by the thought of the dead baby and the mother I had left behind. Next day, as soon as the snowstorm abated, Pelagea Ivanovna would bring her to the hospital, and then the big question would be whether I managed to pull her through. But how was I to pull her through? For the fact was that my methods were purely hit and miss: I was hopelessly ignorant. Up till now I had been lucky and had successfully pulled off some incredible things; but today my luck had run out. I felt my heart gripped by loneliness, by cold, by awareness of my utter isolation. What was more, by breaking the baby’s arm I might have actually committed a crime. I felt like driving off somewhere to cast myself at someone’s feet and confess that I, Doctor So-and-So, had broken a child’s arm—take away my degree, dear colleagues, I am unworthy of it, send me to Sakhalin! God, how neurotic I felt!
I slumped to the bottom of the sleigh and huddled up to stop the cold from devouring me quite so ferociously, and felt like a wretched little puppy, homeless and clumsy.
We drove and drove for hours, until the light over the hospital gateway, small but so cheering and welcoming, came in sight. It flickered, vanished, flared up, disappeared again, then beckoned once more. The sight of it eased my desolation a little, and when the light at last shone firmly before my eyes, when it grew bigger and closer, when the hospital walls changed from black to whitish and I drove through the gateway, I was already saying to myself:
‘The arm doesn’t matter. The baby was already dead when you broke it. Don’t think about the arm; remember that the mother’s alive.’
The lantern and the familiar porch cheered me up somewhat; but even so, once indoors and climbing the stairs to my study, feeling the heat from the stove and savouring in advance the healing oblivion of sleep, I mumbled to myself:
‘That may be so, but the loneliness is terrible here. Terrible.’
The razor lay on the table, beside it a jug of once-hot water. I threw the razor contemptuously into a drawer. And I was badly in need of a shave …
And now a whole year has passed. While it lasted it seemed endlessly varied, multifarious, complex and terrible, although I now realise that it has flown by like a hurricane. I stare into the mirror and see the traces that it has left on my face. There is more severity and anxiety in my eyes, the mouth is more confident and manly, while the vertical wrinkle between my eyebrows will remain for a lifetime—as long, in fact, as my memories. I can see them as I look in the mirror, chasing each other in headlong succession.
In the days when I was still worried by the thought that I might lose my medical degree, I imagined some fantastic tribunal calling me to account and fearsome judges asking me:
‘What about the soldier’s jaw? Answer, miserable graduate!’
I am never likely to forget it. It all happened because although Demyan Lukich could draw teeth as handily as a carpenter pulling rusty nails out of old timber, tact and a sense of my own dignity told me that one of the first things I should do at Muryovo hospital was to learn to extract teeth myself. Demyan Lukich might be absent or sick; our midwives could do anything, with one exception—they would not pull teeth out; it was not their job.
And so … I well remember the red-cheeked but suffering face of the man sitting in front of me on a stool. He was a soldier, one of the many who had returned home from the disintegrating front line after the revolution. I recall equally well the massive, powerful but carious tooth, solidly rooted in the jaw. Frowning in an effort to look as if I knew what I was doing and grunting with effort, I clamped the pincers on the tooth, vividly recalling as I did so Chekhov’s famous short story about a sexton having his tooth pulled. Suddenly, for the first time, that story did not seem funny at all. There was a loud crunching noise from the soldier’s mouth and he gave a short yelp:
‘Oo-ow!’
After that I felt no more resistance and the pincers jerked out of his mouth gripping a white, bloodstained object. At the sight of it my heart missed a beat, because this object exceeded any tooth in size, even a soldier’s molar. At first I could not understand it, then I almost burst into tears: although the jaws of the pincers held a tooth with a very long root, there was also dangling from the tooth an enormous, jagged piece of gleaming white bone.
‘I’ve broken his jaw …’ I thought, and my legs went weak. With a prayer of thanks to fate that neither the feldsher nor the midwives were watching me, I furtively wrapped the fruit of my over-enthusiastic labours in a piece of gauze and hid it in my pocket. Swaying on his stool, the soldier was clutching the leg of the gynaecological chair with one hand and a leg of the stool with the other as he stared at me wildly, his eyes starting out of his head. In some confusion I handed him a glass with a solution of potassium permanganate and said:
‘Rinse.’
It was a stupid thing to do. He took a mouthful of the solution, but when he spat it out into the bowl, it came out mixed with the soldier’s crimson blood as a dense liquid of indescribable colour. At once blood began spurting out of his mouth so fast that I froze with horror. If I had slit the wretched man’s throat with a razor, I doubt if he would have bled harder. Pushing aside the glass of permanganate I flung myself at the soldier with pads of gauze and plugged the gaping hole in his jaw. The gauze instantly turned red, and as I took it out I was appalled to see that the hole was big enough for a large greengage to have fitted into it with room to spare.
‘I’ve sent this soldier to glory,’ I thought despairingly as I tugged long strips of gauze out of the jar. At last the bleeding stopped and I painted the hole in his jaw with iodine.
‘Don’t eat anything for the next three hours,’ I said to my patient in a shaky voice.
‘Thank you very much, sir,’ the soldier replied, staring with some amazement at the bowl full of his blood.
‘Er, look …’ I said miserably, ‘I tell you what … you’d better come and see me again tomorrow or the day after. I, er … well, I shall have to take another look … You have another tooth alongside which looks suspicious. All right?’
‘Thanks very much,’ the soldier replied sullenly as he went out clutching his cheek. I staggered into the waiting room and sat there for a while, clasping my head and rocking back and forth as though myself suffering from toothache. About five times I pulled the hard, bloodstained lump out of my pocket and put it back again.
For a week I lived in a fog, grew thin and sickly.
‘The soldier will get gangrene, blood-poisoning … God, why did I have to use the pincers on him?’
Absurd visions floated before my mind’s eye. The soldier is beginning to shiver. For a while he is well enough, he walks about, talks about Kerensky and life in the front line; then he talks less and less. Soon he no longer wants to talk about Kerensky. Now he is lying on a cotton pillow and he is delirious. He has a temperature of 104°. The whole village calls to see him. Finally, his nose growing sharper, he is laid out on the table with an ikon on his chest.
The villagers start gossiping.
‘What did he die from?’
‘That doctor pulled his tooth out.’
‘Ah, so that was it, was it?’
And so the talk goes on. There is an enquiry. A stern man comes:
‘Did you extract the soldier’s tooth?’
‘Yes … I did.’
The soldier is exhumed. A trial. Disgrace. I am the cause of his death. And I am no longer a doctor, but a wretched outcast, worse—an unperson.
The soldier did not come back, and my misery increased as the gauze-wrapped lump in my desk drawer dried and turned the colour of rust. Within a week I would have to go into town to fetch my staff’s pay. I went after five days, and made my way straight to a doctor in the district hospital. He was a man with a little nicotine-stained beard who had worked there for t
wenty-five years; he had seen a great deal in his time. I sat that evening in his study, dejectedly sipping lemon tea and fidgeting with the tablecloth. At last I could hold out no longer, and with much beating about the bush I made up a vague, spurious story about how I had heard of cases … if one extracted a tooth … broke the jaw … gangrene could result, couldn’t it? Well, a piece of bone … I had read somewhere …
He listened and listened, staring at me with faded eyes from under his shaggy eyebrows and then suddenly he said:
‘You broke off the tooth-socket … Don’t worry, you’ll make a fine tooth-puller in time … Forget the tea, let’s go and have some vodka before dinner.’
And at once the tormenting vision of that soldier vanished from my mind forever.
Ah, those memories in the mirror. A whole year of them. How I laugh now when I think about that tooth-socket! Of course, I shall never be able to draw teeth the way Demyan Lukich does. After all, he extracts about five a day while I do about one a fortnight. Even so, I can pull them well enough to be the envy of many doctors; I don’t break the socket any more, and if I did I would not lose my head.
But teeth are nothing compared with all the things I saw and did in that year of unique experience.
Evening was seeping into my room. The lamp was already lit and as I floated in an acrid haze of tobacco smoke totting up my achievements, my heart overflowed with pride. I had done two amputations at the hip, and I had lost count of all the fingers. There were eighteen curettages listed, a hernia and a tracheotomy, all of them successful. And the number of gigantic abscesses I had lanced, not to mention broken limbs set in plaster or starch. I had corrected dislocations. Intubations. Childbirth. Whatever they come with, I’ve dealt with it. Admittedly I won’t undertake a caesarian section; I send them into town for that. But forceps, versions—any number.
When I was sitting the forensic medicine paper of my finals, I remember the professor saying:
‘Describe gunshot wounds inflicted at point-blank range.’
I launched into a long and woolly description, during which a page of a very thick textbook floated in my visual memory. At last I ran out of steam, the professor gave me a look of disgust and said in a grating voice:
‘Nothing resembling what you have described is to be found in point-blank wounds. How many “fives”* have you been given so far?’
‘Fifteen,’ I replied.
He put a ‘three’ against my name and I went out of the room covered in disgrace.
On qualifying, I was soon posted to Muryovo and now I am alone here. The devil alone knows what the characteristics of point-blank wounds are supposed to be, but when I was faced with a man lying on my operating table with a bubbly foam, pink with blood, oozing over his lips, did I lose my head? I did not, even though his chest had been peppered with buckshot at point-blank range, one lung was visible and the flesh of his chest hung in shreds. Six weeks later he left my hospital alive. At university I was not once permitted to hold a pair of obstetrical forceps, yet here—trembling, I admit—I applied them in a moment. I must confess that one baby I delivered looked rather odd: half of its head was swollen, bluish-purple and without an eye. I turned cold, dimly hearing Pelagea Ivanovna as she said consolingly:
‘It’s all right, doctor, you’ve just put one half of the forceps over his eye.’
I shivered with anxiety for two days, but after that the head returned to normal.
And the wounds I have stitched—the cases of suppurating pleurisy when I have had to prise the ribs apart; the cases of pneumonia, typhus, cancer, syphilis, hernia (successfully treated), haemorrhoids, sarcoma.
In a moment of inspiration I opened the out-patients’ register and spent an hour analysing and totalling. In a year, up to the very hour of that evening, I had seen 15,613 patients; 200 inpatients had been admitted, of whom only six died.
I closed the book and tottered to bed. At twenty-five years old and celebrating my first professional anniversary, I lay in bed and thought as I fell asleep that I was now vastly experienced. What had I to fear? Nothing. I had extracted peas lodged in little boys’ ears, I had wielded the knife countless times … My hand had acquired courage and did not shake. I spotted all tricky complications and had acquired a unique ability to understand the things that peasant women say. I was able to interpret them like Sherlock Holmes deciphering mysterious documents. Sleep is creeping up on me.
‘I cannot,’ I mumbled, growing sleepier, ‘honestly imagine being brought a case that would floor me … perhaps in Moscow they might accuse me of a “feldsher” attitude to medicine … well, let them … it’s all right for them in their clinics and teaching hospitals, X-ray cabinets and so on … whereas here there’s just me … peasants couldn’t live without me … How I used to shudder whenever there was a knock at the door, how I winced with fear … Now, though …’
‘When did it happen?’
‘Last week, sir … It all swelled up.’
And the woman began to whimper.
It was a grey October morning, the first day of my second year. Yesterday evening I had been congratulating myself, and now this morning I was standing there in my white coat nonplussed.
She was holding a year-old baby in her arms like a log, and the infant had no left eye. In place of an eye there protruded between taught, overstretched eyelids a yellow-coloured ball the size of a small egg. The baby was struggling and crying in pain, the woman snivelling. And I was at a loss.
I looked at it from every possible angle. Demyan Lukich and the midwife were standing behind me in silence; they had never seen anything like it.
‘What on earth is it? Cerebral hernia?… Hmm … well, at least he’s alive … Sarcoma? No, rather too soft … Some revolting, unknown kind of tumour. How could it have developed … from an empty eye socket? Perhaps there never was an eye … at any rate, there isn’t now.’
‘Look here,’ I said in a burst of inspiration, ‘we shall have to cut this thing out.’
I had a mental picture of how I would cut the lower lid, move it to one side and … and what? What then? Perhaps it really is part of the brain … Ugh, it’s soft enough … feels like brain.
‘What, cut him open?’ the peasant woman asked, turning pale. ‘Cut his eye? I won’t consent.’ Horrified, she began wrapping the infant in his rags.
‘He has no eye,’ I replied categorically. ‘Just take a look at where his eye ought to be. Your baby has a strange sort of swelling.’
‘Give him some drops, then,’ said the woman fearfully. ‘You’re joking! What sort of drops? No drops are going to do him any good!’
‘You wouldn’t leave him without an eye, would you?’
‘But he has no eye, I tell you.’
‘He had one the day before yesterday!’ the woman exclaimed in desperation. (God!)
‘Well, if you say so, then I suppose … hell … only he hasn’t got one now, has he? In any case, my dear, you’d better take the child into town. Right away, so they can operate … Don’t you agree, Demyan Lukich?’
‘M’yes,’ the feldsher replied gravely, obviously not knowing what to say, ‘I’ve never seen the like of it.’
‘Take him to be cut open in town?’ the woman cried in horror. ‘I won’t let you.’
In the end the woman took her baby away without giving us permission to touch the eye. For two days I racked my brains. shrugged my shoulders and ferreted about in the library in search of illustrations showing babies with protuberant swellings in place of their eyes … hopeless.
Then I forgot about the child altogether.
A week passed.
‘Anna Zhukhova!’ I shouted. In came a cheerful peasant woman carrying a baby.
‘What’s the trouble?’ I enquired mechanically.
‘All’s well, he’s not going to die,’ the woman announced with a sarcastic grin. The sound of her voice made me sit up with a jerk.
‘Recognise him?’ she asked mockingly.
‘Wait a
moment … that’s … wait a moment—is that the child who …?’
‘That’s him. Remember you said he had no eye, doctor, and you’d have to cut him open to …’
I felt I was going off my head. The woman stared at me triumphantly, her eyes laughing. The baby lay in her arms gazing out at the world with brown eyes. Of the yellow tumour there was no sign.
‘This is witchcraft,’ I thought weakly. When I had somewhat recovered my wits, I cautiously drew down the eyelid. The baby whimpered and tried to turn his head, but I was still able to see it: a tiny little scar on the mucous membrane … Aha!
‘As we were driving away from here, it burst.’
‘No need to tell me,’ I said with embarrassment. ‘I see what it was now.’
‘And you said he had no eye. Well, it grew again, didn’t it?’ And the woman giggled, taunting me.
‘I see now, damn it … An enormous abscess developed under his lower lid, swelled and completely covered the eye … Then when it burst, the pus ran out and everything went back into place.’
No, even when I’m on the verge of sleep I shall never again boast that nothing can surprise me. Now that this year is past, the next year will be just as full of surprises as the first. One never stops learning.
* Russian examinations, which are generally oral, are marked on a scale of 1 to 5. ‘5’ indicates ‘distinction’, ‘4’ is ‘good’, ‘3’ is usually a bare pass.