A Country Doctor's Notebook

  The miller talked sense. What was more, he turned out to be literate, and his every gesture was indicative of respect for the science to which I was devoted—medicine.

  ‘Well, my dear fellow,’ I said as I tapped his broad, warm chest, ‘you have malaria. Recurrent fever … Right now we have a whole ward empty. I strongly advise you to come in for treatment. We can keep you under the necessary observation. I’ll start by treating you with powders, and then if that does no good, we’ll give you a few injections. Soon put you right. How about it, then?’

  ‘Thank you very much, sir!’ the miller replied most politely. ‘Heard a lot about you. They’re all very satisfied. They say you do them all so much good. I’ll gladly have the injections—anything to be cured.’

  ‘Ah, this man is a true ray of light in the darkness!’ I thought as I sat down at the desk to write. So doing, my feeling was of such pleasure that it might not have been just any miller but my own brother come for a stay in my hospital.

  On one prescription form I wrote:

  ‘Chinini mur. 0.5

  D.T. dos. N10

  S: Miller Khudov

  1 dose in powder form at midnight.’

  And signed it with a flourish. On another form I wrote:

  ‘Pelagea Ivanovna, please admit the miller and put him in Ward 2. He has malaria. Quinine in powder form as prescribed to be administered approx. 4 hours before the attack, i.e. at midnight. Here is an exception for you—a literate, intelligent miller!’

  When I was already in bed I received a note in reply from the hand of the grumpy, yawning Aksinya:

  ‘Dear doctor, All done. Pel. Ivanovna L.’

  I went to sleep … and woke up.

  ‘What is it? What? What is it, Aksinya?’ I mumbled. Aksinya was standing there, modestly covering herself with her dark-coloured skirt with white polka dots. A flickering wax candle lit up her sleepy, worried features.

  ‘Marya has just come running over—Pelagea Ivanovna has given orders for you to be called at once.’

  ‘What’s the matter?’

  ‘She says the miller in Ward 2 is dying.’

  ‘Wha-at? Dying? How can he be dying?’ For an instant, until I found my slippers, my bare feet felt the chill of the floor. I broke several matches and spent a long time poking them at the wick until it lit with a blue flame. The clock showed exactly six o’clock.

  ‘What’s happened? Surely it is malaria and not something else? What on earth can be the matter with him? His pulse was excellent …’

  No more than five minutes later, with my socks inside out, unkempt, my jacket unbuttoned and wearing felt boots, I bounded across the courtyard, still pitch-dark, and ran to Ward 2.

  There on an unmade bed, beside a crumpled heap of bed-clothes, in the light of a small kerosene lamp sat the miller, wearing a hospital nightshirt. His red beard was dishevelled, and his eyes looked to me black and huge. He was swaying like a drunkard, staring about him in terror, breathing heavily …

  Marya, the nurse, gaped at his purpling face.

  Pelagea Ivanovna, her hair down and with her overall only half on, flew towards me.

  ‘Doctor!’ she exclaimed in a hoarse voice. ‘I swear to you it wasn’t my fault! How was anyone to know? You made a point of telling me the man was intelligent.’

  ‘What’s happened?’

  Pelagea Ivanovna wrung her hands as she said:

  ‘Just imagine, doctor—he swallowed all ten doses of quinine at once! At midnight.’

  A murky winter dawn. Demyan Lukich removed the stomach-pump. There was a smell of camphor; on the floor stood a bowl full of reddish-brown liquid. Pale and exhausted, the miller lay wrapped in a white sheet up to his chin, his red beard jutting upwards. I bent over him and felt his pulse to make sure that he would survive the emergency.

  ‘Well, how do you feel?’ I enquired.

  ‘Can’t see a thing … oh … ooh …’ groaned the miller in a faint bass.

  ‘Nor can I,’ I answered in some irritation.

  ‘Wassat?’ the miller asked (his hearing was still poor).

  ‘Just tell me one thing, old man: why the hell did you do it?’ I shouted into his ear.

  Glumly and reluctantly came the mumbling answer:

  ‘Well, it seemed a waste of time taking all them powders one at a time. So I thought I’d swallow ’em all at once and be done with it.’

  ‘Incredible!’ I exclaimed.

  ‘He must have made it up!’ said the feldsher in a malicious aside.

  ‘No, I will fight it … I will … I …’ After a hard night, sweet sleep overtook me. Darkness, black as Egypt’s night, descended and in it I was standing alone, armed with something that might have been a sword or might have been a stethoscope. I was moving forward and fighting … somewhere at the back of beyond. But I was not alone. With me was my warrior band: Demyan Lukich, Anna Nikolaevna, Pelagea Ivanovna, all dressed in white overalls, all pressing forward.

  Sleep … what a boon …

  BAPTISM BY ROTATION

  AS TIME PASSED IN MY COUNTRY HOSPITAL, I gradually got used to the new way of life.

  They were braking flax in the villages as they had always done, the roads were still impassable, and no more than five patients came to my daily surgery. My evenings were entirely free, and I spent them sorting out the library, reading surgical manuals and spending long hours drinking tea alone with the gently humming samovar.

  For whole days and nights it poured with rain, the drops pounded unceasingly on the roof and the water cascaded past my window, swirling along the gutter and into a tub. Outside was slush, darkness and fog, through which the windows of the feldsher’s house and the kerosene lantern over the gateway were no more than faint, blurred patches of light.

  On one such evening I was sitting in my study with an atlas of topographical anatomy. The absolute silence was only disturbed by the occasional gnawing of mice behind the sideboard in the dining-room.

  I read until my eyelids grew so heavy that they began to stick together. Finally I yawned, put the atlas aside and decided to go to bed. I stretched in pleasant anticipation of sleeping soundly to the accompaniment of the noisy pounding of the rain, then went across to my bedroom, undressed and lay down.

  No sooner had my head touched the pillow than there swam hazily before me the face of Anna Prokhorova, a girl of seventeen from the village of Toropovo. She had needed a tooth extracting. Demyan Lukich, the feldsher, floated silently past holding a gleaming pair of pincers. Remembering how he always said ‘suchlike’ instead of ‘such’ because he was fond of a high-falutin’ style, I smiled and fell asleep.

  About half an hour later, however, I suddenly woke up as though I had been pinched, sat up, stared fearfully into the darkness and listened.

  Someone was drumming loudly and insistently on the outer door and I immediately sensed that those knocks boded no good.

  Then came a knock on the door of my quarters.

  The noise stopped, there was a grating of bolts, the sound of the cook talking, an indistinct voice in reply, then someone came creaking up the stairs, passed quietly through the study and knocked on my bedroom door.

  ‘Who is it?’

  ‘It’s me,’ came the reply in a respectful whisper. ‘Me, Aksinya, the nurse.’

  ‘What’s the matter?’

  ‘Anna Nikolaevna has sent for you. They want you to come to the hospital as quickly as possible.’

  ‘What’s happened?’ I asked, feeling my heart literally miss a beat.

  ‘A woman has been brought in from Dultsevo. She’s having a difficult labour.’

  ‘Here we go!’ I thought to myself, quite unable to get my feet into my slippers. ‘Hell, the matches won’t light. Ah well, it had to happen sooner or later. You can’t expect to get nothing but cases of laryngitis or abdominal catarrh all your life.’

  ‘All right, go and tell them I’m coming at once!’ I shouted as I got out of bed. Aksinya’s footsteps shuffled away from the
door and the bolt grated again. Sleep vanished in a moment. Hurriedly, with shaking fingers, I lit the lamp and began dressing. Half past eleven … What could be wrong with this woman who was having a difficult birth? Malpresentation? Narrow pelvis? Or perhaps something worse. I might even have to use forceps. Should I send her straight into town? Out of the question! A fine doctor he is, they’ll all say. In any case, I have no right to do that. No, I really must do it myself. But do what? God alone knows. It would be disastrous if I lost my head—I might disgrace myself in front of the midwives. Anyway, I must have a look first; no point in getting worried prematurely …

  I dressed, threw an overcoat over my shoulders, and hoping that all would be well, ran to the hospital through the rain across the creaking duckboards. At the entrance I could see a cart in the semi-darkness, the horse pawing at the rotten boards under its hooves.

  ‘Did you bring the woman in labour?’ I asked the figure lurking by the horse.

  ‘Yes, that’s right … we did, sir,’ a woman’s voice replied dolefully.

  Despite the hour, the hospital was alive and bustling. A flickering pressure-lamp was burning in the surgery. In the little passage leading to the delivery room Aksinya slipped past me carrying a basin. A faint moan came through the door and died away again. I opened the door and went into the delivery room. The small, whitewashed room was brightly lit by a lamp in the ceiling. On a bed alongside the operating table, covered with a blanket up to her chin, lay a young woman. Her face was contorted in a grimace of pain and wet strands of hair were sticking to her forehead. Holding a large thermometer, Anna Nikolaevna was preparing a solution in a graduated jug, while Pelagea Ivanovna was getting clean sheets out of the cupboard. The feldsher was leaning against the wall in a Napoleonic pose. Seeing me, they all jerked into life. The pregnant woman opened her eyes, wrung her hands and renewed her pathetic, long drawn-out groaning.

  ‘Well now, what seems to be the trouble?’ I asked, sounding confident.

  ‘Transverse lie,’ Anna Nikolaevna answered promptly as she went on pouring water into the solution.

  ‘I see-ee,’ I drawled, and added, frowning: ‘Well, let’s have a look …’

  ‘Aksinya! Wash the doctor’s hands!’ snapped Anna Nikolaevna. Her expression was solemn and serious.

  As the water flowed, rinsing away the lather from my hands, reddened from scrubbing, I asked Anna Nikolaevna a few trivial questions, such as when the woman had been brought in, where she was from … Pelagea Ivanovna’s hand turned back the blanket, I sat down on the edge of the bed and began gently feeling the swollen belly. The woman groaned, stretched, dug her fingers into her flesh and crumpled the sheet.

  ‘There, there, relax … it won’t take long,’ I said as I carefully put my hands to the hot, dry, distended skin.

  The fact was that once the experienced Anna Nikolaevna had told me what was wrong, this examination was quite pointless. I could examine the woman as much as I liked, but I would not find out any more than Anna Nikolaevna knew already. Her diagnosis was, of course, correct: transverse lie. It was obvious. Well, what next?

  Frowning, I continued palpating the belly on all sides and glanced sidelong at the midwives’ faces. Both were watching with intense concentration and their looks registered approval of what I was doing. But although my movements were confident and correct, I did my best to conceal my unease as thoroughly as possible.

  ‘Very well,’ I said with a sigh, standing up from the bed, as there was nothing more to be seen from an external examination. ‘Let’s examine her internally.’

  Another look of approval from Anna Nikolaevna.

  ‘Aksinya!’

  More water flowed.

  ‘Oh, if only I could consult Döderlein now!’ I thought miserably as I soaped my hands. Alas, this was quite impossible. In any case, how could Döderlein help me at a moment like this? I washed off the thick lather and painted my fingers with iodine. A clean sheet rustled in Pelagea Ivanovna’s hands and, bending down over the expectant mother, I began cautiously and timidly to carry out an internal examination. Into my mind came an involuntary recollection of the operating theatre in the maternity hospital. Gleaming electric lights in frosted-glass globes, a shining tiled floor, taps and instruments a-glitter everywhere. A junior registrar in a snow-white coat is manipulating the woman, surrounded by three intern assistants, probationers, and a crowd of students doing their practicals. Everything bright, well ordered and safe.

  And there was I, all on my own, with a woman in agony on my hands and I was responsible for her. I had no idea, however, what I was supposed to do to help her, because I had seen childbirth at close quarters only twice in my life in a hospital, and both occasions were completely normal. The fact that I was conducting an examination was of no value to me or to the woman; I understood absolutely nothing and could feel nothing of what was inside her.

  It was time to make some sort of decision.

  ‘Transverse lie … since it’s a transverse lie I must … I must …’

  ‘Turn it round by the foot,’ muttered Anna Nikolaevna as though thinking aloud, unable to restrain herself.

  An older, more experienced doctor would have looked askance at her for butting in, but I am not the kind to take offence.

  ‘Yes,’ I concurred gravely, ‘a podalic version.’

  The pages of Döderlein flickered before my eyes. Internal method … Combined method … External method … Page after page, covered in illustrations. A pelvis; twisted, crushed babies with enormous heads … a little dangling arm with a loop on it.

  Indeed I had read it not long ago and had underlined it, soaking up every word, mentally picturing the interrelationship of every part of the whole and every method. And as I read it I imagined that the entire text was being imprinted on my brain for ever.

  Yet now only one sentence of it floated back into my memory:

  ‘A transverse lie is a wholly unfavourable position.’

  Too true. Wholly unfavourable both for the woman and for a doctor who only qualified six months ago.

  ‘Very well, we’ll do it,’ I said as I stood up.

  Anna Nikolaevna’s expression came to life.

  ‘Demyan Lukich,’ she turned to the feldsher, ‘get the chloroform ready.’

  It was a good thing that she had said so, because I was still not certain whether the operation was supposed to be done under anaesthesia or not! Of course, under anaesthesia—how else?

  Still, I must have a look at Döderlein …

  As I washed my hands I said:

  ‘All right, then … prepare her for anaesthesia and make her comfortable. I’ll be back in a moment; I must just go to my room and fetch some cigarettes.’

  ‘Very good, doctor, we’ll be ready by the time you come back,’ replied Anna Nikolaevna.

  I dried my hands, the nurse threw my coat over my shoulders and without putting my arms into the sleeves I set off for home at a run.

  In my study I lit the lamp and, forgetting to take off my cap, rushed straight to the bookcase.

  There it was—Döderlein’s Operative Obstetrics. I began hastily to leaf through the glossy pages.

  ‘… version is always a dangerous operation for the mother …’

  A cold shiver ran down my spine.

  ‘The chief danger lies in the possibility of a spontaneous rupture of the uterus …’

  Spon-tan-e-ous …

  ‘If in introducing his hand into the uterus the obstetrician encounters any hindrances to penetrating to the foot, whether from lack of space or as a result of a contraction of the uterine wall, he should refrain from further attempts to carry out the version …’

  Good. Provided I am able, by some miracle, to recognise these ‘hindrances’ and I refrain from ‘further attempts’, what, might I ask, am I then supposed to do with an anaesthetised woman from the village of Dultsevo?

  Further:

  ‘It is absolutely impermissible to attempt to reach the feet by penetrati
ng behind the back of the foetus …’

  Noted.

  ‘It must be regarded as erroneous to grasp the upper leg, as doing so may easily result in the foetus being revolved too far; this can cause the foetus to suffer a severe blow, which can have the most deplorable consequences …’

  ‘Deplorable consequences.’ Rather a vague phrase, but how sinister. What if the husband of the woman from Dultsevo is left a widower? I wiped the sweat from my brow, rallied my strength and disregarded all the terrible things that could go wrong, trying only to remember the absolute essentials: what I had to do, where and how to put my hands. But as I ran my eye over the lines of black print, I kept encountering new horrors. They leaped out at me from the page.

  ‘… in view of the extreme danger of rupture …’

  ‘… the internal and combined methods must be classified as among the most dangerous obstetric operations to which a mother can be subjected …’

  And as a grand finale:

  ‘… with every hour of delay the danger increases …’

  That was enough. My reading had borne fruit: my head was in a complete muddle. For a moment I was convinced that I understood nothing, and above all that I had no idea what sort of version I was going to perform: combined, bi-polar, internal, external …

  I abandoned Döderlein and sank into an armchair, struggling to reduce my random thoughts to order. Then I glanced at my watch. Hell! I had already spent twenty minutes in my room, and they were waiting for me.

  ‘… with every hour of delay …’

  Hours are made up of minutes, and at times like this the minutes fly past at insane speed. I threw Döderlein aside and ran back to the hospital.

  Everything there was ready. The feldsher was standing over a little table preparing the anaesthetic mask and the chloroform bottle. The expectant mother already lay on the operating table. Her ceaseless moans could be heard all over the hospital.