‘There now, be brave,’ Pelagea Ivanovna muttered consolingly as she bent over the woman, ‘the doctor will help you in a moment.’
‘Oh, no! I haven’t the strength … No … I can’t stand it!’
‘Don’t be afraid,’ whispered the midwife. ‘You’ll stand it. We’ll just give you something to sniff, and then you won’t feel anything.’
Water gushed noisily from the taps as Anna Nikolaevna and I began washing and scrubbing our arms bared to the elbow. Against a background of groans and screams Anna Nikolaevna described to me how my predecessor, an experienced surgeon, had performed versions. I listened avidly to her, trying not to miss a single word. Those ten minutes told me more than everything I had read on obstetrics for my qualifying exams, in which I had actually passed the obstetrics paper ‘with distinction’. From her brief remarks, unfinished sentences and passing hints I learned the essentials which are not to be found in any textbooks. And by the time I had begun to dry the perfect whiteness and cleanliness of my hands with sterile gauze, I was seized with confidence and a firm and absolutely definite plan had formed in my mind. There was simply no need to bother any longer over whether it was to be a combined or bi-polar version.
None of these learned words meant anything at that moment. Only one thing mattered: I had to put one hand inside, assist the version with the other hand from outside and without relying on books but on common sense, without which no doctor is any good, carefully but firmly bring one foot downwards and pull the baby after it.
I had to be calm and cautious yet at the same time utterly decisive and unfaltering.
‘Right, off you go,’ I instructed the feldsher as I began painting my fingers with iodine.
At once Pelagea Ivanovna folded the woman’s arms and the feldsher clamped the mask over her agonised face. Chloroform slowly began to drip out of the dark yellow glass bottle, and the room started to fill with the sweet, nauseous odour. The expressions of the feldsher and midwives hardened with concentration, as though inspired …
‘Haaa! Ah!’ The woman suddenly shrieked. For a few seconds she writhed convulsively, trying to force away the mask.
‘Hold her!’
Pelagea Ivanovna seized her by the arms and lay across her chest. The woman cried out a few more times, jerking her face away from the mask. Her movements slowed down, although she mumbled dully:
‘Oh … let me go … ah …’
She grew weaker and weaker. The white room was silent. The translucent drops continued to drip, drip, drip on to the white gauze.
‘Pulse, Pelagea Ivanovna?’
‘Firm.’
Pelagea Ivanovna raised the woman’s arm and let it drop: as lifeless as a leather thong, it flopped on to the sheet. Removing the mask, the feldsher examined the pupil of her eye.
‘She’s asleep.’
A pool of blood. My arms covered in blood up to the elbows. Bloodstains on the sheets. Red clots and lumps of gauze. Pelagea Ivanovna shaking and slapping the baby, Aksinya rattling buckets as she poured water into basins.
The baby was dipped alternately into cold and hot water. He did not make a sound, his head flopping lifelessly from side to side as though on a thread. Then suddenly there came a noise somewhere between a squeak and a sigh, followed by the first weak, hoarse cry.
‘He’s alive … alive …’ mumbled Pelagea Ivanovna as she laid the baby on a pillow.
And the mother was alive. Fortunately nothing had gone wrong. I felt her pulse. Yes, it was firm and steady; the feldsher gently shook her by the shoulder as he said:
‘Wake up now, my dear.’
The bloodstained sheets were thrown aside and the mother hastily covered with a clean one before the feldsher and Aksinya wheeled her away to the ward. The swaddled baby was borne away on his pillow, the brown, wrinkled little face staring out from its white wrapping as he cried ceaselessly in a thin, pathetic whimper.
Water gushing from the taps of the sluice. Anna Nikolaevna coughed as she dragged hungrily at a cigarette.
‘You did the version well, doctor. You seemed very confident.’
Scrubbing furiously at my hands, I glanced sidelong at her: was she being sarcastic? But no, her expression was a sincere one of pride and satisfaction. My heart was brimming with joy. I glanced round at the white and bloodstained disorder, at the red water in the basin and felt that I had won. But somewhere deep down there wriggled a worm of doubt.
‘Let’s wait and see what happens now,’ I said.
Anna Nikolaevna turned to look at me in astonishment.
‘What can happen? Everything’s all right.’
I mumbled something vague in reply. What I had meant to say was to wonder whether the mother was really safe and sound, whether I might not have done her some harm during the operation … the thought nagged dully at my mind. My knowledge of obstetrics was so vague, so fragmentary and bookish. What about a rupture? How would it show? And when would it show—now or, perhaps, later? Better not talk about that.
‘Well, almost anything,’ I said. ‘The possibility of infection cannot be ruled out,’ I added, repeating the first sentence from some textbook that came into my mind.
‘Oh, tha-at,’ Anna Nikolaevna drawled complacently. ‘Well, with luck nothing of that sort will happen. How could it, anyway? Everything here is clean and sterile.’
It was after one o’clock when I went back to my room. In a pool of light on the desk in my study lay Döderlein open at the page headed ‘Dangers of Version’. For another hour after that, sipping my cooling tea, I sat over it, turning the pages. And an interesting thing happened: all the previously obscure passages became entirely comprehensible, as though they had been flooded with light; and there, at night, under the lamplight in the depth of the countryside I realised what real knowledge was.
‘One can gain a lot of experience in a country practice,’ I thought as I fell asleep, ‘but even so one must go on and on reading, reading … more and more …’
THE SPECKLED RASH
‘THIS IS IT!’ INTUITION PROMPTED ME. NO NEED to rely on my knowledge; as a doctor only six months qualified, I had none. Afraid to touch the man’s bare, warm shoulder (though there was nothing to fear), I said to him from where I stood:
‘Just move nearer to the light, would you?’
He turned the way I wanted him to, and the light of the kerosene pressure-lamp shone on his yellow-tinged skin. A white, speckled rash showed through the yellow colouring of his flanks and bulging chest. ‘Like stars in the sky,’ I thought to myself with a chill of fear as I bent down to his chest. Then I drew my eyes away from it and up to his face. Before me was a man of about forty with an untidy, ashen-grey beard and bright little eyes under swollen lids. To my great amazement I saw in those eyes a look of dignity and a sense of his own importance. Bored and indifferent, he blinked occasionally as he adjusted the belt of his trousers.
‘This is it—syphilis,’ I repeated grimly to myself. This was my first professional encounter with it, as I had been flung straight from university into a remote village.
I stumbled on this case of syphilis by chance. The patient had come to me complaining of a congested throat. All unawares, without a thought of syphilis, I had told him to get undressed, and only then did I see the speckled rash.
Putting all the symptoms together—his hoarseness, the sinister inflammation of his throat, the strange white patches on it and his mottled chest—I guessed at the trouble. My first, cowardly reaction was to rub my hands with a ball of sublimate of mercury. The minute it took to do this was poisoned by the anxious thought that he might have coughed on my hands. Then weakly and squeamishly I rolled a glass spatula in my hands and inspected my patient’s throat with it. Where should I put the spatula? I decided to place it on a wad of cotton wool on the window ledge.
‘Well now,’ I said, ‘you see … er … it seems … in fact it’s quite certain … you see, you have a rather unpleasant disease—you have syphilis …’
&n
bsp; As soon as I had said this I felt awkward. I thought he might be frightened out of his wits. But not at all. He gave me a sidelong glance, rather as a hen looks up with her round eye when she hears a voice calling her. I was astonished to see mistrust in his round eye.
‘You’ve got syphilis,’ I repeated softly.
‘What’s that, then?’ asked the man with the speckled rash.
I had a brief, sharp mental vision of a snow-white ward at the university hospital, a lecture-theatre filled with rows of students’ heads and the grey beard of the professor of venereology … But I quickly came to myself and remembered that I was about a thousand miles away from the lecture-theatre and thirty miles from the nearest railway, and that my only light was a kerosene lamp … I could hear the dull buzz of voices coming from my numerous patients waiting their turn on the other side of the white door. Outside the window, night was steadily drawing in and the first winter snow was flying on the wind.
I made my patient take off more clothes and found a primary lesion which was already healing. I was no longer in any doubt, and felt the pride which invariably arose inside me whenever I made a correct diagnosis.
‘You can get dressed again,’ I said. ‘You’ve got syphilis! It is an extremely serious illness which affects the whole body. It will take a long time to cure.’
Here I faltered because—I swear it—I detected in that hen-like gaze astonishment clearly mixed with derision.
‘But I’m only a bit hoarse in the throat,’ said the patient.
‘Yes, I know. That’s why it’s gone hoarse, and that’s why you’ve got a rash on your chest. Have a look at your chest.’
He squinted at his chest. The ironic glint in his eyes did not fade.
‘Couldn’t you just give me something for my throat?’ he asked.
‘Why does he keep on like this?’ I thought somewhat impatiently. ‘I’m talking about syphilis and all he worries about is his throat!’
‘Look here,’ I continued aloud, ‘your throat is a minor matter. We’ll make your throat better too, but the most important thing is to get rid of the general disease. And the treatment’s going to take a long time—two years.’
At this the patient stared at me. I saw the verdict in his eyes: You’ve gone off your head, doctor!
‘Why so long?’ he asked. ‘How can it take two years? All I need is something to gargle for my throat.’
I saw red. I started to speak. I was no longer afraid of frightening him. Oh, no; on the contrary, I even hinted that his nose might drop off. I told him what the future held for him if he did not take the necessary treatment. I mentioned how contagious syphilis was and spoke at length about plates, spoons and cups, and about separate towels.
‘Are you married?’ I said.
‘Yes, I am,’ he answered in amazement.
‘Send your wife to me immediately!’ I said heatedly. ‘I suppose she’s sick too, isn’t she?’
‘Send the wife?’ he asked, looking at me in great astonishment.
We went on in this vein. He kept blinking and looking into my eyes, and I into his. It was, in fact, less of a conversation than a monologue—a brilliant monologue by me, which would have earned a final year student the highest marks from any professor. I discovered that I was a mine of information on syphilis. My unexpected resourcefulness filled in the lacunae of all those passages where the German and Russian textbooks fail to go into detail. I told him what happens to the bones of an untreated syphilitic and sketched en passant an outline of progressive paralysis. Then there were his offspring—and how was his wife to be saved? Or if she was already infected, which she was bound to be, how was she to be treated?
In the end my torrent of words dried up and I self-consciously took out of my pocket a reference book in a red binding with gold lettering. It was my faithful friend, and I was never parted from it in those first stages of my difficult career. How many times did it come to my rescue when the accursed problem of prescriptions gaped before me like a black abyss! While the patient was getting dressed I furtively leafed through its pages and found what I needed.
Mercury ointment is a great remedy!
‘You must rub this stuff on you. You’ll be given six little bags of ointment. You’ll rub on one bagful a day, like this …’
I gave a vigorous demonstration of how to do it, rubbing my overall with my open palm.
‘Today you must rub it on your arm, tomorrow on your leg, then on the other arm. When you’ve rubbed it on six times, wash it all off and come and see me. Without fail. Do you hear? Without fail! And apart from this, you must take great care of your teeth and your mouth in general while you are under treatment. I’ll give you a mouthwash. After meals you must be certain to rinse out your mouth.’
‘And my throat?’ he asked hoarsely, and at once I noticed that he only came to life at the word ‘mouthwash’.
‘Yes, yes, your throat too.’
A few minutes later the yellow back of his sheepskin jerkin was disappearing through the door and a woman in a headscarf was elbowing past him. A few minutes later, as I ran along the half-dark passage from my out-patient surgery to get some cigarettes from the pharmacist, I happened to overhear a hoarse whisper:
‘He’s no good. Young fellow. I’ve just got a sore throat, see, but he looks me all over … chest, belly … I’ve more than enough work on my hands and it took me half a day to get to the hospital. By the time I get back it’ll be dark. Lord, here am I with nothing but a sore throat and he gives me ointment for my legs.’
‘Careless, careless,’ a quavering peasant woman’s voice agreed, and then suddenly stopped short as I flitted past like an apparition in my white overall. I could not help looking round, and in the semi-darkness I recognised the little beard looking as if it were made of tow, the heavy eyelids, the hen-like eyes and the ferociously hoarse voice. I pulled my head into my shoulders and furtively tried to hunch myself up as if I were guilty, and disappeared with a burning sense of resentment. I was in a terrible state.
Had I been completely wasting my time?
I refused to believe it. Every morning for a month I studied the reception book as keenly as a detective, expecting to come across the surname of the wife of the man who had listened so attentively to my monologue on syphilis. I waited for the man himself for a whole month. He never came back. When a month had passed the memory of him faded, I stopped worrying and forgot him. Because there was always something new, and every working day in those remote backwoods brought unexpected and difficult cases which forced me to overtax my brain; countless times I would be reduced to utter perplexity, only to recover my presence of mind and return to the struggle with new zest.
Now that many years have passed and I am far from that remote hospital with its peeling white walls, I cast my mind back to the speckled rash on his chest. Where is he? What is he doing? Don’t tell me, I know. If he is still alive, he and his wife are visiting the ramshackle old hospital from time to time. They are complaining of lesions on their legs. I can clearly picture him unwrapping his foot-cloths and looking for sympathy. The young doctor, who may be a man or a woman, in a patched overall, is bending over his legs, pressing his fingers on the bone above the lesion and looking for the cause. He finds it, writes in his book: ‘Lues III’, and then asks whether he has ever been prescribed black ointment.
And then, just as I remember him now, he will remember me, the year 1917, snow outside the window and six little bags of waxed paper, six sticky unused lumps.
‘Yes, he did give me some,’ he will say, and this time his expression will no longer be ironical but full of dread. The doctor will write out a prescription for potassium iodide or maybe some other treatment. And maybe he will take a glance at his reference book just as I did …
Greetings, dear colleague!
‘… and then, dearest wife, give my kindest regards to Safron Ivanovich. And apart from that, dear wife, go and see our doctor because for the last six months I have been suffering
from a foul and painful disease, syphilis. I didn’t tell you when I was with you. Take the treatment for it.
Your husband, Anatoly Bukov.’
The young woman pressed a corner of her flannel shawl to her mouth, sat down on the bench and shook with sobs. Her fair curls, wet with melted snow, lay across her forehead.
‘Isn’t he a swine?’ she cried.
‘Yes, he is,’ I answered firmly.
Then followed the most difficult and agonising part of her visit. I had to calm her; but how was I to do it? We whispered for a long time to the accompaniment of the rumble of impatient voices in the waiting room. My soul was not yet blunted to human suffering and from somewhere in its depths I was able to find comforting words. First of all I tried to banish her fear. I told her that so far nothing was definite and she must not give way to despair before she had been examined. Even then there was no cause for despair: I told her with what success this terrible disease was nowadays being treated.
‘The swine,’ the young woman sobbed and choked on her tears.
‘Yes, he’s a swine,’ I echoed.
We spent quite a long time swearing at this ‘dearest husband’ who had spent a short time at home and then left for Moscow. In the end the woman’s tears began to dry, leaving stains on her face and swollen eyelids over her dark despairing eyes.
‘What am I going to do? I have two children,’ she said in a husky, exhausted voice.
‘Wait, wait,’ I mumbled. ‘We’ll see what has to be done.’
I called the midwife, Pelagea Ivanovna, and the three of us retired to a separate ward where there was a gynaecological chair.
‘The scoundrel,’ Pelagea Ivanovna hissed through her teeth. The woman was silent, her eyes two black pits staring out of the window at the twilight.
It was one of the most thorough examinations I have ever made. Pelagea Ivanovna and I did not miss an inch of her body. But nowhere could I find anything suspicious.
‘Do you know,’ I said, hoping passionately that this was not wishful thinking and that we should not later find the sinister, hard, primary chancre: ‘Do you know what? You can stop worrying! There’s hope. Yes, there is. Of course there’s still a chance that it might develop, but right now there’s. nothing wrong with you.’