A Country Doctor's Notebook

  On my rounds I would march urgently round the ward, followed by a male and two female assistants. As I stopped at the bedside of a sick man, dripping with fever and wheezing miserably, I would force my brain to disgorge everything that was in it. My fingers would feel the hot, dry skin, I would examine his pupils, tap his ribs, listen to the deep-down, mysterious beat of the heart, all the while obsessed by one thought—how can I save him? And how can I save the next patient—and the next …?

  All of them!

  It was like a battle, which began every morning by the pale light reflected from the snow and ended by the fitful yellow gleam of a pressure-lamp.

  ‘How will all this end, I’d like to know?’ I said to myself one night. ‘The sleighs will keep on coming all through January, February and March.’

  I wrote to Grachyovka politely reminding them that my practice was supposed to be manned by a second doctor.

  The letter set off on its twenty-five-mile journey by wood-sledge across an ocean of snow. Three days later came the reply: they said yes, of course, of course, definitely, only not at present … no one would be coming for the time being …

  The letter ended with a few flattering comments on my work and good wishes for my continued success.

  Inspired by those remarks I returned to swabbing, injecting diphtheria serum, lancing abscesses of monstrous proportions, applying plastercasts.

  On Tuesday there were not a hundred but a hundred and eleven out-patients. I finished my surgery at nine o’clock in the evening and fell asleep trying to guess how many there would be on Wednesday. I dreamed that nine hundred people came.

  There was something unusually white about the morning light as it shone through my window. I opened my eyes, unaware of what had woken me up. Then I realised what it was: someone was knocking.

  ‘Doctor …’ I recognised the voice of Pelagea Ivanovna. ‘Are you awake?’

  ‘Mm-hmm,’ I mumbled, still half asleep.

  ‘I’ve come to say you needn’t hurry over to surgery this morning. Only two people have come.’

  ‘What? You’re joking.’

  ‘No, honestly. There’s a blizzard, doctor, a blizzard,’ she repeated joyfully through the keyhole. ‘And the two who are here have only got decayed teeth. Demyan Lukich will pull them out.’

  ‘Yes, but …’ Without knowing why, I had already jumped out of bed.

  The day turned out splendidly. After doing my round, I spent the rest of the time lounging around my quarters, whistling snatches of opera, smoking, drumming my fingers on the windowpanes. Outside was a sight I had never seen before. There was no sky and no earth—only twisting, swirling whiteness, sideways and aslant, up and down, as though the devil had gone mad with a packet of tooth-powder.

  At noon I issued an instruction to Aksinya to boil three buckets and a kettle of water. I had not had a proper wash for a month.

  Between us Aksinya and I dragged from the storeroom a wash-tub of unbelievable dimensions and put it on the kitchen floor. (No question, naturally, of there being any proper bathtubs in our remote spot; the only ones were in the hospital itself—and they were broken.)

  By about two o’clock in the afternoon the whirling mesh of snow outside had noticeably thinned out, and I was sitting naked in the washtub with a lathered head.

  ‘Ah, this is more like it …’ I muttered deliciously as I poured scalding water down my back. ‘This is the life! We’ll have lunch afterwards and then—bed. And provided I’m allowed a full night’s sleep, I don’t care if a hundred and fifty people come tomorrow. What’s the news, Aksinya?’

  Aksinya was in the scullery, waiting till my ablutions were completed.

  ‘The clerk at the Shalometyevo estate is getting married,’ Aksinya replied.

  ‘Is he now! So she’s accepted him, has she?’

  ‘Of course. He’s madly in love …’ crooned Aksinya, clattering the dishes.

  ‘Is she pretty?’

  ‘Prettiest girl for miles around. Slim, blonde …’

  ‘You don’t say!’

  At that moment there was a hammering at the door. Frowning, I started to rinse myself and listened.

  ‘The doctor’s having a bath,’ Aksinya sang out, to be answered by a rumbling bass voice.

  ‘A note for you, doctor,’ Aksinya squeaked through the keyhole.

  ‘Pass it round the door.’

  I clambered out of the bath, shivering and cursing my luck as I took the damp envelope from Aksinya’s hand.

  ‘I’m not leaving this tub, that’s for sure. After all, I’m only human,’ I said without much confidence as I sat down again in the washtub and opened the letter.

  Dear Colleague (large exclamation mark). I impl (crossed out) beg you earnestly to come at once. A woman has suffered a blow on the head and is bleeding from the orific … (crossed out) from her nose and mouth. She is unconscious. I cannot cope. I earnestly beg you to come. The driver’s horses are excellent. Her pulse is poor. Have administered camphor. (Signed) Doctor (illegible).

  ‘Born unlucky,’ I thought miserably as I looked at the firewood glowing in the stove.

  ‘Was it a man who brought this?’

  ‘Yes.’

  ‘Ask him to come in here.’

  He entered and for a moment I thought he was an ancient Roman from his gleaming helmet planted on top of a fur hat with enormous earflaps. He was enveloped in a wolfskin coat, and I felt the gust of cold as he came in.

  ‘Why are you wearing a helmet?’ I enquired, shielding my partly washed body with a towel.

  ‘I’m a fireman from Shalometyevo. We have a fire brigade there …’ the Roman explained.

  ‘Who is the doctor who wrote this?’

  ‘He came on a visit to the agronomist. Young doctor, he is. It’s a terrible business, terrible …’

  ‘Who is the woman?’

  ‘The clerk’s bride-to-be.’

  Aksinya groaned from behind the door.

  ‘What happened?’ (I could hear Aksinya sidle up and glue her ear to the door.)

  ‘Yesterday they had an engagement party, and afterwards the clerk wanted to take her for a sleigh-ride. He harnessed up a fast horse, sat her in the sleigh and started off towards the gate. But then the horse broke into a gallop with such a jerk that the girl fell out and hit her forehead on the gatepost. She just sort of flew out. It was the most terrible accident, I can’t tell you … They had to hold the clerk down to stop him killing himself. He’s gone crazy.’

  ‘Look,’ I said miserably, ‘I’m having a bath. Why couldn’t you have brought her here?’ So saying I doused my head with water and rinsed the soap into the tub.

  ‘Couldn’t be done, sir,’ the fireman said in an agonised voice and clasped his hands in entreaty. ‘Not a chance, sir. The girl would have died.’

  ‘But how can we go? There’s a blizzard outside!’

  ‘It’s letting up—in fact, sir, it’s died down completely. I’ve a couple of fast horses, harnessed in tandem. We’ll be there inside an hour.’

  I gave a faint groan, clambered out of the tub, and sluiced myself furiously with two buckets of water. Then, squatting on my haunches in front of the mouth of the stove I made an attempt to dry my hair a little by sticking my head right in.

  ‘I’m bound to end up with pneumonia after a trip like this. In any case, what am I going to do with her? I can tell from his note that this doctor is even less experienced than I am. I know absolutely nothing except the few tips I’ve managed to pick up in six months’ practice, and he knows even less. He’s obviously only just qualified. And he thinks I’m an experienced man …’

  Preoccupied with these thoughts, I was not even aware of getting dressed, which was no simple matter: trousers and shirt, felt boots, over my shirt a leather jerkin, then an overcoat topped by a sheepskin, fur hat, and my bag containing caffeine, camphor, morphine, adrenalin, clamps, sterile dressings, hypodermic, probe, a Browning automatic, cigarettes, matches, watch, stethoscope.
br />   The weather was no longer so alarming, although the daylight was fading and darkness drawing in as we drove through the outskirts of the village. The snowfall seemed to have eased, and was falling diagonally in only one direction against my right cheek. The fireman’s bulk completely hid the rear horse’s rump from my view. The animals set off at a cracking pace, got into their stride, and the sleigh began flying over the bumpy track. I sank down into the seat and at once started to warm up; I thought of pneumonia and wondered whether a fragment of bone had broken off from inside the girl’s skull and penetrated the brain.

  ‘Are these fire brigade horses?’ I asked through my sheepskin collar.

  ‘Oh-huh … huh …’ grunted the driver without turning round.

  ‘What has the doctor done to her?’

  ‘Well, sir, he … huh … trouble is, he’s only studied venereal diseases.’

  The blizzard moaned through a copse, then lashed out, whistling, as we drove past the shelter of the trees. I felt I was swaying, swaying, swaying … until I found myself in the changing-room of Sandunov’s steam baths in Moscow—fully dressed, wearing my fur coat, and bathed in sweat. Then a torch flared up, the baths filled with cold water, I opened my eyes and saw a helmet shimmering in a blood-red glow. I thought there was a fire … then I blinked and realised that we had arrived. I was outside a white colonnaded building in the neo-classical style of Nicholas I. All around was pitch darkness, I was surrounded by firemen and a flame was flickering above their heads. There-upon I dragged out my watch through a chink in my fur coat: it was five o’clock. The drive had taken not one hour but two and a half.

  ‘Make sure at once that I have some horses to take me back,’ I said.

  ‘Very good,’ the driver replied.

  Half asleep and feeling as damp under my leather jerkin as though I had been in a hot compress, I went into the hallway. Lamplight struck me from one side, throwing shadows on the varnished floor. A fair-haired young man with a haunted look came running out wearing trousers that had a freshly ironed crease. His white tie with black polka dots was askew, his starched shirt-front had come loose and was bulging out, but his jacket looked fresh from the tailors, brand new, with creases so crisp that they might have been cut out of metal.

  The man waved his arms, clutched my fur coat and shook me as he pressed against me, moaning softly:

  ‘Oh, doctor … my dear fellow … quickly … she’s dying. I’m a murderer.’ He glanced aside, opened his eyes in a wild, tragic stare and said to someone: ‘I’m a murderer, that’s what I am.’

  Then he broke into sobs, clutched at his thin, straggling hair and began pulling at it. I could see from the strands sticking to his fingers that he was literally tearing out his hair.

  ‘Stop it,’ I said and pushed his arm aside.

  He was led away, and some women came running towards me.

  My coat was removed, I was led over gleaming floors and into a room with a white bed. A very young doctor rose from a chair to greet me. His expression was agonised and distraught. For a second I caught a look of astonishment in his eyes as he saw that I was as young as he was. We were, in fact, as alike as two portraits of the same person; we were even the same age. Then he was so overcome with delight at seeing me that he even gulped for breath.

  ‘I’m so glad … my dear colleague … you see, her pulse is failing. The fact is I’m a venereologist. Thank God you came.’

  Lying on a piece of gauze on the table was a hypodermic syringe and several ampoules of yellow oil. The sound of the clerk weeping could be heard through the door, which then closed as the figure of a woman in white materialised at my shoulder. The bedroom was in semi-darkness, a piece of green material having been draped half over the lamp. A face the colour of paper lay on the pillow amid the greenish gloom. The nose had begun to look pinched and sharp, and the nostrils were plugged with cotton wool that was pink with blood.

  ‘Her pulse …’ the doctor whispered to me.

  I took the lifeless arm, applied my fingers with a now habitual gesture and shuddered. I could feel a thin, rapid flutter which broke off and picked up again as a mere faint thread. I felt the customary stab of cold in the pit of my stomach as I always do when I see death face to face. I hate it. I managed to break off the end of a capsule and draw the yellow oil into the syringe, but the injection was only a mechanical gesture and forcing the liquid under the skin of the girl’s arm was a waste of time.

  Her lower jaw began to twitch as though she were choking, slackened and hung down; the body tensed under the blanket as though hunching with cold, then went limp. And the last trickle of her pulse faded away beneath my fingers.

  ‘She’s dead,’ I whispered into the doctor’s ear.

  The white figure with grey hair collapsed on to the smooth blanket and fell across the body, shaking convulsively.

  ‘Hush, hush,’ I said softly to the woman in white. The doctor grimaced uneasily towards the door.

  ‘He has been tormenting me,’ he said in a very low voice.

  Between us we arranged to leave the weeping mother in the bedroom, to tell nothing to anyone else, and to remove the clerk to a distant room. There I said to him:

  ‘If you won’t allow us to inject you with a sedative, we can’t do anything. You are distracting us and preventing us from working.’

  Finally he agreed. Weeping quietly, he took off his jacket, we rolled up the sleeve of the smart new shirt he had bought specially for his engagement party and gave him a morphine injection. The other doctor returned to the dead girl on the pretext of attending to her, while I stayed with the clerk. The morphine worked sooner than I had expected. Within a quarter of an hour his maudlin laments became more and more incoherent, he grew drowsy, then laid his tear-stained face on his arm and fell asleep, oblivious at last to the weeping, the movement, the rustling and muffled sobs around us.

  ‘Look, my dear fellow, it’s dangerous to try and go back now. You could easily lose your way,’ the doctor whispered to me in the hallway. ‘Stay and spend the night here.’

  ‘No, I can’t. I must go at all costs. The driver promised that I would be taken back at once.’

  ‘They can certainly take you back, but you must realise …’

  ‘I have three typhus patients whom I can’t leave. I have to see them every night.’

  ‘Well, if that’s the case …’

  As we stood there in the hall he diluted some spirit with water and gave it to me to drink, which I immediately followed by eating a piece of ham. I felt a warm glow in my stomach and my sense of depression was dulled a little. I went back into the bedroom for a last look at the dead girl, glanced once more at the clerk, left the doctor a capsule of morphine, wrapped myself up and went out on to the porch.

  The horses stood hanging their heads as the storm whistled and snow lashed at their flanks. A torch flickered.

  ‘Do you know the way?’ I enquired as I wound a muffler across my mouth.

  ‘We know the way all right,’ the driver replied gloomily (he was no longer wearing his helmet), ‘but you ought to stop here for the night …’

  The very earflaps of his hat told me that he would almost rather die than go.

  ‘You ought to stay, sir,’ added another man, who was holding the guttering torch. ‘It’s bad out there.’

  ‘Eight miles …’ I grumbled. ‘We’ll make it. I have patients who are seriously ill …’ And I climbed into the sleigh.

  I confess I omitted to say that the mere thought of staying in that house of misfortune, where I was impotent and useless, was intolerable.

  Hopelessly, the coachman sat down heavily on the driver’s seat, straightened up and gave a jerk as we moved off through the gateway at a smart pace. The torch went out as though it had vanished or been doused. A minute later, though, something else caught my attention: turning round with difficulty, I noticed that not only was the torch no more to be seen but Shalometyevo itself and all its buildings had disappeared as if in a dre
am. This gave me an unpleasant shock.

  ‘That’s pretty odd,’ I half-thought, half-mumbled to myself. I stuck my nose out for a moment, but the weather was so terrible that I stuck it in again. The whole world had been rolled into one bundle that was being buffeted in every direction at once.

  For a moment I wondered whether to turn back, but I rejected the idea, burrowed deeper into the hay at the bottom of the sledge as though in a boat, hunched myself up and closed my eyes. At once the scrap of green material on the lamp and a white face floated before my inner eye, immediately followed by a flash of realisation: ‘It’s a fracture of the base of the skull … Yes, of course … that’s it!’ In a burst of confidence I felt that this must be the correct diagnosis. A brainwave—but what good was it? It was as useless now as it would have been earlier; there was nothing to be done about it. What a ghastly thing to happen! What absurdly precarious lives we lead! What must be happening now in that house? It was too sickening even to contemplate. Then I began to feel sorry for myself: mine was a hard life. Everyone else was asleep now, their stoves a-glow, and once more I had been prevented from taking a proper bath. The blizzard was tossing me about like a leaf. Even when I did reach home, the chances were that I would be called out somewhere else. Or I would catch pneumonia and die out here … In this mood of self-pity I sank into the dark of oblivion, though I have no idea how long I spent in that state: this time I did not dream of being in a bath-house, because I was too cold. And it grew colder and colder.

  When I opened my eyes a black back loomed in front of me, and I realised that we were not moving any longer.

  ‘Have we arrived?’ I asked, blinking as I gazed blearily around me.

  The black-coated driver shifted gloomily in his seat, then suddenly jumped down, and I had the impression that he was being whirled around. Without a trace of deference he said:

  ‘No we haven’t … ought to listen to what people say … What did I tell you? It’ll be the death of us and the horses too.’

  ‘Don’t tell me you’ve lost the road?’ A cold shiver went down my spine.

  ‘Road? What road?’ the driver echoed in a despairing voice. ‘The road might be anywhere for all I can see now. There’s not a sign of it … We’ve been driving for four hours, but God knows where we’ve been going. That’s what comes of …’