|
Literary Review
A doctor's dilemma
RAVI VYAS
Medicine is my lawful wife; literature, my mistress. When I am tired of one, I spend the night with the other... Medicine enlarged the field of my observations, enriched me with knowledge, the true value of which for me as a writer can be understood only by one who is a physician.
Anton Chekhov
AMONG the large number of men and women practising medicine, only a few have been able to write stories based on their experiences for the general reader that reflected human diversity and perversity which is, after all, the lock and stock of literature. Of the most accomplished of them, it can be said that their words were a natural extension of their healing. Any patient who is familiar with their stories and essays — and poems too — soon recognises their concern for those who came to them for help and their understanding of the difficulties and satisfactions of caring for the sick. What the best medical writers have done is to let the story come forward unhampered, though they themselves are not only in it but of it as well. Being good doctors, they have not hesitated to immerse themselves in another's life or in another's narrative, but they do not take it over. They tell the story, as it is, unvarnished, and leave it to us to take it or leave it.
Some of the best examples of such dedicated physicians are Oliver Goldsmith, Oliver Wendell Holmes, Arthur Conan Doyle, William Carlos Williams (Somerset Maugham and John Keats and some others are dropped because they did not practise), Robert Bridges and A.J. Cronin. This is a widely disparate group but what unites them is that they had all seen life in extremis, seen men and women in bravery, in selfishness and astonishing selflessness, up close and not merely personal but indeed beneath the skin. Above all, they faced life squarely, had the courage and comic gift to investigate the contradictoriness of human nature and come up smiling at what they saw — and, so, make us smile too.
The contemporary writer who best exemplifies these qualities is Mikhail Bulgakov (1891-1940) in A Country Doctor's Notebook though, of course, he is best known for his satirical novels on Stalinist Russia in The Master and Margarita, Black Snow, The White Guard and The Heart of a Dog. As the title tells you, Notebook (1925-27) is based on Bulgakov's personal experiences in a one-doctor, small regional hospital — what we would now call a polyclinic — in the wilds of northwest Russia. It is mid-winter, there is no telephone, and the roads are impassable. But from the snow-bound countryside there comes daily a macabre procession of ailing peasants, walking wounded or carried on sleighs, for him to cure. These nine stories, keen and bright as a scalpel, are a record of how he coped.
Short story writers, it is said, are really poets and what the short story sets out to achieve is "an insight". Told in a deliberately callous way, the material could be unbearable. But Bulgakov's frankness, fresh observation — "my eyes as yet unclouded by experience" — and gentle self-deprecating humour, the agonies and triumphs of a medical novice pitched with the terrifying responsibility makes this a minor classic of all times. Bulgakov writes in that wonderfully plain, conversational style that he worked so hard to achieve. This is how he starts off "The Embroidered Towel": "If you have never driven over country roads it is useless for me to tell you about it; you wouldn't understand anyway. But if you have, I would rather not remind you of it. To cut a long story short, my driver and I spent exactly twenty-four hours covering the thirty miles which separates the distant town of Grachyovka from Muryovo hospital... " The scientific litmus of veracity is always revealed in tone, style and voice. Bulgakov's youthful appearance is a dreadful worry to him, especially when he notices the kindly but critical glances of the two medical midwives who are his assistants. He tries to speak in a deeper voice, and more slowly, as befits a real doctor. Alone at night, he breaks into cold sweats at the thought of some crisis that may arrive next morning. A strangulated hernia? Peritonitis? From delivery room and operation theatre, he rushes across the yard to his study and try to make some connection between the complicated diagrams in his anatomy textbooks and the human beings patiently waiting.
An urban creature, he hates the countryside and the loneliness. The nearest street lamp, he bitterly calculates, is 32 miles away — and the nearest cinema. Answering a call from a colleague 20 miles away, he is driven through a blizzard in a horse-drawn sleigh, keeping a pursuing pack of wolves at bay with an automatic pistol.
The casualties that come to the hospital are hardly less hair-raising. A young woman has her leg torn off in a crushing machine; a child dying of diptherial croup whose throat had to be cut open to insert a pipe so that she can breathe. Because of Bulgakov's tone and style, we feel, by proxy, the responsibility, the expert concentration, the triumph that in reality only a skilled surgeon can feel within himself. These success stories are talked about, as happens in small towns and villages, magnified and hailed as miracles and the stream of patients becomes a flood. He works far into the night in the operating theatre, drags himself to bed till he is shaken by some other nocturnal emergency.
So a year passed... All around nothing seem to have changed. But I have changed a great deal. I shall celebrate the anniversary alone with my memories.
I look into the mirror. Yes, the difference is enormous. A year ago, this mirror, just unpacked from my trunk, reflected a shaven face. My twenty-four head was adorned with a parting. Now the parting is gone, my hair is brushed unceremoniously straight back. Who is there to impress with a straight parting any way, when you are twenty miles from the railway line? The same has happened with my shaving: my upper lip now wears a solid growth rather like a harsh yellow toothbrush; my cheeks feel like a cheese grater, so that if my forearm happens to start itching while I am at work I get relief by rubbing it against my cheek.
It always gets like that when I shave only once a week instead of three times.
So, at the end of the year he has treated 15,613 patients and there is no end to them.
But it is Bulgakov's feelings (it must be remembered that much of Russian literature is emotional, not intellectual) about the peasants in his care — a mixture of idealism and despair — that is the sub-text of these stories. It is an ever-lasting refrain: their stupidity beggars belief.
Issued with a week's supply of drugs, carefully measured and in daily doses, they swallow the lot in one go and then return to be stomach-pumped back to life! Much as Bulgakov despairs of the Russian peasant and his ways, he discovers that in these characters there still sits a mind, and the mind of the dullest is not dull because, at its very lowest, it will at least reflect the social dilemma (or class?) in which it is born. There is, in other words, hope of redemption, which could be seen in the success of the Soviet education programme since 1917.
Bulgakov conveys a sense of being a lone soldier of reason and enlightenment pitted against the vast, dark, ocean-like mass of peasant ignorance and superstition. Again and again, he stresses what it means to experience the physical reality of the backwardness of rural Russia that had caused such agony to the liberal educated elite: that intolerable discrepancy between the advanced civilisation and culture enjoyed by a small minority and the fearsome, pre-literate, medieval world of the peasantry. He is constantly haunted by an awareness that in dealing with them he is actually at the point of contact between two cultures which are about five hundred years apart in time.
All the stories are set against a background of night, winter, blizzards and gales. This is not a literary device to heighten the sense of drama, urgency or danger: it expresses Bulgakov's profound feeling that in rural Russia, a doctor is simply someone fighting an elemental force. The dominant, recurring images are light and dark: light at the entrance of the hospital, the lamp in his study and a single light burning in the otherwise darkened, storm-swept building. These pinpoints of light are contrasted with the vast, malevolent surrounding darkness, which threatens to engulf them, yet doesn't quite succeed in putting them out. There is hope yet, if you have the courage and stamina to stick it out. (You get the same feeling when you go into the interiors of eastern U.P. and Bihar.) Meanwhile, far away at the battlefront of the civil war, a new world is being born. The last story in this collection, "The Murderer", is about another young doctor, hiding in Kiev, listening excitedly to the guns of the approaching Bolsheviks. Arrested and dragged before the brutal White cavalry commander, whose atrocities had spread terror in the town, he survives through a prodigious feat of daring. Contrasted with him in "Morphine" is Bulgakov's successor in the regional hospital who, overcome by loneliness,becomes a morphine addict and shoots himself. Both stories in different ways celebrate courage (call it mental strength, if you like) — the virtue that shines from every angle of this profoundly human collection by one of the greatest of modern Russian writers.
A Country Doctor's Notebook, Mikhail Bulgakov, translated by Michael Glenny, Collins Harvill, in 1975, price £3.50.
Printer friendly
page
Send this article to Friends by
E-Mail
Literary Review
|
