A Country Doctor's Notebook (4 page)

They tied the ligatures and then, knees knocking, I started sewing up the skin with widely-spaced stitches.
Suddenly I stopped, brought to my senses by an inspired thought: I left a gap for drainage in which I inserted a gauze wick. My eyes were dimmed with sweat. I felt as if I were in a steam bath.

I heaved a sigh of relief. I looked wearily at the stump and at her waxen face and asked:

‘Is she alive?'

‘Yes, she's alive,' came the immediate and almost soundless echo as the
feldsher
and Anna Nikolaevna replied in unison.

‘She'll last perhaps another minute or so,' the
feldsher
mouthed voicelessly into my ear. Then he hesitated and suggested tentatively:

‘Perhaps you needn't touch the other leg, doctor. We could just bandage it, you know … otherwise she won't last till the ward … all right? Better if she doesn't die in the theatre.'

‘Let's have the plaster,' I uttered hoarsely, urged on by some unknown force.

The floor was covered in white blobs of gypsum. We were all bathed in sweat. The body lay lifeless. Its right leg was encased in plaster and the shin showed through where in another inspired moment I had left a window to coincide with the fracture.

‘She's alive,' the assistant breathed in surprise.

Then we started lifting her and an enormous cavity could be seen under the sheet—we had left a third of her body on the operating table.

Shadows flitted down the passage, nurses darted to and fro and I saw a dishevelled male figure shuffle past along the wall and let out a muffled howl. But he was led away. Silence fell.

In the operating room I washed off the blood which had stained my arms up to the elbow.

‘I suppose you've done a lot of amputations, doctor?' Anna Nikolaevna asked suddenly. ‘That was very good, no worse than Leopold.'

She invariably pronounced the name ‘Leopold' as if she were talking about the dean of a medical school.

I glanced suspiciously at their faces and saw respect and astonishment in all of them, including Demyan Lukich and Pelagea Ivanovna.

‘Hm, well, the fact is I've done only two …'

Why did I lie? I cannot understand it to this day.

The hospital was utterly silent.

‘When she dies, be sure to send for me,' I told the
feldsher
in an undertone, and for some reason instead of just answering ‘All right,' he said deferentially:

‘Very good, sir.'

A few minutes later I was standing beside the green-shaded lamp in the study of the doctor's quarters. There was not a sound to be heard.

A pale face was reflected in the pitch-dark window.

‘No, I don't look like Dmitry the Pretender, and, do you know, I seem to have aged, there's a furrow between my eyebrows … right now there'll be a knock … and they'll say, “She's dead”.

‘Yes, I'll go and have a last look, any minute now there'll be a knock …'

There was a knock at the door. It was two and a half months later. One of the first bright days of winter was shining through the window.

He came in; only then did I really look at him. Yes, he definitely had good features. Forty-five years old. Sparkling eyes.

Then a rustling sound. A young girl of enchanting beauty came bounding in on crutches; she had only one leg and was dressed in a very wide skirt with a red border at the hem.

She looked at me and her cheeks flushed pink.

‘In Moscow … in Moscow,' I said and started writing down an address, ‘they'll fix you up with a prosthesis—an artificial leg.'

‘Kiss his hand,' the father suddenly commanded her. I was so confused that I kissed her on the nose instead of the lips.

Then, hanging on her crutches, she undid a bundle and out fell a snow-white towel artlessly embroidered with a red cockerel. So that was what she'd been hiding under her pillow when I did my rounds in the ward! And indeed I remembered seeing some thread on her bedside table.

‘I can't accept it,' I said sternly, and even shook my head. But she gave me such a look that I took it.

It hung in my bedroom in Muryovo and then went with me on my travels. In the end it grew threadbare, faded, wore out and disappeared just as memories fade and disappear.

SO I WAS ALONE, SURROUNDED BY NOVEMBER gloom and whirling snow; the house was smothered in it and there was a moaning in the chimneys. I had spent all twenty-four years of my life in a huge city and thought that blizzards only howled in novels. It appeared that they howled in real life. The evenings here are unusually long, and I fell to daydreaming, staring at the reflection on the window of the lamp with its dark green shade. I dreamed of the nearest town, thirty-two miles away. I longed to leave my country clinic and go there. They had electricity, and there were four doctors whom I could consult. At all events it would be less frightening than this place. But there was no chance of running away, and at times I realised that it would be cowardly. It was for precisely this, after all, that I had been studying medicine.

‘Yes, but suppose they bring me a woman in labour and there are complications? Or, say, a patient with a strangulated hernia? What shall I do then? Kindly tell me that. Forty-eight days ago I qualified “with distinction”; but distinction is one thing and hernia is another. Once I watched a professor operating on a strangulated hernia. He did it, while I sat in the amphitheatre. And I only just managed to survive …'

More than once I broke out in a cold sweat down my
spine at the thought of hernia. Every evening, as I drank my tea, I would sit in the same attitude: by my left hand lay all the manuals on obstetrical surgery, on top of them the small edition of Döderlein. To my right were ten different illustrated volumes on operative surgery. I groaned, smoked and drank cold tea without milk.

Once I fell asleep. I remember that night perfectly—it was 29 November, and I was woken by someone banging on the door. Five minutes later I was pulling on my trousers, my eyes glued imploringly to those sacred books on operative surgery. I could hear the creaking of sleigh-runners in the yard—my ears had become unusually sensitive. The case turned out to be, if anything, even more terrifying than a hernia or a transverse foetus. At eleven o'clock that night a little girl was brought to the Muryovo hospital. The nurse said tonelessly to me:

‘The little girl's weak, she's dying … Would you come over to the hospital, please, doctor …'

I remember crossing the yard towards the hospital porch, mesmerised by the flickering light of a kerosene lamp. The lights were on in the surgery, and all my assistants were waiting for me, already dressed in their overalls: the
feldsher
Demyan Lukich, young but very capable, and two experienced midwives, Anna Nikolaevna and Pelagea Ivanovna. Only twenty-four years old, having qualified a mere two months ago, I had been placed in charge of the Muryovo hospital.

The
feldsher
solemnly flung open the door and the mother came in—or rather she seemed to fly in, slithering on her ice-covered felt boots, unmelted snow still on her shawl. In her arms she carried a bundle, from which came a steady hissing, whistling sound. The mother's face
was contorted with noiseless weeping. When she had thrown off her sheepskin coat and shawl and unwrapped the bundle, I saw a little girl of about three years old. For a while the sight of her made me forget operative surgery, my loneliness, the load of useless knowledge acquired at university: it was all completely effaced by the beauty of this baby girl. What can I liken her to? You only see children like that on chocolate boxes—hair curling naturally into big ringlets the colour of ripe rye, enormous dark blue eyes, doll-like cheeks. They used to draw angels like that. But in the depths of her eyes was a strange cloudiness and I recognised it as terror—the child could not breathe. ‘She'll be dead in an hour,' I thought with absolute certainty, feeling a sharp twinge of pity for the child.

Her throat was contracting into hollows with each breath, her veins were swollen and her face was turning from pink to a pale lilac. I immediately realised what this colouring meant. I made my first diagnosis, which was not only correct but, more important, was given at the same moment as the midwives' with all their experience: ‘The little girl has diphtherial croup. Her throat is already choked with membrane and soon it will be blocked completely.'

‘How long has she been ill?' I asked, breaking the tense silence of my assistants.

‘Five days now,' the mother answered, staring hard at me with dry eyes.

‘Diphtheria,' I said to the
feldsher
through clenched teeth, and turned to the mother:

‘Why have you left it so long?'

At that moment I heard a tearful voice behind me:

‘Five days, sir, five days!'

I turned round and saw that a round-faced old woman had silently come in. ‘I wish these old women didn't exist,' I thought to myself. With an aching presentiment of trouble I said:

‘Quiet, woman, you're only in the way,' and repeated to the mother: ‘Why have you left it so long? Five days? Hmm?'

Suddenly with an automatic movement the mother handed the little girl to the grandmother and sank to her knees in front of me.

‘Give her some medicine,' she said and banged her forehead on the floor. ‘I'll kill myself if she dies.'

‘Get up at once,' I replied, ‘or I won't even talk to you.'

The mother stood up quickly with a rustle of her wide skirt, took the baby from the grandmother and started rocking it. The old woman turned to the doorpost and began praying, while the little girl continued to breathe with a snake-like hiss. The
feldsher
said:

‘That's what they're all like. These people!' And he gave a twitch of his moustache.

‘Does that mean she's going to die?' the mother asked, staring at me with what looked like black fury.

‘Yes, she'll die,' I said quietly and firmly.

The grandmother picked up the hem of her skirt and wiped her eyes. The mother shouted in an ugly voice:

‘Give her something! Help her! Give her some medicine!'

I could see what was in store for me and remained firm.

‘What medicine can I give her? Go on, you tell me. The little girl is suffocating, her throat is already blocked up. For five days you kept her ten miles away from me. Now what do you want me to do?'

‘You're the one who's supposed to know,' the old woman whined by my left shoulder in an affected voice which made me immediately detest her.

‘Shut up!' I said to her. I turned to the
feldsher
and ordered the little girl to be taken away. The mother handed her to the midwife and the child started to struggle, evidently trying to cry, but her voice could no longer make itself heard. The mother made a protective move towards her, but we kept her away and I managed to look into the little girl's throat by the light of the pressure-lamp. I had never seen diphtheria before except for mild, forgettable cases. Her throat was full of ragged, pulsating, white substance. The little girl suddenly breathed out and spat in my face, but I was so absorbed that I did not flinch.

‘Well now,' I said, astonished at my own calm. ‘This is the situation: it's late, and the little girl is dying. Nothing will help her except one thing—an operation.'

I was appalled, wondering why I had said this, but I could not help saying it. The thought flashed through my mind: ‘What if she agrees to it?'

‘How do you mean?' the mother asked.

‘I'll have to cut open her throat near the bottom of her neck and put in a silver pipe so that she can breathe, and then maybe we can save her,' I explained.

The mother looked at me as if I was mad and shielded the little girl from me with her arms, while the old woman started muttering again:

‘The idea! Don't you let them cut her open! What—cut her throat?'

‘Go away, old woman,' I said to her with hatred. ‘Inject the camphor!' I ordered the
feldsher
.

The mother refused to hand over the little girl when
she saw the syringe, but we explained to her that there was nothing terrible about it.

‘Perhaps that will cure her?' she asked.

‘No, it won't cure her at all.'

Then the mother burst into tears.

‘Stop it,' I said. I took out my watch, and added: ‘I'm giving you five minutes to think it over. If you don't agree in five minutes, I shall refuse to do it.'

‘I don't agree!' the mother said sharply.

‘No, we won't agree to it,' the grandmother put in.

‘It's up to you,' I said in a hollow voice, and thought: ‘Well, that's that. It makes it easier for me. I've said my piece and given them a chance. Look how dumbfounded the midwives are. They've refused and I'm saved.' No sooner had I thought this than some other being spoke for me in a voice that was not mine:

‘Look, have you gone mad? What do you mean by not agreeing? You're condemning the baby to death. You must consent. Have you no pity?'

‘No!' the mother shouted once more.

I thought to myself: ‘What am I doing? I shall only kill the child.' But I said:

‘Come on, come on—you've got to agree! You must! Look, her nails are already turning blue.'

‘No, no!'

‘All right, take them to the ward. Let them sit there.'

They were led away down the half-lit passage. I could hear the weeping of the women and the hissing of the little girl. The
feldsher
returned almost at once and said:

‘They've agreed!'

I felt my blood run cold, but I said in a clear voice:

‘Sterilise a scalpel, scissors, hooks and a probe at once.'

A minute later I was running across the yard, through a swirling, blinding snowstorm. I rushed to my room and, counting the minutes, grabbed a book, leafed through it and found an illustration of a tracheotomy. Everything about it was clear and simple: the throat was laid open and the knife plunged into the windpipe. I started reading the text, but could take none of it in—the words seemed to jump before my eyes. I had never seen a tracheotomy performed. ‘Ah well, it's a bit late now,' I said to myself, and looked miserably at the green lamp and the clear illustration. Feeling that I had suddenly been burdened with a most fearful and difficult task, I went back to the hospital, oblivious of the snowstorm.