All That Is Solid Melts into Air (3 page)

Raisa, his secretary, heard the cartoon squeak of his approach and was already standing by her desk holding a bunch of notecards as he rounded the corner. He nodded his greeting and walked into his office, leaving open the door for her as she trailed him. She began reciting the messages as he took off his jacket and settled himself at his desk.

Some referrals. Replies to referrals. A message from the editor of the state medical journal. Requests for responses to new initiatives from the hospital management committee. Invitations for lecture slots.

He stopped listening after the first few.

He made some calls, dictated two or three of the most pressing letters and then left for the theatre.

His first task was an endoscopy on a young woman. She had come in the previous afternoon, certain that a chicken bone had lodged itself in her neck. Nothing had shown up on the X-ray but it was possible that a bone fragment had lodged itself in her trachea, obscuring itself from view. He had spoken to her the evening before. A young woman, full of certainty. A trainee dentist. Sharp-featured. Thin. Her bones discernible under her skin, her clavicles running a straight line under her shoulders, so distinct that when he had spoken to her he couldn’t help picturing an artist’s sketch of her body, the construction lines as prominent as those of her features.

She was adamant about the pain and would gag involuntarily every now and again, sometimes in midsentence. When this happened, though, it barely interrupted her speech. She was unshocked at the reactions of her body, adapting to them.

It was her first stay in a hospital, but there was no sign of nerves. She had a faith in professional procedure, she clearly understood the precautions they would take, trusted in the skill of the surgical staff. Usually he would leave this type of job for one of the registrars, but he had volunteered to do it himself. After he’d spoken with her, a part of him wanted to repay her faith in them. She expected them to be expert and so he would match that, bringing his personal talent and experience to bear. And, besides, he welcomed the easing in. Doing something routine would be a way of warming himself up for the larger tasks of his day.

On the operating table Maya Petrovna Maximova lay on her side, anesthetized, her lips fitted around a mouthpiece with a hole in the centre, ready to take in the tube of the endoscope. Patients always looked so different in their vulnerable state; the personality she had shown the night before was all but erased.

The viewing screen was placed just above her head, to her right. Stanislav Nicolaevych, his new junior surgeon, stood beside him. Not that there was any need for his presence here, he too could practically do the procedure in his sleep, but it was his way of marking his territory, reminding Grigory that he was more than capable of it.

The tube was handed to him, and Grigory began to feed it through the plastic hole in the patient’s mouthpiece. He pushed it forward slowly and steadily, careful to maintain a slight momentum but cautious also not to puncture any tissue. The insides of her mouth filled the screen and the short journey began, past the flap of the epiglottis at the back of the mouth as he gently forced the tube downwards. Maya, although unconscious, gagged, her muscles doing their job. Past the opening of the larynx and the two protrusions of the vocal chords, like small internal fangs, and into the oesophagus. He slowed here, searching for a foreign body. And finally he could see it, a tiny piece of grey gristle that had embedded itself in the wall. Using the pincers attached underneath the camera he plucked it out, drawing a pinprick of blood. He pulled the tube back out, released the fragment into a steel dish, and entered once more, checking to see if there were any ancillary pieces, but he found nothing.

Job done, he handed the tube back to the attending nurse and took his leave, moving on to another patient in the adjoining theatre.

He liked the quick satisfaction that came from routine procedures. No thinking to do and minimal risks involved. The patient would be freed from all discomfort. In a couple of days, she will have forgotten all about that area of her throat, forgotten about him, free to go about her normal days. Nothing in this job was mundane. And it never bored him. Every tiny element had a purpose.

The next hour was taken up with placing a catheter in a man in his midforties with subclavian-vein thrombosis. Grigory let Stanislav close this one up to show him that taking on the endoscopy wasn’t a judgement on his competency.

Finally, before lunch there was a stent insertion. Usually he played music at this time, but he wasn’t in the mood today. The change in routine had an effect on his junior surgeons and nurses though; they were left to guess why there was silence.

He ate a large lunch in the canteen with his old friend Vasily Simenov, an endocrinologist. Grigory rarely ate much, but today he indulged himself because of the day that it was. He and Vasily had served in the military together: ran and cleaned their guns and ran and stripped them down and put them back together and ran some more. They forged their friendship by holding each other up as they scaled the snowy climbs of the Urals, half their bodyweight strapped to their backs.

When a position had become vacant in his unit Grigory had seen to it that Vasily was transferred in. It was one of the few times he had used his influence to sway things. He needed someone in the hospital who he could be himself with, who knew him before he was who he was. Of course there were mumblings from the rest of the staff, but they quietened over the passing months as Vasily proved his expertise.

After lunch there was a triple bypass that took almost four hours, which Grigory struggled through, feeling bloated after his meal and sweating through the later stages of the operation, the nurse constantly swabbing his brow and offering up the drinking straw attached to his bottle of tepid water.

Until finally, he left the hospital and made his way to the baths.

SO GRIGORY NEEDS
this swim even more than usual. From the middle of the afternoon he has looked forward to this immersion in the chilled water. And now that he’s standing on the edge of the pool, he savours the moment, drawing it out.

He’ll swim and then go back for some night reading. It’s his favourite part of the day, his mind cleared of practicalities, his body placated by exercise.

The curve of his spine is pulled sideways with idiopathic scoliosis, a condition he’s had since childhood. It acts as a personal weather system, dictating his mood and tone with its fluctuating activities, and this is another reason for the routine. He thinks of it as a peace offering, a plea for respite, a secret pact with his troublesome vertebrae. Raising his arms above his head, he traces a wide circumference through the air. He relishes this moment, the moment before entering into a new state, from air to water. Fine blond hairs riffle along his limbs. He dips his back into a concave curve and lowers his head into his shoulders, bending his thick legs as he does so. Grigory cuts through the air until he feels the wholeness of the water sluicing around him. A body of water. He’s always liked this phrase; on the news, when snowmelts flood the regions; or in geography exams, when he was asked to compare the size of lakes and seas and channels. We inhabit bodies of water—he thinks when he hears the term—with all our fluids and juices. We have an aquatic mass of our own: tides, maelstroms, undercurrents.

Once submerged, he takes aggressive strokes, lengthening his arms to their limit, stretching his fingers, tearing through the undulating surface, wanting to temper the water or for it to temper him.

He reaches the far wall and tumbles in expert fashion, flipping his heels over his head, his legs shooting him through the pool, torso corkscrewing to right himself, bulleting underneath the surface.

In the first years of his career, when Grigory was gaining experience as a physician, the pool was a great source of inspiration for him. Often, if a patient had remained undiagnosed for more than three days, he would dive in and wait for the water and motion to provide an answer, which, invariably, it did.

And he’s an exceptional swimmer, a fact that has spread among his acquaintances. A story surfaced in the hospital recently about his time in the military, when he and his comrades showed up at a grand party in a dacha somewhere near Zavidovo. Grigory got so drunk that he couldn’t stand upright, so his comrades threw him into the swimming pool for safety and Grigory floated there, unaided, for the rest of the night. He couldn’t remember the party, a fact which, considering the circumstances, didn’t make the story any less true.

Of course it made good gossip in the hospital. He knows it hasn’t come from Vasily. They never talk about their military life to anyone else—it’s a point of honour between them—so Grigory has no idea how it emerged. But he doesn’t care. Maybe it’s good for them to see him in a different light, to see him as something other than their responsible superior. It would remind them that he’s a man going about his duty, just as they are.

He has never heard the story told inside the hospital walls. He hasn’t caught a snatched conversation in a nurses’ station, or two orderlies whispering by the coffee machine. But he knows it’s there, in the ether, the same way he knows when one of the registrars sneaks in late to rounds or when a junior surgeon is unsure of the exact location of the intercostal nodes.

The rush of silence as, eyes closed, he listens to channels of water passing his ears.

Grigory understands the power of the unspoken. To progress is to become fluent in the language. His rise in stature increased its pace when Grigory noticed that people in positions of power could hold almost an entire conversation with only a few simple words. He gained influence by understanding what his older, more junior, colleagues did not: that power lurks in silences, in whispered conversations in the corner of a room, in contained gestures: a dip of the head, a pat of the forearm. It has often struck him that the most powerful men he has met also have the greatest range of physical articulations, a vital ability in a sphere where a misinterpreted comment can end even the most celebrated of careers.

He cranes his arms over his head and plunges them under the surface, limbs travelling from water to air to water, bubbles leaking from his nose. After a few lengths the actions become automatic and his encounter this morning reemerges. He sees the shoes again, ghosts standing in formation.

He couldn’t begin to guess—and would never want to—how many of his patients have had their lives cut short. And although it was never something he had fully articulated, even to himself, it was no coincidence that he had chosen a job that valued human life in a state that had always disregarded it so readily.

Simple physical actions. Arms and legs. Head and torso. No thought required, just motion in water. He places his arms by his sides, paddles gently with his feet, and opens his eyes to the space that envelops him, lined in white ceramic.

The old silences are echoing. In the past year there has been a steady stream of young men coming through the doors with knife wounds. The emergency rooms now have to deal with drug overdoses. Sometimes, on weekends, there are full fistfights in the reception area. Secret bars are popping up in abandoned factories or unused rail depots. Anger is beginning to seep out. People aren’t so careful with what they say anymore. Grigory sees traffic lights burst apart by rocks, road signs that have been scrawled over. Public property used to be an almost sacred thing, collective property. No one touched it before. That too has changed.

He doesn’t feel any revulsion towards the present or nostalgia for tradition; anger is a presence to be welcomed. Everyone, including himself, has spent too long denying the accumulation of commonplace evidence. Injustices have mounted up on everybody’s doorstep.

He pulls himself out of the pool, water funnelling down.

In the steam room sits Zhykhov, chief of administration at the hospital, talking to an acquaintance. Grigory knows the man’s not a friend because Zhykhov’s laughing that laugh of his, barking it out, obviously trying to ingratiate himself.

The acquaintance is smoking a wilting cigar. The smoke drifts up and mingles with the steam, the two substances circling each other in a formal dance. His lank hair droops over his forehead. Grigory finds something quite familiar about the man, something that engages him, the way he looks to the ceiling when he speaks, the rhythm of his smoking. Something.

Zhykhov raises a hand and beckons him over. Grigory is a good twenty years younger than him and Zhykhov wants to be cast in the light of youthful vigour.

“Our head of surgery, Dr. Grigory Ivanovich Brovkin. Look at him. A brilliant career ahead of him. Everything he could wish for at his fingertips.”

Grigory laughs dutifully. “Perhaps the brilliance is all behind me.”

Zhykhov raises a thumb to his companion and waggles his hand.

“Don’t worry, Vladimir, he’s rarely this modest. This man, such ambition I have never seen. A python, this man. He squeezes every breath of rationality out of you. Arguing with him is a full gloves-off affair. This man is a fucking wordsmith.”

The acquaintance looks bemused. “I like my surgeons to be good with their hands, I’m not looking for someone who can dominate a debating chamber.”

Grigory remembers.

“You like a surgeon who can remove an inflamed appendix.”

The man lowers his cigar and stares at Grigory. Unconsciously he runs the tips of his fingers along the neat scar to the right of his stomach. He’s trying to figure out if Grigory has mentioned this because he noticed the mark. But the way he said it implies a familiarity.

“Have you been to Kursk?” he asks tentatively. Grigory can tell that the man is rarely unbalanced like this. He’s a man who knows things about other people. He’s not used to them having some insight into his life.

“Yes. I operated on you.”

“I don’t remember you. But then I hardly knew where I was at the time.”

He offers his hand and Grigory shakes it.