Cancer Ward (11 page)

At long last she took offense. “You're putting me in a stupid, ludicrous position. For the last time,
please.
”

Of course it was a mistake on her part to humiliate herself like that. Why should she do the pleading? But he instantly bared his arm and held it out. “All right, but only for you. You may take three cc.'s.”

In fact, she felt ill at ease with him, and one day something funny happened. Kostoglotov said, “You don't look like a German. You must have taken your husband's name?”

“Yes.” The word fell involuntarily from her lips.

Why had she said that? Because at that moment it would have hurt to say anything else.

He didn't ask her anything more.

In fact Gangart had been her father's and her grandfather's name. They were Russianized Germans. But what should she have said. “I'm not married … I've never been married?”

Out of the question.

6. The Story of an Analysis

First, Ludmila Afanasyevna took Kostoglotov into the treatment room. A female patient had just emerged after her session. The huge 180,000-volt X-ray tube, hanging by wires from the ceiling, had been in operation almost nonstop since 8
A.M.
There was no ventilation and the air was full of that sweetish, slightly repellent X-ray warmth.

This warmth (although there was more to it than just warmth) made itself felt in the lungs and became repellent to the patients after half a dozen or so sessions. But Ludmila Afanasyevna had grown used to it and never even noticed whether it was pleasant or not. She had started work there twenty years ago when the machine had no shield of any sort. She had also been caught under a high-tension wire and very nearly killed. Every day she breathed in the air of the X-ray rooms, and she sat in on screening sessions for far longer than was allowed. In spite of all the modern shields and gloves, she had certainly taken in many more rads than even the most acquiescent and seriously ill patients, except that nobody bothered to count the rads or to add them up.

She was in a hurry, not only because she wanted to get out quickly, but also because the X-ray program could not be delayed even for a few minutes. She motioned Kostoglotov to lie on the hard couch under the X-ray tube and to uncover his stomach. Then she went over his skin with some sort of cool, tickly brush. She outlined something and seemed to be painting figures on it.

After this she told the nurse about the “quadrant scheme” and how she was to apply the tube to each quadrant. She then ordered the patient to turn over onto his stomach and she brushed some more lines on his back. “Come and see me after the session,” she said.

When she had left the room, the nurse told Kostoglotov to turn over onto his back again and laid sheets around the first quadrant. Then she brought up heavy mats of rubber impregnated with lead, which she used to cover all the surrounding areas which were not for the moment to receive the direct force of the X rays. The pressure of the pliable mats, molded to his body, was pleasantly heavy.

Then the nurse too went out and shut the door. Now she could see him only through a little window in the thick wall. A quiet humming began, the auxiliary lamps lit up, the main tube started to glow.

Through the square of skin that had been left clear on his stomach, through the layers of flesh and organs whose names their owner himself did not know, through the mass of the toadlike tumor, through the stomach and entrails, through the blood that flowed along his arteries and veins, through lymph and cells, through the spine and lesser bones and again through more layers of flesh, vessels and skin on his back, then through the hard wooden board of the couch, through the four-centimeter-thick floorboards, through the props, through the filling beneath the boards, down, down, until they disappeared into the very stone foundations of the building or into the earth, poured the harsh X rays, the trembling vectors of electric and magnetic fields, unimaginable to the human mind, or else the more comprehensible quanta that like shells out of guns pounded and riddled everything in their path.

And this barbarous bombardment of heavy quanta, soundless and unnoticed by the assaulted tissues, had after twelve sessions given Kostoglotov back his desire and taste for life, his appetite, even his good spirits. After the second and third bombardments he was free of the pain that had made his existence intolerable, and eager to understand how these penetrating little shells could bomb a tumor without touching the rest of the body. Kostoglotov could not give himself unreservedly to the treatment until he had grasped for himself the theory behind it and so was able to believe in it.

He had tried to discover the theory of X-ray therapy from Vera Kornilyevna, that sweet woman who had utterly disarmed his prejudice and caution after their first meeting by the stairs when he had been determined that though the fire brigade and the militia might drag him away, he would never leave the place of his own free will. “Don't be afraid, just explain,” he used to reassure her. “I'm like an intelligent soldier who has to understand his mission before he'll fight. How is it that X rays can destroy a tumor without touching the other tissues?”

Vera Kornilyevna's feelings always showed first on her lips, not in her eyes. She had such responsive, delicate lips—like little wings. It was on them that her hesitation was now expressed: they fluttered with doubt.

(What could she tell him about the blind artillery which cuts down its own men with the same pleasure as it does the enemy's?)

“Well, I'm not supposed to … oh, all right. Of course the X ray smashes everything it meets. Only normal tissues recover quickly, tumor tissues don't.”

Maybe what she had said was the truth, maybe it wasn't; anyway Kostoglotov was glad to hear it. “Oh well, in that case I'll join in the game. Thank you. Now I know I'll get better!”

And in fact he was getting better. He lay down eagerly under the X ray and during each session tried to will the tumor cells to believe they were breaking up, that they were
kaput.
At other times he would lie under the tube thinking about whatever entered his head, or he might even doze off.

Just at that moment, his eyes having taken in the mass of hanging pipes and wires, he wanted to know why there were so many of them. And if there was a cooling system there, was it water- or oil-based? But his thoughts did not stay long on this subject; he could not provide himself with any explanation.

As it happened, he began thinking about Vera Gangart. Such a sweet woman would never have been seen in Ush-Terek. And women like that were always married. However, putting the husband as it were in parentheses, he was thinking of her without him. He was thinking how nice it would be to talk to her not just for a moment but for a long, long time, to walk with her in the hospital courtyard, for instance. Sometimes he would shock her by the harshness of his judgments—she looked so funny when she was confused. Every time she smiled her goodness shone like a little sun, even when you met her by chance in the corridor or as she came into the ward. She wasn't professionally kind, she was just naturally kind. Her smile was kind, not so much her smile as the lips themselves. They were vital, separate lips, which seemed about to flutter from her face like a lark into the sky. They were made, as all lips are, for kissing, yet they had other more important work to do: to sing of brightness and beauty.

The tube hummed faintly and musically.

He was thinking about Vera Gangart but he was also thinking about Zoya. The strongest memory he had of last night (it had kept on cropping up all morning) was of her neatly supported breasts which formed, as it were, a little shelf, almost horizontal. While they gossiped yesterday a large, heavy ruler for drawing lines in registers lay on the table beside them. The ruler was made not of plywood but out of a planed block. All evening Kostoglotov had had a temptation—to pick it up and lay it on the shelf of her breasts, to test whether it would slide off or not. He rather thought it wouldn't.

He also remembered, with gratitude, the particularly heavy lead-impregnated mat which they had laid on his body just below his stomach. That mat had pressed against him and reassured him cheerfully, “I'll protect you, don't be afraid!”

But maybe it wouldn't? Maybe it wasn't thick enough? Or perhaps they hadn't positioned it accurately?

During these last twelve days Kostoglotov had returned not simply to life—to food, movement and a cheerful disposition—but also to the loveliest feeling in life which in his agony of the last few months he had completely lost. It proved that the lead mat was holding the defenses!

Nonetheless he had to get out of the clinic while he was still all right.

He didn't even notice that the humming had stopped and the pink wires had begun to grow cold. The nurse came in and began to take off the shields and the sheets. He swung his feet off the couch and then got a good view of the violet squares and figures drawn on his stomach.

“How can I wash with all this?” he asked the nurse.

“Only with the doctors' permission.”

“A fine state of affairs. What's the idea? Is it meant to last for a month?”

He went to see Dontsova. She was sitting in the short-focus apparatus room. Through her square glasses, rounded at the four corners, she was examining some large X-ray films against the light. Both machines were switched off, both windows were open and there was no one else in the room.

“Sit down,” said Dontsova drily.

He sat down. She went on comparing the X rays.

Although Kostoglotov argued with her, he did it only as a defense against the excesses of medicine, as laid out in a mass of instructions. As for Ludmila Afanasyevna herself, she inspired only confidence, not just by her masculine decisiveness, by the precise orders she gave as she watched the screen in the darkness, by her age and her indisputable dedication to work and work alone, but also, above all, by the confident way in which, right from the very first day, she had felt for the outline of his tumor and traced its circumference so precisely. The tumor itself proclaimed the accuracy of her touch, for it had felt something too. Only a patient can judge whether the doctor understands a tumor correctly with his fingers. Dontsova had felt out his tumor so well that she didn't need an X-ray photograph.

She laid aside the X-ray photographs, took off her glasses and said, “Kostoglotov, there is too big a gap in your case history. We must be absolutely certain of the nature of your primary tumor.”

When Dontsova started talking like a doctor, she always spoke much more quickly. In one breath she would leap through long sentences and difficult terms. “What you tell us of your operation the year before last and the position of the present secondaries is in agreement with our diagnosis. However, there are other possibilities which can't be excluded, and this complicates your treatment for us. You'll understand it's impossible now to take a sample of your secondary.”

“Thank God! I wouldn't have let you take one.”

“I still don't understand why we can't get hold of the slides with the sections of your primary. Are you absolutely sure there was a histological analysis?”

“Yes, I'm sure.”

“In that case why were you not told the result?”

She rattled on in the rapid style of a busy person. Some of her words slipped by and had to be guessed at.

Kostoglotov, however, had got out of the habit of hurrying. “The result? There were such stormy goings-on where we were, Ludmila Afanasyevna, such an extraordinary situation that I give you my word of honor.… I'd have been ashamed to ask about a little thing like my biopsy. Heads were rolling. And I didn't even understand what a biopsy was for.” Kostoglotov liked to use medical terms when he was talking to doctors.

“Of course you didn't understand. But those doctors must have understood. These things can't be played about with.”

“Doc-tors?”

He glanced at her, at her gray hair which she did not conceal or dye, and took in the concentrated, businesslike expression of her face with its somewhat prominent cheekbones.

Wasn't that typical of life? Here, sitting in front of him, was his compatriot, his contemporary and well-wisher. They were talking in their own language, common to them both, and still he couldn't explain the simplest thing to her. It seemed one had to start too far back, or else end the explanation too soon.

“Ludmila Afanasyevna, those doctors couldn't do a thing. The first surgeon was a Ukrainian. He decided I was to have an operation and got me ready for it, and then he was taken on a prisoners' transport the night before the operation.”

“So?”

“So nothing. They took him away.”

“I'm sorry but … he must have had warning. He could have.…”

Kostoglotov burst out laughing. He thought it very amusing. “Nobody ever warns you about a transport, Ludmila Afanasyevna. That's the whole point. They like to pull you out unexpectedly.”

Dontsova's broad forehead creased into a frown. Kostoglotov must be talking nonsense.

“But if he had a patient due for operation…?”

“Huh! Listen to me: they brought in a Lithuanian who'd done an even better job of it than me. He'd swallowed an aluminum spoon, a tablespoon.”

“However could he have managed that?”

“He did it on purpose. He wanted to get out of solitary. How was he to know they were taking the surgeon away?”

“So what happened next? Wasn't your tumor growing very fast?”

“That's right, from morning to evening—it was really getting down to it. Then about five days later they brought another surgeon from another compound. He was a German, Karl Fyodorovich. So, he got settled into his new job and after a day or so he operated on me. But words like ‘malignant tumor' and ‘secondaries'—no one told me anything about them. I'd never even heard of them.”