A Country Doctor's Notebook (3 page)

Through clenched teeth I grunted:

‘Hm … no, well, I … yes, rather young looking …'

After that we went down to the pharmacy and a glance was enough to tell me that it was supplied with every conceivable medicine. Its two sombre rooms smelled strongly of herbs and its shelves were filled with an endless variety of preparations. There were even foreign patent medicines, which, need I add, I had never heard of.

‘Leopold Leopoldovich ordered these,' Pelagea Ivanovna reported proudly.

‘This Leopold was nothing short of a genius,' I thought and was filled with respect for the mysterious Leopold who had left the quiet little village of Muryovo behind him.

Besides fire, man also needs to find his bearings. I had long since eaten the cockerel, Yegorich had stuffed my mattress with straw and covered it with a sheet, and a light was burning in my study. Spellbound, I sat and stared at the legendary Leopold's third great achievement: the bookcase was crammed with books. I counted roughly thirty volumes of surgery manuals in Russian and German. And the books on therapeutics! The beautiful leather-bound anatomical atlases!

Evening drew on and I started to find my bearings.

‘It's not my fault,' I repeated to myself stubbornly and
unhappily. ‘I've got my degree and a first class one at that. Didn't I warn them back in town that I wanted to start off as a junior partner in a practice? But no, they just smiled and said, “You'll get your bearings.” So now I've got to find my bearings. Suppose they bring me a hernia? Just tell me how I'll find my bearings with that? And more to the point, what will a hernia patient feel like when I get my hands on him? Will he find his bearings in the next world?' The thought made my blood run cold.

‘What about peritonitis? Oh no! Or croup, that country children get? When is tracheotomy indicated? Even if it doesn't need tracheotomy I shall be pretty much at sea … What about … what about … deliveries! I forgot about deliveries! Incorrect positions. What on earth will I do? What a fool I was! I should have refused this job. I really should. They should have found themselves another Leopold.'

Miserable, I paced up and down the twilit study. When I came up to the lamp I caught sight of the reflection of my pale face and of the light of the lamp in the window set against the boundless darkness of the fields.

‘I'm like Dmitry the Pretender—nothing but a sham,' I thought stupidly and sat down at the table again.

I spent about two lonely hours of self-torment and only stopped when my nerves could no longer bear the horrors I had summoned up. Then I started to calm down and even to work out a plan of action.

‘Let's see now … they tell me admissions are almost nil at the moment. They're braking flax in the villages, the roads are impassable …'

‘That's just when they will bring you a hernia,' thundered a harsh voice in my mind, ‘because a man with a
cold won't make the effort over impassable roads but rest assured they'll bring you a hernia, my dear doctor.'

There was something in what the voice said. I shuddered.

‘Be quiet,' I said to it. ‘It won't necessarily be a hernia. Stop being so neurotic. You can't back out once you've begun.'

‘You said it!' the voice answered spitefully.

‘All right then … I won't take a step without my reference book … If I have to prescribe something I can think it over while I wash my hands and the reference book will be lying open on top of the patients' register. I shall make out wholesome but simple prescriptions, say, sodium salicylate, 0.5 grammes in powder form three times a day.'

‘You might as well prescribe baking soda! Why don't you just prescribe soda?' the voice was blatantly making fun of me.

‘What's soda got to do with it? I'll also prescribe an infusion of ipecacuanha, 180 c.c. Or 200 c.c. if you don't mind.'

And although no one was asking for ipecacuanha as I sat there alone by the lamp, I sheepishly turned the pages in the pharmacopoeia and checked ipecacuanha; meanwhile I automatically read in passing that there was a certain substance called ‘Insipin' which is none other than ‘ethereal sulphate of quinine-diglycolic acid.' Apparently it doesn't taste of quinine! What is it for? And how is it prescribed? What is it, a powder? To hell with it!

‘That's all very well, but what are you going to do about a hernia?' The voice of Fear continued to pester me.

‘I'll put them into a bath,' I defended myself in exasperation, ‘and try to reduce it.'

‘What if it's a strangulated one, old boy? Baths won't be much use then, will they! A strangulated hernia!' Fear chanted in a demoniac voice, ‘You'll have to cut it out …!'

I gave in and all but burst into tears. I sent out a prayer to the darkness outside the window: please, anything but not a strangulated hernia.

Weariness then crooned:

‘Go to bed, unhappy physician. Sleep on it. Calm down and stop being neurotic. Look how still the dark is outside the window, the fields are cold and sleeping, there is no hernia. You can think about it in the morning. You'll settle down … Sleep … drop that book of diagrams, you won't make head or tail of it anyway … hernial orifice …'

I don't remember him arriving. I only remember the bolt grating in the door, a shriek from Aksinya and a cart creaking out in the yard.

He was hatless, his sheepskin coat unbuttoned, his beard was dishevelled and there was a mad look in his eyes.

He crossed himself, fell on his knees and banged his forehead against the floor. This to me!

‘I'm a lost man,' I thought wretchedly.

‘Now, now—what's the matter?' I muttered and pulled at his grey sleeve.

His face twisted and he started mumbling a breathless and incoherent answer:

‘Oh doctor, sir … sir … she's all I've got, she's all I've got, she's all I've got,' he burst out suddenly in a voice so young-sounding and powerful that the lampshade trembled. ‘Oh, sir, oh …' He wrung his hands in misery and started knocking his forehead against the floorboards as if
trying to smash them. ‘Why? Why am I being punished? What have I done to deserve God's anger?'

‘What is it? What's happened?' I cried out, feeling the blood draining from my face.

He jumped to his feet, rushed towards me and whispered:

‘Anything you want, doctor, sir … I'll give you money, take as much money as you want. As much as you want. We'll pay you in food if you like. Only don't let her die. Don't let her die. Even if she's to be a cripple, I don't mind. I don't mind!' He shouted to the ceiling. ‘I've got enough to feed her, I can manage.'

I could see Aksinya's pale face in the black rectangle of the door. I was overcome with anguish.

‘Well, what is it? Speak!' I cried irritably.

He stopped. His eyes went blank and he whispered, as if telling me a secret:

‘She fell into the brake.'

‘Brake … brake? What's that?'

‘Flax, they were braking flax, doctor,' Aksinya whispered in explanation, ‘you know, brake, flax braking …'

‘Here's a fine beginning. This is it. Oh why did I ever come?' I said to myself in horror.

‘Who?'

‘My daughter,' he answered in a whisper, and then shouted, ‘Help me!' Once again he threw himself to the floor and his hair, cut like a mop in peasant fashion, fell into his eyes.

The pressure-lamp with its lopsided tin shade burned with hot beams of light. She lay on the operating table, on white, fresh-smelling oilcloth and when I saw her all thoughts of hernia vanished from my mind.

Her fair, almost reddish hair hung down from the table in a matted clump. She had a gigantic plait which reached to the floor.

Her calico skirt was torn and stained with blood in various shades from brown to oily scarlet. The light of the kerosene lamp was a lively yellow in comparison with her paper-white face, and her nose was beginning to sharpen. On her white face, motionless as a plaster cast, a truly rare beauty was fading away before my eyes. Seldom in life does one see such a face.

The operating theatre was completely silent for about ten seconds, but from behind the closed doors came the muffled sounds of someone shouting and banging his head over and over again.

‘Gone out of his mind,' I thought. ‘The nurses must be seeing to him. Why is she so beautiful? Though he does have good bone structure; the mother must have been a beautiful woman. He's a widower.…'

‘Is he a widower?' I whispered automatically.

‘Yes, he is,' Pelagea Ivanovna answered quietly.

Then Demyan Lukich, almost as if in anger, ripped the skirt from hem to waist, baring her instantly. I looked, and what I saw was even worse than I had expected. Strictly speaking there was no left leg. From the smashed knee down there were just bloody shreds, battered red flesh and splinters of white bone protruding in all directions. The right leg was fractured at the shin so that the tips of both bones had punctured the skin and her foot lay lifelessly on its side, as though disconnected.

‘Yes …' the
feldsher
pronounced softly and that was all he said.

Thereupon I regained my wits and started feeling her
pulse. Her cold wrist registered nothing. Only after a few seconds did I detect a barely perceptible, irregular ripple. It passed and was followed by a pause during which I had time to glance at her white lips and nostrils, which were turning blue. I already felt like saying ‘It's all over', but fortunately controlled myself … there was another hint of a beat.

‘The end of a mangled human being,' I said to myself. ‘There's really nothing more to be done.'

But suddenly I said sternly, in a voice that I did not recognise:

‘Camphor.'

Anna Nikolaevna bent over to my ear and whispered:

‘What for, doctor? Don't torture her. What's the point of smashing her up any more? She'll die any minute now … you won't save her.'

I gave her an angry look and said:

‘I asked for camphor …' in such a way that she flushed, marched resentfully to the little table and broke an ampoule. The
feldsher
obviously did not approve of the camphor either. Nonetheless he deftly and swiftly took hold of a syringe and the yellow oil went under the skin of her shoulder.

‘Die. Die quickly,' I said to myself. ‘Die. Otherwise what am I to do with you?'

‘She'll die now,' whispered the
feldsher
as if guessing my thoughts. He glanced meaningfully at the sheet but apparently changed his mind. It seemed a pity to stain it with blood. But a few seconds later he had to cover her. She lay like a corpse, but did not die. Suddenly my head became quite clear, as if I were standing under the glass roof of the anatomy theatre in that faraway medical school.

‘Camphor again,' I said hoarsely.

And once again the
feldsher
obediently injected the oil.

‘Is she really not going to die?' I thought in despair. ‘Will I really have to …'

Everything lit up in my mind and I suddenly became aware without any textbooks, without any advice or help (and with unshakeable conviction), that now, for the first time in my life I had to perform an amputation on a dying person. And that that person would die under the knife. She was bound to die under the knife; after all, there was no blood left in her body. It had all drained out through her shattered legs over six miles and there was not even a sign that she was conscious. She was silent. Oh, why didn't she die? What would her maddened father say to me?

‘Prepare for an amputation,' I said to the assistant in a voice that was not my own.

The midwife gave me a fierce look but the
feldsher
showed a spark of sympathy in his eyes and began busying himself with the instruments. A primus-stove started to roar.

A quarter of an hour passed. I raised her cold eyelid and looked with superstitious fear at the expiring eye. It told me nothing. How could a semi-corpse stay alive? Drops of sweat ran uncontrollably down my forehead from under my white cap and Pelagea wiped away the salt sweat with gauze. What remained of the blood in the girl's veins was now diluted with caffeine. Ought it to have been injected or not? Anna Nikolaevna was gently massaging the swellings caused by the saline solution. And the girl lived on.

I picked up the knife, trying to imitate the man I had once in my life seen perform an amputation, at university.
I entreated fate not to let her die at least in the next half hour. ‘Let her die in the ward, when I've finished the operation …'

I had only common sense to rely on, and it was stimulated into action by the extraordinary situation. Like an experienced butcher, I made a neat circular incision in her thigh with the razor-sharp knife and the skin parted without exuding the smallest drop of blood. ‘What will I do if the vessels start bleeding?' I thought, and without turning my head glanced at the row of forceps. I cut through a huge piece of female flesh together with one of the vessels—it looked like a little whitish pipe—but not a drop of blood emerged from it. I stopped it up with a pair of forceps and proceeded, clamping on forceps wherever I suspected the existence of a vessel. ‘Arteria … arteria … what the devil is it called?' The operating theatre had begun to take on a thoroughly professional look. The forceps were hanging in clusters. My assistants drew them back with gauze, retracting the flesh, and I started sawing the round bone with a gleaming, fine-toothed saw. ‘Why isn't she dying? It's astonishing … God, how people cling to life!'

The bone fell away. Demyan Lukich was left with what had been a girl's leg in his hands. Shreds of flesh and bone. This was all discarded and there remained on the table a young girl shortened, as it were, by a third, with a stump splayed out to one side. ‘Just a little bit more … Please don't die,' I wished ardently, ‘keep going till they take you to the ward, let me come out of this frightful episode with some credit.'