Physicians, stories and human nature
It seems that there has always been appreciable presence of doctors in literature, there is even an article in Wikipedia named “Physician writer”. Gawande, Chekhov, Schiller, Rabelais, Sacks to name a few. Medicine gives one an intimate insight and a peculiar angle on life and people.
Today I wanted to talk about one of the less known works of Michail Bulgakov that recounts with some degree of fictionalization the realities of being a physician in the beginning of the twentieth century - “A young doctor’s notebook”.
Bulgakov’s better known, and arguable his chef-d’oeuvre, though I respectfully disagree, is “Master and Margarita”. It was on my school’s reading list. It was probably the most provocative and fantastic of the whole Russian literature school program but as an inveterate fan of fantasy and sci-fi I was not neither moved, nor greatly impressed by it. It was an interesting and amusing diversion from the classic, where the whole of Russian Literature is held on the backs of three elephants, whose names are: An Unwanted Person, An Insignificant Person, and A New Person, who in their turn are standing on the back of a giant turtle, whose name is Suffering. After all, one can have too much of Dostoevsky. To anyone considering Russian literature but slightly overwhelmed by it, I recommend to give Bulgakov a try.
Getting back to the topic though, Bulgakov got qualified and sometime later was sent to work as a provincial doctor for almost two years around the time of Civil War and Revolution in Russia (1917–1920). Unlike the protagonist of his stories, he has had some clinical experience and was not exactly recently minted, though the struggle was fresh enough when he wrote a series of short stories. What is somewhat striking is that the topics shown are nothing new: superstitious, uneducated and rather belligerent local populace whose main interest lies in a quick cure (preferably a pill or a tonic), while being malcontent and distrustful towards this new young man, who claims to be a doctor, the struggle with stepping into the former county doctor’s giant shoes and of trying to prove oneself, to be taken seriously, the lack of funding and of crucial resources, and last but not least — lack of clinical experience and an impostor syndrome. The series is as much about the patients, as it is about the birth of the protagonist as a doctor. It seems to be an almost baptismal act in seven to nine acts, depending on how one counts.
In the first story we are introduced to our hero Dr.Bomgard as arrives to Muriyeno hospital in September of 1917 and at the threshold he is told by one of the staff of the hospital the their doctor is Leopold Leopoldovich whose retirement though well-deserved is a huge blow to the healthcare facility. He is not believed when he says that he is the new doctor. Other people working in the clinic are two midwifes and a feldsher (which literally means field shearer stemming from the barber-surgeons of old, this position in somewhere between the physician assistant and paramedic in modern day Russian healthcare).
Dr. Bomgard decides to try and make the best of th is opportunity, and settles down to sleep in the apartment of the former county doctor. However, his meditations on his predecessor are disrupted when a distraught man bursts in demanding help — it is the harvest time and his only child got under the wheat crusher. He begs for the doctor to save her and brings her into the office. The girl had sustained severe trauma — one of her legs is almost torn off, and the other was crushed considerably. Dr. Bomgard is horrified and the rest of the staff think that it is unwise to intervene as the girl had lost too much blood and will likely die on the operating couch. They advice the doctor to leave the girl to die peacefully as surgery would almost certainly bring only further suffering. One of the midwifes notes that the patient dying during hopeless surgery will not do anyone any good. Thus our hero is thrown into life and death situation right at the beginning and has to make a difficult decision. I won’t go further here because for one thing — no spoilers, and for another — I’d like to get more people interested in Bulgakov’s works, so hopefully adding a bit of an intrigue will help me out.
There are several other novelettes in the series. The overarching theme as I see it is, that no matter how far we’ve got technologically and scientifically speaking, we are still the same mammals that have evolved to roam the savanna in Pleistocene. We are dressed, living in permanent shelters (well, some of us) and find our mates and nourishment differently, but we are very similar to our ancestor in may ways. And the hundred years difference that separates us from Bulgakov’s medical practice is nothing compared to that. The challenges of this profession nowadays are similar, though transformed to various degrees.
I’ve read the book in my third year of medschool (the full curriculum is six years in Russia) and it was an eye opener. By then I’ve already encountered real doctors and patients in their varied natural habitats, as it were, and I saw them and their challenges as modern as a matter of course. One is naturally tempted to think of sufficiently remote past as “the dark old days” but it is biased way of assessing the situation. This compelling series of stories helped me to build rapport , as it were, with antecedent colleagues of mine, and to develop a new appreciation for the struggles and challenges of my future profession, as well as to better understand my patients and their concerns.
