A Country Doctor’s Notebook – Mikhail Bulgakov

18 June 2014
Chapters 1-3
This appears to be a memoir, but a carefully crafted one. I’m enjoying it, because Bulgakov is so good at putting us in the shoes of a newly-qualified doctor who seems to know what he’s doing despite being convinced that he’s clueless. The self-doubt is established from the start, and it’s almost clownish. He has a first-class degree from his Moscow medical school – the same school which, in times of crisis, he regards as useless – but on his first night he has nightmares about strangulated hernias.

His arrival in ‘the back of beyond’ – the staff’s description, in this translation, for this outpost 32 miles from the nearest town – is highly inauspicious. Even inSeptember he is chilled to the bone by the 24-hour ride next to a taciturn driver. The books and impressive collection of recently bought surgical instruments collected by the previous doctor, the one the staff speak of with a kind of hushed reverence, do nothing for his self-esteem. And he predicts, rightly, that nobody will be able to believe that someone so boyish-looking could really be a doctor….

But then things start to go right. A beautiful girl is brought in with her legs crushed in a farm machine, and the staff make it clear there’s nothing he can do. Against his own better judgment – he can always hear the voice of a forthright, mocking alter-ego urging him not to be such a coward – he performs his first ever amputation. She doesn’t die, and he is the hero of the hour…. This is in Chapter 1. A three-your-old, as beautiful as the girl with the crushed leg, has diphtheria that has been left too long before treatment. This time, he is even more daring, inserting a ‘steel windpipe’ in an operation he has only ever seen being performed once. This seems to be turning into a feel-good story as, in both operations, our man is so good at hiding his certainty of failure that the other staff praise his coolness.

It’s better than I suspect I’ve made it sound. Some of the things he has to deal with are so preposterous and unexpected that I laughed out loud – and this is before we’ve heard about the absurdities of the locals, their deceptions and superstitions. But at least they now believe their young doctor knows what he’s doing. As winter deepens, he’s starting to believe it himself.

19 June 2014
Chapters 4-6
Clever. Bulgakov has spent three chapters lulling us into a cosy sense of security. The doctor is young but basically highly competent, the staff are hard-working and the local populace are their own worst enemies, often hilariously so. Fine. But in these central episodes, particularly the one that comes right in the middle of the book, he gets serious. Ok, he’s always been serious – but the tone has been leavened by his mockery of his younger self and by the absurdity of situations he finds himself in. There isn’t so much leavening now.

There’s still self-mockery in Chapter 4. A woman is in labour with the foetus presenting in what the young doctor’s textbook calls the worst possible position. On the pretext of going back for cigarettes – later he tells us that on a busy day he can get through 50 or more – he reads up on the subject in his room and sends his mind into a pessimistic whirl. He decides he can’t possibly do anything to help… but he has to return to the theatre anyway. And, with discreet hints from the midwife and her references to how the previous doctor used to do things, he plunges in. And, reader, through a mixture of common sense and the knowledge that has somehow got into his head, he saves both the child and the mother.

It’s the end of the chapter when he suggests that some kind of corner has been turned. He reads through the same pages after the operation and ‘an interesting thing happened: all the previously obscure passages became comprehensible.’ Theory and practice have come together, almost magically, and he realises that ‘One can gain a lot of experience in a country practice.’ Ah.

And the middle chapter moves things on further. So far, despite being convinced of his own incompetence, our man hasn’t actually got a single thing wrong. Of course, this is not a diary, and the man writing this – there are several references to this older self in these chapters – is clearly choosing which episodes to include or not include. But what he comes up against now, something that has been presented in fairly flippant terms previously, is the intractable ignorance of the locals. It might not usually matter a great deal, but with The Speckled Rash – this chapter’s title – it’s a matter of life and death. The rash is an early sign of syphilis, and the doctor recognises it in a blithely confident-seeming patient. What he soon comes to realise is that the man has no intentions of following the course of treatment which he warns will take months. He never sees the man again.

This is the way into the issue that Bulgakov the writer has chosen to take. After that he reports how his younger self, looking back over the previous doctor’s records, discovers a near-epidemic which, despite his predecessor’s efforts, the populace do not take seriously. He has already told us that a success he has with one woman, who follows his advice to the letter, is the exception. Early signs, lesions that appear later, children born with the disease or those who have caught it from unwashed spoons and bowls, all appear in his surgery. He decides he must do something about it, and opens a ward in a makeshift annexe. And he has some success. But the older writer imagines the young doctor who must be managing it all these years later. ‘What is happening there and who is there now? … Greetings, dear colleague!’ Perhaps the idea of a lasting legacy is a comfort.

Chapter 6, The Blizzard, is the one that made me begin to realise that if this started off as a memoir it’s turning into something else. It’s an unashamedly literary short story, from the besotted bridegroom-to-be to the tragic accident as his fiancée is thrown from the sleigh on the eve of the wedding to the blizzard that nearly kills the doctor and sleigh-driver to the wolves who would have killed them both if he had forgotten his trusted Browning pistol. Before we get to this story, and to the woman who dies of her injuries shortly after his arrival, our man is taking his first bath in a month on a day when a blizzard means he won’t have his usual 100 or more patients to see. Doctor as hero? We’ve had a lot of that, and maybe this is why Bulgakov decides to undermine him. Having complained roundly about how his patients never take advice, he doesn’t take that of the driver, who knows that the return trip in the blizzard, now worse than ever, would be folly. Before it ends, with the wolves still around, ‘Mentally, I could already see my own lacerated entrails….’ That’ll teach him.

20 June
Chapters 7-9 – to the end
Chapter 7, The Vanishing Eye, could easily have been the last chapter. Bulgakov has carefully formed it into a mock-cautionary tale that moves from a complacent summing-up of what he has learnt in his first year, via a mystery that stumps him despite having simple explanation, to a final-line reminder that ‘One never stops learning.’ The retrospective of his first year is full of staggering lists of the numbers of patients seen, treatments offered, different operations performed and, yes, mistakes made that gave him nightmares at the time. Despite these, ‘I cannot,’ he mumbles to himself after making these lists, ‘imagine being brought a case that would floor me.’ But, inevitably, the very next morning that’s what happens when a child is brought to him with an eye that seems to have been replaced by an egg-sized monstrosity. He wants to operate, is forbidden by the boy’s mother – who triumphantly brings him the boy two weeks later, with the eye fully healed. Another lesson learned, and he could have ended it on that cosy, satisfying note.

But he doesn’t, and Chapters 8 and 9 take it somewhere else entirely. In Chapter 8 our man has completed his probationary period, is on what seems an entirely different planet, in a town with electricity at a big hospital specialist staff. But that’s just a framing device for the real story, Morphine. It’s terrifying, presented as the verbatim transcript of a diary kept by a man who has just shot himself, a doctor the narrator knew at medical school, now in his probationary year. Unlike our man, this one couldn’t stand the responsibility and loneliness, and started to take morphine. In just over 20 pages we are taken on a horrifying journey. This tale of addiction begins, as they always do, with the young man imagining that he is in control of the drug he takes for an unaccountable pain in his stomach. Hah. Soon he is blaming everybody – his mistress, who is one of the nurses at the hospital, the doctor who tries to cure him in Moscow, the pharmacist who refuses to supply him with as much morphine as he wants. At times of lucidity he is even able to blame himself, but these moments don’t usually last long. It’s so plausible I wondered whether it was a genuine diary. Or whether Bulgakov himself was an addict….

Chapter 9 is almost as harrowing and, I suspect, never published in Bulgakov’s lifetime. It mainly consists of a story told by another narrator, a usually quiet doctor colleague who can become a great raconteur, describing a time when he killed a patient deliberately. And we’re back in the (fairly recent) past when the revolution was still in progress and individual commanders could become viciously tyrannical. Again, it seems so plausible I began to wonder whether it was Bulgakov writing from his own experience. Ok, maybe he didn’t kill a sadistic army colonel before escaping into a convenient back alley… but maybe he was put in a position in which he would have if he could. I don’t know when this particular story was actually written, but it seems to derive from a similar sense of outrage at what revolution can lead to as The Master and Margarita. Everything, including any sense of ethical behaviour, is in chaos.

And that’s it. There’s no tidy summing-up, no overview – we had whatever we’re going to get of that in Chapter 7 – because, I understand from the Introduction, these stories were only collected later. Nonetheless, there’s a definite progression from those almost (if not quite) jaunty early stories to the hard questions being asked in the later ones. I’m not surprised he gave up his medical career for writing.