Михаил Булгаков - A Country Doctor's Notebook

‘Deplorable consequences.’ Rather a vague phrase, but how sinister. What if the husband of the woman from Dultsevo is left a widower? I wiped the sweat from my brow, rallied my strength and disregarded all the terrible things that could go wrong, trying only to remember the absolute essentials: what I had to do, where and how to put my hands. But as I ran my eye over the lines of black print, I kept encountering new horrors. They leaped out at me from the page.

‘… in view of the extreme danger of rupture …’

‘… the internal and combined methods must be classified as among the most dangerous obstetric operations to which a mother can be subjected …’

And as a grand finale:

‘… with every hour of delay the danger increases …’

That was enough. My reading had borne fruit: my head was in a complete muddle. For a moment I was convinced that I understood nothing, and above all that I had no idea what sort of version I was going to perform: combined, bi-polar, internal, external …

I abandoned Döderlein and sank into an armchair, struggling to reduce my random thoughts to order. Then I glanced at my watch. Hell! I had already spent twenty minutes in my room, and they were waiting for me.

‘… with every hour of delay …’

Hours are made up of minutes, and at times like this the minutes fly past at insane speed. I threw Döderlein aside and ran back to the hospital.

Everything there was ready. The feldsher was standing over a little table preparing the anaesthetic mask and the chloroform bottle. The expectant mother already lay on the operating table. Her ceaseless moans could be heard all over the hospital.

‘There now, be brave,’ Pelagea Ivanovna muttered consolingly as she bent over the woman, ‘the doctor will help you in a moment.’

‘Oh, no! I haven’t the strength … No … I can’t stand it!’

‘Don’t be afraid,’ whispered the midwife. ‘You’ll stand it. We’ll just give you something to sniff, and then you won’t feel anything.’

Water gushed noisily from the taps as Anna Nikolaevna and I began washing and scrubbing our arms bared to the elbow. Against a background of groans and screams Anna Nikolaevna described to me how my predecessor, an experienced surgeon, had performed versions. I listened avidly to her, trying not to miss a single word. Those ten minutes told me more than everything I had read on obstetrics for my qualifying exams, in which I had actually passed the obstetrics paper ‘with distinction’. From her brief remarks, unfinished sentences and passing hints I learned the essentials which are not to be found in any textbooks. And by the time I had begun to dry the perfect whiteness and cleanliness of my hands with sterile gauze, I was seized with confidence and a firm and absolutely definite plan had formed in my mind. There was simply no need to bother any longer over whether it was to be a combined or bi-polar version.

None of these learned words meant anything at that moment. Only one thing mattered: I had to put one hand inside, assist the version with the other hand from outside and without relying on books but on common sense, without which no doctor is any good, carefully but firmly bring one foot downwards and pull the baby after it.

I had to be calm and cautious yet at the same time utterly decisive and unfaltering.

‘Right, off you go,’ I instructed the feldsher as I began painting my fingers with iodine.

At once Pelagea Ivanovna folded the woman’s arms and the feldsher clamped the mask over her agonised face. Chloroform slowly began to drip out of the dark yellow glass bottle, and the room started to fill with the sweet, nauseous odour. The expressions of the feldsher and midwives hardened with concentration, as though inspired …

‘Haaa! Ah!’ The woman suddenly shrieked. For a few seconds she writhed convulsively, trying to force away the mask.

‘Hold her!’

Pelagea Ivanovna seized her by the arms and lay across her chest. The woman cried out a few more times, jerking her face away from the mask. Her movements slowed down, although she mumbled dully:

‘Oh … let me go … ah …’

She grew weaker and weaker. The white room was silent. The translucent drops continued to drip, drip, drip on to the white gauze.

‘Pulse, Pelagea Ivanovna?’

‘Firm.’

Pelagea Ivanovna raised the woman’s arm and let it drop: as lifeless as a leather thong, it flopped on to the sheet. Removing the mask, the feldsher examined the pupil of her eye.

‘She’s asleep.’

A pool of blood. My arms covered in blood up to the elbows. Bloodstains on the sheets. Red clots and lumps of gauze. Pelagea Ivanovna shaking and slapping the baby, Aksinya rattling buckets as she poured water into basins.

The baby was dipped alternately into cold and hot water. He did not make a sound, his head flopping lifelessly from side to side as though on a thread. Then suddenly there came a noise somewhere between a squeak and a sigh, followed by the first weak, hoarse cry.

‘He’s alive … alive …’ mumbled Pelagea Ivanovna as she laid the baby on a pillow.

And the mother was alive. Fortunately nothing had gone wrong. I felt her pulse. Yes, it was firm and steady; the feldsher gently shook her by the shoulder as he said:

‘Wake up now, my dear.’

The bloodstained sheets were thrown aside and the mother hastily covered with a clean one before the feldsher and Aksinya wheeled her away to the ward. The swaddled baby was borne away on his pillow, the brown, wrinkled little face staring out from its white wrapping as he cried ceaselessly in a thin, pathetic whimper.

Water gushing from the taps of the sluice. Anna Nikolaevna coughed as she dragged hungrily at a cigarette.

‘You did the version well, doctor. You seemed very confident.’

Scrubbing furiously at my hands, I glanced sidelong at her: was she being sarcastic? But no, her expression was a sincere one of pride and satisfaction. My heart was brimming with joy. I glanced round at the white and bloodstained disorder, at the red water in the basin and felt that I had won. But somewhere deep down there wriggled a worm of doubt.

‘Let’s wait and see what happens now,’ I said.

Anna Nikolaevna turned to look at me in astonishment.

‘What can happen? Everything’s all right.’

I mumbled something vague in reply. What I had meant to say was to wonder whether the mother was really safe and sound, whether I might not have done her some harm during the operation … the thought nagged dully at my mind. My knowledge of obstetrics was so vague, so fragmentary and bookish. What about a rupture? How would it show? And when would it show—now or, perhaps, later? Better not talk about that.

‘Well, almost anything,’ I said. ‘The possibility of infection cannot be ruled out,’ I added, repeating the first sentence from some textbook that came into my mind.

‘Oh, tha-at,’ Anna Nikolaevna drawled complacently. ‘Well, with luck nothing of that sort will happen. How could it, anyway? Everything here is clean and sterile.’

It was after one o’clock when I went back to my room. In a pool of light on the desk in my study lay Döderlein open at the page headed ‘Dangers of Version’. For another hour after that, sipping my cooling tea, I sat over it, turning the pages. And an interesting thing happened: all the previously obscure passages became entirely comprehensible, as though they had been flooded with light; and there, at night, under the lamplight in the depth of the countryside I realised what real knowledge was.

‘One can gain a lot of experience in a country practice,’ I thought as I fell asleep, ‘but even so one must go on and on reading, reading … more and more …’