Михаил Булгаков - A Country Doctor's Notebook

‘The little girl’s weak, she’s dying … Would you come over to the hospital, please, doctor …’

I remember crossing the yard towards the hospital porch, mesmerised by the flickering light of a kerosene lamp. The lights were on in the surgery, and all my assistants were waiting for me, already dressed in their overalls: the feldsher Demyan Lukich, young but very capable, and two experienced midwives, Anna Nikolaevna and Pelagea Ivanovna. Only twenty-four years old, having qualified a mere two months ago, I had been placed in charge of the Muryovo hospital.

The feldsher solemnly flung open the door and the mother came in—or rather she seemed to fly in, slithering on her ice-covered felt boots, unmelted snow still on her shawl. In her arms she carried a bundle, from which came a steady hissing, whistling sound. The mother’s face was contorted with noiseless weeping. When she had thrown off her sheepskin coat and shawl and unwrapped the bundle, I saw a little girl of about three years old. For a while the sight of her made me forget operative surgery, my loneliness, the load of useless knowledge acquired at university: it was all completely effaced by the beauty of this baby girl. What can I liken her to? You only see children like that on chocolate boxes—hair curling naturally into big ringlets the colour of ripe rye, enormous dark blue eyes, doll-like cheeks. They used to draw angels like that. But in the depths of her eyes was a strange cloudiness and I recognised it as terror—the child could not breathe. ‘She’ll be dead in an hour,’ I thought with absolute certainty, feeling a sharp twinge of pity for the child.

Her throat was contracting into hollows with each breath, her veins were swollen and her face was turning from pink to a pale lilac. I immediately realised what this colouring meant. I made my first diagnosis, which was not only correct but, more important, was given at the same moment as the midwives’ with all their experience: ‘The little girl has diphtherial croup. Her throat is already choked with membrane and soon it will be blocked completely.’

‘How long has she been ill?’ I asked, breaking the tense silence of my assistants.

‘Five days now,’ the mother answered, staring hard at me with dry eyes.

‘Diphtheria,’ I said to the feldsher through clenched teeth, and turned to the mother:

‘Why have you left it so long?’

At that moment I heard a tearful voice behind me:

‘Five days, sir, five days!’

I turned round and saw that a round-faced old woman had silently come in. ‘I wish these old women didn’t exist,’ I thought to myself. With an aching presentiment of trouble I said:

‘Quiet, woman, you’re only in the way,’ and repeated to the mother: ‘Why have you left it so long? Five days? Hmm?’

Suddenly with an automatic movement the mother handed the little girl to the grandmother and sank to her knees in front of me.

‘Give her some medicine,’ she said and banged her forehead on the floor. ‘I’ll kill myself if she dies.’

‘Get up at once,’ I replied, ‘or I won’t even talk to you.’

The mother stood up quickly with a rustle of her wide skirt, took the baby from the grandmother and started rocking it. The old woman turned to the doorpost and began praying, while the little girl continued to breathe with a snake-like hiss. The feldsher said:

‘That’s what they’re all like. These people!’ And he gave a twitch of his moustache.

‘Does that mean she’s going to die?’ the mother asked, staring at me with what looked like black fury.

‘Yes, she’ll die,’ I said quietly and firmly.

The grandmother picked up the hem of her skirt and wiped her eyes. The mother shouted in an ugly voice:

‘Give her something! Help her! Give her some medicine!’

I could see what was in store for me and remained firm.

‘What medicine can I give her? Go on, you tell me. The little girl is suffocating, her throat is already blocked up. For five days you kept her ten miles away from me. Now what do you want me to do?’

‘You’re the one who’s supposed to know,’ the old woman whined by my left shoulder in an affected voice which made me immediately detest her.

‘Shut up!’ I said to her. I turned to the feldsher and ordered the little girl to be taken away. The mother handed her to the midwife and the child started to struggle, evidently trying to cry, but her voice could no longer make itself heard. The mother made a protective move towards her, but we kept her away and I managed to look into the little girl’s throat by the light of the pressure-lamp. I had never seen diphtheria before except for mild, forgettable cases. Her throat was full of ragged, pulsating, white substance. The little girl suddenly breathed out and spat in my face, but I was so absorbed that I did not flinch.

‘Well now,’ I said, astonished at my own calm. ‘This is the situation: it’s late, and the little girl is dying. Nothing will help her except one thing—an operation.’

I was appalled, wondering why I had said this, but I could not help saying it. The thought flashed through my mind: ‘What if she agrees to it?’

‘How do you mean?’ the mother asked.

‘I’ll have to cut open her throat near the bottom of her neck and put in a silver pipe so that she can breathe, and then maybe we can save her,’ I explained.

The mother looked at me as if I was mad and shielded the little girl from me with her arms, while the old woman started muttering again:

‘The idea! Don’t you let them cut her open! What—cut her throat?’

‘Go away, old woman,’ I said to her with hatred. ‘Inject the camphor!’ I ordered the feldsher .

The mother refused to hand over the little girl when she saw the syringe, but we explained to her that there was nothing terrible about it.

‘Perhaps that will cure her?’ she asked.

‘No, it won’t cure her at all.’

Then the mother burst into tears.

‘Stop it,’ I said. I took out my watch, and added: ‘I’m giving you five minutes to think it over. If you don’t agree in five minutes, I shall refuse to do it.’

‘I don’t agree!’ the mother said sharply.

‘No, we won’t agree to it,’ the grandmother put in.

‘It’s up to you,’ I said in a hollow voice, and thought: ‘Well, that’s that. It makes it easier for me. I’ve said my piece and given them a chance. Look how dumbfounded the midwives are. They’ve refused and I’m saved.’ No sooner had I thought this than some other being spoke for me in a voice that was not mine:

‘Look, have you gone mad? What do you mean by not agreeing? You’re condemning the baby to death. You must consent. Have you no pity?’

‘No!’ the mother shouted once more.

I thought to myself: ‘What am I doing? I shall only kill the child.’ But I said:

‘Come on, come on—you’ve got to agree! You must! Look, her nails are already turning blue.’

‘No, no!’

‘All right, take them to the ward. Let them sit there.’

They were led away down the half-lit passage. I could hear the weeping of the women and the hissing of the little girl. The feldsher returned almost at once and said:

‘They’ve agreed!’

I felt my blood run cold, but I said in a clear voice:

‘Sterilise a scalpel, scissors, hooks and a probe at once.’

A minute later I was running across the yard, through a swirling, blinding snowstorm. I rushed to my room and, counting the minutes, grabbed a book, leafed through it and found an illustration of a tracheotomy. Everything about it was clear and simple: the throat was laid open and the knife plunged into the windpipe. I started reading the text, but could take none of it in—the words seemed to jump before my eyes. I had never seen a tracheotomy performed. ‘Ah well, it’s a bit late now,’ I said to myself, and looked miserably at the green lamp and the clear illustration. Feeling that I had suddenly been burdened with a most fearful and difficult task, I went back to the hospital, oblivious of the snowstorm.