Michael Honig - The Senility of Vladimir P.

Sheremetev leaned over him and smoothed his ruffled hair. ‘I’m sorry I had to use the injection,’ he murmured. ‘Sleep well, Vladimir Vladimirovich.’

He left, closing the door quietly behind him.

Soon, all was quiet again in the dacha. Vladimir snored, visions of the Chechen, temporarily, dissolved by the tranquilliser in his blood. A few metres away, Sheremetev had gone back to sleep, the baby monitor rustling quietly on the bedside table beside him. Downstairs, Stepanin slumbered in the arms of the maid, Elena Dmitrovna Mirzayev, his lover. Behind the door off the main entrance hall, the guard on duty lay asleep on a comfortable bed that the security contingent had set up in a warm, cosy antechamber.

Only the new housekeeper, Galina Ivanovna Barkovskaya, was awake. She sat at the desk in her office, a table lamp glowing, poring over the dacha’s accounts.

THE NEXT MORNING, PROFESSOR Kalin arrived at ten o’clock for his monthly visit. He brought with him another expert, Professor L P Andreevsky, who visited only every second or third time to oversee Vladimir’s general physical health. Sheremetev took the two doctors upstairs to the sitting room, where Vladimir was waiting for them.

At each visit, Professor Kalin attempted to evaluate Vladimir’s awareness and memory, charting its decline in the notes he dictated in his car after he left the dacha. Vladimir never made it easy for him, perhaps, at some level, sensing that the professor’s questions carried an implication of illness, even if he no longer had any insight into what that illness was.

Professor Kalin crouched in front of the ex-president and started off on his usual questions to test if Vladimir had any awareness of his current time and place. Sheremetev and Andreevsky exchanged a glance. Vladimir hadn’t given a correct answer to even one of those questions for the last twelve months.

The professor nodded to himself. ‘Do you know this man here?’ he asked, pointing at Sheremetev.

‘Do you ?’ riposted Vladimir, which was one of his stock evasions when asked a question he had no idea how to answer.

‘Yes.’

‘Then who is he?’

‘Don’t you know?’ asked the professor.

‘Don’t you?’ shot back Vladimir.

‘Do you know, Vladimir Vladimirovich?’

‘Why should I tell you? Who are you, anyway?’

‘Don’t you remember?’

‘I’ve never met you in my life.’

‘I’m Professor Kalin,’ said the professor for the fifth time that morning.

‘What about him?’ demanded Vladimir, pointing to the other doctor.

‘That’s Professor Andreevsky. He’s another doctor, like me. He’s been looking after you for years.’

Vladimir grunted dismissively.

Professor Kalin stood up. He glanced at his colleague and gestured towards Vladimir, inviting Andreevsky to take over.

Andreevsky drew out his stethoscope. ‘May I, Vladimir Vladi­mirovich?’

Vladimir turned to Sheremetev. ‘Is he a doctor?’

Sheremetev nodded.

Vladimir scrutinised Andreevsky for a moment, then slowly unbuttoned his pyjama top.

The professor laid his stethoscope on Vladimir’s chest. He listened to his heart, then began to move the stethoscope from place to place. ‘Breathe in… Breathe out… Very good. Continue please. In… Out… In… Out…’

‘That’s enough,’ said Vladimir irritably, and pushed the stethoscope away.

Andreevsky stepped back. ‘Blood pressure?’ he said to Sheremetev.

Sheremetev pulled out the chart on which he recorded the blood pressure readings that he had been instructed to take twice a week. The results of the urine tests that he regularly took were there as well, together with other pages detailing the medications that Vladimir had received and notes on his behaviour.

Andreevsky looked over the blood pressure chart. ‘Fit as an ox,’ he murmured, handing the chart to Kalin.

‘Fit as a Siberian ox!’ declared Vladimir, whose hearing showed no sign of accompanying his intellect into decrepitude.

Kalin turned the page and scanned the behaviour charts. He saw the note that Sheremetev had made that morning of the episode that had taken place overnight. Prior to that, there had been almost three weeks without the need for an injection to top up the tranquilliser and sedative tablets that Vladimir took each night before bed.

‘What happened exactly last night?’ asked Kalin.

‘He thought he was fighting with someone,’ said Sheremetev.

‘But he’d had his tablets?’

‘Of course.’

‘Do you know who he was fighting with?’

Sheremetev glanced at Vladimir, who was staring straight ahead, as if oblivious to the conversation going on around him. ‘The same as always.’

Vladimir’s eyes narrowed and his nose wrinkled slightly.

Kalin handed the charts back to Sheremetev. ‘Vladimir Vladi­mirovich,’ he said, crouching down to his eye level again, ‘did someone come here last night?’

‘Last night?’ said Vladimir.

Kalin nodded.

Vladimir shrugged. ‘Do I know you?’

‘I’m Professor Kalin. I look after you.’

‘Why do you look after me? I’m as strong as… something or other.’

‘That’s good,’ said Kalin. ‘It’s good to be strong. Does anyone come to bother you?’

‘Do you know what I would do if someone came to bother me?’ countered Vladimir.

‘Tell me. What would you do?’

Vladimir smiled craftily. Never reveal your strategy, he knew, not even to your friends. Especially not your friends. ‘If you want to find out, I’d advise you to try,’ he replied, and then chuckled to himself.

Kalin watched him for a moment. ‘Vladimir Vladimirovich, is there anything else you want to tell us before we go?’

‘What should I tell you?’

‘Whatever you like.’

‘You’re the doctor, aren’t you? You should be telling me!’

‘Alright,’ said Kalin. ‘Well, I’ll tell you what – I’ll see you again in a month, alright?’

‘Where will you see me?’ said Vladimir.

‘Here. We’ll come back.’

‘How do you know I’ll be here?’

‘If you’re not here, we’ll find you.’

Vladimir grinned. ‘No, you won’t.’

Kalin stood up. ‘Goodbye, Vladimir Vladimirovich. I’ll see you again in a month.’

Vladimir didn’t reply, as if keeping his counsel.

Sheremetev accompanied the two professors out of the room. Once the door to the suite was closed behind them, Kalin stopped.

‘I could increase the tranquilliser, I suppose,’ he said to Andreev­sky, in a weary, dispirited tone.

‘If you’re asking my opinion, Vyacha,’ responded Andreevksy brightly, ‘from a cardiovascular and respiratory perspective, he could take it.’

Kalin gave his colleague an irritable look. That opinion did nothing to solve his dilemma, and from the jauntiness with which Andreevsky had pronounced it, Kalin suspected the fact amused him.

The professor held out his hand to Sheremetev for the charts. He made a show of minutely examining the notes on Vladimir’s behaviour. After a while he began to rub at his nose as if he had an itch, a habit he had, Sheremetev knew by now, whenever he was trying to disguise his procrastination.

The dilemma was the same dilemma that confronted Professor Kalin each month, and everyone in the corridor – not only Kalin himself, but Sheremetev and Andreevsky as well – knew it. The tranquilliser that the professor had prescribed to reduce the rages when Vladimir still had insight into his condition had numerous potential side effects, which included, paradoxically, delusions, hallucinations and agitation. Right now, that was exactly what Vladimir had. Reducing the dose of tranquilliser might therefore solve the problem. On the other hand, these delusions, hallucinations and agitation might have nothing at all to do with the medication, but be due to Vladimir’s dementia, and it might be the medication that was keeping them in check – in which case, increasing the dose might solve the problem. The only way to tell for certain would be to reduce the dose and see what happened, but the one thing one could say for certain about reducing the medication after so many years of use was that there would be severe withdrawal effects, which might well include… delusions, hallucinations and agitation. All in all it was an unholy mess and it would take months and months to sort it out, months in which the medication would have to be reduced in gradual, tiny steps and during which Vladimir would need to be monitored closely and assessed, ideally, once a week.