A Country Doctor's Notebook (9 page)

And then, just as I remember him now, he will remember me, the year 1917, snow outside the window and six little bags of waxed paper, six sticky unused lumps.

‘Yes, he did give me some,' he will say, and this time his expression will no longer be ironical but full of dread. The doctor will write out a prescription for potassium iodide or maybe some other treatment. And maybe he will take a glance at his reference book just as I did …

Greetings, dear colleague!

The young woman pressed a corner of her flannel shawl to her mouth, sat down on the bench and shook with sobs. Her fair curls, wet with melted snow, lay across her forehead.

‘Isn't he a swine?' she cried.

‘Yes, he is,' I answered firmly.

Then followed the most difficult and agonising part of her visit. I had to calm her; but how was I to do it? We whispered for a long time to the accompaniment of the rumble of impatient voices in the waiting room. My soul was not yet blunted to human suffering and from somewhere in its depths I was able to find comforting words. First of all I tried to banish her fear. I told her that so far nothing was definite and she must not give way to despair before she had been examined. Even then there was no cause for despair: I told her with what success this terrible disease was nowadays being treated.

‘The swine,' the young woman sobbed and choked on her tears.

‘Yes, he's a swine,' I echoed.

We spent quite a long time swearing at this ‘dearest husband' who had spent a short time at home and then left for Moscow. In the end the woman's tears began to dry, leaving stains on her face and swollen eyelids over her dark despairing eyes.

‘What am I going to do? I have two children,' she said in a husky, exhausted voice.

‘Wait, wait,' I mumbled. ‘We'll see what has to be done.'

I called the midwife, Pelagea Ivanovna, and the three of us retired to a separate ward where there was a gynaecological chair.

‘The scoundrel,' Pelagea Ivanovna hissed through her teeth. The woman was silent, her eyes two black pits staring out of the window at the twilight.

It was one of the most thorough examinations I have ever made. Pelagea Ivanovna and I did not miss an inch of her body. But nowhere could I find anything suspicious.

‘Do you know,' I said, hoping passionately that this was not wishful thinking and that we should not later find the sinister, hard, primary chancre: ‘Do you know what? You can stop worrying! There's hope. Yes, there is. Of course there's still a chance that it might develop, but right now there's. nothing wrong with you.'

‘Nothing?' the woman asked hoarsely. ‘Nothing?' Her eyes began to shine and her cheekbones flushed with colour. ‘But say it begins?'

‘I can't understand it myself,' I said under my breath to Pelagea Ivanovna. ‘According to what she's told us, she ought to be infected. But there's nothing.'

‘Nothing at all,' Pelagea Ivanovna repeated after me.

We spent another few minutes whispering about dates and various intimate matters and I told the woman she would have to come regularly to the hospital.

As I looked at her then I saw that she was crushed. Hope had crept in and almost immediately vanished. She burst into tears and went away like a dark shadow. From that time on she lived under a sword of Damocles. Every Saturday she came silently to my surgery. She lost a lot of weight and her cheekbones protruded more sharply, her eyes became sunken and encircled by shadows. She would untie her shawl with a habitual movement and we would all three go to the ward to examine her.

The first three Saturdays passed and we found nothing. Then gradually she started to recover. Her eyes regained their sparkle, her face livened and the drawn look began to smooth out. The odds rose in our favour. The danger was passing. On the fourth Saturday I spoke with certainty. I could count on a roughly ninety per cent chance of a favourable outcome. The first twenty-one-day period was well past. There remained the remote possibility that the chancre might develop extremely late. That period finally passed too, and one day, as I threw the shiny mirror away into the basin, having felt her glands for the last time, I said to the woman:

‘You are no longer in any danger. You needn't come any more. You have been lucky.'

‘I'm all right?' she asked in an unforgettable voice.

‘Yes, you're fine.'

I lack the power to describe her face. I remember that she bowed low from the waist and went out.

She did, however, come once more. She was holding a
bundle in her arms—two pounds of butter and two dozen eggs. After a terrible inner struggle, I accepted neither. Being so young, I felt very proud of this. But later, when I had to go without food in the years immediately after the revolution, I often thought of the kerosene lamp, those dark eyes, and the golden slab of butter marked with fingerprints and with droplets of water oozing out of it like dew.

But why should I recall this woman, condemned to four months of terror, when so many years have passed since then? There is a reason. For she was my second suspected syphilis patient and I later devoted the best years of my life to venereal diseases. The first was the man with the speckled rash on his chest. She was the second, and the only exception, because she was afraid: the only one to remain in my memory from all the work that we four (Pelagea Ivanovna, Anna Nikolaevna, Demyan Lukich and myself) did by the light of those kerosene lamps.

While she was going through her agonizing Saturday visits as if waiting for her execution, I started investigating the disease. The long autumn evenings and the hot tiled stove produced such warmth and stillness that I felt all alone in the world with my lamp. Somewhere outside life was raging like a storm, but here only the slanting rain could be heard tapping at my window, then turning imperceptibly into soundless snow. I sat for long hours studying the last five years' records of the out-patients' surgery. The names of people and villages passed before me in their thousands and tens of thousands. I was looking for syphilis in these columns of people and I came across it often. There were rows of boring, routine entries like ‘Bronchitis', ‘Laryngitis', and others … But here it was: ‘Lues III'. And in the margin in the same bold hand:

‘R. Ung. hydrarg. ciner. 3.0 D.t.d.'

That was it—the black ointment.

And off I would go again. Again the bronchitis and catarrh would dance before my eyes and then suddenly there would be a break … ‘Lues' again.

The more frequent entries, in fact, were of secondary syphilis. Tertiary cases occurred less often, and then potassium iodide was boldly written in the ‘Treatment' column.

The more I read the old mildew-smelling folios of the outpatients' register which I had retrieved from the attic, the more light filtered into my inexperienced head. I began to understand some appalling things.

Where, for instance, were the entries for primary lesions? Somehow there did not seem to be any. There was hardly a single one among a thousand names. What could this mean?

‘This means,' I said in the dark to myself and to the mouse that was nibbling the backs of the old books on the shelves, ‘this means that the people here have no conception of syphilis and the lesions don't frighten them. I see. And then they heal spontaneously, leaving a scar. And is that all? No, that's not all! For then secondary syphilis, the vicious stage, sets in. Semyon Khotov, aged 32, will get a sore throat and oozing papules and then he will go to the hospital and he will be given the grey ointment …'

The light cast by my lamp formed a circle on the table and the chocolate-coloured woman lying on the bottom of the ashtray had vanished under the pile of cigarette butts.

‘I'll find this Semyon Khotov. Let's see now …' The slightly yellowing pages of the out-patients' register crackled faintly. On 17 June 1916 Semyon Khotov was given
six bags of mercury ointment, invented long ago to heal people like him. I can imagine my predecessor saying to Semyon as he handed him the ointment:

‘Semyon, when you've rubbed it on six times, wash it all off and come and see me again. Do you hear me, Semyon?'

Semyon bowed, of course, and thanked the doctor in a hoarse voice. Well, in another ten to twelve days he is bound to appear in the book again. Let's see … Cigarette smoke, rustle of pages. Hmm … not a sign of him! He's not there ten days later, nor twenty. He's not there at all. Poor Semyon Khotov. In all likelihood the speckled rash has vanished like the stars at dawn and the condylomata have dried up. And Semyon will surely perish. I shall probably see him at my surgery with gummatous lesions. Is the bridge of his nose still intact? Are the pupils of his eyes symmetrical? Poor Semyon!

But whom have we here? Not Semyon Khotov, but Ivan Karpov. Nothing surprising in that. Why shouldn't Karpov fall ill? Yes, but wait a minute—why has he been prescribed calomel with sugar and milk in small doses? The reason is that Ivan is two years old! And he is suffering from ‘Lues II'. That fateful ‘II'! He was covered in a rash when his mother carried him in and he struggled out of the doctor's strong grasp. It is all quite clear.

‘I know, I can guess. Now I realise where the two-year-old had the primary lesion which always precedes the secondary stage. It was in the mouth! He got it from his spoon.'

What lessons there are to be learned from the backwoods, from the peace and quiet of country life! Yes, the old register has many interesting things to tell the young doctor.

Above Ivan Karpov there was written:

‘Avdotya Karpova, aged 39.'

Who was she? Oh, I see. She was Ivan's mother. She was carrying him as he cried.

And below Ivan Karpov:

‘Maria Karpova, aged 8.'

Who's that? His sister. More calomel …

The whole family is there. A family. There's only one member missing—Karpov, 35 to 40 years old. His first name is not known. Was it Sidor, Pyotr …? Anyway, it doesn't matter.

Ah, here's the document. Now I see. He probably came back from the damned war and did not ‘confess', or maybe he did not know that he needed to. Then he went away again. And that's how it began. After Avdotya, Maria; after Maria, Ivan. They used the same soup bowls and towels.

Here's another family. And another. There's an old man, seventy years old. ‘Lues II'. An old man. What had he done wrong? Nothing. He had simply shared a mug; non-sexual contagion. It was daylight outside, with the whitish light of an early December dawn. I had sat up the whole lonely night poring over the hospital records and the splendid German textbooks with their colourful illustrations.

On my way to the bedroom I mumbled through a yawn:

‘I'm going to fight this thing.'

In order to fight it I had to see it. And it was not long in coming. A sleigh road had been laid, and on some days as many as a hundred patients came to see me. The day
would begin in cloudy white light and end with a black haze into which the last sleighs would disappear with a mysterious hiss.

It came in many insidious guises. It would take the form of whitish lesions in an adolescent girl's throat, or of bandy legs, or of deep-seated, indolent ulcers on an old woman's yellow legs, or of oozing papules on the body of a woman in her prime. Sometimes it proudly displayed itself on the forehead as a crescent-shaped ‘crown of Venus', or, as an indirect punishment for the sins of their fathers, on children with noses that were the shape of a Cossack's saddle. And there were other times when it simply escaped my attention. I was only just out of the lecture-theatre, after all!

Unaided and alone I thought it all out for myself. Somewhere the disease was lurking in people's bones and in their minds. I learned a great deal.

‘They told me to rub some stuff on.'

‘Was it black ointment?'

‘That's it, sir, black ointment.'

‘On alternate limbs? On the arm one day, on the leg the next?'

‘So he did. How did you know?' (flatteringly).

How could I fail to know? It was all so obvious. Just look at that gumma!

‘Were you in great pain?'

‘I should think so! Howled more than a woman having a baby.'

‘Uhuh … did you have a sore throat?'

‘That's right. I had a sore throat. Last year.'

‘I see. Did Leopold Leopoldovich give you the ointment?'

‘That's right. Black as my boot, it was.'

‘Well, you made a bad job of rubbing it on. You didn't do it properly …'

I wasted countless kilograms of grey ointment. I prescribed masses of potassium iodide and used a great deal of strong language. I managed to persuade a few to come back after they had rubbed on the first six bagfuls of ointment. A few of these actually underwent the initial course of injections, although most did not complete them. The majority slipped through my fingers like sand in an hourglass, and I could not go looking for them out in the snowbound darkness. I became convinced that syphilis was so fearful here precisely because it was not feared. And that is why, at the beginning of these reminiscences, I introduced the woman with the dark eyes. I remember her with a kind of heartfelt respect for her very fear. But she was the only one!

As I matured, I grew more single-minded and sometimes even sullen. I dreamed of when my spell in that job would be over and I could return to the university town, where it would be easier to fight syphilis.

On one such gloomy day a very good-looking young woman came to my surgery at the hospital holding a swaddled baby in her arms. Two toddlers stumbled in after her, hindered by their oversized felt boots as they hung on to the blue skirt which flared out from under her sheepskin jacket.