nataliya

"I am a doctor, thrown straight from the university bench into a far away village, in the beginning of the revolution."¹¹ EXTRA! EXTRA! Now to be translated to a small screen featuring Daniel Radcliffe. And it will be "a new black comedy". I kid you not. I'm still trying to decide how I feel about it.Mikhail Bulgakov, the amazing Russian writer of The Master and Margarita fame, was a medical doctor by training. Just like the young protagonist of his semi-autobiographical collection of short stories The Notes of a Young Doctor (translated as A Country Doctor's Notebook), he has spent the time of his internship in a country hospital in the middle of nowhere, having to deal with insane patient volume, confusing diagnoses, and plain human stubbornness and stupidity that can make any medical professional's life a living hell. And what amazed me is that so many of these things are still present even in our sophisticated modern-day medicine. Some things never change, do they?" We are cut off from people. The first gas lights are nine miles away at the railroad station [...] A train to Moscow would rush by with a whistle without stopping - it does not need a God-forsaken station lost in the blizzard [...] We are alone here."A Country Doctor's Notebook describes the 'highlights' of the internship time of a brand-new young medical graduate Dr. Bomgard, sent straight from the medical university in Russia in the winter of 1917 to be the only doctor in a provincial hospital (the staff there consisting of a couple of nurses and a pharmacist) without any supervision or backup - save for quite a few medical textbooks and brand-new medical knowledge that he brought with him. This gives quite a new meaning to the whole 'thrown in at the deep end' phrase, doesn't it?"Well, and what if they bring in a woman in a complicated labor? Or, let's say, a patient with a strangulated hernia? What am I supposed to do then? Please, kindly tell me. Forty-eight days ago I graduated with high distinction, but distinction is one thing and hernia is another. Once I saw my professor operate on the strangulated hernia. He was doing it, and I was sitting in the audience, watching him. And that's it. I felt cold sweat running along my spinal column when I thought about hernias. Every night I sat in the same pose, having drank tea: on my left side, I had all the manuals on operative gynecology, with Dodelein's atlas on top. And on my right - ten different illustrated surgical manuals."Some of the situations seem almost surreal in their severity and grave danger. Picture a young doctor having to perform a maneuver to turn a malpositioned fetus in the mother's womb to save two lives - and never having done this procedure before, flipping through the pages of the textbook minutes before the surgery to figure out what the hell he is supposed to do. Imagine him performing a tracheostomy (surgically opening a throat to enable breathing) on a small dying child with diphtheria while her frantic mother is waiting outside. Think about discovering that your seemingly intelligent patient has taken his entire course of medications all at once (to speed up the healing process, apparently) and now is almost dying in front of your eyes. Imagine the entire villages infected with syphilis without having any idea about the disease or its severity, and abandoning life-saving treatment halfway through at the earliest signs of improvement. Think about realizing that your colleague has fallen prey to the deadly morphine addiction, painstakingly documenting the horrific mental and physical destruction (by the way, probably one of the earliest realistic portrayals of narcotic addiction in fiction, and based on personal experience with the drug, no less)."I felt defeated, broken, flattened by the cruel fate. Fate threw me into this wilderness and made me fight my battles alone, without any support or instruction. What unbelievable difficulties I have to suffer through. They can bring in any strange or difficult case, most often a surgical case, and I have to face it, with my unshaven face, and win. And if you don't win, then you have to suffer and torture yourself - like now, riding along a bumpy country road, leaving behind an infant's little corpse and his mother."The young doctor's patients are poor peasants - illiterate, superstitious, ignorant of their diseases, frustratingly suspicious of surgeries and other "out there" treatments. After building up a favorable reputation after a miraculous life-saving amputation on day one, the doctor ends up seeing over a hundred patients daily (that's in addition to the hospitalized patients), often having almost no time to sleep, and often still having to make a house call to a woman dying in labor or a patient too sick to be transported to the hospital, often riding miles in miles in the middle of Russian winter blizzard."After that, I started seeing about a hundred peasants a day. I stopped eating dinners. Mathematics is a cruel science. Let's imagine that I was spending only five minutes - five! - with every one of my hundred patients. Five hundred minutes - eight hours and twenty minutes. All in a row, please note that. And besides that I had a hospital ward for thirty patients. And in addition to that, I was still performing surgeries." The young doctor/ Bulgakov's alter ego laments the ignorance of his patients that endangers their lives and the lives of their loved ones, facilitates the spread of diseases, and causes harm and grief. And yet, so unlike the doctor stereotype of that long-gone era he exhibits astounding patience and perseverance, fighting the uphill battle and actually succeeding with every life saved, every disaster averted. These stories are often sad but at the same time life-affirming. And I happily give this book about my colleague almost a hundred years ago, facing similar problems that we encounter even in modern medicine, five well-earned stars."In a bout of inspiration, I opened a clinic patient roster and began counting. I counted for an hour. In a year I have seen 15,613 patients, I had 200 hospitalized patients, and only six died."