Cancer Ward (56 page)

“What about that girl with the straw-colored hair?” asked Lev Leonidovich. “Isn't there some other way we can help her, Yevgenia Ustinovna? Must we amputate?”

“It's unavoidable,” said Yevgenia Ustinovna, drawing in her curved, heavily made-up lips. “And we'll have to give her a dose of X ray afterwards.”

“It makes you feel wretched,” Lev Leonidovich suddenly sighed. His odd-shaped head was crowned with the funny little cap. He bowed his head and seemed to be examining his fingernails, drawing his thumb, which was enormous, across the forefingers. “The hand literally rebels against doing an amputation on someone so young,” he mumbled. “You have a feeling you're going against nature.”

He drew his index finger round his thumbnail. Whatever he did, nothing would help. He raised his head. “Well, comrades,” he said, “do you understand Shulubin's case now?”

“
CR recti
?” said Pantyokhina.

“Yes,
CR recti.
But you know how they found out about it? It shows how much all our cancer propaganda and oncological stations are worth. Oreshchenkov was right when he once said at a conference, ‘A doctor who's squeamish about putting his finger in a patient's anus isn't a doctor at all.' The number of things our people neglect! Shulubin dragged himself from one outpatient's clinic to another complaining about frequent calls of nature, rectal blood and then pains. They did every imaginable test on him except the simplest one of all, feeling with the finger. They treated him for dysentery and piles, but it didn't help. Then he read a cancer poster hanging on the wall in one of the outpatients' clinics. He's an educated man, he read it and he guessed. So with his own finger he felt his own tumor. Now why couldn't the doctors have done it six months earlier?”

“Is it deep?”

“About seven centimeters, just behind the sphincter. If we'd caught it earlier we could have kept the rectal muscle controlled and he'd have remained a normal human being. But now the sphincter's affected we'll have to remove the rectum. It means he'll lose control of his stool, and it means we'll have to take the colon out to one side. What sort of a life is that? And he's a good fellow…”

They began to prepare the list of tomorrow's operations. On it they marked which of the operations required pre-operative treatment, what with, who should be bathed, who prepared and in what way.

“Chaly hardly needs pre-operative treatment!” said Lev Leonidovich. “It's cancer of the stomach. But he's such a cheerful character, it's almost unheard of.”

(If he only knew it, Chaly was planning to treat himself the next morning with a bottle of alcohol!)

They worked out who was going to assist whom, and who would take care of the blood count. Inevitably it worked out that Lev Leonidovich would be assisted by Angelica. This meant that once again she would be standing there across the table, with the theater nurse moving back and forth on one side, and instead of devoting herself to the job would spend the whole time watching out of the corner of one eye to see what he was up to with the theater nurse.

She was a bit of a psycho as well, you only had to cross her to see that. So there was no way of being certain whether her silk thread was properly sterilized or not. And this was what the whole operation depended on … Damn these women! They didn't know the simple masculine rule: working and sex don't mix.

The girl's parents had made a mistake in calling her Angelica when she was born. Of course they could hardly have foreseen what a demon she would grow up to be. Lev Leonidovich took a sideways peek at her pretty, though foxy, little face and felt like saying to her peaceably, “Listen, Angelica—or Angela, or whatever name you want us to call you—you're not entirely without qualifications and ability, you know. If you applied yourself to surgery instead of scheming to get yourself married, you might be doing a decent job of work by now. Listen, there's no point in our having a quarrel. After all, we stand side by side at the operating table…”

But she'd have interpreted this to mean that he was exhausted by the campaign and was surrendering.

He also felt like giving a detailed account of yesterday's trial. He had begun telling Yevgenia Ustinovna the story briefly while they were smoking. But he didn't feel much like telling these particular colleagues about it.

The moment the conference was over, Lev Leonidovich stood up, lit a cigarette and strode down the corridor toward the radiotherapy department. He swung his excessively long arms boldly as he walked, cleaving the air with his glazed white-coated chest. Vera Gangart was the one he felt like talking to. He found her in the near-focus X-ray unit. She was sitting at a table with Dontsova, doing some paperwork.

“It's time for your lunch break,” he declared. “Give me a chair.”

He threw the chair under him and sat down. He was in the mood for a gay, friendly chat, but then he noticed something. “You're not very pleased to see me, are you?” he said.

Dontsova smiled lightly, twisting her hornrimmed spectacles round her fingers. “On the contrary, I'm doing my best to get on good terms with you. Will you operate on me?”

“Operate on you? Not for anything in the world!”

“Why not?”

“Because if I hack you to death they'll say I did it out of jealousy, because your department's more successful than mine.”

“No jokes, Lev Leonidovich. I'm being serious.”

It was true, one could hardly imagine Ludmila Afanasyevna making jokes. Vera was sitting there looking very sad. She had shrunk into herself, her shoulders hunched as if she was cold.

“Ludmila Afanasyevna will have to be examined during the next few days, Lev. It seems she's had pains in her stomach for some time, but she didn't tell anyone. Fine oncologist she is!”

“And of course you've already collected your evidence and you can prove it's cancer, is that right?” Lev Leonidovich curved those extraordinary eyebrows stretching from temple to temple. He always wore a mocking expression, even during the most ordinary conversation when there was nothing to laugh at. But you could never tell whom he was mocking.

“Not all of it, not yet,” Dontsova admitted.

“Well, what evidence is there? For example?”

She told him.

“That's not enough!” was Lev Leonidovich's verdict. “Let Verochka here sign the diagnosis, then we'll talk. They're giving me my own clinic soon, so I'll take Verochka away from you to be my diagnostician. Will you give her up?”

“I won't give Vera up for anything. Get yourself someone else.”

“I won't take anyone else, I only want Verochka. Why should I operate on you, if you won't give her up?”

He was finishing the last few puffs of his cigarette, looking about him and chatting jokingly, but in his thoughts he was completely serious. As his old teacher Koryakov used to say, “When you're young you haven't the experience, when you're old you haven't the strength.” But just at the moment Gangart was like himself, at the peak age when the ear of experience had already ripened and yet the stem of energy is still strong. Before his eyes she had developed from a girlish intern into a diagnostician so acute that he believed in her no less than he believed in Dontsova herself. With a diagnostician like her a surgeon, however skeptical, knew no cares. The trouble was that for a woman this peak time of life was even shorter than it was for a man.

“Have you got your lunch with you?” he asked Vera. “You won't be eating it anyway, you'll be taking it back home, won't you? Let me eat it.”

Amid much joking and laughing some cheese sandwiches appeared. He began eating them and offering them round. “You have one!… Oh yes, I went to the trial yesterday. You should have come, too, you'd have learned something. It was in a school building. About four hundred people were there, they knew it was going to be interesting. I'll tell you what happened. A child suffering from volvulus and twisted bowels was operated on. He lived several days after it was done. He even started going out and playing games—this is established. Then his bowels got partially twisted again and he died. The wretched surgeon had to put up with eight months of investigation—goodness knows how he went on operating all that time. Present at the trial were a representative of the city health service, the city's chief surgeon, and a public prosecutor
*
from the medical college, Can you imagine? He went on and on about the surgeon's criminally negligent attitude. The parents were brought forward as witnesses—fine witnesses they made! They said something about a blanket not being straight, it was all nonsense. As for the public, the doctor's fellow citizens, they just sat there staring, saying to themselves, ‘What bastards these doctors are!' Yet some of the public are doctors. We know how stupid it all is, we can see the whirlpool that's going to draw us in; it's bound to get us in the end, you today, me tomorrow. But still we say nothing. If I hadn't just come from Moscow I'd probably have said nothing either, but after two refreshing months there values seem to change, both the Moscow values and the local ones here. Cast-iron barriers turn out to be made of rotten wood. So I stuck my neck out. I got up and made a speech.”

“Are you allowed to make speeches?”

“Well, yes, it's a sort of debate. I told them, ‘You ought to be ashamed of yourselves, organizing this circus'—I really gave it to them! They tried to stop me, they threatened to cut me short. ‘How do you know a judicial error's any easier to make than a medical error?' I said. ‘This whole case should be under
scientific
investigation, not judicial at all. You should've got a group of doctors together, doctors and no one else, and had them do a qualified scientific analysis. Every Tuesday and every Friday we surgeons take enormous risks, we walk into a minefield. Our work is entirely based on trust. A mother ought to entrust her child to us, not stand up as a witness against us in a courtroom.'”

Lev Leonidovich was getting excited all over again, he could feel something trembling in his throat. He had forgotten the unfinished sandwich. He tore his half-empty pack as he took out a cigarette and lit it.

“And this surgeon was Russian! If he'd been a German, or, let's say, a Y-yid”—his lips protruded as he drew out the soft “y” and at length—“they'd all be crying ‘Hang him! Why wait?' They clapped after I'd finished, but how could I have kept silent? If they're putting a noose round your neck, you have to tear it off, there's no point in waiting.”

Vera had been shaking her head from side to side all the time he was recounting his story. She was shocked. Her eyes expressed understanding, intelligence and strained dismay—which was why Lev Leonidovich liked telling her such things. Ludmila Afanasyevna had looked puzzled as she listened. Now she shook her large head with its ashen, short-cropped hair.

“I don't agree with you,” she said. “What other way is there of dealing with us doctors? I remember once a surgeon sewed up a swab into a patient's stomach—they just forgot about it! Somewhere else they injected a physiological saline solution instead of Novocain. There was another case where they let a leg go dead inside a cast. Somebody else made a mistake about dosage, gave ten times the right amount. We do sometimes transfuse blood of the wrong group. We do inflict burns. What other way can they deal with us? They should pull us up by the hair, like children!”

“Ludmila Afanasyevna, you're killing me!” said Lev Leonidovich, raising one large hand to his head as if to protect it. “How can you talk like this, you of all people? This is a problem that goes beyond medicine. It's a struggle that concerns the nature of our whole society.”

“Here's the answer, here's the answer!” said Gangart, trying to make peace. She seized their arms to stop them waving them at each other. “Of course doctors must carry greater responsibility, but at the same time their patient quota ought to be lowered by two or three times. Look at outpatients: nine an hour! Isn't it appalling! Give us a chance to talk to each patient in peace and quiet, and to think in peace and quiet as well. When it comes to operations, a surgeon should do one a day—not three!”

But Ludmila Afanasyevna and Lev Leonidovich carried on shouting at each other. They couldn't agree. Finally Vera managed to calm them down. “What was the result, then?” she asked.

Lev Leonidovich unscrewed his eyes and smiled. “We saved him!” he said. “The whole trial fizzled out. The only thing the court recognized was incorrect entries in the case history. But wait! That wasn't the end of it. After the verdict was pronounced the city health service director made a speech, you know, about how we aren't educating our doctors properly, or our patients, and how we don't hold enough trade-union meetings. Then finally we had a speech from the chief city surgeon. What was his conclusion after all this? What was his message? ‘Comrades,' he said, ‘putting doctors on trial shows superb initiative, truly superb!'”

27. Each Has His Own Interests

It was an ordinary weekday and ordinary rounds were in progress. Vera Kornilyevna was going to see her radiotherapy cases. She was by herself, but on the upper landing she was joined by one of the nurses.

The nurse was Zoya.

They stood for a while beside Sibgatov, but they didn't stay with him long because every new step in his case was decided by Ludmila Afanasyevna herself. They went into the ward.

As it happened, they were both exactly the same height. Their lips, eyes, and caps were on the same level. But since Zoya was the more thickset she seemed the larger as well. One could foresee that in two years' time when she became a doctor she'd look more imposing than Vera Kornilyevna.

They walked down the row opposite Oleg's. He could see only their backs, the dark-brown knot of hair sticking out from under Vera Kornilyevna's cap and the golden ringlets under Zoya's.