Cancer Ward (69 page)

Then suddenly, within a few days, her own body had fallen out of this great, orderly system. It had struck the hard earth and was now like a helpless sack crammed with organs—organs which might at any moment be seized with pain and cry out.

Within a few days everything had been turned inside out. Her body was, as before, composed of parts she knew well, but the whole was unknown and frightening.

When her son had been small they used to look at pictures together. Ordinary household objects—a tea kettle, a spoon or a chair—were unrecognizable to him if drawn from an unusual angle. The course of her disease and her new place in the system of treatment had now become equally unrecognizable to her. As from today she ceased to be a rational guiding force in the treatment, she had become an unreasoning, resistant lump of matter. The moment she admitted the disease existed, she was crushed by it like a frog underfoot. Adjusting to the disease was at first unbearable. Her world had capsized, the entire arrangement of her existence was disrupted. She was not yet dead, and yet she had had to give up her husband, her son, her daughter, her grandson, and her medical work as well, even though it was her own work, medicine, that would now be rolling over her and through her like a noisy train. In a single day she had to give up everything and suffer, a pale-green shadow, not knowing for a long time whether she was to die irrevocably or return to life.

It had once occurred to her that there was a lack of color, joy, festivity in her life—it was all work and worry, work and worry. But how wonderful the old life seemed now! Parting with it was so unthinkable it made her scream.

Already the whole of this Sunday had been unlike any other Sunday: it had consisted of a preparation of her intestines for the next day's X ray.

On Monday at a quarter past nine, as agreed, Dormidont Tikhonovich, Vera Gangart and another intern turned off the lights in the X-ray room and began to adapt themselves to the dark. Ludmila Afanasyevna undressed and went behind the screen. An orderly handed her the first glass of barium meal. As she took it she spilled some. The hand that held the glass was quite used to pressing and kneading patients' stomachs, in this very room, clad in a rubber glove, but today it was shaking.

They went through the familiar routine: feeling her, pressing her, turning her round, making her raise her arms and breathe in. Then they lowered the camera, placed her on the table and photographed her from various angles. They had to allow time for the contrast mass to spread into the digestive tract. Of course the X-ray apparatus wasn't allowed to stand idle meanwhile; the intern was letting her regular patients through. Ludmila Afanasyevna even sat down and tried to help a few times, but her mind wouldn't concentrate and she wasn't much use. Again the time came for her to go behind the screen, to drink the barium, lie down and be photographed.

It was an examination like any other, only it didn't take place in the usual businesslike silence, interrupted by brief commands from the doctors, Oreshchenkov kept up a humorous banter with his young assistants, making jokes at their expense, at Ludmila Afanasyevna's and at his own. He told them how as a student he had been ejected for bad behavior from the Moscow Arts Theatre, just after it came into existence. It was a première of
The Power of Darkness.
*
Akim was blowing his nose and undoing his puttees so realistically that Dormidont and the friend he was with began to hiss. After that occasion, he said, every time he went to the Moscow Arts Theatre he was afraid he might be recognized and thrown out again. They were all trying to talk as much as possible to relieve the painful pauses between the moments of silent examination. Dontsova could tell, though, that Gangart's throat was dry and that it was an effort for her to speak. She knew her well enough to be sure about that.

But of course this was the way Ludmila Afanasyevna wanted it. She drank the barium meal, wiped her mouth and reaffirmed, “No, the patient shouldn't know everything. I always thought so and I still do. When the time comes for discussion, I shall leave the room.”

They accepted this arrangement. Each time the doctors wanted to talk, Ludmila Afanasyevna went out and tried to find herself some work with the X-ray lab. assistants or with the case histories. There was plenty to be done, but today she found she could not complete anything. Every time they called her in she went with pounding heart, hoping that they would greet her with good news, that Verochka Gangart would throw her arms around her with relief and congratulate her. But it didn't happen; there were only more instructions, more twists and turns under the camera, more examinations.

As Ludmila Afanasyevna obeyed each new order she couldn't help pondering and trying to explain it. “I can see what you're looking for, I can tell from your methods.” She let the words slip out.

As she saw it, they suspected a tumor not of the stomach or of the duodenum but of the oesophagus. This was the most difficult type of all because the operation required partial opening of the chest cavity.

“Come on, Ludochka,” Oreshchenkov boomed through the darkness. “First you want an early diagnosis and now you say you don't like our methods! Would you rather wait three months or more? Then we'll tell you the result outright.”

“No, thank you, I can do without a three-months' wait!”

She refused, too, to look at the large, most important X ray, which they had received from the laboratory by the end of the day. She had dropped her decisive, masculine gestures and was sitting there limply on a chair under the bright overhead lamp, waiting for Oreshchenkov's concluding words—for his words and his decision, not for his diagnosis.

“Well then, my respected colleague,” Oreshchenkov drawled the words out benevolently, “the celebrities are divided in their opinion.”

As he said this his eyes kept watch from under his angular eyebrows. They saw how confused she was. One might have expected the resolute, unyielding Dontsova to show more strength in such a trial. Her sudden collapse confirmed Oreshchenkov's opinion that modern man is helpless when confronted with death, that he has no weapon to meet it with.

“Which one of you is it who thinks the worst?” asked Dontsova, making an effort to smile.

(I hope it's not him!)

Oreshchenkov spread the fingers of one hand to show his doubt. “Your ‘daughters' are the ones who believe the worst,” he said; “see how you've brought them up? I take a more cheerful view.”

The corner of his lips curved slightly—a sign of good humor and benevolence. Gangart sat there, pale as a ghost, as though
her
fate was being decided.

“I see. Thank you.” Dontsova felt a little better. “So now what?”

How many times had patients sat there waiting for her to announce her decision after a similar moment of respite? Invariably the decision was based on science and statistics, a conclusion crosschecked and attained by logic. What a cask of horrors, she now thought, lies concealed in this moment of respite!

“Well, Ludochka,” Oreshchenkov rumbled on soothingly, “it's an unjust world, you know. If you weren't one of us we'd be turning you straight over to the surgeons with an alternative diagnosis. They would hack away at you a bit and slice something out in the process. You know what miserable creatures they are, they can't open up an abdomen without taking out a souvenir. They'd cut you open and then it would transpire which of us was right. But you
are
one of us after all, and we have our friends Lenochka and Seryozha in the Radiology Institute in Moscow. So what we've decided is this: we want you to go there. All right? They'll read what we write about you and give you a lookover. We'll have more opinions to go by. Also if there has to be an operation they'll do it better there. In fact, everything can be done better there, isn't that so?”

(He had said, “If there has to be an operation.” Was he trying to say it mightn't be necessary? Or perhaps he meant that … No, it must be worse than that …)

“You mean,” Dontsova hazarded, “that the operation's so complicated you daren't do it here?”

“Oh no, of course not,” replied Oreshchenkov, frowning and raising his voice a little. “You mustn't look for a hidden meaning behind what I said. It's just that we're arranging a little … what's the word?… a little extra ‘pull' for you. If you don't believe us”—he nodded toward the table—“take the film and look for yourself.”

It was simple, wasn't it? All she had to do was reach out for it and make her own analysis.

“No, no,” said Dontsova, drawing an imaginary line between herself and the X-ray plate. “I don't want to.”

And so the decision was taken. They talked to the senior doctor, then Dontsova went to the Republic's Ministry of Health. Strangely enough, there was no delay there, they gave her a leave pass and an admission chit to the Moscow clinic. It was suddenly apparent that there was no reason whatever to keep her in the town where she had worked these past twenty years.

Dontsova had known what she was doing when she had concealed her pain from everyone. You only had to tell one person and irresistibly the avalanche was set in motion, nothing depended on you any more.

Her ties in life, which had seemed so strong and permanent, were loosening and breaking, all in a space of hours rather than days.

In the clinic and at home she was unique and irreplaceable. Now she was being replaced.

We are so attached to the earth, and yet we are incapable of holding onto it.

There was no point in further delay. On Wednesday that same week she went on her last rounds of the wards with Gangart. She was transferring the administration of the radiology department to her.

The rounds began in the morning and continued almost until lunchtime. Dontsova relied on Verochka Gangart, who was familiar with the cases of all her inpatients. Yet as she began to walk past their beds, knowing it would be at least a month before she returned to them, if she ever did, for the first time for days she felt lucid and a little stronger. She regained her interest in work and her ability to reason. In the morning she had intended to go through her affairs and sign the last necessary papers as quickly as possible, then go home and prepare for the journey, but the plan had gone by the board. She was so used to taking personal charge of everything that even today she couldn't leave a single patient without making at least a month's mental forecast. She had to foresee the course of the disease, and what treatment and emergency measures might become necessary. She walked through the wards almost exactly as usual. It gave her the first hours of relief she had had in the whirl of the last few days.

She was getting acclimatized to her misfortune.

Yet as she passed through the wards, she felt as if she had been deprived of her rights as a doctor, as if she had been disqualified because of some unforgivable act, fortunately not yet announced to the patients. She examined, prescribed and issued instructions, gazing at each patient like a false prophet, while all the time there was a chill running down her spine. She no longer had the authority to pass verdicts of life and death upon others. In a few days' time she would be lying in a hospital bed, as helpless and as dumb as they were, neglecting her appearance, awaiting the pronouncements of her more experienced seniors, afraid of the pain, perhaps regretting that she had entered that particular clinic at all. She might even come to doubt whether they were giving her the right treatment and long to get rid of her hospital pajamas and go home in the evening, as most people do, as though this were the greatest happiness in the world.

These were the thoughts that plagued her and weakened her normal resolute cast of mind.

Meanwhile Vera Kornilyevna was taking on a joyless burden she did not want at this price. In fact she didn't want it at all.

They called her “Mother,” and for Vera this was no empty word. She had produced the worst diagnosis of the three doctors. She expected Ludmila Afanasyevna to have to undergo an exhausting operation which she might not survive, undermined as she was by chronic radiation sickness. As she walked through the wards beside her it occurred to her that this might well be the last time, that she might spend many more years walking daily between these beds recalling with a pang of sorrow the woman who had made a doctor of her.

Unobtrusively she lifted a finger and brushed aside a tear.

But today of all days Vera's prognoses had to be accurate as never before. She couldn't miss asking a single important question, because henceforward for the first time these fifty or so lives would be her responsibility entirely. There would be no one to turn to or ask advice from.

And so, upset and worried, the doctors carried on their rounds for half the day. First they went through the women's wards, then they visited the patients whose beds were out on the landing or in the corridor. Naturally enough, they lingered beside Sibgatov.

They had given so much of themselves to try to save this quiet Tartar, yet all they had won was a few months' delay. And what miserable months—a pitiful existence in an unlit, unventilated corner of the landing! His sacrum could no longer support him, he could only hold himself upright by pressing against his back with his two strong arms. His only exercise was a walk into the next-door ward where he would sit and listen to the conversation. His only air was what reached him from a distant window. His only sky was the ceiling.

But even this miserable life, consisting of nothing but medical treatments, orderlies' quarrels, hospital food and games of dominoes, even life with that gaping wound in his back was good enough for his pain-racked eyes to light up with gratitude every time the doctors came on their rounds.

It made Dontsova realize that if she rejected her own yardstick and adopted Sibgatov's, she could still count herself lucky.

Somehow Sibgatov had already heard that it was Ludmila Afanasyevna's last day.