Cancer Ward (8 page)

“He's on a special diet now,” broke in Vera Kornilyevna in her lilting voice, kindheartedly, like a nanny. She smiled at Dyomka, and he smiled back.

“Transfusion?” Gangart asked Dontsova the question quickly and quietly. She took back the case history.

“Yes. Well, what do you think, Dyomka?” Ludmila Afanasyevna gave him another searching look. “Shall we go on with the X rays?”

“Of course we go on.” The boy's face lit up and he looked at her gratefully.

He thought that the X rays were to be instead of an operation, that that was what Dontsova had meant. (What she had really meant was that before operating on bone sarcoma, its activity has to be suppressed by irradiation to prevent the formation of secondaries.)

Egenberdiev had been getting himself ready for some time. He kept a sharp lookout, and as soon as Ludmila Afanasyevna got up from the next bed he stood bolt upright in the passageway, puffed up his chest and towered soldier-like above her.

Dontsova gave him a smile, leaned toward his lip and inspected the scab. Gangart was quietly reading out figures to her.

“Yes, very good!” she said encouragingly, louder than necessary, as people do when speaking to someone whose native tongue is different from their own. “You're making good progress, Egenberdiev! You'll soon be going home.”

Ahmadjan knew what he was supposed to do. He had to translate what she said into Uzbek. (He and Egenberdiev understood one another, although each thought the other was murdering the language.)
*

Egenberdiev gazed at Ludmila Afanasyevna. His eyes showed hope and trust, delight even, the delight with which simple souls regard genuinely educated, genuinely useful people. Nevertheless he raised his hand to the scab and said something. “But it's becoming larger? It's grown?” Ahmadjan translated.

“It will all fall off. That's what's meant to happen.” Dontsova was articulating the words particularly loudly. “It will all fall away! Three months' rest at home, and then you'll come back to us!”

She went across to the old man Mursalimov, who was already sitting with his feet hanging down. He tried to get up to meet her, but she stopped him and sat down next to him. The emaciated, bronze-skinned old man looked at her with the same faith in her omnipotence. Through Ahmadjan she asked about his cough and told him to lift up his shirt. She felt his chest lightly where it hurt and knocked on it with her fingers over her other hand, meanwhile listening to Vera Kornilyevna telling her about the number of sessions, the blood count and the injections. Then she silently examined the case history herself. Once upon a time every organ had been necessary, everything in its place inside a healthy body. But now it all seemed to be superfluous, knots of muscle and angles of bone protruding from under the skin.

Dontsova prescribed some new injections. Then she asked him to point out among the bottles on his bedside table which pills he was taking. Mursalimov picked up an empty bottle of multi-vitamins.

“When did you buy these?” Dontsova inquired.

Ahmadjan translated: two days ago.

“Well, where are the pills?”

He'd taken them all.

“What do you mean, you've taken them all?” Dontsova was flabbergasted. “All at once?”

“No. Two different times,” Ahmadjan relayed to her.

The doctors, the nurses, the Russian patients and Ahmadjan all burst out laughing. Mursalimov bared his teeth—he had not yet understood.

Only Pavel Nikolayevich was filled with indignation at their senseless, untimely, criminal laughter. Well, he'd soon sober them up! He had been debating which pose to use to confront the doctors, and had decided his point could be best made in a semi-reclining position, with his legs drawn up under him.

“It's all right. It doesn't matter!” Dontsova reassured Mursalimov. She prescribed some more vitamin C, wiped her hands on the towel so fervently proffered to her by one of the nurses and turned with a look of concern on her face toward the next bed. Now, as she stood close to the window and facing it, one could see her unhealthy, grayish complexion. There was a very tired, almost sickly, expression on her face.

Sitting up sternly in bed, bald, in his skullcap and glasses, Pavel Nikolayevich looked rather like a schoolteacher, not any old schoolteacher but a distinguished one who had brought up hundreds of pupils. He waited until Ludmila Afanasyevna was quite close to his bed, then he adjusted his glasses and declared, “Comrade Dontsova, I shall be forced to inform the Ministry of Health of the way things are conducted at this clinic. And I shall have to telephone Comrade Ostapenko.”

She did not tremble or go pale, but perhaps her complexion became a little more pasty. She made a strange movement with her shoulders, a circular movement as though her shoulders were tired and longed to be rid of the harness which held them.

“If you have good contacts in the Ministry of Health,” she agreed with him at once, “and if you're in a position to telephone Comrade Ostapenko, I can think of several more things you might add. Shall I tell you what they are?”

“There is nothing that needs to be added. Your display of indifference is quite enough as it is. I have been in here for
eighteen
hours, and nobody is giving me treatment. And I am a…” (There was nothing more he could say to her. Surely she could supply the rest herself!)

Everyone in the room was silent, staring at Rusanov. It was Gangart who was shocked, not Dontsova. Her lips tightened into a thin line. She frowned and knit her brows, as if she had seen something irrevocable take place and been powerless to avert it.

Dontsova, her large frame towering over the seated Rusanov, did not even permit herself a frown. She made another circular movement of her shoulders and said in a quiet, conciliatory tone, “That's why I'm here—to give you treatment.”

“No. It's too late now.” Pavel Nikolayevich cut her short. “I've seen quite enough of the way things are done here, and I'm leaving. No one shows the slightest interest, nobody bothers to make a diagnosis!” There was an unintended tremble in his voice; he was really offended.

“You've had your diagnosis,” Dontsova said slowly, both bands gripping the foot of his bed, “and there's nowhere else for you to go. No other hospital in the republic will take patients with your particular illness.”

“But you told me I don't have cancer!… What is the diagnosis?”

“Generally speaking, we don't have to tell our patients what's wrong with them, but if it will make you feel any better, very well—it's lymphoma.”

“You mean it's not cancer?”

“Of course it's not.” Her face and voice bore no trace of the bitterness that naturally comes from a quarrel, for she could see clearly enough the fist-sized tumor under his jaw. Who could she feel bitter against? The tumor? “Nobody forced you to come here. You can discharge yourself whenever you like. But remember…” She hesitated. “People don't only die of cancer.” It was like a friendly warning.

“What's this? Are you trying to frighten me?” Pavel Nikolayevich exclaimed. “Why are you doing it? That's against the rules of professional etiquette.” He was still rattling away as hard as he could, but at the word “die” everything had suddenly frozen inside him. His voice was noticeably softer when he added, “You … you mean my condition is all that dangerous?”

“Of course it will be if you keep moving from one hospital to another. Take off your scarf. Stand up, please.”

He took off his scarf and stood up on the floor. Gently Dontsova began to feel the tumor and then the healthy side of the neck, comparing the two. She asked him to move his head back as far as it would go. (It wouldn't go very far. The tumor immediately began to pull it back.) Next he had to bend it forward as far as possible, then twist it to the left and the right.

So that was it! His head had apparently already lost practically all its freedom of movement, that amazing effortless freedom which when we possess it goes completely unnoticed.

“Take off your jacket, please.”

His green and brown pajama jacket had large buttons and was the right size. No one would have thought it could be difficult to take off. But when he stretched his arms it pulled at his neck, and Pavel Nikolayevich groaned. The situation
was
serious! The impressive, gray-haired nurse helped him untangle himself from the sleeves.

“Do your armpits hurt?” Dontsova asked. “Does anything bother you?”

“Why, might it spread down there as well?” Rusanov's voice had now dropped and was even quieter than Ludmila Afanasyevna's.

“Stretch your arms out sideways.” Concentrating and pressing hard, she began to feel his armpits.

“What sort of treatment will it be?” Pavel Nikolayevich asked.

“Injections. I told you.”

“Where? Right into the tumor?”

“No. Intravenously.”

“How often?”

“Three times a week. You can get dressed now.”

“And an operation is … impossible?”

(Behind the question lay an overriding fear—of being stretched out on the operating table. Like all patients he preferred any other long-term treatment.)

“An operation would be pointless.” She was wiping her hands on the towel the nurse held out to her.

“I'm very glad to hear it,” Pavel Nikolayevich thought to himself. Nevertheless he would have to consult Kapa. Using personal influence in a roundabout way was never very easy. In reality, the influence he had was not as much as he might have wished for, or as great as he was now pretending it was. It was not at all an easy thing to telephone Comrade Ostapenko.

“All right, I'll think about it. Then we'll decide tomorrow?”

“No,” said Dontsova mercilessly, “you must decide today. We can't give any injections tomorrow, it's Saturday.”

More rules! Doesn't she realize rules are made to be broken? “Why on earth can't I have injections on Saturday?”

“Because we have to follow your reactions very carefully, both on the day of the injection and the day after. And we can't do that on a Sunday.”

“So you mean … it's a serious injection?”

Ludmila Afanasyevna did not answer. She had already moved to Kostoglotov's bed.

“Couldn't we wait till Monday…?”

“Comrade Rusanov! You accused us of waiting eighteen hours before treating you. How can you now suggest waiting seventy-two?” (She had already won the battle. Her steam roller was crushing him; there was nothing he could do.) “Either we take you in for treatment or we don't. If it's yes, you will have your first injection at eleven o'clock this morning. If it's no, then you must sign to the effect that you refuse to accept our treatment and I'll have you discharged today. But we certainly don't have the right to keep you here for three days without doing anything. While I'm finishing my rounds in this room, please think it over and tell me what you've decided.”

Rusanov buried his face in his hands.

Gangart, her white coat fitting tightly right up to her neck, walked silently past him. Olympiada Vladislavovna followed like a ship in full sail.

Dontsova, weary of the argument, hoped to be cheered up at the next bed.

“Well, Kostoglotov, what do you have to say?”

Kostoglotov smoothed down a few of his tufts of hair and answered in the loud, confident voice of a healthy man, “I feel fine, Ludmila Afanasyevna. Couldn't be better!”

The doctors exchanged glances. Vera Kornilyevna's lips were smiling faintly, but her eyes—they were fairly laughing with joy.

“Well, all right” Dontsova sat down on his bed. “Describe it in words. How do you feel? What's the difference since you've been here?”

“With pleasure.” Kostoglotov was only too willing. “The pain started to go down after the second session. After the fourth it had gone completely. And my temperature went down too. I'm sleeping very well now, ten hours a night, in any position, and it doesn't hurt. Before, I couldn't find a single comfortable position. I never used to want to loot at food, and now I finish everything and ask for second helpings. And it doesn't hurt.”

“And it doesn't hurt?” Gangart burst out laughing.

“And they give you the second helpings?” Dontsova was laughing too.

“Sometimes. But what else is there to say? My whole attitude to the world has changed. When I arrived I was a dead man. Now I'm alive.”

“No vomiting?”

“No.”

Dontsova and Gangart looked at Kostoglotov and beamed, just as a teacher looks at a star pupil and takes more pride in a question excellently answered than in his own knowledge and experience. Teachers become attached to such pupils.

“Can you feel the tumor?”

“It doesn't bother me any more.”

“But can you feel it?”

“Well, when I lie down I can feel something heavy, almost as if it's rolling around. But it doesn't bother me,” Kostoglotov insisted.

“All right, lie down.”

Kostoglotov went through his routine. (During the past month many doctors and medical students had examined his tumor in various hospitals. They used even to call in colleagues from other rooms to feel it. Everyone had been amazed by it.) He lifted his legs onto the bed, drew up his knees, lay on his back without a pillow and uncovered his stomach. He could feel at once how this toad inside him, his companion through life, had dug itself deep in and was pressing against him.

Ludmila Afanasyevna sat next to him. With gentle, circular movements her hand moved closer to the tumor.

“Don't tense up, don't tense up,” she kept reminding him. He knew he shouldn't but he still kept tensing himself in instinctive defense, hindering the examination. Finally, having persuaded his belly to relax trustingly, she felt, deep down beside the stomach, the edge of the tumor. Then she went on to feel all round it, gently at first, then more firmly, and then, a third time, more firmly still.