Cancer Ward (9 page)

Gangart was looking over her shoulder, and Kostoglotov was looking at Gangart. She was a very likable person. She wanted to be strict, but she couldn't—she got accustomed to her patients so quickly. She tried to be grown-up, but that didn't work either. There was something of the little girl about her.

“I can feel it distinctly, the same as before,” Ludmila Afanasyevna announced. “It's a little flatter, there's no doubt about that. It's settled a little further in and released the stomach. That's why it doesn't hurt him. It's softer. But the circumference is almost the same. Will you take a look?”

“No, I don't think so. I do it every day. It's better to take a break from it. Blood count—twenty-five. White cells—five eight hundred. Sedimentation … There, you can see for yourself…”

Rusanov raised his head from his hands and asked the nurse in a whisper, “The injections? Are they very painful?”

Kostoglotov was also making inquiries. “Ludmila Afanasyevna, how many more sessions will I have?”

“We can't decide that quite yet.”

“No, but roughly? When do you think I'll be discharged?”

“What?”
She raised her head from the case history. “What did you say?”

“When are you going to discharge me?” Kostoglotov repeated just as confidently. He gripped his shins with his hands and assumed an independent air. All trace of admiration for the star pupil had vanished from Dontsova's gaze. He was now just a difficult patient whose face expressed deep-rooted stubbornness.

“I'm just
beginning
to treat you!” she cut him short. “Starting from tomorrow. Up to now we've only been setting our sights.”

But Kostoglotov would not give way. “Ludmila Afanasyevna, I'd like to explain something to you. I realize I'm not cured yet, but I'm not aiming at a complete cure.”

Well, what a bunch of patients! Each one better than the next! Ludmila Afanasyevna was frowning. This time she was angry. “Whatever are you talking about? Are you in your right mind?”

“Ludmila Afanasyevna.” Kostoglotov raised one large hand to wave aside any further accusations. “Discussions about the sanity or insanity of contemporary man will take us far from the point … I am really grateful to you for bringing me into this enjoyable state of health. Now I want to make use of it a little and live. But what will happen if I have further treatment … I do not know.” While he was speaking, Ludmila Afanasyevna's lower lip jutted with impatience and indignation. Gangart's eyebrows had twitched: she was looking from one to the other, eager to intervene and to pacify. Olympiada Vladislavovna was gazing haughtily down at the rebel. “In fact, I don't want to pay too high a price now for the hope of a life some time in the future. I want to depend on the natural defenses of the organism.…”

“You and your natural defenses of the organism came crawling into this clinic on all fours,” Dontsova came back with a sharp rebuke. She got up from the bed. “You don't even understand the game you're playing. I won't even talk to you!”

She waved her hand like a man and turned toward Azovkin. Kostoglotov lay there, his knees pulled up under the blanket. He looked implacable, like a black dog.

“Ludmila Afanasyevna, I still want to discuss the matter with you. You may be interested in this as an experiment, in seeing how it will end. But I want to live in peace, if only for a year. That's all.”

“Very well.” Dontsova threw the words over her shoulder. “You'll be sent for.”

She was now looking at Azovkin. She had not yet been able to switch the annoyance from her face or voice.

Azovkin did not get up. He just sat there holding his stomach, merely raising his head to greet the arrival of the doctors. His lips did not form the whole of a mouth: each lip expressed its own separate suffering. In his eyes there was no emotion except entreaty, a plea for help to those who could not hear.

“Well, Kolya, how are things?” Ludmila Afanasyevna encircled his shoulders with her arms.

“Ba-ad,” he answered very softly. When he spoke only his mouth moved: he tried not to expel any air from his chest, because the slightest jolt of the lungs was passed on toward the stomach and the tumor.

Six months ago he had been striding along, a spade over his shoulder, at the head of a Young Communists' Sunday working party, singing at the top of his voice. Now he could not raise his voice above a whisper, even when talking about his pain.

“All right, Kolya, let's think about this together.” Dontsova was speaking just as softly as he. “Perhaps you're tired of the treatment. Perhaps you're fed up with being in hospital. Is that right?”

“Yes.…”

“This is your home town. Perhaps a rest at home would do you good. Would you like that? We can discharge you for a month, or six weeks.”

“After that you'd … take me in again?”

“Of course we'll take you in. You're one of us now. It'll give you a rest from the injections. Instead you can buy medicine from the chemist and put it under your tongue three times a day.”

“Sinestrol?”

“Yes.”

Dontsova and Gangart did not realize that for months Azovkin had been frantically begging extra medicine from every duty nurse and night-duty doctor—sleeping pills, painkillers, every sort of extra powder or pill except those prescribed for him orally or by injection. This reserve supply Azovkin crammed into a little cloth bag, which he kept ready to save himself with on the day when the doctors stopped helping him.

“You need a rest, my dear Kolya … a rest.”

It was very quiet in the ward. Rusanov sighed, and raised his head from his hands. His words rang through the room. “Doctor, I give in. Inject me!”

5. The Doctors' Worries

What name can one give it? Frustration? Depression? When melancholy sets in, a kind of invisible but thick and heavy fog invades the heart, envelops the body, constricting its very core. All we feel is this constriction, this haze around us. We don't even understand at first what it is that grips us.

This was what Vera Kornilyevna felt as she finished her rounds and went down the stairs with Dontsova. She was very upset.

In such circumstances it helps to take stock of oneself and consider what it's all about, to put something up as a protective barrier, too.

But there wasn't time for her to take stock.

This was the position; she was anxious about “Mother.” (This was what the three radiotherapy interns called Ludmila Afanasyevna among themselves.) She was like a mother to them partly because of her age—they were all about thirty, while she was nearly fifty—and partly because of the special zeal with which she taught them to work. She herself was keen to the point of being obsessed, and she wanted all her three “daughters” to absorb that same keenness and obsession. She was among the last of the school of doctors with a grasp of X-ray diagnosis as well as X-ray therapy. For some time there had been a general trend toward fragmentation of knowledge, but in spite of this she tried to make her interns keep up with both.

She had no secrets, there was nothing she kept to herself and would not share. And when Gangart occasionally showed herself sharper and quicker than her “mother,” Ludmila Afanasyevna was only too pleased. Vera had worked with her for eight years, ever since leaving medical college, and all the power she felt she now possessed—the power to pull back from creeping death those who came and implored her to save them—every atom of it came from her contact with Ludmila Afanasyevna.

This fellow Rusanov might turn out to be a tedious nuisance to Mother. Only a magician can fix a head on a body, but any fool can lop it off.

How she wished there was only one Rusanov. Any patient with bitterness in his heart was capable of behaving like this, and when hounds are in full cry you cannot just call them off at will. These threats left not a footprint on water, but a furrow in the mind. A furrow can always be leveled and filled with sand, but if any drunken huntsman shouts, “Down with doctors,” or “Down with engineers,” there is always a hunting crop to hand.

The black clouds of suspicion, gathered once over the white coats,
*
had left shreds behind hovering here and there. Quite recently an M.G.B.
**
chauffeur had been admitted to the clinic with a stomach tumor. He was a surgical case. Vera Kornilyevna had had nothing to do with him, except that once when she was on night duty, making her evening rounds, he had complained to her of sleeping badly. She had prescribed bromural; however, the sister told her only small doses were available, so she had said, “Give him two powders in one dose.” The patient took them from her and Vera Kornilyevna never noticed the peculiar way he looked at her. And no one would have known, if one of the girl laboratory assistants hadn't been living in the same flat as the chauffeur and come to visit him in the ward. She came running to Vera Kornilyevna in great excitement. The chauffeur had not taken the powders. Why were there two together? He'd lain awake all night, and now he was questioning the assistant, “Why is her last name Gangart? Tell me more about her. She tried to poison me. We'd better check up on her.”

Vera spent several weeks waiting to be checked up on, several weeks of having to make her diagnoses confidently, impeccably, with inspiration even, of measuring doses accurately, of encouraging her patients with glances and smiles to make up for their finding themselves inside this notorious cancer circle, and all the time expecting one of them to look at her as if to say, “Are you a poisoner?”

Another reason why today's rounds had been particularly difficult was that Kostoglotov, a patient who had made especially good progress and whom Vera Kornilyevna had for some reason treated with particular kindness, had made a point of questioning Mother in that very manner, suspecting that some wicked experiment was being practiced on him.

Ludmila Afanasyevna was also thoroughly depressed as she finished her rounds. She remembered the unpleasant business there had been over Polina Zavodchikova, that prize troublemaker. It wasn't she who had been ill, but her son. She had come into the clinic just to be with him. They operated and removed an internal tumor, and she fell upon the surgeon in the corridor demanding a piece of her son's tumor. If it had not been for Lev Leonidovich, she might well have got it. Her plan was to take the piece to another clinic to have the diagnosis confirmed, and if it hadn't agreed with Dontsova's diagnosis she'd have demanded money or taken them to court.

Every member of the hospital staff could remember some similar incident.

Now that the rounds were over, they were on their way to discuss among themselves what they couldn't talk about in front of the patients, and to take decisions.

Rooms were scarce in the cancer wing, and there was not even a small one to be found for the radiotherapists. There was no accommodation for them either in the gamma-gun unit or in the unit with the long-focus 120,000- and 200,000-volt X-ray installations. There was a room in the X-ray diagnosis unit, but it was always dark in there, so they had to make do with a table in the near-focus X-ray unit. It was here they dealt with their daily problems and wrote out their case histories. As if it wasn't enough to have to spend years working in the nauseating X-ray filled air, with its peculiar smell and heat, they had to do their writing in it too.

They came in and sat down beside each other at the large, rough-surfaced table that had no drawers. Vera Kornilyevna flipped through the inpatients' cards, the women's and the men's, dividing them into cases she would deal with herself and cases they would have to decide about together. Ludmila Afanasyevna looked gloomily down at the table, tapping it with her pencil. Her lower lip stuck out slightly.

Vera Kornilyevna looked at her sympathetically, but could not make up her mind to speak either about Rusanov and Kostoglotov or about the lot of doctors in general, because there was no sense in repeating what they all knew. She would have to be subtle and choose her words carefully, otherwise she might hurt her instead of consoling her.

Ludmila Afanasyevna spoke. “It's infuriating, isn't it, how powerless we are?” (This could be said of many of the patients examined that day.) She started tapping her pencil again. “Of course, there's been no mistake on our side.” (This could apply to either Azovkin or Mursalimov.) “We were a bit out in one of our diagnoses, but we gave the right treatment. We couldn't have given a smaller dose. It was that barrel that finished us.”

Ah yes, she was thinking about Sibgatov. There are some thankless cases on which you spend three times your usual ingenuity and still can't save the patient. When Sibgatov was first carried in on a stretcher the X rays showed destruction of almost the entire sacrum. The error had been in establishing a bone sarcoma, even though they had consulted a professor. Only later did it gradually emerge that the trouble was caused by a large-celled tumor, which makes fluid appear in the bone and transforms it into a jelly-like tissue. Still, the treatment in both cases was the same.

The sacrum cannot be removed or sawn out. It is the cornerstone of the body. The only thing left was X-ray therapy, which had to be immediate and in large doses. Small ones would not be any good. And Sibgatov got better! The sacrum strengthened. He recovered, but the doses he'd been given were large enough for a horse, and the surrounding tissue became excessively sensitive, developing a tendency to form new malignant tumors. Now his blood and tissue were refusing to respond to radiotherapy, a new tumor was raging and nothing could be done to defeat it. It could only be contained.

For the doctor this meant a sense of helplessness, a feeling that the methods used were not yet effective. And heartfelt pity, simple, ordinary pity. There was Sibgatov, a gentle, well-mannered, mournful Tartar, so ready with his gratitude, and all that could be done for him was to prolong his suffering.