Cancer Ward (10 page)

This morning Nizamutdin Bahramovich had summoned Dontsova for a special reason: to increase the turnover of beds. In all doubtful cases, where there was no assurance of improvement, the patient was to be discharged. Dontsova agreed with this. There was a constant line of applicants for admission sitting in the waiting room, sometimes for days on end, and requests were always coming in from provincial cancer clinics asking permission to send patients. She agreed in principle; and there was no one who came so obviously within this category as Sibgatov. But she was incapable of discharging him. The struggle for this single sacrum had been too long and too exhausting. At this point she could not yield to a simple, reasonable suggestion or give up going through the motions, however faint the hope was that death, not the doctor, would be the one to make an error. Sibgatov had even caused a change in Dontsova's scientific interest. She had become absorbed in the pathology of bones for one reason only—to save him. There might well be patients waiting with equally pressing claims, but even so she couldn't let go of Sibgatov. She was ready to use all her cunning with the senior doctor to protect him.

Nizamutdin Bahramovich insisted too on discharging those who were doomed. So far as possible, their deaths should occur outside the clinic. This would increase the turnover of beds, it would also be less depressing for those who remained and it would help the statistics, because the patients discharged would be listed not as “deaths” but as “deteriorations.”

Azovkin fell into this category and was to be discharged today. Over the months his case history had become a thick book made of sheets of coarse brown paper all stuck together. In the paper were tiny, whitish flecks of wood that made the pen stick as lines and figures were entered in violet and blue ink. Behind this sheaf of papers both doctors saw a town-raised boy, sweating with pain, sitting doubled up on his bed. However quietly and softly the figures were read out, they were more inexorable than the thunderings of a court-martial, and against them there was no appeal. There were 26,000 rads in him, of which 12,000 were from his last series; he'd had fifty injections of Sinestrol, seven blood transfusions, in spite of which there were still only 3,400 white corpuscles, and as for the red … The secondaries were tearing his defenses to pieces like tanks, they were hardening the thoracic wall and appearing in the lungs, inflaming the nodes over the collarbones. The organism was providing no reinforcements, nothing to stop their advance.

The doctors were still flipping through the cards, finishing those they had earlier laid aside. An X-ray laboratory nurse continued treating the outpatients. Just now she had a four-year-old girl in a little blue dress in there with her mother. The girl's face was covered with red vascular swellings; they were still small and nonmalignant, but it was normal to treat these with radiotherapy to stop them degenerating into malignancy. The little girl herself couldn't care less. She had no idea that on her tiny lip she might already be bearing the heavy mask of death. It was not the first time she'd been there, and she'd lost her fear. She chattered like a bird, stretching out her hands to the nickel-plated parts of the apparatus and enjoying the shiny world around her. Her whole session took only three minutes, but she had no desire at all to spend them sitting motionless under the narrow tube precisely pointed at the sore places. She kept extricating herself and turning away. The X-ray technician grew nervous, switched off the current and re-aimed the tube at her again and again. Her mother held out a toy to attract her attention and promised her more presents if she would only sit still.

Then a gloomy old woman came in and spent ages unwinding her scarf and taking off her jacket. She was followed by a woman inpatient wearing a gray dressing gown, with a little spherical pigmented tumor on the sole of her foot. All that had happened was that a nail in her shoe had pricked her. She was talking merrily away to the nurse, little realizing that this tiny ball no more than a centimeter wide was the very queen of malignant tumors, a melanoblastoma. Whether they liked it or not, the doctors had to spend time on these patients as well. They examined them and advised the nurse. And so by now it was long past the time when Vera Kornilyevna was supposed to give Rusanov his embiquine injection. She took out the last card and laid it in front of Ludmila Afanasyevna. It was one she'd been purposely holding back—Kostoglotov's.

“It's an appallingly neglected case,” she said, “but our treatment has got off to a brilliant start. Only he's a very obstinate man. I'm afraid he really may refuse to go on with it.”

“Just let him try.” Ludmila Afanasyevna brought her hand down on the table. “Kostoglotov's disease is the same as Azovkin's. The only difference is that his treatment seems to be working. How dare he refuse it?”

“He won't dare with you,” Gangart at once agreed, “but I'm not sure I can outdo him in obstinacy. Can I send him to see you?” She was scratching off some bits of fluff that had stuck to her fingernail. “Our relations are a bit difficult at the moment … I can't seem to manage to speak to him with any authority—I don't know why.”

Their relations had been difficult ever since the first time they met.

*   *   *

It was an overcast January day and the rain was pouring down. Gangart had just begun her night as doctor on duty in the clinic. At about nine o'clock the fat, healthy-looking main-floor orderly came to see her with a complaint. “Doctor, one of the patients is making a scene. I can't cope with him on my own. If something isn't done they'll all be round our necks.”

Vera Kornilyevna went outside and saw there was a man lying on the floor right by the locked door of the matron's dark little office by the main staircase. He was a lanky fellow dressed in a pair of high boots, a soldier's faded greatcoat and a civilian fur hat with earflaps. It was too small for him, but he'd managed to pull it on. There was a duffel bag under his head, and he was evidently about to go to sleep. Gangart walked right up to him, her well-shaped legs tapering down to a pair of high-heeled shoes (she never dressed carelessly), and looked at him severely, trying to shame him with her stare and make him get up. But although he saw her, he looked back at her quite unconcernedly. He didn't move an inch, in fact it looked as if he'd even closed his eyes.

“Who are you?” she asked him.

“A human being,” he answered quietly, unperturbed.

“Do you have an admission card?”

“Yes.”

“When did you get it?”

“Today.”

The marks on the floor beside him showed that his coat must be wet through. So must his boots and his duffel bag.

“Well, you can't lie here. It's … it's not allowed. Besides, it's not seemly…”

“It's seemly enough,” he answered faintly. “This is my country. Why should I be ashamed?”

Vera Kornilyevna was confused. She felt she couldn't possibly shout at him and order him to get up. And anyway, it wouldn't have any effect.

She cast a look in the direction of the waiting room. During the day it was crowded with visitors and people waiting. There were usually three garden benches for relatives to use as they talked to patients. But at night, when the clinic was locked up, people who had come a long way and had nowhere to go were put up in there. There were only two benches in there at the moment. An old woman was lying on one of them, and a young Uzbek woman in a colorful scarf had laid her child on the other and was sitting beside it.

She could permit him to lie on the waiting-room floor, but it was covered with mud from all the shoes that had trodden on it, and on this side of the glass everything had been sterilized and anyone who came here had to wear hospital dress or white coats.

Once again Vera Kornilyevna glanced at this wild-looking patient. His sharp, emaciated face already registered the indifference of death.

“There's no one in town you can go to?”

“No.”

“Have you tried the hotels?”

“Yes, I've tried.” He was tired by now of answering her.

“There are five hotels here.”

“They wouldn't even listen to me.” He closed his eyes, as if to indicate that the audience was over.

If only he'd come earlier, thought Gangart. “Some of our nurses let patients stay the night at their homes. They don't charge much.”

He lay there with his eyes closed.

“He says, ‘I don't mind if I have to lie here a week,'” the duty orderly went into the attack. “Right in everybody's way! ‘Until they give me a bed,' he says! It's disgraceful! Get up, stop playing the fool! This floor's been
sterilized!
” The orderly advanced upon him.

“Why are there only two benches? Wasn't there a third?” said Gangart with surprise in her voice.

“There—they moved the third one over there.” The orderly pointed through the glass door.

It was true. One bench had been taken into the corridor leading to the apparatus room. It was now used for the outpatients to sit on when they came for their sessions during the day.

Vera Kornilyevna told the orderly to unlock the door to the corridor. She said to the sick man, “I'll move you somewhere more comfortable. Please get up.”

He looked at her, suspiciously at first. Then, tormented and twitching with pain, he started to rise to his feet. It was obvious that every movement, every turn of his body, was an effort He got up, but left his duffel bag lying on the floor; it would be too painful for him to bend down and pick it up now.

Vera Kornilyevna bent down easily. With her white fingers she picked up the dirty, soaking-wet duffel bag and gave it to him.

“Thank you.” He gave her a crooked smile. “Things have come to a pretty pass…”

There was a damp, oblong stain on the floor where he had been lying.

“You've been in the rain?” She gazed at him sympathetically. “Take off your coat. It's warm in there in the corridor. You aren't feverish? You don't have a temperature?” His forehead was completely covered by the wretched tight black hat, its fur flaps hanging, so she laid her fingers on his cheek instead.

One touch was enough to tell her that he did have a temperature.

“Are you taking anything?”

The look he gave her was rather different this time. It did not express such utter alienation.

“Analgin.”

“Have you any?”

“Um-m.”

“Shall I bring you some sleeping pills?”

“If you can.”

“Oh yes.” She remembered suddenly. “Can I see your admission card?”

Perhaps he smiled, or perhaps his lips moved in obedience to some spasm of pain. “If I don't have the paper, it's back out into the rain, is that it?” He undid the top hooks on his greatcoat and pulled the card from the pocket of the army shirt that showed underneath. It actually had been issued that morning in the outpatients' department. She looked at it: he was one of her patients, a radiotherapy patient. She took the card and went off to get the sleeping pills. “I'll go and get them now. Come and lie down.”

“Wait a minute, wait a minute.” He suddenly came to life. “Give me back that paper. I know these tricks.”

“What are you afraid of?” She turned round, offended. “Don't you trust me?”

He looked at her doubtfully and grunted, “Why should I trust you? You and I haven't drunk from the same bowl of soup.…” He went and lay down.

Suddenly she was annoyed. She didn't come back to see him, instead she sent an orderly with the sleeping pills and the admission card. She wrote “urgent” at the top of the card, underlined it and put an exclamation mark.

It was night when next she came past him. He was asleep. The bench was quite good for sleeping on, he couldn't fall off it. The curved back formed a half-trough with the curve of the seat. He had taken off his wet coat, but he'd spread it out on top of him, one side over his legs and the other over his shoulders. The soles of his boots hung over the edge of the bench. There wasn't a single sound inch on them. They were patched all over with bits of black and red leather. There were metal caps on the toes and small horseshoes on the heels.

In the morning Vera Kornilyevna mentioned him to the matron, who then put him on the upper landing.

*   *   *

After that first day Kostoglotov had never been rude to Gangart again. When he spoke to her it was politely and in his normal urbane manner. He was the first to say good morning, and would even greet her with a friendly smile. But she always had the feeling that he might do something a bit strange.

And sure enough, the day before yesterday she'd summoned him for a test to determine his blood group. She prepared an empty syringe to take blood from his vein, and immediately he rolled down his sleeve again and announced firmly, “I'm very sorry, Vera Kornilyevna, but you'll have to get along without the sample.”

“For goodness' sake, why?”

“They've drunk enough of my blood already. I don't want to give any more. Someone else can give it, someone who's got plenty of blood.”

“You ought to be ashamed of yourself! You're a man, aren't you?” She looked at him with that well-known feminine mockery that men cannot endure. “I'll only take three cubic centimeters.”

“Three! Cc.'s? What do you need it for?”

“We'll determine your blood group with a compatibility reaction, and if we have the right kind of blood we'll give you 250 cc.'s.”

“Me? Blood transfusion? God forbid! What do I need someone else's blood for? I don't want anyone else's and I'm not giving a drop of my own. Make a note of my blood group. I remember it from the war, when I was at the front.”

And nothing she said would change his mind. He refused to give way, finding new and unexpected arguments. He was convinced it was all a waste of time.