Cancer Ward (13 page)

“Absolutely essential.”

“But I don't want it.”

“Why on earth not?”

“In the first place, it's unnatural. If I need grape sugar, give it to me through the mouth! Why this twentieth-century gimmick? Why should every medicine be given by injection? You don't see anything similar in nature or among animals, do you? In a hundred years' time they'll laugh at us and call us savages. And then, the way they give injections! One nurse gets it right first time, another punctures your … your ulnary flexion to bits. I just don't want it. And now I see you're getting ready to give me blood transfusions.…”

“You ought to be delighted! Somebody's willing to give their blood for you. That means health, life!”

“But I don't want it! They gave a Chechen here a transfusion in front of me once. Afterwards he was in convulsions on his bed for three hours. They said, ‘Incomplete compatibility'! Then they gave someone else blood and missed the vein. A great lump came up on his arm. Now it's compresses and vapor baths for a whole month. I don't want it.”

“But substantial X-ray treatment is impossible without transfusion!”

“Then don't give it! Why do you assume you have the right to decide for someone else? Don't you agree it's a terrifying right, one that rarely leads to good? You should be careful. No one's entitled to it, not even doctors.”

“But doctors
are
entitled to that right—doctors above all,” exclaimed Dontsova with deep conviction. By now she was really angry. “Without that right there'd be no such thing as medicine!”

“And look what it leads to. You're going to deliver a lecture on radiation sickness soon, aren't you?”

“How do you know that?” Ludmila Afanasyevna was quite astonished.

“Well, it wasn't very difficult. I assumed…”

(It was quite simple. He had seen a thick folder of typescript lying on her table. Although the title was upside down, he had managed to read it during the conversation and had understood its meaning.)

“… Or rather I guessed. There is a new name, radiation sickness, which means there must be lectures about it. But you see, twenty years ago you irradiated some old Kostoglotov in spite of his protests that he was afraid of the treatment, and you reassured him that everything was all right, because you didn't know then that radiation sickness existed. It's the same with me today. I don't know yet what I'm supposed to be afraid of. I just want you to let me go. I want to recover under my own resources. Then maybe I'll just get better. Isn't that right?”

Doctors have one sacred principle: the patient must never be frightened, he must be encouraged. But with a patient as importunate as Kostoglotov exactly the reverse tactics were required—shock.

“Better? No,
you won't get better!
Let me assure you”—her four fingers slammed the table like a whisk swatting a fly—“that you won't. You are going—” she paused to measure the blow—“
to die
!”

She looked at him to see him flinch. But he merely fell silent.

“You'll be exactly like Azovkin—and you've seen the condition he's in. Well, you've got the same disease as him in an almost identical state of neglect. We're saving Ahmadjan because we began to give him radiotherapy immediately after his operation. But with you we've lost two years, can you imagine it? There should have been another operation straight away on the lymph node, next to the one they operated on, but they let it go, do you see, and the secondaries just flowed on! Your tumor is one of the most dangerous kinds of cancer. It is very rapid to develop and acutely malignant, which means secondaries appear very quickly too. Not long ago its mortality rate was reckoned at 95 per cent. Does that satisfy you? Look, I'll show you…”

She dragged a folder out of a pile and began to rummage through it.

Kostoglotov was silent. Then he spoke up, but quietly, without any of the self-confidence he had shown a few minutes earlier.

“To be frank, I'm not much of a clinger to life. It's not only that there's none ahead of me, there's none behind me either. If I had a chance of six months of life, I'd want to live them to the full. But I can't make plans for ten or twenty years ahead. Extra treatment means extra torment. There'll be radiation sickness, vomiting … what's the point?”

“Ah yes, I've found it! Here are our statistics.” And she turned toward him a double page taken from an exercise book. Right across the top of the sheet was written the name of his type of tumor. Then on the left-hand side was a heading, “Already dead,” and on the right, “Still alive.” There were three columns of names, written in at different times, some in pencil, some in ink. On the left there were no corrections, but on the right, crossings out, crossings out, crossings out.… “This is what we do. When a patient's discharged, we write his name in the right-hand list and then transfer him to the left-hand one.… Still, there are some lucky ones who've stayed in the right-hand one. Do you see?”

She gave him another moment to look at the list and to think about it.

“You
think
you're cured.” She returned to the attack with vigor. “You're as ill as you ever were. You're no different than when you were admitted. The only thing that's been made clear is that your tumor
can
be fought, that all is not lost yet. And this is the moment you choose to announce you're leaving! All right, go! Get your discharge today! I'll arrange it for you now. And then I'll put your name down on the list—‘Still alive.'”

He was silent.

“Come on, make up your mind!”

“Ludmila Afanasyevna”—Kostoglotov was ready for a compromise—“Look, if what's needed is a reasonable number of sessions, say, five or ten…”

“Not five or ten! Either no sessions at all or else as many as are necessary! That means, from today, two sessions daily instead of one, and all the requisite treatment. And no smoking! And one more essential condition: you must accept your treatment not just with faith but with
joy!
That's the only way you'll ever recover!”

He lowered his head. Part of today's bargaining with the doctors had been in anticipation, He had been dreading that they were going to propose another operation, but they hadn't. X-ray treatment was tolerable, it wasn't too bad.

Kostoglotov had something in reserve—a secret medicine, a mandrake root from Issyk Kul. There was a motive behind his wish to go back to his place in the woodlands—he wanted to treat himself with the root. Because he had the root, he'd really only come to the cancer clinic to see what it was like.

Dr. Dontsova saw she had won the battle and could afford to be magnanimous.

“All right then, I won't give you glucose. You can have another injection instead, an intramuscular one.”

Kostoglotov smiled. “I see I'm going to have to give way.”

“And please, see if you can hurry up that letter from Omsk.”

As he left the room it seemed to him that he was walking between two eternities, on one side a list of the living, with its inevitable crossings out, on the other—
eternal
exile. Eternal as the stars, as, the galaxies.

7. The Right to Treat

The strange thing is that if Kostoglotov had persevered with his questions—What sort of injection was it? What was its purpose? Was it really necessary and morally justified?—if he had forced Ludmila Afanasyevna to explain the workings and the possible consequences of the new treatment, then very possibly he would have rebelled once and for all.

But precisely at this point, having exhausted all his brilliant arguments, he had capitulated.

She had been deliberately cunning, she had mentioned the injection as something quite insignificant because she was tired of all this explaining. Also, she knew for sure that this was the moment, after the action of the X rays in their pure state had been tested on the patient, to deal the tumor yet another crucial blow. It was a treatment highly recommended for this particular type of cancer by the most up-to-date authorities. Now that she anticipated the amazing success that attended Kostoglotov's treatment, she could not possibly weaken before his obstinacy or neglect to attack him with all the weapons she believed in. True, there were no slides available with sections of his primary, but all her intuition, her powers of observation and her memory suggested to her that the tumor was the kind she suspected—not a teratoma, not a sarcoma.…

It was on this very type of tumor with precisely these secondaries that Dr. Dontsova was writing her doctoral thesis. In fact she was not writing it full-time, she had begun it sometime in the past, dropped it and added a bit more from time to time. Her teacher, Dr. Oreshchenkov, and her friends tried to convince her it would come out splendidly, but she was always harried and oppressed by circumstances and could no longer foresee a time when she'd be in a position to present it. This wasn't through any lack of experience or material; on the contrary, there was too much of both. Every day they would call her either to the X-ray screen or to the laboratory or to someone's bedside; to combine this with hours of selecting and describing X-ray photographs, with formulations and systematization, let alone with passing the preliminary exams, was beyond human strength.

She could have obtained a six-month sabbatical for research, but there was never a day when her patients were doing quite well enough or when her training sessions with the three young interns could be cut short, so that she could go off for half a year.

Ludmila Afanasyevna believed it was Leo Tolstoy who had said about his brother, he had all the abilities but none of the defects of a real writer. Perhaps she didn't have the defects of a Ph.D. either. She had no particular desire to hear people whisper as she passed, “She's not an ordinary doctor, she's a doctor of philosophy, she's Dontsova,” nor to see those tiny, but so weighty, initials added at the head of her articles (more than a dozen of them had already been published, all short but to the point). True, a little extra money never came amiss. But if the thing wasn't going to come off, it just wasn't going to.

When it came to what is called day-to-day scientific work, she had enough to do without the thesis. In their hospital they had conferences on clinical anatomy, analyzing mistaken diagnoses and treatment, and reporting on new methods. Attendance and active participation in these were essential. (Of course the radiotherapists and surgeons in any case consulted daily to sort out mistakes and decide on new methods—but the conferences were a thing apart.) In town too there was a scientific society of X-ray specialists which held lectures and demonstrations. In addition to this, a society of oncologists had recently been started. Dontsova was not only a member but secretary too, and as in all new ventures things were pretty hectic. And then there was the Institute for Advanced Medical Training, and there was correspondence with the
Radiologists' Journal
and the
Oncological Journal
and the Academy of Medical Science and the information center. And so it appeared that although “Big Science” seemed to be confined to Moscow and Leningrad, while out here they simply carried on treating people, nonetheless there was rarely a day devoted just to treatment without bothering about science.

Today had been typical. She had had to call the president of the Radiological Society about her forthcoming lecture. Then she'd had to glance through two short articles in a journal, reply to a letter from Moscow, and to another from a cancer clinic out in the wilds asking for clarification. In a few minutes the senior surgeon, after finishing her day's work in the theater, was due to bring Dontsova one of her gynecological patients for consultation. And then, toward the end of the outpatients' surgery, she had to take one of her interns to see the patient from Tashauz with a suspected tumor of the small intestine. Later on today there was a meeting she had arranged herself with the X-ray laboratory workers to discuss more efficient use of their apparatus: the idea was to process more patients. And Rusanov's embiquine injection had to be kept in mind, too. She'd have to go up and see him. They had only just started treating patients in his condition: up till then they had sent them on to Moscow.

She'd lost a lot of time in that nonsensical wrangle with pigheaded Kostoglotov—an indulgence on her part from a methodical point of view. The technicians in charge of refitting the gamma apparatus had twice peered round the door while they'd been talking. They wanted to show Dontsova that certain work not foreseen in the estimates was now necessary, and to get her to sign a chit for it and to try to square the senior doctor. Now they had finally collared her and were taking her there, but in the corridor on the way a nurse gave her a telegram. It was from Novocherkassk, from Anna Zatsyrko. They hadn't seen each other or written for fifteen years, but she was her dear friend of the old days when they had studied midwifery together in Saratov in 1924, before she went to medical college. Anna's telegram said her eldest son Vadim would be coming to the clinic that day or the next, He had fallen ill on a geological expedition. Would Ludmila Afanasyevna give him friendly attention and write explaining frankly what was wrong with him? Upset by this, she left the technicians and went to ask the matron to reserve Azovkin's bed for Vadim Zatsyrko till the end of the day. Mita, the matron, was as always dashing around the clinic and it wasn't easy to find her. When at last she was found and had promised Vadim a bed, she presented Ludmila Afanasyevna with a new problem: the best nurse in the radiotherapy department, Olympiada Vladislavovna, had been requested for a ten-day seminar of trade union treasurers in town. For those ten days a replacement would have to be found. This was so impossible and impermissible that Mita and Dontsova strode there and then through room after room to the registrar's office to telephone the Party district committee and get it canceled. But the telephone was engaged first at their end, then at the other, and when they got through they were passed on and told to ring the union's area committee, who were absolutely astonished at the doctors' political irresponsibility—did they really suppose trade union finances could be left to run themselves? Clearly neither the Party committee members nor the union committee members, nor their relatives had yet been bitten by a tumor, nor did they expect to be. Ludmila Afanasyevna took the opportunity to ring the Radiological Society, then rushed off to ask the senior doctor to intercede; but he had some outsiders with him and was discussing the most economical way of repairing one wing of the building. So it was all left in the air, and she passed through the X-ray diagnosis department, where she had no work that day, on the way to her own room. The people in the department were taking a break, writing up their results by the light of a red lamp. They reported there and then to Ludmila Afanasyevna that they'd counted the reserves of film and that at the present rate of consumption there was enough for only three more weeks. This meant an emergency, because orders for film were never filled in less than a month. Dontsova realized that either that day or the next she'd have to arrange a meeting between the pharmacist and the senior doctor (not an easy thing to do) and get them to send off an order.