Cancer Ward (65 page)

“I'd be a fine one if I turned down my own students,” Oreshchenkov replied, looking at her steadily. Dontsova couldn't see him very well at the moment, but for the last two years she'd noticed a certain gleam of detachment in his unswerving gaze. It had appeared after the death of his wife. “But if you have to … take sick leave for a bit, will Verochka take your place?”

(Take sick leave! He had chosen the mildest term of all! Did it mean, did it mean there was nothing wrong with her?)

“Yes, she will. She's a mature specialist now, she's quite capable of running the department.”

Oreshchenkov nodded. He gripped his narrow beard. “Yes,” he said, “she may be a mature specialist, but what about her getting married?”

Dontsova shook her head.

“My granddaughter's like that too,” Oreshchenkov went on, his voice dropping to a whisper, quite unnecessarily. “She can't find anyone right for her. It's a difficult business.”

The angles of his eyebrows shifted slightly to register his concern.

He made a point of insisting there should be no delay. He would examine Dontsova on Monday.

(Why was he in such a hurry?…)

Then came the pause when, presumably, it was time for her to say “Thank you” and take her leave. She stood up, but Oreshchenkov insisted she take a glass of tea with him.

“Really, I don't want any tea,” Ludmila Afanasyevna told him.

“Well, I do. It's just time for my tea.” He was making a determined effort to pull her out of the category of the criminally ill into the category of the hopelessly healthy.

“Are your young people at home?” she asked him.

The young people were the same age as Ludmila Afanasyevna.

“No, they're not. My granddaughter isn't here either. I'm on my own.”

(Still, it was in his consulting room that he had received her as a doctor. It was only here that he could impress her with the true significance of what he said.)

“Are you going to play the hostess for me, then?” she said. “Because I won't let you.”

“No, there's no need for that. I've got a full thermos. There are some cakes and plates for them in the cupboard; you can get them if you like.”

They moved into the dining room and sat down to drink their tea at one corner of a square oak table, big enough for an elephant to dance on and much too big to be got through any of the doors. The wall clock, not in its first youth, showed that it was still quite early.

Dormidont Tikhonovich began to talk about his granddaughter, who was his favorite. She had recently finished a course at the Conservatoire. She played charmingly and she was both intelligent (a rarity among musicians) and attractive. He showed Ludmila Afanasyevna a new photo of her, but he didn't talk about her excessively, he didn't insist on Ludmila Afanasyevna giving his granddaughter her undivided attention—not that she could have given her undivided attention to anything; it had been smashed to pieces now and would never be put together again. How odd it was to be sitting here, carefree, drinking tea with someone who already knew the extent of the danger and could probably foresee how the illness would develop. Yet there he sat, and not one word would he utter. All he did was to pass the cookies.

She had someone to talk about too, not her divorced daughter—that was much too painful a subject—but her son. Having finished his eighth year in school, he had announced that he had come to the conclusion that he saw no point in further study. Neither his father nor his mother could find a single argument to sway him; arguments just bounced off his head. “You have to have an education!”—“Why should I?”—“Education and culture are the most important things in life.”—“The most important thing in life is to have a good time.”—“But you'll never get a decent job without education.”—“I don't need one.”—“You mean you're happy to be an ordinary laborer?”—“No, you won't catch me working like a donkey.”—“Well, what will you live on, then?”—“I'll always find something. You only have to know what's what.” He had fallen in with some very suspicious characters and Ludmila Afansyevna was worried.

The expression on Oreshchenkov's face indicated that he heard stories like this before. He said, “You know, one of the problems is that our young people have lost one of their most important preceptors—the family doctor! Girls of fourteen and boys of sixteen need to have a doctor to talk to—not in a classroom forty at a time (though they don't even have that these days), and not in the school surgery either, with people coming in at three-minute intervals. It had to be the same ‘uncle' who examined their throats when they were little children and came to tea at their house. Now what if this kind, stern, impartial ‘uncle' of a doctor, who never gives in to your temper or wheedlings as parents do, were suddenly to take the youngster into his surgery, lock the door and gently start an obscure sort of conversation, both embarrassing and interesting, and then, without any prompting, were to guess all his or her most important and difficult questions and answer them himself? And what if he invited them back for another talk? Surely this would not only guard them against making mistakes, against giving in to bad urges, against harming their bodies? Mightn't it also cleanse and correct their whole view of the world? Once their chief anxieties and desires are understood, they will no longer imagine they're so hopelessly incomprehensible in other respects. From that moment on, they will find the arguments their parents produce much more impressive too.”

Ludmila Afanasyevna had herself prompted him to this discourse by telling the story of her son. Since her son's problems were still unsolved, she ought now to be listening to what Oreshchenkov said and thinking how best to apply it to the case. When he spoke it was in a full, pleasant voice which had not yet cracked with age. His eyes were bright and lively with meaning which added conviction to his words. But Dontsova noticed that as the minutes went by she was losing the blissful calm that had refreshed her in his consulting room armchair; there was an unpleasant dreary feeling rising in her chest, a sensation of something lost, of something being lost even as she listened to his well-thought-out speech, an urge to get up and run away, although she had no idea where to, why, or for what purpose.

“You're right,” she agreed. “We
have
neglected sex education.”

“We seem to think children ought to pick it all up for themselves like animals. And that's exactly how they do—like animals. We seem to think it's unnecessary to warn children against perversion, because we work from the assumption that in a healthy society they should all be normal. So they have to learn from one another, and what they learn is vague and distorted. In all other fields we regard it as essential that our children be guided. It's only in this field that guidance is considered ‘shameful.' That is why you sometimes meet grown women who have never experienced the full range of emotion, for the simple reason that the man didn't know how to treat her on their first night.”

“Hmm, yes,” said Dontsova.

“Yes indeed!” said Oreshchenkov firmly. He had noticed the momentary troubled, confused, impatient expression on Dontsova's face. But since she wasn't eager to know the nature of her disease, why keep going over the symptoms on Saturday night when she would only have to step behind an X-ray machine on Monday? It was his job to distract her by conversation, and what better topic could there be for doctors to talk about? “Generally speaking,” he remarked, “the family doctor is the most comforting figure in our lives, and now he's being pulled up by the roots. The family doctor is a figure without whom the family cannot exist in a developed society. He knows the needs of each member of the family, just as the mother knows their tastes. There's no shame in taking to him some trivial complaint you'd never take to the outpatients' clinic, which entails getting an appointment card and waiting your turn, and where there's a quota of nine patients an hour. And yet all neglected illnesses arise out of these trifling complaints. How many adult human beings are there, now, at this minute, rushing about in mute panic wishing they could find a doctor, the kind of person to whom they can pour out the fears they have deeply concealed or even found shameful? Looking for the right doctor is the sort of thing you can't always ask your friends for advice about. You can't advertise for one in a newspaper either. In fact, it's a matter as essentially intimate as a search for a husband or a wife. But nowadays it's easier to find a good wife than a doctor ready to look after you personally for as long as you want, and who understands you fully and truly.”

Ludmila Afanasyevna frowned. These were abstract ideas. Meanwhile her head was whirling with more and more symptoms arranging themselves in the worst possible pattern.

“That's all very well, but how many family doctors would you need? It simply doesn't fit into the system of a free universal national health service.”

“It'll fit into a universal national health service, but it won't fit into a free health service,” said Oreshchenkov, rumbling on and clinging confidently to his point.

“But it's our greatest achievement, the fact that it's a free service.”

“Is this in fact such a great achievement? What does ‘free' mean? The doctors don't work for nothing, you know. It only means that they're paid out of the national budget and the budget is supported by patients. It isn't free treatment, it's depersonalized treatment. If a patient kept the money that pays for his treatments, he would have turned the ten roubles he has to spend at the doctor's over and over in his hands. He could go to the doctor five times over if he really needed to.”

“But he wouldn't be able to afford it?”

“He would say, ‘To hell with the new drapes and spare pair of shoes. What's the use of them if I'm not healthy?' Is it any better as things are now? You would be ready to pay goodness knows how much for a decent reception at the doctor's, but there's no one to go to get it. They all have their schedules and their quotas, and so it's ‘Next patient, please.' As for the clinics that do charge fees, the turnover's even faster than in the others. Why do people go there? Because they want a chit or certificate or sick leave or an invalid's pension card. The doctor's job there is to catch the malingerers; patients and doctors are like enemies. Do you call that medicine? Or take actual drugs and medicine, for instance. In the twenties all medicines were free. Do you remember?”

“Is that right? Yes, I think they were. One forgets.”

“You'd really forgotten, have you? They were all free of charge, but we had to give it up. Do you know why?”

“I suppose it must have been too expensive for the government,” said Dontsova with an effort, closing her eyes for a short while.

“It wasn't only that, it was also that it was extremely wasteful. The patient was bound to grab all the drugs he could since they cost him nothing and the result was he threw half of them away. Of course I'm not saying all treatments should be paid for by the patient. It's the primary treatment that ought to be. After a patient has been directed to enter hospital or undergo treatment that involves complicated apparatus, then it's only fair it should be free. But even so, take any clinic: why do two surgeons do the operations while the other three just gape at them? Because they get their salaries come what may, so why worry? If they got their money from the patients, nobody would ever consult them. Then your Halmuhamedov and your Pantyokhina would be running round in circles, wouldn't they? One way or the other, Ludochka, the doctor should
depend
on the impression he makes on his patients, he should be dependent on his popularity. Nowadays he isn't.”

“God help us if we had to depend on every single patient, that scandalmonger Polina Zavodchikova, for instance…”

“No, we should depend on her as well.”

“That's sheer humiliation!”

“Is it any worse than depending on the senior doctor? Is it any less honest than drawing a government salary like some bureaucratic civil servant?”

“But some of these patients dig down into every detail—Rabinovich and Kostoglotov, for example. They wear you out asking theoretical questions. Are we supposed to answer every single one?”

Not a crease furrowed Oreshchenkov's high forehead. He had always known Ludmila Dontsova's limitations: they were not narrow, either. She was quite capable of considering and treating the trickiest cases, all on her own as well. The two hundred or so unassuming little items she had published in medical journals were examples of the most difficult type of diagnosis, which was the most difficult aspect of medicine. Why should he expect any more of her?

“That's right,” he said, “you must answer every single one.”

“Well, where do we find the time?” objected Dontsova indignantly, warming up to the argument. It was all very well for him, walking up and down the room in his slippers. “Have you any idea what the pace of work is like at medical institutions nowadays? It was different in your day. Just think how many patients there are for every doctor.”

“With the right kind of primary system,” Oreshchenkov countered, “there'd be fewer cases altogether, and no neglected ones. The primary doctor should have no more patients than his memory and personal knowledge can cover. Then he could treat each patient as a subject on his own. Treating diseases separately is work on the
feldsher
*
level.”

“Oh dear!” sighed Dontsova wearily. As if there was any chance of their private conversation changing or reforming anything of consequence! “It's a frightening thought, treating each patient as a subject on his own.”

Oreshchenkov too sensed that it was time he stopped. Verbosity was a vice he had developed in his old age.