Cancer Ward (7 page)

4. The Patients' Worries

For the surgical cases, whose tumors were to be arrested by an operation, there was not enough room in the wards on the lower floor. They were put upstairs with the “X-ray” patients, those prescribed radiotherapy or chemical treatment. For this reason there were two different rounds upstairs every morning, one for the radiotherapists, one for the surgeons.

The fourth of February was a Friday, operation day, when the surgeons did not make their rounds. So Vera Kornilyevna Gangart, the radiotherapist on duty, did not start her rounds immediately after the five-minute briefing. She just glanced inside as she passed the door of the men's ward.

Dr. Gangart was shapely and not tall. Her shapeliness was emphasized by her narrow waist, to which all the contours of her body seemed to point. Her hair, gathered in an unfashionable bun on the back of her head, was lighter than black but darker than dark-brown.

Ahmadjan caught sight of her and nodded to her happily. Kostoglotov also had time to raise his head from his large book and bow to her from afar. She smiled to both of them and raised one finger, as if to warn her children to sit quietly while she was away. Then she moved from the doorway and was gone.

Today she was to go round the wards not alone but with Ludmila Afanasyevna Dontsova, who was in charge of the radiotherapy department. But Ludmila Afanasyevna had been called in to see Nizamutdin Bahramovich, the senior doctor, and he was holding her up.

Dontsova would only sacrifice her X-ray diagnostic sessions on the days she did her rounds, once a week. Usually she would spend those two first morning hours, the best of the day, when the eye is at its sharpest and the mind at its clearest, sitting with the intern assigned to her in front of the screen. She saw this as the most complicated part of her work, and after more than twenty years of it, had realized what a high price has to be paid in particular for diagnostic mistakes. In her department there were three doctors, all young women. To ensure that they all became equally experienced and that none of them lagged behind in diagnostic skill, Dontsova changed them round every three months. They worked either in the outpatients' department or in the X-ray diagnosis room or as house physician in the clinic.

Dr. Gangart was at present assigned to the third task. The most important, dangerous and little-researched part of it was to check that the radiation doses were correct. There was no formula for calculating the right intensity of a dose, for knowing how much would be most lethal for an individual tumor yet least harmful to the rest of the body. There was no formula but there was a certain experience, a certain intuition, which could be correlated with the condition of the patient. After all, this was an operation too—but by rays, in the dark and over a period of time. It was impossible to avoid damaging or destroying healthy cells.

As for the rest of her duties, the house physician needed only to be methodical; arrange tests on time, check them and make notes on thirty case histories. No doctor likes filling out forms, but Vera Kornilyevna put up with it because for these three months they became
her
patients, not pale mergings of light and shade on a screen but her own permanent, living charges who trusted her and waited on the encouragement of her voice and the comfort of her glance. And when the time came to give up her stint as house physician, she was always sorry to say goodbye to the ones she had not had the time to cure.

Olympiada Vladislavovna, the nurse on duty, was an elderly, grayish-haired, portly woman who looked more imposing than some of the doctors. She had just gone round the wards telling the radiotherapy patients to stay in their places. But in the large women's ward it was as though the patients had been waiting for exactly this announcement. One after the other, in their identical gray dressing gowns, they filed onto the landing and down the stairs: had the old boy come with the sour cream? Or the old woman with the milk? They would peer from the clinic porch through the theater windows (the lower halves were whitewashed, but through the upper halves they could see the nurses' and surgeons' caps and the bright overhead lamps) or they would wash their clothes in the sink or go and visit someone.

It was the shabby gray dressing gowns of rough cotton, so untidy-looking even when perfectly clean, as well as the fact that they were about to undergo surgery, that set these women apart, deprived them of their womanliness and their feminine charm. The dressing gowns had no cut whatever. They were all enormous, so that any woman, however fat, could easily wrap one around her. The drooping sleeves looked like wide, shapeless smokestacks. The men's pink and white striped jackets were much neater, but the women were never issued dresses, only those dressing gowns without buttons or buttonholes. Some of them shortened the dressing gowns, others lengthened them. They all had the same way of tightening the cotton belt to hide their nightdresses and of holding the flaps across their breasts. No woman suffering from disease and in such a drab dressing gown had a chance of gladdening anyone's eye, and they all knew it.

In the men's ward everyone except Rusanov waited for the rounds quietly and without much movement.

An old Uzbek called Mursalimov, a collective-farm watchman, was lying stretched out on his back on his neatly made bed. As usual, he wore his battered old skullcap. He must have been glad about one thing: his cough was not tearing him to pieces. He had folded his hands across his suffocating chest and was staring at one spot on the ceiling. The dark-bronze skin of his skull-like head was tightly stretched. The small bones of his nose, the jawbone and the sharp chinbone behind his pointed beard were all clearly visible. His ears had thinned and become no more than fiat pieces of cartilage. He had only to dry up a bit more and turn a little blacker and he'd be a mummy.

Next to him Egenberdiev, a middle-aged Kazakh shepherd, was not lying but sitting on his bed, legs crossed as though he was sitting on a rug at home. With the palms of his large, powerful hands he held his big, round knees. His taut, tough body was so tightly knit that if he sometimes swayed a little in spite of his immobility, it was like the swaying of a tower or a factory chimney. His back and shoulders stretched the pink and white jacket tight, and the cuffs on his muscular forearms were on the point of tearing, The small ulcer on his lip, the reason for his entering hospital, had been turned by the rays into a large, crimson scab that obstructed his mouth and made it hard for him to eat and drink. But he did not toss about, fidget or shout. He would eat everything on his plate steadily and without fail and then sit like that for hours quite peacefully, gazing into space.

Further down, in the bed by the door, sixteen-year-old Dyomka had his bad leg stretched out. He was continually stroking and lightly massaging the gnawing spot on his shin, his other leg folded up kitten-style, just reading, not noticing a thing. In fact, he read the whole time he was not sleeping or undergoing treatment. In the laboratory where they did all the analyses the senior lab assistant had a cupboard full of books. Dyomka was allowed to go there and change his books for himself without waiting for them to be changed for the whole ward. Now he was reading a thick magazine with a bluish cover,
*
not a new one but a tattered, faded copy. There were no new ones in the lab. girl's cupboard.

Proshka too had made his bed properly without hollows or wrinkles and was sitting quietly and patiently with his feet on the floor like a man in the best of health. In fact he
was
quite healthy. He had nothing to complain about in the ward. He had no external sign of disease, and there was a healthy tan on his cheeks. A smooth lock of hair lay across his forehead. He was a fit young man, fit enough even to go dancing.

Next to him Ahmadjan had found no one to play with, so he had placed a chessboard diagonally across his blanket and was playing checkers against himself.

Yefrem, his bandage encasing him like a suit of armor, his head immobilized, was no longer stomping along the corridor spreading gloom. Instead, he had propped himself up with two pillows and was completely absorbed in the book which Kostoglotov had forced upon him the day before. He was turning over its pages so slowly one might have thought he was dozing over it.

Azovkin was suffering exactly as he had been the day before. Quite probably he had not slept at all. His things were scattered over the window sill and the bedside table, and his bed was all rumpled. His forehead and temples were covered in perspiration, and his yellow face reflected the pain writhing inside him. Sometimes he stood on the floor, bent double, leaning his elbows against the bed. At other times he would seize his stomach in both hands and fold his whole body around them. For many days he had not even answered the questions people asked him. He said nothing about himself. He used his powers of speech only for begging extra medicine from the nurses and doctors. When people came from home to visit him, he would send them out to buy more of the medicines he had seen in the hospital.

Outside it was a gloomy, still, colorless day. Kostoglotov came back from his morning X ray and without asking Pavel Nikolayevich opened a small window above his head. The air he let in was damp but not cold.

Pavel Nikolayevich was afraid of his tumor catching cold. He wrapped up his neck and sat down by the wall. How dumb they all were, how submissive, wooden almost! Except for Azovkin, nobody really looked as if he was suffering. They were not really worthy of recovery. It must have been Gorky who said the only people worthy of freedom are those prepared to go out and fight for it every day. As for Pavel Nikolayevich, already that morning he had taken certain resolute steps. As soon as the registrar's office was open he had telephoned home and told his wife what he had decided during the night: applications were to made through all possible channels; he must be transferred to Moscow; he would not risk staying and dying in this place. Kapa knew how to get things done, she must already have set to work. Of course, it was sheer weakness—he shouldn't have been afraid of a tumor and stooped to taking a bed in a place like this. Nobody would ever believe it, but it was a fact that since three o'clock yesterday afternoon no one had even come to feel whether the tumor had grown bigger. Nobody had given him any medicine. Assassins in white coats—that was well said.
*
They'd just hung up a temperature chart for idiots to look at. The orderly hadn't even come in to make his bed. He had had to do it himself! My word, our medical institutions still need a great deal of smartening up!

At last the doctors appeared, but they still wouldn't enter the room. They stood over there for quite a while, on the other side of the door, round Sibgatov, who had bared his back and was showing it to them. (Meanwhile Kostoglotov had hidden his book under the mattress.)

Finally, though, they came into the ward: Dr. Dontsova, Dr. Gangart and a portly, gray-haired nurse with a notebook in her hand and a towel over her arm. The entry of several white coats all at once always brings with it a wave of attention, fear and hope; and the strength of these feelings grows with the whiteness of the gowns and caps and the sternness of the faces. The sternest and most solemn of all was that of the nurse Olympiada Vladislavovna. For her the morning rounds were like divine service for a deacon. She was a nurse for whom the doctors were of a higher order than ordinary people. She knew that doctors understood everything, never made mistakes and never gave wrong instructions. She jotted down every instruction in her notebook with a sensation almost of joy—something the young nurses no longer had.

But even after they were in the ward, the doctors made no undue haste toward Rusanov's bed! Ludmila Afanasyevna, a heavy woman with simple, heavy features, her hair already ashen but well trimmed and waved, said a quiet general “Good morning,” and then stopped by the first bed, by Dyomka. She peered at him searchingly.

“What are you reading, Dyomka?” (Can't she think of anything more intelligent to say? She's meant to be on duty!)

Dyomka did not name the title. He did what many people do, turned over the magazine with the faded blue cover and showed it to her. Dontsova narrowed her eyes.

“Oh, it's such an old one, it's two years old. Why?”

“There's an interesting article,” said Dyomka with a significant air.

“What about?”

“About
sincerity!
” he replied, even more emphatically. “It says literature without sincerity…” He was lowering his bad leg onto the floor, but Ludmila Afanasyevna quickly checked him.

“Don't do that. Roll up your pajamas.”

He rolled up his trouser leg, and she sat down on the edge of his bed. Carefully, using just two or three fingers, she began to probe gently round the affected part.

Vera Kornilyevna leaned against the foot of the bed behind her, looked over her shoulder and said quietly, “Fifteen sessions, three thousand rads.”

“Does it hurt there?”

“Yes, it does.”

“And here?”

“It hurts further up, too.”

“Well, why didn't you say so? Don't be such a hero! Tell me when it starts to hurt.”

She slowly felt around the edges. “Does it hurt without being touched? At night?”

Dyomka's face was smooth. There still was not a single hair on it. But its permanently tense expression made him look much more grown-up than he was.

“It nags me day and night.”

Ludmila Afanasyevna and Gangart exchanged glances.

“But have you noticed if it hurts more or less since you've been here?”

“I don't know! Maybe it's a bit better. Maybe I'm just imagining things.”

“Blood count?” Ludmila Afanasyevna asked. Gangart handed her the case history. Ludmila Afanasyevna flipped through it, then looked at the boy.

“How's your appetite?”

“I've always liked eating,” Dyomka replied grandly.