Having inspected the hospital, Andrei Yefimych came to the conclusion that it was an immoral institution and highly detrimental to the health of the citizens. In his opinion, the most intelligent thing that could be done would be to discharge the patients and close the place down. But for that he reckoned that his will alone was not enough and in any case it would be useless; when physical and moral uncleanness was driven out of one place, it went to another; one had to wait until it dispersed of itself. Besides, if people had opened the hospital and put up with it in their town, it meant they needed it; prejudice and all this everyday filth and muck are necessary, because in time they turn into something useful, as dung turns into black earth. There is nothing good in the world that does not have some filth in its origin.
On taking over the post, Andrei Yefimych treated these disorders with apparent indifference. He merely asked the peasant caretakers and nurses not to sleep in the wards, and installed two cabinets with instruments. The superintendent, the matron, the assistant doctor, and the surgical erysipelas stayed where they were.
Andrei Yefimych is extremely fond of intelligence and honesty, but he lacks character and faith in his right to organize an intelligent and honest life around him. He is positively incapable of ordering, prohibiting, or insisting. It looks as if he has taken a vow never to raise his voice or speak in the imperative. To say “give” or “bring” is hard for him; when he wants to eat, he coughs irresolutely and says to his cook: “How about some tea?” or “How about some dinner?” But to tell the superintendent to stop stealing, or to dismiss him, or to abolish the useless, parasitic post altogether—is completely beyond his strength. When Andrei Yefimych is deceived or flattered, or handed a false receipt to sign knowingly, he turns as red as a lobster and feels guilty, but all the same he signs the receipt; when the patients complain to him that they are hungry or that the nurses are rude, he gets embarrassed and mutters guiltily:
“All right, all right, I’ll look into it later … There’s probably some misunderstanding …”
At first Andrei Yefimych worked very assiduously. He received every day from morning till dinnertime, did surgery and even took up the practice of obstetrics. Ladies said of him that he was attentive and excellent at diagnosing illnesses, especially in children and women. But as time went on he became noticeably bored with the monotony and obvious uselessness of the work. Today you receive thirty patients, and tomorrow, lo and behold, thirty-five come pouring in, and the next day forty, and so it goes, day after day, year after year, and the town mortality rate does not go down, and the patients do not stop coming. To give serious aid to forty outpatients between morning and dinnertime was physically impossible, which meant, willy-nilly, that it was all a deceit. During the fiscal year twelve thousand outpatients were received, which meant, simply speaking, that twelve thousand people were deceived. To put the seriously ill in the hospital and care for them according to the rules of science was also impossible, because while there were rules, there was no science; and to abandon philosophy and follow the rules pedantically, as other doctors did, you first of all needed cleanliness and ventilation, not filth, and wholesome food, not soup made from stinking pickled cabbage, and good assistants, not thieves.
Then, too, why prevent people from dying, if death is the normal and natural end of every man? So what if some dealer or clerk lives for an extra five or ten years? If the purpose of medical science is seen as the alleviation of suffering by medication, then, willy-nilly, the question arises: why alleviate it? First, they say that suffering leads man to perfection, and, second, if mankind really learns to alleviate its suffering with pills and drops, it will completely abandon religion and philosophy, in which it has hitherto found not only a defense against all calamities, but even happiness. Pushkin suffered terribly before death, poor Heine lay paralyzed for many years: why should there be no illness for some Andrei Yefimych or Matryona Savishna, whose life is insipid and would be completely empty and similar to the life of an amoeba were it not for suffering?
Oppressed by such reasoning, Andrei Yefimych threw up his hands and stopped going to the hospital every day.
VI
His life goes like this. Ordinarily he gets up in the morning at around eight, dresses and has tea. Then he sits in his study and reads or goes to the hospital. There, in the hospital, in a dark, narrow corridor, the outpatients sit waiting to be received. Peasants and nurses rush past them, their boots stomping on the brick floor, skinny patients in robes pass by, dead bodies and pots of excrement are carried out, children cry, a drafty wind blows. Andrei Yefimych knows that for the feverish, the consumptive, and the impressionable sick in general, such an atmosphere is torture, but what can he do? In the receiving room he is met by his assistant, Sergei Sergeich, a small, fat man with a clean-shaven, well-scrubbed, plump face, with soft, smooth manners, wearing a roomy new suit and looking more like a senator than an assistant doctor. He has an enormous practice in town, wears a white tie, and considers himself more knowledgeable than the doctor, who has no practice at all. In the corner of the receiving room stands a big icon in a case, with a heavy icon lamp, beside it a candle stand under a white cover; on the walls hang portraits of bishops, a view of the Svyatogorsk monastery, and wreaths of dried cornflowers. Sergei Sergeich is religious and a lover of the beauteous. The icon was installed at his expense; on Sundays one of the patients, on his orders, reads an akathist5 aloud in the receiving room, and after the reading Sergei Sergeich himself makes the rounds of all the wards carrying a censer and censing everybody.
The patients are many, but time is short, and so the business is confined to a brief questioning and the dispensing of some sort of medicine like camphor ointment or castor oil. Andrei Yefimych sits with his cheek propped on his fist, deep in thought, and asks questions mechanically. Sergei Sergeich also sits rubbing his little hands and occasionally mixes in.
“We get sick and suffer want,” he says, “because we don’t pray properly to the merciful Lord. Yes!”
Andrei Yefimych does not do any surgery during receiving hours; he got out of the habit long ago, and the sight of blood upsets him unpleasantly. When he has to open a child’s mouth to look down his throat, and the child shouts and resists with his little hands, the noise in his ears makes him giddy and tears come to his eyes. He hastens to prescribe some medicine and waves his arms, so that the peasant mother will quickly take the child away.
While receiving, he quickly becomes bored with the patients’ timidity, their witlessness, the proximity of the beauteous Sergei Sergeich, the portraits on the walls, and his own questions, which he has been asking unvaryingly for twenty years now. And he leaves after receiving five or six patients. The assistant doctor receives the rest without him.
With the agreeable thought that, thank God, he has had no private practice for a long time, and that no one will bother him, Andrei Yefimych goes home, sits down immediately at the desk in his study, and begins to read. He reads a lot, and always with great pleasure. Half of his salary goes on books, and of the six rooms of his apartment, three are heaped with books and old magazines. He likes writings on history and philosophy most of all; in the field of medicine, he subscribes to The Doctor, which he always starts reading from the back. Each time the reading goes on uninterruptedly for several hours without tiring him. He does not read quickly and impulsively, as Ivan Dmitrich used to, but slowly, sensitively, often lingering over places that please or puzzle him. Beside the book there always stands a little carafe of vodka, and a pickled cucumber or apple lies directly on the baize, without a plate. Every half hour, without taking his eyes off the book, he pours himself a glass of vodka and drinks it, then, without looking, feels for the pickle and takes a bite.
At three o’clock he warily approaches the kitchen door, coughs, and says:
“Daryushka, how about some dinner …”
After dinner, rather poor and slovenly, Andrei Yefimych paces about his rooms, his arms folded on his chest, and thin
ks. It strikes four, then five, and still he paces and thinks. Occasionally the kitchen door creaks, and Daryushka’s red, sleepy face peeks out.
“Andrei Yefimych, isn’t it time you had your beer?” she asks worriedly.
“No, not yet …” he replies. “I’ll wait a bit … wait a bit …”
Towards evening the postmaster, Mikhail Averyanych, usually comes, the only man in town whose company Andrei Yefimych does not find burdensome. Mikhail Averyanych was once a very rich landowner and served in the cavalry, but he was ruined and, out of need, joined the postal service in his old age. He has a hale and hearty look, magnificent gray side-whiskers, well-bred manners, and a loud, pleasant voice. He is kind and sensitive, but hot-tempered. When a client at the post office protests, disagrees, or simply begins to argue, Mikhail Averyanych turns purple, shakes all over, and in a thundering voice shouts: “Silence!” so that the post office has long since acquired the reputation of an institution one fears to visit. Mikhail Averyanych respects and loves Andrei Yefimych for his education and nobility of soul, but to the rest of the townspeople he behaves haughtily, as to his own subordinates.
“And here I am!” he says, coming in to Andrei Yefimych’s. “Good evening, my dear! You must be tired of me by now, eh?”
“On the contrary, I’m very glad,” the doctor replies. “I’m always glad to see you.”
The friends sit down on the sofa in the study and smoke silently for a time.
“Daryushka, how about some beer!” says Andrei Yefimych.
The first bottle is also drunk silently—the doctor deep in thought, and Mikhail Averyanych with a merry, animated air, like a man who has something very interesting to tell. It is always the doctor who begins the conversation.
“What a pity,” he says slowly and softly, shaking his head and not looking his interlocutor in the eye (he never looks anyone in the eye), “what a great pity, my esteemed Mikhail Averyanych, that our town is totally lacking in people who enjoy and are capable of carrying on an intelligent and interesting conversation. That is an enormous privation for us. Even the intelligentsia is not above banality; the level of its development, I assure you, is no whit higher than in the lower estates.”
“Quite right. I agree.”
“You yourself are aware,” the doctor continues softly and measuredly, “that everything in this world is insignificant and uninteresting except the higher spiritual manifestations of human reason. Reason draws a sharp distinction between animal and man, hints at the divinity of the latter, and for him, to a certain degree, even takes the place of immortality, which does not exist. Hence, reason is the only possible source of pleasure. We, however, neither see nor hear any reason around us—which means we are deprived of pleasure. True, we have books, but that is not at all the same as live conversation and intercourse. If you will permit me a not entirely successful comparison, books are the scores, while conversation is the singing.”
“Quite right.”
Silence ensues. Daryushka comes from the kitchen and, with an expression of dumb grief, her face propped on her fist, stops in the doorway to listen.
“Ah!” sighs Mikhail Averyanych. “To ask reason of people nowadays!”
And he talks about how life used to be wholesome, gay, and interesting, what a smart intelligentsia there was in Russia and how highly it placed the notions of honor and friendship. Money was lent without receipt, and it was considered a disgrace not to offer a helping hand to a needy comrade. “And what campaigns, adventures, skirmishes there were, what comrades, what women! And the Caucasus—what an astonishing country! And the wife of one of the battalion commanders, a strange woman, used to dress up as an officer and ride off into the mountains in the evening alone, without an escort. They said she was having a romance with some princeling in a village there.”
“Saints alive …” Daryushka sighs.
“And how they drank! How they ate! What desperate liberals they were!”
Andrei Yefimych listens and hears nothing; he ponders something and sips his beer.
“I often dream about intelligent people and conversations with them,” he says unexpectedly, interrupting Mikhail Averyanych. “My father gave me an excellent education, but, influenced by the ideas of the sixties,6 he forced me to become a doctor. I think that if I hadn’t obeyed him, I would now be at the very center of the intellectual movement. I would probably be a member of some faculty. Of course, reason is not eternal and also passes, but you already know why I am well disposed towards it. Life is a vexing trap. When a thinking man reaches maturity and attains to adult consciousness, he involuntarily feels as if he is in a trap from which there is no escape. Indeed, against his will he is called by certain accidents from non-being into life … Why? He wants to learn the meaning and aim of his existence, and he is not told or else is told absurdities; he knocks—it is not opened; death comes to him—also against his will. And so, as people in prison, bound by a common misfortune, feel better when they come together, so also in life the trap can be disregarded when people inclined to analysis and generalization come together and spend time exchanging proud, free ideas. In this sense reason is an irreplaceable pleasure.”
“Quite right.”
Without looking his interlocutor in the eye, softly and with pauses, Andrei Yefimych goes on talking about intelligent people and his conversations with them, and Mikhail Averyanych listens to him attentively and agrees: “Quite right.”
“And you don’t believe in the immortality of the soul?” the postmaster suddenly asks.
“No, my esteemed Mikhail Averyanych, I do not believe in it and have no grounds for doing so.”
“I confess that I, too, have doubts. Though, incidentally, I have the feeling that I’ll never die. Hey, I think to myself, you old duffer, it’s time for you to die! And a little voice in my soul says: don’t believe it, you won’t die! …”
After nine, Mikhail Averyanych leaves. Putting his fur coat on in the front hall, he says with a sigh:
“But what a hole the fates have brought us to! The most vexing thing is that we’ll have to die here as well. Ah! …”
VII
After seeing his friend off, Andrei Yefimych sits down at the desk and again begins to read. The stillness of the evening and then the night is not broken by any sound, and time seems to stop, transfixed, with the doctor over the book, and it seems that nothing exists except for this book and the lamp with its green shade. The doctor’s coarse, peasant face gradually lights up with a smile of tenderness and delight at the movements of the human spirit. Oh, why is man not immortal? he thinks. Why brain centers and convolutions, why sight, speech, self-awareness, genius, if it is all doomed to sink into the ground and in the final end to cool down along with the earth’s crust and then whirl without sense or purpose, for millions of years, with the earth around the sun? For that cooling down and whirling around there was no need at all to bring man out of non-being, along with his lofty, almost divine reason, and then, as if in mockery, turn him into clay.
The life cycle! But what cowardice to comfort oneself with this surrogate of immortality! The unconcious processes that occur in nature are even lower than human stupidity, for in stupidity there is still consciousness and will, while in these processes there is nothing. Only a coward whose fear of death is greater than his dignity can comfort himself with the thought that in time his body will live in grass, a stone, a toad … To see one’s own immortality in the life cycle is as strange as to prophesy a brilliant future to the case after the costly violin has been broken and made useless.
When the clock strikes, Andrei Yefimych throws himself back in his armchair and closes his eyes in order to think a little. And inadvertently, under the influence of the good thoughts he has found in his book, he casts a glance over his past and present. The past is repulsive, better not to recall it. And the present is the same as the past. He knows that all the while his thoughts are whirling together with the cooled-down earth around the sun, in the big
building next door to the doctor’s apartment people are languishing in disease and physical uncleanness; perhaps someone is lying awake and battling with insects, or someone is coming down with erysipelas or moaning because his bandage is too tight; perhaps the patients are playing cards with the nurses and drinking vodka. Twelve thousand people have been deceived during the fiscal year; the whole hospital business, just as twenty years ago, is built on theft, squabbles, gossip, chumminess, crude charlatanism, and, just as before, the hospital is an immoral institution, highly detrimental to the townspeople’s health. He knows that in Ward No. 6, behind the grilles, Nikita is beating the patients, and that Moiseika goes around town every day begging for alms.
On the other hand, he knows perfectly well that a fabulous change has come over medicine in the last twenty-five years. When he was studying at the university, it seemed to him that the same lot that had befallen alchemy and metaphysics would soon befall medicine, but now, when he reads at night, medicine touches him and arouses astonishment and even rapture in him. Indeed, what unexpected splendor, what a revolution! Owing to antiseptics, such operations are performed as the great Pirogov7 considered impossible even in spe.8 Ordinary zemstvo doctors dare to perform resections of the knee, only one out of a hundred Caesarean sections ends in death, and gallstones are considered such a trifle that no one even writes about them. Syphilis can be radically cured. And the theory of heredity, hypnotism, the discoveries of Pasteur and Koch,9 hygiene, and statistics, and our Russian zemstvo doctors? Psychiatry, with its present-day classification of illnesses, its methods of diagnosis and treatment, is a whole Mt. Elbrus10 compared to what it used to be. No one pours cold water over madmen’s heads now, or puts them in straitjackets: they are kept like human beings and, as the newspapers report, even have performances and balls organized for them. Andrei Yefimych knows that, given present-day views and tastes, such an abomination as Ward No. 6 is perhaps only possible two hundred miles from the railroad, in a town where the mayor and all the councilmen are semi-literate bourgeois, who see a doctor as a sort of priest who is to be believed without any criticism, even if he starts pouring molten tin down people’s throats; anywhere else the public and the newspapers would long ago have smashed this little Bastille to bits.