A View Through Literature

based on
 Mikhail Bulgakov's A Country Doctor's Notebook

Becoming A Country Doctor


      Many history books describe the nineteenth-century transformation of the Russian peasant population's reliance on traditional health treatments to modern medical care.  This slow but worthwhile process, aimed mainly at reducing the unnecessary infant and maternal deaths that resulted from the incompetence of traditional remedies and the absence of adequate medical care, has an important place in the history of modern medicine.  However, finding a literary work that captures the emotional and personal sides of this historical event is very rare.  Mikhail Bulgakov, one of the first few who acted as a missionary for the Russian medical reformers by becoming a country doctor and introducing the peasant population to modern medical care, captured his experiences and events in a narrative memoir, entitled A Country Doctor’s Notebook.  Bulgakov’s narrative serves as a study guide to the nineteenth-century peasant way of life and the process of medical modernization of the people in the countryside.

     Mikhail Bulgakov was born in Kiev in 1891.  Although he is most known for his literary works such as The Master and Margarita, before dedicating his life to literature, Mikhail Bulgakov was a country doctor.  At the age of only twenty-five, he graduated as a doctor from Kiev University.  During this period, the Russian government and medical reformers became anxious to improve the health of the population by introducing qualified medical doctors to the peasant community.  Mikhail Bulgakov was soon drafted by the government and sent to a small one-doctor hospital in a rural town of Grachyovka and began his career as a doctor and a medical reformer, on a mission to bring adequate medical care to the Russian peasantry.  He later captured his eighteen-month assignment as the only doctor in the environmentally hazardous and somewhat primitive peasant town, in A Country Doctor’s Notebook (7).

    One of the greatest hardships that Bulgakov has to overcome during his stay in the countryside is adapting to the uncivilized and brutally Click for information about this paintinglonesome environment.  When he first arrives, he notes that it has taken him twenty-four hours to travel the distance of thirty-two miles from the central city hospital to his remote country village.  The poor country roads, “impassable in the winter blizzards and springtime thaw,” are the only means of traveling to the depths of the countryside.  Mikhail later remembers how frustrating it is to “drive twelve miles in a tandem-harnessed sleigh to a woman in labour...while keeping a pack of wolves at bay with a pistol” (8, 114).  The natural environment of rural Russia is harsh, and Bulgakov feels like he is always “fighting an elemental force,” which can be seen in his constant mentioning of night, blizzards, winter, and gales (9).  Along with the hardships provided by mother nature, the lonesome experience in the remote rural town, “entirely cut off from the outside world,” is psychologically detrimental and depressing: “where are the people, the electric lights of Moscow...I look out of my windows at nothing but darkness” (41).  Furthermore, the primitive living and housing conditions in Grachyovka make life and work very uncomfortable.  Bulgakov often recalls the maternity hospital in the city with its “gleaming electric lights, shining tiled floor...clean instruments...and assistants,” wishing he could return to the civilized world to which he is accustomed (56).

    While battling personal hardships and adjustments in the new environment, Bulgakov realizes that his task is not only to give his patients modern medical care, but also to teach them modern ideas of the civilized world.  Bulgakov notes that while the rest of the world is modernizing and industrializing, in the Russian countryside, life is still based solely on cultural and traditional customs and ideas.  Bulgakov describes peasants as people who live in a time capsule; to him, the peasant population is a different culture, “five hundred years” behind in time (8).  The “pre-literate” peasants are like children, who need to be trained to become competent and knowledgeable beings.  On one occasion, while treating a man for laryngitis, the doctor recalls giving him mustard-plasters to put on his back and chest.  After the patient kept coming back with complaints, it was discovered that the patient applied the mustard-plasters to the back of his jacket, instead of his bare body (45).

    One of the major battles that Bulgakov has to deal with are the hazardous superstitious and traditional remedies that peasant women use during pregnancy and childbirth.  On one occasion, while examining a woman about to deliver her baby, the doctor finds sugar in her birth canal.  The woman has been taught by the local midwife (wise-woman) that she is having a difficult birth because her baby does not want to come out:  it needs to be lured out with something sweet.  Another woman is having a breech birth and the peasant midwife hangs her upside down so the baby will turn around.  Yet another popular remedy mentioned by Bulgakov, teaches women in labor to chew on hair to ease the pains of childbirth (45).  Russian peasants have been actively practicing these dangerous superstitious remedies for hundreds of years and strongly believed in their causes and success.   Realizing how difficult it will be to teach these women that the traditional remedies used and advocated by the trusted midwives for hundreds of years are doing them more harm than good, Bulgakov has a “sense of being a lone soldier of reason and enlightenment pitted against the vast, dark, ocean-like mass of peasant ignorance and superstition”(8).  Even when the peasant women try to adopt the new medical ideas on their own, their attempts often turn out to be fatal.  One woman, learning that doctors rupture the birth sac, uses a table knife on her own and cuts her baby’s head by mistake, causing it to die (46).  Bulgakov has to learn to be patient with the peasants’ slow process of learning and adapting to modern medical practices.

    Bulgakov admits that the most difficult and “worst of all” cases during his practice in the countryside have to do with childbirth.  Bulgakov says that his knowledge of obstetrics is very poor, “because [he] had seen childbirth only twice in [his] lifetime in a hospital”(56).  However, since one of the main reasons the Russian government began the medical modernization programs in the countryside was to replace incompetent midwives with knowledgeable obstetricians, it was very important for Bulgakov to assist women successfully at childbirth.  In his A Country Doctor’s Notebook, he remembers Click for information about this picturehow important his performance as a medical professional is: “It would be disastrous if I lost my head–I might disgrace myself in front of the midwives ”(54).  Bulgakov knows that he must demonstrate his abilities especially well in the difficult cases, so that his superiority as compared to a traditional midwife can be proven (46).  Mikhail Bulgakov admits his feelings of frustration and disparity with this kind of “front-line post, where alone and without the least support [he] must rely [solely] on [his] own resources” (115).  His fears and worries are demonstrated in a recalled difficult delivery involving a ‘transverse lie,’ or a breech birth.   Bulgakov remembers his frightening and nerve-wracking decision-making process during this case.  Referring to a book , Operative Obstetrics, which confirms his fear of the delivery being very dangerous to both the mother and the baby, he frantically reads about the procedure of turning the baby inside the mother’s uterus.  After successfully managing to safely deliver the baby, he is still filled with confusion and doubt of his abilities, as he wonders “whether the mother was really safe and sound” after the delivery (61).  It is clear that his wide knowledge of medicine has allowed Bulgakov to take on the treatment of any illness successfully, as well as the performance of any operation, even the most difficult and dangerous case of childbirth.

    By the end of his assignment in the country hospital, Mikhail Bulgakov realizes that the experience has not only helped the peasant population, but has made him stronger as well.  Bulgakov is able to achieve what the Russian government intended; he becomes popular among the peasantry by being able to treat diseases and save lives in cases that are traditionally believed to cause death.  By demonstrating success in his practice, he is able to turn the peasants away from harmful traditional ways of treating illnesses and curing diseases to competent medical practices.     Although there are still some peasants who cannot be convinced to trust the modern medicine, who have “slipped through [his] fingers,” Bulgakov’s practice is described as very busy and physically exhausting (75).  He sacrifices a lot of his own health, strength, and time to better the lives of countless others.  He recalls working from dawn to midnight, often skipping lunch, seeing as many as a hundred patients per day.  However, Mikhail Bulgakov admits his feeling of pride and inspiration as he opens his patients’ register book and notes that he had seen 15,613 patients in one year (107).  Even after finishing his job as the country doctor, he recalls that what the experience has given him is priceless.  Not only does he serve his nation and his people by modernizing and improving healthcare, he also becomes brave and ready to take on any challenge that life brings (116).

    By gathering his experiences as a country doctor during the nineteenth-century medical transformation of the Russian peasant population in A Country Doctor’s Notebook, Mikhail Bulgakov has provided the world with an intimate personal look into this historic event.  Bulgakov is able to capture views and feelings that no historical source can ever provide.  His personal narrative, containing vivid illustrations of the peasant way of life and the introduction of modern medicine to the rural areas of Russia, serves a great purpose in the study of that period.  After reading Bulgakov’s memoir, the conviction is reinforced that this event in history was not merely a medical transformation, but a long and frustrating process that involved hardships and sacrifices from both the peasants and the country doctors.  Mikhail Bulgakov serves as an example of the many doctors who devoted their careers to serving their nation and improving the health of hundreds of thousands of Russian peasants.
 
 





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