DRAWING ON RUSSIAN LITERATURE
It is said that doctors make good writers because they are good observers and listeners. There is now a long list of doctors who have become famous writers. Many writers, with no medical training, by working with meticulous recording and attention to detail have been able to describe the human condition and even illnesses with amazing accuracy. Leo Tolstoy, for example, in The Death of Ivan Ilyich (1886), describes a case of terminal illness and existential regret at a life lived inauthentically, while Graham Greene in A Burnt-Out Case (1960) depicts leprosy.
Books and articles on the medical humanities often draw on Russian literature to show the interaction between medicine and literature. Two examples of Russian writers who were also doctors and had chronic illnesses were Anton Chekhov (1860–1904)1,2 and Mikhail Bulgakov (1891–1940).3
CHEKHOV AND TUBERCULOSIS
Chekhov practised medicine on and off for most of his life but turned to writing as a medical student to earn money. In 1888 the novella The Steppe was published as a partly autobiographical work seen through the eyes of a child. He is best known for his hundreds of short stories, investigative journalism in Sakhalin Island, where he examined prison conditions in Siberia — described as: ‘… the best work of journalism written in the nineteenth century’,4 and, of course, his plays (particularly The Seagull, Uncle Vanya, The Three Sisters, and The Cherry Orchard).
For the last 20 years of his life he suffered from tuberculosis and had his first haemoptysis in 1883. This did not stop him working as a doctor and writer. For many years he tried to ignore his illness and was probably in self-denial.2 Towards the end of his life, tuberculosis is discussed in his letters and the futility of many of the treatments available at that time. Doctors do feature in some of his stories and plays. Perhaps the most notable is Dr Ragin in the short story ‘Ward 6’ who eventually becomes a patient on the ward he used to look after.
This story demonstrates Chekhov’s interest in psychiatry. Then there is the story of Doctor Startsev in the 1898 short story ‘Ionych’ who starts out as a young, idealistic country GP and ends up old and obese with a vast practice, with some similarities to the hero in Cronin’s The Citadel. Dr Astrov in Uncle Vanya is a burnt-out utopian idealist. Most of these characters were poorly paid and overworked, with very few therapeutic tools at their disposal. Chekhov’s finest work was written after 1890 and his last play, The Cherry Orchard, was completed shortly before he died.
A CALL FROM STALIN
In the case of Bulgakov his medical career lasted only a few years before he became a full-time writer. This was not before he was sent away after qualification to work as an isolated country doctor and had a spell addicted to morphine. These two episodes are described in A Country Doctor’s Notebook (1925–1927) and Morphine (1926), and are semi-autobiographical. For much of his life Bulgakov was a playwright but he had to contend with the constant disappointment of his plays and writings being censored. One of the exceptions was the play The Days of the Turbins (1926), which was much admired by Stalin. Bulgakov sent a letter of complaint to the authorities about these restrictions and was most surprised when Stalin himself phoned him at home to discuss these complaints! The result was his re-appointment to the Moscow Art Theatre but there was no let-up in the censorship of his work. Bulgakov set about his magnum opus The Master and Margarita, written in the Soviet Union between 1928 and 1940 during Stalin’s regime. This work then occupied him on and off to the end of his life. He used to give readings in private and only completed his final editing of the work a few weeks before his death in 1940. This masterpiece was eventually published posthumously by his wife in 1966. One of the most often quoted phrases in the book ‘Manuscripts don’t burn’ relates to the stubborn, indestructible power of art.5 The genre of the book is magic realism but it also contains much comic satire. Bulgakov describes in his letters, in great detail, his anxiety and depression associated with the suppression of his plays and written work. Towards the end of his life he developed chronic renal failure. His letters tell us of the extreme lethargy caused by this condition, which eventually led to his death.
CENSORSHIP AND CHRONIC ILLNESS
Chekhov belonged to the golden age of realist Russian writers and Bulgakov to the silver age of symbolists. Both writers suffered censorship under different regimes, Chekhov under the Tsars and Bulgakov under Stalin and the Soviet regime. The latter was a far more severe type of censorship, resulting in most of his work being banned in his lifetime. Both writers loved the theatre and were playwrights.
Finally, both suffered from serious chronic diseases for which there was no effective treatment at that time when they were at the height of their creative powers. They have, however, left some great literature for posterity for us to enjoy.
- © British Journal of General Practice 2018