(本文原作者为牛津 John Radcliffe Hospital 的妇产科医生 Chris Bird)
In 1916 Mikhail Bulgakov, 24 years old and fresh from medical school in Kiev, was posted to a snowbound rural clinic in northwestern Russia, “thirty-two miles from the nearest electric light,” to fill a gap left by doctors serving on the eastern front. In his semi-fictionalised account, A Country Doctor's Notebook, the young medic spends the journey to the remote hospital on rutted tracks, worrying about how he will cope with tracheotomies and obstructed labour (he has seen only two normal deliveries at medical school), fretting over his youthful appearance, and urging himself to walk, not run.
He doesn't have to wait long before a cart rumbles into the hospital yard carrying a young woman with a leg smashed in a flax brake, her pulse barely palpable. “‘Die. Die quickly,' I said to myself. ‘Die. Otherwise what am I to do with you?'” However, he horrifies himself by ordering the “feldsher,” the Russian equivalent of a physician's assistant, to prepare the theatre for an amputation. His own adrenaline as potent as the camphor injections given to revive the patient, he saves her by removing the leg.
Later he is presented with a fetus with a transverse lie and has to examine the woman in front of the hospital's veteran midwife: “The fact was that once the experienced Anna Nikolaevna had told me what was wrong, this examination was quite pointless.” The midwife breaks protocol, advising a “podalic version.” The doctor gravely concurs, announces that he's off for a cigarette, and runs to look up “podalic version” in his textbook of operative obstetrics. As they scrub in, Anna Nikolaevna recounts how his predecessor performed the procedure. “I listened avidly to her, trying not to miss a single word. Those ten minutes told me more than everything I had read on obstetrics for my qualifying exams, in which I had actually passed the obstetrics paper ‘with distinction.'”
Such an internship, including an attack by wolves while on his way to a home visit in the middle of a blizzard, is no longer the norm for house officers (although it remains so for many doctors in the developing world). But Bulgakov's struggle with the dark Russian winter swirling outside his window symbolises the lack of experience, loneliness, and the worry of breaking the Hippocratic oath that gnaws at the sleep of junior doctors everywhere. (以上情节皆与短剧如出一辙) Shattered by morphine addiction, typhus, and his forced conscription during the brutal Russian civil war, Bulgakov abandoned medicine to write, including the novel The Master and Margarita. The attentions of the Soviet censors, Stalin's secret police, and renal disease pushed Bulgakov into an early grave (his brother Nikolai escaped Russia to become a respected cardiologist in Paris). He had his doubts about the medical profession—“I won't call doctors murderers, that would be too harsh, but I will call them casual untalented hacks”—but medicine was for him a light in the dark days of Soviet repression. “Each person ought to be a doctor,” Bulgakov wrote, “in the sense of disarming all the invisible enemies threatening life.” 在吗啡上瘾、梅毒、和在这场野蛮的内战的强制征兵的高压下,Bulgakov决定弃医从文,并写下了小说《大师与玛格丽特》( )。苏维埃的审核制度、斯大林的秘密警察与肾病迫使 Gulgakov 英年早逝。而值得一提的是,他的哥哥 Nikolai 逃离到了巴黎成为了一名心脏病医生。Gulgakov 对从医有着这样的质疑:「我不会称医生是杀人犯,但是我认为他们是漫不经心的二流人士」。可医学对他来说,仍是苏维埃强权压迫下黑暗日子里的一丝光明:「每个人都应该成为一个医生,去与那些在威胁生命的看不见的敌人们斗争。」