Cancer Ward (12 page)

“But he sent away a biopsy?”

“I didn't know then. I didn't know about biopsies or anything. I just lay there after the operation. There were little sacks of sand on top of me. By the end of the week I'd begun learning to move my feet from the bed to the floor, to stand up. Suddenly they went round the camp to collect another transport, about seven hundred men—troublemakers, they said—and Karl Fyodorovich, the gentlest man alive, happened to be in the transport. They took him straight from the hut. They wouldn't even let him do a last round of his patients.”

“Absurd!”

“Wait till you hear some real absurdity.” Kostoglotov was becoming more than usually animated. “A friend of mine came running in and whispered that I was on the list for the transport too. The woman in charge of the infirmary, Madame Dubinskaya, had given her agreement, knowing I couldn't walk and that they hadn't even taken out my stitches—what a bitch! I'm sorry.… Well, I made a firm decision. To travel in a cattle truck with unremoved stitches would mean infection and certain death, so I thought, When they come for me I'll tell them, ‘Shoot me here on the bed, I'm not going anywhere.' I'll tell them straight out! But they didn't come for me, and it wasn't because of any kindness on the part of Madame Dubinskaya; she was quite surprised I hadn't been sent. No, they'd checked up in the registration section and found I had less than a year left to serve. But I've got off the point.… Anyway I went over to the window and looked out. Behind the hospital woodpile there was a parade ground, twenty meters away, where they were herding everyone with their things ready for the transport. Karl Fyodorovich saw me in the window and shouted, ‘Kostoglotov, open the window!' The guards yelled at him, ‘Shut up, you bastard.' But he shouted, ‘Kostoglotov, remember this, it's very important, I sent the section of your tumor to Omsk for histological analysis, to the department of pathological anatomy, remember!' Well, they herded them away. Those were my doctors, your predecessors. Are they to blame?”

Kostoglotov threw himself back in his chair. He had got himself very worked up, caught up by the atmosphere of that other hospital.

Separating the essential from the superfluous (in patients' stories there is always plenty of the superfluous), Dontsova came back to the point that interested her:

“Well, what was the answer from Omsk? Was there one? Did they tell you anything?”

Kostoglotov shrugged his angular shoulders. “Nobody told me a thing. And I didn't understand why Karl Fyodorovich shouted what he did. But then last autumn, in exile, when the disease had really got hold of me, an old gynecologist fellow, a friend of mine, began to insist that I make inquiries. So I wrote to my camp. No answer. Then I wrote a complaint to the camp administration. About two months later I got an answer: ‘After careful investigation of your personal file, there appears to be no possibility of tracing your analysis.' I was already so ill with this tumor that I was ready to abandon the whole correspondence, but since the
komendatura
*
weren't letting me out for treatment in any case, I thought I'd take a chance and write to Omsk. I wrote to the department of pathological anatomy, and I got an answer in a few days. It was already January, that was before they let me come here.”

“Well, come on then! Where is it? Where's the answer?”

“Ludmila Afanasyevna, when I came here I couldn't have cared less about anything. It was a slip of paper without a letterhead, without a stamp, simply a letter from a laboratory worker in the department. She was kind enough to write that on the exact date I mentioned and from the very settlement where I was, a specimen had come in and analysis had been carried out and had confirmed—that's right, the type of tumor you've suspected all along—and that an answer had then been sent to the hospital which had made the inquiry, that is to our camp hospital. What happened next was just typical. I genuinely believe that the answer came, but nobody wanted to know about it, and Madame Dubinskaya.…”

No, Dontsova just could not understand this sort of logic! Her arms were crossed and she was impatiently slapping her cupped hands against the upper part of each arm, above the elbow.

“But that answer must have meant you needed X-ray therapy
immediately!
”

“What?” Kostoglotov narrowed his eyes jokingly and looked at her. “X-ray therapy?”

There you are! A quarter of an hour he'd been talking to her, and what had he got across? She still didn't understand a thing.

“Ludmila Afanasyevna,” he pleaded with her, “you see, to understand what things are like over there … well, very few people have any idea. What X-ray therapy? I was still feeling pain where they had operated, as Ahmadjan is now, for instance. I was already back on general duties, pouring concrete, and it just didn't occur to me that I have the right to be dissatisfied. Have you any idea how heavy a deep container of liquid concrete is, when two people have to lift it?”

She lowered her head. It was as if it was she who had sent him out to carry concrete. Yes, it might be a bit complicated to clear up the details of this case history.

“All right then. But what about this answer from the department of pathological anatomy? Why did it have no stamp? Why was it a private letter?”

“I was grateful enough to get a private letter.” Kostoglotov was still trying to convince her. “That laboratory assistant just happened to be a kind woman. After all, there are more kind women than men, at least that's my impression.… Why was it a private letter? Because of our mania for secrecy! She wrote later on, ‘The tumor specimen was sent to us anonymously, with no indication of the patient's name. Therefore we cannot give you an official certificate, and we can't let you have slides of the specimen either.'” Kostoglotov was getting annoyed. Annoyance expressed itself in his face more quickly than any other emotion. “What a state secret! Idiots! They're scared that in some department they'll find out that in some camp there's a prisoner languishing called Kostoglotov. The king of France's twin brother! So the anonymous letter will go on lying there, and you'll have to rack your brains about how to treat me. But they've kept their secret!”

Dontsova's look was firm and clear. She stuck to her point.

“I still ought to put the letter in your case history.”

“All right, when I go back to my
aul
I'll send it to you.”

“No, I need it sooner than that. Can't your gynecologist friend find it and send it?”

“Yes, I suppose he can … but I want to know when
I
can go back there.” Kostoglotov looked at her somberly.

“You will go home,” Dontsova weighed her words one by one with great emphasis, “when I consider it necessary to interrupt your treatment. And then you will only go temporarily.”

Kostoglotov had been waiting for this moment in the conversation. He couldn't let it go by without a fight.

“Ludmila Afanasyevna! Can't we get away from this tone of voice? You sound like a grownup talking to a child. Why not talk as an adult to an adult? Seriously, when you were on your rounds this morning I…”

“Yes, on my rounds this morning”—Dontsova's big face looked quite threatening—“you made a disgraceful scene. What are you trying to do? Upset the patients? What are you putting into their heads?”

“What was I trying to do?” He spoke without heat but emphatically, as Dontsova had. He sat up, his back firm against the back of the chair, “I simply wanted to remind you of my right to dispose of my own life. A man can dispose of his own life, can't he? You agree I have that right?”

Dontsova looked down at his colorless, winding scar and was silent. Kostoglotov developed his point:

“You see, you start from a completely false position. No sooner does a patient come to you than you begin to do all his thinking for him. After that, the thinking's done by your standing orders, your five-minute conferences, your program, your plan and the honor of your medical department. And one again I become a grain of sand, just as I was in the camp. Once again nothing
depends
on me.”

“The clinic obtains written consent from every patient before every operation,” Dontsova reminded him.

(Why had she mentioned an operation? He'd never let himself be operated on, not for anything!)

“Thank you! Thank you for that anyway! Even though it's only for its own protection, the clinic at least does that. Unless there's an operation you simply don't ask the patient anything. And you never explain anything! But surely X rays have some effect too?”

“Where did you get all these rumors about X rays?” Dontsova made a guess. “Was it from Rabinovich?”

“I don't know any Rabinovich!” Kostoglotov shook his head firmly. “I'm talking about the principle of the thing.”

(It was in fact from Rabinovich that he'd heard these gloomy stories about the aftereffects of X rays, but he'd promised not to give him away. Rabinovich was an outpatient who had already had more than two hundred sessions. He'd made very heavy weather of them and with every dozen he'd felt closer to death than recovery. Where he lived no one understood him, not a soul in his apartment or his building or his block. They were healthy people who ran about from noon till night thinking of successes or failures—things that seemed terribly important to them. Even his own family had got tired of him. It was only here, on the steps of the cancer clinic, that the patients listened to him for hours and sympathized. They understood what it means to a man when a small triangular area grows bone-hard and the irradiation scars lie thick on the skin where the X rays have penetrated.)

Honestly, there he was talking about “the principle of the thing!” Wasn't that just what Dontsova and her assistants needed—to spend days talking to patients about the principles on which they were being treated! Where would they find the time for the treatment then?

Every now and again some stubborn, meticulous lover of knowledge, like this man or Rabinovich, would crop up out of a batch of fifty patients and run her into the ground, prizing explanations out of her about the course of his disease. When this happened, one couldn't avoid the hard task of offering the occasional explanation. And Kostoglotov's case was a special one even from the medical point of view by virtue of the extraordinary negligence with which it had been handled. Up to the time of her arrival on the scene, when he had finally been allowed out to receive treatment, it was as if there had been a malicious conspiracy to drive him to the very borderline of death. His case was a special one too because of the exceptionally rapid revival which had begun under X-ray treatment.

“Kostoglotov! Twelve sessions of X rays have turned you from a corpse into a living human being. How dare you attack your treatment? You complain that they gave you no treatment in the camp or in exile, that they neglected you, and in the same breath you grumble because people
are
treating you and taking trouble over you. Where's the logic in that?”

“Obviously there's no logic.” Kostoglotov shook his shaggy black mane. “But maybe there needn't be any, Ludmila Afanasyevna. After all, man is a complicated being, why should he be explainable by logic? Or for that matter by economics? Or physiology? Yes, I did come to you as a corpse, and I begged you to take me in, and I lay on the floor by the staircase. And therefore you make the logical deduction that I came to you to be saved
at any price!
But I don't want to be saved at any price! There isn't anything in the world for which I'd agree to pay
any
price!” He began to speak more quickly. It was something he never liked doing, but Dontsova was making an attempt to interrupt and he still had a great deal more to say on the subject. “I came to you
to relieve my suffering!
I said, ‘I'm in terrible pain, help me!' And you did. And now I'm not in pain. Thank you! Thank you! I'm grateful and I'm in your debt. Only now let me go. Just let me crawl away like a dog to my kennel, so I can lick my wounds and rest till I'm better.”

“And when the disease catches up with you, you'll come crawling back to us?”

“Perhaps. Perhaps I'll come crawling back to you.”

“And we shall have to take you?”

“Yes! And that's where I see your mercy. What are you worried about? Your recovery percentages? Your records? How you'll be able to explain letting me go after fifteen sessions when the Academy of Medical Science recommends not less than sixty?”

Never in her life had she heard such incoherent rubbish. As a matter of fact, from the records' point of view it would be to her advantage to discharge him and make a note of “Marked improvement.” This would never apply after fifty sessions.

But he kept hammering away at his point.

“As far as I'm concerned, it's enough that you've driven back the tumor and stopped it. It's on the defensive. I'm on the defensive too. Fine. A soldier has a much better life in defense. And whatever happens you'll never be able to cure me completely. There's no such thing as a complete cure in cancer. All processes of nature are characterized by the law of diminishing returns, they reach a point where big efforts yield small results. In the beginning my tumor was breaking up quickly. Now it'll go slowly. So let me go with what's left of my blood.”

“Where did you pick up all this information, I'd like to know?” Dontsova frowned.

“Ever since I was a child I've loved browsing through medical books.”

“But what
exactly
are you afraid of in our treatment?”

“Ludmila Afanasyevna, I don't know what to be afraid of. I'm not a doctor. Perhaps you know but don't want to tell me. For example, Vera Kornilyevna wants to put me on a course of glucose injections.…”