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177 8 Emergency An Introduction to Mikhail Bulgakov’s “The Steel Windpipe” Mikhail Bulgakov (1891–1940) qualified as a doctor in 1916 but gave up the practice of medicine in 1920 to devote himself to writing. His best-known works are the satirical novella The Heart of a Dog, completed in 1925 though published in the Soviet Union only in 1987, and The Master and Margarita, completed in 1938 and finally published in a full version in 1973. Bulgakov also authored a number of plays but these, too, were perceived as controversial by the Soviet censor and, like his prose works, banned for years on end. “The Steel Windpipe” is one of several stories that date from early in Bulgakov’s career. They appeared between 1925 and 1927 in two monthlies, Krasnaya panorama, a magazine aimed at a general readership , and Meditsinsky rabotnik, a journal directed at the medical profession . Bulgakov intended to collect the stories into a volume to be entitled The Notes of a Young Doctor; however, he never realized this plan so that the stories for long fell into oblivion. Six of them, including “The Steel Windpipe,” appeared in 1966 in Bulgakov’s Collected Prose; three more were unearthed for their first translation into English in 1975 under the title A Country Doctor’s Notebook. These stories are clearly autobiographical in origin, drawing on Bulgakov’s own experiences as the sole doctor in a remote rural area in the northwestern part of European Russia where he was drafted immediately after his graduation from medical school. By 1916, in the middle of World War I, there was such a critical shortage of medical resources 178 Emergency! in Russia that newly qualified doctors were sent to government clinics and country hospitals without the important additional training normally provided by the years of internship and residency. Inexperienced, cut off by poor roads, winter blizzards, and a lack of telephones, as well as handicapped by a shortage of proper equipment and supplies, these fledgling physicians were left to cope as best they could, not merely with a wide range of diseases and emergencies but also with the ignorant, superstitious peasants who were their patients. Their only helpers were midwives and semi-skilled assistants known as feldshers. The toll taken by the strain of these primitive conditions and the tremendous burden of responsibility is brought out in the story “Morphine” in which another young doctor in the same situation as Bulgakov breaks down under the pressure, becomes addicted to morphine, and eventually commits suicide. All the stories are, like “The Steel Windpipe,” written as first person narratives. All of them, too, insist on the gloom of the extremely long winters, the terrifying isolation, and the doctor’s incessant anxieties about his capacity to handle the crises that suddenly occur at the hospital. Generally the anticipatory fear turns out to be worse than the reality. Many of the cases, despite the doctor’s trepidation, have a reasonably good outcome , although some patients are recalcitrant, suspicious, and disobedient of orders, taking their medications as they see fit. Occasionally there is even a glimmer of humor at the expense of the exhausted doctor who fails to recognize something obvious such as a baby’s “vanishing eye” when covered by an enormous abscess that bursts and drains spontaneously. “The Steel Windpipe” is a highly dramatic tale in which a child’s life is at stake. When she is brought to the hospital by her mother and grandmother , she is already on the verge of death from diphtheria. The peasant women, with mistaken expectations of the hospital, openly vent their anger at the doctor for not having the curative medicine they had hoped for. The extremely slow dissemination of medical progress is illustrated by the fact that diphtheria antitoxin, one of the earliest signal successes of laboratory research, is still not available in these backwoods over twenty years after its first production in 1894. The only hope of saving the little girl’s life is a tracheotomy, that is, the insertion of a steel windpipe into her throat in order to drain the pus choking her. This method of treating diphtheria had been devised in 1885. In having recourse to it, the doctor has to continue to use the nineteenth-century methods of treatment even in the second decade of the twentieth century because he has no access to more modern, better means in that remote location. The situation is an emergency, for the child...

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