There was a total of around 13,000 doctors practising in Russia when Chekhov entered his first year of medical school, and about 16,000 when he graduated along with 200 other young men. Russian physicians were severely tested by the famine of 1891-92 and the cholera epidemics of 1892-93, which revealed that Russia's medical provision was still very backward when compared with that of other European countries. As usual, the Tsarist administration impeded progress through its complicated bureaucratic apparatus and restrictive practices. In the face of the obstacles it put up, many Russian doctors succumbed to apathy and despair: Dr Ragin in Chekhov's searing story 5Ward No. 6' is one such figure. Chekhov himself took an active role in both the famine relief effort and the campaign to fight the cholera epidemics. His conscientiousness as a doctor had been inculcated at an early age, and he had rece ;ved consistently high marks in his exams which he had to pass at the end of every year at medical school. Medicine was not a subject for slackers.
When Chekhov matriculated, Russia's oldest univers ty had four taculr.es (medic le, law, history and physics), several thousand students, a hundred or so teaching staff, and a uniform: dark green jacket with gold buttons, and a blue-lined fur cap.34 Chekhov spent his first two years as a medical student attending lectures in the two main buildings, situated opposite the Kremlin. Dissections began in his second year, along with studies in physiology, embryology and pathology. In 1882 Chekhov began the practical side of his training in the university's clinics on nearby Rozhdestvenka Street. This was where he attended anatomy classes, and observed post-mortems. The following year he had to travel up to the top of Petrovka Street to the Novoekaterinskaya - or New Catherine Hospital - to acquire skills in surgerv. The Novoekaterinskaya, founded in 1775, was Moscow's oldest and largest hospital, with 852 beds. From 1833 it had been housed in an elegant yellow classical building with the longest portico in the city and twelve Ionic columns. Before it was turned into a hosp;tal it had been the Gagarin Mansion, and formerly the aristocratic English Club, where Pierre Bezukhov challenges
he New Catherine Hospital in Moscow
the dastardly Dolokhov to a duel in War and Peace. After the Revolution it became Municipal CI nical Hospital No. 24. In 1883 Chejchov was a student of the distinguished Professor Alexei Ostroumov at the Novoekaterinskaya; in 1897 he became Ostroumov's patient when he was taken, after his haemorrhage at the Hermitage restaurant, to the university clinics in their new location near the Novodevichy Convent, near to where Tolstoy ' ved.
It was in 1884, the year that he graduated, that Chekhov first developed the symptoms o^ the tuberculosi I which would later kill him. He was one of those doctors who choose not to admit to .llness however, hoping that a healthy mental attitude would be the best kind of preventative medicine. In the case of tuberculosis this only worked up to a point. Rumours of Chekhov's frail health had been rife for a while, but still people were shocked to discover how ill he was in 1897. After this date, Chekhov put into practice the lessons he had learned from Marcus Aurelius and suffered his illness stoically, making light of its unpleasant symptoms rght until the very end.
Most of Chekhov's pract.cal medial work took place in the late 1880s, immediately after he qualified. He acquired valuable experience at the zemstvo hospital near Voskresensk where his family spent their summer in 1884, and also spent two weeks working as a locum in nearby Zvenigorod. In June he wrote a revealing letter to Nikolai Leikin about a post-mortem that he conducted that summer out in the countryside:
The body was dressed in a red shirt and new trousers, covered by a sheet, and on top of the sheet was a towel with an icon. We asked the policeman if he could get us some water; there was a pond w;th plenty of water in it near by, but nobody would let us have a bucket for fear of our making it unclean. One peasant from this village, which is called Manekhino, devised a cunning plan: they would steal a bucket from neighbouring Trukhino, because no one could care less about a bucket belonging to somebody else . . . When and where and how they were going to steal it was not clear, but they were terribly pleased with their stratagem and there were smiles all round . . . The actual post-mortem revealed twenty broken ribs, a swollen lung and a strong smell of alcohol from the stomach. Death had resulted from foul play in the shape of strangulation. The drunk man's chest had been crushed by something heavy, probably a well-bu.'t peasant's knee. There were a number of abrasions on the body caused by attempts at resuscitation. Apparendy the Manekhino peasants, when they found the body, rocked and pummelled it so enthusiastically for two hours that the murderer's future defence lawyer will have every right to ask an expert witness if the ribs had not been broken as a result of these attentions ... Somehow however I don't think these questions will ever be asked. There will be no counsel for the defence, nor indeed any accused either . . ,35
Chekhov applied for a position in the children's hospital in the area in 1884, but he ended up practising as a part-time private physician in Moscow. Since most of his patients were friends and colleagues, or else people who were extremely poor, he never made any money. Indeed, he almost made a loss after having to pay for cabs. And on one occasion he spent four hours just getting to one of his patients. Then, in April 1889, when his state of mind was like the cold spring weather ('mud, cold, rain'), Chekhov had to start visiting his own brother twice a day.36 Nikolai had stopped drinking, but his 'artistic' way of life had finally caught up with him. A few months later on a hot summer's day, surrounded by his family at their dacha retreat in the Ukraine, he would die of tuberculosis.
Until 1888 or so Chekhov toyed with the idea of abandoning literature for medicine, and this is when he wrote letters about medicine being his wife and literature his mistress (in one signing himself 'Antony and Meditsina', thus making medicine, a feminine noun in Russian, into a person). He was still writing hundreds of stories at this point, but he was also seeing hundreds of patients, some of whom he received between the hours of twelve and three, and some of whom he visited at home. But Dr Chekhov really never stood a chance against Antosha Chekhonte, the best-selling author. Once he started writing for literary journals.the numbers dropped - to the benefit of his writing, but to the detriment of his medical career. Even as a doctor, he had been attracted to the literary side of medicine, planning a doctoral dissertation first on che topic of sexual authority, and then on the history of medicine in Russia. His medical background was of inestimable value, of course, when he came to write about the penal colony on the Sibe ian island of Sakhalin, after his painstaking research into the living conditions of its incumbents. And at the end of his life his medical training impelled him to do something for the numerous terminally ill people who migrated south to Yalta in the futile hope of finding a cure without any way of supporting themselves. Most people would agrse that Cheknov paid the debt to science that he clearly felt he owed.
Ill
The Expanding Chest of Drawers
Tatyana (with her Russian soul,
herself not knowing why)
loved the Russian winter
with its cold beauty:
hoar-frost in the sun on an icy day,
sledges, and the pink glow
Of snow in a late dawn.37