“A Steppe Doctor” by Sergei Linkov

The doctor’s fingertips have turned to gelatin. He is certain that with each hour they are wearing down, leaving watery smears on the skins of his patients and on his notes. His handwriting has become a hideous thing, thorny as the broken stems of the steppe outside and full of childish loops. He wrestles with a prescription, strikes it through and begins another. This one isn’t much better. He wonders who he is trying to please. Who will read his notes here, but himself?

This man is sick, very sick. The doctor’s fingers slither down his chest, tapping out hollows in his quivering bird-lungs. Every now and then, the doctor’s body reminds him that he hasn’t used the toilet since the early hours of the morning. Which morning? There have been two mornings since he last slept, after all. Or was it more? He is becoming stupid under the great steppe sun.

But he can still help this man, stupid as he is. He takes up his stethoscope and listens to the music of the man’s adenocarcinoma. He has many things to tell the man. He speaks, imagining bacilli flitting through the air around him like the moths that come to visit him when he lights the night with his kerosene lamps and tends to people sicker than this man. As a doctor he is gracious, and does not like to fight. He invites the bacilli into the delicate plumbing of his body. He imagines them weaving nests in the most secret parts of himself.

“I’m tired, doctor,” says the man. “Let me go home. Let me die in peace.”

The doctor protests. He tells the man of the treatment modalities still available, and of the capital, that shadowy thing that he speaks of so often and to so little avail. If the people here could go to the capital he would no longer be their doctor, and he could sleep every night, and eat and use the toilet whenever he needed to. The doctor is afraid of uselessness. He makes page after page of notes; scrubs his own instruments; mixes his own morphine and barbital. He makes appeals to the sick man, careful to keep his voice within that which in better parts would be known as “professional norms”. When the man leaves, he wants to weep.

It is a pitiful thing, when a doctor does not like to fight.

The doctor has a game he likes to play. Each day, he tasks himself with looking upon one thing that is good and beautiful. There is a dead tree just outside his window where the owls raise their young. The little ones are covered in down, and the insides of their mouths are as pink as coral. But using the same good thing two days in a row is cheating, so the doctor looks instead to the dead grass, neither green nor golden. There, at the very edge of his vision, a red steppe tulip is beginning to bloom. Though he cannot see it from the window, he knows that the petals of these tulips are tipped with yellow at the bottom, and where they meet the stem lies a puff of chocolate brown. The tulip is so lovely that he asks himself whether it would be within the rules of the game to look upon it again when it has finished blooming. Are the bud and the blossom the same? Are the owls different owls each new day of their lives? The doctor wonders just how many good things he could count if he stretched them out like this.

But owlets fall from their nests, and rats drag away their little bones. All across the steppe, a million good things are turning into evil things. If tomorrow the doctor forgets his tulip and averts his gaze, he will not see the moment when the rats come.

The doctor’s notes loop around the page in ways that his torrid thoughts can no longer follow. Now would be the perfect time to go and relieve himself. But the toilet is down the corridor, and patients would stare after him with their rueful beast-eyes. So the doctor chooses instead to steal just a few more moments for his tulip, gazing past its pursed lips into its unknowable innards.

The next patient is a young woman, straw-haired and sunny, her mouth wide as a frog’s. She is with child. When the doctor checks the woman’s file, he sees that she was born on the same day as he. It seems right to tell her.

She smiles her froggish smile. “Small world,” she says.

“Yes,” he says, “small world, irrefutably small.” He asks her whether she knows that the Stoics said the cosmos is forever being destroyed and created anew with only the tiniest of variations, meaning that at some point he could have been her twin. He is certain that the Stoics said no such thing.

She tells him that she thinks her child will be a boy. He asks her how she knows. She tells him all about the wise women, and the herbs that have special affinities for male and female. Then she tells him all about her husband, and her mother who will be a grandmother very soon. The doctor stops listening as she undresses and presents her swollen belly. He thinks instead of the lie of his own hair, of the smell of his clothes and the color under his eyes. It would be a cruel thing, to deprive men of their own vanity. He wonders if the Stoics had helped at all to hide the fact that he has no brain left in his head.

He lets her talk. He lets her imprison him in her tepid warmth. How he wishes she had instead come to him in despair, cursing herself and cursing her child as she raised her little fists to rend the heavens. Then he could have searched for the right words to cauterise her discontent, and kept his mind off his own aching body. 

There is weeping outside. Have the steppe gods listened? The young woman starts, asking if she should leave. The doctor is finished with her anyway. He informs her that everything about her child is quite satisfactory, and hands her a slip of paper with the thorny date of her next appointment.

“Are you sure this is right, Doctor?” she asks him. The baby will already be here in September, after all.

Of course, of course, how silly. What a good thing she can read what he’s written. He gives her a new date, thornier than the last. She does not seem to mind that he can no longer write or think. She is kinder than he had given her credit for, this Stoics’ twin of his. As she leaves, she even flashes another smile, showing the perfect white teeth with which she sucked him dry so effortlessly.

The weeping one is a mother with a sick child. A girl, no older than six, bent into a tiny huddle of pain as she gasps for air with dog-like barks. Her tongue is as blue as her cornflower dress. Epiglottitis, the doctor thinks, it must be. He opens himself up to her suffering like the owlets open their mouths to the moon. I have to cut her, he says to her mother, enjoying the timbre of his own voice. She will not breathe otherwise.

“Let her live,” she cries, clutching the child’s cornflower hands. “Do whatever you must, only please, God, let her live.”

The doctor takes the child into his arms. His nurse, the one with the stiff dark hair and glasses, charges past him into the operating room. She is a good woman, quick and reliable. She prepares the instruments and ketamine as he lays the child out on the table. Already, blood is rushing back into the hollow space where his brain used to be, while a thousand nerve fibers bloom once more in his hands. He thinks of some puerile nonsense to say to the child as she shuts her terrified eyes and surrenders to the ketamine. It would not do to tell the child that he is more grateful to her than she will ever know.

The child’s throat parts easily under the doctor’s scalpel. The nurse’s brow grows slick with sweat as the red drops that ripen on the edge of the incision. Her knuckles are white beneath the girl’s jawbone. She is a fine nurse, the doctor thinks. She never complains, or speaks unnecessarily. The doctor wonders whether she has a girl of a similar age at home, and it occurs to him that he’s never cared enough to ask. 

“Go,” says the doctor. The retractor fits under the child’s infrahyoid like a hand in a tailored glove. “Go and lie down.” 

“I can’t leave you with her,” the nurse says. “There is nobody else.” 

“Go,” he insists, “drink some water. I will manage.”

“You are kind, Doctor.” Uncomplaining as always, she ducks out of her room. 

The doctor chases his new strength, fanning it across his tongue like an infant who has missed his mother’s milk. He cuts through the rings of her trachea, searching within the blood and flesh of this child for the treasure the steppe has taken from him, the golden city with which he bought a flower and a broken stem. The petals tumble out of his hands and catch the wind. When he sees the spurt of arterial blood, he finally knows what he has wrought upon this child with his gelatin fingers. But the doctor does not like to fight. So he sets his scalpel down neatly, and sinks into the morning that dwells in her eyes. 

Sergei Linkov is a Russian studying medicine in South Africa, with a particular focus on rural healthcare.

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