The physician-narrator celebrates his 24th birthday in the company of two midwives and a feldsher (physician’s assistant). They toil in a remote area of Russia where conditions are harsh. The doctor tells the group about a peasant woman who requested a refill of belladonna (an atropine-like drug) that was prescribed for stomach pain the day before. Although the instructions were to take five drops as needed, the bottle was completely empty already. Since the woman had no signs of belladonna poisoning, the feldsher concludes she shared it or maybe even sold it to other villagers.

The group shares other stories about patient mistakes and misguided beliefs. That same night a man comes to the doctor’s house. He is a miller suffering from recurrent fevers. The physician diagnoses malaria and remarks how sensible and literate the patient is. Powdered quinine is prescribed to be taken once a day before the onset of fever. Soon the doctor receives word the miller is dying. The patient has defied the instructions and taken all 10 doses of quinine at one time to expedite his recovery. His stomach is pumped, and he survives the overdose.


The story takes place during a December snowstorm in 1916. Darkness symbolizes both ignorance and isolation. The doctor’s tenure treating scores of sick peasants in such a remote area is primarily focused on survival--theirs and his. One midwife even announces her hope that the doctor survives his stay in the countryside.

The tale nicely captures the camaraderie of health professionals as well as their knack for recounting interesting case histories. By way of powerful imagery, it underscores the "war" that physicians rage against not only disease but also the ignorance of some patients along with their lack of compliance. The narrator likens his handling of the stethoscope to gripping a revolver. At the conclusion of the story, he dreams of fighting with a sword (or maybe a stethoscope), flanked by fellow medical warriors (the feldsher and midwives).

The story highlights the difficulty in guaranteeing that patients will follow medical directions. Their version of common sense sometimes clashes with medical protocol. For example, the midwives chat about a few unusual incidents involving pregnant patients. One pregnant woman was found hanging upside down to facilitate the delivery of a breech baby. On another occasion, granulated sugar was discovered in the birth canal because the mother hoped to entice the baby out during a difficult labor.

This tale demonstrates just how difficult communication between doctors and patients can be and warns us not to take it for granted. It also cautions how easy it is to misread patients. First impressions of some individuals may ultimately prove hazardous to their health.


Translated from the Russian by Michael Glenny.

Primary Source

A Country Doctor's Notebook


Collins & Harvill

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