Looking back on his first year of medical practice in an out-of-the-way section of Russia, a 25 year old physician reflects on how much he has changed both personally and professionally. He lists the year's accomplishments: performing a tracheostomy, successful intubations, amputations, many obstetrical deliveries, and setting several fractures and dislocations. With pride, the doctor calculates he has seen 15,613 patients in his first twelve months of practice.

He recalls some poignant moments. A pregnant woman has a baby while lying in the grass near a stream. The doctor pulls a soldier's carious tooth but is horrified when a piece of bone is attached to it. During a delivery, he inadvertently fractures a baby's arm and the infant is born dead.

Basking in his year's worth of experience and newfound clinical confidence, the physician quickly comprehends the limits of his knowledge on the first day of his second year in practice when a mother brings her baby to the doctor. The infant's left eye appears to be missing. In its place sits an egg-like nodule. Unsure of the diagnosis and worried about the possibility of a tumor, the physician recommends cutting the nodule out. The mother refuses. One week later she returns with her child whose left eye is now normal in appearance. The doctor deduces that the boy had an abscess of the eyelid that had spontaneously ruptured.


The main lesson of this superb story about the first year of solo medical practice in a rural area is best summarized by its last line: "One never stops learning" (109). No matter how much experience a physician accumulates, the practice of medicine remains full of surprises. While experience is an excellent teacher, the narrator recognizes that good judgment and a devotion to lifelong learning are vital to the maturation of a clinician.

The novice physician not only struggles with patient ignorance and the forces of Nature (at one point, he is snowed in for two days at the hospital), but his own insecurity as he encounters a multitude of difficult clinical cases. He must continually balance his own uncertainty with the need for immediate action. The young physician bears much guilt as he realizes that his on-the-job training sometimes results in adverse outcomes for certain patients.

Obstetrical care appears to be the doctor's greatest challenge and fear. His description of delivering a dead baby and accidentally breaking its little arm is heartbreaking. The doctor readily admits that he is grateful for any luck that falls his way. After only one year of medical practice, the narrator is aware of the dramatic metamorphosis he has undergone. His face has become more confident but also weathered. Doubt is replaced by hubris--but not for very long!


Translated from the Russian by Michael Glenny.

Primary Source

A Country Doctor's Notebook


Collins & Harvill

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