Bulgakov’s “A Young Doctor’s Notebook” is a compelling read that vividly captures the daunting experiences of newly qualified doctors. Picking up this book for holiday reading, it immediately resonated with the intense emotions and challenges I recall from my own early days in medicine – the heavy weight of responsibility coupled with the stark reality of inadequate support.
While my initial experiences as a houseman in a bustling London hospital were set in a vastly different context from Bulgakov’s, the core feelings were strikingly similar. Bulgakov, fresh out of medical school, was thrust into the role of sole doctor at a remote rural hospital in pre-revolution Russia. Imagine the scope of his duties: managing all emergencies – from medical and obstetric to paediatric, surgical, and orthopaedic – alongside overseeing ward patients. His team consisted of just a couple of feldshers (healthcare assistants) and two midwives. The sheer volume of patients he attended to daily, around 100 new cases, is staggering.
It brought back to me what it felt like to be a newly qualified doctor with scary responsibilities.
Every doctor carries within them stories of procedures that veered close to disaster, or perhaps, more frequently, instances where things thankfully went well, but only after a heart-stopping near miss. Bulgakov masterfully portrays these moments of intense pressure and uncertainty. He recounts nerve-wracking emergency tracheostomies, the grim necessity of amputating severely damaged limbs, and the delicate complexities of difficult childbirths. He expertly articulates the internal conflict between his terrified inner self and the outwardly projected persona of confident professionalism – a necessary façade. And then there are his private moments of profound despair. This resonates deeply with Bill Styles’ renowned concept of the “mask of professional brilliance” that many doctors learn to wear.
Bulgakov’s narrative style naturally draws comparisons to Chekhov, yet it retains its distinct originality. These stories were initially published in Russian “medical journals,” which one might consider the precursors to publications like the missed World Medicine or the concise narratives found in today’s medical magazines.
Bulgakov shines brightest when recounting his own experiences, unburdened by modern patient confidentiality constraints. Perhaps the only story that slightly misses the mark is the lengthy, fictionalized diary of a colleague succumbing to morphine addiction, detailing the self-deception, the sordid transgressions, and the inevitable downfall.
Bulgakov’s depiction of early 20th-century, surgery-focused, low-tech medical practice serves as a stark reminder of the almost miraculous advancements of modern medicine. However, his work also underscores a timeless truth: medical practice inherently involves navigating precarious situations. For us, the doctors immersed in this work, the weight of personal responsibility is ever-present. It transcends being merely a job.
Bulgakov’s setting – a young doctor in a remote, peasant community where patients held onto hopes for miracles while viewing modern science with suspicion – bears striking parallels to contemporary scenarios, such as treating Covid-19 and numerous other situations where patient beliefs and medical realities intersect.
Reading “A Young Doctor’s Notebook” illuminated the enduring common threads in the experience of being a doctor, whether in the early 20th century, the 21st century, or indeed, likely any era. Bulgakov’s tales, infused with dark humour and a strain of optimistic cynicism, echo the stories we continue to share amongst ourselves, the medical tribe, as we navigate the pressures of our profession – a tribe whose unique challenges often remain incomprehensible to those outside it.
Featured book
A young doctor’s notebook. Mikhail Bulgakov. First published in Russian as short stories, 1925 – 27. Republished: Alma Classics 2012, ISBN-13: 978-1847492869
