So I was alone, surrounded by November gloom and whirling snow; the house was smothered in it and there was a moaning in the chimneys. I had spent all twenty-four years of my life in a huge city and thought that blizzards only howled in novels. It appeared that they- howled in real life. The evenings here are unusually long, and I fell to daydreaming, staring at the reflection on the window of the lamp with its dark green shade. I dreamed of the nearest town, thirtytwo miles away. I longed to leave my country clinic and go there.

They had electricity, and there were four doctors whom I could consult. At all events it would be less frightening than this place. But there was no chance of running away, and at times I realised that it would be cowardly. It was for precisely this, after all, that I had been studying medicine.

‘Yes, but suppose they bring me a woman in labour and there are complications? Or, say, a patient with a strangulated hernia? What shall I do then? Kindly tell me that. Forty-eight days ago I qualified “with distinction”; but distinction is one thing and hernia is another. Once I watched a professor operating on a strangulated hernia. He did it, while I sat in the amphitheatre. And I only just managed to survive…

More than once I broke out in a cold sweat down my spine at the thought of hernia. Every evening, as I drank my tea, I would sit in the same attitude: by my left hand lay all the manuals on obstetrical surgery, on top of them the small edition of Doderlein. To my right were ten different illustrated volumes on operative surgery. I groaned, smoked and drank cold tea without milk.

Once I fell asleep. I remember that night perfectly-it was 29 November, and I was woken by someone banging on the door. Five minutes later I was pulling on my trousers, my eyes glued imploringly to those sacred books on operative surgery. I could hear the creaking of sleigh-runners in the yard-my ears had become unusually sensitive.

The case turned out to be, if anything, even more terrifying than a hernia or a transverse foetus. At eleven o’clock that night a little girl was brought to the Muryovo hospital. The nurse said tonelessly to me: ‘The little girl’s weak, she’s dying. . . Would you come over to the hospital, please, doctor. . .’

I remember crossing the yard towards the hospital porch, mesmerised by the flickering light of a kerosene lamp. The lights were on in the surgery, and all my assistants were waiting for me, already dressed in their overalls: the feldsher Demyan Lukich, young but very capable, and two experienced midwives, Anna Nikolaevna and Pelagea Ivanovna. Only twenty-four years old, having qualified a mere two months ago, I had been placed in charge of the Muryovo hospital.

The feldsher solemnly flung open the door and the mother came in-or rather she seemed to fly in, slithering on her ice-covered felt boots, unmelted snow still on her shawl. In her arms she carried a bundle, from which came a steady hissing, whistling sound. The mother’s face was contorted with noiseless weeping. When she had thrown off her sheepskin coat and shawl and unwrapped the bundle, I saw a little girl of about three years old. For a while the sight of her made me forget operative surgery, my loneliness, the load of useless knowledge acquired at university: it was all completely effaced by the beauty of this baby girl. What can I liken her to? You only see children like that on chocolate boxes-hair curling naturally into big ringlets the colour of ripe rye, enormous dark blue eyes, doll- like cheeks. They used to draw angels like that. But in the depths of her eyes was a strange cloudiness and I recognised it as terror – the child could not breathe. ‘She’ll be dead in an hour,’ I thought with absolute certainty, feeling a sharp twinge of pity for the child.

Her throat was contracting into hollows with each breath, her veins were swollen and her face was turning from pink to a pale lilac. I immediately realised what this colouring meant. I made my first diagnosis, which was not only correct but, more important, was given at the same moment as the midwives’ with all their experience: ‘The little girl has diphtherial croup. Her throat is already choked with membrane and soon it will be blocked completely.’

‘How long has she been ill?’ I asked, breaking the tense silence of my assistants. ‘Five days now,’ the mother answered, staring hard at me with dry eyes.

‘Diphtheria,’ I said to the feldsher through clenched teeth, and turned to the mother: ‘Why have you left it so long?’

At that moment I heard a tearful voice behind me: ‘Five days, sir, five days!’

I turned round and saw that a round-faced old woman had silently come in. ‘I wish these old women didn’t exist,’ I thought to myself.

With an aching presentiment of trouble I said: ‘Quiet, woman, you’re only in the way,’ and repeated to the mother: ‘Why have you left it so long? Five days?

Hmm?’

Suddenly with an automatic movement the mother handed the little girl to the grandmother and sank to her knees in front of me.

‘Give her some medicine,’ she said and banged her forehead on the floor. ‘I’ll kill myself if she dies.’

‘Get up at once,’ I replied, ‘or I won’t even talk to you.’

The mother stood up quickly with a rustle of her wide skirt, took the baby from the grandmother and started rocking it. The old woman turned to the doorpost and began praying, while the little girl continued to breathe with a snake-like hiss. The feldsher said: ‘That’s what they’re all like. These people!’ And he gave a twitch of his moustache.

‘Does that mean she’s going to die?’ the mother asked, staring at me with what looked like black fury.

‘Yes, she’ll die,’ I said quietly and firmly.

The grandmother picked up the hem of her skirt and wiped her eyes. The mother shouted in an ugly voice: ‘Give her something! Help her! Give her some medicine!’

I could see what was in store for me and remained firm.

‘What medicine can I give her? Go on, you tell me. The little girl is suffocating, her throat is already blocked up. For five days you kept her ten miles away from me. Now what do you want me to do?’

‘You’re the one who’s supposed to know,’ the old woman whined by my left shoulder in an affected voice which made me immediately detest her.

‘Shut up!’ I said to her. I turned to the feldsher and ordered the little girl to be taken away. The mother handed her to the midwife and the child started to struggle, evidently trying to cry, but her voice could no longer make itself heard. The mother made a protective move towards her, but we kept her away and I managed to look into the little girl’s throat by the light of the pressure-lamp. I had never seen diphtheria before except for mild, forgettable cases. Her throat was full of ragged, pulsating, white substance. The little girl suddenly breathed out and spat in my face, but I was so absorbed that I did not flinch.

‘Well now,’ I said, astonished at my own calm. ‘This is the situation: it’s late, and the little girl is dying. Nothing will help her except one thing – an operation.’

I was appalled, wondering why I had said this, but I could not help saying it. The thought flashed through my mind: ‘What if she agrees to it?’

‘How do you mean?’ the mother asked.

‘I’ll have to cut open her throat near the bottom of her neck and put in a silver pipe so that she can breathe, and then maybe we can save her,’ I explained.

The mother looked at me as if I was mad and shielded the little girl from me with her arms, while the old woman started muttering again: ‘The idea! Don’t you let them cut her open! What-cut her throat?’

‘Go away, old woman,’ I said to her with hatred. ‘Inject the camphor!’ I ordered the feldsher.

The mother refused to hand over the little girl when she saw the syringe, but we explained to her that there was nothing terrible about it.

‘Perhaps that will cure her?’ she asked.

‘No, it won’t cure her at all.’ Then the mother burst into tears.

‘Stop it,’ I said. I took out my watch, and added: ‘I’m giving you five minutes to think it over. If you don’t agree in five minutes, I shall refuse to do it.’

‘I don’t agree!’ the mother said sharply.

‘No, we won’t agree to it,’ the grandmother put in.

‘It’s up to you,’ I said in a hollow voice, and thought: ‘Well, that’s that. It makes it easier for me. I’ve said my piece and given them a chance. Look how dumbfounded the midwives are. They’ve refused and I’m saved.’ No sooner had I thought this than some other being spoke for me in a voice that was not mine:

‘Look, have you gone mad? What do you mean by not agreeing? You’re condemning the baby to death. You must consent. Have you no pity?’

‘No!’ the mother shouted once more.

I thought to myself: ‘What am I doing? I shall only kill the child.’

But I said: ‘Come on, come on-you’ve got to agree! YOU must! Look, her nails are already turning blue.’

‘No, no!’

‘All right, take them to the ward. Let them sit there.’

They were led away down the half-lit passage. I could hear the weeping of the women and the hissing of the little girl. The feldsher returned almost at once and said: ‘They’ve agreed!’

I felt my blood run cold, but I said in a clear voice: ‘Sterilise a scalpel, scissors, hooks and a probe at once.’

A minute later I was running across the yard, through a swirling, blinding snowstorm. I rushed to my room and, counting the minutes, grabbed a book, leafed through it and found an illustration of a tracheotomy.

Everything about it was clear and simple: the throat was laid open and the knife plunged into the windpipe. I started reading the text, but could take none of it in-the words seemed to jump before my eyes. I had never seen a tracheotomy performed. ‘Ah well, it’s a bit late now,’ I said to myself, and looked miserably at the green lamp and the clear illustration. Feeling that I had suddenly been burdened with a most fearful and difficult task, I went back to the hospital, oblivious of the snowstorm.

In the surgery a dim figure in full skirts clung to me and a voice whined: ‘Oh, sir, how can you cut a little girl’s throat? How can you? She’s agreed to it because she’s stupid. But you haven’t got my permission – no you haven’t. I agree to giving her medicine, but I shan’t allow her throat to be cut.’

‘Get this woman out!’ I shouted, and added vehemently: ‘You’re the stupid one! Yes, you are. And she’s the clever one. Anyway, nobody asked you! Get her out of here!’

A midwife took a firm hold of the old woman and pushed her out of the room.

‘Ready!’ the feldsher said suddenly.

We went into the small operating theatre; the shiny instruments, blinding lamplight and oilcloth seemed to belong to another world…

for the last time I went out to the mother, and the little girl could scarcely be torn from her arms. She just said in a hoarse voice: my husband’s away in town. When he comes back and finds out what I’ve done, he’ll kill me!’

‘Yes, he’ll kill her,’ the old woman echoed, looking at me in horror. ‘Don’t let them into the operating theatre!’ I ordered.

So we were left in the operating theatre, my assistants, myself, and Lidka, the little girl. She sat naked and pathetic on the table and wept soundlessly. They laid her on the table, strapped her down, washed her throat and painted it with iodine, I picked up the scalpel, still wondering what on earth I was doing. It was very quiet. With the scalpel I made a vertical incision down the swollen white throat. Not one drop of blood emerged. Again I drew the knife along the white strip which protruded between the slit skin. Again not a trace of blood. Slowly, trying to remember the illustrations in my textbooks, I started to part the delicate tissues with the blunt probe. At once dark blood gushed out from the lower end of the wound, flooding it instantly and pouring down her neck. The feldsher started to stanch it with swabs but could not stop the flow. Calling to mind everything I had seen at university, I set about clamping the edges of the wound with forceps, but this did no good either.

I went cold and my forehead broke out in a sweat. I bitterly regretted having studied medicine and having landed myself in this wilderness. In angry desperation I jabbed the forceps haphazardly into the region of the wound, snapped them shut and the flow of blood stopped immediately. We swabbed the wound with pieces of gauze; now it faced me clean and absolutely incomprehensible. There was no windpipe anywhere to be seen. This wound of mine was quite unlike any illustration. I spent the next two or three minutes aimlessly poking about in the wound, first with the scalpel and then with the probe, searching for the windpipe. After two minutes of this, I despaired of finding it.

‘This is the end,’ I thought. ‘Why did I ever do this? I needn’t have offered to do the operation, and Lidka could have died quietly in the ward. As it is she will die with her throat slit open and I can never prove that she would have died anyway, that I couldn’t have made it any worse. . .’

The midwife wiped my brow in silence. ‘I ought to put down my scalpel and say: I don’t know what to do next.’

As I thought this I pictured the mother’s eyes. I picked up the knife again and made a deep, undirected slash into Lidka’s neck. The tissues parted and to my surprise the windpipe appeared before me.

‘Hooks!’ I croaked hoarsely.

The feldsher handed them to me. I pierced each side with a hook and handed one of them to him. Now I could see one thing only: the greyish ringlets of the windpipe. I thrust the sharp knife into it – and froze in horror. The windpipe was coming out of the incision and the feldsher appeared to have taken leave of his wits: he was tearing it out.

Behind me the two midwives gasped. I looked up and saw what was the matter: the feldsher had fainted from the oppressive heat and, still holding the hook, was tearing at the windpipe. ‘It’s fate,’ I thought, ‘everything’s against me. We’ve certainly murdered Lidka now.’ And I added grimly to myself: ‘As soon as I get back to my room, I’ll shootmyself.’ Then the older midwife, who was evidently very experienced, pounced on the feldsher and tore the hook out of his hand, sayingthrough her clenched teeth: ‘Go on, doctor…’

The feldsher collapsed to the floor with a crash but we did not turn to look at him. I plunged the scalpel into the trachea and then inserted a silver tube. It slid in easily but Lidka remained motionless. The air did not flow into her windpipe as it should have done. I sighed deeply and stopped: I had done all I could. I felt like begging someone’s forgiveness for having been so thoughtless as to study medicine. Silence reigned. I could see Lidka turning blue. I was just about to give up and weep, when the child suddenly gave a violent convulsion, expelled a fountain of disgusting clotted matter through the tube, and the air whistled into her windpipe. As he started to breathe, the little girl began to howl. That instant the feldsher got to his feet, pale and sweaty, looked at her throat in stupefied horror and helped me to sew it up.

Dazed, my vision blurred by a film of sweat, I saw the happy faces of the midwives and one of them said to me: ‘You did the operation brilliantly, doctor.’

I thought she was making fun of me and glowered at her. Then the doors were opened and a gust of fresh air blew in. Lidka was carried out wrapped in a sheet and at once the mother appeared in the doorway.

Her eyes had the look of a wild beast. She asked me: ‘Well?’

When I heard the sound of her voice, I felt a cold sweat run down my back as I realised what it would have been like if Lidka had diedon the table. But I answered her in a very calm voice: ‘Don’t worry, she’s alive. And she’ll stay alive, I hope. Only she won’t be able to talk until we take the pipe out, so don’t let that upset Just then the grandmother seemed to materialise from nowhere and crossed herself, bowing to the doorhandle, to me, and to the ceiling.

This time I did not lose my temper with her, I turned away and ordered Lidka to be given a camphor injection and for the staff to take turns at watching her.

Then I went across the yard to my quarters. I remember the green lamp burning in my study, Doderlein lying there and books scattered everywhere. I walked over to the couch fully YOU.’

Just then the grandmother seemed to materialise from nowhere and crossed herself, bowing to the doorhandle, to me, and to the ceiling. This time I did not lose my temper with her, I turned away and ordered Lidka to be given a camphor injection and for the staff to take turns at watching her. Then I went across the yard to my quarters. I remember the green lamp burning in my study, Doderlein lying there and books scattered everywhere. I walked over to the couch fully dressed, lay down and was immediately lost to the world in a dreamless sleep.

A month passed, then another. I grew more experienced and some of the things I saw were rather more frightening than Lidka’s throat, which passed out of my mind. Snow lay all around, and the size of my practice grew daily. Early in the new year, a woman came to my surgery holding by the hand a little girl wrapped in so many layers that she looked as round as a little barrel. The woman’s eyes were shining. I took a good look and recognised them.

‘Ah, Lidka! How are things?’ ‘Everything’s fine.’

The mother unwound the scarves from Lidka’s neck. Though she was shy and resisted I managed to raise her chin and took a look. Her pink neck was marked with a brown vertical scar crossed by two fine stitch marks.

‘All’s well,’ I said. ‘You needn’t come any more.’

‘Thank you, doctor, thank YOU,’ the mother said, and turned to Lidka: ‘Say thank you to the gentleman!’ But Lidka had no wish to speak to me.

I never saw her again. Gradually I forgot about her. Meanwhile my practice still grew. The day came when I had a hundred and ten patients. We began at nine in the morning and finished at eight in the evening. Reeling with fatigue, I was taking off my overall when the senior midwife said to me: ‘It’s the tracheotomy that has brought you all these patients. Do you know what they’re saying in the villages? The story goes that when Lidka was ill a steel throat was put into her instead of her own and then sewn up. People go to her village especially to look at her. There’s fame for you, doctor. Congratulations.’

‘So they think she’s living with a steel one now, do they?’ I enquired.

‘That’s right. But you were wonderful, doctor. You did it so coolly, it was marvellous to watch.’

‘Hm, well, I never allow myself to worry, you know,’ I said, not knowing why. I was too tired even to feel ashamed, so I just looked away. I said goodnight and went home. Snow was falling in large flakes, covering everything, the lantern was lit and my house looked silent, soIitary and imposing. As I walked I had only one desire – sleep.