BJS Bookshelf: A Country Doctor’s Notebook by Mikhail Bulgakov

“Banal prejudice. People are most unfair to doctors and to us surgeons in particular. Just think: a man does a hundred appendectomies and the hundred and first patient expires on the operating table. Is that murder?”

Mikhail Bulgakov is better known for his literary masterpieces such as The Master and Margarita and The Heart of a Dog. However, this series of short stories is directly inspired by his experiences as a doctor, not as a writer. The main character, Dr Vladmir Bomgard has just graduated from medical school and is sent to work in a remote hospital in the geographically hostile Russian countryside. As the only doctor on premises, and with the help of a medical practitioner and two midwives, he has to navigate many challenges including his lack of experience, limited resources, snow blizzards and a generally uneducated patient clientele, all while filling in the shoes of his presumably more qualified predecessor. Struggling with feelings of imposter syndrome, he is particularly intimidated by surgical and obstetric emergencies, starting his account by establishing that a strangulated hernia is the epitome of all difficulties.  

Through dedication, reading, support from his staff and sheer serendipity, he establishes a name for himself, eventually becoming a reference for colleagues who will follow in his footsteps. The book takes the reader through a rural doctor’s struggles in treating various emergencies and afflictions such as trauma, complicated labour, children with obstructed airways, syphilis and many others. It also touches on various other sensitive topics such as bridging the gap between medical school and real-world practice, having difficult conversations with patients who hold different values, and dealing with colleagues who suffer a drug addiction. 

Surgeons will enjoy reading this book tremendously and will not only relate to the technically accurate descriptions of various surgical procedures, but also to the universal sentiment of wanting to do the best for one’s patients despite the odds. Young surgeons will find they are not unique in their fears and struggles, bearing in mind that the book is set in 1916, whereas more experienced surgeons will laugh as they recognize their younger selves in the book’s main character. “Suppose they bring me a hernia? Just tell me how I’ll find my bearings with that? And more to the point, what will a hernia patient feel like when I get my hands on him? Will he find his bearings in the next world?”

A Country Doctor’s Notebook is a light, candid and enjoyable read that serves as a faithful account of the many tacit aspects and challenges of medical practice that perhaps should be addressed directly in medical schools and surgical residency programmes.