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 Döderlein. 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.