He finds that a man with a sore throat has the rash of secondary syphilis, and is exasperated by the patient’s continued fussing about his throat. The doctor thinks he looks too young, perceives the dubious looks of patients who think they know better, and struggles both to reassure and to induce an appropriate sense of urgency and gravity. Struggling with the version of a stillbirth, he breaks the baby’s arm and agonises that he will be stripped of his medical degree. But if you are wrong? And if the patient dies after your intervention, you will be blamed. If a patient will die if you don’t act, at least you can give them a chance. Like Bulgakov, I had the able ‘assistance’ of a nursing sister, who I suspected would have done the job much better herself. And finding, in my first week as a houseman, that I was expected to do a regular minor operations list. Except for the fierce family of a screaming toddler in casualty, who became fans after I escaped into the office and returned to reduce his pulled elbow as if I did it every day of my life. Yet this is what he has to do, and he does it, as the midwife advises him discreetly from years of acquired wisdom. In the latter he rushes off to read his obstetric manual, which describes the manoeuvre as ‘among the most dangerous obstetric operations to which a mother can be subjected’. The book includes jaw-dropping accounts of having to amputate the leg of a young girl who had fallen into a farm machine, of performing a tracheotomy in an advanced case of diphtheria, and of undertaking combined internal and external version to deliver the baby of a woman in labour. A Country Doctor’s Notebook describes seeing 100 patients a day, looking after a 40-bed ward, performing operations, and being dragged out of bed five times in 2 weeks to attend deliveries. This was general practice in verity - he had to deal with whatever and however much turned up. He studied medicine in Kiev, qualified in 1916, and was immediately posted to a remote hospital, where - as the only doctor - he worked with an unqualified assistant and two midwives. It would have made a worthy alternative to The Citadel by AJ Cronin, which I used to present to foundation year 2 doctors at the end of their attachments (and wonder if they read).īulgakov (1891–1940) is best known for his fantastical novel, The Master and Margarita, which inspired the Rolling Stones’ song Sympathy for the Devil. Some of its power resides in resonances and contrasts with the life I have lived. It’s a career too late now, and perhaps it would have been better to read before applying to medical school anyway. Several of its chapters were published in Russian magazines in the 1920s, but they were not collated until the 1960s, and the book was translated into English in 1975 (published in the UK by Collins & Harvill press), so it had not long been available. I doubt whether A Country Doctor’s Notebook by Mikhail Afanasievich Bulgakov was on the reading list I received between my A levels and starting my medical studies.

Family practice notebook