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10 The Pharos/Summer 2012 in medical school— and after

An artist’s flair is sometimes worth a scientist’s brains – Anton Chekhov

Leon Morgenstern, MD The author (AΩA, New York University, 1943) is Emeritus it significantly enlarged the scope of my observations and Director of the Center for Health Care Ethics and Emeritus enriched me with knowledge whose true worth to a writer Director of at Cedars-Sinai Medical Center in Los can be evaluated only by somebody who is himself a doctor; Angeles, and Emeritus Professor of Surgery at the David it has also provided me with a sense of direction, and I am Geffen School of Medicine at UCLA. sure that my closeness to medicine has also enabled me to avoid many mistakes.1p425 t is often overlooked, and sometimes forgotten, that Anton Chekhov, the noted Russian writer of short stories and plays, Medical school was a pivotal juncture in the delicate balance Iwas also a doctor. He was one of the principal authors in between the two careers. It made him into the doctor he was. what has been called the Golden Age of Russian Literature It helped him reach the goal of becoming the writer he was in the mid- and late-nineteenth century, along with Fyodor to be. Dostoevsky, , and Ivan Turgenev. Chekhov was born in Taganrog, a port town founded by In 1879 at the age of nineteen, Anton Chekhov enrolled in Peter the Great on the Sea of Azov in Southern . His the medical school of Moscow University. He was destined family was only one generation removed from serfdom, hav- to become a famous author rather than a famous doctor. His ing had its freedom bought by an industrious grandfather, talent in writing eclipsed any ambition he might have had in the only one of his kin who could read and write. His father medicine, but his devotion to doctoring remained evident in had no formal education, was a stern disciplinarian and head his literary works as well as in his medical activities through- of the household, and had a penchant for failure in all of his out his lifetime. As he himself put it, bread-winning ventures. Anton was the third of six born to this impecunious family. Theirs was a struggle to rise I have no doubt that my involvement in medical sci- above their legacy of the economic enslavement of serfdom ence has had a strong influence on my literary activities; to a life of independence and respectability. In that struggle it was Anton who eventually achieved that goal for his family.2,3 At age eight Anton entered the Taganrog gymnasium to Anton Chekhov. Portrait by Nikolai Chekhov. © Sovfoto. begin his elementary and high school education. He was a

The Pharos/Summer 2012 11 Anton Chekhov in medical school—and after

Chekhov with family and friends, 1890. Anton Chekhov at 28 years of age. All photos © Bettmann/CORBIS

mediocre student, more interested in the usual pastimes of When Anton was still in high school at age sixteen his boyhood than in the quest for good grades. At age fifteen, father fled to Moscow to escape going to debtor’s prison. A he was stricken with a severe abdominal illness, described as short time later his mother left to join him there with the two “peritonitis.” The Taganrog school doctor who treated him, younger children. The older brothers had also already left to a Dr. Schlempfe, encouraged young Anton to strive for a ca- study in Moscow. Anton was left to fend for himself for the reer in medicine, preferably at his own alma mater in Zurich, next two years, attending high school, working at tutoring and Switzerland. While in high school, Anton did dream of Zurich other odd jobs, and longing for the company of his close-knit and its medical school but eventually resigned himself more family. realistically to settle for medical school in Moscow. He wrote If grades were then, as they are now, a meaningful pre- to his brother Misha, “I have only one secret illness which tor- requisite to medical school entry, Anton’s performance as a ments me . . . lack of money.” 4pp38–39 That same year his father student would never have earned him admission. In a crucial wrote, “Antosha! When you finish studying at the Taganrog examination at the gymnasium for university eligibility he gimnazia, you must join the [Moscow] Medical faculty, for failed in mathematics, did poorly in Latin, as well as in natu- which you have our blessing.” 5p62 The choice of medicine as ral science, all usual requirements for admission to medical a career goal reflected not only the early exhortation by Dr. school. Nevertheless, by a special vote, he was gratuitously Schlempfe in that direction but also the promise of a stable granted a matriculation certificate for the Moscow University source of income for his impoverished family. Curiously, many medical school in June 1879. He was also awarded a sorely years later, in a letter to a friend, he wrote, needed stipend of twenty-five silver roubles a month by the Taganrog City Council. In August of 1879, he was off to In 1879 I entered the Medical School of Moscow Moscow for the beginning of not one, but two careers. The University. At the time I had only a vague knowledge of the one in medicine was about to begin; the other, writing, was al- University’s various faculties, and I do not remember why I ready in progress. He had written humorous sketches, verses, chose medicine, but I have had no subsequent regrets.1p425 and even the outline for a drama (“Fatherlessness”) while still in high school. These have never been published. Medical

12 The Pharos/Summer 2012 Chekhov’s dacha. Chekhov’s with his wife -Chechova. school would provide a new and more productive venue for for a busy household, hardly conducive to the quiet atmo- refining and developing his talents as a storyteller while he sphere more suited to the study requirements of a first-year studied to become a doctor. medical student. As Anton put it, in a letter to his brother There were nine medical schools in Russia at the time. All Alexander, were government schools tightly regulated and controlled by a rigid bureaucracy. Medical education was sponsored and Nikolka has gone to Voskresensk with Maria, it’s Mishka’s supported by the government, a system that allowed poor name day [birthday], Father is sleeping, Mother is praying, students such as Chekhov to attend. The affluent gentry gen- Auntie’s thinking about herbs, Anna is washing dishes and is erally stayed away. Curricula were patterned after and similar about to bring in the piss-pot, I am writing and wondering to Western schools. Among the great things happening in how many times tonight my whole body will be racked with medicine at the time were the innovations in microbiology pain for my presumption in daring to be a writer? I’m getting by Louis Pasteur in France and Robert Koch in Germany, in on with my medical studies.1p15 surgery by Theodor Billroth of Germany and Joseph Lister of England, and in immunobiology by Paul Ehrlich of Germany. In medical school, as a first-year student, Anton was soon None of these seemed to have had great impact on the studies immersed in chemistry, physics, zoology, and, of course, that Anton was ready to commence.5–10 anatomy. There was no shortage of bodies of the poor in When Anton rejoined his family in Moscow to begin his nineteenth-century Moscow. From these unfortunates, each medical studies he brought with him two students to board medical student had a corpse of his own for dissection. In his with the family and provide needed income. His father, Pavel, first examination in anatomy, Anton received a 3 (equivalent was still debt-ridden and all but destitute. Anton, though to a C). He also had a life outside of school, carousing with heavily involved with the stresses of his first-year classes, friends in popular student bars, paying an occasional visit to became the literal head of the household. His older brothers, a brothel, and pursuing other nonacademic ventures. Most Alexander and Nicolai, had moved elsewhere. His mother, significantly, however, he continued his attempts at writing. younger brothers Vania and Misha, and his sister Masha made In this he had his older brother Alexander, also an aspiring

The Pharos/Summer 2012 13 Anton Chekhov in medical school—and after

Chekhov with the cast of the Moscow Artist Theatre, during a reading of his play . Chekhov circa 1900.

writer, as a mentor and advisor on how to get published. In disease-ridden patients. The experience reinforced his choice a letter years later he wrote, “Oh, with what trash I began . . . of medicine as a calling. Little else is known of his academic my God, with what trash!” 11p8 The “trash” consisted of stories, achievements that year. Nor was there much doing in writing. sketches, and jokes submitted to the local weekly magazines That was about to change. in Moscow, most of which were rejected. But to earn money Anton’s third year began in September of 1881. Among his for a celebratory cake for his mother’s birthday, he finally had new subjects were obstetrics and gynecology, diagnostics, and a piece accepted for publication. It was a parody based on his skin diseases. Live patients replaced corpses in the curricu- impressions of his father and grandfather called, “Letter to a lum. Anton was particularly impressed with his professor of Learned Neighbor,” published in the weekly Moscow journal Medicine, G. A. Zacharin, as a clinician, teacher, and patient The Dragonfly toward the middle of his first year at medical advocate. He felt that Zacharin was comparable in medicine school. He signed it “Antosha Chekhonte,” the first of several to Leo Tolstoy in literature. This teacher may have imbued the pseudonyms he would use in his early writing. This first suc- young medical student with his unflagging interest in social cess was a landmark event for him. programs and projects. The second year began in November 1880. Days were Judging from his literary output, writing seemed now to devoted to dissection of corpses and to the study of pharma- have assumed a higher priority than his clinical and academic cology. The Chekhov family, habitually mobile, moved again responsibilities. Anton’s connections with the weekly liter- to quarters no more conducive to study or reflection than ary magazines in Moscow and St. Petersburg flourished. He before. Anton continued writing and collecting rejections. had sketches and stories accepted in The Alarm Clock, The To add to his distractions, Tsar Alexander II was assassinated Dragonfly, and The Spectator, a St. Petersburg publication. by terrorists and the country was in turmoil. In June of 1881 One of his stories, “Intrigue,” featuring a vainglorious and The Alarm Clock, another popular weekly journal in Moscow, pompous academician, was undoubtedly based on one of printed another of his sketches. That summer, still a second- his teachers. As a novice in the publishing world he adopted year student, he helped a country doctor in the neighboring several pseudonyms in addition to his first one, “Antosha town of Chikino minister to the needs of a parade of poor, Chekhonte,” including “Mr. Baldastov,” “My Brother’s Brother,”

14 The Pharos/Summer 2012 Chekhov circa 1900. Anton Chekhov, aged 20, with his brother, the painter N. P. From left, Anton Chekhov, Maxim Gorki, and Count Tolstoy, Chekhov. circa 1900. Popperfoto/Getty Images

and “The Man without a Spleen.” The monetary rewards were has colic; that’s why she’s crying all the time.” I am unfor- more than enough to support the entire Chekhov household. tunate enough to be a doctor, so everybody seems to think Although he was still only half a doctor his literary career was they have to talk to me about medicine. And when they get now well on its way. tired of discussing medicine, they start on literature . . . By the fourth year he was contributing regularly to the . . . . I promise myself faithfully never to have children of journals Fragments and The Spectator. He also wrote a num- my own . . .1p28 ber of stories for The Alarm Clock. It is difficult to reconcile his literary output with his academic responsibilities as a full- Anton’s final year involved many examinations and case time student. Yet he received a 5 (Outstanding) in gynecology. studies in the medical and nervous disease clinics. He also The continued frenetic atmosphere of his life is best performed and wrote reports on many autopsies. In a letter to described in his own words, his brother Alexander he described the heightening tempo and pressure as the year drew to an end: I am currently writing in the most awful conditions, with a great weight of non-literary activities hammering merci- My final exams are coming up (despite your desire, you toad, lessly at my conscience, a visiting relation’s baby scream- that I would fail to get through to the fifth year), and if I pass ing in the next room, while in another room my father is them I shall be able to call myself by the same title as the reading aloud to my mother from [Leskov’s] “The Sealed esteemed Kachilovsky [a well-known local physician]. Just Angel” . . . Someone has got the music box going, so I have as the tears of the mouse affect the cat, just so is the idleness to listen to [Offenbach’s] La Belle Hélène . . . I’d like to slope of my former years catching up on me now. Woe is me! I am off to the dacha, but it’s one in the morning . . . It would be having to learn almost everything again from scratch. Then, hard to imagine a worse situation for someone who wants not only have I got the exams looming over me, there are to be a writer. My bed is occupied by the visiting relation also cadavers to work on, clinical studies with the inevitable [Alexander Chekhov]; he keeps buttonholding me and start- history of diseases, hospital rounds . . . the more I work the ing to talk about medical subjects. “My daughter probably more I feel I’m not up to it. My mind has lost its ability to

The Pharos/Summer 2012 15 Anton Chekhov in medical school—and after

cram; I’m getting old, there’s the writing.1pp29–30 on cab fares every day. I have many acquaintances and there- fore have a lot of patients. Half of them I treat free of charge, Notwithstanding his fears, he did pass his final exams and the other half pay me three to five roubles a time.1p42 on June 16, 1884, he was granted the certificate of General Practitioner from the Rector of the University. Almost si- Despite a burgeoning practice, his literary output continued to multaneously he earned an equivalent recognition as a writer grow. He managed to produce a regular stream of stories and by publishing his first book, a collection of his best stories sketches for the Moscow and St. Petersburg journals. Many of entitled Tales of Melpomene. He could have opted for two ad- his themes arose from his new experiences with patients, not ditional years at the medical school that would have qualified only for the stories that he was then writing, but for many of him for the title Doctor of Medicine (equivalent to a Ph.D.) the works still to be written. His medical experiences proved

Medicine is my lawful wedded wife, and literature is my mistress

— Anton Chekhov

and a career path in academia, but his strong motivation a rich source of material for both plots and characters that toward writing suppressed any inclination in that direction. brought him early acclaim and provided him themes for a There were no celebratory events marking Dr. Chekhov’s lifetime.13–15 entry into the medical profession, nor was there an internship. In 1888 Anton received the prestigious Pushkin Prize In July he took a temporary position in the town of Zvenigorod for literature from the Russian Academy. It was an unusual as a replacement for one of the local physicians, seeing thirty honor for a young writer only twenty-eight years old who or forty patients a day. When that ended he worked with the had been writing chiefly for weekly journals in Moscow and coroner and the district doctor in performing autopsies for a St. Petersburg. His growing success as a writer however did couple of months. Finally in the autumn of 1884 he returned to not diminish his dedication to the profession of medicine. Moscow and began the practice of medicine.12 It was not a lu- That continued for the remainder of Chekhov’s life. In 1890 crative practice, but an active one, seeing patients by traveling he embarked on an arduous trip to the Russian penal colony by troika to their home or seeing them in his office for such of Sakhalin, a desolate island in the far North Pacific off the ailments as typhoid, tuberculosis, and dysentery. The status east coast of Russia just north of Japan, to study the health of the doctor, especially that of general practitioner, was not a and living conditions of the condemned prisoners there. He lofty one. It was equivalent to that of an artisan and its rewards said that the trip was a repayment of his debt to medicine. The were meager, since the general population was poor. Most journey involved a difficult eighty-one-day trip across Siberia doctors received some government support or were enrolled by boat on inland waterways, and by train, troika, sledge, and in government supported programs. Russian law required that coach on land. Access to the island then involved another all patients requesting treatment or care be seen. rough two-day trip by steamer. That Anton’s tubercular and In December of 1884 Anton wrote to his brother Kolia asthenic frame withstood this punishing journey is a tribute to (Nicolai) that he had been “bleeding from the throat” 1p40 for his resolve and commitment. He stayed and toured the island, three days. He must have known by then that it was a har- interviewing many prisoners and their families and taking co- binger of a lifetime struggle with tuberculosis, no stranger to pious notes of his observations. Following the trip he wrote a the Chekhov family. (There was tuberculosis in his mother’s withering and detailed report of his findings, accompanied by family). But in a classic example of denial he added, “Apart his medical and social commentary, entitled Sakhalin Island: from that I am fine . . . I imagine the cause is a burst blood Travel Notes. Published in 1893 in serial form and later in 1895 vessel.” 1p40 It was the first overt sign of the disease that would as a book it was widely read in Russia. Concern and advocacy eventually kill him twenty years later. Kolia himself died of for the prisoners of Sakhalin was not a passing fancy. For tuberculosis in 1889. Anton it became a lifelong cause that he supported materially By 1885 Anton could write to his uncle in Taganrog, and in continuing advocacy for the improvement of the plight of its unwilling inhabitants. Sakhalin was for Chekhov, both My medical career is progressing little by little. I’ve been as a project and publication, one of his finest achievements treating a lot of people. I have to spend more than a rouble as a doctor.

16 The Pharos/Summer 2012 In the spring of 1892 Anton purchased an estate for himself In answer to a comment by his friend Alexey Suvorin about and his clan forty-five miles south of Moscow in the village of his efforts in medicine as well as writing, Anton answered: . He and members of his family would reside there for the next seven years. There he wrote some of his most You advise me not to chase after two hares at once, famous works, including “Ward Six” and “The ,” as and you think I should give up all thoughts of a career in well as many other stories. There he also wrote the plays Uncle medicine. But I don’t see why one shouldn’t chase two hares Vanya and The Seagull. In his role as a physician he estab- at once, even literally: one can do this if one has enough lished a free clinic for the surrounding peasant population and hounds. Admittedly I don’t have enough hounds (this time ministered to their minor complaints as well as their major in the metaphorical sense), but being conscious of having illnesses, which included tuberculosis, dysentery, syphilis, two trades rather than just one does make me happier and worm infestation, and malnutrition. He saw over a thousand more at ease with myself.1p149 patients a year. Though the clinic was free, it did not preclude gifts peculiar to the countryside in lieu of fees. Anton did catch both hares. Mixing metaphors, he went on Hardly had he settled in Melikhovo when an epidemic of with his famous quote cholera struck the surrounding region. Anton immediately volunteered his services as a physician, offering to man a vil- Medicine is my lawful wedded wife, and literature is my lage clinic. He ended up making the rounds of twenty stricken mistress. When I’ve had enough of one, I can go and spend villages, doing what he could to care for the sick and stem the the night with the other. You may well call this disorderly epidemic by inspecting sites for sanitary conditions and mak- conduct, but at least it stops me getting bored, and in any ing recommendations for curbing pollution of water supplies. event I am sure that neither of them is the loser from my The epidemic was under control within three months and infidelity. If it were not for medicine I would not be devoting Anton returned to Melikhovo to resume his writing and his my leisure moments and my private thoughts to literature; I parallel duties as rural physician. haven’t the discipline to do so.1p149

Funeral of Anton Chekhov. The cortège, with a white hearse, has reached the Kusnetska bridge. 1904. fF

The Pharos/Summer 2012 17 Anton Chekhov in medical school—and after

There was another answer in store for Suvorin’s letter, In was a cavalry school. During the Nazi occupation of Taganrog March 1897, while visiting Moscow, Anton had a severe pul- in 1941 through 1943 it was a military headquarters. In 1975 it monary hemorrhage that almost cost him his life. He finally was properly named after its most illustrious graduate, Anton admitted to himself and to others that he had tuberculosis. Chekhov. Both his brother and aunt had succumbed to the disease His medical school, the Moscow University Medical within the previous two years. On the advice of his doctors he School, is now The I. M. Sechenov First Moscow State Medical gave up the practice of medicine and he did not protest their University, the oldest medical school in Russia. About 9000 decision. It had been thirteen years since he had graduated students from Russia and foreign countries study annually at from medical school. The career with his “lawful wife” was the academy in many disciplines related to medicine. It still at an end. lists Dr. Anton Chekhov as one of its most famous graduates. In his other activities the event slowed but did not stop him. In 1898 he moved to Yalta in the to escape the References rigors of the northern Russian winter. He continued to write 1. Bartlett R, editor. Anton Chekhov: A Life in Letters. London: stories, novellas, plays (, Two Sisters) Penguin Books; 2004. and a sheaf of letters. He traveled to Moscow frequently. He 2. Troyat H. Chekhov. New York: E. P. Dutton; 1986. lent his support to numerous social causes. He married and 3. Bartlett R. Chekhov: Scenes from a Life. London: The Free was happy in the new relationship. Only his health could not Press; 2004. match his ambitions. The ravages of his advancing tuberculo- 4. Magarshack D. Checkhov­­—A Life. Westport (CT): Green- sis were exacting their toll. wood Press; 1970: 38–39. In June 1904, still desperately seeking a cure and hopeful 5. Rayfield D. Anton Chekhov: A Life. Evanston (IL): North- for some relief from his worsening symptoms, he traveled western University Press; 1997. with his wife to a sanatorium and spa in the Black Forest of 6. Cytowic RE. Anton Chekhov: A physician-genius in spite of Germany. It was a futile gesture. A specialist who saw him himself. N Carolina Med J 1975; 36: 612–14. shortly after his arrival in Germany listened to his lungs, threw 7. Cytowic RE. Anton Chekhov: A physician-genius in spite of up his hands and left the room without saying a word. Anton himself. Part II. N Carolina Med J 1975; 36: 679–81. and his wife must have suspected that this would be his last 8. Cytowic RE. Anton Chekhov: A physician-genius in spite of journey. Yet on June 16 he wrote to his sister Masha, himself. Part III. N Carolina Med J 1975; 36: 733–5. 9. Cytowic RE. Anton Chekhov: A physician-genius in spite My health has improved. I don’t notice now as I go about of himself. Part IV Conclusion. N Carolina Med J 1976; 37: 29–31. that I am ill; my asthma is better, nothing is aching. The only 10. Satran R. Chekhov and Rossolimo: Careers in medicine and trace left of my illness is extreme thinness; my legs are thin neurology in Russia 100 years ago. Neurol 2005: 64: 121–27. as they have never been.16p296 11. Yarmolinsky A, editor. The Portable Chekhov. New Zealand: Penguin Books; 1947. Two weeks later, on July 2, 1904, twenty years after he had 12. Todd J. Anton Chekhov: General practitioner and pioneer in received his certificate as a general practitioner from the social medicine. Practitioner 1954; 173: 605–10. Moscow Medical School, Anton Chekhov was dead. 13. Pritchett VS. Chekhov: A Spirit Set Free. New York: Random In the annals of literature and medicine Chekhov is a mas- House; 1988. ter in depicting doctors and patients in their complex roles as 14. Carter R. Anton P. Chekhov, MD (1860–1904): Dual medical they confront illness and death. Over forty of his stories are and literary careers. Ann Thorac Surg 1996; 61: 1557–63. about doctors17 and doctors are major characters in three of 15. Cohen B. Anton Chekhov (1860–1904)—A 19th century phy- his best known plays. He was a master of a simple yet lyrical sician. J Med Biog 2007; 15: 166–73. style that enchanted readers from the early days of the comic 16. Chekhov A. Letters of Anton Chekhov. Teddington (UK): journals in Moscow and St. Petersburg to audiences in the cur- The Echo Library; 2006. rent Broadway Theatre in New York, where his last and most 17. Coulehan J, editor. Chekhov’s Doctors: A Collection of Chek- popular play, The Cherry Orchard, is being performed as this hov’s Medical Tales. Kent (OH): Kent State University Press; 2003. is written.11,18 18. Lahr J. Up against it: Russians and renegades at the end of Anton Chekhov is known and remembered as a great their rope. New Yorker 2011 Dec 12: 89–91. writer. It should also be remembered that he was a dedicated doctor. The author’s address is: 8700 Beverly Boulevard, Becker #216 Addendum Los Angeles, California 90048 The Taganrog Gymnasium is now the Chekhov Gymnasium, E-mail: [email protected] a Literary Museum. During the of 1917 it

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