Student notes on Bulgakov’s ‘Morphine’

(by stefanon)

Written in 1926, Morphine is a short story that’s part of a collection known as “A Country Doctor’s Notebook”, which though not his most prominent work (the Master and Margarita claims this title), serves as a prime example of Bulgakov’s gripping narration and fantastic characterisation.

Upon reading this story, I felt that in order to comprehend the text, we must examine the two protagonists, who stand in stark contrast to each other when juxtaposed, alongside the main themes and issues raised in the text.

Dr. Vladimir Mikhailovich Bomgard
As such, he’s the text’s main hero. Displaying many virtues, he portrays the ideals that we expect in a physician. Passionate, hardworking, diligent. We can see his passion for the art of medicine on several occasions. He admires the town hospital as if it were the most magnificent building he’s seen, exclaiming: “Oh, what a splendid thing a large hospital is, with its smooth, well oiled-machinery! He’s also very eager to read up medical texts and fill gaps in his knowledge, as seen in his mental notes to “read up some psychiatry and his musings about “the mechanism of sleep.

However, this may very well be a sign of the internal inadequacies that Dr. Bomgard feels upon his transfer to the town. During his time in the rural settlement of Gorelovo, he was as such a jack of all trades. With its drawbacks of isolation and lack of personal stimulation, Gorelovo could at least provide Bomgard with a wide variety of medical cases, that required him to keep his mind sharp and his skill set varied. Now however: “for the first time [Bomgard] felt that there was a limit to [his] responsibilities”. As he says:

“My days were wholly taken up with diphtheria and scarlet fever. But only my days. I started sleeping at night, undisturbed by that ominous nocturnal tapping downstairs, which meant that I was likely to be roused and dragged out into the darkness to face danger or whatever fate had in store.

We must ask ourselves- does he maybe feel that his proficiency as a doctor is fading? It’s possible, that with all of the Hospital’s superb facilities and increased opportunities for recreation and socialising, Bomgard’s vision of himself as a multi skilled doctor is fading. Therefore, with all of his attempts to block Gorelovo out of his memory, he keeps revisiting the countryside in his mind before sleep, “fragments of recollection passing through his fading consciousness” .

Yet, it’s not the place that he thinks about but rather, it’s the job that he remembers and now wonders about. Who’s in his place, what are they doing? He cannot let go of the thought of returning to general practice, and it is perhaps for this reason that he hopes to move on even further, past the small town hospital, to
“Moscow.. a clinic.. asphalt, the bright lights” .

He sees the country clinic and the small town hospital as rites of passage as such- steps on his way to Moscow. It is for this reason I believe, that Bomgard is so unnerved upon his receipt of Polyakov’s letter. He sees Gorelovo as an indelible part of his past, yet, it’s a part to which he shall never return, since he’s completed his duty and owes nothing to the place. Therefore, it’s not surprising that upon receiving a letter that calls upon his duty as a physician (A duty to which he strictly adheres to) to return to Gorelovo, Bomgard is furious. “It was an absurd, hysterical letter, enough to give the recipient migraine. There, it was starting: the nerve on my temple was starting to twitch…”

Polyakov’s death by suicide meant next to nothing to Bomgard, however, it does allow him to get a hold of Polyakov’s diary, and brings out Bomgard’s main personal flaw- pride. The diary highlights Polyakov’s weakness, his struggle with addiction and his inability to manage the countryside practice that he took over from Bomgard. As he’s reading it, he must feel increasingly confident in his ability as a physician, which is his overwhelming concern. Personally, my main issue with Bomgard’s personality is highlighted in the closing line. He ponders: “Should I publish the diary which was entrusted to me? I should. Here it is.

We must ask- of what value is publishing the diary to Bomgard, other than highlighting his strength as a physician against Polyakov’s weakness? It cannot act as a discouraging agent as such, since it wasn’t through his own fault that Polyakov became addicted to morphine. And it cannot help overcome the isolation that country doctors feel- rural people still need doctors. Hence, the diary that documents Polyakov’s personal demise, the diary that was entrusted to him, was exploited by Bomgard. It shows, that as a physician, Bomgard overcame the struggle of Gorelovo- he had the strength and determination to. Publishing the diary highlighted Polyakov’s inability to do so, although both physicians had the same starting point. The act of publishing the diary serves to show us a clear divide in physicians’ qualities as doctors and as people- though Bomgard may be a superb clinician, unfortunately, he’s not the most admirable person.

Dr. Sergei Polyakov
As such, his personality is that of an addict. But, he does provide a refreshing view of “the doctor”. In Polyakov, we see that a physician is not necessarily a superhero- he/she is just as vulnerable and flawed as any human. There is a prevalent sense of pity evoked by Polyakov’s writings, which Bulgakov intertwines with elicited feelings of revulsion and perhaps even fury at the doctor’s failure to overcome his inner struggles. After all, we must realise- that Polyakov is at large, a victim of circumstance rather than a free acting agent. For a reason we’re untold of, Amneris leaves Polyakov, leaving him in deep emotional turmoil, struggling to cope with his cruel thoughts: “Did I really want to kill her? Kill her?

He seeks isolation, doesn’t want to see people. It’s probably no coincidence then, that his psychological anguish manifests itself physically, and Polyakov is  “stricken one night with such pain that he starts to writhe all over the bed.
Cue Anna Kirillovna’s morphine injection- one involuntary act which, when combined with Polyakov’s underlying depression leads to his demise. It is morphine that allows him to forget Amneris, his thoughts about her slowly fading, until a month later (15th of Februrary -> 19th of March) he forgets her completely, and openly admits: “I have morphine to thank for that.

His infatuation with Anna Kirillovna, who later becomes his mistress, is also quite fascinating. We must ask ourselves, whether or not the feelings are genuine. As it stands, she’s the only person who currently feeds his addiction. He relies on her to make up his morphine solutions, to revive him upon his cocaine overdose, and to be the external support that he needs. His stint with cocaine is also quite interesting. It’s an attempt to replace morphine, to beat his addiction. Now that his psychological wound has healed, he doesn’t need morphine as an antidepressant anymore, but rather, he needs it because he has become addicted. He’s fully aware of this condition, and is plagued by a sense of shame that stems from it.
He becomes paranoid, afraid that “other people may find out about [his] vice”.

The main fear associated with this would be losing his doctor’s licence. This highlights the fact that Polyakov still sees his personal and professional lives as two different entities- his addiction shouldn’t have an impact on his role as a doctor, although, he’s grateful for his location in his “isolated practice”. It’s precisely the perfect medical setting that allows a doctor to indulge in his personal vices, such as a morphine addiction.

We do feel quite frustrated at Polyakov’s futile attempts to beat addiction. He convinces himself that he can indeed beat it, and that with proper help and treatment he’ll overcome his struggle, but reality begs to differ. He uses the revolution as a pretence to indulge in his addiction, and turns to both lies and theft in order to gain access to the drug.
What’s interesting is his awareness of his actions, which he documents in the diary. He makes notes to himself to
“tear that page out”  when referring to more shameful episodes of theft. He never does this, which leads us to assume that although he does have brief moments of lucidity, his life is now prevalently chaotic, insane, and fluctuating between euphoria and living hell.

He deteriorates both physically and mentally. He now hallucinates even when sober, and grows physically thin and weary. He vomits frequently, his body is covered in abscesses and ulcers. He has become a doctor with no regard for sterility, the crystals of morphine are what he now sees as “life giving”. Bulgakov’s skill as a writer shines through, in the way we can see the diary entries becoming shorter and more abbreviated, as was stated earlier on in the story by Dr. Bomgard. Bulgakov hints at the fact that Polyakov’s suicide may be a pre-meditated act, as he tells Anna that he’ll “leave here by February”.

His diary entries become increasingly shorter, his thoughts increasingly more sporadic and staccato. The thought of staying alive becomes unbearable, and after intending the notebook for Bomgard, Polyakov kills himself by gunshot, having previously stated that he has no fear of rifles after the Muscovite revolution. Ultimately, his addiction won. Whatever the doctorly qualities Polyakov was trying to hang onto were, his personal vices overcame his professional virtues.

Themes and Imagery
The most prevalent theme was addiction, however, I believe that because it’s so confined to the character of Polyakov, examining the character offers more insight than examining the theme specifically does. Therefore, I believe that a much more valuable issue to consider is isolation within medicine. It’s undoubted, that rural areas do require their medics, it’s a simple fact of life. But we must ask- what kind of doctor should work there? As evident, Bomgard hated the rural lifestyle. He  couldn’t wait to get out of Gorelovo. Polyakov on the other side, embraced the isolation, but for all the wrong reasons. The seclusion of a rural landscape allowed him to wallow in his own depression, and was evidently a very unhealthy environment. Therefore, I wonder- is there a type of doctor who’s ideally suited to a life of isolation and disease? Although the era of the story is different, we must still remember, that essentially, medicine is about people serving other people. It’s about interacting with live human beings to the closest extent. Hence, is it even probable, that there even is a type of doctor who would voluntarily give up stimulating social interactions and go work in an area such as Gorelovo?

Image-wise, my absolute favourite image in the story was when Bomgard describes Polyakov’s death. He says “greyish violet shadows, like the shadows cast at sunset, showed more and more clear in the hollows around his nostrils, and a fine sweat, like droplets of mercury, was forming in the shadows.It’s an image that combines the natural world with the human form and with death. The image highlights how death is a process that awaits all of us, and how although it may seem alien and terrifying, it’s a natural progression that follows life. The slipping of Polyakov from this world may indeed be described as a dark shadow at the end of a sunset.


Extreme medicine

[Published in current issue of the IHCA magazine, Scope]

As if medical students don’t have enough to be getting on with, I inveigled a few of them to join me and a couple of doctor friends to go to a Russian-made film entitled Morphia, screened in the Light House cinema as part of the Dublin Film Festival. We had used the book upon which the film is based as a text in class a few weeks earlier, so the chance to see a screen adaptation was a happy coincidence.

The students are participating in a programme developed by the School of Medicine, Trinity College Dublin to give first-year medical students the chance to do a six-week long arts & humanities module alongside all their traditional medical science subjects. For the module, they get to choose from a range of options including creative writing, perception, philosophy, ethics, advocacy and history.

In the literature module, we read two texts or extracts every week with some medical angle or other, hear a brief presentation on each from one of the students and then discuss the portrayals of illness, doctors or patients in the texts. It seems to be going very well and I’m getting the sense that the students are going to benefit from this earlier-than-normal exposure through literature to some key issues in the practice of medicine. There’s quite a bit of reading involved, though, so fair play to the ones from the group who on top of all that chose to come along to the cinema as well.

I had warned them that the Film Festival programme suggested bringing along a sick-back for Morphia. This is an adaption of a rather bleak collection of autobiographical stories by the Russian doctor and writer, Mikhail Bulgakov. Set during World War I and the Bolshevik Revolution, the movie tells a story of a just-qualified doctor, Mikhail Alexeivitch Polyakov, who is sent out back-of-beyond to run a small, rural medical facility. While the centre itself is well run and well stocked, the life the young doctor is thrown into is very challenging: adjusting to rural ways of doing things and the people, living up to patients’ and colleagues’ expectations, awkward cases and difficult patients, long hours and no social life.

Polyakov quickly adopts morphine as a way of coping and isn’t long becoming an addict. The movie traces his Train Spotting-like decline from promising young doctor open to the social changes that the revolution promises (“Don’t call me Sir. Call me Doctor, or Alexeivitch Polyakov.”) to a down-and-out criminal casually dismissing all humanity about him in the service of his addiction. This personal story parallels the social disintegration of the times, and the film explores how private weakness can have profound and public impact on those around us. The film’s shocking final scene, set with obvious intent in a crowded cinema, is given additional impact by having the credits roll without the usual soundtrack to help relieve the tension.

To say the style of the film is gritty realism is to understate the case. The graphic nature of the medical scenes, of the doctor’s physical symptoms as he abuses, and of the lives of the people, make US medical dramas seem positively Fisher Price by comparison. “Beyond gratuitous at times,” was how Kerri, one of the medical students I was with, put it.

The Bulgakov original text is a “standard” in reading lists for medical humanities courses. Case after case described so honestly by the Bulgakov character make for great discussion and debate among medical students of many of the issues that will confront them in the future, albeit in a very different country and time. The film blends those cases with the story of morphine addiction to create something very different but still useful in the context of medical education.

Psychiatrist, Aoibhinn Lynch, afterwards told us she felt the early stages of the film in particular were still relevant to today, dealing with issues – both personal and professional – that many newly-qualified doctors still confront when starting out: “moving to a place where you are without the usual social supports; being thrown in at the deep end, as it were; the panic of encountering things that you have only read about in books; the fear that people will think that you are a bad doctor if you don’t know what to do; the difficulties of building new relationships in a small community where the doctor is seen as something of an authority figure.”

Jennifer, a first-year medical student, empathised with the doctor up to a point: “The weight of expectation bearing down on him, and the obvious stress, marginalisation and heartache he was trying to deal with would negatively impact on the best of us, and in any situation like this we must all find a coping mechanism to deal with it.”

“I myself sometimes find the world of medicine to be a daunting one,” Jennifer admits, “with a frightening amount of responsibility, and even at this early stage in my journey towards becoming a doctor I find myself somewhat fearful. Polyakov’s struggle with substance abuse was a slippery slope down which theoretically any of us could fall … but hopefully won’t. Sometimes our own mental health needs to come first.”

Cillian pointed out that “As the film showed, despite common misconceptions, a doctor is like any other person, and can succumb to their demons if the right supports are not in place to help them.” Kerri point to the fact that in a lot of television and film doctors are presented as very moral, clean-living characters, “yet we had a lecture at the start of the year with some fairly shocking statistics on the number of doctors with addiction problems.”

Rather than having particular resonance for a medical student, Daire felt there was more of a universal relevance for any one who can identify their own struggles with those of the young doctor as he progressively turns away from the usual crutches of career, sex, compassion, humanity.

Overall, it was great to be able to see such a superbly made “foreign” film in Dublin and to make practical use of it as food for thought. In the literature module, we’re moving on now to pick up on one of the minor themes of the film: psychiatric treatment. We’re going to use extracts from Sebastian Barry’s novel The Secret Scripture, which in beautiful prose deals with one of the issues that caught Dr Lynch’s attention in particular: “I thought it was interesting and unfortunately typical that the psychiatric hospital where Polyakov was treated was portrayed as the most miserable place – dirty, no privacy, patients subjugated and cowed, literally stripped of their clothes and dignity. This is not an uncommon portrayal of psychiatric treatment in film and the arts – and sadly not one which would encourage anyone to seek treatment”.

Perhaps this next generation of doctors will be better equipped to analyse and do something about such negative portrayals.

Screening of a film based on Bulgakov’s Notes

On Tuesday 23rd of this month at 8.15pm, as part of the Dublin Film Festival there’s a screening at the Light House cinema of Aleskey Balabanov’s take on Bulgakov’s Notes of a Young Doctor. It sounds very gruesome (“Sick-bags at the ready” is how the blurb opens), but if any of you are interested in going, let me know and I’ll book a bunch of tickets so we can go as a group.

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