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|Title:||Commentary on Excerpts From The Letters of Anton Chekhov, Letters of Anton Chekhov, and Doctor Chekhov: A Study in Literature and Medicine|
|Abstract:||On June 16, 1884, around the same time that William Osler accepted his appointment as professor of medicine at the University of Pennsylvania, a young man from the provincial port town of Taganrog, Russia, graduated from the medical school at Moscow State University. The young man’s father was a failed shopkeeper; his grandfather, a freed serf. Having gone bankrupt in Taganrog, the family sought a fresh start in Moscow. Although the youth had won a full scholarship, he had to “moonlight” throughout medical school to help support his struggling parents and siblings. Fortunately, the young man—Anton Chekhov—found his form of moonlighting to be congenial work. Using a number of pseudonyms, he dashed off a seemingly endless series of humorous stories for local newspapers and magazines. While the publishers paid only five kopeks per line, Chekhov’s volume generated sufficient income for him and his family to get by. Upon graduation, he was able to rent a small house in a middle-class section of Moscow and hang out his shingle as a general practitioner. In many ways Chekhov was a typical medical student. In letters to his brothers and friends, we find him complaining about the usual things—fatigue, memorization, cramming, and difficult examinations. He also expressed the general feeling of inadequacy that often haunts doctors-in-training: “Am I an imposter, a mirage, or an honest to goodness doctor?”1 Chekhov was neither an academic star, nor a social standout. However, he did excel in two arenas. The first was what we now call narrative medicine. Dr. Pavel Archangelsky, his preceptor during a rural medicine rotation, marveled at Chekhov’s skill with patients: “He listened quietly to them, never raising his voice however tired he was even if the patient was talking about things quite irrelevant to the illness.”2 Grigory Rossolimo, a friend and classmate, later remembered that Chekhov “collected the elements of the case history together with surprising ease and accuracy.”2 His special interest was listening to the narrative of “the ordinary life of the patient.”2 Chekhov soon had a growing general practice. However, many of his patients were unable to pay him, while others were friends and acquaintances whom he did not charge. Like most doctors of his time, Chekhov spent much of each day making house calls, which could easily result in very little net income. Chekhov’s literary career progressed rapidly. He published three acclaimed collections of stories in as many years and, in 1886, won the coveted Pushkin Prize for literature. Thus, he soon was earning enough money from writing to be able to close his private practice and devote the rest of his medical life to volunteer practice and public health. Chekhov’s second area of special expertise was preventive medicine and public health, inspired by his professor, Dr. Eric Erismann, who was among the first Russians to study the influence of social conditions on health. Some months after graduation, Chekhov wrote to his friend Alexei Suvorin, “The more experienced a doctor, the better he knows the power of hygiene and the relative weakness of treatment.”2 Chekhov’s first major public health initiative was a study of conditions in the penal colonies on Sakhalin Island in 1890. After a harrowing 6,000-mile trip across Siberia, Chekhov spent several months surveying every household and institution on the island with a 12-item data collection form for demographic and medical information. He later claimed to have completed over 10,000 of these forms in three months, a feat that (if true) would qualify Chekhov as the speediest epidemiologist of all time. After struggling with his data for years, he submitted a dissertation to the Moscow State University, hoping to qualify for the equivalent of a PhD. However, the medical faculty was not impressed. Chekhov later reworked the material into The Island of Sakhalin (1895), a curious, but engrossing, compendium of travelogue, geography, history, medicine, and health statistics. After returning from Sakhalin, Chekhov purchased a rundown estate at Melikhovo, about 50 miles south of Moscow. He and his parents and sister made it their home for the next several years, during which he matured as a writer, general practitioner, and humanitarian. He served as the district public health physician during a cholera epidemic and, later, continued his heavy involvement in community activism, building a school for peasants near his home, raising funds to help famine victims, and, near the end of his life, helping to establish a sanitarium for tuberculosis victims at Yalta. In a famous quotation from one of his letters, Chekhov claimed that medicine was his “lawful wedded wife” and literature his “mistress.” However, during most of his career, the reverse seems equally, or even more, apt. Chekhov earned his daily bread by creating drama and literature, but he practiced medicine out of passion for the art of healing and compassion for his fellow man. Jack Coulehan, MD, MPH J. Coulehan is emeritus professor, Department of Preventive|
|Appears in Collections:||Academic Medicine 2015|
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