In 1918, the Russian writer and physician Mikhail Bulgakov set up a medical practice in his native Kyiv (Curtis 5-6). There, in the midst of the Russian revolution and civil war, he would witness the battles for Kyiv by various forces, including the Bolsheviks, the Whites, and the Ukrainian Nationalists. These experiences formed the basis for his semi-autobiographical novel, The White Guard, written in the 1920s. The White Guard tells the story of the Turbin siblings, a Russian family with Tsarist sympathies, living in Kyiv. The eldest, the doctor Alexei Turbin (roughly Bulgakov’s alter-ego) volunteers as a military doctor for a regiment aligned with the White cause. Towards the end of the novel, Alexei, recovering from a near-fatal gunshot wound sustained at the hands of Symon Petlyura’s Ukrainian Nationalist forces, encounters the syphilitic poet Rusakov, who comes to him for a consultation.
The encounter between Alexei and Rusakov is tragicomic. Rusakov, believing that his only hope of a cure is to reject his previously atheistic verse and turn to the divine, has embraced a religious devotion so fanatical that it tests the borders between madness and sanity. His consultation with Alexei is a tug of war between the scientific practice of medicine and the divine intervention that Rusakov believes is his only hope. Alexei goes through the ordinary motions of testing and diagnosis (checking pupils, testing reflexes) and prescribing medicine and treatments (bromide, mercury, blood transfusions, “no cocaine. Or alcohol. Or women”) (251-3), all while trying to persuade Rusakov to lighten up his religious fixation:
“So,” Alexei said, laying down his hammer, “you’re evidently a religious person.”
“Yes, I think about God and pray to Him day and night. He is my only refuge and comforter.”
“That’s wonderful, of course […] and I respect that. But this is my advice: while you are being treated, put such persistent thoughts about God to one side. It seems they’re becoming something of an idée fixe with you. And in your condition that’s harmful. You need fresh air, exercise and sleep.”
“I pray at night.”
“No, you need to change that habit and reduce the time you spend praying. It will simply tire you out, and you need rest.” (251-2).
While Alexei is nominally treating the physical signs of Rusakov’s syphilis, he is also making futile attempts to save Rusakov’s sanity. However, one wonders if there is a grain of truth in Rusakov’s delusional state. The images he resorts to are increasingly apocalyptic, evoking the Antichrist, and comparing the fate of Kyiv to that of Sodom and Gomorrah (252), which are fitting for a city rocked by war and facing a highly uncertain fate. Alexei’s attempts to maintain normalcy appear to be a (futile) mode of self-preservation. When Rusakov refers to Alexei’s “sacred work,” the doctor protests, “I don’t see anything particularly sacred in the work I do. I charge the usual fee for a course of treatment, like everybody else” (253). There is, of course, nothing “usual” about Alexei’s consultation room anymore. The doctor himself has just been a patient, and his entire way of life is on the verge of collapse. In the depths of his madness, Rusakov may in fact be closer to the truth than Alexei. Ironically, one of the treatments Alexei chooses for Rusakov is mercury, not an uncommonly prescribed remedy for syphilis but one that “could produce many of the same symptoms [as syphilis], notably blackened or loose teeth, hair loss, aches, pains, and bleeding of the bowel. Looking back over firsthand accounts, it is difficult to distinguish the disease from the supposed cure” (Ropper and Burrell 72). Alexei looks away from rather than towards the patient in that he completely misses the point. Rusakov’s religious proclamations lead the doctor to exclaim in frustration, “My dear chap, please stop all that stuff. […] Otherwise you’ll find yourself in a psychiatric hospital” (252).
Rusakov, however, has the last word. The final chapter of The White Guard takes place on the eve of the Bolshevik takeover of Kyiv, on the verge of a new wave of conflict and uncertainty. It is here that we leave the Turbins, ignorant of their eventual fate. Bulgakov’s narrator weaves in and out of various characters’ minds, some asleep and some awake, including Rusakov. Rusakov has not taken Alexei’s medical advice and is reading the Book of Revelation, including the passages on the creation of the new world. As he reads:
[T]he more his mind became like a shining sword, piercing the darkness.
Disease and suffering now appeared unimportant to him, lacking all substance. His illness fell away, like the scabby bark from a forgotten tree that had been felled in the forest. He saw the blue, bottomless mist of the centuries, the endless corridor of the millennia. And, instead of fear, he felt awe and the wisdom of submissiveness. He felt at peace (263-4).
Medicine cannot help Rusakov (he is perhaps far too ill for that), but his newfound, expansive sense of the cosmos brings him reassurance. Bulgakov appears to suggest that when faced with circumstances beyond one’s control, whether total war or severe illness beyond the power of medicine, all one can do is endure. Alexei disputes Rusakov’s claim that the doctor’s work is “sacred.” Indeed, Rusakov cannot be cured, but there is a sense of serenity that can be found beyond the cure, in “the blue, bottomless mist of the centuries, the endless corridor of the millennia.” In this space, “Disease and suffering now appeared unimportant to him, lacking all substance. His illness fell away […] He felt at peace.”
Works Cited
Bulgakov, Mikhail. The White Guard. Translated by Roger Cockrell, Alma Classics, 2012.
Curtis, J. A. E. (ed) Manuscripts Don’t Burn: Mikhail Bulgakov – A Life in Letters and Diaries. Bloomsbury, 1991.
Ropper, Allan H. and Brian David Burrell. How the Brain Lost its Mind: Sex, Hysteria, and the Riddle of Mental Illness. Avery, 2019.
Image Credit: An Alaskan Inuit skull, showing the effects of syphilis. Photograph by Ales Hrdlicka, ca. 1910. Wellcome Collection. Public Domain Mark. Source: Wellcome Collection. https://wellcomecollection.org/works/tcwntb58
