Medical Classics: Cancer Ward (Solzhenitsyn)
By Aleksandr Solzhenitsyn
First published in 1968
The semi-autobiographical novel, “Cancer Ward“, is set in a cancer hospital in the Soviet province of Uszbekistan in the late 1950s. Like Solzhenitsyn himself, the main character, Oleg Kostoglotov (“bon-chewer”) spent some years in the Gulag, was sentenced to perpetual exile in Kazakhstan, became ill with cancer, war treated in a cancer clinic and made a good recovery. The book describes the profound effec
At a different level Cancer Ward is to be understood as a political allegory: “A man dies from a tumour, so how can a country survive with growths like labour camps and exiles?” The ward itself with its heterogeneous mix of patients from different ethnic groups and social backgrounds reflects to a certain degree Soviet society. There are fierce debates on, for instance, social origin. The opportunistic apparatchik, Rusanov, who has made a successful career out of denouncing friends as well as foes, prides himself on his proletarian forebears. Kostoglotov booms at him in response that even he, Rusanov, had ten proletarian grandfathers. If he were not a worker himself, he wouldn’t be a proletarian.
What is much less well know than the allegorical dimensions of Cancer Ward is the psychological realism of the filigreed portraits of both patients and staff. We see how being admitted to the cancer ward ist like being sent to the Gulag. In both cases there may be loss of status, loss of individuality and loss of a future perspective. We see how cancer can isolate the sufferer from even her closest relatives and friends, how some patients become anxiously preoccupied and constantly check their bodies for physical changes, how they sometimes come to think that it is no longer they, but the tumour that is in charge, and how they may feel as if they were dead. Patient are not unlike prisoners in that their lives resemble a “river that flows into the sands”.
Solzhenitsyn has an equally good understanding of the mind-set of the doctors. The main purpose of the ward round was to improve the morale of the patients. Euphemisms, vague formulations and downright lies were routine tools of the trade. The doctors rarely said what they actually thought – until they sat down together later and “the general impression of improvement and recovery … was completely exploded”. One patient who had not responded to treatment was simply ignored by the doctors. Patient were discharged before they could die in order to improve the clinical statistics – no palliative care here. In individual consultations with patients some of the doctors were more honest, and even showed natural kindness, rather than mere professional kindness. When Ludmila Dontsova, the lead oncologist, herself became ill with cancer, she did not want to know anything about the details of her condition, treatment or prognosis.
Cancer Ward is not only a forceful indictment of political abuse, but an insightful and cogent study of the psychological reactions of both doctors and patients to life-threatening illness.
Consultant Psychiatrist, London