“Suppose they bring me a woman in labour and there are complications”
“A patient with a strangulated hernia. What shall I do then?”
Tension and suspense swells as the doctor sweats at the thought of having to execute a complex operation, such as a strangulated hernia or complicated birth.
“More than once I broke out in a cold sweat down my spine at the thought of a hernia.”
In the doctors living area there is a stack of medical books teaching how to carry out operations. This shows that the doctor is a studious person. The doctor’s new surroundings seem to be slightly affecting his senses.
“My ears had become unusually sensitive”
This piece of information makes the reader further question the doctor’s incompetence at being a doctor.
As the doctor sits in his living room reading medical operation manuals, the reader assumes that he is waiting for the inevitable operation call. One piece of information supplied in this passage is particularly shocking to the reader:
“I groaned, smoked and drank tea”
The thought of a doctor, someone so medically informed and knowledgeable, smoking is quite ludicrous to the reader. A doctor, someone who understands all of the health implications and risks and potential damages of smoking, smokes anyway. It makes the reader lose belief in the doctor’s integrity and intelligence. The author up to this point has done much to fill the reader’s mind with doubt surrounding the doctor’s credentials.
As the reader might have suspected by this point, the doctor is summoned to perform an operation. A midwife banging on his front door disturbs his sleep and mindless musings to inform him that there is a very weak, young girl who is dying.
“The little girl’s weak, she’s dying…”
As the doctor prepares himself for what he has feared, he makes the situation seem much worse to the reader.
“The case turned out to be, if anything, even more terrifying than a hernia or a transverse foetus.”
This builds the tension and suspense greatly. The reader by know is filled with uncertainty about the doctor’s abilities and capacity to succeed in the medical field. When they read that the forthcoming operation the doctor must complete is worse than any of his worst nightmares they conclude that the doctor will fail his maiden operation.
When the doctor first sees and analyzes the patient he almost immediately diagnoses her to have Diphtheria.
“The little girl has diphtheria.”
This throws doubt into the reader’s mind. They suddenly have new found faith in the doctor. He has made a confident diagnosis within seconds. There is hope that he might still be able to avert disaster. For a short moment tension is relieved.
The little girl is not however the doctors only problem. A distraught and anxious mother frets over her daughter. The girl’s grandmother increases the pressure and the tension on the doctor. The doctor detests her at first sight.
“”I wish these old women didn’t exist.” I thought to myself.”
The added pressure and stress of having to work under personally unlikable circumstances for the doctor increases the tension and suspense. The reader already has doubts about the doctor and working under strenuous conditions will not help cast these doubts aside.
As the doctor’s initial examination of the girl ends, he is told by the girl’s mother and grandmother that she has been ill for five days. The doctor believes there is nothing he can do and that the girl will surely die.
“The little girl is suffocating, her throat is already blocked up. For five days you kept her ten miles away from me. Now what do you want me to do?”
The mother’s and grandmother’s response to this is to heap more tension and pressure on to the doctor.
“You’re the one who’s supposed to know.”
This increases the responsibility and tension on the doctor. It increases the suspense and tension in the story and reader.
The doctor instructs the “feldsher” who is his assistant, to take the little girl away. Whilst the midwives wrestle with the distraught mother the doctor can take a closer inspection of the little girl’s throat. For some reason, unknown even to the doctor himself, he suggests an operation that could save the girls life.
“I was appalled, wondering why I had said this”
After the doctor describes the process he is willing to perform, a tracheotomy, the mother is horrified and at first she and the grandmother refuse to let the girl be treated. The doctor again goes against his will and persuades them to agree. They relent and accept the treatment. The doctor is very dramatic in his persuasion telling the girls guardians that they are denying the girls chance for longer life and that she will certainly die if not treated.
“Look, have you gone mad? What do you mean by not agreeing? You’re condemning the baby to death. You must consent. Have you no pity?”
This shows to the reader that the doctor might not be such an incompetent person after all. The doctor’s conscience could be responsible for forcing him into persuading the girl’s guardians into giving their consent. The doctor did not want to do the operation for fear of failing, but his determination to make the girl’s mother and grandmother see his point of view and give the child a chance to live prevail over the mother’s and grandmother’s apparent stupidity and stubbornness. The tension however greatly mounts at their decision to agree to the operation. The reader still does not believe the doctor will complete the operation successfully. In the reader’s opinion it is most likely that the girl has been condemned to death either way. If she doesn’t have the operation, she dies, but if the doctor attempts and operation she will also die. This builds the tension and suspense in the reader.
After the doctor has received the guardian’s approval to perform the operation, he hurries back to his living room for some desperate revision. The weather seems to have deteriorated which adds to the atmosphere and gloom of the doctor’s prospects.
“A swirling, blinding snowstorm.”
Once the girls operation has begun the doctor’s fears build tremendously. The suspension and tension escalates from the moment that the operation begins.
“I went cold and my forehead broke put in a sweat. I bitterly regretted having studied medicine and having landed myself in this wilderness.”
This shows the doctors lament for attempting to succeed in an area so diverse and complex. The tension is immense, the reader can almost not bear to read on as the doctor’s worst nightmares unfold. The reference to a “wilderness” is clever because it makes the reader think of the wilderness the doctor is really in and the vicious weather raging outside. The word “wilderness” is also used to show that the doctor is very unaccustomed to his surroundings and the new challenges that are currently facing him.
The doctor cannot recall any of the diagrams or texts concerning tracheotomies. He basically has no clue about how to complete the operation. The tension is electric throughout most of the operation.
“In angry desperation I jabbed the forceps haphazardly into the region of the wound.”
The doctor is mindlessly probing around the wound he has made in the girl’s neck, hoping that through some stroke of luck he will remember something of use. At this point he doctor seems to have lost all of his self belief. The suspense the reader feels develops into a much stronger force, as the doctor’s torment continues. Somehow the doctor blunders his way through the operation. He makes another correct incision and uncovers the girl’s windpipe. As the doctor uses hooks to pull the incision in the girl’s neck open the “feldsher” apparently feeling the tension more than others collapses. It is at this point, when the feldsher collapses and drags a hook to the floor with him, opening the girls wound, that the suspense climaxes. Just as it looked as though the doctor was somehow going to survive the operation, disaster strikes.
“The feldsher had fainted. Still holding the hook, he was tearing at the windpipe”
The doctor’s bold and rash attempt to complete and operation he was fearful of undertaking in the first place, appears to be destined for failure, until a strong midwife dashes the hook from the feldsher and urges the doctor to proceed. The doctor continues the operation and the title of the story becomes apparent when he inserts a metal pipe into the girl’s throat to help her breathe.
In the aftermath of the operation the doctor is congratulated by the midwives and the feldsher. As the child recovers and is returned to her mother the doctor realizes how terrible it might have been if he had not been successful.
“I felt a cold sweat run down my back as I realized what it would have been like if Lidka (the little girl) had died on the table.”
The author, Mikhail Bulgakov, uses and creates, tension and drama very effectively in this story. He begins to build up tension almost from the start of the story. The setting is very suitable for the story. The sense of isolation leaves the doctor with no other option but to operate. The blizzard also emphasizes this feeling of isolation. During the operation the tension is at a climax. The doctor does not seem to be having any luck. When the feldsher collapses and the success of the operation is in jeopardy so close to completion the tension is very great.
