Dr. Chekhov’s patients: Suvorin and Leskov

Early in 1892, Chekhov bought a modest estate in Melikhovo, forty miles south of Moscow. In March, he moved there from Moscow together with his parents and sister, and would live in Melikhovo until 1899. From time to time, he would take the train to visit Moscow and even St. Petersburg: most of his work was then published in Novoye Vremya (“New Time”), Alexei Suvorin’s Petersburg-based journal.

In the fall of 1892, Suvorin complained of bouts of dizziness and general ill health. Writing back, Chekhov dismissed his publisher’s concerns as symptoms of old age rather than any specific, life-threatening disease. Apparently, Suvorin was not convinced. Chekhov took the overnight train from Moscow to St. Petersburg on October 30 and examined Suvorin in person. When the two met face to face, the 32-year-old doctor talked the 58-year-old patient out of his morbid anxiety. In the long run, life proved Chekhov right: Suvorin would live for almost twenty more years. He died in August 1912 aged 77.

Chekhov examined another man of letters during his stay in St. Petersburg. It was Nikolai Leskov, an author Chekhov deeply respected and possibly even regarded as a mentor. Leskov, 61, believed that he was seriously ill but was convinced that his disease was not sufficiently understood by doctors. Chekhov agreed with the former but not so much with the latter. He told a friend (if the friend’s memory can be trusted), “Yes, he [Leskov] has no more than a year to live.” In his Nov. 5 letter – still from St. Petersburg – to Dr. Obolonsky, a Moscow acquaintance, Chekhov contrasted the cases of Suvorin and Leskov:

Suvorin staggered in the street two or three times; he was frightened and wrote me a dreary and hopeless letter. Now he has calmed down; apparently, he is perfectly healthy and has forgotten about his dizzy spells…

I’m going to St. Pete again before Christmastide. Would you like to go for a ride together [with me]? You would then treat Leskov, who is very ill…

However, as Donald Rayfield remarks in his biography, Chekhov “reassured” Leskov, probably downplaying the threat and trying to cheer up the old man. Most likely, it was in line with the basic tenets of the profession: do not make things worse. Clearly, Leskov harbored no illusions about his condition – it was not the case of a patient blissfully unaware of his imminent demise. However, telling him bluntly “no more than a year” would have been a case – literally – of brutal honesty, and could have shortened what little time was still available to him.

Anyway, Chekhov’s assurances failed to improve Leskov’s view of his prospects. Two weeks later, Leskov had a notary witness his will. Then, early in December 1892, he wrote an unofficial testament to his friends. Its largest section was an appeal to take care of an orphaned girl Leskov had informally adopted. The opening request, however, was for autopsy on his body, to determine the cause of his heart disease. All the doctors, wrote Leskov, had assured him there were no pathological changes in his heart.

When Leskov died, Chekhov wrote (in a letter to Suvorin) that Leskov’s claim had been wrong: the doctors knew well what was going on with his heart but concealed it from him. Perhaps Chekhov generalized from his own experience but I’d offer that the best practice at the time was to avoid disclosing the diagnosis to the patient if the disclosure could aggravate his condition.

Was it the best course in Leskov’s case? He lived for more than two years after being examined by Chekhov and died of bronchitis, having suffered for years from ischemia, which manifested itself as angina pectoris (or pectoralis). At autopsy, “obesity of the heart” was detected (fatty infiltration perhaps?), making the pathologists wonder why it had not provoked a deadly pulmonary edema.

Living on borrowed time in those final years, Leskov wrote his last and probably the most sophisticated and cryptic novella. Its title is puzzling to the modern Russian ear but the primary intended meaning, I believe, is close to The Hiding Place of a Hare or The Hare’s (or Hares’) Hiding Place; less literally, The Hare in Hiding. Leskov did not insist on publishing the story immediately, since it was vulnerable to accusations of religious heterodoxy and censors would insist on revisions and excisions. It was only published after the February revolution, in 1917.

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