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Learning Empathy through Chekhov

Guy Glass — Mon, 29 Dec 2025 14:21:13 +0000

In 2015 this 50-something- year-old psychiatrist graduated from Stony Brook University with a Master of Fine Arts degree in playwriting. For my thesis project, I was of course required to write a play. During my time at Stony Brook, I had also become involved with the medical humanities program at the medical school. At first, I took a course in the department as an elective. The following semester I became a co-teacher in the same course. We were already using plays, e.g., an adaptation of The Death of Ivan Ilyich, so it seemed sensible to fulfil my requirement by creating something to use for didactic purposes.

Before embarking on my project, I reviewed the literature pertaining to the use of plays in medical settings. Friedrich Schiller, the German playwright (who was, incidentally, a physician), laid the groundwork for the use of theater as an educational tool in his 1784 essay “The Stage as a Moral Institution” calling it “a great school of practical wisdom, a guide for civil life, and a key to the mind” (Schiller, page 252). In his view, the theatricalization of the “vices and virtues of men” and of “human woe” not only makes them more palatable, but it also actually teaches the audience to be more empathic.

I found a wide range of milieus in which plays have been used. In 1938, The Federal Theatre Project, a program sponsored by the WPA, produced a play entitled Spirochete with the goal of reducing the spread of syphilis (Flanagan, page 144). More recently, dramatic narratives were used by scientists to provide a forum for learning about human genetics; these have been collected in a volume entitled The Drama of DNA.

A pioneering program that proved inspirational to me is Medical Readers’ Theater, developed in the 1980s at East Carolina University’s Brody School of Medicine. Stories by William Carlos Williams and other doctor writers have been turned into scripts used to encourage dialogue among medical staff, students and the public about a variety of medical issues. These plays are available in anthologies accompanied by discussion questions.

There are also numerous popular plays which are natural fits for teaching because they illustrate points of ethics, diagnosis, doctor-patient relationship, etc. at the same time as just being entertaining. Some of the ones I have used include Wit, A Streetcar Named Desire, and Next to Normal.

While deciding what to do for my thesis project, I was becoming quite taken with Anton Chekhov’s writing through working with Jack Coulehan at Stony Brook. Previously, although I knew of course that Chekhov had a reputation for being one of the great playwrights, I had had the impression that his plays were a bit boring because nothing much happens in them. What can I say? I must just not have seen the right productions.

Chekhov at Melikhovo

I researched Chekhov’s life, read his short stories, and even plowed through Sakhalin Island, the epidemiological survey he wrote about health conditions in a penal colony. As a result, I became an admirer and gained insight into his method. It does not matter whether there appears to be anything happening or not. The author’s job is to record what he observes. It is not by chance that this is also the job of a physician. One can understand why Chekhov might have wanted to continue to practice medicine even after becoming one of Russia’s most celebrated writers. Chekhov soon became my personal role model as a doctor writer, and it felt like an honor to dedicate my time and energy to his work, and in my own extremely modest way, to add to his dramatic corpus.

Chekhov wrote over 500 short stories, and doctors play a significant role in about 25 of them. I chose “A Nervous Breakdown” (1889) and “A Doctor’s Visit” (1898) “for adaptation. As “A Doctor’s Visit” has fewer characters and is the shorter of the two that is the one I use to teach. Some students may even have read the original story already because it is so well known.

The plot may be summarized as follows: A doctor has been summoned away from the city to see the daughter of a factory owner, but for some reason he sends his assistant instead. (Perhaps he just did not want to go out to the boondocks.) The assistant doctor arrives at the house and examines the young lady. After not finding anything wrong, he concludes that he’s been called for nothing. The patient’s mother, who is depressed and overwhelmed, implores him to spend the night instead of going home to his family. The doctor is not in a position to refuse, but he feels as if his time is being wasted and he is annoyed.

However, in the short time he is in the factory town, the doctor gets a sense of what it is like in live in such a place. He sees how unhealthy the environment is for the workers. He sees how, despite having lavished a fortune on expensive furnishings, the inhabitants of the house are miserable. Adding insult to injury, a servant repeatedly contradicts him and gets on his nerves.

In spite of the prejudices he has brought with him from the city, the totality of his experience makes an impression on this doctor. The next morning, he meets with the patient again. This time, he recognizes that she is a sensitive and intelligent young lady, and he now has empathy for what she must be going through. There is a moment of understanding between them. Although it does not perhaps appear as if the doctor has applied any treatment, the patient responds and shows a sense of hope. The doctor has also changed as a result of this experience. He leaves the house and heads home in a good mood.

Like general practitioners today, general practitioners in 19^th-century Russia undoubtedly ended up doing a good bit of psychiatry. Although Chekhov and Freud were contemporaries, there seems to be no evidence that Chekhov was aware of Freud’s “talking cure. “ But even if not, and even if the doctor in “A Doctor’s Visit” does not think he has done anything, the doctor has in fact unwittingly administered a brief psychotherapy session. The powerful results he obtains with such simple means remind me of some of my own experiences as a psychiatrist. Sometimes when one uses one’s psychoanalytic theories to make what one thinks are brilliant interpretations, they fall on deaf ears. Just being present and listening often produces the best outcomes.

The greatest technical challenge this playwright confronted in dramatizing “A Doctor’s Visit” was figuring what to do about the doctor’s internal thoughts. There is plenty of spoken dialogue in Chekhov’s story, and I used much of it practically verbatim. But how to dramatize one’s inner dialogue? It would be cumbersome to have a narrator describe it, and unnatural to have the doctor verbalize it. My solution was to create a brand-new character, a young apprentice, someone the doctor uses to bounce ideas off. I hope audiences and readers feel this was a reasonable compromise on my part.

My adaptations of Chekhov’s two stories made their debut in 2015. Since then, “A Doctor’s Visit” has been used to teach students at several medical schools: Stony Brook, Drexel, New York University, Boston University, Cleveland Clinic, and the University of Pennsylvania. At all but one of these I introduced the play in person, read the stage directions aloud, and led the discussion. The text of the play is included in an appendix to this article in the hope that other schools will take it up. And I am still available to read stage directions!

References:
Chekhov, Anton: “A Doctor’s Visit.” Translated by Constance Garnett. https://www.ibiblio.org/eldritch/ac/jr/193.h
Coulehan, Jack. “Cold Eye, Warm Heart: Medicine and Anton Chekhov.” MedHum, October 2, 2025 Flanagan, Hallie. 1940, reprinted 1985. Arena: The Story of the Federal Theatre. New York: Limelight Editions
Rothenberg, Karen H. and Bush, Lynn Wein. 2014. The Drama of DNA. New York: Oxford University Press
Savitt, Todd L. (ed.) 2002. Medical Readers’ Theater: A Guide and Scripts. Iowa City: University of Iowa Press
Schiller, Friedrich. 1784. “The Stage as a Moral Institution.” In Theatre/Theory/Theatre, 250-254. New York: Applause

Web image created based on this vintage illustration from WikiCommons

A Doctor’s Visit: An Adaptation of a Short Story by Chekhov

by Guy Fredrick Glass

Downloads of this play may be distributed and performed for educational purposes only, with permission of the author. Dr Glass may be contacted at gf***@*ol.com

The Winter Soldier by Daniel Mason

Steven Field — Thu, 18 Sep 2025 17:47:13 +0000

When The Winter Soldier opens, Lucius Kszelewski, youngest son of a patrician Polish family living in Vienna, is on a train bound in the dead of winter for a field hospital in the Carpathian Mountains. It is 1915, and Austria-Hungary is at war with Russia. Lucius, a medical student, has completed only six semesters of medical school, but World War I has intervened, and due to a shortage of physicians in the army the government has decreed that students may graduate early, become doctors, and immediately be commissioned. Lucius has done so and is on his way to Lemnowice, a Galician village, where he believes he will work with other physicians and finally learn to be “a real doctor.”

When he arrives, he finds that the hospital is an expropriated village church overrun by rats and ravaged by typhus, and he is the only physician. The hospital is run by a nun, Sister Margarete, assisted only by orderlies, and the patient load runs the gamut from fractures and gunshot wounds to gangrenous legs and massive head trauma. The front is only a few kilometers away, and the wounded arrive continuously; the quiet and formal Sister Margarete confidently and unobtrusively guides him through rounds, surgeries, and battlefield medicine. Lucius is initially wary of her, perhaps a bit awed by her, and ultimately falls in love with her.

The transforming event is the arrival of the “winter soldier,” Jozsef Horvath, brought in from the snow mute and shell-shocked, but with no visible wounds. For Lucius, who is fascinated by diseases of the brain and mind, this patient presents a tremendous challenge. Lucius is sure that Horvath has “war neurosis,” what the British physicians of the time were calling shell shock and what we today would call PTSD, and he is determined to understand and heal him. Lucius and Margarete make slow progress with their patient, but his attempts to care for the patient have unintended effects, and Lucius must then deal with the consequences of his actions.

The war, and the hospital routine, go on. One day, while Lucius and Margarete are relaxing in the woods, Margarete runs off; Lucius returns to the village, but Margarete is not there. While Lucius and the staff search for her, Lucius gets lost; he stumbles onto a battlefield and is dragooned into service with a regiment of the Austrian infantry. He ultimately escapes and tries to make his way back to the field hospital, and to Margarete, but Lemnowice has fallen to the Russians. The hospital has been evacuated—and Margarete has disappeared. Lucius’ search for her will take him across the war-torn remnant of the Empire.

The Winter Soldier is a war story, a doctor story, and a romance, and it also poses a wrenching question of medical ethics. This is a lot to ask of any novel, but Mason pulls it off with aplomb. The writing is lyrical; the author’s descriptions of the variation of the seasons in the Carpathian forests are poetic and beautifully detailed, and his characterizations are finely drawn. We can not only clearly see, but also feel that we know, these people, not only the major figures of the doctor and the nurse, but also the orderlies, the Austrian soldiers, Lucius’ somewhat bemused Professor Zimmer, and Lucius’ parents (who are marvels of characterization: the retired military officer father who lives on past glory and cannot see his son for who he is, and the controlling, clever, acid-tongued society grande dame mother who can only see her son for who she thinks he should be). Lucius and Margarete feel real, and their interaction feels real…and complicated. The historical setting comes alive with detail, and the reader truly feels that they are in that place at that time, whether at a formal dinner in a Viennese mansion or treating war casualties in a Galician backwater. And the medical details are correct, not just the medical terms but even the way in which they are used in dialogue, which is not surprising, as Mason is a physician; it isn’t always easy to get this right, but Mason does.

But the true heart of the medical story here is the ethical quandary in which Lucius finds himself—the complex nature of the doctor-patient relationship, the motivations which drive it, and the decisions we make. Although this takes up a relatively short page count, its repercussions continue throughout the novel.

The novel has a particular, though minor, resonance for the time of COVID-19 (though it was released two years before the pandemic occurred). The action of the novel is set in motion when, due to a war-induced doctor shortage, medical schools decided to allow upper-level students like Lucius to graduate early and become doctors, and then immediately posted them, often with little practical experience, to field hospitals near the front lines. Several American medical schools took a superficially similar action in Spring 2020 when doctors were desperately needed to help staff hospital units during the coronavirus pandemic, although this only applied to fourth-years who were but a few months short of graduation and would have already had the clinical experience which Lucius lacked. So while the situations aren’t entirely analogous, the concept of students opting into a trial by fire is.

The Winter Soldier can be appreciated for its historical perspective, its story of human relationships, the ethical dilemma it poses, and the beauty of its prose. Or enjoyed for what it is—a great read.

The Winter Soldier
Daniel Mason
New York, Little Brown & Co., 2018; 318 pp.

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.
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Cold Eye, Warm Heart: Medicine and Anton Chekhov

Jack Coulehan — Wed, 06 Aug 2025 13:58:04 +0000

While visiting Anton Chekhov’s estate near Melikhovo, I purchased a reproduction of a late 19^th century painting in which a doctor sits at the foot of a child’s bed in a darkened sick room. A second child plays on the floor. The physician speaks earnestly to the anxious mother, who stands beside him, wearing crumpled clothes and a babushka. Is the news good or bad? Will the boy survive? Whatever the outcome, this doctor appears to embody the best elements of traditional medical virtue. The scene is much like Sir Luke Fildes’ ever popular painting of “The Doctor” (1891). But the striking difference in this case is the man’s identity. The doctor in the Russian sickroom is Anton Pavlovich Chekhov, one of masters of world literature.

Chekhov by Osip Braz

The artist depicts Chekhov as he was in the early 1890’s, soon after he had purchased a small, dilapidated estate and moved there from Moscow with his family. In addition to serving as country doctor and public health official in Melikhovo, Chekhov at that time was composing many of the stories and plays that made him one of Russia’s most well-loved writers and a major influence on 20^th century literature. How was he able to pursue two such different and demanding careers? Several years earlier, at the height of Chekhov’s early literary success, his friend Alexi Suvorin had urged the young writer to give up medicine. Don’t spread yourself too thin, he said. You’ll never reach your potential unless you concentrate on writing. In response, Chekhov wrote, “You advise me not to chase after two hares at once and to forget about practicing medicine. Well, I don’t see what’s so impossible about chasing two hares at once… Medicine is my lawful wedded wife and literature my mistress. When one gets on my nerves, I spend the night with the other. This may be somewhat disorganized, but then again, it’s not boring, and anyway, neither loses anything by my duplicity.” (1) In this famous passage, the 28-year-old writer dances lightly over a fundamental truth of his life and identity. In fact, Chekhov’s career was not so much a matter of jumping from one bedroom to another, as was the case perhaps with the poets Wallace Stevens and T. S. Eliot, or the composer Charles Ives. Rather, Chekhov thrived on the effective, if not always seamless, integration of the arts of medicine and writing, which reinforced one another throughout his creative life. This essay explores that integration, and the manner in which Chekhov’s cold eye (objectivity) and warm heart (compassion) reveal themselves in his medical and literary lives.

DOCTOR CHEKHOV

“Medicine Is My Lawful Wife”

When he graduated from the Moscow State University School of Medicine in June 1884, Chekhov was already earning his living as a professional writer. The grandson of serfs, Anton was the third of six children in a poor merchant family from Taganrog, a southern provincial town on the shore of Sea of Azov. His father had moved the family to Moscow after going bankrupt in 1877. By the time Anton entered medical school on a scholarship in 1879, the Chekhovs were living in squalor. His father had a dead-end job. His older brothers were alcoholics and generally unemployed. Anton soon discovered that he could ameliorate the situation by selling comic sketches to local magazines for eight kopecks per line. This was a type of moonlighting he loved. He wrote obsessively, often knocking off a story or two each night, after spending the day listening to lectures or working in the hospital. Chekhov ultimately published more than 200 pieces while a medical student, most of them under his preferred pseudonym, Antosha Chekhonte.

Chekhov was a natural storyteller. Thus, it wasn’t surprising that the newly minted Doctor Chekhov continued to write, even after he opened his office and patients began to arrive. “Continued to write” is an understatement. Chekhov published 54 stories in 1885, 76 in 1886, and 57 in 1887. His work evolved from humorous sketches to longer, more serious stories for leading literary journals. In 1888 Chekhov won the prestigious Pushkin Prize and published “The Steppe,” his longest and most innovative story to date. Ivanov, his first full-length play, had a successful premiere in St. Petersburg in January 1889. By that time the young doctor had become one of the best known writers in Russia.

Yet Chekhov always saw himself as a physician, even though in 1889 he did, in fact, retire from a normal paying practice; after that, he offered his medical services at no charge, even though the generous Chekhov often found himself financially strapped. He took care of the peasants near Melikhovo (as depicted in the painting), donated his services to the government as a district physician, and engaged regularly in public health initiatives. In less than five months in 1891, Chekhov reported seeing 453 patients at a district health center and making 576 house calls, in addition to his home practice. (2) Throughout his life, Chekhov also was heavily involved in grass roots activism, building schools for peasants, raising funds to help famine victims, and, later, near the end of his life, supporting the establishment of a sanitarium for tuberculosis victims at Yalta.

“My Debt To Medicine”

One of the best known of these public health efforts was his 1890 epidemiological survey of health and social conditions in the prison colonies on Sakhalin Island. Traveling by himself, Chekhov journeyed six weeks by train, steamboat, and horse-drawn carriage across Siberia to reach the 1000-km long Pacific island on which the Czarist government had recently established a notorious gulag. There, he embarked on a one-man, three-month survey of the population, tenaciously picking his way from settlement to settlement and from house to house, often by foot.

Biographers have long tried to pinpoint his motivation for this perilous journey. During the year prior to the trip, Chekhov had undergone a crisis of confidence. In a letter to Suvorin, he opined, “I don’t love money enough for medicine, and I lack the necessary passion—and therefore talent—for literature. The fire in me burns with an even, lethargic flame; it never flares up or roars… I have very little passion. Add to that the following psychopathic trait: for two years now, seeing my works in print has for some reason given me no pleasure.” (3) He reported symptoms suggestive of clinical depression, perhaps precipitated by grief over the death of his brother Nicholas from tuberculosis. There was also a literary issue. The master of the short story had promised himself that he would create a Tolstoy-like novel that would confirm his status as a serious writer. But he was unable to do so.

Undoubtedly a major factor for choosing Sakhalin was Chekhov’s desire to pay his debt to medicine. He had recently developed a scientific interest in penology and had read about the dismal conditions in the Siberian gulag. He saw an opportunity to influence this situation by obtaining accurate data on the health status of Sakhalin convicts. He had never completed the research thesis (the equivalent of a Ph.D.) that would make him eligible to be a medical specialist or professor. Hence, his notion of “my debt to medicine”—he would perform a survey, write his thesis, and become a teacher.

Ultimately, Chekhov claimed to visit every settlement and survey every household on Sakhalin Island, using a 12-item data collection form. He said he completed over 10,000 of these forms in three months, a feat that (if true) qualifies Chekhov as the speediest shoe-leather epidemiologist of all time. After his return to European Russia, the author found it difficult to organize his data into a coherent study. While he had planned to write a strictly scientific monograph, his creative spirit struggled with the limitations of science. What about his personal experience? What about the interesting stories? After struggling for years, in 1895 Chekhov published The Island of Sakhalin, a curious (but engrossing) mixture of journal, geography, history, medicine, statistics, and travelogue. (4) Unfortunately, the faculty of the University of Moscow was unimpressed.

“As I Grow Older, the Pulse of Life in Me Beats Faster”

Picture the mature Chekhov—a middle-aged bachelor, longish face, rather neatly trimmed beard, a prince-nez clipped to the bridge of his nose. His household included his aging parents and his sister Masha, an unmarried schoolteacher who had become his confidant and secretary. His three surviving brothers looked to him for guidance and financial help. Anton was popular, witty, and generous. Among the guests at Melikhovo, there were frequently female admirers. Chekhov’s encounters with women were flirtatious and obviously enjoyable. He had teasing, sexually charged relationships with several women, but whether any of these liaisons are actually “affairs” is uncertain.

The doctor in the painting already suffered from the tuberculosis from which he would die at the age of 44 years. In fact, he first coughed blood as a medical student. Yet, Chekhov dismissed that episode and each subsequent episode that occurred with disheartening regularity as “influenza” or “bronchitis,” steadfastly refusing to label himself consumptive. As a physician Chekhov must surely have understood the meaning of his symptoms. Was his denial simply a face to show others? Or was his denial so great that it made him unaware? The cat finally came out of the bag in early 1897. While dining at a restaurant in Moscow, Chekhov had a violent spell of hemoptysis that left him critically ill. For the first time, he sought medical treatment and entered the clinic run by Dr. Ostropov, one of his medical school professors. Chekhov’s chronic illness progressively worsened. At the insistence of his doctors, Chekhov left his beloved Melikhovo after 1898 and lived mostly at a new home in the sunny Black Sea resort of Yalta.

It was also during these last years that the bachelor writer courted and married Olga Knipper, an actress with the Moscow Theater Arts Company. Even after their marriage in 1901, Olga remained at work in Moscow during much of the year, while the invalid Chekhov lived in Yalta, theirs being perhaps one of the earliest examples of the modern two-career commuter marriage. Chekhov found himself able to devote less and less of his waning energy to writing, especially since he refused to give up his social and philanthropic activities. Nonetheless, between 1898 and his death in 1904 Chekhov completed some of his greatest work, including several stories, two novellas (“Peasants” and “In the Ravine”), and his last plays, The Three Sisters (1900) and The Cherry Orchard (1903).

COLD EYE, WARM HEART

Chekhov’s Doctors

Several characteristics of Chekhov’s work reveal the influence of medical training and practice. He used clinical knowledge to lend accuracy to his descriptions of disease and medical situations. This characteristic is perhaps most clearly seen in the characterization of mental disorders. For example, the title character in Ivanov is a subtle portrait of a man suffering from clinical depression, who eventually commits suicide. The young heiress in “A Doctor’s Visit” presents symptoms we would now label as generalized anxiety or panic disorder. The title character in Uncle Vanya appears to have a neurotic depression, a condition that meets today’s DSM 5 criteria for Persistent Depressive Disorder. In the peculiar story called “The Black Monk,” Chekhov describes a psychotic condition, presumably schizophrenia.

Chekhov also drew from his medical experience in creating a multitude of physician characters. Doctors play significant roles in nearly 30 stories and in all of his major plays, except The Cherry Orchard. The author’s sensibility as a medical insider gives insight and poignancy to these characters, who range from committed altruists to lazy bureaucrats to burned out cases. Chekhov knew too much about the contemporary state of medical science to portray his doctors as curing many people. Thus, they often appear impotent. Yet, at their best Chekhov’s doctors convey the seamless fabric of tenderness (compassion) and steadiness (detachment) that lies at the heart of good medical practice. They also demonstrate courage, altruism, and self-effacement. For example, in “The Grasshopper” (1892) Dr. Dymov dies as a result of contracting diphtheria from a patient. Dr. Kirilov in “Enemies” (1887) demonstrates extraordinary devotion to duty by leaving his distraught wife and dead son in order to make an emergency house call.

Perhaps Chekhov’s most textured portrait of a good physician appears in “A Doctor’s Visit” (1898). The protagonist, Korolyov, is a young doctor substituting for his boss, the professor of medicine. During the course of the story he moves from being a careful observer (detached concern) who ascertains that his young patient has nothing wrong but a “case of nerves,” to making an imaginative leap by which he connects more deeply with her. This empathic connection allows him to relieve some of her suffering by re-framing her illness. While he cannot solve her existential problems, his demonstration of solidarity leads her to trust him and to gain insight. Korolyov is like Chekhov himself. Dr. Pavel Archangelsky, who supervised Chekhov’s first job as a physician, captured the author’s ability to listen carefully when he later commented: “… he did everything with attention and a manifest love of what he was doing, especially toward the patients who passed through his hands. He listened quietly to them, never raising his voice, however tired he was and even if the patient was talking about things quite irrelevant to his illness.” (5)

At the other end of the spectrum, some of Chekhov’s doctors are insensitive, incompetent, or impaired. Mayer, the callous medical student in “A Nervous Breakdown” (1889) is a disaster. Mayer can rattle off statistics on the number of whores in London and Moscow, but he is unable to “see” (empathize with) the suffering of the living-and-breathing whores he encounters. Shelestov in “Intrigues” (1883) and the public health doctor in “Darkness” (1887) are examples of self-centered physicians a little further along in their professional lives. The former is superficial and pompous; the latter is narrow-minded and detached.

Chekhov’s most complete insensitive and acquisitive social climber is found in “Ionych” (1898). Dr. Startsev, when the reader first meets him, is a young physician setting up practice in a provincial town. After surviving an unrequited infatuation with the daughter of a wealthy townsman, Startsev devotes himself entirely to work. His practice prospers and he branches out into real estate. As he grows corpulent and wealthy, Startsev loses touch with his patients (and his own humanity):

“Probably because his throat is covered with rolls of fat, his voice has changed; it has become thin and sharp. His temper has changed, too; he has become ill humored and irritable. When he sees his patients, he is usually out of temper; he impatiently taps the floor with his stick, and shouts in his disagreeable voice: ‘Be so good as to confine yourself to answering my questions! Don’t talk so much!’” (6)

“Ionych” traces the progressive destruction of a medical practitioner who finds that medical affluence is more to his liking than the emotionally and physically difficult path of medical virtue.

Some of Chekhov’s most interesting doctors are tortured by existential or spiritual conflict. Chekhov accurately depicted professional burnout, a syndrome characterized by depletion, detachment, depersonalization, denial, and depression. (7) Dr. Kirilov, who chooses to “go to the office” instead of mourning with his wife, may illustrate the relatively early phase of emotional detachment. Dr. Ovchinnikov in “An Awkward Business” (1888) demonstrates the more advanced symptom of depersonalization when he slugs his assistant in response to the man’s incompetence. The overworked Ovchinnikov reacts to his personal depletion by objectifying and dehumanizing his assistant, a response that compromises the medical care he is trying to protect. Chebutykin in The Three Sisters (1900) illustrates the extreme of alcoholism. Though still employed as a military physician, Chebutykin convincingly asserts that he has forgotten all the medicine he ever learned.

Ragin in “Ward #6” (1892) and Nikolai Stepanovich in “A Dreary Story” (1889) are complex characters in whom depression and burnout are superimposed on a deep sense of existential failure. Like many of Chekhov’s characters, these physicians suffer from a lack of self-knowledge; they move through life relying on one form of self-deception or another. When they were younger, they committed themselves to noble ideals—Stepanovich to teaching and Ragin to practice in a provincial hospital. But in the long run they never “found” themselves. Professor Stepanovich yearns for a unifying moral principle that would knit together the fragments of his life. Dr. Ragin experiences his failure as emotional numbness. He yearns to suffer, assuming that if he experienced pain, he would be freed from his inability to feel. Thus, the academic physician pines for salvation in the cognitive sphere; the practitioner yearns for emotional redemption. In each case the focus remains inward, rather than turning outward to others, in whom salvation might actually be found.

Medical Sensibility

Medical attitudes and methodology play a larger role in Chekhov’s work than does medical knowledge. He believed that his duty as a writer was to present his observations clearly and accurately; in other words, to lay out the data in an objective fashion and allow readers to reach their own conclusions, rather than providing an author’s interpretation. He wrote, “The artist should not be a judge of his characters and what they say, but only an objective observer.” (8)

This objective attitude put him in conflict with most other Russian writers of the time. It was a major source of conflict with Tolstoy, who was widely revered at the time as a living saint. The two men enjoyed a close personal bond but approached writing with radically different philosophies. After his mid-life religious conversion, Tolstoy viewed literature as a way to communicate his moral vision. He preached the gospel of a radical Christianity, in which all men work together to achieve economic and social equality. However, he rejected the concept of material progress and was particularly skeptical of medicine and doctors. Chekhov, on the other hand, strove to be objective, to present people as they are and the world as it is. His medical training taught him to be a careful observer; his medical attitude made him leery of judging others.

Other Russian writers and intellectuals spoke out against the czarist government’s repressive social institutions. While this protest was disguised in various ways in order to satisfy the state censors, late 19^th century Russians (like their 20^th century counterparts) learned to speak and understand a subtle code of insurrection. The intellectuals addressed “big issues”—democracy, education, social revolution. They wrote articles, organized meetings, and gave speeches. Here again, Chekhov found himself on a different wavelength. He rarely engaged in theoretical discussion and did not advocate radical social change. Rather, he preferred a pragmatic, case-based approach. His goals were relatively limited, but achievable. Treat the sick patient. Document and publicize the abysmal condition of prisoners. Contain the cholera epidemic. Provide financial assistance to keep farmers afloat during the famine. Raise money for a new school. On and on, but always specific and personal.

In “About Love” (1898), the narrator speculates on the essence of love. Are there universal characteristics that identify love wherever it occurs? “What seems to fit one instance doesn’t fit a dozen others,” the narrator concludes. “It’s best to interpret each instance separately in my view, without trying to generalize. We must isolate each individual case, as doctors say.” (9) Indeed, Chekhov’s stories and plays rigorously follow this dictum. While many of his Russian contemporaries used fiction to advance moral or social theories, Dr. Chekhov focused on the complexities of human interaction. In Chekhov’s world, biology and circumstance constrain freedom. People often do not listen. Acts performed with good intentions frequently result in hurtful outcomes. And yet occasionally and in unexpected places, one finds a glimmer of love, courage, spirituality, or healing. “Never generalize,” Chekhov tells his readers. “Never theorize. Pay attention to the particulars. Focus on the concrete.” In this respect, the 19^th century physician-storyteller presages the 20^th century physician-poet, William Carlos Williams, who coined the aphorism, “No ideas but in things.”

In the long run, Chekhov’s objectivity and aversion to theory played a major role in the development of modern literature, as 20^th century writers followed Chekhov in attempting to describe the world of human character and relationship objectively, and allowing that world to speak for itself. To the extent that Chekhov’s “lawful wedded wife” contributed to his sensitivity, skills, and attitudes, perhaps medical education and practice played an unanticipated role in the history of literature, his delightful “mistress.”

Adapted in part from Coulehan J. (Ed.) Chekhov’s Doctors, Kent State University Press, 2003

Sir Luke Fildes’ “The Doctor,” is in the Tate: File:The Doctor Luke Fildes crop.jpg – Wikimedia Commons

Portrait of Chekhov: File: Chekhov 1898 by Osip Braz.jpg – Wikimedia Commons

REFERENCES
1, Chekhov A. The Selected Letters of Anton Chekhov, translated by Sidonie Lederer, New York, The Ecco Press, 1984, p.
2, Coope J. Doctor Chekhov. A Study in Literature and Medicine, Chale, Isle of Wight, Cross Publishing, 1997, p.
3, Chekhov A. The Selected Letters of Anton Chekhov, translated by Sidonie Lederer, New York, The Ecco Press, 1984, p. 81.
4, Chekhov A. A Journey to Sakhalin, translated by Brian Reeve, Cambridge, Ian Faulkner Publishing, 1993.
5, Coope J. Doctor Chekhov. A Study in Literature and Medicine, Chale, Isle of Wight, Cross Publishing, 1997, p. 27.
6, Chekhov A. Ionych. In: The Tales of Chekhov. Volume 3, translated by Constance Garnett, New York, The Ecco Press, 1972, p. 91.
7, Coulehan JL. Being a Physician. In: Mengel MB, Holleman WL (Eds.) Fundamentals of Clinical Practice. A Textbook on the Patient, Doctor, and Society, New York, Plenum Medical Books Company, 1997, pp. 73-101.
8, Chekhov A. The Selected Letters of Anton Chekhov, translated by Sidonie Lederer, New York, The Ecco Press, 1984, p. 54.
9, Chekhov A. About love. In: The Tales of Chekhov. Volume 5, translated by Constance Garnett, New York, The Ecco Press, 1972, p. 290.

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Chekhov 1898 by Osip Braz

A country doctor, Gregory Ovchinnikov, begins his daily rounds in the hospital. He soon notices that his assistant, Smirnovsky, is drunk. When the assistant refuses to obey an order and verbally snaps back at him, Ovchinnikov hits the man in his face. The angry physician then rushes out of the ward and goes back to his lodgings, abandoning his patients.

At first, Ovchinnikov considers demanding that the town council fire Smirnovsky. Later, after he calms down and goes back to work, he begins to appreciate the enormity of his unprofessional act — perhaps the town council will fire him for assaulting his assistant. Strangely, when the assistant comes to apologize, the doctor indicates that it is he, the doctor, who has behaved inexcusably. The assistant is stunned but decides to report Ovchinnikov to the council. Of course, the council demands that the lower-class Smirnovsky apologize to the upper-class Ovchinnikov.

This story illustrates both a conflict of conscience and a conflict between social classes. With regard to the latter, it is quite clear that the town council would never rule against the gentleman-physician in favor of the drunken, lower class medical orderly. The physician, however, struggles with his own conscience: was he justified in hitting the man? If not, what should he do to make amends?

Originally Published 1888
Jack Coulehan (Ed.) Chekhov’s Doctors, Kent State University Press, 2003. Translated by Ronald Hingley.

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database (Litmed).

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