Kelso, United Kingdom
It was a time in general practice when doctors still visited patients for other than purely medical reasons. Back then, it was easy to forget why or when a particular visit had started or how it had mysteriously evolved into a regular one. “Chronic” was the often vaguely demeaning term used to denote visits of this kind. Now called registrars, young apprentice doctors were then known as trainees. And it was natural that the regular doctor might temporally “decant” some of these patients onto a new trainee. As these patients had few unpredictable medical concerns, the new doctor’s inexperience was unlikely to result in any medical harm. In addition, a fresh, young face provided a welcome break from a schedule of visits receding into the far distance—to be ended only by death or retirement.
I was launched into rural general practice in Scotland in such a time, as trainee to a particularly kind, elderly, country doctor, whose humanity and caring nature had led to the accumulation of just such a “chronic list.” Invited to take on a select number of these patients, I learned much of human nature and even something of medicine, but one individual generated especial affection in me, and his history greatly enlarged my hitherto narrow experience of life and humankind.
Retired, Ivan and his wife Valya worked at a local farm, tending the garden, collecting the eggs from the old-fashioned henhouse, and lending an elderly hand with certain seasonal jobs on the farm in exchange for lodging. His incessant smoking of Greek and/or Turkish cigarettes had led to his chronic bronchitis and unpredictable myocardial ischemia, whose persistent resistance to treatment suggested an infirm diagnosis. The monitoring of these conditions was, I presumed, the purpose of my calls, but I quickly realized that the pleasure both patient and doctor derived probably constituted my trainer’s main motive for the visits.
Invariably wearing Russian-style headgear and loyally subscribing to a Russian weekly newspaper from the local newsagent, this elderly Russian comfortably signaling his nationality on a farm in Cold War Britain was initially puzzling. Despite Ivan’s preference for Russian to English, over the course of my visits I slowly pieced together his complex personal history, inexorably intertwined with the tortuous pre-war, inter-war, and immediate post-war Eastern European politics, of which then I knew nothing and know only slightly more today. During our time together, I laboriously elicited details of Ivan’s biography through the haze of his fractured, “Russified” English and came to understand more clearly what had led him and his wife to the life they were living at the time we met.
Russland-Süd (Ukraine), Soldaten, Sturmgeschütz III, December 1943
Ivan had been born into a Ukrainian peasant family living in pre-Communist, Russian-ruled Ukraine near the politically meaningless Russian border. In 1920, a detachment of Red Guards attacked and butchered his entire pro-Tsarist, “white” village. Successfully feigning death in a ditch, the sixteen-year-old Ivan survived. In the company of one or two other survivors from neighboring “white” villages, he traversed the Ukraine and Romania to Serbia, in the newly-established Yugoslavia. Here, he obtained employment before enlisting in the Royalist army and, later, probably in the pro-German forces—though he was always vague in tracing this part of his life. Out of the tortured maelstrom of post-WWII Yugoslavia, he eventually emerged in Italy as one of the countless refugees whose undocumented existence and “disposal” posed such insuperable challenges to the Allied authorities in Europe in the aftermath of the war.
Having no wish to return to Tito’s unified communist Yugoslavia, he was sent to a refugee camp in Dundee, Scotland, which was run by a British authority tasked with matching refugees of the conflict with suitable employment—in Ivan’s case, agricultural. For a year, he worked on various farms in Angus. There, he met and married a Ukrainian peasant woman who had originated from a village near his own but whose arrival in Scotland neither she nor the receiving authorities had been able to unravel. The couple was subsequently allocated by the Authority to the farm in the rich agricultural lands of the Berwickshire Merse where I first made their acquaintance.
At harvest time, wearing Ukrainian working clothes, Ivan and Valya gleaned corn from behind the reaper-and-binders and, in later years, the powerful, sophisticated combine-harvesters that displaced the binders. From these gathered seeds of corn they ground the coarse flour to bake Ukrainian-style loaves of bread. From the fruit trees in the farmhouse garden, they also produced various jams, many of which would be donated to the families of fellow workers and to other favored individuals, such as their doctor. On the labels, he would painstakingly inscribe the contents in charmingly phonetic English script. Since Ivan associated me with their regular doctor, I was favored with many of these jars of jam, whose delicious flavors I can still recall with pleasure—and some nostalgia. During this time I became increasingly aware of my patient’s kindly, humorous personality and of his well-rounded, philosophical nature garnered from the buffets that life had dealt him.
I never achieved a comparable acquaintanceship with his wife, Valya. Her extremely self-effacing nature hid her in their tiny kitchen, and a rapidly fatal medical condition struck her not long after I first met the elderly couple. As she spoke no English, it was with great difficulty that I persuaded her to be admitted even to our local “cottage” hospital, with the intention of referring her on to our local district hospital after an initial diagnosis. However, this intention was frustrated by her unstoppable terminal decline over the course of two days. During her pitifully short stay in the hospital, the kindly nursing staff completely failed to persuade her to remove the Ukrainian peasant costume she had struggled into before the ambulance transported her to the hospital.
I continued my visits with Ivan to monitor his medical condition, but more to discuss Russian and Eastern European history—as well as current East/West politics—through a blue haze of pungent, foreign cigarette smoke. I continued to receive vegetables from his garden and jars of the latest batch of jams. He often indicated that it would help him greatly if I were to learn Russian—since our discussions would then be much more fruitful. Although there never seemed to be time to respond to this very reasonable suggestion, we appeared to achieve a mutual understanding.
However, he soon became quite ill with an inevitable, and untreatable, carcinoma of the lung. I admitted him to our local cottage hospital in order to more regularly assess his condition during the short span of life still available to him. Strained by the busy schedule of daytime general practice, I would drop in to chat with him in the evenings. One evening, the dying colors of a particularly beautiful sunset gently touched the river Tweed, reflecting a deep ruby light on the hospital windows at its banks. The evening nursing rounds had come and gone, and the ward was quiet. Ivan was in bed, and I sat down beside him. We talked of the day he had spent—the first ever in a hospital bed—and how he felt.
He said he was comfortable and content. I knew him well enough to know that he understood his death was approaching and that he was content to face what lay ahead without fear. His rapidly weakening condition had already suggested that Ivan would die soon in this small, friendly hospital beside the Tweed, in the country that had offered him sanctuary after the convulsions that had engulfed his far-off Russian Ukraine.
He began to speak again of the terrible day when his young life was torn apart all those years ago. It was lunchtime on the sunny day when the Red Army had roared into his village. The entire population of the village—minus his father, who had ridden off to the local town to seek supplies—had been forced at bayonet point to the center of the village. Rather than shoot the captives immediately, the troops dragged the infants and very young children from their parents. Seizing and swinging them by their feet, the troops battered the children’s heads against the village walls. Only then, the squad, which had stood poised to shoot, received the order to kill every remaining child and adult as they howled in terror. It was at this moment of almost inevitable annihilation that Ivan, with the desperate, youthful will to live, rolled into a ditch that bordered the killing ground, seeking camouflage beneath the bodies of his family and neighbors. Hiding, he heard shots as the troops immediately dispatched with those still living, including two burly men who obscured him.
Ivan lay for an eternity as the troops drank, smoked, and laughed—cut suddenly by the sound of a galloping horse approaching the village. The horse stopped and whinnied confusedly, and Ivan recognized all too well the sound of his father’s horse returning from town. Under the weight of the corpses, Ivan had pressed his face into the village dust praying that his father had heard the shots and would take caution before entering the village. His prayers had not been answered. After a short pause his father coaxed his horse down the hut-lined street, which led to the killing ground. A burst of gun shots cut his father’s surprised cry short, punctuated by a heavy thud.
Engrossed in memory, Ivan stopped talking. Tears rolled down his cheeks. Contemplating the supremely sheltered life I’d led, I struggled to comprehend the unfathomable vulnerability of so many lives. I pictured my sixteen-year-old self, a reasonably happy, typical teenager blessed with a loving family. I could have endured neither what he had suffered that day nor all the desperate days that followed. But mostly I thought of the cruel tragedy of so many young lives brutally cut short by men who were also fathers and older brothers, albeit not to the young ones they murdered. I imagined looking into the faces of these men (and of all such—in all periods of history) and shuddered at the disjunction of heart and mind, and I wept too.
Because of our close relationship, Ivan shared with me the intimate details of this terrible period in his young life. His story and, more so, his dignified recounting of these traumatic events affected me deeply, leading me to inquire into the life-stories of my future patients—life-stories which I not only felt privileged to hear, but which often had strong bearings on their medical conditions. He taught me to never make assumptions based on inadequate and superficial considerations. I hope that I have applied this lesson throughout my professional life.
Before he died, Ivan gave me his beloved Russian hat. I have it yet.
DR. CHRISTOPHER H. CAMERON, MB, ChBwas born in 1940 in Edinburgh, Scotland. He commenced studies of classics and ancient history in Edinburgh University. After a year, he underwent a “Damascene conversion” and moved to the medical school. He became a general practitioner in Kelso, a small country town in the Scottish Borders. After 25 years in general practice he recommenced studies as a “mature” student at Edinburgh University, receiving an MA in English language, Scottish history, Russian and Gaelic, and an MSc in an etymological and linguistic study of non-standard bird names still used in the Scottish Borders.