November 13, 2013

How to cure us: the medical demons and demonic medicine of Dr. Mikhail Bulgakov


A portrait of Mikhail Bulgakov.

Like most men of science, Serge Voronoff was a romantic. His dream was simple: to prove the viability of cross-species tissue grafts—or, in layman’s terms, to replace the past-their-prime testicles of his human patients with a brand-new pair of monkey balls.

He started small. Backed by his American wife (a wealthy heiress who also served as his lab assistant) he performed over 500 test transplants on sheep, goats, and a bull. In 1920, he embedded small sections of baboon and chimpanzee testicle inside a live human scrotum. The resulting “rejuvination” launched him into the stratosphere of scientific superstardom—so much so that, by the end of the 1940s, thousands of men around the world had been treated by him for senility, hypothyroidism, poor eyesight, schizophrenia, and “muscle weakness.” At one point, demand for his services became so rabid that he converted a stylish villa on the Italian Riviera into a combination laboratory/farm, where monkeys could be raised in comfort—until of course it was time for their testicles to be chopped off.

It was an exciting time for medicine, and a terrible time to be a doctor—at least according to Voronoff’s countryman and fellow practitioner, Mikhail Bulgakov. By 1920 (the year of that first “successful” scrotal transplant), the phlegmatic Ukranian had diagnosed himself conclusively as sick: of war, displacement, and most of all his job. “I experienced a mental crisis on February 15th, 1920,” he later wrote, “When I gave up medicine forever and devoted myself to literature.”

He was 29 years old, but his short career had already run through at least three romantic medical stereotypes. He had served as a Red Cross volunteer in World War One and a conscript in the Russian Civil War (this became The White Guard). He’d buried himself in remote Smolensk province, treating over 15,000 patients in a single year (A Country Doctor’s Notebook). He’d even spent six months as a specialist in venereal disease—an experience that we might conjecture led him to Voronoff, and his monkeys, and, eventually, the resolution to give up practicing the Rational Art and begin satirizing it (The Heart of a Dog).

His decision is not as surprising as it seems. The tradition of doctor/writers in Russian literature has two foundational saints—two figures who established medicine as not just a day job, but an activity that can shape and even feed creative work. The first of these saints is Anton Chekhov, who chuckles over his successors like Gandalf presiding over a dwarven banquet. The second is Yuri Zhivago, the rapturous poet-hero of Boris Pasternak’s novel Doctor Zhivago. As writers, they are pretty much opposites, but as mythological characters they share one important detail: they are at war with themselves. Their art requires time, space, stability; but their practice places constant demands on them—demands that, for the most part, they end up giving in to. Because when you get right down to it, human life is more important than writing, even when that writing is being done by a genius.

This willingness to put life (medicine) before art (writing) is what makes the doctor-writer such a perversely attractive figure; it is also, interestingly enough, an inversion of the Western imagination’s previous reigning medical archetype, Faust. The Great Bad Doctor, you’ll remember, made the very un-Chekhovian choice of knowledge over love and power over humanity—a decision that today would be condemned in all but the most cartoonish practices. For while the carrot of certain knowledge might have seemed like a reasonable goal in the 18th century, in the 21st, the doctor must come to terms with a little thing called The Human Element. He must be willing to accept that his geometrical diagnoses will be realized within the problematic sphere of actual patients, who are complicated, contradictory, neither wholly good nor entirely evil. Like characters in a Chekhov story, in other words.

The situation is perhaps not all that different in literature. Again, this is mostly Chekhov’s fault—for in the two-hundred years separating Goethe and us, writing has traded much of its mythological Technicolor for high-resolution portraiture, the key tenet of which is that human beings are neither entirely good nor wholly evil, but complicated. Partisans of this method like to present it as a heightened version of simple observation: a physics rather than a metaphysics. But the truth is that there is a real philosophy underlying such representation. “Human beings are complicated”, implying not only, a) we should try and understand that complexity, but also, b) that ultimately, we cannot. So reading—and writing—becomes a process, not of judging, or condemning, or even understanding but of accepting the fact that, to quote Alice Munro, who James Wood recently called “our Chekhov:” “The complexity of things—the things within things—just seems to be endless. I mean nothing is easy, nothing is simple.”

One of the fascinating things about Bulgakov’s early novel The Heart of a Dog (completed in 1925, though not published in the Soviet Union until the 1980s) is how little it seems to care about this kind of Chekhovian complexity—how much it embraces instead an older, more explicitly-Faustian form of representation, combining satire, fable—even science fiction. The naïve young rationalists in Bulgakov’s first books have their optimism sobered by experience in a way that would have pleased any of the great Russian realists; but by the 1920s, the idea of anyone “coming of age” began to look less attractive. After all, what’s the use of being initiated into an adult world that seems to be actively trying to kill itself? Or, to put it another way, why accept “the complexity of things” when that acceptance requires you to set aside your sense of good and evil?

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The Heart of a Dog does not set aside this sense; at the same time, it never makes the mistake of becoming a simple story of good characters versus bad characters. If anything, the “evil” that it satirizes is not a person at all, but a way of thinking: a spirit that has descended on the human population of the book like a huckster commandeering a small town. This “love the sinner, hate the sin” focus is indebted both to Bulgakov’s religious sympathies (his grandfather was an Orthodox priest) and his medical background. It understands evil as a sort of disease: a “soul sickness” whose goal is self-propagation and whose inevitable side effect is the imprudent destruction of its host.

Bulgakov’s record of this destruction takes the form of a case study. The mutt Sharik is subjected to what is essentially an inversion of Vornoff’s “rejuvination” technique. His testicles and pituitary gland are removed, and then replaced them with organs culled from a human being. Within weeks, the once loyal pet has become a cigarette-smoking vagrant, whose cunning and willingness to collude earn him instant success within the local Soviet bureaucracy. He even gives himself a name and patronymic: the grotesque-sounding Polygraph Polygraphovich Sharikov. His ambition is so boundless in fact that eventually his betrayed master, the surgeon Philip Phillippovich, is forced to admit scientific defeat and reverse the operation, returning Sharik to his original canine state.

A dog again, with his dog’s “heart” replaced, Sharik becomes faithful, grateful, content. “I’ve been so lucky, so lucky,” he thinks, dozing off on the doctor’s rug. He is happy, in other words; he has learned his lesson. Unfortunately, the same cannot be said of Philip Philippovich, who Bulgakov shows us in the novella’s final paragraph:

“The important man plunged his hands dressed in slippery gloves into jars, pulling out brains, a stubborn man, a persistent one, searching for something all the time, cutting, examining, squinting, and singing…”

The Frankensteinian monstrousness of this silhouette—which we see through Sharik’s eyes—is shocking. It is as if Bulgakov had decided to end his case study by revealing that in fact the scientist performing the experiment was the one we should have been keeping our eyes on the whole time. He was infected, not the subject – but infected with what? Humanity? Language? Rationalism? Or the strange automatism of the practitioner, the “stubborn” scientist who continues his indefatigable fight against death without any sense of proportion or restraint?

Phillip Phillippovich whistles while he works, and this is scary because it suggests that he is unconflicted about what he does. A brilliant man, he is also, in his own way, pretty stupid. He has confused himself with god—someone whose will can and should become fact without any resistance, just because it is his. Unlike Bulgakov, he sees nothing wrong with his actions; on the contrary, he blames Sharik, his subject, the conditions of the experiment. And, because conditions can be changed, he sees nothing wrong with repeating his mistake, over and over again until he gets it right.

The Heart of a Dog provided a convincing diagnosis—a diagnosis that Bulgakov would eventually return to and expand in his much more famous opus, The Master and Margarita. The subject of the later book was, again, the disintegration of an infected organism; but the organism this time was an entire city, maybe even Russia itself. Its characters included Christ, the devil, most of Moscow, and of course a writer —one driven to the point of mental breakdown by the incompatibility of his story with the story that everyone around him seems is telling themselves. That story is, of course, Soviet life: a lie so pervasive that it had become the truth, at least for many Russians in the 1920s. So the unreality that the devil Woland brings to Moscow—an unreality that includes witches, gigantic cats, talking heads—is itself not a disease, but a symptom of a sickness that is already there. It grows, boils, rages and finally breaks, leaving in its wake a city full of people wracked but also refreshingly aware of how close their seemingly-invincible society is to falling apart.

If this ending sounds more hopeful than the one offered by The Heart of a Dog, that’s because it is. It’s a cure of sorts: a catharsis, to use a word that was canonized by Aristotle but originally had the medical connotation of purging a body of its ill humors. In the ancient Greek universe, which operated under Hippocrates’s homeopathic conception of medicine (homeopathic meaning, essentially, that “like cures like”), this kind of agitation of an already agitated organism was as sound a medical practice as bloodletting or the Venice treacle; but today’s practitioners believe something different. To our more allopathically-inclined minds (allopathy: the cure by opposites), the best way to heal an agitated person is to calm him down, in the same way that the best way to cure a fever is to artificially-induce (say through two Tylenol) a not-feverish state. If you’re worried, don’t get more worried: calm down. If you’re really upset, take a deep breath. Read something happy, or sad in a happy way, like a Law and Order novelization. Experience a world that is simpler and better organized than your own, and so return to that state that even the Greeks thought was the best: balance.

Bulgakov’s best work, like his life, is not balanced; on the contrary, it pitches and reels like a fever dream, as the reader hangs on in terror and delight. Read today, it seems to sit halfway between the apocalyptic bacchanalia of Faust and the “epidemic” novels of the 1990s. Zombies too. Flip as it may sound, I think it’s fair to say that the author of Master and Margarita would have loved zombies, not because they are frightening but because like all monsters they demonstrate something important about our shared experience of evil, which was demonic in the great-man-obsessed 19th century, but which the 20th century revealed to be at least partly a matter of numbers. Evil is not cruel, any more than a hurricane is cruel—but it is hungry. It wants to keep going, even when its keeping going means that everything else has to stop. Its most precise medical equivalent is cancer, which is after all just cells losing the ability to stop multiplying, increasing, surviving.

Bulgakov survived too, at least until the nephrosclerosis he’d inherited from his father ended up catching up with him. As a doctor, he’d seen this death coming for years – had even predicted it as a young man, before Stalin made even 49 years look like a stretch for a writer of dissident literature. His best works—including Master and Margarita—were still unpublished at the time of his death; bur he knew better than to despair completely. “You don’t know the future,” he reminded his wife in 1938, two years before his death, and twenty-eight years before his great novel finally appeared.


JOSH BILLINGS is a writer and translator who lives in Rockland, Maine. Melville House has published his translations of Alexander Pushkin's Tales of Belkin and Alexander Kuprin's The Duel. Recent writing of his has appeared in The Collagist and The Literary Review. He blogs at