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Care in a Land of Closing Hospitals

The Russian writer Maxim Osipov was best known as a medical doctor, until he began to publish arresting, empathetic stories of sickness and treatment.

Courtesy of New York Review Books

Echocardiology is the science of using high frequency sound waves to create pictures of the heart. During an echo test, a doctor observes the functionality of the heart, monitoring the pathways by which blood moves for any irregularities. Before he became known as one of the best living prose writers in Russia, Dr. Maxim Osipov co-wrote a textbook on the subject: Clinical Echocardiology (1993). For years, he was largely known for his work as a doctor and publisher of medical literature. That all changed in 2005 when a patient and close friend of his died. Osipov gave the man’s widow sections from his diary that contained references to her husband. He told her not to show them to anyone. She showed them to everyone, including publishers. Eventually, Osipov’s diary entries came out in the Russian journal Znamya (The Banner). From there followed more short stories, literary prizes, and a reputation—befitting a cardiologist—for producing, now through words, piercing images of the inner workings of the human heart. 

New York Review Books, 312 pp., $17.95

Osipov’s new book, Rock, Paper, Scissors, is a collection of short stories translated from Russian by an award-winning team of translators (Boris Dralyuk, Alex Fleming and Anne-Marie Jackson) and comes with foreword by none other than Nobel prize winning author Svetlana Alexievich. It is an ironically glitzy English language debut for an unassuming middle-aged writer who lives outside of Russia’s glamorous capitals of Moscow and St. Petersburg.

Osipov, who is 56 years old, lives in the small town of Tarusa, Russia (population 9,660). It is just 90 miles south of Moscow, but it might as well be on the other side of the planet (which would geographically be Russia too I guess). Osipov continues to practice medicine in Tarusa, thanks largely to himself. In 2007, when the town’s only hospital faced closure, he created a charitable foundation to keep it afloat. He still runs the foundation and posts fundraising calls for various pieces of medical equipment on his Facebook account.

In his stories Osipov positions the provincial doctor as a confidant; the doctor’s visit is a rare moment of unguarded intimacy. These encounters, so vital to the physical and mental wellbeing of patients, have become fewer and farther between in rural Russia where hospital closures are a constant threat. Rock Paper Scissors puts these realities center stage, so that readers from any part of the world that is facing a healthcare crisis (including the United States) will recognize the dynamics he portrays. As access to care becomes increasingly restricted by rising costs, insurance bureaucracy, and hospital deserts, the stories show what that we lose not just information about our health. We lose someone to talk to.  

Osipov joins a long tradition of doctors turned writers in Russian letters, though he’s sometimes bristled at comparisons. In a 2010 interview with Radio Svoboda, he complained that in almost every review of his work, “those three bogatyrs make their appearance: Chekhov, Veresaev, and Bulgakov.” He is compared to Chekhov particularly frequently, especially now that he has been writing more and more for the stage. Born almost a hundred years earlier in 1860, Chekhov grew up in abject poverty and started writing humorous sketches for newspapers as a way to supplement the family’s paltry income. It was a practice he would continue even after becoming a doctor. “Medicine is my lawful wedded wife and literature my mistress,” he once wrote to a friend.

Though Chekhov, like Osipov now, claimed that his writing life and medicine were firmly separate, in his later, more mature prose, stories regularly center on anxious medical students, weary country doctors, and sick, frightened patients. His 1896 story “Ward No. 6,” a fictional account of life in a provincial mental ward, is still read today as a testament to the misunderstood and under-appreciated struggle of the mentally ill. Chekhov’s work as a medical doctor is often used by scholars of Russian literature to explain the raw emotion of his writing, a prose that so effortlessly evoked feelings of vulnerability, empathy, and the power of kindness in the face of tragedy.

Svetlana Alexievich finds these same qualities in Osipov’s writing, noting in her foreword to Rock, Paper, Scissors that he “relates to his characters as to patients; he asks them where it hurts.” Though Osipov likes to downplay the influence of medicine on his writing, in the eleven stories that make up Rock, Paper, Scissors, doctors are frequent protagonists, and hospital visits, illness, and above all the fleeting nature of life, are all central themes. In his Radio Svoboda interview, Osipov says that he finds in his patients a kind of authentic language: “When [people] say that something on their body hurts,” he explains, “they’re not lying or saying it to be fashionable; it really bothers them.” In Rock Paper Scissors, Osipov would seem to draw on that sincerity of speech, depicting characters lacking in pretense and made naked by fear.

The long, arduous, often fatally delayed search for proper care is a recurring theme in Rock, Paper, Scissors. One story, “The Gypsy,” revolves around a doctor who supplements his income at an underserviced rural hospital by accompanying patients seeking advanced medical care on flights to the United States (sometimes Portland, Maine, sometimes Portland, Oregon—which inevitably causes a mix-up). The patient in that story is on her way to Portland (Oregon) from Yoshkar-Ola, Russia. Her husband tells the doctor that they once had to travel “fifteen hours by train” to undergo a procedure.

In another story, “The Mill,” about a paper mill in the fictional city of Liebknechtsk, the doctor who works at the local hospital remarks, “Had [I] not moved there, they might as well have closed the hospital as it wouldn’t have met its licensing requirements, and the entire mill complex would have had to go god knows where for treatment.” This is, of course, not a problem specific to Russia. It has been reported that 16 percent of Americans live 30 miles away from a hospital, a distance that can make the difference between life and death in times of emergency.

But Rock, Paper, Scissors gestures deeper than simply documenting the struggles people face in finding convenient and reliable healthcare. It explores the narrative function of medicine and the storytelling potential that exists in the doctor-patient relationship. In Osipov’s stories, doctors are frequently vessels by which the stories of their patients are told, after the patient has passed away or after their mental faculties make it difficult for them to recall who they once were. In a story titled “After Eternity: The Notes of a Literary Directory,” my favorite of the collection, an elderly pensioner faced with the daunting task of traveling to Moscow for care simply absconds. He leaves with his doctor a manuscript containing his memoirs, stories about his time in the city of Eternity, a fictional mining town in the Far North, where he supposedly served as the literary director for a local theater. In another story “Good People,” Bella, an elderly widow with Alzheimer’s volunteers her time at a children’s hospital called; the staff help her remember the pieces of her life that are increasingly outside her grasp, reminding her of who she is and the brilliant career she had as an actress. 

It is perhaps unsurprising then that Rock, Paper, Scissors, a collection so influenced by Osipov’s other life as a doctor, is, at its core, about the preciousness of life. In that same story, Bella tells us that one memory of hers is safe—the day she met her husband, Lev, at a skiing resort. When Lev first comes to St. Petersburg (which she remembers as Leningrad) to live with her, they walk around the city and plan their life together, sorting out the particulars of job, family, and home. When the conversation makes Bella suddenly burst into tears, Lev comforts her; he tells her “her tears are perfectly natural, they need no explanation, because this moment isn’t just any moment, it’s special and it will never come again.” With this new beautiful and heartbreaking collection of stories, Maxim Osipov, doctor, writer, resident of Tarusa, never lets us forget that our lives are special, and they will never come again.