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BMJ. 2007 September 29; 335(7621): 673.
PMCID: PMC1995507
Medical Classics

Cancer Ward

Paul Crichton, consultant psychiatrist, London

The semi-autobiographical novel Cancer Ward is set in a cancer hospital in the Soviet province of Uzbekistan in the late 1950s. Like Solzhenitsyn, the main character, Oleg Kostoglotov (“bone chewer”) spends some years in the Gulag, is sentenced to perpetual exile in Kazakhstan, becomes ill with cancer, is treated in a cancer clinic, and makes a good recovery. The book describes the profound effects that the experience of labour camps, exile, and then cancer can have on an individual.

Cancer Ward is meant to be understood as a political allegory—tumours kill, so how can a country survive with “growths” like labour camps and exiles? The ward, with its heterogenous mix of patients from different ethnic groups and social backgrounds, reflects to a certain degree Soviet society. There are fierce debates on, for instance, social origin.The opportunistic apparatchik Rusanov, who has made a successful career out of denouncing friends as well as foes, prides himself on his proletarian forebears. Kostoglotov booms at him in response that even if he, Rusanov, had 10 proletarian grandfathers, if he were not a worker himself, he wouldn't be a proletarian.

What is much less well known than the allegorical dimensions of Cancer Ward is the psychological realism of the portraits of both patients and staff. We see how being admitted to the cancer ward is like being sent to the Gulag. In both cases there may be a loss of status, loss of individuality, and loss of a future perspective. We see how cancer can isolate sufferers from even their closest relatives and friends, how some patients become anxiously preoccupied and constantly check their bodies for physical changes, how they sometimes come to think that it is no longer they but the tumour that is in charge, and how they may feel as if they were dead. Patients are not unlike prisoners in that their lives resemble “a river that flows into the sands.”

Solzhenitsyn has an equally good understanding of the mindset of the doctors. The main purpose of the ward round is to improve the morale of the patients. Euphemisms, vague formulations, and downright lies are routine tools of the trade. The doctors rarely say what they think—until they sit down together later and “the general impression of improvement and recovery was completely exploded.” One patient who has not responded to treatment is simply ignored by the doctors. Patients are discharged before they can die in order to improve the clinical statistics—no palliative care here. In individual consultations with patients some of the doctors are more honest, and even show natural kindness, rather than mere professional kindness. When Ludmila Dontsova, the lead oncologist, becomes ill with cancer, she does not want to know anything about the details of her condition, treatment, or prognosis.

Cancer Ward is not only a forceful indictment of political abuse, but an insightful and cogent study of the psychological reactions of both doctors and patients to life threatening illness.

Notes

Cancer Ward

By Aleksandr Solzhenitsyn

First published 1968


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