Anton Chekhov:

Striking a balance between medicine and literature

by K.W.A. Jayawardane

When we encounter the name of Anton Pavlovich Chekhov (1860-1904), we at once would think of a major playwright and the greatest of all short story writers. However, many people might not know that he was a qualified doctor who practised medicine. He was also a psychologist, sociologist, a pioneer in social medicine and the foremost among the physician writers.

Anton Chekhov was born in Taganrog, Russia, on January 29, 1860 as the third child of five children. His father compelled Anton to help him in his shop, and also conscripted him to the church choir. Though his mother was very kind to him, his childhood remained a painful memory to him, which he invoked in his works later. In one of his letters he wrote, "when I was a child, I had no childhood".

Anton Chekhov

After briefly attending a local school, he entered the town high school where he studied for 10 years, and graduated at the age of 19. The last few years in school he lived alone and supported him by coaching younger boys. His father, gone bankrupt had moved to Moscow with the rest of the family to start life anew.

In his student days he was popular for skills in improvising comic amateur dramatics and for his ability to mimic teachers and priests. He also wrote some comic sketches. By this time he had read widely in the town library and was a frequent theatergoer.

Destitute parents

In 1879 he joined his family in Moscow and enrolled in the medical faculty. Young Anton Chekhov chose medicine as a good source of income to support his destitute parents and two brothers Aleksander, a journalist and Nicolay an artist who provided little financial help and his sister Mariya. But he faced the thorny question of how to survive the period of schooling. In the midst of his medical studies, he supported the impoverished family by writing short homorous sketches and short stories to the Moscow and St Petersberg newspapers under the pen name "Antosha Chekhonte" school nickname.

He prowled the streets, race tracts, railway stations, taverns and courtrooms for writing material. He learned to scribble one short story, a joke, a farcical sketch a day. "I don't remember a single story on which I worked more than 24 hours" he wrote later. Although he was thus forced to write to journals for economic survival, he vowed not to die a journalist. He said, "it is better to treat loathsome diseases than make money for vile stories sneering at drunken shopkeepers .... I shall plunge into medicine, there is salvation in it, although I do not behave myself as a medical man."

Medicine

After graduation from medical school in 1884, he went to Voskresensk hospital near Moscow and continued to write while practising medicine. Two careers in full swing Chekhov often linked his medical career to his "lawful wedded wife", and his writing to a mistress. "When one gets on my nerves, I spent the night with the other", he wrote. From there he returned to Moscow and started a large practice.

But half of his patients were poor and had no money to pay. It brought him great pleasure in treating them gratis. While engaged in two professions he received a letter from Dimitri Grigorovich, respected and eminent novelist praising his originality and writing talent. This made a great change in him and started taking writing seriously.

Dimitri introduced Chekhov to Suvorin, editor of New Times who became the young author's editor and mentor. The most prolific year in his life was 1886-67, during which he published 166 stories and became widely recognised among the Russian literati. His editor pressured Chekhov to abandon medicine for writing, but he refused saying, "I feel more contended when I remember that I have two professions not one... If I had not my medical work I could hardly give my leisure and my spare thoughts to literature."

Initially Chekhov too thought that medicine might impair his creativity as a writer, but later he expressed indebtedness to medicine. He was able to integrate medicine and literature into a seamless union. He wrote, "There is no doubt in my mind that study of medicine has significantly broadened the scope of my observations and enriched me as a writer only a doctor can appreciate".

He always kept a notebook in which he recorded observations with psychological insight into his patients, laying bare their secret motives. Essentially a short story writer, he used simplicity and impressionism to portray sympathetically the psychology of the common man. Similarly his plays, popular today, written in a light and ethereal style, while static, have an inner psychological evolution. The best examples is the 'Cherry Orchard.'

Chekhov suffered from ill health throughout his adult life. He knew that he was suffering from tuberculosis which killed his elder brother. But he kept his illness as a secret from his medical colleagues because the only treatment advised then was going to Cremia or resorts abroad, which for him was not financially possible. Furthermore, such a move would disrupt his medical and literary career and result in hardships for his family. In spite of his illness he still practised medicine intermittently and travelled widely in Russia and wrote stories for a livelihood. In 1888 he received the Pushkin prize for the best literary work of the year for his collection of stories.

Sociological expedition

In early 1890 he sought relief from the urban life by undertaking a one-man sociological expedition to a remote island Sakhalin, which is nearly 6000 miles east of Moscow, on the other side of Siberia, and was notorious as an Imperial Russian penal settlement nicknamed "Devil's Island". It was before the Trans-Siberian railway had even begun, and was a long and hazardous ordeal by carriage and riverboat.

After reaching there in three months he studied the local conditions and found venereal diseases and prostitution rampant, hospital ill equipped, dirty, and prisoners were rotting in the cells. He felt that the drunkard wardens alone were not guilty for the horrendous prison conditions, but all those of us who show no interest and concern. He took a census, the only one that had been carried out in Russia on a scientific basis. After the study he returned by sea via Hong Kong and Sri Lanka.

In Colombo he stayed at the Grand Oriental Hotel where a wing had been named after him. He published his findings as a research thesis titled The Island of Sakhalin (1893-94), which remains a 400 page landmark study in social medicine and a classic in Russian penology which also influenced the prison reforms.

His experience in Sakhalin island increased his social consciousness and observed, "I have now firmly grasped with my mind and my soul that had suffered so much, that man's destiny either does not exist at all, or exists in one thing only: in a love full of self-sacrifice for one's neighbour". Chekhov continued to probe deeply into the lives of his patients for hidden motives, thus preceding psychosomatic medicine by half a century. He was always interested in medical psychology. His soul-penetrating observations helped him immensely in his works.

A remarkable insight into the psychological problems of academic medicine is very well portrayed in the 'Dreary Story' - a penetrating study of an aged professor of medicine. This and 'Ivanov' which culminate in the suicide of a young man are the most famous of his clinical studies.

After returning from Sahalin his health deteriorated and showed clear signs of evidence of tuberculosis of lung and intestines, resulting in depression, cynicism, and the poetry of death which permeated his stories of 1891 and 1892.

Melikovo

He actively helped in the disastrous peasant famine of 1891-92 as physician and medical administrator. After this exhausting experience he wanted to escape from Moscow and bought a 240 hectare estate in Melikovo about 80 km from Moscow providing a home for his aging parents and for his sister Maria, who acted as his housekeeper and remained unmarried to look after her brother. He practised medicine, but most of his patients were peasants, whom he treated free of charge. There he became a member of the Sanitary Council, and helped to build roads and hospitals. He salvaged a medical journal "The Surgical Chronicle" and said, "saving a good surgical journal is just as useful as doing 20,000 successful operations".

As far as short stories are concerned, Melikovo period was the most creative period in Russia than any other single work of Chekhov. One of his most famous dramas 'The Seagull' also was written during this period. Chekhov had a warm admiration for Leo Tolstoy, the well-known novelist and thinker. Later he rejected his doctrine and wrote attacking his teachings. He wrote several stories with his new views one particularly outstanding is "Ward Number Six".

By 1887 his health further deteriorated and the doctors advised him to go to a warm climate and he spent more than eight months in Biarritz, Nice and Paris. On his return he sold his Melikovo estate and built a villa in Yalta and formally gave up medicine. By 1888 he was concentrating on quality at the expense of quantity, dropping from over 100 items a year in 1886 and 1887 to only 10 in 1888.

Marriage

Women played an important role in Chekhov's writing and life. He had enjoyed the friendship of many that found Chekhov handsome, companionable and appealing and his frequent female guests included actresses and writers. He had once said, "these sweet creatures give love and take little from man: only his youth". Chekhov seemed reluctant to have permanent relationships with women. His family urged him to get married, but he responded by saying the "there is no use marrying except for love... sexual attraction, one flesh, all the rest is unreliable and dull, no matter how wisely we calculate."

In 1888 a young actress Olga Knipper who was appearing in his plays had attracted Chekhov. After three-year courtship they were married in 1901. Less than three months after marriage they had to separate, Olga a premiere actress at the Moscow Art Theatre had to go for rehearsals. She wanted to give up but Chekhov discouraged her stating that living apart was due to the devil implanting germs in him and in her a love of art. Except for the winter months and rare visits, the Chekhovs lived apart, but communicated almost daily by letters.

Towards the end of his life he became friendly with Maxim Gorky, ten years his junior but already a popular young author. Chekhov gave Gorky much detailed advice on the techniques of fiction writing. Anton Chekhov refined the technique of short story writing, used simplicity and impressionism to portray sympathetically the psychology of the common man, admired and imitated later by many modern writers in English. Among them are George Bernard Shaw, Somerset Maugham, Ernest Hemingway, Katherine Mansfield, John Middleton Murray, Sherwood Anderson, Raymond Carver and J.B. Priestly.

Anton Chekhov's revolutionary theatrical credo was that "in real life people don't spend every minute shooting each other, hanging themselves and making confessions of love. They don't spend all their time saying clever things. They are more occupied with eating, drinking, flirting and talking stupidities.... Life must be exactly as it is, and the people as they are... not on stilts".

His four great plays "The Seagull", "Uncle Vanya", "The Three Sisters", and "The Cherry Orchard" form a quartet of masterpieces unique in modern theatrical literature, memorable for economy of words, great precision in expression, and philosophy of life. They remain timeless, contemporary, and fresh even today. Chekhov's work provides a panoramic study of Russia of his day, and one so accurate that it could even be used as a sociological source.

By 1903 his condition further deteriorated and doctors advised him to go to a spa in the Black Forest resort city of Badenweiler near Basal. Chekhov and Olga left Moscow on June 3, 1904, stopped in Berlin and consulted an eminent doctor who offered him no hope. On July 2, 1904 he passed away peacefully at the age of 44. As Rosol very correctly had said, Anton Chekhov's life has shown that for many medical practitioners, non-medical interests are the best defence against job burnout. A firm hold on the outside world can give physicians, in particular, valuable first-hand knowledge of the lives and pursuits of the patients sitting on their examination tables. Armed with this fuller understanding, physicians who successfully balance their passions can offer the world far more than the medical healing.