Appendix, the Russian way by Julia Hesley

1985, Russia, Soviet Union

I gasped, wrapped my hands around my stomach, and curled into a ball, trying to catch my breath. It was as if someone had stabbed me in the back. The waves of pain rolled through my body like heavy punches. Was it stomach flu? A heart attack?

Reluctantly, the pain loosened its grip on me, letting me take a breath. What the hell just happened? I waited in the dark. The clock on my bedside table said it was two in the morning. What could I do? Call for an ambulance? The phone booth was across the street from our college dorm building. I tried getting up. A new wave of agony bent me in half, and I was back in bed. The pain wasn’t going away.

Lena stirred in her bed across the room.

“Lena,” I said. Tried to. My voice croaked. She turned toward me. “Please, wake up—.”

 Then everything went dark.

#

“Devushka, wake up.” Someone shook my shoulder. I opened my eyes: two men in white coats by my bed, a blood pressure cuff around my arm, and someone’s fingers on my pulse. Out by the window, in her house dress, Lena stood, her eyes filled with panic.

“Where does it hurt?” one of the men asked. “When did it start? Is it a sharp pain or a dull ache?”

I winced, trying to reply, and failing. It hurt even to breathe.

The medic stood up. “We’re taking you to a hospital.”

Two ambulance workers put me on a stretcher and took me to a white van parked in front of the dorm entrance. Tears ran down my cheeks: every movement worsened the pain.

I must have blacked out again. When I opened my eyes, I was staring at a green-colored wall — institutional green. I was lying on a cot in a brightly lit room that smelled of antiseptic, chlorine, and, somehow, of oranges.

I sat up and leaned against the wall, shivering. The pain subsided a bit, leaving me with a dull ache. To my left, behind a reception counter, a woman in a white coat glanced in my direction, got up, and came toward me.

“Is anyone with you?” she asked.

“No,” I shook my head. She checked my chart.

“Lie down and wait,” she said. “We’ll take you in when we can,” and she walked back to her Plexiglas-protected booth. I looked around—  the hallway was dark and empty. Nobody was barging through the doors, shaking up the Plexiglass booth, demanding that the doctor see me right away. I was on my own. My pulse was racing, and I broke into a cold sweat, shaking.

An orderly rolled my hospital cot down another green, despair-colored hallway, parked me in a corner, and handed me a paper-thin cotton gown. Carefully, gritting my teeth, I unfurled myself from a fetal position and wrapped the robe around me, but it didn’t do much to protect me against the chill that slithered across the floor. A nurse rushed in, took my vitals, and left.

Another wait. A man in a white coat came to my cot; his name tag, stitched on his breast pocket, said: “Doctor Litvinov K.L.”  He looked young but tired. An intern?

“Hello,” he offered, examining my chart, “Let’s see. Does it hurt when I press here?”

He poked and probed my stomach, his cold and sharp fingers quickly finding the painful spots. 

“You’re running a fever. I’ll order your blood and urine tests, and then we’ll talk.” He hurried out.

Was this how the hospitals work? Being twenty years old, I had somehow managed to avoid hospital stays up to now. What did I expect? Someone to hold my hand when it hurts? I closed my eyes and waited. Frigid air enveloped my body, seeped through my pores, chilling me from the inside, and soon, I was shivering. The nurse walked in, took my blood, and left. I was a cog in a slow, indifferent system. Fear coiled inside, siding up to my pain, whispering in my ear: people died in hospitals all the time. Especially in small-town hospitals. Especially in the middle of the night.

My teeth clattered, the only sound in the hallway.

It was probably another hour before I saw Doctor Litvinov again.

“I have your blood test results. Elevated white blood cells count,” the doctor looked at the notes. “You have an infection. Based on how you describe the pain and its location, it looks like you have an inflamed appendix.” 

“Looks like?” I raised my eyebrows. “You mean you are not sure?”

“Well, I can’t look inside you, can I?” He snapped and put his notes down. He was so young. Was he even qualified? “We can only diagnose an inflamed appendix based on a clinical picture. In short, we need to take it out.”

A surgery?

“Wait…You’re going to cut me open even if you don’t know for sure?”

Can I trust him? Did he know what he was doing?

A wave of pain ripped through my insides, sending me into a loud wail.

Doctor Litvinov sank into the chair next to me.

“Nadya, listen.” He took a deep breath, and ran his hand across his stubble. “If it is an appendix and we don’t remove it in time, it will burst very soon, and you’ll get peritonitis. Pus in your stomach. You will die.”

I didn’t want to die. Not here, not tonight, not in this dingy hallway. What choice did I have?

“All right,” I said as I gritted my teeth.

“I’ll be right back,” and he walked out.

I closed my eyes. Somewhere close by, my doctor was talking to someone quietly at first. Quickly, it escalated; Doctor Litvinov’s voice was getting louder, angrier. “No, she’s fine right now. She can wait!”

Why were they arguing?

Another man’s voice, slow, drawn-out, deliberate. “ It’s your career…” 

Litvinov: “Under my responsibility. Observation only.”

He walked back, his jaw set straight as he glanced at his watch. “Change of plan. Let’s wait. We’ll just monitor you for now. The morning shift comes in two hours.”  

#

These two hours dragged on as I shivered under a thin itchy blanket. Slowly, the morning light crept through a narrow window. The pain throbbed inside me – an animal that was moving around, growing, gaining strength. Suddenly, it gripped me hard, and I screamed, then I vomited, unable to hold back.

“Please, help!” I croaked as my stomach seemed to turn itself inside out with every eruption.

Outside the hallway, loud and confident voices were giving orders. Clanking of metal instruments. Hushed replies. Quick steps across the linoleum.

“Help!”

A nurse walked in, looked at me, called for help. More people, hurrying, rolling me somewhere.

“Nadya,” someone called. A statuesque blonde was standing next to my bed, next to Doctor Litvinov: freshly pressed white coat, hair tucked under a cap.

“I’m Doctor Kuznetsova,” she said, “let’s take a look at you.”

“Do not touch my stomach,” I growled and curled in a fetal position, my insides on fire.

 She checked my chart and frowned.

“Why wasn’t she taken into surgery hours ago?” The blond turned around and glared at Doctor Litvinov. He averted his eyes and bit his lip. “Another bad judgment, Litvinov. I’m tired of it,” she snapped. “Goes on your file. Scrub in.”

She turned toward the nurse. “Surgery. Right now!”

They wheeled me into the surgery– a large, white-tile covered room, separated into partitions by green plastic curtains. A smell of disinfectant hit my nostrils at the same time as the blast of frigid air. The room was like the inside of a refrigerator.

Several pairs of quick hands pulled the gown off me, leaving me naked on the operating table. A large lamp lit up above me, the flood of light over my stomach. A small partition went over my chest. I lifted my eyes: right above me, reflected in the mirrors surrounding the lighting fixture, I could see my stomach and someone’s hand wiping my belly with the orange iodine.

Muffled conversation in the background:

“… enough Novocaine for today?”

“..not sure. … check with the head nurse— “

Quick steps leaving the room.

 Doctor Litvinov returned, his hand on my shoulder. “Nadya, I’m going to give you a few pain-numbing shots, and it’s going to hurt.” A white mask covered his face, with only the warm brown eyes showing. Fear closed its sharp fingers around my heart, and I started to pant. Something melted in Doctor Litvinov’s eyes, and he leaned in closer. “There, there, don’t be scared. Everything is going to be all right. You can hold on to these,” he pointed to the metal rails around the surgical table.

“I have to go in with the needle as deep as I possibly can, so… deep breaths, and, just hold on, devushka.”

This was not real. It was not happening to me.

The needle looked huge.

Oh God, no. 

It went into my stomach slowly, and I cried out. I lay there, shivering, exposed, waiting for the anesthetic to take. I was breathing hard, trying to keep the panic from taking over me.

“Another one going in. Hang in there,” and the second needle went in, going even deeper into my body. The pain was unbearable. Tears streamed down my cheeks as I squeezed the cold handrails. The worst of it was over, wasn’t it?

Doctor Kuznetsova appeared on the other side of the operating table, chirping orders to personnel I couldn’t see.

“Nadya, are you ready?” She didn’t wait for the answer. ” We’re going to make an incision, so stay still,” she ordered, her gloved hands holding a scalpel. She angled the blade at my belly, and a horrible realization hit me at once: I was not getting any anesthesia beyond the Novocaine. They were going to cut me open with me fully awake.

“Stop, please…” It was too late.

A scalpel made the first cut, splitting my skin. I yelled out: the anesthesia wasn’t enough to mask all the pain. I felt the second cut. And the rest of them. My flesh was separated, pulled, and pushed, accompanied by the impersonal, detached chatter above me.

They are cutting me up. This must be a nightmare. I need to wake up…

The curtain in front of my face protected me mercifully from seeing it all until I accidentally lifted my eyes to the mirror. An open bloody wound reflected in the mirror.

“Stop!” I yelled, and they paused. Cold sweat covered my face, and I was shivering. “Can you give me general anesthesia? Please. I’m begging you.”

“The anesthesiologist is busy.” Doctor Litvinov nodded at the partition. “With a leg amputation. Besides, we don’t use general anesthesia for small surgeries.” She looked down at me, raising the bloody scalpel again. “Now, the worst part is coming up: we have to pull your intestines together for sewing, so you’ll feel it. Hang on tight.”

I grabbed the steel handles of the operating table. Cold sweat. More screaming. The bright light. Pain, making me half-delirious.

They must have given me some medication after all. That, or I went into a shock because everything disappeared.

#

Sunlight on my eyelids, a warm caress. Loud chatter, coming from all directions, clanking of dishes, laughter. A dull ache came from my abdomen. Where was I? Hospital. The surgery. I winced and opened my eyes.

It must have been visiting hours: the already-cramped room was full of visitors. The smells of food were making me nauseous. I closed my eyes again and drifted away.

“Nadya, wake up. Can you hear me?” Someone shook my shoulder. Lena. I groaned.

“Please, wake up,” she said. I opened my eyes again, squinting in the bright light.

Lena drew a sharp breath. “Thank God, you’re all right. I was so worried. You were out for almost two days. They just brought you back from intensive care today.”

My cracked lips were slow to move. “Thank you… for calling the ambulance.”

Lena took my hand.

“Nadya, you were lucky. They took your appendix out just in time. It ruptured during the surgery.”

That long night in the observation room. They waited, and waited, and then postponed my surgery.

My roommate’s eyes filled with tears. “I’m sorry I wasn’t there, I would have–“

The next few days were a blur of pain, sleep, fever, more antibiotics. My incision was infected, and the nurse came in twice a day to clean the yellow pus seeping through the bandages while I gripped the side of the bed until my knuckles were white. Lena came to visit an hour each day. She sat on a chair next to my bed while I stared at the wall, unseeing.

“Are you all right?” she’d asked, concern on her face.

“I’m just tired.”

Lena slipped some money to the orderlies before she left, the only way to ensure they would pay any attention to me. When I finally got up, a week after the surgery, the orderlies helped me walk across the room to the bathroom, a twenty-step trip that took ten minutes.

#

Ten days in, I woke up in the middle of the night, cold sweat pooling on my chest, a scream dying on my lips. I tossed, unable to get comfortable in a sagging hospital bed. The stench of unwashed bodies, iodine, and boiled cabbage overpowered the room. I got up and crept out of the room – carefully, slowly, still slouching to protect my still-tender scar – and stopped in front of the nursing station. Olga, my favorite nurse, was there. She was very efficient, but there was a softness and homeliness around her: warm eyes, round face, gentle touch. Like my mother.

She looked at me, a question in her eyes. 

“I’m all right, just can’t sleep.”

“Sit down,” Olga nodded at a plastic chair.

“Want some tea?” she asked. I nodded, grateful, wrapping my cold hands around the hot cup.

The night was quiet, with an occasional door opening in the hallway and a remote clanking of some metal instruments.

I sipped my tea. There was a lot I didn’t know about hospitals. And surgeries. I shuddered.

“Olga, why didn’t they give me general anesthesia?”

“Not enough drugs,” she said flatly, just stating facts. “Never is. And not enough hands. The chief of surgery has been asking for another anesthesiologist for years.” 

We sat in silence for a bit.

“We’re always short on everything,” she said. Bitterness in Olga’s voice was like an old scab that gets picked every day and never heals, just keeps on bleeding. She lowered her voice and quickly glanced around the empty hallway. This was the mid-eighties; we were well past the Stalin era, past the black cars taking people away at night for a wrong word said at a wrong time. But Olga still looked over her shoulder to see if anyone was listening, just in case.

She wanted to talk, and I knew why. A Soviet citizen was used to keeping things to himself. It was always at night when that bottled-up anger that was brewing there all day long, all year long, a lifetime, would find its way out. Buried deep inside, often kept down with vodka, it pulsed just underneath the surface, living, seething. When provoked, it pushed through the thin veneer of doublespeak, the forced smiles, and the endless upbeat feed on the TV.

 “We haven’t had any repairs done here in the last decade. The plumbing is rusty and leaking, the linoleum is torn up, and you’ve seen the bedding.” 

The hospital’s dented aluminum plates must have come from a prison.

“The chief physician spends all his time arguing with our health department. He has to fight for everything: equipment, medications, supplies. And then,” she leaned in closer, “of course, everyone steals what they can. Have to survive somehow.”

I wasn’t even going to judge what she said. The theft of necessities was a way of life for many.

“Can’t you find a job at another hospital?” I asked, but I knew the answer as soon as I said it.

“It’s the same everywhere. It’s this city. It’s the whole fucking country.”

I went back to the communal room: ten beds, five on each side. Someone was groaning, calling for a nurse. Shortly, a doctor walked in. Doctor Litvinov. I watched him check on the patient and give instructions to the nurse. He turned to leave, then saw me sitting up and walked over.

“Well, hello there, Nadya,” he said. “Can’t sleep?”

I shook my head.

“You’re doing better.” Even in the semi-darkness of the night light, I could see days-old stubble on his face and dark circles under his kind eyes. He was probably just out of med school. A few years older than me.

“I am, finally.”

“Doctor,” I hesitated but pressed on. There was something that didn’t make sense that night, and I had to know. “Why did you postpone the surgery that night?”

He cringed, rubbed his chin as if unsure if he could trust me, then sat on the chair next to my bed and leaned in closer.

“Nadya,” he lowered his voice, “two surgeons were operating that night; one was busy, and the other was a bit… under the weather,” he shuffled his feet, averting his eyes, his euphemism clear. “I didn’t want him cutting you. I took my chances that you would last through the night until the day shift.”

I stared at him for a full minute, an understanding passing between us. He saved me from a drunk man with a scalpel.

I almost died here at this hospital, and there wasn’t anything personal about it.

I left the hospital three days later with an ugly scar: a five-incher, bumpy, roughly stitched, running across my belly, from my hip down to my pubic bone.

Julia Hesley resides in the Pacific Northwest. An immigrant from Russia, she tells the stories of Soviet life behind the Iron Curtain.