12

Anna holds the hands of two little girls while several more cluster around her legs. Some of the littlest ones find outdoor play overwhelming, and even on the coldest days the children are outdoors for at least an hour. In summer they spend much of their day in the courtyard or on the verandah. They’re very lucky to have so much outdoor space – grass, and asphalt too for rainy days – but today, in a cold, blustery October wind, Anna will be glad enough when it’s time to take the children indoors. In a minute she’ll get them going with another game of tag, or a race. Little Masha needs to run about; she must be frozen. Not only is she clinging to Anna’s hand, but she’s also rubbing her face against it. She’s a nervous, sensitive child who looks on with dread at the bigger children with their flaring red cheeks and pounding boots as they rush across the yard.

‘Mashenka, do you want to run a little race with me? How about you, Tanya? Shall we see who can run fastest over to the silver birch?’

They are so lucky. They have trees for shade, and a concrete pool (empty now) for the children to splash about in during the hottest days of summer. Anna has to hand it to Morozova: she has a genius for extracting ‘special funds’ for the nursery and is forever on the alert for new initiatives of which they can be at the forefront …

‘Have you heard?’ demands Irina. Irina isn’t braceleted with children; she packs her ‘clingers’ off with a sharp word, and they soon learn not to come to her. Anna suspects that even Irina disapproves of her softness. These children need to be socialized, for goodness’ sake, and they won’t learn by holding on to Anna’s skirts.

But they learn this way too, Anna believes. The shy or fragile children grow more confident if they’re allowed to take things slowly. They start off silent, then they’re talking to me, then I can get them talking to one another. Soon we can play a little game, and then other children come along to join in and there you are. They’re all playing together.

‘Just a minute, Irinochka, let me give these little ones a race and then I’ll be with you.’

‘You shouldn’t be running in your condition.’

Anna feels a warm flush of pleasure, but answers, ‘It’s fine. Come on, Mashenka, Tanya – and you, Vova, I bet you’re good at running. Let’s see who can get to the silver birch first. One, two, three, GO.’

She drops her arm, and they’re off. Anna jogs with them, keeping the pace. Nervy little Mashenka, to everyone’s surprise, covers the ground first. She hangs her head as they all clap her, but Anna catches a glimpse of a smile.

‘What were you going to tell me about, then, Irinochka?’ she asks when she comes back. What fresh horrors are in store for us? But of course she doesn’t ask this question aloud, not even of Irina.

Irina frowns. ‘It’s no joke. Morozova’s latest is that we’ve got to mark the kids’ drawings. Just think of what that’s going to mean. Every single one’s got to be graded and put in a file so we can do a progress assessment every six months. How much time’s that going to take?’

‘Oh dear.’

‘ “Oh dear”? Anna, just think about it, it’s worth a bit more than “Oh dear”.’

‘The last statistics lecture I went to, one of the group was telling us they’ve started marking the artwork at their place. Some of the parents don’t like it apparently. But they’ve got different parents from ours. Theirs are all teachers and university professors. Ours probably wouldn’t complain.’ Because they’re cowed by Morozova, she doesn’t add, who represents to them the voice of the high-ups themselves. You can laugh at her behind her back, you can grumble all you like, but you know she’ll get her way.

‘It’s not the parents I’m bothered about, it’s us,’ declares Irina. ‘Every week it gets worse. More boxes to tick, more things to get wrong. You’re so lucky, you’ll be getting a break from it soon. My God, if I were in your position I’d think I’d died and gone to heaven.’

‘No you wouldn’t, you’d be bored to death. Look at all the freedom you have.’

‘Freedom to work all my life until I’m one of those poor old half-crazy women bargaining over the price of chicken feet? What kind of freedom is that? Sometimes I really think that’s what’s going to happen to me. I’ll work until I’m worn out. Can you imagine still lugging these kids about when you’re coming up to sixty? There’ll be a hundred times as many forms to fill in by then. I won’t meet anyone. I’ll never have children of my own.’

How angry and bitter she sounds. ‘Irinochka, don’t. You’re lovely. Someone will snap you up, just wait.’

‘Who will? The men who should have married me are dead. The younger men – the ones who weren’t in the war – they want the really young girls, not old hags like me. Oh, for heaven’s sake, Anna, how many kids do you want hanging off your arms? Tell them to shove off and play!’

‘They will in a minute. Vova, can you start the race for us this time? Just say, “One, two, three, GO,” and bring your hand down like this. All you others, don’t move until Vova says, “GO.” I’ll watch and see if you’re all running your very hardest.’

Irina and Anna watch as Vova holds up his hand proudly, ready to give the signal just as Anna gave it. The little ones jostle themselves into a line.

‘One, two, three, GO!’ shouts Vova in his thin, clear voice, and the children surge forward. But Masha doesn’t make it. She trips and falls forward on to the asphalt as the others pelt away towards the birch tree. Anna hurries forward to pick her up.

‘No, you idiot, let me!’ shouts Irina. ‘You can’t go picking up these kids now.’

Masha is all right once she has got her breath back. Fortunately she is so thickly wrapped in her padded jacket, scarf and woollen helmet that her face has not even touched the ground. She doesn’t cry.

‘Good girl! Now off you go to the others and see who’s won. Thanks, Irinochka, I know I shouldn’t be lifting them, but sometimes you can’t help it.’

‘Yes, you can help it. You’ve got to put yourself first. Morozova’s not going to care if you have a miscarriage in the cause of picking up some snotty kid.’

‘I should be all right now,’ says Anna. ‘It’s past four months.’

‘All the same, you’ve got to be careful.’

Irina is so interested in Anna’s pregnancy. It’s almost as if Anna were having the baby for both of them. Three weeks after she heard Anna was pregnant, she brought in a beautifully wrapped paper parcel. In it was a cobwebby white knitted jacket.

‘Did you make that yourself, Irina?’

Irina shook her head, laughing. ‘No chance. I bribed my sister. She knits so fast you can’t even see the needles.’

‘It’s beautiful. He can wear it on special occasions.’

‘Do you think it’s going to be a boy?’

‘No, not really. I suppose I only say “he” because I’m used to Kolya.’

‘I expect your husband wants a boy,’ said Irina, nodding her head and looking wise.

‘I don’t think he cares, as long as it’s healthy. That’s the trouble with being a doctor. They see so much disease and suffering that they forget a normal child is really quite common.’

Irina fingered the delicate wool. ‘You put it on over the warm layers. It’s decorative, really.’

‘It’s perfect. You could never buy anything like this in the shops.’

The two women embraced. As they separated, Irina asked with apparent casualness, ‘What does it feel like, Anna?’

‘You mean being pregnant?’

‘Of course.’

‘I don’t feel very pregnant yet. In a way nothing’s changed, but at the same time everything’s changed. Also, I feel hungry all the time but when I start eating I wonder why I’m putting the food in my mouth.’

‘You’ve got to eat.’

‘Well, of course. It’s just that everything tastes different.’

Irina sighed. ‘Isn’t it strange? A few weeks ago you were just like me – except you were married, of course – and now everything’s completely different for you. All your future, and everything.’

‘Mmm.’

She couldn’t tell Irina about the crazy, fearful exultation that sometimes came over her in the dead of night, long after Andrei had fallen asleep. Her waking self told her not to be too confident. She might easily miscarry; these were early days. But her secret self was sure. She would hold her own child in her arms at last. Those were things you couldn’t say to anyone else, especially not to Irina.

The wind is growing colder, and swinging round to the north-east. Snow will come soon. The last ragged leaves will be swept off the trees, and the children will squeal with excitement when the first flakes drift past the windows, and then thicken, resolving themselves into a true snowfall, the first of the year. For the children, it’s so long since last year’s snows melted. They stare with wide, startled eyes at the new world, and then fling themselves out into it.

‘The real trouble with Morozova,’ grumbles Irina, ‘is that she’s absolutely determined to get this nursery on to “the cutting edge of early-years excellence”. “Cutting edge”! I ask you. She’s so sharp she’ll cut herself one of these days.’

‘You shouldn’t say that, Irinochka.’

‘Only to you. You’re so calm, Anna, I don’t know how you do it.’

Anna feels a stab of shame. She is always cautious, even with Irina, but Irina trusts Anna enough to share indiscretions with her. Anna wishes she could be more open, but it’s impossible. Only with Andrei; and even then there are thoughts she keeps to herself. It’s the way she was brought up, no doubt.

‘I expect there’ll be a course on criteria for early-years drawing assessment,’ she says, deadpan, to make up.

‘And you’ll be sent on it. Morozova always sends you. She thinks I’m thick as a brick.’

‘She most certainly doesn’t! That’s ridiculous. You’re our resident hygiene expert, aren’t you?’

‘Yes. Theory and practice of scrubbing hands and bums, that’s me.’

‘That’s all of us. Come on, it’s nearly half past, we’d better get them in.’

*

Andrei has a meeting about sanatoria quotas. It’s a subject dear to his heart. Thalassotherapy, in particular, has a proven record of success with certain types of rheumatism. The problem is getting the beds for the children who really need them: those whose joint articulation is so impaired that they are developing compensating abnormalities of gait and flexion.

In theory, the main criterion for the sanatorium beds is need; in practice, there’s a hierarchy, which not only excludes many who could benefit from treatment, but also vigorously defends its own interests.

It’s a long, bruising meeting. Sometimes he wonders if he’s doing more harm than good to his patients by arguing for them.

‘I hope you understand, Dr Alekseyev, that we have to apply the most rigorous and impartial selection procedures.’

‘Naturally I understand that.’

‘We cannot allow the slightest appearance of special pleading. Your patient group is only one of many that have strong claims to the forty-day-treatment allocation at the Red Star sanatorium. You are aware that there is pioneering work under way with children who suffer from recurrent pneumonia. The climate of the Yalta region is considered particularly beneficial to these patients.’

‘And who is the clinician in charge of the pneumonia cases?’ asks Andrei blandly. He knows the answer, and they know that he knows it.

‘Dr E. V. Denisova is in charge of the research project.’

I bet she is. One of the most single-minded careerists he’s ever met. An average doctor, but as an operator her style verges on the brilliant. Between him and Denisova, there’s no contest. But all the same, just for the hell of it, he’ll fight it out.

‘How many beds are available to us?’

Rustling of papers. Sideways glances. ‘For the forty-day treatment, you mean?’

‘Yes.’

‘According to my latest information, we have been offered a package of twenty-eight beds for the period 1st May to 10th June next year.’

‘Twenty-eight beds! But that’s exceptionally generous, surely. We’ve never been offered so many at the Red Star before. Couldn’t we divide up the beds between our specialities?’

‘But you must understand that this is a block allocation. The purpose of the allocation would be most satisfactorily answered by sending a cohort of patients under the care of a particular specialist.’

‘I am sure I could find twenty-eight patients, if that’s what’s required.’ He’s determined to push this one to the limits. His only weapon is an assumption of naivety, so that they are forced to explain themselves. But he feels weary. Maybe he should give in, and let Denisova have those beds.

More rustling of papers. Impatient, irritated looks. Doesn’t Alekseyev have the sense to understand that the deal is already done?

‘I believe’ – stiffly, with an air of reproof – ‘that it is chiefly due to the initiative of Dr E. V. Denisova that this very significant and satisfactory allocation has been made to us. It seems only reasonable, therefore, that her excellent pioneering research work should represent the hospital in the therapeutic setting of the Red Star.’

And Denisova hasn’t even had to turn up and alienate people. Those Red Star places have rolled on to her plate like fat, sweet dumplings. No doubt she’s worked hard enough for them, though, behind the scenes.

‘I fully understand the importance of sanatorium provision in the case of children with recurrent pneumonia,’ he says quietly. ‘That is not the issue. Equally, I’m sure that Dr Denisova’s work is of high quality and deserves support. But all the same, I’m obliged to make the case for my own patients. I think I’m right in saying that twenty-eight beds is an exceptional allocation. Early intervention is vital for my patients. Otherwise, frankly, the benefit that they can derive from rehabilitation decreases sharply. We end up with severely disabled patients. In some cases – not in all, I’m certainly not saying that – early, intensive physical therapy and thalassotherapy have been proven to be beneficial. I’d like to cite the research of Dr I. S. Makarov, published in Moscow last year. I’d be glad to provide copies to this committee. I’m not asking for twenty-eight beds, or even half that number. Even five beds would make an enormous difference to patient outcomes.’

He has much more to say. He would like a great deal more detail about the patients involved in Denisova’s research, her treatment outcomes to date, and what other resources she has already managed to secure. But no. The whole thing is tied up already. Either they are discussing this provision disinterestedly and professionally, or they are not. Why bang on a closed door?

He’s getting cynical. He never thought that would happen to him. Sometimes he just wants to say: Enough. Have it your way, and see what comes of it. But he can’t. The system, for all its faults, is a million times better than what was there for these children before. His little Tanyas are entitled to treatment, and on the whole they get it. Things are not perfect, but every system has its committees, its Denisovas, Russovs and Retinskayas.

You have to remain hopeful. You have to believe that what you do makes a difference.

‘You are very eloquent on behalf of your patients, young man,’ says old Gerasimov, who has been silent until now. He’s one of the old school. He must be close to sixty now. In his youth he was a medic with the Red Army, during the Civil War. He’s a Party member who has somehow survived everything and remained a decent man. There is a glint of sympathy in his stern face. He won’t like Denisova’s machinations – or her backers – but he will believe that ‘for the greater good’ the committee must show a united front.

‘I hope I am,’ replies Andrei.

‘But in this case, I am afraid we must disappoint you.’

Andrei looks around the committee members. They regard him – or avoid his glance – with an air of faint annoyance. Some scribble busily on their memo pads. Others stretch exaggeratedly, as if to emphasize how physically taxing it is to sit in a chair for hours and make decisions. These committees are certainly burdensome, but one has to do one’s duty. Andrei knows them all, and yet he has a sudden certainty that if he were drowning, not one would reach out a hand. Except old Gerasimov, perhaps.

He nods, gets up from his chair, thanks the committee and makes his exit.

It’s good to go straight to Radiology and the consoling presence of real work. He needs to talk to Sofya about a couple of X-rays that have to be redone. If she’s got a minute, maybe they can get some tea and have a quick chat about how things are going. She’s always asking after Anna these days. Funny how all the women are so interested in Anna’s pregnancy, whereas the men, after initial congratulations, say nothing. It’s natural enough, he supposes. In fact, now he looks back, plenty of his colleagues must have become fathers without more than a conventional word from Andrei.

But everything changes when it’s your own. Once or twice he’s even said the words aloud: ‘my son’ or ‘my daughter’. He felt like an imposter, but he supposes that once the baby is born, it will seem quite natural. A child; their child. His child. When she first told him, tears came to his eyes. He knew then how much he’d wanted this without daring to realize how much he wanted it. He had almost given up hope. He and Anna were young and strong and it was years since they’d used any form of contraception. If they were able to have a child together, it would have happened by now. He’d never wanted to drag her into the misery of clinical investigations. Nothing was more likely to ruin their happiness. He knew enough; gently, he tried to make sure they did everything that would give them the best possible chance of conception.

But now, suddenly, when he’d given up expecting it, she had conceived. From the day she told him she thought she was pregnant, he’d been struck by how certain she seemed. After so much anxiety – so much grief, if he were honest – he thought she might have been tense and fearful, in case things went wrong. But she seemed quite calm. His own joy was so overwhelming that he became afraid. Something would go wrong. He had spent too many years telling himself that it didn’t matter, because he and Anna were happy and they had Kolya. He thought he had convinced himself.

He won’t change towards Kolya. The boy won’t notice any difference. He vows this to himself, in silence.

A child. His child. He hurries onward, swinging through the main doors of Radiology.

‘Is Sofya Vasilievna about?’ he asks one of the nurses.

‘No, she’s got a group of students,’ replies the nurse, and pushes her trolley away. He hesitates. Probably better to come back later; she might be a while. But as he’s hovering outside one of the doors with its warning sign, Lena rushes up to him.

‘I need to talk to you. Come on.’

‘But, Lena –’

‘Quick, this way.’ Something in her tone makes him follow her without further questions, out of the department, down one of the long wards that are waiting for refurbishment. Lena stops outside a door, and glances both ways before opening it. ‘Hurry up!’

‘But, Lena, it’s a cupboard.’

‘I know it’s a cupboard, for heaven’s sake!’

They are inside. Lena feels for a switch and he hears it click before a feeble light comes on, showing shelves up to the ceiling, piled with hospital linen. It’s a big cupboard and there’s space for three or four people to stand upright inside it.

‘Isn’t this a bit melodramatic, Lena?’

Lena shrugs. ‘If you like. But we can’t waste time, I’ve only got ten minutes.’ For a bizarre instant he thinks she’s offering him sex, but of course that’s impossible. Not Lena; not him, either. ‘Listen,’ she carries on, ‘I’ve heard something about the Volkov boy. He’s coming in later today.’

Whoever is in charge of this cupboard seems to like their job, thinks Andrei. The sheets are ranged immaculately, with all the sharp, starched edges matched. He can see the double line of sewing by the seam, where they’ve been turned sides to middle. Nothing wasted. That’s how it should be. Only people are to be wasted.

‘For a check-up?’ he asks, fending off what he already knows.

‘No. He’s developed further symptoms. They’ve been to their private doctor, and now he’s coming in for a chest X-ray. Persistent cough and shortness of breath.’

‘I see.’

‘There’s a hell of a panic on in Admin. My friend works there.’ Lena, so discreet. Even to him she doesn’t name the friend. ‘Borodin or Ryazanova ought to see the boy,’ says Lena, naming the paediatric respiratory consultants. ‘It’s not your area. It was bad enough the way you got dragged in last time. Besides, it may just be flu. It’s that time of the year.’

But from the first moment she mentioned the boy’s name, certainty plumbed him like a lead weight. ‘Further symptoms’; ‘chest X-ray’. Of course he sees, and so does Lena. Osteosarcoma is one of the cancers which is most likely to produce secondaries in the lungs. Four months since the operation; that would be quick, but not impossibly quick. There may even have been some nodules at the time of Gorya’s earlier treatment, but they were still too small for the X-rays to pick them up then. Tumours in the lung can grow so fast, especially in a child of that age.

It’s a while since he last saw Gorya. The boy’s done very well in rehabilitation. Andrei’s abiding memory is that of Gorya swinging himself on his crutches down an endlessly long corridor. His face was unchildlike in its grim determination. He was being fitted for a prosthesis, but then there were problems with residual swelling and tenderness in the stump and so Gorya continued on crutches for the time being. What an expert he became, in no time. Children were like that.

‘Thanks for letting me know, Lena.’

He sees her hesitate. She’s got something else to tell him and she doesn’t know quite how to say it.

‘What is it, Lena?’

‘My friend in Admin said Volkov asked for your file to be sent to him again.’

‘I see.’

‘You should have got out!’

‘It’s not so easy. Anyway, it’s too late for all that now.’

‘Probably it won’t come to anything. After all, things are better – they aren’t like they used to be. It’s not as bad as that.’

‘ “Life has become better, comrades, life has become more cheerful,” ’ quotes Andrei savagely. Only to Lena, out of all his colleagues, would he dare to say such a thing. Lena gave him her own hostage to fortune long ago, when she told him that she hadn’t seen her father since she was seventeen. ‘He was taken away, in ’37, and we never saw him again. By some miracle the rest of us weren’t touched. Of course, my mother had to denounce him – that was a long-standing agreement between them, for the sake of the children. If she’d been arrested, he’d have done the same.’

‘Pity we can’t smoke in a linen cupboard,’ says Lena now, ‘I could kill for a cigarette.’

‘Me too.’

If there are secondaries in the lungs, there’s nothing more that can be done for Gorya. They can offer palliative care, that’s all: morphine, sedatives, physiotherapy and draining away of the fluid that will collect as the tumours grow.

All that child’s pain and fear and mutilation and slow recovery might as well never have happened. Sometimes it makes you doubt what you’re doing.

‘Don’t,’ says Lena.

‘What?’

‘You had no choice. He had to have the amputation.’

‘Are you a mind-reader, Lena?’

‘No. Just good at reading your face.’

He looks away, confused. The cupboard really is very small. He can smell the clean linen, and also Lena herself. Skin, hair, flesh. A warm human being, close to him, her eyes full of concern.

Fear squeezes his heart again, driving out all other thoughts.

‘Well, I can’t spend the rest of my day in a cupboard with you, more’s the pity,’ says Lena, with a smile that fails to deceive either of them.

‘Lena – thank you. If I don’t see you –’

‘Don’t talk such rubbish.’

‘No, listen. If anything happens, you must go to Anna. Tell her to do what your mother did, for the sake of the baby and Kolya. You know what I mean. I can’t talk to Anna about it now, not when she’s pregnant. Will you promise me that, Lena?’

For the only time, and with shame, Andrei makes use of what he knows Lena feels for him.

‘All right,’ says Lena, ‘although she probably won’t listen. I wouldn’t, if it were me.’

After this, everything happens quickly. An hour later, Andrei is intercepted on the way to his ward round.

‘You are requested to come immediately to Medical Personnel.’

‘But I’m doing a ward round with Professor Maslov.’

‘He has been informed.’

Andrei follows the clerk’s trim, bouncing figure along the corridors. He doesn’t know her. A new girl perhaps, or a transfer from another department. She is very young, but she gives him the message with a look of cold, smug disapproval. For some absurd reason he is hurt by this, as if he expected her to smile.

She turns aside before she reaches the main office of Medical Personnel, and opens a door to her left. The small room is empty. She gestures for him to go forward.

‘But there’s no one there,’ says Andrei.

She looks at him as if he is stupid to have expected there to be anyone in the room.

‘Please wait,’ she says, and he finds himself grateful for that much politeness, as she closes the door on him. He listens to her heels tapping away down the corridor. Well, at least she hasn’t turned the key on him, he thinks, and smiles to himself, a little grimly. She can’t be more than twenty. Just a few years older than Kolya. Why let the attitude of a chit like that get to him?

The minutes lengthen. His nerves crisp with irritation as he thinks of Professor Maslov on the ward round without him. He’ll have the notes, of course, but not the detailed exchange of views and findings that mark his relationship with Andrei. Maslov is a fine physician, one of the very best. Close to retirement now but unsparing in his efforts to pass on decades of expertise. And what is even more remarkable, given his age and status, he is always open to the latest ideas and research. He treats Andrei more as a colleague than as a junior. Andrei considers himself fortunate to have the chance to work with Maslov, and now, with no warning, he’s failing to turn up for the ward round. What the hell is Maslov going to think?

He glances at his watch. Quarter to five. He’s been waiting half an hour at least. He should sit down and try to relax. Why doesn’t he just walk out of the door? It isn’t locked. ‘You should have got out,’ Lena had said. Perhaps there is still a chance, if he is prepared to take it.

He hears a distant clang. A nurse dropping a bedpan, no doubt. What a catastrophe, magnified by the long, bare corridors. Admin can’t protect themselves entirely from the sounds and smells of the hospital, although they keep themselves safely out of sight most of the time. Even here in this little bare room, the hospital breathes around him like a huge organism of which he is a part. He cannot separate himself, not by his own choice. If they force him, that’s another matter. But no power on earth will make him say, of his own volition, ‘I don’t belong here.’

The door opens. The pert little face of the clerk looks round it. She frowns on seeing Andrei, as if she expected him to disappear or to turn into someone else.

‘You are to come with me,’ she says.

As he follows her for a second time, Andrei is sure she’s taking him to Volkov, and he gets the measure of what Volkov has already done. He has turned the hospital into his own place, running by his own rules. A doctor can miss a ward round and cool his heels in an empty office for half an hour. People can be sent for without explanation and even without reason. There is a larger reason, which is that they must learn that they have now entered Volkov’s world.

Well, thinks Andrei, perhaps. But what if I refuse? What if I continue to believe that the man I’m going to see is the father of a sick child, and that he’s full of anger and vengeance because he dreads what’s coming next? You’re the parent, Volkov, and I’m the doctor. Nothing’s going to change that.