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Ann Thorac Surg 1996;61:1557-1563
© 1996 The Society of Thoracic Surgeons
Indian Wells, California
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Doctors have disgusting days and hours; God forbid anyone experiencing them. It is true that ignoramuses and sneaks are not a rarity among doctors any more than among writers, engineers, people generally, but those disgusting hours and days of which I am speaking fall only to doctors, and because of that, in fairness, much should be forgiven them. Chekhov, Letter (August 18, 1891)
Chekhov, letter (August 18, 1891)
Doctor Anton Pavlovich Chekhov, masterful short story writer and dramatist, is one of the giants of world literature. Often minimized is that he ranks preeminent among physician-writers, contributing significantly to the medical profession in prerevolutionary Russia. Chekhov, a generous, compassionate family physician, declared that medicine was his first love or ``legal wife'' and literature his ``mistress.'' He practiced medicine until ordered to quit because of rampaging tuberculosis, which killed him at age 44.
Chekhov was born, the third of six children, on January 17, 1860, in the southern Russian port city of Taganrog. His father, a struggling grocer, went bankrupt and fled to Moscow to avoid debtors' prison. The family left Anton in Taganrog to support himself by tutoring until he completed high school 3 years later. ``When I was a child,'' Chekhov later wrote, ``I had no childhood.''
Frail as a child, Chekhov at age 5 suffered his first of many attacks of acute respiratory distress. Anton's first serious illness at 17 was diagnosed as ``peritonitis'' by a school physician, Dr Strempf. The exact cause never was established, but Chekhov suffered all his life from intestinal complaints, suggesting the possibility of gastrointestinal tuberculosis. The kindly physician befriended his young patient and influenced Chekhov to seriously consider going to medical school in Zürich, though he could not afford to go. ``I have only one secret illness which torments me ... lack of money,'' he wrote his brother Michael in November 1877 [1]. Upon graduating from high school, Chekhov received a small scholarship from the city of Taganrog that enabled him to enter Moscow University to study medicine. Twenty years later, in a letter to Doctor Grigory Rossolimo, his medical school classmate, Chekhov confessed, ``I do not remember for what reason I chose the medical [field]; but I did not regret my choice afterwards'' [2].
Chekhov joined his family in Moscow and enrolled in medical school in the autumn of 1879. In the midst of his medical studies, he supported the impoverished family by writing short humorous sketches and pot-boilers for Moscow and St. Petersburg newspapers under the pen name of ``Antosha Chekhonte.'' Fascinated by the foibles of human nature, the affable young medical student prowled the Moscow streets, race tracks, railway stations, taverns, and even courtrooms for writing material. He learned to scribble one short story, joke, or farcical sketch a day. ``I don't remember a single story on which I worked for more than twenty-four hours,'' he confessed [1]. Although he was forced into journalism for economic survival, Chekhov vowed not to die a journalist. ``A newspaper man is a crook at best,'' he wrote to one of his brothers. To a friend, he wrote: ``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.'' During this rigorous apprenticeship, his writing evolved from clarity and laconism into the seductive, rhythmic prose that became the hallmark of his short stories and plays.
After graduating from medical school, Chekhov went to Voskresensk, a small town near Moscow, where he practiced medicine at the nearby local government hospital. He obtained much clinical experience there, ``wondering how many times I shall be jerked out of bed in the night because I dare to go on writing. I am also working at my medicine. Operations every day. I read, write, go-a-roving in the evening, drink vodka in moderation, listen to music, singing, etc.'' Later he moved to the village of Zvenigorod for about 3 months as director of the hospital as a locum tenens, performing autopsies, attending inquests, and testifying in court, among other medical duties.
In December 1884, at age 24, Chekhov returned to Moscow and started his large medical practice. His mother heartily approved: ``If you work hard you will always find a way to make a living in Moscow'' [3]. However, most of his patients were poor and unable to pay for their care. ``I am glad that I have my medical profession, which I do not practice for the sake of money,'' he wrote. To his uncle Mitrofan, he wrote in 1885: ``My medical practice keeps me busy.... I have many friends and acquaintances and therefore not a few patients. Half of them I have to treat gratis, and the other half pay me three or five rubles for a visit.... I haven't made my fortune yet and I don't expect to make one soon'' [1].
On March 28, 1886, Chekhov received an unexpected letter from Dmitri Grigorovich, a respected and eminent novelist, praising his originality and writing talent. ``What you need is respect for your skill-a rare gift,'' he advised. This proved to be a watershed event in Chekhov's life, as he began to take his writing seriously. Grigorovich introduced Chekhov to Suvorin, the editor of the prestigious St. Petersburg New Times, who became the young author's editor and mentor. Chekhov's most prolific year was 1886 to 1887, in which he published 166 stories and became widely recognized among the Russian literati.
Literature at first was a secondary interest for Chekhov, because he regarded medicine as a more respectable and humane profession. However, his interest turned to literature as it produced an increasing source of income for him, and as his more serious stories, such as ``Grief'' (1885), ``The Huntsman'' (1885), and ``Misery'' (1886), were published in more prestigious journals. These narratives, written with clarity and concision of an accomplished artist, attracted the attention of a wide reading public, and he became well known in literary circles.
Chekhov initially felt that medicine might impair his creativity as a writer, as a physician nurtures few illusions, and this ``somewhat desiccates life.'' Nevertheless, he was able to integrate medicine and literature into a seamless union. Numerous references to the debt Chekhov owes to medicine for his literary success may be found in his prolific and revelatory letters. Concerning ``An Attack of Nerves,'' a clinical story describing a nervous breakdown in a sensitive young man after a visit to a Moscow brothel, Dr Chekhov wrote, ``As a man of medicine I feel that I have accurately described mental suffering in accordance with all the rules of psychiatry'' [4]. He confided to his publisher, Suvorin, that his medical knowledge provided him with insight into a woman's psyche during pregnancy, exemplified in his story ``The Nameday Party.'' Chekhov wrote: ``It's great to be a doctor and understand what you're writing about. The ladies are saying that the childbirth is described correctly'' [4]. Chekhov also admitted an indebtedness to his medical training for giving him a deep understanding of people and human relations. To his classmate he wrote: ``There is no doubt in my mind that my study of medicine has ... significantly broadened the scope of my observations and enriched me with knowledge whose value for me as a writer only a doctor can appreciate'' [5].
Chekhov kept a notebook in which he recorded observations with psychological insight into his patients, laying bare their secret motives. In reminiscing years later about the relationships of medicine and literature, Chekhov often stated that medicine was his lawful wife and literature his mistress. ``When I get fed up with one,'' he told his publisher Suvorin, ``I spend the night with the other. Though it is irregular, it is less boring this way.'' In time the mistress not only replaced the wife, but also became the major source of his financial support.
During the first 6 years after finishing medical school, Chekhov worked indefatigably in the dual professions of medicine and literature, Dr Chekhov providing the inspiration and material for Chekhov the writer. To Suvorin in 1886 he wrote: ``I am a doctor and practice medicine.... I cannot guarantee that tomorrow I won't be dragged from my table for a whole day.'' The same year he wrote to Grigorovich: ``I am a doctor and am steeped ear deep in my practice'' [6]. Pressured by Suvorin 2 years later to abandon medicine for writing, Chekhov answered, ``You advise me not to hunt after two hares at once and not to think of practicing medicine.... I feel more contented when I remember that I have two professions and not one.... If I had not my medical work I could hardly give my leisure and my spare thoughts to literature'' [5].
Chekhov's perceived aloofness or ``principled objectivity'' is reflected in his remark to the Russian novelist Ivan Bunin that the writer must be ice-cold and unemotional. The scientific approach he learned in medical school molded his general outlook on life and reinforced his objectivity and tendency to reserve premature judgement. In a letter to A. N. Plecheheer on October 4, 1888, he declared, ``I am not a liberal, not a conservative, not a gradualist, not a monk, and not an indifferentist. I would like to be a free artist.... I hate violence in all their forms ... Pharisaism, stupidity, and arbitrariness dwell not only in the houses of merchants and in lockups; I see them in science, in literature, among the youth.... I regard trademarks and labels as prejudices'' [7].
Unlike Tolstoy or Dostoevski, Chekhov was not religious in a conventional theological sense. Turned off by Tolstoyian views on religion, Chekhov observed that ``rationality and truth tell me that in electricity and steam there is more love for man than in chastity and vegetarianism.'' However, with his health rapidly declining, Dr Chekhov left the door slightly ajar and reflected 2 years before he died that ``in the distant future mankind will know the truth of the real God, i.e., not guess at it, not seek it in Dostoyevsky, but know clearly, as one knows that twice two is four'' [7]. There seems little doubt that a humanistic Chekhov empathized with Judeo-Christian beliefs.
Chekhov's medical training instilled in him that a writer ``must be as objective as a chemist.'' However, he emphatically denied that this view implied an ``indifference to good and evil, the absence of ideals and ideas.'' Castigating mercenary doctors in his writing, he questioned how one could ``pile up capital and still keep your virginity.'' Although Chekhov felt that ``it would be nice to combine art with sermonizing,'' he felt that ``this is extremely difficult and almost impossible'' for his personal narrative style. Doing so would weaken the image and destroy the compactness of his story. Like James Joyce, Chekhov expected the reader to distill meaning from his stories. ``When I write I count on the reader to fill in the subjective elements missing in the story,'' he wrote [8].
Chekhov suffered from ill health most of his adult life, and the year he graduated from medical school he experienced the first of many episodes of hemoptysis, a harbinger of an early death. For several years he suffered recurrent bouts of fever, productive cough, and chest pain that kept him awake many nights. In retrospect, this was most likely from tuberculous bronchiectasis. In a letter to Suvorin on October 14, 1888, Chekhov revealed that ``every winter, autumn and spring, and every damp day in summer ... I cough. But it only alarms me when I see blood: there is something menacing about blood pouring from my mouth, as there is in flames from a fire'' [9]. However, Chekhov often complained about less serious ailments such as hemorrhoids, diarrhea, constipation, heart palpitations, muscular twitching, migraine headaches, and phlebitis. He was nonchalant and minimized the nature of his more serious lung disease, the ``illegal liaison with the bacilli,'' even though blood-spitting occurred at least twice yearly beginning in 1884. He was undoubtedly aware of the gravity of his symptoms, which were similar to those of his elder brother Nicholas, who suffered from advanced pulmonary tuberculosis and moved in with Chekhov in 1886.
Chekhov, the compassionate, companionable doctor who viewed life through the prism of objectivity, shut his eyes and denied the reality of his own disease for years until he was alarmed by massive pulmonary hemorrhage in a Moscow restaurant in 1887. Suvorin, his dinner companion, recorded in his diary that Chekhov was frightened and admitted that his condition was very serious. ``To calm our patients,'' Chekhov confided, ``we usually tell them that their coughing is due to some upset of the stomach, and when they have a discharge of blood that it is of hemorrhoidal origin. But no cough is ever caused by a condition of the stomach, and discharge of blood is always from the lungs. My blood is coming from my right lung as it did in my brother and another relative of mine who also died of consumption'' [10]. This finally induced Chekhov to consent to an examination by his friend Dr Obolovsky. After recurrent hemorrhages, Dr Obolovsky rushed his apprehensive patient to Professor Ostroumov, a pulmonary specialist, who admitted Chekhov to his clinic. Advanced apical tuberculosis was diagnosed and Chekhov was ordered to retire from active medical practice.
Not often appreciated is just how profoundly this grave illness affected his character, the mood of his literary output, and his private life. Although his first serious hemorrhage occurred on December 8, 1884, tuberculosis probably had developed 1 year earlier, when he complained of being ``dreadfully tired'' with cough, fever, and weight loss. To Leykin he wrote on December 10, 1884: ``For the last three days blood has been flowing from my throat. The hemorrhage is interfering with my writing.... The cause is probably a burst blood vessel.... My only consolation is that the chemist is letting me have my medicine at a reduced price.''
In a letter to his uncle Mitrofan on January 31, 1885, Chekhov hinted that he had tuberculosis by confessing that ``last December I fell ill with blood-spitting and made up my mind to raise a loan from the literary fund and go abroad to treatment.'' From Chekhov's consideration of seeking treatment, biographer Magarshack deduced that ``he knew perfectly well that he had T.B.'' Chekhov the pragmatist kept secret his illness from medical colleagues because the only treatment advised then entailed going to the Crimea or resorts abroad, which for him was not financially possible. Furthermore, such a move would disrupt his medical and literary careers and result in hardship for his family.
Chekhov still practiced medicine intermittently and traveled widely in Russia and wrote stories for a livelihood. He journeyed into the Don steppe and in 1888 published his much acclaimed novella, ``The Steppe.'' During this year he received the coveted Pushkin prize for the best literary work of the year for his collection of stories. Chekhov achieved widespread fame in Russia, finally considered himself a professional writer, and significantly improved his financial position (Fig 1
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For 3 months Chekhov studied local conditions and found venereal disease and prostitution rampant, and the hospitals ill-equipped and dirty. During this visit to Russia's ``Devil's Island,'' the 30-year-old Chekhov worried that he had wasted his medical knowledge, writing, ``We have made millions of people rot in prison ... in a barbaric manner.'' He felt that the drunkard wardens alone were not guilty for the horrendous prison conditions, ``but all those of us who show no interest or concern'' [9]. He took a census (based on some 10,000 cards) of the penal colony-the first one carried out in Russia on a scientific basis. The Island of Sakhalin, an authoritative scientific work published in 1895, remains a 400-page landmark study in social medicine and a classic in Russian penology, influencing the prison reforms of 1892. The utter depravity that Chekhov saw on Sakhalin Island haunted him for a long time. His subsequent work reflected his increased social consciousness. In ``The Story of an Unknown Man'' (1893), Chekhov 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 neighbor'' [11].
Russian critics were vitriolic in charging that his writing reflected indifference to both human suffering and urgent sociopolitical questions. The exhausting 9,600-km trip to Sakhalin proved that he was aware of and committed to alleviating human suffering and poverty. ``[Before medicine] I stand convicted of base ingratitude. Medicine cannot now accuse me of treachery,'' he wrote to Suvorin on January 2, 1894, ``I have paid just tribute to knowledge and to the thing old writers call pedantry.''
In 1893, Chekhov planned to submit The Island of Sakhalin as a thesis for the degree of Doctor of Medical Sciences. Its acceptance would have qualified him for a faculty position at the medical school at Moscow University as a lecturer. To Professor Rossolimo, a prominent neuropathologist whose help he sought, Chekhov wrote, ``If I were a teacher, I would try to draw my audience as deeply as possible into the area of subjective feeling of patients, for I think it would prove really useful to the students'' [12]. Chekhov's request of the degree was regarded by the dean as unworthy; regardless, he continued to probe deeply into the lives of his patients for hidden motives, thus preceding psychosomatic medicine by a half century. ``It seems to me that as a doctor I have described the sickness of the soul correctly,'' he declared. His concern was always with his patients as human beings, and he practiced the maxim that a physician must be ``humane to the tips of his fingers'' [13].
Remarkable insight into the psychological problems of academic medicine is portrayed in ``A Dreary Story,'' the penetrating study of an aged professor of medicine facing death. Written when Chekhov was 29, this is an ingenious and tragic depiction of a dying man unable to externalize his inner world, unsatisfied with his achievements. Chekhov was always interested in medical psychology, and his success as a writer stemmed from a detached but soul-penetrating observation of his patients.
After returning to Moscow from Sakhalin, Chekhov's tuberculosis became much more virulent. The unmistakable clinical picture presented recurrent cough and hemoptysis, fever, headaches, and abdominal pain with blood in the stool-all strong evidence of tuberculosis of the lung and intestines [14]. He realized that he probably would not reach middle age. Depression, cynicism, and the poetry of death permeated his stories of 1891 to 1892.
Chekhov aided in the disastrous peasant famine of 1891 to 1892, as both physician and medical administrator. After this exhausting experience, in 1892 he was anxious to escape Moscow and the publicity his fame brought, and sought serenity with his family in the country, buying a 240-hectare estate in the village of Melikhovo, about 80 km south of Moscow. He practiced medicine, often besieged by peasants who came long distances seeking care, which Chekhov gave without charge. Being public spirited, he became a member of the Sanitary Council, and helped to build roads, hospitals, and schools, and salvage a medical journal, The Surgical Chronicle. ``Saving a good surgical journal is just as useful as doing 20,000 successful operations,'' he observed. Stories written during this period reflect intense activity-probably a reaction to his failing health. Painful hemorrhoids also made life miserable and writing difficult. In the spring of 1894 another flare-up of pulmonary symptoms occurred; this was followed by blindness of his right eye lasting several months.
Years after a short engagement to Dunya Efros in 1886, women again began to play an important role in Chekhov's writing and life. Women always found Chekhov handsome, companionable, and appealing; Magarshack described ``fantastic tales of his love affairs'' as a medical student [1]. In Melikhovo, his frequent female guests included actresses, writers such as Lydia Avilova, and Lika Mizinovo, his devoted sister's friend. Flirtatious at first but indifferent later, Chekhov seemed reticent to forge permanent relationships with women. ``These sweet creatures give love and take little from man: only his youth,'' he wrote to Suvorin in January 1895. His relationships with women were partially handicapped by physical debility, but he also felt that women were incompatible with his art, led to creative inertia, and would deprive him of inner peace and independence. Chekhov was continually urged by his family to get married. He responded to his brother's goading: ``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'' [15].
In spite of many distractions, the Melikhovo period (1892 to 1898) was very productive. During this time, Chekhov wrote some of his most powerful short stories, including his masterpiece, ``The Peasants'': brilliant unsentimental pictures of peasant life. He developed a ``new'' short story, brief ``slices of life'' fashioned from trivial events in human experience, undistinguished by plot, with deep psychological insight. Called the ``Russian Maupassant,'' for whose literary style he had great admiration, Chekhov refined the technique of the short story into a form most imitated by modern writers, including George Bernard Shaw, Somerset Maugham, Ernest Hemingway, Katherine Mansfield, Sherwood Anderson, and Raymond Carver.
The only dramatic work produced with certainty by Chekhov during this period was ``The Seagull,'' written in his little cherry orchard studio. This play, a disaster when performed in St. Petersburg in 1896, was hissed off the stage. Chekhov was profoundly distressed and vowed, ``Never will I write these plays or try to produce them, not if I live to be 700 years old.'' The colossal egos of the directors always nettled Chekhov, who later wrote, ``The stage is a scaffold on which the playwright is executed'' [16]. However, 2 years later the play experienced a brilliant revival at the Moscow Art Theater, establishing Chekhov as a masterful, innovative playwright and a founder of modern drama.
Chekhov's infatuation with the theater began during his youth in Taganrog, when he would slip into the theater at night despite the school inspector's probing eyes. Chekhov wrote his first plays at 18. His earliest preserved play, ``Platonov,'' was written when he was 21. ``This first undertaking of Chekhov the dramatist,'' Melchinger noted, ``has unbelievable originality, freshness and innovation'' [14]. Chekhov later rejected this play, then revised it as ``Ivanov,'' calling it his ``literary abortion.'' Nevertheless, it revolutionized theatrical art by portraying the inner emotional life of the characters-``the drama of inner action.'' In this play Chekhov describes Dr Lvov as ``an honest, straightforward, excitable but also narrow-minded and plain spoken man.'' The main character, Ivanov, also admonishes Dr Lvov for his imperception and harsh judgement: ``We all have too many wheels and gears for it to be judged by first impressions.... Isn't it possible to be a good doctor-and at the same time not to understand people?''
``The Seagull,'' introducing the use of mood, symbolism, and psychological dramatic action as a new theatrical form, was the most innovative of his plays and marked the author as an established playwright. Chekhov abhorred the conventional Russian theater with its melodramatic, unrealistic emotional crises. In a famous letter in 1887 he formulated his revolutionary theatrical credo: ``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're more occupied with eating, drinking, flirting and talking stupidities.... Life must be exactly as it is. And people as they are-not on stilts'' [14].
His four great plays-``The Seagull,'' ``Uncle Vanya,'' ``The Three Sisters,'' and, his last, ``The Cherry Orchard,'' completed with great difficulty only months before his death-form a quartet of masterpieces unique in modern theatrical literature. Memorable for Chekhov's economy of words, great precision in expression, and philosophy of life, they remain timeless, contemporary, and fresh even today. ``It is this genius for stating only the simplest truth as simply as can be that makes Chekhov inexhaustible-like life,'' Rexroth wrote [17].
In the fall of 1897, Chekhov's deteriorating health convinced his doctors to advise him to go to a warmer climate, where he spent more than 8 months enjoying Biarritz, Nice, and Paris. After working tirelessly for years, Chekhov finally loosened up and praised idleness as a prerequisite to happiness; he realized that sensualness or impulsiveness may be more rewarding than cold indifference or rationalization. He enjoyed the leisurely life in Nice and Paris, even though he knew he was dying of his illness. ``My disease is going crescendo-it's incurable,'' he conceded to his rumored mistress, Lydia Avilova [18]. Later, in Yalta after observing other consumptives, he ironically noted the ``classlessness ... of the bacilli'' discovered by Koch in 1882. ``I believe in Koch ... praise God'' [19].
Because of ill health, Chekhov was forced to sell his Melikhovo estate on his return to Moscow in 1898. He built a villa in Yalta and formally gave up the practice of medicine. The Moscow Art Theater opened the same year and featured successful performances of ``Uncle Vanya'' and ``The Seagull''; at rehearsal on September 9, 1898, Chekhov met the lovely, enchanting actress Olga Knipper, who was appearing in his plays. After a 3-year courtship, mostly by mail, they were married secretly in Moscow on May 25, 1901, honeymooning in a government sanitorium near Ufa in southeast Russia.
Two weeks before the marriage, the doctors in Moscow found that Chekhov's condition had seriously deteriorated. They referred him to a sanitorium for 8 weeks of treatment, prescribing fermented mare's milk (Kumiss cure). The accommodations were primitive and unpleasant, and the couple left after 6 weeks and returned to Yalta. Less than 3 months after marriage they separated, Olga returning to Moscow for rehearsals at the Art Theater and Chekhov remaining in Yalta.
Although they were deeply in love and enjoyed each other's company, the painful, frustrating but mutually agreed upon separations inevitably led to tension. Olga, 30 and a premiere actress at the Moscow Art Theater, at first insisted on pursuing her acting career, but later seriously considered giving it up. Chekhov discouraged this idea, consoling Olga that living apart was due ``to the devil that planted germs in me and in you a love of art'' [20]. Except for the summer months and other rare visits, the Chekhovs lived apart, but communicated almost daily by letter, which were numerous and later published. Olga, Chekhov's ``little German girl,'' was highly intelligent, sensitive and tempestuous, whereas Chekhov was more stable and phlegmatic. He rarely complained, though frequently confined by illness to his villa in Yalta. Olga observed: ``You are always so even and untroubled.... This is not because of any frigidity in your nature, or from indifference, but there is something in you which does not allow you to attach importance to the things of everyday life'' [20].
Olga Knipper, though sometimes portrayed by biographer-critics as a predatory female not unlike those fictionally satirized by Chekhov, was the type of woman he wanted: delightful and lovable, as good to Chekhov as he allowed her to be, with his reserve and difficulty of revealing his inner feelings. Olga, who lived to be 89 and experienced a brilliant theatrical career, regarded the brief period of her marriage to Chekhov as the most memorable of her life.
Just before their marriage, Chekhov had told Olga, ``I have everything in order, everything except one trifle-my health'' [1]. Olga was not fully aware of how severely ill Chekhov was, though she begged to be told exactly what his medical problems were. But for years Chekhov artfully concealed his illness from everyone.
Chekhov spent the last 2
years of his life in Yalta, with as many frequent but brief trips to Moscow as his health allowed. Reproached for failing to visit his wife more frequently, Chekhov explained: ``My little crocodile, my remarkable wife. I didn't come to Moscow, in spite of my promise!... I had only just arrived in Yalta when ... I began to cough terribly and completely lost my appetite. It became out of the question to write or travel'' [21].
Chekhov, confined to his villa, became increasingly secluded from the outside world. As he came closer to death, Chekhov the artist, the loner who hated loneliness, wanted most of what was inaccessible to him-sensuous excitement. ``If you are afraid of solitude, don't marry,'' he recorded in his Notebook. Olga, too, was a tormented soul-young, attractive, famous, and longing for the intense excitement of living. She wrote: ``How do you feel, my darling! Anton, I need you, I need your great mind, your thoughts, your originality, your love, your tenderness, your gentleness, and your affection'' [21].
In Yalta, Chekhov had severe pains of imprecise origin, which became worse and required narcotics for relief [14]. Chekhov consulted Professor Ostroumov in Moscow in June 1903, who found ``emphysema, a very bad right lung, remnants of pleurisy, etc., etc.'' However, his doctor allowed him to stay in Moscow during the winter of 1903 to 1904 to be with Olga. A jubilant Chekhov wrote a friend: ``I married and am very glad I did.... My life has changed for the better'' [22].
Nonchalant about his steadily deteriorating health in the harsh winter, Chekhov-under protest-attended the opening night of ``The Cherry Orchard'' on his forty-fourth birthday, January 17, 1904, and also in celebration of 25 years of writing. Deathly pale, thin, and trying to suppress coughing, he stood on stage and received a great ovation. Two days later he wrote, ``At the premier of my play I was honored, and so amply that I still haven't recovered from it.''
Chekhov returned to Yalta in February somewhat improved and in a state of euphoria (Fig 2). Although he considered traveling abroad, this was impossible as pulmonary symptoms with marked shortness of breath recurred. Narcotics were again required to control abdominal pain. On May 1, 1903, Chekhov traveled to Moscow for the last time, acutely ill and totally ex hausted on arrival. He was forced to remain in bed for 3 weeks, and was then advised by his doctors to go to a spa in the Black Forest resort city of Badenweiler, near Basel. He told Bunin, ``I am going away to die like a dog'' [14].
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In 1986 Raymond Carver described Chekhov's last days, in Chekhovian style, in ``Errand,'' acknowledging his debt to the master short story writer [23]. On the evening of 1 July, Chekhov told Olga a humorous story that made her laugh, then fell asleep. At half-past 12 in the morning of July 2, 1904, Chekhov woke up pallid, with agonal dyspnea and rattling respiration. He requested a doctor. ``Ich sterbe,'' Chekhov whispered to Dr Schworer. ``Champagne was brought to stimulate his failing heart,'' Olga wrote in her memoirs [24]. Chekhov took the glass, smiled to Olga and said, ``It's a long time since I drank champagne.'' He emptied his glass, began to ramble, fell on his left side, and stopped breathing. He died at 3 AM, death most likely asphyxial due to massive lung hemorrhage. His body was placed in a zinc coffin and sent to Moscow in a refrigerated car, arriving on July 9. Chekhov was buried beside his father's grave in Novo-Devichy Cemetery in the curve of the Moscow River, 3.2 km south of the Kremlin. On November 16, 1933, the body was exhumed and reburied in a part of the cemetery designated for actors of the Moscow Art Theater.
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