The end of the 19th century was a complex and contradictory time. It is not surprising that it was in 1891 that one of the most mysterious Russian writers was born. We are talking about Mikhail Afanasyevich Bulgakov - director, playwright, mystic, author of scripts and opera librettos. Bulgakov's story is no less fascinating than his work, and the Literaguru team takes the liberty to prove it.

Birthday of M.A. Bulgakov - May 3 (15). The father of the future writer, Afanasy Ivanovich, was a professor at the Theological Academy of Kyiv. Mother, Varvara Mikhailovna Bulgakova (Pokrovskaya), raised seven children: Mikhail, Vera, Nadezhda, Varvara, Nikolai, Ivan, Elena. The family often staged plays for which Mikhail composed plays. Since childhood, he loved plays, vaudeville, and space scenes.

Bulgakov's house was a favorite meeting place for the creative intelligentsia. His parents often invited famous friends, who had a certain influence on the gifted boy Misha. He loved to listen to adult conversations and willingly participated in them.

Youth: education and early career

Bulgakov studied at gymnasium No. 1 in Kyiv. After graduating in 1901, he became a student at the Faculty of Medicine at Kyiv University. The choice of profession was influenced by the financial condition of the future writer: after the death of his father, Bulgakov took responsibility for big family. His mother remarried. All the children, except Mikhail, remained on good terms with their stepfather. The eldest son wanted to be financially independent. He graduated from the university in 1916 and received a medical degree with honors.

During the First World War, Mikhail Bulgakov served as a field doctor for several months, then received a position in the village of Nikolskoye (Smolensk province). Then some stories were written, later included in the series “Notes of a Young Doctor.” Due to the routine of boring provincial life, Bulgakov began to use drugs, which were available to many representatives of his profession by occupation. He asked to be transferred to a new place so that his drug addiction would be hidden from others: in any other case, the doctor could be deprived of his diploma. A devoted wife, who secretly diluted the drug, helped him get rid of the misfortune. She did her best to force her husband to give up his bad habit.

In 1917, Mikhail Bulgakov received the position of head of departments of the Vyazemsk city zemstvo hospital. A year later, Bulgakov and his wife returned to Kyiv, where the writer was engaged in private medical practice. Dependence on morphine was defeated, but instead of drugs, Mikhail Bulgakov often drank alcohol.

Creation

At the end of 1918, Mikhail Bulgakov joined the officer corps. It is not established whether he was drafted as a military doctor, or whether he himself expressed a desire to become a member of the detachment. F. Keller, the deputy commander-in-chief, disbanded the troops, so he did not then participate in the fighting. But already in 1919 he was mobilized into the UPR army. Bulgakov escaped. Versions regarding the writer's further fate differ: some witnesses claimed that he served in the Red Army, some that he did not leave Kyiv until the arrival of the Whites. It is reliably known that the writer was mobilized into the Volunteer Army (1919). At the same time, he published the feuilleton “Future Prospects.” The Kyiv events were reflected in the works “The Extraordinary Adventures of the Doctor” (1922), “ White Guard"(1924). It is worth noting that the writer chose literature as his main occupation in 1920: after completing his service in the Vladikavkaz hospital, he began writing for the newspaper “Caucasus”. Bulgakov's creative path was thorny: during the period of the struggle for power, an unfriendly statement addressed to one of the parties could end in death.

Genres, themes and issues

In the early twenties, Bulgakov wrote mainly works about the revolution, mainly plays, which were subsequently staged on the stage of the Vladikavkaz Revolutionary Committee. Since 1921, the writer lived in Moscow and worked in various newspapers and magazines. In addition to feuilletons, he published individual chapters of stories. For example, “Notes on Cuffs” was published on the pages of the Berlin newspaper “Nakanune”. Especially many essays and reports - 120 - were published in the newspaper "Gudok" (1922-1926). Bulgakov was a member of the Russian Association of Proletarian Writers, but his artistic world was not dependent on the ideology of the union: he wrote with great sympathy about the white movement and the tragic fate of the intelligentsia. His problems were much broader and richer than permitted. For example, Social responsibility scientists for their inventions, satire on the new way of life in the country, etc.

In 1925, the play “Days of the Turbins” was written. She was a resounding success on the stage of the Moscow Art Academic Theater. Even Joseph Stalin appreciated the work, but still, in every thematic speech he focused on the anti-Soviet nature of Bulgakov’s plays. Soon the writer’s work was criticized. Over the next ten years, hundreds of scathing reviews were published. The play “Running” about the Civil War was banned from being staged: Bulgakov refused to make the text “ideologically correct.” In 1928-29 The performances “Zoyka’s Apartment”, “Days of the Turbins”, “Crimson Island” were excluded from the theaters’ repertoire.

But the emigrants studied with interest the key works of Bulgakov. He wrote about the role of science in human life, about the importance of correct attitude towards each other. In 1929, the writer was thinking about the future novel “The Master and Margarita”. A year later, the first edition of the manuscript appeared. Religious themes, criticism of Soviet realities - all this made the appearance of Bulgakov’s works on the pages of newspapers impossible. It is not surprising that the writer seriously thought about moving abroad. He even wrote a letter to the Government, in which he asked either to allow him to leave, or to give him the opportunity to work in peace. For the next six years, Mikhail Bulgakov was an assistant director at the Moscow Art Theater.

Philosophy

The most famous works give an idea of ​​the philosophy of the master of the printed word. For example, the story “The Diaboliad” (1922) describes the problem of “little people”, which the classics so often addressed. According to Bulgakov, bureaucracy and indifference are a real devilish force, and it is difficult to resist. The already mentioned novel “The White Guard” is largely autobiographical in nature. This is the biography of one family who found themselves in a difficult situation: Civil War, enemies, the need to choose. Some believed that Bulgakov was too loyal to the White Guards, others reproached the author for his loyalty to the Soviet regime.

The story “Fatal Eggs” (1924) tells the truly fantastic story of a scientist who accidentally bred a new species of reptiles. These creatures multiply continuously and soon fill the entire city. Some philologists argue that the image of Professor Persikov reflects the figures of the biologist Alexander Gurvich and the leader of the proletariat V.I. Lenin. Another famous story is “Heart of a Dog” (1925). Interestingly, it was officially published in the USSR only in 1987. At first glance, the plot is satirical: a professor transplants a human pituitary gland into a dog, and the dog Sharik becomes a human. But is he human?.. Someone sees in this story a prediction of future repressions.

Originality of style

The author's main trump card was mysticism, which he wove into realistic works. Thanks to this, critics could not directly accuse him of offending the feelings of the proletariat. The writer skillfully combined outright fiction and real socio-political problems. However, its fantastic elements are always an allegory for similar phenomena that actually occur.

For example, the novel “The Master and Margarita” combines a variety of genres: from parable to farce. Satan, who chose the name Woland for himself, one day arrives in Moscow. He meets people who are being punished for their sins. Alas, the only force of justice in Soviet Moscow is the devil, because officials and their henchmen are stupid, greedy and cruel to their own fellow citizens. They are the real evil. Against this backdrop, a love story unfolds between the talented Master (in fact, Maxim Gorky was called a master in the 1930s) and the brave Margarita. Only mystical intervention saved the creators from certain death in a madhouse. For obvious reasons, the novel was published after Bulgakov's death. The same fate awaited the unfinished “Theatrical Novel” about the world of writers and theatergoers (1936-37) and, for example, the play “Ivan Vasilyevich” (1936), the film based on which is still watched to this day.

Writer's character

Friends and acquaintances considered Bulgakov both charming and very modest. The writer was always polite and knew how to step into the shadows in time. He had a talent for storytelling: when he managed to overcome his shyness, everyone present listened only to him. The author's character was based on best qualities Russian intelligentsia: education, humanity, compassion and delicacy.

Bulgakov loved to joke, never envied anyone and never sought a better life. He was distinguished by sociability and secrecy, fearlessness and incorruptibility, strength of character and gullibility. Before his death, the writer said only one thing about the novel “The Master and Margarita”: “So that they know.” This is his meager description of his brilliant creation.

Personal life

1. While still a student, Mikhail Bulgakov married Tatiana Nikolaevna Lappa. The family had to face a shortage Money. The writer’s first wife is the prototype of Anna Kirillovna (the story “Morphine”): selfless, wise, ready to support. It was she who pulled him out of the drug nightmare, and with her he went through the years of devastation and bloody strife of the Russian people. But a full-fledged family did not work out with her, because in those hungry years it was difficult to think about children. The wife suffered greatly from the need to have abortions, because of this, the Bulgakovs’ relationship began to crack.
2. So time would have passed if not for one evening: in 1924 Bulgakov was introduced Lyubov Evgenievna Belozerskaya. She had connections in the world of literature, and it was not without her help that The White Guard was published. Love became not just a friend and comrade, like Tatyana, but also the writer’s muse. This is the writer’s second wife, the affair with whom was bright and passionate.
3. In 1929 he met Elena Shilovskaya. Subsequently, he admitted that he only loved this woman. At the time of the meeting, both were married, but the feelings turned out to be very strong. Elena Sergeevna was next to Bulgakov until his death. Bulgakov had no children. His first wife had two abortions from him. Perhaps that is why he always felt guilty before Tatyana Lappa. Evgeny Shilovsky became the adopted son of the writer.

1. Bulgakov's first work is “The Adventures of Svetlana.” The story was written when the future writer was seven years old.
2. The play “Days of the Turbins” was loved by Joseph Stalin. When the author asked to be released abroad, Stalin himself called Bulgakov with the question: “What, are you very tired of us?” Stalin watched “Zoyka’s Apartment” at least eight times. It is believed that he patronized the writer. In 1934, Bulgakov asked for a trip abroad so that he could improve his health. He was refused: Stalin understood that if the writer remained in another country, then “Days of the Turbins” would have to be removed from the repertoire. These are the features of the author’s relationship with the authorities
3. In 1938, Bulgakov wrote a play about Stalin at the request of representatives of the Moscow Art Theater. The leader read the script for “Batum” and was not too pleased: he did not want the general public to find out about his past.
4. “Morphine,” which tells the story of a doctor’s drug addiction, is an autobiographical work that helped Bulgakov overcome addiction. By confessing to the paper, he received strength to fight the disease.
5. The author was very self-critical, so he loved to collect criticism from strangers. He cut out all reviews of his creations from newspapers. Out of 298, they were negative, and only three people praised Bulgakov’s work in his entire life. Thus, the writer knew firsthand the fate of his hunted hero - the Master.
6. The relationship between the writer and his colleagues was very difficult. Someone supported him, for example, director Stanislavsky threatened to close his legendary theater if the screening of “The White Guard” was banned there. And someone, for example, Vladimir Mayakovsky, suggested booing the showing of the play. He publicly criticized his colleague, assessing his achievements very impartially.
7. The Behemoth cat, it turns out, was not the author’s invention at all. Its prototype was Bulgakov’s phenomenally smart black dog with the same nickname.

Death

Why did Bulgakov die? In the late thirties, he often spoke of his imminent death. Friends considered it a joke: the writer loved practical jokes. In fact, Bulgakov, a former doctor, noticed the first signs of nephrosclerosis, a severe hereditary disease. In 1939 the diagnosis was made.

Bulgakov was 48 years old - the same age as his father, who died of nephrosclerosis. At the end of his life, he began using morphine again to dull the pain. When he went blind, his wife wrote chapters of The Master and Margarita for him from dictation. The edit stopped at Margarita’s words: “So, it means that the writers are going after the coffin?” On March 10, 1940, Bulgakov died. He was buried at the Novodevichy cemetery.

Bulgakov's House

In 2004, the opening of the Bulgakov House, a museum-theater and cultural and educational center, took place in Moscow. Visitors can ride a tram, see an electronic exhibition dedicated to the life and work of the writer, sign up for a night tour of the “bad apartment” and meet the real cat Hippopotamus. The function of the museum is to preserve Bulgakov’s legacy. The concept is related to the mystical theme that the great writer loved so much.

There is also an outstanding Bulgakov Museum in Kyiv. The apartment is riddled with secret passages and holes. For example, from the closet you can get into a secret room where there is something like an office. There you can also see many exhibits telling about the writer’s childhood.

Mikhail Bulgakov is a Russian writer and playwright, the author of many works that today are considered classics of Russian literature. It is enough to name such novels as “The Master and Margarita”, “The White Guard” and the stories “Diaboliad”, “Heart of a Dog”, “Notes on the Cuffs”. Many of Bulgakov's books and plays have been filmed.

Childhood and youth

Mikhail was born in Kyiv in the family of professor-theologian Afanasy Ivanovich and his wife Varvara Mikhailovna, who was raising seven children. Misha was the oldest child and, whenever possible, helped his parents manage the household. Of the other Bulgakov children, the most famous were Nikolai, who became a biologist, Ivan, who became famous in emigration as a balalaika musician, and Varvara, who turned out to be the prototype of Elena Turbina in the novel “The White Guard.”

After graduating from high school, Mikhail Bulgakov entered the university at the Faculty of Medicine. His choice turned out to be connected solely with mercantile desires - both uncles of the future writer were doctors and earned very good money. For a boy who grew up in a large family, this nuance was fundamental.

During the First World War, Mikhail Afanasyevich served in the front-line zone as a doctor, after which he healed in Vyazma, and later in Kyiv, as a venereologist. In the early 20s, he moved to Moscow and began literary activity, first as a feuilletonist, later as a playwright and theater director Moscow Art Theater and the Central Theater of Working Youth.

Books

The first published book by Mikhail Bulgakov was the story “The Adventures of Chichikov,” written in a satirical manner. It was followed by the partially autobiographical “Notes on Cuffs,” the social drama “Diaboliad,” and the writer’s first major work, the novel “The White Guard.” Surprisingly, Bulgakov’s first novel was criticized from all sides: local censorship called it anti-communist, and the foreign press described it as too loyal to the Soviet regime.

Mikhail Afanasyevich spoke about the beginning of his medical career in the collection of short stories “Notes of a Young Doctor,” which is still read with great interest today. The story “Morphine” especially stands out. One of the author’s most famous books, “The Heart of a Dog,” is also associated with medicine, although in reality it is a subtle satire on Bulgakov’s contemporary reality. At the same time, the fantastic story “Fatal Eggs” was written.

By 1930, Mikhail Afanasyevich’s works were no longer published. For example, “The Heart of a Dog” was first published only in 1987, “The Life of Monsieur de Moliere” and “Theatrical Novel” - in 1965. And the most powerful and incredibly large-scale novel, “The Master and Margarita,” which Bulgakov wrote from 1929 until his death, was first published only in the late 60s, and then only in an abbreviated form.

In March 1930, the writer, who had lost his footing, sent a letter to the government in which he asked to decide his fate - either to be allowed to emigrate, or to be given the opportunity to work. As a result, he received a personal call and was told that he would be allowed to stage plays. But the publication of Bulgakov’s books never resumed during his lifetime.

Theater

Back in 1925, Mikhail Bulgakov’s plays were staged on the stage of Moscow theaters with great success - “Zoyka’s Apartment”, “Days of the Turbins” based on the novel “The White Guard”, “Running”, “Crimson Island”. A year later, the ministry wanted to ban the production of “Days of the Turbins” as an “anti-Soviet thing,” but it was decided not to do this, since Stalin really liked the performance, who visited it 14 times.

Soon, Bulgakov's plays were removed from the repertoire of all theaters in the country, and only in 1930, after the personal intervention of the Leader, Mikhail Afanasyevich was reinstated as a playwright and director.

He staged Gogol's "Dead Souls" and Dickens's "The Pickwick Club", but his original plays "", "Bliss", "Ivan Vasilyevich" and others were never published during the playwright's lifetime.

The only exception was the play “The Cabal of the Holy One,” staged based on Bulgakov’s play “” in 1936 after a five-year series of refusals. The premiere was a huge success, but the troupe managed to give only 7 performances, after which the play was banned. After this, Mikhail Afanasyevich quits the theater and subsequently earns a living as a translator.

Personal life

The first wife of the great writer was Tatyana Lappa. Their wedding was more than poor - the bride did not even have a veil, and they then lived very modestly. By the way, it was Tatyana who became the prototype for Anna Kirillovna from the story “Morphine”.

In 1925, Bulgakov met Lyubov Belozerskaya, who came from an old family of princes. She was fond of literature and fully understood Mikhail Afanasyevich as a creator. The writer immediately divorces Lappa and marries Belozerskaya.

And in 1932 he meets Elena Sergeevna Shilovskaya, née Nuremberg. A man leaves his second wife and leads his third down the aisle. By the way, it was Elena who was depicted in his most famous novel in the image of Margarita. Bulgakov lived with his third wife until the end of his life, and it was she who made titanic efforts to ensure that the works of her loved one were subsequently published. Mikhail had no children with any of his wives.

There is a funny arithmetic-mystical situation with the Bulgakov spouses. Each of them had three official marriages, like himself. Moreover, for the first wife Tatyana, Mikhail was the first husband, for the second Lyubov - the second, and for the third Elena, respectively, the third. So Bulgakov’s mysticism is present not only in books, but also in life.

Death

In 1939, the writer worked on the play “Batum” about Joseph Stalin, in the hope that such a work would definitely not be banned. The play was already being prepared for production when the order came to stop rehearsals. After this, Bulgakov’s health began to deteriorate sharply - he began to lose his vision, and congenital kidney disease also made itself felt.

Mikhail Afanasyevich returned to using morphine to relieve pain symptoms. Since the winter of 1940, the playwright stopped getting out of bed, and on March 10, the great writer passed away. Mikhail Bulgakov was buried at the Novodevichy cemetery, and on his grave, at the insistence of his wife, a stone was placed that had previously been installed on the grave.

Bibliography

• 1922 - “The Adventures of Chichikov”
• 1923 - “Notes of a Young Doctor”
• 1923 - “Diaboliad”
• 1923 - “Notes on Cuffs”
• 1924 - “White Guard”
• 1924 - “Fatal Eggs”
• 1925 - “Heart of a Dog”
• 1925 - “Zoyka’s Apartment”
• 1928 - “Running”
• 1929 - “To a Secret Friend”
• 1929 - “Cabal of the Saint”
• 1929-1940 - “The Master and Margarita”
• 1933 - “The Life of Monsieur de Molière”
• 1936 - “Ivan Vasilyevich”
• 1937 - “Theatrical Romance”

L.I. Butler

State Educational Institution of Higher Professional Education "First Moscow State Medical University named after I.M. Sechenov" Ministry of Health and Social Development of the Russian Federation, Moscow

In March 1940, in his Moscow apartment in a now defunct building on Nashchokinsky Lane. (former Furmanova St., 3), Mikhail Afanasyevich Bulgakov died hard and painfully. Three weeks before his death, blind and tormented by unbearable pain, he stopped editing his famous novel “The Master and Margarita,” which was already completed in terms of plot, although internally it remained not entirely complete.

In the materials relating to the life of Bulgakov, there is a fact that amazes the imagination. A healthy and practically disease-free writer predicts his end. Moreover, he not only names the year, but also cites the circumstances of death, which was still a good half-dozen years away and which was not foreshadowed at that time. "Bear in mind,- he warned his new chosen one, Elena Sergeevna, - I will die very hard - give me an oath that you will not send me to the hospital, and I will die in your arms.”. These words were so engraved in the memory of the future wife that thirty years later she without hesitation cited them in one of her letters to the writer’s brother living in Paris, to whom she wrote: “I accidentally smiled - it was 1932, Misha was just over 40 years old, he was healthy, very young...”.

With the same request, or rather the plea of ​​a seriously ill patient, not to send him to the hospital, he already turned to his first wife, Tatyana Lappa, during the terrible time for both of them of the writer’s drug addiction in 1915. But then it was already a real situation with which, Fortunately, with the help of my wife, I managed to cope, getting rid of my seemingly incurable illness forever. And now nothing gave Bulgakov a reason for such predictions and demanding oaths from his new wife. Perhaps it was just a hoax or a practical joke, so characteristic of his works and characteristic of himself? From time to time he reminded his wife about this strange conversation, but Elena Sergeevna still did not take it seriously, although
just in case, she regularly forced him to see doctors and carry out tests. Doctors did not find any signs of illness in the writer, and studies did not reveal any abnormalities.

Meanwhile, the “appointed” (Elena Sergeevna’s word) deadline was approaching. And when it came, Bulgakov “began to speak in a light joking tone about “ Last year, the last play,” etc. But since his health was in excellent, proven condition, all these words could not be taken seriously,” - we read in her letter to the writer’s brother in Paris. Does this not resemble the situation with Berlioz, the hero of “The Master and Margarita”, who did not take Woland’s warning about his imminent death seriously?

So, what happened to Mikhail Bulgakov? What kind of illness could cause in six months
from the moment the first symptoms appeared to the death of a practically healthy, creatively extremely active person, who had previously constantly undergone medical examinations that did not reveal any pathology? However, a reservation should certainly be made here. The results of clinical and other research methods did not reveal signs of somatic pathology. Meanwhile, according to the recollections of the writer’s wife, his contemporaries and consulting doctors, Bulgakov for a long time exhibited typical signs of a neurotic state with anxiety-phobic disorders.

So, in the archive of M.A. Bulgakov, a doctor’s form with a medical report was found: “05/22/1934. On this date I established that M.A. Bulgakov has severe exhaustion nervous system with symptoms of psychosthenia, as a result of which he was prescribed rest, bed rest and drug treatment.
Comrade Bulgakov will be able to start work in 4-5 days. Alexey Lyutsianovich Iverov. Doctor of the Moscow Art Theater".

E.S. herself mentions such neurotic conditions and attempts to treat them. Bulgakov in his diaries of 1934

“On the 13th we went to Leningrad and were treated there by Dr. Polonsky with electrification.”

"25-th of August. M.A. still afraid to walk alone. I walked him to the Theater, then went to pick him up.”

“October 13. At M.A. bad with nerves. Fear of space, loneliness. Thinking about whether to contact
to hypnosis?

"The 20th of October. M.A. I phoned Andrei Andreevich (A.A. Arend. - L.D.) about a meeting with Dr. Berg. M.A. I decided to be treated with hypnosis for my fears.”

“November 19. After hypnosis with M.A. The attacks of fear begin to disappear, the mood is even, cheerful and good performance. Now - if only he could still walk down the street alone.”

"November 22. At ten o'clock in the evening M.A. got up, got dressed and went alone to the Leontyevs. He didn’t walk alone for six months.”

In letters to V. Veresaev, also a doctor by profession, Bulgakov admitted: “I have become sick, Vikenty Vikentyevich. I won’t list the symptoms, I’ll just say that I stopped responding to business letters. And there is often a poisonous thought - have I really completed my circle? The disease manifested itself with extremely unpleasant sensations of “darkest anxiety”, “complete hopelessness, neurasthenic fears".

As far as this seems possible from epistolary sources and documentary materials, an analysis of the course of M. Bulgakov’s illness indicates that the writer’s illness manifested itself only in September 1939, i.e. 6 months before his death. Since then
Bulgakov himself was counting down his illness, which he told his wife, who wrote down his words in his diary on 02/11/1940 (a month before his death): “ ...for the first time in all five months of illness I am happy... I’m lying... in peace, you are with me... This is happiness...”.

In September 1939, after a serious stressful situation for him (a review from a writer who went on a business trip to work on a play about Stalin), Bulgakov decides to go on vacation to Leningrad. He writes a corresponding statement to the management of the Bolshoi Theater, where he worked as a consultant to the repertoire department. And on the very first day of his stay in Leningrad, walking with his wife along Nevsky Prospekt, Bulgakov suddenly felt that he could not distinguish the inscriptions on the signs. A similar situation had already taken place once in Moscow - before his trip to Leningrad, which the writer told his sister, Elena Afanasyevna: “ About the first noticeable loss of vision - for a moment (I was sitting and talking with one lady, and suddenly she seemed to be covered in a cloud - I stopped seeing her).
I decided that it was an accident, my nerves were acting up, nervous fatigue”.

Alarmed by a repeated episode of vision loss, the writer returns to the Astoria Hotel. The search for an ophthalmologist begins urgently, and on September 12 Bulgakov is examined by Leningrad professor N.I. Andogsky: “ Visual acuity: right eye - 0.5; left - 0.8. Phenomena of presbyopia. Phenomena of inflammation of the optic nerves in both eyes with the participation of the surrounding retina: in the left - unknown
significantly, in the right - more significantly. The vessels are significantly dilated and tortuous.

Glasses for classes: pr. + 2.75 D; a lion. +1.75 D.

Sol.calcii chlorati cristillisiti 5% -200.0. 1 tbsp. l. 3 times per
day.

09/12/1939. Prof. N.I. Andogsky, Volodarsky Ave.,
10, apt. 8".

“Your business is bad”“, says the professor after examining the patient, strongly recommending that he immediately return to Moscow and do a urine test. Bulgakov immediately remembered, and perhaps he always remembered this, that thirty-three years ago, at the beginning of September 1906, his father suddenly began to go blind, and six months later he was gone. In a month my father would have turned forty-eight years old. This was exactly the age at which the writer himself was now... Being a doctor, Bulgakov, of course, understood that visual impairment was just a symptom of a disease that would take him to the grave

his father and which he received, apparently, by inheritance. Now, what once seemed like a distant and not very certain future has become a real and brutal present. Is everything really destined from above? And is that fateful period approaching, determined for himself by the writer himself long before the first signs of the disease appeared?

Alarmed by the unexpected situation, the Bulgakovs return to Moscow. The writer informs the administration of the Bolshoi Theater that he returned from vacation earlier - on September 15, 1939.

Now we know that the reason for the unused vacation was the sudden onset of the writer’s illness. Since the main symptom of the disease was acute visual impairment, upon arrival in Moscow, frequent ophthalmological examinations are carried out.

09/28/1939. Oculist: “Bilateral neuritis optici on the left eye there is less hemorrhage and white eyesgov, on the right the phenomena are expressed more sharply: there is a departmentwhite hemorrhages and white lesions V.OD approximately and without glass about 0.2. V.OS is greater than 0.2. Field of view at manual research is not expanded.

30.09.1939. “The study will be repeated with further researchvisual acuity tables. Leeches will be possible repeat. In the eyes twice a day Pilocarpine and Dionine”. Prof. Strakh.

09/30/1939. Repeated examination by an ophthalmologist: “Neuritis opticiwith hemorrhages".

As you can see, the fundus revealed changes characteristic of severe arterial hypertension, the presence of which in Bulgakov was not mentioned anywhere in the available materials before the events unfolded. For the first time, we learn about the writer’s true blood pressure numbers only after the appearance of eye symptoms.

“09/20/1939. Polyclinic of the People's Commissariat of Health of the USSR (Gagarinsky Ave., 37). Bulgakov M.A. Blood pressure according to Korotkov Max. -205/ Minimum. 120mm”. The next day, September 21, 1939, there was a home visit from Dr. Zakharov, who from now on would be supervised by M.A. Bulgakov until his last days. A receipt order for the visit (12 rubles 50 kopecks) and a prescription for the purchase of 6 leeches (5 rubles 40 kopecks) were issued.

So, AD Bulgakov’s figures turned out to be quite impressive. Did such blood pressure indicators really occur for a long time in the writer, who did not even suspect it? One way or another, the clinical situation gave the doctors reason to suspect, and most likely, with a high probability, diagnose kidney disease. In this regard, regular tests of the writer’s urine and blood begin. The first urine test in this series of studies was performed on September 16, 1939. Here are the results:

Bulgakov M.A. An. urine: from 09/16/1939:

Transparency - complete, straw-yellow color, specific gravity - 1016, protein - 0.9%o, squamous epithelium - a fair amount, leukocytes - 2-4 in the field of view, no red blood cells, hyaline casts - up to 10 in the preparation, granular casts - single in the preparation, a fair amount of uric acid crystals, mucus - a little.”

In early October, a urine test is performed using the Zimnitsky method.
“Polyclinic of the People's Commissariat of Health of the USSR (Gagarinsky Ave., 37)

02.10.1939. An/ urine according to Zimnitsky Bulgakova M.A.

1 - 1009. 2 - 1006. 3 - 1006. 4 - 1007. 5 - 1007. 6 - 1007. DD- 775 k.s. ND - 550 k.s.”.

The detected changes in urine tests are quite moderate. Noteworthy is the low specific gravity and the presence of hyaline and single granular cylinders in the preparation. At the same time, there is a small amount of protein in the urine, leukocytes in the absence of red blood cells. Uric acid crystals in large quantities appear to have been an occasional laboratory finding,
since they were no longer detected. In the urine analysis according to Zimnitsky, isosthenuria was noticed.

A study of peripheral blood on September 16, 1939 revealed no changes.

“Polyclinic of the People's Commissariat of Health of the USSR (Gagarinsky Ave., 37)

M.A. Bulgakov. blood analysis. 09/16/1939

It is noteworthy that the hemoglobin level was within the normal range, which does not fully correspond to the concept that the writer had chronic renal failure (CRF) at the time of the study. Repeated analyzes of peripheral blood collected by E.S. Bulgakov's collection of materials could not be found.

However, there were also other tests:

“09/25/1939. A blood test for RV (for Dr. Zakharov) is negative.”

And completely disappointing indicators were revealed in another study:

“Study No. 47445.46 of patient M.A. Bulgakov from 09/25/1939

The amount of residual nitrogen in the blood according to the Assel method is 81.6 mg% (normal is 20-40 mg%). The reaction to indican using the Gas method gave traces.

02.10.1939. The amount of residual nitrogen according to the Assel method is 64.8 mg% (the norm is 20-40 mg%). The indican reaction is negative.

09.10.1939. Residual nitrogen 43.2 mg% (norm - 20-40 mg%) indican - negative.”

The results obtained confirmed the presence of chronic renal failure in the patient, although its cause remained not entirely clear. Perhaps this is why Dr. Zakharov, who was observing Bulgakov, decided to order a blood test for RV (Wassermann reaction).

Shocked by the sudden onset of her husband’s serious illness, E.S. Bulgakova, after a break, resumes her diary entries: “ September 29. There is no desire to return to what was missed. Therefore, straight to Misha’s serious illness: headaches are the main scourge. By evening Misha feels better in his head. Events are boiling all around, but they reach us silently, because we are amazed by our misfortune.”

In a letter dated 10.1939 to a Kyiv friend of his youth, Gshesinsky, Bulgakov himself voiced the nature of his illness: “Now it’s my turn, I have kidney disease, complicated by visual impairment. I lie there, deprived of the opportunity to read, write and see the light...” “Well, what can I tell you about? The left eye showed significant signs of improvement. Now, however, the flu has appeared on my road,
but maybe he’ll leave without spoiling anything...”

The diagnosis of renal disease complicated by chronic renal failure was apparently confirmed by Professor M.S. Vovsi, an authoritative clinician, one of the consultants of the Kremlin Medical Center, with experience in the field of kidney pathology, and the author of the subsequently published monograph “Diseases of the Urinary Organs.”

After examining Bulgakov M.S. Vovsi was too categorical about the patient's prognosis;
the fatality of the writer’s illness was obvious to the professor. He offered to hospitalize the patient in the Kremlin hospital, but Mikhail Afanasyevich categorically refused, reminding his wife of the word she had given not to leave him and to be with him
to end.

Leaving and saying goodbye in the hallway, Vovsi said to his wife: “I don’t insist, since it’s a matter of three days.” This was his verdict. But Bulgakov lived after that for another six months.

The dynamics of subsequent urine tests indicate a constantly low specific gravity (1010-1017), moderate proteinuria, the presence of single leached red blood cells and the almost constant presence of hyaline (up to 40 in the preparation) and waxy (less often) cylinders in varying quantities. Over the past month, a significant increase in the amount of protein (up to 6.6%) in the urine, the number of red blood cells in the field of view, as well as hyaline and waxy casts in the specimen (see. table).

The latest urine test found in the archives of E.S. Bulgakova, dates back to February 29, 1940. It can be assumed that no further urine studies were carried out. Perhaps the patient has developed anuria. Moreover, among the materials available in the archive, a piece of paper is found with the inscription “SALIRGAN - a diuretic.” Pasted next to it is a form from the outpatient clinic of the 1st Therapeutic Clinic 1 MMI, on which it is written: tartaric acid and sodium citrate. Further
on a separate sheet: 10% Salirgan solution and 5% Theophylline solution.

In attempts to find an explanation for these records, it can be assumed that one of the doctors gave recommendations (possibly by telephone) for the prescription of diuretics in connection with the onset of anuria. After all, Salirgan is a powerful mercury diuretic, which was actively used along with other mercury drugs (Novorit, Mercuzal) during Bulgakov’s illness and even later.

Table . Results of urine examination of M.A. Bulgakov (September 1939-February 1940).

At the same time, M.A.’s swollen face Bulgakov in a photograph taken in February 1940 confirms the assumption of possible anuria, and high proteinuria (3.6-6.0% of protein in urine) in analyzes from 02.02 to 29.02.1940 (see. table) gives reason to suspect even the development of nephrotic syndrome in the writer. The results of a blood test dated 02/09/1940 indicate a deterioration in renal function. So, if the content of residual nitrogen in the blood on January 24, 1940 was 69.6 mg%, then on February 9, 1940 the blood parameters worsened:

“Residual nitrogen according to the Assel method is 96 mg%.

Blood creatinine according to the Jaffe method - 3.6 mg% (normal - up to 2.5 mg%).

The reaction to indican by the Gas method is positive (+).”

By the way, the mention of citrate is also, apparently, not accidental. It is known that sodium citrate was used to reduce renal acidosis, and also as an osmotic laxative, which could also be indicated for a patient with chronic renal failure. At the same time, it is possible that sodium citrate in the form of a 5% solution could be intended to determine ROE indicators using the Panchenkov method, since blood collection for research was carried out at home due to the severity of Bulgakov’s condition. However, as already mentioned, the results of studies of peripheral
blood, with the exception of the analysis dated September 12, 1939, could not be found.

When analyzing some of the collected materials found in the archive (notes, notes, recipes, etc.), one should not forget about the tense and anxious state of E.S. Bulgakova, on whose shoulders fell the difficult mission of caring and psychological support for her sick husband,

assistance in editing his latest novel, fulfilling all medical orders, inviting consultants, answering phone calls, etc. Therefore, we are often faced with a lack of order and fragmentary notes, sometimes made in a hurry on separate sheets of paper, either in ink or pencil. The writer's wife has a lot of worries, nothing should be left out. Every little thing can matter for the health of Mikhail Afanasyevich. Here is one of the typical
records made by E.S. Bulgakova on a typewriter without a date: “ At Nick. Ant: learn about jelly (fish and meat), learn about taking blood. Report analysis. Find out about cabbage powder (from Pokrovsky). Order the necessary medications: injections, mixture, powders, triad, eye drops...”.

Meanwhile, there is tension in the apartment of the building in Nashchokinsky lane. was growing. Bulgakov's condition steadily deteriorated. Based on the available selection of prescriptions, one can assume the presence of leading clinical symptoms and their dynamics. As before, analgesic drugs continued to be prescribed for headaches - most often in the form of a combination of pyramidon, phenacetin, caffeine, sometimes together with luminal. Injections of magnesium sulfate, leeching and bloodletting were the main means of treating arterial hypertension. So, in one of the entries in the diary of E.S. Bulgakova we find: “09.10.1939. Yesterday a big bloodletting - 780 g, strong headache.
This afternoon it’s a little easier, but I have to take powders.”

And here are the medical prescriptions in those days:

“10/27/1939. Magnesia amp. 6.

10/27/1939. I ask you to place leeches for M. A. Bulgakov to the mastoid processes and temples on both sides.
Vr. Zakharov.”

Appointments without date: “Padutin, magnesium sulfate 25% orally, diuretin + papaverine, infusion of valerian root + sodium bromide, leeches - 5-6, bloodletting - 3.”

From the memoirs of E.A. Zemskaya (nieces of M.A. Bulgakov): “...I found him terribly thin and
pale in a darkened room, wearing dark glasses over his eyes, wearing a black Master’s cap on his head, sitting in bed...”, - 08.11.1939.

The USSR Writers' Union takes, as far as possible, participation in the fate of its colleague. Bulgakov is visited at home by the chairman of the Writers' Union A.A. Fadeev, about which we find an entry in E.S.’s diaries: “ October 18. Two interesting calls today. The first is from Fadeev that he will come to visit Misha tomorrow..." By decision of the Writers' Union, he is provided with financial assistance in the amount of 5,000
rub. In November 1939, at a meeting of the Union of Writers of the USSR, the issue of sending Bulgakov and his wife to the government sanatorium “Barvikha” was considered.

The very fact of sending a patient with severe, almost terminal renal failure to sanatorium treatment is somewhat surprising. It is possible that this was just a “merciful” action on the part of the authorities, voiced by the USSR SP in relation to the sick writer, as if as a sign of loyalty and care for him. After all, for a patient with chronic renal failure, a sanatorium is not the best
a suitable place to stay for treatment. In December 1939, three months before his death, Bulgakov did not belong to the category of “sanatorium patients.” That is why, at his request, supported by the Writers' Union, his wife went with him to the sanatorium.

The main method of treatment for Bulgakov there was carefully developed dietary measures -
Tia, about which the writer writes from the sanatorium to his sister Elena Afanasyevna:

“Barvikha. 3.12.1939

Dear Lelya!

Here's some news about me. The left eye showed significant improvement. The right eye lags behind it, but is also trying to do something good... According to the doctors, it turns out that since there is improvement in the eyes, it means that there is an improvement in the kidney process. And if so, then I have hope that this time I will get away from the old lady with the scythe... Now the flu kept me a little in bed, but I had already started going out and was in the forest for walks. And much stronger... They treat me carefully and mainly with a specially selected and combined diet. Mainly vegetables of all types and fruits...”

In these lines, the writer still retains faith in the improvement of his condition and the opportunity to return to literary activity.

Unfortunately, the hopes pinned (if any at all) on the “sanatorium service” for the writer Bulgakov were not justified. Having returned from the Barvikha sanatorium in a depressed state, having felt practically no improvement and realizing my tragic situation,

Bulgakov writes in December 1939 to his longtime friend, physician A. Gdeshinsky, in Kyiv: “...well, I returned from the sanatorium. What’s wrong with me?.. If I tell you frankly and in confidence, I’m sick of the thought that I came back to die. This doesn’t suit me for one reason: it’s painful, boring and vulgar. As you know, there is one decent type of death - from firearms, but, unfortunately, I don’t have one. More precisely speaking about the disease: a clearly felt struggle between the signs of life and death takes place in me. In particular, on the side of life - improved vision. But enough about the disease! I can only add one thing: towards the end of my life I had to endure another disappointment - in general practitioners. I won’t call them murderers, that would be too cruel, but I will gladly call them performers, hacks and mediocrities. There are exceptions, of course, but how rare they are! And what can these exceptions help if, say, for ailments like mine, allopaths not only have no remedies, but sometimes they cannot recognize the ailment itself.

Time will pass, and our therapists will be laughed at like Moliere’s doctors. Said-
This does not apply to surgeons, ophthalmologists, or dentists. To the best of doctors, Elena Sergeevna, too. But she can’t cope alone, so she accepted a new faith and switched to a homeopath. And most of all, may God help us all who are sick!<...>”.

Unlike the October letter to Gdeshinsky, this message was written in a state of obvious depression caused by a severe somatic illness, without any hope not only for a cure, but even for improvement. There was a lack of faith in medicine and a certain ironic attitude towards doctors. The lines of the letter evoke suicidal thoughts: “ ...As you know, there is one decent type of death - from a firearm, but, unfortunately, I don’t have one...”. By the way, it is no coincidence that the writer, exhausted by illness, once turned to his wife with the words: “ Ask Sergei(wife’s son. - L.D.) gun", - which E.S. mentions in his diaries. Bulgakov.

The patient's condition continues to deteriorate, which is manifested by incessant headaches
(most likely due to severe hypertension), signs of increasing azotemic intoxication. The serious condition forces the wife not only to constantly contact her doctor, but also to consult with other reputable clinicians. At the same time, as often happens, the opinions of consultants were not always unanimous, which involuntarily baffled and indecisiveness not only the patient himself, but also his relatives.

From the diary of E.S. Bulgakova: “January 24. Bad day. Misha has a constant headache. I took four enhanced powders - it didn’t help. Attacks of nausea. I called Uncle Misha - Pokrovsky (M.A. Bulgakov’s maternal uncle, doctor - L.D.) for tomorrow morning. And now - eleven o’clock in the evening - I called Zakharov. Having learned about Misha’s condition, he came out to us and will come in 20 minutes.” 02/03/1940. Bulgakov is advised by Professor V.N. Vinogradov, personal physician I.V. Stalin. Here are the recommendations of Prof. V.N. Vinogradova:

"1. Routine - going to bed at 12 o'clock at night.
2. Diet - dairy-vegetable.
3. Drink no more than 5 glasses per day.
4 Papaverine powders, etc. 3 times a day.
5. (to sister) Injections Myol/+Spasmol gj 1.0 each.
6. Daily foot baths with mustard 1 tbsp. l.,
10 pm.
7 At night, mixture with chloral hydrate, 11 hours
evenings.
8. Eye drops morning and evening.”

This is how patients with chronic renal failure were treated just 70 years ago! The given recommendations reflect the ideas of doctors of that time about the management of patients with chronic renal failure, but today they have no more than historical interest.

On one of the last pages of the notebook with notes from E.S. Bulgakova provides a list of doctors who treated
and advised M.A. Bulgakov:

“The professors and doctors who treated Bulgakov during (M.A. Bulgakov’s) illness. Prof. Andogsky, Arendt, Rappoport, Zabugin, Aksenov, Zakharov; prof. Vovsi, prof. Strakh. Prof. Burmin. Prof. Gehrke. Levin, Badylkes. Manyukova. Maria Pavlovna. Prof. Konchalovsky. Prof. Averbakh, prof. Vinogradov. Zhadovsky, Pokrovsky P.N., Pokrovsky M.M.... Tseitlin, Shapiro M.L., Blumenthal V.L., Uspensky V.P., Strukov”.

As you can see, the above list includes well-known specialists in various fields of medicine,
mainly highly qualified therapists who had extensive clinical experience and a fairly high reputation among Moscow patients. It is interesting that the last name - Strukova (without initials) - was apparently added later, judging by the fact that it was written in pencil. If we are talking about the famous pathologist Academician A.I. Strukov, his role in “managing the sick Bulgakov” remains unclear.

However, it is not difficult to guess about the mission performed in front of the relatives of the deceased by pathologist Strukov.

It is appropriate here to quote the words of M.O. Chudakova (“...his blood vessels were like those of a seventy-year-oldhim old man...") and director Roman Viktyuk “...I remembered her (Elena Sergeevna. - L.D.) story about how Bulgakov was treated, it seems, for kidney problems, and when they opened it, it turned out that the heart was riddled tiny holes...”.

Wasn’t the source of the received E.S. Bulgakov’s information was precisely Professor A.I. Strukov, who in 1956 became the head of the department of pathological anatomy of the 1st MMI?

02/17/1940. In addition to the prescriptions previously prescribed to Bulgakov, one more appears: “Adonilini 20.0 DS 15 drops. for suffocation." The drug belongs to the cardiac glycosides, the prescription of which may have become necessary. In the prescription signature (“for choking”), you can guess the reason for prescribing this drug - the patient has signs of left ventricular failure,
most likely against the background of severe arterial hypertension. The next day (02/18/1940) six leeches are actually prescribed. Among other prescriptions written by the same doctor (Zakharov?):

“02/19/1940. Cito. Anaesthesini 0.5 n 6 gj 2-3 for vomiting.
24.02.1940. Chloroformi /// 300.0 1 teaspoon after 20-30 minutes.
02/24/1940. Cerii oxalyci a 0.3 S. 1 serving. appointment.
And of course: Pyramidon, caffeine for headaches. Pyramidon (powder) for headaches.”

In one of the last photographs, signed on February 11, M.A. Bulgakov in winter clothes, which indicates his “leaving the house” in those days, although this photograph could have been taken a little earlier, for example, January 24, 1940.

Indeed, in the diary entry of the writer’s wife we ​​find: “January 24, 1940: Bad day. Misha has a constant headache. I took four enhanced powders - it didn’t help. Attacks of nausea. /.../ We’ve been living poorly these last few days, few people come or call. Misha ruled the novel. I wrote. Complains about his heart. At about eight o’clock we went outside, but immediately returned - I couldn’t, I was tired.”

In the book of the writer’s niece, E.A. Zemskaya, there is another photograph of Bulgakov with a handwritten inscription: “Thank you, dear Olya and Lena, for your letter. I wish you happiness in life. M. Bulgakov. 8/II 1940”. This is the last autograph of the writer, stored in the family archive. Right across his face, as he often did before, it was written in blue ink, in incorrect handwriting, showing that the writer did not see. The lines overlap one another.

Two weeks before his death, a visit from a doctor from the People's Commissariat of Health on 02/25/1940.

“Status: General serious condition, sharp severe headaches. Heart: dull tones. No arrhythmia is noted. The pulse is symmetrical in both arms, but uneven: 74-92 per minute. Blood pressure max. 195-200 min - 100. The impression of a pre-uremic state. Doctor M. Rosselov...”

By the way, for some reason there are no recommendations for treatment, at least for lowering blood pressure. Perhaps this was one of the last visits of a doctor from the Narkomzdrav clinic, where M.A., who lived nearby, was observed. Bulgakov and in which he was often given numerous laboratory research. Let us briefly recall the history of this clinic, which dates back more than 100 years and has included a unique patient in its annals. At first (1907-1922) it was A.V.’s private surgical hospital. Chegodaeva, which in 1922 became the central medical and diagnostic institution of Moscow and the periphery. Subsequently, for several years, the clinic became the guardian of the health of scientists: a clinic of the medical section of the Central Commission for the Improvement of the Living Life of Scientists (CEKUBU) (1925-1931), and then a clinic of the Commission for the Assistance of Scientists (CSU) (1931-1939).

The consultants at the clinic were leading Russian specialists called upon to provide
highly qualified medical assistance to the scientific and then creative elite of the state.
In 1939, this medical institution was renamed the Central Clinic of the People's Commissariat of Health of the USSR (later - the Ministry of Health of the USSR), where M.A. was observed and examined until the end of his days. Bulgakov.

This is how Bulgakov’s friend, director S.A., recalled the last days of the dying writer. Ermolinsky: “These were days of silent moral suffering. The words slowly died in him... The usual doses of sleeping pills stopped working.

And long recipes appeared, dotted with cabalistic Latinisms. According to these prescriptions, which exceeded all required standards, they stopped dispensing medicine to our envoys: poison. I had to go to the pharmacy myself to explain what was happening.<...>I went up into the hall and asked for the manager. He remembered Bulgakov, his thorough client, and, handing me the medicine, sadly shook his head.<...>Nothing could help anymore.

His entire body was poisoned... ...he became blind. When I leaned towards him, he felt my face with his hands and recognized me. He recognized Lena (Elena Sergeevna - L.D.) by her steps, as soon as she appeared
in the room. Bulgakov was lying on the bed naked, wearing only a loincloth (even the sheets hurt him), and suddenly asked me: “Do I look like Christ?..” His body was dry. He has lost a lot of weight...”(recorded 1964-1965).

Six months after the death of the writer, Sergei Ermolinsky had to pay for the connection
With " counter-revolutionary Bulgakov”.

Ermolinsky was arrested and sentenced to three years in exile “for propaganda of anti-Soviet, counterrevolutionary, so-called writer Bulgakov, whom death took away in time.”(words
investigator). From the words thrown by investigator S. Ermolinsky, it is easy to conclude that only death saved the disgraced writer from the dungeons of the NKVD. And the assurances of A.A. Fadeev’s words to the terminally ill Bulgakov: “Get well, now everything will be different... We will send you to Italy...” - were nothing more than fulfilling the instructions of the most important director who staged this whole
royal performance.

His diaries, kept for 7 years, E.S. Bulgakov ends with the last breath of Mikhail Afanasyevich: “ 03/10/1940. 16 hours. Misha died".

The usual worries in such situations begin in the house: the sculptor Merkurov appears, removing M.A. from the face. Bulgakov's death mask, the original of which is now kept in the Museum of the Art Theater.

A memorial service is scheduled for 03/11/1940 at the Writers' Union. According to the preliminary ritual protocol, after the funeral meeting on the way to the crematorium of the Donskoy Monastery, a stop is planned at the Art and Bolshoi theaters. Bulgakov studies discuss the question of why
M. Bulgakov was cremated and not buried, which would be natural for a believer. E.A. Zemskaya mentions the funeral service in absentia in the church on Ostozhenka, organized by the writer’s sisters. So, on the one hand - cremation, on the other - funeral service in absentia. Why? The answer to this question is E.S. Bulgakov does not give.

The day after Bulgakov’s death, a telephone call was heard in his apartment from Stalin’s reception room and someone’s voice asked: is it true that Comrade Bulgakov has died? Having received an affirmative answer, the questioner hung up without saying another word. Apparently, those at the opposite end of the telephone line felt some relief due to
a natural solution to many problems faced by power structures related to the writer’s work. However, it is still not possible to obtain an affirmative answer to the question about the nature of the writer’s kidney disease.

About M.A.’s illness Bulgakov

In the death certificate of M.A. Bulgakov, issued on March 11, 1940, the cause of death is indicated: nephrosclerosis, uremia. As you know, death certificates are issued on the basis of medical documentation: a medical certificate about the disease or the results of a pathological autopsy. We do not have a pathologist's opinion on the cause
death of M. Bulgakov, since there is no reliable information about whether a pathological autopsy of the writer was carried out. Therefore, most likely the death certificate was issued on the basis of a certificate from the clinic.

When analyzing the nature of kidney damage in M. Bulgakov, the concept of hereditary kidney pathology seemed attractive from the very beginning, taking into account the strikingly similar course of the disease in his father - age, signs of the disease, sudden blindness, death from chronic renal failure at the same age as the writer. Among the possible hereditary diseases, the most realistic assumption was polycystic kidney disease with the development of end-stage renal failure.
However, putting forward the concept of polycystic kidney disease, we then have the right to assume that the numerous doctors consulting the writer, including well-known professors, either could not detect the increased size of the kidneys characteristic of polycystic transformation during the examination of the patient, or did not bother to palpate the patient’s kidneys at all with severe hypertension, changes in urine and a “family history of kidney disease.” Such a seemingly blatant neglect of propaedeutic methods, which were a priority in the middle of the last century, is tantamount to ignoring, for example, ultrasound examination of the kidneys in similar patients in our time. Thus, the diagnosis of polycystic kidney disease along with other hereditary nephropathies seems the least likely cause of chronic renal failure in Bulgakov.

From our point of view, another diagnostic hypothesis deserves attention, especially in the light of modern ideas about drug-induced nephropathies. There is reason to suggest that M.A. has chronic interstitial nephritis of drug origin. Bulgakov. Let's try to argue for this diagnostic concept.

In a letter to the writer’s brother, Nikolai Afanasyevich, dated October 17, 1960, i.e. 20 years after the death of Mikhail Afanasyevich, E.S. Bulgakova reports: “...once a year (usually in the spring) I forced him to do all sorts of tests and x-rays. Everything gave good results, and the only thing that often tormented him was headaches, but he saved himself from them with the triad - caffeine, phenacetin, pyramidon. But in the fall of 1939, an illness suddenly fell upon him, he felt a sharp loss of vision (this was in Leningrad, where we went on vacation) ... ".

In her diaries, Elena Sergeevna often mentions Bulgakov’s headaches long before the first manifestations of kidney damage. 05/01/1934: “...yesterday Gorchakov and Nikitin had dinner with us... M.A. met them, lying in bed, he had a wild headache. But then he came to life and got up for dinner.”

08/29/1934: “M.A. came back with a wild migraine (obviously, as always, Annushka was holding back her food), lay down with a heating pad on her head and occasionally inserted her word.”.

Apparently, during one of these (migraine?) attacks of headaches, Bulgakov was found at home by the chief administrator of the Art Theater F.N. Michalsky (the famous Philip Philipovich Tulumbasov from “ Theatrical novel"), who recalled: " ...Mikhail Afanasyevich is reclining on the sofa. Feet in hot water, cold compresses on head and heart. “Well, tell me!” I repeat the story several times about A.S.’s call. Enukidze, and about the festive mood in the theater. Having overcome himself, Mikhail Afanasyevich rises. After all, something needs to be done. “Let's go! Let's go! ".

In the archive collected by E.S. Bulgakova, there is a series of recipes documenting the purpose of the writer medicines(aspirin, pyramidon, phenacetin, codeine, caffeine), which was indicated in the prescription signature - “for headaches”. These prescriptions were prescribed with enviable regularity by the attending physician Zakharov, who also resorted to all sorts of tricks to “uninterruptedly” provide the unfortunate patient with these drugs. One of his notes to M. Bulgakov’s wife can serve as confirmation: “Deeply respected. Elena Sergeevna. I prescribe aspirin, caffeine and codeine not together, but separately so that the pharmacy does not delay dispensing due to preparation. Give M.A. aspirin tablet, table. caffeine and tab. codeine. I go to bed late. Call me. Zakharov 04/26/1939”.

Long-term use of analgesic drugs long before the onset of symptoms of kidney disease suggests their possible role in the development of renal pathology in M.A. Bulgakov.

Indeed, if we assume that the writer’s constant headaches were a manifestation of a neurotic disorder, which was confirmed by many doctors, then the analgesic drugs prescribed in connection with this (according to documentary data, since 1933) could play a fatal role in terms of the development of chronic interstitial pain in the patient. jade of medicinal origin. It is with long-term regular use of non-narcotic analgesics (phenacetin, aspirin, amidopyrine, etc.) that chronic interstitial nephritis most often develops, often occurring with necrosis of the renal papillae (analgesic nephropathy) - (I.E. Tareeva).

Phenacetin was initially considered the main nephrotoxic drug, which even gave rise to
isolation of a separate form of nephropathies - phenacetin nephritis. Later it turned out that
interstitial nephritis can be caused not only by phenacetin, but also by other analgesics,
as well as caffeine and codeine, which can also cause psychological dependence.

Unfortunately, the potential nephrotoxicity of phenacetin and other analgesics is likely not
was well known to the doctors who prescribed these drugs to the writer, since the first description of phenacetin nephritis was published by O. Spuhler and N. Zollinger only in 1953. Moreover, if doctors had known that Bulgakov had hypertensive nephropathy, it is unlikely that these drugs would have been prescribed with so easily and without the slightest shadow of doubt about their potential nephrotoxicity.

We must not forget about Bulgakov’s history of transient drug addiction, so vividly and expressively described in his story “Morphine.” The writer managed to get rid of morphine addiction with the help of his first wife, Tatyana Lappa. Given the writer's history, he could easily have become dependent on the analgesics prescribed to him for headaches. These pains, judging by the recollections of the wife, for some time turned into main problem writer's health status: “ 1st of May
1938 M.A. I went to Arendt in the evening for advice on what to do - I was overcome by headaches" Andrei Andreevich Arendt is the founder of Soviet pediatric neurosurgery, who worked from 1934 to 1941 in the department created by N.N. Burdenko Central Neurosurgical Institute and taught at the Department of Neurosurgery of the Central Institute for Advanced Medical Studies.

We dare to suggest that the fantastic situations described in “The Master and Margarita” with the beheading of the chairman of MASSOLIT Berlioz and the entertainer of the Variety Theater could have been inspired by the severe, painful headaches that haunted the writer, and the impossibility of getting rid of them by any means, except perhaps “liberation from the very heads." Let us recall that in both cases the head separated from the body shows signs of life. The head of the entertainer Bengalsky in the hands of Fagot screams for help from the doctor, cries and promises not to
continue to grind all sorts of nonsense. And on the dead face of Berlioz’s severed head, with whom Woland is talking, Margarita suddenly sees “living eyes, full of thought and suffering.” So, the head, separated from the body, continues to live, and headaches continue to torment Mikhail Bulgakov.

Thus, at that time, renal disease was either not diagnosed or not suspected at all. We find confirmation of this in the diaries of E.S. Bulgakova, as already mentioned, insisted on periodic examinations of her husband: “ 10.20.1933. ...a day under the sign of doctors: M.A. I went to Blumenthal and had an x-ray - about my kidneys - they had been sick for some time. But they say everything is fine”. From this entry it turns out that some, albeit minor, symptoms of the writer already occurred in 1933. However, the doctors consulting Bulgakov stated that he was only overworked, as mentioned in Elena Sergeevna’s diaries: “ In the evening we have Damir. Found it at M.A. severe overwork” (12/07/1933). And six months later, again about overwork: “...yesterday they called Misha Shapiro. I found him to be very tired. Heart in order” (06/01/1934). The question arises whether these worthy and experienced doctors could conduct an examination
a patient who constantly complains of headaches, without measuring arterial (blood) pressure;
nia? The answer is most likely negative. After all, a device for measuring blood pressure was introduced
into the clinical practice of Riva-Rocci in 1896, and in November 1905, at a meeting of the Scientific Meetings of the Clinical Military Hospital society, a report by Dr. Nikolai Sergeevich Korotkov “On the question of methods for studying blood pressure” was heard. Without a doubt, the method of measuring blood pressure at that time could not but be used in Russia, in particular, by doctors consulting the writer. In this case, we have the right to assume that Bulgakov did not have arterial hypertension, at least in 1933-1934. As already mentioned, the first information about the writer’s blood pressure figures relates, according to the archival materials at our disposal, to the time of development of eye symptoms, i.e., to the advanced phase of the disease.

Well, what then to do with the changes in the fundus revealed in September 1939, which, it would seem, eloquently testified to the duration of arterial hypertension? When answering the question posed, it should be borne in mind that the increase in blood pressure in Bulgakov, first registered in 1939, could also be a manifestation of analgesic nephropathy. With this pathology, arterial hypertension develops much more often than with other forms of chronic
interstitial nephritis, and can sometimes become malignant. This is precisely the course of hypertension with the development of severe retinopathy that occurred in the writer.

But let’s try to admit that these permanent headaches were Bulgakov’s main
clinical manifestation of undiagnosed arterial hypertension complicated by nephrosclerosis with the development of chronic renal failure. True, in this case it is necessary to make one more assumption about the failure to detect hypertension by doctors advising the writer. Let us pay attention to one, although not documented, fact. B. Myagkov’s book “Pedigree of M. Bulgakov” provides information that allows one to suspect the presence of arterial hypertension at a young age. “ ...At the height of the session, a message from the Main Military Sanitary Directorate arrived from Petrograd announcing the next military conscription, and Mikhail ( unexpected fact!) “expresses a desire” to serve in the highly secret elite Naval Department. But the never-violated conditions of service let us down - Orthodox faith, education and absolute physical health. According to modern doctors, high blood pressure even then (in April-May 1915) was a subtle harbinger of a future terrible and tragic disease - hypertensive nephrosclerosis. The wording “unfit for military marching service” kept the young doctor Bulgakov against his will. He received the diploma of “doctor with honors” on March 7, 1917.” .

Also, indirect confirmation of the writer’s long-existing arterial hypertension can be the information we received in a private conversation with Marietta Chudakova that, according to E.S. Bulgakova, the writer’s blood vessels, as the doctors told her, turned out to be like those of a 70-year-old. This meant, of course, atherosclerotic vascular lesions, the development of which is known to be promoted by the presence of hypertension. But such information was not available in the 1940s. in the absence of methods
Intravital visualization of blood vessels could only be obtained on the basis of a pathological examination. In this case, the diagnostic concept of nephrosclerosis against the background of arterial hypertension with the subsequent development of chronic renal failure seems justified. At the time of Bulgakov’s illness, the established classification of kidney diseases among doctors, proposed by the German internist Volhard together with the pathologist Fahr, prevailed. Volgard and Fahr distinguished nephritis, nephrosis, nephrosclerosis. According to doctors, the course of the writer’s illness was more consistent with
nephrosclerosis, which was reflected in the death certificate: nephrosclerosis, uremia.

It is interesting to note that the nature of the disease in Mikhail Bulgakov is to a certain extent reminiscent of the clinical situation in the Russian emperor Alexandra III, who at one time was advised by Grigory Zakharyin, who mistakenly assessed the emperor’s illness as heart failure.

If we discuss the possibility of early arterial hypertension in the writer and his father, then an alternative diagnostic concept may be an anomaly of the renal vessels with the development of renovascular hypertension. Clinically significant anomalies of the renal vessels are fibromuscular dysplasia (congenital underdevelopment of the muscular lining of the artery with replacement
its fibrous tissue), congenital stenosis and aneurysm of the renal artery, leading to the development of vasorenal arterial hypertension.

However, the accepted diagnostic concept of nephrosclerosis against the background of arterial hypertension does not exclude the negative impact of excessive consumption of analgesics, which may aggravate functional disorders and contribute to the progression of renal failure.

At the same time, some features of the course of end-stage renal failure in our patient are noteworthy. First of all, this is a pain syndrome, which was mentioned in letters by many who surrounded the writer at that time. In the fall of 1939, during last illness Bulgakov was often visited and cared for by his sister who was dying. On November 8, 1939, sister Nadya notified her of the writer’s illness. November seventeenth

1939 B. wrote: “ Dear Nadya! Today I was with my brother Misha, where I was called by phone. He has been feeling better in recent days, but today, before I left, he began to complain of pain in the lower back (in the kidney area).”. We also find information about pain in the lower back and abdomen in other sources. So, immediately after the New Year holiday (01/02/1940), a postcard was sent to Elena Afanasyevna, written entirely in Elena Sergeevna’s hand. “ Lelya, my dear, I am writing to you at Misha’s request... Misha is feeling worse, his headaches have started again, and there are more (sic!) stomach pains. Kiss
you, your Elena.” In the diary entry of E.S. Bulgakova dated 02/15/1940 we read: “I am writing after a long break. On January 25, apparently, the second - strongest - attack of the disease began. Expressed in intensifying, unresponsive headaches, and in new pain in the abdominal area, and in vomiting, and in hiccups. In a word - the attack is stronger than the first. I only wrote down the medical history, but not a word in the diary.”.

And here are the memories of the writer’s friend, director Sergei Ermolinsky: “ ...every muscle ached unbearably at the slightest movement. He screamed, unable to stop himself from screaming. This scream is still in my ears. We were close, and no matter how painful it was for him from our touches, he stood strong and, without even groaning quietly, said, barely audible, with his lips alone: ​​“You are doing this well... Good...”

The question arises about the causes and possible mechanisms for the development of pain in the kidney area in a patient with chronic renal failure. The most reasonable and generally accepted interpretation of the pain syndrome is uremic polyneuropathy as one of the manifestations of chronic renal failure. However, polyneuropathy syndrome manifests itself mainly as pain in the extremities, and in the notes of the writer’s wife and sister it is indicated
also for abdominal and lower back pain. These pains could be associated either with the presence of nephrolithiasis or with an inflammatory process in the kidneys (pyelonephritis?). Both pathological processes in patients with chronic renal failure are characteristic of polycystic kidney disease, which, however, again brings us back to the already rejected concept of polycystic transformation. But with analgesic nephropathy, pyelonephritis and nephrolithiasis may be associated, which may be accompanied by gross hematuria (see. latest tests urine in table). As for the mentioned pain “in the abdominal area,” they could be caused by the development of an erosive-ulcerative process in the stomach against the background of terminal chronic renal failure, as well as continued use of analgesics.

So, “our consultation” regarding the nature of Mikhail Bulgakov’s kidney disease is completed. We discussed several diagnostic hypotheses, among which interstitial nephritis of drug origin (analgesic nephropathy) seems to be the most reasonable. Even if we accept the official cause of death stated in the death certificate (nephrosclerosis,
uremia), the role of analgesics in the aggravation and progression of renal failure cannot be completely excluded. It is necessary to be aware that the unavailability in the middle of the last century of methods such as computed tomography and morphological examination of renal biopsies, which have become almost routine in modern nephrology, limited diagnostic capabilities, if not completely deprived of them in this category of patients. The absence of pathological results the study does not confirm or reject any of the diagnostic concepts discussed" Thus, today the cause of chronic renal failure in M.A. Bulgakov remains completely undeciphered and constitutes one of his secrets, kept along with the writer’s ashes under a gravestone at the Novodevichy cemetery. Under this stone, which was also covered in a mystical aura and was allegedly taken from the grave of N.V. Gogol, there is another secret of the Master. This is the secret of his rare, incomparable talent, which fascinates every reader. And unraveling this mystery will be much more difficult, if possible at all.

Topics of Mikhail Bulgakov - remember the scientific work with the determination of traces of morphine and markers of nephrosclerosis? Now, in two posts, we present to you clinical picture illness and death of the great writer. And we will rely on the wonderful article by L.I. Dvoretsky “The Illness and Death of the Master (about the illness of Mikhail Bulgakov)”, published in the April 2010 issue of the journal “Clinical Nephrology”.

In 1932, writer Mikhail Bulgakov warned his new chosen one, Elena Sergeevna: “ Keep in mind, I will die very hard - give me an oath that you will not send me to the hospital, and I will die in your arms».

Bulgakov with his wife Elena

There were eight years left before the writer’s death, during which he would complete and almost finish the great work “The Master and Margarita”, in which there would also be hints of sudden death (remember the barman Sokov: “... He will die in nine months, in February next year, from liver cancer in the clinic of the First Moscow State University, in the fourth ward.")…

Within six months from the onset of the first symptoms, the disease developed to a painful, cruel death: in the last three weeks, Bulgakov went blind, was tormented by terrible pain and stopped editing the novel. What kind of illness treated the writer so cruelly? Moreover, he regularly underwent examinations that did not reveal any somatic pathologies. However, he had already experienced neurotic disorders.

So, in the archive of M.A. Bulgakov, a doctor’s form with a medical report was found:

“05/22/1934. On this date I established that M.A. Bulgakov has a sharp depletion of the nervous system with symptoms of psychosthenia, as a result of which he is prescribed rest, bed rest and drug treatment.
Comrade Bulgakov will be able to start work in 4-5 days. Alexey Lyutsianovich Iverov. Doctor of the Moscow Art Theater.”

Elena Sergeevna Bulgakova herself mentions such neurotic conditions and attempts to treat them in her diaries in 1934:

“On the 13th we went to Leningrad and were treated there by Dr. Polonsky with electrification.”

“October 13. At M.A. bad with nerves. Fear of space, loneliness. Thinking about turning to hypnosis?”

"The 20th of October. M.A. I phoned Andrei Andreevich (A.A. Arend. - L.D.) about a meeting with Dr. Berg. M.A. I decided to be treated with hypnosis for my fears.”

“November 19. After hypnosis with M.A. The attacks of fear begin to disappear, the mood is even, cheerful and good performance. Now - if only he could still walk down the street alone.”

"November 22. At ten o'clock in the evening M.A. got up, got dressed and went alone to the Leontyevs. He didn’t walk alone for six months.”

In letters to Vikenty Veresaev, also a doctor by profession (remember his “Notes of a Doctor”), Bulgakov admitted: “I have become sick, Vikenty Vikentyevich. I won’t list the symptoms, I’ll just say that I stopped responding to business letters. And there is often a poisonous thought - had I really completed my circle? The disease announced itself with extremely unpleasant sensations of “the darkest anxiety,” “complete hopelessness, neurasthenic fears.”

Vikenty Veresaev

"Somatics" manifested itself in September 1939.

It was from that time that Bulgakov himself began counting his illness, which he told his wife, who wrote down his words in his diary on February 11, 1940 (a month before his death): “... for the first time in all five months of illness I am happy... I’m lying... in peace, you are with me... This is happiness...”.

In September 1939, after a serious stressful situation for him (a review from a writer who went on a business trip to work on a play about Stalin), Bulgakov decides to go on vacation to Leningrad. He writes a corresponding statement to the management of the Bolshoi Theater, where he worked as a consultant to the repertoire department. And on the very first day of his stay in Leningrad, walking with his wife along Nevsky Prospekt, Bulgakov suddenly felt that he could not distinguish the inscriptions on the signs.

A similar situation once already took place in Moscow - before his trip to Leningrad, which the writer told his sister, Elena Afanasyevna: “About the first noticeable loss of vision - for a moment (I was sitting, talking with one lady, and suddenly she seemed to be covered in a cloud - I stopped seeing her). I decided that it was an accident, my nerves were acting up, nervous fatigue.”.

Alarmed by a repeated episode of vision loss, the writer returns to the Astoria Hotel. The search for an ophthalmologist begins urgently, and on September 12 Bulgakov is examined by Leningrad professor N.I. Andogsky:

“Visual acuity: right eye – 0.5; left – 0.8. Phenomena of presbyopia. Phenomena of inflammation of the optic nerves in both eyes with the participation of the surrounding retina: in the left - slightly, in the right - more significantly. The vessels are significantly dilated and tortuous.

Glasses for classes: pr. + 2.75 D; a lion. +1.75 D.
Sol.calcii chlorati cristillisiti 5% -200.0. 1 tbsp. l. 3 times per
day.
09/12/1939. Prof. N.I. Andogsky, Volodarsky Ave.,
10, apt. 8".

The professor tells him: “Your case is bad.” Bulgakov, a doctor himself, understands that things are even worse: at about 40 years old, this is exactly how the disease began that took the life of his father in 1907. He returns from vacation ahead of schedule, September 15, 1939.

First - examinations by an ophthalmologist.

09/28/1939. Ophthalmologist: “Bilateral neuritis optici on the left eye is smaller without hemorrhages and white spots, on the right the phenomena are more pronounced: there are isolated hemorrhages and white spots V.OD approximately and without glasses about 0.2. V.OS is greater than 0.2. The field of view during manual examination is not expanded.

09/30/1939. “The study will be repeated with a study of visual acuity using tables. Leeches can be repeated. In the eyes twice a day Pilocarpine and Dionine.” Prof. Strakh.

09/30/1939. Repeated examination by the ophthalmologist: “Neuritis optici with hemorrhages.”

As you can see, the fundus revealed changes characteristic of severe arterial hypertension, the presence of which in Bulgakov was not mentioned anywhere in the available materials before the events unfolded. For the first time, we learn about the writer’s true blood pressure numbers only after the appearance of eye symptoms.

“09/20/1939. Polyclinic of the People's Commissariat of Health of the USSR (Gagarinsky Ave., 37). Bulgakov M.A. Blood pressure according to Korotkov Max. -205/ Minimum. 120 mm” The next day, September 21, 1939, there was a home visit from Dr. Zakharov, who from now on would be supervised by M.A. Bulgakov until his last days. A receipt order for the visit (12 rubles 50 kopecks) and a prescription for the purchase of 6 leeches (5 rubles 40 kopecks) were issued.

A little later, the blood test(s) gives very alarming results:

“Study No. 47445.46 of patient M.A. Bulgakov from 09/25/1939
The amount of residual nitrogen in the blood according to the Assel method is 81.6 mg% (normal is 20–40 mg%). The reaction to indican using the Gas method gave traces.
02.10.1939. The amount of residual nitrogen according to the Assel method is 64.8 mg% (the norm is 20–40 mg%). The indican reaction is negative.
09.10.1939. Residual nitrogen 43.2 mg% (normal – 20–40 mg%) indican – negative.”

The diagnosis becomes clear: chronic renal failure. Bulgakov puts it on himself too. In a letter dated 10.1939 to a Kyiv friend of his youth, Gshesinsky, Bulgakov himself voiced the nature of his illness: “Now it’s my turn, I have kidney disease, complicated by visual impairment. I lie there, deprived of the opportunity to read, write and see the light...” “Well, what can I tell you about? The left eye showed significant signs of improvement. Now, however, the flu has appeared on my way, but maybe it will go away without spoiling anything...”

Professor Miron Semenovich Vovsi, an authoritative clinician, one of the Kremlin’s consultants, who had experience in the field of kidney pathology, and the author of the subsequently published monograph “Diseases of the Urinary Organs,” who examined him in the same October, confirmed the diagnosis, and, saying goodbye, told the writer’s wife that gives him only three days to live. Bulgakov lived for another six months.

Mikhail Vovsi

Bulgakov's condition steadily deteriorated. Based on the available selection of prescriptions, one can assume the presence of leading clinical symptoms and their dynamics. As before, analgesic drugs continued to be prescribed for headaches - most often in the form of a combination of pyramidon, phenacetin, caffeine, sometimes together with luminal. Injections of magnesium sulfate, leeching and bloodletting were the main means of treating arterial hypertension. So, in one of the entries in the diary of E.S. Bulgakova we find: “09.10.1939. Yesterday there was a lot of bloodletting - 780 g, severe headache. This afternoon it’s a little easier, but I have to take powders.”

The USSR Writers' Union takes, as far as possible, participation in the fate of its colleague. Bulgakov is visited at home by the chairman of the Writers’ Union, Alexander Fadeev, about which we find an entry in E.S.’s diaries: “October 18. Two interesting calls today. The first is from Fadeev that he will come to visit Misha tomorrow...” By decision of the Writers' Union, he is provided with financial assistance in the amount of 5,000
rub. In November 1939, at a meeting of the Union of Writers of the USSR, the issue of sending Bulgakov and his wife to the government sanatorium “Barvikha” was considered.

Alexander Fadeev

The very fact of sending a patient with severe, almost terminal renal failure to sanatorium treatment is somewhat surprising. It is possible that this was just a “merciful” action on the part of the authorities, voiced by the USSR SP in relation to the sick writer, as if as a sign of loyalty and care for him. After all, for a patient with chronic renal failure, a sanatorium is not the best
a suitable place to stay for treatment. In December 1939, three months before his death, Bulgakov did not belong to the category of “sanatorium patients.” That is why, at his request, supported by the Writers' Union, his wife went with him to the sanatorium.

The main method of treatment for Bulgakov there was carefully designed dietary measures, about which the writer writes from the sanatorium to his sister Elena Afanasyevna:

“Barvikha. 3.12.1939
Dear Lelya!

Here's some news about me. The left eye showed significant improvement. The right eye lags behind it, but is also trying to do something good... According to the doctors, it turns out that since there is improvement in the eyes, it means that there is an improvement in the kidney process. And if so, then I have hope that this time I will get away from the old lady with the scythe... Now the flu kept me a little in bed, but I had already started going out and was in the forest for walks. And much stronger... They treat me carefully and mainly with a specially selected and combined diet. Mainly vegetables of all types and fruits...”

In these lines, the writer still retains faith in the improvement of his condition and the opportunity to return to literary activity.

Unfortunately, the hopes pinned (if any at all) on the “sanatorium service” for the writer Bulgakov were not justified. Having returned from the Barvikha sanatorium in a depressed state, having felt virtually no improvement and realizing his tragic situation, Bulgakov wrote in December 1939 to his longtime medical friend Alexander Gdeshinsky in Kyiv:

“...well, I returned from the sanatorium. What’s wrong with me?.. If I tell you frankly and in confidence, I’m sick of the thought that I came back to die. This doesn’t suit me for one reason: it’s painful, boring and vulgar. As you know, there is one decent type of death - from a firearm, but, unfortunately, I don’t have one. More precisely speaking about the disease: a clearly felt struggle between the signs of life and death takes place in me. In particular, on the side of life is improved vision. But enough about the disease! I can only add one thing: towards the end of my life I had to endure another disappointment - in general practitioners. I won’t call them murderers, that would be too cruel, but I will gladly call them performers, hacks and mediocrities. There are exceptions, of course, but how rare they are! And what can these exceptions help if, say, for ailments like mine, allopaths not only have no remedies, but sometimes they cannot recognize the ailment itself.
Time will pass, and our therapists will be laughed at like Moliere’s doctors. What has been said does not apply to surgeons, ophthalmologists, and dentists. To the best of doctors, Elena Sergeevna, too. But she can’t cope alone, so she accepted a new faith and switched to a homeopath. And most of all, may God help us all who are sick!<...>”.

The condition continued to worsen:

From the diary of E.S. Bulgakova: “January 24. Bad day. Misha has a constant headache. I took four enhanced powders - it didn’t help. Attacks of nausea. I called Uncle Misha - Pokrovsky (M.A. Bulgakov’s maternal uncle, doctor - L.D.) for tomorrow morning. And now – eleven o’clock in the evening – I called Zakharov. Having learned about Misha’s condition, he came out to us and will come in 20 minutes.”

02/03/1940. Bulgakov is advised by Professor Vladimir Nikitich Vinogradov, personal physician I.V. Stalin, who later almost died in the “Doctors’ Case.” Here are the recommendations of Prof. V.N. Vinogradova:

"1. Routine – going to bed at 12 o’clock at night.
2. Diet – dairy-vegetable.
3. Drink no more than 5 glasses per day.
4 Papaverine powders, etc. 3 times a day.
5. (to sister) Injections Myol/+Spasmol gj 1.0 each.
6. Daily foot baths with mustard 1 tbsp. l.,
10 pm.
7 At night, mixture with chloral hydrate, 11 hours
evenings.
8. Eye drops morning and evening.”

Vladimir Vinogradov

This is how patients with chronic renal failure were treated just three quarters of a century ago! The given recommendations reflect the ideas of doctors of that time about the management of patients with chronic renal failure, but today they have no more than historical interest.

Sergey Ermolinsky

Bulgakov’s friend, director and screenwriter Sergei Ermolinsky recalled the last days of the dying writer:

“These were days of silent moral suffering. The words slowly died in him... The usual doses of sleeping pills stopped working.

And long recipes appeared, dotted with cabalistic Latinisms. According to these prescriptions, which exceeded all required standards, they stopped dispensing medicine to our envoys: poison. I had to go to the pharmacy myself to explain what was happening.<...>I went up into the hall and asked for the manager. He remembered Bulgakov, his thorough client, and, handing me the medicine, sadly shook his head.<...>Nothing could help anymore.
His entire body was poisoned... ...he became blind. When I leaned towards him, he felt my face with his hands and recognized me. He recognized Lena (Elena Sergeevna - L.D.) by her steps, as soon as she appeared
in the room. Bulgakov was lying on the bed naked, wearing only a loincloth (even the sheets hurt him), and suddenly asked me: “Do I look like Christ?..” His body was dry. He has lost a lot of weight...” (recorded 1964–1965).

His diaries, kept for 7 years, E.S. Bulgakov ends with the last breath of Mikhail Afanasyevich: “03/10/1940. 16 hours. Misha died."

To be continued.

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