Mikhail Afanasyevich Bulgakov became one of the most read, discussed and remembered authors of the 20th century. His creativity personal life and even death are complemented by secrets and legends, and the novel “The Master and Margarita” inscribed the name of its creator in golden letters in the annals of Russian and world literature. But secrets always shrouded his person, and the question: “Why did Bulgakov make himself a death mask?” was never fully revealed.

Hard way

Now Bulgakov’s name is well known, but there was a time when his works were not published, and he himself was under careful surveillance by the authorities and rabid party supporters. This both irritated and frustrated the writer, because he had to constantly be on alert so as not to give rise to idle conversations and complaints. Bulgakov's life was never simple - neither while working as a doctor, nor as an author of theatrical plays, nor as a novelist. But the last imprint - Bulgakov's death mask - suggests that high society, and first of all the authorities, appreciated his talent.

Personal life

Mikhail Afanasyevich was born on May 3, 1891 in Kyiv in the family of a teacher at the Kyiv Theological Academy. He was the oldest child. In addition to him, his parents had two brothers and four sisters. When the boy turned seven, his father fell ill with nephrosclerosis and soon died.

Mikhail received his secondary education at the best Kyiv gymnasium, but was not particularly diligent. This did not prevent the young man from entering the medical faculty of the Imperial University. Just at this moment the war of 1914-1918 began, and education took place in military field conditions. At the same time, he meets his future wife Tatyana Lappa, a fifteen-year-old girl with great promise. They did not put everything on hold, and when Bulgakov was in his second year, they got married.

World War I

This historical event did not cause a split in the measured life of the young couple. They did everything together. Tatyana followed her husband to front-line hospitals, organized triage and assistance centers for victims, and actively participated in work as a nurse and assistant. Bulgakov received his medical diploma while at the front. In March 1916, the future writer was recalled to the rear and put in charge of a medical center. There he began his formal medical practice. You can read about her in the stories “Notes of a Young Doctor” and “Morphine.”

Addiction

In the summer of 1917, while performing a tracheotomy on a child suffering from diphtheria, Mikhail Afanasyevich decided that he might have become infected, and as a preventive measure he prescribed morphine to relieve itching and pain. Knowing that the medicine was highly addictive, he continued to take it and over time became his permanent “patient.” His wife Tatyana Lappa did not accept this state of affairs and, together with I.P. Voskresensky, was able to rid the writer of this habit. But his medical career was over, since morphinism was considered an incurable disease. Later, having overcome the habit, he was able to start a private practice. This was useful, since there were battles in Kyiv and its suburbs, the government was constantly changing, and qualified medical care was required. This time is reflected in the novel “The White Guard”. Not only but also members of his family appear there: sisters, brother, brother-in-law.

North Caucasus

In the winter of 1919, Bulgakov was again mobilized as a person liable for military service and sent to Vladikavkaz. There he settles down, calls his wife by telegram and continues to treat. Participates in military operations, helps the local population, writes stories. Basically he describes his “adventures”, life in an unusual environment. In 1920, medicine was finished forever. And a new milestone in life began - journalism and the so-called small genres (stories, novellas), which were published in local North Caucasian newspapers. Bulgakov wanted fame, but his wife did not share his aspirations. Then they began a mutual breakup. But when a writer falls ill with typhus, his wife nurses him, day and night, sitting next to his bed. After recovery, I had to get used to the new order, since Soviet power came to Vladikavkaz.

Difficult period

The twenties of the last century were difficult for the Bulgakov family. It was necessary to earn a living through hard daily work. This greatly exhausted the writer and did not allow him to breathe easy. During this period, he began to write “commercial” literature, mainly plays, which he himself did not like and considered unworthy to be called art. Later he ordered to burn them all.

The power of the Soviets increasingly tightened the regime; not only works were criticized, but also random scattered phrases collected by ill-wishers. Naturally, it became difficult to live in such conditions, and the couple left first for Batum, and then for Moscow.

Moscow life

Many people associated the image of Bulgakov with the heroes of his own works, which was later proven by life itself. Having changed several apartments, the couple stopped in a house at the address: st. Bolshaya Sadovaya 10, apartment No. 50, immortalized in the author’s most famous novel “The Master and Margarita”. Problems with work began again, in stores food was issued using cards, and it was extremely difficult to get these treasured pieces of paper.

On February 1, 1922, Bulgakov’s mother dies. This event becomes a terrible blow for him; it is especially offensive for the writer that he does not even have the opportunity to go to the funeral. Two years later there is a final break with Lappa. By the time of their divorce, Mikhail Afanasyevich was already having a stormy affair with Lyubov Belozerskaya, who became his second wife. She was a ballerina, a woman from high society. This is exactly how Bulgakov dreamed of the writer’s wife, but their marriage was short-lived.

Perechistenskoe time

The time of blossoming of Bulgakov's career as a writer and playwright is coming. His plays are staged, the audience greets them favorably, life gets better. But at the same time, the NKVD begins to take an interest in the writer and tries to accuse him of disrespect for the current government or something worse. How bans rained down: on performances, on publishing in the press, on public speaking. Then the lack of money came again. In 1926, the writer was even summoned for interrogation. On April 18 of the same year, the famous telephone conversation with Stalin took place, which again changed Bulgakov’s life for the better. He was hired as a director at the Moscow Art Theater.

Nuremberg-Shilovskaya-Bulgakova

It was there, at the Moscow Art Theater, that the writer met his third wife, Elena Sergeevna Shilovskaya. At first they were just friends, but then they realized that they couldn’t live without each other, and decided not to torture anyone. Shilovskaya's break with her first husband was very long and unpleasant. She had two children, whom the couple divided among themselves, and immediately after Belozerskaya gave Bulgakov a divorce, the lovers got married. This woman became a real support and support for him in the most difficult years of his life. While working on the most famous novel and during the period of illness.

"Master and Margarita" and recent years

Work on the central novel completely captured the writer, he devoted a lot of attention and effort to it. In 1928, only the idea for the book appeared; in 1930, a draft version was published, which went through significant transformations necessary for the text that everyone probably remembers by heart to be published. Some pages were rewritten dozens of times, and the last years of Bulgakov’s life were occupied with editing ready-made fragments and dictating the “final” version to Elena Sergeevna.

But dramatic activity did not stand idle in the last years of Bulgakov’s life. He stages plays based on the works of his favorite authors - Gogol and Pushkin, and writes “on the table” himself. Alexander Sergeevich was the only poet whom the writer loved. And one of those figures from whom Bulgakov was removed was planning a theatrical work about Stalin, but the Secretary General stopped these attempts.

On death's door

On September 10, 1939, the writer suddenly lost his sight. Bulgakov (the cause of his father's death was nephrosclerosis) recalls all the symptoms of this illness and comes to the conclusion that he has the same disease. Thanks to the efforts of his wife and sanatorium-resort treatment, the manifestations of sclerosis are receding. This allows you to even return to the abandoned work, but not for long.

The date of Bulgakov's death is March 10, 1940, twenty-five in the afternoon. He passed away into another world, stoically enduring all the suffering and pain. Leaving behind a rich creative heritage. The mystery of Mikhail Bulgakov’s death was not a secret at all: complications of nephrosclerosis destroyed him just like his father. He knew how it would end. Of course, no one could say exactly when this sad event would happen, when Bulgakov would die. The cause of death was obvious, but how much longer he could hold on to life was not.

The memorial service and funeral were very solemn. According to tradition, the death mask was removed from the writer’s face. It was decided to cremate Bulgakov, according to his will. Mikhail Afanasyevich's comrades in writing, colleagues from the Moscow Art Theater, and members of the Writers' Union came to the memorial service. Even Stalin’s secretary called, and after that a large epitaph was published in Literaturnaya Gazeta. He was buried at the Novodevichy cemetery, not far from Chekhov’s grave.

If you are concerned about the question: “Where is Bulgakov’s death mask kept?”, then the answer is simple: it went to the same posthumous casts, to a museum. At that time, such sculptures were made only in exceptional cases, which speaks of respect and veneration for Bulgakov as a talented writer, despite all the difficulties of his life’s journey. There is no, and could not have been, a clause in the writer’s will that included a death mask. Bulgakov was never interested in idle foppery, especially this kind. His colleagues decided to capture this very moment.

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 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 “he began to speak in a light, joking tone about “the last year, the last play,” etc. But since his health was in excellent, verified condition, all these words could not be taken seriously,” - we read in her letter to the writer’s brother in Paris. Doesn't this remind you of 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 long time Typical signs of a neurotic state with anxiety-phobic disorders were observed.

So, in the archive of M.A. Bulgakov found a medical form with a medical report: “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 Theatre”.

E.S. herself mentions such neurotic conditions and attempts to treat them. Bulgakov in the 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 accompanied him to the Theater, then I went for him.

“October 13th. 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. decided to be treated by hypnosis for his fears.”

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

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

In letters to V. Veresaev, also a doctor by profession, Bulgakov admitted: “I have become ill, Vikenty Vikentievich. 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, 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. Optometrist: “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. Strakhov.

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. Discharged receipt order for a visit (12 rubles 50 kopecks) and a prescription for the purchase of 6 leeches (5 rubles 40 kopecks).

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 about 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, apparently, were an episodic laboratory find,
since they were no longer detected. In the urine analysis according to Zimnitsky, isosthenuria was noticed.

In the study of peripheral blood dated 09/16/1939, no changes were detected.

“Polyclinic of the People's Commissariat of Health of the USSR (Gagarinsky pr-t, 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 in the collected E.S. Bulgakov's selection of materials could not be found.

However, there were also other analyses:

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

And quite 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 29th. 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 02.29.1940 (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 missed. Every little thing can be important 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 there was a lot of bloodletting - 780 g, severe headache.
This afternoon is 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 dimly lit room, wearing dark glasses over his eyes, wearing a black Master’s cap on his head, sitting in bed...”, - 08.11.1939.

The Union of Writers of the USSR takes part, as far as possible, in the fate of a colleague. Bulgakov is visited at home by the chairman of the Union of Writers A.A. Fadeev, about which we find an entry in the diaries of E.S.: “ October 18. There are 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 CRF, a sanatorium is not the most
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. 12/3/1939

Dear Lela!

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 a firearm, but, unfortunately, I don’t have one. Speaking more precisely 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. 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 E.S. Bulgakova gives a list of doctors who treated
and advised M.A. Bulgakov:

“Professors and doctors who treated Bulgakov during (M.A. Bulgakov’s) illness. Prof. Andogsky, Arendt, Rappoport, Zabugin, Aksenov, Zakharov; prof. Vovsi, prof. Strakhov. 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're talking about about the famous pathologist academician A.I. Strukov, his role in the “management of the sick Bulgakov” remains unclear.

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

Here it is appropriate to quote the words of M.O. Chudakova (“... he had vessels, like those of seventyhim an old man…”) and directed by Roman Viktyuk “... I remembered her (Elena Sergeevna. - L.D.) story about how Bulgakov was treated, it seems, from the kidneys, 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. with 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 live the last days badly, few people come, call. Misha ruled the novel. I wrote. Complains about his heart. At eight o'clock we went out into the street, but immediately returned - I could not, 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 kept 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 Narkomzdrav camp on 02/25/1940.

“Status: General serious condition, sharp severe headaches. Heart: dull tones. No arrhythmia is noted. The pulse is symmetrical on both hands, but uneven 74-92 in 1 minute. Blood pressure max. 195-200 min - 100. The impression of a preuremic 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 often carried out numerous laboratory studies. 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 private surgical hospital of A.V. Chegodaeva, which in 1922 became the central medical and diagnostic institution of Moscow and the periphery. Subsequently, over the course of 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 care scientific and then the creative elite of the state.
In 1939, this medical institution was renamed the Central Polyclinic 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 at 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 March 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 light of modern ideas about medicinal 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 result, 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 supper.”

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 prescription of medications to the writer (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 his wife, have for some time become the main problem of the writer’s health: “ 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 thoughts 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 the writer already had some, albeit minor, symptoms 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 exactly 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 came 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.” .

And 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. During 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 Mikhail Bulgakov’s illness is to a certain extent reminiscent of the clinical situation of the Russian Emperor Alexander III, who was once 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 Bulgakov's last illness, his sister often visited and took care of his dying brother. On November 8, 1939, Sister Nadya informed her of the writer's illness. November seventeenth

1939 B. wrote: “ Dear Nadya! Today I visited 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 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 February 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 the latest urine tests 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.

"Encyclopedia of Death. Chronicles of Charon"

Part 2: Dictionary of Selected Deaths

The ability to live well and die well is one and the same science.

Epicurus

BULGAKOV Mikhail Afanasyevich

(1891 - 1940) Russian writer

His illness became apparent in the fall of 1939 during a trip to Leningrad. The diagnosis was as follows: acutely developing high hypertension, renal sclerosis. Returning to Moscow, Bulgakov fell ill until the end of his days.

“I came to him on the very first day after their arrival,” recalls the writer’s close friend, playwright Sergei Ermolinsky. “He was unexpectedly calm. He consistently told me everything that would happen to him for six months - how the disease would develop. He called weeks, months and even dates, defining all stages of the disease. I didn’t believe him, but then everything went according to the schedule he himself had drawn... When he called me, I went to him. One day, looking up at me, he spoke , lowering his voice and using some unusual words, as if embarrassed:

I wanted to tell you something... You see... Like every mortal, it seems to me that there is no death. It is simply impossible to imagine. And she is.

He thought for a moment and then said that spiritual communication with a loved one does not go away after his death, on the contrary, it can intensify, and this is very important for this to happen... Life flows around him in waves, but no longer touches him. The same thought, day and night, no sleep. The words appear visibly, you can jump up and write them down, but you can’t stand up, and everything blurs, is forgotten, disappears. This is how beautiful satanic witches fly over the yar, just as they fly in his novel. AND real life turns into a vision, breaking away from everyday life, refuting it with fiction in order to crush vulgar vanity and evil.

Almost until the very last day, he worried about his novel, demanded that this page or that page be read to him... These were days of silent and unrelieved suffering. The words slowly died in him... The usual doses of sleeping pills stopped working...

His entire body was poisoned, every muscle ached unbearably at the slightest movement. He screamed, unable to stop himself from screaming. This scream is still in my ears. We carefully turned it over. No matter how painful it was for him from our touches, he stood strong and, even groaning quietly, said to me barely audibly, with only his lips:

You do it well... Okay...

He's blind.

He lay naked, only with a loincloth. His body was dry. He lost a lot of weight... Zhenya, Lena’s eldest son (Elena Sergeevna Bulgakova’s son from her first marriage), came in the morning. Bulgakov touched his face and smiled. He did this not only because he loved this dark-haired, very handsome young man, coldly reserved in an adult way - he did it not only for him, but also for Lena. Perhaps this was the last manifestation of his love for her - and gratitude.

On March 10 at 4 o'clock in the afternoon he died. For some reason it always seems to me that it was at dawn. The next morning - or maybe the same day, the time has shifted in my memory, but it seems to be the next morning - the phone rang. I came up. They spoke from Stalin's Secretariat. The voice asked:

Is it true that Comrade Bulgakov died?

Yes, he died.

The one who spoke to me hung up."

To Ermolinsky’s memoirs one should add several entries from the diary of Bulgakov’s wife Elena Sergeevna. She testifies that in the last month of his life he was deep in his thoughts, looking at those around him with alienated eyes. And yet, despite physical suffering and a painful mental state, he found the courage in himself to joke, when dying, “with the same power of humor and wit.” He continued to work on the novel “The Master and Margarita”.

Here are the latest entries from the diary of E. S. Bulgakova:

I dictated a page (about Stepa - Yalta).

Work on a novel.

Terribly hard day. “Can you get Eugene’s revolver?”

He said: “All my life I despised, that is, I did not despise, but did not understand... Philemon and Baucis... and now I understand, this is the only valuable thing in life.”

Me: "Be courageous."

In the morning, at 11 o'clock. “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... Sergei is in the next room.”

12.40:

"Happiness is lying for a long time... in the apartment... of a loved one... hearing his voice... that's all... nothing else is needed..."

At 8 o’clock (to Sergei) “Be fearless, that’s the main thing.”

In the morning: “You are everything to me, you replaced the entire globe. I saw in a dream that you and I were on the globe.” All the time, all day long, unusually affectionate, gentle, all the time loving words - my love... I love you - you will never understand this.

In the morning - meeting, hugged tightly, spoke as tenderly, happily, as before before the illness, when they parted for at least a short time. Then (after the attack): die, die... (pause)... but death is still terrible... however, I hope that (pause)... today is the last, no, the penultimate day...

Without date.

Strong, drawn-out, upbeat: “I love you, I love you, I love you!” - Like a spell. I will love you all my life... - Mine!

"Oh my gold!" (In a moment of terrible pain - with force). Then, separately and with difficulty opening his mouth: go-lub-ka... mi-la-ya. When I fell asleep, I wrote down what I remembered. “Come to me, I will kiss you and cross you just in case... You were my wife, the best, irreplaceable, charming... When I heard the click of your heels... You were the most the best woman in the world. My deity, my happiness, my joy. I love you! And if I am destined to live, I will love you all my life. My queen, my queen, my star, which has always shone for me in my earthly life! You loved my things, I wrote them for you... I love you, I adore you! My love, my wife, my life!" Before this: "Did you love me? And then, tell me, my friend, my faithful friend..."

16.39. Misha died."

And one more thing. Valentin Kataev, whom Bulgakov did not like and even once publicly called an “ass,” tells how he visited Bulgakov shortly before his death. “He (Bulgakov) said as usual:

I am old and seriously ill. This time he wasn't joking. He was truly terminally ill, and as a doctor he knew this well. He had an exhausted, sallow face. My heart sank.

Unfortunately, I can’t offer you anything other than this,” he said and took out a bottle of cold water from behind the window. We clinked glasses and took a sip. He bore his poverty with dignity.

“I’ll die soon,” he said dispassionately. I began to say what they always say in such cases - to convince him that he was suspicious, that he was mistaken.

“I can even tell you how it will be,” he interrupted me without listening to the end. “I will lie in a coffin, and when they begin to carry me out, this is what will happen: since the stairs are narrow, they will begin to turn my coffin and the right corner will will hit the door of Romashov, who lives on the floor below.

Everything happened exactly as he predicted. The corner of his coffin hit the door of the playwright Boris Romashov..."

10th of March. 16.39. Misha died.

Valentin Kataev said that shortly before his death Bulgakov told him:
"I will die soon. I can even tell you how it will be. I will lie in a coffin, and when they begin to carry me out, this is what will happen: since the stairs are narrow, they will begin to turn my coffin and, at the right angle, it will hit the door of Romashov, who lives on the floor below.”
Everything happened exactly as he predicted.
The corner of his coffin hit the door of playwright Boris Romashov.
In the fall of 1939, during a trip to Leningrad, Bulgakov was diagnosed with acutely developing high blood pressure and renal sclerosis. As a doctor, Mikhail Afanasyevich understood that he was doomed.
Returning to Moscow, he fell ill and never got up. He suffered terribly, every movement brought unbearable pain. He was unable to hold back his scream; the sleeping pills did not help. He's blind.

Latest entries from the diary of E. S. Bulgakova:
January 1, 1940.
... Quietly, by candlelight, we met New Year: Ermolinsky - with a glass of vodka in his hands, Seryozha (son of E.S.) and I - with white wine, and Misha - with a beaker of the mixture. They made a stuffed animal of Misha’s disease - with a fox’s head (from my silver fox), and Seryozha, by lot, shot him...
28 January.
Working on a novel.
1st of February. Terribly hard day. “Can you get a revolver from Evgeniy?” (Evgeny Shilovsky is Elena Sergeevna’s previous husband, a military leader).
February 6.
In the morning, at 11 o'clock. “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... Sergei is in the next room.”
12.40:
“Happiness is lying for a long time... in the apartment... of a loved one... hearing his voice... that’s all... the rest is not needed...”

February 29.
In the morning: “You are everything to me, you have replaced the entire globe. I saw in a dream that you and I were on the globe.” All the time, all day long, unusually affectionate, gentle, all the time loving words - my love... I love you - you will never understand this.
March 1.
In the morning - meeting, hugged tightly, spoke as tenderly, happily, as before before the illness, when they parted for at least a short time. Then (after the attack): die, die... (pause)... but death is still terrible... however, I hope that (pause)... today is the last, no, the penultimate day...
March 8.
"Oh my gold!" (In a moment of terrible pain - with force). Then, separately and with difficulty opening your mouth: go-lub-ka... mi-la-ya. When I fell asleep, I wrote down what I remembered. “Come to me, I will kiss you and cross you just in case... You were my wife, the best, irreplaceable, charming... When I heard the click of your heels... You were the best woman in the world. My deity, my happiness, my joy. I love you! And if I am destined to live, I will love you all my life. My queen, my queen, my star, which has always shone for me in my earthly life! You loved my things, I wrote them for you... I love you, I adore you! My love, my wife, my life! Before this: “Did you love me? And then, tell me, my friend, my faithful friend...”
10th of March. 16.39.
Misha died.

Typically, a writer describes something that has already happened. Bulgakov had the gift of foresight - what he wrote about happened later.
He also predicted his own death. He named the year and even described her circumstances.
“Keep in mind,” he warned his wife, 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.” Elena Sergeevna took an oath and subsequently fulfilled it.
She forced him to be regularly examined by doctors, but even the most thorough examinations revealed nothing. Meanwhile, the appointed time (Elena Sergeevna’s word) was approaching, and when the last year arrived, Bulgakov, in his usual joking tone, informed her about it.

Elena Sergeevna Bulgakova

In September 1939, the Bulgakovs went to Leningrad, and while walking along Nevsky Prospect, Mikhail Afanasyevich’s vision began to darken. The professor who examined Bulgakov on the same day said: “Your case is bad.”
Everything repeated itself as 33 years ago at the beginning of September 1906. Then Bulgakov’s father suddenly began to go blind. Six months later he was gone. He did not live a month before his 48th birthday. Mikhail Afanasyevich was also at this age on the day of his first attack of sudden blindness.
Since Bulgakov was a doctor by training, he understood perfectly well that temporary blindness was only a symptom of the disease from which his father died, and which he inherited to his son.


Father of M. A. Bulgakov - Afanasy Ivanovich
Bulgakov, ordinary professor of the Kyiv
Theological Academy, Doctor of Theology

Bulgakov has a series of stories, “Notes of a Young Doctor,” in which the narration is told on behalf of a young doctor who has just received his diploma and was sent to work in the Russian outback. There are a lot of characters in this series: both the protagonist’s colleagues and his patients. And one more character, between whom the main conflict occurs and the main character. This character is death. She is present in every story.


Memorial plaque in honor of M A Bulgakov,
installed on the building of a regional hospital in Chernivtsi (Ukraine),
where in 1916 he worked as a surgeon

Conflict with death is characteristic of all creativity, and indeed of the writer’s entire life.
At the end of 1921, he could not shake the feeling that someone close to him was about to die. In January 1922, his mother died of typhus.

Varvara Mikhailovna - the writer’s mother

In the fall of 1922, Bulgakov wrote a short story, “The Red Crown.” Main character story loses his brother, and he appears to him wearing a red crown. The crown is an identifying sign of death. The action of "Red Crown" takes place in a psychiatric clinic. Later, many other heroes of Bulgakov will get there.
Bulgakov is not afraid of death as such; literary oblivion is much more terrible for him. Sometimes he even blurts out: “I wish for nothing but death.”
What is this? Suicidal tendencies? In no case. Bulgakov had a very definite view on this method of dying - he considered it unacceptable. The fact is that at the age of 23 he witnessed a suicide. His friend shot himself almost in front of his eyes. Death did not come immediately. Bulgakov, as a doctor, tried to save his friend, but only prolonged the agony. It is not for nothing that in “The Master and Margarita” suicides appear before the reader as subjects of the devil.
However, a month and a half before his death, he writes: “As you know, there is one decent type of death - from a firearm, but, unfortunately, I don’t have one.
It is indecent, in his opinion, to die in a hospital. Woland in “The Master and Margarita” says: “What is the point of dying in a ward amid the groans and wheezes of the hopelessly ill? Isn’t it better... having taken poison, to move to the sounds of strings?..”
Many of his heroes commit or are about to commit suicide. Thus, an almost Hamlet-like question runs through all of Bulgakov’s work, and, perhaps, throughout Bulgakov’s life: to shoot or not to shoot?..
The hero of his story “Morphine”, Doctor Polyakov, who is addicted to the drug and was unable to overcome his terrible addiction, decides to shoot. It must be said that Bulgakov himself went through this addiction, but he had the strength to give up the drug.

But let's return to death. It is with her help that Levi Matthew tries to save Yeshua (“The Master and Margarita”) from suffering on the cross, but God or providence prevents him from doing this.
In general, in Bulgakov’s works, only lightweight, useless people die an easy death: Berlioz in The Master and Margarita, Feldman in The White Guard. Those whose life has meaning not only for themselves, experience great torment before leaving it - be it the wandering Jewish writer Yeshua Ha-Nozri or the Russian writer Mikhail Afanasyevich Bulgakov.
Bulgakov wrote his main novel “The Master and Margarita” until his death, but never finished the work (it was completed by his wife, Elena Sergeevna). Although in one of the preparatory notebooks for the novel, the writer writes an order to himself: “Finish it before you die!..” Alas...


“The Master and Margarita”: “Manuscripts don’t burn...”

In 1939, Bulgakov wrote a play about Stalin (making a deal with the Devil?). At first, the play is received well and they even begin to prepare for production, but its main character personally decides not to stage the play. This is a huge psychological shock for Bulgakov. This is what gives impetus to the rapid development of the disease.
Bulgakov, who was traveling to the Caucasus to see the location where the play takes place, was literally sent back halfway by a telegram “from above.”
Here is what Elena Sergeevna writes: “After three hours of frantic driving we were at the apartment. Misha didn’t allow the lights to be turned on: the candles were burning!”
Fear of light was one of the symptoms of the disease.
“He walked around the apartment, rubbed his hands and said – it smells like a dead man.”
There were 207 days left until death.
Photophobia, temporary blindness - in fact, all these are symptoms of a disease not of vision, but... of the kidneys. Hypertensive nephrosclerosis. The writer’s father died from this disease, and now he himself was dying from it.
For reference
Nephrosclerosis (synonym: “wrinkled kidney”) – pathological condition, in which the kidney tissue is replaced by connective tissue, and the kidney itself decreases in size (“shrinks”), while its functions are disrupted until the kidney stops working completely.
Bulgakov once told one of his friends: “Keep in mind, the most vile disease is the kidneys. She sneaks up like a thief. Stealthily, without giving any pain signals.
This is exactly what happens most often. Therefore, if I were the chief of all police, I would replace passports with a urine test, only on the basis of which I would put a registration stamp.”
Let us remember that the first time temporary loss of vision occurred in Leningrad. The Bulgakovs return to Moscow, where Mikhail Afanasyevich is examined by the future general of the medical service, Miron Semenovich Vovsi. He strongly recommends that the writer go to the Kremlin clinic. The wife also insists, but Bulgakov reminds her of an old promise.
Already at the door, Vovsi says: “I don’t insist, since it’s a matter of three days.” However, Bulgakov lived for another six months.


Miron Semenovich Vovsi (1897-1960) – Soviet therapist and
medical scientist. Doctor of Medical Sciences (1936), Professor (1936),
Major General of Medical Service (1943). Honored Worker
sciences of the RSFSR (1944), academician of the USSR Academy of Medical Sciences (1948). Author scientific works,
mainly about the treatment of diseases of the kidneys, lungs, organs
blood circulation; developed the main provisions of the military field
therapy, of which he is one of the founders.

On the first day after returning from Leningrad, the Bulgakovs were visited by Sergei Ermolinsky (the same one to whom Bulgakov told about the insidiousness of the kidneys). Mikhail Afanasyevich consistently described to him how the disease would develop. He named months, weeks and even dates.
“I didn’t believe him,” Yermolinsky admitted, “but then everything went according to the schedule he himself had drawn.”
On October 10, Bulgakov writes a will, according to which, everything that belongs to him, and, first of all, copyright, passes to Elena Sergeevna.
Bulgakov died hard. He was tormented by pain, but death still did not come. On February 1, 1940, he turns to his wife: “You can get it from Evgeniy (son of Elena Sergeevna - auto) revolver?" He asked heaven for death. Anna Akhmatova understood this state of his very well and later reflected in her poems:
And you are a terrible guest
He let me in
And he was alone with her.


M. A. Bulgakov on his deathbed

Mikhail Afanasyevich Bulgakov died on March 10, 1940.
Before the funeral service, Moscow sculptor S. D. Merkurov removed the death mask from M. Bulgakov’s face.


Bulgakov's death mask

First they said goodbye to the deceased at home, then the coffin was transported to the Writers' Union. There was no music at farewell (Bulgakov himself asked for this). Playwright Aleksei Faiko, the Bulgakovs' neighbor on the landing, spoke at the memorial service. From the Writers' Union we went to the crematorium.
For a long time there was no monument at the grave of Mikhail Bulgakov. There were many offers, but Elena Sergeevna refused them all. Once she went into the workshop at the Novodevichy cemetery and saw some kind of block in the pit. The director of the workshop explained that it was a gologotha, a stone taken from Gogol's grave, since a new monument had taken its place. Elena Sergeevna installed a calvary on her husband’s grave.


Grave of Mikhail Afanasyevich and Elena Sergeevna Bulgakov
at the Novodevichy cemetery in Moscow

Bulgakov had a special relationship with Gogol. Needless to say, the "devilry" present in many of Bulgakov's works is the adherence to Gogol's traditions.
In one of the letters, he describes his dream: “... A well-known little man with a sharp nose and big crazy eyes ran into me at night. He exclaimed: “What does this mean?!” It wasn't just a dream. Gogol was outraged by Bulgakov’s free staging “ Dead souls". The same letter contains the phrase addressed to Gogol: "Cover me with your cast-iron overcoat." Maybe not with an overcoat, but with a stone...
Being already on the edge of the grave, the blinded Bulgakov asked to read to him about the last days and hours of Gogol.
And about the last days and hours of Bulgakov, his neighbor, screenwriter Yevgeny Gabrilovich, told: “We heard from our apartment how he was dying. Anxious voices, screams, crying. Late in the evening from the balcony one could see a green lamp covered with a shawl, and people, sleeplessly and mournfully illuminated by it. Gabrilovich does not write how many such evenings, days, nights there were, but he especially remembered the last one. He remembers how he writes: “a terrible, powerless, piercing female scream.”
But she still got to the diary and wrote down: “16.39. Misha died."


Diary of Elena Sergeevna Bulgakova