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The story opens with a description of a lunatic asylum, ward no. six, in a provincial hospital. The ward has five pitiful inmates—including the "imbecile" Jew Moiseika—and is overseen by a coarse porter named Nikita. The narrator describes how a university-educated inmate named Ivan Gromov drove himself mad with paranoia and was admitted to the asylum. The hospital is run by Dr. Andrei Yefimich Rabin, a "strange man" who became a doctor to humor his father, after actually wanting to become a priest. Rabin begins his career as a highly motivated physician who looks after his patients with the greatest of care. However, he is soon disillusioned by the "uselessness" of his task, neglects to visit the wards, and becomes indifferent to his patients' plight. Rabin eases his conscience with the thought that every man is born to die and concludes that "suffering leads man to perfection."
The doctor fills his time reading books and discussing questions of immortality with the postmaster Mikhail Averianych. Rabin proposes to his friend that life is "a vexatious trap" in which mankind's only solace is the company of other intelligent men. As Rabin grows more preoccupied with death and the meaning of life, he turns away from Mikhail and toward Gromov for intellectual companionship. Initially spiteful and hostile, the lunatic mocks Rabin for his "rationalizations" and stoic philosophy. Gromov's attitude then softens to one of "condescending irony" as he sees how the doctor values his opinions. The hospital staff grows concerned for Rabin's sanity, and even the doctor notices "an air of mystery" all around him. Things come to a head when Rabin is invited to attend a committee meeting that is actually an inquiry into his psychological health. Rabin is "insulted and angered" by this patronizing treatment and decides to go on a trip to Moscow and Warsaw with Mikhail.
The trip is not a success as Rabin grows annoyed with his friend and spends all of his money on paying their expenses. On his return, the doctor finds that he has been ousted from his post by Dr. Khobotov and fired without a pension. Although Mikhail vows to pay back all the money he owes, Rabin sinks into a fatalistic depression. He decides that every facet of his life is "trivial and inconsequential" and is rudely dismissive of Dr. Khobotov's and Mikhail's offers of help. Although he later apologizes for his outbursts, Rabin finds himself tricked by Khobotov into entering ward no. 6. Once there, Rabin finds that he cannot leave and fearfully concedes that he is being shown "real life" for the first time. Egged on by Gromov, Rabin is beaten by Nikita for daring to protest at his incarceration. The doctor miserably concludes that just as he unconsciously abused the lunatics during the past, so he too is being unjustly treated. The following day, Rabin dies of an apoplectic stroke. Before he passes into "oblivion forever," the doctor rejects the philosophy of immortality and has a vision of running deer. Only the doctor's old cook and his faithful friend Mikhail attend the funeral.
As one of Chekhov's longer and more politicized stories, "Ward No. Six" was published to universal acclaim in 1892. It explores the conflict between reality and philosophy—namely, how people intellectualize reality to justify their own inaction. These two conflicting ideas are personified in the lunatic Gromov and the apathetic Dr. Rabin. A die-hard realist, Gromov declares that Rabin's isolationism is only "laziness, fakirism and stupefaction." This is a harsh but essentially true judgment. In particular, we see that the doctor retreats into the comfort of "rationalization" to assuage his own conscience. Rabin knows that the hospital is an "immoral institution...prejudicial to the health of the townspeople," but he feels no compassion for its patients or inmates. As he remarks to Gromov, there is "nothing but idle chance" in his being a doctor and in Gromov being an asylum patient. Rabin thus justifies his indifference to others' plight by suggesting that everything is subject to chance. This doctrine is both unconvincing and heartless, and the author seems to scorn Rabin's philosophy. We see how Rabin, a self-confessed stoic, is forced to confront pain and loneliness. Ultimately, goaded on by Gromov, the doctor ends up condemning the senseless reality of suffering and rejecting his previous philosophy. The tale's supreme irony is that this conversion occurs within an asylum that the protagonist had held to be permissible, on the grounds that it was provided for by chance.
But ward no. six is more than a setting for Rabin's moral conversion, it is also a microcosm of Russian society. The porter Nikita monitors his inmates like a prison warden; Moiseika represents the capitalist mindset with his fascination for collecting money; and Gromov personifies society's activist element, railing against injustice. This paranoid lunatic condemns the status quo: Gromov is a radical who dares to challenge what David Margarshack terms Rabin's "non- resistance to evil." To better understand Chekhov's sympathetic characterization of Gromov and his condemnation of Ragin, one should note that the author visited the notorious Sakhalin prison in 1890. Chekhov was profoundly affected by his experiences at the prison, where he surveyed the inmates and witnessed first- hand the horrors of prison life. It thus comes as no surprise to see the author challenging society's dehumanization of criminals and lunatics in "Ward No. Six." In particular, he questions the abuses committed by officials whose authority is upheld by the state. However, Chekhov does not use his story to force a personal or political philosophy onto his readers. Ultimately, we are left to make up our own minds on the issue of state control and institutional corruption. "Ward No. Six" is a work that raises important issues regarding the relationships between citizens and state, and between people in positions of power and those whom they incapacitate.
Similarly, although he deals with broad philosophical and moral questions in this tale, Chekhov never overlooks his passion for details. We read that Rabin's asylum-issue shirt is too long and that his dressing gown "smelt of smoked fish." These descriptions subtly evoke the mood of the ward as well as making Rabin's experiences seem more pathetic. The scent of smoked fish lingers in our noses as it does Rabin's: it is something that cannot be reasoned away and, as such, symbolizes the miserable reality of the doctor's new life.