The struggle for survival is the main theme of the book. The men in the Kolyma camps, by and large, want to survive. Indeed, that is the only desire left in them. Many of the political prisoners have other issues. They are often former Communist party cadre, who did not keep up with the new trends of brutality of the dictatorship of Stalin. For most of the men, however, the struggle for survival is all they can think about anymore. They are exhausted working in the mines and their food supply is not adequate. In addition, the political prisoners must deal with the criminal element, that is given better conditions and more freedom. The likelihood of criminals surviving Kolyma is significantly higher since they can often get administrative jobs and get time to recuperate from the vicious cold work in the gold mines. Many of the political prisoners that do survive are the ones able to stay in hospitals. As shown in the story "Shock Therapy," this creates a huge incentive to fake physical conditions and diseases. In the story "A Piece of Meat," the reader sees the criminal element as well using hospitals as places to rest