6.12.1913  -  12.12.2002

Books of N.M.Amosov


Translated from the Russian by Alexander kafirov
English translation © Alexander Kafirov 1990 Printed in the USSR
Photos are reproduced here with kind permission from the author
and the Radio and Telegraph Agency of the Ukraine (RATAU)

The theme of Death is stronger than the theme of Love

I begin this new book about my life at four in the morning. I've been tossing and turning all night. I took a sleeping pill but it's useless; I just can't sleep.

And the reason for my insomnia is a frequent one: a woman I operated on yesterday is in critical condition. I hardly keep myself from calling the hospital, knowing that you cannot keep doctors-on-duty in the intensive care ward till Doomsday. And then I fear they will say "She has died."

She is the principal of a rural school, thirty years of age, but couldn't work for half a year already. She'd lost all hope.

"It's a very dangerous situation. I'll have to sew in two artificial valves."

Her lips were pursed; she is tense. She's made up her mind to fight against fate.

"Do it. I simply can't endure it any longer. I put all my hopes on you."

She puts all her hopes on me... I wish I could be so certain. "Tell your relatives to come. The operation will be in three days. On Thursday."

I knew enough of her life as was necessary for me to take a decision. No more. I cannot be sentimental before an operation. Let her children and her husband, and her sick father, and her class of schoolchildren whom she abandoned after the winter holidays when she could not work any more stay far from my ruminations. All this would be later... if... ever.

Her medical history is all I need now: "Aortic incompetence, stenosis and mitral incompetence, and additionally, extensive mitral calcification. Dense liver almost up to the navel, despite diuretics and three months of treatment in a specialized therapeutic department. Dyspnea even at rest." And still she keeps her spirits up:

"Don't worry... I'm still strong. I still do my own laundry, although sitting."

Her X-ray: greatly enlarged heart, on the left its shadow almost touches the ribs. A special examination has confirmed the diagnosis and pointed to low reserves of the cardiac muscle. But they still allow for an operation.

All this is in the past. I recall it to distance myself. Different "whys" don't leave me in peace. Why is the blood pressure high? Why is there no urine? Why does she not wake up?... Larisa (on duty in the intensive care ward) says: "Cardiac weakness." But why? It always torments me: why is it that before the operation, the heart managed somehow with three defective valves, so now, when these defects have been corrected, why cardiac weakness?

You don't have to pretend. You very well know that you were not able to organize physiological research capable of giving answers to all these "whys". Other clinics have them, and their results are better...

Five o'clock. Soon I'll have to get up.

The operation was a success. The whole team was up to the mark: assistants did what they had to — no less and no more. The latter is very important. Lyubochka Veselovskaya, a scrub nurse, was at her best. (It is always a pleasure for me to sense her presence at my right sleeve.) I did not confide in the anesthesiologist — he was too self-assured. Vitya Maximenko was at the heart-lung apparatus (the apparatus for artificial blood circulation; AIK after the Russion words); he knows his job and is half-way through his doctoral dissertation...

Apart from the two defects that we expected, there was another one — stenosis and tricuspid incompetence, something that could be easily corrected. (It was I who invented this technique. A perfect one. I say this to gain a foothold.) We replaced both the aortic and mitral valves with prostheses. The valves have a coated saddle to prevent thrombosis (also my invention). The AIK machine ran for 105 minutes — not too long.

Everything was done without the slightest error. Then why was it a failure?

As I was leaving, my assistants were closing the incision. Diastolic pressure — 120, urine began to trickle... But when I returned to the intensive care ward to check in an hour, my patient was still there. Systolic pressure was low, and diastolic high; no urine, no sign that she was waking up... The self-sufficient anesthesiologist let me down: did not send for me... I cannot be a Jack-of-all-trades. A stinging thought: "If you don't trust someone, stay with the patient yourself or don't operate..." These inner dialogues tormented me. My doubts give me no peace...

I go over yesterday's events once more in slow motion. That morning, before rolling the patient to the operating room, I sent for her relatives. Brutal reality: a patient may die, but the relatives remain alive. They should know what you don't dare tell the patient — they cannot be killed by the truth.

(...If the relatives had refused to allow me to operate, how simple it would have been now. I could have slept well and would go to the clinic fresh...)

Surgeons like complicated, even risky operations. They are the delights of the profession. While talking with patients and relatives, they may subconsciously push them to decide in favour of the operation. I have feared this all my life and strictly see to it that this is done only in the interests of the patient. No, no, I have not sinned. (Are you sure? Yes.)

But this talk with relatives before the operation is always painful. The three entered my office. In front — a lean elderly woman in a jacket long out of fashion with a Hero of Labour medal on her lapel; she was followed by two men — peasants, judging by their faces and attire.

"I am her aunt. And this is her husband and he's her brother..."

They look at me with distrust and I feel not quite myself. "Take her and leave me in peace." But, in all honesty, how long will she live without the operation?

True, we shall have to replace two valves. Otherwise she will live for two years, with a bit of luck. But her condition will become worse with each passing day and eventually, she will be inoperable. (Inoperable, for sure.)

If the operation is successful, she will feel... say, more or less satisfactory and might even be able to work. Unfortunately, the operation is extremely dangerous. (I explain the reason for that.)

They look dismayed. What else could you expect? If even I, the surgeon, cannot give any guarantees I am absolutely sure I will not make any mistakes, but there are other people involved and there is always Nature herself...

I begin to feel pity for relatives. How can they decide if they know nothing? They can only have full confidence in the doctor, unblemished by doubts of his decency. Sometimes we hear such remarks as "You never miss a chance to open somebody up..." And this means to derive pleasure from an operation. (No, this is not the case with me.) Therefore I did not say what I was thinking: "If you have doubts, you'd better take her home."

For a long time, I have studied the nature of man: I have my own hypotheses, observations, books. (It may happen that I will write about it.) I have no delusions or idealizations. I feel deep sorrow for people who subject their kin to mortally dangerous operations. And shame. Shame for my profession and, for myself that I cannot save all of them, and cannot even say for sure whether they should be operated on or not. Every fourth patient dies after valve prosthetics, and with Fallot's tetralogy (narrowing of the entrance to the pulmonary artery and also a defect of the intraventricular septum - commonly known as a hole in the heart) isn't this permissable?

All this is so agonizing that for almost 15 years, I have been planning to give up surgery and go into cybernetics.

"Now, I've told you... Make your choice..."

The man that looks younger wants to say something. Will they, once again, plead for guarantees?

"You know... We are in mourning... Her father died the day before yesterday... There was nobody to take care of him since we are here. The heart."

Well, I never! Today you may have another corpse. Verily. How will you stand it? First impulse: "Then let's cancel it!"

"No, no, please, don't. We didn't tell her... If she finds out, she will never be able to make up her mind... And what will she do then? Die?"

It might be for the better if she doesn't make up her mind... How can I operate under such circumstances? But they are also right. To cancel and tell her would be too heavy a blow. And if they don't tell her — how long can they keep it a secret? Besides, she had already made up her mind... No doubt, it would be better to operate now. But I...

"Good. If that's the way you want it — we shall operate. Don't expect any news till three p. m., but then, please, one of you should be here. Anything might happen... Unfortunately..."

I can't pronounce sympathetic words and keep people's spirits up. And who will pity me? They are almost sure of success. People, in general, are optimistic. Or are they so sure of us? "If he dares, then, for sure, he knows what he is doing." That's what they probably think.

They left, and I kept sitting without a thought on my mind for about ten minutes, fully depressed.

Then I walked around the clinic, stepped in into the intensive care ward — to see the patient whom I had operated on the day before yesterday. That was no picnic, to be sure. A plump elderly woman with a serious defect.

Thank God, she is getting better. Even cheerful. Otherwise... And what do you mean by "otherwise?" You can't take the patient off the table after the first incision has been made. You can't tell her: "I won't operate — I'm too nervous."

I entered the operating room — the operation was already under way.

"Boys, please, be careful." I told them what had happened. They didn't say anything. And what did I expect them to say? "We swear to keep our mouths shut."

The relatives assailed me as I was leaving the operating room. I told them about the operation, that she had three defects, that I had sewed in two valves, and that everything seemed to be O.K.

"Thank you, thank you..."

"Wait a bit. The risk is still too high. She is still sleeping."


The rest I have already told you. Now I'm up at six in the morning. First I dress, then run — morning exercises. Shower. Food... Life goes on.


Evening of the same day.

There has been no miracle. The Lord has turned his face from me. And those unhappy relatives as well. In the morning, as I was writing, a small ray of hope sparkled: "What if she wakes up?" Such things did happen.

While I was negotiating the corridor to my office, I saw doctors from the intensive care ward. I did not ask them: "How are the things there?" What for? They would tell me at the conference. There was no need to fuss. Death does not like it.

A usual morning conference. There will be no operations today. It's Friday, a day of reports, reviews, and rounds — both mine and heads of departments — and discussions.

Surgeons reported on their operations of the day before. Briefly, indifferently and critically. That was our arrangement.

I also reported mine with all the attendant circumstances. I reproached the anesthesiologist, but did not attack him — I was not sure, after all, that he had made a slip.

The report of the doctor-on-duty was too optimistic: supposedly the systolic pressure increased, the diastolic had come down, and urine had begun to trickle. But the patient had not regained consciousness. (Could it be that we still had a chance?)

When I entered the ward after the conference, I immediatelly saw that she was in a bad way.

The face was swollen and pale. (And her hair — it was bright red — a rare color in the Ukraine...)

Natasha Vorobyeva, in charge of the intensive care ward today, reported:

"The pressure is being maintained only with large doses of drugs; no urine since eight in the morning, and analyses are very bad. Cerebral coma."

I don't have any miracle drugs up my sleeve. My years of personal experience prompt that there is no chance. Artificial respiration and drugs would only prolong the agony for another few hours. But that was what we need. It would be easier when the hope of her relatives had faded slowly away.

"Won't they have to commit both of them to the earth at once?"

I wanted to head for home, but I thought better of it. I dragged myself to Yakov Abramovich's department (Yasha, sometimes I called him Yashka) to select patients for the next week's operations. Formally, the department is known as a "rehabilitation department," since it is meant for post-op therapy of patients and restoration of their working capacity. They do this to the extent that it is possible and even have a sanatorium in the outskirts of the city (gymnastics and psychotherapy). But their main job is to treat patients who are admitted to the hospital for the second time with problems after previous operations. It would seem that this is a therapeutic department for our clinic, but half of their patients will be operated on for a second time. In fact it is an assembly point for most grave patients.

There are two surgeons in the department — Kolya Dotsenko and Seryozha Didenko. They perform so-called closed comissurotomies (dilatation of accreted mitral valve cusps) and I do valve prosthetics. No doubt, these are the most complicated operations.

I selected my high-risk heart patients and left the clinic through the back entrance. The relatives had not come to my office. Apparently the doctors in charge had informed them, and I was grateful to them for that.

The patient died on Friday night. An autopsy was performed. The heart was presented on Monday at the morning conference. Everything had been done correctly. The cause of death was cardiac incompetence, a weak cardiac muscle. The weight of the heart exceeded the norm by three times. So I could rest in peace and blame her disease for that.

I keep a diary. It's not that I scribble regularly, but once in a while... particularly on blue days. A few notes. Less than two notebooks in thirteen years. I peeped into my diary after this death when fear seized me: there were no changes.

I will cite only one entry with a happy ending. Exactly the way I put it:

30.XI.68. Friday. As for yesterday Operation: female, 35 years, second admission. 1st time — three years ago mitral+tricuspid stenosis, comissurotomy. Relapse. Planned to correct two valves. Knyshov opened the chest. Dense commissures, on the left, where the previous incision was made, failed to separate them from the lung. The right atrium is very tense. Began artificial circulation. Dissection of the right atrium. Examination: stenosis and incompetence of the tricuspid valve. Dissection of the interatrial septum: left atrium small, mitral valve barely visible. By touch. Incision —3 by 1.5 cm. Pronounced calcinosis. Fear: how will I sew in the valve prosthesis? Began to remove cusps with calcium piece by piece. In about 30 minutes I hear the fuss around the AIK machine. Leonard: "Reduce productivity, send for blood." N.M.: "Sew in only one valve." I could not do it any faster: under artificial circulation, everything must be done as quickly as possible. Dissected, put sutures through the valve ring (some parts had calcium on them). Began to implant the valve. Implanted and began to tie the knots. As soon as I finished the cuff came off the frame. Had to replace it with another valve. A nightmare! Sewed in another one. They were fussing around the whole while. I know already that the tube of the pump has broken. Connected up the tricuspid valve. That's the end of it. Switched off the AIK machine. 4.5 1 of blood ran out. A crack in the pump's tube. 15 mm. Productivity reduced from 3 do 1.5.

And as if nothing had happened! She woke up, and by night all parameters were normal. Today: bilirubin 8, hemoglobin dropped from 80 to 40 per cent. Used 17 ampules of blood; nurses and relatives donated their own, so it would be fresh for her.

But what a lot we have lived through! Rozana in particular. Today she is better and even smiles. Reassures me: examines the tubes each time. It's her word against mine.

Same day at seventeen hundred, had a meeting with the Minister on additional personnel for heart transplants.

An envoy from Kirillin, a top official. There is all hope that they will permit it. I am prepared to do anything to get additional personnel for this purpose. This official requested that, if possible, I did not mention heart transplants in the documents. The Minister treated us to coffee and red caviar sandwiches. I did not wait for an invitation but helped myself to the goodies. By that time I was hungry as a wolf. The meeting was over at 19.30.

2.XII. Monday. Tonight, my patient (Lyuba by name) felt bad. They sent for me, I came. Sputum. Intubation. Left the tube in her till five in the morning. Saw her in the afternoon: weak, hoarse. Tracheobronchitis. Turned on all the humidifiers in her room. I am not sure. I was told she wanted the operation so she could live.

Today I had reception hours as a member of Parliament. Apartments. Many unhappy people. Too difficult for me — these reception hours each Monday.

Then Lena Nikolaevna Leon and I drafted the list for additional personnel —30 specialists. Too many. They will never allow it. Everyone tells me: "Ask for more, they will cross out some of them for sure, and you will get what you need." I don't like it, but I gave in to their reasoning.

Tomorrow — Fallot's tetralogy after anastomosis (anastomosis between the pulmonary artery and the aorta). A repeat operation. I fear it. Not to forget a sleeping pill.


That's what my diary looks like. Self-expression. I made my notes in it when surgery wore me out.


And this has been going on my whole life. Almost my whole life — for the more than 40 years since I became a surgeon. True, I had a rather peaceful life before that: a year as a graduate student, a year as a staff physician in Cherepovets. And then during the war, I was chief surgeon of a field hospital, then — chief surgeon in Bryansk region. I've been at this clinic since 1952. I also made notes during the war. Twenty five years later they were published as the PPG 2266: A Surgeon's War. It has everything. It does not describe shellings, bombardments, attacks by the Germans or hunger. But it describes in full operations, deaths, the bitterness of mistakes and helplessness. In the summer of 1962, after one unhappy day I wrote The Open Heart. (That is when we have just begun artificial circulation.) Neither book is. good for light entertainment... This one isn't either.

Apparently, an outsider should be bored by all these detailed descriptions of hemorrhages, bronchial obstructions, cardiasthenias, cerebral embolism, sudden heart fibrillations, faults, damage of respiratory apparatuses, infarctions, cerebral hemorrhages, pneumonias and sudden inexplicable deaths, plain and simple. Painful talks with relatives. Monotony? Far from it. For me, all these cases are different. The only thing that stays the same is the feeling of guilt when a patient dies.

More than six hundred of my patients have expired following operations like the previous one. Two to three thousand hours of stress.

The nights before and after. Days of complications following operations and continuing till death. All this is mine. But the grief is theirs — their mothers', husbands', wives', and fathers'. Their grief is part and parcel of me. How big is it? It cannot be relieved by the lives of other patients who were saved and the happiness of other mothers...


Beginning of August. Heat, vacation. Not a real one, since for many years I have not taken my vacation all in "one piece." I operate for a week, then spend a week at home writing. I never go to resorts. Only twice I was at some health resort or other: in 1948 and 1967.

I am bored to death by long vacations.

It is high time I took a break: the last two weeks were good. Therefore nobody was taken to the intensive care ward and there were no suppurations.

How easy and pleasant it is when your patients do not die.

Both weeks I performed four operations, all of them complicated. Misha Zinkovskiy is on leave, therefore I selected children with congenital heart failure. My young department heads are eager to operate, but I do not want to use my authority. Used it only when it was necessary. Until now.

A surgeon has an indescribable feeling of omnipotence when he performs a complicated operation on a patient with a high risk of failure... It's as if he is the Almighty.

An urchin, transparent, a skinny runt of eight, weighs 29 kilograms; the heart is very big, decompensation. Diagnosis: "Complete anomalous drainage of the pulmonary veins." All his pulmonary veins run into a separate collector and enter the vena cava superior instead of the left atrium. The left side of the heart and, subsequently, the whole body, receive too little blood through the opening in the interatrial septum. That is why the boy is not growing at all. A complicated reconstruction must be done. At the same time no obstacles should be erected; artificial circulation should be discontinued in such a way that the left ventricle, which was weakened by idleness, will not be overloaded... So that there will be no air bubbles in the heart cavities so they will not reach the brain. So that the AIK machine would not have to work very long; otherwise the plasma proteins and thrombocytes will be destroyed and the blood will not coagulate...

O.K., let's not go into details. How satisfying it was when he opened the eyes and followed the instructions: "Move fingers of your right hand. Now your left. Move your right foot, now left... And now sleep!"


And it is so gratifying to tell his mother: "Everything is O.K. so far." So far... Much still lies ahead. (She was sitting withdrawn, small, slender, already not young, grey-haired.)

I was even more pleased when they told me in the evening: "Fully conscious, hemodynamics (circulation) and analyses are normal." And in the morning, when making rounds, I saw they had taken his tube out already, and he was asking for yogurt...

I am so eager to give all the technicalities of these eight operations and describe all the feelings that I experienced, but I will resist the temptation.

(You should not put on airs, old man. There was nothing extraordinary about it. The usual valves, tetrads, triads and sewing up of interventricular septa. Not so simple that your assistants can do it, but far from being the aerobatics of repeated multivalvular prostheses on the dying... Don't turn up your nose.)

Sixty-seven — pretty old for a heart surgeon. I know only a few surgeons in the world who could do that. Therefore I always watch myself. "How is it now?" And I don't see any difference between now and twenty or thirty years ago. I am convinced that I work even better.

Let's not say "better"; suffice it to say "not worse." The trouble is that nobody will tell you the truth, and could not even if dared. In evaluating any technical performance, there is a psychological motivation — how it "should be": bad — in a young and inexperienced doctor and in an old one — his hands are already trembling. That is the way they make the evaluation. Therefore, I have to search for my own criteria. Objective and independent, without prejudice. I have them: frequency of technical errors, quickness, and final results. It all depends on how complicated an operation is and how critical is the condition of the patient. At our clinic, we have stringent standards for all these indices. The list of operations for each day indicates the level of risk, which depends on the condition of the patient. The title shows how complicated it will be, the expected duration of artificial circulation — quickness, hemorrhage or complications, and last but not least, errors. In case of a fatality, we fill in a special card which lists all the errors made by those who operated — the result of discussion at the conference after the autopsy has been performed. At the end of the year, we sum up overall and individual results. They are discussed in the open.

See how efficient it is.

With only one exception: dictatorship.

The doctor in charge of a large surgical clinic is always a dictator. If he is a sap, then there is no clinic. Undivided authority and discipline, just like in wartime, is in order.

Therefore, I may criticize my subordinates objectively and give them all possible marks. If my tone of voice is explicit, nobody will dare to object. They will converse in whispers behind my back, whisper their indignation — and only that. And I can tell the reason for the death of my patient: whether it was disease or my assistants that were responsible. But the problem is that I may rest assured that everything was done correctly and that I am perfect. Human nature is so perfidious. It is important not to cross the danger line.

Therefore, apart from honest self-criticism (you cannot expect criticism from your subordinates) I have another method of self-control.

And it has a primitive name. "Voting." Direct, secret and equal.

Here is the just of it. Anya, my secretary, types up lists with a column of the names of department and laboratory heads, a total of twelve. They have to be evaluated in accordance with the post they are holding, according to their "personal qualities" and "efficiency." Opposite each name a voter gives his evaluation: "yes" (means "plus"), "no" (minus") and "zero" ("do not know", "cannot evaluate").

At the morning conference, without warning, these sheets are handed to all doctors and researchers — seventy of them. I explain the rules.

"Secrecy is guaranteed. The results will not be made public. Anyone who is concerned may come to me and ask about the results, providing he wants to know."

"You can fill these in any time today; don't rush. The ballot box, sealed with tape, is in the waiting-room."

Each time I finger through voting sheets with trepidation, counting my pluses, minuses and zeros... The first, the second and the third year.

Each time, up till now, I breathed a sigh of relief: the danger was over.

And, in fact, I have good stable indices. My professional characteristics — two or three minuses, my personal characteristics — five to seven. Five or ten percent condemn or even hate me — nothing to write home about. Take into account my dictatorial position: to be demanding without giving in, and it is not always possible to put my demands delicately. (I strongly recommend this evaluation procedure for all those in position of authority. Reliable feedback. And safe at the same time: you may not disclose the results.)

Last year, 1979, was quite good. For the first time in my life, I did not make a single fatal surgical error. There were no hemorrhages, eruptions of sutures, or incorrectly selected valves which had to be reimplanted, etc.

See how verbose was my digression. But nothing can be done. Heart operations have nothing to do with general guidance.


Red gladioli on top of the electric heater designed to look like a fireplace. On Friday I was visited by a young couple — both with artificial valves. The husband had two valves, and his wife had a mitral valve. Six years had passed after their discharge. They met in the clinic and married after treatment in a sanatorium. Their child is four. They came in for a check up. I will not say that they looked wonderful. Both were thin. His liver was not in the best of shape. They can hardly make ends meet. His wife is the bread winner, and their parents help them.

I took them to X-ray. His heart was enlarged and unreliable. Hers was better.

"We want another child... Does our physical condition make that feasible?"

I often hear such questions. They embarrass me and are even annoying. People are too frivolous.

"Isn't one enough? You might develop an embolism or something could go wrong with the valve... You know that yourselves without my telling you. Who will take care of your son or daughter then?"

"Nikolai Mikhailovich, don't worry about us; everything will be fine... And if worst comes to worst... Yura's parents are young."

"No, I don't recommend that you do it. It's too dangerous!"

The woman is confused.

"But what if I am already...? Does that mean an abortion?"

"You should have told me right away..."

"Yes, you guessed."

They look distressed. I am not sure they will follow my advice. They asked for vouchers to a sanatorium. A good couple. I'll have to do my best to support them. They gave me a photograph of them with the son.

I am worried about them and their child. And now they want a second... I should have said: "You're crazy!", but I could not bring myself to say it. Suffice it to recall their frankness... Every year, three percent of all patients with artificial valves die. Another four percent develop embolism. And they know all about it. "Valvers" have a peculiar brotherhood; they call each other on the phone and correspond with each other. Under such conditions, each day is a gift of Fate...

Some fifteen years ago, I used to give consultations to all the outpatients. Up to 100 patients on Mondays. New patients and old timers — they all came to see me, and I was in a direct contact with all of them — the suffering, the doomed, full of grief and fear. But among them were those who came for a check up: children who had become grown ups, men who took up their jobs once again, women who showed me photographs of children born after their operations... All this helped me to endure the failures.

Nowadays the clinic has been enlarged incredibly. More than two thousand operations a year. And there are almost 30,000 outpatients. I do not do consulting anymore, for I've climbed to the top of the pyramid of staff physicians, researchers, and heads of departments... There are a few patients who dare break through to me. Not because I refused them, but because of the myth: "He's an Academician." They are shy to trouble me. A pity. I miss positive emotions.

I know in my mind — it has been calculated — that I have performed about seven thousand operations (excluding the wartime ones). Of them — about four thousand on the heart, three and a half with the AIK machine, with artificial circulation, were the most complicated operations of the almost 30,000 performed by all surgeons in the clinic. And that is a whole township of people who work and enjoy life, and children who would have been dead for sure if it were not for me. That is, without juggling the facts, approximately 28,000 lives which I have saved. And I can claim my rights to their lives. (I have this right, since all the surgeons were trained by me, they all operate using my methods, some of them from the second generation already...) We even tried to evaluate the economic effect of the clinic: the contribution of the people we have saved to the national economy. And the figure was quite large — about six million roubles a year. Total expenditures for our clinic have been about two million annually.

That will do. I am on leave. I can afford not to think of the clinic, of surgery, of my work.

But what shall I do? What shall I think of?

I will write a book which I began at four o'clock in the morning, three weeks ago. I will sit at my desk for eight hours and type, since this is something I have to do. This is a need I cannot satisfy by talking with my kin: it makes me feel ashamed to be a burden of them, and they could care less about all this. Instead, I give vent to my feelings on clean paper. It cannot talk back or be bored with me.

This will be a book about myself and other people, about life, surgery and science, about the past and the future... I will tell the truth and only the truth, but not the whole truth. I cannot confide the whole truth even to paper: I am still a better surgeon than a lot of young men, and I don't plan to kick the bucket any time soon. I want to live surrounded by people. My self-expression on paper might touch them, and the feedback might lower my modest level of spiritual comfort. Therefore I will save the whole truth for my next (last?) book when the feedback will not be able to affect me.

(My dear, you use such cheap maxims that you should be ashamed of yourself. Let's not be sly: self-expression — this is all well and good, but you are also thinking of publishing this book.)

True, I entertain this thought. I am already spoiled by public attention and poisoned by fame. But not to the end. I would go on writing even without a small ray of hope.

Now let's define the content. So that readers will know in advance what they should not expect of me: romance.


Relatives and friends, in particular. Alas, they have almost all died. The pantheon? Love? Just a little bit, a long-standing one and within the safest limits.

Travel. Dogs. Books.

Events. Deaths. Fighting old age.

And a whole range of sciences, although the approach is amateurish Cybernetics. Psychology. Natural and artificial intellect. A little bit on society, but within reasonable limits.

But a lot about man. This is a subject that has interested me my whole life.

And then something else.

However, I don't have any plan in mind — everything will turn round and about. It is very difficult not to be carried away, and I do not see any reason for that.

It is a pity that I do not have a talent for writing. It seems to me that this is manifest in the ability to fancy all the details and to find words for thoughts and feelings. Mainly for feelings; original thoughts seldom come to one's mind. As far as feelings and words go — I am particularly touched by poets. Well, nothing can be done about it. I do not have this gift. And my claims are modest: no brilliance, mere information.

So, let us begin.

But first, let me introduce you to the "object" of my writing: our clinic.

We have three buildings. A new, five-storey one was built five years ago; the old three-storey one, now remodeled, has been functioning for almost twenty-five years. There is an old operating theater — we have been using for ten years now.

I will describe, in brief, the dislocation and the structure and will enumerate those whose names will be mentioned often in my notes.

The new building. The fifth floor. Acquired valvular diseases and heart blocks. Head of the department — Dr. of Sci. (Medicine) Leonid Lukich Sitar. (He is not yet forty, I call him Lyonya.)

The fourth floor. Acquired valvular diseases and IHD. Head — Gennady Vasilievich Knyshev, Dr. of Sci. He is the boss — the deputy director. (My post is unofficial, that of "supervisor.") Deputy — Vasya Ursulenko.

The third floor. Department of gerontological congenital heart diseases. Head — Mikhail Frantzevich Zinkovskiy, Dr. of Sci., who began to work in the clinic more than twenty years ago while still a student. His assistants — Seryozha Dekukha and Petya Ignatov, both Cand. of Sci., "senior researchers."

The second floor. Small children with congenital heart diseases. The youngest department head, Cand. of Sci. Alexander Stepanovich Valko. Tolya Tereschenko is his senior doctor. They are also in charge of patients with purulent complications. They are in a special section. Anna Vasilievna Malakhova is the head doctor in that section. She has been working with me since 1943 when we were together in a field hospital. (Poor thing, she has borne with me for so many years!)

The first floor. Intensive care, the focus of all our troubles, passions and joys. Patients are under supervision there after operations — for two days or more, depending on the seriousness and complications. (I visit it every day, sometimes several times a day.) Misha Atamanyuk is in charge of this department. Last year he defended his doctoral thesis; he is a surgeon and the secretary of our Party organization. There is no clear distinction between his assistants: there are no senior or junior ones. But still, there are candidates of science Sasha Vednev and Natasha Vorobieva; future candidates Sveta Petrova, Vitya Krivenliy and Andrey Govenko. And physicians Lyuoa, Larisa, Volodya...

On the same floor, in a separate wing are offices and rooms for doctors in the two most important services — anesthesiology and artificial circulation. Our chief anesthesiologist is Prof. Alexei Alexeyevich Tziganiy (I still call him Alyosha). His chief assistant is Oleg Malinovskiy, a candidate of science. We have many anesthesiologists — about twenty in all.

The artificial circulation laboratory. It is headed by Vitya Maximenko, a young doctor, future candidate of science. On his staff are distinguished technicians, for instance, Rozana Davydovna Gabovich (simply Rozana). She has been working with me for more than 25 years, and Dina Moiseyevna Appel who has been at the AIK machine for eighteen years.

On the ground floor of the main building are laboratories and diagnostic offices. Some of them have worked with me for a long time — Nelly Dmitrievna, Faina Afrikanovna, Valya Gurando. On the same floor is computer cybernetics. The chief is Ozar Petrovich Mintzer, also Dr. of Sci. Then there are a conference-hall, and a casualty ward...

An intensive care unit headed by Yakov Abramovich Bendet is in the old building. I have already introduced him to you. Professor Bendet has worked in the clinic for almost a quarter of a century.

The first floor is occupied by a blood transfusion centre (5 tons a year!). Its founder and the doctor in charge is Anatoly Nikolaevich Krishtof, a former surgeon, one of our old timers. The same floor shares room with the most important diagnostic unit, the so-called "Elema" — a cardiac catheterization and radio X-ray unit. Yuri Vladimirovich Panichkin is the head of this unit. Lina Brusan is his right hand.

On the ground floor are a pharmacy and an outpatient clinic that consults 30,000 patients a year.

The clinic is well-staffed — more than 700 people. Doctors of science, candidates of science and physicians, nurses and aids. Some of them do the work of several ordinary doctors. The head administrator is Victor Avvakumovich Zavorotny, Cand. of Sci., and his deputy, Miroslav Mikhailovich Shaketa.

They are all good people. And I love them. In fact, they are extremely good, since there are no squabbles, intrigues, complaints, or anonymous letters. No doubt, they are a different breed...