Nikolay Amosov    WORLD OUTLOOK

The prostrate body of Sasha. A corpse? Dima is standing on a stool sharply pressing Sasha's chest: a closed chest heart massage. Lenya is furiously squeezing the oxygen bag. Oxana is wringing her hands. The nurses are fumbling around not really knowing what to do. Pale faces, frightened eyes. A picture of utter despair.

Adrenalin! Have you tried adrenalin?'

'Not yet. We started the massage -'

'Marina! Two cubic millimetres! Quick!'

I want to massage the heart myself. Perhaps I can do that better: experience. Quiet, you fool! Dima is doing it very well, he is younger and stronger.

'Oxana, what do you see on the screen?'

'Nothing, because of the massage -'

No, nothing can be done. Nothing. How could I, how could I ? How could I sit up there, reading. A scientist!

'Dima, stop for a second! All right. Oxana, what do we have there?'

Silence. Tension. Oxana is watching the screen. It seems that all this takes an eternity.

Oxana sighs loudly.

'There are some irregular contractions.'

'Dima! Massage! Adrenalin!'

Keep going, keep going, Dima. Perhaps we shall succeed. Good God.

The adhesive tape has already been removed from the wound.

'Just a second, Dima. Stand by.'

A long needle, direct into the heart. One cube of adrenalin.

'Massage!'

One minute. Two. Silence.

It is dark in my soul. Despair. What for, what for? No, I shouldn't lament. There is no law of retribution here. Everything is clear. We are fools. Bungling idiots. Limited modelling installations. We need machines. But this does not help me now. I'm not a machine. I'm alive.

But what about Sasha? All right, let's see.

'Dima, stop massaging! Oxana, watch the screen! Somebody, take his pulse! Hey you, stop pumping the bag! Don't you know better?'

'Good contractions, about a hundred per minute.'

'Even pulse.'

However, all this information is superfluous. I can see the chest working. The heart has picked up, and picked up well.

'Pupils?'

'Contracted. They contracted immediately after the start of the massage.'

There is a collective sigh of momentary relief. Faces have become relaxed, eyes quiet. But within me everything is trembling, and at the same time a strange sort of weakness is spreading all over my body. I feel that I may collapse.

'Give me a chair. And you - get down. Why are you standing there like an idiot?'

This to Dima. He is still standing on the stool, erect, tall, angular. A handsome boy, really.

Once again Sasha has gone away from me. All I see is an unconscious body. A stranger. And I myself am absolutely empty inside. I know what may happen now, and therefore I'm not at all happy.

'Now tell me everything. Oxana, don't take your eyes off that screen.'

'There's not much to tell. Everything was going on fine. Here's the record. He opened his eyes, several times. His breathing was improving normally. We were quite satisfied. Oxana disconnected her screen for a moment, wanted to move the apparatus, and suddenly something stabbed me in the heart. I raised his eyelids - wide pupils! I shouted like mad and started the massage. Everyone came running.'

I should have been here sooner! Several times I wanted to but couldn't lift my behind from a chair.

I am studying the records. When I left the pulse was a hundred and twenty. Then gradually it had started to fall off, and the last record, eighty-five. This was twenty minutes ago, about ten minutes before the stoppage.

Dull anger, annoyance. I hate to look at all of them, I hate even to swear. Mistakes, mistakes again!

'What have you been doing here? Didn't you see that the pulse was falling off faster than normally? That meant that the vagus, the wandering nerve, was acting up. You were probably in a hurry to go home? I know that it's late, and you're tired, but the patient doesn't care. And you! Relaxed after your success? Thought that you were heroes, and everything was over? Probably sat here wagging your tongues.'

Silence. Everyone looks hurt.

I'm not being just. For that matter, we had all relaxed. And I sat there thinking about lofty matters, reading those idiotic theories. Sasha didn't know to whom he was giving his notebook. Had I been here I wouldn't have missed it. Am I sure? No.

We should administer a little atropine to lower the irritation of the pneumogastric nerve, the so-called vagus. That's what I think, but perhaps the situation is more complicated than that. A devilishly complex machine the human being, and we are helpless facing it. Much more could have been done, engineering-wise, to help us, all our mechanical aids are still to primitive. All right, let's think about that later.

I must learn to treat my co-workers with more consideration. They are probably thinking now: 'To hell with this damned clinic. You work like a slave, put all your soul into it, and all you get is criticism and reproach.' I must learn to control my temper, and my tongue. One tone softer:

'For how long do you think the heart had stopped?'

Dima jumps in eagerly:

'I don't know exactly, but it couldn't be more than a minute or so. Oxana just disconnected her machine.'

Lenya cuts in:

'The pupils contracted immediately after Dima started the massage.'

'All right, take all tests. Blood for an analysis. Oxana, how is it going?'

Oxana's eyes are glued to the screen. She is terribly upset. Red in the face. She knows that she should not have disconnected the monitor, even for a moment.'

'Not bad. Not any worse than before. A hundred and forty.'

'That's the adrenalin. It will wear off.'

It takes two-three minutes for all calculations. The report: everything is satisfactory.

But all this does not cheer me up. Of course, it is good that he is alive. So far. But first of all I don't know how long the heart hadn't been working. I don't particularly trust their reports. Not that they are lying, but it is difficult to evaluate everything properly. Then there is a natural tendency to imagine that the situation is better than it really is. We all need this for ourselves.

If the heart stops for over five minutes the cortex dies. And who wants Sasha without his brain, or even with a damaged brain? However, this is academic: cases like that always die. I've never known one survive. Yes, this is all very sad.

The second point. Very few patients survive the postoperative heart stoppage. Usually it is possible to start it up, but not for long. It stops again, the second time, the third. Then forever. But the valve has been inserted well, the stoppage was of a reflexive kind, and not because of any organic weakness of the heart muscle. There is hope. Not much, but still.

'He opened his eyes!'

Everyone is satisfied, but there is no real elation. The danger is still too great. Only Dima is openly beaming. Perhaps it was he who made the original mistake, but now everyone can see that this mistake has been corrected. Almost. And that he indeed noticed it in time.

We must develop control machines so that we do not have to depend on people's attention. What attention could Dima give when he has been in a state of extreme tension for seven hours?

Once again death is in the room. I am well aware of this. There is not too much hope. However, the heart is working well, I can see Sasha's chest heaving. I don't know, but we must hope for the best. This is the effect of adrenalin, of course. And what will happen when it wears off?

What shall I do then? Go home, lie on my couch, drink a glass or two, cry a little with dry eyes, and then, operate again? For how long?

But what else can I do? Retire? I know very well I wouldn't be happy away from my work. I should consider myself a coward, a deserter. I'm not suffering from inflated ego, but how can I abandon all this, all these people who regard me with such respect and hope? I can't offer them anything except surgery. I'm not a youngster, and my brain is not that adaptable. I'm no Sasha. And Sasha won't be there any longer:

Funny. All these people, all those books have inserted into me those programmes of public service, and they have gone deep into my soul, have become my instincts. I can't get away from them. I believe Sasha who says that everything is mechanical, but not to me. To me it's pain, anguish, tears.

I am not a hero. I fear pain for instance. I'm not afraid of death, no, but I'm afraid of pain. This is true. Death holds no terror for me. Just a pose? No. This is true. Freud was probably not a very big man if he considered instincts to be unconquerable.

Enough of Freud, enough of theories. Because of them I sat in my room longer than necessary. But Sasha is alive! I must now try to keep him alive. To save his life, no matter what.

I am going through the whole thing in my mind. Just like a machine, but probably not as well. The agitation of the pneumogastric nerve has already been curbed by adrenalin. Now we must build up the normal heart contractions. There are ways of doing that.

'Let's administer some AFT and Lanacordal. After that, a complete check-up.'

The girls start to move. They are doing everything quickly, precisely. It is a pleasure to watch them work. Yes, they work well, but they didn't figure things out soon enough. Am I sure I could have done? No, not sure. But still my modelling installation is perhaps better. Thank you.

Now all we can do is wait. Oxana is watching her screen without batting an eye. Dima and Lenya take the blood pressure every five minutes. They have connected the suction system to the drainage tube from the pleural area; there was no haemorrhaging before, but now anything can happen, the heart and the pectoral area were squashed quite a bit during the massage. Some damage is practically unavoidable. Even the sutures could have come apart, especially in those patches. The pump starts and immediately some hundred and fifty cubes of blood flow into the ampoule, and then it starts to drip in large steady drops. This is much too much.

'Transfusion. Keep the cube-per-cube balance!'

Problem, and a serious one. What if the haemorrhaging doesn't stop? Open the chest and check on all sutures? This is always dangerous, but after a heart stoppage, extremely so. Now we shouldn't even think about it. The stoppage may recur at any moment. We must use our entire arsenal of anti-haemorrhage medications.

'Come on, children!'

I rattle off the Latin names of the drugs. There is a new spurt of general activity.

I am sitting broken-hearted, filled with dull anguish.

No one leaves. There are about ten doctors here. It's long past seven o'clock, and they serve no dinners here for overtime workers.

'Open the windows, the air is foul. And why are you all standing here? Some of you can go home.'

Silence.

There is a great deal being written about communism. Some claim that it is practically here. But, in fact, there are plenty of sceptics. 'What communism? So-and-so was caught stealing, so-and-so is using protection and pull.' I personally don't think any perfect society can be built so quickly, but when I look at my young doctors I feel warmth coming into my heart. Many of them are married, have children. They would probably like to go to a film or play with their kids. But instead they stay here until seven, until nine in the evening, the whole night if necessary, getting no overtime bonuses or free time benefits. And they are here on time the next morning with red-rimmed eyes and never a grumble. Of course now and then they miss something, make a mistake. 'Bunglers! Idiots!' Like Stepan this morning. I wonder if he's gone home? No, I saw him sitting in the ward. He used to play chess with Sasha. I am sorry for him, but what could I do? That boy undoubtedly died because of his negligence, and Onipko is still on the danger list.

Yes, about communism. I have been to America, visited their hospitals. Physicians there are working hard, from morning till night, and I think, have compassion for their patients. Just like us. But no, not quite. I'll never forget a scene I saw once, through the glass, just like our glass. It was a very difficult operation with artificial blood circulation, very complicated, very troublesome. The patient was still in the room, barely alive. And in the corner the surgeons and anaesthetists had gathered for a conference, speaking in low voices and writing something on a piece of paper. I asked the interpreter, a very nice fellow, what they were doing. The microphone was still connected, and he listened through his receiver. 'They are dividing the fee for the operation.'

I felt sick. I didn't want to look at them any longer. I told the interpreter, I couldn't contain myself, but he was surprised. 'But didn't they earn this money honestly?' What could I answer? Would this be possible with us? No. These forty years have not been spent in vain. True, the result could have been better, and we must do our best to improve it all the time. There are still too many egotists, too many deviations. So many that sometimes I feel frightened, is it possible that these green sprouts might wilt?

No, this is my depression talking. They will not wilt.

'Well, Oxana?'

'A hundred and twenty-five, but growing weaker.'

Now Dima comes in:

'The pressure is falling off, too. It was a hundred and ten, and now only ninety-five.'

Oh God, here it comes! The inevitable. The pressure will keep slacking off, and then the heart will stop again. 'Don't stop, don't stop, I beg you!'

There is no one to beg. You can rely only on yourself. And on those kids there.

Dima again:

'Perhaps we can add adrenalin to the drip? To keep up the pressure?'

'Yes, add, but only very little.'

Adrenalin makes the vessels contract. This builds up the pressure, but also puts an extra stress on the heart. It would have been better to build up the contractions. But we have administered all the available medicaments for it, and they haven't helped. No, I'm still afraid of adrenalin.

'Dima, you haven't done it yet? Don't. Let's try cortisone instead. A large dose. Have you tried it?'

The report: not yet. How could we have forgotten about it? We don't know yet exactly how it works, but in some cases it performs miracles. Apparently it builds up the function of all cells. Very good stuff.

Liuba, the anaesthetist nurse, fills a syringe and inserts it into the drip. Now it will enter Sasha's body along with the blood.

Meanwhile the bleeding continues. True, it has fallen off to forty drops per minute, but this may be the result of the lowering blood pressure.

'Send a request for some additional blood. Two litres. Fresh.'

How much blood have we used today? Probably about three litres. But this is a special case. In America they order five litres for a routine operation. Why should they economize? The patients pay, the unemployed sell blood. I had seen those advertisements in their newspapers: 'Blood donors wanted, immediate payment.' And I saw them queuing up outside the blood banks, mostly poorly dressed people, some of them drunk.

What time is it? It is half an hour since the stoppage. This is not bad. I must telephone home and tell them I shall be delayed indefinitely and not to wait for me. My wife is probably worrying about Sasha, he is her favourite, too. She always sets him up as an example to me, such courtesy, such good manners. This is true, but manners are not the main thing. Very well, I will go.

I get up.

No, I'm afraid to leave. Frightened. It seems to me that the moment I go his heart will stop again. I'd better wait here until the heart pressure becomes stabilized. Are you sure it will? No, of course not. I usually prepare myself for the worst.

Everyone is silent. Dima is taking the pulse. Lenya is working the bag. The patient is asleep. We don't want to wake him up.

'Pressure?'

'Ninety to ninety-five.'

'Oxana? '

'No change. A hundred and twenty.'

I must sit and wait. Surgery is not merely operations, excitement, passions. It is also waiting, sweating, suffering. 'What to do next?'

There is nothing to do at the moment. Unless the bleeding stops I shall have to open the wound. Oh no! I feel cold shivers running down my spine. I'd rather die than hold that heart again in my hands. Dramatics. But almost true.

Life and death. How much there is in those two simple words. Poets, scientists. But in fact, all this is very simple. At least this is what Sasha used to say. I remember his words. 'Living systems differ from the dead only by their complexity. Only by their programme of digesting information.' Our living things on this earth are composed of albumen bodies. Out of this there are various structures operating on different levels of complexity of their programmes. Microbes derive nitrogen from the air. The worm reacts to the most primitive influences and his behaviour is limited to a few basic movements. This is the limit of his programme. Man is capable of absorbing and retaining a great deal from outward influences, or information as Sasha calls it. His movements are extremely varied. But still he is a mere machine operating in accordance with a very complex set of programmes. Once this would have sounded like sacrilege. Because then people only knew how to produce the most primitive models, they accepted things and did not attempt to compete with nature. Now all this has changed, or rather is changing, more and more. Man will build some incredibly complicated electronic machines which will model life. They will move, feel, think. They will compose music and write poetry. Why can't that be called life? It is not important from what material a complicated system is constructed, albumen molecules or semi-conductive elements. Houses are built of different materials, but serve the same purpose. The important point is to make an artificial structure which could absorb and digest complex information, and act upon it with certain correct programmes.

Then man can become immortal. Not a whole man, but his intellect, and probably even his emotions.

I am handling the subject as a hard-bitten cybernetist. Too bad no one can listen to my mental models. Then they would know what wide interests I have. Everyone considers himself intelligent, and I'm no exception. But am I, in fact? I have remembered Sasha's words all right, but I'm not at all sure that all this is so.

Too many elements must be used to create the human organism. And who would arrange all these elements in the correct order? Still there are machines even now which no single man can design and build, and they work.

Memories again. I remember one night Sasha was daydreaming in my study. I don't remember his exact words, but I can reconstruct the sense:

'An electronic brain will be built, a tremendous one. Mathematicians and engineers have not the slightest doubt about it. This will be done, and perhaps sooner than we think. A machine which will be capable of development and learning, and infinitely faster than any man. They would, for instance, connect it to a scientist. The machine would instantly absorb his way of thinking, all his knowledge, his character, his feelings. It would become his alter ego. The scientist will die, but his mechanical brain will continue to live and create.'

'Deliver lectures, write treatises, listen to music, swear at its assistants?'

'Don't laugh, professor. When it grows old because machines also grow old it will pass everything on to its mechanical successor.'

And so, eternal succession.

But then he contradicted himself:

'No, unfortunately, all this will be much more difficult. No system can be fully repeated. It is impossible to create an exact electronic copy of my brain, with all its cells and peculiar combination of cells. It is possible to create another one, better than mine. It would take everything from me, like a son or a good pupil, but it would remain a thing apart. It would develop and perfect itself, leaving me far behind, and drawing further and further away from me. Then I shall die. But something will be left of me. Perhaps even a good deal. And this is pleasant to contemplate.'

'An old father expiring in the electronic arms of his genius son?'

Sasha just smiled dreamily, and his eyes sparkled.

I am sitting with Maria Vassilievna in a corner of the operating theatre. While I was reading upstairs she had been making the rounds of the wards, but as soon as she heard about the stoppage, she came in. We are both thinking our own thoughts, but they are the same. About him.

'Masha, have you any hope?'

Her look is serious and sober.

'Yes. We must save him. It's our duty.'

'As if anyone cared for our duty!'

'I just can't imagine him dead.'

'Neither can I, but there's so little we can do.'

I turn to our kids: 'How is he doing? Any improvement?'

Dima:

'So far the pressure's holding up. Pulse, a hundred and ten. We still have no analyses.'

'Send for them. Hurry them up.'

'It's no use, they are doing all they can. Valya is doing everything herself.'

Valya is our laboratory head. She is one of my friends. We have many people working in the clinic, some of them are just my collaborators, some are friends. I don't particularly fraternize with them, don't hold any special conversations, but I know that they are my friends.

Maria Vassilievna is the closest one. She is not looking very well. I wish she would dye her hair at least. This is how age creeps up. She came into the clinic a mere slip of a girl. Well, there's nothing to be surprised about. That was twenty years ago. Yes, twenty. Twenty years of living together, working together, growing old together.

'I have gone through the wards. Nothing particular to report. Let's call off the operation with the AIK machine for tomorrow. I, for one, have no strength left.'

'All right, Masha. Call it off.'

She continues:

'Everyone is jittery, wondering about Sasha. They are whispering in all the corners. Raissa Sergeyevna fairly jumped at me. "He is already dead, but you're keeping it from me!" You should have spoken more kindly to her this morning. She is a good woman -'

'To hell with her! I was kind enough. The fool!'

This is true, this is the way I feel. Here he is, and he can die at any moment, and I'm heartbroken, but I don't regret my decision to operate. Had I refused, as his wife begged me to, he would have started to die in two-three months in the ward and it would have been too late to do anything then. And I would have seen a constant reproach in his eyes. Even if we are defeated, it's better to go down struggling. Better for me. And as for him, much better.

I could have refused, of course, on purely medical grounds. No one would have reproached me. I could have been lying on my sofa now, reading. There is a new novel by Steinbeck. Lenochka would have been chirping around me. Idyll. But in the depth of my mind, a thought: 'coward'.

And in the morning, his look: You have let me down, you bastard.' And all I could have done would be to lower my eyes, and avoid his room.

No, it's better this way. I'm trying to be severe with myself. Am I absolutely sure that my decision was right? Well, not one hundred per cent, no. We could have waited a little, could have experimented on a few lighter cases. Could have gathered experience. We could have avoided the heart stoppage, perhaps, and the haemorrhage. But what about the liver? Would it have lasted long enough? How do I know? Perhaps. Once again I come up against the same thing, no precise knowledge. Cybernetics could have helped here. To hell with cybernetics! I'm sick of the word.

Petro¹ approaches:

'I have given Onipko a fluoroscopic examination and changed the drainage tubes. His condition is still critical, but I'm pretty sure he'll pull through. Stepan is with him.'

Stepan is with him! Trying to expiate his sins. He has a short memory, this Stepan.

I know that Petro is trying to extract a reprieve for Stepan from me, taking advantage of my weakened state. Not yet. I limit myself to a non-commital statement:

'All right. We'll see.'

I could not say 'no' outright, I am afraid to tempt fate. Superstitions. I will go into this tomorrow. And today, am I trying to fool God? Funny. Man is funny. Today God could have squeezed out of me any condition in exchange for Sasha's life. Outside this, his chances with me are not good. Because I really don't need anything, neither money, nor fame, not even love. I just want peace, to be left alone, if possible. But there is no God to bargain with.

Time is passing. Fifty minutes after the stoppage. The heart action seems to have stabilized. The blood pressure remains constant, eighty to ninety. He woke up, became restless and was given sedatives. Now he sleeps like a baby. Only his lips remain blue, the heart does not pump enough blood. But all the analyses are satisfactory.

Our hopes are rising. There have been cases when patients survived even late heart stoppages. True, not many, perhaps one out of ten. However Sasha's odds are already much better. Usually after having stopped, the heart works for five... ten... fifteen minutes, then stops again. All the really dangerous time barriers have been passed. He still has a chance. And so have I.

Miracles in medicine are rare, but nonetheless they happen.

One night a few years ago I performed an emergency operation on a lad with a mitral stenosis. He developed oedema. This is like an avalanche, a man can die in thirty minutes choking on blood foam accumulating in the lungs due to the high pressure in the pericardium, caused either by a heart condition or emotion. The boy was scared by something, if I remember correctly by the death of a man in his ward. They brought him into the operating theatre blue and unconscious. I could only wash my hands in alcohol, and Marina had barely enough time to throw a sterilized sheet on the table. In a few minutes I separated the folds of the mitral valve with my finger, the pressure came down, and the young man came to life. I went into the next room quite satisfied and started to write the surgery report. And suddenly, just like today: 'The heart has stopped!' They noticed it at once, on the electrocardiagraph monitor screen. We gave the boy closed chest massage, a success. The blood pressure went up to normal. I went back to finish my report. Another stoppage. We started the heart up once more. In twenty minutes, again. After that I went home, unhappy, after the third stoppage there was no longer any hope. So I left my kids to take care of it. When I returned to the clinic the next morning I didn't even bother to ask I was so sure that the man was dead, but suddenly they told me that he was alive! After I left, the heart stopped again, and again they started it up with massage. It worked for an hour and they decided that all danger was over. They moved the young man into the ward, and there, already in bed, his heart stopped, for the fifth time! They started it up, this time with final success. The man is still alive. This is a miracle.

I wish there were more of them.

However I must telephone home. Now I can leave without too much risk, Maria Vassilievna can take over for me. Also they are not likely to grow negligent again, they are still too scared. But still, just in case:

'Look, children, don't go to sleep. I'll be up in my room for a while. You, Oxana, especially. If you have to leave even for a moment, ask one of the doctors to take over. I don't want that screen to be left unattended even for five seconds. Clear?'

Affirmative nods. I leave.

My office. It is almost dark. I don't switch on the light, it is better like this. Quieter. I telephone home:

'Hello? Are you all home already? How is Lenochka?'

My wife answers. All is well. Lenochka wants to know how soon I shall come home. She has grown up. She no longer asks: 'Is everything all right, Daddy? The patient died?'

How do I know when I shall be back. I give a short report, feeling sorry for myself.

'I shan't be home yet unless he dies. Don't worry about me. No, I haven't eaten. I'll eat later. It is not important.'

My wife is not particularly distressed about my fast. She understands that it is ridiculous to speak about food at a time like this. In fact, I even have some. On my table I see a glass dish of fruit salad and a sweet roll. This has probably been brought in by the head night nurse. But where did she get such a roll? It is not from our kitchen. Some anonymous donor, someone has brought it from home to nibble at night. Perhaps Valya from the laboratory?

First, a smoke. 'I'm trading bread for drags of stale tobacco.' The melody has stuck in my head.

This is medicine for you. Once the heart had originally started, it had absolutely no reason to stop. Obviously we had overlooked something, had not appreciated fully the real situation. Everything could have been controlled in time by simple medications.

Doctors laugh when I talk to them about cybernetics. But this is not a laughing matter. Only machines can solve some of our problems, remove the uncertain human element from our work. So far we have only abstract ideas about it, nothing that can be applied immediately. But this depends on all of us. It will take a great deal of time, study, effort and money to dress these abstract skeleton ideas into mechanical flesh, but it must be done. A machine giving us exact information on the state of the patient, a computer with a colossal memory, and then other machines designed to treat each case properly, surgically and chemically.

I shan't live long enough. Besides I'm not very well suited for this work. Not clever enough, and not sufficiently educated.

But how useful all this would have been in Sasha's case! He is still young. If we can keep him alive for a few more hours, everything will be fine. At least, for today.

Through the opaque door I can see a vague silhouette. Someone has come to the door, stopped there and is listening. This annoys me. It is not someone from the theatre, they wouldn't have waited.

'All right, who is it? Come in! Why are you standing there like that?'

'...Why are you standing there like that?' - the words of the old woman from Pushkin's 'The Queen of Spades'. Association. The machine continues to work. My favourite opera.

The old nanny from the reception room shuffles in.

'Excuse me, professor. Some girl, or young lady, wants to see you. I didn't want to bother you, I know you don't want to see anyone, but she insists.'

So she is thinking about me, this old woman, takes pity on me. But this doesn't help me. I'm all alone, and no one can help with my burden.

'What does she want?'

'She says it's personal.'

'I've got nothing personal to discuss with anyone.'

'Yes, but she sort of looks personal.'

Of yes, of course! How could I not have guessed at once? Certainly this could not be a woman looking for a love adventure, even though surgeons often have a strange attraction for women, rather like famous artists. This must be that one, the one to whom Sasha wrote his letter. A wife is in one part of the building, and a mistress in another. But no, how crude of me! What sort of mistress can she be to Sasha, now? I'm thinking this way only because I'm unhappy. Well, I suppose I must speak to her, for Sasha's sake.

'All right, let her in.'

I am switching on the light.

I don't want this conversation. Almost as little as I want a conversation with Raya. But this is my duty, my moral obligation. I must discharge my obligations. I owe a lot to people, they have been responsible for my being what I am today. No, they have not given me anything! No? And what about those children who had been brought up in the jungle among animals? They had remained animals, and I have developed into a human being. 'The programmes of behaviour are developed through education.' This is from Sasha's notebook. One should never exaggerate one's own importance.

It will be interesting to see the woman with whom Sasha is involved. I must listen to her and try to be polite.

But what shall I talk to her about? She would not be able to understand anything. I have no kind words to offer anyone at the moment. I need them myself.

Sasha said, 'Read the letter, then you will understand'. No, I can't read it now. I don't feel easy about Sasha any longer. I can't forgive myself that haemorrhage and that heart stoppage.

Let her come. I can give her nothing but a brief factual report and a few polite words. Even for Sasha's sake. If I can't help Sasha, what can I do for her?

There she is now, behind the door. It didn't take her long to climb the stairs. Or probably the old woman had brought her up before coming to see me. Thinking that I would not receive her, she could always take her down. 'What's the use of running up and down.' Logical.

A knock at the door.

'Come in!'

The door opens. She enters.

I look. Yes, quite good-looking. About thirty. Good figure, fine legs. Ridiculous, legs at a moment like this! An old reflex. Stupid impressions, completely out of place here.

'Good evening. I've come to inquire about Sasha, Alexander Popovsky.

'Please sit down.'

A pause. She is very good-looking.

'Please forgive me.'

The beginning of the inevitable phrase, '... for disturbing you at this hour when you must be very tired'. And so on. But no, she falls silent.

The next inevitable programme: 'What can I do for you?' But I hold it back. Let her talk instead. I have no feeling whatsoever towards her.

'Tell me, will he live?'

No, it is impossible to avoid those trite questions! Just impossible. I feel anger stirring in the back of my mind.

'I don't know. We are doing everything in our power. Forgive me, but I don't feel like explaining anything to you at the moment. If I am brief you won't understand anything. And I have no time for lectures. Besides, I don't even know who you are. The only close relative of Popovsky I know of is his wife.'

Stop! She jumps up, becomes red in the face. Damn it, how crude can I be?

'Then excuse me. I didn't know you were like that.'

I am so ashamed of myself I feel like dropping through the floor. I can see that she has some sharp words ready for me. I wish she would spit them out. One should be slapped in the face for behaving as I have. I must try to repair some of the damage.

'Unfortunately, I'm not an angel. Don't think all this is easy for me, I am very tired, very upset. If you can, don't feel offended. We will talk about this later. Just be patient and don't ask silly questions. Here is a key, it opens the door of the next room. It is my private laboratory, and there's a couch there. Go inside, lock yourself in and don't switch on the light. I will speak to you when I'm ready. Is that all right?'

'Yes.'

She takes the key and leaves without even looking at me. How unpleasant! Perhaps my last words have smoothed it over a little? I can imagine Sasha looking at me with reproach in his eyes. God will not forgive me for this. But he must be understanding. Yes, but also very stern. One can't hurt the weak and the unhappy even when they ask stupid questions. Retribution. What nonsense crawls into my head tonight. Ridiculous. There is nothing, everything is just a machine.

The problem is that no one knows how to run it.

   ¹A Ukrainian form of Peter. Onipko is also a Ukrainian name. Apparently the locale of this book is a city in the Ukraine.

Prof. N.AMOSOV
Translated from the Russian by George St.George
© George St.George, 1966