6.12.1913  -  12.12.2002

Books of N.M.Amosov

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...and Night. Stepan

Again the corridor, the stairway. It is now night. The clinic is quiet. Only in the interns' room there is a sound of conversation. The voice of Oleg. Of course. He can never keep it down.

How long will I have to walk up and down like this? Up to my office, down to the theatre. Perhaps everything is all right there. Doubtful. Major surgery has destroyed my sense of optimism. Nothing is easy. Everything must be fought over, torn out with your teeth. Shall I stop and see Raya? No, I don't feel easy about that. Just spoken to Irina, and now to the wife? How would I look at her, try to comfort her? But why not? It is all Sasha's doing, not mine. Still, I feel that now I am a sort of accomplice. But what could I do, send that poor woman away? Hard to tell. The problem of good and evil, of virtue and sin.

I enter the operating theatre. No particular picture of happiness. Sasha is breathing by himself, but through the oxygen tube. Dima is near his face looking down, checking on his pupils I imagine. Near the ampoule connected with the drainage tube, Lenya, Petro, Genya, all crouching. Maria Vassilievna is hovering over them with a stopwatch. Clearly they are counting blood drops. It means that the haemorrhage is continuing. The main problem remains unsolved.

Pay your debts, my friend. What debts? What have I done? Stepan perhaps? Or is it Sasha who is paying for Irina with his blood? Needless questions. The sense of subconscious guilt is universal. Everyone is a debtor to everyone else. The interdependence of guilt.

I wait until they finish the count. Then:


Petro volunteers a report:

'Everything is in order. Only the haemorrhage continues, just as before.'

'Everything's in order! You're an incorrigible optimist. There's just one hitch: your patients are dying too often.'

He is silent, hurt. A tactless remark, perhaps, but now I'm annoyed with the whole world. How long can a man suffer? Just take a look: a continuing haemorrhage, a prospect of repeated operation. Open the wound, look for the bleeding vessel which you probably won't find anyway because this is a general oozing from many vessels due to the lowered coagulation factor of the blood. This means anaesthesia again and again the danger of heart stoppage. Again this, and again that! I feel sick even thinking about it, I just have no strength left. A momentary lightning-like thought: 'Why didn't he die at once?' Then a sense of horror: am I a monster to even allow a thought like that to enter my head?

'How many drops?'

'About fifty now. It falls off and increases periodically. In the last half-hour, one hundred and twenty cubes.'

A quick calculation. This means, about two hundred and fifty per hour. Six litres per twenty-four hours. It means that the equal amount must be replaced by transfusion. With damaged liver and kidneys this is practically fatal. And where would we get so much fresh matching blood?

'The coagulation level?'

'Clots are forming at six minutes, but not particularly firm.'

'Have you administered everything according to the chart?'

'Yes, here's the record.'

Dima gives it to me. A long one, everything is recorded to a second. I'm checking it. Yes, everything has been done to improve coagulation. But can anyone guarantee that there is not one bleeding vessel somewhere? Has this not happened before? Especially possible because the heart had been massaged through the closed chest during the occlusion.

I'm standing there, thinking. As always thoughts are coming in on several levels at the same time. The main one, what to do now? Open the wound, or wait? Of course eventually the haemorrhaging will stop, but how to wait through this, and what will happen then? An operation, even if no single source of bleeding is found, usually helps. You can always tie up a vessel here, burn it down there, and then the system somehow generally reacts positively to repeated surgery. But-oh God, how afraid I am to cut those stitches open! To see that heart again, to feel its contractions under my fingers! And to expect every second that each is the last one. 'Defibrillator! Massage!' No, I can't face it. I just can't face it. I haven't the strength at the moment.

The thoughts on the second level: Irina is suffering in a dark laboratory. Raya in the waiting room downstairs. He doesn't love either one. They both probably know it. I know what this means, I had gone through this myself. But what are all those emotional sufferings compared to this! I'd be glad to go through love-and-jealousy torture for a year just not to stand here and try to decide what to do. No, I'm lying, a year is too much. One can go insane. I just don't know what's better, or worse.

Still another level: everyone has wilted. It is eleven o'clock. Have they eaten anything? Well, probably nibbled at something. They are young. Appetites. I can go on and on without food, but what about them? I again!

All right, but what's to be done, anyway?

'What are the other showings?'


'Not too bad. Pulse, one hundred and twenty-four; the blood pressure fluctuates between one hundred and one hundred and thirty. The venous, one hundred and forty millimetres. The density of venous blood was fifty, now it is fifty-seven.'


'Not very much. Lenya, show the bottle. This is the yield for the last half-hour.'

Lenya shows: about fifty cubes of dark liquid. I am afraid we might have trouble in this department. Actually, however, this is not too alarming. If it goes on like this, we may expect about two litres. This is sufficient.

'Go ahead.'

'He woke up once and even became restless, we administered sedatives. Breathing, you can see for yourself: rather even, and he has been breathing by himself. If you decide not to... well then we can extract the tube in a little while.'

'How much blood have you in reserve?'

'Liuba will look. Liuba, please check in the refrigerator.'

'How is it that you don't know yourself? You must be aware of this every minute you are here!'

'I've got a bit mixed up, professor. I've just been checking on the entire loss and replacement. I believe we have about a litre left.'

'You believe! You must know.'

I'm jumping down his throat for no good reason. No, there is a reason. There have been occasions with this same Dima. 'No more blood!'

Liuba comes back. She has calculated all the reserves. Even written them down. How thin she is, pale, traces of lipstick on her lips. A pretty girl, she likes to make up, but now she is too worn out to care. She can hardly move. Her robe is stained with blood, but she pays no attention.

'We have five hundred cubes of fresh blood, and about seven hundred and fifty of the old, ten days. Also there's some old blood of the first type group, and blood from the machine, but with high haemolysis.'

'There's your litre!'

This situation is now clear. We must send for some fresh blood. But the main problem remains unsolved. I must decide what to do. Who can possibly take this burden off my mind? Nobody. This is my task. One can't take a vote on this, I am supposed to know better than anyone. Sasha's life is in my hands. A quick thought: shall I wake him up and ask him? After all, this is his life. Stupid. He would not know what you're talking about. Ask Raya, or that other one, Irina? You're a fool, professor. They are scared, unhappy women, and this is your friend. Is friendship a less meaningful relationship than sex? Perhaps, less. Here is intellect; there, emotion. And which is more meaningful for him? I don't know. He has a highly over-developed intellect, and this hurts people who love him. Poor Irina.

Nonsense, she won't die. Or will she? Women like that can die of love, even in our rational age. Despite all her intellectual interests. She may decide to end it all. Didn't you feel the same way yourself?

No, this probability is not high. Irina will live, and so will Raya. And what about Sasha? I can't really evaluate. Of course, the odds have become better than they were this morning, but there are still plenty of dangers.

But anyway, what to do? Talk to the kids? Of course none of them can possibly think up anything new because there is just nothing one can think of. A really accurate decision can't be made in view of the incomplete information and there is no way of getting more at the moment. However:

'Comrades, come here. Let's step out and talk this over. Dima and Oxana will stay here and watch the patient. It won't be long.'

They are filing out, dragging their feet. Everyone is exhausted. We go to the interns' room. We find Oleg and Valya discussing something, there is so much tobacco smoke that one can cut it with a knife. Apparently they have got hold of a fresh supply of cigarettes.

Gradually the room is filling up. Even Stepan has appeared from nowhere. He feels that the 'chief is too preoccupied and too unhappy to jump at him. He is mistaken.

'Stepan Stepanovich, why haven't you gone home after your shift?'

'I'm watching Onipko. He is still critical, but there is an improvement.'

I want to say something nasty, but I control myself. To hell with him, let him stay here. Expiation of sins. But just let him expiate his guilt, and there would be no getting rid of him. Personally I have nothing against him, a good man, intelligent. But how can I forgive him for neglecting our patients ? Well, never mind. Later.

'All right, comrades, you all know the situation. What do you suggest? Shall we operate now, or wait? And if wait, then what else can we do now?'

I know that they can't suggest anything which I don't know myself. I'm not exaggerating my intelligence, but I've had more experience than any one of them, and they have already done everything that could possibly be done while I was sitting up in my office, delving into Sasha's love life. We can administer this medication or that again, but this will hardly change the situation. And this is not a case to experiment on, it has probably been the most complicated operation we have ever performed in this clinic, taking into consideration the patient's condition. And then, and I must confess this openly, after all, this is Sasha. This makes any decision much harder, for me, in any event. I hate to guess and experiment in his case. Again we must deplore the limitations of our science and hope that cybernetics will change all this in the future. But I shan't live that long. It is all nonsense.

Just as I expected. Petro:

'We can repeat the whole course of medications promoting coagulation.'


'This has been done twice. What's the use of repeating something to which the patient does not respond? After all, this is not harmless. Of course, if the professor decides against the operation, we shall repeat this later. We must count on the haemorrhage continuing at least until the morning, if not longer.'

Semyon reports that our station has no more fresh blood of either the three or one type groups, and it must be sent for elsewhere. And the old blood would be obviously harmful to Sasha.

'Then what do you suggest, surgery?'

'No, I suggest nothing. I am scared to death when I think of the possible second heart stoppage.'

For a while there is silence. I am looking at all of them. There they are, all different, but all good. No one-hundred-percenters, but each a valuable member of the profession. And I? Everyone tends to exaggerate his own importance. Sasha claims that good and evil can be accurately calculated if one approaches this problem from the standpoint of society. In the olden days this was simpler. Then Christians thought that in God's office there was a sort of computer for each person which automatically evaluated people's behaviour, and then submitted the final figure for God's decision. It was more or less arithmetically decided. So-and-so went up, so-and-so down.

I see Stepan shifting his weight from one foot to the other near the door, dying to say something. I throw a straight questioning look in his direction:

'Well? Speak up.'

'Professor, supposing we, you try a direct blood transfusion?'

And immediately, before I can react:

'I have blood of the third group, haemoglobin eighty, and I'll be glad to donate.'

We all look at him with amazement. This is an idea! We all feel a little taken aback, are we a bunch of idiots not to have thought of this simple thing sooner? There is such a method of arresting stubborn haemorrhaging - not simply fresh blood, but a direct transfusion from vein to vein, so as not to destroy anything even the most minute components. We have forgotten about it because we normally do not use it. We have tried it a few times in some very critical cases, but got no response and, after that, have generally discarded it. Needlessly. This is no guaranteed method, but some clinics claim definite positive results in some cases.

Oleg can't contain himself:

'Good man, Stepan! Genius! And you wanted to get rid of him, professor!'

I am silent. The first happy reaction has already worn off. I mentally jumped at it, just like the rest, because it eliminated the necessity of an immediate decision, but now I am already considering the whole thing soberly. Basically, the suggestion is good. It just may help. But if it doesn't work, and there are many chances that it won't, there will be a certain loss of critical time. True, not much, we should see results quite quickly. Yes, a good suggestion. It annoys me a little that it was Stepan who has come out with it. Now, the amnesty is unavoidable. Not that I'm against it, but I'd like to arrive at it myself instead of being forced into it. It would be a good thing to take the blood from someone else; otherwise Stepan would instantly graduate into a hero. But that wouldn't be just and I can't allow that.

'Stepa1, of course, is no genius, but none of us, alas, are geniuses either. Rather the contrary. We should have thought of this sooner, but we haven't and Stepa has, let's give the devil his due. It was a good suggestion, and I'm taking it. But you, Stepa, don't get the idea that after this you will go on bungling as much as you like. I shall watch you like a hawk, and I'll miss nothing, don't have any hopes.

This perhaps is again a bit of unnecessary cruelty. God's electric computer is working through me.'

We have enough people here with the three-type blood, besides Stepan.'

This is Maria Vassilievna, the merciless disciplinarian. Also, the conscience of the world. She would forgive anyone murdering her, but not a doctor neglecting a patient. She is right, there are enough prospective donors in this very room, but Stepan deserves preferential treatment, he is the author of the original idea. Besides, this must be important to him and not only for his self-rehabilitation in the eyes of his colleagues. He needs it for himself, to prove that he is not as worthless as he must have felt himself to be the whole day. Let him get the full dose.

'We shall take the blood from Stepan. Let's hope it will prove to be lucky.'

'And that Sasha won't become stupid after that.'

This is Oleg's contribution. He never loses his sense of humour even though his witticisms are not always very appropriate.

Everyone is happy.

The fact that surgery has been postponed is a great relief, and the choice of Stepan as a donor is also appreciated. I don't think there are many of us here really eager to play this part, after a day like we've had. Not because we are afraid, but no one likes pain. I for one dislike injections, the moment a needle touches me, I cringe. And this will be a very thick needle. Of course, if it is necessary, all of us would volunteer, but if there is another volunteer, so much the better.

And Stepan is fairly beaming. There is a theatrical streak in him; he likes effects. All right, let him have his fill. The important thing is the result.

'Oleg, you're the youngest, and the most energetic. You will handle the transfusion.'

Oleg is the youngest of our senior doctors. He is not really very young, perhaps thirty, but he looks years younger, a mere boy. I even doubt whether he shaves, though of course he must.

'But let's hurry, kids.'

'What are we to do with the breathing tube? Shall we extract it?'

'I don't know... I think we'd better use slight gas anaesthesia. It's harmless, and it's best for him not to wake up during this procedure. That might cause some psychological damage.'

Everyone agrees. It will delay the final waking up, but one hour more or less does not make that much difference. Oleg energetically chucks away his cigarette butt and commands:

'All right boys. Finish your cigarettes and let's go. Stepa, when were you in the bath-house last?'

'I take a shower every morning! Only missed today, because of the double shift.'

'Tsk, tsk, such culture!'

A direct blood transfusion is a simple procedure. There is a special set of tubes and gauges. A needle is inserted into the donor's vein, and also into one of the recipient's. The blood is transmitted by a special syringe, without the use of any anti-coagulants used in conservation.

Oleg and Stepan go out, but we stay here. There is no point in rushing. The preparation will take at least half an hour.

As always during these night sessions there is an acute cigarette shortage. We have to send Genya to my office, I still have two packets there. One is immediately picked to pieces.

The conversation now comes round to the surgical profession. Why has everyone chosen this clinic and this heartbreaking work?


'I like strong sensations during heart operations. Not in any other branch of medicine, or even routine surgery, is there so much excitement. When you hold a human heart in your hand, it is such a unique feeling.'

True. Strong sensations attract many young people. In one period of my life I had been attracted by them as well. But now I feel sorry for patients who provide us with such sensations. There are some young surgeons who undertake practically hopeless operations for this kind of excitement. Not in our clinic, we watch against this very strictly.

But anyway one cannot discard this stimulus. For these sensations in the operating theatre a surgeon is willing to pay with days and nights of hard thankless toil: ambulatory work, bandaging, writing up case histories, even talking to patients' relatives. Probably there is nothing morbid or evil in this. Semyon has already defended his candidate's dissertation, but it is not pure science which has brought him here. Operations. The romanticism of surgery.

Now Vasya, our aspirant, takes the floor. He is very young, with an obstinate chin. He will go far.

'I'm here to work on my dissertation. They offered to let me do this in our institute, but there it's all dead routine, appendices and fractures. Here, at least, there are new ideas, new methods, complicated operations.'

This is the second stimulus of young doctors, to write quick theses. It is true that it is difficult to find a good theme working in a routine clinic; all of them have been used and re-used. It does not mean that all the problems of general surgery have been solved; on the contrary, much is still very obscure and uncertain. Old methods have become antiquated, the new not yet fully developed. The routine clinics have no time for research, they can't study such problems as shock, infection, biological reactions, because there are not enough new ideas and no proper equipment. For this one needs large modern laboratories with all the costly new equipment, in medical research one can't work by touch.

In our clinic, as in all those of this type, we are breaking virgin soil. We are a show place and the government is generous with funds. We can experiment and study various diagnostic and physiological problems, in a place like ours it is much easier to find and develop a spectacular dissertation. Besides all this is connected with exciting actual work, here we study, we teach, we allow young surgeons to show their initiative and operate. In fact one can quickly carve out a career from here, always providing that one has surgical talent. Well, this is understandable. Doctors are also people, they want to get ahead, to make a career.

'Appendices and fractures must also be treated,' Maria Vassilievna cuts in with an ominous calm.

'Sure, but that's not for me.'

'Not for me either,' Genya supports Vasya. 'I want to get to the very top of my profession.'

Now Maria Vassilievna is outraged:

'I'm ashamed of you boys, shocked! One speaks about excitement, another pure science, the third, his dissertation, still another, his profession and his career! And where are the patients? Where are compassion and mercy? Where is the sense of service? Where is the noblest of professions?'

Direct questions. All are silent, a little taken aback by this attack. Yes, where is all that? Are our patients merely the material for theses, study, science? But this is not so with my kids. I know this definitely, I've been watching them. In any event, not completely so. I must support them.

'Maria Vassilievna, you're not just. There is the noble profession and there is compassion. Can't you see it? Look at them all sitting here, what do you think they are doing, writing dissertations?'

'Stop it, professor, don't defend them. I think our youngsters don't have enough dedication. It is a profession to them, they don't really care what they are, physicians, agronomists, engineers. Medicine is not a profession, not in this sense. It is service. It must be and that's what they don't understand. And if they are sitting here, hungry and without tobacco, well, it proves nothing. Some of them are here because it's their duty, others because they are just curious, and some even because of you. Should you go home now, many of them would disappear as well.'

Embarrassment. Some, perhaps all, would like to protest, but Maria is a senior doctor here, they like and respect her and don't dare to argue with her.

Only Petro decides to speak. Very quietly:

'You, Masha, haven't examined their souls and you don't know what's going on there. Not everyone cries when people die, and not all brag about their compassion, but all our boys and girls -'.

She interrupts him:

'Oh stop it, stop it! I know their souls very well. Sure, they work hard, but if anything happens in the ward, no one would think of sending a telegram to relatives so that they could come and find their dear one still living, not unless you remind them of it! And you... oh, what's the use of talking! I'm going.'

She gets up and leaves.

Petro smiles crookedly. 'What a woman. What a sweet disposition.'

Silence. Everyone feels uneasy.

I am thinking. Snatches of thought. There is something in what Maria said. Mercy. This word has gone out of fashion. Probably unfortunately. I'm not speaking about merciful God, but a sister of mercy as they used to call nurses was not bad at all. Once this was considered to be a great virtue, mercy. Now it has almost become equated with weakness and sentimentality. No one ever speaks about it as proof of a person's nobility.

Mercy and compassion as emotions have two sources. One is the instinct of propagation, especially in the case of children. Then, the instinctive transposition of 'programmes of suffering' upon oneself. It is true even about dogs, beat one, another whines.

But mercy is basically a natural reaction. When man, especially child, learns the basic ethics of social behaviour this natural feeling can be highly developed. Not in an equal measure in everybody, but everyone is susceptible to it. The brain must support good instincts rather than rationalize them away.

This closely concerns us medical people who are constantly dealing with people's suffering. It would seem that compassion should grow and develop with each year of practice, but this unfortunately is not so in the majority of cases. Very unfortunately.

Getting used to it, getting accustomed. This is a remarkable mechanism, habit; the acclimatization of the system to strong irritants which at first produce violent reaction, but then gradually cease to act at all. These programmes work starting at the level of a simple cell and ending with the most complex psychic functions. At first other people's suffering causes you pain, but then you get used to it as if it were your own pain, and learn to live with it. It doesn't bother you so much any more. Then comes a day when a doctor or a nurse notices that their sense of compassion has all but gone. Some would not admit this, but once you start thinking back and honestly remembering things, you will find this point in your own career. This is the normal defence mechanism. Only a few resist it, these few have over-developed compassion centres. These centres do not submit to habit. Such people are sorely tried if they have to work in a place like ours. True, they suffer, but they also experience the highest sense of happiness when they succeed in triumphing over death. This feeling is akin to a sudden release from cruel pain.

Unfortunately patients themselves are doing much to smother the sense of compassion in doctors and nurses. When man performs some service, he expects a reward. He does not realize it perhaps, but he wants it. No money, no presents, those things only insult you, but some expression of gratitude, some emotional return. This greatly supports all the reflexes of compassion.

And I can't say that our patients are especially generous in this respect.

A doctor performs an operation, all has gone well, but when the patient is released he often forgets to thank or even go and say goodbye to his doctor. Most of them explain it by saying: 'I knew how busy you were and I didn't want to waste your time.' Of course, I am very busy and can't arrange any special thanksgiving audiences, but he, the patient, certainly could have found time to come, or even write a little note.

No point in talking about this. I am already old and I understand everything. And I don't condemn anyone, I have got over it. But younger doctors feel bitter about it, and for a good reason. In different economic systems the doctor's services are paid for with money, with us a few words of gratitude go a long way in making our work rewarding.

One old woman doctor, a brilliant gynecologist, who had worked for many years in the same town and had saved many women, once told me:

'I meet my former patient and I see her cross the street to the other side in order not to speak to me. She is avoiding me, hoping that I have not seen her, but I don't feel bitter about it. Just imagine that you have borrowed a great deal of money in an emergency, and have no way of paying it back, and that your creditors don't demand it, and don't even expect it. You are very grateful to them, but would it be easy for you to speak to them? It is a degrading feeling to be an insolvent debtor.'

She was probably right, but it is difficult for young doctors to accept this philosophy. They want a return for their work. And I wanted it also, in the past.

Patients must understand that when a doctor saves a dangerously sick person he not only expends his time and effort, but puts into it a small part of his soul which can be paid for only with gratitude. At least, a good doctor must give this part of his soul if he is a real physician and not a hack. And our patients often overlook this point.

It is so sad to watch how a chain of misunderstandings and mutual hurts often builds up between a doctor and a patient eventually making them strangers, and in some cases even enemies. Gratitude comes so hard to some people. Perhaps I look upon this with a bit of prejudice, but I can't help it. Doctors are also people and they have human weaknesses, they can't all be like Maria Vassilievna.

So how could I condemn my young doctors as she is doing? She cannot understand it because her own centres of compassion have long since grown out of all proportion. Perhaps this is the only thing which sustains her in life, she has nothing at all besides her work, our clinic. She is unflinching in her selflessness and nobility. These people are necessary, they remain the living symbols of humanity, but it is unrealistic to expect everyone to be a saint.

However in one respect she is right, people without souls should not be admitted into our work. Our laws are too liberal in this respect. I don't advocate punishing medical careerists and egocentrics or putting them in jail, this is a crime but not a punishable one. It would be enough to revoke their permits to practice. Quite sufficient. Or at least they should be taken off actual hospital work and put into laboratories where their egotism could not hurt people.

Teacher and physician. Those are two professions in which love of people is an absolutely necessary qualification. And the government should be a little more generous with them.

I understand that there is a purpose in limiting their material returns in order to keep the undesirables out of this work, but they should receive at least as much attention and material comfort as the specialists who build machines.

'Well, children, do you suppose you've made a mistake in your choice of profession?'

Silence. Quite understandable. It is indelicate to speak about this. Especially when this question comes from the chief.

Well, I suppose I'd better go somewhere. There is no prospect of any engaging conversation here. They are all too tired and are still smarting from Masha's attack.

I kill my half-smoked cigarette and leave.

I don't want to go into the operating theatre. I don't want to be in the way or create an impression that I'm checking on them. They always do something wrong, and this irritates me. I am tired of forever fighting against some small imperfection. In the mornings I have enough energy for that, but not at night.

At this point I can't help Sasha in any way.

I also don't want to look at Onipko or any other critical case. There is Maria, there is Petro. Why should they have enough energy when I'm so played out? Well, Maria is tireless, and Petro is young. Probably nothing really terrible has happened there anyway. Otherwise I would have known.

To my room upstairs?

Irina is there. She would hear the click of the electric switch and listen behind the partition, what has happened to Sasha? I don't feel like talking to her now. There is nothing new I can tell her, and I have largely exhausted my sympathy for her tonight.

Where to, then? The balcony. Let's have another smoke. There are chairs and no one would see me there. The patients are now asleep. Or at least lying quietly in their beds. Many are awaiting some news of Sasha. Like Raya and Irina.

Darkness. Warmth. Peculiar spring air.

I am thinking back. Trying to remember conversations, events.

How different all my young doctors are. There are no two persons completely alike in the world, they are all alike and all different. The multiplicity of alikeness. There should be a mathematical term for this.

Programmes of behaviour, from Sasha's notebook.

A devilishly complex thing, this human behaviour. There are so many people the behaviour of whom I can't understand. Not only criminals. Those are extreme cases. Heroes. Loafers. Drunks. Good family men. Insensitive doctors. Half-insane inventors. Dreamers. And then, just people - going to work, coming home, watching television, bearing children, sleeping with their wives. Mostly honest, modestly dull, modestly cowardly, they love luke-warmly and hate the same way. What sustains them in life?

To each his own. Different programmes of behaviour.

Probably it is important to learn about those programmes. Important for modelling. I am already juggling these terms as if they were my own.

It is important primarily in order to know oneself. To find some new ammunition for the battle of living. For happiness. Otherwise each of us is wandering in a trackless forest of passions and anguishes.

It is also important for society. To create a better community of men, to develop programmes for a very complex system of which man is an integral part. This work cannot be replaced by just producing tons of steel or even grain.

Of course, men are different. Until recently this had been accepted as an axiom. All that one could do was to create a composite image of the average man, and taking him as a pattern, calculate distribution of material goods and moral principles.

Now this has been changed. Sasha and his friends say that their machines can write down the programmes of all the different brains in the world and reduce them to mathematical formulas. One can record the thoughts and feelings of all men, arrange this material symphonically and play back the whole system, the model society. Obviously the existing computers can create only very crude models. And they can merely scratch the surface of the future. But even now they can arrange and calculate many more factors than a single human brain, or even a collection of many brains. This is true about medicine as well. Even the existing machines have widened our horizons tremendously, and when fully developed these diagnostic and therapeutic machines will probably come up with more accurate answers than a whole medical convention can do at present.

I don't know. It is hard to imagine a machine which can combine thousands of working intellects and temperaments, and then issue absolutely correct formulas for planning and governing. Day-dreamers, these cybernetists!

I gaze round.

Clouds have covered the whole sky. Only on the horizon where the sun has set there is still a narrow band of roseate light.

What would happen to our town after an atomic explosion? It is so difficult to imagine children, buds on the trees, and that. One's mind refuses to accept such a combination.

This just cannot happen! Unfortunately it can.

America. Once a guiding light for everything new and progressive in the world. And now? I was there, I saw. Waves of cynicism, pessimism, sex, greed. Merciless exploitation of all the basest instincts. Of course there are also men there who search, but it is a difficult climate for them. Twelve television channels and all preach the same thing: 'Hit him! Kill him!' Children's stores full of toy weapons. Books in drug-stores with tortured faces on multi-coloured covers. Violence. This poison spreads, it engulfs youth, children, everybody. All this is aimed at communism, socialism, everything that differs from the political and economic system of the country. How can anyone bring them any new ideas if they refuse to see anything besides television screens and crime books? When they are not permitted to see anything else?

Here at home we also have numbers of those who want to stop everything, to freeze, to limit. It is not easy to argue with them.

The pictures.

The operation theatre. Everyone is around Sasha. Maria Vassilievna with her compassion. Stepa ready to donate his blood. Happy. Petro who had been trying so hard to rehabilitate him. Vasya who wants a dissertation. Irina in the dark laboratory. She loves. Raya also loves. And Sasha himself almost a fanatic of his own formulas into which he writes love, happiness, behaviour, society.

Everyone is moved by something in life.

One physiologist (I have forgotten his name) has found the centre of pleasure in a rat's brain. He inserted an electrode into it and switched on a low current. Apparently the rat experienced some very pleasurable feeling. No one knows what was in her brain, visions of food, the feeling of giving suck to her children, or meeting with her lover. They had taught her how to switch the current on by pressing the button with her snout. From then on, she forgot everything in the world and spent all her time pressing it. I have even seen a photograph of that lucky rodent.

If only it were possible to introduce such a pleasure wire into the human brain. Then all we should have to do to be happy would be to press the contact, without operations, love, art, books.

The desire to get the maximum pleasure and minimum of the unpleasant, this is the basic mechanism governing our activity. There is a built-in regulator which switches on various programmes offered by the body and brain. The brain programmes are ingrained by society and supported by creative impulses. Children and animals think only about one day, but adults are trying to look into the future.

The pleasure centres are agitated by the fulfilment of the animal programmes, food, love, children. Or simply by the completion of some piece of work. And besides that, by freedom. Gratification of curiosity. Searching. There is also a warm feeling when someone strokes your head, 'you're so good'. The primitive happiness.

The brain has developed a whole set of conditionary reflexes substituting for these primary agitators of the pleasure centres. These reflexes can become so powerful in man that they can overpower all the bodily signals. Society, people can make them unstoppable. Or at least, give them a powerful stimulus. And once this is started, it often can't be stopped.

Strong agitation of the pleasure centre is happiness. It is unfortunate that this soon wears off and is replaced by indifference. It becomes a habit. Lasting animal happiness is impossible, it is too acute. The contrast of suffering makes it even sharper.

With animals it is simpler. You eat your fill, walk around, sleep. A little time, and you are ready again.

It is more difficult with men. The condition agitator, unless it is supported by a basic one, ceases to agitate after a while and may develop into a brake. This is what Pavlov said. Wise words, but they require a small correction. For a dog, yes. Man can develop a set of non-animal brain agitators which can act continually even when the subject is a completely abstract one. Not without interruptions, of course, but rather like food. Wait a bit and start all over again.

It is good for a man to have such a fixed brain agitator, an urge to invent, to write, to create, to do good to people, or simply to derive happiness out of his work or profession.

Society must teach this to children. To inject into them correct social programmes. Otherwise, life may become a disaster. Nature has planted so many traps in our way. Every instinct can be turned into a vice. Food can lead to greed, the sex instinct to lewdness, the desire to receive recognition to egotism and cruel disregard for others.

Is it possible to graft in such non-animal programmes and stop the flow of slush from below?

Well, it is time to go. If this last gamble is lost, then we must again decide what to do next. And there is nothing at all on which a correct decision can be based. Flip a coin? When shall we have those clever machines which could decide for us?

Why worry. I shan't live that long. No.

There are so many centrifugal forces separating people. Sasha had defined them clearly in his work. The limitation of learning. Misunderstanding. People don't understand one another simply because they don't know what they are talking about. Semantics. Subjectivity colours everything. One's own convictions discard everything that does not fit them. How much harm has been done by deeply convinced but limited people!

Perhaps the thing which must be done first is the rejection of one's own categorical opinions. We must realize that our own modelling installations are very limited. That all seemingly simple things are in fact complicated and have many sides to them, each as good as another. Multiplicity of truths, each as true as the rest.

And again we need some very intelligent machines able to model and analyze very complicated systems for us. Or at least supply us with material based on definite mathematical facts.

It is easy to write recipes for behaviour. It is infinitely more difficult to make up these recipes and prescriptions.

I am going.

Probably everything is ready there.

Must be.

   1A diminutive form of Stepan or Stephen. It establishes a certain warmth here.


Translated from the Russian by George St.George
© George St.George, 1966