6.12.1913  -  12.12.2002

Books of N.M.Amosov

Diary. November, 18

Half of November is over. Today is Saturday, but I am not going to rest. The next week is lost time as far as operations are concerned — I have to go to Moscow to the Session of the Medical Academy. Then I'll visit my sister and aunt in Yaroslavl, and after that, drop in on Vladimir Ivanovich Burakovsky at the Institute to learn from him how to handle children. Then I have to see several friends — for information purposes. On Monday I will operate on two patients, and then I will leave.

I am in no mood to rest. For two weeks, I have operated without any losses — eight patients. And now there is a girl with tetralogy of Fallot in critical condition. The day before yesterday, I came home at 11 p.m.; second operation that day was a long one; the patient started bleeding, so I performed a thoracotomy. We cannot learn to operate on children. It's enough to make you weak. (An extremely cyanotic girl with a hemoglobin of 130, she previously had vascular anastomosis, then it was closed, and her condition was aggravated; so there was nothing left to do but operate.)

Writing is catching. I can think and complain on paper — it will accept everything. "Verbal communication" is difficult. The relatives always have their own scope of interests, which rarely coincide with mine. This coincidence is different with my daughter, wife or colleagues, but still it is small. Information is rapidly exhausted during the process of communication, and time is required for it to accumulate once again. Paper does not have its own "scope" of interests, if you do not see editors and readers behind it. At least I try not to see them.

Now I do not want to write of patients, of the clinic — all the developments seem to be new, but they have happened before. I do not want to write of science either; the truths that I will pronounce — I won't overestimate.

Where should I let my thoughts travel? I want this travel to be easy — not trying, since there is no sense in that.

Recollections. I have not yet touched on them. But when my soul starts whining, exhausted, it's high time to do it.

Memory is an amazing thing. The brain accumulates much information (models) during a lifetime. New information each time. The old information is gradually if it is not used. The sum of models initially increases with age and then begins to diminish. The memory keeps only what is repeated and what is important. You have to recall it regularly, and in this way you train the model. And if the telephone number is jotted down in your address book, why should you remember it?

It sounds dull when you pronounce words.

My memory makes me sad. The new I remembered with difficulty, and the old is going with the wind... It seems that the sum of information is diminishing. What are all the other "programmes of action with models" worth — that's I call thinking — if no information is left? These "programmes" have not seemed to be getting rusty up till now, but the memory... It is getting difficult to recall various events. The "access time" is getting prolonged with the expansion of the information file, as computer programmers would put it. That would not be bad. But what if it's simply sclerosis? No, that cannot be. My cholesterol level is like that of a young boy. Automatic memorizing of the new deteriorates with age, because the synthesis of new proteins in the neurons is decelerating. They are responsible for the establishment and maintenance of communication between "neuron models." Old age cannot be avoided irrespective of how much one runs or eats cabbage. But I hope to postpone it.

Cherie, my dog, lies in the armchair which is close to me and regularly pushes her head under my elbow, asking for "caress," this warms my soul.

So what can you manage to recall, old man?

Even paper will get sick and tired of minor daily facts registered by one's memory in the past. They live close to the present and when they emerge in the conscience, such events echo weakly in the feeling. That's why they are valuable. Not real in terms of their force, but in terms of their... I am eager to add "specificity." But is it possible to insert such a word into a line about feelings?

Real. Unreal. Probable. The past, the present, the future. I have introduced these concepts into my hypothesis on thinking.

Real is what is at present perceived by receptors and evaluated by feelings. The present moment: I look, I see, I feel. But not only that. "This day of work" and "this year of writing a book" are also real. They are perceived as the period of time, occupied by this activity. The real and the present, the detailed and generalized — what is the interrelationship between these concepts? My past: no doubt it actually occurred, but... the action is over. So is it real? Yes... But it happened in the past. On Monday, I will operate on female. The blood has already been prepared. Is it real? Yes and no. Anything might happen. The Probable. The Future. How good it would be to meet in Moscow... I will never meet. She has died. Unreal. But I have a picture of meeting her in my mind; it can be taken from the past, and I may add details on the order of my present day feelings (I'm 67 after all!) and will get a complex composition which awakens feelings as if they were real ("specific"). But alas, they are much weaker. On guard is the indisputable: "it is not the present." And this spoils everything. That's the way we interpret art — feelings with corrections made by reality. You can watch, then recall a film, go through it in your mind, but you can't act in it. No sense here.

Another thing is the future, providing it is realistic. It causes almost real feelings and prompts you to act, spare no efforts, and strain. But once again with a correction. If a car is heading for us, where do we get all the energy necessary to run away for fearing it will crash into us?... Now! One-hundred per cent reality and probability to the second... The premonition of pain has the same effect as real pain and stimulates maximum tension.

Or take another situation. Suppose, I've decided to write a book, say, about society. It will take a lot of effort, and the editors are stern in their judgements. But who knows, maybe the book will gain recognition. The probability of success is determined by weighing the pros and cons... And there is yet another factor: it will be a long time before the book comes off the press. How old will I be by then?

So this is a model of the future. We spare no efforts chiefly for the sake of the future, rather than for immediate gratification: we engage in delayed gratification chiefly to achieve pleasure or to free ourselves from the bondage of troubles in the future, say, in a week, a month or a year. The level of tension, and the resolution to start acting are determined by the expected enhancement of pleasant feelings, the probability of attaining the objective, and the time factor, i.e., the length of time required to realize a particular desire. Impatient people have a very small time factor; they live for the present, and are incapable of delayed gratification. There are more persistent individuals who are ready to work years and years for the sake of happiness in the distant future, even if the probability of success is low...

Once the human reason has calculated that the rest of a life time is insufficient to achieve larger goals, one must content oneself with immediate tasks and objectives and derive satistaction from the mere fact of doing. There is no other choice, although this is not the kind of happiness people want for themselves.

The human brain is a wonderful thing. Its inquisitive search beam can be directed anywhere in the past or to the fantasy of one's desire. It can consider a scientific problem, for example.

However, when things in our clinic are going from bad to worse, it is hardly possible to pick a happy moment from my memory and take pleasure in some substitute for happiness... Hell, no!

For such moments, I have a selection of records: Requiems by Mozart, Verdi, and Foret. The memory is so sensitive to the mood at different times: various events and periods of life are coloured in different hues, and a shadow is cast over the good when one feels unhappy, and vice versa...

Once again I asked myself a question: "Has there been any hap­piness at all?"

I know for sure that I have been happy at times, but at present, I do not believe it. There was always something that interfered with the proper train of events. Or maybe I'm a pessimist by nature. In any case, I'm feeling low, and my memory is turned to the sad moments of the past.