6.12.1913  -  12.12.2002

Books of N.M.Amosov

Diary. Monday, December, 8

Saturday was my birthday I turned sixty-seven. I don't like this day not because it adds another year to my age, but because of the efforts required and the embarrassment I feel when accepting congratulations. In the evening, we receive guests — it is our annual reception. Lida usually makes a big fuss about it. She usually stays awake for two nights, cooking and cooking... Frankly, this behaviour irritates me. The people who come are really fine folks. The guest list has remained unchanged for many years. I can't say that all of them are close friends; they're just nice people; that's all. Most are surgeons or professors. One rule I observe strictly My colleagues and subordinates are not invited.

But enough of this.

I got another present for my birthday that really brought me joy.

On Thursday, I operated on Larisa N., the very girl whom I had examined with fear some six months before.

On Wednesday, I operated on two patients with defective aortic valves and said that Thursday Larisa would be operated on. I got home late and slept badly having anxiety dreams in which I was performing one operation after another. All the time, I was wondering what I could do with her narrow aorta: there were several ways to widen it, all rather complicated. In fact, they couldn't be used in Larisa's case, since that would have prolonged perfusion, and she would have been unable to cope with hemolysis.

So, I could only hope for a miracle; however, life is merciless with respect to nice people as I had learned long ago from my patients.

On the day of the operation, after the decision has been taken, I don't think about the patient's personality. Everything is subordinate to an inner order that instructs me to pull myself together, not wasting time and strength on sentiments: this approach would enable me to operate upon the person dearest in the world to me.

The girl was to be operated upon second to avoid any complications with the other operation, should her operation be prolonged. The first case was a woman with a defective mitral valve; everything went well. The second began at one thirty. The team was excellent: Lyuba Veselovskaya, my permanent assistant during the year, a top-rate surgical nurse, and a sort of tutor for beginners. Swift, sharp-tongued, and somewhat capricious. Nikolai Dotsenko and Sergei were also reliable assistants. Valery Litvinenko, anesthesiologist. There had been friction between us. He was a bit too self-confident but knew his job. Last but not least, our AIK machine operator, Victor Maximenko, perfusiologist.

When we met, I got the bad news immediately:

"The pericardium region is soldered, like after an operation. There are even calcium depositions. Probably the result of an infection." That was really bad news, meaning that the heart could not be cooled with ice, therefore, chemical stoppage of the heart, so-called cardioplegia, was also impossible. The only thing that could be done was to send cooled blood through the coronary vessels. This also implied that access to the mitral valve would be hindered, since the heart was fixed. Hence, I would need additional time, and trauma was inevitable.

I'm not goind to describe the operation in detail. The diagnosis was confirmed. The tricuspid incompetence was remedied by narrowing the ring (so-called annuloplication). Mitral incompetence was eliminated by introducing a hemispheric prosthesis. Finally, the major trouble was the aortic valve. On Saturday, I had readied an American prosthesis, a small one. However, I managed without it, placing a Soviet-made one. It was somewhat bigger, so it was rather difficult to put it in place, the aorta disrupted almost crosswise, and I had to sew the breaks. It was a painful job, taking 140 minutes of perfusion; however, hemolysis was low.

The heart started to beat, but the bleeding lasted for almost two hours. Finally, we coped with this, as well. Then Nikolai took my place and sewed in the breast bone. I was sitting nearby, waiting for him to finish. The only thing left was to wait for her to wake up. Then we could say that the first stage was behind us. With that thought, I left the theatre. The patient was without a tube by then, sleeping. I had tea and switched on some music. It was 7 p.m., and I had entered the operating room at 11 in the morning.

Half an hour I spent in the office, waiting for the operation to end. Let them sew the wound and take her out of the theatre. Meanwhile, I would keep myself busy going through the huge pile of letters on my desk. Having read some of them, I went to see what's going on, trying not to show my fear.

Thank God, she was awake. In any case, when called loudly, she opened her eyes. Everything was O.K., but it was too early to rejoice.

Soon she was taken to the intensive care unit, showing no signs of deterioration. Assisted respiration was switched off.

"Larisa, breathe deeply, breathe."

Undoubtedly, she was awake by then: a sensible glance, no bleeding, normal excretion of urine, and normal blood circulation.

Soon after eight, Valery removed the tube. (This is a rather complicated procedure: one must put a normal saliva solution in the trachea, inducing coughing, then pump the solution out in order to wash the bronchi and free them from blood and sputum. The next step is to remove the tube, inducing coughing once again, then tell the patient to spit out the sputum and saliva. The patient when conscious, feels tremendous relief.)

I waited for another half an hour: nothing went wrong. I couldn't believe that everything was going so well, and raced home, full of joy.

On Friday, I met the doctor-on-duty in the lobby. He immediately answered my unspoken question: "Everything is O.K."

In the conference room, I saw a bunch of red and pink carnations on the desk in front of my seat. Those present met me standing, with applause — congratulating me on my birthday. Speeches are not a custom with us. I thanked them and we started our daily routine: reports by surgeons, information from the doctors-on-duty, etc. Then we heard a preliminary defence of a doctoral thesis written by Irina Chepkaya, a beautiful young woman. Her father, Professor Leonard Chepky, had been our chief anesthesiologist for a long time. Her thesis dealt with therapeutic aspects of congenital heart diseases. Everything went smoothly. She had managed to write her thesis in four years, though she had a husband and a child to take care of. Good girl! During the past six months, I had heard preliminary thesis defenses almost every Friday. It so happened that our young people had quietly grown into scientists. Well, another dozen or two Ph. Ds wouldn't hurt the clinic.

During my daily rounds, I checked Larisa's condition: blood circulation, psyche, respiration. No complaints. However, the bilirubin content was significantly higher the norm. This meant a new range of troubles — the liver might fail, leading to an outbreak of some old infection or even a new one, in the wound. So it was too early to rejoice, although there were ground for hope. The parents hadn't come to see me yet... Well, I was not offended: they were shy and modest people, I knew. Her mother had made many friends in the clinic during the last six months and knew everything about her daughter's condition without asking me. As for me, I could do perfectly well without any thanks: the best gratitude for me is when my patients remain alive after their operations. This is more than enough to make me happy.

I was about to go home when the nurses came in to congratulate me. Lyuba gave me carnations on behalf of all. I kissed her on both cheeks: our surgical nurses are a fine bunch of women, and, frankly, I have a weakness for them and haven't sworn at them for many years. Well, I raise my voice occasionally but don't use foul language. Everything imaginable had happened in the past, but I had never used foul language in the operating room. Alas, some surgeons are often rude during operations.

On Saturday, I went to the clinic to have a look at Larisa. No reason to worry. I hoped that everything would go well for her.

This was the best present I could possibly have gotten for my birthday.