6.12.1913  -  12.12.2002

Books of N.M.Amosov

Diary. December, 12

Friday, three-thirty in the morning. Unable to sleep, I sit down to write in my diary. The two last days have been extremely hard. Yesterday I had three operations: I'm not getting any younger, so I've decided to try to operate on three patients a day whenever we have operations. Frankly, the first operation was a "closed" one without the AIK machine. A fourteen-year-old boy with a congenital interconnection between the coronary artery and the cavity of the right ventricle of the heart. The usual diameter of the coronary artery is three millimetre, and in his case it was twenty at least. In fact, the boy's artery looked like a pulsing sausage on the ventricle surface, with its end going into the cavity and discharging a lot of blood. When I put my finger on it, I could hear loud noise. I put in several stitches at that spot, and the noise disappeared. The boy will be completely healthy. Without an operation, he was threatened with decompensation.

The second patient underwent an operation aimed at replacing the mitral valve; the third had his aortic valve replaced with a man-made one. The latter was also a boy of twelve, with a small build and quite lean. The risk was enormous, for his heart was too big. Thank God, everything went well. The operation lasted several hours; I waited for my assistants to remove the tubes and left reassured of the outcome. It was almost ten in the evening...

What a pleasure it is to sit alone in the office in the evening, when all the operations have been successful. I've brought in an old wireless and now can enjoy music over the radio: it helps me relax and dispells gloomy thoughts.

There are no operations today, only the routine Friday business. The week was more or less successful: fifty-two operations, and only two deaths. We're going to discuss them today: are they legitimate? Yes, when the patient operated on is in critical condition and finally dies because of complications which are caused by the gravity of his condition — that is when the operation itself is performed correctly. Nevertheless, it sounds ridiculous to an outsider — a "legitimate" death.

I recall that it was on the very day in 1951 when I was ordained surgeon, as it were. It was my debut performance, as well. It happened during the Third National Conference on Theoretical Surgery. I, the unknown surgeon Amosoff from Bryansk, had sent two papers: one on purulent pneumonectomy and the other on pneumonectomy (resection) in TB patients. Both papers were accepted by the organizing committee and I was given ten minutes for each. The sessions were held at the Institute of Obstetrics in Moscow, and I made both presentations in the same day. I was very nervous, reading out my prepared texts and showing the tables I had drawn and my poorly made slides (a better quality was unattainable at the time). My materials were the most extensive and the results were the best of those presented. (I didn't keep the papers, but there were some 150 resections on TB patients, with a two percent death rate, and about 100 purulent pneumonectomies, with a four or five percent death rate.) When I was through with my papers, the audience even applauded.

After the session, I was approached by Alexander Bakulev, one of the founding fathers of the national school of surgery. I clearly remember his words:

"I think you could make a good doctoral thesis on the basis of your papers..."

He didn't know I was already a Candidate of Science (a degree that corresponds to a Ph. D. in the West). I told him that I had written and typed my thesis on TB which would give me the right to a professorship but was afraid to present it: the Review and Qualifications Board might turn it down.

"Bring it to me at the clinic. At ten in the morning." The next morning, I was sitting in the lobby of the First City Hospital:

I had come early, ahead of the appointed time. Suddenly, I saw two generals from the Medical Corps entering the building: one was Alexander Melnikov (Naval Medical Corps), the other was Petr Kupriyanov (General Medical Corps), an academician. I remained seated. As they were passing by, they stopped and greeted me. I jumped up, pleasantly surprised. We shook hands, and they congratulated me on the splendid results of my studies. It was then that I realized I'd received recognition as a surgeon. These are the specifics of our trade: if you work well, you'll be recognized as a first-rate specialist, no matter whether you're an academician or an ordinary doctor.

At ten, I was shown into Bakulev's office. The furniture was simple; it had probably been left-over from the time of Professor Sergei Spasokukotsky. Bakulev shared the room with another professor: this kind of democracy is rare today. Don't forget that Bakulev was President of the country's Medical Academy at the time.

Bakulev received me rather coldly and didn't indulge in lengthy conversations. He took my thesis, promised to read it within a month's time and give me his opinion afterwards.

He kept his word: he called me up in exactly one month and returned the manuscript, saying it was O.K. and could be defended. I was amazed to see numerous remarks in the margins: he had really read it thoroughly. To show his displeasure, he underlined descriptive words like "splendid" or "remarkable." At the end of our meeting he instructed me to come back with the manuscript retyped, and then we would decide which institution the thesis could be defended at.

I came back in the fall. Beside Bakulev, I saw Efim Berezov in his office — they were old friends and had worked together under the guidance of Spasokukotsky. They agreed that the best thing would be to defend the thesis in the town of Gorky, at the local medical school. Berezov promised to be one of the official opponents, inviting professors Lev Bogush and Boris Korolev as the other members of the team. Those were the celebrities who blessed both my dissertations. (When I defended my first thesis, the opponent was Nikolai Blokhin, President of the Medical Academy.)