6.12.1913  -  12.12.2002

Books of N.M.Amosov

Diary. June, 16

I have not made any entries in my diary for two months. Diverse monotony. Operations. Deaths. Recoveries. All different and all similar.

I thought a lot. I reread my scribbling and was displeased. Nothing to write home about. It was not the whole truth about people and life. I fear that what I have written will offend my readers. They will be offended for themselves and for the dead. The whole truth was stated only in figures, in results. Science is still primitive for scientists and dull for others. I will edit what I have written and give it to those whom I trust to read.

Last night I was walking home from the clinic along Kreschatik Street watching the people as I went. I tried to guess from their faces what they really lived for. Were they happy? If they were, then what was the reason for that? I tried to apply it to myself.

A beautiful night, it wasn't hot any more.

Walking by were jeans-clad boys and girls. There were many happy or, at least pleased people. Couples in love, their eyes shining, seeing only each other, the whole world was non-existent for them. But there were also sad people.

The elderly people were quite different. Fatigue was evident on their faces. What concerns did they have? Mainly trifling, but they were frightening and spoiled life.

What did all these unpleasantries mean in the face of death, though very often they seemed horrible?

Death in one form or another touches all of us. A son dies, a fiancee is killed. The grave illness of someone close makes us face the reality of death. But this is something we see twice or thrice in a lifetime. It's the ones who have the disease that die, often despite operations. "I failed to save this person" — that's a good formula of consolation for such cases. And here, goodness knows why and how we live our lives...

The feeling of guilt does not leave me; I am disappointed in myself for misunderstanding nature.

I walked and watched the faces.

How lucky all these people were that they weren't heart surgeons and didn't perform operations with artificial circulation.

I'll tell my readers a little bit about what's been going on so I can relax before tomorrow's operations.

The two months following my last diary entry were, so to say, so-so. I operated a lot — no less than two days a week, three operations a day, by all means. We have had so many patients in the clinic, thirteen operations each day, five with the AIK machine. My usual contingent — valves with high risk or usual congenital defects, a death rate of apporoximately one in six. The minimal proportion necessary for me to live and preserve a zero level of moral comfort.

At the beginning of May I was in Czechoslovakia for a week. We were invited (just think of it!) by philosophers from the Academy of Sciences. I delivered two lectures and had three discussions on the algorithm of intellect and artificial intellect. I could see for myself that I ranked high. However, I was not deluded: I must either publish several fundamental theoretical works with many pages, citations, and names or design a convincing model of the intellect. Without this, my ideas are interesting enough but do not carry any weight.

I was treated with respect by both profesors and academicians. I strolled around Prague with pleasure, since I had not been there since 1967. I visited two cardiological hospitals — one for adults and the other for children. The surgery departments were excellent, particularly where small children were concerned.

I returned home, and everything continued as before — operations, complications, insomnia, the joys of recovery. Everything was "balanced" — no major failures and miscalculations.

During the last week of May, I was preparing my report for an important event — the 30th All-Union Congress of Surgeons in Minsk. We seldom get together — once in six or seven years. It is pleasant to meet old friends. To give a report is a great honour.

This time, the proceedings for the Congress were different than usual: only two plenary sessions and special interest sections on the other days. This is a proper procedure since surgery has become so specialized. My report was the first one given at the Heart Section: "Experience in Valvular Prostheses." I did not write the report but prepared the slides only.

I divided the activities of our clinic into stages. The two most recent periods in our "revolution" formed the basis of my report. If not for that, there would have been nothing to talk about; it would have to be a shame to climb the rostrum. Now everything is quite different. For initial prosthetics of the mitral valve, the mortality rate has been reduced from 25 to 8 percent. For the aortic valve, it has gone down from 27 to 8 percent. The figures are convincing — 230 operations "before" and 230 "after." We are back to international standards.

I attended more than half of the meetings in earnest (I hate to sit through them). Rather interesting were the reports on microsurgery during the first day. The perspectives are optimistic, and these tech­niques are useful for sewing the smallest vessels or restructuring organs. I listened to the reports on lung and stomach surgery and recalled my previous operations. I was not very happy at that time, but I did not live so hopelessly as I do now...

I was greatly impressed by Yevgeny Nikolaevich Meshalkin's report: more than a hundred prostheses performed using hypothermia. I would not believe it if I did not see it for myself in 1977. They have prolonged circulation arrest to 35 minutes. I have never seen anything like that anywhere in the world, and I cannot understand how they do it. Yevgeny Nikolaevich is a strong man, I saw that back in 1955 when observing my first heart operation ever. I followed his example and began to operate on the heart myself...

(Was it worth doing? I could have continued to operate on the lungs and stomach like so many others do, and I would have lived a quiet life. But when I begin to think about my decision, it was worth it. It is only heart surgery, particularly with the AIK machine that gives me the feeling of the greatest tension, of the ultimate struggle for life.)

It was wonderful to run at the Minsk stadium...

What else can I say about the Congress? I had a nice rest. I did not miss my clinic. Far from it. But still, I left a day before the Congress ended so that on Friday, June 5th, I would be able to examine the patients who would be operated on the next week.

Then everything went sour. A rainy spell began. There had been just such a period when our "syndrome" was in full swing. Could such a thing happen again? It was dreadful even to consider. I didn't believe it, since we had used our new method on more than 600 patients (including those with congenital defects). No, I will not describe those gloomy weeks.

Life went on. We had a good rain after a long hot spell and our patients began to feel better. There were fewer complications.

Lida and I went to our country house. My wife hoped to get me interested in nature, and while I was there, I liked it. I could have stayed for a week. But when I came home, I changed my mind. What did I need a country house for? I liked my study better. Chestnut trees almost blocked the view from my window; I had music and many good books which I had no time to read.

I am afraid it's too difficult for my family to live with me. I try not to show it, but I'm rather gloomy. By the way, no one approaches me during such periods. The only one that never irritates me is Cherie. My daughter jokes: "If you could be half that gentle with us." She is wrong. I love my family. I simply do not want to talk. All those patients on artificial respiration or with gastric hemorrhages or infections are constantly on my mind. I cannot but think about them.

I've got tired of writing, so I will race through the end of the last rainy week. It would have been good to stop operating, or at least not to take high risk patients, but nothing doing — I try to resist fate.

On Monday, 15 June one high risk patient gave me a ray of hope. She had regained consciousness without a doubt — she nodded her head in answer to my questions, moved her hands and feet. She might yet escape the inevitable. And then just before the conference, a girl I had not dared to operate on for a long time dropped in (two valves). Red-cheeked and beautiful, but looking a bit older than when I had treated her.

"I am absolutely healthy now."

Her father was with her. He said everything parents usually say in such cases...

That helped a little.