6.12.1913  -  12.12.2002

Books of N.M.Amosov

Instead of afterword

I will tell you at once: there was no happiness. It would be funny to expect it at seventy. But there were many misfortunes. I fought honestly: I did not take any vacations at all either in 1983 or in 1984, I did not receive my director's salary, and did not go to my country house in a state car. (They will say: "You are play-acting!" Let them. There will be always people who will say that; but I have surely entered the period when I work without looking back.)

In the first year and a half the Institute functioned, we performed by 1,300 operations more than the top figures of 1982 — by 40 per cent more.

We would have performed even more than that, but there were no patients, although that seems strange, since we know they are out there somewhere. The local doctors must start thinking of their responsibility for the lives of their patients, particularly the children.

Is it difficult to be a director?

No, not too difficult. Although all directors complain: the bosses at the top are too demanding and unjust, whereas one's subordinates, to put it delicately, are egoistic.

I am not sure it is true. When I was forced in April of 1983 (almost with tears in my eyes) to agree to become a director at least for a year, I was sorry for all the possibilities that would never materialize — to read, write, philosophize, model — but I had no fear about my abilities to function.

Now a few words about subordinates and bosses. First about the former. The decision of the Party and the Government to form work collectives is a good thing since it facilitates management. Openness, honesty, and irreproachable behaviour (relative, there are no absolutes). And what is most important — a noble, lofty goal. And then there is no need to fear anything.

On the very first morning, I invited all of them to the conference hall and said, approximately, the following:

"Did we want this Institute? Well, whether we did or not, we have got it. They have placed their trust in us. We will have to work hard: 3,000 operations in 1983, 3,500 in 1984. These figures mean lives saved. And this is realistic, although difficult. Our operating staff was increased, but the research team was left intact. We have to do it. I will not punish anybody. (I made the first official reprimand only in the third year of my directorship; I could not do otherwise.) I won't be just all smiles, but you, in your turn, must demand that all the bosses, myself included, should work hard and be honest."

A week later we voted: I received 86 votes for and 6 against. Chiefs of the various departments were, in general, assessed favourably.

It was even simpler with the bosses — nobody was against hard and honest work. And all of them helped our Institute. We ranked high in number of operations, and their quality was not so bad.

When a reception was held in honour of my 70th birthday, Vladimir Ivanovich Burakovsky praised me highly. And other people did as well. It was very pleasant to hear all this, although I initially did my best to resist having any notice taken of this occasion at work. And I was awarded a medal into the bargain.

I sewed three valves in on my birthday. (It's rather difficult to abstain from vanity... Or self-affirmation?)

But still there was no happiness. We failed to reduce the mortality rate, the total number of fatalities increased in proportion to the number of operations. There were various complications. This whole book is dedicated to them, so why should I repeat myself...

In January the directorate received an anonymous letter viciously complaining about and attacking me. No, it did not upset me too much, although it was very unpleasant to receive it. I made this anonymous letter public at the conference. And once again I held a vote — may be I was a bad manager, scolded the staff too often, or demanded too much... Apparently, that was not so — only three of them gave me minuses.

But I could not remain indifferent to the deaths of my patients. In April mortality went up, and I had two deaths in succession of patients who should have lived in my estimation. That meant I was a bad manager.

The year during which I promised to be the director ended. I handed in my resignation to Anatoly Efimovich Romanenko, the Minister of Health. He said he would see to the details. I began to wait. I did not operate but spent all my time on administrative affairs — mostly scolding. I thought about what I would like to be doing. I refreshed in my memory the old projects I had abandoned during the past three years.

The most difficult question was whom should I recommend as the new director. I selected two candidates and wanted to have a vote — to see which of them was to the liking of the staff. (Secret ballot, of course.) I made arrangements with our Party organizer. Bad luck — that very day (only once that whole year) the commuter train was two hours late. When I finally arrived, there was a riot — they said I had done it on purpose. And such a matter could not be decided in such a fashion. I got angry: "Let the Minister appoint the new director himself!" All this being said I left for my country house. (For two summers, I had been going there every day. I could do some reading on the commuter train — two additional hours a day!)

That evening at nine, Cherie and I went to the forest. I did not see or hear anything — I was too busy thinking about the main thing in my life.

And it was precisely at that moment that I was struck with fear. The next day, they would make the decision final, and I would not be able to do anything.

"What are you doing, Amosoff? You have not brought your plans to a conclusion. You will have your 3,500 operations a year, but you have to do something about the mortality rate! And how can you leave your 800 employees in the lurch when you are not operating any worse (for the time being) and your head is still clear? And what are you doing to substitute for the main thing in your life?"

I had done a lot of thinking during the month my letter of resignation was at the minister's office. There was an episode of grave heart arrhythmia. I was quite healthy, operated and run a lot. But when I made an attempt to assess my life, it turned out that the price was not too high. The price of my own life was not too high, but what about the lives of thousands of other people, or children? Could their lives be put on the same level as my beloved models?

Models of society were extremely interesting, but they were only toys! Until the correlation between innate and learned behaviour is measured, until the paths and rate of the technological progress can be predicted, the probability of these models was...

Were they really necessary? No doubt, they were. But for their development, decades would be required and I had almost no time left. Or take artificial intelligence — it seemed that I knew how to construct such a thing, but the necessary technology was lacking and I could not invent it. Although my colleagues in cybernetics worked extremely productively, they also needed the proper conditions and time. They needed me not to generate ideas, but to "push through" their paper­work. However that I did parallel to my directorship. And how could I compare thousands of actual human lives with abstract toys? I did not need what was fast approaching fame as a writer, and I was no longer interested in art to any great extent... (So what the heck did I need the rest of my life for?!)

The next day I went to Anatoly Efimovich and took back my resignation, planning to stay on until I was fired. It was Friday morning, and the staff was waiting at the conference to see what new director I would bring them after my visit to the Minister: you can well imagine the scene of my return.

Since then, I have been working with no regrets. I do not look to the side and am not afraid of the end. All personal doings and interests have been shored into the background. We have to reduce the mortality rate to acceptable figures, to identify in the Ukrainian Republic and send to the Institute patients with heart defects, particularly children, and to raise the annual number of operations to four thousand.

I must do this in such a way that all my colleagues at the Institute will make these objectives their own so that the work will be... I wanted to write joyful, but I will not do that, since heart surgery can never be unconditionally pleasant. But it is vitally important, and this is the main thing.

Recently, there has appeared a ray of hope for reducing the mortality rate. Otherwise, I would not write about it in my concluding remarks. However, there have been rays of hope in the past...

Translated from the Russian by Alexander kafirov
English translation © Alexander Kafirov 1990 Printed in the USSR
Photos are reproduced here with kind permission from the author
and the Radio and Telegraph Agency of the Ukraine (RATAU)