6.12.1913  -  12.12.2002

Books of N.M.Amosov

Home   >   Publications   >   Books of N.M.Amosov   >   Russian Surgeon   >   ...and Night. Myself

...and Night. Myself

The operating theatre again. How many times today?

The situation:

Sasha is on the table. Asleep. He is breathing on his own, through a tube. Lenya is helping him a little, softly squeezing the oxygen bag in rhythm with his own breath. Besides Sasha, on another table, lies our hero Stepa, a blissful smile on his face. Paying in full for his sins and omissions. Between them there is a small table on which is the uncomplicated apparatus for direct blood transfusion. Oleg is in command, ready to start. His face registers impatience. The tube has already been connected to two veins. Marina stands over sterilized instruments on her table.

Oxana is sitting in front of the monitor screen, just as before. She must be very tired. She has been sitting like this for fourteen hours. She is afraid to leave, what if there is another stoppage? The moment we are through with this little operation, I must send her home.

Dima is writing something in his journal. Genya is crouching in front of the drainage tube, counting the drops. Maria Vassilievna is here, Petro, and some of the other youngsters.

Again the same often repeated question:

'What are the showings?'


'Everything's normal. We are ready, all the analyses have been taken. We were just going to send for you.'

'Very well, Oleg, let's go. Pump steadily without interruptions so that the blood won't coagulate in transit. About one full syringe every twenty seconds.'

Oleg goes to work.

'Genya, how's the blood flow?'

'Fluctuating between forty-five and fifty-five drops per minute.'

Silence. All I can hear are the small clicks of the apparatus being switched from suction to injection. Dima keeps his hand on Sasha's pulse. Oxana is watching the cardiograph screen without taking her eyes off it for a second.

'Shall we give him additional anaesthesia?'

'No, there's no point. There are no shivers.'

Five minutes pass. We have transfused some two hundred and fifty milligrams. The haemorrhage rate remains unchanged. Is it possible that this will also prove to be a vain hope?

Well, what shall we do then? Wait longer or open the wound and look for the bleeding vessel? Everything has been considered carefully. Kidneys. Liver, Enough!

'What about urine?'

Genya looks at the bottle connected to the catheter. It is half filled with dark-brown liquid.

'Forty cubes in the last thirty minutes.'

Dima cuts in:

'The analyses are slightly improving.'

Well, this is not too bad. The kidneys are working. It means that we can go on with the transfusion. I am scared to death of operating again. Let's wait. It is too early to despair.

Oleg is continuing the transfusion. Everything is proceeding smoothly. Stepan looks fine. He is strong, five hundred cubes mean nothing to him. He is tired, hasn't slept for probably forty hours. Can this harm the patient? I remember reading somewhere that dogs receiving tired blood go to sleep. Well, this wouldn't be so bad in our case. The longer Sasha sleeps the better. Let's wait and see.

Everything is going on so simply and undramatically. A newspaperman would call this 'heroic sacrifice of a young physician'.

'Professor. Two syringes more and we'll have five hundred cubes. Shall I stop?'

Stepan cuts in without waiting for me:

'Take two hundred more, Oleg. I feel fine, it won't hurt me.'

'Shut up, Stepa! You won't be a hero to us even if we bleed you to death!'

A hint at our lack of appreciation?

'Let's do it this way: take two hundred and fifty cubes more from Stepan, and immediately give him a plasma transfusion. In this way Sasha will receive all he needs, and Stepan will get a good compensation.'

This suggestion comes from Maria Vassilievna. A very wise one. To take seven hundred and fifty cubic milligrammes of the donor's blood may be dangerous, but this way the loss will be compensated in full. And of course Stepan's fresh blood is infinitely more beneficial to Sasha than the frozen. They have already given him over a litre of that, and it hasn't produced any results.

The venous pressure is low, and there is no danger of overloading the heart.

'Well Stepa, do you feel dizzy?'

'I? Not at all! I feel fine!'

'All right then, let's do it. There is some ten-day blood in the refrigerator. Get it, and get everything ready for the transfusion, into the same vein. Don't hurry Oleg, let them get ready. Incidentally, how's Onipko? Who has checked on him tonight?'

Petro reports that Onipko is all right.

Maria Vassilievna smiles:

'Stepan owes us a full litre for him.'

Meanwhile our hero suddenly begins to wilt. His eyelids droop. He tries to fight drowsiness, but then surrenders and goes to sleep. He even begins to snore a little. We all become slightly alarmed. Dima grabs his wrist, I take the other. This is all we need, another complication. But no. The pulse is good.

'Let's take his blood pressure. I think he's simply tired and of course there's a loss of blood... Is his transfusion ready? Don't wake him up, let him sleep through it.

About fifteen minutes have passed since the beginning of the transfusion. On the tenth minute the haemorrhaging seemed to diminish. Nothing conclusive yet.

Meanwhile the transfusion gear for Stepan has been set up. Oleg takes the last syringe from him, and switches the pump off. Now Stepan begins to get his compensation drop by drop.

'Look at him, sleeps like a saint. Has rehabilitated himself in the eyes of the Chief and the collective!'

To a certain extent, yes. But not completely. He has proved to us that he is a good man, but will he make a good physician? Only the future will tell. But of course any thought of dismissing him is out of the question for the moment.

'When you finish the transfusion, wheel him into the next room and let him sleep there the whole night if he wants. But keep an eye on him. Anything may happen you know. This is a lot of blood to take out of a tired man.'

Now all our attention is concentrated on the blood drainage tube. Everyone is here; several people are counting the drops at the same time. The effect must become evident in ten to fifteen minutes. That is the critical time. If the haemorrhage rate does not improve by then, we shall have to operate. I am in despair when I think about it.

'For the last five minutes the rate hasn't exceeded forty drops.'

'Keep counting. Lenya, cut off all anaesthesia. Stepan's blood will keep him asleep anyway.'

Suddenly there is the click of Genya's stopwatch.

'Thirty drops! This is the lowest yet!'

'We had twenty once. Stop celebrating.'

Genya starts his watch again.

'I haven't seen that! While I've been watching it's never gone below forty!'

Everyone is dead tired. At the end of his tether. But we must wait.

Someone wails like a mediaeval conjurer:

'Stop, stop! Come on, stop, stop!'

But this bit of witchcraft doesn't help. The drops continue to slide down the tube.

'We should have brought in a village blood-stopper. There used to be old women like that, they would whisper something over the wound, and no more bleeding. My mother saw one herself. True, I don't quite trust mamma, she's the nervous type.'

This is Oleg. Everyone is smiling.

'If we could have found such a home-grown witch we should have signed her up at the clinic at a senior science worker's rate!'

'What rate? We should have all chipped in and paid her double!'

Various joking proposals. Haerrtorrhaging is one of our principal enemies. One would pay anything to eliminate it. Even out of the eighty-rouble-per-month pay.

Meanwhile Sasha begins to stir. He is waking up.


He opens his eyes. Still no recognition in his look.

'Sasha, look at me!'

A few movements of eyelids and brows and then his eyes focus on my face. He has recognized me! I can see this by some undefinable little signs. He moves his head trying to tell me how uncomfortable he feels.

'I know, the tube is bothering you? Wait a little while and we'll take it out.'

Yes, we can extract the tube now, but first we must make absolutely sure that his breathing has been fully restored. It seems to me that it has.

'Lie quietly and try to breathe deeply... Concentrate on this one programme.'

Sasha closes his eyes, tries to concentrate, if this is at all possible in his condition. Probably he simply drops off to sleep. The brain has quickly exhausted itself and has switched off.

'Genya, how many drops?'

'Twenty-five for the past three minutes.'

Is it possible that our ordeal is coming to an end? Hard to believe. Instinctively I steel myself against new surprises. But logic and experience tell me that the probability of any new complication is not high. For tonight at least. Even the urine is passing well. If the heart continues to work like this, the kidneys will solve their problem.

If only the haemorrhage could be held down. Even if it continues at this rate, this is now not very dangerous. It would stop certainly within twelve hours. The total loss of blood would not be more than six hundred cubes. And that is tolerable.

We are waiting. Ten minutes more. We go out to the outside hall to smoke. We don't want to talk any more. It is past midnight.

We come back. Sasha is lying with his eyes open, and they show that he is conscious. He moves his head impatiently. It is obvious that the breathing tube causes him acute discomfort.

'All right, Dima. Let's take it out.'

Dima inserts into the trachea a stiff dose of penicillin solution, and then pumps it out through a thin tube. Sasha coughs. This is a good sign. Two tears appear in the corners of his eyes and roll down. Why? Because of coughing, or because of pain?

Dima extracts the packed bandage from the oral cavity. He must have packed it in really tight. Sasha's face instantly assumes its normal expression. Now he can be shown to anyone. Even Irina. This can be done through the glass ceiling while he is still here. However I don't want to go now. Sasha is moving and trying to push out the tube with his tongue.

'All right, all right, keep still. I'm taking it out.'

The tube is extracted. This ends the first post-operative stage officially. All the main bodily functions have been restored.

'Well, Sasha, do you think you can say at least one little word to us?'

He makes an effort, smiles and whispers:


How wonderful it is for all of us to hear this first word!

Not because he thanks us. We are grateful to him for being alive. We all have put our hand to this.

Apparently he has liked the idea of talking. He whispers again, only with his lips:

'Did you put in the valve?'

'Yes, yes, we did. It's sitting very pretty.'

He sighs, with immense relief. Apparently he has been thinking about this ever since he came to and has been tortured by doubts. He wanted a new valve, not a plastic patch-up.

'Say something aloud, with full voice.'

He winces and then says in a very weak hoarse voice:

'My back hurts, the table is so hard.'

'We'll transfer you into a bed straight away.'

Of course his back hurts! We took him out of the ward at ten in the morning and now it is almost one o'clock, fifteen hours. But now this is all. Two ward nurses are wheeling in the bed. The rollers creak, as always they have not been properly oiled. But who cares?

'Take all analyses for the last time, and let's move him into the ward.'

There is no point in keeping him in the post-anaesthesia room. We can do everything in the ward.

I'm glad. Very glad. Nonetheless I think I'll go and let Irina look at him through the glass. They will admit Raya into the ward, but it may be a long time before this poor Irina will see him again. Perhaps a very long time.

And maybe even never. This is also still possible.

I run up to the third floor, knock at the laboratory door. She opens it at once, frightened:

'Something's wrong?'

'On the contrary, everything's fine. Come with me, I'll show him to you through the ceiling glass, while he's still in the theatre.'

I walk with her quickly to the observation room. Fortunately it is deserted.

It is a strange picture from here. Somewhat unreal. You can't hear voices. People are walking under your feet just like a silent film.

Sasha has already been moved into the bed. They are fixing the holders for transfusion drips. Maria Vassilievna is wiping his forehead with a wet towel. She is doing this in a special surgical way, lightly and yet thoroughly. I know this from experience, no one can wipe sweat off my face during operations like Masha.

Irina presses her face against the glass, probably wants him to notice her. But it is not necessary, really. He shouldn't be emotionally disturbed for the moment. Sleep would be the best thing for him. But he is awake.

I gently touch her arm. 'Well, that's enough, dear. Stop it. Come into my room for a moment.'

'Professor, please. A second more.'

I am waiting impatiently near the door. A reflexive thought: 'poor girl'. But only for an instant, now I'm an optimist. Everything will work out. Sasha is alive, and that's the main thing.

I see the bed being wheeled out. Irina rises and joins me, walking behind me.

We come to my room. I don't want any long conversations. Dismissing politeness, I remain standing not offering her a chair.

'Irina Nikolaevna, this is all for tonight. Now you must go home.'

She makes a protesting move, but I cut her off: 'Please, no arguments! Nothing will happen until tomorrow. Leave your telephone number. I shall sleep here.'

'Well, I suppose I must obey. I have no rights... even to go behind the coffin.'

I have absolutely no desire to engage in any emotional discussions. I don't want to complicate my life for the moment. Therefore let her go. Later. Later we'll sort all this out.

'Let's go. I'll walk with you to the door. The main entrance is closed.'

'You don't have to. I've been here before, at night.'

Is that so? Very strange. I thought they hadn't been seeing each other here. All right, I won't go into details. If she's been here, she's been here. Probably while he was here the last time.

'Thank you very much, professor. I hope you will find time to speak to me, one of these days?'

'Yes, of course. I'll telephone you, or you'll telephone me. You can call me at home.'

'Goodbye then. Please, look after Sasha, will you?'

Why does she say that? But then, she's in love, and this is stronger than friendship. Therefore she has the right to talk this way.

She leaves. Good. Another problem has been put behind. At least for the time being. I shall go to the ward, they must have taken him there by now. Could something have happened in transit? It seems to be so easy, to wheel a patient into the lift and out of it, but some patients react even to that.

I am walking along a long corridor. Overhead lights have been switched off; only here and there night lamps on nurses' posts cast their glow upon their desks. Everything is quiet and peaceful. No one moans. On this floor are mostly children with congenital heart disorders. All wards have glass doors. Everything is dark. No, here is some light. What does this mean? Shall I look in?'

A small room, three beds. Two girls are asleep, their blankets are disarranged. One of them, Lusya, has been operated on and will be sent home in a few days. Petro sewed up a hole between the ventricles using the blood circulation machine. There were post-operative complications, and we have had quite a bit of trouble with her. Once we sat around her bed the whole night. But now she is asleep, so pink and pretty. Smiling. Dreaming about coming home and seeing her dolls again? She is happy. She looks a little like my Lenochka.

Nothing alarming has happened here. Anna Maximovna, the fat middle-aged nurse, is giving a penicillin injection to Vitya1. The boy is half asleep and whimpering. She is talking to him softly and tenderly. This is pleasant to hear.

The post-operative station. Maria Dimitrievna is fumbling with some syringes. Why is she here? Has she not been relieved? No, Sonya is here.

'Maria Dimitrievna, what are you doing here?'

'Oh, I got stuck a little and then the last bus left and it was too late to go home.'

This is a bare-faced lie. I know that she lives two blocks away from the clinic. She simply did not want to let some less experienced nurse take care of Sasha. She knows that this is going to be a difficult night for him.

I walk into the ward. Sasha is in bed, his eyes are closed. He is moaning softly. Pain. The first night is always difficult. You can't use too much sedation because it inhibits breathing, and smaller doses don't produce any effect. But he is pink. This is good.

Doctors and nurses are all around him. Dima is taking his blood pressure, Lenya is writing something in the chart, Genya is again near the drainage tube. Oxana is rigging up her cardiascope; she probably wants to check on the heart action here in the ward before leaving.

Even Valya is here with her test tubes. Petro, Oleg, the whole crowd. They won't let him die. If this could be done always.

'No problems in transit?'

'The blood pressure has gone down a little, but it's rising.'

'Well, Sasha, how is it?'

He opens his eyes. The look of a suffering man. He probably thinks, 'It would be better to die.'

'Keep it up, Sasha. It will be easier tomorrow. Use your will power.'

He whispers:

'I'll try, thanks.'

'Hold back your thanks a little. Much depends on you now. Remember the influence of the brain on the whole structure. And now, just try to sleep and let us worry.'

Maria Vassilievna comes in with Raya. Raya's face is pale, tired, wet with tears. A crumpled handkerchief is in her hand.

She comes to me, finds my hand, squeezes it.

'I've been suffering so much, so much.'

She has been suffering! And what about all the others? And Sasha! But probably she doesn't mean it that way. I won't tell her anything unpleasant.

'Never mind, Raissa Sergeyevna, the worst is over. Just look at him, and go away, he needs rest. If you don't want to go home, we'll arrange a bed for you in the interns' room on the first floor.'

'I'd like to stay with him. Please!'

'Out of the question! Don't even ask. We don't allow anyone to stay in the wards, not even in the children's!'

I won't let her stay here. One can't expect anything from her besides panic. Let her look, and get out.

Sasha hears her voice, I hoped he wouldn't. But he crooks his finger, gestures to her to come closer. Whispers:

'Raya, how's Serezha?'

'Everything's fine, darling, don't worry. I have telephoned home. He doesn't know anything.'

'Don't tell him - before we know for sure.'

It means that he is still conscious of danger. He has been in this clinic too long not to realize that anything might happen. I can imagine how he longs to see his son, after having faced death. Never mind, my friend. Now I have hope. The valve is a pretty good thing. If it is inserted well, it can work like a clock. For months; perhaps, for years. And later, well, we'll think about that later.

'Oxana, what's with you?'

'A hundred and seventeen. The arhythmia just as before, no better, no worse, but the function of the miocardium seems to be improving.'

To Genya:

'How many drops?'

'Twenty, and steady. No indication of increasing. And the liquid has become more transparent.'

That's good. This danger is over. I look at the urine bottle. It is also filling up well.

'Oxana, wrap up and go home. Leave the screen here. They will watch it.'

To others:

'Well, comrades, this is all for tonight. Tomorrow is another day. One surgeon and one anaesthetist will stay here overnight. Maria, put up Raissa Sergeyevna for the night.'

And so, the day is done. It seems that Sasha will not die tonight. I can sleep for a while. I can't go home though, in case something happens. Medicine is not a precise science. I shall ask Aunt Fenya to make a bed for me in my office. A cup of tea would have been nice, but that's improbable. The kitchen is closed, and the nurses wouldn't have any. Or would they?

I find Fenya, our night nanny, tell her the problem. She considers it.

A fine old woman. How many of our former patients remember you with a warm feeling! And how many eyes have you closed!

'I'll speak to the head nurse, see what I can do. Don't worry, we'll think up something.'

I'm not worrying. I can do without tea.


Once again I'm in my office. Damn it, how tired I am of this room.

Let's open the window. Moist darkness. It is drizzling outside. This is very good for the young buds. How wonderfully they smell, those first linden buds! I can never have enough of that fragrance.

Let's have a cigarette. The last one for tonight.

Victory. Victory over death. Sounds a little pompous. I don't like theatrical phrases like that, but they always come into my head, driven there by books, newspapers, radio.

Am I glad? Of course! Sasha is alive. He will think, talk, write. I can see him sitting in that chair there, developing his theories. Sparkling eyes. Broad gestures.

Stop! Don't let your fantasy run wild. There are many unpleasant possibilities yet. Very well, I won't.

I'm glad, but still I do not feel the happy excitement which I used to feel when I was young. I'm tired. So this battle has been won, perhaps. (Touch wood! Funny.) Well, almost won. This is pleasant. Very. And still I feel that another layer of something dark and painful has been deposited in my soul. I can't explain it. Probably, the residue of fear and pain. I've had enough of both today.

A picture: the blood spurting furiously from the hole in the ventricle. I am tied in knots by fear and despair. Nothing is left inside me but this terror, while some of my brain centres are working furiously trying to cope with the situation. Well, I won. But it could have been different. An enormous loss of blood, the heart is empty. Massage. Weak, infrequent contractions. Within me everything is crying: 'contract, contract, for God's sake, contract!' Now it begins to stop, and finally becomes still. Nothing else can be done. Everyone lets his arms fall. I stand for a moment, understanding nothing. Then go away. 'Stitch it up.' Emptiness. I am envying him. I wish I were dead.

And another: Dima is standing on the stool savagely pressing on Sasha's chest. Sweat is running down his face, his eyes are full of fear. Oxana is dashing round her screen, wringing her hands. A quick thought: 'well, this is it. Even if it starts again, it will stop.' I can do nothing, I just watch. And cry inside. Anger, anger at everyone. 'Missed again, you bastards!' Other epithets, even saltier. And what about yourself? Who was sitting there upstairs reading cybernetics? A new wave of savage anger, at myself, at medicine. Oxana's voice: 'no contractions!' All right, stop, you -'. Everyone is standing about, motionless, crushed.

All right, let's not imagine things. This time it was different. All has gone well - more or less well. The burden has been lifted, like a saddle from a horse, but the sores remain, the ache.

These sores deposited in my soul over a period of so many years don't permit me to feel any jubilation now. Or ever.

Then abandon it all! You can find some easy work: deliver lectures to students, operate on hernias, sometime a bit of abdominal surgery, gall bladders. There will be also some unpleasant moments, but nothing like this, once I turn difficult cases over to young doctors to experiment on. You can help Lenochka to do her home-work, read good books, go to the theatre. Even think up various theories of medicine and write books. Comfort, bliss. And the same money, or more. Money is a secondary consideration. Not altogether, but what I have is enough.


Aunt Fenya brings in some tea! Two glasses, a few slices of white bread. And even on a clean towel!

'Please eat, comrade professor. You are probably tired after a day like this.'

'Thank you, Aunt Fenya, thank you very much.'

The old woman would like to stay here and chat, but somehow I don't know how to carry on such conversations. She understood from my expression that I'd like to be alone and went out, promising to bring in some bedding.

How wonderful it is to drink hot tea when your entire mouth is coated with tobacco! I suppose I could eat something more substantial now. Well, never mind.

I am tired. My back is aching. A heavy head. And still I know that I won't sleep. Overwork. Sedatives? I'd better wait. I must try to keep myself in check.

They should give Sasha some sleeping pills. Probably Dima will take care of that. Shall I go and take another look? I can't force myself to get up. Dima will not forget.

The meaning of life. To save people, to perform complicated operations. To work on new and better ones, so that fewer people would die. To teach young doctors to work honestly. Science, theories. To understand my work and do it better. This is my craft. This is the way I serve others. My duty.

Now something else: Lenochka. Everyone must rear children. This is not only a duty, but a necessity. This is pleasant. Very.

And now something personal. To understand what this is all about. Why treat people, educate children when the world stands on the brink of destruction? Perhaps all that I'm trying to do is already senseless. I want to believe very much that this is not so. But belief is not enough. I want to know. I want to touch those calculations which affect our future.

Nonetheless, it is wonderful that Sasha is alive! True, I don't think he'll live long enough to see his thinking machines. But he will contribute something to this work. If only that Irina lets him. A family break-up, divorce, emotions. He wouldn't live through them. But how to guard him against it? I will try, of course, but my means are limited. His brain is a system which I can't run. Besides, he's much more intelligent than I. I just hope I can save his heart, the physical one, without trying to save his soul. (Soul! Ridiculous.) Never mind. If necessary, I'll put in another valve. Or even an entire artificial heart. They are working on that.

How brave you are! Do you know how many valves you yourself are good for? One scientist said that each person has just so much of adaptable energy given to him at birth, to handle and resist all the strong outside influences. Almost surely I have pretty nearly spent my quota. But maybe that scientist was mistaken? Well, never mind, I'll keep spending it for as long as I can, without trying to economize. I want to be useful to humanity. I am admiring myself again. What a hero!

It is disgusting to catch yourself doing this. I am giving so much of myself to my patients! I am fighting so selflessly against death!' A hell of a thing. Does this happen to me only, or to other people as well?

Man. First of all, every man must do something, well, poorly or just average. He must also think about his work. Also differently, deeply or superficially, but he must do it. Third: he must learn to examine his work and his thoughts in a detached way. This is a good medicine for some diseases, for instance, vanity. One can step out of oneself and look at oneself objectively. And then, in most cases, he will discover that he is neither good nor bad, but just average.

Where is Aunt Fenya with those blankets ? Perhaps she is delicately giving me time to finish my tea, knowing that if I see a bed I should collapse into it without eating. But most probably she is just giving a bedpan to some patient. Good.

I see her coming, and she is dragging a mattress with her!

'Aunt Fenya, what for? This divan is very soft.'

'I want you to be comfortable, professor. You look pretty awful.'

'How are things in the post-operative station? Have you heard anything?'

'Everything must be pretty quiet, comrade professor. Maria Dimitrievna went to the head nurse's room to lie down for a while, she wouldn't have done it if there were anything. She specially stayed here to take care of Sasha. But he must be all right. You have golden hands.'

'Stop it! You needn't praise me too!'

'And how not to praise you? Everyone is saying the same thing, the whole town -'.

'All right, all right.'

Meaning: please go away, granny. I don't know if she understood or not, but she leaves, wishing me goodnight.

There's not much of the night left. It is now one-thirty, and I never sleep later than six.

I undress, switch off the desk lamp and stretch out. What a delight, to lie down after a day like this! My whole body is aching. However, this is a pleasant ache. The sheets are not too well ironed. I can feel it with my skin. Our laundry is not working too well. To hell with it!

Sleep, sleep, sleep.

I am lying still. The process of relaxation must spread from the motor centres to the brain.

But somehow it doesn't.

Sleep... sleep...

No, the machine is working. Again, about the meaning of life. There is no meaning: just two sets of behaviour programmes. This, according to Sasha. I have really got used to his ideas. I can juggle them any way I want.

The animal programme, to bear children and bring them up. So that they can live and bear their own children. Generally, not a bad programme. But it does not imply any specially humane attitude towards one's neighbours. Grab, tear, strike everyone down. To bear good children one must be strong and healthy. Also this affords secondary pleasures, the sense of conquest, domination, material self-enrichment. The brain gives these animal pleasures some added taste.

Faces, events... drifting through my mind. Some animal programmes... To brag about my valve operation in the Society, one of them. Crying Raya, another one. Has Irina reached her home yet? She loves Sasha, the third animal programme.

Second programmes, the social ones. Man must work for others. Even when this is unpleasant. So that everyone can live better. This doesn't bring such sharp pleasures as love and children. Sometimes, no pleasure at all. But one must force himself.

It was simpler before. People believed in God. Love your neighbour, go to paradise. Otherwise, the eternal fire. Punishment and encouragement, based on the self-same animal programmes.

There is no God. Science. Everyone knows: the punishment can come only from men, here and now. If you are crafty and clever, you can avoid it. And derive pleasure from living. The triumph of instincts. Freudism.

And what about happiness?

The primitive man was happy when he had enough food, when he was warm and with his family. And the modern one? He can't live without society. He gets pleasure out of communion not only with his dear ones, but with strangers, pleasure from his work, out of doing something which is appreciated by others, all this has become necessary for his spiritual comfort.

There is a rather overworked expression: 'useful social activity'. One shouldn't laugh at it. Happiness coming from below is sharp, but it is not lasting, and is not sufficient to sustain the modern man. Only when it is combined with this useful social activity does it provide man with a secure anchor in life.

But, my friend, who is arguing against that? Have you ever read anything anywhere to contradict this? In books, in newspapers, no, but some people do not follow this rule. Then you must argue with them, prove to them this self-evident truth.

And what about yourself?

I have lived long enough. My animal emotions have gone to the second place. I don't want anything which they bring, I know there is no sense in that. I am not fooling myself. The instinct of survival keeps me living, but it doesn't give me happiness.

Then what really sustains me? Family, Lenochka. Yes, of course, but that isn't enough. When on a holiday with the family, I go crazy. I don't know what to do with myself. What then? Little faces of the children when they go home from the clinic? Their mother's eyes?

I realize that all these social programmes are artificially grafted into me by society. Very well! I don't care. They give me satisfaction and help me to bear all difficulties.

Probably it is very essential to convince yourself that this is so. Once you're convinced, you're happy. So I am happy, so what?

Sleep, you happy one. Sleep.

No, to fall asleep is not that easy. New thoughts march into the brain, rank after rank. Today has already gone by. Sasha will live, almost certainly. One more valve successfully put in. This is important, this is another valve. Every day luckless people come to us with mitral insufficiencies. We used to shrug our shoulders, and send them away. Now all this is in the past.

If we perform just one operation per week, many people can be saved. But it is possible to perform even two. Like the one we had today? No, that's too much. All my girls and boys were completely exhausted, and will take days to recover. Myself, also. But we shall improve our technique. Perhaps Genya's idea about inserting valves is really a breakthrough. Clever boy. Does he ever think about the meaning of life? Probably not yet. But he is kind, and that is sufficient meaning for him.

All right, if we put in just one valve per week, we can operate on about forty cases a year. This is already a figure about which one can talk. Figure? Talk? Those animal programmes are indestructible. Well, to hell with them. I am what I am. Too late to become a saint.

What surgery do we have booked for tomorrow? The operation with the AIK machine has been called off. It is too bad I have surrendered to weakness. Perhaps we can still go ahead with it? No. They have already told the boy's mother. A mother's heart is not a toy, you can't bounce it back and forth. So, instead of that little Lenya, we'll take that man, Sorokin, with the constricted aorta. Petro will do the actual surgery. Yes, that's a good idea. But if I remember correctly, there are possible lime deposits in the valve there. So I'll have to stand by and take over if it becomes necessary.

Yes, but I wanted to leave early tomorrow and do some writing. I should have sent that article long ago. Never mind, it can wait. Wait. It is good to get tired, and then stretch out like this. If only not tomorrow... with its worries... always more worries...

   1A diminutive form of Victor. There is little differentiation between masculine and feminine names in this usage.