Part One – There
(Eastern Hemisphere)
CHAPTER SEVENTY TWO – THE MOSCOW EXPERIMENT: A NEW LIFE AND ITS SECRETS. AN OVATION
1. A new life and its secrets
It’s good that the residency began in September and not later. There were still a couple of months left before the onset of the snowy period, enough time to lay out your routes, outline landmarks, deal with transport, before the snow hid half of the signs, names, and crossings from you for six months. In such a big city as Moscow, figuring out where is everything, is not easy, and sometimes there is no one to ask – crowds of Muscovites, preoccupied with getting food and goods, run without looking or listening to the questions of guests of the capital, frightened by hustle and bustle. Merry fellows, for the sake of humor, can sent you in the opposite direction, to another bus, metro line or train station. That’s funny, isn’t it?
But gradually you learn to navigate, remember bus numbers, metro stations, transfers, schedules. And then, instead of constantly monitoring inscriptions, advertisements, numbers, letters, you begin to look closely at people, at the faces of fellow travelers. In the mornings and after work they are not at all attractive. They are sleepy, tired, gloomy.
I looked around the whole car of passengers on the train – there is not a single smile, the corners of everyone’s lips are downward. Where am I going? I’m going to work from one suburb, where we all live, to another, where the main buildings of my new medical world are located – the Central Research Institute for Surgeons Improvement (SRISI).
We have a peculiar life at home. In the apartment of Colonel Malinik, the director of the capital’s military plant, six people live in three small rooms. In fact, people mainly sleep here – this is a world of relaxation and sleep.
My father-in-law gets up before everyone else, at five in the morning. He has to go to the factory, and even though a military GAZ car with a driver is waiting for him at the entrance at six, it’s still an hour away. I get up at six and rush out of the house half an hour later. It takes me an hour and a half to get there: by train, metro with transfers and on foot.
Then my mother-in-law and my wife stand up. Both work nearby, but besides work they have a lot of household chores to do. The last to rise are my daughter and her great-grandmother Tanya. They spend the whole day at home until Lilya comes and takes Ana for a walk. They go to the river to feed the ducks with bread. Teitl is already old and has difficulty looking after her great-granddaughter. The great-grandmother with pleasure, six times a day, rereads to the great-granddaughter children books “Kolobok” (Little Round Ban) and “The Speckled Hen” that Ana already hates.
We are returning home in reverse order. Everyone comes tired, dreaming of getting some sleep, but I also need to read medical literature. At home, the whole family, does not have a dinner in patriarchal way, as in Tbilisi. Firstly, everyone had already had lunch at work, with whatever they got at hand. The food in the canteens is tasteless. But you need something to eat. You can have dinner or a snack at home, but, and secondly, only three people can sit in our kitchen (it’s difficult for four). Setting the table in the living room where my wife, Ana and I sleep is a whole task, this is for the weekends. Therefore, we eat in two shifts, depending on who needs to eat first. There is no entertainment on weekdays; it’s good if you can socialize at home. The damned TV constantly campaigns for Soviet power. I hate this TV worse than my daughter hates “The Speckled Hen”. It seems that eggs will soon begin beaten not only in fairy tales, but also in real life. Everything is permeated with propaganda and you can’t find a decent movie. But fortunately, the TV is in my in-law’s bedroom, far from us. And all we can do is watch good dreams.
The Institute is a completely different world. White and official. Everyone tries to look successful and comfortable in the eyes of their coworkers, although I think many people have the same thing at home. The institute is headed by a general. Military field surgery has always been an important component of Soviet medicine, but the general is also married to the daughter of Podgorny, the Chairman of the Presidium of the Supreme Council of the USSR, although already former and deceased. Her daughter Olya, the general’s stepdaughter, and I are two excellent students who were accepted immediately after graduating from the institute. I never tire of wondering how I got into this kingdom of party and government bureaucracy. And one day I’ve found it out.
I remember that at the very beginning of my residency, a young doctor, also our resident, once run at a brisk trot along the corridor (as was customary to show zeal), stopped me to gossip.
“It turned out that in our ranks (he meant, among the newly admitted surgical residents), there are two people who are very well connected with authorities,” he told me in confidence.
It was funny to hear that. I had no doubt that there were many more of them then two, nevertheless I asked,
“Who are they?”
“Those who were accepted immediately after medical school. This is the director’s daughter and Neiman’s nephew.”
“Is this the director’s daughter Olya?”
“Yes, Olenka Podgorny.”
“And who is Neiman?”
“He is one of our doctors from the younger generation.”
But I was only interested in the imaginary uncle. It is clear that the doctor did not know the resident, but only his last name. I didn’t look like a one from younger generation.
“No, I’m not interested in the nephew, but in the uncle. Who is he?”
“Don’t you know who Neiman is?”
“No, I don’t. Who is he?”
“He is the head of the rocket science and artificial satellites committee.”
Wow! So that’s why they accepted me! They thought I was the big man’s nephew. I remembered how, just in case, the head of the personnel department spoke to me with restraint. From the very beginning he suspected that Neiman was not just an excellent student with a long tongue. And, not by chance, Professor Litovsky and Academician Ruskin referred him…
Although no! Ruskin said that he no longer has an official position, but can think over of a non-standard method. Is the vague “uncle-nephew” connection really was this unconventional approach? Wow, that’s Ruskin! It was not for nothing that he was a student of Nikolaev, who developed unusual surgical methods – “to deceive the body in order to restore function.” The teacher could not even imagine that his “non-standard technique”, more than sixty years after the disaster on the Bolshoi Kamenny Bridge (Large Stone Bridge), would help not the patient, but the doctor. And no one could have imagined that this doctor would be me.
2. An ovation
Mark Vladimirovich was the pride of our specialty. I would say the beauty and the pride, but I’m afraid to sin against the truth. Anyway, his eighty-fifth anniversary was celebrated even before my appearance within the walls of the glorious Institute for Advanced Training of Surgeons – SRISI, as its not the most sarcastic listeners joked. You could usually hear lectures of the best USSR doctors here and meet a variety of specialists who from time to time undergo advanced training. We, young residents and graduate students, working in the institute’s clinic close to the luminaries, were called “nurseries,” and the most sarcastic doctors called the Research Institute for Surgical Improvement of Suckers. It’s not hard to guess how they joked about us. But not the hero of this story.
A contemporary of the century, he was one of the representatives of the old school, at least in the eyes of young people. Undoubtedly, the charm of a person starts from his appearance. A two-meter, broad-shouldered, not at all slouching, strong as a samurai (can you call an eighty-seven-year-old Jew that?) with the fingers of a pianist and the eyes of a scientist, looked at you with a slight ironic smile. He talked as if neither revolution nor war had ever happened, and he, just as he celebrated his bar mitzvah in nineteen hundred and thirteen, remained in this most prosperous year of Russian life. At the same time, he took part in all Soviet wars, starting with the battles at Khalkhin Gol. Even then he was the chief surgeon of the Far Eastern Army, and during the Patriotic War he was in charge of the front’s Traumatology Service. Despite his combat experience, or perhaps precisely because of it, he was the author of a countless number of works and the educator of a legion of outstanding doctors. Being a professor and an academician, he always behaved affably and extremely respectfully, remembering the middle name of each nurse assistant, and did not allow himself to address even young female students by their first name.
Olenka Podgorny is a pretty girl who was accepted into residency immediately after graduating from medical school and, as they said, thanks to family connections. She was always saying with surprise,
“Well, why Ruskin is the only one who doesn’t call me Olenka? He doesn’t want to?”
“Who doesn’t want you?” our party organizer, Timofey Stepanovich, a candidate of science (PhD) and a rising star of the institute, chuckled, but in men’s conversations during night shifts he always openly admitted,
“Olenka may not want us, along with our dissertations and party units.”
After being on duty at the morning conference, the youth were usually subjected to severe criticism from the audience. This was, so to speak, a didactic technique – numerous authors of famous textbooks and monographs, present live, demonstrated to the audience the first part of the saying “hard in learning.” (“Hard in learning – easy in battle”). In serious situations, the responsible duty officer stood up for the duty officer and explained to the respected audience what and how it “really” happened. Thus, any mistake, even a medical one, could, in principle, be attributed to the beginner’s inability to coherently state the essence of the matter. But, alas, not always…
When Olenka Podgorny, who was on duty at night, used a personal laser pointer brought by her parents “from there” and showed a thin horizontal line of a patellar fracture on X-rays, nothing foreshadowed problems. The pictures were taken… the night before last.
It turns out that the patient with a fresh fracture was then operated on an outpatient basis – several strong sutures were placed, a back splint was placed that did not allow the leg to bend at the knee, and he was sent home.
At home, the patient bent his leg. The stitches cut through and he was brought back to us. In the new X-ray, the fragments were much further apart than in the first one. But our medicine was the most advanced in the world and knew no mercy. Under the leadership of Timofey Stepanovich, Dr. Podgorny performed the operation, tightly fixing the fragments with wire, and tied a new splint to the leg. The director of the institute, lieutenant-general of the medical service, husband of Olenka’s mother, sitting on the stage in the presidium, thoughtfully nodded the beautifully set head of the graying womanizer. The head physician, Academician Kuzyakin, an oncologist, was scribbling something in a notebook with a pencil. The deputy director for science was quietly talking with the party organizer. Everything looked completely fine, if not for Ruskin’s high-raised hand. He asked to speak.
“This is a very good opportunity,” said Mark Vladimirovich with a barely noticeable drawling accent, getting up and heading to the speaker’s podium and microphone, “Just for improving the skills of our young doctors.”
Academician Kuzyakin raised his eyebrows, wondering what good could come from a fractured patella. Timofey Stepanovich raised his head, he was all attention. Olenka batted her eyelashes and straightened her already perfectly ironed robe.
Ruskin continued,
“There are many mistakes here to discuss and understand how to and how not to do. Why do you think the stitches were cut through after the operation?”
“Because the patient violated the instructions,” Olya reported with Komsomol courage.
“There is no law for fools!” Timofey supported from the presidium, demonstrating his peopleness and partisanship at the same time.
“That’s how we will defend ourselves in court, and I ask my colleagues about the medical reason for cutting through,” answered the old doctor and, without waiting for new hypotheses, he continued, “Because the fragments were stitched with tension, with the knee fully extended.” Nature protests! The slightest bend and the tissues cannot bear the load. What do you think will happen now with the new even stronger seams?”
“They metastasize,” Kuzyakin chuckled in the general’s ear.
“Will they cut through again?” Olenka suggested in horror.
“When trying to bend the knee, they will undoubtedly cut through. And if you spare the stitches, the joint will stop working. This is why it is correct to suture the fragments with the knee slightly bent and begin physical therapy immediately, a few days after surgery.
A wave-like movement of heads arose in the presidium. They came together and then diverged, whispers were heard, and then the flushed party organizer stood up and announced,
“We, comrades, consulted and decided to recognize the actions of the duty brigade in the current conditions as satisfactory.”
Ruskin, who was already walking to his place in the hall, suddenly braked and returned to the microphone,
“Understand me,” he said, “We are all colleagues here. A lot of young people. They must learn to help the sick! Therefore, I do not discuss whether to recognize the actions as satisfactory or not, but explain how to treat correctly!”
The hum of voices gradually grew in the hall. The director of the Institution pulled the microphone on the presidium table closer to him,
“I will not be mistaken if, on behalf of our entire large and friendly team, I express my sincere gratitude to the patriarch of traumatology and military field surgery, Academician Ruskin, for his constant contribution to the training of young personnel. While remaining, in general, undoubted admirers of his scientific and teaching talent, we cannot deny the achievements of doctors of the younger generation, who are looking for their own paths in the building creative process of our time…”
Mark Vladimirovich, pursing his lips, silently nodded to the beat of the handsome general’s words, and then, as if had remembered something, began to applaud. And the entire audience supported this unplanned action with enthusiasm and pleasure. Discordant at first, the applause grew stronger and found rhythm. Ruskin, bowing his head, slowly moved towards the exit, and an incessant ovation followed him outside the walls of the assembly hall…
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