Part One – There
(Eastern Hemisphere)
CHAPTER SEVENTY FIVE – THE MOSCOW EXPERIMENT: IN THE CENTRAL HOSPITAL
The first year in SRISI gone chaotic. Rotations that is, clinics, changed several times, I had to adapt to new places and teams. Sometimes it was easy, you fell in with the flow and worked with full dedication for a couple of months, studying operations and assisting. Sometimes, no one needed you at the clinic, and the management preferred to formally conduct classes and send home curious medical residents like me. In all cases, when in two months you had already adapted to a new place and its customs, knew convenient lines of communication with your places and, importantly, where to eat, “the end bell rang” and you moved to a new clinic for a new rotation. But usually the whole second year was allocated for one clinic.
I thought that I would end up in the clinic of the Science-Research Institute for Surgical Improvement at the Central Hospital with Professor Aron Naumovich Litovsky. A two-month rotation there only strengthened my decision. Everything suited me here. Geographical location – it was not for nothing that the hospital was called Central. It was more convenient to go there from our Grechikha by train and subway from the outskirts to the center, than to SRISI – from the outskirts – to the center, and then from the center to another outskirts. City was around. Finally, you lived in Moscow, a capital with beautiful buildings and parks, and not in some concrete boxes for temporary support of life. The director of the clinic and the topic of research interested me – this was the most important thing, but the clinic team was not the least important. And now I’ll remember about the clinic’s team – it is worth of.
The entire clinic consisted of three departments (two traumatology and one orthopedic, related directly to the Central Hospital) and a scientific and methodological center (a professor, two senior researchers, two junior researchers and me, a resident), who received a salary outside the staff of the Central Hospital, and on the staff of SRISI. As always, double subordination created new opportunities – you could receive your salary at SRISI, and be hired as a doctor on duty at the Central Hospital and receive money for being on duty. All of us, the lucky ones, did just that, except for the professor…
But, most important part of clinic were people. I liked them better here. They were more open and welcoming than at the institute, which was overpopulated with celebrities and behind-the-scenes intrigue. Although my non-Moscow and non-proletarian past played a certain role. They understood with a sixth sense that I did not envy, did not intrigue, I helped from the heart and in return, they opened up to me with their good qualities. Many times have I heard from coworkers,
“How can you tolerate Tonya? She’s a stingy villager, a second-class doctor, she became MD from a nurse!”
Antonina Ivanovna, indeed, studied at a medical college before medical school and did not shine in her outlook, but was a very responsible and conscientious doctor.
“Nick, you’re like fresh air here,” she said, “You can’t imagine how much envy there is in our doctors. Take the key from my desk, it contains chocolate and personal sharpened surgical instruments. If you need them while on duty, take as much as you want or need!”
She lived modestly with her husband and daughter, went to a dacha near Moscow to grow vegetables and fruits. Having bought a small Zaporozhets car, she confessed only to me at work. I congratulated her with all my heart.
Antonina’s main competitor was Elena Semyonovna, a fading beauty who showed promise at Professor Chaklin’s clinic twenty years ago. Of course, life confused all her cards, and she, bitterly disappointed, preferred dark humor. We became friends through humor.
“How do you communicate with Antonina?” she was surprised, “You are interested in everything, you read, you travel, you strive, but Tonya’s outlook is (she showed a hole between her thumb and forefinger), smaller than a vagina! And she’s a stingy person – she’ll hang herself for one potato!”
In response Antonina usually wryly smiled and said,
“Well, Elena is ready to give herself completely for one potato, but alas everybody prefer fresh potato.”
The competition between the men was fiercer, but more diplomatic. It was customary at conferences (this is the SRISI style) to crap on the opponent as much as possible, so that everyone would be convinced of what a nothingness he is.
Of course, since there were no traces of nonentities in our clinic, the squabbles were reduced to trifles. As a rule, everyone was wrong, and only the professor and his deputy Subbotin (a very talented doctor and editor of the clinic’s proceedings) summed up the disputes.
“Pay attention,” the professor told me, “Most mistakes are based on poor knowledge of anatomy and stereometry. You, Nick, may be my last student, and you’re okay with geometry. All that remains to you is to thoroughly learn the anatomy of arm and leg! Is it really difficult?”
The professor sometimes scolded everyone, regardless of rank and age, who could not name the smallest vessel or nerve. I remember how indignant his fellow countryman, Arkady Ilyich, was saying,
“He boasts so much of his memory! Is it good to trample on the dignity of an old doctor, fellow countryman and a Jew? He would have fought as much as I did on the war, then came to his senses after a concussion, and then studied all nerves and blood vessels after work!”
The head of the trauma department, Friedland, invited me to his office for a cup of coffee and said,
“Arkady Ilyich doesn’t remember a damn thing, everyone knows this, but he is an experienced doctor, and I wouldn’t dare to criticize him publicly. And you?”
“I wouldn’t scold anyone at all. There are a lot of good doctors here!”
Friedland squirmed as if the sugar in his coffee had suddenly disappeared.
“It’s like you’re not from the Soviet Union. Maybe you are a believer?”
“No, Boris Moiseevich, I am non-Soviet, I am Georgian. In Georgia, people are respected for their merits and business qualities.”
“And for wealth?”
“And they also respect wealth.”
“Isn’t it a shame to be rich?”
“No. It’s honorable! Of course, you need to be able to get along with everyone…”
“And if you find out that I’m rich…”
“I’ll be just as happy to drink coffee with you as before.”
“So know! I’m very rich!”
“I’m happy for you and your family. I can imagine how difficult it is for you to live in Moscow conditions of secrecy and envy.”
“No! You can’t imagine it! You are the only one in the clinic with whom I can speak frankly.”
“Maybe there are others? Give it a try.”
“God save me from such an attempt!”
We often talked with Boris Moiseevich on similar topics. In addition to the desire to talk about his condition, acquired not by theft, but by treating patients, he was exploring ways to buy a foreign car. In the end, he bought an Alfa Romeo, but was afraid to admit at work that it was his car, allegedly borrowed it from a friend for a ride. He still boasted only to me.
The head of another department, orthopedics, Konstantin Lvovich Misyuk, was an intelligent man who always switched to a soldier’s foul language at the end of the working day, after the women had gone home. I also sometimes popped into his office.
“Something…?” he looked at me warily.
“No, no, everything is calm. Popped in for a cup of coffee.”
“Who invited you to coffee?”
“Your wife, Natalya Petrovna.”
“Let her give you coffee in my absence.”
“Do you want the department to say that in your absence Natalya Petrovna meets with a Georgian resident in your office?”
“She doesn’t meet, but treats him to coffee.”
“So they should also peek through the keyhole?!”
“What a bur you are! Okay, I’ll make you a cup of coffee. I don’t have it for everyone!”
“So this is the problem?”
“What else?”
“I thought you were sparing it, but you’re just running out of coffee.” I’ll bring you a can of Brazilian instant tomorrow. Will it work?”
“Of course it will, but tomorrow you will forget or pretend that you forgot.”
“No,” I laughed, “Of course I won’t forget! I’m from Georgia. We don’t spare coffee for friends!”
Misyuk, despite his stinginess, was a nice man and a good doctor and a lover of fables. He told them to you in batches.
One day we, several doctors, were standing and laughing at his tales, when suddenly the door opened and a ragged grandmother turned to Konstantin Lvovich,
“Son, aren’t you an ushnyuk?” (Slang for ear MD)
We were all doubled over with laughter, but to understand the situation you need to know a popular joke. Here it is.
(In the hospital, an old grandmother tells the doctor),
“Son, aren’t you an ushnyuk? (Slang for ear MD)
“No, grandma.”
“Or maybe a glaznyuk?” (Slang for eye MD)
“No, granny, not a glaznyuk.”
“Who will you be?”
“In your language, I’m a pizdyuk (pussy MD), but actually, I’m a gynecologist.”
Now it’s clear what made us laugh so much. We were all tempted to call a jokester as he was called in the joke, but prudence prevailed and we shouted,
“No, granny, he’s just Misyuk.”
“A? Pissyuk (Piss MD)?” said the grandmother, “I’m okay with peeing for now. I can’t hear well. I need an ushnyuk!”
I don’t remember the head of the second Trauma department; he was often sick and was soon replaced by a relatively young doctor, athlete, climber, and ascetic. If it were appropriate, I would call him a kibbutznik, but over time – it became true! He moved to Israel and during the war operated a few patients in field (“inhuman”) conditions, as befits a modest, unremarkable superman.
Doctor Subbotin seemed to be a very pleasant person. He was incredibly well read and in terms of his knowledge he occupied a very low position, being only a candidate, and not a doctor of science (PhD not DS or Higher Doctorate – double PhD). He always didn’t have enough time to write and defend his damn doctoral dissertation. Alas, the culprit was the usual Russian weakness for alcohol. Over time, when the professor retired, his deputy did not have enough ranks and titles to keep the center in his hands, and the management fled to the medical institute.
I have interesting memories of joint operations on the hands and feet with Dr. Subbotin. I learned to work with them well and preferred neat, precise and even beautiful work to hammering endoprostheses into bone. At that time, not all prostheses were placed on cement, and the operation sometimes resembled the work of a butcher. And the snow-white, bloodless tissues of the hand looked like just a picture, compared to the pools of blood and scraps of muscle on the surgeons’ glasses.
So, one day I asked Dr. Subbotin if anyone was renting out an apartment. Mom, suffering from arthritis, decided to visit me in the capital’s clinic and get treatment. Subbotin was terribly surprised, saying, how I knew that his friends just yesterday left for Cuba for six months, and their apartment is ready to accept guests.
We quickly made the agreement. Mom lived in the center of Moscow for some time until I, through the city health department, “pushed” her permission for treatment in the capital. I must say, there were no real problems with this.
Aron Naumovich examined my mother’s joints and confirmed that the right foot can be operated on if the patient wishes, the rest is simple arthritis, which will remain with the patient forever. Mom did not dare to undergo surgery and spent ten days in the clinic receiving physiotherapeutic treatment (PT). That’s how it was done in the USSR! During this time, my mother became friends with one young woman, Nina, who, unlike my mother, had surgery on both feet.
At that time I became interested in the technique of painless operations. I read that famous surgeon Vishnevsky operated on the heart under local anesthesia (!) and decided that in this case not a single patient of mine would complain of pain during the operation. To do this, it was only necessary to strictly follow the technique of local anesthesia, not to advance the needle in front of the anesthetic, but, on the contrary, the medicine – in front of the needle.
So, I am operating on Nina, Misyuk is assisting me, everything is going well and suddenly, the syringe explodes in my hands. I didn’t even feel any pain, but my blood splashed right onto the table, and Nina’s blood from my gloves got into my wound.
Misyuk wanted to call for a replacement, but I refused. We’re in the operating room! “Novocain! Stitches! New gloves and continued!”
After the operation, which otherwise went well, I decided to joke and asked Nina,
“I’m completely healthy, my blood in your wound is safe for you, and can you say the same?”
Nina was silent for a moment. I did not like it.
“I guess that I probably can,” she said thoughtfully.
Everything inside me went cold.
“What does “probably” mean? Any unusual contacts?”
She nodded silently, “A decent black person.”
I’m still glad that her assessment turned out to be correct!
To strengthen the spirit of my patients before an operation, I offered them a bet. If they confirmed that there was no pain, they would give me a small chocolate bar; if they said that it was painful, I will give them a hundred rubles! And no matter how dangerous it seemed to tempt someone with a hundred, not a single patient even joked. Everyone always happily treated me to chocolate. And who knows what a separate apartment in the center of Moscow, nice women around and an abundance of chocolate would lead me to, but suddenly I discovered that I was not alone using the apartment. It was like that.
Once I operated until late and has stayed overnight in a Moscow apartment. From there it was about ten minutes by trolleybus to work. At night I woke up from the sound of something moving, as if a thin chain began to roll off the edge of the table onto the floor. I turned on the light and discovered a stream of black insects climbing the wall to the ceiling, then crossing it to their goal – a warm bed, onto which they dived like brave paratroopers. The body of their agitated opponent burned and itched. The remaining half of the night I bathed, splashed what I could on my enemies and went for work as soon as it was light.
“What are you doing here, neither light nor dawn?” on-duty Subbotin asked me.
“I’m evicted!” I said gloomily. “By the unaccounted tenants,” and told him the story of the night.
“Okay, don’t make a mountain out of a hill. There are bedbugs everywhere. If you spray them, they will die.”
“I don’t panic, but the neighbors have a newborn, and they called the sanitary and epidemiological station.”
They actually came from the station, tore up the wallpaper and… ordered renovation to be made. Of course, neither I nor Subbotin began to make renovation in someone else’s apartment. So our agreement was given a long life. And it was a pity, the apartment was perfectly located.
During the second year of residency, many interesting things happened. One of them was that my Baku cousin Valya entered Moscow for resuscitation residency. That was great! And unexpectedly.
The door to our apartment near Moscow opened; Valya’s joyful face shone on the threshold.
“I don’t understand how I found you!” she said optimistically, “This is not a city, but some kind of scattered domino.”
My father-in-law, the hospitable host, was already busy setting the table and bringing in chairs. My curious daughter met her adventurous aunt. Wherever Valya then dragged her: to poultry and flea markets to buy dogs (no!) turtles (no!) but chickens are ok…
Two yellow fluffy lumps settled in a box under our kitchen table, but after two weeks they turned into white chickens, littering everything around and causing Ana a severe allergy. We had to walk around the area and place the chickens with “good people.” There was no question of making soup from these chicken.
Valya had friends in Moscow from swimming competitions, Elya and Alim. As Valya said, their love began with those competitions, and that they still passionately love each other. I immediately had a completely different opinion about “still”. Once, as soon as we entered, Elya managed to whisper,
“You and I drank half a bottle of cognac yesterday.”
Alim appeared after her.
“Hello,” I said, “What a delicious cognac! We couldn’t resist and dropped in on the second day to finish it off.”
Elya looked at me gratefully. Her look expressed a lot. Valya could not understand what deep conclusions I was drawing from an open bottle of cognac. But I was afraid that I was right. Elya got into trouble.
Together with her friend she went to a conference in Riga on cancer treatment. A couple of days later, two “lucky” guys sat down at their table in a cafe and politely informed them that Moscow whores could work in this territory only by paying them a fee.
“How dare you?!” the girls were indignant, “Here are our certificates from conference! We are scientists, you have confused us with someone else.”
“Let’s state we also have same type of certificates from conference,” said the pimps, “But a mistake could have happened. Here, take the disk, everything is recorded on it. If you are not there, forgive us for the mistake, if you are there, tomorrow you will be paying us 1000 rubles each, or the disk will be received at your home, at your work and at your local police station.”
“We barely managed to stop these vile blackmailers!” this is how Elya story has ended. But, I’m afraid, the conference cost her dearly. She got very sick, treated for a poorly understood lung disease and, extremely emaciated, died in couple of years. Sad story…
But sadness is a common leitmotif in medical stories. Some of them seem interesting to me. This is the story that happened on my first on-call duty at the Central Hospital.
The situation at floors was quite calm. I sat in the resident’s room and slowly filled out medical records. Suddenly the duty nurse Klava, a pretty girl, entered the room and playfully asked,
“Do you need help?”
“What are you, dear? No, of course not.”
“Well, as you know, everything is calm for now,” and she left, shrugging her shoulders.
The calmness soon ended. Patients complained of pain and asked for medications. For one patient with a traction of the broken hip, no meds were helping. And I fired from an artillery gun – I injected her morphine intravenously, fortunately her high blood pressure allowed it. The woman calmed down, fell asleep and at night no longer caused any disturbances, she slept peacefully (pulse, blood pressure, everything was normal).
The next morning we are going to the conference. Friedland, as usual, jokes,
“Grandma Petrov (or grandpa Ivanov) haven’t started eating shit yet?’ (That is, have they developed post-traumatic psychosis?)
“No, they haven’t started.”
“That’s okay,” he promises, “They will start.”
I’m reporting at the conference how the night went, and telling everything in detail. I see the people became wary and fell silent. I understand that the shelling will begin now.
“So,” says Aron Naumovich, “Have you seen the traction?”
“Yes, sure.”
“Have you tried adding weight?”
“No. Ah… I understand, I had to start with this.”
“Of course! Severe pain means the fragments have shifted and are pressing on the nerve; they need to be pushed apart with the great traction. This usually helps immediately, without medication. But I don’t want to scold you for your courage.”
“I remember you soaped my neck for something like that years ago!” said Sasha, acting head of Second Trauma Department.
“Do you know what the difference is? Nick took patient’s blood pressure and then administered morphine, and you started it immediately.”
“What if she collapsed?”
“And you stop this practice of sending newcomers to duty without instructions. He was alone, covering three floors.”
“A combat assistant Claudia was on duty with him,” giggled the young doctor Misha, “Didn’t she offer her help?”
And again, I sincerely confessed,
“She offered, but what can she do, fill out charts?!”
My answer was drowned in the Homeric laughter of all the doctors. At that time, I didn’t yet know how nurses help doctors on duty.
The audience, “in general,” approved of my actions during my first duty.
Generally speaking, traumatology and orthopedics are different fields. The first is urgent, quick and most importantly – help. The second, on the contrary, is a leisurely, planned treatment to achieve an optimal result. Here are some examples.
I come on duty at the Central Hospital after a morning meeting at SRISI and find out that I will be kept overnight with a seriously injured patient who fell out of the bus and injured her knee. However, her fracture was fixed, a splint was applied, medications were prescribed, and the only task of the duty officer was to monitor the general condition of the patient.
“You can’t even touch her leg or feel her pulse with such terrible swelling,” Natalya Petrovna, the attending physician, and Friedland, the head of the First Trauma Department, tell me.
The next morning, on Saturday, I am replaced by our young doctor, Alin, who is preparing his dissertation (PhD) defense. I show him the woman, tell the whole story, but he does not agree with the calm assessment of the “old men.”
“It’s good if it’s just swelling, but what if it’s not? No blood circulation? We need to call vascular surgeons!”
I agree. Don’t guess, but know for sure! He contacts vascular surgeons. They promise to come before noon. I go home, annoyed that I did not raise the alarm earlier, relying on the advice of experienced doctors.
On Monday we all learn that vascular surgeons discovered a ruptured popliteal artery, hematoma and gangrene of the leg only on Saturday evening. Now, after amputation of her leg, the woman was in intensive care, fighting for her life. A few days later she passed away…
A much more optimistic story has happened with the girl Kogusheva. She came from the North Caucasus to treat paralysis of her right arm. More precisely, the thumb on her right hand did not work, it did not oppose the rest fingers, which made her hand non-functional, while the girl wanted to become a doctor.
She ended up in my ward, and the attending physician was our boss. His working diagnosis was obstetric paralysis, and he was going to transfer muscles from the inner side of her arm to the external side. It would seem – no problem, but I have encountered obstetric paralysis and, usually, the cases affected a significantly larger number of nerves and muscles. And I started asking questions the girl and her Moscow aunt, and then I called her mother at home.
It turned out that she was born a normal child, there was no damage to the nerves during childbirth, but at the age of about a year she fell off the table and broke her arm. So I got the impression that we are dealing with traumatic damage to an isolated nerve. This had to be proven by studying her muscles. At SRISI there was a lot of such good equipment from capitalist countries, and I took the girl for tests. Tests confirmed my hypothesis and showed that there are healthy muscles on the back of the hand that can be transplanted to the thumb and retrained. Cosmetically, it was much better and less noticeable, which is important for a woman. Well, in case of failure, there were always healthy, unused muscles on the inside of the arm.
During the presentation of the case, I said that I wanted to share my thoughts with the audience. I divided the board in half, titled the halves “Obstetric” and “Traumatic”, and collected significantly more arguments in favor of a trauma.
“So what?” Friedland was surprised, “He’s not eating yet, but he will!”
“The difference is that obstetric paralysis caused by a brachial plexus injury affects a group of nerves and muscles, and finding healthy muscles for transplantation is not easy.”
“It looks like Dr. Neiman is right, and we should order a myography,” Aron Naumovmch said thoughtfully.
“That’s what I did,” I continued my story and hung colorful graphics from foreign printers on the board.
“What a dog!” the boss praised me.
“He’s growing!” Sasha the head of the Second Trauma noted.
“A cup of coffee from me!” Misyuk chuckled.
“And what is from him?” Subbotin smiled slyly.
“What is your plan?” the chief asked the question point blank.
I reported a simple operation, emphasizing aesthetics and a backup plan in case of failure.
“Have you read anywhere about such an operation?” asked the professor.
Well, I read also something else, but a politically correct answer was required. So I, looking down modestly, answered,
In journal “Hand Surgery.”
“I think that Dr. Neiman should operate this patient personally,” said Aron Naumovich, “Of course, I will assist him.”
That’s how it all happened. Of course, the professor drank my blood during the operation, clinging to whatever he could, but after half a year I saw Kogusheva firmly sticking out her thumb: “This is how our business is!”
Over time, I began to take on more and more on-calls at the hospital. This was the only way to train myself in different situations. In addition, many doctors already trusted me and easily handed over their scheduled duty hours along with cash. Misyuk was always haggling and trying to pay part of the money. He said,
“Your on-call duty is cheaper than mine, why are you robbing me?”
“Strange logic! Do I really want to be on duty? Is this my day? You persuade me, seduce me to be on-call instead of you, but don’t want to pay? Think in over and prepare cash, Konstantin Lvovich, before I go home.”
Friedland heard our bargaining,
“Konstantin Lvovich, admit it, you are Kalman Leibovich, judging by your bargaining with the guy. By the way, was it Christ who send you Brazilian coffee from Rio de Janeiro?”
On the recommendation of Dr. Subbotin, they began to allow me to be on duty in a separate building where embassy employees were hospitalized. The food here was not hospital-style, it was tasty, there were vending machines with drinks and bags with snacks, and the patients themselves gave interesting souvenirs to the doctors.
Once Subbotin called me to operate on a black princess. This was my first non-white patient. The girl was lying naked on the table and already asleep, and I immediately examined such an unusual black, but completely ordinary human body and even smelled it.
“What are you doing, Dr. Neiman?!” the operating nurse was dumbfounded.
“I am comparing blacks and whites! No difference except skin color. Racists keep lying that blacks smell bad.”
“So she’s a princess!”
“I haven’t seen her passport, but her anatomy is obvious. No difference!”
Once upon a time, an American grandmother Smith was admitted to us with a fracture of the femoral neck. Among the tourists attracted by Gorbachev’s perestroika, she landed on Red Square, and there were cobblestones! Grandmother, unlike the black princess, did not have any diplomatic status, so she ended up in the First Trauma in the ward with grandmother Ivanov, who had already started eating shit a couple of times, but reversibly.
“Nothing,” usually said Boris Moiseevich who had a great patience, “It’s just around the corner!”
At the height of my duty, a young blonde in jeans and a jacket appeared and introduced herself as Andreya, the vice-consul of the American embassy in Moscow. She talked crap in Russian that we quickly slipped into English plus everything possible, like drawings. I gallantly escorted the blonde into the ward, where she made sure that Granny Smith was doing quite well, and promised her to contact the family and discuss options for treatment and transportation home.
Apparently, she did all this honestly. But grandmother Ivanov turned out to be quicker. Early in the morning, when the night nurse aid had already finished cleaning up the First Trauma Department, she tore off her shirt with the colorful inscriptions “The USSR Ministry of Health warns” and, smearing herself from head to toe with shit, began to howl, in full Ivanov style (i.e. very loud). Granny Smith moaned in horror,
“Help me, for God’s sake!”
They did a good job as a duo, but the stench was terrible.
Friedland came in the morning and immediately asked,
“Grandma Ivanov started eating shit?”
“Yes, she has started.”
“Who is howling?”
“She and Grandma Smith.”
“It’s true: living with wolves means howling like a wolf!”
But the professor came and, of course, put things in order – he transferred Grandma Smith to orthopedics, where the care was better. However, the grandmother decided to have the operation at home, and Vice-Consul Andreya invited me to accompany her to America. Andreya said that the entry visa would be ready today. But I was not at all sure that the exit visa would be ready so quickly, so I politely refused, explaining that I could not leave my patients unattended.
And do you think that I could have?
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