6.12.1913  -  12.12.2002

Books of N.M.Amosov

Diary. Saturday

Yesterday I was given a present and, in addition to it, a good deal of grief.

I was told that a former patient of mine was seeking an appointment with me, O.K. (People tend to believe that it is impossible to get an appointment with me. On the contrary, I never refuse if I'm free. I don't receive patients at home, however.)

A tall, thin woman of fifty-odd years entered the room. A protruding belly My first thought was ascites. Here is her case history.

Twenty years ago she had been an in-patient at my clinic. Her condition was very serious. The head of the department wanted to discharge her, because she couldn't be operated on. The woman insisted on an operation, claiming that she'd withstand everything. I operated on her. It took her a long time to recover, but she survived. What she told me was approximately as follows: "I felt fine, went back to my place on the Amur River, recovered, and worked at hard jobs in the taiga. Have two grown children. My son is a college graduate, married and has kids of his own. My daughter is, on the contrary, good-for-nothing. She has a daughter, now six, who's staying with me since her mother abandoned her. My granddaughter is the apple of my eye, but my health has been worsening since her mother left her. I have a suffocating sensation, and my liver's protruding. I knew that I should come and visit you, but I kept postponing the trip: it's a long journey, you know, and I felt sorry for my granddaughter, I came only last year, but you weren't here at the time, so I couldn't see you. I was on the second floor. They told me that a valve could be put in, although it was very dangerous. I got frightened, since I had no one to leave my granddaughter with. Here I am again; I feel awful. I decided I had to see you by all means. So tell me honestly: can anything be done for me? It's important for me to know — I've got to find someone to take care of the girl. My daughter-in-law doesn't want to take her, but there're other people who are eager to look after her..."

"Could you please undress..."

Everything was clear without examination — ascites. Her liver was up to her navel. I asked her whether she was taking any diuretic drugs.

"I've been taking them for three years. In the spring, the doctor told me to take three pills at once, and I had almost half a bucket of urine. I nearly died and had cramps... The doctor was an inexperienced one, I told her I only needed one pill. But she said she was the doctor not me..."

"An operation is out of question: you would never survive it. Without an operation, you may live some time if you look after yourself and take the prescribed medicine. I'm not going to admit you to the clinic: it's useless."

It was hard to say these cruel words. I might have taken her, but I was afraid I would give in and operate on her, particularly when she saw that others were recovering. For her — and I know that for sure — the replacement of that valve would mean certain death. She had been ill for more than twenty years, suffering from severe decompensation. She was still alive only because of her strong will.

She didn't argue with the verdict. Obvioustly, she had been expec­ting it: nothing revealed her worry or excitement.

"It was important for me to hear that from you. Now I'm going home to find a place for the girl... Who knows — maybe I'll live at least until she starts school... Thank you Doctor... thank you very much. You saved me once, and I brought up my kids alone, without a husband. He died young; we'd lived only fifteen years together. So thank you once again..."

I have always been amazed at how calm the Russian people are in the face of death — like this woman who spoke about it as if it had nothing to do with her.

"Well, I'll go home now... Only my urine flow is low, and I have a long journey ahead."

I asked her about medicine and found that she had none. I sent for some pills and the assistant brought half a box. I gave her the instructions as to how to take them and what to look out for. The examination was over, but the woman was still standing in the room, in vacillation. Then she sighed and began to open her bag. "The same thing again," thought I with bitterness and disappointment — and I was right.

"Will you kindly accept this small gift, my dear doctor. I know that you are against these things, but I don't need anything from you now. This is for the past, for the twenty years of life you've given me — and for my children..."

I tried to turn the gift down, saying that I couldn't help her in any case... She didn't listen to me but put half a litre of red caviar and a smoked fish half a metre long on the table.

"Please, take this; don't offend me... It's home-made. We live on the Amur; my son does some fishing... We have lots of this stuff back home..."

"Isn't it prohibited?"

"They allow us to go out once before the fish go in shoals. It's legal; don't worry. Please take it, it's home-made."

What could I do? It's shameful to accept these gifts, but how can I reject them? It's so simple to offend people by rejecting their well-intended presents — by rejecting them off-handedly. There are such situations. So, willy-nilly, I took the caviar and the fish.

She was glad, and quicky left the room, bowing.

What a mixed feeling I had! Ot the one hand, I felt sorry for the woman: a courageous person who thought not of herself but of other people, as usual! It was hard for her to die because of her granddaughter! On the other, I felt bitter because of my inability to save her. If she had only come two years earlier... Besides, there was the feeling of shame that I'd accepted her gift. How could I take it home? (I had a small bag; the fish wouldn't fit in it.) So I put the fish in the very back of the cabinet and the can in the bag.

Afterwards, I went back to the clinic to bring my instruments and cut the fish into pieces. What a funny scene; I felt like a naughty schoolboy!

In any case, it's good that no one at our clinic accepts gifts. It's distressing to learn how this illness is spreading in medicine and other spheres of life, as well. Some fifteen years ago, I put a notice in the vestibule: I request that the patients and their relatives refrain from giving gifts to all our personnel, except flowers. Signed: Dr. Amosoff. Since then, the notice has been periodically removed and posted again. I cannot definitely say that it is one hundred per cent effective; brandy and sweet do reach the doctors, but money and gifts are not accepted, I'm almost sure. It is not only a matter of intelligence or sense of duty. Periodically, I have to repeat that if I hear about any bribe-taking I'll expell the guilty party from the clinic (to be more precise, I'll see to it that they are expelled). This threat has not been fulfilled yet. However, I raised this point twice at morning conferences, without mentioning names. Just dropping transparent hints. The guilty parties both left the clinic on their own free will.