Bursa, Turkey (Winter 2018)
|Portrait of Nikolai Amosov. Photo by L. Sherstennikov.|
In 1962, after his visit to the USA, heart surgeon Nikolai Amosov (1913-2002) became obsessed by artificial heart valves. There were no opportunities for this in the Soviet Union – neither information nor technology. Amosov sewed his first cusp of the artificial heart valve from a nylon shirt he bought with personal money during one of his trips abroad. Foreign daily allowances for Soviet doctors were meagre, up to $15. Amosov would spend the very last cent of it to purchase the heparin or nylon shirts – which USSR did not produce.
In 1963, the Americans Starr and Edwards published a new a heart valve based on the ball-and-cage principle.1 The ball was made of silicone rubber and steel saddle, and had a lining around the rim with a synthetic cloth for fixation to the heart. It was a solid thing with the diameter of 4 cm.
An engineer from a plant in the Urals made an exact copy of Starr’s valve for Soviet surgeons. It soon was found to have a defect in that clots would form on the border where the “fabric” adhered to the steel; clots were coming off and causing brain embolisms. Amosov became scared and stopped operations. He began to think.
Eventually he decided to cover the whole saddle with fabric so no bare metal was exposed. As the saddle now was wholly covered and thrombus did not form. Moreover, instead of a ball, he created a hemisphere shape, thus reducing the size by almost half. The design was given to the factory and put into production. Thus Dr. Amosov moved world medicine to a new level (1965). He became a developer of successfully stitched prosthetic heart valve with antithrombotic coating. Later, such prostheses began to be produced all over the world.
In the autumn of 1969, heart transplantation had already been started in several places. Amosov was impressed by the success of Barnard, Cooley, and Shumway.2,3,4 And he also wanted to participate. After getting permission from the Ministry of Health and enduring long preparations at the hospital, he created a laboratory of transplantation immunology in Kiev. The only thing that remained was to find a person with a dead brain but a live heart.
Then one day such a donor appeared. “A young girl got into a car accident, her cranium was smashed, there was a gaping wound, she was on artificial respiration, with very low blood pressure. She was put directly into the “donor” operating room. We conducted the encephalogram: the brain had died. We thought that as soon as the heart stopped, we would connect her to the artificial blood circulation. She will be dead, but we will revive her heart and take it out” remembered Amosov. Everything was done, except for the last step. He could not find the courage to demand girl’s heart from inconsolable relatives. “Let us wait a little more, her heart is still working, maybe she will not die!” prayed the parents. How naive they were to believe that life was in the heart.5 But insisting seemed to be an inconceivable sacrilege. He gave up. Her heart contracted for several more hours. The patient who needed the transplant stayed at the clinic for about a month and then died quietly. Amosov never tried again.
By the mid-seventies, the team let by Amosov would carry out about fifteen hundred operations a year. Later, their number reached five thousand annually. It was the highest figure in the USSR, and one of the best in the world. But Amosov still could not accept that patients died and was trying to find a solution outside of medicine.
He was getting more and more into cybernetics, becoming interested in computer models not only of the human organism but also of the individual and society. “People are so strongly disgusted from the Marxist worldview that they do not want to know any. But no. A man cannot do without thinking about eternal: peace, reason, man, society, future, God!” wrote Amosov. He strongly believed that artificial intelligence of the highest rank with the reproduction of all functions of the human intellect was possible. However, this part of the research was not interesting for the authorities. “In our department, we created the heuristic models of the body, individual and society in order to arm the operative mind of the doctor, teacher, politician and, most importantly, the scientist. I would not say we have succeeded a lot, but there is no demand for real intelligence, and therefore there is no money. Our mind is lazy, as yet.”6
|On bypass at the hospital. 80s. XX century.|
And the surgeon returned to the path of cardiac surgery again, although it was still difficult for him to pass through every lethal case. Particularly painful for him was the time when a girl died during surgery – almost the same age as his own daughter. “Sveta Petrova (resuscitator) just called from the clinic: a girl with a tetralogy of Fallot had died… A writer has hundreds of pages, pulling out the details like a spider-web until he or she gets to the deceased. But here – everything is taken from real life. There is drama behind every patient. We have many deaths, twenty-four operations a day, all branches are overcrowded,” wrote Amosov in his diary. He desperately wanted to share his pain, so he started writing. Little did he know that he would get creative juices flowing and become one of the best-selling authors in USSR and the world. His very first work Mysli i serdce (1965) was translated into thirty languages and published in millions of copies.7 After that, there were more books: The Open Heart (1966), Notes from the Future (1970), PPG-2266: A Surgeon’s War (1975), to name some.
During the Second World War, Amosov conducted forty-thousand of operations – thirty daily. He saw injuries, pain, death every day; and just like Demiurges, he controlled over the fate of people deciding whose life can be saved and who should be left to die.8 But his heart did not grow stale, nor did he lose awareness of the uniqueness and value of life. That is what made him so popular among readers.
In 1992, at the age of eighty, he ceased to operate. His life became empty – there were only writing and thinking about the inevitable aging. Then Amosov began his Experiment, the purpose of which was to find out whether it was possible to develop techniques that would help to defeat the aging of the body.10 Martin Heidegger would call this questioning one’s “being-towards-death.”10 In Heideggerian sense Amosov lived an “authentic life,” thus he really existed, seeing as he was totally aware of the mortality of people, however desperately fighting against it, or at least trying to defer it.
To break the vicious circle of aging and even rejuvenate, Dr. Amosov did the Experiment on himself by greatly increasing physical activity. He did daily 5 km run and 2500 gymnastic movements, half of them with 5kg dumbbells. Within six months the old age surprisingly receded. He felt almost like in his “seventies.” He would run 6 km, walk quickly, almost did not stagger, stenocardia disappeared.
In the spring of 1996, it turned out that his heart had enlarged and its function worsened. This made him cut back on running, but he did not change the gymnastics. A year later it became harder for him to walk. Admittedly – from the old age. The experiment helped to retain all internal organs healthy, but it could not help the enlarged heart.
Six days before his ninetieth birthday his body gave up. In one of his last notes, Amosov wrote:
“Hope is not lost, maybe one day it will be possible to compensate heart? Nature is powerful..
Come on, Amosov. Do not lie to yourself.”11
- Matthews Annette M., The Development of the Starr-Edwards Heart Valve. Historical Perspectives. November 1998; 25:282-293. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC325574/pdf/thij 00023-0065.pdf. Accessed December 14, 2017.
- Brink J., Cooper D., Heart Transplantation: The Contributions of Christiaan Barnard and the University of Cape Town/Groote Schuur Hospital. World Journal of Surgery. 2005;29(8):953-961. doi:10.1007/s00268-005-0154-2.
- Schudel M., Cooley, surgeon who performed first U.S. heart transplant, dies at 96. Washington Post. November 18, 2016. Available from: https://www.washingtonpost.com/national/health-science/denton-a-cooley-surgeon-who-performed-first-us-heart-transplant-dies-at-96/2016/11/18/ae976862-adbd-11e6-8b45-f8e493f06fcd_story.html?utm_term=.13089a1190a4. Accessed December 29, 2017.
- Altman L. K., Norman E. Shumway, 83, Who Made the Heart Transplant a Standard Operation, Dies. New York Times. February 11, 2006. Available at: http://www.nytimes.com/2006/02/11/health/norman-e-shumway-83-who-made-the-heart-transplant-a-standard.html. Accessed December 29, 2017.
- It was only in 1987, when after the struggle of Valery Shumakov, another Soviet surgeon, common sense prevailed in the USSR, and the death of the brain began to be considered as the death of a person.
- Amosov N., Kredo. Dialog. 1994;1. Available from: https://www.booksite.ru/amosov/1_06.html. Accessed December 29, 2018.
- The book was firstly translated into English by St. George and published in London as Russian Surgeon in 1966 (Amosov N. Russian Surgeon trans by St.George. London: Spearman; 1966).
- His memoirs from the mobile field hospital translated into English can be read in PPG-2266: A Surgeon’s War (1975) and available on Amazon at https://www.amazon.com/PPG-2266-surgeons-Nikolai-Mikhailovich-Amosov/dp/0809290553.
- Amosov N., Thoughts on the experiment. Nikolay Amosov. World Outlook. January, 2001. Available from: http://ukrainiancomputing.org/AMOSOV/outlook4.html. Accessed January 2, 2018.
- Critchley S., Being and Time: Part 6. The Guardian. July 13, 2014. Available from: https://www.theguardian.com/commentisfree/belief/2009/jul/13/heidegger-being-time. Accessed January 10, 2018.
- Golosa Vremen. [Voices of the Time]. Mirrovozreniye. 2001. Available at: http://icfcst.kiev.ua/amosov/golosaru/108. Accessed January 10, 2018.
- Photos accessed from Amosov’s personal web site http://icfcst.kiev.ua/amosov/photoru/207
OLENA LUPALO is about to finish her Master’s degree in Sociology at Uludağ University in Bursa, Turkey. Her scientific interests include the sociological studies of ethics, aesthetics, art, and the environment. She enjoys exploring the many questions related to medicine that fall within the scope of philosophy and sociology.