with the chernobyl victims : an american doctor\'s inside report from moscow\'s hospital no. 6
The call from Moscow came at 10: 00 on Sunday morning. The doctor\'s tired voiceRobert P. Gail could barely hear: \"Dick, the Soviet Union agreed to let you do this,Dr. Paul)Terasaki and (Dr. Yair)Reisner come. There are three flights to Moscow today. Can you do it with supplies? \"In the last three days, I have prepared for this, assuming that the Soviet Union will give me a visa to ship the required medical supplies and equipment from the West, and helped Gail transplant healthy bone marrow to the Chernobyl nuclear power plant in Ukraine, the victim of the April 26 explosion and radiation leak. However, my reaction seems mysterious. \"We will do what we can,\" I told Gail . \" Then hung up the phone. I was excited and worried but didn\'t have time to sort out how I felt. I told the news to my wife, Mary Jane, and then ran out of the door and drove to my office on the fourth floor of the UCLA Medical Center in Westwood. There, two assistants and a doctor are already packing the last batch of medical supplies quickly, and these things will soon become a temporary modern blood. A typing lab in an elderly hospital in Moscow Since Gail left in May 1, several of us have spent three days collecting supplies from the UCLA medical center pharmacy, and through the connection of Armand Hammer, the chairman of the Western oil company and the people who arranged for Gail to go to Moscow. Gaelic kept calling from Moscow\'s private office day and night, asking for another antibiotic to be added to the list of drugs needed to help victims fight their lives -- Severe radiation exposure can lead to infection. He reported that the Soviet Union also lacked the equipment and chemicals needed to conduct large-scale military exercises. Size of bone marrow transplant- Six in particular-inch-long, heavy- Working needles designed to extract bone marrow from donors, as well as reagents to preserve bone marrow once it is harvested. At the medical center, research nurse Nancy Lyddane, research technician Kyoung Lee and Dr. Drew Winston, an infectious disease patient. Six boxes of medicines and supplies were packed by disease experts. They had six more hours to refuel before the plane took off, and now only three hours off. We waited until the last minute to get these perishable chemicals out. I called Mary Jane and told her to pack my luggage into a trail mix and jogging suit during her indefinite stay in the Soviet Union. Then we loaded the crate with the wagon provided by the hammer. Soon my wife and two daughters, 13-year-old Stephanie and 7-year-old Christine took me to Los Angeles. A. International Airport. When Mary Jane was driving, I was at the last time -- Search in minutes to make sure I have everything I need. There are 8 slow-running clothes and enough underwear for me to wear for a year. - Only a few pairs of casual pants. I threw some underwear and jogging clothes into the back seat, but to avoid having free time I kept the trail mix and even a few rolls of film. After parking in front of the Airport Lufthansa terminal, a colleague of Hammer ( Who is driving a full-load wagon from the University of California, Los Angeles? My wife and I, the youngest members of these two international events- Some of them weigh 50 pounds. - From the car, line up in front of the airline\'s check-in counter. I boarded the plane and carried a briefcase with me, a crate with the most precious and perishable supplies of dry ice, several medical books on bone marrow transplants and a bag for the night A flight attendant refused to arrange a seat for me because I have exceeded the one-time carrier limit for the airline --on bag. Whether the plane is half-empty. The waiter finally took my bag down and checked it down below. I\'m sitting next to Paul Terasaki, an international organization typing authority and director of the University of California, Los Angeles -- Typing lab Yair Reisner, a biochemistry and immunologist at the Weizman Institute in Israel, is currently a researcher at Sloan Memorial Hospital The Kettering Cancer Center in New York will meet us in Moscow. I know from a previous conversation that Reisner was anxious about the arrangements. We don\'t have a visa. - They will send it to us when we arrive, and this is an unprecedented procedure. However, the situation in Resner, as a citizen of Israel, is complex; Since Israel has no diplomatic relations with the Soviet Union, its citizens usually do not get visas. He insisted on the phone that Gail picked him up at the airport and said that he would not get off the plane unless Gail was there. In the air, I had the opportunity to start thinking about the magnitude of the project, and I was getting nervous myself. For the past eight years, I have been doing bone marrow transplant and controlled dose radiotherapy for leukemia patients. Now I am about to suffer from the worst nuclear disaster in peace in history. In addition to the challenges of treating so many seriously ill patients, I also feel that a scientist knows that I am at the forefront of medicine and that I will witness a drama that may one day produce great knowledge. But there are a lot of uncertainties: how many victims need emergency medical care? How well are they injured and how will we assess them? How do our Soviet colleagues feel about us, how capable and prepared they are? In the end, are we in danger? Will Yu Bo arrive in Moscow? Will our food supply be contaminated? Terasaki and I went through a newspaper, but the claims of Western diplomats contradict each other --- It turned out to be very exaggerated. - This will only add to our confusion about the scale of the Chernobyl accident. More complicated, neither Terasaki nor I have been to the eastern countries, let alone the Soviet Union. About the flight, Terasaki moved to the back seat to sleep. But I\'m at 16- Two-hour flight. Stay in Frankfurt for an hour I am concerned that some rigid and formal Soviet customs officers who do not know our purpose will destroy our perishable materials by delaying at the airport. Our first hour in the Soviet Union. - We arrived in Moscow later in the afternoon. - Gail and five health doctors greeted us and they will be our translators and guardians for the next 13 days, when our luggage and medical supplies are cleaned up, we were taken to the VIP room on one side of the terminal building and sent to hospital No. a few minutes later6. I\'m exhausted but now the adrenaline is on me. Terasaki and I have a total of 22 boxes of supplies and equipment, and almost all of them have been cleared without delay. We immediately began to take apart perishable food and put it in the refrigerator. Then we start building our lab, and its microscope and tray will be used to test and match the tissue types of patients and potential donors. A microscope that enhances the contrast between blood cells was misplaced and four days later found it in a corner of the airport baggage claim area. We had to borrow another one before we found it. The next day when Gail met Resina at the airport, our team was done. We stayed at the Soviet hotel first- Accommodation is provided by Russian standards, usually reserved for diplomats. The hotel is old and luxurious, some sultry, covered with red carpet, big and tall. arched rooms. I have not fully recovered from my initial exhaustion and jet lag, and it is difficult to sleep for more than four or five hours every night. Our health guide took us to and from the hotel. Last- It is almost impossible to complete minor changes to the schedule. Our only unaccompanied moment was before breakfast, from 6: 30 to 7 when Gail and I were jogging on the street in front of the hotel. Once we ran six miles to the Red Square. No one seems to know who we are, but we are getting quite a bit of attention. - Especially Gaelic, wearing an \"American\" sports shirt. While our actions are not officially restricted, we are here to help the victims of the accident, not the tourists. Outside the medical profession, we rarely see the Soviets. The Western press conference in Moscow asked US detailed questions that we could not answer. - In fact, we learn more from them than they do from us. We feel very isolated. All we know is what happened at Hospital No. 6. We work 12 to 15 hours a day. We arrive at the hospital from 9 to 10 every morning and check with the doctor. Angelina guscova and Dr. Alexander Balanov, two senior doctors at the second hospital6. Our professional interaction is very good; the Latin- Medical terms transcend cultural and linguistic differences. Guskova and Baranov supervised a tough game. Reminds me of the working group of junior doctors for American residents. Most of these young Soviet doctors were women, and many of them stayed in the hospital for a few days at a time to take care of the worst victims of Chernobyl. We all avoid talking about politics. A doctor, a doctor. Veshesslove Stepanov likes to tell jokes to ease tensions in the United States. S. - But even he would dance around something that could not even be considered a political issue. In my free time, I ask a question with political color from time to time. The Soviets are cunning Dodgers. \"What do your people think of Stalin today? \"I asked an official from the Ministry of Health. He thought for a moment and then declared: \"Stalin made some mistakes, but he led the Soviet Union at a critical time in history. \"Angelina guscova, the hospital\'s chief physician, is burly, no. Nonsense woman in her 50 s; Alexander Baranov, in the middle of him In his 40 s, bald and thin, he is a hematology in charge of bone marrow transplant. While we still rely on officials from the Ministry of Health to act as translators, they all speak some English. When we started talking about patient care, it was very soon clear that both Guskova and Baranov were excellent clinicians who had a long-term interest in the effects of radiation. Guscova studied the previous nuclear tests. Facilities accidents and health around the world Nursing staff were inadvertently exposed to laboratory radiation. She developed an important method to estimate the radiation dose absorbed by individuals in the accident. Since it is impossible to know how much radiation each victim has exposed, her approach has proved to be a valuable tool in our assessment of Chernobyl victims. Based on these predictions, we decide which patients need a bone marrow transplant; We only had transplant procedures for victims who we estimated had received 500 or more radiation. Guskova\'s approach uses formulas to estimate exposure based on the rate of decrease in the victim\'s white blood cell count and the degree of decomposition of the blood and bone marrow chromosome structure. In the first four days after the explosion, the Soviets have listed the daily White blood cell decline. But these estimates don\'t prepare us for the huge damage to the victim\'s soft tissue. According to Guskova\'s estimates, many of them received less radiation during the explosion than typical cancer patients received during standard radiation therapy. We often provide a higher dose of therapeutic radiation for leukemia patients, but never see the extent of soft radiation The victims of the Chernobyl accident suffered tissue damage. The reason why Guskova\'s estimate of radiation exposure is inconsistent with the victim\'s extensive tissue damage is not clear. One possible explanation is that a large number of radioactive particles are inhaled or swallowed up and are shown as damage to the mouth, intestines and lungs. This damage is not reflected in the condition of white blood cells or bone marrow. Guskova\'s formula also has the potential to be inaccurate due to the lack of information on the Chernobyl accident. Our main task is to assist in the assessment and care of 35 critically ill radiation victims. Prior to our arrival, nine of the most affected babies underwent a transplant, some using bone marrow, and some using tissues taken out of the liver of a stillborn or aborted baby. This second procedure, known as fetal liver transplant, is generally not as effective as bone marrow transplant and is therefore the last resort, only if a matching donor is not found, or when the patient\'s white blood cells are depleted, so that it can not be used when organizing typing between the donor and the patient. ( The fetal liver is very similar to the bone marrow because it contains bloodforming cells. During fetal development, these cells are transferred from the yolk sac to the fetal liver and finally to the bone marrow, where they live all the time in the rest of the individual\'s life. The disadvantage of using fetal liver cells is that they are usually not enough for transplant, which increases the chance of rejection. ) We helped with a total of 10 bone marrow transplants to help extract the bone marrow from the donor and inject it into the patient. We are introduced to all patients and many of their family members as American doctors who are allowed to visit, however, like doctors and nurses, they have to wear sterile masks, boots and dresses- The urine, blood, feces and secretions of these patients are potentially radioactive. Although touch and hug are not prohibited, there is very little physical contact between family members. Sterile clothes interfere, in addition, the burn skin of the injured victim is very sensitive. Everyone will thank us for coming. They seem gratified to know that drugs in the United States will be used in their care. Despite our increased supply, Soviet doctors have had to deal with a serious shortage of technology and equipment for 20 years or more. Compared to most American hospitals, the facilities here are very simple. The building itself is in disrepair and has no air conditioning. The Soviets bought most of the hospital equipment from the United States and other Western countries and made very little of it themselves. It is clear that they do not have the ability to deal with a large number of casualties, and one of the most obvious facts is that there is no automatic bloodcell counter. The Soviets did not measure blood counts in 20 seconds with a device that could be found in most blood officer offices in Beverly Hills, but instead counted blood cells under a microscope- It takes 30 minutes of process. ( In the last days of the Soviet Union, a French company donated $100,000 in blood. cell counter. The Soviets were assembling it when we left. ) We had to face frequent failures, which forced us to work longer to avoid delays in any transplant and risk our lives. During our first transplant, a very old lab cover used to maintain aseptic conditions began to smell like burnt rubber. When working properly, the hood blows the filtered air onto the table Prevent bacteria from polluting the top surface of bone marrow preparations in the air. The Hood never worked again, but fortunately none of the bone marrow was contaminated. We ensure this by preparing the cultures of each bone marrow sample. Another time, within 24 hours after Reisner set up the laboratory in the second hospital. 6, he had to pack all 10 boxes of equipment and move to a nearby facility because the only centrifuge available in the hospital was broken during the second transplant. Although the machine is broken and we lose part of the bone marrow, we are able to restore enough cells to continue the transplant --- Unpleasant but not life. Threat, delay. The centrifuge separates heavy cells from light cells in a dazzling rotation, which is absolutely necessary in the pre-transplant bone marrow. Only the light- Density cells are cells that can restore the immune system for transplant. The heavier the cell, the more mature it will not multiply. For the next two days, Reisner had to work late into the night to return as scheduled. All bone marrow transplants are obtained from family members whose tissue type matches the most with the patient. Although it takes a lot of hard work to match the organization type, the actual porting is relatively simple. General anesthesia for the donor, 6- Insert the inch needle into the hip bone, which is the easiest and safest place to extract the bone marrow. In an hour, the bone marrow was punctured more than 200 times. The material-- This is the source of blood and the basis of the immune system, it looks like the blood itself- Inhale the syringe one teaspoon at a time until about 10% of the bone marrow of a pint or body is collected. It is then placed in a bag and injected into the patient during a procedure similar to a transfusion. The donor\'s bone marrow cells flow through the blood and find the way to the patient\'s bone marrow. For blood donors, this process is similar to giving blood to a unit. We can\'t find the perfect donor for several victims. But over the past five years, Reisner has developed an innovative program to prevent corruption. versus- Host disease, when the cells of the donor\'s immune system reside in the bone marrow, identifies the transplant recipient as a foreign tissue and attacks the recipient in the same way as anti-infection. Reisner\'s technique removes bone marrow cells that cause graftversus- Host disease without destroying the cells needed for the patient to regenerate new bone marrow and immunity. The operation takes six hours. Four transplant patients need the help of Resner. The most challenging part of a bone marrow transplant is the use of antibiotics and other support measures to maintain the victim\'s life until the bone marrow has a chance to transplant. It takes 2 to 4 weeks for bone marrow cells to grow enough to restore blood production. Until this time has passed, there is no way to know if the transplant will be successful. This is a competition between infection and recovery of the body\'s immune system. Of the 19 transplant recipients, 13 died before the transplant itself had a chance to grow. As of mid- Six others were alive in June. Since returning to the United States, Gail and I have continued to communicate daily with Soviet doctors on the condition and care of patients by telex. We have secured additional medical supplies for them. Gael has made a second visit and plans to return again by the end of July to formally sign an international cooperation agreement to assess the impact of Chernobyl. Two patients stood out from my memory. One of them was a fireman among him. People in their 20 s are members of a group that called immediately after the explosion to put out the fire. They were the first in the factory and his injury was the worst. He knew he had received potentially lethal doses. But he\'s not afraid. He has the same enduring but fearful expression of many of my leukemia patients at UCLA. It is puzzling that he is dying, and the firefighters in the nearby hospital room are hardly damaged by tissue. The two fought side by side, 20 feet metres apart. It is clear that radiation exposure is incomplete and uneven. 20 feet of things determine life and death. For a few days, his condition has deteriorated because his intestines have suffered severe radiation damage. The first cell killed by radiation is the fastest growing cell, the cell that connects the mouth and intestines. Slower-growing cells can repair radiation damage before splitting, thus increasing the chance of survival. He died early in the morning. When I went to the hospital for rounds, his wife stood outside the door and cried. She was comforted by the nurse when the children wandered in the hallway. Another patient who didn\'t leave my mind was a Soviet doctor in his 30 s who was not much younger than me who lived near Chernobyl. He was introduced as a hero: knowing the risks, he entered the nuclear To rescue the man injured in the original explosion, the reactor was built. In the process, he consciously sacrificed himself and saved the lives of many people. He was still awake when I saw him, although occasionally he was unconscious. He simply greeted him in Russian. He has shown early signs of severe radiation exposure. His injury was the most serious, and his pain worsened day after day. Both on his mouth and face are black herpes blisters, usually the first symptom of the disease. His skin really cracked in front of our eyes. First, the sensitive folds around the groin and under the arm become red and ulcer, and then the ulcers slowly spread to his entire body. A few days later, he was burned with red, crying skin all over his body. At the end of the day, he could hardly recognize it. We injected him with morphine and continuously increased the dose, but even then it did not relieve his pain. The membrane on the young doctor\'s intestines has been eroded and he has severe diarrhea. About 12 days after the explosion, he died a week after receiving a transplant. Trained Soviet doctors seem to have gone beyond and dealt with the situation well. We are careful not to replace their characters. We have more experience with bone marrow transplants, but they have more knowledge about accidental radiation. This is a good cooperative relationship. Earlier, Gail, Terasaki, Reisner and I discussed whether we should focus on surgery and patient care, or whether we should invest time in training the Soviets in the field of bone marrow transplants. We all agree with the latter. Our guidance and training for junior Soviet doctors and technicians, as well as the books and techniques we left behind, are a legacy that I am proud. Fortunately, I have No fear of the aftermath of Moscow, only one measurement at No hospital exit Detected any radiation on my clothes. One night, my left foot shoes sent a positive reading and I wiped the radiation off the floor mat. The Chernobyl disaster shows the devastating effects of exposure to radiation. This shows that it is not possible to provide adequate health care in a larger nuclear disaster. As a cancer doctor, I am used to dealing with dead patients. This is different; I was overwhelmed by human suffering. But the fact is that the damage and human suffering caused by nuclear weapons will be immeasurable. By contrast, Chernobyl will be pale.