Side by Side With Amosov

Friday, 30.11.68

Yesterday: surgery; subject: female, aged 35; repeated operation. First one 3 years ago; [diagnosis] mitral and right atrioventricular stenosis; insufficiency still there. [My colleague] offered to sew in two valves. Knyshov opened the ribcage. Tight adhesions, one left of the lung, reincision, could not be removed. Right auricle very tense. Superior vena cava was bad for cannulation; the tube wouldn’t get through. Cardiopulmonary bypass applied. Right atrioventricular valve showed one commisure stenosis, the other one showed insufficiency due to rupture (?). Interatrial septum dissected. 3 by 1.5 opening; calcification. Left atrium relatively small. Very hard to sew in the valve. Fussing about the heart-lung machine. Leonardo: “Reduce efficiency, send for blood.” M.M., “just one valve.” Had to take my time; always have to, balancing on the verge [of life and death]. Did the threads, started reducing the valve. Hard but I’d tested it, so I finally did it. Did the knots (braiding) without touching the steel. And then saw that the braid had torn clear of the skeleton. I had to do the sewing all over again! Tough! I knew the tube was torn. Sewing done. Fixed the tricuspid valve. Plastic surgery with 2 stitches per commisure. The other one divided 3 x 2, not less than the valve’s. Period. Stopped the heart-lung machine at one hour 53 min. Checked for tricuspid valve deficiency. None. 4.5 l of blood spent. Tube’s fissure 15 mm, leaking with every twist and turn. Efficiency down to 1.3 l/min against 3 — and nothing! Patient woke up. Back to normal by midnight. Today: bilirubin at 8mg%, hemoglobin down from 80 to 40 (breakdown), 17 ampoules of blood transfused plus 2 liters of blood substitutes. Relatives looked for and found a Rh-negative donor. Hard time for everyone, especially for Rozanna. Examined her today. Looked okay, even smiled.

Had a meeting with the Minister [of Health] at 17:00, re staff expansion. Kyrylenko’s man a typical apparatchik with dead fish eyes, wearing a cheap coat. Could be a decent type, but what does he know? He was supposed to and passed judgment. That’s how our science is financed. He even lectured me discreetly. Had a little party day before yesterday with Sasha. Shared a few drinks and had a good time. Hopefully, they will allow us [to hire more personnel]. I asked not to mention the heart transplant in the memo, if possible. I’d do anything just to get more personnel, for I need it badly. At the Minister’s we were served coffee and sandwiches with red caviar. I grabbed one and ate without being invited; I was starved by the evening. Meeting ended 19:30.

Thursday, 05.12.68

8 a.m.

Miscellaneous. I feel like writing. Nothing scientific. Why? Probably because fiction is a way to express oneself, convey one’s emotions. Scientific writing is meant to convey information. The trouble is, I lack talent (I’m reading All the King’s Men [by Robert Penn Warren]. It’s gorgeous, brilliant!). Besides, they have toughened the conditions. Unbelievable! I have a plot in mind. A story about a writer and cybernetics. Could write in the first person. Meeting in the woods, as previously. The writer invites the cybernetics specialist over. He is interested in the character. Then his wife cheats on him.

Once again, ideas and books. What do I want? What can I do? What will I be allowed to do? Describing emotions? We’ve been through this and I doubt I could do it any better. Maybe just to vent my own feelings? I could describe the modeling of thinking. Except that I know: Popularizing would be on a scale excluding information. They wouldn’t allow me to relate the tragedy of an individual aware of his uselessness as a communal member. They would want optimism.

I could ignore all taboos and write for myself — or for the future. But I am not up to it. I am not sure I am capable of producing literary masterpieces. Besides, it takes so much time and effort. Am I so weak I can’t endure that desire to write? I am not. I must withstand it, there are so many other things to be done.

21:00

Have tried to do some writing. Turned out awkward, so I am not up to it. Keep thinking about the “main book” — a story outlining my philosophy, my views on science and life. My credo.

Main points:

1. What is the truth? Probably also a model when it comes to a sophisticated system. There are no simple systems; take, for example, all those elementary particles, quarks, and such. Science is based on facts. Now this surely brings you to a model, structure, phenomena, and functions.

The level of truth is the degree of a given model’s precision.

2. One has to understand exactly what a given model is all about. Also, information.

What is the physical meaning of a model? Is it information? Probably it is vagueness, when abc, abd, abe give rise to one D. Somewhere nature allows this vagueness.

Or maybe this is unnecessary? A model can be a character of some superior alphabet, an accurate expression of a given word — or a sign indicating an inferior notion. In which case determinism is still there and this model serves to preserve all those “amenities” and acronyms. Yet this does not seem to be advantageous, since as many characters of that superior alphabet would be required to describe every condition of that inferior system. Conversion would be necessarily probabilistic (?) and flexible.

3. Cognition and modeling.

4. Working out complex systems, biology of medicine.

5. What is man? Nature and ways to study it.

Every point is tentative, leaving open questions and hypotheses. It takes a great deal of serious research to meet the quantity criterion.

6. Theory of psyche. The issue of artificial intelligence.

7. Models of society.

8. Models of philosophic notions.

9. A theory of social management. The choice and upgrading of social systems.

10. Forecasting man and society.

11. What is to be done by man and the citizen?

Here things objective and subjective, relating to quality and quantity, will be intertwined everywhere.

I could try to camouflage the essence under a “scientific title,” something to do with modeling. But I would have to state the truth in the first variant anyway. I already have sections of the “main book.” They could be updated, using, for example, artificial intelligence; but there is nothing on sociology and biology. Something I will have to do, no way to avoid it.

16.12.68

Briefly on what has happened over ten days.

06.12 [68]: birthday party marking 55 years. Was visited by the Fedorovskys, Bratus, Tanya, and Polina. Had a good time.

07.12 [68]: Spent the whole day drawing a new pump design. Good to realize I still remember the craft. Left for the Session [of the Supreme Soviet of the USSR] in the evening.

And yes, operated on a valvule on December 6. Surgery passed uneventfully. Did surgeries every day.

Nothing to write about the Session. Everything is in the press. Good thing we were in the same audience, so we could stay there for four hours only. Visited all of the friends. Met with journalists. Left a day earlier to do a surgery. Had to ask Georgadze’s permission. He said sure, my friend, go and save your patients (with a pronounced Georgian accent). Returned [to Kyiv] Friday morning and operated on two valves, aortal and mitral. The mitral one proved a problem. I should have substitute the right atrioventricular valve, but the heart started fibrillating, so I had to make do with plastic surgery. Didn’t come out as good as expected.

The patients are generally OK today. Made the rounds. The guys are putting together the pump. I had changed the design substantially, and I’m not sure about the result.

Had visitors telling about the symposium in Tbilisi. Sounds like success — or maybe they want it to sound that way. A plenary meeting of cardiologists had taken place in Kyiv while I was away. Our people received cardiologists [from other countries/localities] and seem satisfied. We appear to be the best in the field.

Did a heart transplant on a corpse. Interesting.

Kopnin’s article “On Philosophy” in Literaturnaya gazeta. Attacks a foreigner (I forget his name) saying that philosophy has outlived itself or should seek another application. Kopnin (Director of the Institute of Philosophy under the Academy of Sciences of the USSR) says, of course, that Marxist philosophy is the thing.

I have already thought about this.

No place for philosophy. I could refute any given tenet (see the “main book”). But there is the question, How is man to live further? How should one answer this? Perhaps the subject should not be overcomplicated. A child is born and grows up, behaving as he will, yet he is exposed to restrictions; they want him to behave like they want. At first, such restrictions are met with dislike; subsequently, they are taken for granted. As that child grows up he becomes yet another individual siring his offspring and teaching them all these things. No need to trust in God (as is the case with my daughter, for example). That’s artificial. Sciences, such as sociology and psychology, should study man, provide an optimum model of society and try to implement it.

It is, however, unclear what should be done about the ideals. An [adequate] society cannot be built relaying on materialism, as the notion of being embraces only the instincts — or one’s own individual comfort on a broader scale. Society demands the negation of egotism, meaning that one has to take into consideration not only oneself, but others as well. The first rule: Do unto others as you would have them do unto you. Regrettably, this formula appears interpreted by every individual in a very subjective manner.

The diversity of models is the most complicated aspect in managing society. Unfortunately, this diversity is increasing.

Returning to ideals. I think the trouble is that man is not good enough by nature; adults can easily perceive as much, whereupon they no longer want to give themselves to others — in other words, they refuse to follow the ideal path. And then everything falls apart. Children have to be raised on those ideals, consciously overstating the human virtues. Otherwise the adult products of this education will be even worse. That’s the crux of the matter. Science demands that we speak the truth; religion or the prophesy of communism demands that we embroider man.

But maybe this isn’t necessary — I mean all that embroidering. Perhaps man will turn out so different that everything will be said and done by stating the truth.

We need a model of man and experimenting, so we can get the characteristics. Then we will be able to discuss the actual possibility of building an optimum society.

Wednesday, 18.12

Another failure. A male patient, aged 35. Compound mitral malfunction, manifest insufficiency. The usual prosthetic procedure. Not difficult at all. 55 minutes of perfusion. Grave calcification. Lung artery hypertension remains high (perhaps even higher) after corrective surgery. No fibrillation. Semicircular valve. Brief cardiac weakness after the end of perfusion. Back to normal. I had washed and was about to change when they shouted fibrillation. I rushed back, had alcohol poured over my hands and gown and gloves on. The [heart-lung] machine was almost disassembled but still clean. Massage. Machine activated. Defibrillation. Contact. Another one, then another. Catheter inserted in the femoral vein. After quite some time and effort, parallel perfusion via femoral vessels. Wound sewn up with a tampon (hemostasis took long — and L.N. wanted to start the heart-lung machine on the other table just as fibrillation had begun; she helped me and then fixed the initial atrial septal defect). We should have run the machine for 5-6 hours; instead we stopped it 2.5 hrs later. We waited and monitored the patient. Condition worsened 8 min. later. We started the heart-lung machine, but the heart was fibrillating. Opened the wound, inserted another femoral catheter. Efficiency rate: 2.7 l/min. I was worn out. I went and lied down on the couch in my office, spent some time in the darkness. Went home (19:00). I had to go to a party with the “cadets” — it was a must. Then Y.N. called, saying the patient was responding, opening his eyes at 2 l/min. I gave the instructions. Was back home [from the restaurant] at midnight; had had 100 g of alcohol in all. Called the hospital and learned that the patient had expired at 21:00. I suspected that the valve was not good enough, but not sure. I still don’t know if it was a mistake. Hypertension must have been too high and no probing. Experience: parallel perfusion, perhaps lasting long.

Friday evening, 20.12

P.M. done yesterday. Hemispheric valve stuck transversally, never closing. Had I done an operative exploration, I would have corrected the situation. The jamming had occurred when withdrawing the tube, a spreader blindly inserted between the hemisphere (or sphere) and the circle. Krivchikov’s original design made it impossible, but the factory simplified the design and it happened. Amazing how the man had lived with that thing for so long. And a great pity. If only I had missed that party! Yury had explored the thing with his finger before the patient’s death, but had been unable to figure out what was happening.

The impression is that patients always die because of the surgeon’s mistakes.

No valve sewn in yesterday and it was stenosis rather than deficiency. Actually, there was some right atrioventricular deficiency, but it was corrected by semicircularly tightening the ring. I thought that the patients should be examined more thoroughly from now on. Today: sewing in two valves, a mitral and an aortic one. The surgery took a very long time; had the heart- lung machine working for 2 hrs 20 min. The mitral one was real tough. Thank God for the outcome. So far so good.

Was visited by a Dnipro woman journalist before the surgery.

Saturday evening, 21.12

Visited the clinic during the day. The patient seems OK, although he had sustained another thoracotomy during the night; all of a sudden the drainage pipe started spewing out liquid. Hennady got scared, he told me later he almost had a heart attack (and he’s a big fellow, 180, athletic). Nothing alarming discovered.

Weather lousy during the day, but it must be nice in the woods. The cars racing by are dirty, windshields splattered with mud flying from under the wheels of the cars ahead. Katia took her music exam and passed it with an A.

About literary writing. When I feel like writing, the first question is ideas. I wouldn’t be any better than the next man trying to portray people and their animal doings. Meaning that I should try to propagate some ideas. What for? I know that it’s hopeless; one can’t voice one’s ideas clearly and convey them to people because all those other people are so complicated and in a state of competition. Who will read any of this? Other people have different ideas. There is no way to influence the world. This society will evolve spontaneously.

So why bother?

Everything has been thought over a hundred times. One must do something one can enjoy — like surgery.

Publicity is not bad at all, on the other hand. Yesterday, when they were taking me home from a [public] lecture, an engineer praised my talent, although he did not seem a clever one.

I would love to write some fiction based on science, a book describing my ideas and attracting public attention.

I have pondered the idea many times — and I have always decided that real science is incompatible with any literary plot, be it a story or novel.

Friday morning, 27.12

Mistakes! Again mistakes! No end to them. Yesterday’s surgery. Two valves, mitral and aortic, were to be sewn in. Pericardium sealed tight. Oversized right atrium. Inspection revealed right atrioventricular deficiency. Heart-lung machine at work. A bit of coiling applied. Lenticular valve introduced (we had received the valves and then advised to postpone using them, but we were in short supply and I had thought it would work — how very presumptuous of me! — the more so that we were considering 3 valves. So the valve was sewn in. The heart contracted, so the aortic insufficiency was not conspicuous.

Interatrial septum incision. Huge left atrium. Stenosis, insufficient bicuspid valve, calcination. Leaking aorta. Had to insert an aortic valve. Perfusion effective only in the left artery. So far so good. Patient cooled to -23° C. Valve in place, aorta patched up. Then we opened [the chest] and saw an obsolete valvae, with supports, passing some 400 mm a minute. Managed to sew in a semicircular valve in the mitral opening. The heart started after the first stroke. I pulled out the drainage carefully, along my finger (see previous disaster). Everybody was happy; 2 hrs 20 min. [with the patient alive], we started patching up the atrium, with a bulbous-end probe in the tricuspid valve, lest it close and pump in the air. But as I felt for the valve ring I discovered that the “plate” was not there. It had fallen out and was now in the hollow of the ventricle and I couldn’t reach it through the narrow aperture. I was horrified. I lashed out at Hennady. Why hadn’t he checked it? L.N. retorted, Why did you take it [the valve] in the first place? They said we shouldn’t, didn’t they? I was trying to get [to the valve ring] all the while and couldn’t. The “plate” had sunk all the way to the pulmonary artery and disappeared. I thought I had pushed it through. But then L.N. spotted the edge by the valve. We had a hard time getting it out and then putting it in place. Wasted a lot of time, although the heart was doing OK.

There is an end to everything. Patient patched up. Three hours of perfusion. Hemolysis: 500 mg%.

Heartbeat satisfactory, but no urinary excretion. And there is hemorrhage. I did the hemostasis myself, took quite a while. Hennady put the finishing touches as I was in my office, discussing the design of a parallel perfusion apparatus with Zinkovsky and Vadym. Then the patient was transferred to ICU, showing no sign of awakening (embolism? could be anything, considering the haste). Persistent hemorrhage. Patient had received direct transfusion from the fat Mykhailo while in the operating room. It had not helped. Repeated thoracotomy. Did it myself. Scattered spot hemorrhage. Took an hour, maybe longer. Then they started patching him up and I went home at 22:00. Had to take a bus, was tired (having had a coffee and an apple). I left them and trusted them to make as many transfusions as necessary.

Yevhen called at 23:00 to say that the patient was still bleeding, very little by way of urinary excretion, and hemolysis at 90. Coagulometer readings very poor; the liver must have taken a heavy blow. Still, the patient seemed to be coming through.

Hennady called at 00:30. The situation was going from bad to worse, blood pressure going down, hemorrhage still on. As he was finishing the call a nurse rushed in, shouting cardiac arrest. I had the time to tell him no massage, no resuscitation.

So that’s it. I have a headache. I should have applied a semispherical valve. Damned fool!

Another surgery today. Fortunately, no valves involved.

Sunday morning, 29.12.68

Had some rest, slept without sedatives. Friday saw a simple surgery (5 mm ventricular septal defect, one mattress [quilted] suture). There had been causes for alarm, though. The girl operator had mistaken the tank tubes and had almost killed the baby (27 kg) with carbon dioxide. Fortunately, Dina had been around to help and the heart still to be operated on. The heart had stopped almost as soon as connected [to the machine]. I untied the strings and proceeded to massage and the anesthetist had taken care of her breathing. We were afraid she would have brain edema. Fortunately, she did not.

The surgical year is over. Nothing much to write home about; some 14% death rate using the heart-lung machine; about 4% with stenosis; lots of mistakes made by the surgeons, especially by me. Including a fatal error that summer when I patched up excess from the left ventricle through the left atrium, in the presence of ventricular septal defect. Some attainments are also on record. Valves. Two patients surviving with two valves (although one still risks getting infected). We have also tried three valves. 3 of 24 with a single valve have died (figures to be checked). All were grave ciliary arrhythmia cases.

Some headway made in terms of transplant arrangements and resuscitation. Agreement seems to have been achieved [upstairs] to receive potential donors in the resuscitation division. Arrangements still to be made with the ambulance service. Looks as though we will make heart transplants, after all.

However, the past year was marked by hopes that never came true. My literary writing went down the drain. They are not going to print the second part of my science fiction story, despite all of the drastic changes made. Now I am convinced that talent does not suffice, either. I am further convinced that writing anything is no use; we shall not live to see better times, and with me it just doesn’t work when I can’t stop doing it. I am not one of those writing for a happier future. I want to write, but it’s not an overwhelming desire.

Also, there is the dead hope for artificial intelligence. All is well, I have worked out an excellent hypothesis (I do think that it’s a discovery, although no one seems to appreciate it here). I have developed a method of semantic networks using models with variable potentials, although it can’t be implemented using our computers. Too many calculations to be made and selecting the characteristics is too difficult. The Lora computer we have and Sasha’s MOD software don’t seem capable of handling the task, and there is little chance of carrying out the verbal model. This past month I worked out a new approach, algorithms of conscience, but I don’t expect it to succeed either. Besides, it is even further from physiology.

Sphere (the inner sphere model). I have put together a task force, but the people are showing a poor performance. I have to take care of everything myself — and I don’t have the time and not even the interest.

Socium (as Dmytro puts it). It proved very difficult to draw up a hypothesis relating to the activities of society. But I have made some headway there too. There is a draft model. But where am I going to submit it? Can I expect any publishing house to go along with my project? Will anyone allow me to act out this ideological model? Also, it’s nothing but scholasticism without experimental characteristics.

Of course, I have developed a new philosophy. I know I have. Yet I won’t be able to prove it. They won’t even allow it to appear in print, and there will be no public trial/discussion. For the whole thing would require staggering sums in terms of spending and a lot of time. Time. That’s the main thing. Yes, I feel as though I were made of steel. Yet I am 55, so I try to focus in simple, real, contemporary things. Surgery, because the result is immediate, a matter of days.

I perform surgeries every day, four days a week I am a good surgeon, except that I make mistakes. I hope to make fewer mistakes. Of course, it takes an effort to make progress in science. The people on my team are doing something, we will accomplish something, and will have something published. Perhaps another title will be conferred eventually (such as membership of the Soviet Academy of Sciences; being an Academician won’t hurt in old age — in fact, I was made Academician of the Ukrainian Academy last December; now they want me to run for the Academy of Medical Sciences and I don’t want to, because I know that they will vote me down).

Well, there you have it. The events in August brought forth all the disillusionment I had accumulated. It became obvious that I would not outlive the regime, that the world was a ship plying the waters without anyone at the helm, without any sails. I am the man in the street, of no importance whatsoever. Who am I to try do anything about that?

Therefore, we will proceed to operate on our patients.

And simply live.

Same date, later that day.

I feel like writing. What is it? Vanity? I am wrack my brain. No, rather an effort to express myself. Ridiculous. To express what? What kind of wisdom have I mastered? Trying to console myself? Yes. I have mastered some knowledge. Rather, I have found approaches, not solutions . “Information Theory of Complex Systems.” Philosophy. I can sense the way an experiment should be staged to solve the problem of society.

Let’s face it, I’m almost showing off.

Being able to write is a gorgeous opportunity, especially if you have the gift of eloquence, conveying your feelings, making the reader share them with you. Sometimes I think that I have this gift, although it’s a far cry from [Robert Penn] Warren (I am still reading All the King’s Men).

Plot: heart transplant, regardless of the outcome. Dramatic story anyway.

Not enough. I can’t repeat Mikh[ail] Ivanovich. I must find someone young and very much on the intellectual side, one with all of that “main book.”

Yet a novel is necessary. Where to get it? A love story.

Thursday morning, 02.01.69

The New Year was celebrated at home, by the three of us. Watched television. Dull. I had something to eat, drank very little. Went to bed at two a.m. Had a call in the morning. Volodymyr Mykheyev, the duty physician, saying there was an emergency. A female patient, named D., had fallen down the elevator shaft at 11:30.

Thus began my New Year.

The patients had been watching television on the ground floor and had started departing to their wards at 00:30 when that patient D. (the woman, by the way, whose tube had burst and valve had torn loose in surgery) had taken the elevator key from the duty nurse’s drawer, opened the elevator door, and taken the jump. The elevator car was upstairs and the blocking system was out of order. The only good thing was that she had to jump only one floor.

Retrieving her from the shaft was long and painful, as the door below could not be opened at once, so they had to use bed linen as hoisting material. Took them a couple of hours.

Result: slight concussion, typical distal radius fracture, upper shin-bone hairline fracture, mild left iliac, pelvic, and nasal bone fractures (mild). Her nose was dissected, lots of nasal hemorrhage, multiple contusions on the hips. Hemoglobin count lowering from 66% to 40%. Inexplicable, all signs indicating that she had not lost that much blood.

I was at the clinic about midday. The woman had been transferred to the X-ray room and they were about to fix the spoke bone fracture.

Afterwards, Katia and I went skiing in the woods of Holosiyevo for a couple of hours. It was great! Except that my daughter kept complaining about her skiing skill.

[Called the hospital] that same evening, inquired about patient D. Condition: satisfactory.

Two surgeries today.

All official barriers in getting donor help surmounted. We got an official paper from the Health Ministry of the Ukrainian SSR, allowing us to receive patients subject to major resuscitation, also to have heart-lung machines and operating theaters. Heart transplant not mentioned, but everybody understands everything. I had been to the City Health Department and to the ambulance service, visiting Nat. Anur., the head physician. Now all we need is to have the premises fixed up. I had also visited Dr. Milko, Rector of the Medical Institute, about organizing a study group, so he would perhaps give me some subordinator undergraduate students. 30-31 lab dogs operated upon. A heart was extracted and linked by tubes to a recipient Monday. The heart worked beautifully until installed. We’ll probably follow the same procedure with humans, attaching dubious hearts to recipients. Tried to insert plugs in vessels Tuesday. Tried to link vena cava. Failed, had to suture them. The dog died when being transferred. Have to use human corpses to practice and perfect.

Scrub nurses invited me to a party on 31st, toward the end of the day. Had a few drinks and had a long discussions with Dr. Satmari, Dr. Knyshov, Dr. Leonard, and Dr. Tolia S.

That same morning, on 31st, presided over a conference dedicated to “criticism and self-criticism.” Had a heated debate with L.N. 18 out 24 deaths during surgeries employing the heart-lung machine are obvious professional errors. Likewise, 10 out of 12 stenosis cases. Some reserve! I told them I would perform the surgeries myself from now on. Tough but right, I think.

Friday morning, 03.01.69

As they (physicians and nurses) approached the elevator, the shaft was absolutely dark and one could hear weak moans and sniveling from way down, as though someone were choking on his own blood.

Sewed in a valva yesterday and operated on a ventricular septal defect case complimented with hypertension. Good results. My family and I are traveling to Moscow.

About my novel. Here’s the plot. A surgeon, heart transplant, a young man, affairs with women. He is a noted researcher, learned in cybernetics like me. Medicine (?), Sphere, psychology, sociology. His past (engineering) like mine (war and childhood put off for further use). The most complicated aspect: his private life. Will he be married? Single? Divorced? Getting divorced? Falling in love? Married yet falling in love? With whom? An assistant, a woman professor versed in neurophysiology? Or already divorced? Has a son he hasn’t actually seen, and an inveterate wife refusing to forgive him for his past? Yes, a doctor and one that does not seem enthusiastic about remembering his past. He has a lover and she could have a daughter. So I could somehow convey the father’s feelings. Feeling dissatisfied with having no son? So he is in love. Doesn’t seem right somehow. Other aspects: equality but no commitments.

Guidelines:

1. Personal: a novel — but ending on what note? Where is happiness? Doesn’t sound right.

2. Heart transplant. The outcome depends on what is actually taking place. Maybe a clearer stand taken after Vyshnevsky? Surgeons are human, after all (a narrow approach?).

3. Cybernetics: questions, just questions. No answers. Disappointments — and yet...

Trips: America (cybernetics), England (surgery) — almost all of this true — and sociological discourses.

Morning 05.01.69, Moscow

Beginning: I am writing all this just to figure everything out. Lots of questions remain unanswered, old and new ones. Writing seems to help. I am a scientist. In any case, officially Professor and Doctor of Science. I am even a “Meritorious Worker” of something or other. Too bad, they voted me down as Academician. In such cases people usually refer to their “enemies.” I wouldn’t say so. In fact, I don’t think I deserve any favors, so I bear no grudges with all those academicians. My friends say that all those others are no better than you are. True, but I didn’t stage an election campaign. All those academicians need signs of respect, they want others to please ask them some favors; they want to be flattered.

Getting back to those questions:

What is man? Society? Science and the future?

Finally, how should one live?

Another plot: I am who I am, and everything is true. The advantage is sincerity, it helps you and makes your task easier.

Drawbacks:

There will be no novel. Too many repetitions of my Thoughts and the Heart. Everybody would look for identities — I mean people who have assisted me.

Third option. A sequel to Thoughts and the Heart. I really could discuss wisdom, being 55.

(To be continued)