2014-05-08

V. Guitberg

February 25th, the fourth morning after the surgery. Tanya is again the nurse on duty today. First there is a visit by a group of doctors and students. It is lead by Kathleen. The group stops at my feet near my bed. Kathleen quickly passes to my headboard. She succinctly tells about my condition, using abbreviations and technical terms that I do not understand.

I see Dr. Glenn is standing in the middle of the group. While Kathleen reports, he looks at me, but seems to be listening attentively to Kathleen. He is not smiling at me. I look at him and try to guess his thoughts and feelings. I think he feels the satisfaction of the surgery well done, and now only overseeing the work of others.

He did what he had to do to preserve and extend my life. In this, his functions ended. However, he was concerned because my physiological and psychological state is a result of his operation. This surgery knocked me out of the traditional way of life and has brought on a difficult period. There could be unforeseen troubles yet. All of this "pleasure" could have been provided to me by another surgeon too, if the surgery was inevitable, but it was done by Dr. Glenn due to our mutual desire.

Kathleen answers the questions asked by students and other doctors. Dr. Glenn only listens and is silent. A tall, imposing man joins the conversation. I met him on the next day, during my walks down the corridor with Misha. His name is Alex, he is a cardiologist, an immigrant from Greece. Here he looks like the senior of the group, and as such is showing a clear interest in Kathleen’s report and asks questions.

Everything is happening at a very fast pace: questions, answers Kathleen and all go out.

Efficiency and democratic relations of staff create an atmosphere that attracts me, and I already feel like a participant in the project of my recovery. I am very comfortable to be around these people. Though not as a specialist, but as a regular person, I feel with them as equals. I even have the advantage - I am their client.

After they left, I imagined how circumvention of doctors would look at a Soviet hospital. Quite sure, that now too little has changed, if not gotten worse.  

I tried to imagine Dr. Glenn in Russia. He would have to move in the aisle between non-partitioned beds, ahead of his colleagues in a white robe, with an overlooking unshakable dignity and absolute inaccessibility. Behind him, at a respectful distance, the group of just “ordinary” doctors and students would follow. Pausing at the bedside of the patient who attracted his attention. He pretends that he listens to the report of the doctor on duty about the patient's health condition. Then he utters "very important" instructions about further treatment and goes on to the next patient, on whom he randomly set his mind, and to whom he is completely indifferent, as to all other patients.

The most important thing in this theatre is the display of subordination. With just the mere appearance of such an important figure, there should be a sense of subordination.

It is impossible to imagine such a scene in a Canadian hospital. I see that everyone here feels and behaves as an equal, everyone is responsible for the performance of their, and only their functions.It gives me great pleasure to see respect and tolerance towards each other by people from different ethnic groups. Be it on the street, in transport, in a public place, in companies, in government institutions, no matter where they are on the job ladder. This is in contrast to mono-ethnic countries where the indigenous population feels like the owner of their land and becomes the de facto privileged.

In Canada, only the Indians as the indigenous population, and live in areas assigned to them and have a range of benefits, which gives rise to their serious problems. The remaining ethnic groups are equally likely to consider this country as their own.

Shortly after our arrival in Canada, maybe after a year, I watched a television broadcast of the inauguration then newly appointed Governor General of Canada, Romeo LeBlanc. I remember his words (almost literally), which determined my attitude towards the country, the people and the entire surroundings:

-       In Canada, there are no privileged individuals; we are all here equal, because we are all just immigrants, but some of us came here earlier than others did. That’s all.

In the hospital, there is still some disparity between patients and staff. Each patient is the most important person, whose life is the responsibility of the qualified personnel, who do everything they can to keep the patient healthy and happy.

If the patient does not abuse his position, they will feel warm attitude towards themselves, and will be in a very supportive and comfortable environment. At least this is how I feel.

I still had the desire to speak with Dr. Glenn about the operation, which I successfully endured thanks to his high level of professionalism and skill.

Such an operation, although it is not unusual for him, could still be fraught with unforeseen situations. I do not know, maybe there were complications, and he dealt with them.

As a methodologist, which I consider myself without undue modesty, I understand that for each type of surgery there should be designed a methodology for it's implementation, and approved according to the standard. I can see it even on the cuts on my body, made ​in exactly the same places as in the figures in the description of my surgery in booklets.

During each surgery, the surgeon adapts the standardized plan to each specific patient.

I can easily imagine this situation by comparing it with architecture. There is a standard project as a model, which, when applied in specific circumstances has to be adapted to them.

For people, any major surgery is a unique experience in their life, perhaps the most important, which sometimes may be the last. It is said that the miner and the surgeon are both wrong just once, the miner - in his life, and the surgeon – in the life of a patient.

Generally speaking, my surgery was a special occasion and dangerous experience only for me, but for Dr. Glenn - everyday work, more or less complicated, but nothing unusual, even if the operation ends in failure. It's inevitable - in every job, there are bugs and failures. The human factor can never be ruled out.

Very little time passed from the moment that I mentioned in the previous chapter, where before the operation I was asked who would operate on me, when informing that it would be Dr. Glenn, the feedback was always most enthusiastic. Everyone thought I was lucky that he took to make such a complex operation. He is widely known as a highly talented and highly professional surgeon.

I also think this way now. I think, as in any other area, highly qualified specialists are exceedingly rare. Not all surgeons are able to perform the necessary changes in the standard technique of implementation during the operation, as well as not all doctors can make a correct diagnosis, so we have such sad statistics with regards to medical errors.

Although there is a group of people involved in the operation, each of whom performs a well-defined action, during the operation the surgeon makes the final decisions.

Thus, the surgeon must analyze all events and symptoms, and coordinate the actions of all the members of the operating team. Does an operation always proceed according to plan? What if suddenly there is a "free lance" situation not accounted for by the approved methodology? So it’s necessary to analyze, analyze, and analyze more.

Needless to say, that the human analysis may not be sufficiently complete and accurate, but surgeons must make the right decision on how to act in a given situation.

So the risk is great enough. I'm going to tell Dr. Glenn about how our computer system could help him.

Physicians participating in the circumvention left the room, and I was brought breakfast. It consisted of the same dishes that I had yesterday and the previous two days. I probably lost weight quickly because I ate little, although the meal was quite tasty.

Tanya and Misha came just after the doctors' observations. They were annoyed that they came too late; they did not think that the observation would be so early. Misha again was unable to meet with Dr. Glenn. He wants to see him in order to get information about me, but I want to give information to Dr. Glenn about my computer system. I want to introduce myself as a demo.

I have not had time to finish breakfast, so kefir, Chia, greens and pickled cabbage, which prepared my family, arrived just in time. These supplements are a very valuable contribution of vitamins to the hospital food.

Apart from breakfast, the heartiest meals were lunch (midday meal) and dinner (about 6 pm), consisting usually of three courses. Chicken soup with dry biscuits, the second - a meat or fish dish with mashed potatoes and boiled vegetables. Actually, there was little need to bring food from home. Hospital food wasn't bad, but adding homemade dishes made the meals more suitable for my stomach.

Misha was trying to figure out why I was not brought those dishes that we ordered yesterday. The woman in charge of the kitchen explained that the information from the menu that we ordered from for me for the next day, gets into the kitchen computer only in 48-72 hours. So, for now just enjoy what you are given. Perhaps, for many patients it is not a problem, they just leave uneaten that which they don't like, such as my roommate for example. In my opinion, he eats and drinks only what someone brings from home.

Such a lag of information in a computer system means that the meal ordered for me for tomorrow, I could get only in 2-3 days.

Of course, I did not come to the hospital to eat, although this serious issue was debated before the operation. After all, food is an extremely important component in the rehabilitation process.

If for the cardiosurgical center the priority is to perform the surgery at a high level of quality, then for the kitchen, the main goal should be to provide each patient with useful food at the same high level.

Much later, when I was already at home, I read in the newspaper that the nutritional problem exists in all hospitals in Ontario. It also cited the opinion of the American writer and therapist Martin Henry Fischer, who was once asked how to reform the management of the hospital to provide maximum nutrition, he tartly replied:

-          Very simple - kill all nutritionists and resurrect French chefs.

If I'm brought the food that I ordered anyway, then there really isn't any need for a nutritionist, let them find a new qualification, as for me, I would certainly get more pleasure from French food, which would then positively impact on my rehabilitation.

Food is, and always has been for all an object of desire.

Wonderful Scottish poet Robert Burns dedicated these verses to the dinner table:

from Burns Night: My Supper With Rabbie:

“Some hae meat and canna eat,
And some would eat that want it;
But we hae meat, and we can eat,
Sae let the Lord be thankit.”

My strength has recovered quite quickly, in no small part thanks to the homemade additives that make the food more tasty and wholesome. I do not want to downplay the role of nutritionists, but they can only give general advice. In order to design the optimal diet for each patient, nutritionists should be well aware of patient’s health, and be able to take in account all its aspects. Today none of the nutritionists can do this.

So again, I think back to our computer system (ComRAD/II&ES), which analytical capabilities able to optimize the nutrition of patients, according to the state of their health. The system will be able to select for each person the menu that contains the most useful food that he or she likes, and that will interact well with the optimized set of medications, or even replace them.

The opportunity is for each patient to receive nutritious food which they like, and this would significantly cut down on wasted food and hospital expenditures. For now, we can only dream of it.

Tanya and Misha went snacking in the cafe on the 1st floor of the hospital. I suspect that the food wasn't prepared by a French chef from Paris, but Tanya found that the omelette was very tasty. For Misha, as he is a vegetarian, it was much more difficult to pick the right food.

In their absence, some volunteers came and brought books in different languages. I took a Russian magazine called "Biography”, which I've never seen before, as well as a book in English about the Red Army. It's interesting how the Red Army is perceived here in the West.

Last year's magazine, which talks about the personal lives of celebrities past and present, proved to be typical tabloid.Restlessly smiling Kelly invites me to walk again. She wants me walking with her without a walker, takes it away from me, and persuades:

-          Do not hold on to it, because I'm with you- and make me go, but slowly, she brings the walker just in case.

Misha prepares a report from the hospital. He asks Kathleen and the nurses about data related to my health condition, and send them via email to our relatives and friends living in Canada and other countries.

People thank him and make enquiries if he is late with dispatch. I also ask him to give all my thanks to all who enquire about me.

As Jocelyn did yesterday, today Tania very professionally performs the same procedures, required for nurse. I have established a routine in my life that four times a day my temperature is measured, along with blood pressure, pulse and blood oxygen levels, as well as blood tests and ECG scans. Everything is done under the supervision of a nurse or by her directly. Today, all the indicators are good, except for heart rate. It has not yet dropped, and remains at 110-115 bpm. It's too high a pulse, but this is not unusual for those who underwent a serious surgery.

Watching at the nurse, I enjoyed her actions, how she is confident, calm, thoughtful, with no fuss and non-intrusive when performs all of the above procedures, she injects Coumadin to thin the blood, brings me all the prescribed medication - and everything at the appointed time.

I have no fear that she could confuse anything.

I ask Tania where she is from, and how she acquired such professionalism, where she worked. It turns out that she had quite extensive experience as a nurse in Israel, and before immigration - in Russia. She has also has been working for 5 years in this current hospital.

About the "virtues" of hospital conditions in Russia, I am fairly well informed. Only I'd like to know, whether there are differences in the conditions of hospital patients and in particular in her work when comparing Israel and Canada. To my satisfaction, she does not see a big difference, and that the level of health service is about the same.I've heard and read about the high level of medicine in Israel, and was pleased to learn that the hospital in which I am treated, is not behind Israeli hospitals, even in the service.

Immigration tempers people and teaches them that you must do quality work if you really want to be in good standing and earn well.

My Italian neighbour behaves very aggressively the entire evening. He has become accustomed that I often call a nurse for him. When he can not find the call button, he is trying to reach me. He wants to push the heavy fabric partitions that separate us. If it fails, and I can not help, he in desperation shouts, calling the nurse and it seems to me he is afraid of something.

Tonight Dargia is on duty again. She is a young Chinese woman of small stature and very mobile, who has been given a difficult assignment. In addition, she has been working for two consecutive nights. As she was unable to give the old man her constant attention, she decided to take him closer to her main nursing post.

She called another nurse and together they instantly launched his bed and, with the words:

  - Dad, do not worry, you'll be in our company - quickly took him away.

They returned him at 6:00 in the morning. This allowed me to sleep for at least this short period. I think that he too, slept.

February26 - the fifth day after the surgery. As always, first comes the doctor with a book and a stethoscope, after him the weighing, pills, and breakfast. Once again, I was lucky this afternoon, as Jocelyn is again the nurse on duty. Either she decided to bathe me, or it was prescribed that on the fifth day I should take a shower.

Probably only mom has ever bathed me this way in my infancy. Jocelyn adjusted the water, so that it was not too hot, lathered my entire body with a soft cloth, very carefully, then without soap washed my joints and wiped me with a clean and dry towel, finally she dressed me in two hospital gown, the same as before the surgery.

This was incredible pleasure! As they say, I felt as if I was reborn again.

Tanya and Misha arrived around lunch time. This time they brought supplements not only for my lunch, but a meal for themselves too. They found that it is possible to eat in the waiting room next door to my room. There are a microwave and a coffee maker.

They brought me greetings and wishes from the "support team."

Soon after Tanya and Misha finished their lunch, they came back to me, and like yesterday, a volunteer arrived, this time a different, elderly man. He obviously wanted to give us some useful advice, but at this time Jocelyn came in with a diagnostic device. The man excused himself, but still managed to give some good advice to Tanya and Misha before leaving.

-          For your family and friends make an answering machine message as follows:

“- If you are inquiring about Vitali's health, please leave your name and phone number and we will call you as soon as possible." If you don't do this, then you will be barraged with endless calls- he said.

It was good advice, but as I mentioned earlier, Misha already embodied another great idea to send our entire "support group" information by e-mail. Tanya is freed from having to answer any calls, which for sure, would continue the entire evening.

This is what happened after Misha returned to his family in Victoria BC, and while I was in a rehabilitation hospital. Every evening Tanya had to answering numerous calls and had to talk for a long time with distant and close relatives and friends.

Although it was tiring to tell everyone about the same thing, but it was nice that family and friends remembered and tried to support me in difficult times.

After lunch, I go for a walk down the hall accompanied by Misha, although I can already do it myself. We met a cardiologist, whom I noticed yesterday during the doctor's observation. We began to talk. His name is Alex. Just like Katya-Katyusha, he was also interested to know where we are from, and when we immigrated to Canada. Upon learning that we were from Moscow, he was glad. It turned out that his mother was studied in Moscow, and is now a professor at the University of Athens teaching Russian literature. Alex, however, only knows a few simple words in Russian.

He believes that my treatment is going well, but the pulse is still too frequent. They are trying to bring it down to normal, but if they can not, then I will be moved to a rehabilitation centre where my treatment will continue.

Because of the weakness, I nap a lot. Between meals, and between my walks, between taking analyzes, but the longest dreams I have are when I'm given a magnesium IV drip, which I have every day for 2 hours. A needle in injected into my left hand, through which a solution is fed from the dripper, it is not the most pleasant feeling. In my dream, I am trying to sort out the versions of the text of my book: "Optimal Design in Nature and Society", which I have been writing for a couple of years and wanted to finish before the operation, but could not finish, because of the endless re-editing. Now I have no doubt that the opening chapters of the book again require a fundamental alteration. I do not have enough power to record thoughts that come to mind, and I realize that many of them I will forget, but the fact that I'm thinking about it almost brings me back to working state.

Finally, the night comes, and I fall asleep. My neighbour also behaves surprisingly quiet. Apparently, he was given a sedative. We would have slept all night quietly, if the night nurse on duty Ann did not wake us at about 12 o'clock.

She reminds me of the character of the "main wife" of a small-time trader from a not so outstanding old Indian film.

She is pretty full-figured, middle aged, attractive in her own way, and very colourful, full of makeup. Ann is decorated with coloured beads and other jewellery on her ears and hands, she is quite different from the other nurses and from the modern Indian women familiar to me.

It's amazing that there are people with very similar characters belonging to different ethnic groups. Ann really reminded me of some of our Russian nurses. She does not just enter the   room, she floats in, and despite the deep night, she turns on all the lights at once, and wakes us up with a loud voice, announcing her arrival. She is eager to attract attention and to show us that she is in charge here. In this hospital, none of the nurses behaves so unceremoniously.

My Italian neighbour was afraid of her the entire evening, and for some reason called her Ali in a very plaintive voice. Perhaps, in his mind, she is a Shah of Persia, or a Maharajah. In everything else, she is no less professional than other nurses are; she does everything accurately and on time, at the same time maintaining an air of being in charge.

After checking the status of my and my neighbour's heartbeats, she calmly announces that my heart is not functioning too well, and masterfully injects a shot of Coumadin in my tummy. I too felt like my heart wanted to jump out of my chest. I try to explain Anne that my rapid pulse is the result of her rowdy behaviour. She woke me up too abruptly, but I will probably calm down soon.She doesn't respond to my words, and leaves the room, pushing away from me the potty, which in Russia we call a "duck", made from very light material, like compressed cardboard. During the day, one of the nurses on duty put it on my table, so that at night I will not need to get up to go to the toilet. I have never used the 'duck', and was not planning on using it, so I perceived her actions as nothing but humorous, but still unpleasant.

As she left, standing in the doorway, she left some strict instructions and turned off the light.

It turned out that in our chamber she is on duty for only one shift. My neighbour is lucky.  

The rest of the night I sleep sporadically, and in my waking intervals I am continuing to edit the book. This helps me go back to sleep peacefully every time, albeit with the knowledge that I will not remember any of my edits when I awake.

Morning of February 27. The smiling Chinese nurse is already here, and with him brings a positive mood. After questioning and probing me, he as usual finds that everything is going as it should. With a satisfied air, as if this is only due to his efforts, he leaves with his book under his arm. I have never seen him write anything in his book.

I called my Tanyushka to say hello. I do this every morning. Sometimes she phones first, but her call may coincide with when I go to the toilet, or when a nurse comes to see me, or an observation from doctors.

And now too, before I could talk to her, came in a large group of doctors. It is observation. They all huddled at the edge of my bed, so I could see them all. Dr. Glenn is again standing modestly in the middle of the group of students and near to Alex. Alex nods to me like an old friend. Kathleen reports, as always, quickly, busily responding to questions. Dr. Glenn again does not take his eyes off of me, this time I think he has a pleased expression. Obviously, he is satisfied as Kathleen is describing my condition. The observation lasts no more than 10 minutes. After all leave, Kathleen promises me that she would return.

Today Tanya is again the nurse on duty. She came with a device at the time of the observation, but she stopped and waited patiently until the observation ended. She was listening to what they had to say about me.

I know what I need to do tomorrow, at the next observation. I will prepare in my mind a short conversation with Dr. Glenn and would ask him to stay for a couple of minutes.Tanya and Misha again rushed to make it to the doctor's observation, so that Misha could listen and maybe could ask some questions to Dr. Glenn. Unfortunately, they did not make it in time again. But they brought me, as always, a fresh apple and yogurt. The hospital's diet includes yogurt too, but it is too sweet for me.

Today Misha was meeting up with some of his friends, so they could not stay long. They confirmed that today my health indicators are good and left satisfied.

All day and even at night while I am awake, I am trying to prepare in my mind a speech for tomorrow's encounter with Dr. Glenn, at the next observation. I need to prepare myself, especially psychologically, because I'm hoping that from this meeting I can move forward in promoting my computer system.

February 28. A week has passed since my surgery. I guess that tomorrow I may be discharged. For further treatment, I will likely be transferred to a rehabilitation hospital. This is not so easy to get, you need to have a very good reason. Apparently, in my case it was my very elevated heart rate, as well as my family circumstances. We live as only a couple, and Tanya does not drive a car. I too am not ready to drive yet.Home care for us is not available, we would need to be disabled to qualify, but we do not want to be disabled. Our house has many stairs. So, due to my health condition Tanya will have a very difficult time coping with my household chores. Apparently, with all this taken into account, I will have one more hospital.

Tomorrow Misha goes back to his family in Victoria and again Tanya will be at our home alone. Now for her visit to me, it is necessary to contact someone from the "support group" who has a car, and who does not work from morning till evening.

Of course, we have Vic, Julia, and Yana, but they are very busy. Our friends from the "support group", who are more united due to Misha's e-mails, mostly are seniors and therefore can more easily manage their time.

Today again, Jocelyn is on duty. I am very happy. I am calmest with her and with nurse Tania. I fully rely on them; I do not need to worry about anything or controlling anything. I am still waiting for the observation of Dr. Glenn.

Kathleen came. She disconnected the pacemaker, but decided to keep the monitor. So I only got some relief. She confirmed that tomorrow I would be discharged, and left. There was no observation. Obviously, everything pertaining to me has already been decided.I had no choice, but to address to Dr. Glenn in my dream. I was only able to write this speech down much later.

I think that there would be many sceptics who would have laughed at my stunt, but I always want to act on the principle of "at least I tried to do it."

I believe that I am an optimist and I completely agree with Churchill's words on the matter: "A pessimist sees the difficulty in every opportunity. An optimistis looking for opportunity in the every difficulty."  

In my life, there were many difficulties that I have created for myself, trying to realize my ideas and projects. Naturally, I'm always looking for ways to overcome these difficulties, and often I have found them. In this case, since I was unable to meet with Dr. Glenn, and as I am still in the hospital, I decided to write him a short letter, and the rest I hope express verbally in our meeting. I will continue to look for such opportunities to present my proposal.

Appeal toDr.Glenn
(recorded only on March 5)

"Dear Dr. Glenn, first of all I would like to express to you enormous gratitude from my, revived by you heart, for successfully executing the valve replacement surgery on me.

I can imagine how busy you are. I've read that your hospital makes more than 1,000 heart operations a year. However, I would be very grateful if you could find a few minutes to read my letter-proposal, which I hope might interest you.

What I want to suggest to you, has to do with the research program being developed under your guidance, "The Minimally Invasive Cardiac Surgical (MICS)." As I have gleaned from my conversations with Dr. Estrin, as a result of the implementation of this program, the surgery similar to that which I endured, would be bloodless. My proposal has to do with bring this closer and making surgical procedures even safer than they are now. I would very much like to live to see that day.

For many years I have been working with a group of doctors and programmers on the creation of an optimal designing system of "the Intelligent Design and Expert System (II&ES)"© and its application in medicine - system ComRAD©.

Why design? We believe that every conscious action is the result of its design and decision-making, and this requires accurate knowledge and skill to use them properly.

Our system consists of a unique unified Knowledge Base, which consists of "knowledge modules" necessary to perform the required actions, and a complex program CoSMoS©, designed to work with the knowledge base and formulate a method for system analysis.As I understand, you are developing a method MICS using television screens for visual observation of the actions of the surgeon, who controls the catheter. With ComRAD it's possible to ensure that, such operations are performed by a robot, which will make them extremely reliable. And the surgeons control over the actions of the robot will be minimal. ComRAD will be able to take into account the status of all the systems of the human body, when performing any complicated surgeries.

Our methodological approach will significantly accelerate the development of your program and achieve the highest quality results.

I would be very grateful if you could find the opportunity to meet with me at a convenient time for you and discuss the results of my surgery and my proposal.

Sincerely, Vitali Guitberg

Addendum

(which I hope to express orally)

My many years of experience in the development of large and complex computer systems for optimal design tells me that your program is extremely complex, and as the patient I am able to understand how important it is. I have developed “The methodology of systems analysis and computer-aided design (MCAD)"©, and on the basis of it has helped to execute the project ComRAD/II&ES, which I mentioned in my letter. All of these could be useful for the effective execution of your program MICS.

Thinking about adapting this methodology to the MICS Program, I preceded from the obvious to me provisions:

- any surgery requires continuous analysis of many characteristics of the health status of the surgical patient, which have to be quickly and in detail analyzed according to their relationships to each other, and to be taken into account in real time;

- human capabilities are too limited to accomplish all of this and make the best decision.

While using the features of ComRAD/II&ES, it will be possible to create a robot that will be capable of fulfilling these requirements very precisely and accurately during the surgery for replacement of heart valves or blood vessels.

The system II&ES is based on the universal Knowledge Base (KB), and due to this can be used in the optimal designing. The unique modular electronic ontology of the KB contains records of scientific knowledge, composed using a system analysis. Due to the Knowledge Base, II&ES represents a fundamental system for creating its applications in various fields of human activity.

As I already mentioned, the system ComRAD represents only one of the applications of II&ES in the medical field.

There is a simple methodological example of ComRAD, which we called ANAMNESIS. I gave you the IP address for ANAMNESIS when we first met. You can watch it online and make sure that the analysis of all the systems in the human body is quite possible to achieve in a split second with the use of the Knowledge Base.

ANAMNESIS – is a pre-diagnostic test that is working with a knowledge base. It contains a list of 153 symptoms and other factors related to human health. ANAMNESIS analyzes the patient's symptoms and determines which systems of his body require immediate attention, which do not require such urgency, and which are functioning normally. This is just the initial and incomplete model of the system, but it can be already be used in medical practice and be developed further. It is obvious that ANAMNESIS provides opportunities to complement new tests for the more detailed analyzes. Further, it is possible to establish a relationship between symptoms and medications as well with other medical facilities, such as labs, pharmacies, etc.

As an individual who has undergone a risky surgery, I was concerned with the status of all the systems in my body. Of course, my family doctor is primarily responsible for this, but all the same chronic diseases remain, especially in the case of elderly patients when the patient comes to your operating table. Can you be sure that you have all the necessary information about them, and that no unforeseen complications will arise?

Many of your patients do not have family physicians, and could not take important preoperative examinations. I am sure that a surgeon when making a decision about a surgery needs to have all the information about that patient so as to avoid contraindications with other systems of his body to perform such a major operation. Without ANAMNESIS, make it extremely difficult and expensive.

ANAMNESIS illustrates the analytical capabilities inherent in ComRAD for getting the optimal results.

In developing "The Minimally Invasive Cardiac Surgical Program,” you're mainly aiming at the utilization of visual devices that allow you to see your actions during the operation on the TV screen. As far as I know, this approach has been used in other hospitals in experimental operations.

I understand that this direction is still possible to develop, although the methodological approach that focuses on the visualization of manual procedures has many limitations.

Accomplished projects already show that extremely delicate operations are much safer to perform with the help of computer-assisted robotic manipulators.

I only learned about the program of “closed" surgeries carried out under your leadership just before my operation, so it would have been unforgivably brazen of me to comment on   the methodology therein. But I know that there is no systems such as ours anywhere in the world, one that will be able instantly find optimal solutions, when the unique Knowledge Base is filled with scientific medical knowledge.

With the utilization of our system, it becomes possible to construct a high-precision robotic arm that performs the operation in an optimal way under the supervision of the surgeon. Each robot must "know" how to act. In the presence of the necessary information in the e-Knowledge Base, the robot can perform subtle manipulation, impossible for humans.

Of course, the robot's arm should be under the control of the surgeon, who in case of an emergency is able to take control of the robot. At the same time, the system is constantly learning, with an infinitely expanding Knowledge Base.

To work with a large Knowledge Base, we intend to use a Variable Logic Processor developed by the Norwegian University of Technology in collaboration with us. An electronic chip monitor, created by an Israeli company, monitors the status of many parameters of the heart, and transmits their values ​​to ComRAD.

Both devices are designed to work online and make up an important part of the technical support of the system. The system is able to adapt to almost any existing and emerging devices, thanks to the availability of the Knowledge Base.

Now that my speech was formed in the mind, I needed to find a way to explain to Dr. Glenn's what I intend to do in the near future. With the satisfied thought that in this particular case "an exit is found," I fell asleep quietly.

February 29, early morning. The Chinese doc is again the first who comes to visit me. He touches my stomach, listens to my heart, examines the seam and legs, his whole appearance shows that he is satisfied and he leaves.

Today again, there is no doctor observation.

Kathleen drops in; she's in a very good mood, with metal tongs in her hands and says that now she will free me from the wires. A sharp movement bares my chest and a sharp movement disconnects the terminals of the thick wires that are connected with the measurement instruments. She commands:

- Take a deep breath and hold it.

With incredible speed of the tweezers, she pulls out of my chest the metal wires. No pain, but I feel like Kathleen pulls them out of my body. It all took seconds.

Now you can breathe.

-          Was it painful? No? You Russians are strong people. You drink vodka. Look what I pulled out from your heart.

She shows me in her palm crumpled thin elastic wires. It turns out that the devices were connected directly to the heart with these wires.

Well, finally, my chest is without wires. Like a mountain fell from my shoulders!

I look out the window, this morning a heavy snow is falling, and covering everything. I am worried about Tanya and Misha, because the road, for sure, is slippery. But by lunchtime, everything is melted. Both arrived on time and stayed a while.

Misha goes back to his family in Victoria today. It's quite sad for me. He completely dedicated the entire 10 days to me and Tanya, and only took two evenings off to meet up with old friends.

Time flew so fast, while our son was with us! When will we meet again, and not just on Skype? I do not want to think about it and try to make predictions. It depends on many factors that are still unknown.

We will try to do everything possible that our meeting takes place.

I was pleased with a call from my granddaughter Yana. She wanted to come, but I said that I better let her come to the rehabilitation hospital. She agreed.

Tanya calls and reports that Misha is at Pearson airport and is boarding his plane.

I'll await further news from him.

I notice that my thoughts are slowly returning to the usual household affairs. It pleases me.

At night, before my discharge, there is a new nurse on duty Darie, a middle-aged woman; it seems that she is from South America. She is so graceful that when she moves, I can imagine her in a dance.

Dari does everything slowly, particularly calmly, softly and delicately, as if dancing.

She somehow managed to calm the Italian, and he slept all night.

March 1.The smiling Chinese nurse came for one last time, looked at me again, and was satisfied. Tanya was supposed to be the nurse on duty today, but instead of her came two staff nurse Monica, a young and very beautiful woman, who looks like a teenager. Said that she is on duty today, along with her student, whose name is Ben.

Ben – a quite tall, sturdy, black-haired man looks much older than Monica does. I thought that the comment about him being a student was a joke, and I even joked:

-          As I understand it, you are his professor, and he is your student.

 In my opinion, she liked this comparison. Monica confirmed that at 12 o'clock I will be transported to a rehabilitation hospital. She was very busy and she was back only a couple of times with Ben, who brought the same diagnostic devise. The measured my usual vital signs.

-          What happens to my pulse?- I ask.

-          It still too high, but it's okay. I can explain the reason.

She took my red heart-shaped pillow, which I now will not part with, and showed:

-          Imagine that this is your heart, mentally divide it into two parts by a horizontal line. Above this line the muscles are damaged after the surgery, they are still very weak; their work must be compensated with the healthy muscles, located below the line. You're not a young man and your muscles are not very strong, so a healthy muscle contracts more. Over time, it should bounce back.

Monica could really be a professor. The explanation was very clear and intelligible throughout, except for the meaning of the word "normal". I didn't not question her, because at my age its very variable. Ben came by with a few parting Coumadin shots.

Monica appeared for the last time only before the discharge. Kathleen ran into the room, took off the monitor, my last burden that hung on me, wished success and said goodbye. I see that nurse Tania stood shyly to the side. She came to wish a speedy recovery, explained her absence by the fact that suddenly she was directed to take care of other patients.

Finally, a social service worker came, asks detailed such as in what kind of house and with whom do I live, how many stairs in the house, etc. She brought a list of numbers to call if we need to be subsidized for our transportation or home care.

I agreed with Tanya agreed that she and Vic would meet with me in the rehabilitation hospital. I left the D3 department, my double room, with a feeling of sincere gratitude to all the medical staff. All of them engaged with me in good faith, they were caring and friendly in helping me to recover after undergoing surgery.

Kathleen brought a few pages of my case file.

I got dressed, folded my things in small plastic bags, and walked into the waiting room near my chamber. On the way out I waved good bye to the Italian man and wished him a speedy recovery. I could not even imagine that by fate our paths would cross again.

At exactly 12 o’clock, a car came for me. Two strong men put me on a stretcher with belts attached, took my things and took me to a rehabilitation hospital.

We must assume that the first phase of the project "replacing heart valves" including the postoperative intensive care and 8 days of rehabilitation in the surgical therapy centre were completed more or less successfully, but the heart rate remained relatively high, ranging from 110 to 115 per minute.

The next stage of my rehabilitation was to reduce the heart rate. This was entrusted to another team of medical staff.

I went to meet with them.

(to be continued)

 

Translated from Russian by Elijah Guitberg