The Oath: A Surgeon under Fire
http://www.100md.com
《新英格兰医药杂志》
The manifest theme of this revealing and fascinating book is the inherent and perpetual conflict between the universalism of the Hippocratic oath and the particularism of selecting patients on the basis of any number of criteria (age, sex, race, color, class, nationality, religion, wealth, and so on). What makes this book exceptional is that the ground on which this conflict is played out reflects the struggle between Chechnya and Russia at the end of the 20th century. The author is a Chechen physician who put his life on the line, time and again, because he chose to honor the oath and treat both Chechen people and Russian people. It is unfortunate that the book's title does not reflect the venue and the substance of the story; the subtitle states only "A Surgeon under Fire."
(Figure)
The surgeon is Khassan Baiev, and the book first provides valuable background information on Chechnya, a small region of the Caucasus, incorporated against its will into the Tsarist and Soviet empires, of the Muslim faith, and striving for some kind of independence or autonomy. In 1944, during World War II, the region's entire population was deported to Kazakhstan, Kirghizia, and Siberia on Stalin's orders (as were those of other, neighboring ethnic regions), on the grounds that they were sympathizers of the Germans and thus branded as traitors by the Russians. At the present time, the epithet has been replaced by "bandits," although the author also qualifies for the "traitor" appellation because of the formula "Whoever helps my enemy is my enemy."
Dr. Baiev's parents were allowed to return in 1959 to their native land, where he was born in 1963. He chose a career in medicine, specializing in facial surgery, and successfully practiced as a cosmetic surgeon in Moscow. At the outbreak of the first Russian–Chechen war (1994 to 1996), he decided to return home and served as a doctor and surgeon. After a few years of uneasy truce, hostilities resumed in 1999, and again Baiev found himself on the front lines and performed thousands of operations (mostly amputations) and treated all, civilian and military, Russian and Chechen. In one period of two days, he performed 67 amputations and 7 brain surgeries. He often lacked surgical instruments and worked with ordinary carpentry tools (saws and drills) that were difficult to sterilize and keep sharp.
What was most appalling was that his patients were primarily civilians, children, women, and the elderly: "innocent victims sacrificed on the altar of power-hungry leaders on both sides of the conflict." He thus holds no brief for the Chechen warlords who looted or extorted or kidnapped people to enrich themselves any more than for the Russians who shelled indiscriminately and pillaged and killed at random. "Bullets, rockets, mortars, shrapnel — each produces its own kind of wound," he writes. Lethal fragmentation bombs caused "shredded intestines, livers, kidneys, and sexual organs reduced to ground meat." Dr. Baiev adds that he and his staff gave blood every two weeks, sometimes once a week.
Because he treated patients from both sides, he was condemned to death for being not only a "traitor" but also a "bandit-doctor" (for treating Chechens) or a "pig-doctor" (for treating Russians). The fact that he survived can only be called miraculous, as there is no other word to convey that meaning. In one episode he describes, he escaped death twice in a single day. Because of the stressful conditions of his life and his work, he suffered, at times, severe depression and was even hospitalized for several weeks. He attributes his recovery, among other things, to his faith in Allah and his devotion to his work.
Eventually it became clear that his life continued to be in danger, and several organizations (including Physicians for Human Rights and Amnesty International) managed to arrange for his emigration to the United States, at first on a temporary basis and then permanently as a political refugee. The description of Baiev's departure to New York from the Moscow airport, where he was stopped, interrogated, and eventually allowed to board the plane as the doors were being closed, is so suspenseful that it revived in me similar feelings of anxiety — which I experienced when I left the Soviet Union — at the idea of being arbitrarily detained. Baiev's description of the nature of medical and surgical practices in the United States as compared with what he experienced back home is itself a reason to read the book.
This is a unique story. It teaches us a great deal about the Chechen situation today, and particularly about the effects of the wars on the civilian population. Recent media accounts of what goes on in Chechnya are consistent with what the author describes in the book. This is an important testimony that belongs in the annals of the history of medicine.
Mark G. Field, Ph.D.
Harvard University
Cambridge, MA 02139
mfield@hsph.harvard.edu(By Khassan Baiev, with Ru)
(Figure)
The surgeon is Khassan Baiev, and the book first provides valuable background information on Chechnya, a small region of the Caucasus, incorporated against its will into the Tsarist and Soviet empires, of the Muslim faith, and striving for some kind of independence or autonomy. In 1944, during World War II, the region's entire population was deported to Kazakhstan, Kirghizia, and Siberia on Stalin's orders (as were those of other, neighboring ethnic regions), on the grounds that they were sympathizers of the Germans and thus branded as traitors by the Russians. At the present time, the epithet has been replaced by "bandits," although the author also qualifies for the "traitor" appellation because of the formula "Whoever helps my enemy is my enemy."
Dr. Baiev's parents were allowed to return in 1959 to their native land, where he was born in 1963. He chose a career in medicine, specializing in facial surgery, and successfully practiced as a cosmetic surgeon in Moscow. At the outbreak of the first Russian–Chechen war (1994 to 1996), he decided to return home and served as a doctor and surgeon. After a few years of uneasy truce, hostilities resumed in 1999, and again Baiev found himself on the front lines and performed thousands of operations (mostly amputations) and treated all, civilian and military, Russian and Chechen. In one period of two days, he performed 67 amputations and 7 brain surgeries. He often lacked surgical instruments and worked with ordinary carpentry tools (saws and drills) that were difficult to sterilize and keep sharp.
What was most appalling was that his patients were primarily civilians, children, women, and the elderly: "innocent victims sacrificed on the altar of power-hungry leaders on both sides of the conflict." He thus holds no brief for the Chechen warlords who looted or extorted or kidnapped people to enrich themselves any more than for the Russians who shelled indiscriminately and pillaged and killed at random. "Bullets, rockets, mortars, shrapnel — each produces its own kind of wound," he writes. Lethal fragmentation bombs caused "shredded intestines, livers, kidneys, and sexual organs reduced to ground meat." Dr. Baiev adds that he and his staff gave blood every two weeks, sometimes once a week.
Because he treated patients from both sides, he was condemned to death for being not only a "traitor" but also a "bandit-doctor" (for treating Chechens) or a "pig-doctor" (for treating Russians). The fact that he survived can only be called miraculous, as there is no other word to convey that meaning. In one episode he describes, he escaped death twice in a single day. Because of the stressful conditions of his life and his work, he suffered, at times, severe depression and was even hospitalized for several weeks. He attributes his recovery, among other things, to his faith in Allah and his devotion to his work.
Eventually it became clear that his life continued to be in danger, and several organizations (including Physicians for Human Rights and Amnesty International) managed to arrange for his emigration to the United States, at first on a temporary basis and then permanently as a political refugee. The description of Baiev's departure to New York from the Moscow airport, where he was stopped, interrogated, and eventually allowed to board the plane as the doors were being closed, is so suspenseful that it revived in me similar feelings of anxiety — which I experienced when I left the Soviet Union — at the idea of being arbitrarily detained. Baiev's description of the nature of medical and surgical practices in the United States as compared with what he experienced back home is itself a reason to read the book.
This is a unique story. It teaches us a great deal about the Chechen situation today, and particularly about the effects of the wars on the civilian population. Recent media accounts of what goes on in Chechnya are consistent with what the author describes in the book. This is an important testimony that belongs in the annals of the history of medicine.
Mark G. Field, Ph.D.
Harvard University
Cambridge, MA 02139
mfield@hsph.harvard.edu(By Khassan Baiev, with Ru)