During all this time, the immigration of Soviet Jews or anybody else to anywhere else was completely shut down. So, I was out of work for two years and eventually had to spend the summer months of 1980 doing hard labor in the country, about twelve hours a day in southern Russia to make some money to support my young family. The spirit was still there, and I kept reading literature and preparing for the medical exam in the United States. I remember lonely mornings, after early-morning work was over (I was working as a beekeeper, deep in some grove, far away from the closest town) and sometimes in the evening, walking the woods of southern Russia (Voronezh region). I was conducting imaginary dialogues with myself, using newly learned words and also rereading chapters from The Merck Manual and copied pages from Harrison’s Principles of Internal Medicine. I clearly realized that there was very little hope for me to ever use this fragmented knowledge in the near future or ever. Nevertheless, this was one of the few things that was keeping me from depression, insanity—giving up and crawling into some totally different pocket of life. In other words, giving up hope to live in the free world and to be who I always have been—a physician. I remember the sound of trees being cut by the local loggers, deep in the woods as I was walking among the trees, memorizing and repeating and memorizing typical medical discussions during morning rounds at an American hospital.

Another core of my life that kept me straight was poetry. I had been writing in earnest for several years by then (1980). I had a typewritten collection made on a mechanical typewriter, as people of my generation did at the time; even self-publishing was impossible. As a matter of fact, it was very dangerous because it was against the law and could be considered anti-Soviet propaganda. So we read poems to each other in small groups or just to friends and did some typewritten copies. Unfortunately, because of my preoccupation with medicine and studying English and making money for my family, poetry was not coming to me easily during this period. Still, I was walking in those woods, trying to put some lines together, trying to overhear some fragments of sounds, process metaphorically what was happening. I was trying to seize time in flight. Interestingly, those feelings and images resurfaced later on in some poems, in both languages, twenty to thirty years later.

In medicine experience is enormously important. But also in poetry. Life is the process of accumulation of material for artistic expression, as long as the artist is not afraid to look into the depths of his own life, weaknesses, fears but also register wonderful moments that passed forever, still always available to be burned in art’s oven, giving some light and sending the shadows of the past to move through your room.

I don’t know exactly what influenced the authority’s decision to let us go, along with a few hundred other Moscow families, in the winter of 1981. It was a miracle, a very narrow window of opportunity, and we used it. We didn’t enjoy Vienna at the time, since it was right after another Palestinian terrorist attempt on the life of Soviet Jews bound to Israel at the Vienna airport. So, we were escorted by the Viennese police, along with plainclothes Israeli agents, to the big, heavily guarded castle formerly of some nobleman and then belonging to the Red Cross and then to the Sochnut, the Jewish Agency for Israel. We made a conscious decision to go to the United States. Both my wife and I felt very Western-oriented, very interested in the idea of America, and I simply felt that I wanted to have more opportunities. We were transported to Rome, where I continued studying and began writing letters of application to obtain a job in the United States, somewhere on the East Coast between Washington and New York, where we had friends and where we felt the culture was closer to ours.

From then on one can consider this a success story. Some of my friends from the medical school were already at the NIH, working in NCI, fellows or researchers. I had some publications, and the associate director of the NCI, Dr. Bruce Chabner, knew some of my mentors on the other side, from the Soviet Union, by publications and occasional meetings in Russia. I received a Fogarty International Fellowship in medical science and spent an exciting year in the Division of Cancer Treatment at the National Cancer Institute. My immunology background and clinical pathology training helped a lot; I felt very much at home, gave a few talks, and even managed to publish a paper in the first few months after arriving there. I did not even realize how important this was for my future career, experience with research and being a fellow at the National Cancer Institute. My boss then, Dr. Paul Bunn, currently president of ASCO, explained to me in very simple terms: “Andrey, if you want to pursue a scientific career, you have to hang around me at the NCI for about five years to confirm your Russian PhD. If you want to go and become an American physician, it is okay with me; you can leave as soon as you are ready, but remember you will have to give up real science. Because for several years of very, very hard work, you are going to be in the process of being shaped up by a very tough system of postgraduate training.” But I had already made up my mind in the deep woods of southern Russia a couple of years prior to do this.

Pathology residency was a natural path for me, since I had already had pathology training in Russia and was very much involved with research. Frankly, several times later on, I had second thoughts in the course of my training. I was afraid to become secondary in the medical system, not being in control, not having my own patients, making decisions, and dealing directly with people. I almost made the decision to leave pathology and sign up for an internal medicine residency at the VA Medical Center in Washington, D.C., where I had my rotations at that time. I was enrolled in the program at the George Washington University Medical Center and the VA Medical Center.

My first job in the US
was at the VA Medical Center:
Nights of the boxed breath
and the smell of stale piss;
chain-smokers, the collapsed lobes
overgrown by the relentless pink matter;
laryngless vets, talking in robot voices;
emaciated black guys in the men’s room,
puffing through the tracheostomy tubes;
a burn unit survivor
hit by a Kamikaze
at the very end.

The young, Jewish doctors
were rotating for a year or two,
running around with syringes,
dispensing chemotherapy, then
disappearing into the green sponge
of the suburban universe.

My way back to the newly rented home
was graced by a sunset that touched
crosses on the descending lawn
by the soldiers’ home, lit up
Rock Creek for a few minutes,
lingered pensively in the tree crowns
over the mansions at Connecticut Avenue,
then went underground somewhere
in Pennsylvania.

Around was the darkness,
punctuated by a dialogue
between the towers on the flagships:
The Naval Hospital and the Mormon Temple,
guiding the large cargo planes,
gliding through the black milk
of the night breath toward
Andrews Air Force Base.

But I stayed in pathology, and after years of becoming a very experienced cancer diagnostician, I never regretted this again. I also become a cytopathologist, performing a lot of fine needle aspirations on patients, and have become an expert at this. Because of my clinical and research experience, I was approached several times by commercial medical companies to acquire a directorship and to run the medical branch of such a company. I always turned this down. I love the feeling of coming to the hospital in the morning, joking with technicians, nurses whom I know from my work in the OR (in my scrubs, doing frozen sections). The so-called “frozen section room” is right in the operating block, and surgeons often come by to look at the specimen, rub shoulders, to look into the microscope with us and make a decision together. This is what I enjoy. Pile of consults on my desk, each slide is somebody’s life (or death¼) story. Sometimes patients come by to ask a question. People refer a lot of patients to me, with thyroid or breast masses to perform fine needle aspiration on, to advise, to help make a decision whether the patient should be operated on or not.

***

Over the years I realized that I created my own philosophy of what I was doing in medicine. A physician should have an idea of what he/she is doing. Not simply being good at what you do, making good money, and following your training and skills. So, despite the fact that I was very well trained in regimens, protocols, policies, knowing closely all those magical terms and notions, I always had my own philosophy about my place in the process. As a diagnostic clinical pathologist, I have always felt that the main idea is to prevent any harm to the patient: by unnecessary surgery, excessive, broader operation; by hopeless chemotherapy, based on some approach, statistically prolonging the life of a patient from six months to seven and a half months; and a variety of unnecessary tests and sometimes dangerous procedures. The latter factors are directly related to the main disease of American medicine—its defensive malaise, attempt to protect from the devastating, humiliating, and demoralizing malpractice lawsuits, of which I myself have been a victim several times. As I mentioned before I am a breast specialist and a specialist in cancer diagnosis. One of the hardest memories of my medical career was being frivolously sued for a breast cancer case (I was completely cleared by the jury). An experienced, cynical, cold-blooded plaintiff’s attorney was accusing me of an attempted murder of a patient, who was sitting on a bench with her family nearby, the lawyer reading lines from John Donne: “For whom the bells tolls; it tolls for thee.”

***

At the beginning of the new millennium, I realized that my choice of diagnostic medicine (cancer diagnostic pathology) was even less incidental than I had thought. I am talking about rapid development of molecular medicine, identification of abnormalities, diagnosis of diseases based not only on chemical tests of blood compounds or examination of patterns in the tissue, but on detecting molecular abnormalities germane to a certain condition or disease. This is a fascinating area of modern medicine related to dissecting nucleic acids in the tissue and the ability to actually visualize the changes (fluorescence in situ hybridization, immunocytochemical methods, and such). I remember my high school fascination with the gel formation
by mixing two chemical substances, creating a new texture of the matter. “Metaphysically,” this is the same thing.

***

My father was a great surgeon, came to visit me once in the United States and was very warmly received by the American surgeons in my hospital (at the time, Lenox Hill Hospital in Manhattan) who knew his name and his innovations in stapling surgery. He died at the age of seventy-three in 1994 of a malignant brain tumor. I went to Moscow to be with my father when he was diagnosed and review, myself, the pathology specimens. It was still the same old Russia: good, skillful surgeons, some very dedicated and kind nurses, few medications, horrible conditions. My father was an in-patient in the Neurosurgery Institute, a very prestigious, highly desirable institution. He was lying in a small bed, three other men in the same room, after craniotomy and brain surgery. Those were privileged people, some leaders and administrators from the provincial cities. Their wives came there to live with them in the same room since there were not enough nurses and nurses’ aides. There was no place to stay in Moscow at the time, or they didn’t have enough money for that, so the wives slept, feet to head, in the same bed with their husbands, who were also recovering after craniotomy and brain surgery. I would bring my father, a few days after brain biopsy, to the communal toilet on the floor, with broken windows in the late fall, old newspapers instead of toilet paper, several diehard smokers with their heads bandaged, puffing heavy, unfiltered cigarettes.

My father was buried in Moscow at the “German Cemetery” in the Lefortovo district of Moscow. This is an old neighborhood, established in the early eighteenth century at the time of Peter the Great by German craftsmen, builders, and military men invited by the tsar to Russia. Later on it was the “cemetery of choice” for the upper layer of the Moscow society: professors, military men, and later by the Soviet upper middle class (the academic, artistic, and military elite). My grandfather, a hero of World War II, was buried there. So my father joined him. A year later, my grandmother. This place has become my real home in Moscow after so much changed in the central part of the city due to a distasteful excess of money, oil, and gas. Everything stays the same in this part of the world: the wrought-iron gate, the overgrown paths, small mausoleums, little chapel. In June everything is covered by ever-flying fluff from everlasting Moscow poplars. It’s a summer snowfall all around the city, especially in this area because of the abundance of mature poplars. In June the place looks like it is covered by silent, heavy snowfall.

I almost knew by heart all those med-school books
piled on my chest: Hencke und Lubarsh, Abrikosoff,
the books filled with dust of the anatomy museums
still guarded by the infants floating in the liquid,
long-desired drink of our victorious infantry.
Then: Merck, Harrison, their principles as heavy
as the New England snow sheets.

We know a disease has its own time structure:
After the torpid phase—explosion at some point,
creating a palpable image that we have to study
and study until it’s hard to breathe.

Night opens all the books, and the gray wind turns the pages.
I studied them; I ate them
until my brain was turned
into a cracked stone with lengthy lines of convolutions.
Who would remember now all those stories of destruction,
the voyages of fever across the world’s ocean?
The pappataci fever. Who would know?
I know you would.

You knew all the answers.
You wanted me to study in order
to survive this life.
It does not matter anymore.
What matters is that the air vanishes.
This very air that feeds the cells, their cytoplasm,
those wonderful, convex membranes, and to give the air of presence,
to project the gesture, to make us exclaim the words
when we are not asked, that is
our ethnic trait.

It’s getting closer, and I still can’t find
the subject in all those books.
Where is that page, this line in the subject matter,
that would classify the void,
this wide, black hole growing on me
as you grow smaller and smaller?

During periods of hardship in my life (my father’s death in Russia, Mother’s stroke in New Jersey, two divorces [artists’ occupational hazard?], my daughter’s dramatic divorce from my younger friend-poet), medical work and coming to the hospital every morning helped. Habitual stress, hard routine, intellectual challenge, all this kept me going more than any psychiatrist, Prozac, and such. Putting on a clean shirt, tie, and white coat has been like a sacred moment of putting on the uniform and a weapon for a military officer.

My daughter, then an internal medicine intern at Columbia-Presbyterian in New York, stayed at my house after her dramatic exit from her husband’s madhouse, and I was with her, a fourth generation of physicians in the family—three at the First Moscow Medical School and her, graduate of the NYU Medical School. I thought, at the time, that if my grandparents, during their around-the-world trip, escaping the Civil War in Russia, did not decide to return to Moscow from the war-torn Odessa, my life would have been different. They could have relatively easily taken the other direction, sailed to New York, where my father would have been born and become who he was, a great surgeon in that great city. I (or whoever I would be) would become one of the fortunate doctor’s children, probably going to NYU as well. I never regretted that my grandparents took that turn—to the North, not to the West. That gave birth to my bilingual, dual life. My poetry, probably, would have been very different and would not live its own life in intercultural, interlingual space between poetry and medicine, between rock and a hard place.

Many laypeople, even physicians, don’t understand that being a physician implies a certain type of thought process, an almost subconscious feeling of clinical situation. It’s like a police officer, a military man. You either are or are not. It’s a certain type of personality. Like a credit card with unique password—“not transferable.” The key part of being a pathologist is ability (or talent) of recognizing a pattern of abnormality. Same as a radiologist. A radiation oncologist uses radiation and does not cut anything. A nutritionist or a psychiatrist looks at some tests, talks to the patient, and gives recommendations. In all those situations a physician makes a diagnostic or treatment decision based on vast knowledge but, very importantly, on an inborn natural intuition, matured over the years of experience. When I discuss a breast cancer case with a surgeon, radiologist, or oncologist, I discuss actual circumstances of the case (history, clinical situation, possible consequences of treatment) as much as morphological diagnostic pattern visualized under the microscope.

Once, residents in pathology showed me a photo of a specimen: extrauterine tubal pregnancy, with a formed embryo looking out from the opened tube like an astronaut looking out of a small spaceship. I sensed a beauty in this picture, beauty of nature, similar to a beauty of trees (do they know how wonderful they are?), cats, etc. It is an aesthetic beauty of life. Being very much pro-women’s rights, emancipation, and such, I did not realize how negatively and erroneously this poem would be understood at the poetry seminars and workshops.

The world was glistening inside my soft universe
in the filigreed web of warmth,
pulsating and feeding my unborn hopes,
tentacles of attachments, frustrations, death.

I could have been a father, a sister,
carpenter, savior, the judge, an executioner.
My actuarial survival
was not yet registered.
The winds of unknowing
caressed my mother’s skin.
And the pain was vanishing

because I did not exist anymore.
I was not accounted for.
And still, brothers and sisters,
we were bonded and floating together
in the shared hardship.
For only you could appreciate
my gift to you:
My silent grace, the gentle beauty, dignity,
and what I would not have done to the world.

And remember, there are others
for whom not only I,
but also you
are a mistake.