We all tried to avoid talking politics. One of the physicians, a Dr. Veshesslov Stepanov, liked to tell jokes that played off the tensions in U.S.-Soviet relations, but even he would dance around certain questions that could not even be considered to be political. Every now and again, during an idle moment, I'd ask a question with political overtones. The Soviets were artful dodgers. "How is Stalin regarded today by your people?" I asked one of the Ministry of Health officials. He pondered for a moment and then announced: "Stalin made some mistakes, but he led the Soviet Union during a critical period of history."
Angelina Guskova, the hospital's chief physician, is a stout, no-nonsense woman in her 50s; Alexander Baranov, in his mid-40s, bald and thin, is a hematologist in charge of bone marrow transplants. Both of them speak some English, though we'd still depend on the Ministry of Health officials to act as translators. When we began discussing patient care, it quickly became clear that both Guskova and Baranov were excellent clinicians with a longstanding interest in the effects of radiation. Guskova had studied the few previous nuclear-facility mishaps worldwide as well as cases in which health-care workers had been inadvertently overexposed to laboratory radiation. She'd formulated an important method of estimating the dose of radiation absorbed by individuals during accidents. Because it wasn't possible to know how much radiation each victim had been exposed to, her method proved an invaluable tool in our assessment of the Chernobyl victims. Based on those projections, we decided which patients needed bone marrow transplants; we only gave transplants to those victims we estimated had received 500 or more rads of radiation.
Guskova's method estimates the amount of exposure by using a formula based on how quickly the victim's white blood cell count drops and the degree of breakdown in the chromosome structure of the blood and bone marrow. The Soviets had tabulated the daily fall of white blood counts during the first four days following the explosion.
But the estimates didn't prepare us for the tremendous amount of injury to the victims' soft tissues. According to Guskova's estimates, many of them had received less radiation exposure during the blast than a typical cancer patient receives during standard radiation treatment. We routinely give higher dosages of therapeutic radiation for leukemia patients but never see the degree of soft-tissue damage that the Chernobyl victims suffered.
Why Guskova's estimates of radiation exposure didn't parallel the extensive tissue damage of the victims is unclear. One possible explanation is that great amounts of radioactive particles were either inhaled or swallowed, and showed up as damage to the mouth, intestines and lungs. That damage wouldn't be reflected in the condition of the white blood cells or of the bone marrow. It's also possible that Guskova's formula may have been inaccurate because of the lack of information shrouding the Chernobyl accident.
Our primary task was to assist with the evaluation and care of 35 critically ill radiation victims. Before we arrived, nine of the most severely affected had been given transplants, some using bone marrow and some using tissue taken from the livers of stillborn or aborted babies. This second procedure, known as a fetal liver transplant, is generally less effective than a bone marrow transplant and so is a last resort, employed only when a matching donor can't be found or when the patient's white blood cells are so depleted that a tissue typing between donor and patient can't be performed. (Fetal liver is very similar to the bone marrow in that it contains the blood-forming cells. In fetal development, these cells travel from the yolk sac to the fetal liver and finally to the bone marrow, where they reside for the remainder of that individual's life. The disadvantage to using fetal liver cells is that there often are not enough of them for a transplant and this increases the chances for rejection.)
We helped perform a total of 10 bone marrow transplants, assisting in the extraction of bone marrow from donors and the infusion of it into patients. We were introduced as American doctors to all the patients and many members of their families, who were allowed to visit but, like the physicians and nurses, had to wear sterile masks, boots and gowns--the urine, blood, stool and secretions of these patients were potentially radioactive. Though touching and hugging were not forbidden, there was little physical contact between family members. The sterile outfits interfered, and besides, the burned skin of the injured victims was extremely sensitive. Each person would find a moment to thank us for coming. They seemed comforted knowing that American medications would be used in their care.