/»The Unsinkable Ship of Bosch»/

Through the narrow hospital corridor, they quickly wheeled a stretcher on which lay an unconscious naked woman. Doctors and nurses crowded around her as they ran. It was frantic, like imitating a bad, implausible movie. Someone was carrying an IV on extended arms, fixed into the woman's vein. Another person was trying to ventilate her with an Ambu bag on the move. Several people supported the body from different sides to prevent it from toppling over at a turn. Everyone's faces were scared.
Olya,
через десять минут поднимайся в операционную. Будем делать кесарево этой Станицкой.
Ее перевели из областного роддома к нам в реанимацию.
В коме.
Проблемы с почками.
Вся отечная.
Моча — как холодец.
Белок раз в двадцать выше нормы.
Уремия.
Плод уже не выслушивается,
но на всякий случай подойди,
пожалуйста.
Сразу объясню: уремия в дословном переводе с латыни означает мочекровие.
Когда почки перестают работать,
моча не фильтруется,
а всасывается в кровь.
И необратимо отравляет ткани мозга,
сердца и других органов.
For a pregnant woman, it's a disaster. Because the fetus receives harmful metabolic products and toxins instead of oxygen and nutrients - ammonia, urea, nitrogenous wastes.
Olga had just had a lecture with sixth-year students. She quickly took the students to observe the primary resuscitation of a deeply premature newborn. Reflectors—operating lamps—were focused from all sides on the abdomen of the pregnant woman. The doctors were performing a C-section based on the mother's indications, the concern for the baby was secondary.
Now all efforts were being made to save the woman.
Pregnancy had become an unbearable strain for her body,
and all excessive burdens needed to be immediately removed,
including the premature fetus,
to give the woman a chance to survive.
The atmosphere in the operating room was tense — a suffocating sense of death
lurking just nearby.
The gynecologists began a cesarean section on the swollen, motionless body,
emanating a smell of urine and ammonia.
After about seven minutes, the baby was extracted and handed over to Olga on the resuscitation table.
His body was purple-blue and swollen, like a water-filled balloon.
“Yes,
the hope that you will survive,
baby,
is very slim,”
Olga thought while performing resuscitation quickly and skillfully.
Around her stood students,
catching her every word and movement.
There was no room for even the smallest mistake.
She inserted the breathing tube into the trachea.
But the premature baby was so small,
that even the thinnest tube barely fit into his airways.
Olga was very afraid,
что порвет гортань или трахею каким-нибудь неверным миллиметровым движением. Но,
кажется,
обошлось.
Она включила аппарат искусственного дыхания,
выставила подходящий режим.
Сердце ребенка прослушивалось еле-еле,
ритм был медленный.
«Похоже,
что в перикарде собралось немного водички».
Ольга объяснила студентам,
что незрелый ребенок родился в анасарке — общем тяжелом отеке.
И даже в сердечной сумке у него — жидкость.
Это очень затрудняет работу сердца,
потому прогноз для жизни в данном случае весьма дискутабелен.
«More precisely — negative,» she thought, quickly inserted a catheter into his umbilical vein, drew a small volume of blood by simply using a syringe and poured it out for various analyses. In exchange, she introduced pre-thawed plasma. Then the baby was urgently transferred to the intensive care unit and placed in an incubator.
During the ultrasound examination, free fluid was indeed detected in the pericardium. Olga took a risk and thereby impressed the students, raising her rating by a hundred points.
— performed a puncture and removed the excess fluid from the pericardial sac. Hitting the pericardial space with a needle and not touching the constantly beating heart of such a small child is true mastery.
Now it was easy to do.
There simply was no choice.
If the fluid is not removed immediately,
the heart will "drown" within a few hours,
struggling against the viscous transudate.
The heart tones immediately became a bit clearer,
and the child's color gradually changed from blue to gray-pink.
Olga and the students went to continue their work: discussing the diagnosis and treatment for this boy. A few minutes later, a man unfamiliar to Olga literally burst into the study room, grabbed her by the arm above the elbow, and very emotionally asked:
— How is my child? I was told that you examined him. I am Stanitsky. Tell me, will my son live?
— I don’t want to give you false hope. The child is very premature. He is not breathing on his own. In addition, he has accumulated a lot of fluid in the cavities. Including in the pericardial and pleural.
Это затрудняет способность сердца сокращаться и способность легких двигаться во время вдоха. Более того,
головной мозг также пострадал,
и отек мозга — значительный.
Поэтому шансов у мальчика очень мало.
— Ольга говорила сухо и строго.
Лучше сразу все сказать,
как есть.
Мужчины воспринимают это обычно сдержанно.
Что нужно сделать,
чтобы спасти моего сына?
Говорите,
какие нужны лекарства?
Каких докторов привезти для консультации?
Я сделаю все.
Не молчите,
прошу вас.
— Все?
Я должна знать,

насколько вы платежеспособны?
— I will pay you whatever you say.
— You took me too literally.
The medication
your child needs right now,
it's called Alveofact,
costs about four hundred dollars per vial.
And you need at least four vials,
considering
the child's weight is almost one kilogram.
— One kilogram?!
— What did you think,
a thirty-week fetus would weigh five?
When the swelling goes down,
it will be about eight hundred grams,
at most.
And there's no guarantee,

что ваш ребенок выживет даже после введения этого дорогого лекарства, я вам не даю.
Так что думайте.
— Это вы его продаете?
Или в какой аптеке его купить?
— он начинал раздражать Ольгу своей чересчур суетливой энергией.
— Я не продаю,
а преподаю,
с вашего позволения.
А ближайшая аптека,
где можно купить альвеофакт.
расположена в Киеве.
— Он нужен срочно?
Я сейчас же еду.
— Да,
настолько срочно,
что вы не успеете туда и обратно.
Есть кто-нибудь у вас в Киеве,
кто может немедленно оплатить лекарство и передать самолетом?
— Да.
— He took out his cell phone, a thick notebook, flipped through it quickly, and started making calls. Within a few minutes, he had arranged everything.
— Anything else you need?
Olga wrote a list of additional medicines and handed it to Stanitsky.
— Is this urgent?
She imagined him jumping into his car with vertical takeoff. Driving in the left lane and running red lights. If she dared to even slightly nod in response. So Olga replied that it would be preferable to get everything in about three hours. Along with the alveofact,
ordered in Kiev.
Olga had used this expensive drug no more than ten times in her practice. Believe me, it was worth its cost. Deeply premature and unpromising infants began to breathe on their own after receiving Alveofact. It prevented lung tissue from collapsing and expanded the unopened immature lungs of the most underweight and weakest newborns. The current financial situation in domestic medicine does not allow administering this medication to all the children who need it.
And it was painful to lose premature infants with lung atelectasis, knowing that a couple of vials of Alveofact would have given them the green light into this world.
Olga named the little Stanitsky Kostik.
Because he was exactly skin and bones.
He had a face typical of deeply premature babies, that of a "thinker."
With a large skull,
a high forehead, and a thoughtful, tense look of a person,
who is tightly held by the hand by a bald grandmother Death.
Only fools or outright cynics can think,

что новорожденные дети или даже такие маленькие выкидыши, как этот Станицкий,
ничего не чувствуют и не понимают.
Поверьте,
они понимают и чувствуют все.
И,
особенно,
дети в реанимации.
Которые находятся на пороге между жизнью и смертью.
И дверь за ними может захлопнуться в любую минуту.
Навсегда.
Такой ребенок,
лежащий в кувезе и подключенный к жизнеобеспечивающей системе,
чувствует происходящее вокруг себя много лучше,
чем взрослые сознательные люди.
Когда доктор растерян и не владеет ситуацией,
как будто кто-то слышит его молитву.
— And the little preemie in the incubator will sense with a movement, or a sigh, or through an almost imperceptible aura, that salvation is near.
And in the same sensory way, will convey its gratitude to the doctor.
And will support — you're on the right path,
auntie.
Forward!
Olga could recall instances
when a very seriously ill child with brain hemorrhages,
congenital meningitis, or convulsions received large intravenous doses of sedatives and anticonvulsants and was in deep sedation (to put it simply — under anesthesia).
Suddenly, the child would wake up,
although he was pumped with drugs and by all the canons of medicine should have been deeply asleep, he began to move chaotically,
tried to scream and attract the attention of the doctors and nurses
who were nearby.
In his wide-open eyes, anxiety,
pain,
horror was growing.
His restlessness was justified.
Only the doctors realized this too late.
In ten or maybe twenty minutes, the power would be cut off in the entire maternity hospital - the artificial respirator would stop working.
And the baby would die
because he still couldn't breathe on his own.
Or maybe they connected the incompatible blood group to his vein by mistake, which was meant for another child…


That's probably why nature has arranged it so that adults don't remember anything from early childhood — the stimuli and sensations in the first days of life after the warm and secure maternal womb are too strong.
And the fear of death, probably, is nothing else but an erased memory of the endless fear of birth.


Finally, the medicine was brought from Kyiv.
Half an hour later, Stanitsky wouldn't have needed it.
He was weakening visibly,
hormones and cardiac stimulants could no longer provide him with cardiovascular adaptation. In the chest cavity, only a harsh mechanical inhalation was heard, and at the edges — a completely "mute" lung.
Olga carefully, with reverence, shook the vial of alveofact and drew its contents into the syringe.
The most crucial moment remained — to introduce the medication into the lungs. It had to be done at the start of inhalation. And to manage to push the medication into the furthest parts of the lungs — the alveoli — before the child starts exhaling. In a premature infant, inhalation lasts less,
than half a second. Stanitsky's task was further complicated by the fact that he didn't take any independent breaths at all, only on the machine.
That is,
the syringe with alveofact had to be attached to the plastic tube of the breathing circuit.
“Well,
here goes nothing,”
Olga thought and pressed the syringe plunger.
Everything went as it should.
The drug starts working immediately.
In just twenty minutes, little Kostik was switched to the assisted ventilation mode.
The machine helped him breathe a few times a minute,
but the child breathed on his own.
Of course,
shallowly and irregularly.
But the skin tone gradually became infused with the cherished pink hue. This indicated the normalization of gas exchange in the lungs.
Everyone understood that little Stanitsky still had many problems ahead. But the first steps to save his life were successfully taken. And professionally. His first night in life passed even better than expected. What resuscitators call "without incident".
In the morning, Olga examined him together with the doctors of the pediatric ICU, wrote a prescription sheet for the day. And a thought flashed through her mind, a hunch,
что не надо вводить повторно альвеофакт. Ребенок дышал неплохо для своего гестационного возраста.
Но искушение поддержать первый эффект от редкого лекарства,
еще улучшить работу легких было сильнее.
И в рекомендациях по применению говорилось,
что целесообразно повторять введение препарата в течение первых трех суток жизни.
Доктора договорились,
что Ольга даст задание студентам и к девяти,
то есть,
через двадцать несчастных минут,
придет в реанимацию и сделает Станицкому альвеофакт.
Но благими намерениями,
как известно из Данте,
The road to hell is paved. While still in the study room, Olga heard a desperate cry:
— Olga Borisovna! Quickly, come here!
It turned out that the head of intensive care had decided to administer the medication into Stanitsky's tube on her own.
From the outside, it seemed like a fairly simple task — a quick injection with the syringe, and all set.
But she couldn't precisely gauge the inhalation phase,
and the pressure peak from the administered alveofact coincided with the child's exhalation.
Due to the high pressure, the lung tissue of the premature infant couldn't withstand it and tore.
A lung tear is called "pneumothorax" in medicine.
Это крайне тяжелое состояние, когда при каждом вдохе воздух накачивается в плевральную полость, легкое поджимается к корню и перестает дышать. Сердце смещается в сторону неповрежденного легкого и тоже его сильно сдавливает. Ребенок синеет, вся грудная клетка быстро заполняется воздухом и наступает смерть.
Станицкий не только посинел, он моментально почернел. За два аппаратных вдоха его легкие и сердце оказались прижатыми к корню языка. Так Ольге показалось сразу.
She grabbed the first needle she could find and quickly inserted it into the third intercostal space on the right. This was first aid.
Kostik got a few minutes of respite.
Air escaped from his pleural cavity through the thin needle with a barely audible hissing sound.
Then the pediatric surgeons placed a permanent drain — a rubber tube that barely fit between the child's thin ribs.
Now the condition of the little baby became almost hopeless.
To add pneumothorax to his array of severe prematurity and massive edema would simply mean killing him.
Olga was in agony, even though she understood that pneumothorax was quite a common complication in neonatology, and the improper administration of alveofact had only triggered it. Immature lungs often rupture where they are most delicate:
Stanitsky's father arrived, exhausted from waiting and sleepless nights. His temples were vividly gray. Olga did not remember exactly, but it seemed that yesterday his hair was completely black. She told him, smoothing the corners, that the boy was in very bad condition and complications with the lungs had started.
— What else can be done? — he had such an approach to every problem,
even the most unsolvable ones, that they must be solved no matter what.
Must — and that's it.
And nothing is impossible.
"Pray,"
— Olga wanted to respond in despair.
The treatment and care of little Stanitsky was her narrow track.
A breakthrough.
Kursk Bulge.
Olga spent eight days
without leaving the intensive care unit.
As soon as she left him,
he started having problems.
Half of them were due to the amateurness of inexperienced doctors.
Each of them wanted to contribute to the boy's recovery and prescribed some new medication on their own.
Olga struggled to teach them that the fewer appointments there were,
the higher the chances of success.
Kostik lay there, miserable and thin,
entangled in IV lines,
drainage tubes,
and monitor wires.
He clung to life.
Olga couldn't shake the feeling
that the profoundly premature baby was doing it consciously.
The little one would squeeze his eyes shut
when he was in pain
and would smile with thin, gray lips
when the pain passed.
He was conserving his strength to survive and didn’t even cry.

Olga was greeted by the baby with lively movements of his tiny hands and feet. When she walked away, the baby would sigh deeply and sadly.
One week after the rupture of his lung, Olga carefully removed the drainage tube from his chest cavity along with the encrusted pus and dried blood. The lung tissue had fused at the site of the rupture. Upon auscultation, the right lung crackled, like snow in frosty weather. The swelling had subsided. The exhausted baby barely weighed eight hundred grams.
— Kitten, — she would call him. He would unclench his little fists,
the wrinkles on his thin, beautiful face also smoothed out a bit. He opened his eyes wide,
and then he resembled an alien.
Very defenseless in a new strange world,
filled with pain,
fear, and uncertainty.
The head of the
ICU allowed senior Stanitsky to enter the intensive care unit and meet his son.
Tenderly and sadly, the two-meter tall father observed his tiny son.
He touched the child.
His hand, inserted into the incubator, was twice the size of the baby.
Сильный взрослый мужчина смахнул с ресниц слезы. Его потрясло,
что ребенок такой маленький и бледный,
через тонкую кожу можно рассмотреть все сосуды.
Он представлял себе все-таки сына.
Обычного ребенка.
Ну,
чуть поменьше других.
То,
что это существо было массой меньше буханки хлеба,
привело его в ужас.
— Завтра Костик начнет учиться дышать.
Не спеша,
дня за три,
может,
пять,
снимем его с аппарата.
И переведем на самостоятельное дыхание.
Потом поедете в детскую больницу набирать вес и расти,
— Ольга была горда собой в тот момент,
когда говорила все это отцу Станицкому. Было чем гордиться — сегодня Костика зарегистрировали,
как ребенка.
До этого он числился обидным поздним выкидышем.
Всю ночь у Ольги болела голова.
Она во сне ощущала,
как в ее черепе кипятятся остатки головного мозга.
И Ольга мысленно утешала себя сквозь сон,
что раз голова болит,
значит,
она есть.
Ей снилась,
как в убыстренном кино,
последняя неделя — кровь,
разорванные легкие,
остановившиеся сердца.
Все эти яркие,
в оранжевых тонах кошмары выстраивались в клин,
похожий на журавлиный,

when she was telling all this to Father Stanitsky. There was something to be proud of — today Kostik was registered as a child.
Before that, he was considered a painful late miscarriage.
All night long, Olga had a headache.
She felt in her sleep
as if the remnants of her brain were boiling in her skull.
And Olga mentally consoled herself through her sleep,
that if her head was aching,
it meant
she still had one.
She dreamed,
like in a fast-forwarded movie,
of the last week — blood,
torn lungs,
stopped hearts.
All these vivid,
orange-tinted nightmares lined up in a wedge,
like a flock of cranes,
without touching or adding any HTML tags, nor touching the layout or mnemonics, just translate to English:
and were flying in circles, encircling her with a narrow ring.
And she knew,
that she wouldn't be able to find an escape from it.
Just before morning, Olga was urgently summoned to the maternity hospital.
A pair of premature twins were born there,
both — boys,
in critical condition.
She was cheerfully greeted by the on-duty resuscitator Alina Sukhonog.
She’s a unique character.
It's worth telling about her in detail.
Alina,
after finishing dental school,
suddenly decided to become a neonatologist.
A prestigious profession,
interesting,
clean.
In the Western classification of medical specialties, neonatology is at the highest level, followed by neurosurgery, anesthesiology, and cardiac surgery.


Aline's sister worked as an associate professor of therapy and easily realized her dream by getting her a job in a maternity hospital.
Despite not having even specialized pediatric education.
In terms of professional training, Aline did not stand out from her colleagues from VAP.
Their IQs were all far to the left of zero on the x-axis.


But Aline had one big advantage,

с помощью которого она легко могла обскакать по безнадежной глупости кого угодно. Она была инфантильна.
У нее было плоское тело десятилетней девочки.
Только ростом под сто семьдесят.
Нужно было время,
чтобы привыкнуть ко всем ее кахектичным углам,
острым ключицам,
высушенным лопаткам,
коленям и безобразным впадинам вместо округлостей.
И психическое развитие у нее тоже остановилось в десятилетнем возрасте.
Или двумя годами раньше.
Больные дети в реанимации для нее были как куклы: можно поиграть,
или забросить в угол,
или разбить,

with which she could easily outrun anyone in hopeless stupidity. She was infantile.
She had the flat body of a ten-year-old girl.
Only with a height of about one hundred seventy centimeters.
It took time
to get used to her cachectic angles,
sharp collarbones,
emaciated shoulder blades,
knees, and unsightly hollows instead of curves.
Her mental development also stopped at the age of ten.
Or two years earlier.
For her, sick children in intensive care were like dolls: to play with,
or throw into a corner,
or break,
continuing to smile — soon they would buy a new one. Sometimes during an entire night shift, she wouldn't visit the sick children in the ICU, but would instead dance passionately to the screams from the radio.
In front of the mirror in the doctors' lounge.
She would tell everyone that during these times, her prince from the Looking-Glass was watching her.
And admiring her.
Alyna was always inexplicably cheerful.
A pathological syndrome of imaginary well-being.
She had neither a place to live,
nor a husband,
nor even,
at the very least,
a shabby boyfriend.
Nor a child — no one.
Another person in her place would have already hanged themselves out of despair. Or ended up in a psychiatric hospital with severe depression.
But she felt quite happy.
From that series,
that if a person is unconditionally happy,
then they must either be a fool,
or a lunatic, or a scoundrel.
Alina successfully played all three roles.
Simultaneously.
Now she was joyfully greeting Olga in the intensive care unit.
It was a very early June morning,
tender and fresh.
Pierced by the rare coolness of the beginning summer.
The sky in the east was already painted with the yellow and red clouds of a new day.
Alyna rambled on incessantly while Olga changed into medical attire:
— Twins were born.
Both weigh one and a half kilograms.
They are Professor Gaydar's grandchildren from the Department of General Hygiene.
Such a funny man,
— and she told a couple of stale jokes about professors.
— Both children are in extremely critical condition,
they will start crying any minute now.
Bruised.
As she uttered these words,
Alyna was beaming with a May Day parade smile.
— Volkov from the regional health department has already inquired about these twins,
— she reported obsequiously,
— and Professor Peshkin called too.

Because that's why we called you. The children are "top-class."
Bill Ivanovich ordered to bring you urgently.
Do not leave the twins unattended.
Do everything possible.
If these children die,
we will all be fired.
Their words echoed with insistent submission and endless wretchedness,
poorly disguised under pseudo-humanism.
— Wait,
— Olga shivered from a bad premonition.
There was no need to ask.
She already knew.
— Are you saying
the twins are in critical condition?
Are they breathing on their own or on something?
There were only three ventilators in the resuscitation unit of the city maternity hospital.

Two of them were occupied on Stanickii and another full-term beautiful baby, Sharko, with a birth injury. And only one old "Vabulog" remained free.
The issue of
the lack of breathing apparatuses and that every fourth critically ill child had to die
because it was impossible to provide them with respiratory support
did not concern anyone in Vanns.
When Olga tried to talk about this at various conferences or mortality reviews,
people looked at her
like she was crazy — "the regional health department doesn't have money for doctors' salaries,
а этой днепропетровской выскочке подавай дыхательный аппарат. Да вы хоть знаете,
что он стоит двадцать тысяч долларов?».
Алина коротко взгрустнула.
Как маленькая девочка,
у которой с носа любимой игрушки облупилась краска:
— Я доложила Волкову,
что аппарат есть только для одного из двойни.
Он приказал немедленно снять выкидыша Станицкого с ИВЛ!
И отдать дыхательный аппарат второму недоноску Гайдару.
Я,
само собой,
так и сделала.
Ольга бежала по длинному коридору в реан.зал.
Еще надеясь,
что маленький Костик дождался ее.
And he still has at least a singular heartbeat. Then she can "breathe" for him using the bag,
she’s encountered this situation before in her practice.
The cooled blue corpse had long been taken out of the incubator and carelessly covered with a swaddle.
Olga lifted it slightly.
Thin,
fists clenched hands.
Gray mouth.
The foam on the lips had not yet dried.
In his wide-open eyes she caught the sight of slowly
fading life.
And she couldn't help but watch,
as it reluctantly left the child's body.
Until eternal frost blossomed on his dimmed sclera.
Nearby, the artificial respiration apparatus made rhythmic noises,

отобранный час назад у Станицкого.
Olga provided the necessary assistance to the newborn twins. These boys were not to blame,
they just got lucky.
Big guys took care of them.
And at the cost of another's life, they were given a chance.
Unfortunately,
they could not be saved.
The Gaidar children died by the end of their first day of life.
They had identical congenital heart defects.
Incompatible with life.
If this cheerful canary Alina understood anything,
when she was sticking the stethoscope into her protruded ears and pretending
to listen to the child,
she would have immediately performed a heart ultrasound on the twins. And she would have realized
that the Gaidar twins had no chance of survival.
They are blue not because of collapsed lungs.
The reason is a heart defect and impaired blood flow.
And the respiratory apparatus would not only fail to save the little twins,
but would even worsen their condition.
Then,
maybe,
she would have thought
before disconnecting the oxygen from the recovering Kostik... And little Stanitsky would now greet Olga with a quiet,
serenade-like aura of Schubert,
an aura of gratitude.
And would blink with its mysterious alien eyes: "I want to live so much."
Olga looked at herself in the mirror — a tired, pale face. Her light hair made it appear even more colorless and haggard.
She took a mouthful of cigarette smoke and blew it into her own face.
She hated herself: "Why did you,
you old hag,
go home.
Couldn't you stay here a few more days?
You,
and only you are to blame for Kostik's death."

Tears of impotent rage streamed down the face of the mirror's reflection.
Aline floated into the doctors' lounge, blinding everyone with her unfading imbecilic smile:
— Why are we crying? Feeling sorry for the little bird?
Now Alinochka will make Olga Borisovna her coffee.
And everything will be alright.
The thought that an idiot is a mysterious, unpredictable substance and,
by and large,
a severe and most incurable disease did not bring Olga her usual relief.
She tried to explain to Aline in an elevated tone,
что та только что вбила восемь гвоздей в крышку гроба мальчика Станицкого.
Alyna blinked rapidly with thoughtless eyes. In which neither thought nor feeling ever lived.
The brown paint of anger spread across her thin, acne-ridden face,
mixing all the expressions available to this face into an indeterminate mush.
And Olha fell silent.
Talking about the truth makes sense only with someone
who can perceive this truth.
Or truth in general.
Three years passed.

Gynecologists strictly forbade the Stanitsky family from having children — the next pregnancy would cost the woman her life. The father of little Kostik sometimes visits Olga and tells her how his wife cries when diaper commercials come on TV. They do not know the truth about their son.
Aline is alive, healthy, and works in the children's intensive care unit. She continues to fill her street with "innocently slain" on the city cemetery in Rassoshentsy. Moreover, Professor Peshkin took her into his department.
and now she teaches neonatology to students at the medical academy.
If you see a skinny thirty-five-year-old girl with a ponytail of sparse greasy hair, always in a short skirt, with bony protrusions at the hip joints, and sucking on a Chupa Chups — that's her. You are not mistaken. Cross to the other side.

Published with the permission of Svetlana Borisovna Olkhovich,



author of the book "Bosch's Unsinkable Ship”

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