Chernobyl

Chapter 16

Radiation kills the cells of living things by spoiling the way the cells grow, and so it is the fastest-growing parts of the human body that suffer the most. The lining of the mouth and the digestive tract are quickly damaged, but it is the bone marrow that is most at risk. The marrow of the bones is where the blood's cells are manufactured, thousands at a time, to replace those that are always being lost in the body's normal wear and tear. When the bone marrow is damaged by radiation, blood counts drop. The blood loses its ability to fight off infection, to carry oxygen from the lungs, even to clot. It does not much matter whether the harmful radiation comes from nuclear war, from a natural source, or from something like Chernobyl. What matters is how much radiation is received.

There are many ways of measuring the damage caused by radiation, but the handiest unit is called the "rad," which is short for "radiation absorbed dose." (In technical terms, one rad is defined as that amount of ionizing radiation that deposits 100 ergs of energy in each gram of exposed biological tissue.) The number of rads tells the story. A person who has received no more than 150 rads is likely to recover completely. Around 300 rads his life is in balance, but blood transfusions, antibiotics, and the best of nursing care should pull him through.

Five hundred rads and over means that the bone

marrow is destroyed, and without bone marrow no one can live for long.

In the swaying, jolting ambulance en route to Hospital No. 18 in Kiev, Tamara Sheranchuk wished she had ironed fewer of her husband's shirts and taken more time to look at his books. Perhaps there would have been something in them about these "rads" and "roentgens." She knew very well that such dose numbers were very important. The experts from Moscow's Hospital No. 6 had explained that to all of the Pripyat and Chernobyl doctors, in that quick, twenty-minute briefing that was all anyone had time for that weekend. Unfortunately, she didn't really know what they meant. Even more unfortunately, the casualties who came to her medicpoint didn't wear numbers. Some of them didn't wear much of anything at all. Before they got to the medics they went through radiometric screening. As often as not, the counters squealed the alarm as they sniffed the garments, and then their contaminated outer clothing was taken away from them and added to the heap of condemned goods. They were lucky if they got a smock or a bathrobe from the dwindling stores to cover their underwear. They were luckier still if it was only their clothes that made the detectors squeal.

And even the ones who had swallowed or inhaled radioactive material were not as frustrating as those who had merely been exposed to intense radiation. They were the hardest ones to diagnose. There wasn't any visible wound. They were weak, they felt nauseated, they vomited unpredictably; yes, very well, those were precisely the early symptoms of radiation sickness. They were also the symptoms of shock or overexertion or a hundred other things, even simple fatigue, and certainly every human being working to control the damage from the accident had every right to a great deal of fatigue. Including Tamara Sheranchuk herself.

So what Tamara had been doing, before she was ordered onto an ambulance to accompany four of the seriously wounded to Hospital Number 18 in Kiev, were the simple medical things she had always done for injured people: poultice and debride, sew and dress. It was not enough.

There wasn't really room for four patients in the ambulance, much less for Tamara herself and the stands that held the plasma and antibiotics that trickled into the bloodstream of two of the patients. There were not enough clamps for so many stands, and so, as the ambulance swayed, Tamara had to have one hand to steady a glucose drip and another to catch a stand of saline solution that was about to topple, and none at all to keep herself from bouncing about.

These particular patients had — at least, were thought to have had — only light doses of radiation, if any at all. Three of them were seriously burned. Unfortunately, only one of the three was unconscious. The other two could not help moaning and crying out as the ambulance lurched and Tamara fought to stay awake and steady the IV stands. There was a nasty smell in the ambulance, part vomit and part smoke and part what really smelled most of all like burned meat.

The fourth patient was a woman, with chest pains, perhaps the beginning of a heart attack. She was elderly and conscious; she lay there without speaking, watching Tamara as she tried to deal with the others. When Tamara sat back for a moment, brushing hair out of her eyes and wishing she dared close them for a moment, the woman spoke. "I've seen you before," she said, and when Tamara identified herself nodded. "Yes, to be sure. Don't you remember me? I'm Paraska Kandyba. Deputy Director Smin's secretary."

"Of course," said Tamara, letting go of the saline stand to reach for her chart. "Yes, and they've given you heparin and nitroglycerine. How are you feeling?"

"A headache. Nothing more now."

"Yes, that is from the nitroglycerine. It is unpleasant, but it's better if I don't give you anything for it until you reach the hospital."

"I don't want anything." The woman added apologetically, "I know it was very foolish of me to try to help out, at my age. But in such a terrible thing—"

Tamara saw that the secretary was weeping. Yes, certainly it had been very foolish; Paraska Kandyba had been near the plant all day, begging for the chance to get into the administration block to rescue her boss's papers, and what was the importance of that? But all Tamara said was, "It was very brave of you."

Paraska raised her head to stare at the doctor. "Brave? But not sensible. And Deputy Director Smin is also not sensible! He is not a young man. And yet I saw him in and out of the plant, right with the firemen, until they sent him off to the hospital in Moscow. Oh, he didn't want to go, I can tell you!"

"No, of course not," Tamara soothed, letting go of the chart to rescue the toppling saline stand again. "Tell me, Paraska," she ventured. "Did you by any chance see my husband today?"

But Paraska Kandyba only shook her head and continued weeping. It was obvious that her tears and her concern were all for Deputy Director Simyon Smin.

When they reached Hospital No. 18 in the city of Kiev, Tamara Sheranchuk dragged herself out of the ambulance for the transfer of the patients. She wasn't needed. She stood aside while the hospital's own orderlies took over, efficiently unloading the patients and wheeling them into the receiving room. She was looking forward to the ride back. It would be nearly two hours! Two hours in which she could stretch out in the ambulance and sleep. She leaned against the door of the ambulance, dreaming of that wonderful two-hour trip, when she realized the driver had poked her and said, "Look at them."

Tamara blinked. "Look at what?"

"Those people! Look, they are acting as if nothing had happened!"

It was true. She gazed around the streets of Kiev wonder-ingly. Here in Kiev, at least, it was, after all, a peaceful Sunday afternoon! People were strolling the wide streets, children were laughing as they played, a few early blossoms were on the chestnut trees, the bright posters were everywhere for the May Day celebration. How incredible, Tamara marveled, that all these people could be going about their normal lives, unaware of the hell that was raging less than a hundred and fifty kilometers away.

"They're lucky," grumbled the ambulance driver, and Tamara shook her head.

"Not really," she said. "No one is very lucky today. They simply have not yet found it out. Are we through here? Then let's go back to Chernobyl."

As the ambulance driver, who had had no more sleep than Tamara, wearily started to turn the vehicle around, a man came running out begging for a lift. He explained that he was a doctor trained in radiation sickness, called in from his weekend for the emergency. Tamara made herself stay awake; here was a chance to learn something useful! She asked him about the numbers. "Yes, exactly," he said, "above 500 rads the only hope is to somehow give them living bone marrow."

"And how is that done?"

"Fetal liver transplants," he said. "In some places they actually transplant bone marrow — this is done in America sometimes — but there are great problems. First of all, the patient's own bone marrow must be destroyed, otherwise the transplant will be rejected. Then there must be an exact typing match, and it is not easy to type bone marrow — and if that is wrong, the transplant will still be rejected. Of course, that itself is serious; a patient who might otherwise recover could be killed by the rejection process."

"And what is the fetal liver procedure?"

"In the embryo," he said, "it is the liver cells that perform the functions of the adult bone marrow in manufacturing blood cells. So from aborted fetuses we extract the liver, purify the cells, and inject them into the patient." He hesitated. "That, too, has a poor success rate," he admitted, "but for patients with more than 500 rads there is, after all, no choice."

"Ah, yes," said Tamara, "but how do you know what the exposure has been, since not all the victims are thoughtful enough to carry dosimeters?"

The young specialist said enthusiastically, "That is the key, of course. The doctor in Hospital Number Six in Moscow, where I trained, has developed a procedure. We take blood counts at two-hour intervals and compare them with a standard profile. We can see how rapidly the cells deteriorate, and from that we can determine what the exposure has been. .."

But by then Tamara was asleep beside him.

Tamara had almost allowed herself to hope that by the time she got back the fire would be under control, the emergency over. But it seemed it was worse than ever. Pripyat had been evacuated. (And where had her son, Boris, gone?) The ambulance was sent on to Chernobyl town, thirty kilometers away from the reactor. It was, it seemed, as near as was really safe, and so now there was talk that everyone, everyone, within that thirty kilometer radius of the plant was to be ordered away. And where would they find places for all these people to stay? There were a dozen villages and nearly thirty collective farms in the area; where would they all go?

It was not just the people now. Half the farms in the area raised livestock, cattle mostly, but any number of sheep, pigs, goats, even a few horses. Many of the animals came from the kolkhozists' private ventures, which made their owners doubly desperate to save them.

As they circled around the town of Pripyat and the stricken plant, Tamara looked longingly out of the back of the ambulance. Sheranchuk was there. Doing, Tamara was sure, something doggedly heroic and certainly dangerous. If only she could take him and Boris and run away!

It did not occur to her that this was almost the first time she had been separated from her husband when her principal worry had not been that he might be with another woman.

When they reached the town of Chernobyl they were directed to the bus station.

There Tamara Sheranchuk set up shop, but she had no more than entered the room set aside for the medics than her boss, the chief of surgery from the Pripyat clinic, wrinkled her nose and scowled. "When did you change your clothes last?" she barked. "Go at once. Shower. Eat something. Get cleaned up. Don't come back for one hour."

"But there are so many patients—"

"There are plenty of doctors now, too," said the elder — woman. "Go now."

And indeed when Tamara came back in a clean white gown, her hair still damp but pulled neatly to the back of her head, there were four strange doctors taking their turns with the influx. Two were from Kursk, one from Kiev, the dark, small, Oriental-looking woman all the way from Volgograd.

"But they must have emptied out every hospital in the Soviet Union," said Tamara.

The woman from Volgograd said, "No, the hospitals are all fully staffed. It is people like us who were off duty, now we give up our Sunday to come here to help."

"And are the people in Volgograd so concerned about an explosion in the Ukraine?"

"The people in Volgograd know nothing about an explosion in the Ukraine. Neither did I. I was simply told to report to the airport at nine this morning, Sunday or no, and here I am. What is holding up the line? Send in the next patient!"

Even the patients were easier to deal with here. Triage had already been done — again, by teams of fresh doctors brought in from everywhere, taking their turns at the medicpoint in the Chernobyl town bus station. The seriously injured ones had already been sorted out and sent off to hospitals elsewhere. The ones that were coming through were lightly injured, or not injured at all. For most of them all Tamara had to do was a quick physical check — the eyes, the pulse, the blood pressure, the inside of the mouth; a quick questioning about symptoms and a few cc's of blood drawn for a lab somewhere to make a count. Then she passed them on. Most of them went directly onto buses or trains, for those who were able to travel were counted at once as evacuees.

"Mother," said a voice from the next queue, and when she looked up from her patient she saw that it was a young boy. His face was filthy and he wore an outsized Army blouse, not his own; it took a moment for her to realize that it was her son.

"Boris! Are you all right?"

"I think so. Only they are sending all the Komsomols away now."

"And quite time for it, too! But where are you going?" she demanded.

"Oh, to a summer camp, Mother! A good one! Maybe Artek, down on the Black Sea — and, oh, Mother," he said joyfully, "it isn't going to cost us a kopeck!"