The heart of the matter

Russia’s health is as shaky as Yeltsin's

MALCOLM GRAY October 7 1996

The heart of the matter

Russia’s health is as shaky as Yeltsin's

MALCOLM GRAY October 7 1996

The heart of the matter

RUSSIA

Russia’s health is as shaky as Yeltsin's

It comes down to this: the political health of the world’s largest country is now tied to the damaged heart of its recently re-elected president. A team of cardiac specialists met in Moscow last week and finally confirmed that Boris Yeltsin would undergo a triple or even quadruple bypass operation. But the delay involved means that the political and economic instability brought on by Yeltsin’s weakness will only worsen—and pressure will mount for him to step aside.

Dr. Renat Akchurin dispelled some of the rumors that have swept Russia since just before the July 3 presidential runoff election, when Yeltsin suffered his third heart attack in one year—undisclosed at the time—and largely disappeared from public view. Akchurin, a prominent Moscow cardiologist, announced that he and a team of about 12 cardiac specialists would operate on Yeltsin in six to 10 weeks. But a date for surgery that might be as late as December only emphasized that Yeltsin will need lengthy preparation—and his recuperation could take another two months. The uncertainty also focused attention on who might replace him running the country—temporarily or permanently. In an interview published on the weekend, Alexander Lebed, Yeltsin’s powerful national security czar, called on the president to transfer his powers while he remains ill. Said Lebed: “It’s not clear

whether we have a president or not.”

The situation, said Sergei Molotchkov, an analyst at Moscow’s U.S.A. and Canada Institute, “is like the so-called era of stagnation during the 1980s when the country was run by Leonid Brezhnev.” But the ailing Soviet dictator had the then-powerful Communist party to back up his palsied grip on power. Like his much-bemedalled predecessor, though, Yeltsin would be hard to budge. A 1993 constitution that Yeltsin largely dictated leaves it up to the president to decide if and when health reasons should force him to quit. And there is no need for anything so drastic, argue Yeltsin aides, pointing to the conclusions reached by the president’s cardiac advisers after a three-hour discussion. One of the most prominent is Michael DeBakey, the U.S. doctor who pioneered the bypass operation. The 88-year-old specialist met Yeltsin last week and was particularly upbeat about his chances of recovery. Said DeBakey: “There is no reason the president shouldn’t be restored to full normal activity.”

To many Russians, though, that prognosis had the ring of communism’s old promises that a bright future lay just around the corner. Now as then, unfortunately, optimistic forecasts do little to treat an immediate crisis. And with Yeltsin all but absent from the Kremlin, there is a clear need for top-down action on issues ranging from the

fragile peace in Chechnya to NATO’s plans to expand into Eastern Europe. Russia’s chronic economic problems are threatening to cause massive social upheaval. Many state employees are again waiting for overdue salary payments. Lebed had earlier warned that the financial squeeze on the army could ignite an armed rebellion this fall. To Lebed, the country is on the brink of chaos. “We are at a dangerous limit, a very dangerous limit,” he said. “It is not a time to fight. We must get out of the abyss.”

Yeltsin’s health problems have depressed Russia’s fledgling stock exchanges and given pause to already scant foreign investors. They advanced only $6.6 billion last year— just half, for instance, of what comparatively small, but more stable, Hungary pulled in. Brokers are currently trying to attract $540 million from overseas investors for a oneper-cent stake in Gazprom, the natural gas monopoly that is Russia’s biggest company.

Even many of Yeltsin’s colleagues doubt that he can pull off another of his patented comebacks and serve out his second term. At 65, Yeltsin is eight years past the average life expectancy for men in a society where fried or fatty foods are common. As is drinking: according to such close aides as former press secretary Pavel Voshchanov, Yeltsin’s chances of recovery will be made more difficult by kidneys and a liver weakened by years of knocking back vodka toasts. Yeltsin’s doctors last week pronounced those presidential organs to be in relatively good shape. But Voshchanov, who worked for Yeltsin for eight months in 1991, has flatly stated that his former boss has cirrhosis. In fact, Voshchanov said, he was frequently

stymied by Yeltsin’s fondness for social tippling. “Often I could not answer questions about our schedule because so much depended on our dinner plans: who would be there, when we would eat—and how many bottles would be standing on the table.”

The doctors and the Kremlin have co-operated to put the best possible spin on the president’s light workload. DeBakey stressed that Yeltsin’s heart condition had not affected his mental abilities. And chief of staff Anatoly Chubais emphasized that he now ships daily packages of documents to Yeltsin at Moscow’s Central Clinical Hospital, which he entered for tests on Sept. 13.

Yeltsin’s rivals have drawn entirely different conclusions, especially from Chubais’s revelation that the president spends as little as 2 h hours a day on state affairs. “The Yeltsin era is over,” declared Grigori Yavlinski, a liberal economist who finished fourth in the presidential campaign. Yavlinski blamed Yeltsin’s habit of dividing power among competing factions for the paralysis at the top levels of government. Added Viktor Kremenyuk, the U.S.A. and Canada Institute’s director: “The president is the key to everything. If he is not in good health

and capable of working long hours every day, then management of the government quickly becomes a mess. There is no one person and no mechanisms—not even a vice-president—who could take over national leadership if the president is incapacitated.” Yeltsin has already ceded some of his powers to Prime Minister Viktor Chernomyrdin. He is also prepared to transfer, briefly, control over Russia’s nuclear weaponry to the prime minister during his surgery. But with power spread between a ruling triumvirate of Chernomyrdin, Lebed and Chubais, the president’s men oscillate between public demonstrations of loyalty and jockeying for position in an undeclared succession race.

Lebed was already working to fulfil his own prediction that he will be president before 2000—the end of Yeltsin’s four-year term. In recent weeks, Lebed has undertaken high-profile trips to Belarus, where there is widespread public support for a reunion with Russia, and to Chechnya, where he ironed out threats to the peace deal he negotiated with separatist rebels in August. He has also issued tough warnings to the West against NATO expansion and criticized the government for ignoring its impoverished armed forces. But Lebed will still have competition in a formal race to succeed Yeltsin. Gennady Zyuganov, the Communist candidate whom Yeltsin beat by 10 million votes, is ready to run again. Zyuganov, too, says that Yeltsin is too sick to rule. He also charges that the Yeltsin team committed electoral fraud by lying about the president’s health just before voting day.

“What else could we do?” responded one key member of the president’s victorious re-election team. “If we had let it out that the president had more heart problems, we might now have a Communist president.” So much for an election that supposedly signalled a decisive break with the past. Instead, Russians find themselves in an all-too-familiar situation: muddling through an uncertain present on the strength of a promise that things will get better.

BYPASSING THE PRESIDENT

In joining the hundreds of thousands of patients worldwide who have undergone heart bypass operations, Boris Yeltsin faces all the risks of major surgery—and then some. In order to repair an organ covered with the scar tissue of three heart attacks, heart surgeons will cut through Yeltsin’s breastbone with surgical saws. That invasive procedure can take four or five hours, according to Alexander Anikin, a 28-year-old surgeon at Moscow’s Institute of Cardiology. Then, a team of eight to 12 specialists will go on to what Anikin calls simple plumbing. This lV2-hour second stage involves replacing—or bypassing—blood vessels that have become narrowed or closed off, due to a buildup of fatty tissue, with healthy veins taken from the patient’s leg. Sewn in place, the transplanted veins can then carry a full flow of blood to the heart.

The risks are present throughout. A patient has to be fit enough to withstand the physical

assault of the operation itself. And the doctors and nurses involved must work smoothly as a team. Among the key members are a cardiologist overseeing the process and a surgeon doing the cutting and sewing. They are supported by an anaesthesiologist, who continually monitors the unconscious patient, and a perfusion unit that operates the heart-lung machine that keeps the patient alive while the heart is stopped during the operation.

The team will also pump in anticoagulants to thin Yeltsin’s blood and aid circulation while he is on the machine. This procedure must be reversed when the operation is finished so that his blood will clot and he will avoid hemorrhaging. To handle the anticoagulants, Yeltsin needs a healthy liver. Despite rumors about his drinking, the president’s medical advisers insist that he will meet that crucial requirement. After up to two months of rest, Yeltsin will—they hope—be ready again for the rigors of the presidency. M.G.

MALCOLM GRAY