* * *
As befits a disease created unwittingly by mankind, acute radiation syndrome is a cruel, complex, and poorly understood affliction that tests modern medicine to its limits. The radiation exposure responsible for causing ARS may be over in a few seconds and unaccompanied by any initial reaction. But its destructive effects begin immediately, as the high-energy rays and particles of alpha, beta, and gamma radiation snap strands of DNA, and the exposed cells start to die. Nausea and vomiting set in, with a speed and intensity contingent on the dose, and the skin may redden. But the nausea eventually passes, the discoloration of all but the most severe burns fades within eighteen hours, and the patient enters a comfortable latency period. Depending on the severity of their exposure, this deceptive period of apparent well-being can last for days or even weeks, and only afterward will the further symptoms of ARS develop. The lower the dose, the longer the latency and the greater the likelihood of recovery—given the right treatment.
The patients arriving from Chernobyl had been exposed to radiation in a terrible variety of ways: the firefighters who had climbed to the roofs of Unit Three had breathed in alpha- and beta-emitting smoke, been dusted with fallout and shot through with gamma rays from the fuel pellets and core fragments surrounding them. Their doses depended on where they stood. A few meters here or there would make the difference between life and death. The operators struggling to contain the damage inside Unit Four had been mantled in dust and radioactive steam from the explosion and from broken pipes, had been drenched in water heavy with beta-emitting particles, and had searched through ruins littered with debris from the reactor core. Some had breathed in radioactive xenon, krypton, and argon, short-lived but intensely radioactive gases that would sear the soft tissue of their mouths and airways. Others would suffer widespread skin burns from gamma rays or from the beta particles that had settled on their skin or soaked into their clothes. Some had been exposed for minutes, others for much longer. Alexander Akimov, who—along with Toptunov—had labored ankle-deep in radioactive water in the fruitless attempt to cool the shattered reactor, came off the plane in Moscow in the same filthy overalls he had worn throughout that night. They continued to irradiate his skin for more than twenty-four hours, until they were finally removed by the triage nurses at Hospital Number Six.
Yet by the time they reached Moscow, a full day after the accident began, only the most gravely affected of the 207 patients exhibited any outward signs of sickness.
A half dozen of the firefighters—led by Lieutenant Pravik from the Chernobyl station brigade, reinforced by men from the Pripyat town squad, and afforded no protection against gamma waves by their canvas uniforms—had absorbed such acute doses that when they arrived in Hospital Number Six, their complexions had already faded from red to a waxy gray, the outer layer of their skin killed by radiation. Internal damage was just as hard to discern but would eventually prove equally grievous, affecting the parts of the body where cells naturally multiply the fastest, especially the lungs and airways, intestines, and bone marrow. The treatment available for the affected organs was limited to blood transfusions, antibiotics to fight infections, and—for the worst cases—a bone marrow transplant, a risky procedure fraught with complications and side effects that could themselves prove fatal.
As Dr. Guskova and her team knew, by the time the outward symptoms of ARS appeared—including swelling, skin burns and necrosis, bloody diarrhea and hemorrhaging, the decimation of bone marrow, corrosion of the airways and digestive system—it would be too late for them to intervene. And without detailed knowledge of the circumstances of a victim’s exposure, an accurate picture of their dose—and the appropriate treatment—was hard to ascertain. Even in the smallest and closely defined nuclear accidents, triage was almost entirely a matter of estimation and guesswork. In the chaos that followed the explosion of Reactor Number Four, few of the accident victims had been aware of how or where they had been exposed to radiation. The station’s own monitoring staff had been overwhelmed; the firefighters had been issued no radiometric equipment at all, and the operators had been wearing only crude personal badge dosimeters designed for daily use inside the plant and measuring only up to 2 rem. Those that had been recovered from the overalls of hospitalized staff had been carefully bagged and flown to Moscow, only to be inadvertently destroyed during decontamination.
But Guskova’s decades of work in radiation pathology had helped her pioneer a method of biological dosimetry, gauging exposure based on interviews and tests. These included the time taken for the initial onset of vomiting and a count of white blood cells, or leukocytes. Manufactured in the bone marrow, these cells are the foundation of the body’s immune system and among the most reliable biological markers of the effects of ARS. By measuring the patient’s leukocyte count and the rate at which it was falling, the doctors could provide a corresponding estimate of the dose each had received. It was a laborious process. Lacking automatic blood cell counters of a kind common in the offices of Western hematologists, the clinicians had to conduct the counts by eye, under a microscope; instead of twenty seconds, each one took a half hour.
The white cell test was part of a battery of analyses used to provide a likely prognosis for each patient, and the patients quickly grew used to having blood drawn daily, either from a fingertip or a vein. The doctors also took samples to measure the levels of strontium and cesium contaminating their skin, and examined their urine for evidence of sodium 24—which would indicate exposure to nuclear fission and can render the body itself radioactive. But it was the blood test that remained the crucial bellwether of who would survive and who—almost certainly—would not.
When Natalia Yuvchenko went to ask the doctors about Alexander’s condition, they said she would simply have to wait.
“Within the first three weeks, we’ll know,” they told her. “Just be prepared for the worst.”
* * *
By May 1, Guskova and her staff had completed the work of identifying the patients who were less badly injured and moving those who required intensive care into separate rooms, to prevent cross-infection. When a doctor came to Piotr Khmel’s room to discuss his test results, he seemed puzzled that the young firefighter’s counts revealed relatively little damage, despite the initial reddening of his skin. He asked Khmel if he had recently taken a holiday anywhere sunny. The physician seemed to think a vacation was a more likely explanation for his patient’s tan than having been exposed to the gamma radiation of the burning reactor. There were only two reasons his white cell count could be so healthy.
“Either you weren’t there, or you’d been drinking,” the doctor said. “Tell me the truth.”
Khmel, wary of what would happen if the hospital reported that he’d been drunk on duty, sheepishly admitted he’d been out that night. There had been a lot of vodka. “It was Officers’ Day,” he said.
The doctor smiled and clapped him on the shoulder. “Nice job, Lieutenant. Now we’ll make you better.”
* * *
By now, the relatives of the victims had begun to reach the hospital not just from Pripyat and Kiev but also from elsewhere in the Soviet Union. Lieutenant Pravik’s mother was one of the first to arrive and barely left her son’s side from that moment on. The doctors suggested to wives and parents that they bring food to help keep up their loved one’s strength and recommended making goose or chicken broth. From his bed, Pravik sent a cheerful letter to his young wife and their month-old daughter, in which he apologized for his poor handwriting and his absence from home.
“Greetings, my darlings!” he wrote. “A big hello to you from the holiday-maker and moocher. . . . I’m slacking from my responsibilities in raising Natashka, our little one. Things are good here. They have settled us in the medical clinic for observation. As you know, everyone who was there before is now here, so I’m enjoying having my entire entourage around. We go out for walks, in the evenings we take in the sights of Moscow at night. The one downside is we have to take it a
ll in from our window. And probably for the next one or two months. Sadly, those are the rules. Until they complete their assessment, they can’t discharge us.
“Nadya, you are reading this letter and crying. Don’t—dry your eyes. Everything turned out okay. We will live until we’re a hundred. And our beloved little daughter will outgrow us three times over. I miss you both very much. . . . Mama is here with me now. She hotfooted it over here. She will call you and let you know how I’m feeling. And I’m feeling just fine.”
* * *
The parents of Senior Reactor Control Engineer Leonid Toptunov had been at their dacha outside Tallinn when they heard there had been an accident at the power station where their son worked, and they rushed home. On Tuesday they received a telegram from Leonid: “MAMA I AM IN HOSPITAL IN MOSCOW I FEEL OK,” he wrote and added the address where they could find him. Vera Toptunova and her husband took the first available flight from Estonia. When they arrived at Hospital Number Six the next day, they were taken upstairs and led down a narrow corridor, where Leonid came out of his room to meet them. Wearing short white pajamas and a matching cap, he seemed well. He could walk by himself and insisted he felt good. “Everything is fine! Don’t get upset, Mama,” he said, and smiled. “Everything is okay.”
But when she looked down, Vera could see that he wasn’t fine at all. Where Leonid’s pajama pants ended, they revealed that something terrible had already begun happening to his skin: it was the ugly damson color of a day-old black eye, as if the surface of his legs and feet had been bruised all over, or dipped in something corrosive.
* * *
Dr. Robert Gale was a man of regular habits. Each morning, he rose early, while his wife and three children were still asleep, to shave and then take a swim in the pool of their house in Bel-Air, in the fragrant foothills of the Santa Monica Mountains. Afterward, he would begin making calls to colleagues in New York and Europe, where the working day had already begun. On April 29, he was still in the bathroom, listening to the radio, when he first heard news of the accident. But it wasn’t until later that morning, when he learned there had been casualties at the Chernobyl plant, that it occurred to him he might be able to help.
At forty, Gale was a hematologist at the UCLA Medical Center and a specialist in bone marrow transplants. Favoring wooden clogs he had custom-made on Melrose Avenue and broad ties decorated with images of whales or sheep, he was an avid jogger who ate frozen yogurt for lunch every day and an ardent self-publicist who enjoyed his reputation as a maverick. He was also the committee chairman of the international research-sharing registry for bone marrow transplants and recognized that its resources might be vital in helping to save the lives of anyone struck by acute radiation syndrome. Gale knew that the USSR had already formally rejected offers of medical assistance from the US State Department, but he planned a different approach: through his friend and patron Armand Hammer. At around nine thirty that morning, he picked up the telephone.
The chairman of American oil company Occidental Petroleum, Armand Hammer was a renowned philanthropist and art collector. Born in New York to committed Communists, he had first traveled to the USSR in 1921 after having broken off his medical studies, ostensibly to look after the Soviet interests of his father’s drug company. In Moscow, he met Lenin, who granted Hammer trade concessions that became the basis of a business fortune—and opened a direct line to Soviet leaders that would endure for almost seventy years. Although he would eventually be unmasked as one of history’s great charlatans—a knowing tool of the Soviet secret police, a con man, and a traitor—at eighty-seven, Hammer was still burnishing his reputation as a globe-trotting humanitarian, described by Walter Cronkite as “an almost unique bridge between Communism and capitalism.”
Gale had met Hammer while visiting the USSR in 1978, to attend a medical conference at Moscow State University, and later got to know him well through Hammer’s initiative to find a cure for cancer. He could think of no better conduit for an offer of help to the casualties from Chernobyl.
Gale tracked down Hammer at a hotel in Washington, DC, and explained the potential importance of bone marrow transplants in saving the victims of radiation exposure. Later that same day, Hammer addressed a letter to Mikhail Gorbachev, petitioning on Gale’s behalf, and delivered it by telex to the Kremlin. By Thursday afternoon, the doctor was striding through Los Angeles International Airport—tickets in hand and attended by a retinue of press photographers—on his way to Moscow.
* * *
On the landings of Hospital Number Six, the operators from the plant gathered to talk, smoke, and discuss the mystery that preoccupied them all: the cause of the accident that had put them there. KGB officers and investigators from the Soviet prosecutor’s office went from room to room to conduct bedside interrogations, and the firemen and engineers made wild guesses, but nobody really knew how the explosion could have happened. Those trained in nuclear engineering and reactor physics—among them Deputy Chief Engineer Dyatlov, Alexander Akimov, Leonid Toptunov, and Sasha Yuvchenko—were still at a loss to understand it.
“We are open to any suggestion, lads,” Dyatlov told the young technicians who had followed his orders that night. “Don’t be afraid to come out with even the most far-fetched ideas.”
Even when their condition began to worsen, they never discussed who was to blame. At their son’s bedside, the parents of Leonid Toptunov—who had pressed the AZ-5 button, which had triggered the explosion—were both afraid to bring up the subject of the accident. But eventually Vera felt bold enough to ask him about it directly.
“Lionechka,” she said. “What happened—how could it happen?”
“Mama, I did everything right,” he said. “I did everything according to the regulations.”
Then a doctor interrupted, signaling her not to disturb her son any further. They never discussed the accident again.
* * *
On the morning of Thursday, May 1, Ludmilla Ignatenko was summoned to Angelina Guskova’s sixth-floor office, and the doctor explained that it would be necessary to conduct a bone marrow transplant on her husband. Vasily Ignatenko, a sergeant in the Pripyat town fire brigade and the most accomplished athlete in the unit, had fought the fires on the roof of Unit Three alongside Lieutenant Pravik. A marrow donor from his immediate family was now required to save his life. Guskova explained that his closest relatives were already en route to Moscow for this purpose.
Six days had now passed since the accident, and the initial latency period of ARS was ending for the most seriously irradiated patients. Vasily had been placed on an IV and was given constant injections. That night, he surprised Ludmilla with a bouquet of flowers he had asked his nurse to help smuggle in, and together the couple watched the May Day fireworks from his room, high on the eighth floor of the hospital. Vasily was still able to stand, and he wrapped his arms around her as they gazed from the window. But his condition had already declined so badly that he could no longer drink the broth she brought him. The doctors suggested trying raw eggs, but he couldn’t keep those down, either.
Identifying marrow donors for the most acutely exposed patients was also becoming difficult: their white blood cell counts were falling so quickly that it was hard to find enough of them to complete the tissue-typing analysis. For those relatives shown by the tests to be good potential donors, the donation process was its own ordeal. Among the first to undergo the procedure was Vera Toptunova, then fifty years old. After administering a general anesthetic, doctors made two incisions in her buttocks and used heavy-duty, six-inch-long needles to puncture her hip bones and draw out the marrow, a teaspoon at a time. It took around ninety minutes to make the two hundred insertions necessary to fill a beaker with a quart of reddish-pink fluid. Technicians strained this to remove pieces of fat and bone, processed it in a centrifuge, placed it in a bag, and transfused it into a vein in her son’s arm. Then the wait began for the marrow cells to reach the cavities in his bones and begin manufacturing healthy new blo
od cells.
When Vasily Ignatenko heard that his younger sister Natalia was the best candidate for donation, he refused permission for the doctors to proceed. “I won’t accept bone marrow from Natasha!” he said. “I’d rather die!” Even when his wife explained that it would cause her no long-term harm, Ignatenko resisted. Eventually his older sister Lyuda submitted to the procedure instead.
By the end of the first week, Hospital Number Six’s head of hematology, Dr. Alexander Baranov, had overseen three bone marrow transplants on some of the worst-affected patients, including Toptunov and Akimov. But three more patients had been so irradiated that there were no leukocytes left in their bodies with which to make a match. On these men, the Soviet doctors instead tried a new, experimental transplant technique using cells from the livers of stillborn or aborted fetuses. This treatment stood even less chance of success than the marrow graft, but Guskova’s staff knew there was little else they could do: these patients were already beyond help.
By then, the limitations of biological dosimetry were becoming apparent. Guskova’s initial calculations had suggested that some men had received only low doses of radiation—less than some cancer patients receive as part of standard radiotherapy treatment. Yet this analysis could reveal only the effect of gamma rays on bone marrow and took no account of the damage wrought by internal irradiation, caused by breathing radioactive smoke, dust, and steam or ingesting radioactive particles. And as the visible signs of beta burns slowly became more apparent on the victims’ skin, the doctors were astonished by their scale and severity. On May 2 Dr. Baranov estimated that ten of his patients wouldn’t make it out of Hospital Number Six alive. Before long, he would increase the number to thirty-seven.
Midnight in Chernobyl Page 27