Left Houston 3:40 pm on KLM #662 and arrived in Amsterdam at 7:00 a.m. Smooth flight -- rested and slept. Left Amsterdam
9:05 a.m. Monday, September 23, 1996 and arrived in Moscow at 2: 15 p.m. Was awakened by a journalist to give an interview.
I was met at the gate by a Russian delegation headed by Prof. Eugene Chasov and Renat Ackturin and including a young lady
interpreter and security guards. I was then taken to the Kremlin Guest House, a beautifully appointed somewhat secluded large
house in a wooded area in the south of Moscow used by the President for VIP guests. I have a large bedroom and bath as well
as a large sitting room.
In the car on the way to the house, Chasov told me about Yeltsin's current medical
condition. He stated that Yeltsin had poor heart function with an ejection fraction of 20. He said the medical team was somewhat
discouraged about the possibility of surgical treatment.
I then met with Chasov and Ackturin and observed the following medical facts about President Yeltsin: He has a history of
a myocardial infarction first in July 1995, second in September 1995, third in June 1996. All of this was kept secret because
of the elections. Moreover he did not comply with medical advice about restricting his activities. He even went hunting shortly
following his third infarction shooting about 100 ducks.
In August 1996, an Echocardiogram showed an ejection fraction of 20. In early September 1996 coronary angiogram was performed
at Chasov's Institute. It showed extensive atherosclerotic occlusive lesions in the Right, LAD, Diagonal, and Obtuse
marginal coronary arteries with reasonably patent distal segments. These lesions were not considered amenable to balloon angioplasty.
Liver and kidney function studies were normal but there were studies done that suggested decreased function of the thyroid
Particularly significant has been the finding of severe anemia which was of recent origin since the hemoglobin, RBC, and hematocrit
done one month ago were normal.
The drop in the RBC to 1.8 million has not been explained. I suggested this indicates blood loss and they agreed but up to
now they have not found the source. He has now had two units of blood transfusion. I shall obtain more information and am
scheduled to see President Yeltsin on Wednesday, September 25, 1996.
In the evening (9/23/96) 1 was taken to the President Hotel for the reception and dinner of the Bourakovsky Festrchrift. There
were many toasts as usual on such an occasion and I was asked to give the third toast after Brokeria and Petrovsky. Among
the Americans there were Bohnson, Sabiston, Lillehi, Callow, and Bigelow.
Tuesday, September 24, 1996
Attended meeting in honor of Vladimir Bourakovsky and in early afternoon I gave my lecture on arterial occlusive disease.
Journalists and members of the News Media were swarming at the Palace Hotel when 1 entered and they followed me into the auditorium
making it difficult to start the meeting. It took about one half hour to move them into the back of the auditorium before
the meeting could get started. Most of them remained in the auditorium the entire day.
At the end of the session at about 5:30 pm, Dr. Brokeria held a press conference but stated that there would be no questions
concerning Yeltsin. Despite this statement most of the questions were about Yeltsin, and I had simply to decline answering
A reception and dinner was held afterwards and then I went back to my guarded residence.
Wednesday, September 25, 1996
At 9:30 am, I met with Ackturin and Chasov at the Cardiology Research Institute and again reviewed the medical data on Yeltsin
and then we all went to the Special Kremlin Clinic Hospital where Yeltsin is hospitalized.
We then met with the medical team headed by Professor Sergey Mironov and Prof. Andrey Vorobiev. They were cordial, seemed
pleased to see me, but the general mood seemed discouraged. They showed me the laboratory studies showing his B.U.N. Creatinine
and Liver and Pulmonary function studies to be perfectly normal. His hemoglobin was 8., hemocrit 22, and RBC 2.4 million (this
had risen from 1.8 after 2 units of blood transfusion). The thyroid function studies showed mild hypothyroidism.
They then showed me the angiogram which showed complete occlusion of the right coronary artery at its midportion, significant
stenosis of the LAD proximally and the diagonal and obtuse marginal coronary arteries with good patent distal segments. It
would appear he will need at least 4 bypasses - right LAD, diagonal, and obtuse marginal.
We then reviewed the echocardiogram done about one month ago which showed dyskinesia of the apical wall with an ejection fraction
of 20. We then compared this with the echocardiogram performed today, as I had requested. It was gratifying to see the significant
improvement in contractility of the left ventricle and the ejection fraction of 30-35.
On this basis, I stated that I believed the heart was "stunned" or in "hibernation" rather than severely damaged.
I stated that this was a good prognostic sign and that a bypass operation should be done and that he would get a good result.
Chasov, Ackturin, and the entire medical team responded buoyantly. There was a striking change in the entire medical personnel
from a gloomy attitude to a much happier atmosphere.
I was then asked if I would like to examine President Yeltsin; I stated that I would, and was then taken to Mr. Yeltsin's
quarters. He was standing awaiting my entrance into his room and greeted me warmly with a smile and handshake and a 'thank
you' (Sapceba). He told me he felt fine, had no symptoms except some sense of weakness or fatigue. he looked good with
well-groomed hair wearing slippers and a sweater. This was in sharp contrast to the picture and television appearance which
I had seen in which he looked weary and haggard. I then performed a physical examination. There were no bruits over the carotid
arteries (a Doppler previously done showed no stenosis). His heart sounds were regular (sinus) and normal. There were no rales
and breath sounds were good. The abdomen was soft with no organomegely. The liver did not extend below the costal margin.
Femoral and pedal pulses were normal.
I then returned to the office and meeting room of his medical team and gave them my report and recommendations as follows:
1. That he needs a coronary bypass operation with at least 3 and probably 4 bypasses.
2. That the operation should be postponed for about 6 weeks for the following reasons:
a. He is clinically and cardiologically stable and asymptomatic so there is no immediate urgency.
b. His echocardiogram showed marked improvement in myocardial contractility in the past month indicating a probable "stunning"
or "hibernation" effect with further improvement with a little more time.
c. There is need to determine the cause of the significant blood loss which will require further hematological studies.
d. There is need to stabilize the thyroid function. He has been started on Thyroxin.
e. He should be put on a well-organized and structured rehabilitation and dietary program (his cholesterol is twice normal)
to improve his general condition and muscular tone.
They asked me to write my report and recommendations, which I did by dictating to Dr. Sergei Iona, who translated into Russian,
and then I signed the report.
The medical team enthusiastically endorsed my recommendations and asked me to give them directly to President Yeltsin. We
then returned to his room and I sat down with him and gave him my recommendations. He told me he was ready for the operation
and looked forward to having it done so he could get back to his duties. He certainly reflected a very healthy attitude --
There was no evidence of depression. He then asked me if he could spend a few hours a day at his Kremlin office. I told him
I would not recommend leaving his hospital quarters, but there was no reason for him not to carry on some business from his
room and see official visitors a few hours a day. It was important however for him to be closely monitored by his physicians
and to carry out the cardiac rehabilitation program.
I then met his daughter, Tatyana, who, after giving her my report, was most gracious and thanked me warmly.
As I was leaving, Mr. Yeltsin asked me to express his grateful appreciation to President Clinton. In this connection I was
able a little later to reach Ambassador Pickering by phone and gave him my report and Mr. Yeltsin's expression of gratitude
to President Clinton as well as mine. Mr. Pickering expressed his appreciation for my services and thanked me. He said he
would transmit my report to President Clinton and then gave me a list of telephone numbers where I could always reach him:
709 5246 5056
and the following number at the White House: Steven Pifer 202 - 456 - 9161.
The change in the rather gloomy atmosphere that prevailed among the medical team to one of buoyant joy became increasingly
evident after I gave my report. They invited me to join them at a table, which was quickly prepared with food and drinks,
and we had the usual toasts of friendship and grateful appreciation and wishing President Yeltsin a good recovery.
I was then told that President Yeltsin requested that I hold a press conference at 4 pm namely for the Russian journalists
but when I arrived at the place for the conference there were about 50 press and television people representing the international
news media waiting in the street saying they were not invited. I then asked the Kremlin officer in charge of the press conference
to allow them to come in. He complied but because of the size of the room, many were left out in the street, and I told them
I would meet with them after I finished with the group in the building which I did. I thought it went off very well particularly
since I gave a very hopeful report and corrected some of the misleading and depressing speculative reports that had been circulating.
Later I discussed with Chasov, Ackturin, and Prof. Mironov that I would be responsible for providing back-up support at the
time of the operation with a ventricular assist device. I suggested that Ackturin and his anesthesiologist come to the Methodist
Hospital for a short period of observation and training with George Noon and our team for this purpose.
In the evening I attended a special dinner hosted by Prime Minister Chernomyrdin at a special new building constructed by
the Gasprom firm. It is a beautiful building with tasteful decor, guest rooms, office space, and a health spa. Chasov and
Ackturin and his wife were also present. I gave the Prime Minister my report on President Yeltsin and he thanked me heartily.
After dinner he gave me some presents including 2 beautiful engraved saber knives, 2 paintings of a typical Russian pastoral
scene, and some amber beads for Katrin.
Thursday, September 26, 1996
I spent most of this day giving interviews first with CNN, then with ABC, then NBC, and then CBS. In addition I gave an interview
with Associated Press. They all ask the same questions and seem to have difficulty believing that President Yeltsin has not
had a stroke and that his liver and kidneys are normal. There were so many rumors and discouraging reports about his health
that they had difficulty accepting my report that seemed so optimistic.
I was informed by Chasov and some other members of the Russian team of physicians that the "opposition" to the Yeltsin
regime was not happy with my report, which appeared on the Russian television and newspapers and which I gave to the Russian
Journalist at the press conference yesterday. It now became evident to me that President Yeltsin's request that I hold
the press conference was a smart political move to blunt the clamoring efforts of his opposition for his resignation because
of his illness.
In the evening we had dinner with Chasov at a beautiful restaurant with entertainment which included a gypsy singing and musical
group. There was a girl playing the violin with great dexterity and technical excellence. A second group presented a dancing
group similar to the Can Can with such skimpy costumes that would never have been allowed by the former communist regime.
Friday, September 27, 1996
I spent the morning making a special tour of the Kremlin Palace and President residence. They were both lavishly appointed.
The palace reminded me of the Versailles. The President's building was more modem and tastefully done with all modern
I was then invited to the Sanitarium Hospital for lunch with Prof. Mironov and the President's medical team. They received
me with warm hospitality and expressed their sentiments with numerous toasts. They also gave me some gifts.
I was then taken to the airport where I met CNN, The Wall Street Journal, and CBC and again was interviewed.