The Soviet Doctor Who Cut Out His Own Appendix

"This is it… I have to think through the only possible way out - to operate on myself… It's almost impossible… but I can't just fold my arms and give up..."

In 1961, Leonid Rogozov (14 March 1934 – 21 September 2000), the only doctor stationed at the Soviet Antarctic station on the Sixth Soviet Antarctic Expedition, removed his own appendix during an emergency operation.

 

Leonid Rogozov appendix

 

We know what happened because Dr Rogozov wrote about his ordeal. He was awarded the Order of the Red Banner of Labour, which honoured great deeds and services to the Soviet state and society. But more than national pride. Leonid Rogozov’s derring-do, skill and courage are testament to the will to live.

His auto-appendectomy was heroic. As he wrote in his diary:

“It seems that I have appendicitis. I am keeping quiet about it, even smiling. Why frighten my friends? Who could be of help? A polar explorer’s only encounter with medicine is likely to have been in a dentist’s chair…

“I did not sleep at all last night. It hurts like the devil! A snow storm whipping through my soul, wailing like 100 jackals…

“Still no obvious symptoms that perforation is imminent, but an oppressive feeling of foreboding hangs over me… This is it… I have to think through the only possible way out – to operate on myself… It’s almost impossible… but I can’t just fold my arms and give up…

“I’ve never felt so awful in my entire life. The building is shaking like a small toy in the storm. The guys have found out. They keep coming by to calm me down. And I’m upset with myself – I’ve spoiled everyone’s holiday. Tomorrow is May Day. And now everyone’s running around, preparing the autoclave. We have to sterilise the bedding, because we’re going to operate…

“I’m getting worse. I’ve told the guys. Now they’ll start taking everything we don’t need out of the room…

“My poor assistants! At the last minute I looked over at them. They stood there in their surgical whites, whiter than white themselves. I was scared too. But when I picked up the needle with the novocaine and gave myself the first injection, somehow I automatically switched into operating mode, and from that point on I didn’t notice anything else.

“The bleeding is quite heavy, but I take my time… Opening the peritoneum, I injured the blind gut and had to sew it up… I grow weaker and weaker, my head starts to spin. Every four to five minutes I rest for 20 – 25 seconds.

“Finally here it is, the cursed appendage! With horror I notice the dark stain at its base. That means just a day longer and it would have burst… My heart seized up and noticeably slowed, my hands felt like rubber. Well, I thought, it’s going to end badly and all that was left was removing the appendix.”

 

Leonid Rogozov

 

What happened is also detailed in the publication Rogozov KI: Self-operation. Soviet Antarctic Expedition Information Bulletin 4:233, 1964. In his own words, Leonid Rogozov wrote:

On the morning of April 29, 1961, I did not feel well. The symptoms notices were weakness, general malaise and, later, nausea. Within a few hours, pain arose in the upper portion of the abdomen, which soon shifted to the right lower quadrant. Body temperature rose to 37.4°C. It was clearly a case of appendicitis.

Every possible measure was taken for conservative resolution, i.e., without surgical intervention, but to no avail; the inflammatory process continued to progress. On April 30, signs of possible perforation of the appendix and localised peritonitis were present: body temperature increased markedly, vomiting became more frequent and the general condition worsened. There was no possibility of obtaining medical help from Mirny in time, as Mirny is approximately 1,000 km from Novolazararevskaya Station. Though there are foreign stations nearer, none of them had an airplane, and a blizzard ruled out a flight in any case. By evening of April 30, the patient’s condition was worse, and there were signs of the development of pyoappendicitis. And immediate operation was necessary to save the patient’s life. The only solution was to operate on myself.

Preparations for the operation where begun. My co-workers at the station got the room ready while I involved a plan of operation. Since the necessary equipment and surgical instruments were stored outside at negative temperature, the resterilisation was considerably facilitated. Aerologists F.F. Kabot an R.N. Pyzhov were in charge of sterilisation. A sterile solution of novocaine for local anestesia had already been prepared. Meteorologist A N Artem’yev and driver ZM Teplinskiy were asked to assist in the operation. It was decided that A N Artem’yev would hold the retractors well ZM Teplinskiy would use a mirror for visualisation of areas not directly visible in the operative field. The ‘assistants’ were briefly instructed improper behaviour during the operation. In the event that the patient lost consciousness they were instructed to inject the drugs in the syringes I had prepared and to administer artificial respiration.

The position of the patient at operation was designed to make it possible for him to perform the operation with minimal use of the mirror . A semi-reclining position with the body half-turned and to the left was selected, so that weight rested on the left hip, and the lower half of the body was elevated to an angle of 30°.

After the physician and assistant Artem’yev scrubbed, the latter put on a sterile gown and gloves. The table with the operating equipment and instruments was moved next to the patient’s bad. Then the operative field (abdomen) was prepared and I took the position described above.

At 22 hours Moscow time, April 30, the abdominal wall was anaesthetised with 0.5% Novocain solution; at 22 hours 15 minutes, a typical 10 to 12 cm incision was made. The mirror was used while the peritoneum was being exposed, when it was sutured, and for detection of the vermiform appendix; i.e. when particular precision and accuracy were necessary since the bottom of the wound was very difficult to see. Otherwise, the body position chosen was very satisfactory. It was frequently necessary to raise my head in order to see better, and sometimes I had to work entirely by feel. General weakness became severe after 30 to 40 minutes and vertigo developed so that short pauses for a rest were necessary. After resection and of the severely diseased vermiform appendix (a 2×2 cm perforation was found at its base), antibiotics were introduced into the peritoneal cavity and the wound was tightly sutured. The operation was completed at midnight, April 30.

Postoperative condition were moderately poor. After four days the excretory function was normal and signs of localised peritonitis had disappeared. The temperature was normal after five days, and after seven days the stitches were removed. The wound was completely healed. The assistants conducted themselves well during the operation and showed stamina and presence of mind. It was particularly difficult for A N Artem’yev as he was forced to kneel throughout the operation. Excellent post-operative care was organised for me. Within two weeks I was able to carry out my normal duties, and I could even do heavy work after a month.

Received June 6, 1962.

More than a year later Leonid Rogozov and his colleagues left Antarctica, and on 29 May 1962 their ship docked at Leningrad harbour. The next day Rogozov returned to his work at the clinic. He worked and taught in the Department of General Surgery of the First Leningrad Medical Institute. He never returned to the Antarctic and died in St Petersburg.

 

Via: Sheffield University, BBC Witness