Autoposy in Korosten

Nine years ago I witnessed the autopsy of a infant in Korosten, a small town in the Zhytomer province, about 150 kilometers southwest of Chernobyl. Today, her story and the story of the many children who are still dying from the consequences of the nuclear tragedy in the former USSR, comes back to haunt me. I just can't believe that, twenty years after Chernobyl, hundreds of Americans are being exposed to the same threat that is killing generations in Eastern Europe. This is what I learned.

***

It is October 2000 and I am in a cab going to the regional children’s clinic in Korosten, a northern town in Zhytomyr Province, Ukraine. The guy who is driving my translator, Olena and I seems both baffled and intrigued by my destination. He just isn’t able to find a reasonable motivation for somebody wanting to go there. Bu I do have my reasons.

In April 1986, about 150 kilometers away, technicians at the Chernobyl nuclear power-plant began an experiment that would spiral out of control into an explosion releasing a cloud of radioactivity into the atmosphere. It is, according to the United Nations, “the greatest environmental catastrophe in the history of humanity.” Now I am there, about to spend nearly a month traveling with representatives of various Ukrainian and international health organizations, recording my impressions for New Mass Media’s chain of weekly alternative papers in New York and Connecticut. Much of my work will be published in 2000 as a three-part series called “Culture of Cancer” and it will win the Connecticut Society of Professional Journalists’ first prize for feature writing that year.

A quick look at any population table shows what it almost too incredible to believe: In an era of explosive growth when the number of humans on this planet doubles with increasing speed, Ukraine and Belarus, the two countries surrounding Chernobyl station, are experiencing negative population growth. What I knew by then are even more heartbreaking statistics: A scant 5 per cent of the children born in this area are considered healthy, over 9 million people had been affected directly or indirectly by the accident at Chernobyl and the full effects of this exposure would not be measurable for another 50 years . Still, a recent study published in the Swiss Medical Weekly showed Belarus experiencing a 40 percent increase in cancer between 1990 and 2004 with a 125 percent increase eventually expected. Compared to the year prior to the accident, 1999 saw an increase of 50 percent in breast cancer mortality, 30 percent in prostate cancer in Ukraine proper and by 50-120 percent in all the radioactively polluted areas. Infant mortality rates run from 13 to 20 deaths per thousand. A citizen’s life expectancy decreased by 4.9 years for men and by 2 years for women between 1990-1999.

Indeed, children of these countries are showing long-term damage associated with radioactivity. They have elevated rates of soft-tissue cancers (leukemia, thyroid cancer and tumors) and birth defects (limb deformities, spinabifida and cleft palettes) up to 100 times what is considered the norm. Later this day, I will witness an autopsy that will dramatically exemplify these facts.

***

The taxi driver says there is nothing to do or see in Korosten. The city isn’t even important enough to warrant a description in my Lonely Planet guidebook of Ukraine and Belarus where it is merely a dot on a map and listed as officially outside the “affected zone” surrounding Chernobyl. But when we explain him that we are touring the country looking for evidence of the effects Chernobyl’s contamination has had on Ukraine over the past fifteen years, he says, emphatically, “Then this is the perfect place to visit.”

Even though we are miles away from the Exclusion Zone around the nuclear power plant, the effects of long-term exposure to are evident throughout the province. The dosimeter we carry reads hot, sometimes ten times what is considered normal background radiation, and especially so in a graveyard we visit, the numbers climbing as we approach the bodies under the earth and their accumulations of radiation.

When we arrive at the clinic in Korosten, the Chief Doctor is apologetic. He is bone-tired from the long hours he’s been working lately and he has just lost a patient, an infant girl, the day before. It shows in his eyes, the exhaustion and the loss and he is sorry that his time with us will be limited, but he has to help perform the autopsy on that dead child to determine what killed her.

“Infection is a big problem,” whispers Olena.

The hospital needs everything, the doctor tells us, starting with decent food for the patients and enough fuel to keep the wards warm. Weary yet soft-spoken, he tells us how frustrating it is for him to be so handicapped. He often shrugs and rolls his eyes.

“This Zhytomyr,” he says.

I’d heard that phrase spoken in that way before and I’d seen that gesture used as an explanation, apology or epithet, as if the name of the province itself is somehow ill-fated; cursed by God and man and nature and the radioactive poison from the world’s worst nuclear disaster. Here, famine and war and now radioactive poison roll easily across the landscape. For Ukrainians, just the name conjures an image of suffering. This Zhytomyr, indeed.

***

Children are dying from the lack of even the simplest antibiotics. The only thing the hospital’s staff is able to do is wash everything with great lashings of chlorine bleach until the place smells like a swimming pool.

Using triage techniques as they do in disaster-swamped emergency rooms or combat surgery units, the hospital staff evaluates each child that arrived. There just aren’t any resources available to provide much more than simple first aid. The easiest cases, the broken bones and the dehydration, are treated and released back into their parents’ care armed with state-issued brochures describing cleanliness and food pyramids. The cases for which there is some hope might be sent to the regional hospital in Zhytomyr. The hopeless cases are placed in the wards, surrounded by icons and Orthodox crosses and the odor of bleach. Anxious mothers in the waiting room peer at us as we pass, as though they think we may have brought a miracle.

The doctor is apologetic because his time is limited, but especially because he seem to feel guilty of the devastation around him. He acts as if he are responsible for the 100 percent increase in leukemia and cancer, the 250 percent increase in congenital birth defects, the 2400 percent increase in thyroid cancer, the 1000 percent increase in suicide within the affected are a and the condition called “Chernobyl AIDS,” a severe comprising of the body’s immune system that allows a host of opportunistic diseases access to the infected .

The girl, dead since the day before, had been prepare d for an autopsy and he is due to attend and assist. The parents of the baby, a young couple from a small village and the pathologist are there too. I look at Olena and she knew what I would next ask.

“May we be allowed to attend this autopsy?” I ask and Olena translates.

“Of course,” replies the doctor.

***

We wait for the pathologist and ponder what we are doing. Neither of us planned to witness the dissection of a human that day, but for disparate reasons, we both feel compelled to explore this opportunity.

There I am, in Zhytomyr, to look closely into the dark places where genetic damage, disease and disinterest strangle the potential of a six-week old child.

Her parents wait together near an ancient blue automobile of Soviet manufacture. They do not speak; the mother stare s at the ground between her feet and the father smokes. They are young, surely not more than 25 and probably around ten years old when the reactor at Chernobyl threw its invisible poison over their homes. Perhaps they had prepared for May Day in their schools, made banners and practiced songs to celebrate the legacy of Communism and Lenin and the grand Soviet Union. They probably never imagined they would be waiting, almost fifteen years later, outside a cowshed to learn what killed their baby.

***

We are invited to enter the morgue and immediately the smell of formalin, a sweet, cloying and distinctly chemical perfume, surrounds us. It permeates our clothing. (Later that evening, back in the city of Zhytomyr, our dinner companions would remark upon the odor.) In that dim entryway, I could see through a tall door into the examination room. On one table, an adult body waits under a stiff canvas shroud. On the far table, touched by a beam of autumn sunlight, is the infant’s body, waxen and waiting. A thin cord nearly lost in the folds of her throat carries a crucifix that rests beside her body on the steel table.

The attending nurse, the doctor and the pathologist discusses the case in murmurs. Olena and I circle the cold metal table as we try to hide our nervousness. We are reluctant to betray how difficult it would be to watch these medical men skin and gut this doll-like creature.
I wonder if this is the smartest thing I could have chosen to do that morning. It is, however, far too late to ask that question. The procedure is beginning and, just as there is no crying in baseball, there is no passing out or vomiting allowed in Ukrainian cowshed morgues.
But first, the pathologist stood to face me, a foot-long knife in his hand. He spoke in Latin.
I try to smile and rack my already disheveled mind for a memory of the Latin classes I took when I is 17-years old. All I could remember is “sic semper tyrannus” and the declination for “amo.” I continue to smile.

“What kind of doctor is this?” the pathologist asks the room, switching to Ukrainian.

Immediately, I am demoted.

“He is a journalist,” answers Olena. “A medical journalist.”

The pathologist ponders this for a moment. He seems unconvinced but did not carry the question further. He began to cut.

“This is the place,” he says, “where the dead may speak to the living.” I wonder whether he heard that at a seminar, read it in a book or heard it on a television show. I know I had. But it is a dramatic thing to say at that particular moment and it certainly stuck in our minds.

***

The skin across the child’s chest is thin, paper thin and covering an only slightly thicker layer of fat that rustles as the pathologist peels it away. We could see that the ribs are not even bones yet, just slips of cartilage that yields easily to the shears he uses to cut a deep triangle from clavicle to diaphragm, a wedge of meat and gristle that opens to expose the lungs.

“Atrophy,” he says. “Atrophy and anemia,” he added. “These [lungs] should be bright red everywhere and, see here, at the bottom, they are dark and gray.” And, indeed, the spongy mass of tissue is dull gray below the esophagus. This child struggled for the few breaths she had been able to take.

Beneath her lungs, now removed and spread upon the table, her heart seems enlarged, choked within the sac surrounding it and stuffed into the tiny chest.

“This heart is swollen, enlarged,” says the pathologist.

By that time, our shock at seeing this child so displayed has lessened and we begin to lean in toward the table to follow the pathologist’s knife as he points to features of the organs. I take photographs. He snips small bits of tissue from the liver, the kidneys, for later testing and analysis.

“What causes these symptoms?” I ask the doctor. “Are these common problems?”

“The cause?” he answers. “Poor diet, poor hygiene. Maybe the mother had an infection during the fetus’ development. Maybe something happened when the child is in the womb."

I ask if these findings are common.

“Too common” is the answer I get.

I learn later, thanks to the extensive research done by UN Health Authorities, that heart and circulatory disorders among the population of the zone we are visiting increased 25 percent from 1986 to 2000; digestive system disorders increased by 28 percent; genito-urniary system disorders by 39 percent; nervous and sensory organ disorders by 43 percent; blood and circulatory illnesses by 43 percent; bone, muscle and connective tissue diseases by 62 percent; malignant tumors by 38 percent. Even more important, the relationship between mother and child while in uterus has been severely compromised by the Chernobyl accident. Changes in hormonal status lead to longer gestation and complications with birth. Problems in after-birth development of children are still being found. And I asked if these problems are “common.”

The pathologist rummages through the child’s abdomen, eventually lifting all the organs out to spread them across the table. Kidneys, intestines, bowels, stomach, liver and pancreas--they all show the same signs. Her organs seem glassy and fragile, crumbling under the pathologist’s most delicate touch; unused yet useless.

The doctor stared at the empty cavity into what is once a living child. Her spine is visible, though from a new angle, a straight line of corrugation down the interior of her body. The nurse began to cut and care fully peel the child’s scalp; bringing it down to expose the skull and to cover her eyes, her nose, her mouth. It is a blinding mask created from her own skin.

“The background radiation decreases the effectiveness of all the immune systems,” the Doctor explained. “Combined with poor nutrition, both the mother and the child are open to all sorts of infection, to virus and bacteria that normally would not be any trouble. The constant exposures to these low levels of radiation, levels of radiation that are called safe levels, leave the fetus and the infant and the child vulnerable to damage. So, even if this child’s cause of death is another infection, the causes of the infection are the economic conditions of the country. And, needless to say, the radiation.”

“How many children are affected this way?” I ask and Olena explains, delicately, about families evicted by the government and relocated far away from their former homes in the area now fenced off and forbidden, whole cities, towns and villages scattered throughout the larger Soviet population, perhaps 50 to a 100 thousand salted across the country. This not only removed them from continued exposure to radiation, it also diluted their impact on health statistics throughout the Soviet Union. Olena describes the official system of double-entry record keeping. She explains how infections and birth defects and congenital cardiovascular problems and spinabifida could be symptoms of any number of environmental and industrial influences, of poor diet and harsh climate. Ukraine’s lack of technology used to determine such things, she explained, is coupled with an ethnic Ukrainian fatalism, a gloomy artistic soul that shrugs to accept dwindling birthrates, increased miscarriages and stillbirths and increased infant mortality.

[I had seen the note-card files myself in the capital city’s main hospital and I had heard the official statistician answer my same question. “Who knows?” he’d answered while gesturing at a wall lined with long drawers all filled with handwritten 3x5 cards documenting each case, each child admitted for treatment. “How can anyone ever know?”]

The pathologist prepares to open the girl's skull and finds it difficult. What would normally be a soft cranium is hard; what would normally be large ribbons of cartilage are only thin lines of white connecting the plates of hardened bone.

"Most unusual," says the pathologist as he tries first one knife and then another and then another in his attempt to pierce her tiny head. It is awkward for a moment as he attempts to hold the body still and apply the force necessary to open her skull. The nurse holds the infant's legs to keep them from disturbing and undignified flopping.

Finally, the pathologist makes a hole large enough to insert his shears, the same shears he used to open her chest, and snips along the thin, soft lines between the plates of skull bone. As he opens the four quarters of her skull, a grim flower blossoming, the delicate crunch causes us all to fight against our instinct to flinch. We are , after all, professionals.

The nurse spreads a faded yellow towel with a print of small blue teddy bears across the table and the pathologist pulls the mass of the child's brain out.

"It is swollen," he says as he begins to probe and separate the jellied mass across the towel.

"Nothing wrong here except it is too large."

We all peer closely as he divides and re-divides her brain, takes a tissue sample, spreads the beige forms and convolutions wider and deeper. As he reaches its base, close to the brain stem, he finds what he is seeking. A strip of leathery, hard material in what should be soft, gelatinous tissue tells the story, provides an end to this examination.

"Toxic plasmosis," the pathologist declare s. "An infection from an animal, from another species, most likely a cat."

He cuts more samples and transfers them to the specimen bottles.

"Plus, the mother had herpes," adds the doctor.

I am stunned. Herpes is an affliction I associate with disco-dancing and porn stars, certainly not the pale, drained waif outside, that simple country-girl from the Ukrainian wheat fields into whose daughter’s guts I am looking.

"Herpes?" I ask.

"Oh, yes," he says. "It's a big problem here."

The pathologist removes his gloves and puts down the tools he has used to ferret out this mystery.

"Herpes?" I ask again.

"She also had chlamydia," he tells me.

"Chlamydia? Also?"

Olena moves to my side.

“These diseases come from the doctor,” she tells me. “They cannot sterilize their instruments properly or they reuse instruments meant to be for one-time use. Many women bring their own specula to their examinations. That way they know it’s clean.”

I take a few last photographs of the child’s empty shell, while the nurse begins to gather organs and what is left of the brain into a tidy bundle. We remove ourselves from the building. But the odor of formalin clung to our clothing for the rest of the day.

The pathologist and the doctor step down the walkway to speak with the parents, to tell them the preliminary results from their daughter's autopsy before they began their work on the tissue samples they'd taken from her. They explained about the infections, about the atrophy and anemia, about the toxic plasmosis, about the swollen brain and the enlarged heart. They all stood close together, the young parents and the young owner of the ancient car and the weary doctors; a tight circle of dull pain next to the rusting Muscovitch automobile.

"This Zhytomyr," I hear the doctor tell them as he rolls his eyes and shrugs.



Variations of this piece have appeared in The Fairfield County Weekly, Bridgeport, Connecticut, and online at Orato.com.