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‘We saved his life’ The Russian doctors who treated Navalny on his diagnosis, the decision to send him abroad, and more

Source: Meduza

On the morning of August 22, Russian opposition politician Alexey Navalny was medevaced to the Charité Hospital in Berlin. Prior to that, he spent 44 hours at an emergency hospital in the Siberian City of Omsk, after becoming violently ill on board a flight from Tomsk to Moscow. Navalny’s family members and coworkers immediately assumed he had been poisoned, and suspected the doctors in Omsk of trying to cover it up — particularly, due to the fact that people who appeared to be plain clothes officers showed up at the hospital, and doctors spent more than 24 hours refusing to release Navalny for transport to Germany for further treatment. On Monday, August 24, the hospital’s chief physician, Alexander Murakhovsky, and his deputy in the medical department, Anatoly Kalinichenko, held a press conference. Here’s how they answered journalists’ questions about Navalny’s condition, his diagnosis, the decision to move him, and the men in plain clothes. 

Update: Later in the day on Monday, doctors at the Charité Hospital in Berlin released a statement confirming clinical evidence pointing to the fact that Navalny was poisoned with a “cholinesterase inhibitor” — a chemical often found in pesticides and nerve agents. In response, health officials in Omsk insisted that Navalny had tested negative for a wide range of synthetic substances, including inhibitors.

On Navalny’s condition

Alexander Murakhovsky: Navalny came to us in a coma. We saved his life with great effort. We made every effort to stabilize his condition, because his relatives wanted to move him to another clinic. We released [him] for transport as soon as [he] stabilized.

Anatoly Kalinichenko: We received the signal that they were bringing a seriously-ill patient, he was taken off the plane, the preliminary diagnosis was a coma [of uncertain origin]. The doctors worked as quickly as possible, immediately [conducting] diagnostics and treatment, as well as intensive care, including resuscitation.

On Navalny’s diagnosis and suspected poisoning

Kalinichenko: What’s a coma of uncertain origin? [When] a person arrives unconscious, but without external damage. Such a coma [has] a panel of several dozen diagnoses that can explain this condition. We save the person and simultaneously eliminate a lot of diagnoses. We arrived at certain diagnoses and certain treatment protocols, which made it possible to stabilize Navalny. But we didn’t make a final diagnosis and transferred the patient.

“Poisoning” was one of the first diagnoses. He was in an ambulance, so the patient was taken to the toxicology department. The diagnosis remained with us until the end of the first day, since we hadn’t yet received the responses from the two laboratories — [in] Moscow and Tomsk — about the fact that they didn’t identify any chemical and toxicological substances that could be regarded as poisons, or products that act like poisons. [After that] we moved away from the “poisoning” diagnosis 

On evacuating Navalny to Germany

Kalinichenko: The need for transportation was, in our opinion, doubtful. According to our rules, the attending physician makes the decision on transport and takes responsibility for the patient making it. How can we pressure a doctor just because of the hype? But we took into account his relatives’ wishes. When the plane from Germany arrived in Omsk on the morning of August 21, I went to them personally and invited them to our hospital. They examined Navalny, examined the medications (they had to make sure they had the same ones), and determined that the patient was transportable.

Along with our Moscow colleagues, we came to the conclusion that although there were positive dynamics, the patient’s condition was unstable up until recently (we fought for his life every minute for about a day and a half). We decided we would wait a little longer, if there wasn’t any further deterioration, we would return to the question of transportation. At around 6:00 p.m., on August 21, the German doctors came to the hospital, and during the final consultation at 8:30 p.m., we came to the conclusion that transport was possible. Around 11:00 p.m., I told my German colleagues that we were ready. But they replied that departure would be at 8:00 a.m. the next day. As I understand it, this was the pilots’ decision.

On talking to journalists

Kalinichenko: We treated Navalny the same as we would treat any other patient. But we understood that because of his socio-political status we would receive increased attention. We decided that we wouldn’t cut ourselves off from communication. But our opportunities to inform were limited by the law. In this situation neither public interest, nor the permission of relatives to disclose information are enough for us. 

On talking to Navalny’s relatives

Kalinichenko: We updated them about the results of the treatment and they were taken to the patient’s ward. At first, communication with Navalny’s relatives was more strenuous for us than usual. But I think that once they understood that we doctors are doing everything possible and [doing it] successfully, the tension subsided.

Murakhovsky: I met with Navalny’s wife in my office five times. There were doctors at these meetings, including [ones] from Moscow. We agreed that we would tell the relatives more than I explained at the press-conferences — simply out of human impulse. They promised that they wouldn’t disclose this information. 

On public pressure and threats

Kalinichenko: I escorted Navalny to the airport, finished up work, and returned home during the evening of August 22, I went on the Internet — and was amazed at the storm of negativity. Even well-known doctors, without access to information, allowed themselves [to make] comments about the fact that the diagnosis was wrong, the treatment was wrong, about not showing the test results (even though they know that we aren’t legally allowed to do this). Nevertheless, we received much more support from the medical community than negativity. 

We gave the doctors in intensive care the opportunity to assist Navalny without any distractions. But work at the hospital itself was difficult: crowds of people on the property, snapshots of patients who are being brought in by ambulance — it was rather unpleasant. As an active social media user, I received dozens of physical threats against me, my wife, and my children. But of course this didn’t affect anything in terms of the patient’s treatment.

Murakhovsky: No one threatened me personally. But there were many calls to the [front desk] — maybe a thousand, maybe more.

On the people in plain clothes and their influence on the doctors

Murakhovsky: I can’t say who these people in plain clothes were. There were a lot [of people] in my office, but I can’t say who was there doing what. They came, [asked], “Is everything okay?” — “It’s normal.” They left. They were enquiring, that’s all. 

There couldn’t be any influence on the patient’s treatment, a priori. All decisions were made during consultations attended by between seven and ten doctors from different institutions, including three from Moscow. Everything was collegial, everything was formalized, everything was signed.

Kalinichenko: There wasn’t a single diagnosis, or a single line of testing that I agreed upon with anyone else.

On why Navalny’s family members weren’t allowed to talk to the German doctors at the hospital

Murakhovsky: I was told about this, but I can say that this is probably an expression of the will of [our] German colleagues. They didn’t want to talk to anyone. They got into a vehicle and left. 

On reports from Omsk health officials about alcohol and caffeine in Navalny’s urine

Kalinichenko: We’re restricted by laws in everything, including this. We found some substances, we took this into account in our work, but we can’t talk about it. Even now, I can neither confirm nor deny that they found alcohol and caffeine in [Navalny’s] urine. The fact that there [can be] alcohol in the urine, but not in the blood is normal, if, for example, the person was drinking alcohol the day before. But we didn’t make any diagnoses such as alcohol poisoning or intoxication.

On the squat toilet at the hospital

Murakhovsky: This toilet is located in the reception area, where a complete reconstruction is underway. 

On Navalny’s condition after he flew to Germany

Murakhovsky: On August 22, I sent the Charité clinic a letter, in which I offered our help if needed. On August 23, I received a reply. They thanked [us] and said that the patient’s condition was stable [but] serious.

Kalinichenko: We can’t give a prognosis on Navalny’s condition, since we [only] monitored him for 44 hours at the hospital. We can’t say what condition he’s in now. We passed all of the test results on to them. I can [only] wish for Alexey’s recovery and return to duty.