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I Am A Medical Professional ?

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Are your clinics turning into a three-ring circus? Then you might find some comic relief in reading about the mayhem that ensued when the fictional Professor Preobrazhensky transplanted a pair of human testicles and a pituitary gland into a stray dog.

The dog was nursed back to heath and housed in his waiting room, only to start transforming into a rather foul-mouthed and cat hating human. Needless to say, things did not go terribly well from that point. ‘Heart of a Dog’ has as many layers as the proverbial onion. This novel is certainly full of anti-communist symbolism, which led to a 40-year delay in publication. It also raises intriguing moral questions, but its real appeal to me is as a surreal farce. This is escapist literature at its finest.

While this sounds like a marvellously imaginative premise for a novel, it surely has no foundation in reality? I recently impugned George Hook for his cavalier comments about modern medical ethics, but medical professionals have at times matched the popular stereotypes of the evil scientist.

In the case of this book, it would seem plausible that Bulgakov based his surgeon protagonist on Dr Serge Voronoff. Like Bulgakov’s Philip Philippovich Preobrazhensky, Voronoff dallied at the edges of morality by transplanting bits of monkey testicles into elderly men whose sexual powers were waning. Voronoff, a Russian émigré who plied his trade in France, was not driven into exile for his experiments like the fictional Dr Moreau. Indeed he was lauded for his abilities to breathe new life into ageing bodies.

Voronoff conducted his work unhindered by ethical doubts, worries about immune rejection or the risk of zoonotic infections. As popular as he was in the 1920’s, history has taken a justifiably more circumspect view of his unusual operations. The most extreme revisionist view of Voronoff is that he was responsible for the HIV/AIDS epidemic– a twist that would place him near the top of the list of evil scientists.

A thoughtful analysis of this theory was published in Xenotransplantation in 2012 (admittedly, not one of the journals I regularly peruse) under that headline grabbing title: ‘Voronoff to virion: 1920s testis transplantation and AIDS’. Although he was transplanting chimpanzee tissue, with the theoretical risk of introducing Simian Immunodeficiency Virus (SIV) in to humans, this paper acquits Voronoff of this potentially monstrous crime against humanity on the basis of dates and the source of his animals. Nevertheless, it was a very close brush with infamy.

Testicular xenografts are unlikely to become mainstream anytime soon – the benefits that patients claimed from such treatments are more easily achieved today with testosterone replacement therapy or Viagra. But the grafting of genetically altered pig organs is waiting in the wings and with it the challenges of bringing onside public opinion. With stories of AIDS and monkey testicles only a click away on Google, that might be a harder sell than the hard working researchers imagine.

In ‘Heart of a Dog,’ Sharik (the transplant recipient) slowly takes on the characteristics of the human donor. His fur falls out, he starts to walk upright and begins to talk. He also slowly takes on the criminal persona of the original owner of the pituitary gland and testicles. One wonders if any of Voronoff’s patients started to show similar traits from the original monkey donors. Being of a fanciful nature, I also wonder if such treatments are currently offered to rich Americans in secret New York clinics with discrete, black, un-numbered doors. Are orang-utans endangered as much by unethical surgeons in search of male genitalia as by de-forestation? Might such a procedure help to restore sexual virility to a 70 year-old billionaire at the minor cost of an excess of wispy, orange hair? Who cares about the side effects of an explosive, primitive anger when you are restored to your natural alpha-male status?

This is what starts happening when you read the writings of Bulgakov. You find yourself freed from the mundane logic of life and free to explore whatever bizarre notions your head can muster. His other great masterpiece, ‘The Master And Margarita,’ is even more mentally liberating than ‘Heart of a Dog’. The plot revolves around the Devil, his entourage, Pontius Pilate and a few witches. It also features one of the most enlightened fictional psychiatrists you are ever likely to meet, the wonderfully thoughtful Dr. Stravinksy. In a world that seems to be going crazy, the best cure is a dose of total insanity. ‘The Master And Margarita’ is just that.

I can tell those books that have made a real impact on me by the fact that I can remember where I was when I first read them. I first discovered ‘Heart of a Dog’ in a pile of battered second hand books on a small boat while travelling around the Galapagos Islands seven years ago. Between more typical holiday reading and lots of books in Spanish and Dutch, there was little choice, but it was serendipity at her finest. That setting also gives a neat segue into my next book choice: ‘Galápagos’ by Kurt Vonnegut. It explores what might happen to humanity over the next million years if modern society is completely destroyed in a massive financial and environmental crisis.

I wonder who would be crazy enough to precipitate that?