By Sara Lentati
BBC World Service 5 May 2

During an expedition to the
Antarctic, Russian surgeon Leonid
Rogozov became seriously ill. He
needed an operation - and as the
only doctor on the team, he
realised he would have to do it
himself.

As the polar winter rolled in, 27-year-old
Leonid Rogozov started to feel tired,
weak and nauseous. Later, a strong pain
developed down the right side of his
abdomen.

"Being a surgeon, he had no difficulty in
diagnosing acute appendicitis," says his
son, Vladislav. "It was a condition he'd
operated on many times, and in the
civilised world it's a routine operation.

But unfortunately he didn't find himself
in the civilised world - instead he was in
the middle of a polar wasteland."
Rogozov was part of the sixth Soviet
Antarctic expedition - a team of 12 had
been sent to build a new base at the
Schirmacher Oasis.

The Novolazarevskaya Station was up
and running by the middle of February
1961, and with their mission complete
the group settled down to see out the
hostile winter months.

Leonid Rogozov (R) relaxing with one
Antarctica's best known inhabitants
But by the end of April, Rogozov's life
was in danger and he had no hope of
outside help. The journey from Russia to
the Antarctic had taken 36 days by sea,
and the ship wouldn't be back for
another year. Flying was impossible
because of the snow and blizzards.

"He was confronted with a very difficult
situation of life and death," says
Vladislav. "He could wait for no help, or
make an attempt to operate on himself."
It was not an easy choice. Rogozov knew
his appendix could burst and if that
happened, it would almost certainly kill
him - and while he considered his
options, his symptoms got worse.

"He had to open his own abdomen to
take his intestines out," says Vladislav.
"He didn't know if that was humanly
possible."

In addition, this was the Cold War, with
East and West competing in nuclear,
space and polar races - the weight of
which rested on both nations and
individuals.

The commander in charge of the
Novolazarevskaya base had to get
Moscow's blessing for the operation to go
ahead. "If my father was to fail and die it
would definitely put a hard hat of
negative publicity on the Soviet
Antarctic programme," says Vladislav.
Rogozov made his decision - he would
perform an auto-appendectomy rather
than die not doing anything.
"I did not sleep at all last night. It hurts
like the devil! A snow storm whipping
through my soul, wailing like 100
jackals," he wrote in his diary.
"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."

Brave heart

Rogozov worked out a detailed plan for how the operation would unfold and assigned his colleagues specific roles and tasks. He nominated two main assistants to hand him instruments, position the lamp, and hold a mirror - he planned to use the reflection to see what he was doing. The station director was also in the room, in case one of the others became faint.
"He was so systematic he even instructed them what to do if he was losing consciousness - how to inject him with adrenalin and perform artificial ventilation," says Vladislav. "I don't think his preparation could have been better."
A general anaesthetic was out of the question. He was able to administer a local anaesthetic to his abdominal wall but once he had cut through, removing the appendix would have to be done without further pain relief, in order to keep his head as clear as possible.
"My poor assistants! At the last minute I looked over at them. They stood there in their surgical whites, whiter than white themselves," Rogozov wrote later. "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."
Rogozov had intended to use a mirror to help him operate but he found its inverted view too much of a hindrance so he ended up working by touch, without gloves.
As he reached the final and hardest part of the operation, he almost lost consciousness. He began to fear he would fail at the final hurdle.
"The bleeding is quite heavy, but I take my time... Opening the peritoneum, I injured the blind gut and had to sew it up," Rogozov wrote. "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."
But he didn't fail. After nearly two hours he had completed the operation, down to the final stitch. Then, before allowing himself to rest, he instructed his assistants how to wash the surgical instruments and only when the room was clean and tidy did Rogozov take some antibiotics and sleeping tablets.
It was a staggering achievement. "Most importantly he was relieved because he had another chance to live," says Vladislav. Rogozov returned to his normal duties just two weeks later.

What if?
"I was a medical student in the early 60s and remember being taught what to do if we found ourselves in the Antarctic with appendicitis. We were told to sit upright with our knees pulled up our chests. Then if the appendix did burst, in this position we had the best chance of pus draining into the bottom of the pelvis and becoming walled off in an abscess, rather than infecting the peritoneum - the membrane that covers the inside of the abdomen. Peritonitis can kill you. We weren't advised to reach for the scalpel." Dr Duncan Gee
There was to be one more twist to this extraordinary story. A spell of exceptionally bad weather and thick sea ice meant the ship due to pick them up in April 1962 couldn't get close enough and the team thought they would have to spend another year in Antarctica. As a surgeon, Rogozov was concerned about losing touch with the medical world, and on a personal level he was trapped in the place where he had the most terrible experience of his life.
In his diary he wrote: "More and more often waves of dull home sickness and hatred of this cursed Antarctica wash over me. How odd it seems that I ever agreed to go on this expedition. All the exoticism of Antarctica was exhausted within a month and in return I'm losing two years of my life. My clinic, which I love more than any worldly pleasure, seems as far from here as Mars."
To the relief of the whole team they were eventually airlifted out, albeit slightly later than planned.
"They had to be evacuated by single- engine planes," says Vladislav. "Very dramatically one of the planes almost dropped into the sea."
Rogozov returned home a national hero. His incredible survival story was a powerful tool for the Soviet propaganda machine. Just 18 days before performing his operation, fellow Russian, Yuri Gagarin, had become the first man in space, and comparisons were drawn between the two men.
"It was a strong parallel because they were both of the same age, 27, they both came from working class backgrounds, and they both achieved something that had not been achieved in human history before. They were prototypes of the ideal national superhero," says Vladislav. Leonid Rogozov in Leningrad (now St Petersburg) a few years after his return to Russia
Rogozov was awarded the Order of the Red Banner of Labour which honoured great deeds and services to the Soviet state and society. His bravery was held up as a symbol to the rest of the world: "Look at this generation of young people that our system has produced - young, handsome, smiling, nice fellows," says Vladislav. "But at the same time made of steel and iron determination."
Rogozov, though, shunned the publicity. The day after he returned home he went back to his hospital and resumed his career.
Appendectomies are now compulsory for Antarctic explorers from several countries such as Australia. And some in the medical profession have suggested the procedure should be given to any future astronauts leaving the Earth to form a colony on Mars or the Moon. Looking back at his father's legacy, Vladislav believes it is one of inspiration. "If you find yourself in a seemingly desperate situation when all the odds are against you. Even if you are in the middle of the most hostile environment, do not give up. Believe in yourself and fight, fight for life." Vladislav Rogozov spoke to Witness on BBC World Service.

Wow!!! Even with the local anaesthesia, he must have been in some amount of pain. A huge risk he took, glad that it paid off.