HOW 5 BOSTON DOCTORS TEAMED UP TO SAVE A LIFE
PHYSICIANS ACTED QUICKLY TO REVIVE SOVIET JOURNALIST IN OSLO

Author: By David Warsh, Globe Staff

Date: Wednesday, December 11, 1985
Page: 25
Section: NATIONAL/FOREIGN

Within seconds, an impromptu team of five Boston doctors was formed and, aided by a prominent Soviet physician, saved the victim's life.

"They said I was in charge, so I guess I was in charge," said Dr. James Muller, assistant director of the cardiac care unit at Brigham and Women's Hospital. Muller took over the task of coordinating the rescue effort as the Soviet television cameraman lay on the carpeted hotel floor. He later prevailed over a Norwegian ambulance doctor who wanted to leave Novikov for dead.

But the presence of two emergency experts in particular - Dr. Marcia Goldberg, a resident in internal medicine at Massachusetts General Hospital, and Dr. Jennifer Leaning, director of emergency services at the Harvard Community Health Plan's Cambridge center - may have made the difference. They pulled Novikov from the sofa where he had slumped and set in motion the procedures that eventually saved him.

"This may be the most completely recorded code (slang for an emergency involving a team of doctors) in history," said Dr. John Pastore, director of the cardiac laboratory at St. Elizabeth's Hospital and an associate professor at Tufts Medical School, who was one of the five US doctors who worked on Novikov.

"It was an amazing piece of work," said Leaning, who first hopped on a chair to see, then elbowed her way across the room to join in the effort.

"There were ironies here that you wouldn't have thought of if you were a Hollywood writer," Muller said.

The drama began about a half hour into a combative press conference at which reporters pressed two Nobel Peace Prize recipients, Dr. Bernard Lown and Dr. Yevgeni Chazov, on what critics call their indifference to the plight of dissidents in the Soviet Union.

Suddenly Novikov, who had suffered two previous heart attacks, slumped in his seat, his face twitching with convulsions. "I was sitting next to him," Goldberg recalled. "I grabbed him, got him to the floor and opened his shirt."

"Marcia said something to me," said Peter Zheutlin, press officer for the International Physicians for the Prevention of Nuclear War, the organization that was awarded the Nobel prize. "I shouted to Dr. Lown, and that was enough to stop the press conference." Moments later, Zheutlin was dashing for Goldberg's room in search of a stethoscope.

Many of those present thought that the disruption was the result of a fistfight in the charged atmosphere - or worse. "I didn't hear a shot," said Muller. "I thought at first perhaps a knife."

"My first thought was to hit him - to thump his chest," said Pastore, who was sitting nearby. He hit Novikov hard on the chest once, in an effort to change the heart's rhythm. Then he began a rhythmic pumping of the chest, a task in which many doctors, including Chazov, then took turns.

At one point, even psychiatrist Eric Chivian, a cofounder of the physicians' group, was pressed into chest massage duty. "We like to use the psychiatrists for the heavy physical tasks," Pastore joked yesterday.

Within minutes, it was clear that Novikov was indeed a victim of a cardiac arrest; ventricular fibrillation was later diagnosed. Pastore and Dr. Sydney Alexander, chief of cardiology at the Lahey Clinic, searched for a pulse in Novikov's femoral arteries. There was none.

Muller gave him mouth-to-mouth resuscitation; emergency equipment was on the way from the SAS Skandanavia hotel in downtown Oslo. Leaning inserted an endotrachial tube to force air into Novikov's lungs.

Oxygen arrived, and with it a Norwegian physician. Next came a defibrillator machine, designed to shock the heart into resuming a normal rhythm. Lown - who 20 years before had invented the device - leaned forward and said to Muller, "Don't waste time. The defibrillator is here. Shock him." Lown, who paced back and forth as the rescue operation proceeded, wept when it ended, thinking Novikov had died.

When the ambulance arrived - it took 10 or 15 minutes, according to press aide Zheutlin, "though it seemed to take forever" - the Norwegian anesthesiologist accompanying it had to push through crowds, past television crews and reporters.

But then a new conflict developed. After one shock Novikov appeared dead - he had no pulse - and the Norwegian doctor shrugged. Muller shouted, "You just can't stop."

"We don't take them to the hospital if they're dead," the Norwegian replied.

"What we had was a power struggle then, the most intense of several," Muller recalled. "The Norwegian was very, very angry."

Quickly, doctors applied a second shock, and the cameraman was put on a stretcher and wheeled off. Muller and the Norwegian doctor accompanied him. Once in the ambulance, the patient was hooked up to a monitor, which showed that his pulse was back, his heart beat regular.

Muller, who visited Novikov yesterday, said he thought he would survive. And when Chazov visited, the patient recognized him and spoke.

In the end, what witnesses made of the incident depended on where they stood. Lown saw it as a metaphor for his group's response to the controversy that has dogged this year's peace prize. "It is the same with the threat of nuclear war. You treat it first and ask questions afterwards," he said.

But a Russian expatriate attending the press conference was reported by his colleagues in the press to have openly speculated that the Soviets staged the heart attack because the questions were getting too tough.

To Leaning it was just good medicine. "Everyone knew exactly what to do," she said.

MARINE;12/10,11:36 NKELLY;12/11,13:18 RESCUE11