Life and Death

A talk with Fr. Alexei Timakov, a priest and emergency room doctor

Priest Alexei Timakov is doctor by profession who has worked in both intensive care units and the emergency room for many years. What kind of experience does one have seeing people die and return to life every day? What happens after life? And how should we prepare ourselves for death, or, to be more exact, for eternal and true life? Our talk with Priest Alexei will be precisely on this theme. We will also touch upon the specific nature of the science of resuscitation.

    

Fr. Alexei, can you explain what is the purpose of resuscitation from the medical point of view?

Resuscitation is a complex of measures aimed at returning to life those who are clinically dead. And clinical death is the cessation of blood circulation and breathing, but first of all, of blood circulation.

And why does cessation of blood circulation happen? Does the heart stop beating?

Indeed, sometimes the heart stops—it has contracted but cannot expand. But in most cases the heart still works but it cannot pump the blood any more. If the heart rate is right, it contracts thus: first the atrium and then the ventricle. But as soon as each muscle starts contracting separately and incoherently, the heart cannot pump the blood any more, though it can still work. And clinical death begins.

How long can clinical death last?

It can last up to four minutes, if no measures are taken. Next irreversible brain changes begin, and that is no longer clinical death, but brain death. If certain measures are taken, for example cardiac massage, then it is still possible to pump the blood and prolong a normal situation for some time.

Please, tell us how you, the son of a priest, became a doctor?

It was entirely “according to the law.” First I entered an institute and then graduated from it. Yes, I am from the family of a priest. My elder brother became a priest when still very young, and my mother was very anxious about her elder son’s priesthood and that probably played a key role in my future choice of life path. At the same time the mandatory army service came along and the institute gave me an opportunity to get the rank of lieutenant without military service (and I am a lieutenant in the “deep” reserve). And I do not regret becoming a doctor at all. I like my job very much. I devoted seventeen years of my life to medicine.

And not just to medicine but to resuscitation.

I believe that it is the simplest branch of medicine.

The simplest?!

Definitely. The tasks are as easy as those for a third grader: Blood is “poured out” of one tube into other tube. The main thing is not to pour too much. And that is all! Pure mathematics: you only count the amounts of what is “poured in” and “poured out”, how much a patient perspires and so on. And some drugs. But just a little—the fewer drugs we use, the better it is.

Doctors responsible for resuscitation, at the boundary between life and death, see many people die… How do doctors perceive this?

Most physicians are cynics, and that is a normal defense reaction. If you work in an intensive care unit and are not a cynic at all, you will probably not be able to work as a doctor…

You mean various jokes about death?

Yes, constant jokes about people’s repose. But nevertheless, they are all very lovely!

Do you remember your first resuscitation? Did you have to learn much? After all, theory is one thing, and a dying patient before you is another thing…

My first place of employment was hospital no. 81. An excellent doctor, Constantine Mikhailovich Ivanov, was my principal teacher in medicine. At first, for half a year, I worked under his supervision, and later I worked alongside him. And these contacts with him, this possibility to come up and ask something at any time proved to be pivotal for me. Something was “flowing” from him into me, but I will never become like him and will never reach his level and skills of medical treatment. He was a doctor gifted by God. He used to speak figuratively, for example, “In the beginning I simply lay down with my patient on his bed.” That is, he “was sick” together with his patient. And indeed he felt and heard his patients amazingly. And that was my first resuscitation.

What did you have to do?

I had to bring a patient back to life! By the way, it is physically no easy task—to do external cardiac massage that I mentioned above: when the cessation of blood circulation occurs, you need to make the heart pump the blood (by pressing the breastbone to the spinal column), to make it work as a pump. Several doctors are involved, all of them are in a sweat and get utterly exhausted… They swap places: one doctor, another doctor, and so on. It is a labor-intensive and often thankless process… And at the same time you need to restore breathing because it stops quite soon. And you need to resuscitate your patient with oxygenation (provision of oxygen) and “breathe” for him. And since the situation is acute, you have no time to turn on the medical ventilation apparatus, so you have to resort to “mouth-to-mouth respiration”, when one “is breathing” and another is resuscitating.

I remember one day we resuscitated a patient for a long time, but the procedure proved unsuccessful. Constantine Mikhailovich stands up: “Why have we been trying to resuscitate? The soul has flown away!” And he opens the ventilating window. This was 1987, when nobody was supposed to believe in the existence of the soul.

“And he suddenly realized that God exists”

Priest Alexei Timakov Priest Alexei Timakov
And people came to believe in God through such cynicism?

Today the majority of my acquaintances believe in God. But I do not think they were believers at that time.

As a doctor responsible for resuscitation I spoke with my colleagues very much in those years, all the more so because I had rather good basic knowledge. But they had absolutely no basic knowledge of philosophy or religion at all. They only had their own fantasies. They stewed in their own juice. And I well remember one special conversation that I initiated myself. I was on duty on that day, but there were no patients in the ward. And my colleague, a young doctor, came to me. He was about four years younger than me.

How old were you at that time?

It was 1987; I was then 28. And so, that doctor had graduated from his institute shortly before, and his qualifications were: basketball player! And in the Soviet era people who indulged in sports and, say, played basketball in an institute team, would pass exams on easy terms. He was a very strong bald-headed guy. He was at once made the institute’s Komsomol organizer, so he was responsible for the Soviet education. By at that time many mocked and ignored all that, but the Soviet background was what it was. So he came to me just in order to chatter at night. And I said to him, “Imagine that you are an emergency physician (I had had such experience by that time) and you are called on two occasions one after another for the same reason—someone fell from a height. The first call is at about 11 p.m. You arrive and question all the eyewitnesses and it turns out that a young man spotted a girl on the eaves or on a window-sill. He walked on the ledge trying to rescue her but failed and fell off. Or there was a fire, or some other incident… In short, he fell down. You cannot do anything to help him. You have come, have seen everything and expressed your sympathy… The police arrive, you certify the death, and leave. But, at about 2 a.m., as soon as you lie down on your trestle bed to have a rest, you’ve got a new emergency call. You take your bag and immediately go. You arrive and learn that it is again a fall from a height—but this time it is some wino who mistook a window for a door. What will you think of each of these two people? Won’t you have different attitudes?”

There is some degree of cynicism in this comparison, too…

And that guy began to ponder this. He did not know the basics of philosophy, yet he was not stupid and liked to reflect closely, although he did mistakes. To his credit, when I pointed to his errors he returned to making the logical sequence anew. We talked with him for about five hours; in any case, for a very long time. He figured out all these sequences: What, how, why and so on. Firstly, why is his attitude towards these two people different? After all, you are a physician and in both cases there was fall from a height, in both cases you can do nothing to help them. From a doctor’s point of view, all is the same here, but you think quite differently of each of them—you have pity for the first guy and feel some sort of irritation with the second one.

We came to the conclusion: In the first case the man performed an act of self-sacrifice, and in the second case the man wasted himself. And life is so good; it is the most precious thing! But, secondly, if you consider self-sacrifice as something to die for, then you need to find out whether there is something for which you can sacrifice your life. He thought, puffed for long time and turned red. He really took great pains. And he made a conclusion that indeed there are three things for which you can sacrifice your life.

The first thing is love. This applies to war as well: any soldier is ready to die for his parents, for his child, for his wife… For the their sake and our of love for them. He does not want to die, but he does, because he knows that there is no other way. The second thing is probably creative work.

Interesting!

Yes, creative work. Very often people do not spare themselves at work and waste their health. Let us recall that the biologist Ilia Mechnikov (1845-1916) drank cholera vibrio hoping that he would be infected but that did not happen. He could not understand the reason, but the explanation is that his intestines worked very well. Can you imagine this act of self-sacrifice? Yes, here is his love for mankind, but first of all it is a creative impulse. Let us recall how people paint pictures and write poems—they are entirely absorbed and immersed in their work. Playing is another kind of creativity. I remember how I once played chess on a train as a boy of ten. My father then lost to me. Seriously! On that day I beat a very good chess player, although myself I played so-so. I remember that situation when I was absorbed in that game and lived by it! This is creativity too. But I do not want to say that it is a kind of fanaticism. No. You are seriously engaged in it.

And the last thing is the truth. The search for the truth.

The highest?

No, all three of them are the highest.

Are they equal?

They can only exist together.

This is a very interesting idea!

What is creativity without love? Hiroshima. What is love without the truth like?

Cruelty?

No. There is a proverb: “Love is blind.”[1] Someone has a goat but thinks it is a prince or a princess from a fairy tale. Yes, anyone has the right to fall in love with a goat. It is white, furry, and nice! But do not make a prince out of it!

So love, the truth and creativity cannot exist without each other! The Russian writer Boris Pasternak (1890-1960) said the following: The purpose of creative work is full dedication to one’s cause rather than popularity and success. And what about the purpose of love?

To get closer to God…

Self-sacrifice! Full devotion! And what about the purpose of the search for the truth? The same! And it is Golgotha as well! Remember, it is Golgotha!

But in that conversation I was not helping him find these categories—he found them himself. I only helped him a little bit. We also recalled the philosopher Giordano Bruno (1548-1600), though Bruno has nothing to do with creative work.

Giordano Bruno?

Yes. The Soviet era had its own stereotypes and clichés when it came to creative undertakings… All in all, everything gradually came to normal in that fellow’s mind: he thought he made all these right conclusions himself without my help. But there was no trick there. So, love, the truth, and creativity. And we concluded that these are interrelated and cannot exist separately. I said to him, “Listen, you are a living individual and you have a personal identity. Tell me if there is something greater than personal being?” He said “No.” I go on: “We have singled out three categories, but we have not put it bluntly, and the question arises: Do these three categories have an identity in terms of personality? If they don’t, then we should not give our lives for their sake, otherwise that would be a waste of ourselves.”

And what was his reaction?

He was deep in thought. It was very pleasant and curious to watch the countenance of a person who was himself coming to realize the fact of the existence of God. He was sitting there and coming to this conclusion. It seems his spectacles moved up to his forehead, his mouth opened widely and he became wide-eyed. “Alexei Vladimirovich? How can it be?! I am quite sure that it is not so, that such things do not exist! How have I come to this conclusion?” I answered, “We have proceeded from an unproven premise!” “From which one?” he asked with a happy voice. “We proceeded from the fact that life has a meaning. If life has a meaning, then God exists! And if there is no God, then life has no purpose. And one does not exist without the other.” He drooped at once, left the room and then avoided me for two or three months.

It was 1987. The following year, 1988, opened a new epoch with its celebration of the millennium of Baptism of Russia! People began to talk about the soul, about God. And one day he came up to me and said, “I have been baptized!” And I realize that it was his own choice.

I still well remember that story: his countenance, this Komsomol organizer, a young basketball player and a novice resuscitation doctor, still a young fellow… He recognized that God exists!

Arseny Gulyga and the meaning of life

Arseny Vladimirovich Gulyga (1921-1996), a noted historian of philosophy. Arseny Vladimirovich Gulyga (1921-1996), a noted historian of philosophy.
You knew Arseny Gulyga, the famous philosopher. You were present at his final moments of life…

That was a memorable meeting in my life. I still communicate with his widow. It was in his (Arseny Gulyga’s) lifetime that I encouraged his wife to keep the fasts. But the main thing is, beyond a doubt, his last words. The point is not what he said, but how he said these words! It was my cynicism; I came up to a dying man whom I regarded as a person. As an individual person! And he could not live any more… He was not to live according to a number of parameters: sugar, blood pressure and so on. But the process of the organism’s adaptation occurred, and he could breathe and even think with his extremely high blood and sugar levels. His thoughts were very clear. To be honest, I wanted to mock at him slightly. I had read that he was “a philosopher”. And what was an average philosopher in the Soviet era like? A Marxist-Leninist. This is what crossed my mind at once. And, with my biography, my attitude towards Marxists-Leninists was negative. So I said to him with a slight jeer: “It is time for you to think of the meaning of life! Though I suppose this is what you have been doing throughout your life.” And he replied: “Yes, indeed I have been doing it all my life!” And I understood that it was true. This is what he did all his life: He searched for the meaning of life. For his entire life! I was terribly ashamed for my self-confidence. And glory be to God that I was ashamed.

Arseny Vladimirovich was a bearer of the three qualities you mentioned: self-sacrifice, creative work and love, wasn’t he?

I think, in his relationship with his wife there was an ocean of love… Though I cannot speak about it now, I did not know this person well enough. And at that time I was unaware that he was one of the last real Russian philosophers. It was later that I read his book, The Creators of the Russian Idea

But for me the way one or another person speaks matters, and not only what he says. It is very important! When two people speak the same language and there is harmony between them, only then will it be possible to express something adequately.

Did you have an impression that Arseny Gulyga was a man who found God?

I would say that he never lost Him. I was told the following a anecdotal story: When Arseny Vladimirovich came to his teacher, Alexei Fyodorovich Losev (1893-1988; a great Russian philosopher and philologist)—Gulyga was a Cossack and therefore, a straightforward fellow—Losev during their conversation asked him, “Are you Orthodox?” Now, philosophy in the Soviet school did not allow you to be Orthodox. Gulyga hesitated… “Are you Russian?” Losev asked. “Yes, I am,” he replied. “Go away, you fool! You are Orthodox!” This is what was said. Surely he was not Orthodox in the full sense of this word. He was not church-going at all. But, glory to God, his wife is a practicing Orthodox and a church-going lady. I thank God for my meeting with this man from the bottom of my heart. Eternal memory to him!

“They hear, see and understand everything!”

    

Once you said that spiritual life goes on even if a person is unconscious…

I adhere to this opinion. There was some decisive situation for me that formed that opinion… But it is up to the Lord’s judgment whether I am right or not.

The story is as follows. Once I was asked to give Communion to a dying woman. At the time we did not have the practice of reserving the Blood of Christ after Liturgies. So I came to see the patient’s condition. And I saw that the woman was unconscious. From certain parameters I understood that she had only one or two hours to live. And I said aloud in her presence, “Wait for me till tomorrow. There will be Blood, and so I will come and give you Communion.” And she “waited” until my arrival! According to her physiological parameters she could not have lived until the following day! I realize that any resuscitation doctor will say: Anything is possible. Nobody knows how one or another person clings to life and what maintains one’s life. In the case with that woman all her parameters went beyond all limits; she was too weak to live for another day. But she lived until my arrival and passed away an hour or two after I had given her Communion.

And the next story is perhaps more revealing. Again, my self-confidence, self-conceit and haughty attitude towards others were exposed. I was invited to give Communion to another sick woman. I came and saw something like a lifeless heap. From the medical point of view it could hardly have been called a human being, but it was moving. I decided not to ask the sick woman any questions and started anointing her. But at some moment she started exclaiming, “Thank you! Thank you! Thank you! Thank you!” And as I was reading the verses of repentance, she gave all the absolutely right responses at exactly the right times!

There were many other miraculous situations. Although in the case of the second woman, she was not in coma. In the case of the first woman, who waited for Communion for a whole day, there was coma. And I believe she heard my words. What is coma like? It is a total areflexia, no impulses can be perceived at that time. But she did hear me!

There is one more example. A resuscitation: We tried to bring a patient back to life for two hours, but all in vain. And I said aloud, “Stop! That is enough! Let’s certify death!” And I suddenly hear: ratta-tat-tat! His heart began to beat!

From a scientific point of view, these facts, of course, may be not sufficient, and I realize that that experience of mine by no means should be absolutized. This is just my personal credo, my personal faith. But I do believe that a man can hear and understand in any situation.

In emergency medical care, when physicians struggle for people’s lives, miracles do occur.

Are there many miracles in the resuscitation practice?

I regard these events as miracles. So a small collection of my short stories is called A Miracle is with Us. I believe that any person who thinks rationally will say, “No, that is a coincidence”. A coincidence or something else… One can invent any explanations. I just think that it is a miracle when a person responds to God’s call and when the Lord is present.

I suppose the in the Holy Scriptures most miracles are natural or scientific by nature. The laws of the universe are by no means violated here. An event happens at a specific moment in a concrete situation. What is the Biblical crossing of the Jordan (see Joshua chapter 3) like? An earthquake occurs, and apparently a rockslide blocks the riverbed. If I am not mistaken, a similar thing occurred again as late as 1929: then the Jordan was blocked for several hours after an earthquake. So the Israelites easily crossed the Jordan, and by that time water forces its way through rocks and the river becomes full-flowing again. The miracle is that it happened just at the right time.

In his book, Transition: the Last Illness, Death and Afterwards, the Russian surgeon Pyotr Petrovich Kalinovsky gives many stories (related by both physicians and patients) on how people’s souls left their bodies during clinical death. Do you personally know any such stories?

I cannot say I have rich experience. But one story is really remarkable. One day we resuscitated a patient for a very long time and finally one of us said, “Stop! That is enough!” And the patient heard these words! It was clinical death—he was absolutely unconscious. More than that, he was under general anesthesia and was unable to sense anything. However, he did hear the words: “Stop! That is enough!” How? In what way? Which organ perceived that? I have no idea! His soul obviously may have seen this—a sort of an out of body experience. And he decided to return. Definitely it was with the help of God. This example is very significant, yet it is not proof of anything. Many will explain it by some biochemical alterations of the cortex or other causes.

And what will you say about “the light at the end of the tunnel” seen by many people during clinical death?

This experience is very universal! It is too universal to be explained by mere biochemical disorders. But I prefer the book, Life After Life, by Raymond Moody (a modern American philosopher, psychologist, doctor and author). It contains a very rich material.

Empirically proven?

Exactly. And there are many similar moments there. We can recall another phenomenon. There is an expression: “To get blind drunk” (in Russian: “to drink till the demons come home”). It is well known that alcohol affects the cerebral cortex… But it is a strangely universal experience. Those suffering from delirium always try “to throw down a bug” from their knees. They really see these bugs! A very good aphorism belongs to Fyodor Dostoyevsky: “I agree that ghosts appear only to very sick people, but it does not mean that ghosts do not exist!” Sick people, unlike healthy people, are much closer to the beyond, to the other world, and it is easier for them to see it.

The mentally ill as well as physically ill?

Absolutely! And the experience is too universal!

Don’t wince at Christ

Priest Alexei Timakov Priest Alexei Timakov
I feel certain you asked yourself this question: What is the boundary between the material and the spiritual worlds like?

In my view, this is the meeting with Christ. I wrote about this in my article, “On the Way to the Last Judgment”.

And how can we imagine it? Let us first imagine this picture: a caveman who has never seen the light. He has adapted well to life in caves. He knows perfectly how to wade across a river, how to find a snail or to catch a fish for food… But if we take this caveman out to the light, to the sunshine, then according to the Russian physiologist Pyotr Anokhin (1898-1974) his eyes will suffer a terrible, terrible pain. The caveman does have eyes, but he did not use them. This natural light hits his unaccustomed eyes. He might say, “Please, let me go back to my cave!” We are like these cave dwellers. We do have spiritual sight, but we do not use it. Our physical eyes are sufficient for us…

A striking metaphor!

We have perfectly adjusted ourselves to living in a cave. When are we in contact with the spiritual world? When we pray! If prayer is the breath of the soul, then for most of us it is at most breathing “through a straw.”

The Gospel is the life-giving water. I suppose you read the Gospel, but how many of your acquaintances do it regularly? There are few of them, I think. Confession is washing of our souls and Holy Communion is food for our souls: these are our guidelines. They are very basic and fundamental. Regularly attending church services and doing good deeds are also among them… But the bulk of our population lacks all this. All these things enable us to somehow see a little bit of the spiritual world. But only a little bit…

Returning to our comparison with a cave: this is not an ordinary cave, but, rather, a maze… I can walk along an underground river and somewhere after the 137th turn a sunbeam falls on the wall. I will come to that spot regularly and look at this sunbeam. My eyes will start slightly distinguishing something and getting used to it. And after another fifty turns a play of light and shade will begin. These are our good deeds and all that I mentioned above. This is our spiritual vision.

And when I die I will stand before Christ. And there will be light. Most likely it will be an unbearable light and it is likely that I will close my eyes. And I dare not say with confidence that I will exclaim: “I want to be with You!” This is despite the fact that I am a priest and serve at the altar… It is no guarantee of anything… It is a person’s internal experience that matters…

The Kingdom of God is within us (see Luke 17:21).

It is so. But we do not know if we are worthy of the Kingdom of Heaven. I cannot say this about myself, but I really can say it about Arseny Gulyga who truly stood before Christ. “I have been doing it all my life,” he said. And I understand that he walked toward it.

And he will succeed.

Yes, he will! And he will bear this light and go further. Although he never attended church and had no experience of Christian life… Let us recall the two thieves at Calvary. The penitent (good) thief was able to see the light of Christ. But the other (impenitent) thief proved unable to see it! The latter went on abusing Christ. He could not see the light of the Savior. One of them noticed it, but the other one did not. Why? I do not know. What allowed this righteous robber to come to his senses? What did he manage to experience on the cross and therefore begin to admire Christ in the highest sense of this word? And this moment teaches us reverence. Reverence for all things; and little by little we start perceiving the spiritual world, so that we may not go blind during our meeting with Jesus.

I have no doubt that the Lord wants to save all of us. But the question is whether we are worthy of salvation…

And what would you suggest to people whose relatives revived?

First of all, to take Communion as often as possible! Partake of the sacraments of repentance and the Eucharist. And their participation should not be merely formal. But how to do that—I don’t know.

Nikita Filatov spoke with Priest Alexei Timakov
Translated by Dmitry Lapa

Pravoslavie.ru

6/18/2016


[1] The analogous Russian proverb translates as “Love is wicked—you can even fall in love with a goat.”

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