From the archives: Alexei Navalny, Russian opposition leader, lawyer, and anti-corruption activist, died earlier this month in an Arctic penal colony, where he was serving a three-decade sentence. Officially known as a “corrective colony”, these are Russia’s most notorious prisons with reputations for hard labour and harder punishment. But the entire Russian penal system is regarded as a brutal one. In 2008, Tatiana Riabinkina spent six months working as a doctor at Yekaterinburg Prison. As she explains in this 2023 article, it proved to be a shattering experience.
We were sitting, smoking on the windowsill in a bare examination room. There were outdated but clean furnishings around us, with patches on the upholstery and traces of multiple repairs on wooden chair legs, seats and arms. Olga, who had invited me to work here, was a general surgeon. I had just recently finished my internship as a traumatologist.
We opened the window and the cigarette smoke mixed in the clean air with the smell of blooming lilac.
“Those guys you’ve seen in the hospital corridor, they look angelic but they are prisoners who have good standing with the security guards. They are very friendly and always ready to help, but you shouldn’t trust them completely,” she said.
“Mmm?” I raised my eyebrows. I knew that working in the prison hospital would not be easy.
“When work finishes and our crew goes home,” she continued, “only one doctor and a few nurses stay in the hospital with the orderlies and patients.”
“Is there a guard?” I asked.
“No. But in the staffroom, we have an emergency button; I’ll show it to you. It works only during the day. At night, the orderlies turn it off. They know where the wire goes.”
“Why do they do that?” I imagined myself alone at night surrounded only by prisoners, and I involuntarily took a long drag on my cigarette.
“Just in case. I think they like to feel that they can control something even if only at night.” Olga shook the ashes off her cigarette. “And you know what? I’m ready to bet that during your first few shifts, some patients will die. You should think of it as a coincidence or the work of a mystic. It just seems that someone always dies every time a new doctor or nurse comes to their first night duties. The orderlies and all the hospitals will watch your reaction. You should be ready.”
She retrieved the ashtray from the shabby drawer. We put out the cigarettes and went to the staffroom to plan my shifts. My strange experience had started.
Very quickly, I recognised that my academic knowledge didn’t fit the reality of prison. One experienced surgeon operated on a patient with a damaged foot. I assisted him in fitting a very strange device on the patient’s foot, saying nothing about it in the operating room.
Later, I said, “What a strange contraption you installed. I was taught metal parts like this shouldn’t touch swollen tissues because it could cause necrosis.”
“You’ll see,” he answered confidently. “He will recover. Remember they are prisoners, so they live in extreme circumstances, where their bodies must adapt and mobilise all their resources, like in a war. This metal construction could cause necrosis in any patient outside, but not here.”
A few days later, I was astonished to see that the swelling on the patient’s foot had reduced, and he was starting to recover. Later, I watched how that doctor told another patient to wash his inflamed wound with laundry soap.
“We don’t have enough medicine,” he explained calmly. “We don’t even have enough painkillers and antipyretics.”
Once, I operated on a patient who was bleeding from several small blood vessels. We didn’t have an electro coagulator or anything else for these cases, and it was not easy to stop the outflow of blood from his wound.
“Do you smoke?” I asked him.
“Yes, I do,” he muttered cautiously, thinking that now I would ban his only pleasure. “Smoke more,” I advised, “in order to narrow your vessels and stop the bleeding.” Could I ever have thought that one day I would recommend to a patient to smoke more?
“Do you sympathise with them or not?” I asked Olga one day as we sat and smoked. There was nobody in the staffroom except us. We were sipping tea, looking out the window at the lilac bush and a bunch of prisoners smoking on the back porch.
“It is a really difficult question,” she answered, thoughtfully. “Of course, you should be cautious, but remember that one day, you could go to jail, too. Not all of them are criminals, and in our country, anybody can be imprisoned. Especially if you are a doctor.
“Recently, an orderly was released. He was a brilliant neurosurgeon outside, but here he just washed the floor and cleaned our scalpels. It happens. Somebody can find a reason to imprison every single person – whoever he or she is.
“In another case,” Olga chuckled, “I treated a very old and blind man. He was in jail for murder. As it turned out, he had killed his wife. When I asked him how, being blind, he killed her, he answered with a dark grin: ‘I felt my way to her neck.’ He might have wanted to strangle me, too, if he could.”
Making my rounds on night duty, I came to the Department of Medical Therapy, and a nurse said one of the patients had a terrible oedema (swelling caused by trapped fluids.) On the ward, I saw a young man aged about 20, whose tissues were clearly swollen. He spoke with great effort and breathed heavily.
“How long has he been like this?” I asked, glancing at his documents. He was hospitalised with the diagnosis “ankylosing spondylitis”, a disease that deforms the spine and joints. The oedema was not indicated in his papers.
“About three days,” the orderly answered. “And he’s getting worse.”
I found a list of his treatments and noticed they had been giving him a low dose of diuretic tablets. Too low a dose.
“Does he urinate?”
“No,” the orderly answered. “It’s been about two days.”
I examined the patient’s abdomen: his bladder was empty. It seemed his kidneys couldn’t manage, and all liquid had moved into his body tissue. I urgently prescribed him a high dose of diuretic by injection and went to the staffroom. There, I made a call to our anaesthetist, Elena, to ask for her help. I had received training as a traumatologist and had only basic knowledge of medical therapy. Elena told me in detail what to do.
“As it appears, time is lost,” she added. “I don’t know if we can save him.”
“What will you write as cause of death?” the head of hospital, Valery, asked me carefully in the morning.
“Renal insufficiency and pulmonary oedema,” I answered. They looked at each other.
“The therapists treated him for a different diagnosis, didn’t they?” he asked.
“Yeah, they did. And he didn’t receive the treatment he needed.”
Valery went out of the staffroom and returned a little later.
“I spoke with them,” he said calmly. “Could you please write ankylosing spondylitis as a cause of death?”
“Of course not!” I exclaimed. “They missed the diagnosis. He could be alive now if they had given him the right medicine in the right doses. They have these drugs; I treated him with them tonight.”
Valery said nothing, but I saw he was confused. Several minutes later, the phone rang for me. It was a chief of the department of medical therapy. She asked me the same question: what did I write as cause of death? When I answered, she suddenly started to shout. “Could you look at his documents? He had another diagnosis!”
“It was wrong. There was no information in his papers that he had an oedema during the last days and no notes that he didn’t urinate. The main diagnosis was renal insufficiency,” I protested, shocked by her obstinate and uncooperative tone.
“Are you a physician? What do you know about it? You must write ankylosing spondylitis. Yeah, he had a little oedema, but we gave him the diuretic.”
“No, I can’t do it. I don’t need to be a physician to see it wasn’t enough for him. He needed big doses of diuretic by injections, and you should have given him other medicines, too.”
“You are a half-educated, selfish upstart!” She hissed into the phone with anger. “You need to learn more and to get out of our business.” She hung up.
“It’s obvious nonsense, the same as if we wrote, ‘He died from scoliosis.’ Nobody dies from scoliosis!” I exclaimed.
“Listen, please,” Valery said softly. “This is a carefully balanced system, and it should stay stable. If you write the correct diagnosis, questions will be asked. Why didn’t they treat him properly? It is negligence, and we will lose one or two doctors. Who will take their place? The salaries here are very low and the conditions are too poor.”
“But the post-mortem examination?” I asked, puzzled.
“Pathologists will confirm any nonsense we write. They have been doing it for years because otherwise our system will collapse.”
I felt confused and insulted, but by then we had been smoking, drinking tea and conversing for about an hour. Finally, my long-held ideals wilted, and I did what they wanted. I don’t know if I did right when I finally wrote the wrong diagnosis.
When I came into the resuscitation room, the patient was reading a book. It was the only time I had seen any prisoner reading. He smiled at me (I remembered it because the prisoners never smiled) and said, “I’m getting better. No pain any more.”
“Is it really going to go well tonight?” I wondered, heading for the staffroom. It was not. In the early morning, they woke me up. An orderly reported with an inscrutable face: “There is a suicide in the resuscitation room. He hanged himself. We found him just now.”
I ran into the resuscitation room. There were many splinters on the floor and the one lamp was broken. I saw several drops of blood on the empty, messy bed. The patient was hanged on a wire tied on to a curtain holder near the window. His left hand was streaked with paths of dried blood. I quickly ordered the others to get him down on the floor, got the loop of wire from around his neck and made sure that resuscitation was not an option.
In the morning, the investigator emerged and asked me for a private interview. “What do you think about it?” He took his time lighting a cigarette. I took a hard gulp of my strong coffee.
“I don’t think it was a real suicide,” I said firmly, “And I’m ready to prove it.”
“Do, please,” he nodded.
“First of all, he was recovering well yesterday evening. He felt very good and told me so. He said it with a kind of joy. He didn’t look like a depressed person.”
“Hmm …” he raised his eyebrows. “Unfortunately, you are not a psychiatrist, and it was impossible to determine his mood. We can’t accept this argument.”
“Okay, but that’s not all,” I continued vigorously. “Second, it looks like he tried to cut his veins in his arm but failed, so he hanged himself. However, I had consulted him previously and he was left-handed. He would have cut his right arm, but we saw his left arm was cut.”
“Okay,” he kept his cold, grey eyes on me. “Anything else?”
“Yes. I observed him before the operation, and you can read it in his documents. He had an old neurological problem, so couldn’t raise his hands higher than the level of his shoulders. He couldn’t tie a wire on a curtain holder, so he couldn’t hang himself.”
“I see,” he took a long drag. Suddenly, he gave me an unnatural grin that made his face look like a plastic toy. But his eyes stayed serious and didn’t fit with his Hollywood smile.
“You told me everything and I listened. I know it was not a suicide, but we will never find the murderer, or the reason why this guy was killed. Nobody will tell us. And we don’t want to open a criminal case because it means loads of paperwork, and that will just get on our nerves.
“What’s more, since the orderlies described this case as a suicide, it means somebody wishes very much to make it look this way. If you prove it was a murder, one morning the doctors will find you hanging on a window frame. And do you know what people will say? ‘The job was too hard for such a young girl. She couldn’t cope.’ I advise you not to discuss it with your colleagues. You never know which wall has ears.”
Another day, two prisoners were brought into the hospital corridor. The guards told me nothing and forced them to face the wall with their arms outstretched. Then they put bags over their heads. The prisoners were tired – I couldn’t see their faces, but noticed they staggered and their arms sagged down.
The guards hit them with their fists to force them to stand still.
“What are you doing and why are you here?” I demanded, outraged. “Remove the bags and let me examine them to see if they need my help.”
“No, they don’t,” one of the guards answered with an insolent tone, “And we’ll finish soon.”
“You must stop it immediately!” I said, now hard with rage. “On my watch, you must carry out my orders in the hospital.”
It must have been a strange scene: a young woman snarling at several massive, cocky guards with sticks and guns and dressed in body armour. It was like a tiny dog barking at a herd of rhinos. However, my unexpected response confused them and they took the bags off the prisoners’ heads and led them down to the first floor.
There were two isolation rooms. Each space contained only a steel bed. The guards ordered the two prisoners to bring a bed from one room to another, and then set them in front of each other. They put the prisoners on the beds and fastened them with leather belts.
“They only need to rest,” the guards grinned, “but they are so dangerous they need to be fastened. We are going to send them with an escort to another prison in the morning.”
They left the door open. Two guards brought chairs and stayed near the door all night. Why didn’t they close that door? Did they want to listen to the prisoners talk? I didn’t know.
That night, I smoked with Alexey, who was a doctor, like me, but saw himself more as an officer.
“What is happening?” I couldn’t calm down. “Why do they do such awful things?”
It turned out the story was more complex than I could imagine. There was a Georgian diaspora in the prison, and it had a great influence on everything.
The usual practice was that a “prison boss”, also called a “thief in law”, chose a boy for his own sexual pleasure. Those boys were humiliated and raped. Some of them later committed suicide. This system had been operating for decades. However, occasionally the system went wrong, as was happening at that very moment, and now the prison seethed with indignation.
One “thief in law” from among the Georgians had become too close to his boy. He started to protect him, spending a lot of time with him and – most outrageously – started to consult him on various questions. At first, the Georgians asked their “boss” to give him up, but he refused. Then the situation began to grow more heated, and the non-Georgian prisoners had started to make jokes.
Other Georgians defiantly told the prison boss to get rid of the boy.
“Let us kill him or kill him yourself,” they demanded.
The Georgians were all in danger of losing their authority in the eyes of the other prisoners. However, the boss refused again. He knew about the risks but did it anyway. The Georgians then decided to get rid of them both. There was only one way: to ask the guards to help preserve the stability of the prison.
Now the guards were showing the prison, including the hospital, that “order” was being restored.
“It seems their relationship is very strong,” I muttered. “They have endured so much. I hope in their new prison everything will be better for them.”
I was so affected by what I’d seen, a day after they were taken away, I asked Valery to clarify if they had arrived at the new prison. “They didn’t.” He shook his head. “They were shot dead yesterday while trying to escape in the small railway station. In fact, they didn’t even need to try.”
On my last day in the hospital, my colleagues organised a farewell tea party with cookies in the staffroom. Every doctor was there, and some of them said they envied me because they simply couldn’t change their own lives.
My ex-colleagues managed to safeguard their souls, their grasp of beauty and sense of humour. How did they manage it in a place where inhuman activities occur and where a monstrous system can turn you into a bolt within a machine? I don’t know. Few can resist the grinding pressure. I couldn’t, but I’m glad to believe that some can.
Tatiana Riabinkina gave up medicine after her prison experience to pursue a career in music. She now works as a composer and music teacher in Temuka. This article first appeared in the January 28, 2023 edition of the New Zealand Listener.