Rounds are at 9:15 every morning no pre-rounding at 4:30 or rounds at 6:30. There is no operative schedule as such, Conducted in Russian and consists mostly of a seated discussion in a smoky room.

Back in his office by 10:15 am people are starting to file by the office. The door opens without a knock."Gevorg Vigenovitch, ais deh a?" They ask, "Is Gevorg Vigenovitch here?"

At the age of thirty, Dr. Gevork Yaghjyan has already earned his patronym, a sign of respect.I think back to last year when I visited the hospital. Some of the nurses were starting to add his father's name to his and it is catchy. Once the world sees that those who work with you respect you, they take the cue from them.

Everyday is different. No clinic days, no operative days, just a combination of craziness, adrenaline and the ordinary in varying proportions.No call q3 or q4, call when ever they put you on the schedule, and it any case it doesn't matter so much when you are the only specialist in the country that can handle the case.Call is everyday and pay is about $20 per month. How many of us would enter a profession with statistics like that? The surgeons are paid by their grateful patients according to their means.In some cases the pay might be a home cooked meal followed by toasts of vodka brought to the hospital by the patient's family to celebrate a successful operation. The patient's family laughs when the doctors tell them that we are not used to such close relations.

One day a girl from a region near ex-soviet Georgia is brought in.She was treated by local doctors after a traumatic car accident but her leg became so infected that the skin had to be removed from the knee to the ankle. She will be treated with antibiotics and then skin will be grafted from both iliac crests to cover the defect, a gunshot wound to the buttocks that severed the sciatic nerve, a gunshot wound to the hand that shattered the third and fourth metacarpals beyond recognition except in the x-ray wherethe illusion of a whole had persisted, a girl with a facial nerve that was severed by a small injury on the side of the neck who looks fine until she smile and her face takes on a twisted shape.

A worker brought in by Gevorg's brother who seems to have severed the recurrent branch of the median nerve, a small boy whose head is beginning to scar after a sore throat. The patient's self refer themselves to those in the city who have the best reputation so that seemingly strange cases are brought to the attention of the microsurgeon. And in the middle of all this there are those who come for cosmetic surgery,breast augmentation, rhinoplasty, face lifts. A seemingly frivolous undertaking in a place where every induction of anesthesia, and every operation seems to bear an unbelievable risk.

The business of not treating one's own family or friend's is unthinkable in a country where everything is done by relations. To deny your closest

The past weekend we drove from brought in His brother Araik comes by with a

The first time Gevorg invited me to the hospital I remember well, it was to help him change the bandages of a soldier from Karabagh who had been flown to their center.