To the world, Yeltsin's post-operative recovery was normal -- if anything about the Russian president can be called "normal." According to official pronouncements, Yeltsin was already working in bed and walking around the hospital just a few days after surgery. He even convinced doctors to transfer him to a hospital closer to home sweet Kremlin.

But then you read a report in the St. Petersburg Times English quoting Yeltsin's daughters saying that their father "remains in visible pain, does not watch television or answer the telephone and has difficulty swallowing food."

Pre-op
A strange post-operative period would harmonize perfectly, however, with the strange pre-operative period. Seldom have so many speculated so long about the coronary health of a presidential candidate. Yeltsin, recall, was fatigued, erratic, and wan toward the end of his campaign last June.

After winning the election, Yeltsin disappeared from public view. As speculation about his heart problems increased, he finally announced on Sept. 5th the upcoming surgery, crediting his new candor to a desire "to have a society based on truth." Times have changed: In 1992, a year after being forced to rest for two weeks because of heart problems, Yeltsin told French television "I have never had any heart trouble."

His security advisor, Aleksandr Lebed, even called for Yeltsin to step aside since the nation was drifting with an ailing leader. "There is a president and at the same time, there is no president," Lebed said. Lebed was soon looking for work.

This kind of reluctance to admit disease is not limited to Russian politicos, says Rodman Starke, senior vice-president for science and medicine, American Heart Association. "Everybody denies disease, and people in high-visibility positions tend to deny more than others. We are all aware of politicians in this country who have kept disease under wraps."

For such a long build-up, it was an extremely quick quintuple bypass operation: Yeltsin spent just 68 minutes on the heart-lung machine, although the entire operation did take six hours.

With luck, the Yeltsin operation could force Russians to look again at a disease that is killing them in horrendous numbers. The Russian Federation has the distinction of the highest rate of cardiovascular disease in the world. Each year, these illnesses kill 1,318 men, and 607 women per 100,000 population. (Comparable figures for the United States are 460 for men and 222 for women. For Italy, they are even lower: 343 men and 148 women).

Still, says Starke, Yeltsin must realize that bypass grafting does not cure disease, it only reverses symptoms. "The thing that patients all miss is that neither angioplasty nor coronary artery bypass surgery treats the underlying disease. They treat the plumbing difficulties." After surgery, he says, patients have to "take an active part in the partnership for healing, with exercise, quitting smoking, a cholesterol program. There are lots of things people can do. To simply say 'I've been fixed,'well, that's not true."

Want a up-close view of bypass surgery? So did The Why Files.

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