On Thursday, February 2, the young Russian journalist and pro-democracy activist Vladimir Kara-Murza was at his in-laws’ apartment in Moscow when he suddenly felt ill. He appeared confused and disoriented. His parents-in-law rushed him into a taxi and to a hospital. By the time they arrived, Kara-Murza was experiencing organ failure. Fortunately, the doctor who admitted him was the same one who had treated Kara-Murza’s previous multiple-organ-failure episode, in May 2015. The doctor wasted no time starting treatment, beginning with dialysis.
Kara-Murza, who is thirty-five, is normally in good health. He is also a longtime opponent of the Putin regime. He divides his time between Washington, D.C., where his wife and three children live, and Moscow, where he works for a foundation started and funded by Mikhail Khodorkovsky, the former oil tycoon and Kremlin critic who spent more than a decade in Russian prisons. Kara-Murza was a close friend of Boris Nemtsov, the leading opposition politician who was assassinated in front of the Kremlin in early 2015. Perhaps most important, Kara-Murza lobbied US politicians in 2012 to pass the Magnitsky Act, which authorizes the Treasury to institute sanctions against Russians implicated in gross human rights abuses. Several Russian officials have been added to the list every year since. Kara-Murza has been a vocal proponent of individual sanctions—so while most Russians have probably never heard of him, he has made a record number of enemies among the people who run the country.
After a week in critical condition, Kara-Murza has been improving. He remains hospitalized in Moscow, with a diagnosis of “acute intoxication.” Details of his condition are still emerging. I have been corresponding with his father, Vladimir Kara-Murza Sr., a longtime television and radio journalist who had spent the past decade working for what is left of Russia’s independent media. Vladimir Sr. complains about a morbid sense of déjà vu: this poisoning feels just like the last one—and like what happened to other Russian activists he knew.
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It was May 26, 2015. The text message from Lev Trubkovich’s mother read, “Call me.” She repeated the request three or four times in quick succession. Lev, a freelance video producer in New York, dialed her as soon as he could, but now she was unreachable. He finally got hold of his stepfather, Vladimir Sr., in Moscow, on Skype. His stepfather was brief: “Vova,” he said—using the diminutive of Vladimir to refer to his son—“is in the hospital in critical condition. Read the wires.” On the wires, Lev found scores of nearly identical news items. They were not, as he learned later, exactly accurate, but they reflected one basic fact: his then-thirty-three-year-old stepbrother, Vladimir Jr., was in a coma.
Vladimir Sr. had been getting ready to leave the house to host his nightly current-affairs program on Radio Liberty when an old friend of his son’s messaged him on Facebook: “Volodya wasn’t feeling well, he’s come down with something, we called an ambulance and they took him to Hospital Number 23.” Nothing in this message made sense. Something was terribly wrong, and Vladimir Sr. was already getting into a cab driven by a man who took him to work nearly every night. It was a short drive from his apartment building to Hospital Number 23 but, of course, it was evening in Moscow, the height of rush hour, and Vladimir Sr. ran the final couple of hundred meters across a bridge, leaving the driver in traffic. The driver had motioned to him to stop fumbling in his pockets: he could pay later. He ran into the hospital to find his son being wheeled down the corridor.
Vladimir Jr.’s face was white. This was not paleness: it was a complete absence of color. An hour or so earlier he had collapsed and vomited at the same time—this was when his friend had called an ambulance. Now a doctor was saying to his father, “His diastolic blood pressure is zero.” Vladimir Sr. struggled to understand. The diastolic is the lower number in a blood-pressure reading.
“How long can a person live with this kind of pressure?” he asked.
“A person cannot live with this kind of pressure,” the doctor answered. “Do you know a cardiologist?”
This was perhaps the first thing anyone had said that made sense. In Soviet society, in which Vladimir Sr. had come of age, and in Russian society, in which he had raised his son, one’s network of friends was the measure of one’s well-being, and in times of crisis, of one’s chances for survival. Did Vladimir Sr. know a cardiologist? He called a contemporary artist in Berlin, who connected him with Moscow’s top heart surgeon, who also happened to be a top art collector. Vladimir Sr.’s media name helped. The surgeon arranged for an immediate transfer to the best and biggest heart-medicine center, a mercifully short distance from Hospital Number 23. The words “heart transplant” were said. Vladimir Sr. was told they would operate in the morning. His son would be in the intensive-care unit until then, and he should go home. His own mother called, demanding to know why he had not been on the air that evening. “Vova has come down with something,” he said.
By the time Vladimir Sr. returned at six the next morning, the plan had changed. The famous surgeon—the art collector—had seen his son and said there was nothing wrong with his heart. Vladimir Jr. had been transferred again, just across the courtyard, to the intensive-care unit of a general hospital. The chief there diagnosed “acute poisoning.” He said Vladimir Jr. needed dialysis but none of the dialysis machines were available. Vladimir Sr. cajoled, and he may have begged, and fortunately the medical staff kept recognizing him from his television show, so in a few hours Vladimir Jr. was hooked up to an artificial kidney.
Now Vladimir Sr. asked the chief how the poisoning could have happened.
“I see no evidence of foul play,” the doctor said.
“What do you mean, you see no evidence of foul play? He was perfectly healthy yesterday morning!” Somehow it seemed important to Vladimir Sr. to stress that his son had been more than simply healthy—he had been perfectly healthy. His only ailment had ever been an allergy to the poplar-tree seeds that cover Moscow that time of year.
Then Vladimir Jr.’s internal organs failed. Just when his blood pressure had been restored, while on the dialysis machine, his heart, lungs, stomach, liver, spleen, and pancreas stopped functioning. Together with the kidneys, that made seven different internal organs that now had to be replaced with machines, which breathed for Vladimir Jr. and pumped and filtered his blood for him. He received his sustenance intravenously and excreted waste through tubes. When Vladimir Sr. was allowed to see his son on May 30—four days after he had last glimpsed him on a gurney in the hallway of Hospital Number 23—he counted forty different tubes and wires protruding from his head and torso. The doctors described it as “a total catastrophe of the body.”
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In September 2004, more than ten years earlier, something similar had happened to someone Vladimir Sr. knew. Anna Politkovskaya, the investigative journalist with the muckraking weekly Novaya Gazeta, was on a plane, on her way to the town of Beslan to report on the school siege and massacre, which was then unfolding. She collapsed during the flight, and by the time she was brought to a hospital in the city of Rostov, she had slipped into a coma. Within hours she had suffered multiple organ failure. The toxin that had caused her body’s “total catastrophe” was never identified, perhaps in part because the hospital in Rostov had discarded all the tests that were taken. As Politkovskaya wrote at the time, the samples had been destroyed “on orders from on high.” Just over two years later, in October 2006, Politkovskaya was shot and killed in Moscow, laying to rest any doubt that her strange intoxication had been an assassination attempt.
Vladimir Sr. could not believe that someone wanted his son dead. He had considered Politkovskaya a fighter, a formidable opponent of the regime, while his son was a naive romantic, a kid with a good head and misplaced political ambitions. (Shortly after graduating from Cambridge University with top honors, the younger Kara-Murza, still in his twenties, had run, and lost, for a seat in the Russian parliament.) He posed no real threat to anyone. Vladimir Sr. grew convinced that it had been an accident of sorts—that his son had ingested poison intended for someone else, probably by picking up the teacup of one of his usual dinner companions, who tended to be better-known anti-Putin activists or older, more experienced politicians, or both.
One of these politicians was Nemtsov, who was murdered exactly three months before Vladimir Jr. slipped into a coma. Nemtsov had been a fixture of Russian politics ever since Russian politics came into existence, with the collapse of the Soviet Union. He’d been a popular young governor in the early 1990s, a poster boy for post-Communist reforms, then a cabinet member in Boris Yeltsin’s administration—and rumored to be his hand-picked successor. Then, after Yeltsin picked someone entirely different, Nemtsov continued to organize, protest, and even run in what remained of elections. Vladimir Jr. had been by his side some of that time. When Nemtsov was shot, late one night on a bridge near the Kremlin, Vladimir Jr. was utterly devastated.
For Vladimir Sr., the memory of Nemtsov’s murder made his own son’s poisoning seem all the more incredible. Nemtsov had been a household name in Russia; to the extent that people knew who Vladimir Jr. was, it was mainly as his father’s son. The more Vladimir Sr. thought about it, the more certain he grew that his son had drunk poison from someone else’s cup.
Vladimir Sr. did not say any of this publicly. What he said to the scores of journalists who started calling once the news about his son broke was this: “I don’t see any sign of foul play. We are putting our trust in the doctors at City Hospital Number One.” His stepson Lev, who was doing as he had been told and reading the wires, thought, “He sounds like someone addressing hostage-takers.”
He was. Vladimir Jr. was tethered to a roomful of machines that belonged to a Russian state hospital. Khodorkovsky, his employer, had wanted to pay to have him evacuated for treatment abroad, but an Israeli doctor who came to organize the airlift deemed it impossible: he said that he saw no way to ensure that the patient would survive the drive to the Moscow airport.
Vladimir Sr. continued to do what Russians do in times of trouble: he made calls to people he imagined might be able to help. One influential friend, a former Yeltsin official who now held a comfortable post in the Putin administration, said, “The chief has ordered him cured.” By “the chief” he could have meant only Putin himself. An order like that, communicated through the health-care hierarchy from the Kremlin, meant that the doctors must break with the usual Russian hospital culture of fatalistic neglect and do more than they knew they could to save their patient. Putin’s will now held Vladimir Jr.’s only hope for survival.
When Vladimir Sr. was not making phone calls, he was receiving them: a pro-Kremlin tabloid famous for rewarding informants in hospitals had written about Vladimir Jr.’s hospitalization within twenty-four hours of the original ambulance call. Now everyone wanted to know what had happened and whom the father blamed. A senior doctor at the hospital told Vladimir Sr. precisely what to say—the trusting words that Lev had read on the wires. The doctor then had Vladimir Jr. moved to a more comfortable room, where his parents could visit him, and even placed a guard at the door. Vladimir Sr. understood that this was his reward for transmitting the correct message.
The message was blessedly easy to spread. Not only did reporters unquestioningly reproduce the statement dictated to Vladimir Sr. by the doctor but a self-policing mechanism instantly kicked in: journalists and bloggers began shaming those who speculated that Vladimir Jr. may have been intentionally poisoned (I was one object of such shaming). Without being explicitly asked to do so, and without phrasing their request directly, a small, spontaneous army began virtually chanting, Keep quiet so he may live.
This, too, was a hostage situation, albeit not a literal one: it was what a great Soviet sociologist, Yuri Levada, had once termed “collective hostage-taking,” which he described as one of “the most potent instruments of coercion and intimidation used by the Soviet state.” This institution derived from a centuries-old tradition of krugovaia poruka—literally, “circular bail.” If, for example, a village resident failed to pay his taxes, the property of any of his neighbors—and any number of his neighbors—could be seized and sold at auction. The threat transformed all members of a given community into enforcers, but not in accordance with codified law—they had to devise their own means of ensuring compliance. It was a nearly fail-safe mechanism of coercion. In the decades after the Great Terror, when most Soviet citizens did not face an immediate threat of imprisonment, the overwhelming majority of the population was kept passive by the understanding that any action could endanger a larger group. For example, when my parents decided to emigrate in the late 1970s, my mother quit her editorial job, which she loved (and the income from which was essential for our family’s livelihood), months before applying for an exit visa, to prevent any negative consequences for her colleagues—for having harbored a traitor to the Soviet cause.
In the case of Vladimir Jr., the situation seemed perfectly clear-cut: in a matter of life and death, there could be no justification for making the otherwise eminently reasonable suggestion that this man, like at least half a dozen others before him, had been poisoned in retaliation for his opposition to Putin. Even Khodorkovsky, who had spent ten years in prison for opposing Putin, refrained from public statements on the matter, surrendering to the resurrection of one of the most important mechanisms of the Soviet totalitarian state.
Vladimir Sr. settled into a routine. In the mornings, he would go to the hospital to see if his son was still alive: this sort of information was not given over the phone. The hardest part was the elevator ride down to intensive care—it was, evidently for pragmatic reasons, located in the basement, next to the morgue. (He invariably shared the lift with orderlies carrying body bags, on their way down to Intensive Care to collect those who had not survived the night. Or at least it seemed that they always rode with him.) After seeing that his son was still alive, Vladimir Sr. would go to the morning meeting of the radio station Echo Moskvy, on which he also had a show. Then he would return to the hospital and stay until it was time to host his show on Radio Liberty.
Vladimir Jr. started regaining consciousness after a week. Speech came later. “Papa, let’s look out the window,” he said. This was the Vladimirs’ stock phrase, used for decades to assert familiarity and a shared point of view—and now employed to show that Vladimir Jr. knew who he was. He had no idea what had happened to him.
It was a month before he could be transported by ambulance to board a plane to fly to Washington, D.C., where he entered a rehabilitation facility. He had lain in bed for so long that the hair on the back of his head had rubbed off—“like when he was a baby,” thought his father—and the muscles of his arms and legs had atrophied. He had a blister on his heel from hitting it on the edge of the mattress repeatedly, from the pain.
By mid-September, Vladimir Jr. had recovered sufficiently to walk, using a cane, to receive an award posthumously given to Nemtsov from Senator John McCain. On September 26, four months after the poisoning, he wrote to his father, “Why wasn’t there a criminal probe?”
Vladimir Sr. could explain. A local Moscow detective had contacted him soon after his son was hospitalized, to ask if he wanted to file a complaint. Vladimir Sr. remembered that after Nemtsov was killed, the police confiscated the dead man’s computers and documents and sealed his apartment—all in the name of conducting a criminal investigation. He imagined his own computer and phone getting seized (they were already tapped, often to comical effect: the software used to collect data off his phone must have been misfiring, because messages and senders seemed to be crossed at random). Worse, he imagined his son being considered a material witness and being prevented from leaving the country if and when he recovered—being held hostage. He told the investigator that no probe was necessary; he even said that he would be willing to write a statement declining any help from the police.
But as Vladimir Jr. was being gradually unhooked from the machines of the Russian state in City Hospital Number One, his father began asking questions. The doctors at the hospital said that Vladimir Jr. had overdosed on antidepressants, which had also interacted with anti-allergy nose drops—it was poplar-tree season—causing a catastrophic reaction; American doctors whom he contacted separately a short time later called the interaction hypothesis absurd. As for the antidepressants, Vladimir Sr. dutifully repeated this explanation to the Russian journalists who asked, but privately he and his ex-wife, Vladimir Jr.’s mother, went to their son’s apartment to check his prescription and count the pills. As they expected, they found that their son had been taking his medication precisely according to instructions: there had been no overdose. The medication itself was Prozac, which may be one of the least likely pharmaceuticals ever to cause kidney failure, in any dose.
Vladimir Sr. asked for blood or tissue samples that had been taken before his son’s body was cleansed of toxins by dialysis. The doctors said that they needed to protect the patient’s privacy and could not release the samples. At that point the patient himself was still in a coma—and the doctors naturally perceived no violation of privacy in having his father, who had a power of attorney, give permission for intubation, dialysis, life support, and the like. By the time Vladimir Jr. regained consciousness, the samples had somehow been discarded.
Vladimir Sr. had better luck at Hospital Number 23, which had drawn blood when his son was first brought there by ambulance. The doctors there gave the father a compact disc with the test results, and Vladimir Sr. sent it to Israel to be analyzed. The Israeli doctors saw nothing unusual. Of course, this was only the results. The blood itself had been discarded.
Early on, Khodorkovsky had called asking that hair and nail cuttings be taken for analysis. He must have learned this technique from one of his own lawyers, Karina Moskalenko, who had repeatedly taken Khodorkovsky’s fingernail cuttings while he was in prison—in order to document that he was receiving psychoactive drugs with his prison food, without his consent. (Moskalenko had some personal experience with poisoning, too: in 2008 her husband, two children, and, especially, Moskalenko herself, had felt ill—the culprit was soon identified as mercury in the car she had been driving around Strasbourg, where she worked on cases before the European Court for Human Rights; French investigators found no foul play, but Moskalenko remained skeptical of their conclusion.). The nail and hair clippings, along with the t-shirt with vomit residue from May 26, were sent to laboratories outside of Russia, and these found nothing of note. One of Khodorkovsky’s other staff members, a thirty-year-old blonde named Maria Baronova who ran a legal-assistance program for political prisoners, spent hours explaining to her colleagues that looking for the toxin was worse than looking for a needle in a haystack: with a needle, you at least know what it looks like. With the toxin, there was no hypothesis as to what it might be, only the vague—and unfounded—hope that it had gotten into such far reaches as the nails and hair in sufficient amounts to be noticed. Baronova had been a chemist in her former life, and she had never imagined that her old profession would become relevant to her new, political line of work.
On September 7, 2015, Vladimir Kara-Murza Jr. turned thirty-four. His father had been waiting for this day: something had made him believe that the milestone meant that the threat to his son’s life had been vanquished. The following day, Vladimir Sr. made the rounds of the doctors who had treated his son, delivering a bouquet of flowers to each. This, of course, included the doctor who had instructed him what to tell the journalists who asked about foul play.
It took Vladimir Jr. about a year to regain full use of his arms and legs. In the summer of 2016 he ran for a seat in the Russian parliament—and lost. He made a film about Boris Nemtsov. On February 2 of this year, he screened the film in the city of Tver, a couple of hours’ drive from Moscow, and then went to his in-laws’ apartment in Moscow, where he fell ill.
Maintaining one’s connections to good doctors in proper working order is a useful old Soviet habit. While the in-laws were getting Vladimir Jr. into a taxi, his father dialed the doctor who had treated him the last time. The doctor said that he had transferred from Hospital Number One to Hospital Number Seven—and the cab changed course and went directly to Hospital Number Seven.