An American Heart Surgeon Travels to Kyiv

“Get down,” said the colonel, “and turn out your light.” The train was slowing through the dark countryside. I could barely make out a building far across a field in the moonlight. I was not sure what the alarm was about, but I trusted the colonel and so I minded his directions and sat quietly hunched on the bottom bunk of a Soviet style train, peeking out of the corner of a window but drawing the curtain fast. The cold on my cheek felt reassuring, letting me convince myself I wasn’t going to get sick as the train lurched to a stop. In my interview with the colonel, he had made it clear he could get me across the border, but he could not guarantee my safety from a missile strike. A sitting train is a target, a moving train less so. The night does not protect from wayward blasts. Transportation is like lifeblood— it is no coincidence we refer to roads as major arteries. As a cardiothoracic surgeon, I understood the nuance.

The war had been raging for just more than two months. The trains had recently started allowing passage in from the border of Poland. The lines of people fleeing both the Eastern and Western cities were long, but tickets going to Lviv and Kyiv were relatively easy to acquire. During the first days of the war, women and children were huddled in narrow corridors with 15 people to a four-person car, standing room only. I almost felt guilty in my sleeping bunk riding across the Ukrainian countryside. The train started again, only a faint red glow on the horizon, no sounds of explosion as we continued on toward the city.

We arrived in the morning around seven o’clock and checked into our hotel for breakfast. There was no waiting. Our rooms were ready, alongside those of international Red Cross workers and correspondents. The dining room was quiet, with one attendant behind the bar and a few international aid workers at scattered tables. Having arrived early in the morning and wanting to stave off jetlag, I decided to go for a walk.

The streets were barricaded by antitank hedgehogs and few people were out and about. The stores were mostly closed, but still displayed mannequins in last season’s fashions. Boarded candy and souvenir shops were interspersed with travel agencies long since abandoned. Performance posters from the Christmas and New Year’s season five months earlier still hung on the marquee. The street signs had all been spray painted over and there were no maps of the city. No “you are here” at the bus stops. No directions to the center of famous tourist attractions.

There was a slight drizzle in the air, and I was halfway down the street when the air raid siren pierced the calm. The only other people on the street were a couple walking arm in arm, and I was not sure what to do. Did I duck into a portico? Could I find an open shop? Was it better to stand near a tree or a building? The risk, it seemed, was not a direct hit but crumbling mortar, bricks, and steel. I did not see any open doors in which to find shelter, so, foolishly, I kept walking. The sirens kept wailing and I was mostly alone on the street. I passed a few men with looks of boredom here and there as they smoked under awnings. They paid me no notice and I took comfort that this was just another part of life here during the war. The air defense systems were working well, and the people had a calm acceptance, as it had been 10 days since a ballistic missile had penetrated the bubble. Back at the hotel, the lobby had livened with reporters and soldiers milling about.

Arriving in Kyiv, I found that cell phone plans and credit card purchases were not the same as those in the rest of Europe. The Ukrainian defenses had left the cell phone towers operational but heavily monitored. They were using the communication network to track Russian units via social media chats and pictures sent back to Russia via the cellular networks. Many of the towers had been lost, but many still stood. But for an U.S. citizen with a basic Verizon phone, it was not quite communication as usual. Via WiFi, I was able to contact the director of the Amosov Heart Institute, Dr. Kostyantin Rudenko, to let him know I had arrived and was available and ready for whatever was needed. He had been giving a seminar in Lviv that weekend and he would not be back at work until Monday. I told him I was anxious to get to the hospital and help where I could. He connected me with one of his junior associates, Maxime, who agreed to pick me up on Sunday morning and get me acclimated to the hospital.

After a delectable breakfast at the hotel buffet consisting of a variety of Ukrainian delicacies such as pickled herring with sour cream, blintzes, lunch meats with sliced cheeses, cucumbers and tomatoes, I met Maxime in front of the porte-cochère of the hotel. He appeared to be in his late 20s and, luckily for me, spoke  English well. On subsequent drives to the hospital, he taught me a few phrases in Ukrainian. We discussed the ICU and congenital heart surgery without the aid of pulmonary artery catheters. We also discussed some of the customs in the hospital as he led me through the corridors.

On our rounds that day, we did some troubleshooting for a chest tube case. It had been some time since I had seen three glass bottles placed in series instead of a plastic dry seal pleurevac. We rounded on a soldier who was found to have a symptomatic aneurysm while he had been fighting at the front. Some of the soldiers had been diagnosed with heart diseases provoked by the stress of the fighting. The civilians had waited for their turn and were beginning to trickle in to the heart hospital again.

The windows of the hospital had a view of a courtyard and a building halted mid construction. The lower floors had exterior brick walls, but the middle floors consisted of shell space and open iron beams. No one knew how long the new hospital building would be in this limbo. The glass in the current building had been hastily taped to lend what little support it could during shell blasts. The hospital seemed almost abandoned on that first Sunday, and I got the feeling everyone needed more rest than they could afford.

Returning to the hotel just after lunch, I was able to meet with the colonel and several American soldiers who had come to volunteer at the outset of the war. After three months of intense fighting, they were recuperating in Kyiv and considering furloughs back home to see wives and girlfriends. I rode with them as they went to the battlefields of Bucha and Moshchun, where they had endured the heaviest fighting during the Russian advance on Kyiv.

The road to Moshchun was heavily guarded. Barriers into the village had been erected and were staffed by armed patrol. Our driver took our passports to one of the soldiers and explained who we were. After an inspection, we were allowed to drive along the forested road into the village. At the base of the village, we stopped in front of bombed cars and small buses. Axles were bent at angles with exposed rotors and jagged glass stuck in the seals. The winter had already rusted the metal, and much of the paint had been burned off.

The house where my companions had been holed up for six days was still standing. The façade was gone, but the construction of concrete and steel stood in defiance. The mortar was pocked as if the gunners from the Russian fortifications had fired nonstop day and night. My companions talked about how they had provided fire cover for a man and his daughter who, with no other choices, had run across an open field under direct enemy fire trying to reach the trenches of the Ukrainian army in the woods behind the house. My companions did not leave their posts in that farmhouse until the Russian army retreated. 

“Hey doc,” they said as we explored the makeshift tent littered with scraps, cigarettes—what was clearly a field dressing station. There was blood on the wooden crates, on the dirt, andon scraps of cloth ground into the soil. This was not the fresh operation of a guided team. These were soldiers who were wounded themselves, unable to make it to the safety of the trees 150 yards away. These were the remnant pools of what the snow had not caught and the rain had not cleansed. This was a chasm away from where my companions had stationed themselves. If they had been hit, they would not have made it to the lean-to.

As we walked further, we noted winter gear blown out of disabled tanks, an icon or two still tucked in the walls of a trench, unexploded ordnance littering every path, and a Ukrainian flag, bullet riddled but still waving. There was almost no one to stare at us and wonder what we were doing. Only one couple who had made it through the days of fighting burrowed in their house was around to give us a curious glance. Somehow, they had managed to survive with their dog and a few chickens, being the last house down the lane.

It struck me that I was a foreigner in this landscape. All my companions had survived eight or more years in Afghanistan and Iraq. They had survived what can only be described as a massacre in Moshchun. And yet, they were here for more, serving what they deem as their purpose. After four hours, we drove off. Silence enshrouded our car. Processing. Was it like processing a death after a surgery? I did not have the courage to ask. Was this a morbidity and mortality conference for those who survived?

Dinner that night was filled with stories. Stories from the last three months and stories from the deserts of the Middle East. Stories from college pranks and from lives left behind. There were no stories about those who did not make it.

The next morning, I met Maxime on the street to go to the hospital. As with every hospital, it was much busier on a Monday than a Sunday. The flow of life was starting to resemble its common theme. The operating suite had 10 large rooms that I would later learn were busy every day with operations ranging from CABG to aortic surgery, septal myectomies, and complex congenital heart surgeries. I would discuss ablation procedures and the AtriCure device with local surgeons. We discussed our techniques. I witnessed the ingenuity of reusing what we in the United States consider completely disposable. Every morning, I was met by a surgeon who said in his best Texas drawl, “Good morning, my dear friend.” He had spent a year in Houston, and his greeting transported me back to my home state. Many of the surgeons had spent time training in the United States. They worked not only to take care of patients, but to advance their profession and their country just as we do.

As I integrated into the Amosov National Institute of Cardiovascular Surgery, the doctors asked me many questions about our ICU care and traditions within my hospital at home. They were curious as to why a U.S. surgeon would come to help their country. They were gracious and grateful. As I settled in, I could even joke in the operating room.

I had used a Gigli saw as a resident for below knee amputations but had not used one to open a sternum. The first time it was handed to me, I paused for a moment too long and the anesthesiologist spoke up and asked if I really knew what I was doing. I thought for a moment and said yes. I began dissecting under the sternum with my finger when I heard in English a resounding “Stop! Stop! Stop!” He then pointed to a long steel trocar, which I was not quite sure how to attach to the Gigli and tunnel underneath the sternum. A Stryker saw is a luxury not afforded in each of the OR rooms at the Institute. I learned that the sternum was to be opened by sawing vigorously from the manubrium to the xyphoid with an upward slant. After that, the operation proceeded with some laughing about what amounted in Ukraine to my inexperience.

On my final day, I was able to work with the chief of the institute, Dr. Kostiantyn Rudenko. He has performed more than 500 septal myectomies for hypertrophic cardiomyopathy with world class results. He discussed with me his training in Italy with Paolo Ferrazzi and his desire to teach this technique to his colleagues throughout Ukraine. In fact, he had been traveling to lecture about this technique when I had arrived in Kyiv. At that time, I did not feel that I had traveled to Ukraine to help a country at war. It seemed that I had been blessed with an opportunity for hands-on learning in a rich cultural environment. Dr. Rudenko has built a successful and robust program without previous experience, and he is sustaining it despite the war.

As talk inevitably turned to the war at hand, the resident on the case that day shared that he had grown up in the village of Moshchun. He had been there on 5 March 2022, visiting his family with his wife and baby daughter. He had seen the tanks roll in and somehow had been able to escape the slaughter. He returned to work after that weekend and was one of many who spent the next few weeks sleeping in the hospital, waiting for what most of the world felt was inevitable for the capitol. He continued steadfast in his desire to become a cardiac surgeon.

The surgeries continue. The logistics of getting organs, equipment, supplies and expertise across a country where you cannot fly and continuing heart surgery amid scarce resources demonstrate the resilience of those who have dedicated their lives to the art and science of what touches the human heart.
The Amosov National Institute of cardiovascular Surgery is in need of cardiopulmonary bypass cannulas and mitral valve sutures. Used items can be rinsed clean of blood and sent via MEEST Express to Ukraine.

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