Andriy had been positive that the war would start soon since Autumn, 2021. It was in the air – constant provocations on the border, building up of enormous amounts of troops and military hardware. The war, although largely ignored by the Western media, had de facto been going on since 2014. By Winter, 2022 it was clear that Ukraine had rejected various forms of diplomatic blackmail, otherwise known as “peace agreements”. To top it all up, one of Andriy’s medical colleagues, an ex-graduate of the Saint-Petersburg Military Medical Academy was following a private social media group of Russian military medics, his former peers, where he learned that they had set up field hospitals, as well as the whole medical evacuation chain near the border. One simply does not deploy 100K+ troops and hardware, setting up the whole military medical infrastructure near the border of a country you have been leading a proxy war against for the last eight years as an exercise. It was the time to get ready.
Talking to Andriy, it was clear that his personal war story was also going to be about other people that he is directly responsible for – his patients, the hospital staff, and the country in general. As a practising anesthesiologist, as wel as the Deputy Medical Director with a high-level managerial role in the hospital, but also a husband and a father of three small children have undoubtredly affected his decision-making process. He keeps saying that all his responsibilities are closely interconnected, often complimenting, but sometimes being in conflict with each other, when he tries to make “the best choice with the information available under the current circumstances”. In the course of the war, it has been very clear to Andriy (and his wife) when he has had to put his community first, by refusing to leave the country at the beginning of the invasion, for example
As the invasion was becoming more and more inevitable, those lines of responsibility needed to be addressed urgently. Andriy got to work. At home, in a village near Kyiv he had already installed a diesel-powered generator. All he needed to do was to buy enough fuel, and a storage container. He sourced a 1000-litre plastic one, and filled it up up to the hilt. It turned out to be one of his best decisions as prices on both high-capacity containers, and diesel have skyrocketed while their availability reduced dramatically after the war started.
At work, he ordered, and took an active part in the production of an emergency plan for triage and treatment of mass casualities in case they needed to become a field hospital. None of them were military doctors, but they used their social connection to get all the expertise they needed. It must be said that the majority of hospital staff were still in denial, refusing to accept the inevitability of the impending invasion. However, there was a large enough core that exercised a rational approach, and took an active part in the preparations.
Andriy felt that they had done a good job. In January, he and his wife went for a weekly skying trip to Andorra. They both needed a break, however short in order to relieve the tension of waiting for the war. Andriy remembers a slight, but persistent feeling of guilt of leaving Ukraine at the time. He remembers the all-consuming desire to make it back before the war started. They did…
On the morning of February, 24th 2022 Andriy woke up at 5 a.m. as usual. He heard the first explosions at a distance, and realized that the war was finally under way. He calmly got off the bed, trying not to wake up his wife, dressed up, and made his way towards his car. He made it to the nearest supermarket, which was open 24/7 without any problems. He was the only customer in the shop when he got there. By the time he was paying at the cashier, there were about fifty people behind him in a queque. The girl at the counter could not stop crying as she was scanning his goods.
On his way back home, he saw a huge traffic jam of cars full of people who were trying to get out of Kyiv, while military trucks carrying soldiers and hardware were heading towards the city.
His wife was up by the time he got home. Normally a highly-rational woman in full control of her environment, she was in a state of complete meltdown. It was the first time he saw her like that, and it was a scary sight. Andriy realized that he had to take a full control over all the aspects of his family life in order to carry them through this. He also had another big responsibility, which was his work – all the patients, and colleagues who were waiting for him at the hospital. After hastily calming his wife, he made his way there, which was luckily against the traffic on that fateful morning.
At work, there was a chaos and panic too. Luckily, Andriy and his team had prepared a major incident plan beforehand, so they had some clear rules to adhere too, which was giving them some feeling of control over what was going on. One of the first things they did was to discharge elective patients, the ones that were judged as being well enough to be at home. There was a distinct sound associated with the first day of the war. It was the sound of little wheels of suitcases being pulled by the patients leaving the hospital. That sound made in unison by dozens of suitcases was strangely similar to the sound of jet engines of Russian war planes flying overhead.
Andriy was in a rush to get back home on that day. He had great responsibilities at work, but he also realized that he had his family to care for. From then on, all his decisions were going to be based on weighing up those responsibilties. He had to rise up to being a strong leader of his family, and his work colleagues, as well as continue his clinical practice as a military anesthesiologist, having had no experience of treating combat injuries previously.
When he got home, he found his wife and three children in a desperate state. He himself felt strangely calm inside. He had been preparing himself for what was unfolding on that day, and he was executing his plan step-by-step. He knew that calmness was contagious, just like panic, and he was trying hard not to project any signs of the latter. They boarded up their windows on that day as did all their neighbours (the ones who had not run away). Andriy remembers spending most of that evening answering non-stop phone calls from friends, family, and colleagues. The situation was changing hourly, and everyone was sharing the latest info with each other.
Thinking about the first day of the war, and analysing peoples’ initial reactions, Andriy observed three types of responses:
- Counteroffensive. It is a well-known fact that in the first days of the war, assault rifles were being handed over to ordinary citizens. There were a few distribution points throughout the city, basically some military trucks where people could come and collect an AK-47 rifle. Some background checks were being made in some places, while in others guns were handed over to whoever queued up for them, and queueing up they were! A lot of people were determined to protect their city, to fight for it till their last breath. Those were not just purely emotional responses – in one of the Kyiv’s leafy suburbs where AKs were just being handed over to whoever showed up for them, those very citizens then armed with automatic rifles managed to eliminate an entire Russian infantry unit, who tried to break into the city from that direction.
- Escape, running away. There was a significant number of people who chose that path – four leading surgeons from Andriy’s hospital disappeared on the first day of the war, having managed to sneak out of the city before the roads got blocked. It was an irrational getaway, governed by fear for their lives. In fact, there was a bigger risk of being bombed down by Russian planes, and artillery, than staying in Kyiv. In fact, it did happen more than once, and some people met their faith that way.
- Numbness, paralysis, “see how it goes’ attitude. Quite a few people decided to sit it out, and passively observe the events as they were unfolding, potentially joining the winning side later.
On the second day, it became clear that the safest way for the hospital staff to carry on was to move to the hospital with their families. For Andriy and his family it was not hard – they enjoy wild camping and white water rafting, so were fully equipped for sleeping on the floor of the hospital basement.
On the third day, the city looked deserted. People briskly walking their dogs were the only sign of life on the previously busy streets.
Meanwhile, all elective patients, and patients who were well enough to go home had been discharged. The hospital was open for emergencies only. Andriy sent his colleagues around to the nearby checkpoints to tell the soldiers, and volunteers to send all the wounded, and people who are acutely ill to their hospital.
Under Andriy’s leadership the doctors set up an Emergency Department for admission and triage of mass casualities. Although there was no active street gun fights in their area, there were rumours of numerous Russian saboteur groups operating throughout the city. An ambulance was shot at nearby; another one was seized, and used to break into the hospital grounds only to be destroyed by the soldiers from the 72nd Infantry Brigade, which was stationed there by then. From then on, all the ambulances arriving at the hospital were first searched by the soldiers. It was only after that quick, but thorough search that an ambulance was allowed to pass through the gates. The hospital staff developed very close reationship with the soldiers. They stayed in the old Soviet-era bomb shelter underneath the hospital, and were catered for by the hospital canteen.
It was social networks that determined the course of the war in those first few days. There were a few Telegram channels where you could get all the up-to-date information about movements of Russian troops and saboteur groups to watch out for. For example, there was a group of Chechens disguised as doctors in white gowns going around in an ambulance, which was later found and destroyed. In more then one occasion, people were passing coordinates of Russian troops to their military, so that thtey could be eliminated. Andriy says that it was astonishing to him that Russians did not think about shutting down the internet, or block the social media at the very least. A lot of them met their fate due to its inventive use by Ukrainian citizens.
Andriy remembers doing his first hospital round surrounded by the soldiers carrying automatic rifles. The hospital consists of a few buildings occupying a large territory in quite a picturesque park. It was a long walk, and it felt surreal, but Andriy got used to it quite quickly.
There was one incident that he remembers particularly vividly. His close friend’s mum succumbed to a chronic illness on day four of the war. Her last wish was to be buried in her hometown of Ivano-Frankivsk at the west of the country. It would have been an insane thing to do then, not only because of logistical challenges, but also bureaucracy, which nobody cancelled because of the war. They needed to obtain a death certificate from a local authority which was situated right in the middle of one of the most intense battles of the first days of the war near a military airport on the outskirts of Kyiv. Three thousand Russian marines were eliminated as a result of that firefight. Andriy’s friend was abolutely determined to fulfill his mother’s last wish, and it took Andriy a lot of effort to talk him out of it. The common sense and self-preservation instinct did prevail, and they agreed to bury her temporarily at a field near the hospital.
Burying the dead was a challenge in those early days of the war. A few hearses were shot at by the Russian saboteurs, and most of the funeral directors were refusing to transport the deseased around the city without military convoys. Through his connections, Andriy managed to find one who agreed to do it. He remembers standing in front of the open grave with an Orthodox priest saying the prayers, while Russian helicopters and ballistic missiles were flying overhead. The priest went into some sort of trance, and was going on and on as if he had completely disconnected from reality, and was transporting the soul of the dead to Heaven quite literally. Andriy remembers thinking that they were all going to end up in the same grave while he was doing it. It was a surreal experience that haunts him to this day.
As an aside, his friend has managed to obtain a permission to exhume his mother’s body, and is in the process of organizing her proper burial in her hometown according to her last wish.
They were no active battles near the hospital. It is situated in the southern outskirts of the city close to a freeway leading to Odesa, the only one that was not cut off by the Russians during their initial assault. They had planned to seize Kyiv in three days, which since then has become an internet meme. Still, the hospital did receive a number of casualties, and some of them have been etched into Andriy’s mind forever. There was a young girl with an open brain injury admitted on day five, or six. She was in a car with some strangers, who had managed to escape from Chernigov, a city that Russians had managed to seize very quickly. They had made it to Kyiv, and were high on Adrenaline when they saw the city lights. It was getting dark, and they did not notice a checkpoint. They did not stop, and were shot at by the Ukrainian soldiers who thought that they were saboteurs trying to get in. One of the bullets shot off a large piece of the car door, which then flew and cracked the girl’s skull open. She was brought in barely alive with her pulsating brain visible through a gaping wound. They spent a long time resuscitating her, but it was futile…
As the hospital was in a fairly safe place, it also became a large hub for all the medical humanitarian aid coming into the city. They would sort the boxes of tactical medical aid, and send it to military units fighting on the frontlines. They would also liaise with the other hospitals, and send them the things that they needed the most. They were doing that for the first two months. There were places fully dependent on those shipments, and they were given the first priority.
All the hospital staff stayed together in the extensive network of hospital underground corridors and basements. Everyone brought in their families with them. There was a lot of camaraderie and mutual support; they cooked, and shared their meals together, they looked after each other’s children. None of the hospital’s managers had left, and they were living in the basement with everyone else. Andriy was also sleeping on the floor next to his wife and three kids. They also looked after their a daughter of another anesthesiologist, who had just had a new baby. The presence of children was an important positive factor for the staff – they felt hope seeing kids playing in the dimly lit hospital basement as if there had been no war going on around them.
Not everyone stayed in Kyiv in those first few days. Four leading surgeons had managed to escape from the city before the roads were blocked. Andriy remembers calling one of them on their phone when he needed him to attend to see a casualty in their new make-shift ED. “Sorry, man, but we are already in Poland”, was his reply. The doctors who had chosen to leave were not respected by those who stayed. Surgeons and anesthesiologists in particular were in high demand, as is always the case during wartime. They were seen as bearers of a social contract that they were not supposed to break. They were like soldiers on the frontline, and their disappearance were seen almost as a desertion. It was a choice between your family, and your country, and the vast majority was choosing the latter, while having very little respect for those who had chosen the former.
Andriy remembers one pivotal moment, which particularly affected his colleagues, solidifying their determination to stay and do their job no matter what. It was when the Russian war crimes in Bucha first came to light. A picturesque town near Kyiv, Bucha had become home to many internal refugees from the Donetsk region in the East, after the war had broken out there in 2014. Having escaped Russians then, that thriving community was one of the first to experience the full force of their genocidal army, who have always been infamous for ignoring the Geneva Convention, or a basic respect of human life and dignity. The photos from Bucha shook everybody. There was no turning back then – everyone knew that they had a moral duty to stay, and do their job in order to survive as a nation. After Bucha, it became clear that the real Russian objective was to eliminate Ukrainian national identity by a total genocide of those, who wanted to keep it. Everyone knew that they could be next, so they pulled themselves together and got to work.
Meanwhile, the security situation was getting worse every day. On day 8, Andriy and his family decided that it would be safer for their children if his wife took them to her parents, who lived in Chernovtsy, a remote town near the Romanian border, which was far removed from the frontlines. Also, as of writing this story in May, 2023 it has never been hit by Russian rockets, or drones,
The only way to get there was to take an “evacuation train” departing from the Kyiv’s Central Railway Station. Having said their goodbyes to the hospital staff, whom they had gotten very close to in that first week of the war, they made their way to their house to pick up some things to take with them. Before leaving home for the station, Andriy’s five year old son sat down to tie his shoes and broke into tears: “Why do I have to leave my house? Why do they want to kill us? Why did they invade us?” “Well, they are just bad people” – Andriy did not know what to tell his son. “So, then we have to kill them too?” “Yes” – was Andriy’s answer.
His son saying “why do we have to leave our house?” has gotten stuck in Andriy’s mind forever. He has kept asking himself that question ever since, particularly when he has had to make a difficult decision. That pure, unadulterated child’s question has become his motto; the image of his son asking it while leaving, perhaps for a very long time has been the most powerful image of this war.
It was the first time they drove through the city since the beginning of the war. The streets were empty, the city felt deserted. On their way, there were a lot of burned down, and shot through cars and vans used by Russian saboteurs. They had been destroyed by the Ukrainian territorial Army, and regular forces. The children kept quiet during their whole journey.
Once they reached the station they saw apocalyptic scenes of thousands of people trying to get into evacuation trains. There was no timetable, or destinations that one could choose from. They just had to catch the next train pulling up to the station, and departing towards the west once full, which took only a few minutes. Only women and children were allowed into those trains. Men were staying behind. Andriy thought that it reminded him of the scenes that he had seen in the movies about the Second World War.
The family decided to stay in an underground corridor underneath a platform in fear of being bombed. The next train happened to arrive on that platform, so they were the first to board it.
The Ukrainian Railway Service has to be commended for having pulled that off. In spite of the real threat of being attacked from the air (and a few trains were in fact bombed at the beginning of the war), they persisted with their mission to evacuate the most vulnerable in the first month of the war. The train drivers and station workers did not quit. Like the medical staff in the hospital, they realized that they had to fight their own war, to put their public duty above their responsibilities for the families, and even their own safety.
After saying goodbye to his family, Andriy headed back to the hospital. He was feeling relieved that his family was on their way to a relative safety. At the same time, he was still worried whether they would get to their final destination. In fact, there were legitimate reasons to be worried – an evacuation train was shelled by Russians on the following day. He was also worried about his own future. What was going to happen to him? Were they going to target the hospital?
They carried on living in the hospital for another month until Russian troops were pushed out from the Kyiv region. Russians called it “a strategic re-grouping”, but essentially it was a near total wipeout of their troops and hardware, and a great morale booster for Ukranians.
After a month of separation, Andriy’s family returned, and they all moved back to live in their house. A lot of other families were also re-united with their loved ones. The city was gradually coming back to life.
Andriy sent his hospital doctors to the Mechnikov Hospital in the city of Dnipro in the east of the country. Mechnikov was one of the largest Trauma centres, which had been dealing with combat injuries since 2014. They were situated only hundred miles from the frontline, and were overwhelmed with the number of casualites. Andriy wanted to relieve the pressure on them, and organized an interhospital transfer of the most severely wounded soldiers to their Intensive Care Unit during that visit. And so, the never-ending flow of combat injuries began – they have continued admitting interhospital transfers from other general hospitals situated closer to the frontlines, as well as frontlines themselves, and are now treating around 1100 soldiers, some of them having stayed with them for 4-5 months.
They are all civilian doctors and nurses, and like many medics in other Ukrainian hospitals they have had to learn to deal with military trauma pretty quickly. Andriy says that many find psychological, and emotional aspects particularly hard to deal with. The majority of doctors in his hospital are fairly young people in their thirties and forties, and nurses in their twenties. Seeing people of their age, or often even younger with horrendous life-changing injuries, they could do very little to help with is undoubtedly taking its toll on their mental health. Every death is a tragedy. Standing at a funeral next to the family of someone they have done their best to save, but failed is very hard. “He had survived on the frontline, made it to the field hospital, and we have failed to save his life with all the fancy gadgets and equipment of a university hospital?”
Patients with chronic illnesses die differently. Constantly seeing deaths of young people tests one’s resilience. They are not military doctors, nobody had ever taught them any coping strategies – they have to come up with their own ones. “Why, what for?”- they keep asking themselves in vain.
There are a lot of young guys, whose life is not going to be the same again. There is a soldier in their hospital right now, a 20-year old, who had suffered a blast injury having stepped on an IED. He now needs a multiple-stage reconstructions of his genito-urinary system. He will never have children, or have sex…
Among Andriy’s social circle there is nobody who has not lost a relative, or a loved one. Everyone has been touched by the war – all have emotional wounds, many have physical ones. Doctors and nurses deal with both on a daily basis. They also live under a permanent threat of a physical harm as Russians continue their rocket terror campaign. Andriy’s house is in a village, which is situated along the trajectory path leading to the Kyiv’s main electrical power plant. Rockets and drones are frequently shot down near his village. The air defence forces try to hit them at a distance over the forest, but there is a danger that one day their house might be hit. In fact, a large fragment of an intercepted missile has landed in someone’s garden just a few hundred metres away from Andriy’s house recently.
The longer this war drags on, the more profoundly it affects the very social fabric of the Ukrainian society. Although many families have come back to join their husbands and fathers after Russians were pushed back out of the Kyiv region, most are still spread out all over Europe, and many have already gotten used to the Western life. Their children are in physical schools, rather than virtual ones; women have found jobs, and got into various carreer ladders. As a consequence, families are falling apart. A few men at his hospital are going through a divorce, while others are clearly feeling the strain of separation from their families who are now settled in the West, and are not keen to come back. It clearly affects their work, which as their manager, Andriy has to deal with.
There are other problems. The work is relentless and hard. A lot of those wounded soldiers require daily trips to theatre for debridements and washouts of their wounds, which take a long time to heal. They also try and maintain elective work, both cancer, and transplants, which puts a great financial strain on the system as both programmes are very expensive to run. Right now, the Ukrainian healthcare is 100% dependent on humanitarian aid. Medical staff is feeling the financial hardship as the cost of living is rising, while their real-time earnings continue to fall.
For civilian doctors there is another issue. The vast majority did not take a course in combat medicine while at the university. According to the outdated Soviet-era laws, this absence of military qualifications means that if drafted, they would have to go to the frontlines as combat medics, rather than qualified specialists, even if they are surgeons, and anesthesiologists, who are in highest demand. That law is affecting Ukrainian healthcare in a very negative way – a few highly trained specialists, including cardiac surgeons have already been killed fighting on the frontlines, rather than helping treat their wounded brothers-in-arms. All the men who wanted to join the army already have. Those who stayed have decided that their fight is going to be more effective if they used the skills that they were best trained at, in the hospital setting.
Andriy and his comrades sees their work of caring for the wounded as a mission. He has a very clear moral code, and demands that everyone follows it too. Since the beginning of the war, they have treated everyone who has been brought in through the hospital gates, including Russian prisoners of war. They have enjoyed the same standards of care as the Ukrainian soldiers that they had fought with. This has never been up for discussion. As doctors, they had been trained to treat, and not to kill. Their task is to become highly effective in treating the wounded, but also maintain higher moral and ethical standards than their enemies by treating their prisoners. The war will be won by their physical, and moral superiority.
When living in the hospital basement with his colleagues, and their families, Andriy was often thinking about what he would have done if Russians had shown up on the hospital grounds and started shooting at them? He did have a shotgun for hunting at home. A lot of his colleagues did have guns at home too. From the start, Andriy imposed clear “no weapons inside the hospital” rules, and was very strict at enforcing them. He decided that their mission was going to be to save lives, rather than to end them. They were and would always remain civilian doctors treating combat injuries. As long as he remains in charge at the hospital, he will make sure that everyone follows this rule. If and when he is drafted, then he would make his individual choice. So far, he is not sure what that choice would be.
Andriy contrasts the moral choices of Ukrainian doctors with their Russian colleagues. Naturally, before the war they had known quite a few of them, having met at various conferences. Andriy himself had presented at a few medical gatherings held in Russia. He had always made a point of making his slides in Ukrainian when doing so. When Russians invaded Ukraine, he and a lot of his Ukrainian senior colleagues wrote to their Russian counterparts pleading them to publish a joint statement of Russian medical community to condemn the war. There was no reply. A complete deafening silence. None of the Russian professional medical societies has stood up against the war. None of Andriy’s Russian colleagues has sent him a private message of support. A few have publicly supported the war.
The Belgorod Medical Association – a region bordering Ukraine, which is within reach of Ukrainian drones, and where a few of them caused fires at military facilities, has published an open letter to the Governor of their region asking him to raise the issue at the Government level so that it could stop launching rockets from their territory. “We do support the Special Military Operation (the usage of the word “war” in relation to Ukraine is banned in Russia now), but please could you stop shelling Ukraine from the territory of our region, as it is constantly under retalliatory attacks by Ukrainians. We all have children, and elderly parents, just like you do, who have become hostages of this situation. Please, help us and our families, so that our lives are safe again”. This is an example of a total moral degradation typical of the Russian medical community, which is just a slice of the larger society.
Andriy also says that their support for the war signifies their professional degradation, in addition to the moral one. “I am against the war, I am against taking lives. You do not deserve to be a doctor if you do not subscribe to that basic principle. Shame on those who think otherwise”, he says.
What is going to happen after the war is finished? Andriy says that Russia has been at war with Ukraine for a few centuries, which tends to flare up every hundred years, or so. Ukrainians are a peace-loving nation, and they tend to forget and forgive pretty quickly. Also, they tend to get entangled in internal fights over who is the most competent to run the country. However, this time is different – they will not forget what Russians have done to their country, to their loved ones. Andriy says that his children hate Russians, and that hatred will persist for generations until the Empire of Evil falls, and everyone forgets about its very existence.
So, yes the war will end only with our total military Victory, and about 90% of Andriy’s social circle passionately believe that this will happen soon.
I do believe so too. I hope that I have managed to write a story worthy of the man. I have been really impressed by his clinical competence, managerial skills, and very high moral standards, which I hope are all visible throughout his story. I am proud to know Andriy personally, and I am humbled by his resilience and humanity. I do believe in the bright future for Ukraine when I meet people like Andriy, the people who will be re-building it after the war is finally over. God Bless each, and every one of them!
Finally, I asked him about what keeps him and his family afloat:
– What keeps you motivated? Where do you find a positive energy to carry on?
– We are alive, and we celebrate this fact every minute of our days, like nobody else in the World right now! When me and my wife have a rare weekend off, we like to go to the Carpatian mountains for some white water rafting. Nothing beats being submerged in water of 9 degrees Celsius. You cannot think about anything else but your own, and your partner’s survival. You end up fighting the hardest war of them all – the war with yourself. The other war does not look as bad after that!