This is a story about a doctor living and working in an occupied territory. It has not been easy to collect pieces of information and put them together so that they make sense. Communication has been very difficult. We have talked a few times on a broken line with automatic gun fire on the background. Valentin has managed to write a few emails while on call as the hospital internet appears to be a bit better. I have compiled all the info together and tried to make sense of it all. I have also tried to stick to the original as much as I could. His style is more reflective, rather than descriptive, and I have tried to keep it to retain the author’s originality. According to Valentin, it is an unfinished story. He is still living it and trying to make sense of it all. This is his attempt to rationalise his experience, and it has been an honour to help him. There are no photos, as I am sure you will understand our concerns about his security.
Valentin (not his real name) is an Anaesthetist working at a general hospital in a small Ukrainian town about 150 miles from the Russian border. He lives alone, having previously divorced his wife. Their grown-up son had left town to study at a university in Kharkiv, a large city not far away. Valentin’s elderly mother lives nearby.
On the 24th of February when the war started Valentin was at home, as he puts it “digesting the news”. His son and his girlfriend showed up shortly afterwards – Kharkiv was under heavy bombardment. Valentin’s town was not, so he spent some time organising their evacuation to the western part of the country while the escape routes were still open, and relatively safe. His mother did not want to go anywhere, so that was that for him too.
The rest of the day, and night went by relatively quietly. Valentin was supposed to be on call at a COVID ward on the following night. If it had been a “normal” day, he would have been pretty sure that it was going to be quiet. The COVID epidemic, after another devastating Autumn-Winter season, was finally fizzling out – there were no critically ill patients requiring an admission into their intensive care unit. However, it was not a “normal” day…
He popped into the hospital director’s office to get some updates, who told him to stay put as they were expecting admissions of causalities from the frontline very soon. He went back home ready to come back to work at a short notice. A couple of hours later a phone did ring – “Come quickly, we have multiple trauma admissions!”
As he was dressing up in the hallway, the lights went out. As it turned out later, they did go out in the whole town and the region around it, as Russian tanks had overturned several power supply towers. The town was left without electricity, central heating, or hot water.
In the hospital, a diesel generator was turned on, which was just enough to power up the sockets in their three intensive care rooms, as well as operating theatres. As Valentin later discovered, there was only enough diesel to last for about 12 hours. A hospital engineer kept calling every couple of hours and begging them to switch the power off for at least 40-50 minutes, as the generator kept overheating.
Valentin remembers the first admission – a Ukrainian soldier who suffered horrendous injuries incompatible with life. He was in agony and died very quickly despite their heroic efforts to save him. On that day they had to treat numerous severely injured soldiers, many of them were dead on arrival. The vast majority were blast injuries, and shrapnel wounds. In those first couple of days, Russians moved very fast, approaching the outskirts of the town.
In the coming days, there were as many civilians as there were military personnel among the wounded. They came with both blast injuries, and gunshot wounds. Everyone came with their own short story attached. For example, one civilian guy was driving his car on the outskirts, when he saw Russian column of tanks, and armoured vehicles. Then, his car was shot at without a warning.
The Intensive Care Unit was located on the ground floor, and their operating theatres were on the first one. As the lift was not working, they had to carry the wounded on stretchers, or even with their hands as those were in short supply. Eventually there were no lights anywhere, except for a couple of portable rather weak theatre ones. They could only use flashlights in the Intensive Care.
In the first couple of nights, they were operating nonstop under an accompaniment of constant artillery cannonade and sounds of shattering windows in the theatre block. On the second night, they finally had a break, both between admissions, and shellings, so Valentin decided to check on his mother. There was no mobile reception anywhere, so he ran towards their house across town through deserted streets in pitch darkness. While he was passing by their maternity hospital, there was an explosion nearby, then shattered window glass started raining down around him leaving him shaken, but miraculously unscathed.
He kept on running. Then, a loud crackling sound underneath his feet, which made him startle. He stood there paralysed with fear, only realising that it was a plastic bottle. His mother was hiding at the basement of her old Soviet-built flimsy block of flats. She was OK, and Valentin breathed a sigh of relief.
Looking back at those first few days, when his world was turning upside down, Valentin could barely remember what it had been like living a “normal life” previously. Those few days completely reset his perception of the world around him, as well as sharpened his survival instincts. It seems that the script of the recent few years had been written to remind both the contented, and disgruntled common men and women of how cushy and comfortable their lives had become, and how fleeting that comfort actually had been. It turned out that chaos was just around the corner. First, the pandemic, which was just starting to ease off, but then the war staged a definitive blow, and seemed to knock out any of their remaining hopes for a better future.
Russians rolled into town on Day 3 of the war. The town itself was relatively spared – they did not have to implement their usual “scorched earth” tactic. Overstretched Ukrainian troops did not put up much resistance, as their priorities lay elsewhere at the time. In short, the town did not suffer anything close to the Mariupol’s levels of destruction, or loss of civilian lives. Also, the first thing Russians did after they seized control of the town was to restore its power supply. That was a typical Russian playbook that they tend to reserve for cities, which give up relatively bloodlessly to gain support of local population. Switch the power off, roll into town in tanks, switch the power back on, and act as saviours from imaginary Nazis, who seem to be on a mission to eliminate their own people who cannot wait to welcome their Russian “de-nazifiers”.
Valentin’s town seemed to be chosen to be made into a model place for Russian propaganda to demonstrate a liberation from Ukrainian Nazis, thus reinforcing an image of “Good Russians”. Preparations had started long before the war. The town is close to the Russian border, so all the Russian propagandist TV channels (i.e. all of them!) are easily accessible there. Like the population of the Donbas region, the town’s inhabitants had been bombarded by the usual mix of programmes about the great Soviet Union, and the geopolitical disaster of its collapse, which had allegedly led to the rise of “Ukrainian Nazis”, and strengthening of the NATO, their main sponsor. They were being convinced that there was no such ethnicity as Ukrainians, that the Russian liberators would eventually come and save them from their nationalist rulers. A parallel reality had been created, and many people had found themselves living in it.
According to Valentin, a significant proportion of the town’s population were either actively welcoming Russians or said that they did not really mind who was in power by the time Russian tanks rolled into the city. A few of older people, who wanted to bring back the USSR belonged to the first group, while some of the younger ones belonged to the other one. For Valentin, it was painful to see those people among his neighbours. Despite the horrors of Bucha, and Mariupol, the tens of thousands of Ukrainians killed by Russians, the tortures, and murders of Ukrainian patriots, which were taking place at the basements of the town’s government buildings turned into medieval dungeons, those brainwashed Ukrainians chose to believe the stories, and images that the Russian TV channels were spitting in their faces. To that effect, all the Ukrainian channels were switched off right after the new rulers came in. It is clearly a painful, and difficult subject for Valentin, and his patriotically minded friends, a story of betrayal as old as the Bible…
As an illustration, he told me a story about his mother’s 80-year-old friend, a former psychiatrist who had a miraculous escape from Mariupol under heavy bombardment. Once, at a dinner table she told Valentin, and his mother that her worst fear was that the Ukrainian Army would come back. “I only wish there would be no bombings. Everything else will sort itself out”.
Another time, about 10 days before the Russian invasion Valentin overheard a conversation between two young people at a bus station:
“Why should we care about which flag we should live under?”
“That’s right, who the hell cares!”
Valentin admits that those people do exist. Although not a majority among the young, they are nonetheless visible. Those sheep do not appreciate the fact that their lives do not cost anything, that those “polite green men” could turn against them in an instant, that they are just little pawns in a big game. His saddest realization is that they will somehow have to co-exist after the war is over.
Apart from those tensions, the life under Russian occupation in their town is pretty “quiet” and “stable” on the surface. Underneath the surface, nicer looking cars get appropriated with a letter “Z” drawn on them to let the owner know not to bother with a police report; empty houses are being broken into and made into a temporary accommodation for the occupiers; people are stopped, searched, and their mobile phones taken – in short, Russians are being Russians. If you want to go towards the Ukrainian territory, then you should be prepared to be stopped, and held at numerous checkpoints for hours, and sometimes days on end – your phone will be thoroughly searched – your photos, messengers, social networks, emails will be closely examined; your documents checked; you will be undressed, strip searched, and every inch of your body examined for suspicious tattoos, which would hint to your affiliation with the Ukrainian military. Anything vaguely pro-Ukrainian – and you will be thrown into a cell, and then God help you…
Unlike Valentin’s town, the other two small ones nearby have been half-destroyed. His hometown stands out as “safe place” with the essentials available to buy at the shops. The first month was hard, with people queuing up in front of empty shops with no cash readily available as cash machines had stopped working, and cards stopped being accepted. There was no electricity for about 10 days. There was no water either and people were queuing up in front of mobile water tanks for hours. Somehow, the town’s council made a re-appearance, and started some repair and maintenance work. The town’s Ukrainian mayor first resigned, and then died under strange circumstances.
Valentin mentions a few things that particularly bother him.
Guilt. He is stuck there, and not on the frontline with the others. There is enough work though, but he does not want to talk about it.
An anticipation of future bombings, and street fights when Russians will finally be pushed out (he has no doubt they will be!). He is particularly worried about his elderly mother’s life.
Uncertainty – not only how it will happen, but when. This uncertainty makes everyday living even more unbearable. An anticipation of pressure from the occupiers. Offers that you cannot refuse. A collaboration that will stain your life forever. It is already being felt by the school teachers as the school year is getting closer. Some of them have already agreed to implement the “Russian curriculum” heavily based on their fascist ideology and vile propaganda. One could only guess what is going to happen to those who will refuse to abide.
Already, a topic of referendum and Russian citizenship for those living in the occupied territories have come up. How is it going to be done? How much pressure will they apply?
Talking to Valentin I realised that the most difficult thing for him is not to live in an occupied territory – it is living with some of his fellow Ukrainians, who have accepted the Russian occupation, dismissing it as some sort of geopolitical game that does not directly affect their lives. Having lived in a small town relatively unaffected by the war in the East, they have never ventured beyond its borders. They watch Russian TV that paints a picture of an ominous world outside full of Nazis, and they accept it as a fact, not willing to explore it, to think for themselves, or to form their own opinions. They have given up an ability to make their own choices, to exercise their will as free-thinking individuals, and that is how Valentin thinks of them – a human biomass guided by the Russian TV as opposed to the Ukrainians, like himself who have made an effort to retain their autonomy, and are continuing to make that effort every day, to make a choice to be individuals in a group of other individuals like them. That frame helps him to survive – he just makes his own choices, however small, and tries to maintain his integrity, to remain true to himself every day, many times a day. He sees other people making similar choices, and that gives him strength to carry on, to be a part of the group. The group that will make it through the occupation and will have to rebuild his beloved Ukraine together.
Hospital life.
Below is a description of cases that Valentin remembers, and not necessarily because they have been clinically challenging, but because they illustrate interactions with their new rulers.
Sometime mid-March, a crying 12-year-old girl was brought in their ED. She had been shot through her right cheek earlier during an evacuation attempt from Mariupol. Their column of cars had been shot at by Russians at the outskirts of the city. A Russian officer, likely a Chechen was escorting her. He seemed very concerned, and eager to help. He kept saying that he had been raised with a gun in his pram, which was probably the same gun he was carrying with him. He said that war was something he understood intimately, and that civilians should stop even trying to make sense of it. He kept asking for the password to the hospital’s wi-fi network, so he could arrange the girl’s transfer to a regional medical centre – it was clear that their small general hospital was unable to provide a specialist care she needed at the time. To be fair to him, he did manage to organise her transfer after a surgical exploration, and washout of her wound was performed in their theatre.
Valentin remembers looking at that Russian officer, and thinking about the cognitive dissonance, the ease with which he seemed to be able to switch from a murderer giving orders to shoot at civilian cars, and a man, probably a father sorting out the hospital transfer of the girl he might have shot at a few hours earlier. That Jeckill and Hyde transformation was uncanny. The officer seemed to be able to change his masks on a whim, just because he felt like it at that particular moment. He seemed to have an air of an absolute moral authority, who has a right to decide who lives, and who does not, and it was terrifying.
It was as if he was saying – “Today, I am a good man, helping a wounded child; tomorrow, I will be doing my job, which might involve killing unarmed civilians, just because I feel like it, or I am given orders to do so. It is a necessity; you will not understand.”
Since the beginning of the occupation, Valentin has had to treat Russian soldiers. Once, he came for his night shift, and saw a stampede of armoured vehicles with the ubiquitous letter “Z” painted on their sides in front of the hospital. Inside, Russians armed to their teeth had swamped the hospital like locusts. They had moved all the civilians elsewhere and put their own wounded on all the available “acute care” beds. It transpired that Ukrainian artillery had successfully hit the railway station where some ammunition was being unloaded. There were multiple causalities of various degrees of severity. Some were dead already, others were being resuscitated, while others had already been attended to, and were waiting to be evacuated elsewhere. The hospital was overwhelmed.
Valentin remembers entering his Intensive Care Unit. There was a dead body in a camouflage lying on a stretcher. The rest of the 7 beds were occupied by Russian soldiers. All the civilian ICU patients had been kicked out of the unit earlier. There were heavily armed Russians everywhere. The seven sick Russians were not doing that great. One was clearly in agony with little help available. Most of the nurses and health care assistants had left, there were only two anaesthetists, including Valentin in the whole hospital so they were doing 24-hour shifts between them. Well, that night they both stayed…
Valentin stayed in the ICU, while his colleague was working in the operating theatre. He was trying to stabilise the patients so that they could survive while waiting in the queue to be operated on, but one could only do so much with intravenous infusions and oxygen if the patient is trying to die of massive bleeding when the tap is still open. A few died in front of him that night. There was one with his bowels outside of his abdomen, who did make it to theatre, but ended up losing the whole length of his small intestine. That meant that he would never be able to eat with his mouth and would instead need to be put on a lifelong intravenous nutrition programme. Apart from losing the ability to enjoy food, that would become a very complicated, logistically challenging, and very expensive way to eat. Valentin remembers feeling sorry for the guy – “Poor bastard, you will soon discover how much Mother Russia really cares about you.”
In the meantime, a group of Russian army medics arrived to facilitate inter-hospital transfers as their small hospital was completely overwhelmed. They behaved reasonably well, even leaving their guns with the guards outside of the theatre block and ICU. They even helped treat the lightly wounded sitting in the hospital corridors. Many of them were Chechens, as well as representatives of other tribes, and ethnic groups living in the Caucasus mountains. Valentin overheard them asking each other about whereabouts of their wounded friends. He was struck by that little glimpse of humanity as Chechens were particularly notorious for being merciless to whoever they consider their enemies.
There appeared to be a clear hierarchy in how evacuees were prioritised – all the Chechens, regardless of their injury severity were evacuated first; then came Russians from the rest of the “Russia proper”; then, recruits from the “Peoples’ Republics” DPR, and LPR – the fake states, occupied by Russia since 2014. Those recruits appeared to be the most disposable, and that seemed to be a recurring pattern. The whole purpose of those “republics” seemed to be a source of cannon fodder for this war. Valentin remembers one of them, a soldier with a leg shattered to pieces. Their surgeons managed to put the bone together, but he needed a long-term care in a specialist hospital in order for his leg to be saved. They waited for a transfer a few days, until it became clear that it was not happening, and had to amputate his leg to prevent severe infection.
At the beginning, there was a steady flow of wounded civilians from the surrounding villages. They were mostly sustaining blast injuries from landmines, and artillery shellings. Valentin’s town is not far from the frontline, some of the villages are still on the Ukrainian side, while others have been occupied. There is also a Russian Army field hospital nearby, where they mostly care for their military while wounded civilians get some basic surgical care and shipped over to Valentin’s hospital. Once, Valentin came in for his on-call shift, and was immediately called to attend to a wounded 14-year-old boy who was already on the operating table. He had been admitted from the Russian field hospital earlier and was in a desperate state. He had sustained multiple shrapnel injuries to his upper and lower limbs, as well as lower abdomen. The operating surgeon opened up some crude sutures hastily put by the Russians in the field hospital, and discovered an unrecognisable mash of lower abdominal and pelvic organs. That experienced and cynical surgeon, who had seen a lot in his long career just sat down and started crying. There was nothing they could do to save that boy. For Valentin, it was one of the most powerful images of this war – a crying surgeon, who is unable to help a child…
Valentin desperately tried to get the boy to a specialised medical centre, but all in vain. As it happened, there was neither mobile connection, nor internet on that night. He begged the local ambulance service to provide a car for a transfer to a regional children’s hospital, but they refused as Russians would not have let it through their checkpoints anyway. He even tried to contact a nearby tertiary referral centre on the occupied territory, but to no avail. The boy died in the morning.
Another time, there was a civilian, a man in his 50s who had been shot into his abdomen. Russian medics at the field hospital had done an operation on him and stitched a couple of wounds in his small intestine. Upon arrival in Valentin’s hospital, he started deteriorating showing signs of severe sepsis. Valentin insisted on taking him to theatre, and sure enough more wounds in his intestines were discovered. He had a rocky post-operative stay on their Intensive Care Unit, but eventually made a full recovery. Valentin has told me about this case to illustrate a general approach to providing medical care to civilians practiced by Russians in their field hospital – very basic, often slapdash interventions, which needed a re-look, re-evaluation, and a re-operation later on.
When asked about what keeps him showing up for work every day, Valentin says that it is mostly caring for the civilians, the townspeople many of whom he knows personally. Despite shortage of everything, it is still possible to make a difference, however small making those people feel a bit better, often just by uttering a kind word when it is not expected.