In Ukraine with English brain surgeon Henry Marsh: The inner life of a brain surgeon

The neurosurgeon and author works with his mentee, Dr Igor Kurilets, in Kiev

Henry Marsh and Igor Kurilets: ‘I liked Kurilets immediately  . . . he was the only doctor I met on my first visit who seemed able to admit openly that the medical situation in Ukraine – at least in neurosurgery – was dire. The Soviet Union had excelled at producing guns and rockets but failed miserably at producing decent healthcare,’ says Marsh.

Henry Marsh and Igor Kurilets: ‘I liked Kurilets immediately . . . he was the only doctor I met on my first visit who seemed able to admit openly that the medical situation in Ukraine – at least in neurosurgery – was dire. The Soviet Union had excelled at producing guns and rockets but failed miserably at producing decent healthcare,’ says Marsh.

 

There is borsch and then there is Ukrainian borsch – but the borsch I had just been served was something else. It was Yelena’s borsch. I was sitting in the Kiev apartment of surgeon Dr Igor Kurilets, sampling the clear beetroot broth cooked by his cardiologist wife.

To my left sat brain surgeon Henry Marsh, who was in Ukraine to work with his Ukrainian mentee, Dr Kurilets, for a week. Since retiring from the NHS (he officially did so last April), Marsh travels to Ukraine about twice a year to assist with difficult operations on a voluntary basis.

“You haven’t eaten Ukrainian borsch until you’ve tried Yelena’s,” said Marsh.

I could see why Marsh preferred to stay with the Kurilets when in Ukraine. He has made more than 40 work-related trips to the country since his first visit in 1992.

The fold-out bed at the Kurilets is well used and Marsh chooses different rooms when he stays depending on whether the couple’s children – a military surgeon son and student daughter – are at home.

The meal was typical of the Ukrainian generosity I experienced during my time there: fresh potato salad, a tender meat dish, black bread and pickled gherkins.

Marsh was in garrulous form. He had just returned from an Italian trip to publicise his book. I gained the impression that the neurosurgeon is still surprised by his literary fame as he told me in detail about being interviewed by renowned Norwegian writer Karl Ove Knausgaard.

The prospect of now being asked to interview Knausgaard for BBC2’s Artsnight programme seemed to make Marsh nervous.

It did not make him as nervous, however, as the experience of watching someone else operate. “Watching others operate is more stressful than operating yourself – 100 times more stressful,” he said.

In the book Do No Harm, Marsh writes: “Early the next morning, I lay in bed thinking about the young woman I had operated on the previous week. She had had a tumour in her spinal cord, between the sixth and seventh cervical vertebrae – although I did not know why, since the operation had seemed to proceed uneventfully – she awoke from the operation paralysed down the right side of her body.

“I had probably tried to take out too much of the tumour. I must have been too sure of myself. I had been insufficiently fearful,” he wrote.

Protest

As if to relive the time, Kurilets proudly showed me a piece of Maidan cobblestone preserved in a case for Marsh, as well as a segment of the Lenin statue torn down by the crowds.

It was clear that for 57-year-old Kurilets, meeting his English mentor had symbolised a quiet revolution in itself, albeit a much gentler one, focused around his career.

“When I first met Kurilets, his medical equipment was stored in a fish tank and he sterilised with formaldehyde,” Marsh explained.

Later that evening, Marsh presented Kurilets with some forceps which he placed on the table. Over the years, Marsh has persisted in taking second-hand medical equipment to Ukraine from the UK – sometimes driving it there himself.

“At one point, I even had boxes of surgical drapes ready to go out, stored in my parents’ garage. The British embassy used to have a truck that came out here every six weeks and they kindly transported a lot of equipment for me.”

Marsh first met Kurilets in 1992 when he was invited to Kiev’s main neurosurgical hospital to deliver lectures about modern brain surgery and the necessary equipment. Ukraine was then newly independent, the country in chaos and the economy close to collapse. As for the hospitals, Marsh described them as “out of a nightmare”.

In his book, Marsh describes meeting Kurilets: “A young man came hurrying up to me like an enthusiastic spaniel. It was the surgeon I had seen ‘operating’ on the paralysed man.”

At that time, Kurilets was the director of the spinal emergency department. Marsh expected Kurilets to assure him that the Ukrainian emergency spinal was the best in the world. Instead, Kurilets said: “Everything terrible here!”

“I liked Kurilets immediately. Apart from Academician Romadanov, he was the only doctor I met on my first visit who seemed able to admit openly that the medical situation in Ukraine – at least in neurosurgery – was dire. The Soviet Union had excelled at producing guns and rockets but failed miserably at producing decent healthcare.”

Marsh later began to visit regularly, mentoring Kurilets and returning as he worked until his retirement. “At least twice a year now, but I can’t handle more than a week,” he said.

Documentary

The English Surgeon

I commented that the apartment was unusually large and Kurilets said it was actually two apartments joined together. He joked that when he was younger he was an “idealist Marxist” but he was now “a capitalist, with two flats and two cars”.

Kurilets and his wife were originally from western Ukraine, the cultural centre of the country where Ukrainian is spoken more than the Russian in Kiev and people are largely Catholic.

They had both been classed as top or “red category” academics in their regions of Ivano-Frankivsk and Uzhgorod so had to relocate to the capital given this status.

While waiting for dinner, I eyed the bookshelves. Among the glossy hardbacks and medical texts, something vied for my attention – a DIY handbook of brain surgery.

Over the years, Marsh had compiled intricate labelled drawings of brain parts, together with a step-by-step guide to each surgical procedure. Kurilets told me you could carry out brain surgery on reading the book, such was Marsh’s ability to make the complex simple.

Yet, on hearing the two men talking later, it’s obvious their work is scarily complicated. In Ukraine, Marsh told me he got “involved towards the end of the operation, to dissect the tumours. This takes 15 years to learn, the tumour can be stuck to everything.”

I heard about two planned operations that week. The first illustrated the financial difficulties of ordinary Ukrainians who happen to get sick.

A woman of 35 with two children had a brain tumour that had resulted in her having only 25 per cent vision in one eye. She had thought of travelling abroad for an operation but the associated cost would be about $40,000 (€36,000) in Germany or Israel.

This would mean selling her home to pay for an operation that had no guarantee of success. She was already going blind.

The other patient was a woman in her 50s from the Cherkassy region of central Ukraine. She had been diagnosed with a tumour two months earlier after waking up one day with a severe headache, nausea and vomiting. The tumour was now pressing on her eyes.

I later heard the first patient had gone blind following the difficult operation. The 10-hour procedure had involved the separation of the tumour from the optic nerve.

Marsh told me later he blamed himself for the outcome and wished he had completed more of the operation himself. He then added: “The more experienced you become, the more difficult the case so the results get worse” and he reminded me of part of a phrase he first quoted in his book,

“All surgeons carry a cemetery with them. The cemetery just gets bigger and bigger.”

The second operation was more successful with the team managing not to paralyse the face.

Some of the tumour had been left behind. Marsh assured me this could be treated with high-dose radiation now but her face was intact.

“We are all faces,” he added.

Over dinner, Kurilets told me of his plan to build a new hospital on the outskirts of Kiev, one that would be designed around patients’ need and that would enable more people to be treated. The plan was that we would drive to see the site in a few days.

Plan hatched, I then took a cab back over the bridge to central Kiev as Kurilets and Marsh configured the practical intricacies of the next day’s surgery.

Dream

As the Baroque splendour of central Kiev faded to grey concrete highways and colourful street stalls, we saw that many homes had blue-and-yellow Ukrainian flags outside. What the Ukrainians lacked in economic clout, they made up for in solidarity.

The farther out we drove, the more flags we saw. We eventually pulled up in a quiet residential road in the area known as Academia, lined with bungalow-type houses and woodland.

Kurilets got out and greeted the workmen as if they were his brothers. We crossed the road to view the former apartment block which is to be turned into a hospital for 30 patients. Kurilets told me that it will take about 10 years in total – from planning to opening – to realise the hospital.

Proudly, he showed us each corner. To him, these were not breeze block- or timber-filled spaces but “the waiting room”, “the space for the MRI scanner,” and “the children’s ward”.

Kurilets insisted on having windows in the new hospital and on keeping the balcony. The back of the building looked out on to woods. There were the two staircases and a newly erected church next to the site.

As well as the financial cost of this project (funded from profits from his private clinic work), there was a personal cost.

Apart from the time involved and need to galvanise a team behind him, Kurilets has had to deal with planning permission bureaucracy and even a businessman attempting to buy up the road to the site.

Kurilets then described the difficulties of life in Ukraine now, whether you are a patient or a doctor.

“Under president Yushchenko after the Orange revolution, you could solve problems either through bribery or legal recourse. Under Yanukovych, you could only solve problems illegally. Now, I don’t know how we will solve problems.”

Such was Kurilets’s enthusiasm for the hospital, it was hard to leave. He told the workmen that we had come from London as they said goodbye, having planned the next phase of Kurilets’s “steel dream”.

On the final day of our trip, Marsh’s publisher in Lviv had organised a book launch. The young audience thumbed each copy and strained their necks to get a good view of the English surgeon reflecting on his career. I sat at the back, taking in the questions from the audience as Marsh charmed them and laughter ensued.

One young woman asked Marsh about the secrets of good health to which he replied, “I do 50 press-ups a day and run 2km-3km a day, 8km-10km at the weekend.”

In his view, high-intensity training may have some benefits and, according to the UK’s medical officer, there was no safe alcohol limit. He did not espouse any special diet, saying exercise was more linked with good health, according to the studies.

Another member of the audience then asked whether doctors ever “grew fond of their patients”.

“Well, I never have,” responded Marsh, “though one colleague married a former patient.”

At this point, someone else joined the panel at the front of the salon. Ihor Chaban, a survivor of the Maidan events in February 2014, greeted Marsh as his story was related to the crowd.

Massacre

I remembered Andrey Kurkov’s description in his Ukraine Diaries: Dispatches from Kiev of the horrors facing the protestors during that week: “The hospitals are overflowing right now. But many of the wounded are in hiding, from their friends as well as from strangers.

“They are afraid of going to hospital because the police have often abducted injured protesters from there to take them to the station, without offering them any medical care.”

Chaban was lucky. Marsh explained he had sustained a bullet wound to the head and the loss of part of the right temporal lobe of his brain.

He told the crowd if the wound had been even a millimetre in the other direction, Chaban would not have fared so well. The bullet had just missed a vital artery – it could have killed him.

Before I left for the trip, friends had asked how I would survive it, equating all of Ukraine with a war zone.

Yet I had thrived on the stories of survival: Kurilets’s struggle to build a new hospital; the patients at the clinic; Marsh’s commitment to Ukraine; and Chaban, the Maidan survivor.

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