{"id":2171,"date":"2018-07-12T18:59:43","date_gmt":"2018-07-12T18:59:43","guid":{"rendered":"http:\/\/www.drshevchuk.com.ua\/?p=2171"},"modified":"2018-07-12T19:18:07","modified_gmt":"2018-07-12T19:18:07","slug":"henry-marsh-ukraine-is-like-a-trabant-that-wants-to-be-a-ferrari","status":"publish","type":"post","link":"http:\/\/www.drshevchuk.com.ua\/?p=2171","title":{"rendered":"Henry Marsh: ‘Ukraine is like a Trabant that wants to be a Ferrari’"},"content":{"rendered":"
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Henry Marsh: ‘Ukraine is like a Trabant that wants to be a Ferrari’<\/h1>\n<\/div>\n<\/div>\n
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Henry Marsh is a celebrated neurosurgeon who travels the world teaching his exacting craft. Robert McCrum joins him in Ukraine as he tries to save the life of 11-year-old Viktoria<\/p>\n

\"\u00e2\u0080\u0098My<\/p>\n

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\u2018My job is to teach. The point is to help the next generation\u2019: Henry Marsh in the operating room at Orlika Children\u2019s hospital, Lviv, Ukraine. Photograph: Karen Robinson for the Observer<\/figcaption><\/figure>\n<\/header>\n
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W<\/span><\/span>e joined the green-gowned brain surgery team soon after daybreak. The chill of the operating theatre was filled with the inevitable frisson of nerves before a big op. Inside the Orlika Street children\u2019s hospital in the suburbs of\u00a0Lviv<\/a>, on the western edge of Ukraine, the patient was waiting for us, under halogen lights, anaesthetised upon the table.<\/p>\n

She was corpse-like in unconsciousness. Her chilled cerise fingernails offered a poignant reminder she is a young girl. Viktoria, who is just 11, has a malignant brain tumour. The day before, in the ICU, she had been weepy, fretful and disoriented with brain sickness. She had come with her mother to this 10- storey late-Soviet paediatric facility for a high-risk, potentially life-saving operation.<\/p>\n

Approached through the echoing shadows of twilit corridors, the ICU had been virtually empty. With so few patients, the hospital seemed over-staffed. At Viktoria\u2019s bedside was one of the world\u2019s best-known neurosurgeons, Henry Marsh, the author of\u00a0Do No Harm<\/em><\/a>, and a celebrity in Ukraine. Here, as much as in Britain, Marsh commands attention for his instinctive candour, a lifetime of experience and his bracing clarity. The author\u00a0Karl Ove Knausgaard<\/a>\u00a0once wrote of Marsh: \u201cHis job is to slice into the brain, the most complex structure we know of in the universe, where everything that makes us human is contained.\u201d<\/p>\n

Viktoria\u2019s mother was frightened at the prospect of her daughter\u2019s surgery, but \u201cProfessor Marsh\u201d presented a cool and impressively frank assessment of the risks and likely outcomes. Although Marsh operates around the world, Lviv is an apt destination for a surgeon who is a junkie for jeopardy. This former Austro-Hungarian provincial capital, once called Lemberg, has been described as the \u201csoul city\u201d of Ukraine. Blink, and you could be in pre-Anschluss Vienna. Barely 50 miles from the Polish border, Lemberg\u2019s cobblestones have the melancholy of streets steeped in atrocities. Long before the current civil war, fought out at the eastern, pro-Russian end of the country, European\u00a0Ukraine<\/a>\u00a0saw Nazi war crimes, and murderous Polish blood feuds, mixed with the horrors of endemic antisemitism.<\/p>\n

\"Moments<\/p>\n

Moments of truth: Henry Marsh examines a brain scan with fellow doctors. Photograph: Karen Robinson for the Observer<\/p>\n

Marsh, who has been coming here since 1992, just after the collapse of the USSR, admits to \u201ca slight obsession\u201d with the transgressive, marginal side of Ukraine, a country that appeals to his maverick instincts.<\/p>\n

In the nationalist half of Ukraine, visiting Europeans such as Marsh \u2013 an English surgeon of half-German descent conducting a neurosurgical consultancy \u2013 offer a parable of an evolving Europe, in which a society at war with Russia struggles to find a place in the new European order through the assistance of philanthropic outsiders.<\/p>\n

Today\u2019s operation says a lot about post-Soviet Ukraine, and possibly even more about Marsh. Ask him about his German mother, her guilt about fleeing the Nazis and his own need to atone for the past; at once you are plunged into the abyss of mitteleuropean history.<\/p>\n

Marsh has watched the country torn apart by the\u00a0Euromaidan conflict of 2013<\/a>, seen pitched battles between demonstrators and the Berkut riot police, and devoted a lot of time to help improve an antiquated medical system. He identifies strongly with Ukraine\u2019s drive for independence. \u201cMy work,\u201d he says, \u201cwas part of the same struggle against corrupt autocracy as the Euromaidan protests.\u201d<\/p>\n

\"Cutting<\/p>\n

Cutting edge: Marsh and Taras Mykytyn, operating on Viktoria\u2019s brain. Photograph: Karen Robinson for the Observer<\/p>\n

In those days, when local medicine was decades behind the west, Marsh worked pro bono, to share a lifetime of experience. He still donates his time and remembers how, on his first visit to Kiev, one of two centres for neurosurgery in the USSR, operating theatres contained buckets with the brains of patients who had died after treatment for acoustic tumours.<\/p>\n

Marsh, who made two films (Your Life in Their Hands<\/em>\u00a0and\u00a0The English Surgeon<\/em>) about his experiences, became something of a local hero, and then published\u00a0Do No Harm<\/em><\/a>, the surprise hit of 2014, adding to his celebrity status. Today, he can\u2019t walk down the street in Lviv without getting stopped for selfies or autographs.<\/p>\n

On this visit, literature and medicine have intersected. He\u2019s here to launch his new book,\u00a0Admissions<\/em><\/a>, and to operate in the Orlika Street hospital, having moved from his former base in Kiev to help his friend, the neurosurgeon Andriy Myzak, and colleague Taras Mykytyn establish good surgical routines.<\/p>\n

The hospital is a microcosm of a society in painful transition, fully equipped with up-to-date technology but lacking both the staff and the management disciplines appropriate to 21st century medicine. Marsh\u2019s philanthropic endeavours will soon run into the same problems. Nevertheless, in anticipation of a long day\u2019s work, Marsh remains optimistic. He prefers Ukraine\u2019s operating theatres: \u201cThey have windows,\u201d he said. Such attractions are a rare bonus. At 67, he\u2019s reaching most surgeons\u2019 sell-by date. In his new book, indeed, he confesses to moments of deep anxiety before embarking on another investigation of the cortex. In the theatre, he betrays none of these qualms, projecting bonhomie and confidence.<\/p>\n

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\"In<\/picture><\/div>\n
In recovery: 11-year-old Viktoria and her mother in intensive care after her surgery. Photograph: Karen Robinson for the Observer<\/div>\n<\/figure>\n

When I joined Marsh and his team of 12 (three surgeons and nine nursing assistants), the world of wellness remained tantalisingly close; beyond the Winnie-the-Pooh stencils on the windows it\u2019s a lovely late-autumn day with sunshine gilding the birch trees.<\/p>\n

Marsh chatted to the anaesthetist while the team prepared.<\/p>\n

The tumour was on Viktoria\u2019s brainstem. It was going to be a tricky operation, but unavoidable. \u201cWithout treatment,\u201d said Marsh, \u201cshe would be dead in a few weeks.\u201d<\/p>\n

First, they positioned the patient\u2019s head for surgery, a delicate manoeuvre. Once the incision had been made, and the skull opened, Marsh and his surgeons navigated their way to the tumour with a microscope.<\/p>\n

Thanks to a Canadian-Ukrainian benefactor, this rundown former Soviet hospital boasts state-of-the-art surgical equipment. The problem, said Marsh, is the lack of training. \u201cMy analogy for Ukraine is that it\u2019s a like a Trabant wanting to become a Ferrari.\u201d<\/p>\n

Marsh\u2019s role that morning was to supervise. \u201cI\u2019m keen not to do too much,\u201d he said. \u201cMy job is to teach. The point is to help the next generation.\u201d We looked across the theatre to Mykytyn, who was preparing to open the patient\u2019s skull. \u201cI don\u2019t want to be a white wizard, flying in as a kind of hit-and-run consultant,\u201d confided Marsh. He broke off to ask about the Ukrainian word for \u201chappy\u201d. It\u2019s important to conduct dangerous brain surgery in a stress-free atmosphere, he instructed.<\/p>\n

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\"Quite<\/picture><\/div>\n
Quite reflection: prayers for healing, as a society at war with Russia struggles to find its place in the new European order. Photograph: Karen Robinson for the Observer<\/div>\n<\/figure>\n

The Orlika team, fully scrubbed up, moved round the operating table like actors in costume. Marsh stood apart: watchful, focused and poised for action. At about 10am, the gruesome \u201cbone-work\u201d began \u2013 the application of drills and retractors to expose the patient\u2019s brain. It\u2019s a slow and delicate operation. The smell of burned flesh mingled with the faint chemical tang of ketamine. The only sign of life on the operating table was the barely perceptible rise and fall of Viktoria\u2019s chest.<\/p>\n

By 11.10, most of the bone-work was completed. At 12.15pm, the microscope was wheeled into position and Marsh began to extract the tumour. \u201cLovely,\u201d he said, as the procedure proceeded. His biggest worry (has the tumour attached itself to the brain-stem?) seemed to have been resolved. At 1.10pm, Marsh looked up from the microscope: \u201cIt\u2019s not bleeding heavily, which is nice.\u201d<\/p>\n

Surgeons hate bleeding. He instructed Mykytyn about what they could see on the monitor: \u201cThat\u2019s not tumour, that\u2019s brain-stem.\u201d It was an awesome moment: in this procedure, Marsh was operating at the crossroads of Viktoria\u2019s consciousness.<\/p>\n

Finally, at 1.35pm, with a tricky manoeuvre complete, everyone could relax. Marsh was cock-a-hoop. He advised Mykytyn to have \u201ca 10-minute wait\u201d before closing the wound, to ensure no further bleeding: \u201cLet\u2019s have an English cup of tea.\u201d He was plainly relieved at the immediate outcome of a hard morning\u2019s work.<\/p>\n

But there was no let-up for the celebrity visitor. While Mykytyn and the team wheeled Viktoria back to the ICU, Marsh took the creaky lift downstairs to conduct an out-patients\u2019 clinic, surrounded by more trainees.<\/p>\n

A mother and her teenage son came in, nervous in the presence of the famous English surgeon, clutching an MRI scan. Marsh affected no interest in the scan. Through an interpreter, he questioned mother and son.<\/p>\n

\u201cHow dizzy? Since when? Where?\u201d When, finally, he looked at the negative, it was as a veteran of neurosurgery who had spent a lifetime studying more than 50,000 brain scans.<\/p>\n

\u201cI\u2019m not sure what this is,\u201d he said, frankly. \u201cIt could be cortical dysplasia. I\u2019d do another scan in a year\u2019s time. The advantage is that it\u2019s completely safe. The disadvantage of waiting is the anxiety. But, if it\u2019s cortical dysplasia, there\u2019ll be no need to operate.\u201d He smiled encouragement at the boy. \u201cYou\u2019ll just have to think about something else. Have a busy life. Get on with things. We call it \u2018distraction.\u2019\u201d At home in England, Marsh fills his spare time with bee-keeping, DIY and woodworking.<\/p>\n

Andriy Myzak hurried in, looking worried. There were post-operative complications with Viktoria. The outpatients\u2019 session went into temporary recess while Marsh consulted. \u201cLet\u2019s wake her up and see,\u201d he concluded.<\/p>\n

The afternoon wore on, Marsh handing out verdicts. To reassure one patient, he introduced himself as \u201cthe strange Englishman\u201d; to another he complimented their \u201cnice brain\u201d. Despite the off-stage drama of Viktoria\u2019s fate, his mood was decisive and upbeat. Eventually, he rose from his chair, stretching: \u201cWelcome to the terrible world of brain surgery.\u201d<\/p>\n

The next day there was an air of despondency; the day\u2019s schedule was cancelled. Viktoria had suffered overnight bleeding, and needed urgent treatment. While Marsh waited to go back into theatre, he conducted further outpatient consultations. A local TV crew turned up to capture \u201cProfessor Marsh\u201d in action. Had he achieved his goals here? \u201cNot yet,\u201d he replied. He insisted there was still \u201ca way to go\u201d, that neurosurgery is \u201cdangerous\u201d, and that \u201cwe should learn from our mistakes.\u201d<\/p>\n

It was very late before Marsh reappeared, visibly exhausted. Viktoria was back in the ICU, in a coma. He spoke, with dismay, about his experience of Ukraine medicine, and the crippling shortage of trained staff. Does he ever get frustrated ? \u201cOh yes, but I am resigned to achieving very little. We\u2019re talking about ripples in a pond. Lecturing to medical students is probably more important than operating.\u201d He reflected on the long arc of history. \u201cMaybe in future they will try to change things. The Ukrainians must sort out their problems for themselves; the poverty and corruption of the country will not be solved quickly.\u201d<\/p>\n

Two days later, we got the news we had all feared. Viktoria was dead.<\/p>\n

Marsh seemed resigned. In\u00a0Do No Harm<\/em>, he quoted the French physician\u00a0Ren\u00e9 Leriche<\/a>, saying: \u201cEvery surgeon carries within himself a small cemetery.\u201d Marsh had been here before, a successful procedure followed by post-operative complications. He blamed himself for not properly checking out the post-op care, but added that this is part of the systemic failure of Ukraine medicine.<\/p>\n

\u201cShe almost certainly died from hopeless post-op care on the ICU,\u201d he said. \u201cThe chances of her recovering from the bleed were pretty slim. The tumour was malignant; it may well have killed her eventually despite radiotherapy. So perhaps it\u2019s better she died quickly, but who\u2019s to know?\u201d<\/p>\n

How were his spirits, I asked. \u201cIt is obviously horrible (he later confessed to being \u201cutterly depressed for several days\u201d), but I have been through worse over the years. Poor Taras [Mykytyn] is devastated.\u201d<\/p>\n

The pioneering medical reformer in Marsh quickly reasserted itself: \u201cThe important thing now is trying to improve post-op care. I have come to understand better the feeling of hopelessness that affects many Ukrainians. How can one change anything when the whole system is corrupt and broken?\u201d<\/p>\n

Later, back in Britain, he reflected on his recent experience: \u201cI go up and down like a yo-yo when I am in Ukraine, and return home exhausted. What keeps me going is the fact that my colleagues want me to continue to visit and work with them. I cannot really stop.\u201d<\/p>\n

Admissions\u00a0by Henry Marsh is published by Weidenfeld & Nicolson at \u00a316.99. To order a copy for \u00a312.99, go to\u00a0<\/em>guardianbookshop.com<\/em><\/a><\/p>\n<\/div>\n

\u0414\u0436\u0435\u0440\u0435\u043b\u043e:<\/strong><\/em>\u00a0https:\/\/www.theguardian.com\/science\/2017\/nov\/26\/henry-marsh-ukraine-is-like-a-trabant-that-wants-to-be-a-ferrari-<\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Henry Marsh: ‘Ukraine is like a Trabant that wants to be a Ferrari’ Henry Marsh is a celebrated neurosurgeon who travels the world teaching his exacting craft. Robert McCrum joins him in Ukraine as he tries to save the life of 11-year-old Viktoria \u2018My job is to teach. The point is to help the next […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[11],"tags":[776,377],"_links":{"self":[{"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=\/wp\/v2\/posts\/2171"}],"collection":[{"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2171"}],"version-history":[{"count":2,"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=\/wp\/v2\/posts\/2171\/revisions"}],"predecessor-version":[{"id":2173,"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=\/wp\/v2\/posts\/2171\/revisions\/2173"}],"wp:attachment":[{"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2171"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2171"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2171"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}