ENGWe spent the 50 days following 24 February working as cardiac surgeons. And then we got married

Photos: Andrii Maksymenko, Oleksandra Telehuzova

Just ten minutes after our conversation began, Heorhii Mankovskyi had to leave in a hurry; an “unstable” patient had been brought in. “This happens,” he said. He briefly returned later on to show us the surgery’s progress on a special monitor. The patient was being saved from a heart attack, and the doctors said he got to the hospital just in time. “The guidewire is right in his heart now, we’re about to put a stent in,” one of the team of cardiac surgeons said, pointing at the screen. “Give 2.5 or 2.75!” I heard in the background. I don’t understand the jargon either, but I found observing their work mesmerizing.

When we talked [on 31 October - ed.], the center’s building on Yurii Illenko Street still had power (if cut off from power, the generator’s supply will last for six hours, then the center’s staff would have to find more diesel to refuel it). However, there was no running water.

Water is essential for the work of the central sterile services department, which is responsible for the processing and sterilization of the surgical instruments and other medical devices required for operations. At the time of our conversation, the medical staff at the center were using tools which did not require sterilization. However, if there was no running water for a week, the situation could become critical, cardiac surgeon Hlib Yemets explained – though added immediately, “We are Ukrainian, we’ll be able to come up with a solution.”

Hlib Yemets, a cardiac surgeon, lives on Lobanovskyi Avenue, across from a building that was hit by a Russian missile on the third day of the full-scale invasion. He said that in one of the videos of the missile strike it is possible to see the missile pass some seven meters away from his 18-th floor apartment. At the time, he was at work. There is still a hole in the building where the missile made impact.

“Operating rooms could not be moved to bomb shelters”

“We kept operating even as we were getting air-raid notifications on our phones, I even have a photo that captured that,” Andrii Maksymenko, a pediatric cardiac surgeon, said. He spent the first weeks after the beginning of the full-scale war going back and forth between the adult and the pediatric departments of the center.

Maksymenko said that in the first days after the full-scale invasion he saw confrontations, and sometimes even shootouts, between Russian sabotage and reconnaissance groups and Ukraine’s territorial defense forces and patrol police: “Some sabotage and reconnaissance groups got as far as the intersection of Chornovil Street and Peremohy (Victory) Avenue. Now and again we could see bullets flying and hear machine gun salvos. This was happening a block or so down from where we were.”

Maksymenko said that when he got to work on 24 February, he saw that his team was ready to continue working and helping kids with congenital and acquired heart defects: “I realized that I was not alone. That inspired everything I have done since,” the cardiac surgeon said.

By the afternoon, all intensive care, cardiology and inpatient beds were being moved to the hospital’s basement. Heavy equipment, laboratories and operating rooms could not be relocated for technical reasons, but also because moving them would compromise sterility. Small children require particularly strict sterility conditions, and operations in the basement would have increased the risk of postoperative complications, Maksymenko explained.

He said that there were so many questions begging immediate attention that he was only able to process his emotional state about a month and a half later: “The best way to overcome panic is to work. I hardly had time to sit down, relax, and think about how bad the situation was.”

At times, doctors and other medical staff would work for two to three days without a break: “People gave their all, even when there was no need for them to. So our administrator took it all into his hands and divided shifts so that no one would work for more than eight hours. They could spend the rest of their time resting and sleeping. The majority of medical staff practically lived at the center for the first month and a half.”

The war has not stopped the center from working closely with maternity wards and hospitals: “Despite shelling, our ambulances go out to bring back newborns diagnosed with heart defects from maternity hospitals. Those children would not have survived with those defects, they required urgent medical assistance.”

“We took care of this kid until he was taken into guardianship”

The majority of the center’s staff remained in Kyiv, though some of them left for western Ukraine, taking their families with them. Some patients were finding it difficult to get to Kyiv. So, several months into Russia’s full-scale invasion, a branch of the center was opened in Lviv (based at the Lviv Oblast Cardiology Center on Kulparkivska Street).

Everyone at the center still remembers a patient who was transferred from the center in Kyiv to the branch in Lviv. The boy had been abandoned by his parents; he was operated on before the war [in Kyiv] but guardianship could not be arranged because of the full-scale invasion: “This patient was with us the entire time until we could arrange for him to be transported to Lviv. He was the center’s kid: everyone took care of him, he’d come with us to the basement,” Maksymenko recalled.

The war, he added, has affected even the health of those kids who had had their surgeries long before 24 February and were living normal lives by then: “The number of heart complications associated with infective endocarditis has increased significantly. Stress, inadequate nutrition, insufficient heating, basements – all of this increased the risks [of complications],” the doctor explained.

At the same time, however, the number of people requiring surgeries had fallen because a large number of children fled abroad (the number of surgeries in the first three months of the war was two times lower than in the corresponding period of 2021; current numbers are 30–40% lower than in 2021). Though there were parents who did not want their kids to undergo surgery abroad and chose to return to Ukraine, despite logistical difficulties and war-related complications:

“Parents of some of our patients would not let cardiologists abroad make any decisions without consulting with us first. Doctors from Poland, Germany, Sweden, Switzerland, and Portugal were surprised by the quality of cardiac surgical care that patients received at our center,” the cardiac surgeon said.

The Center for Pediatric Cardiology and Cardiac Surgery has started offering clinics based at other medical facilities for those who remained in Ukraine but are unable to travel to Kyiv. The center’s staff visited the outskirts of Kyiv along the Obukhiv highway and several locations in the territories liberated from Russian forces, for example the city of Pokrovsk in Donetsk Oblast. Pediatric and adult cardiologists and nurses conducted examinations and consultations in local clinics:

“We saw a large need for this, sometimes up to 70 people would come in a day. These clinics were important for people psychologically, too: they meant that they weren’t forgotten, they’d make people feel less neglected. People felt that their lives mattered not just to their relatives, but to Ukraine,” Maksymenko said.

“We were examining patients on the ground floor, where we used to have paintings”

At the time of Russia’s full-scale invasion, there were 140 adult inpatients in the adult department of the Center for Pediatric Cardiology and Cardiac Surgery, including 34 in intensive care (most of them on ventilators). The staff managed to transfer even those patients, together with all the necessary equipment, to the bomb shelter. The operating room, just as in the pediatric department, could not be moved to the shelter for technical reasons. Keeping it where it was ensured the sterility of the equipment. The center’s surgeons performed all 10 surgeries that had been scheduled for 24 February.

Since the first day of the full-scale war, medical staff at the center have been aware that they might receive people with injuries. They have set up a mobile examination point on the ground floor, a space that used to be decorated with paintings. There, cardiac surgeons examined every incoming patient and decided whether they required medication or surgery.

Volunteers and civil society organizations began delivering medications and humanitarian aid to the center. Whatever the doctors were not able to use at the hospital, they sent to hospitals closer to the front. They sorted through and distributed humanitarian aid to all those who needed it: “People were helping us, so we had to help others,” Oleksandra Telehuzova, a cardiologist, said.

The Center also got in touch with the suppliers of medical consumables: three out of seven agreed to help free of charge. That’s how six procedures of transcatheter aortic valve implantation have been performed since the beginning of the full-scale war, free of charge. One such valve and a corresponding delivery system normally costs 360,000 hryvnias (approximately $9,715). Therefore, Ukrainians who required these surgeries have saved a total of 2 million hryvnias (approximately $54,167).

Overall, the center’s staff performed around 260 surgical interventions, including urgent ones, in the first two and a half months of the war, saving 190 lives – or more.

The center’s staff have also helped operate on wounded soldiers at the Ministry of Internal Affairs hospital. When asked whether they had to perform surgeries they haven’t practiced before, they said: “A cardiologist would not find it difficult to remove a [shell] fragment and eliminate the source of bleeding, as long as there is no damage to the spinal cord and the spine itself.”

“Elderly patients from intensive care units, with catheters, would go into the children’s room to keep the kids company”

Cardiovascular diseases are the top cause of deaths during peace. Many patients with heart diseases in southern and eastern Ukraine might be dying because they cannot access timely help, cardiac surgeons from the center said.

Oleksandra Telehuzova: During the first days of the invasion, ambulances and most hospitals did not work according to their usual schedules. On the second day of the full-scale war, we got a call from another hospital asking us to admit one of their patients who had a life threatening heart defect. This woman had a son who lived in Russia. When she called him and told him that the war had started he told her: “Stop making things up, there is no war.” He refused to talk to her anymore, even though she told him about the state of her health. The woman’s condition kept deteriorating, and that’s when she arrived at our hospital.

Oleksandra Telehuzova: Hlib was operating when the explosion near the TV tower happened. The windows were shaking.

Yes, it was stressful, no one knew what would happen next. But despite that, the atmosphere in the hospital was very warm, we were all like a family. You knew that you could trust the people around you. Hlib and Heorhii [Mankovskyi - ed.] radiated calm, both staff and patients could see their composure. That made them feel that everything was thought out and more or less planned. Once the patients’ health was no longer in danger, we started taking them out to get some fresh air in the hospital’s courtyard.

We’ve even set up a separate kids’ room: there was a large computer left behind by the radiologists and we’d use it to play cartoons for the kids. Elderly patients from intensive care units, with catheters, would go into the room to keep the kids company; this helped them calm down, too.

Many of the staff members had pets which they couldn’t leave with anyone else; they brought some of them into the hospital. Those pets became therapy for many of us, especially for the kids.

After a really difficult day of surgeries (the surgeons only finished working around 22:00 or 23:00) one of our anesthesiologists brought a guitar to the hospital and we decided to sing. We sang Oi u luzi chervona kalyna and Chervona ruta [a Ukrainian folk song and a popular Ukrainian song from the 1960s-70s - ed.] and a couple other songs on one of the hospital floors. Some patients were happy to join in.

One of the patients had a very strict wife: she told him to stay in his ward and not go outside, and he was really abiding by her words. But the morning after we sang, during the patient rounds, he looked at us from under his brow and said “Your Chervona ruta was lovely.” [Smiles]

When did you realize that you could breathe a bit and work at a slightly less frantic pace?

Hlib Yemets: Unfortunately, I’m a smoker. Once, on maybe the 30th day of the war, I stepped outside for a cigarette and saw that the rockets were no longer flying toward us, but the other way round; our forces were repelling the attacks. I realized then that in 10 or 12 days it would be safe to go home.

Oleksandra Telehuzova: I remember that after 50 days in the hospital it was difficult to imagine stepping outside of the hospital grounds, taking a walk, walking on a street. But we felt a relief when it was announced that Russian troops were withdrawing from Kyiv. Other hospitals returned to work, and we were able to return to a more normal schedule as well.

Hlib Yemets: It’s one thing when you’re working with someone, you discuss some professional matters. But I realized that we were bound by more than professional ties and that I will never find another person like her. I got a sense that we must live to the fullest while we’re still alive.

A civil registration office opened right next to the hospital in early April. I proposed on 6 April and we got married on 7 April; we were still wearing our work clothes.

Professionally, Oleksandra Valentynivna is like my eyes: transcatheter surgeries are done blind [it is not an open-heart surgery, so the surgeon has to rely on another doctor to guide their actions - ed.]. She tells me what to do, and I do it. Her job is more difficult than mine. A surgeon performs an operation, and then they’re done. A cardiologist follows their patients throughout their lives. They are real doctors.

Proofreader: Nika Ponomarenko

Design & layout: Anastasiia Hrab