As a Belarusian anesthesiologist emigrated to the United States and built a career

“Right in the intensive care unit, the patient is opened up the stitches on the sternum, inside the heart is no longer beating. The surgeon jumps on him and begins to do a direct heart massage. Anesthesiologists grab the bed and take this corpse into the operating room. There we connect to the devices, we launch the heart ... "

This is a case from the practice of Vyacheslav Barodka, a Belarusian doctor who left for the US 12 years ago. Today he is an anesthesiologist at the famous John Hopkins Hospital (The Johns Hopkins Hospital)which is considered the best clinic in the states. TUT.BY talked with Vyacheslav about medical education in Belarus and the USA, working on 12 hours and saving lives even after death.

Photo of The Johns Hopkins Hospital

3000 dollars were enough, because in Belarus they paid 100

Vyacheslav Barodka studied in the 51 of the Minsk school together with Viktor Kisly - a man who in 2010 would create the world famous game World of Tanks. When for the first time in 90, Belarusian students went to the United States according to the program Work and Travel, it was Victor who told her former classmate about her. Vyacheslav at that moment was studying at the medical faculty of the Belarusian State Medical University.

That’s how she and her brother ended up in the States. Vyacheslav worked as a waiter's assistant in a restaurant: he washed tables, cleared plates, and cut bread. When the summer ended, he returned to Minsk, but his brother stayed behind - he sent textbooks in English to Belarus and figured out how to get a medical degree in the USA.

Vyacheslav graduated from the Belarusian State Medical University and, as a state employee, 3 worked for the state at the children's orthopedic center at the 17 polyclinic. He made time to go to Moscow for exams (the equivalent of our residency in the USA), and immediately after working out the distribution he took a plane ticket across the Atlantic.

- The first stage of the exam is the hardest. It includes all the items that we go through in “honey” in the first 2,5 − 3 of the year. 10 items immediately, 600 issues, for a while. There are hourly blocks, for an hour of 50 questions. That is, for each question a little more than a minute. The question may include a description of the patient’s condition, a question about it, and various response options. This is a very stressful situation.

But it turned out that even more stress lay ahead. Vyacheslav got into a surgical residency in New York. Surgery is considered the most difficult specialization, and the first year it turned out to be very difficult for the Belarusian.

- Every third day - duty. You enter the hospital and exit it in 30 hours. It's very hard. For the first six months after the 24-hour duty, tears came to my eyes: why was it all necessary, for what? - tells Vyacheslav. - Now in America more 24 hours can not work, and after that you should rest no less than 10 hours. Before that, you just will not be allowed into the hospital.

Full surgical residency in the US lasts 5 for years, but sometimes residents are taken only for the first year. For foreigners, this is a chance to get into the system: many specialties require you first to complete a year of general surgery. After that, you can "jump" to the final specialization. Vyacheslav chose anesthesiology and moved to Philadelphia for another year.

A doctor with two years of residency behind him can already work in a hospital. From his class, Vyacheslav was the only one who, having completed an anesthesiology program, continued his specialization. The remaining 14 people went to the hospital. The reason is simple: in the hospital, the doctor was paid 240 thousand dollars a year, while the resident received 36 thousand.

- Familiar Americans twisted his finger to his temple. And three thousand a month was quite enough for me, and the extra money remained. In Belarus, my salary was 90 − 100 dollars. That was enough only to fill the car and drive from the house to the clinic, Vyacheslav recalls.

He continued to study anesthesiology, now with an emphasis on cardio. In total, Vyacheslav spent in the residency 4 of the year, the last two of them - at John Hopkins University in Maryland. The university hospital combines a clinic and research center and is considered one of the best in the United States. Having completed his residency, the Belarusian remained to work there.

Death is not a reason to stop fighting for life

The anesthesiologist not only mixes the "cocktail" of drugs for anesthesia (as Vyacheslav says, with any of the drugs that put the patient to sleep, he can be killed). His main concern is not to allow the patient to die during the operation. If there is a threat to life, it is not the surgeon that is, the anesthesiologist goes to the operating table.

- Modern anesthesiology is very safe compared to what was 30 years ago. But, despite all the equipment, you cannot leave the patient alone for a second. The question of life and death is 1 − 3 minutes. If during the operation the artery is torn, then death occurs in a minute. If the heart has stopped, the patient is lost after 30 seconds. At such moments, the stress is enormous. But we are being prepared for this, says Vyacheslav.

Now for the resident anesthesiologists there are special programs of psychological assistance: when you first lost a patient, it causes shock. Vyacheslav still remembers the first death that occurred in his surgical residency in New York.

- We brought a man with a gunshot wound - 6 − 7 bullets. He was trying to save a team of 20 people: who was transfusing blood, who put the dropper, who intubated, who cut. They saved him, probably an hour, but it did not work out. We objectively understood that we could not do anything, but still it was a huge disappointment ...

When the patient survives on the verge of death, doctors feel an incredible rise.

- During one operation, a sewn vessel was injured in a patient. The heart stopped working. He died in front of the resuscitation team. It would seem that nothing can be done, but the surgical team said: "No, we are going to the end." He is right in the intensive care unit, and the sutures on the sternum are opened, the heart is no longer beating inside. The surgeon puts on non-sterile gloves (those that are near at hand), jumps on the patient and begins to do a direct heart massage. Anesthesiologists grab the bed and take this body along the corridor past relatives to the operating room. There it is connected to the apparatus, the artificial heart and lungs disperse the blood, the surgeons restore the patency of the vessel, launch the heart, bring it back to intensive care.

Doctors were afraid that, saving the life of the patient, they did not have time to save his brain, and after the heart stopped, the cells died without oxygen.

- The next day we came to him, asked if he remembers us. He says to me: “Of course, you were my anesthesiologist,” Vyacheslav says. - We must always fight to the end.

During heart surgery, death on the operating table is rare, but does occur. If an elderly patient has aorta ruptured, this does not necessarily mean that the surgeon blundered. True, sometimes it is difficult to explain to relatives. The courts of the United States consider a lot of lawsuits against doctors. Particularly desperate relatives go around the line of justice.

“About two years ago in Hopkins, there was a story.” After surgery, an elderly patient had complications. I do not remember which ones, perhaps, her paralyzed. Her son returned to the hospital with a pistol, called a surgeon and shot him. Fortunately, I did not kill him, ”Vyacheslav recalls. - This incident thundered all over the country.

Фото: Depositphotos

US healthcare system: treated to the highest standard, not counting money

- The main advantage of the American health care system is the most modern medical equipment and the latest medicines, so this system works wonders. There they are saving those patients for whom no one in Belarus would even have taken it, ”says Vyacheslav.

The biggest plus is connected with the biggest plus of the system. If a person enters the clinic without insurance, they will not save on it, but he will remain a debtor of the hospital. If he has nothing, the cost of treatment should be covered by someone else. And insurance companies put these risks into the cost of insurance, so contributions grow from year to year.

- No one is interested in any financial issues. Sheikh, homeless, prisoner - all are treated equally. This is good and helps to work wonders, but the whole system is in a huge minus. Even if America stops collecting debts at the expense of its military machine, health care will bankrupt the country.

In the international ranking of health systems, which is a reputable agency BloombergThe United States is ranked 50-th place of 55. The country spends 17% of GDP, or 9500 dollars per person per year, to care for the health of its inhabitants. Only Switzerland has more - 9674 dollars - but Switzerland occupies the 14 position in the ranking.

Vyacheslav nods: in European countries, in his opinion, a more reasonable health care system.

- Europeans first consider the money, and then undertake obligations for treatment. The system budget is designed for a certain number of interventions. For them, choose those patients who most need it. The perfect example is Germany or Britain. There, the state pays, controls, identifies key areas. America is strongly focused on business.

With free medicine, as in Belarus, the patient is inclined to shift his responsibility to the doctor, says Vyacheslav. In the West, where a person pays for his health directly from the wallet, and not indirectly from taxes, the situation is the opposite.

- In Western medicine, a huge responsibility is shifted to the patient. The contribution of the health care system to life expectancy is only about 10%. The rest is a way of life. The most dangerous diseases - strokes, myocardial infarction, cancer - is a way of life. In the West, if you have obesity, you drink or smoke, for you insurance premium will be one and a half times higher, because the risk is higher.

On departure to the United States: the possibilities were there

Vyacheslav usually comes to work in the morning in 6.30. His residents appear half an hour earlier. They are preparing an operating room. The first patient is brought into it in 6.45 in the morning. The anesthesiologist usually leaves home for 8 − 9 PM. And so 3 or 4 day a week. One day - academic - is given for reading literature and writing scientific articles.

- It is not quite true to say that I chose the move. When you think about saving people, and not about money, this is complete self-realization. When you disseminate new knowledge in articles and at symposia, you are no longer helping dozens, but hundreds. Unfortunately, such opportunities were there. All life there is work. And you always miss your homeland, - says the Belarusian.

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