You survive or you lose: a civilian doctor's perspective on war

Roman Shtybel, a 26-year-old anesthesiologist, worked in the children's intensive care unit of the Ivano-Frankivsk Oblast Hospital before the full-scale invasion. Last summer he volunteered for the Hospitallers medical battalion. For a month he has been saving the wounded at the front, and for a month he has been saving newborns in the hospital of his hometown. 

He told hromadske about what surprised him about the war, about military doctors who were saved by a sense of humor, and about the wounded who silently endured hellish pain.

"My brother, father and I went to war"

I grew up watching my dad's favorite movie, Propala Hramota (The Lost Letter), stories about rebels and Cossacks, about the Ukrainian Insurgent Army (UPA), which fought for an independent Ukraine. I was a member of the Plast (National Scout Organization of Ukraine) since I was a kid.

My younger brother and I were not raised to hate Russia, but we always knew where trouble was coming from. My great-grandfather was shot dead by drunken Soviet soldiers on the doorstep in front of his family during World War II. They wanted to take the pig, but he wouldn't let them.

Since childhood, I have been fascinated by history and have seen how it is distorted in textbooks. For example, about Kharkiv as the capital of Ukraine. But it never happened! The Bolshevik Communists failed to seize power in Ukrainian Kyiv and announced that Kharkiv would become the capital. I found historical discrepancies and wondered why, what, and how.

In my family, we were taught that we were the owners of our land. If you have land, you are responsible for it and decide what happens to it. This idea applies to Ukraine: we have to become masters of our own land. What happens on it is up to us.

After the invasion, I crossed the Dnipro River for the very first time. People there have different views on life, perceive things in their own way, speak mostly Russian, but they are Ukrainians. And for me, it makes no difference where the bomb drops: Zaporizhzhya, Donetsk, Lviv or Ivano-Frankivsk. This is my country. And it hits me hard.

My brother and I had no options to run away, to wait it out, to hide from mobilization in our homes. We always knew who we were and what land we lived on. Me, him and my father went to war. My friends said: "Boys, you did the right thing, but we don't envy your mother."

On doctors' fears, burnout, and humor

I joined the Hospitallers as a volunteer rather than under contract in the Armed Forces to be able to return to pediatric medicine. There is always a shortage of anesthesiologists at the front, so my first rotation was to Bakhmut, Donetsk Oblast. It was already hot there last summer.

It took me a long time to get used to the explosions. Everything is scary, but when a tank starts operating, there is nothing more terrifying than this sound. First you hear the incoming strike, then the whistle of a shell, then the sound of plaster crumbling, bricks falling or a wall or a building falling at once.

Air raids are also frightening. As a rule, an airplane carries four pieces of ammunition and we wait in the basement for four explosions. One day we heard three, and the last one didn't come for a long time. We decided that it had dropped somewhere earlier, or we didn't hear it because of the artillery. We went outside a little relaxed. We saw a flash in the sky. And it was just like that! I have never ended up in the basement so quickly.

I wasn't afraid to see death, because after children’s deaths it barely scares you anymore. I wasn't afraid of a lot of blood, because I was on duty in the intensive care unit since my third year.

War is an explanatory cause of death or injury. If a person is brought in without a leg or with a shrapnel wound to the chest, you know what to do with it. There is nothing unexpected. In my medical practice, the worst thing is when a child who has been alive for an hour comes to the department. He has seizures, and you can't stop them because you don't know the cause — and there can be many.

Sometimes we see 150-200 wounded in a day at the front. Then we have to stay awake for a long time: the last time I counted was 37 hours. You don't think about being tired. You just work.

I was in Bakhmut in the summer and again in December. The front line was moving, but the hospital remained in the same place. From the point of view of the logic of military affairs, a doctor's position should not be 2-3 kilometers from the front line. But the doctors themselves decided to move closer to the military. They realize that the soldiers need them.

This position has consequences: cardiac surgeons and vascular surgeons, to whom patients were waiting in line for surgeries over the next months, are dying. One can only admire their courage and dedication.

And what an amazing atmosphere there is in a team of such people! If only the entire medical sector of Ukraine had an atmosphere like that of the 93rd and 10th teams I worked with! They came of their own volition, no one mobilized them or forced them. They know exactly why they are here, and they are all on the same page.

There is an expression: "The light is clearly visible in the darkness". So in times of crisis, heroes are born. In civilian life, I have never felt such brotherhood.

There have been lulls for several days when there are no wounded. I tell my crew that we are not only here to save the sick. We replace the doctors from the Armed Forces who have been fighting for over a year, so that they can rest and have less workload. And we take turns.

I communicate with foreign colleagues. They talk about burnout after disasters, such as the earthquake in Turkey. I said: "Guys, let me take you to Bakhmut, and you can tell those people who have been under fire for 14 months about burnout." No one thinks about an 8-hour workday. They understand that you either persevere or lose the war.

Unfortunately, the command that is supposed to solve the problem of burnout among military medics is not doing so. And instead of resting, the doctor has to deal with related issues, such as where to get blood for transfusions.

Military humor is an acquired taste. So are doctors. When doctors go into a military environment, their jokes are off. But for the wounded, they create a relaxed, fun atmosphere. As if they are not providing serious help, but something light. There is one doctor who greets every wounded man with the words: "Which hero city are you from?" This is to prevent the wounded from thinking about their injuries.

The soldiers worry whether their "main organ" is okay: whether it has been affected, whether they will have children. There are a lot of jokes on this topic. Like: "We're here to tickle you," "What kind of wound is a scratch, the most valuable organ is intact," "You're 40 years old, why do you need sex?"

What are these people made of? 

The first thing that surprised me at the front was that there was no panic. Bombs were exploding 200-300 meters away, trees were breaking, cars were burning. No one ever shouted: "Let's run!" I don't understand what these people are made of.

A wounded man is missing a leg. You give him an anesthetic; it hasn't worked yet, and the man doesn't say a word. He just lies there: "Guys, do what you have to do". And there were many of them. They seemed to feel no pain. But then I realized: they endure.

I saw soldiers who could not stand it psychologically. They couldn't even walk or talk, let alone serve. They were just staring at one point.

There are people who perceive war as an adventure. Like a game of cops and robbers. Perhaps it is easier for them. There was a wounded man with a shot in his buttock. The bullet ricocheted down his thigh to his knee. He tells us: "I was told that there was no one near the house, so I came and they opened fire on me. I also started shooting at them, and threw a few grenades. I was given a 'pill' and I ran back." He needs to stay in the hospital for at least a month.

They brought the wounded man with a bullet wound to his shin. He says he immediately put on a tourniquet. He shot back, threw a grenade. And then he walked with a "Mukha" (RPG-18 "Mukha" — a hand-held rocket-propelled anti-tank grenade launcher — ed.) and an assault rifle towards his comrades.

At the front, I did not see any "wimping" or simulation. I have not seen soldiers saying that they are sick and need to go to the hospital. On the contrary, many of them have serious chronic diseases. Ulcers and pancreatitis are only half the problem. There is, for example, Bekhterev's disease, which causes bones to fuse. And at one point, a person just stops moving. They need lifelong therapy. And he says: "I have to be at the front." There is a lot of heroism in this war.

Communication with the military gives you an understanding of how to perceive the news. For example, soldiers are brought in from the same area of the front with approximately the same injuries. One of them says: "All is lost, we are being bombed, we are history". The other goes: "Let's wait a little bit, they will take a break and we will give them a taste of their own medicine." 

Tosia will not do it, we have to do it ourselves

We must realize the price of every peaceful day. I was ticked off when I came from Bakhmut in December and heard the locals moaning about the power outage. In Ivano-Frankivsk, people took turns parking their cars near the switchboard so that the electricians wouldn't turn off the lights manually. It was during scheduled blackouts, when there was a shortage of electricity after the strike on a thermal power plant. Such assholes definitely don't need to be drafted. According to the laws of wartime, either they should pay huge fines or their cars should be confiscated.

I don't understand how two people exist in the same world: one who leaves behind everything he owns and goes to the trenches, where everything is glowing and burning; and some asshole who is uncomfortable being without electricity for a few hours.

We should not just wait for victory, but think about what Ukraine will be like. This is about changes in the mindset and in society. We have to look for ideas that will unite us and help the country develop. In particular, what the military and healthcare will be like. There are many problems in the latter: from quality to the lack of doctors who went abroad in packs. Two years ago, seven people entered Ivano-Frankivsk University to study pediatrics, and before that there were 120. In a decade, medicine may disappear in Ukraine.

Together with my friends, we founded the medical education platform Jump. We want Ukrainian medicine to jump to a new level. The basis of everything is people — students, interns, doctors and nurses. We will start with the quality of their training. Realizing that academic education is largely a descendant of the Soviet system, we plan to fill it with modern approaches and formats.

We need to create such a quality of medicine that every Ukrainian child, even if born weighing 500 grams, would be raised like a flower. I am proud of my work because I am involved in the nation's gene pool.

It is not solely on the front lines that victory is won. There is no point in winning if no one stays in Ukraine, because there will be ruins here, literally and at all social levels.

There is a Galician saying: "Tosia will do it" (short for "it will get done," meaning it will somehow get done — ed.) But Tosia won't do it, you have to do it yourself. Everyone has to do it on their own level. Don't know how? Go volunteer. Just like people go to the gym three times a week. Set aside 2-3 hours a week to unload the car, clean up the debris, bake some goodies.

Anyone can take action. Become involved in the fight.