By Dr. Margaret Curtis, WCI Columnist
I am fortunate enough to be married to a true Renaissance man. My husband, Mike, is a urologist, a hockey rink builder, a high school hockey team announcer (GO RED RIOTS), and an amateur stonemason. He is a former Army reservist and an experienced international aid worker who has done medical relief work in Bangladesh, Bosnia, and Macedonia (with Doctors Without Borders) and in the Western Province of Zambia.
In February 2022, he was also thoroughly burned out.
Mike had been employed by a small community hospital in Maine for 12 years. In 2021, his hospital was acquired by the largest health system in our state, and on top of the usual pressures of practicing medicine, the new administration added a new EMR, a few extra layers of administration, and a larger catchment area. One partner retired, and another stopped taking call. Suddenly, Mike was working 80 hours a week and taking call every other night. He went from preternaturally energetic and enthusiastic to irritable and exhausted. He started having nightmares and a PTSD-like response to his beeping pager.
We decided we had to change something—actually, there wasn’t much of a decision to be made because he couldn’t possibly continue as he was. He gave his notice, to take effect June 2022, and he planned an extended vacation before starting a new job at the VA. Then, on February 24, 2022, Russia invaded Ukraine.
Mike followed the war in Ukraine very closely right from the start and looked for ways to donate to relief efforts. He also, in a way that is typical of him, started trying to figure out how he could get there to help in person. We talked about this at length, of course. If I had asked him to stay home, that would have been the end of it. But I knew who he was when I married him, and I knew how unhappy he had been for the prior year.
He contacted Global Response Medicine (GRM), an international aid organization started by former military medical staff. Its goal is to provide “the best possible care on the worst day of someone’s life.” GRM was sending a surgical team to Ukraine to provide direct patient care alongside Ukrainian medical teams. If this “proof of concept” was successful, it planned to apply for long-term funding. Mike was accepted onto the team.
In April 2022, Mike traveled to Ukraine, via Zurich and Warsaw. His team included two former US Special Operations medics, a retired Navy CRNA, and an EM physician who was in the Austrian military special ops and now practices in Michigan. They were supported by interpreters and a logistics team in Poland.
He spent the next three weeks living and working in two different hospitals about 10-15 miles from the front lines in Mykolaiv, near Odessa. His job was to support the hospital staff in any way needed; that included lots of wound management and first assisting in surgical cases that included trauma, burns, and orthopedic surgery. Some days, he saw multiple burn patients; other days, he might assist with one complex OR case. Mike’s general surgery training of the early 1990s was perfect for the level of care that was possible to provide in this setting: debride, wet to dry dressing, debride again.
Initially, he cringed when he saw hydrogen peroxide and Betadine poured into wounds (in the US, these have been phased out in favor of fancy vacuum dressings). But he realized that, in the circumstances, this was a great way to manage the wounds: preventing infection with a low-cost, widely available option is worth the delay in healing from the inflammatory reaction that this induces.
The hospital was built in the Soviet era with two-foot-thick concrete walls and underground passages that, ironically, allowed it to keep functioning despite Russian shelling. Something else you don’t see often in American hospitals: the friendly dogs who live in the hallways.
What impressed Mike the most was the staff’s determination and ability to make do with resources that most North American physicians would consider totally deficient. No one complained about the plywood window in the OR because shrapnel had blown out the glass the week before or scrubbing in with boiled water poured from a beaker. A Ukrainian world-class weight-lifter had just started that week as the older orthopedic surgeon’s assistant to apply traction. In three weeks, Mike never once reviewed a CT scan.
He also came away with an abiding respect for Ukrainians’ toughness. Everyone he met there spoke of “when we win the war” and “when we send the Russians back home.” Not one person expressed doubt or any interest in capitulating.
Other than missing his family, Mike was completely content in Ukraine. I tell people he would rather risk being hit by Russian drone strikes than complete even one more prior auth, and I’m not really joking. Far from being depressed by the gruesome injuries he saw, he was happy to be using all his skills and energy for a worthy cause and for an admirable people. He describes an almost Zen moment of perfection in a seventh-floor OR with big windows while prepping a patient:
“I knew I was where I belonged: I was talking to the patient (under spinal) in his broken English about which AC/DC song to listen to, talking to the Ukrainian orthopedic surgeon in mutually broken French about the incision, and then, as the air raid siren went off, speaking in German to the anesthesiologist about giving the suddenly anxious patient some Diazepam.”
Mike came home from Ukraine tired but exhilarated. He was excited about medicine again, and I felt like I had my husband back. The last few months of his old job were still demanding, but Mike navigated them with some of his old energy and humor.
He started his new job at the VA in August 2022 but kept in close contact with friends and colleagues in Ukraine. One of them, a Croatian cardiologist who lives in Italy, started working with a Ukrainian aid organization called Stellar Ukraine. Stellar’s mission is to provide medical care and humanitarian aid to non-combatants living in the Kharkiv region near the front lines. Stellar volunteers include medics and ambulance drivers who can provide basic first aid and transport patients to hospitals. A goal is to create mobile primary care clinics to care for residents, many of them elderly, with chronic health problems.
Mike suggested Stellar apply for a grant from the International Rescue Committee (IRC), funded by the United States Agency for International Development (USAID). The founders produced a loose narrative description of the group, and Mike revised it into a grant application that would meet the requirements of both IRC and USAID (The Ukrainians were a little bewildered by items like, “How will you measure patient satisfaction?” and, “Describe your employee grievance process”). The grant was given preliminary approval in January 2023, and we made plans for him to return to Ukraine in February to meet with the team.
The grant would pay for staff and supplies but specifically excluded any equipment that could be used in combat, including personal protective gear. We felt a responsibility to the Stellar staff who would be caring for civilians in and near the frontline, so Mike put out the word to his colleagues at former and current employers and asked for donations for safety supplies. We thought maybe he would raise money to buy a couple of flak jackets. His friends and colleagues responded with overwhelming generosity. In 10 days, they contributed over $8,000. One note said, “1. Be careful 2. F*** Putin.” Mike bought 17 flak jacket tactical vests ($300 each), seven Kevlar helmets, an evacuation sled, and trauma supplies like chest seals.
On this trip, he spent his time in Lviv and Kharkiv, meeting Stellar personnel to discuss organizational structure and to scout locations for logistics operations. In some ways, this was harder than working in a hospital under fire. War-zone humanitarian work attracts people (Mike included) who are independent and action-oriented and who have little patience for niceties like staff meetings. When he arrived, the organization was in some disarray, and when he left it was . . . well, in less disarray. If he was unsure about Stellar’s structure, he had no doubts at all about the competence of the staff. He handed over the supplies he brought with confidence that they would be put to good use. He also met an injured member of Frontline Medics and helped him to apply for a grant as well.
Since he returned home from his second trip, Mike has settled back into his work at the VA. He loves his patients and understands them a little better now. He still advises Stellar. His time in Ukraine has given our whole family a new perspective: on how lucky we are to do work that matters, to have each other, and to live in a free and safe country.
I’ll end by answering a few questions that we are asked frequently.
- Since this is a financial blog: how did you afford these two trips? Mike’s first Ukraine trip was paid for by GRM. He used three weeks of accumulated vacation time. He also used PTO for his second trip. It was actually easier to get this absence approved on relatively short notice. By then, he was employed by the VA, and his supervisors considered this a type of deployment. We paid for his travel ourselves (about $6,000 total), and we have requested reimbursement from the grant. If the reimbursement doesn’t come through, we will consider it money well spent. For both trips, his colleagues were incredibly generous in offering to cover his call (although he did take additional call to pay them back when he got home).
- Were you worried about his safety? Yes, of course. I was reassured knowing that Mike had lived and worked in war zones before (specifically, eight months in Tuzla, Bosnia, during the Bosnian war in 1993), and he would be accompanied at all times by very savvy and experienced safety personnel. The Ukrainian staff would know what areas were more or less safe. I started to worry in April 2022, when the hospital where he was stationed lost running water (that was why they had to use beakers of boiled water). This suggested the front was getting closer and that the city would be shelled. Just before he left for his second trip in February 2023, a GRM founder was killed by a Russian missile attack in Bakhmut. (One of his companions was saved, at least in part, by the protective vest he was wearing at the time; Mike was able to replace it with a new one donated by our community back home.) This certainly gave us pause, but again, we knew he would be in good hands and would use his best judgment.
The media’s job is to report on death and destruction (and it’s important that they do so), but they don’t give much airtime to the relative normalcy that still exists in many parts of a country at war. In some parts of western Ukraine, the notable absence of young children and the signs pointing to the nearest bomb shelter are the only evidence that there is a war going on.
I don’t mean to minimize the risks of going into a war zone, but we also felt there were risks to NOT going.
Mike was miserable in his old job. I don’t believe he was close to substance abuse or suicide (although these are rampant among physicians), but he just couldn’t keep going at that pace and in that environment. Going to Ukraine helped him feel like he was using his training to contribute to something important. He does not always feel that way working in our US healthcare system.
And in an ironic twist: though he came home from Ukraine unscathed, he suffered a compression fracture of a thoracic vertebra on a family ski trip in March. Trying to keep up with your teenage kids is dangerous, folks.
Will he go back to Ukraine? Absolutely. Mike would love to go back as soon as work and family commitments allow. He is hoping to do more international relief work as part of his segue into retirement, and we hope to spend a year based in Eastern Europe while he volunteers. Personally, I am not cut out for war zones, but I look forward to visiting Ukraine once the Russians are sent back home. There are some dogs I want to meet.
Have you done any international aid work? Have you ever had to practice in a war zone? What was it like? Comment below!