“Did You Call an Ambulance?”
Health care facilities are difficult to assess in any country, and there are different opinions about the Russian system. One thing that can be said is that the quality of the doctors and medical staff have to be looked at in the light of what resources and facilities are at their disposal.
‘Three hours left until New Year, and where am I on this New Year’s night?’ thought casualty head doctor Sergey Nikolaevich Togulev, and got out of the ambulance, grabbing his medical kit. Moonlight was reflected in the diamond-like gleam of the falling snow. ‘Odd that there are no lights on in the house,’ he thought, as he knocked at the door. No reply. The doctor pushed the door to the patio open, and caught sight of a man with a stupid but uneasy expression on his face, who was pointing a hunting rifle directly at him. Sergey Nikolaevich felt a chill down the back of his neck. He wasn’t afraid, merely annoyed: ‘A great way to spend New Year, with the barrel of a gun aimed at your chest.’ The doctor smiled and asked: “Did you call an ambulance?”
“And what happened next?” I asked.
“I began to realise that I had to say something to that bloke. It was obvious from the first glance that he was suffering from the DTs, that the man was drunk as a newt”.
“How are you?” I asked, saying the first thing that came into my head.
“Alright”, he answered..
“What are you doing?”
“Guarding the house”.
“From the cops, can’t you see them crawling their way in?”
“Need any help?”
“Nah, you’re alright”, the man shook his head.
“Well I’ll be off then”.
Still aiming his gun at Sergey, the man nodded his head. Turning my back to him, I walked back to the ambulance, with a strong feeling that the weapon could go off at any moment.
I was walking along a narrow path. There was nowhere to jump to as there were deep snowdrifts on either side. I felt fear. Walking towards the ambulance with my back turned to the man was worse than facing the gun. I called the police. They took him off to a psychiatric hospital. Later I found out he had been drinking with his mother for a month and a half. It was a neighbour that had called an ambulance, having heard a cry from the house…
The ambulance was travelling along a bumpy rural road. Ducking and diving in and out of the ditches, brushing against tree branches, the old UAZ leapt out of the forest towards a village with the picturesque name of Naberezhnaya Sloboda. The vehicle went along the village’s only street and came to a halt outside a lop-sided house.
“Did you call an ambulance?” asked Sergey Nikolaevich.
“I did. My neighbour’s got a headache and she feels dizzy and sick,” an elderly lady reported as she came out to meet us.
With a habitual movement, Sergey got out his medical equipment, felt the old woman’s pulse and took her blood pressure.
“210 over 120! She needs to be in hospital!”
“What are you on about dear, what will I do with my cow, chickens and piglet…My children are a long way away in Moscow. Who’s going to feed the animals? Why don’t you give me a jab my dear, and my neighbour will keep an eye on me,” said the sick woman.
The intravenous injection helped. The old lady began to feel better.
“May God grant you health, the woman ultimately muttered weakly.
“Take a tranquilizer, don’t bend down too much, look after yourself,” said Sergey, and left the house with us behind him.
The doctor radioed back to the station that his team was available.
The operator immediately passed on details of a new call-out, and the vehicle turned off to another village.
Twenty minutes later...
A man, 44, was complaining of pain under his breast bone and of shortness of breath.
“We have been building the house for two days, dragging logs, and I was fine; but it’s got me today,” he complained to the doctor.
“Have you been drinking?” Sergey wanted to know.
“We had a little vodka, there was good reason to; we had been working from dawn till dusk, practically without a break.”
“Is this the first time you’ve had chest pains?”
The heavily-built man was lying in bed. His face was red, while the bluish discolouration in the area around his nose and lips stood out unnaturally. While he was talking his breath was strained and there was fear in his eyes. He complained of a burning sensation in his chest and of a feeling of heaviness, Sergey quickly made an examination and concluded that this man was probably having a heart attack.
“Have you taken any medicine at all?”
“No,” the patient replied with difficulty.
Sergey took the patient’s blood pressure and pulse, and gave him nitroglycerin, and started the laborious process of making a cardiogram using equipment dating back to the 1980s.
The doctor’s suspicions were confirmed: “A massive heart attack! The patient needs to be taken to hospital immediately!”
“Doctor, I don’t want to go to hospital, just give me an injection and it’ll all go away. I need to get this house finished tomorrow,” the patient protested weakly.
“Forget about the house now, you are the only important thing now,” Sergey Nikolaevich said sternly, filling a syringe with medicine.
Once he had given the injection of opiate painkillers and anticoagulants and had fitted a drip, the doctor and his driver placed the patient on a stretcher and, without removing the drip, carried him to the vehicle. With siren blaring the ambulance bumped along the road to Naro-Forminsk, a town about 70 km away.
Chances of the patient’s survival were not too great; it was a long, bumpy ride to the cardiology center.
The patient’s condition worsened. The burning pains under the breastbone returned, his blood pressure dropped and his breathlessness increased. It became necessary to stop in order to provide extra assistance: the oxygen supply was switched on, while anaesthetics and hormones were added to the drip. The patient began to feel better.
“Blood pressure 120 over 70, pulse 65; no arrhythmia. We can go!”
The vehicle jerked onwards. The patient was still alive on arrival, but following a fight for his life in the Naro-Forminsk hospital’s cardiology department, he died 2 hours later. The house remained unfinished…
On our return to the local call-out station, we went into a cosy two-story building that housed the ambulance service. Sergey, who is also the director of the ambulance service, has an office on the first floor, along with a consulting room, the radio operator’s office, and a fitted kitchen used for making lunch and having a cup of tea. The second floor contains relaxation rooms and a lounge with a TV in. It’s cosy, clean and warm, although the furniture is old and tatty; the armchairs have holes in them. Indoor plants had been tastefully arranged everywhere. We could rest until the next call-out. But there was no time. Another call!
5 minutes later we were there.
A 55-year old man was complaining of pains in his stomach and chest and of dizziness. Sergey quickly assessed the patient’s condition: he was rosy-cheeked, his eyes were shining and his pulse was rapid.
“Have you had something to drink?” he asked.
“Yeah, we didn’t have much, only a vodka glassful of dichlorvos (an insecticide!).”
“I’m sick of alkies,” the doctor grumbled irritably, “prepare to have your stomach pumped,” Sergei Nikoaevich ordered.
The doctor’s assistant and nurse tied the man’s arms and legs together, to stop him from lashing out, and placed him on his side. They pushed a tube down his throat and flushed his stomach out with ten liters of water. Once the necessary assistance had been given, the man was admitted to the hospital’s medical ward.
The radio operator informed us about another call-out. Another episode of poisoning!
We got to the village of Pionersky quickly. The mother of a 16-year old girl had called us out, the latter was under a psychiatrist.
When we went into the home, the girl was lying unconscious. Two empty packets of phenazepam lay on the table.
“About 20 tablets,” said Sergey Nikolaevich, “so she decided to take her own life?” – He turned to the mother, “When did she take these?”
“I don’t know,” the mother replied with embarrassment, “I’ve only just come in,” the woman sobbed.
“There’s no time to lose,” the doctor checked her pulse, “100 beats per minute!” Then he measured her blood pressure — 90 over 60! “Dilated pupils, poor reaction to light! Intermittent muscle contractions in the face muscles! She is still breathing rhythmically and independently! It’s already two hours since she took the tablets, the patient is pre-comatose!”
The doctor and his assistant worked quickly and efficiently: The girl was given the necessary medication, her stomach was pumped and she was taken to the nearest hospital.
“Why do people commit suicide?” I asked Sergey his opinion.
“In my experience we come across this in people whose psyche is unbalanced. This is usually the case in girls under 20 and alcoholics of any age”, Sergey Nikolaevich replied precisely.
There were several other call-outs during the night. At 9 in the morning a planning meeting is underway. Duty doctor Togulyev has completed his shift and set about his duties as ambulance station director, his second job. Fighting exhaustion, he analysed his team’s work over the last 24 hours, looks at the number of calls, hospitalizations, the effectiveness of the medical help provided, and gives out medicines for the next shift.
During a break I talked to him: “Do any of the ambulance crew have any superstitions?”
He smiled and replied:
“Of course we do. For example, if someone says to us ‘All the best’ just before a shift, it means we can expect some difficult callouts. Another thing is that nobody will put several single-use syringes in his bag at once, it’s better to keep filling up throughout the shift. It’s a sign that there will be many sad cases”.
“You often encounter death; no doubt you have got used to it?”
“Death isn’t something you get used to. When you provide assistance in difficult situations; accidents for example, your senses are numbed, you work on autopilot, which makes it possible to resolve the situation. It is only later that you remember the vivid details and emotions appear”.
Sergey Nikolaevich told me about another recent incidence:
“On that day we were getting one car crash call-out after another. We say that bad things always come in threes. If there has already been a heart attack, expect another and another. The same thing goes with severe stomach pains or bronchial asthma attacks, or car accidents. It’s hard to explain the reason for this phenomenon: whether it’s magnetic forces, or the full moon, or whatever…
“Seven drunken men squeezed into a tiny Zaporozhets and placed a seven-year old girl in the front seat on the lap of one of the passengers. The car set off at breakneck speed and just before a steep slope down to a bridge the driver lost control of the vehicle. The Zaporozhets rammed into a metal roadside kerb, which was the same height as the seats of the small car. The sharp edge of the kerb passed freely through the car’s passenger compartment to the engine (Zaporozhets has its engine at the rear). The people who were sitting at the sides were injured and in a state of shock. Fortunately, the girl was unharmed. The two on the back seat however were cut in half. The corpses were suspended on the car bonnet, while the ripped-off body parts: the loops of the intestine, hands, legs were dangling down, mixed with the road dust.
“Young lads, who had not even reached twenty, having survived Chechnya, died such a pointless death.
“We hadn’t had time to collect our senses after that accident,” continued Sergei Nikolaevich, “when we were called out to another. Two vehicles had collided. In one was a young couple, while in the other a doctor and his family were heading for the dacha. They had a small dog with them. The dog died instantly. For some reason dogs rarely survive car crashes. The woman died in her husband’s arms. He tried to give her the kiss of life, but… doctors have no insurance against disasters, from fate…”
In parting, I asked Sergei Nikolaevich one last question: “What are the positives about your profession?”
“You feel emotionally satisfied, if you have managed to help people whose lives are hanging by a thread, especially children’s. But better still don’t fall ill, don’t get injured, drive carefully and stay healthy. But if something does happen, call us out. We will definitely come.”
A doctor with the ambulance service in the environs of Moscow with no less than seven years experience receives a monthly salary of 5,000 to 7,000 rubles a month for working 7 or 8 24-hour shifts.