Mykhailo Boyko, Frontline Surgeon

Mykhailo Boyko, 31, military surgeon,  officer of the Ukrainian Armed Forces,. In 2019, he graduated from the Ukrainian Military Medical Academy, after he had graduated from the Ternopil Medical University with a  Master’s Degree in Medicine. After graduating from the academy, he was assigned to a hospital located in Donetsk Oblast. Until the end of 2023, Mykhailo had been doing military service at the hospital, occupying different positions: chief of surgical department, leading surgeon, and, after the breakout of Russia’s all-out war, chief medical officer. His team has saved thousands of lives of Ukrainian soldiers.

Doctors at the hospital work 24/7, almost without a sleep and, after a short rest, Mykhailo goes there again to care and save.

During the interview, he spoke about the work performed by military healthcare personnel, their daily feat, difficult moments and achievements.

THE NUMBER OF WOUNDED PATIENTS WAS SIMPLY HUGE

- Mr. Mykhailo, Russia’s oull-out invasion caught you at your workplace - at a hospital in the Donetsk Oblast. Was this a turning point in your service?

- Now everyone is focusing on February 24, 2022, as if the war started on that day.  But in actual fact, however, the war has been going on since 2014, and all this time there have been deaths and injuries, albeit in smaller numbers [than they are now]. The operational phase of the Anti-Terrorist Operation (ATO) and the Joint Forces Operation (JFO) lasted till 2017, and then things had quieted down. The war became positional, evolved into a trench warfare, with sniper duels and everything else - but it still continued, although few people were affected. The war was known to those who were immediately involved in it or resided in areas of immediate hostilities.

By comparison, we had a sense of security until February 2022, because we were located far from the front line, at the home front, speaking hypothetically. But during that time, we had gained a lot of experience, practical and theoretical, and had worked out algorithms of actions to be followed in certain situations. When the full-scale invasion broke out, it comes without saying that hosts of new challenges arose, the main of which was work, work, and work again, around the clock, never-ending by day and by night. The resting time depended on a specific situation: I lay down and rest for some 10 minutes, then have to get up and go to work. There were days without a sleep or rest at all. Sometimes days mixed with nights, there were no shift changes, no rotations; the work was non-stop, literally.

Regarding the flow of wounded patients - I will not say the numbers, but they were really huge. As students we were told about this, it was written in books how to act, how to conduct medical triage, for example, how to prioritize, everything of that kind. From my university experience I remember a subject such as disaster and emergency medicine, which is taught at military training units attached to civilian universities of medicine. They talked about all these things, but I listened then and thought: could this be possible? But we have now felt everything on our own skin, everything has happened in real life.

THE HOSPITAL IS ONE FAMILY

- What kind if issues did you encounter? Did you expect everything to be like this?

- We didn't expect it, we were actually already at war. But no one could even imagine such a huge number of wounded and traumatized patients, that they will be arriving non-stop. I think that what saved us was that the hospital had been located in the war zone for several years in a row, it had accumulated a certain amount of experience, everything was more or less well organized, including the provision of suppplies.

Of course, workloads have increased, but we somehow adapted to it. The hospital is small, one can say it is one family. We were working in concert, like ants. There was no need to set tasks: you go here, do that. People worked for a common goal, intuitively, like one organism, really like an anthill or bees in a hive.

At the beginning, there were some negative nuances with management, because a certain chaos reigned throughout the country, no one knew what would happen next. But it was my hospital that was able to endure all these troubles  with great dignity, overcome them, providing care round-the-clock.

- Didn't you feel a sense of fear?

- No, there was no fear. But there were personal concerns, because my wife and child remained in Kyiv at that time. When missile and rocket attacks began, it remained relatively calm out there, but I could not contact my family, I called them many times, but there was no answer. So I was concerned about them, not about myself.

At the same time, we took all measures deemed necessary to prepare for what awaited us. I did not feel fear as such, there was no time for that, because work absorbed us all. Indeed, we saw some news items, and there were phone calls from our kins. In areas outside of Kyiv, in Hostomel, Irpin, Bucha, in the Kherson Oblast, the map was turning red, and we watched it from afar... We knew our tasks, so we just worked.

- Was there a feeling of imminent, all-out war before February 24, 2022?

- The feeling was there. We were tangential to the war even before it actually started, whether it was called ATO or JFO. It was every day that assaults were carried out and held back, but people lived in the trenches, holding the line of defense. And there were victims, unfortunately also among the civilian population on both sides, and among our military personnel as well. But we were uncertain whether a full-scale invasion would take place. The Russians were moving their forces in and out, then relocating them to other axes in their areas bordering Ukraines, so we had got used to it.

HOME FRONT TOO IS SUFFERING LOSSES

- You said that there were times when you had to rest for just several minutes, literally.  What did you do to set yourself up to endure?

- Difficult to answer. Indeed, there were many days and months when we were working non-stop with no rest. The situation was changing continuously. For example, we are assigned a task specifying that four surgeons, a traumatologist, as many nurses, as many anesthesiologists are to arrive to a specific location.  I collect people and send them there. But I am getting them returned in just a couple of days because the situation has changed dramatically.

Well, regarding the resting time... We couldn’t afford sleeping through all night long, like civilian doctors. This was never the case. You will be lucky if fog and rains are heavy, conseqently, things are becoming a bit calmer at the front line, and the number of wounded patients decreases. Then there is time for a little rest.

And one more thing - the hospital has its task, but in the new realities it has been divided into many smaller tasks dispersed geographically. In one place, for example, they work around the clock, and in another there is an opportunity to have a rest. We had to think about how to change people so that the quality of care would not suffer.

- Were that you who was managing that?

- At the beginning of the full-scale invasion, I was heading the surgical department, performing the duties of the leading surgeon. About a year later, I was appointed head of the medical service, assistant commander in charge of all matters related to medical care. That is to say, I had to manage people both there and there, distribute them, make sure that they have a rest whenever possible. Well, different things happened. I lost 13 kg in the first month...

- Were there life losses among your personnel?

- I won't go into detail, but in the first months of the invasion, the enemy was pushing hard through our defenses in one of the axes, and one of the brigades who were holding the defense lines out there began to unravel. We were tasked with reinforcing their medical company with transport and personnel so as to  evacuate the wounded for us to render them care. Unfortunately, they found themselves trapped into an encirclement along with the medical company. One of our teams, a driver and a paramedic, remained with the medical company, waiting for the night to somehow breach through the encirclement, to escape through the fields. There were two other teams who chose to return to the base, but the enemy met them on the road...

We have information, although I am uncertain whether it’s true or verified, that two Russian tanks simply shot them at close range. The bodies were found, but no ID documents were present at the site. So these people have been declared missing in action and remain in this status to this day. These were ambulance drivers and paramedics who accompanied the wounded petients during evacuation.

The other team members had miraculously escaped through the fields at night, and all of them survived. But people were emotionally depressed, realizing that they could be among those who never returned. It was a shock for our entire team to have their friends and colleagues killed.

IN-HOSPITAL MORTALITY RATE AT THE HOSPITAL IS LESS THAN ONE PERCENT

- What types of wounds and injuries are you currently encountering most often?

- In books on military field surgery, wartime surgery, there can be found a winged statement that war is an epidemic of combat traumas.

After the Second World War, a book was published containing various statistics data. Now the statistics remains unchanged: injured or wounded patients account for 70–80% of the patient population at front-line hospitals. These are explosive injuries caused by shell fragments.

Bullet wounds are relatively few. This suggests that our soldiers suffer wounds while repelling assaults or fighting in close contact engagements, or while counterattacking the enemy. Bullet wounds from small arms are inflicted while fighting at very short ranges. But this amounts to a very small percentage of the total number.

We are dealing mostly with shrapnel injuries or injuries caused by other factors such as explosion; blast wave; fallen debris, rubble or earth; throw or hit. So there is nothing new, except the amount, which is huge, as is the diversity of the injuries. Whatever you can imagine was there to be found.

- How is care for wounded patients organized at the front line? How much time does it take to bring them to your hospital?

- I will not elaborate on the organizational and staff structure. But I will say that there is a first line of care - it is the brigade-level medicine, which searches for the wounded casualties, collects them, provides first premedical aid, and transports them to designated locations where doctors begin to intervene. But their only task is to make sure that the patient gets to the hospital alive. That is, not to fully operate on him or provide the entire scope of care so that a wounded patient could immediately return to duty, but simply to get him to a medical facility.

A front-line hospital is the second level, where qualified medical care is provided, with elements of specialized care. That is, a neurosurgeon, a vascular surgeon, and a traumatologist are present there.

I can say based on my experience that we at our hospital save the most difficult patients who may seem to have very little chances of survival, snatching them from the claws of death, literally. I must also say that the mortality rate amounts to just approximately  0.01% of the total number of in-hospital patietns we care for.

- That is, you save almost everyone...

- I reiterate it once again, I will not revel any of exact numbers, because it wouldn’t be appropriate. But empirically, the 0.01% or maybe 0.02% mortality rate is an excellent result for a frontline hospital like ours.

NEVER DO WE CUT OFF LEGS THAT STILL CAN BE SAVED

- Lots of soldiers lose their limbs while at war - both during hostilities and in hospitals...

- Unfortunately, when the ATO/JFO operations began, Ukraine found itself utterly unprepared for the challenges that arose. The practical and theoretical training level of surgeons mobilized for service from across the country, from various civilian medical institutions was unsatisfactory. And there were lots of unjustified amputations made. But there were also many attempts to save a hopeless limb that resulted in death. After all, when the tissues are already dead, the decay products enter the bloodstream and simply "turn off" the kidneys, so a person dies of kidney failure.

It was a big problem in 2014, but by 2022 a lot of research works and developments had appeared. We all knew what the indications were for amputating a limb or not amputating. We followed those canons. I wouldn't say the amputations are numerous. There are many of them, indeed, but not too many. We made two or thee amputations every day.

- Do doctors make amputation decisions collectively?

 - I, being the head of the department, the leading surgeon, was receiving many calls on such matters, was invited to the operating room, or sent photos or videos. I made the necessary assessments and evaluations so that I could say confidently that, for example, it is necessary to get a limb amputated because it is irreparable and hopeless. In doubtful cases, an intervention was needed from a certain vertical of management, a senior surgeon who oversaw all the hospitals in our area of responsibility. We consulted with him, he asked clarifying questions, and that’s the way decisions were made. Many limbs were saved. But what to do with those limbs in the next stages is a very difficult question to answer.

From what I knew and saw, I can say with confidence that no limb was amputated by anyone by mistake or without due justification. On the contrary, we, I repeat it, were keen to save as much as possible where there were indicatons that a limb could survive. Somewhere, four or five hours’ drive from Dnipro or some other location, at a hospital, a new decision will be made, evaluated through the prism of time - to amputate or leave it in place.

- How many patients did you operate on at your hospital every day?

- They are numbered in the hundreds, sometimes up to three hundred a day. Different things happened, different things.

SURGEON’S BLOOD FOR THE WOUNDED

- Were there enough medicines and blood supplies?

- We submitted applications, and the necessary things were supplied to us very rapidly either by the government, or by volunteers, caring citizens. I told you about an anthill or a beehive – that was same; the whole country became one solid anthill that helped. We even sometimes joked that if we ordered a UFO, volunteers would bring it to us.

And it happened that the blood stock, for example, had ran out,  and they did not have time to deliver it. You operate on a patient, go and donate blood to be transfused. And this happened more than once, and I, of course, donated too.

- But you yourself were tired and barely alive ...

- But what do we do? There were no other options left. We had a list of employees specifying who has which blood type , and whenever a specific type was missing, we simply called: "Guys, girls, we need blood." An orderly, a driver, a cook, a doctor - it doesn't matter who, everyone donated.

But there is a law: if a person becomes a donor, one extra day should be added to his or her vacation time. So our leader obliged us to record who and when donated blood for patients. And when time came to let us go, then he added these days to our off-work time.

MEDICAL EQUIPMENT... FROM A HARDWARE STORE

- How was the situation with necessary supplies changing over time?

- At the very beginning of the full-scale invasion, there was a chaos everywhere, as I said above, but we provided care around the clock, continuously, and we had some supplies reserved from previous times; there had been organized supplies from the government, so we got what we needed. Something that shortened the time of providing care, was helpful during surgeries, some useful gadgets were coming from  caring citizens, public organizations and volunteers. It would be an exaggeration to say that we had to wash bandages, like during the Second World War, hung them on strings for drying and then reuse for bandaging patients. This has never happened. There was any interruption in the deliveries of medications either, never.

But there were also exceptional situations whereas doctors had to make something from materials at hand, sometimes bought from a hardware store. For example, when drains are needed for the abdominal cavity, a polyvinyl chloride tube is simply bought, holes are cut in it, it is sterilized and processed. When you urgently need something that is not available now, then such inventive approach works.

Also in the case of fractures of long tubular bones, for example, the main thing to be done is to fix the fracture. We mostly used external fixation devices, like 4–5 mm rods. They are twisted into the bones and connected together with the help of locks, like in the Ilizarov apparatus, so that the bone fragments do not move anywhere, do not damage the vessels, and this, accordingly, causes less pain and so on. Once we ran out of these screws, so we simply went to a garage to cut ordinary fittings into pieces of the required length. If it was smaller in diameter, we wrapped it with a tape, sterilized it, and that’s how we got out of the situation like that while awaiting for the delivery...

FOREIGN DOCTORS EXPECTED TO SEE "SHAMANS WITH DRUMS"

- Did foreign doctors come to your hospital or provide help?

- The situations were different. The average Ukrainian thinks that there is advanced medicine abroad, doctors are gods, they can do anything... My surgical department, for instance, had a certain staff: surgeons, operating room nurses, anesthesiologists, everyone related to the operating room, to shock surgery. The average age of surgeons was about 30-31 years old, with broadly varying levels of theoretical and practical training. It is like, say, drivers: one drives like Schumacher, and the other drives badly, but still they are both drivers. It's the same with doctors, and it's no secret. But at the beginning of the full-scale invasion, our ranks were replenished with mobilized surgeons, anesthesiologists and reservists from the first operational reserve. They already had work experience in the same hospital in 2015-2018. And we were inspired and supported by knowing that we were not alone.

Then teams from the USA began to arrive: two paramedics and one surgeon or surgical orthopedist, accompanied by an interpreter. All the visiting medics had experience in Iraq and Syria, where the United States of America conducted combat operations. They volunteered to come and work with us.

I got the impression that they expected to find themselves in some wild wasteland where a shaman with a tambourine anoints the patient's head with ashes to make him well. But they saw that we perform titanic work: around the clock, sometimes with limited technical capabilities, but using modern devices and various other things that make surgeon's work easier. They were helping a lot, we were exchanging experiences, suggesting something to each other. The Americans actually saw and learned a lot from us. Warm, friendly relations have been established with some of them, even sometimes we congratulate each other on holidays.

The one I remember best was a professor of pediatric thoracic surgery from North Carolina, whose name I shall not reveal. It was a great pleasue to work with him, and I realized for myself that surgery, in principle, is the same all over the world; surgeons have the same fears of complications or unusual situations. The inventive approaches like I mentioned above were used in the States as well, and their doctors have superstitions and fears of their own. That is, we are made of the same dough: although medicine is extremely well developed in the U.S., the essence is the same.

The Americans worked with us for about three or four months. They came to stay for two weeks, took a vacation at work and traveled at their own expense. The organization that brought them paid for their air tickets, and that was it. No salary, just volunteering, missionary work.

And each of them was really impressed, because they expected that no one here knows anything, but they saw something completely different and, to put it mildly, they were shocked.

- Did they compare that with things they saw in Iraq, Syria?

- You see, they did have combat experience, but that is completely different. A hospital comes there, is deployed in tents and works. But no one says that it is being deployed in a neutral foreign country protected with air defenses and aviation. Each wounded patient gets delivered to the hospital in a helicopter. No other country in the world, excepting us and our enemy has been dealing with such numbers, such huge flows of wounded paitients unseen from the times of WWII. Not a single one…

There were wars, conflicts, but none has seen the use of so many different types of weaponry... I remember one day we were working, explosions started, and we and patients went down to the basement shelter. Everyone began telling jokes in order to lighten the atmosphere, and one wounded border guard, an older man, says: "I've already seen everything except a submarine."

AIR RAID ALARMS DON’T INTERRUPT ONGOING SURGERIES

- How did you work during air raid alerts?

- Well, we took certain measures, I won't name them, but everying was being well calculated, we were ordered to go down to the bomb shelter. But when, for example, a surgery is in progress, a wounded patient is on the table in an extremely difficult, unstable condition, you cannot leave him, because else he will die. Then two surgeons, an operating room nurse, and an anesthesiologist remain in the operating room, while others are allowed to go down to the shelter.

- That is, these doctors stay in place, risking their lives.

- At that moment, you simply do not think that you are risking something or not. You stand there, making a surgery, and then it goes bang-bang, everything shakes. Well, what's next? Windows remain unbroken, and you are working, you cannot leave. And whereas there is a serious patient in the intensive care unit who needs constant care, connected to various devices, then there is also a doctor who watches over everything. Well, that is, even if fighter jets fly somewhere or a package of artillery rockets land, the work always continues.

- It's hard to even imagine...

- Well, we lived in a basement for longer than eight months. When time permitted we went down and lived right there, in the dampness, in the dust and dark...

- How did the power blackouts during winter 2022-23 affect you?

- At that time we already had generators, we thought it all out in advance. The first blackout hit us after the Russians had attacked Kharkiv’s thermal power plant with missiles, when almost all of Eastern Ukraine went dark. By the way, it was on Surgeon's Day. So we were "having fun" by just finishing with a surgery on a severe wound in the abdomen. The main, critical stage of the surgery was done, everything was fine - and suddenly it got dark. Good thing we had specialized medical headlamps and battery-powered breathing equipment. Of course, batteries don't last forever, but in ten minutes’s time our people who were responsible for it started the generator and gave us light. Well, that is, there were no problems left.

DEFENDERS ARE THE SAME PEOPLE YOU SEE EVERY DAY

- Lots of soldiers have passed through your hands. Could you compile an overall portrait of the Ukrainian Warrior?

- All people are very different, totally, in terms of education, age, and body constitution: fat, thin, big, tall, short... Just the people you see around you every day.

I estimate that our service members are aged at between 45-50 on average, and now it will probably be 50+.

For that matter, I would say that there are many women serving in the Armed Forces: both in armor units and in other combat formations. If we talk about a military hospital, there is probably half of them or more. There are fewer women in combat brigades, but there are those women who take part in active actions, who are fighting.

It should be appreciated that, at the beginning of the full-scale invasion, we had brigades that had been gaining combat experience since 2014. I believe that Ukraine was able to resist, in particular, thanks to these people who went through ATO/JFO and knew how to fight. At that time, many of them were released from service for various reasons, but I think that almost all of them came to military commissariats and joined their respective units in the first minutes of war. Like did, for example, the reservists who came to our hospital: on February 26, around 12 PM, they were already standing on my territory, waiting to see what tasks they would be assigned. These were doctors and nurses who arrived in two days, taking into account the time of travel, mostly from the West of Ukraine.

Unfortunately, there are others, such as, for example, citizens who wear embroidered shirts on holidays, shouting out "Glory to Ukraine!" ... For some reason, they have already crossed the Tisza, exited to Great Britain, the USA, Canada, wherever and however they could. That's it. Those who wanted to fight are already fighting or have finished fighting already.

RECALLING UNIQUE CASES

- Can you say how many of our soldiers have you saved personally?

- I’ve never made any of such calculations. Thousands. We’ve been able to pull lots of them out of the jaws of death.  But it wasn’t just me, it's teamwork. Because you can be the best surgeon in the world, but you are standing in the operating room while someone has to bring the wounded patient very fast through the floors, along the corridors, and get him in. These are paramedics, ordinary guys who just have a strong back, strong hands, who do not sleep, but carry, drag the patients on stretchers. Next, there is an operating room nurse who knows how to process everything, prepare it, make sure the requisite supplies are availed and brought to me in good time. Also, the surgeon will not set out surgery without an anesthesiologist alongside.

None of us counted how many people we’ve saved. It's like an assembly line, a machine, and you just stand and work, work, work. We remember only unique, extremely difficult cases, some “trash” as one would say.

- Can you tell me about at least one?

- The most serious was a penetrating wound to the chest with damage to the heart. The left ventricle is the chamber of the heart that pushes blood throughout the body, to the head, the feet. And there was a hole in it caused by a 5 cm shell fragment. Scinece tells us that the guy should have died right at the moment, in seconds and that's it. But, by some miracle, he reached us. We quickly explored the situation, made a decision, got to the heart, removed the fragment, and sewed up the wound. The guy survived at the time, and it was nothing but a miracle. At that time, there were four surgeons present in the operating room: two were 28 years old, and I was 29 at the time, the fourth was 30 years old, plus two more senior anesthesiologists. When I was sewing up the chest, pulling it all together, his heart stopped. We started it again, performed resuscitation measures; he lasted for a bit before his heart stopped again. We reopened the chest and saw the coronary artery clogged up with a blood clot. The scenario now began to be reminiscent of myocardial infarction. We patched the hole in the heart, but the impact, the energy of the fragment had caused thrombosis in that patient. Unfortunately, that guy had died, even though his angels had been pulling him out to the end, and we as well were doing what we could...

We also saw mass arrivals whereas lots of wounded patients are brought in over a short time and we have to do medical triage. It is necessary to determine who should be cared first, who can wait a little, and who cannot be saved because it’s too late, because the patient is already in a state of agony. But that doesn't mean we didn't do anything with someone in agony. We have always aimed to preserve every life as much as possible. And I can say with confidence that we fought for the life of each and every patient until the very end. We did everything imaginable to pull them out of the jaws of death.

We also often operated on and saved patients with gunshot head wounds: approximately 12 decompression trepanations were performed every week. When a fragment enters the skull, it damages the brain, and blood flows out of vessels into the closed space. This blood compresses the brain, which causes a condition similar to a stroke, and a patient can die. The only solution to this is to make, roughly speaking, a hole in the skull to let the blood out.

Well, it's a science, methods and everything else... There is an experience, you can't deny it... Now I'm getting ready to go there again for a three months’ shift.

MILITARY MEDICINE IS WAITING FOR ITS HEROES

- Are you going to the same hospital again?

- I requested it myself. I told the management: I am ready to go if it’s needed, because I know how difficult it is out there.

- What does your wife say?

- Hmmm, what does she say... She's worried, she doesn't want me to go. My son is already four years old, and during that time I was only with him for seven months. I'm a WhatsApp dad (smiles). “Why you, not others?” my wife inquiries. But we have a duty, and we must fulfill it... In my opinion, the trouble is that one and the same people work in the front-line hospital. Nobody wants to change them. There are thousands of surgeons, anesthesiologists, and operating room nurses in civilian medical institutions throughout the country. But they all, it seems, don't care.

- But they are not liable for military service, aren’t they?

- I cannot say, this question should be addressed to TCC’s (territorial centers for recruitment and social support). People probably think that it doesn't concern them. But out there, in hospitals, doctors are falling down from fatigue. Imagine working around the clock: stress, deaths, blood, stench, explosions... And no one will replace you. I am speaking not only about surgeons, but about all people who are involved in shock surgery...

- Was it your dream to become a doctor?

- I dreamed of it as a child. Never did I even consider other options.

- Are your parents have any relation to medicine?

 - Yes, my mother. There are doctors, healthcare workers in her line. So this was the only profession I looked at since childhood.

- Did you want to become a military doctor?

- No, I became a soldier later. It was my conscious choice. When the events of 2014 took place, I wanted to join in all this, to bring some benefit to the state, to do what you can and know how.

- Is there anything you would like to say in conclusion of our conversation?

- That, speaking generally, we have only one problem - personnel. Period. I repeat it in front-line hospitals: people need to be changed, fresh forces are needed, and they are in short supply. So military medicine is waiting for its heroes. Civilian doctors, nurses, welcome!

Olena Kolgusheva

Photos: via Author and courtesy of Mykhailo Boyko