The Story of Andrey Serbin, a Mariupol Doctor
Andrei Serbin is a 27 years old anesthesiologist at the Mariupol Hospital No. 4 in the Left bank district. On February 24, the day of the full-scale military invasion, he arrived at his department and left it only on March 21. During the first week of the war, until the left bank of Mariupol was cut off from the city, doctors were still coming to work.
In early March, two surgeons, two traumatologists, and two anesthesiologists remained in the operating room. Andrey was among them. It was they who performed dozens of operations and assisted hundreds of civilians on the Left Bank. Hospital No. 4 and the maternity hospital were the only medical institutions in this part of the city. Dr Andrey tells of how the doctors managed to fulfill their duty so that there were more survivors than dead.
Cold without end
We were doctors in an isolated hospital and we did our job. That’s it. It wasn’t heroism, just the circumstance we happened to be in. The first wounded man arrived on February 25.
Heating was cut at the end of February. On March 3, almost all of the windows of the northern facade were broken. We had no electricity anymore. On top of this, it started to get cold outside. All this led to the temperature dropping to 4 degrees in the hospital rooms.
We couldn’t use any heaters because the electricity we had was from a diesel generator. There was very little diesel fuel, so we had to save it. The hospital had a generator from before the war, and we burned the pre-war supply of diesel fuel in two days. While the gas stations were still functioning, the hospital administration bought diesel fuel in the first days, then the military brought it to us three or four times.
The patients remained in the hospital even after they recovered. They were filling up the generator and monitoring its smooth operation. But on March 21, as we were leaving, the chief doctor said: “There is barely enough diesel fuel left for 3 to 4 hours of generator operation”.
The whole hospital had two fan heaters. They stood in the operating rooms and were turned on only when an operation was in progress. The windows in the hospital operating rooms were shattered immediately after the first shelling, so we had to move to the pre-operative rooms – these were more or less safe rooms which complied with the rule of two walls.
“Nevertheless, there were several episodes when something flew so close in the middle of an operation that our doors opened with a characteristic roar.”
Because of the cold, we put on all the clothes we had. On top, we wore covid overalls (before the war, covid patients were treated here). This was to protect our things from blood, vomit and other biological fluids, which absolutely everything was stained with. The overalls also seemed to retain more heat.
However, staying in operating rooms for a long time made it unbearably cold for doctors and junior medical staff. It was hard for everyone. Women could not stand it- whenever the situation in the operating room permitted, they would go somewhere, wrap themselves in a blanket and sit, trying to keep warm. The first time we really warmed up was on March 23.
On the brink of starvation
Shops were still open sometime before March 2nd. It was possible to jump out at great personal risk and grab something lying around on the empty shelves of the supermarkets. Things that had no nutritional value were not yet sold out, like chips or olives.
On the first day we went on a short trip and bought four loaves of bread. We stretched this bread right up to mid-March. Then there was no more bread.
The hospital had a catering unit with food supplies. This food was divided into compartments and cooked in crockpots while operations were going on, the generator was turned on and there was light. The food, of course, was very spartan and in small quantities.
Added to the limited supply of food was the problem of cooking large amounts of food. In our department, there were only two crockpots. We had to cook for 20 people. The portions were modest.
The water for cooking was from a well which was a big plus. The well, whose pump was powered by solar panels, was a few kilometers from the hospital. Once every 2 or 3 days, we loaded all the available containers into one of the doctor’s cars and drove around the city for water while it was being shelled constantly.
Nobody liked these outings. When we went to the well, which was in the courtyard of a private house, there were always huge queues. It was the one and only place where drinking water could be obtained. Patients and sick people were allowed to skip the queue.
People who did not dare to go searching for water took it from the sewer, filtered it and boiled it. Even after that, it smelled and had a nasty aftertaste.
On the tenth of March, we operated on a patient whose relatives brought us a box of chicken necks in gratitude. To be honest, I had never eaten anything like that before. But at that time, the forgotten taste of meat significantly cheered up the team. The necks were boiled, stewed, and fried. Of course, no one really liked them, but we would eat anything.
In general, we did not go very hungry. We ate twice a day. But given the cold, the work, the stress, the looming sense of the finiteness of these food supplies and the infinity of the siege, we have now developed a very reverent attitude towards food.
More survivors than dead
In medicine, there is the concept of “golden hour”- the fact that after an injury, a patient needs to be helped as soon as possible. In Mariupol, no one came to us during the “golden hour”.
There were people who lay on the street for days with their legs torn off until they were found and sent to us. There was so much bleeding that it is not clear how some of them survived.
I can’t say for sure, but I think one in five people died after being helped. It’s amazing to me. Without water and electricity, without a full staff of specialists, with periodic mass influxes of patients in a situation where there were more victims than medical personnel, there were more survivors than dead.
First, the ambulance brought the victims. Then on March 7th and 8th there was heavy shelling and communication with the Left Bank was interrupted. After that, the wounded arrived in a variety of ways.
The victims were brought by civilian transports or by the military. There was some kind of armored vehicle, apparently not military, marked with red crosses which brought a lot of people to us. The locals carried the wounded on doors and blankets. Those who had usable legs came themselves.
On March 20, we had only one wounded person. That was also the day when one person was shot dead. This was Dr. Kazantsev. One of the hospital’s old-timers. He was over 60; he worked as head of the department of children’s infectious diseases. On the morning of March 20, the doctor took a kettle and left the building of his department to take the boiled water to the shelter at the neighboring infectious diseases building, where people were staying.
The distance between the two buildings is 10 meters. There was an explosion near the building where Anatoly Borisovich was heading. He was thrown back to his building by the blast. The kettle remained near the crater. Anatoly Borisovich died from a brain injury. We buried him in a flower bed between two buildings – two meters from his place of work.
The rest of the dead were put in bags and taken out into the yard. They lay under the wall of the hospital. According to the rules, forensic experts must determine what caused the death of each person before they could be buried. They were buried immediately after.
Helping Children Boosts Morale
During the entire period, we had about 15 wounded children. The most severe cases were traumatic brain injury. Our hospital didn’t specialize in neurotrauma, so we didn’t have neurosurgeons.
I remember the first girl well. Her name is Anya. There was an explosion, a wheel was thrown from the car and hit the girl on the back of the head.
Everyone immediately took care of the child. One of our young traumatologists performed a decompression craniotomy, an operation that is not at all included in his area of professional competence. It is the same as if a therapist performed an appendectomy.
There was a difficult recovery period after the operation. The girl was on a ventilator for five days. Almost all devices were powered by the network, but there was no electricity, of course. But we did have five batteries. While the generator was working, we were charging them. When one device went down, we quickly switched the girl to another and so on constantly. It was an absolutely extraordinary situation.
We were able to wean Anya off respiratory support and she began breathing on her own. On March 18th, she showed signs of neurological recovery. On March 21, she regained consciousness and could even maintain minimal contact at the yes-no level. We were very proud that we managed to save her.
When Anya was still on the ventilator, the next child came to us- a 6 year old boy with a head injury. After the operation, he recovered very well neurologically. Later, I saw a photo of him and his grandmother in the Mariupol chat rooms. They stayed in the city.
Helping these children, their recovery after operations in such conditions – these were the incidents that raised our morale. Unfortunately, they often brought dead children. And it was even worse when the children came to us alive and we could not help.
“Triage” is the concept of medical sorting of patients based on the severity of their injuries and the likelihood of survival. There were many patients who were in agonizing pain, with extremely severe injuries and a low chance of survival. It is considered wrong to focus primary attention on them, since someone else with a severe injury but with a higher chance of surviving may not receive medical attention and die in the process. It was difficult to make such decisions.
A mother, grandmother, and one-year-old boy went out to their yard to prepare food. A shell hit. Everyone ended up with a head injury. The mother just got scratches. The grandmother suffered rather severe trauma to the face and her eye was seriously injured. But the boy was hit in the head by a fragment. There was an inlet opening through the frontal part of his skull. He was brought to us alive, but the contents of his skull were outside. His mother, of course, refused to understand that there was no chance. We anesthetized the child, that was all we could do. Within 15 minutes of being admitted to the hospital, the child died.
There was an incident where two children were admitted- 10 and 16 years old. As far as I understood, they were not relatives, but they were brought from the same place with severe head injuries. We couldn’t help them. We could only anesthetize them and cover them with a blanket. That’s it.
Medicines were obtained with a crowbar
The stock of medicines in the hospital, of course, was depleted quickly. When the seriousness of the situation began to become clear and pharmacies stopped working, people with higher medical education gathered in groups and forcibly opened pharmacies located near the territory of the hospital.
The drugs for pain relief were the first to run out. There were big problems with infusion solutions. There was no blood. We did transfusions only when we knew that without blood, the patient would definitely die. By March 20th, we had practically nothing left of the medicines with which we could provide assistance.
We did not think about evacuation, we dreamed about it. But since mobile communication was lost on March 5th or 6th, we were in an information vacuum: we didn’t know about the “green corridors” or what was happening at all.
Plus, we regularly heard a typical story from the wounded: We heard someone say that there would be a green corridor, so we went, and we came under fire. Someone has a hole in his stomach, someone’s arm was torn off. Someone was killed on the spot.
This vacuum affected not only our hospital, but the entire Left Bank. On March 16 someone caught a mobile signal connection at night – one “bar” of the Kyivstar network on the fourth floor. And from that moment the pilgrimage began there. Everyone got up, put their hand out the window, tried to catch the connection, to inform relatives who had already buried us several times over in their minds.
And when we got a connection, we began to learn from relatives more or less up-to-date information about safe routes to leave the city. They informed us that there really were reasonably safe exit routes. We began to think about evacuation.
We intended to leave purposefully for the Ukraine side. None of us wanted to stay to work, live in the Russia occupied zones or be moved to Russia. (On April 7, it became known that the Russian invaders took the staff and patients of the Mariupol city hospital No. 4 to the occupied territory of Ukraine. The fate of the people is unknown – Own)
The driver said: “Andryukha, jump out!” And I understood why
On March 18th, our quarter was shelled very intensely with aimed fire. Across the street, a health clinic caught fire. It burned for two days and I thought: “What if we catch fire?”
And the very thought that we might not only be hit but catch a fire made us rapidly consolidate everyone’s efforts towards evacuation.
There were several unsuccessful attempts to leave. Unsuccessful in the sense that we did not leave the Left Bank. Now I understand that it is better to consider them successful, because each time we returned in the same condition as when we left. Not everyone was so lucky.
The main problem was that the “green corridor” began at the exit from Mariupol. We had to reach there first. The left-bank district of Mariupol is closer to Novoazovsk and the side of the Russian occupation. We needed to reach the opposite exit of the city, the western one, and in order to get to it, we had to cross Mariupol.
A typical evacuation attempt in Mariupol from the Left Bank looked like this: people would drive to the bridge, see barricades of cars, and try to get around them. Judging by the number of cars with corpses inside that were shot near the barricades, for many the evacuation route ended there.
Our successful attempt was on March 21st. We were in a convoy of seven vehicles. The day before, an acquaintance of one of our colleagues drove out and reported on the route.
It was necessary to drive along Pashkovsky Street to the Embankment. Run towards a minefield. In front of it, turn and continue driving along “partisan paths” while jumping over the curb, bypassing twisted concrete blocks, and passing through the eastern checkpoints of “Azovstal”, which were broken into trash.
There’s a six-lane road. There was not one square meter on it that was not covered by a huge twisted concrete block. The road ran through “Azovstal”, which was battered non-stop.
In one place it was necessary to go along the tram tracks and turn off them to get to the bridge. Between the barricade of cars and the railing of the bridge there was a gap, barely the width of an ordinary passenger car without mirrors. Those who had mirrors folded them, the rest went as they were. We maneuvered into this crevice with the whole column of cars.
At one point we were almost trapped by a fallen pole, which had a trolleybus power line on it. And this cable, on which everything is fixed, hung across the road. If the car got caught, it wouldn’t just get stuck, it would rip off part of the car.
I was in the first car. We drove up, we realized it’s impossible to get around, and the driver said: “Andriukha, jump out!” I understood why. I jumped out, raised the metal cable above my head, and let our convoy of cars pass. I dropped the cable and ran quickly to our car. They were driving at a low speed so I could get into the car on the move.
A tank stood at the entrance to the central checkpoints, and next to it was a funnel two lanes wide and waist deep. Cars could not pass on the road. Drivers, jumping over the curb, drove between the funnel and the tank. So we jumped out to the central checkpoints. There was another bridge. By this time it had already been destroyed.
But there was another one nearby, it was always called the Old or Hunchbacked. To be honest, in almost four years of my life in Mariupol, I had never seen anyone driving on it. I thought you could only stand on it with a fishing rod, since nothing heavier than a cart ever drove over it. But we passed anyway.
From that moment on, a relatively safe route began. And then began a repeating story of checkpoints, inspections, and communication with people with machine guns. At Russian checkpoints, we were asked to undress: they looked for tattoos and traces of weapons.
In our column, there was a car that did not have a full tank. We all knew for sure that we would have to tow it eventually. It ran out of gasoline 20 kilometers to Mangush. We towed the car to Tokmak- no one even thought of telling the driver that you should not leave without a full tank of gasoline. We refueled and drove to Zaporozhye. On March 26th, I was in the Dnepropetrovsk region. On March 30th, I went to look for a job as a doctor.
We left, but our patients stayed
Have I changed? In Mariupol, it was necessary to work, save, make decisions, fight, warm up, and eventually eat something. And I lived, worked, was constantly part of the operational teams and tried not to think about anything like that. Thoughts after Mariupol are another thing.
The day after our departure, we arrived at the fourth floor of the hospital, where I was with other employees almost all the time. This explosion killed several doctors.
The fact that we left while our patients stayed is very painful. Each doctor establishes an emotional connection with the patient in the process of treatment. They are no longer a stranger to you.
We assured ourselves that we had done all we could, especially in the circumstances that had developed: “Another day or two and we would have been left with nothing. There would be no suture material, no alcohol for disinfecting. No means to provide assistance.” And yet we were all disturbed about leaving our patients behind. Doctors don’t do that. Usually. But I cannot blame myself for the fact that we made the decision to run away from Mariupol, because it’s normal and right. But everyone who left with me has some degree of doubt about the correctness from an ethical standpoint.
Article by Natalia BIRIUKOVA, translated with permission of SVOI
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