The world has changed, Ukraine has changed, we have changed, but the world, Ukraine, and we have not become worse. And return to the old, thank God, will not be! A new life and a new order begins in all its fullness and truth.
The need for the article is due to the fact that during the war and COVID-19 training and education of young doctors became extremely important. When life and death go hand in hand, when not only theory but also practice becomes more important, when decisions must be made quickly, when there is no oxygen for the patient and no blood for the wounded soldier, all this causes intense thinking in every critical situation. How to find a way out? Do doctors know how to do it? Do they see the same black gorilla? And did she see them, or maybe they even met by sight?
The theoretical basis of our study is the achievements of scientists in the field of existential and humanistic psychology at the European and world levels. We have a practical base everywhere: a ward in a hospital, a dugout at the front, and people with their pains and problems everywhere. And the doctor, in addition to knowledge, must still make timely decisions - the only right one, and first save, and only then treat. The experience of doctors and employees, students, patients, statesmen was used in writing the article. The main works on the psychology of thinking, existential psychotherapy, paradoxes and passions in psychotherapy belong to J.-P. Sartre, W. Frankl, E. Dorzen, R. Leing, G.W. Chujko, О.С. Chabanu, O.O. Haustova and others. Presentation of scientific novelty, theoretical and practical significance of the researched problems in training of future doctors, treatment of patients and their rehabilitation during the COVID-19 pandemic and in the post-coding period and rehabilitation of soldiers with post-frontal syndrome was the purpose of the study.
The article analyzes the problem of medical thinking. In particular, how to detect medical thinking in non-physicians. During the war and COVID-19, all people were forced to become doctors. And this is not a whim, but a vital necessity. And how the state copes with this also becomes its viability. The period of rehabilitation of postcoid patients and post-frontal (post-traumatic stress syndrome) soldiers is important, invaluable in the process of transformation of thinking - the transition from waiting in the dugout with weapons in hand, when you hear the whistling of bullets and shells, to a peaceful life when everything changed dramatically. This often causes a deafening emptiness, the formation of a vacuum, which often leads to uncontrolled actions дій And when in that vacuum instead of "angels" settles the "devil", how to drive him out?
Statement of a scientific problem
The urgency of the problem of thinking - to think like a doctor through the eyes of a politician, patient, medical student during training and medical practice - is beyond doubt. Especially when COVID-19 crashed into our heads, and now SARS - CoV-2 and another "double mutant", and to win this, we need new radical approaches in the learning process, which we had no idea before. In recent years, psychology, psychiatry, and existential psychotherapy have increasingly captivated medicine. A special place is given to a patient who came to the doctors with his problem, who sought help with the hope of recovery. But to what extent are we armed with knowledge and ever-increasing practice to boldly meet and help the patient?
Analysis of recent research
The main works on the psychology of thinking, existential psychotherapy, paradoxes and passions in psychotherapy belong to J.-P. Sartre, W. Frankl, E. Dorzen, R. Leing, G.W. Чуйко, О.С. Chabanu, O.O. Haustova and others.
The purpose of the article
Presentation of scientific novelty, theoretical and practical significance of the researched problems in training of future doctors, treatment of patients and their rehabilitation during the COVID-19 pandemic and in the post-coding period and rehabilitation of soldiers with post-frontal syndrome.
Presentation of the main research material
Year 2020 has created many new challenges for the whole world and especially for Ukraine. Difficult implementation of reforms, war in the East, "uninvited guest" COVID-19. Today in Ukraine there are no family, relatives, friends, just neighbors, both older and young, who would not be affected by these problems. We now have two equal fronts. But not to be like waiting for the vaccine: what you did before the vaccination - sat and waited, and after the vaccination - waited and got sick. However, if NATO helps us to train the military, although the war with Russia has already taught us a lot, it is our bloody task to train doctors. And in this we will be helped by our medical students and, of course, our patients.
The Almighty at birth gave us freedom, life and freedom, he also gave man a powerful weapon - the immune system, gave more consciousness and reason for this system to develop and evolve. But he did not create a protocol on how to dispose of this gift. With all this, he is now testing our system with viruses and their strains. Now, we, the authors of the article, say: “Man, you are a unique creature, unique and unique in the whole world. Go, walk, laugh, cry and moan and write your own protocol. " Walk, man, confidently on the planet Earth and do not be afraid of anyone or anything! ”
Severe COVID-19 is associated with four types of disease: obesity - 30.2% of cases, hypertension - 26.2%, diabetes - 20.5%, heart failure - 11.7%, which amounts to 63 , 5% of patients - this is stated in the publication of the American medical journal Amerikan Heart Assotiatison.
In conclusion, based on the above, there are 36.5% of covid patients, of which a certain percentage have suicide attempts. And this is a psychiatric illness. Perhaps, if doctors performed "intelligent vaccination" and other rehabilitation measures with such patients, the serious consequences could not be or at least would be less .
As the psychotherapist, Doctor of Medical Sciences Oleh Chaban aptly remarked: “We are witnessing an“ era ”of neurotic disorders of the late XX and early XXI centuries. has changed into an "era" of depression, and before our eyes is changing into an "era" of anxiety and stress disorders.
We are rethinking the new paradigm of "Coexistence", mentioning that the planet has recorded (studied) 67 thousand bacteria and viruses, and their millions of species, and they most likely appeared before the birth of life on Earth, and they can control through tangential mechanisms not only simple cells, but also complex organisms, including - humans (evidence - the behavior of animals infected with the tetanus virus, the behavior of animals infected with toxoplasmosis, or "increased social activity" of those who received the flu vaccine, etc.). Here is the answer to the "sociality" of Sars-Cov-2.
But there is good news in all this. They are simple to banality: appreciate your "Dunber number" (it is 150) and… Stop being afraid of dogs. And then you will definitely get into the number of optimists who keep immunity from the flu (and now from the crown) much longer than frightened pessimists. Life is interesting! That is why we continue to live ”.
We used the "interview" method when preparing and writing the article. What does an interview mean? In our opinion, an interview is an intervention in a person's subconscious to innervate his consciousness and to express the information in words together with the interviewer in all its fullness and truth.
Henry Kissinger (now 97 years old), an influential expert in international relations, believes that the current COVID-19 pandemic "will change the world order forever." "After the coronavirus, the world will never be the same," he wrote in the Wall Street Journal on April 1, 2021, proposing to start the process of adapting to the new world order in parallel with solving urgent tasks.
We are also convinced that people will have to live with this virus permanently - humanity will disappear sooner than viruses. The virus must be tamed, domesticated and taken for granted, and at the same time be smart.
The WHO warned of a "mass trauma" due to the COVID-19 pandemic. The Director-General of the World Health Organization, Tedros Gebreis, said: "Because World War II has affected many people, the world has suffered massive trauma. Now, with the COVID-19 pandemic, on a larger scale, even more people have been affected, almost the whole world. The trauma provoked by the pandemic is superior to the post-war one. States should see this and prepare for it. "
For his part, Michael Ryan, Executive Director of the WHO Health Emergency Program, stressed the importance of developing public mental health programs: “Mental health and psychological support for individuals and communities should be given importance in all recovery plans, and funds must be allocated for these purposes. "
Benjamin Netanyahu, Prime Minister of Israel on March 4, 21 stated that Israel has completely overcome the pandemic of the COVID-19 virus, the population was vaccinated in a timely manner and in April 2021 in Israel will resume schools and universities, open cafes and restaurants and etc. Thanks to the successful vaccination in the Israeli army, a collective immunity has been created. According to Mossad Cohen Yossi, Israel is urgently convening its spies and members of their military intelligence families working in different parts of the world to vaccinate them. Hundreds of such people have already entered, waiting to be vaccinated for the second time.
Infectious disease specialist, doctor of medical sciences, chief freelance infectious disease specialist of the Ministry of Health of Ukraine Olga Golubovska said in an interview with Gordon: "This is the worst period of all my professional activity. The coronavirus only adapts to the human population, and we adapt to it. Several generations of doctors who have been to us have never encountered this in their lives. This virus is very deadly, this disease is completely different, and it poses completely different tasks for the health care system… The treatment of this disease is quite complex, intuitive, very personal. The virus is unpredictable, but it certainly will not disappear from human life, just later will not be as aggressive as now. Vaccination can stop the spread of coronavirus, but will not stop it, because there is no stopcock in infectious pathology. The immune system will be formed naturally, in addition, there are natural patterns of epidemics and pandemics.
In an interview with obozevatel, Olga Golubovska said: “A year after the beginning of the epidemic, the coronavirus in Ukraine, as well as in the world as a whole, has become more aggressive and unpredictable. The course of the disease is now much more difficult, more often young people became infected and hospitalized. The coronavirus will forever "live" next to humanity."
Since March 2020, the disease has changed five or six times, and treatment protocols have changed accordingly. Now it has changed again, and radically. So when I saw the American protocol of the Virginia School in April, I couldn't believe my eyes, it coincided so much. I take off my hat in front of Paul Marik (American resuscitator - Ed.) And his colleagues. They clearly painted everything from prevention. There are no superfluous words in this protocol. These are the D vitamins that people drink, and there are very few of them who are seriously ill - all from that protocol. He has taken root in Ukraine both among the population and in intensive care units."
We had a casual conversation in the on-line system, and sometimes in person, with our medical students, including foreigners (What you think about that…), about everything that worries us all and the subject of our article. All students, as one, are concerned about our health (knowing that we work with crippled patients), as we are concerned about theirs. However, in general, they came to interesting conclusions: you need to have a high level of knowledge about all diseases and be competent in everything to be able to help patients. Philosophy must be studied, known, loved, possessed and applied. It is necessary to know English and Latin, because 90% of modern literature is published in English. You need to update your knowledge daily and throughout life. If you stopped, you fell behind.
One of the students suggested: "Ask me, in your opinion, the most difficult question, and I will give a comprehensive answer for 7 minutes." It turns out that asking a question is much more difficult than answering it. All this took place in the presence of the whole group in the on-line system. And when we started asking questions, he sometimes asked to repeat again - as we realized, to have time to find the answer on the Internet, to organize their thoughts. It is a pleasure to note and acknowledge the progress of the medical student to a professional doctor, and when this happens in front of the group, the group at such moments approaches and grows to professionalism. In the current information field, not everyone can know and teachers, sometimes you have to learn from a student. I want to cite an English saying: "Youth must sow one's wild oats" - "Youth must sow one's wild oats", which can be understood as "go crazy". Well, this oats doesn't have to be wild. Let them sow, but only let this oats give good seedlings. When teaching students, we always remember that at one time we were also them, sometimes we were also "mad" and also "sowed wild oats". We always start to pull each other’s legs, when we are together. (We always fool around and joke about each other when we are together).
Students understand their own responsibility for their studies and for their future. Their key thesis is: "Nobody will do anything for me." A student learning - teaches himself. How they teach themselves with the help of a teacher determines how they will live on. And still students dream and wait for the day when they will meet again in auditoriums. We are constantly learning from our students and are always proud of their achievements. They go forward, reach their own heights. This is a motivation for us to learn, work, overcome obstacles in our lives. You can't stop - and then you will achieve the desired results.
Here are some examples of the current situation. The intensive care unit of the Mechnikov Hospital in Dnipro is three times overcrowded. The presence of men and women in the same hall no longer worries anyone. "Doctors and nurses leave wet marks from sweat. During the change, they lose liters of fluid. Young girls nurses faint from overheating. You have to persevere for a day. It is a pity that not everyone who writes nonsense on the sofa sees us. All health workers who save from COVID-19 pneumonia are altars. Healthy do not understand this. The merciless week continues. Emotions are fresh. 15 minutes after the detour, "added one of the doctors.
Another doctor (anonymous): “When a patient's lungs are almost 100% affected and you know in advance that it is death, you start acting without a protocol, but vice versa, from practice to theory. And when it's someone else from your family or close acquaintances, and you no longer think about the "watchful" eye of the prosecutor. And when aggressive relatives of the patient are connected, and yet you have to treat !? " There is also good news. In Kyiv, a woman was rescued who gave birth to twins, in which 90% of the lungs were affected, and a covid was found in the babies. As my mother said: "It's better now, we eat ourselves, and I feel better." Their names are Marco and Margarita, and 12 more brothers and sisters are waiting for them at home. We bow our heads to the professionalism and sacrifice of doctors. "
We live in a time of "great change", coronavirus and war. To survive and win, you need to perceive life differently, create your own meaning of life, so in our article we use the knowledge and experience of leading scientists in Ukraine and the world. To win, you have to be armed.
In this regard, we turn to existential psychotherapy, which is based on philosophy and helps people look at their own problems in a social, cultural, political and philosophical context. It draws attention to the values and beliefs that a person adheres to, without trying to change them or restore any status quo, or rather shed light on a person's position in the world, freeing him from the heavy feeling of doing the same thing day in and day out. It encourages a person to study life, rediscovering some things or creating the purpose and meaning of their own existence. This makes possible the existence of paradoxes and the acceptance of the inevitable facts of life, from which we so often try to deviate or ignore them. This allows us to ask questions and review our own values. This encourages a person to find their own directions and be ready to meet with some special opportunities and limitations .
Existential psychotherapy has been practiced for more than a hundred years, its basic theories converging to the philosophical concepts of freedom of Kierkegaard and Nietzsche in the XIX century. and the philosophy of Heidegger and Sartre in the XX century. Tangentially (fictitiously), it has deeper roots, as all Western and Eastern philosophy is concerned with the reappraisal of ordinary values. In fact, the birth of philosophy in ancient Athens can be considered a special (original) project. Socrates, arguing that an incomprehensible life is not worth living, called on those around him to reconsider some hidden and unconscious ideas about life. He spoke of the importance of shedding light on those aspects of human existence that had previously remained hidden or denied. Socrates taught people to reflect on what they took for granted and to question what they did not realize as a problem. Existential therapists follow this path, allowing people to take responsibility for their own lives and confirm their personal authority, rather than follow the crowd, accepting adverse living conditions .
Doubt everything, especially the information and knowledge. Pass everything through the prism of doubt, so you will have real knowledge, perhaps for life, and all the ballast will be discarded. We hope that we will be able to inspire you to start experimenting with your own life and your way of being in therapy. May you have new thoughts about the paradoxes of human existence and maybe you will experience some new passion, and your love for life will only grow.
Such pairs of words as: good and evil, love and hate, life and death - exist separately and never meet; when there is one, there is no second, when there is another, there is no first. As with the history of the Garden of Eden in Eden. One should not think that God always condemns people who want to think of themselves. The choice made by Adam and Eve to bite from the forbidden tree and gain knowledge of good and evil is not necessarily a sin. In fact, God placed this tree in the Garden of Eden, and he himself made it possible to realize existence. In general, God probably did not want people to remain dumb inhabitants of paradise forever. We have met here with the paradox of human existence, on the one hand, as the cause of human suffering and fear, and on the other, as a call to movement, development - says Emmy Van Dorzen, who proposes to consider this phenomenon so that the paradox "works for us , and did not destroy our lives ".
Consider the theme of ontological uncertainty, insecurity through the prism of the ideas of Ronald Laing, set out in his book "Split I". Laing is without a doubt one of the most rebellious figures in the world of psychiatry. In this book, he described the inner world of a schizophrenic like no one before, urging the "man of everyday life" to "learn from a schizophrenic."
Ronald Laing, reflecting on the essence of human experience, says: "People who are often labeled schizophrenia were as aware as possible of the existential dilemmas that ordinary mortals preferred not to talk about." The author shares his stories of agreement and disagreement with various representatives of psychiatry and psychology, openly showing his personal search for truth: “My experience of living in such a therapeutic community for one year as a psychotherapist showed me that I lost my role, function and professional dignity. It completely paralyzed me, deprived me of all the skills I had before, and strength. On a personal level, this seemed like the strongest denial of all, and my ontological uncertainty only grew. "
Emmy Van Dorzen generously shares her experience at various times in her professional and simply human career: “I went through everything Laing said (all the signs of schizophrenia), but I probably wasn't sick of schizophrenia. Most of the clinic staff pretended that they had never experienced such disorders… »To many questions, the author, doubting the answers, and now looking for answers found earlier, and thanks Laing" for the revolution in psychiatry. " It has been recognized that schizophrenics are often capable of a greater understanding of human nature than people who are well integrated into the system [4, p.54-55, 57]. By the way, about doubts. Time and time again, Emmy Van Dorzen shows that doubt is the key to a bold search for truth. "What Laing managed to do the most was to doubt that this was his hobby" .
Considering passion, Emmy Van Dorzen considers it the most powerful force, which, in contrast to the encounter with the paradox, pushes to life, calls for something new and engages in a whirlpool of action. "Thanks to thirst (passion), we feel reborn, as if we have a completely new self" . Reflecting on the struggle between desire and reason, the choice between restrictions and freedom, the encounter with anxiety, seductive calm, the author summarizes: “I am a measure of my own thirst, and I can understand the suffering of my clients only when I have gone through crucible of the same problems ".
Ontological uncertainty and existential anxiety. We have always been persuaded that anxiety is bad, instead of seeing its magical properties. This is especially true of scientific significance, which is far from being studied in the treatment and rehabilitation of sick patients.
Uncertainty causes us to explore this world. Anxiety is what keeps us in shape and prevents us from relaxing. And accepting this reality also allows you to recognize it in others. Perfection, however desirable it may be, is nothing but death. Only when we die does our life end. As long as we live, our lives will be imperfect and incomplete; this is what motivates us to work and improve the world. That is why we are experiencing anxiety. No matter how hard we work and do our job, we eventually come to the conclusion that we are doing wrong and we are always missing something. This is what determines - to be human. Our efforts will not be enough, and we will face this uncertainty until our last breath. And only wisdom will allow us to understand that we need to stop, or it does not matter. Helping patients cope with the same paradoxes and tragicomic shortcomings of our existence is one of the most important challenges of existential psychotherapy . "To understand other people," writes Emmy Van Dorzen, "there are no shortcuts: we must follow this long and confusing path through all these experiences of pain and failure if we can reach out to others in their plight or crisis." Therefore, we must be prepared to overcome the danger both with our patients and in our personal lives. Deepening into the depths is impossible without risk. But we must always know how to regain our balance so that both our patients and ourselves are safe again”. 
To think like a doctor - through the eyes of medical students and patients - we refer in the article to the words of Professor Gennady Fuzailov, who left in the 90s, or rather, "evacuated from the shackles" of the former and now defunct Soviet Union to the United States.
Gennady Fuzailov: "Death is not the worst thing that can happen to a person." A Harvard professor treats children for burns free of charge in Ukraine, which itself is one continuous burn. "Why are you doing all this?" - Ukrainians most often ask Gennady Fuzailov, a professor at Harvard Medical School and a doctor at Massachusetts General Hospital. According to Ukrayinska Pravda, since 2010 he has been flying in from Boston with his team every year to treat children for burns free of charge. "Because women in Ukraine are beautiful," jokes Fuzaylov, when he gets tired of talking about altruism, philanthropy and the fact that a person is not just grasping reflexes and the process of digestion. His statement: "Children feel even the slightest falsehood, they have not yet learned to hide their feelings. And adults have already learned. " This is one of the reasons why he only works with children. The best way to learn all about a pediatrician is to talk to the parents of his patients. Fuzailov knows better than others what burns are. Not only in the medical sense of the word and not only as a doctor. "When people you've studied with and considered friends say you need to leave because you're not like them, you don't understand how that's possible. I have no nostalgia for the Union. It was an artificial shell, where we were driven, and then it burst like an abscess, he recalls, after the collapse of the Union, he and his family emigrated from Uzbekistan to the United States. He has worked at Harvard Medical School for more than 20 years, before which he studied there. "We will only regret two things on our deathbed - that we loved little and traveled little," he quoted Mark Twain on his social media page.
In his spare time at Harvard, Fuzailov traveled the world on medical missions. He treated children in China, Colombia, Guatemala, Haiti, and Africa. In Ukraine, together with his American colleagues, he consulted and operated on more than a thousand children who suffered from burns.
In 2005, all Ukrainian media told the story of five-year-old Nastya Ovchar, who saved her younger sister in a fire and burned almost 80% of her skin. Nastya was the first Ukrainian patient of Dr. Fuzailov at Shriners Hospitals. All the costs of treatment, which is about a million dollars, the hospital took over. Since then, Gennady has received more than 60 children from Ukraine in Boston. Ukraine did not pay a penny for their treatment.
In 2020, for the first time in a decade, Gennady did not come to Ukraine because of a pandemic. In the current 2021 he plans to return, this time to the Dnieper. He dreams that in Ukraine he will no longer be perceived as Aibolit's doctor, who will arrive and save everyone on his own. "I want to share my experience so that Ukrainian doctors understand that medical reform is not only about money and equipment, but also about knowledge and humanity," he said.
Gennady Fuzailov willingly told Ukrayinska Pravda about his patients from Ukraine, about why the right to a dignified death is no less important than the right to a dignified life, about the "black gorilla effect", about the case after which he wanted to leave medicine, about why it is unreasonable to think that foreigners will be able to reform medicine in Ukraine, and about why fishing rods are better than fish and stones are better than sand. Here is an excerpt from this interview.
"After the collapse of the Union, my family emigrated to the United States from Uzbekistan. Although for us it was not emigration, but evacuation. It's hard to forget. My father was the head of a tropical disease clinic in Samarkand, and he was told, "You must resign." "We flew to the States from Sheremetyevo. Passed passport control and were nobody. Without passports, without citizenship. There was no food, no water, no chairs in the hall where we were waiting for departure. The flight was postponed and we were kept there for almost eight hours. My father was in a coat, suit and tie - all such an intellectual. Then he took off his coat, put it on the floor, then squatted on this coat and finally lay down… Such a transformation, when a person is gradually killed dignity.
When we arrived in America, strangers greeted us at the airport with placards: "Fuzaylov family, Welcome to Baltimore!" The first thing they did was feed us. We pounced on the food like wolves. Then we were brought to the apartment, given the keys. There was a clogged refrigerator. We couldn't believe it. How is this possible? Strangers spend money and, most importantly, time on us".
In America, I did not change my name, as many do to start a new life… But a name is your identification. And calling a person by name is half the battle if you want someone to respect you.
It is often said that if I could rewind life, I would not step on this rake. This is manipulation. A person who regrets something in the past crosses out a part of himself. After all, at that moment you needed this rake, which you stepped on. This is how a child learns the world, adults do the same.
A doctor is not just a person with a medical degree. After work you come home, copy books, consult with colleagues. This is a constant "hole" in the head, because someone's life depends on your every decision. And not metaphorically, but literally.
In the XVII century there was such a Dutch doctor Nicholas van Tulp. He proposed the emblem of medicine: a burning candle. And the motto is Allis Inserviendo Ipse Consumor. "By shining on others, you burn yourself." Sounds pathetic, but that's the point of the profession.
I've been at Harvard Medical School for 20 years, and before that I studied here. I have four licenses - pediatrics, anesthesiology, pediatric anesthesiology, pediatric intensive care. All these are years of study: pediatrics - 3 years, pediatric intensive care - 3 years, anesthesiology - 3 years, pediatric anesthesiology - 1.5 years. Today, my working hours at Harvard are divided as follows: 20% - teaching, I give lectures to students and residents, 70% - medical practice at Massachusetts General Hospital, 10% - research work. There is no concentration of medical schools like in Boston in any city in the world. Harvard School has four hospitals. The one I work for is the biggest. This is a crazy block: 150 surgeries and about 800 surgeries a day.
One day a week I work at Shriners. This is a network of hospitals for children affected by burns. For Harvard doctors, this is philanthropy - the hospital doesn't pay us. "
Leland Stenford Junior Universiti is a university named after Leland Stanford Jr. (Leland died of typhus in Europe before the age of 16). Opened on October 1, 1891, 30 km from Los Angeles. Then there were 559 students and 15 teachers. The university's motto, chosen by David Jordan, was: "Die Luft Der Freiheit Welt" (Quote The Wind of Freedom) - a quote from Ulrich von Gutten. 81 Nobel Prize winners studied at the university. At the bachelor's level, there are now 6,800 students and 8,300 graduate students. On the first day, when one teacher and one student fell ill with coronavirus at the university, the university switched to the on-line system. (By the way, when the bubonic plague "ruled" Europe in 1665, a quarter of the population in London died, and the University of Cambridge urgently sent all its students home to "study online").
The operation on the internal organs can take several hours. The patient was operated on, cut off, sutured, discharged, forgotten. And burns and skin deficiency do not disappear, the patient must be operated on again and again, from year to year - and still the defect remains.
Treatment of such patients is not only surgery, but also rehabilitation. The acute period lasts up to 6-8 months, when the patient must be rescued. Then - a decade of reconstructive surgery to restore function. And only then the touches of cosmetic surgery. In contrast to Ukraine, in America the outcome of treatment is assessed only after rehabilitation.
Clinical protocols cannot replace a doctor's head. I know that they are now being actively implemented in Ukraine. Follow the protocol and do not think. We also have general recommendations, you should know them and then act according to the situation. The American doctor is 20% guided in his work by the so-called guidelines. And 80% of actions are based on our individual decision.
"Do you know what the main difference is between us? - I tell my residents now. - You are ten times smarter than me, because I graduated from medical school 27 years ago, and you - three years ago. Your mind is more flexible than mine. But unlike you, I have experience. I take experience, and you take knowledge. And you come to me to gain this experience".
During the procedures, I often assist my students and residents. A graduate of Harvard Medical School must be able to do everything. Our task is to prepare him for independent work as soon as possible and push him out.
Regarding patients from Ukraine, Gennady Fuzailov said the following. "In 15 years, we have brought more than 60 children from Ukraine to Boston. Treatment is free for them. One day in intensive care costs us 10 thousand dollars. "
Today, one person in medicine does not solve anything. This is not the XI century, when Avicenna came and healed everyone with herbs.
When we come to Ukraine and make detours in suits and ties, locals are surprised that doctors at such a parade. In America, this habit has been practiced for years. Patients should see you shaved, fragrant and combed. This is not a whim, but a sign of respect for patients and professional ethics.
"We quote G. Fuzailov's thoughts on the right to a dignified death." It is impossible to get used to death. If one of the doctors tells you that he is used to death, it is a bluff. Even if it is the death of a very old man. Even if you pretend to be used to of this ".
Novice doctors often take a patient's death for granted. Only ten years ago, when I worked in intensive care, I began to treat it differently. When you see that you can do nothing, death is not the worst thing that can happen to a person.
We have always been convinced that a person has everything ahead, just do it, and you will have everything. Some constant races. And this is a mistake, because you do not know what will happen tomorrow. Today is life.
The Hippocratic oath was invented when a man lived to be 25 years old. When no one died of cancer, hypertension, chronic diseases. Women died during childbirth, men - in battle. Only those who had a chance to survive were treated. And Parkinson and Alzheimer's were not born yet.
I often repeat to my students: if your mistake leads to the death of a patient, the greatest punishment will not be that others condemn you, but that you will not give yourself peace.
"Here are some of Professor Fuzaylov's views on parsing errors." In the event of a patient's death or complications, we conduct a detailed analysis. Not to find the culprits. We need to know what could have been done differently. Could it have been done differently? And even if we had done otherwise, what could have been the result. "
Training is held at Harvard every year. Three or four doctors are let into a room with transparent walls, with video cameras aimed at each.
Specially invited actors stage a case. Each of them has a headset, they hear the host's instructions on what to do with the script. Their task is to "rock the ship" to see how the doctors will react. Then we sit with psychologists, look at the recording and tell why they did or said this or that.
At trainings they disassemble everything down to the smallest detail, look for weaknesses.
Do you know what the "black gorilla effect" is? At the training we are told: “You should imitate a heart massage with both hands. In parallel, we will show you a video. There are two teams of four people on it. One team - in white, the other - in black. Players pass the ball to each other. You have to make movements like in a heart massage, watch videos and count how many times these people passed the ball to each other. " The recording is then stopped and the trainees are asked how many times the players have passed the ball. Some say 6 times, some - 8, some - 12. Usually the numbers are different. And then they ask: "Have you seen anything else?" Nobody saw anything. "Now watch the video again," we are told. And we see that at some point, a man in a black gorilla costume appears in the frame, beats himself in the chest like King Kong, and walks away. And no one notices her. Tell me, how is this possible ?!
What conclusion do you know? We focused on the massage and counting how many times the players passed the ball. We did not notice King Kong, we made a mistake in the calculations, and there is no guarantee that we did the massage correctly. A person who controls a process should not be inside the process, because he will not notice the "black gorilla" .
We constantly ask each other for help. Not because someone is stupider, but someone is smarter. And since I understand: if I start doing something and I do not succeed, then I'm doing it wrong. I can continue to blunt, then the patient will die… And I can say: "Stop. I need help". I probably don't see a black gorilla at the moment. We constantly ask each other for help. Unfortunately, this is not the case in Ukraine. Mistakes are treated differently: if you make a mistake, you are ignorant. My lectures were built on the analysis of cases, and the professors simply tore down the roof. They thought that I personally blamed them for something. And I just said: "Gentlemen, you have the same mistake. And you can see it from the side. " For example, a patient has died: he has developed gastric bleeding - a rare complication of burn shock called stress ulcer. Two liters of blood lost - can you imagine this horror? I say, "Prescribe drugs that prevent this complication." They say, "We appoint." So maybe it's worth doubling the dosage? Maybe what you're doing doesn't work? For some reason, the patient died.
I always tell my students, "You made a mistake, that's great!" They ask, "Why?" - "Because now you know how not to do. You will learn more when you make a mistake and understand your mistake than when you accidentally do everything right."
I traveled the world a lot with medical missions. We came, treated and rode. If we come and do everything ourselves, we can help 50 or 70 patients. That's good too. But I realized we could do more.
There are two ways to help - give a person a fish or teach them to fish. The second is more effective. It is important not only to help the sick, but also to influence the medical infrastructure of the country you are coming to. To do this, you must interact with the existing system. Whatever it is - good or bad - it works. In Ukraine, we are looking for talented people so that your doctors, nurses, students can do the same in the future as we do. It is absurd to think that when you get somewhere, you can do everything yourself.
I am often asked: why do you, a successful person, spend your time on all this philanthropy? At first I tried to explain that altruism is inherent in every person. Someone will donate a million, and someone will help my grandmother cross the road.
In the post-Soviet space, people do not really understand the meaning of philanthropy. They often look for some hidden benefit in this. That is why it is important to make them understand that there is a different life, a different perception of a person”.
Gennady Fuzailov continues: “There are no problems with information today, there is a problem with its filtering. Today, no lecturer will tell me anything that I would not find in 10 minutes in online libraries. One of the main tasks of the professor is to motivate the student and teach him to filter the flow of information.
I do not think that foreigners can reform medicine in Ukraine. They will not survive here because they do not know how the system they want to change works from within. Even if they have a great plan, it will be a great plan on paper. This is evidenced by the results of the leadership of the Ukrainian medical industry Ulyana Suprun. They then need to bring a team of their people and place them in all management positions - both in Kyiv and in the regions. In addition to being technically impossible, it is also ideologically wrong. For Ukrainians, this is the same as signing in the inability to tidy up the house. And this is a spit in the face of your talented people who are not allowed to do anything in their homeland.
During these ten years that I have been coming to Ukraine with my team of surgeons, anesthesiologists, nurses, I see simply colossal changes here. Young talented doctors have appeared, approaches to treatment have changed. You do not realize this, because you are boiling inside and you cannot look at yourself from the side.
In 2021, I want to come to Ukraine and give lectures - for senior students, interns, who can still learn something. But I do not want to give dead knowledge that they will find without me. I want people to learn to think, to have their own opinion and to defend it, to enter into dialogue. If you do not have an opinion, how will you treat?
Conflict and aggression are almost always a manifestation of human insecurity, dissatisfaction. Those who think that otherwise they will not be able to reach others, that otherwise they will not hear them, often raise their fever.
About big stones and sand castles. "There is a story about how a professor of philosophy picked up a glass jar, filled it with large stones and asked students if it was full. They answered: yes.
Then he took the small stones and began to fill the jar with them. They took a free place among the big ones. And again he asked the students if the bank was full. They answered in the affirmative again. Then he began to pour sand into the jar. He completely took the free place. The students replied that the bank was now full.
Do you know what the conclusion is? If you fill the jar with sand from the beginning, large stones will not fit there. And with life - do not fill it with sand.
The biggest stones are the fulcrums: family, parents and values. Smaller stones - work, home, friends. Sand is everything else. When people make sand their fulcrum, everything falls apart like a sand castle” .
Returning to the main topic of our article, we will give some examples from our current life during the pandemic, about the problems and conditions that indicate the great negative consequences of the disease, which affect, in particular, the human psyche.
Patient Kateryna, 35, in a state of rehabilitation after the COVID-19 virus: recalling her childhood, told how at the age of 7 she wanted to commit suicide after a quarrel (conflict) with her parents. She imagined how they would cry and mourn at her grave. Then the girl planned to drown in a well. But immediately there were thoughts that she would not be found soon and she would not see her parents crying over her homeland. That stopped her. Apparently, in this family, the jar was filled with small stones and sand and there was no room for large stones.
Therefore, it is necessary to teach children to think and make decisions, because parents will not always be around in life. And the child must be aware of the value of life, he needs to talk about it, explain, prove, this is when - you love.
In Ukraine, the number of suicides (successful and unsuccessful) has risen sharply recently - this is a problem of the state, psychologists, doctors. Apparently, in such families, the jar was filled with sand and there was no room for a large stone (child), although this also happens among adults.
People experience the world in different dimensions. The work of an existential consultant is a study of experience in all dimensions. There are four dimensions. These are: physical (Umwelt), social (Mitwelt), personal (Eigenwelt), and spiritual (Uberwelt).
In each dimension, we face a number of opportunities and opportunities, as well as anticipated limitations and challenges that we should learn to meet and take into account.
In each dimension, we can follow our aspirations, or create the illusion that we are able to cope with obstacles, or despair over the extreme carelessness that we face at any of these levels. In order for our existence to be truly complete, essential, it is important to find a constructive and realistic way to deal with these extremes.
Awareness of the purpose and significance of everyday life gives us the strength to cope with difficulties much greater than those we could previously only imagine .
Healthy people live in Umwelt, Mitwelt, Eigenwelt and Uberwelt at the same time. They are able to adapt to the world of nature, interact with others as with others like them, and are clearly aware of the value of their own experience. Genesis should be defined as an individually unique pattern of opportunity. The unconscious are those opportunities for cognition and experience that a person cannot or does not want to actualize. Then the simple mechanism of suppression is much simpler than it seems; it includes a complex struggle of individual existence against the possibility of non-existence.
Being in the world naturally evokes an understanding of oneself as a living being who appeared in the world. On the other hand, such an understanding leads to the fear of non-existence or non-existence. Rollo May wrote: "To grasp the meaning of one's existence, one must first grasp the fact that he may not exist, that he is on the verge of extinction every second, and that he cannot ignore the inevitability of death, the onset of which cannot be programmed for the future." "We are afraid of nothingness and therefore underestimate our being" .
In our current chaos, some people sympathize with us doctors, and some envy us: we are at the center of all events and are better informed not only theoretically but also practically. People are extremely impressed with the medical profession because doctors are the only ones who have access to life and death. Although priests are also suitable for this role. If doctors simply participate in the processes of life and death, urging people to obey them, then priests have the opportunity to observe the processes in reality and must guide the person.
The patient's thinking is not based on logical laws, but on emotional ones. The moral guideline in the behavior of a doctor in difficult situations that have arisen in the process of medical activity is to create a priority of the value of human life, the value of health.
The difficult experience, as Emmy Van Dorzen writes, "taught me that priests and priests, even existential ones, may know little about life if they do not wish to participate in it themselves." Now I believe that there are people who are more qualified than others, not because of any professional knowledge, but because of a true understanding of the processes that can claim a deep knowledge of the transitions between life and death. Of course, these are mothers who understand how mysterious life is and how close it is to death as soon as the child takes his first breath. This fear is always somewhere nearby when you have a newborn baby in your arms. But most of all, motherhood has taught me that only work and hard work can save lives and prevent death. The challenge of saving lives is a difficult and difficult task. Addictions to the fear of death, provocations and games with death are dangerous sports that obviously lose their appeal as soon as you immerse yourself in life. And, probably, nothing will replace the work of everyday life ".
The Georgian people have majestic words of love for a pregnant woman, mother, child, this word Orsuli (Georgian - ორსული) (Orsuli: ori - two, suli - soul) - two souls (pregnant woman). The other day we noticed such a silent and patient "Orsula" in line on the street in front of the clinic to take tests for COVID-19. She did not want to use her right to go without a queue. She usually stands outside in the rain and snow, cold and wind. There is struggle and despair on her face at the same time, she sends an SOS signal "Save Our Souls". There is a struggle for two souls, for two lives. Maybe now the future dad is at the front? She herself, and no one next to her… The tragedy of Ukraine is not in the decline of the economy, production, political instability. In Ukraine, the birth rate has recently dropped by 40%. We will describe one of the moments of preparation and carrying out operation. The surgeon comes to the patient in the ward, they meet, talk, study each other. We saw an interesting picture at the moment when the patient is under the influence of spinal anesthesia, there is a ritual of dressing the surgeon, with which he lovingly fastens buttons on the robe, ties the ribbons - this is usually done by the operating room nurse. During the operation, if necessary, she will wet a swab on the misty forehead of her surgeon. It is very good when during the operation there is at least one woman in the team of doctors - she has a side thinking. The main tool of the surgeon - a scalpel, a female surgeon before using a scalpel is looking for options to use the scalpel less and much later.
On March 1, 2021, mass vaccination began in Ukraine. The peak of morbidity and deaths is growing every day. You need to be vaccinated. The seventh protocol for the treatment of patients with covid has already been created. Ukraine ranked first in Europe in terms of the number of sick and dead, 481 deaths on April 8, 21. Remember that behind every number in the statistics there is a person, a name and a family.
When the doctor leaves the Chernivtsi Regional Clinical Hospital at the end of his shift and takes the first step on Vladislav Trepko Street, which was dedicated to her in memory of our fellow doctor who rescued and treated the wounded at the front, but could not defend himself, he died. in the war, in the Donbass, defending the freedom and independence of its state Ukraine - the heart is filled with longing and at the same time pride in his work as a doctor. Glory to heroes!
When we visited the wounded soldiers from the front in the military hospital, who are already undergoing rehabilitation after treatment, we saw them listening to the song "White Swans" by the author and performer Khrystyna Panasyuk. The soldiers had tears in their eyes for their dead comrades and in general for the horrors of war. Therefore, we present in the article some excerpts from her story, published in the publication "Censor.NET".
Singer Khrystyna Panasyuk: “You send a new song to the guys in the war, and they turn it on the radio instead of negotiations. The commander quarrels a lot, but then thanks… »
During the Maidan, I just sat in front of the TV screen with a sinking heart, watching the news and crying. His first song about the war - "Ukraine, get up from your knees!" - I wrote after the occupation of Crimea. We don't seem to have had a war yet. Something so incomprehensible began - but no one has yet called it a war. And a song came to my mind that I didn't want soldiers to die…
My first concert took place at a checkpoint where the Ukrainian Volunteer Corps and Kryvbas were stationed. I remember very clearly how a dead boy with the call sign Sever was brought from the Donetsk airport (19-year-old Serhiy Tabala died on November 6, 2014. - Ed.). The soldiers said goodbye to him with shots in the sky. It was so hard, so painful, that words could not convey. It was a concert with tears in my eyes. When I took my guitar out of the warm car and started playing in the cold, I realized that the system was starting to float. The sounds were not what I would like to hear. But I looked into the eyes of the people who listened to me and understood: they don't care what kind of music. What was important to them was what I wanted to convey. These views - to the ants. One of the fighters asked me to play a song that I wrote myself, "They don't take the oath twice." I played on my knees near the APC, and that was an important moment. The moment when you realize that it's important, that your songs are important.
My personal record is 27 concerts in a row. After that, I could barely breathe. Already got on the train: "Finally rest, I'm going home!" And here the right-wingers sit down to you: "Oh, Christ, hello, open the guitar!" It already causes nervous laughter, but you, of course, get a guitar. Because it's important to you. People who want to hear you are important to you. Apparently, the dream of any artist, any musician is to gather stadiums so that a huge number of people can hear you. But at certain moments in life you realize that no stadium can match the dugout. Or with a hospital tent in which two or three fighters lie. They are waiting for you to sing to them. And they are grateful that you do not care.
Pain, war, blood, fire and some emotions of warmth and positivity are very much combined with each other. What should never be combined is combined.
What the fighters write to me inspires me. And when it's bad, it doesn't let you fall. Several times I received messages from people who wanted to commit suicide, but heard my song - and realized that you need to live, and for those around you, and for those who are no more.
I think that war reveals its best sides in everyone. In my personal view and understanding, war is a struggle for justice, it is mercy. This war changed us all, gave us all lessons. She made me a little stronger. What do I dream about? About the dog! I really want to have my own dog. But I understand that for this you first need to start your own home, which I do not have. But there is a dream - and I believe that one day it will come true. I would like to live in a house by the lake. Or by the sea - the main thing is that the water was… I love to look at the water, it inspires me.
And I dream of victory. I am sure that with our people, with our forces, with our steadfastness, it will be soon. Ukraine wants freedom. And we all will definitely have it. I already have a song about victory. I often write songs in advance. Glory to Ukraine!" .
As the authors of this article, we also dream of victory and want it to come sooner. When we listened to the songs performed by Khrystyna Panasyuk and understood her work under bullets at the front, we realized what a titanic rehabilitation work she is doing among our soldiers. Sometimes it's better than medicine.
If the Ukrainian people had not sung, they would have disappeared long ago. And let's remember Ruslana Lyzhychko on the Maidan in Kyiv in 2014 - how courageous our women are ...
Here is another example. Patient Elena (45 years old, lives alone), after a major operation, is in surgery on the verge of life and death. When we escorted her, her dog, the Belgian Shepherd Blask, was on duty near the hospital, and he sniffed that she was in the ward. When we told her that her pet was waiting for her, the woman smiled, and we realized that she would live. In her eyes and smile, we "read": "I have to survive, because without me my dog will die." The meaning of her life was that someone was waiting for her, loved that someone needed her.
Winston Churchill once rightly said, "If the state, choosing between war and shame, chooses shame, it will receive both war and shame." We will add: and if the state conducts negotiations on the territory with the aggressor who robs and kills its people, it is already triple shame.
Such a field of rehabilitation as music therapy is suitable for post-war patients, and especially for post-war soldiers and war veterans. The war will not last forever. It will end soon. Warriors are winners, war heroes will return to their families, to peaceful life and work, although some will subconsciously have a post-frontal syndrome for a long time to come. One can only imagine that such a young warrior, who had seen little in his life, sat for years in a dugout in the heat and cold with a rifle in his hand, and his index finger lay on the trigger… or for hours lying in ambush with a rifle in his hand, thought : "If not you… then he you…" And when a bullet clicks next to you and you take it in your hands, still warm… We remember again Winston Churchill, who himself fought at the front: "I was shot, but not hit." And our warrior is demobilized… And all this is no longer at home, and niches (voids) are formed in the mind of the warrior - if they are not quickly filled with "angels", the "devil" will penetrate into those niches. You yourself understand what can happen, what only vegetative storms are formed in his mind. Is he offered to return to a peaceful life? ... “I have nowhere to return, and I understand that my activity is really needed. I have no right to abandon her. War is an important job that I do systematically and systematically. " Society must remember that a demobilized war veteran who is only 23 years old will return to war after returning from the war. The one who protected you, your family, your village or town - you owe him, and do your best to keep him a warrior for a while.
There are hundreds of methods of rehabilitation with post-frontal syndrome, and one of them is the already mentioned music therapy. Music therapy is a set of methods and techniques that form a rich emotional sphere of the patient by involving him in a range of musical and artistic experiences, form a high rise of optimistic worldview, which is so important for such people. The fact that certain people have such deviations is not due to physical defects of the body, but to the peculiarities of character, which are derived from our perception of the environment. "Tell me what your character is, and I will tell you what disease you will get," is a paraphrase of Socrates' famous statement about psychosomatic medicine. If we consider the session of music psychotherapy from the possibility of action on the physical, emotional and intellectual spheres of the body, bearing in mind that music is the language of nonverbal communication, the greatest effect we can expect when acting on feelings, mood, weakening negative experiences under the influence of music.
Any attempt to hide from life is a problem, and it deprives a person of strength, and at the same time, as a person accepts the challenge of life, it leads to a really deep sense of reality. We may hate our own troubles, but they help us to regain energy, freeing us from complacency, inertia and apathy. We return to true existence only when we are truly ready to face difficulties on our way, while a smooth and quiet life leads to weakness, complacency and self-confidence. The most difficult situations hide numerous opportunities. We must be stable and purposeful, trying to get through the maze of human existence .
Ukraine needs to introduce a nationwide lockdown immediately, without waiting for other areas to "catch fire", cancel all entertainment activities, stock up on oxygen and deploy new beds. According to Censor.NET, Olga Golubovska, a leading infectious disease specialist at the Ministry of Health, stated this in an interview with Obozrevatel on March 18, 2021. According to her, today it is useless to work in the cells, and you need to stock up on oxygen, open new hospitals, competently pursue a vaccination policy. And most importantly - everyone must protect themselves! Together we will win.
Scientists have found out why COVID-19, (SARS-CoV-2), unlike other coronaviruses, is deadly? Researchers at Columbia University's College of Physicians and Surgeons and the Comprehensive Cancer Center have found that SARS-CoV-2 is fatal in antibodies that the body begins to produce in response to infection.
According to Censor.NET on April 30, 21, this was reported by Fakty with reference to MedicalXpress.
A key point in the study was the comparison of the lungs of people who died from Covid-19 and the lungs affected by other types of coronaviruses, but people survived. As a result, scientists have come to a paradoxical conclusion. Antibodies produced to protect against the virus can be fatal. The phenomenon is that antibodies are produced in such large quantities that instead of suppressing inflammation, they, on the contrary, increase it.
In particular, we are talking about cytokine cell molecules such as IL-1β, the number of which in coronavirus disease increases many times. This was an important understanding because there are drugs that suppress the action of certain IL and reduce inflammation.
A number of drugs from this series are already being tested on patients diagnosed with Covid-19.
"We hope that our analysis and the vast resource of accumulated data will help other researchers and pharmaceutical companies to find treatments not only for critically ill patients, but also to reduce complications in people who have suffered a severe form of Covid-19," said MD, Associate Professor. of Medicine Benjamin Isar.
Given the acute relevance of the topic, Professor Izar and a group led by him of more than 40 scientists, completed a series of cellular analyzes in just a few months. While in normal conditions such studies take years .
And now a few words about choosing the title of our article. Despite the fact that in the title of the work "Think and act like a doctor - without pipes and tambourines - during the war and COVID-19", the words "pipes" and "tambourines" are used, but they never appeared in the text itself. This is our "placebo". That's right, but there is a word WITHOUT. We, for our part, also decided to sow our "wild oats". We do not write about it, but we do not forget.
So: pipes (pipes) - Nord Stream-2 (sanctions and suicide and everything that happens around it); tambourines are those people who were not involved in the article, but only drum, sitting on the couch, on the Internet… and interfere with work. In response, we invite such drums to be alternated for only one day in the coded department of the hospital.
Good news: a tourist from Denmark traveling to Ukraine saw a dirty window in a car of a Ukrzaliznytsia train (car 032 16769). I bought a mop and washed it myself. We go to Europe and we have to see it through a clear window, it's called an "environmental approach to visual perception.
We, the authors, are pleased to cooperate with the best medical journal in Ukraine "Psychosomatic Medicine and General Practice", which inspires creativity without restrictions. We thank the editorial board for their work, creativity and patience. Here it is appropriate to mention the apt statement of Oliver Holmes "The main thing is not where we stand, but in which direction we are moving".
- Effective dialogue can clarify a lot not only for the patient but also for the counselor or psychotherapist. It is necessary to find the root of evil not only of the patient's troubles, but also of human troubles, and accordingly of our own problems.
- We believe that existential psychotherapy is one of the effective ways to motivate a person to the meaning of life.
- It is advisable to take into account the small touches of humanistic psychology, which recognizes as its main subject personality as a holistic unique system, which is not something given from the beginning, but an "open opportunity" for self-actualization.
- Drawings by Amy Van Dorzen, a world-renowned specialist in existential psychotherapy, motivate her to take responsibility for her own life, rather than following the crowd in the face of unbearable living conditions.
- Information about the activities in Ukraine and the thoughts of a doctor from the United States Gennady Fuzailov showed us the pros and cons of Ukrainian medicine.
- Think like a doctor: we will have a conversation with our future colleagues, medical students. They worry about their teachers, who are on duty with cunning patients… and sow their "wild oats" with us.
- The discovery for our article was informational materials from various media about the artistic activity of Khrystyna Panasyuk, who, without suspecting it, discovered for herself and us another divine gift of a psychotherapist, whose music inspires fighters to fight and win at the front, and turns away from the suicide of post-war soldiers.
Prospects of the study:
- Be in search of something that contributes to victory at the front and over COVID-19.
- Writing a manual, and perhaps a supplement to the modern protocol for the psychological rehabilitation of postcoid patients and post-war soldiers.
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