REFLECTIONS OF DOCTOR KOMAROVSKY: all about life
Illustration: Vsevolod Shvaiba, Dryads, pencil on paper, 30x40cm
If Ukrainians are asked with whom they associate the word «doctor», the majority will answer unequivocally: with Yevgeny Komarovsky. They unconditionally believe him and at the same time ruthlessly criticize him, love and hate… Simply because the utmost sincerity can leave no one indifferent.
Komarovsky has been more than a doctor for a long time — for millions of people his opinion on many issues, sometimes not directly related to medicine, is of great value. This interview is at the limit of frankness: otherwise Komarovsky cannot be.
Our conversation is about life and death, about children and adults, about politics and morality, about leadership and responsibility…
A MEDICAL LOOK AT THE UKRAINIAN SOCIETY
I look at modern Ukrainian society and the events taking place through the eyes of a doctor. The state and society, just like the individual, can get sick. And then it needs to diagnose and choose a course of treatment. But the patient can only be helped if he really wants to get well.
Let’s start with the simplest and the most obvious things to everyone. When a person is sick, the whole world around him is not a joy. But in a state of illness, you immediately set your life priorities in a different way — what is the most important in life and what is not, what is significant and what is secondary. Physicians approach all problems with one, the highest standard — life and death.
When you have been dealing with death for many years, you perfectly understand what nonsense the information space is filled with, what senseless nonsense public attention is sometimes riveted to, what trifles our politicians are engaged in. The reality in which doctors live and work is completely different.
Yesterday, an absolutely happy person, who had no problems in life, suddenly becomes bedridden, on the verge of life and death. Moreover, it can happen to everyone — at any time, from the most ridiculous and unexpected accident.
Therefore, doctors are accustomed to think extremely rationally and soberly, to think out everything to the «last limit». It is not surprising that they look at what is happening in our country with skepticism.
The doctor understands the true value of life, so he knows how to prioritize. The health of Ukrainians should be at the first place — starting from it, we begin to further define other aspects of state policy.
A simple example: for a healthy society, the main issue is always morality — equality, brotherhood, mutual assistance, support for the weak. Morality gives us behavioral guidelines — «what is good and what is bad?» Based on these moral and ethical ideas, people build their lives and the life of their state.
UKRAINIAN TEEN WITH PERVERTED MORALITY
It seems to me that Ukrainian society cannot mature in any way. Ukrainians, like the «little son» in the well-known poem by Mayakovsky, still cannot completely and utterly honestly answer the question «what is good and what is bad?» Is it good or bad to use physical force on another person if he expresses an opinion that is different from yours?
Is it normal for one deputy to forcefully pull another deputy out of the rostrum? Does this behavior correspond to the morality of an adult, civilized society? Do we understand, for example, that it is possible to determine whether a society is healthy or sick by its relation to old people?
In a recent interview, I suggested prioritizing the fight against COVID. We understand that the risk group consists of people aged 65+. For them, the greatest lethal outcome from infection with the virus is a real threat. But at the same time, you need to understand: such people adhere to rather conservative views, it is difficult to get them to vaccinate. I offered a simple solution: give each grandmother 5,000 hryvnias, and they will happily go to get vaccinated.
Most of all, I was struck by the comments to this interview from tens of thousands of young Ukrainians: «Why should this money be given to some grandmothers? But what about us, why are we worse than grandmothers?» At the same time, everyone forgets that after the age of 65, up to 10% can die from the virus, and in young people the probability of such an outcome is only 0.01 — 00.5%. These grandmothers for young people are competitors in the struggle for survival, they are extra ballast, they are not needed by anyone and are not interesting. Why then support them at all?
Tell me, isn’t such an attitude one of the signs that Ukrainian society is seriously ill? And, naturally, it professes a sick morality — «it’s neither my headache nor my piece of cake» and a national ideology, which is based on gloating and envy. The greatest pleasure comes not from work, development and creativity, but when your house is better than your neighbor’s. And if a neighbor has surpassed you, then there is no greater joy than watching his house burn.
THE MAIN SIGN OF A MATURE, FULL-FLEDGED SOCIETY IS THE RIGHT TO DIGNIFIED DEATH
Some kind of perverted attitude towards death has developed in Ukrainian society, which means that the attitude towards life cannot be completely normal. I am deeply convinced that death is not terrible — in this case almost all philosophers agree with each other. A person is not afraid of the fact that one day he will die, but of the horrors of the transition from this world to another.
It can be extremely painful. It can be accompanied by a loss of human dignity and extreme powerlessness: unable to move, the patient lies among the heaps of sheets, helpless and useless…
Of course, such an end terrifies every normal person. Therefore, the main sign of a mature, full-fledged society is a responsible attitude towards death, respect for it. The right to die with dignity is a fundamental human right. The same as the right to breathe, to love and to be free.
And here, in Ukraine, is a real disaster. Everything needs to be changed here — from the use of painkillers for cancer patients and finishing with nursing homes, as well as the attitude towards those old people who are constantly with us. And respect for death, for the elderly is one of the criteria for a mature society.
Educational measures alone cannot change society’s approach to the death of a neighbor. We need an effective government policy that will provide funding and access to transition support technologies that have been tested in leading clinics in the world.
Moreover, our attitude towards the dying person cannot be determined by the religious denomination to which he belongs. All citizens of Ukraine should have the right to a dignified life and a dignified death equally.
ABOUT FAITH, RELIGION AND HEALING
Religion, in my opinion, is generally too personal and intimate sphere to be discussed publicly. For example, the same as sex. Discussing your relationship with God in public is like discussing sex with your wife with a stranger. You don’t need intermediares to believe.
Personally, I don’t have a lot of statistics when certain religious practices helped people to heal in a miraculous way. Let’s not forget that my patients are mostly children. But when a child is in critical condition, any adult, even a completely unbelieving adult, tries every conceivable and inconceivable means to save his child.
Let’s be honest, sometimes helping desperate people who are easy to manipulate turns into a commercial project. Such ministers have always evoked and still evoke a persistent disgust in me.
MEDICINE, PHILOSOPHY AND CREATIVITY
Since Hippocrates and Plato, medicine has been an integral part of philosophy. In order to heal people, you need to have certain ideological attitudes. A person, on whose decision it often depends whether the patient dies or lives, cannot develop a certain philosophical view of the world.
But I would not idealize the medical community. Philosophy is just one of the important disciplines taught in institutes. But, as it seems to me, in the form in which it is offered to students, it is absolutely unviable — it is very difficult to apply it in real life.
A huge number of people with a doctor’s diploma in their intellectual level is not different from the average citizen. A huge number of them remain outside of philosophical thinking about the world and are not interested in it. Most people just follow the instructions and try to survive somehow. Unfortunately, in our country, doctors participate in this race for survival just like everyone else.
But here, of course, the cultural environment in which a doctor is inclined to a philosophical, creative view of the world is of great importance. We know an incredible number of physicians who have become outstanding writers, poets, thinkers. They are François Rabelais, and Stanislav Lem, and Conan Doyle, and Schiller…
VIKENTY VERESAEV AND NOTES OF A DOCTOR
In domestic literature, for me a completely unique figure is Vikenty Veresaev, who has been worked in Ukraine for many years and left us an amazing Notes of a Doctor. I advise all doctors — both beginners and long-term practitioners — to re-read the book once a year — they perfectly clear brains. Veresaev dotted the «i’s» very well — both in relation to philosophy of life, and in relation to the medical profession.
After the publication of Notes of a Doctor in 1903, he faced some monstrous barrage of criticism. His last words were reviled by doctors, journalists, officials, and ordinary people — everyone who believed that they knew better medicine than he did. Sometimes it seems to me that in modern Ukraine I largely repeat Veresaev’s path.
Those who reject the achievements of science, do not want to follow morality — these are all the same types that can be found in the Notes of a Doctor. Just like a hundred years ago, everyone who thinks logically and intellectually honestly, tries to follow the norms of the profession and morality, these people are declared an enemy.
When you sit in the library at night, torment yourself in search of answers to the «damn questions», your opponents eat and drink well, sleep soundly in their soft beds. They did not learn anything, they do not care about anything except their trough. But they are always ready to declare that you have read all sorts of nonsense, and arrange for you the most real persecution. It is how Ukrainian society was in the time of Veresaev, and it remains so now.
But it is interesting that Veresaev did not remain silent and did not give up. His answer was the second volume of the Notes of a Doctor entitled Regarding the «Doctor’s Notes». Answer to My Critics — it is the highest example of intelligence, intellect and morality. It would be great if every young man who dreams of becoming a doctor, deciding to enter a medical school, first read Veresaev. Then he will understand what he will have to face in reality if he really wants to become a good doctor.
SAVING A CHILD’S LIFE IS MORE IMPORTANT THAN WRITING A NOVEL
It just so happened that I was no stranger to the craft of writing. There is even a section on my website, which, of course, is called in Veresaev’s language — Notes of a Doctor. There are several of my stories, I’m interested in trying myself in small forms. I like to write. And, frankly, I would gladly settle in some wilderness, in a house on the river bank, go fishing and write a novel about the madness of medical life in our country.
But I do not have such an opportunity — I am responsible for my family and many people who are next to me. I certainly cannot be called a system writer, although I have some idea of what writing is. Still, I am the author of 13 books: one monograph and 12 popular science works. I am in demand in this particular genre, and people need it much more than my works of art.
Trust me, it costs a lot to be the author of a popular childcare book. In response, I receive dozens of letters every day from readers, which begin with the words, «Doctor, today your book has saved my child’s life».
After that, you realize that you have no right to waste time on a novel. Moreover, as I said above, doctors are very pragmatic and take a sober view of life — the writer Komarovsky is unlikely to be able to surpass his great predecessors… I read both classics and modern authors with pleasure. I enjoy the mastery of the syllable and the ease with which my beloved Weller or Akunin write. It seems to me that a good writer is one who is easy to read by the majority, and a bad one always hides in the circle of the elite.
THEY NEED SOME KIND OF ADULT THERE!
I often ask myself and others the question, «Why are some people real leaders, while others unsuccessfully stylize like them?» One of my recent interlocutors, an influential Ukrainian lawyer, gave the following characterization to the team that now runs the Ukrainian state, «They need some kind of adult there!» Without a doubt, leadership is a huge responsibility. It’s always about maturity, not about infantilism.
I, as a doctor, have a specific educational mission. And I have no such goal — to impose my opinion on the politics and governance of the country on someone, because political views are always extremely subjective. And my task, as well as the attitude of all modern medicine, is to avoid subjectivity as much as possible. When a child fell and broke his knee (and this situation occurs millions of times every day in the world), it is absolutely unacceptable if 100 doctors give 100 different recommendations on this matter.
There are rare and complex medical cases, but they are a statistical minority. 21st century medicine has a standard recommendation for any standard situation. Therefore, I see it as my duty to introduce people to this information. So that they know how to behave in typical situations and not make mistakes. By itself, this information is not exclusive, for the most part it is known to representatives of the medical community.
Another thing is how I convey this information, how efficiently and easily I do it, adapting standard recommendations to the real conditions of our country. And here, of course, I show some of my vision, some individual art. In fact, what am I trying to do?
Imagine a typical children’s room, with a typical crib, around which a typical grandmother fusses with a can of goat fat and a typical mother wants to steam the child’s feet in a basin of boiling water. It is into this stuffy, archaic atmosphere that I try to let in the fresh air of modern medicine. My task is to send the grandmother to deal with the grandfather, and to give the mother recommendations on how to do the right thing in this situation.
IT IS USELESS TO FORBID A LAUNDRESS WITH AN ECZEMA TO WET HER HANDS!
At the outpatient level, the pediatrician communicates 99% with adults. My task is to convince them that they are responsible for the health of the child. To grow it healthy, you need basic knowledge — you have to study. You must understand that the lifestyle of children now and 30 years ago is absolutely incomparable, so the experience of grandmothers is unlikely to be useful to you.
I convince adults that every decisions related to children should not worsen the life of dad and mom. You should not follow the path of 70% of families that do not pass the test in the first year of a child’s life and fall apart. The child needs loving each other, happy mom and dad — he needs it more than anything else.
It is not as easy path for a doctor as it seems. It has very serious barriers: the financial situation of people, their intellectual and cultural level — people often simply do not understand what you are talking about. In addition, a huge number of medical recommendations cannot be implemented, because the state has created conditions under which they cannot be implemented.
You can sound the alarm as much as you like about the epidemic of childhood obesity, about the dangers of gadgets… But when you tell parents what they should do and what should not do, you feel exactly like Veresaev, who confessed, «I feel bad when I recommend to a laundress with eczema not to wet her hands!»
I am aware that in order to really help children and their parents, it is necessary to radically change people’s attitude to their health — nothing will work out without the intervention of the state. And then, inevitably, you begin to think about leadership, which goes beyond medical knowledge. You start looking for those tools that can force those in power to make decisions that make life easier for people.
ABOUT HUMOR, PROVOCATION AND HYIP
I am often accused for allegedly paradoxical and provocative formulations. It is not true. Yes, I love humor, it is a property of my thinking. In general, humor in medicine helps out a lot — it is a kind of defensive reaction when you have to balance on the brink of life and death. But the humor of a medic is one thing, and when journalists twist your words for the sake of a hype, it is quite another.
For example, in an interview with a journalist, I say that two physical education lessons at school for 45 minutes a week are very few. Because the minimum medical norm is 40 minutes of physical activity per day. It is necessary that children after school stay in school and play sports, and do not run home, buried in smartphones.
School physical education should not be a profanity — physical education in the first lesson, after which the child then sits in sweat for another five hours, no one needs. Seemingly obvious things, everything is logical and correct. But suddenly my interview comes out with the following title Komarovsky: Physical Education in Schools is not Needed! Provocation? Paradox? Of course! But, excuse me, I didn’t come up with all this!
At first, I reacted very painfully to such things, tried to make excuses, to refute. In the end, I just stopped doing it. My team and I are trying to track publications that mention Komarovsky, but it is becoming more and more difficult. There isn’t a day in Ukraine that my name is not mentioned in at least 200 publications. But there is also Belarus, Kazakhstan, Russia…
PUBLIC CAPITAL AS RELIABLE PROTECTION
Do I feel some envy from politicians? Of course. Some are annoyed by the popularity ofKomarovsky. Others want to use it. There is probably not a single major political force in Ukraine whose messengers would not appear in my office. True, there is one problem: political leaders really want me to stand next to them on the pre-election stage, but at the same time they want me to stand next to them in silence.
When I say that politics needs to return the moral dimension, that the country needs to be treated as a sick person is treated, it is not interesting to anyone. Politicians only care about how they can monetize my fame. And there is another big obstacle on the way to a political career — I can’t stand to have power over other people. It always weighs on me terribly.
I am aware that politics is becoming more and more immoral and even criminal; those who create it have terribly distorted concepts of good and evil, professionalism and decency. Therefore, I have always distanced myself from politics, although lately it itself is getting closer and closer to me.
Of course, Ukrainian politics takes revenge for such an attitude towards itself. But 9 million followers on Instagram and 3 million on YouTube save me from its aggression. It is cheaper and safer for politicians not to notice me, because any dishonest game on their part will result in colossal reputational costs for them. I help my subscribers to be healthy and happy, and they help me to be myself and say what I think.
MEDICINES THAT ARE NOT NEEDED: THE SOCIETY DESERVED THEM
Could I be wrong? Yes, like any person. But here it is important to correctly build communication with oneself according to the principle of «never again». A mistake is a reason to draw adequate conclusions and not repeat it again. Let me give you an example. The doctor examines the child, he has a temperature of 37.5 and a slightly red throat. Naturally, you don’t see anything terrible, the situation is standard, everything is fine.
However, it may happen that this particular child has one in 10 thousand! — these are signs of meningococcal nasopharyngitis, which tomorrow transforms into purulent meningitis. But today none of them can be understood and seen — it is not diagnosed on the first day! Today you look at a child and say, «It’s okay», and the next day he has the symptoms of meningitis. What do your parents think of you? You are a killer!
So, there are two options: to put up with it and accept it as the inevitable curse of your profession and not to prescribe meningitis medications to 9,999 people who do not need them. Or you can say, «I don’t want to hear terrible accusations from my parents anymore, so every child with a red throat will be prescribed an antibiotic on the very first day”. The vast majority of my colleagues follow the second path. Is it a medical mistake? Undoubtedly, but society deserves it.
The real mistake is when you find yourself in a situation that you did not foresee, although you could. And, having done it once, you will then try to avoid it all your life. I remember that in the first or second year of medical practice, I was brought to a suffocating child in some remote village. He was already unconscious. I quickly inserted the tube down his throat.
Foam started pouring out of it, and suddenly I found out that there was no electric suction nearby to suck it off. And I again had to take this tube out, because the child would suffocate… Believe me, after such a mistake I will never repeat it. And every time, before putting up the phone, I will ask 150 times, «Do you have an electric pump?»
You learn from mistakes — there is no other option. I have told many times about the case in the city of Kharkov in 1981. Then I put in my first subclavian catheter. So, we made these catheters out of the trim of the radio wires, which we took at the radio factory. Yes, and such medicine was then in the USSR. Then we realized that we were wrong — white wires suited our purposes much better than transparent ones.
ECONOMIC CULTURE OF A DOCTOR: HOW TO COMBINE EARNINGS AND MORALS?
From a moral point of view, medical decision making and business must be clearly separated from each other. When a doctor perceives his medical decision as a business and builds a business model based on it, it is very dangerous.
In this case, the doctor is interested in making you sick, seriously ill, so that you require expensive medications, expensive examinations… When you come to a service station to repair your car, you have at least some knowledge about how the internal combustion system works… But when you come to a doctor to repair your heart, you don’t know anything about your heart, and, to be honest, you don’t really want to. Therefore, you can do whatever you want, invent any kind of manipulation.
Unfortunately, our society itself has created just such an ugly, immoral model of providing medical services — according to the principle «we do not pay you, but you earn from us». In Ukraine, it turns out that if the patients are healthy, then the doctors die of hunger. And then the mechanisms of corruption are connected.
And not so much at the level of clinics, but at the level of the highest state power, which is treated in other places and countries than Ukrainian citizens. And the authorities are extremely disinterested in foreign insurance companies entering our country.
But health insurance is the only way out that I see. When an insurance company undertakes an assessment of medical manipulations in terms of their rationality and validity.
Photos courtesy of Yevgeny Komarovsky
