Open intensive care for relatives, to force the head of the catering Department to try the food, every morning to go to the examination of patients, to learn how to save patients who would have previously waited for death – enough that the hospital was perfect? Alex Light, a cardiologist, the head of one of the largest and oldest hospitals in Russia – Moscow city clinical hospital №1 named after N. And. Pirogov.
Alex Light. Photo: Yefim, Richman
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Alexey Light – the doctor-the cardiologist of the highest category, expert in the field of secondary prevention and cardiorehabilitation, health organization, member of Russian and European cardiology societies, the European society of secondary prevention and cardiorehabilitation, the American College of cardiology, associate Professor of preventive and emergency cardiology, First MSMU n. a. Sechenov
Sometimes you change the fate of a single movement of the handle
– You told me once when my birthday was saving his full namesake, who also was the anniversary.
Yeah, I was on duty, and to us in the intensive care unit did the brunette Alexey, my year of birth, with a circular heart attack terrible.
– Then you also said that in some way saved themselves…
Well, I too… when I was 30 years old, I am 49 now, I am less romantic. But we save ourselves by doing good deeds. And who do we save more? Only himself. Someone a little bit forgets that actually, being an agnostic, an unbeliever, but anyone – in fact, he saves himself. When he plows into the gap in the operating room or do something else. Him in front of him wouldn’t be bad.
– And what case are you glad that you are a doctor?
– When the plane screamed “Doctor-doctor!” (smiles). I had the case – back from somewhere, and suddenly, the flight attendant began to ask: “is There a doctor?” And I was about to get up, suddenly ran past me fifteen healthy men. It was the anesthesiologists who flew with Congress, and therefore for the reanimated grabbed.
When I was happy that I was a doctor? I rejoice that I am a doctor. You want me to ask when I have someone saved and said will he live? But this is quite interesting. Because today you are someone saved, and tomorrow you ain’t saved.
I remember there was a grandfather who made me drink a glass of vodka… he Came to Moscow, and he was stricken by a heart attack. He was brought to the Recreational and we were busy night and day. Then he went to the amendment.
And here comes the morning conference, and suddenly the door opens, and out comes the grandfather, holds a tray a glass and a cucumber red color. He doesn’t pay any attention, came up to me, bows and says, “Drink up, doctor, for my health!”
And that you are in that moment felt?
– Nothing! You know, it is impossible to describe. Do you know why skiers really love their skiing? Because when you are rushing, shouting “Ah-Ah-Ah-Ah!” from the mountain, you get this amount of oxygen in the head that are in some state of euphoria.
And that is probably when you get it, and it may be anything you could properly prescribe the drug and the patient with one fork went on the other, you can make something to see and sometimes change the fate of a single movement of the handle. And for that, you just have to know a lot.
There are people who don’t like me but they are the professionals
You easy was the transition from practical work to management?
– I still quasiparticle doctor, the practice did not leave, do it somehow every day. To annoyed at some of my replica during a crawl, I have to speak the language of the subject. The therapist in this respect easier, much more difficult for doctors and instrumental specialties.
Go to rounds every day to and myself to be in shape, so it is very easy to make. And this is no feat no. Colleagues start at seven in the morning – so runs the world.
– And how is your standard day?
– Seven to come to the hospital, take the stragglers during the night hours – they are very old, have time to brew a Cup of coffee, and then go 1 km 200 m to the ICU entrance. If you arrive by 7:10, so I already had some at home.
At 7:30 watching the resuscitation of the entrance is the emergency room, where they bring the most critically ill patients, for example, with injuries after the accident, and take part in it rather as a therapist, not a doctor. And many of my colleagues – Denis Protsenko, Sergey Petrikov – morning work as doctors must.
I do not teach surgeons to operate on, and obstetricians to deliver babies. But we understand what we’re talking about – we’re talking about the patient. Which needs to be removed, to nurse, to treat.
We have several times a week, conferences with the physician, some issues are solved in working order, using votsap. I have a number of tasks that should be done in a day: monitor a number of things and to engage in strategic.
And you are here adopted as a physician?
I remember when I first came here, one doctor said, “Alexey, how nice to find you here!” Ask: “What am I to you?” – “Seventh”.
I am part of the interior to some extent. The doctors often are changing. It is necessary to take not you, but what you’re doing.
I think people perceive me, not bad, not worse than all the others.
– You had to fire people?
– It was and is. I fired people here more than two of my predecessor, precisely because I was not satisfied with their professional level. But all the decisions that have been associated with the dismissal of the people, was given to me pretty hard.
And when you realize that people your?
– How do you say… Yes, I may be mistaken in the man, but I rarely make mistakes in the professional, so to speak. And if human do not interfere with the nuances of professionalism, a person can be anything.
There are people who don’t like me but they are professionals. And I don’t touch them ever. But if he doesn’t love me and he’s not a professional, it will be difficult to get along together.
The main duty of the physician to know what in a hospital are fed
– Say, chief of the food block you for a year was forced to eat the food prepared for patients. And how was it?
– How? Here is the food. I understand that is of sound mind and memory I put in my mouth this meal will not take. It is the duty of the chief physician to know, than the hospital food. Say: “Call me, please, chief.” Comes. Asking: “want Tea?” And I bring him: “Try it.”
And so a year?
– Well, not that every day…
– What is the result?
– Then another person was appointed. But, he probably already had heard… Well, how? Listen say it again: “do as I Do and not do as I say.” I don’t know how to explain it. You will not believe. And if you don’t, it will affect the patients. And though some crumbs will…
– And what else you can get yourself?
– Me all the time, all exasperated, I head doctor. Besides, I have a explosive temper. But learn, learn. The difficulties were, are and will be an integral part of the work.
– Your office is just a Museum of rare items. You comfortable to be here?
– Yes, cozy. Although occasionally I feel like a Minister of the tsarist government, creaking parquet, come to the window, round panel, portrait of Golitsyn. And behind a window the XXI century, is another story…
– Don’t want to modernize?
– It is quite modern. We are right on this point can look into any operating room, and I can see how much money on any accounts. And it does not need high-tech, it needs brains.
And here please note: all copies of portraits, and a portrait of Theodore Rhine – the original. And he has a very bright eyes. And every night looks at me Professor Rhine, which in 1915 as a German, on the wave of jingoism was made an honorary citizen of Moscow. And in 1923 honorary citizen of Moscow red. He was an honorary doctor and knew his business. And he looks at me every night.
And how do you feel?
– I feel responsibility and some kind of connection.
No matter how much you have scanners, it is important that you do
– What are you proud of as a physician?
– People. I am proud that I managed to accumulate around themselves a very large number of people who are smarter than me, and that these people go to work not just to get paid, but to do this Ministry.
I actually, by and large, not important, good people or bad.
But a good doctor may not be a completely bad person. It’s still contrary to his mission.
For a lot of genuinely, humanly good. With many in the hospital I have a friendly relationship. But that’s not what hit me on the shoulder and say: “Hello Leh”, but in hand I greet all. And people do not lower your eyes and smile.
– First City is one of the few Moscow hospitals, where open access to the intensive care unit…
– If your family member was in intensive care, please come. All the talk, will hold you and him sit down, holding hands. I welcome it. We don’t do it around the clock – we have an emergency hospital, but day and night – for God’s sake.
Just sometimes doctors may be asked to wait if they need to revive someone. But no complaints to resuscitate me at all. From my point of view, all these closed doors only need to ensure that the staff had something to hide and somewhere to obtain a cheap popularity.
On the other hand, I don’t invite everyone. My favorite Yuz Aleshkovsky was an imaginary art gallery, and one of the paintings was called “Misha’s Mother Botvinnikova at a reception at the gynecologist”. You know, you can not turn prayer into farce. We have shirmochki for patients, but not all patients want to be seen by relatives. But, as a rule, those who want much more. The screen may not be enough sometimes, but I try to keep them enough.
And what better to do in terms of treatment?
Says one of my colleagues, we began to do things that never would even touch. Enters the patient with the pulmonary embolism – it is a heavy kind of story – and you need to enter a drug which thins the blood, but she’s bleeding from the disintegrating tumor of the uterus. And you have to understand what to do.
But modern technology is such that you can close uterine vessels, disable the uterus and then to have the thrombolysis to the patient’s breathing, and then take her on the Desk and operate. And sick at home. Previously, she 100% would have died. Here you are asking about sensation. With something to compare it to?
– A miracle?
– No, what a miracle? Half an hour later you went outside and got scolded by the health Department because something is not done, and they’re right, because you don’t have to forget about it.
Your task is not a patient with thromboembolism of cure, and make all doctors are well treated patients with thromboembolism. Just fell in love on the teeth, the term “multidisciplinary team”, but the patient is treated by several doctors. Never in my life have in resuscitation of the patient not only leads anesthesiologist. It is the surgeon, cardiologist, clinical pharmacologist, a psychologist.
And the psychologist?
– Of course, I have a clinical psychology Department. I don’t know with whom psychologists work more with doctors or with patients, but they are needed. When I did it, so to speak, knew that someone had to treat the doctor.
Hospital became to be treated better, and teach, and I do not say this, but for me, and not the people who might be suspected of some sycophantic feelings. But I am a supporter of the theory of small everyday Affairs. Here every day you have to do something.
– These things are hardly possible without funding…
Is it we have so many, but the funding does not solve the problem. No matter how much you have scanners, it is important that you do.
But what we have to do what we haven’t done before, and began to pull patients, not previously out – wow. But it is a merit of people. You know, I do not underestimate the role of personality in history, but just the story itself flows so fast that I became a cure all.
Doctors should be interesting, patients must not be hurt
– What, in your opinion, should be the perfect hospital to which you aspire?
– I seek not for perfect hospital. I strive for the perfect build medical history. Perhaps, for me it’s the Mayo clinic, Heidelberg medical University.
– And what is the main criterion of perfection, so to speak?
– Doctors should be interesting, patients must not be hurt.
– Some patients say that the hospital is about pain.
– The hospital is about life. As long as we live, everything about life. The coat of arms of Mayo’s three shields, one large, the other two are smaller. The large shield – the patient. At the forefront of patient. The shields are a little less – research and education of doctors. All. Here is a great hospital.
– Then there is that “patientorientated” about which now all say so. You like that word?
I don’t like him. Because it’s kind of clumsy word. Is the word “complicity”, “participation”, “compassion”.
– How do you feel about the phrase “medical services”?
– I think it is very wrong that we began to refer to the service sector.
I never refer to the medical service. I belong to the doctors.
There are plenty of unresolved issues – never let them decide, but all my life I’ll
– And how you started?
– I have a very colorful family were artists, lawyers, chemists, physicists, and psychologists – mainly people of intellectual labor. Dad – a physicist, a mother is a doctor. But, first, doctor, you are not 17 years old, when you come to medical school. Although anyone can. Someone twenty years after, and someone who is never still.
In my situation, all decided by the people I met. In the second year I liked the teacher of physiology. He was well read and conducted workshops. And I began to teach physiology to be on the same wavelength. Then there was a lecturer in Microbiology. And in the third year, my mother, the doctor said, “Alex, go to Abram Lvovich Syrkina”. I went and still with him. Then he was a fit 63-year-old man, and he is now 87.
However, I must say that in the first year I was in the Institute were received and worked as an orderly in the 4th city hospital. By eight in the morning and went to work, washed his hands according to the method of Spasokukotskogo – Kochergina. It’s all such greetings from history. It’s very important to understand the continuity, a theory of handshakes. My boss shook hands with Vinogradov, and he Zagarino, and that someone else.
And I’m in the hospital worked, so to speak, not out of fear but out of conscience. And then realized that of course I am going to study medicine. First, perhaps you need to go through a physical initiation, if you will. You can be a very good doctor, but if you can’t to take, not adresas…
But even this is not the most important thing, perhaps. Again, I am shamelessly quoting my teacher, who is a very famous person said, “Abram L. as you so your patients love?” And Abram L. said: “I don’t love anyone, but all compassionate”. You know?
– What is the difference between “love” and “compassion”?
– This is a complex issue. Compassion does not affect the entire spectrum of emotions, compassion is pity, compassion, understanding. Love is a feeling that particularly defies description. It just is. Compassion can be more or less, love cannot be more or less. It’s either there or not.
There are things, that is to say, completely unconscious, the love of children, parents. And you can’t explain why it is there. I love my parents, children, his wife. And probably, the medicine is so interesting that it raises more questions than it answers.
– You have some unresolved issue?
Yes I have a lot of unresolved issues remained. The man’s entire life trying to solve some global issues, but I haven’t decided. And tactical issues we face every day.
– And what global?
Is to change the world, to all the patients didn’t hurt to have all recovered. I never decide, but a lifetime will.
Understand, this is not the pathos, but I don’t even put them in front of him. I have a number of cases, ranging from “fix the visor in traumatology, so it does not fall and did not let anyone on the head” – I also have to prikazivati – to know when I will have a new Arrhythmology and will begin to fail CT scanners, and how will I teach residents, what am I going to do with the neurosurgeons? You know? Therefore, it is not always fun and happy, but always very interesting.
To be ashamed, but praise is still far
– You once said that “it’s a shame not to learn”.
– Well, of course. But this is entirely my prerogative, and the prerogative of any man, because stupid threat.
Imagine if I do not know and do not understand how to use their knowledge. Knowledge is a kind of mosaic you need to add. And someone 60 cubes in this puzzle, and someone as me, 16. But I 16 will combine and slowly add.
I have no illusions about his great intellectual superiority. But it is important not only to know but also to use this knowledge, and this requires practice. You have to see patients every day, but still need to read.
When I became the chief doctor caught himself on the fact that 30-40 minutes of something read or seen, because now the speed is such that you fall behind instantly.
You’re not even a squirrel in a wheel, you are a squirrel on two legs, was not in time, because the amount of information, knowledge, their application is absolutely enormous. If to speak about anesthesiology, it’s just a Symphony orchestra.
– Do you have some way to quickly relax in this mode?
I love a good book. All the time carry a PocketBook, and on any page can open and read, “Dead souls”, for example. Gogol is one of my favorite writers. You get physical pleasure from the text.
I like Dickens, Hoffmann, especially Bulgakov. However, in childhood it is useless to read. Although “Master and Margarita” I’m 13 I have read and re-read constantly.
– In one interview you said that there are moments that bring such a wank, you feel like a Titan. What are these moments?
– Probably was. I don’t remember. You know, medals-some are soldiers, and there are cardboard. I don’t like cardboard medals, but real soldier yet I have little, but some have.
– You don’t want to talk about them?
– I believe that it is immodest. And while we are on the point of development where you are, I believe that glory still nothing special. Us has nothing to be ashamed, but praise is still far.
– How did you answer the question of who should manage the hospital Manager or a doctor?
– There is a giant American research, where he studied 400 hospitals. And hospitals, managed by doctors was more effective than 30-40% than those managed by managers. Of course, it would be better to have a Director, and I would deal only with strategy and medical management. But you know, the thing… We have all the time in the transition period.
But I finished the Moscow city Institute of management “Master of public administration”, and the program of Russian Academy of healthcare management. You get a certain base, know how to read the law, what you can’t – and this is much more than what you can.
You get used to living in a fairly rigid rules of all their actions. And if you do, it saves you from a lot of tragic mistakes.
– Feel you in his place?
– I feel the place where my expectations match the results. My expectations are the strategic things when you are able to open direction, when a project supported by the Department.
Every issue is such a big topic, it is difficult to answer simply. I don’t know how I can describe their breath how to explain it, am I satisfied with my right arm or left leg?
My mood can change several times a day: in the morning go with a bypass inspired and then realize that something isn’t done on the farm, or Vice versa. Want to read, and I have children who at least sometimes have to see dad.
– All heroes interview we ask about the meaning of life. Share your understanding.
– You want to get a simple answer? People are looking for the meaning of life is life. Someone finds, someone finds. But if a man stops looking, he ceases to be human. This is a very difficult thing. The easiest way for you to reply, but I don’t like to lie.
You ask yourself, you’re also a hero. Don’t know the meaning of life in life itself. It’s a bit primitive, of course, but you should not be ashamed of yourself, because yourself you’re a lie you can’t. That’s all.
Talked Hope Prokhorov
Photos: Efim, Richman