UPDATED A Cardiologist in Kyiv: ‘I Hope for the Best’

This blog has been adapted and updated, with permission, from emails Dr. Kozhukhov has been sending to friends and colleagues since the invasion of Ukraine began.

April 1, 2022

Day 37. Ukraine is courageously defending itself from Russian invaders. Today, the Ukrainian military is not only defending itself, but also is counterattacking in some areas.

But some cities have suffered greatly from the hostilities. The city of Mariupol remains completely surrounded by enemy troops, to which the eyes of the whole world are turned. The city is practically wiped from the ground. Mostly it is civilians who’ve suffered. Their houses and civil infrastructure have been destroyed. The city has a predominantly Russian-speaking population. Before the war, the city had 400,000 inhabitants. Now the city has more closer to 100,000 inhabitants, and since the beginning of March there has been no electricity, water, gas, heat, or communication. People are hiding in basements. Russia did not allow the evacuation of civilians. People themselves, at their own peril and risk, fled by personal transport. Many were shot at point-blank range.

The question is: who did the Russian army come to liberate? And from whom? The houses of the inhabitants—these are military facilities? And what about the civil infrastructure, hospitals, and theaters destroyed?

I can tell real stories of my patients. Patient G left Mariupol himself, but his sister stayed. There was no communication with her for 10 days. And finally, she escaped from hell. There were nine people in the car. They got to Zaporozhye. People are shocked. They don't understand what's going on. And the first question they asked on the phone is: and Kyiv is ours, it was not captured? And yesterday, the patient sent a photo saying, here is my house in Mariupol. He is destroyed. This is what's left of it.

Another story, from Kyiv. On three sides of the city, there was a large accumulation of enemy military equipment. In some places just 12 to 15 km from the center of Kyiv. The strategic task of the enemy is to take Kyiv, overthrow the government, and thus conquer all of Ukraine. The plan failed. Since yesterday, part of the Russian troops have been withdrawn to Belarus and the territory of Russia. This is the merit of our military on the battlefield. But it's too early to relax. And another positive moment: the enemy has left the Chernobyl nuclear power plant!

I keep in touch with patients who participated in my center in clinical trials. A week ago everything was fine. The patient W and his family did not plan to leave the city. But when a shell flew into a neighboring house and the house was destroyed, the patient decided to leave for Chernivtsi. He sent me a video of this house.

My story, from Chernihiv. The city of Chernihiv is also in distress from constant shelling. The Ukrainian army courageously defended the city. All bridges around Chernigov were blown up. The supply of food and medicines has been disrupted. Since March 7, there has been no electricity, gas, or water. Constant shelling, explosions. Numerous rocket attacks. Lots of destroyed buildings. Many people sleep in basements.

My relative escaped with his mother and grandmother. At that time there was only one bridge left. In places it was mined. They managed to leave Chernihiv. But it took 5 days to get to a safe place. Fighting took place along the way. They had to return, stay in temporary safe places, and look for alternative ways of travel.

They were able to leave. They stayed alive.

But my wife's mother remained in Chernihiv. She is 90 years old, and she categorically refused to leave. She lives in a private house and takes care of a small herd of goats. She said: this is my land, my life is here, and I will not go anywhere. The house is cold, there is no water, electricity, or gas. It's -9°C. Neighbors sheltered in a house where there was a woodburning stove where one could warm oneself. They hide in the basement at night.

One day our connection to my mother-in-law was lost. Time dragged on, for a long time. More than a week passed, and we didn’t know whether she was alive. We were looking for contact through volunteers, and even through the military. Then, at last, we were told that they had seen her, that she was alive. True, the neighbors' house burned down completely, and she returned to her house.
And only on the 12th day did we manage to talk with her, thanking God that she’s okay.

It's hard to put into words what people have experienced and continue to experience. On the street, all the people have rallied. They stick together, cooking food on a fire. At night they disperse into the cellars. They find a way out of a catastrophic situation. Someone collects phones and walks to another area. Phones are charged by a generator. But this is not enough, you still need to find a place with a stable mobile connection. Yet life goes on!

Chernigov resisted. Chernigov did not give up.

This is the 21st century. Human progress. Then suddenly a war against a peaceful people, a war against the rules, a cruel war. And what would have happened next if Ukraine had not resisted? How could this happen, why did the world allow this, where is our collective security? Today there are no answers to these questions. Perhaps history will find them.

And today there is still a lot to be done to win.

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March 15, 2022

Our 20th day of the war. A siren is sounding right now—an air raid alert. A lot of people don't respond to it, but many people are scared, many go down into bomb shelters, basements. In cities where there is a subway, this is the safest place. Often there are people staying in the subway tunnels on a permanent basis; these are women and children.

What is the situation today? The last few days have been a precarious balance. There are battles on the contact lines. The most difficult situation is in the cities of Mariupol, Kharkiv, Sumy, Chernihiv, and Kyiv.

Separately, about Mariupol, 10 km from the self-proclaimed Luhansk People's Republic (LPR). The area is completely surrounded, and the city is practically wiped off the face of the earth. A full-fledged humanitarian corridor could not be implemented. The only thing yesterday was that 1,000 residents managed to leave the city by private vehicles. There has been no water, electricity, heat, or food in the city for more than 7 days. Almost around the clock, there is a massive shelling of the city with tanks, artillery, and aircraft. About 80% of residential buildings are damaged, and 80% of these cannot be restored. This is a real humanitarian catastrophe. The exact number of civilian casualties cannot be calculated. Soldiers of the Ukrainian army do their best to defend the city.

Kharkov is 20 km from the border with Russia, with more than 1 million inhabitants. Probably the second-worst-hit city in terms of damage to civilian infrastructure, after Mariupol. Around 600 high-rise residential buildings have been destroyed. Most of the population has managed to leave or evacuate. The city is also surrounded on all sides, but the armed forces hold the line.

Chernihiv is 68 km from the border with Belarus. The city was seriously damaged, with a lot of destruction of private and apartment buildings. For several days the city was without water, electricity, and heat. No internet or mobile connection. Communications are now being restored.

My grandmother stayed in Chernihiv. She is 90 years old. She categorically refused to leave. She is sheltered by neighbors. We had no communication with her for 3 days. Only yesterday we managed to find out through the military that she was alive and well.

In Kyiv, half of the inhabitants, and this is about 2 million people, left the city. The capital, as befits, was well fortified. Enemy troops are located on both sides at a distance of 15-20 km. Yesterday and today, my colleague has told me, explosions are heard in different parts of the city. The goal of the enemy is to surround and take the city. But while the city is not completely surrounded, attempts to break into the city were not made. Kyiv is fully provided with all communications and products. There are some difficulties with medications. Hospitals now provide mainly urgent care and have been redesigned to provide assistance to the wounded and injured.

Yesterday, the President of Ukraine visited a military hospital and spoke with wounded soldiers. The government in full force is located in Kyiv and deals with all necessary issues of defense and life support.

Instead of a conclusion, I will say: all residents of Ukraine are patriots of their country and fully support their government. Even in those areas that are occupied by enemy troops, not a single settlement was declared to live “in Russia.” An attempt to create the Kherson People's Republic has failed. People massively go to rallies in front of the occupiers, chanting: Leave, everything is fine with us. We don't need to be saved. Go home alive. This land is Ukraine.

The people of Ukraine are very grateful to everyone who helps Ukraine with humanitarian aid, weapons, and accommodation for refugees. Only by our common efforts can we defeat the latest plague of the 21st century, and thus save the whole world.

I love my country, I respect the Ukrainian people.

Victory will be ours.

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March 11, 2022

Here is an update from Russia's war against Ukraine: Day 16

Russian occupiers continue to bomb peaceful Ukrainian cities. Currently, the Ukrainian army is actively repelling enemy attacks, inflicting heavy losses. The occupiers are bombing peaceful cities of Ukraine, with shells hitting homes, schools, and kindergartens. There are many innocent victims.

On the morning of March 11, the occupiers made an air raid on the Dnepr and powerful explosions were heard in Lutsk and Ivano-Frankivsk. On this day, another attempt will be made to organize humanitarian corridors to evacuate the people from the cities that are most shelled by the enemy. Our government is promptly taking all necessary steps and the army, together with all power structures, are clearly fulfilling their duties.

Local territorial defenses have begun to protect their cities and villages. The local citizen is often stopping enemy columns with their bare hands. They protest against the occupation and refuse enemy humanitarian aid. Ukraine has rallied as one. I am sure that victory will be ours.

I want to share with you what we as cardio-oncologists are doing today. We have been monitoring the situation with regards to the providing of care to cancer patients which, as of March 10, is critical.

In war zones, all services have stopped. In Kyiv, we are still offering some services. I spoke with the National Cancer Institute and the Kiev Cancer Center, where they are only able to offer short courses of chemotherapy.

In Western Ukraine, we can offer full services, but due to the large number of displaced people there are difficulties: limited chemotherapy and limited radiation therapy.

Some patients have crossed the border and are receiving care in neighboring countries, but here there is a problem with the lack of medical documentation and data on treatments performed, and language barriers. We are working on it and we are trying to keep everyone involved in providing care to cancer patients informed.

Yesterday was an important event. ECO-ASCO organized a special online meeting, Impact of the War in Ukraine on Cancer (another briefing is planned for March 18), providing information on the state of oncological care in Ukraine. We are very grateful to all the countries that provided assistance to our patients.

My suggestion to meeting participants was to help to properly organize the providing of oncological care here, in Ukraine, and especially in Western Ukraine. A lot of people have moved here, and they are not going to leave. For those who want to help, my proposal:

• Employ oncologists and chemotherapists who left for Western Ukraine, on-site.
• Establish contacts with oncologists, chemotherapists, who remained at their workplaces to obtain medical documentation.
• Provide drugs for chemotherapy.

There is a lot of work ahead.

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March 4, 2022

Many people are asking me how to help in general, or locally in any country. My reply: Break through the propaganda.

In Russia, they do not know what is happening in Ukraine, they think that this a special operation is being carried out in the Donbas. In fact, it is a full-scale war. If you have family or friends in Russia, tell them. There is a Russian audience on our social networks: write what the situation really is. This will help raise awareness within Russia.

For our friends and colleagues in Russia: the Ukrainian Ministry of Internal Affairs has created the website "Look for Your Own" with data on military prisoners from the Russian Federation that have been captured or killed in Ukraine. A telegram channel "Look for Yours" has also been created. Photos and videos of killed and captured Russian soldiers, as well as known information about them, are also posted here.

A hotline has been created so that relatives of Russian military personnel will be able to find out whether their relatives are still alive, whether they were taken prisoner, whether there are injuries, or decide when and how to pick up the body of a deceased relative from the territory of Ukraine.

As much as possible, send this information among your friends and to whom you can. My hope is that the final recipients will be people from Russia and Belarus, unaware of the truth of what’s happening in my country.

What can you do personally?

Speak up to your politicians and wake them up, put the pressure on them to support the introduction of all possible sanctions—tough ones—against Russia and regime-supporters.

Military help of any kind is very important.

Donate to Ukrainian army and volunteers.

Spread the news in the world and throughout Europe to raise awareness about the war. Let each and every person know about the real situation on the ground in Ukrainian.

Go on the streets and join demonstrations to stop the war in Ukraine.

Repost and forward this message. Make sure it is read by as many eyes as possible.

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March 3, 2022

I am sorry for the long silence. Due to the current situation, I had to evacuate my family to a safer place. Back in Kyiv, it was very unsafe. There was fighting near my house. I'm in good condition because, at one time, I went through Afghanistan–serving as a medic between 1983 and 1985 in Soviet–Afghan War.

Now I'm returning home and to work. The Institute is preparing in case of mass hospitalization of the wounded. For now, only emergency cardiology services are functioning for patients arriving by ambulance, and we will continue to try to do this until we can only treat those wounded in the attack.

What is the situation in Ukraine? The invasion continues, simultaneously from different sides. The Ukrainian people, the army, and the government have rallied as a single whole. We have received huge support from the West and the whole world. In addition to humanitarian aid, weapons are being supplied, which makes it possible to contain the enemy and, in some cases, to push back to the borders.

Hot spots are Chernihiv, Kharkiv, Sumy, Zaporizhzhia, and, of course, a suburb of Kyiv that’s 20-30 km from the center. It's extremely worrisome that the enemy has occupied the Chernobyl nuclear power plant, although the Zaporizhzhia nuclear power plant we have managed to defend. This is the largest station in Europe.

Most importantly, the enemy army has lost momentum. There was no lightning victory. The Ukrainians are mounting a tough rebuff. Self-defense was organized in all cities and villages, and very often the civilian population has not allowed the Russian military columns to pass.

On the reverse side, while earlier in the invasion it was military objectives being attacked, now we are seeing many attacks on civilians: residential buildings, hospitals, infrastructure, and historical monuments have been damaged.

Ukraine took on the battle, the most terrible we have faced in our history. Behind Ukraine is the whole of Western Europe and the whole world. The patriotism of Ukrainians with the support of the whole world will be key to victory.

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February 26, 2022

I consider it my duty to inform you, as a citizen of Ukraine, a doctor, and a scientist, what is really happening. This is a large-scale invasion of Ukraine from all sides. I am located 10 km from Kyiv, near the Zhuliany-Kyiv airport. And next to the airport is my institution, the National Scientific Center Institute of Cardiology.

Most of the team, especially those with children, I gave the opportunity to leave Kyiv while I and part of the team organize the work of the institution in case we need to provide medical assistance to the civilian population.

The war began on February 24 at 5 AM, when strategic military targets were attacked with high-precision weapons: cruise and ballistic missiles. Air defense systems were damaged and an offensive began through all the cordons, with saboteurs and landing groups entering near Kyiv and near other major cities. The main goal is to quickly capture Kyiv, but the army, aviation, national guard, and volunteers are repelling the enemy. This night was the hardest. There were fierce battles around Kyiv and in the city itself.

We survived. At present, it is calm in Kyiv, although residential buildings were damaged and there are losses among the civilian population.

I am an optimist, and until the end did not believe that this could possibly happen. But I hope for the best.

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Off Script is a first-person blog written by leading voices in the field of cardiology. It does not reflect the editorial position of TCTMD.