Unique Ukrainian surgeon Petro Fomin does not share the common stereotype that a surgeon’s “golden hands” is the only thing that can save the patient
This happened three years ago at Stafford, where Kyiv surgeon Petro Fomin sojourned at the invitation of his British colleagues. Having learned that he resorts to diaphragmatic access in serious cases of abdominal surgery, the latter invited Dr. Fomin to take part in a forthcoming difficult operation, gastrectomy, i.e., extensive resection of the stomach in the 76-year- old patient P. who had an oncological pathology.
Yet, when Fomin closely looked at the gastric tissue, he began to doubt that the diagnosis and the proposed surgical tactic were right.
He suggested making a fast diagnosis of the gastric mucosa’s suspicious segment. An instant of microscopic examination showed there were no malignant aberrations. Still, the British surgeon hesitated whether to change the plan. Fomin’s argumentation finally convinced him that a dangerous outcome could be averted.
The next day the surgeons visited P. in the ward. He hugged Fomin and asked to have a photo taken with him. Since then the Englishman, now safe and sound, has been phoning the Kyiv professor every year on this memorable day.
All terrible things come suddenly. K., captain of a merchant marine vessel at anchor in a South African port, suffered a heavy lesion and rupture of the esophagus as a result of the barotrauma he received when using a paint-spray gun. His condition was critical: the captain was on a respirator for several weeks. Although K. gradually came to, he had to be gastrostomized, i.e., an opening was made into the stomach from the skin surface for delivering liquid food, while saliva exuded from the remaining fragment of the esophagus pipe. Like in a Pavlovian conditional reflex experiment... But how can a human being bear this?!
At last, an attempt was made to administer esophagoplasty to the patient. South African surgeons are quite familiar with this kind of plastic surgery because cancer of the esophagus occurs rather often. A bypass canal is made out of a fragment of the colon or the stomach. Naturally, one must first make sure if the patient’s own spare part is suitable for such an operation. It turned out that the anatomic structure of the Ukrainian mariner’s inner organs did not allow so doing. He was discharged with a verdict of authoritative specialists that no plastic surgery was possible.
The former captain came back to Odesa. Some time later he decided to try his luck at Fomin’s clinic. K. and his kin had learned that Fomin employed some other methods of esophagoplasty. Reconstruction by means of a small intestine fragment was a success, and the patient recovered. K. has been plowing the seas again for two years since he overcame a seemingly incurable ailment.
A still more dramatic — life-and-death — condition occurred in US Prof. Mace, a researcher of manmade famine in Ukraine, now living in Kyiv for this purpose. The two previous operations having been a failure due to a wrong diagnosis, the patient was in for a third relaparotomy, a new intrusion into the abdominal cavity. Professor Fomin was invited for a consultation to one of Kyiv’s clinics. The surgeons were inclined to think that all reserves had been exhausted and the risk exceeded the living resource... But Fomin thought otherwise. Another desperate fight that requires, if you like, superior art, and Prof. Mace was brought back to life and work.
“A SURGEON MUST BE ABLE TO ENDURE EVERYTHING”
The future doctor was born in 1939 into a peasant family at a small village near the Mordovian town of Temnikov, Russia, the ancestral home of Admiral Ushakov. After graduating with a gold medal from secondary school in the mid-1950s, he entered the Tomsk Medical Institute, Siberia’s famous citadel of higher medial education. His mentor was the prominent Russian surgeon, Prof. Andrei Savinikh, inventor of a number of esophageal and gastric operations, and designer of remark able medical instruments. Incidentally, Fomin brought some of the latter to Kyiv and still uses them when operating on the esophagus. Petro proved to be talented and deft-handed, and as soon as he graduated from the institute, Academician Savinykh took him under his wing. In a show of true Siberian hospitality, Savinikh would invite thirty to forty colleagues to a festive table. Once he poured Fomin almost a glassful of vodka, saying that a surgeon must be able to endure everything. Of course, that was just a joking ritual.
The young surgeon began to write a Ph.D. dissertation on small- intestine-based esophagoplasty and was at the same time allowed to do a special course that trained doctors to be sent abroad. In 1963 he was destined to attend to and stand by the deathbed of his venerable teacher.
The course attached great, if not extraordinary, attention to learning foreign languages. Going on a three-to-four-day hospital duty (Fomin, his young wife, and a little daughter rented a room, so he had to work a second job), he used every spare minute to consult a dictionary to meet his lady teacher’s strict demands. As a matter of fact, although he never went to Africa, his command of English and French hove come in handy more than once.
Yet, the Dr. Doolittle of Tomsk ended up in Novosibirsk, not on the Limpopo’s banks. The point is the city hosted the Institute of Cardiovascular Surgery headed by a virtually unsurpassable heart surgeon Yevgeny Meshalkin. Fomin was appointed to work here, and very soon he began to constantly assist the institute head during operations. Meshalkin in fact knew no obstacles. He knew how to suture a ventricular septum opening in ten minutes and remove other defects without an artificial blood circulation device and without cooling the patient’s body. Once, when he was performing a repeated rheumatic-heart operation, the thoracic cavity was suddenly flooded with blood. “Needle!” Meshalkin instantly demanded. He treated a blood vessel deep inside and sighed with relief, “Suture up!” The blood was suctioned out later, and the patient was saved.
“What can be called one of Prof. Meshalkin’s most innovative operations,” Dr. Fomin reminisces, “was ‘autotransplantation’ of the lung. Intervention was resorted to in the serious cases of bronchial asthma. The lung was withdrawn from the thoracic cavity and then restored to its original place. The rupture of some nerve links suppressed pathological pulsation, and attacks no longer relapsed. Even now I cannot explain the mechanism of the healing effect, but, in any case, this was done. I also happened to perform several operations of this kind.”
ON THE ROLE OF THE “HOUSING PROBLEM”
Nevertheless, Fomin returned to Tomsk. He was in the tight grip of this city, and there was no other place to take his family. He was awarded a Ph.D. and kept on operating. Fomin still had no housing of his own. It is Prof. Valentina Rogacheva, one of Prof. Savinikh’s closest disciples, who became the next mentor of Petro Fomin.
Then Lady Luck decreed that Rogacheva and Fomin met the remarkable Donetsk-based surgeon Hnat Matiashyn, also an esophagoplasty enthusiast. The report the Tomsk surgeons presented to a Donetsk conference aroused so much interest in him that he decided to keep an eye out for the Siberians. After being appointed chief surgeon of Ukraine’s Ministry of Public Health, Prof. Matiashyn hit upon the idea of inviting his Tomsk colleagues to move to our places. Ukraine’s then Minister of Public Health, Vasyl Bratus, a versatile surgeon himself, decided to support this proposal, the more so that there was a vacant surgery chair at the Kyiv Medical Institute.
Prof. Rogacheva was soon invited for an interview. Speaking to her, the minister said she would be given an apartment. But she also made another urgent request: to organize successful surgery, it would be a good idea to appoint Dr. Fomin assistant professor in the department she was to head. A practical surgeon with a rational mindset, Bratus knew only too well that tandems are extremely useful in surgery, and he decided to meet this request, the only obstacle being the “housing problem.”
“All I can guarantee Fomin is a room in a ministry-owned building,” Bratus’ said, lost in thought. Knowing Fomin’s character, Prof. Rogacheva immediately agreed on his behalf. Neither Doctors Bratus nor Fomin knew at the time that they would have the pleasure of working together — much to the good of patients.
Although the young surgeon was neither ambitious nor conflict-minded, his path in Kyiv was not strewn with roses: there were those who envied him, and there were rivals. Still, he was making steady headway. In 1984, working at the department chaired by Dr. Bratus, Fomin successfully defended in Moscow the higher doctoral dissertation “Plastic Surgery and its Consequences in Cicatrical Obstruction of the Esophagus,” in which he combined and compared several techniques. Needless to say, this kind of surgical maximalism bears a high cost. Dr. Rogacheva retired after some time, and the new department chair chose to hinder his colleague’s growth. It is no secret that professional envy sometimes dominates in the academic world.
STEMMING THE HEMORRHAGE
After resigning as minister, Bratus concentrated on improving the ways of treating gastroenteric hemorrhage. He had been nurturing the idea of setting up a specialized center since he returned from the battlefields of World War II. He needed efficient assistants, so he invited Dr. Fomin to his department based at Hospital No. 15 in Kyiv’s Podil neighborhood. Later, both of them moved to the new premises of the clinic, the second department of outpatient surgery of the Kyiv Medical Institute, and the Gastroenteric Hemorrhage Center, part of the newly-built Hospital No. 12 on Pidvysotsky Street in Kyiv’s Pechersk.
As time went by, Dr. Bratus suggested in the early 1990s that Prof. Fomin be elected his successor. This entailed a certain procedure the outcome of which raised no doubt in Bratus’s mind. Once in the morning Fomin saw Bratus walking the clinic up and down in search of a new office room.
“In fact, I am supposed to cede the department head’s room to you,” said he in explanation.
“Never!” Fomin exclaimed. “You will be working in your present room as long as you wish.” The clinic next to the Friendship of Peoples subway station is a real production line of serious medical assistance. Operations are daily routine, with more than 1500 gasroenteric hemorrhage patients alone being admitted every year. Doctors dealing with this condition are on the round-the-clock emergency duty. What distinguishes the Pidvysotska Street surgical hospital from other similar institutions is, above all, strict discipline and extremely high professionalism. This allowed achieving a four to five-fold reduction in mortality after gastroenteric hemorrhage operations. In respect of the recovery/mortality ratio, the Pechersk clinic undoubtedly meets European standards.
Naturally, this became possible owing to, among other things, the professional skills of Dr. Fomin, who has been performing the most difficult operations here for over a decade, as well as the experience of his colleagues. Dr. Fomin never stops learning: he has visited for this purpose surgical centers in Germany, France, the US, Britain, Holland, Japan, and Israel, at the invitation and expense of his colleagues and missionary organizations.
Interestingly, these trips began by force of circumstances.
“Soon after the Chornobyl accident, our clinic was visited by a Dutch delegation,” Fomin recalls. “They strove to offer aid to Ukraine’s medical institutions, with Baptist Christian churches and organizations spearheading this movement. The white-smocked guests and their retinue went round the wards, listening to quite optimistic Soviet statistics, but the interpreter was still smoothening some rough edges. So I said in English, ‘Gentlemen, we’ve managed to achieve some progress, working with a saw and an ax in the Stone Age. Still, we have hearts, hands, and heads. We are short of many things... Look at our equipment, at the corns our nurses have on their fingers due to cutting napkins by hand, at the method of laboratory blood cell count...”
“Since then, the hospital has been receiving some things as part of humanitarian aid, and I got an opportunity to make professional visits, my organic data are now in the Internet,” the professor continues. “Or take this particular instance. A foreign, perhaps rich enough, citizen was admitted to our clinic because of gastric hemorrhage. I told him after examination that he needed surgery. He asked me to wait a little and got in touch by cell phone with his attending physician in a third country. The physician suggests that I wait for another half-hour or so. Half an hour later he called and gave me the go-ahead to perform surgery. The point is he had found my details on the Internet while I was waiting.”
IN SEARCH OF NEW SURGICAL TECHNOLOGIES
Now, what causes and predetermines success? It is the original combination and sequence of actions. It is perhaps the right time to knock on the door of department Professor Bratus’s office. Although Dr. Bratus no longer operates, he continues to work fruitfully at the clinic and teach.
“We have developed and adhere to the concept that one must first make a precise diagnosis and only then decide on he urgency and level of surgical intervention,” says Dr. Bratus. “The clinic has a round- the-clock endoscopic service and instant-test lab. This immediately clarifies the pathological picture and the ways of preparing and performing an operation. More often than not, hemorrhage is stopped by the endoscopist, while surgeons choose and follow the proper line.”
In the evening, after Dr. Fomin has come back from a consultation on the other side of the city, we resume the chat. I want to know about the development prospects of this vital endeavor. Incidentally, Dr. Fomin was recently elected a corresponding member of Ukraine’s Academy of Medical Science in fair recognition of his competence.
“I want to add to what Bratus said,” he says, “that I do not quite share the common stereotype that what saves the patient is the surgeon’s golden hands. An extremely important role is played in our clinic in the preoperative and postoperative periods by the resuscitation and intensive care team headed by Petro Bulych.
“As to new horizons, the clinic hopes to establish a center of new surgical technologies. Our department is being supported in this by the hospital’s chief doctor Tayisiya Loboda and National Medical University Rector Vitaly Moskalenko. This contains not only purely medical but also pedagogical aspects: students and interns should see an up-to-date level of medicine and learn to apply mini-invasive techniques.
“As far as our clinic is concerned, this means improving endoscopic methods of combating hemorrhages, employing such methods as, for example, clipping of vessels, electric welding of tissues, laparoscopy, using biological glues, etc. Summing up our strategic steps, I can say we are striving for less dangerous and more effective surgical technologies.”
I left when it was dark outside, but the professor still remained behind in the clinic: he was going to examine the newly-admitted patients. The pulse of worry and care never ceases to throb here.
