Brain surgery in a warzone

For Ukrainians, victory is inevitable – but in the country’s hospitals, it is clear that winning the war will come at a terrible price.

By Henry Marsh

I was in Ukraine when the coronation of King Charles III in London and the Red Square Victory Parade in Moscow took place. The similarities between the events were inescapable – the uniforms and soldiers, the sword carried by Penny Mordaunt and the antique T-34 tank. The differences, of course, are also obvious. The coronation is harmless and silly, if in poor taste in a cost-of-living crisis. The Red Square parade is evil and destructive. But what struck me most was that both countries seem intent on self-harm – Britain with Brexit, and Russia with a war it cannot win.

Both countries are weighed down by an imperial past, by elites who have been told they should hold an important role in the world. They resent that they have lost it. So they lie to the public and drag them along – to economic failure for the UK, and to death and disaster for Russians, taking innocent Ukrainians with them.

The price of victory

I spent ten days in Ukraine. There were air-raid sirens in Kyiv, and explosions as missiles were shot down, but the air-raid defences around the city are now very reliable. I felt safe but nobody sleeps well – you are subliminally aware of sudden noises and always on edge.

Ukraine has been part of my life for more than 30 years, and I am proud that the UK has supported the country so strongly. Boris Johnson has heroic status in Ukraine – somewhat ironic given his past history. Talking to my friends confirms what I have always known – there is no alternative to victory over the Russian invaders. Victory is inevitable, but it comes at the cost of quite terrible death and destruction, and there are many more lives to be lost, as the West has hesitated to give Ukraine the weapons it needs.

Walking wounded

Twenty five per cent of battlefield casualties are from head injuries, but neurosurgery doesn’t have a major role in war surgery. You can’t undo severe injury to the brain and surgery is usually limited to “debridement” – tidying up – and repairing scalp and skull injuries.

I was taken to see a young soldier in one of Kyiv’s best private hospitals. His mother-in-law had asked to see me – her daughter had married him just before the war. He had been an elite marathon runner and champion speed climber before he volunteered. He was found on the ground by his comrades, who thought he was dead, but then noticed he was breathing. So they rescued him. He has remained in a deep coma ever since, in a “persistent vegetative state”. I was shown his CT brain scan – it displayed a minute shrapnel fragment lodged precisely in the centre of his brainstem, part of the brain essential for maintaining the conscious state. It sounds a cruel thing to say, I told his mother-in-law as we stood at his bedside, but the best thing your daughter can do is leave him and start her life over again as there is no chance of recovery.

“I know this family,” my colleague told me afterwards. “She will never do that.”

For every death on the battlefield there will be many more injured – with disfiguring facial injuries, for instance – and many will go home with post-traumatic stress disorder. One of my Ukrainian friends knows a drone operator. “He has killed 50 people and is just so sick with it,” she said. “He has to look at them as he kills them.”

All this, for foolish old men in the Kremlin.

Nature cure

There is something to be said for going abroad in early May. I got home from Ukraine after midnight and when I awoke next morning I found that my garden was a riot of blossoms and leaves and rampant weeds, although the slugs – which must have been Russian – had eaten the sunflower seedlings. The joy of seeing the bees I keep in two hives flying up into the sky was intense.

Two lectures I delivered in Ukraine were about the value of “healing gardens” in hospitals and the compelling evidence that a green environment is good for us. I am helping the Smart Medical Aid charity raise funds to create such a garden in the children’s hospital in Dnipro, which cares for many severely injured children. But Dnipro is near the front line and regularly bombarded by the Russians, so there is talk of having the garden indoors or even in the hospital’s bomb shelter. I have some doubts about this. Perhaps it is better to wait until after the war. I would like to think that then a new and better Ukraine will arise from the ashes with well-designed hospitals that have gardens, instead of the dreadful old Soviet ones. But winning the peace will be as difficult, if not more difficult, than winning the war.

Henry Marsh and Dr Rachel Clarke have founded the Hospice Ukraine charity to support palliative care in Ukraine