“I’ve still got my head on my shoulders,” the Ukrainian soldier told me shortly before I operated on him. “I’ll be all right.” He had volunteered to defuse mines, and a Russian drone had dropped a bomb over his position. The blast had obliterated one of his legs below the knee.
Then there was the local opera singer who joined the military to defend his homeland. On patrol, he took a wrong turn and stepped on a mine. He was always so mindful of every step, but at the end of his shift he was hurried and exhausted. The blast traumatically amputated his foot. “How could I let this happen?” he asked after surgery. He begged us to delay his transfer to another hospital by two days so he could celebrate his wife’s birthday. And he pledged he would return to the opera house with or without a prosthesis.
Normally I work at a hospital in Chicago. But in July I spent two weeks embedded in a forward hospital in Zaporizhzhia in southeastern Ukraine — my third volunteer mission to the country since the start of the war and one of many I have made around the world. Not since volunteering in Aleppo, Syria, in 2016 during the civil war there had I witnessed so many traumatic amputations and blast injuries.
In Aleppo we worked out of a basement. In Ukraine at least the hospitals were still standing. But injuries from mines and mortars do not discriminate. The wounds that I encountered in Ukraine looked the same as in Syria: disfigured faces pocked with shrapnel; disemboweled bellies; dismembered bodies; limbs with massive defects of skin with jumbled bone shards, shredded muscle and noodled tendons; gaping chest wounds with collapsed lungs; severe head wounds.
My Syrian heritage inspired me to make my first trip to a war zone, to Aleppo in 2013. I returned repeatedly and went to Liberia during the Ebola epidemic in 2015, Iraq during the violence wrought by the Islamic State in 2017, Ukraine for the first time just weeks after Russia’s invasion and Idlib, Syria, during the Turkish-Syrian earthquake this year, among other places.
I have written often about my experiences in Syria and Ukraine. But I wasn’t always sure what to say when people back home would ask, “Why are you going when you don’t owe them anything?” or when people in the war zones would ask, “Why would you leave your home to come here to risk it all?”
After a decade, I’ve finally been able to articulate some answers.
As doctors, we develop skills and build experience and, along with that expertise, a desire and a sense of obligation to help those most in need. In Syria I learned how to manage war wounds in a battle zone with few supplies. From that sprouted opportunities to assist in other faraway places.
It wasn’t only a matter of doing the right thing. I was also compelled to bear witness to atrocities that some people experience only in words and images — or opt to ignore. It was a way of bringing voice to the voiceless and making a connection with local doctors and patients, many of whom feel beaten down and isolated. The simple act of being physically present, of being able to look a local doctor in the eye as we worked alongside each other, sometimes had a greater impact than an extra box of medicine. It let my fellow physicians know that they are not forgotten.
The medical students I supervise at Northwestern’s Feinberg School of Medicine tell me they are inspired by my stories and that they, too, want to work in disaster medicine. The work is meaningful, but it is dangerous and can take a heavy psychic toll, I warn them. You operate with the understanding that you may find yourself dead or wounded next to the people you are trying to help. You may find yourself alone in a bunker shuddering from artillery blasts, sleeping on a basement floor next to 10 strangers, taking cold showers with a bucket, cutting limbs off humans and wrapping dead children with white shrouds.
“Guard your souls,” I tell them. Be careful not to drown in anguish and hopelessness. That can take a lifetime of practice.
These experiences can also make you a better doctor. My mentors in humanitarian medicine taught me the first rule: Be quiet and listen. We’re not in charge. We’re not heroes or saviors. We’re there to serve.
I learned from Syrian and Ukrainian surgeons how to do more with less: how to operate in an austere, hostile, low-resource environment; how to stay steadfast in the middle of an operation when the hospital you work at is being bombed; how to walk away sane and stable from mass-casualty events in which you can’t save everyone and the closest you get to helping is holding people’s hands as you watch them die.
I learned other lessons. The ambulance drivers, the schoolteachers, the railway workers, the journalists, the soldiers, the nurses, the physicians and the patients that I met in Ukraine taught me more about bravery, leadership, sacrifice and service than any profit-seeking hospital administrator or ladder-climbing academician.
Of course, as doctors, we don’t have to go to Syria or Ukraine to witness courage. It’s right in front of us. In Chicago this year I took care of a 35-year-old woman with cancer of her femur. She was 20 weeks pregnant. She didn’t have enough money for her phone bill, so her obstetrician paid it. She decided not to terminate her pregnancy while undergoing treatment. To save her leg, we surgically removed half of her femur and replaced it with an internal titanium prosthesis. She underwent chemotherapy while pregnant. Last month she delivered a healthy baby but still has a long road ahead as a new mom with more debilitating chemotherapy to come.
That’s courage.
What we as doctors do for a living on the most mundane day is a sacred honor, wherever we do it. It’s unfortunate that it sometimes takes service in wars and disasters to force us to step back to see how terrible the world can be and how good some of us have it. It shows we really are all one community connected through suffering and also how capable we are of helping others through sacrifice.
But sometimes we have to take a journey to find out.
Samer Attar is an orthopedic oncology surgeon with Northwestern Medicine and the Lurie Children’s Hospital of Chicago and a volunteer with the Syrian-American Medical Society.
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