Rustam Akhundov, RCH: ‘Wake us up at night, and we will do it all with our eyes shut’

“We try to do our best because we don’t want to fail him”

He has hundreds of saved lives under his belt, he is one of the top specialists in the hospital. “He is very smart, knows nuances and the specifics of quite a long list of diseases. Because we have a multidisciplinary hospital with different pathologies,” vice head of Intensive Care Unit in the Republican Clinical Hospital Roman Sphaner talks about Rustam Akhundov.

However, for many in the RCH, Akhundov is not only an experienced doctor or boss but also a good friend who is always ready to help both patients and colleagues in their hour of need.

“Emotionally, our job is tough: it is hard to stay face-to-face with problems, worries — this can affect your own health too. This is why we try to speak out, and Mr Akhundov’s support is always felt. I can’t name a specific case, it happens constantly. And he indeed remains a person who is pleasant to talk with outside the hospital. He is an amazing family man, tries to dedicate the rest of his time to his spouse and children. Despite such a job, he always finds a minute if you ask him something or wish something. I am glad to have such a friend and colleague I can always rely on,” Roman Shpaner warmly characterises the doctor.

Any instruction obliges calling the management if something uncommon happens, while critical situations in the ICU happen nearly daily. But Rustam Akhundov has never said: “I don’t know what to do”. At the same time, he knows how to listen to others’ opinion and makes a decision after weighing up all arguments.

His working day starts at 6.30 and lasts for 12-13 hours. In the morning, Akhundov visits his patients in the ICU, in the afternoon, he consults people in the whole hospital, in Perinatal Centre, works with the air ambulance, in the evening, he completes the work he didn’t manage to do during the day — nobody has cancelled paper reports. The head of the unit has 23 doctors, around 50 nurses and 10 assistants under his supervision.

“He has a cool head, he is always collected and ready to come to the rescue. We try to do our best because we don’t want to fail him, we treat him with great respect. Mr Akhundov never loses his self-control, always reflects calmly. He has a unique organisational skill. Some doctors are vanguards, they can be given a critical patient, and such a doctor will set the pace others will catch. Some doctors work great in the ambulance, they think fast, run fast. Mr Akhundov sees us well, accurately appoints positions so that we will bring the biggest benefit,” says an ICU physician Mira Sultanova.

What’s more, Akhundov admits he chose the specialisation “accidentally”: when I graduated from Samara Medical University in 2006, only positions of intensive care physicians were vacant. But in the end, the choice was correct. After an internship, he got to the Interregional Clinical and Diagnostic Centre where he defended his candidate dissertation. In 2012, he joined the RCH and chaired a new unit of the Cardiac Intensive Care Unit. But two years ago, he began to lead the RCH’s Intensive Care Unit or the “big” ICU, as people call it. It is a general multidisciplinary unit where somatic, therapeutic patients stay and people after surgical interventions — with any complication with pathologies.

“ICU sounds horrible for an ordinary person”

The reserved and equable doctor has a focused look, but his eyes don’t show strictness but goodwill. Despite tiredness, an open face with a charming smile is hidden behind the medical mask he took off for a minute to take a photo.

Mr Akhundov, why did you enter the Samara university, not the Kazan one?

Samara was simply closer to Bugulma I come from. My father graduated from this university too. He still works in Bugulma as a dermatologist and venereologist. We have a medical dynasty, my paternal grandfather was a doctor too, my wife is a doctor.

Does your father give you instructions?

We rather changed the seats. He calls me if somebody needs consultation.

How many intensive care manipulations do you perform a day on your own? It is probably great stress when you need to undertake something quickly to save a person.

I perform from 2 to 10 intensive care manipulations a day. It is indirect cardiac massage, defibrillation, a transition to artificial ventilation. This maybe sounds horrible for an ordinary person, but this isn’t a feat, an overarching idea, it is a routine. Wake us up at night, and we will do it all with our eyes shut. The RCH has been transplanting liver and kidneys for the second year. We join this process at the very beginning — we work with the donor, fill in the report on brain death.

Only a brain-dead patient but with the beating heart can become a donor. It is a separate area that is emotionally though but allowing us to save up to four patients. Mistakes are a hundred per cent excluded here. We are very scrupulous about it. To determine the brain is dead, several tests need to be done, this is why a discussion with experts is held.

What’s your workload now?

Our unit has 31 beds, consequently, 31 patients. We discharge around 7-8 people from the ICU and admit the same number. However, we have patients not only in the RCH, we actively work with districts. If they have severe cases, we contact, consult them. Our employees daily travel to districts with the flying doctor service. I also have to travel by helicopter 3-4 times a month. We see on the spot: if we can take the patient, we do it.

What diseases the patients you have now suffer from?

Our unit has young patients, mostly after injuries, neurological surgeries, with sugar metabolic diseases, the other half is the elderly with heart strokes, heart attacks.

Now nearly half of the patients of our unit had viral pneumonia or COVID-19 who already received treatment for their major disease and don’t spread the virus but have consequences. It is mainly the elderly. Their lungs are affected, it is hard to treat them. Scars appear on the tissue of the lungs like after cuts. And these zones can’t participate in breathing but they gradually recover. Such patients require respiratory assistance and ventilation.

Coronavirus causes complications: kidney failure, neurological complications, for instance, a memory loss, nervousness, an unsteady gait. Moreover, many of my patients have chronic diseases. It is convenient that the RCH has almost all specialists, and we invite them to join treatment. The infection is novel, and there are no standard ways of treatment, but we are elaborating methods. With time, when we accumulate a big selection, we will certainly publish something.

“To choose from two evils without extra emotions”

Are you sure of the decisions you make? Don’t you fear?

We carry huge responsibility, it can’t be the other way. If we fear, nothing will work, then we can get exhausted professionally and give up the profession — a lot of people do this.

What do people who leave medicine and go to other spheres lack?

People have different nervous systems. You truly dedicate yourself to every patient we deal with, but, unfortunately, some results can be negative. And when this happens, we feel some bitter loss, emptiness: you tried to help, did your best, but the person isn’t alive anymore. And of course, emotions are accumulated, somebody doesn’t handle it, leaves.

It is necessary to constantly work on yourself, your character, state. At the same time, everything happens fast in the ICU. There is no time to think for long. From two evils, you have to choose the most suitable one to solve the patient’s situation.

In certain cases, we come to an agreement with colleagues. We seek advice, including ask our professor, my teacher Aynagul Bayaliyeva, she also works here. The key principle of a doctor is: “Do no harm!” Everything must be weighed, sensible, smart, without extra emotions.

“When will we have a break?”

Probably more disciplined people work in medicine.

Staff is staff everywhere, it is not easy to manage it. Everybody has a different character, it is necessary to gratify everybody so that the team will work smoothly and friendly. It is necessary to find an approach to everybody, to make sure everybody feels comfortable, so that people won’t think about some inconveniences because we spend here more time than at home.

Do you have to be strict?

Strictness won’t help you. The staff will run away from a strict boss — it is my stance. I am friendly with everybody. Everybody is a professional, and it is necessary to respect it. We don’t have a misunderstanding, we got used consulting with each other. But tension is running high now.

Employees of our ICU actively worked in the COVID-19 Unit in summer — they were short of staff. Tiredness has accumulated during the year. There is one problem now — nobody has been on holiday this year. The employees are asking when they will have a break. But we can’t promise anything now. We have an emergency state, so to speak. The case is that some of our colleagues are also ill now. And one person for us is quite a big resource.

Your speciality and post require constant tension and energy, divest you of free time, hobbies. If we go back, could you have chosen another, calmer job?

I would probably choose the same. Accidents are not accidental. I enjoy what I do: I go to work with pleasure, help people. I feel moral satisfaction with the fact that the patient has been discharged, goes back to his normal life.