Trust and decision making

Every day, throughout the world, mass casualty situations happen due to both natural and man-made events, and severely injured casualties often end up in hospital intensive care units (ICUs). At the same time, every day, there are also patients in life-threatening conditions being treated in ICUs. There is precious little time to waste. Mutual trust, swift decision making under pressure and excellent medical skills are essential for specialists and other medical staff in ICU departments.

Gennadiy Galstyan, MD, PhD, who heads the Department of Intensive Care at the National Research Center for Hematology in Russia, tells us about his working day and about his personal challenges and successes in improving patient care.

Driven to help

You might think that seeing dozens – even hundreds – of patients every day would sap the mental and psychological energy needed for any sort of personal reflection. But, in his 30-year career, each experience seems to have taught Gennadiy Galstyan something new and motivated him yet further, and he never seems to have tired of caring for patients. Every morning he tells himself: “I can make a difference to somebody’s life.” In practice, for the Professor this means always giving his best, so that “at the end of the day I can say, ‘yes, you did well’”.

“ I think it is a great honour to be a doctor and see the lives of our patients years later.”

As head of the Intensive Care Department, his skills are constantly tested. “There was this one boy, almost 30 years ago. At that time, he was four years old and he had acute leukaemia. I transferred him to the ICU,” Professor Galstyan remembers vividly. “It was a very difficult moment for the entire family. The boy was in a serious condition”, he adds. The entire team did everything to stabilise the child and provide the best treatment for him. Leukaemia needs continuous treatment for up to three years, or it can come back. He recalls that “we weren’t sure if he would survive”. But he did – and Gennadiy adds that he has now grown to become a young man with an impressive career as a renowned lawyer in Russia. It makes him proud when a patient whom he once treated is now living a fulfilling life: “I think it is a great honour to be a doctor and see the lives of our patients years later.”

ICUs of the future

Professor Galstyan can look back on great improvements that have been made in the number and quality of ICUs in the country during the past three decades, from improvements in life-sustaining technologies to therapeutic treatments. As a result of broad discoveries in critical care treatments, the curve of life has been extended. As Gennadiy remembers, 30 years ago septic shock in neutropenic patients was not a diagnosis, it was a death sentence. “It was the same situation with mechanical ventilation. Nowadays, we successfully treat half of the patients,” he says. He hopes that medical and scientific advancements will continue to increase and doctors will be able to treat most of their patients.

Gennadiy also believes innovation can change the paradigm of disease treatment, whether that be from cryoprecipitate to FVIII treatment, or from plasma to prothrombin complex concentrates. “Thirty years ago we used only blood components, such as cryoprecipitate, fresh frozen plasma or native plasma concentrate,” he recalls. This has all changed now. “For instance, in our ICU for oncohaematology, in the past two years we have been using Octapharma’s 4-factor prothrombin complex concentrate, a prothrombin complex concentrate (PCC) which contains clotting factors II, VII, IX and X for patients with haemorrhagic disorders,” he explains. “Octapharma’s 4-factor prothrombin complex concentrate is faster, safer and logistically simpler than our only other option: plasma transfusion. Recently, we had a case of rodenticide poisoning where, thanks to this product, we saved several patients’ lives.”

Reflection and learning have become my working habits

The more of an expert you become, the more your expertise is sought, and it is perhaps no surprise that many doctors – including Professor Galstyan – are also teachers helping to improve medical education in Russia. In addition to seeing patients, he is academically active at the Institute of Post Diploma Education for Anesthesiology and Intensive Care, Burnasyan State Research Medical Center, Federal Medical-Biological Agency of Russia. “I do scientific research, such as verifying resources and writing publications, as well as presenting at conferences,” says Gennadiy. “It is gratifying to help train the next generation of doctors, just as my mentors did when passing knowledge to me, and sharing knowledge with my peers,” he adds. “If you ask me who inspired me most in life, I would say my teachers in medicine.”

References
http://npic.orst.edu/factsheets/rodenticides.html