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07.06.2012

PORTRAIT OF A DOCTOR: MIKHAIL DAVYDOV

He is a little modest, joking, his speech is fluent and understandable. He does not put a wall between himself and interlocutor. But quite clearly understands himself and others. He is calm and balanced, but not cold. Rather tough and hot where he feels he is right. Bold and daring scientist who determined in many aspects the development of oncology in Russia. Today, he tells about himself.

– Please tell about your normal working day.


– The schedule was shaped many years ago, and in principle remains the same. At eight o'clock I am at work. First of all I go to the emergency room to get to know condition of patients. Then I meet with my deputies, we discuss plans for the day. Then I held a conference and go to the operating room.

– Do you operate every day?


– Yes. I usally perform operations in the most complicated cases – reinterventions or removal of several organs at once or presence of severe comorbidities. These cases are the most risky ones. Most often these operations involve the abdominal and chest. After operation again meeting with heads of departments, theses, academic councils, patients.


– Have you ever counted your operations?


– I did not count them myself. My collegues did that – the last time in 2008. At that time there were about 15,000 operations. I have one of the largest personal experiences in the world for operations of the chest and abdomen. In the world ranking of surgeons, compiled by Americans in 2001, I was included in the top five surgeons in the world.


– More than 15,000 patients - a huge figure. How many of them do you remember?


– Yes, I remember many of my patients. Maybe because it was always difficult cases, major operations, always risky ones. I've never dealt with plastic or emergency surgery. I always had major operation - for example, when I pull out of the stomach seven or eight organs and then put them back. Recently, a woman called me from Tbilisi; I was her doctor in charge some 27 years ago. And I remember her. It was in another building, there was a very difficult complication, almost deadly - an esophagus tumour breakthrough. I was a surgeon on duty, performed emergency surgery, and she survived. And there are many such cases.


– Are you worried before operations?


– Now I am already not worried. But for a long time I used to be worried - the first 15 years, probably. But now I know that I can get out of any situation, because I have enough experience and knowledge. And if I have not succeeded in it, than nobody else could do it. Even during critical situations, I am absolutely calm. If you start to worry, it affects negatively on your assistants, on the patient and on you personally. It interferes with work. Even in acute situations, I can not allow myself to worry.


– You supervise hundreds of students and young doctors. Some of them came into the profession by chance; some will become good physicians, but not outstanding ones. How about talents who will achieve a lot, do you easily distinguish them?


– There are not so many of them. Maybe two in a hundred, who can manage to become a great master. And it does not mean that the rest of them are mediocrities. They dream of becoming surgeons, try hard. But good education is not enough; there are basic human qualities that are important for a surgeon. A surgeon should be sturdy, not fall into hysterics, be able to make quick decisions and not be afraid of it. And be a decent person.


I recall a case when I was still an intern. The thoracic surgery clinic was led by Boris Sergeevich Peterson. He operated on a young woman and at the stage of lung revision considered that the tumour is benign. He remove the tumor but spared the lung. After the operation, he told a woman that everything is OK. A week later the result of a biopsy appeared – it was cancer. He went into the ward himself and said that he was mistaken and will perform a recurrent operation. It takes courage - to admit your mistake, tell a patient outright, and then do another operation.


– So, a good surgeon cannot be a scoundrel?


– I have not met such surgeons. The character can be difficult, tough. But surgeons are not scoundrels. This is the hardest work that dishonest people just can not stand. Difficult operations, a constant lack of sleep – up to to five awakes a night: a patient is bleeding, does not breathe and so on. I will have a guilty's head for the slightest complication after surgery. And let me I assure you this is not work for money.


We often have to work on the edge. We often do what we should not do. But we do not work formally, we are saving patients. Just imagine a patient in the operating room, who is operated for the third time. There are very difficult anatomical complications, function of vessels is impaired, but nevertheless, I operate to remove a tumour. In principle, no one forces me to do it. Well, it's cancer, a far-gone process involving six organs. No one would dare to accuse me that I refused. Neither court, nor lawyer. But a patient came across the country and he or she hopes that I can help - and I just have to work.


– Should a physician love people?


– Of course. Otherwise, he or she will not be able to work because people will irritate him. Moreover, a physician must actually love a person and fight for him/her until the last minute. I often scold doctors at our center - not because their poor work, but because I'm a perfectionist. I'm annoyed, if the work is done mechanically, without the initiative, inertly. I tell them: "How would you work if it was your mother on the patient plate?" That is my philosophy. You should treat a patient who is on the plate with an open chest or abdomen as your closest person.


– And patient's death is painful?


– Of course! It is very hard. When a patient dies after surgery - feelings are horrible. Simply horrible. It is especially scary if the patient dies as a result of your mistake. But another thing is when the patient was operated perfectly but suddenly a heart attack happens. This is impossible to foresee! It's not your fault, but it is offensive. You tried hard but could not save a patient.
But I am a favourite - this rarely happened with me. Even in my younger years, when I was not so experienced, most operations were successful. I was always working at the cutting edge of new technologies, when nothing was in place yet. Oncology meant amputation only. Today, 95% of patients with bone tumors retain the limb. But earlier it was amputations in 95% of cases. I was developping new technologies, and Nikolai Nikolaevich Blokhin was very angry about this.


– You risked and he thought you were an adventurer?


– Yes. He said that we have doctors whose arms run ahead of head. He scolded me, reproved, but not killed. While he was the president of the Academy of Medical Sciences, and I was a research assistant – an insignificancy! And I sometimes found myself in different situations. For example, there was a woman with diseased arteries. She was advised by Boris Vasilievich Petrovsky - then Minister of Health, Academician. He wrote the conclusion with his academic gold pen that surgery is not indicated for that patient. But I ventured. And she died. At the conference, Blokhin furious asks: "Who is cleverer: Davydov or Petrovsky?!" My answer was that the question is incorrect. I never tried to compare intellect with him, maybe he's smarter, maybe - no. Blokhin kick me away from the conference, and I was sure he will fire me. I went to the administration myself, even wrote a resignation notice. I went to him, иге he calmly asks: "Misha, why are you so depressed?" "Why should I be happy, there is no reason for joy." "But you want to become a surgeon. The surgeon must be calm. Go back to work."


And then he made me the head of thoracic surgery clinic. Over professors' heads, when I was only 36 years old. It was in 1988. And in 1993, he called me again and said that Vadim Gerasimenko, director of the Clinical Institute, became ill and unable to work.


– I think you fit this position.


– What?! How?!? Well, I just got the hang of my clinic!
But he said that I was the only multidisciplinary surgeon and I fit well. And I took it up.


– Were you in doubt about yourself?


– No, I'm not easily frightened. I was sure I can cope. At the morning conference and dared to "scold and stifle" professors for their negligence. But when you together with your colleagues are "in the trenches" of twenty-two operating rooms every day, your authority will be professional, not the administrative one. They had nothing to put forth against me. And they listened to me. And then in 2003 I became the Cancer Center director. I think I will work for another five years and retire.


– What are you going to do in retirement?


– I am a crazy hunter! I hunt all beasts, everywhere. Got 52 bears. I will be hunting in retirement.


– Why this passion for risk? You do not have enough adrenaline?


– Yeah, you know, is not enough. I became indurate. Previously complex cases, difficult surgery, risk excited me. But now I am calm. Like an alligator that saw a chicken. I know I'll grab it. But when you come up to a bear at night – it's courage! A bear is a dangerous animal. Unlike others, it attacks. You actually have only one shot - but if you hurt the beast, it will run at you. The second shot will be at close range. It's natural selection.


BIOGRAPHY

Davydov, Mikhail Ivanovich, was born on October 11, 1947 in the town of Konotop of Sumy region of Ukraine. In 1966 he graduated from the Suvorov Military School in Kiev, served three years in the Airborne Troops. In 1970 he enrolled in the First Moscow Medical Institute named after Sechenov, worked as a laboratory assistant at the Department of Operative Surgery.
He passed residency training (1975 – 1977) and graduate school (1977 – 1980) at Blokhin Cancer Research Center. He defended his Ph.D. thesis ("Combined resection and gastrectomy for cancer of the proximal stomach") and doctor of medical sciencies thesis ("One-stage operations in the combined and surgical treatment of esophageal cancer"), received the title of professor. In 1986 he became a leading researcher at the Thoracic Department. In 1992 he headed the Institute of Clinical Oncology of the N.N. Blokhin Russian Cancer Research Center and in 2001 he became a director of N.N. Blokhin RCRC.
In 2003 he was admitted a member of the Russian Academy of Sciences and in 2004 – a member of the Russian Academy of Medical Sciences. In 2006 he was elected RAMS president and He held this post until March 1, 2011.
During all his professional life, Davydov was developping new methods for surgical treatment of tumors of the lung, esophagus, stomach, and mediastinum. He has developed a fundamentally new method of gastro-esophageal intrapleural and esophageal-intestinal anastomosis. The application of mediastinal and retroperitoneal lymph node dissection improved the results of treatment of the esophagus, lung, and stomach cancers. Davydov was the first in oncology who began to conduct operations with plastic surgery of vena cava, pulmonary artery, and aorta. He developed a method of combined resection of the esophagus with a sleeve resection of trachea and tracheoplasty for esophagus cancer complicated by esophageal-tracheal fistula.
Under the leadership of Davydov 70 doctoral and 100 PhD theses were defended. He has authored or coauthored more than 300 scientific papers, including three monographs and six scientific and methodological films.
For his activity Mikhail Davydov was awarded the State Prize of Russia and the title of Honored Scientist of the Russian Federation.