6. Follow Up: Dr. Kat Egressy's Trip to Ukraine

In this episode I follow up with Dr. Katarina Egressy, a Ukrainian-American pulmonary-critical care physician at UVA. In Episode 1 we discussed her upcoming trip to Ukraine to provide medical and humanitarian aid. She's now back and I sat down with her to discuss the trip, her reflections on returning to her homeland, and the role healthcare providers play in relieving suffering--both here and abroad.

Topics
- Dr. Egressy's thank you's (01:27)
- Overview of the trip (04:16)
- The one experience that stands out (08:25)
- Reflection on Dr. Egressy's cultural identity and connection to Ukraine (12:51)
- What is the role and duty of medicine in the world? (16:51)
- A love letter (21:56)

Links
- Episode 1 with Dr. Egressy: here
- Dr. Egressy's UVA Faculty Page: here
- Follow Dr. Bell on Twitter

Transcript

Intro

[00:00:00] Taison: Hello, everyone! You are listening to This Medicine Life. I'm your host Taison Bell, a Critical Care and Infectious Disease physician at the University of Virginia. And, if you're like me, you may love being an academic medicine, but it's hard, y'all! The goal of this show is to make that just a little easier through the power of connection. We're interviewing medicine faculty, both inside and outside of UVA. Our goal is to connect with each other, to share our stories, our tips for success, and - together - become the best versions of ourselves in life and career. 

[00:00:37] Taison: Last summer I had Dr. Kat Egressy on the show before her trip to Ukraine. That's the country where she's from. And to remind you, she's on faculty in the Pulmonary and Critical Care Division here in the Department of Medicine. And we had a good conversation. And if you haven't listened to that already go back to the show's home page or I'll link to it in the show notes for this episode.

But she went to Ukraine to check on her family and provide both medical and humanitarian aid. And I had her back to discuss the trip, her experiences, and her reflections. And we ended up having a very deep and impactful conversation. So I'm excited to have her back and let's get right to it. 

Kat/Taison Conversation

[00:01:27] Kat Egressy: Thank you for having me back, Taison. First and foremost, I want to echo exactly the same sentiment that I started off with my first pod. I walk in the footsteps of giants and my trip would not be possible without some of the key people who allowed this to happen. And I specifically want to mention some people by name again, for all of your help that people donated and spoke to me and express their condolences and wished me good wishes. So the folks that really made it happen and really stepped into cover for me when I was gone are obviously some of my colleagues from my own division. So specifically: Dr. Jeff Sturek, Dr. Subodh Pandey, Dr. Alex Kadl, Dr. Kyle Enfield, and my own chief Dr. Imre Noth, and Dr. Mitch Rosner. I also want to specifically thank, the amazing people at our pharmacy distribution and division of pharmacy. 

Jordan DeAngelis, Robert Guanci, and Danielle Griggs. They have been unbelievable in terms of allowing the medication to be quickly put together and then delivering it to me and me hopping over and grabbing it from them and delivering to Ukraine. 

So as we start to talk about my trip to Ukraine, I want to preface by saying that. I went to Ukraine already having done some humanitarian trips previously. And having had some experience with international work in crisis situations. During my medical school, I was in Israel during the time of their second Intifada and specifically was involved in hospital operations of humanitarian aid and delivery of healthcare in the crisis situation. 

Also again, during my medical school I had several trips to Africa and understood how it is that healthcare is distributed and delivered in countries of the third world. But in some ways, although I had all that experience, nothing really prepared me to go back to the country of my origin. Especially a country that I felt finally getting back on its feet and especially people that I felt were finally on the path towards democracy. And people like you and I trying to make just everyday living a normal thing: making hair appointments, going for a mani-pedi, putting their children in daycare and overnight they woke up and they literally had nothing and had to become refugees. Had to flee, had to fight, still have to fight, still have to flee. And now are mostly without electricity and in a war that has no end. 

[00:04:16] Taison: So, how did you get in and what did you do once you got there? 

Kat Egressy: To shorten the really long description of my flight and plight of getting into Ukraine it took some time. And once I finally was in Ukraine, I went to visit my father's family. On the Western part of Ukraine. In that part of Ukraine, which is a small local regional hospital. I brought with me some of the medications or all of the medications donated by the UVA community as well as some of the private funds, and donated my time to try to help in any way I can. 

It would be fair to say that the community that I visited was mostly community that was an overwhelming amount of refugee and displaced personnel. But we did see some who mostly were there for neurological recovery as well as psychiatric support.

It shatters me to say that seeing soldiers both within the VA system here, but also overseas and Ukraine, one sees the devastating effect of conflict. And that was one of the harder things for me to try to deal with as a supporting clinician, but also just a visitor with significant ties to Ukrai ne. 

So things that really shocked me were obviously an incredible and disconcerting change in the country that I believed was on the path to a normal standard of living as well as just an incredible void of people who are trying to escape and people trying to cope. Living a day-to-day life. And understanding why this war has to happen. And that is still something that I am trying to grapple with, um, and trying to understand as too why an unnecessary invasion of Ukraine continues to go on and how people really stand up, not only for themselves, but for democracy worldwide. 

Lastly, I think-- and if this is one of the most important points that I think-- had occurred to me before, during, and after multiple times, is that at no point in time, do I as an American, but also I, somebody who grew up in a very multicultural environment and have had influences and multiple cultures and languages within myself take democracy for granted. And I think at times we tend to forget that. We tend to forget that freedom of speech and freedom of expression and simply freedom of existence is such a dyer and also an important right of human being. And having seen that vasnish in Ukraine overnight, that brought that to my mind even more so. 

So there are a lot of conflictual memory from my childhood really plays out from one family, my family, for the country as a whole, but also for the world. Um, and that in itself is a heavy burden. And understanding that this conflict has no end in sight. And we the people of the United States, but also the people of the world have provided an incredible amount to support to Ukraine. And how Ukraine have been able to really stand up to that. Has been very uplifting. But at the same time, seeing in person lives destroyed and shattered and people in hospital beds trying to recover from PTSD of seeing their friends die. And seeing their loved ones being ripped apart by bombing and shells. Of living in the constant. siren of airstrikes and bombings and drone attacks. That is something that the Ukrainian people deal with every day and children go to school like that. So imagine yourself and your kids having to grow up in that kind of environment. And that is what makes it real. 

[00:08:25] Taison: I'm sure there are a lot of experiences that you could share with us about your time there, but is there one story in particular that stands out to you? 

Kat Egressy: Yeah, thanks for asking. I think the story that, for me, has been incredibly moving and emotional has been a story that we received news one day when I was at the hospital trying to help out of a man being found in the woods wandering. The man was brought into the emergency room to try to be identified. And it took several hours to identify this man who was disheveled and was very confused. He was very much altered even though no toxic substances was found on him. With the story later on during the day and night coming out that he was a father in quite a high position within the government of a nearby local city, who's just recently received a news of losing his son on the front lines. And through a craze of just absolute despair and horror of losing his son he decided to take off by himself walking through the woods to try to get to the front lines, to try to fight the invasion. And so to me, in some ways it and then very painful but very poignant way, really represented the pain of Ukrainian people of trying to get back on their feet, knowing that they are literally losing lives and children's lives and young people's lives and older people's lives every single day for-- for a cause that is really supported by a handful of white, old men in Russia. And that is driving the country insane in some way, because of pain and because of loss. And that has stood with me since then. And I think to this day, it makes me incredibly emotional. Because I empathize with that father who essentially lost his mind in some way due to pain and suffering. And in our profession, or at least I'd like to think so, we went into the medical profession to try to alleviate suffering. And seeing pain so up close and seeing suffering. So up close. I think is the hardest part of being anywhere within the conflict situation or active war situation or a refugee camp. 

I think in the Western environment, when we are equipped with tools and bells and whistles and modern technologies, we at times can guard ourselves and really achieve equanimity of being able to be companions, but not direct players, of human pain and suffering. 

Being within the conflict and being up close to someone's unbelievable pain is incredibly difficult because you take part of that pain and you empathize with that pain. And you want to share and take away some of the pain whereby you cannot or may not be able to. And that leaves, I think an indelible mark on my life, but I suspect on other people's lives as they continue on. And I really hope that this fight for democracy and this fight to stop the suffering and the pain really resonates around the world and really is a call for action for everyone to move towards spreading kindness and empathy to at least the small circle of people we know and love if not a larger one. Or maybe a nationwide one. So, if anything, through this podcast, I really would like to put out a call of action for kindness. I know this sounds trite and this may be overused and our days and age, but being so up close and personal with human suffering and not being able to do much about that, except for bearing witness. I think I, even more, so doubled down on my ability to try to empathize and sympathize with my patients. With people who suffer around me that I know and love. And people that I don't know who are suffering and trying to do something in my own small way. 

[00:12:51] Taison: Thanks for sharing that story. Such an incredibly sad experience, and it must be really frustrating to, as you said, not be able to fix what was happening with someone who was experiencing an acute episode of grief. 

There's something you mentioned that I want to follow up on. You had talked before about how you've been in crisis situations and areas of conflict before, but this was the first time you did this in your own country? So, what was that like? I mean, was there anything about your experience that affected your own understanding of your cultural identity and connection to Ukraine? 

Kat Egressy: Thank you for that question. I think it's an incredibly difficult question to answer for me personally. Um, and here are multiple reasons why: first and foremost I have a very conflictual relationship with my cultural identity as my home country or the country of my birth. Really felt like, um, I was returning to a country that persecuted my forefathers. And so to me, that is very difficult to process at the same time as a country that gave me my birth and has provided my nascent development and early childhood development and that is a country that I owe my own cultural awakening in some ways. The conflict stems also from the fact that a country that I left was really the falling apart Soviet Union. The country that I encountered now is a developing new democracy that is barely struggling on its feet that had now been the fallen by an incredible conflict and war. And so my cultural identity within the country of Ukraine, but also all of the other cultures that I carry within me, like Hungarian, German, Jewish, et cetera. All of them overlay my understanding and my lens of interpretation of any experiences that I've had in Ukraine and any experiences that I've had before and after. 

I think it's probably true for anyone who goes back to their homeland, that they have not visited for some time and carries trauma that we all have, but also experiences of their childhood and trying to uncover that matrix and understand that canvas that brought them up is a difficult thing to do overlaid with now an active conflict. Of war. To me, particularly and saliently, that was very difficult because of how truly complicated my childhood was in Ukraine and what stories enveloped it. 

And so, yes, in some ways it was not really meant to be a trip to have a discovery of self, but in some ways it definitely was that and more. I think we all learn and evolve as human beings and it would be bizarre if we didn't, but at the same time there come points in our lives when we really get to know our true selves. And I feel again for a fear of sounding trite: at some point in time in Ukraine, I really felt like I was my own authentic self and I was experiencing life in it's most acute and it's most raw. 

I think people who have gone through trauma or have gone through difficult experiences in our lives can identify with that. And it is a very well-described psychological and psychiatric phenomenon and it was a difficult experience for me on many levels. 

[00:16:54] Taison: Well that's certainly a lot to process and I didn't even consider that the country that you came back to was actually a new country compared to your childhood growing up. So that was a lot to unpack. 

So now that you're back, you're a practicing in the UVA in Charlottesville community. And this certainly is not a war-torn conflict zone, but it does have its own struggles. So, what about your trip has challenged or changed your understanding of health care delivery, both here and abroad? And what is the role of medicine or really the duty of medicine in the world? 

Kat Egressy: Wow. I think, well, how long do we have to unpack that question? We could be here for hours and maybe even days, and probably still will not be finished with answering that question. To me, I see medicine not only as a clinical tool to try to alleviate suffering, but also as a social tool to provide justice and equity in healthcare delivery around the world. But we cannot really function on the world or an international arena at least I don't. And so the way that I think about medicine and my own practice of medicine is trying to live healthcare delivery and equity and policy in the best way that I can with each and every individual patient. I think the act of humanitarian aid has a lot of potential benefit and potential downfalls in its in itself. However, simply by my presence in Ukraine. I think it was hopeful for people who were around me to see that somebody else cares about their plight and about their suffering. And I think the one thing that I can say to underscore why medicine as a social tool, as well as a clinical tool and the social science is that people were incredibly grateful. And that is something as a pulmonary critical care doctor in the last two years. I did not experience as much. 

I think, you know, as much as I do is that during COVID, we've had a really rough patch. We've had many conversations with families who were suffering and struggling. And they have had maybe different political views or maybe different agendas and it felt like we were all not on the same team. When I went to Ukraine to provide humanitarian help in whatever little way that I did. This was not a joint delivery with Doctors Without Borders. This was not a multi-national delivery of aid. This was a one individual with aid of a university and other amazing individuals. 

What was amazing to see is that everybody was on the same page and people were grateful and they felt seen and they were thankful. And I think the more I age and the more I observe of the human spirit, what we truly desire and what we need is to be seen. And to be valued as a human being. And to have our suffering taken seriously. 

And I think more so for people of Ukraine, but also for our own patients. It is important to be valued as a human being and to be seen as a human being. And therefore medicine, and we as physicians, have an incredibly, I dare say political role to play in terms of really putting a megaphone to all the suffering that we see happening on the downstream. And untangling all of the different etiologies or problems that we see that have led to the suffering in the first place. 

I can count for probably hours of multiple social problems that we use doctors encounter all the time. That we know what the root cause problem is. I mean, the first one, especially with the most recent horrific occurrence on UVA campus, is gun violence. And then we talk about violence in the war torn country and how that is propagated by literally a handful of men who decided that war is the right action. 

So there's much to be said I think as a physician, but also as scientists and also a activist in some ways, in terms of understanding how healthcare is delivered not only locally or regionally, but also internationally. And trying to maybe in the very small way to alleviate and improve healthcare delivery everywhere. And really understand, or at least try to speak to the causes of common day occurrences of chaos that we get to deal with on the end result. 

[00:21:56] Taison: It sounds like an incredibly hard emotional toll just to do this work there. I'm curious what actually sustained you on your trip? 

Kat Egressy: So, um, my trip was sustained by two great motivators. Number one that is selfish and personal is to see my family and try to do as much as I can for them in my small way. But my second motivator is really to try to do as much as I can for the people of ukraine to try to, right. The injustice. 

I, in no way at any point in time, expected to be thanked or see gratefulness or see anything in return. In fact, the way that I interpret humanitarian aid is that I do that because I feel that there is a great injustice that has been done. And I feel so grateful for all of the blessings that I have received in my life. And I want to return in any small way some of the things that I've been blessed with. 

Now the seeing of the gratefulness and thankfulness in people's eyes and people's recognition that somebody else comes from a very long way to give them a very small token of trying to make it right, I think, almost took me aback because I have not seen that as much in the last two years of my clinical practice. And it was unexpected. Delightful, obviously, but in some ways it reminded me is that again people just want to be seen and they want to be heard. And having that recognition is probably the most important part of any clinical care delivery. I think we as physicians oftentimes are prized on our ability to deliver the right diagnosis or perform the correct procedure or do so in the best way possible. And that is all incredibly important. The importance is also on clinical bedside and understanding the patient from their own side to the best of our abilities and really just seeing them and their story. Where they are and what they want and how we can help them on that journey. 

And I think that has not been the case at times in my career but I would like for it to be the case more often than not. And I really saw that by my presence in Ukraine, even in a very small way, people felt recognized and they imbued hope. And I think that is the other thing that is so important and critical is that we carry hope and we are messengers of hope. 

I did not think of myself as a messenger of hope when I went to Ukraine, that was not my mission. But seeing that I saw hope spring alive. And with that work continuing on I think in some ways maintaining hope so it's springs eternal that we the people around the world support the people of Ukraine and their fight for independence, freedom and democracy, is probably the most paramount and poignant topic that we can talk about today. 

I cannot thank you more than I already have, but probably I will in the future. I think I would like this podcast to end on the note as a love letter to my medical ICU team and to all of my colleagues and to all of the colleagues that support us on day to day basis. I feel if I may, it feels that in the medical ICU or maybe the emergency room department or on the front lines it feels like we're a tightly knit unit. And we are all fighting for something. We are fighting for life. We're fighting for someone's family we're fighting for someone's children. We're fighting for a nation. We're fighting for democracy for freedom. And it is difficult and frustrating because there's what feels like insurmountable obstacles that face us every day but at the same time, it is the people that surround us that make it all worthwhile. So it is to the people of the medical ICU, the Division of Pulmonary Critical Care is my love letter of hope, springing eternal and to the people of Ukraine. 

[00:26:33] Taison: You know what? I don't have a better way to end so I'm just going to let this track ride out. Thank you for listening. If you enjoyed the show, please subscribe, write a review and tell a friend. We're available wherever you get your podcasts. This show was created and recorded and edited by me. Music is by Dr. Malcolm Lex, whose wife just gave birth to two beautiful baby girls, Maddie and Ellie. I don't know if this means I'll still get good music from him, but we'll see. Views and opinions expressed do not necessarily reflect the view of the University of Virginia or any other entity. As always, please send me your ideas for topics or guests that you want to have on the show. Please stay tuned for the next episode. And, until then, I'll see you around.