In my first couple of essays this past week addressing the question of what Russian medicine looks like from inside the beast, I was largely positive about the operations of the Mariinsky Municipal hospital where I was being treated for Pneumothoras (collapsed lung) consequent to being knocked down by a car in front of my hotel.
And I open this essay with a frank expression of gratitude to the hospital staff for saving my life.
So much for the Big Picture. Now let us move on to the realities of this past week which were a week spent in hell, with much of the suffering unnecessary if hospital care were reorganized here, not just in this one hospital but in Russia generally, because what I describe here is the rule not the exception in Russian medicine.
I am well aware that subscribers to this substack account are favorably disposed to Russia, that many of you would happily come here to experience Russia for yourselves. For that very reason, I issue this essay so that you understand the risks that face you in case you need medical attention, especially hospital care.
I address particular attention to how they deal with patients’ pain, because this was the single most devastating element of my time in the hospital and does not require capital investments, changes in personnel hiring or anything complicated and expensive as require my other observations of what is wrong in their hospitals.
I have in mind the very rare use of general anaesthesia in Russia, when it would be entirely possible to spare the patient the kind of excruciating pain that was inflicted on me 4 times in the past week:
first when a tube was inserted into my right lung to evacuate the air that had entered the thorax and compressed the lung, then twice when it was discovered that the tube had become wrongly lodged and was not facilitating the evacuation so that it was removed and a new tube was inserted. Then finally, yesterday, when that tube was pulled out.
In Belgium, everyone undergoing a colonoscopy is offered the option of general anaesthesia. This has a medical benefit, because it keeps the patient steady, without twitching at each move of the probe. But it also eliminates the discomfort bordering on pain from the probe itself.
Here, the insertion/removal of the tubes inflicted terrific pain, the sort that causes you to black out, without a thought being given to general anaesthesia, or even to strong local anaesthetics. The needle injections of some pain killer around the point of entry of the tube were less effective than what your dentist administers before treating a cavity and they did not wait one minute for even that to take effect. In the best of cases, these local injections could treat only the point of entry and not the pain delivered deep in the chest by the tube’s positioning.
I do not want to sound categorical. One of my ward-mates told me that in his abdominal surgery they used general anaesthesia and he came out fine. But for non-invasive surgery, the Russian philosophy seems to be ‘grin and bear it.’ And for post-operative pain, very little is offered. Another ward-mate in our 3-bed ward who was recovering from a knife stabbing by a disgruntled employee, suffered terribly each evening without adequate pain killers being administered.
In my ward no one slept at night, most likely due to untreated pain. When I returned to my hotel yesterday, I went to bed and slept deeply for 8 hours as partial recovery from sleep deprivation of 6 nights.
Now, I move on to problems with the hospital administration that do have remedies that are not costly if anyone cared to pay attention.
First, the food. The meals were heavily composed of hot cereal or potatoes 3 times a day, with a chunk of ground meat at lunch or dinner, and with some broth or light soup. I like cream of wheat and hot oatmeal. But not 3 times a day. And not when I am immobile as nearly all the patients were. If you go out and chop wood all day, the caloric hot cereals are a blessing. If you lie in bed all day, they turn to cement and clog your intestines. No wonder that my fellow patients and I refused the meals after a day or two.
Second, the manner of address to patients by the hospital personnel which deprives you of any shred of dignity and sharply depresses your morale. In an earlier essay, I pointed out that the support staff, meaning orderlies, janitors, the guy who brings you the meals are quarrelsome nags who speak to you as ‘boys and girls’ or ‘hey, you!’ Who are they? Why are they so rude and offensive? I speak now not just of the female staff aged over 50 but also for their male colleagues of similar age. It is a safe guess, confirmed by Russian friends who visited me in hospital that the lower level personnel are all out-of-towners living at the edges of this metropolis who are not favorably disposed to the urban population and who also, as very underpaid employees, make class war remarks to your face. When I asked if I could just have some soup for dinner, the hag who was serving remarked tartly: “this is not a resort! Go downstairs, go outside and walk to the restaurant on our territory and go eat what you want!”
I initially praised the Russian hospital for having so much personnel on hand to ensure 24/24 surveillance of the patients, all of which compares favorably with the situation in Belgium, France and Germany where support staff is in short supply because these employees came largely from Africa, from the Middle East and Southern Europe who cleared out during Covid and never returned. But, our Gastarbeiters in Belgium were/are all very respectful and kindly towards the patients, not resentful and aggressive as is the case with the Russian support staff in Russia. It would be better if they had here more Central Asian or Caucasus orderlies and helpers, since they too will be better disposed to the patients. And the total number of support staff could be reduced so as to give those in employment real living wages.
Now a word about the professional medical staff. They are good, without question. The senior doctors work as a collegium. Each morning five of them came to visit the wards and to speak with each patient. However, the treating doctors are all younger women, seemingly recent graduates of medical school. What will be the career progression of these women is unclear. Let us remember that from Soviet times, the medical profession was mostly populated by women and was systematically underpaid. Males predominated in dentistry and gynecology, which were uniquely well paid domains.
My closing advice to the Community is to avoid hospitalization in Russia if you have any chance to get out of the country on the first plane. I did not have that option and paid the price. I cannot imagine how someone who does not know the language will survive the experience intact: no one in the Mariinsky Municipal Hospital spoke a word of any language other than Russian.
Copyright Gilbert Doctorow, 2026
