On backbone, music, dynasty, life’s turns and the final choice
— What’s troubling you, Doctor?
Nothing. I try to be thankful for everything Heaven sends. When you spend a lot of time at the side of seriously ill people in an intensive care unit, you start realizing that you are lucky if you have a chance to wake up in the morning, see the sun and talk to other people. I dealt with strokes for many years and my patients literally lost the ability to speak, they suffered since they were unable to express their thoughts. They tried to say something but others failed to understand them and sometimes patients did not understand what others said to them. It is agonizing.
One needs to value the very fact that we are alive and in good health, we can see, hear, speak and fulfill our ideas and plans.
— Often times, people who are on the brink of a catastrophe pray to God to save them, swear they will lead a righteous life, give up smoking, drinking and cursing, but as soon as the danger fades, they forget their promise and return to their devious ways.
A person has to keep his word. I find that my willpower helpful, which connects me with basic human values. In fact, this is how my day usually starts. You can create a space around you and remain inside for some time. That includes a morning conversation with yourself and even the music you listen to on your way to work.
— What music do you like, Veronika Igorevna?
It depends on the day I have ahead of me and for whatever things that I have to get ready. For instance, there is music for the brain's left hemisphere. Mozart and Vivaldi frame things by creating an emotionally smooth and spiritual atmosphere. Rachmaninoff and Tchaikovsky suit the right hemisphere more, they set a different tone.
Sometimes I listen to jazz music, especially if I need to relax on the eve of some serious events…
Life always gives you little joys. In particular, communicating with other people brings joy because everyone is an interesting person in their own way. The most important thing is not to let your day-to-day routine overwhelm you. Someone who is not well prepared sometimes has difficulties in dealing with the daily routine of life. It seems that you have reached a dead-end, you are facing a wall and see no way out. You get swamped with negative feelings instead of positive ones, which makes matters even worse.
No matter what happens, from time to time I hold some sort of psychotherapy meetings with my close staff. Such gatherings make it possible to work in tough settings for a long time and draw positivity from your own inner world.
— How does it look in real life? Like an open lecture or a session with a shrink?
More like the latter. There is an oval table in my office where 10 to 12 members of the Health Ministry's central team can sit - my deputies, aides, department directors - there are 17 of them at the moment.
I gather personnel who deal with an issue currently under discussion. I try to help them get their minds right to solve the task they are facing and warn them that they should not expect the press or social media to show any immediate positive response. There are other things to be concerned about. Everyone needs to have an inspiration from the inside that would make them believe in themselves. Otherwise, it is impossible to cover a difficult road and achieve the desired goals.
— Where and how did you get your inspiration for medicine, Veronika Igorevna?
I consider my job to be a service and I know why I came into the world of medicine.
— Since you have four generations of doctors before you, from you grandfather Pyotr Avraamov, a professor at the Military Medical Academy in St. Petersburg, to your father Igor Skvortsov, a professor, an MD and a renowned neurologist, I don’t think you even had a choice.
In fact, there is always a choice. I was a very creative child, I have a great ear for music, I played piano since I was four, I studied at the Gnessin School and thought about going to a music college…
I went to a math school, I was a fan of mathematics, won various math contests and graduated from school with a gold medal.
In short, my life took many turns. Sometimes, I thought long and hard about my further development. Medicine was not the only option. However, at some point I came to realize that I am mostly interested in the human brain, in the way that it works, controls our bodies and connects the body and the spirit.
By the time I graduated from school, I had concluded that I want to study the brain and it was the reason why I went to the Second Moscow State Medical Institute.
— You chose to specialize in pediatrics…
In my view, the Pediatrics Department offered the broadest and deepest knowledge. You study things from the standpoint of age-related changes, starting from the moment of conception. I have always been fascinated with how the brain is formed, how things first develop and then fade with time. These mysteries were my guiding light.
In my second year of studies, I engaged in research and published my first scientific article, which was included in a compilation dedicated to a national immunohistology congress. The prostaglandins had just been discovered and I studied their influence on the human body.
In my fourth year, I delved into neurology.
I graduated with honors, I had never gotten a single B, and so I was a straight-A student if you will. I didn’t get my grades by cramming or sitting and studying endlessly, I liked to learn. By the end of my medical residence, I was already working at a hospital headed by my teacher Academician Yevgeny Ivanovich Gusev and had already collected enough information for a thesis. I got my master’s degree ahead of time, in 18 months.
I continued to work under Yevgeny Ivanovich. In 1989, I managed to help a patient in a coma, who had been admitted to a general intensive care unit. That night I was on duty as a neurologist. Though I was a very young doctor, I tried my best to use all the knowledge I had to help people. As a result, the patient awoke in the morning. When Academician Gusev learned about it, he suggested that I set up a neurointensive care unit. This is how I took the helm of a new unit at the age of 29 and created it from scratch. This happened at the City Clinical Hospital Number One...
For several years, I only went home to sleep and then returned to work. I pulled people out of various comas. The knowledge about non-specific brain structures that I got interested in while at school, allowed me to unlock certain mysteries. I introduced a multidimensional system to monitor the functional activities of the brain, these methods were new back then. It was not a simple electroencephalography but a full examination involving spectral and coherence analysis, as well as topographical mapping. The evoked potential and magnetic stimulation methods also were a new thing. Vertical chains were studied separately. We could see how various brain regions responded to damage and interacted with each other.
The most important thing is that we monitored the condition of patients for several days, starting from the very first hours after the stroke, which allowed us to detect the most interesting patterns. For example, in the first three to five days, depending on which part of the brain had suffered damage, there is not a single structure that would work normally. It is possible to use the malfunction to make the unaffected parts of the brain take over the job that is usually done by the those currently damaged and thus offset their weakness.
This was the issue I tackled and this is what my MD thesis was dedicated to.
— You became an MD at 33.
I was extremely excited about my work. Depending on monitoring results, we started to use various neuroprotectors – substances that protect the brain. In fact, we created customized cocktails for each patient. It produced good results.
— Did you count the lives that you have saved?
I never kept count but we can estimate the number right now. About 1,500 patients went through my unit in a year, when I headed the Russian National Research Medical University's Neurointensive Care Unit at the City Clinical Hospital Number One for eight years, until 1997.
— What was the most severe case?
We once brought a patient out of a coma on the 91st day… What is ‘severe’? Cases are different. Sometimes, if the brain is still alive, even cardiac arrest does not mean death. We saved many such patients. Clinically dead patients can and should be cured. But when the brain cortex ceases to function and the encephalography device shows a straight line instead of a curved one, it is indeed the end.
Today’s intensive care methods make it possible to turn almost any form of coma into the so-called vegetative state, when only deep brain structures and the brain stem continue to function. Such patients are unable to fully wake up, they only retain the sleep and wake cycle. If we don’t mince words, it is a vegetable existence.
However, the task has always been different – to help the brain recover in full. In most cases, we were successful. Moreover, we could give a head start to almost all of our foreign colleagues.
In 1993, I completed my MD thesis and focused on the development of methods of neuroprotection. It was when Academician Igor Ashmarin initiated the extensive medical use of peptides, special molecules that live in human body for only a few seconds, but kickstart a chain of cascade reactions that have prolonged and versatile effects. We were the world leaders in choosing effective methods to neuroprotect the brain though the term ‘neuroprotection’ was invented later.
In 1994, I delivered a long report about metabolic protection of the brain at an international scientific conference in Germany. Judging by the response of my colleagues, it was received well. During the very first interval between sessions, I was offered three employment contracts to choose from: at a Massachusets neurology center near Boston, at The Charite clinic in Berlin and at a large Spanish clinic. I thanked them for the opportunities, but I didn’t sign any contracts.
Because I was really into my work in Moscow. Besides, I understood my responsibility to the team that I worked with. In 1997, I was entrusted to head the independent Department of Basic and Clinical Neurology at the Russian National Research Medical University, where medical and biological students studied – biophysicists, biochemists and medical cybernetists. Time showed that I was right when I decided to stay. I started to get invitations from the world’s leading neurology clinics as a visiting professor.
— What about your knowledge of foreign languages?
My English was not good back then, I only studied it at school and university. When the need arose, I bought a wonderful four-volume teach-yourself book by Carl Eckersley with cassette tapes and started to study thoroughly. At the same time, I watched films in English with English subtitles, which helped to understand spoken language.
I also began making short trips – which lasted between a week and a month – to work at leading neurological clinics in the US, Great Britain, Germany, Austria and other countries… I met my foreign colleagues and established good personal and working relationship with many of them.
In 1996, I was elected Secretary General of the European Stroke Council, while I also entered an international group of top experts on neuroprotection. We actually outlined major development directions in this area of medicine. In 2001, I became Executive Director of the World Stroke Organization.