You'll live - and that's fine.
February 21 is Paramedic Day.
Author: Sergey Tashevsky
A paramedic differs from a doctor in that he or she hasn't taken the Hippocratic Oath and doesn't take the well-known maxim "do no harm" very seriously. They're usually simply too busy to care. Their job is to save people. Whether they harm them or not is a secondary concern. They'll live, and that's fine.
Since their earliest days, since the Middle Ages, paramedics haven't been considered doctors. Doctors are wealthy gentlemen, slyly extorting money from their patients, comfortably ensconced in warm beds. And who are paramedics? A rabble recruited for pennies, marching alongside the army and, unlike the generals, trying to limit its losses. They bandage someone, operate on someone, and quickly amputate someone else's leg or arm (under rum anesthesia). And then—off they go.
That's exactly how it was when paramedics first came into being. And, essentially, things are much the same today.
The word "feldscher" is German, with the root "feld," meaning "field," and originally meant something like "field barber, surgeon." In the 15th century, as we know, the division between these professions was still rather arbitrary. Barbers not only trimmed and shaved beards but also (as best they could) performed bloodletting, tooth extractions, wound treatment, and bandaging. All this was considered a "craft," and, as in any craft guild, skills were passed down from senior to junior masters. Without any theory or textbooks, this was done through a simple, visual method: "pull harder, bandage tighter, hold tighter." Not like the "medical art" with its Latin consultations and lace handkerchiefs. "Real" doctors were generally forbidden from staining their hands with blood; they only gave instructions. In Europe, barbers were the primary providers of medical treatment and surgery, and this continued until the Late Middle Ages, when (not least thanks to the Crusades and the teachings of Ibn Sina) surgery became a "noble art." Only then did doctors begin to pick up a scalpel.
But in the armies of the Late Middle Ages and the Modern Period, all hope lay in the "field barbers," or medical assistants. Of course, by the 16th century, their profession had already become a fully independent one, without any additional duties like haircuts and shaves. But strict regulations (like, say, in Ancient Rome, where each Roman phalanx was required to have four medics) did not yet exist. "Field medics" often followed armies in baggage trains, along with camp followers, foragers, and other "service personnel." And there was a constant shortage of them.
Some form of order only emerged in the 18th century, and, of course, in the Prussian army, which was renowned for imposing utter order on everything. A well-established system of hospitals, regimental doctors, and paramedics emerged, with several per regiment. These were no longer "self-taught," but rather medical professionals more or less trained in specialized schools, who even passed exams on strict medical standards. For example, they were required to perform limb amputations in the shortest possible time. Speed in surgery of that era was generally considered a cardinal virtue—since there was no painkiller other than a blow to the head and a hefty dose of alcohol, and the patient could die from pain shock at any moment. So, "crack, and that's it!" Moreover, many believed that a quick operation reduced the chance of infection ("what was quickly raised is not considered fallen"), and although this theory is dubious, to put it mildly, some still adhere to it. In any case, Prussian paramedics successfully saved soldiers' lives, and this model became the model for medical services in armies around the world, including the Russian one.
As early as 1741, shortly after the accession of Elizabeth (who, like Peter, enthusiastically introduced various European innovations to Russia), hospitals began accepting students to care for wounded soldiers. These students, who received a very basic medical education, were then sent to military (non-combat) service and were called feldshers. These were often the children of peasants and artisans, and from the late 18th century, by order of Suvorov, soldiers from combat units were also assigned to become "feldshers" if they demonstrated the necessary abilities and talents. However, feldshers were unable to make a significant career at that time: their position was not included in Peter the Great's Table of Ranks. However, it soon became clear that there was a "path to the top": they could rise to the rank of "physician's assistant" and qualify for a salary of 120 rubles per year. However, this was more of a pipe dream. Often, paramedics were stuck in field hospitals and infirmaries, performing difficult and thankless work until old age.
Nevertheless, their numbers in Russia grew rapidly, because their simple and quick (one to one and a half years) education opened up the possibility of a relatively free life for many. This option was especially attractive for the children of serfs, who became "privileged specialists" on their estates, freed from the drudgery of peasant labor. Therefore, by the early 19th century, schools teaching the craft of paramedics were already established at every hospital, graduating hundreds, and then thousands, of professional "chiropractors" each year. During the War of 1812, two or even three paramedics served in each regiment, and military careers were already open to them: the positions of "junior paramedic" and "senior paramedic" corresponded in military rank to senior and junior non-commissioned officer ranks. And in the second half of the 19th century, paramedics suddenly found themselves expanding into the civil service. Because—reforms!
After the emancipation of the serfs and the attempt to establish zemstvo hospitals everywhere, it turned out that Russia was desperately short of doctors. Sometimes, a single professional doctor with a zemstvo doctor's diploma was forced to travel throughout the province, seeing patients here and there. However, there were more than enough physician assistants, or feldshers! And it was through them that post-reform healthcare "for the people" began to be built in Russia.
It wasn't built without a hitch, of course. The centuries-old antagonism between professional doctors and the barely educated paramedics, who were now allowed to perform many of their functions, flared up with renewed vigor. Incidentally, it's beautifully depicted in Chekhov's story. "Surgery" (written in 1884, as they say, "from living material"), where a semi-literate paramedic, unable to extract a village deacon's tooth, is portrayed with utmost contempt: "...paramedic Kuryatin, a fat man of about forty, in a worn chechuncha jacket and frayed tricot trousers. His face expresses a sense of duty and pleasantness. Between the index and middle fingers of his left hand is a cigar, spreading a stench."
Anton Pavlovich's irritation is understandable: self-assured upstart paramedics, having seized "medical power," not only committed medical errors but also discredited the work of doctors. But on the other hand, for ordinary peasants, even such medicine was better than none. And with the advent of retraining systems and medical periodicals (at the end of the 19th century, several professional journals were published for paramedics in Russia), their literacy significantly increased. And by the beginning of the 20th century, when more than 27 paramedic schools were already operating in Russia, the paramedic's figure in the eyes of the general public ceased to be comical. And soon, heroic qualities began to be seen in them.
The First World War, of course, is to blame. Without the daily work of paramedics, it would have claimed many times more lives, and their heroism was now valued almost more than the valor of soldiers. Young men from wealthy families, artists, philosophers, and poets became paramedics, orderlies, and nurses. For example, Nikolai Bruni, the son of an academician of the Imperial Academy of Arts, spent a year as a surgical assistant on a medical train. But, of course, one of the most famous paramedics (or rather, nurses—during the war, they often acted as paramedics, performing surgical operations) was Alexander Vertinsky, who volunteered for the front during World War I.
Vertinsky's work on the 68th medical train, which traveled between the front lines and rear hospitals, has become the subject of many poignant legends, some of which the great artist himself contributed to. Judging by his memoriesHe was clearly proud of these pages of his biography, even though he worked as a nurse for only a few months, from the fall of 1914 to January 1915 (he then returned to Moscow, where his meteoric career in pop music began). However, according to his own records, during this period he performed 35 dressings.
35 in a few months? It seems impossible. But it seems like that's what actually happened:
“I didn’t close my eyes for two days. The Germans were firing explosive bullets, and almost all the wounds were serious. And I was the only one bandaging the seriously wounded. I did the most important work—washing wounds and removing bullets and shrapnel. My hands were, so to speak, ‘sacred’—I wasn’t allowed to touch any foreign objects or things with them. The nurses and assistants changed every five hours, but I remained. Finally, the influx of wounded dried up. Having stood on my feet for almost two days, I was exhausted. While washing my hands, I remembered that I hadn’t eaten anything for a long time, and went inside the greenhouse, where the staff quarters were. The wounded were lying around haphazardly—on stretchers and without, moaning, crying, delirious. Some blue-red circles were spinning wildly before my eyes, I was staggering like a drunk, barely able to comprehend anything. Suddenly I felt someone grab my leg. "Sing me something," the voice asked. I bent down and squatted. Sing? Why? Was he delirious? "Sing... I'm going to die soon," the wounded man asked. As if in a dream, I sank onto the edge of the stretcher and began to sing. I don't remember if I finished the song. In the morning, my comrades had difficulty finding me in a pile of human bodies. I was sleeping, my head on the chest of a dead soldier."
This story—with a song for a dying man—repeated itself exactly 80 years later, when Yuri Shevchuk sang his “Autumn”:
"In a hospital basement in Grozny, where several surgeons and nurses, stupefied by lack of sleep and the screams of the wounded, poured rubbing alcohol into the black mouths of soldiers, cutting and shredding torn limbs and stomachs on raincoats... A paratrooper approached me and whispered: "My brother is dying, asking for you..." Making my way to the exit, littered with stretchers with the wounded, along the steps slippery with mud and blood, I saw a young man lying by the door, already white from blood loss, with his legs torn off. He looked at me and, overcoming the pain, shyly, as if apologizing: "Sing "Autumn", please, I recently heard it at my high school graduation..." Swallowing all the crap that had accumulated in me, I sang... sang... By the end of the third verse, he died..."
This is how everything repeats itself in this world. War, bloodshed, senseless death. And desperate attempts to save a life. But the rank of "paramedic" hasn't existed in the army for over 80 years. Now it's lieutenants, warrant officers, and privates in the medical service. Paramedics—they're in civilian life. Ambulances, physician assistants, hospital medical staff. And that's only in Russia. In Europe, the word "paramedic" has long since sounded archaic. There, they're called paramedics, assistants...
And yet, the essence remains the same. In the West and in the East, in Israel and Palestine, in Russia, in America, in Ukraine, they all wage a desperate battle with death every day. They have no time to figure out who is right and who is wrong, who is a hero and who is a villain. They are on this side of life. And if something happens, they will do everything to ensure that you, too, are on their side.
You'll live - and that's fine.
