I am a retired paramedic formerly with the New York City Fire Department. I now occasionally do nongovernmental organization-volunteer work overseas. In 2017, I worked with NYC Medics in Iraq during the battle to retake Mosul. Last year, I spent time with a medical team bringing care to migrants on the Texas-Mexico border. At the end of May, I went to Lviv, Ukraine, to volunteer with an NGO doing medical evacuations, Global Response Management. We took patients out by road to care centers within Ukraine and other European countries. Almost all of our patients had trauma injuries from the continuing battles on the Russian front in eastern Ukraine — the Donbas region, which is the current center of fighting in the war. I worked alongside two amazing female paramedics from Alaska and an equally impressive female nurse/paramedic from Illinois.

Here are the field notes I wrote during part of my stay. It begins with Day 5, when I arrived in the country after several days’ journey to get there from New York City. It ends on June 6, 102 days into the war. — MARK SHILEN

Ukraine
Day 5, June 1, 2022

The western half of the country is like other old Eastern European cities. Life here is almost normal. The outdoor cafes and restaurants are filled with people. The stores are well stocked. Children play in the parks.

Then you notice the plywood covering the cathedral’s stained-glass windows and various monuments surrounded by sandbags. An unusual number of men are in uniform. The air-raid sirens have not gone off for me yet. I think the city has not been hit by aircraft or long-range missiles. The threat hangs over daily life.

The NGO I am working with is helping to transport wounded patients away from the fighting in the Donbas. Some patients are sent to local hospital, but not all medical treatments are available in Ukraine. Ukrainian airspace is closed to all nonmilitary aircraft. So on other days, ambulance caravans are organized to take seriously injured patients to other countries. These are long, difficult journeys and very hard on people with battlefield injuries.

Today everyone had some kind of amputation. We met 10 elderly civilians at the Lviv train station, all with amputations. We took them to a rehab hospice deep in the countryside. The last 50 miles was on dirt and rock roads through enormous agricultural fields and small villages. I have been in many of these kinds of places. They are invariably horribly depressing. This one, in the middle of nowhere, dilapidated and equipped with an outdoor toilet, however, was warm and loving.

We were all quite moved by the vibe. We were starving and the hospice had unexpectedly organized a simple, delicious dinner of mashed potatoes, chicken and cucumber salad. There is an 11 p.m. curfew in Ukraine. Ambulances are exempted. We arrived back at our quarters at 4 a.m.

Ukraine
Day 6, June 2

A very long day. The air-raid sirens went off last night. I had been mistaken. The Russians lob a missile in this direction about once a week. The city center where I stay has not been hit. This last strike hit a supply depot just out of town. No deaths.

The hotel loudspeaker said everyone should come to the lobby. I went down. It was empty so I went back to sleep.

Up at 4:30 am. Big transport from a local hospital to a transfer hub outside Ukraine. Because Ukrainian airspace is closed, all transports are done by ground. Today we have 36 patients, 13 ambulances and 2 passenger vans.

These caravans are complicated to organize. Patients are stable but need treatment that is unavailable in Ukraine. My patient suffered a severe blast injury in the Donetsk fighting. Paraplegic — spinal column severed — and no feeling from the chest down. He also has a shattered right shoulder, which is possibly infected and causing extreme pain. We inject him with 5 mg of morphine and this gives him some relief. Then, about an hour later, he stops breathing. Luckily he revives and is again completely stable after less than a minute. Truly an anxious moment. There are further problems with a drainage tube but he continues to be stable, though in pain.

After about four hours, our convoy arrived at its destination. This was a rough, painful trip for these patients. An enormous hospital plane was on the tarmac waiting for us. The transfer process was impressive. The staff was huge, including paramedics, nurses, doctors and even anesthesiologists.

Our crew had a hearty lunch with all the other ambulance people. The choice was meat or no meat. The vegetarian food turned out to be surprisingly tasty.

We then headed back to our base, anticipating a 2:30 a.m. wake-up to transport a patient to a location about nine hours away. Hoping for a few hours’ sleep.

Ukraine
Day 7, June 3

Check-in at location: 1:30 a.m.
Checkout: 6:30 a.m.

We picked up the patient at a local hospital. He was 34 years old and had blast injuries from fighting two months ago. He had extensive operations in the lower spinal and abdominal area. Nonambulatory, alert, oriented, animated and traveling with his wife, who is very attentive to his needs. True love when you happily clean up a bed pan three times. Constant suction drainage during transport. In considerable pain from the bouncing of the rough roads. Never complained. A German M.D., Dr. Willie, 78 years old, was supervising transport and gave him painkiller injections a couple of times.

Mad dash to get to the airport through beautiful farm scenery. Problems crossing over a river. We get through. Now a lot of pressure to get to the 4 p.m. plane waiting for us. Fast, white-knuckle driving. Arrived at the airport a bit after 4. But it was O.K. Connected with our other ambulance, which had left at 2:30 a.m. for the other pickup.

Airport security is strict. Mirror check for bombs under ambulance. Only driver, patient and one medical person allowed on tarmac.

Spent the night at another curious hotel. Jolly time with other crews. Local wine and local craft IPA are quite good. Along with pasta quattro formaggi and even Japanese sushi.

The country has a Mediterranean feel. Lots of grapevines in the countryside. Wine culture as opposed to vodka culture.

Ukraine
Day 8, June 4

Travel day.

Another crew are off to southern Ukraine to pick up a patient. We were refused permission to accompany. Deemed too close to the front by the NGO masters. Bitterly disappointed: this place is one of those exotic cities I have always wanted to visit.

Headed back to our base at 10 a.m., no longer hurried. No rivers to cross.

Smoother sailing at customs.

Stocked up at a bus station on wonderful strawberries and other things. Tempted to buy cabbages and tomatoes. They looked so good. No real tomatoes in New York till August. Restrained myself.

Fuel is now a big problem in Ukraine. Severe shortages, rationing and long gas lines. We are limited to 100 liters [about 26 gallons], assuming we can find a station with fuel. Ambulances carry jerry cans. Any run has to be calculated according to its fuel consumption.

Arrived back at base at 8. Air-raid sirens went off twice but ignored them and went back to sleep.

Ukraine
Day 9, June 5

Had a brief sit-down with one of the team’s trauma surgeons operating in Donetsk. He had a graphic portfolio of his work there. Many blown-up, destroyed bodies that they tried to piece back together.

Also met our new security coordinator, a 23-year-veteran of the British SBS [Special Boat Squadron]. This outfit is like our Navy Seals. Impressive man. Very friendly, low key, delightful company. Obviously capable of great violence.

I am struck by the religious devotion of Ukrainians. A constant stream of shrines along the roads depicting the Virgin Mary and Christ. And everywhere, onion dome Orthodox churches.

At 9 a.m., embarked on a nine-hour drive to pick up a patient for transit to another country the next day. Two ambulances, in case one broke down.

Arrived at our pickup at 8:30 p.m. We were put up for the night in a mental hospital. Staff was very nice. Gave us terrible food and warm Sprite but that is what they had. Then they closed the iron gates and locked us in for the night. Spooky.

I am spending a lot of time on the roads and I have not seen any military equipment anywhere. Stuff must be pouring into the country. Perhaps it goes at night.

We have been making long journeys and it is almost impossible to tell that a brutal war is going on. We encounter many sandbagged checkpoints with steel tank traps.

Placid, tranquil, unhurried. The vast fields are all planted and are beautiful shades of spring green. A fellow with a pretty girl pulled into a gas station in a two-seat sports car. I must be misreading things. Or the war, bloody as it is, is just so localized in the east that there is this veneer of normalcy to an outsider. Random rocket attacks all over the country but except for the east, no fighting. Roads, bridges, trains intact.

Ukraine
Day 10, June 6

The staff unlocked the doors and as we pulled out asked if we were being paid. We told them we were volunteering. They thanked us. Nice to get a pat on the head.

We were promised 100 liters of diesel. They gave us only 50. Combined with our other fuel, enough for the 12-hour journey to our next destination.

At another hospital nearby, we meet our patient. Married, with a 2-year-old child. Not regular army. In civilian life he had been a beer salesman. He had joined a  volunteer defense corps as an infantryman and was shipped east. On April 22, during a battles in the east, he met a Russian tank and his war was over. The last thing he remembered was being treated by a female medic who was then killed by a sniper.

The emergency drugs knocked him out. He regained consciousness in the hospital. He was now a paraplegic with a massive upper right arm and shoulder wound. Over the course of a few weeks, his wounds became septic and a fist-size bedsore developed.

By the time we arrived, antibiotics had cured the sepsis and he was medically stable and ready to travel with us. With his mother accompanying him, we set out. The plan was to drive 12 hours across Ukraine. This whole transport seemed a bit mad. A sick man to go such a distance by road. Vagaries of war. You improvise and do the best you can. This was the only option for this patient.

We made a quick detour to a parking lot of an enormous mall, where our patient’s family was waiting to say goodbye. First time they had seen him since his battle wounds. His wife, child, brothers and cousins greeted him. It was a very emotional scene. We all cried. He smiled from his stretcher. Permanently broken body. Loving family. Such a difficult future. A joyous and painful scene.

Off to our destination. And then the shit hit the fan. We entered border control. Bureaucratic standoff that lasted three hours. This transport had been planned and organized two weeks earlier. Someone along the way had neglected to do something. Now it was all fucked up. The time was close to midnight. Frantic calls were made to medical people, ministry people, our NGO bureaucracy. Nothing worked. We were ordered to abort and return to our base with the patient. Hard news for him. His mother cried.

The staff was waiting for us at the local hospital. They were great. They took detailed information about the patient’s condition and provided for his mother. We transferred him.

It was an empty feeling for us. We did not complete our mission. Our patient was in good hands but in limbo.

We returned to our hotel at 3 a.m. We got the next day off. I explored the city, full of grand 19th- and early 20th-century buildings. A beautiful old opera house. Stalinist architecture banished to the outer sections. Saw something written in Hebrew on the side of a building. The city had a large Jewish population till local pogroms and the Nazis eliminated them. Haunting.

Back to work tomorrow. I am here till June 15.

Editor’s note, June 23: Certain details in the article were removed for security reasons at the request of Global Response Management.

Mark Shilen

Mark Shilen is a former paramedic with the New York City Fire Department. For 25 years before that he owned an art gallery in SoHo in Manhattan dealing in antique tribal weavings. He studied at the University of Wisconsin and lives in Brooklyn, N.Y.