Vadim Gushchin is one of a handful of physicians on the East Coast who will perform a high-risk procedure on cancer patients; but the technique is minimally invasive and doesn't require surgery.
From the 1930s through the 1970s, it was quite common to find female surgeons in the Soviet Union. Vadim Gushchin’s grandmother was one of them. It was her strong personality that influenced her grandson, now a surgical oncologist in the Institute for Cancer Care at Mercy Medical Center in Baltimore, Md., to follow in her footsteps.
Gushchin’s parents, however, did not warmly receive that decision.
“In Russia, being a doctor does not bring financial independence,” Gushchin explains. “The only thing my mother knew was that her own mother was never with her, and a physician’s work was not very well compensated. She felt that I would be living with my parents until I was 45 and would never have a car if I became a physician in the United States.”
Fortunately, Gushchin’s mother’s words did not come to fruition.
Close to quitting
Gushchin came to a critical crossroad in his career almost before it had even gotten off the ground. His father died of leukemia one month after his graduation from medical school. That incident nearly prompted Gushchin to forego his medical career.
“I just was coming out of medical school, and I thought very highly about what we can do to treat patients,” Gushchin recalls. “But with my dad, I was completely helpless. And, it was a big disappointment in real life medicine.”
Just seven years after his father’s passing, patients with the same type of leukemia could be treated effectively with a pill. Basic science was catching up with everyday clinical problems, and the impact was most dramatically being demonstrated in oncology. That development, Gushchin says, had a significant impact on his approach to medicine and his patients.
“We are living in a wonderful time when significant discoveries can save patients’ lives,” Gushchin explains. “Now, when I see a patient who I cannot help or cure his disease, I know that sometimes you just give them another year or year-and-a-half and maybe another drug will surface. That actually happens more and more often these days. It’s encouraging. It influences my decisions, and it makes me think about patients differently.”
On the cutting edge
Gushchin is one of a handful of physicians on the East coast who performs isolated limb infusion (ILI) for melanoma. The procedure is high risk, he explains, because if something should go wrong, a patient could lose a limb as a result.
“Very small catheters are put through the skin without need of surgery,” Gushchin explains. “The idea is that you isolate the limb and give a very toxic amount of chemotherapy to circulate in this limb to kill the melanoma. But you do that with a minimally invasive technique — with catheters only, without an incision.”
Isolating the limb prevents high doses of chemotherapy drugs from affecting other organs. The procedure is performed in the operating room with the patient under general anesthesia. At the end of the procedure, the drugs are flushed out of the limb and circulation is returned to normal. Gushchin says that the procedure, which takes about three hours, has blurred the distinction between a medical oncologist and a surgical oncologist.
“Frankly there is no surgery involved,” he says. “For surgical personalities, it’s a boring procedure. But you need to coordinate many details of the procedure, many services, and that’s what my role as a surgeon is about — to find the right patient for the procedure, to coordinate all the services, and to perform the procedure. I’ve been fortunate enough to be in an institution that adopted this procedure early on.”
Sharing and caring
Now Gushchin is working to bring the knowledge of contemporary oncology back to his home country by actively collaborating with colleagues in research and medical education. It began when he spoke with surgeons from the former Soviet Union about his work while attending a medical conference in Europe. The surgeons wanted to set up a similar program, and Gushchin offered his expertise.
“The surgeons traveled to Baltimore to watch the procedure,” Gushchin says. “We talked through the details, and finally I went to Lithuania to give talks and help them implement this treatment for advanced cancer. And it actually took off. Now I’m working with colleagues in the Ukraine to set up a similar program.”
Gushchin says it’s one thing to do surgical oncology in the United States where many resources and options are available. It’s another to go abroad and see the work that needs to be done with far fewer resources.
“It’s a challenge,” Gushchin says. “But I feel that if we can do complex surgery with very few resources, that makes me feel good as a surgeon. It’s a very special feeling that money could never buy.”
Conquering new challenges
When he’s not practicing medicine Gushchin says he tries to spend time away from the computer and the television. In fact, there is no television service in the Gushchin household — a strategic decision, he says. Instead, he spends his time taking on new challenges, like recently starting to play the piano … again.
“I played piano when I was in high school, and I was terrible, frankly,” Gushchin admits. “But, somehow, I finished seven years of training.”
A couple of years ago Gushchin was gifted a piano a friend rebuilt and since then he plays every night, plus lessons. He views this hobby as another challenge and as “a surgical personality” Gushchin is trying to play as good as possible.
Playing the piano also helps Gushchin turn his attention away from being a physician — albeit briefly.
“You do not stop being a physician even away from the hospital,” he says. “You always think about patients. You either talk to them, or you e-mail them. It’s always in the back of your mind. It’s very difficult to switch your attention from that. And you cannot play [the piano] well without switching this attention. And that has been the major challenge for me. But I’m learning. I’m learning.”