When I get the blues, I turn to Gennady. He treated my bipolar disorder in Moscow in the late 1990s when I worked there as an American journalist. Even though I’ve been back in the United States for nearly two decades, he’s the doctor I call when I need to talk, though he’s thousands of miles away.
Our patient-doctor relationship is unique and has evolved into something more resembling a friendship. He never fails to answer my calls, no matter where he is. Sometimes he’s on a business trip in London or Brussels. One time he was learning how to kite surf on a beach in Portugal, his phone lying on a towel in the sand. All these years, I’ve never gotten a voicemail and he never charges me a cent.
He’s not just a doctor who offers medical advice whenever I need it. For 17 years he’s been my “Yes you can” man, always soothing, forever encouraging, blessedly patient and never asking why I don’t call my American psychiatrists who, by tradition, stop interacting with their clients when your case is closed.
I first met Gennady when I walked into a Russian mental health research institute in 1999. Most foreigners with serious mental health issues returned home to seek medical help, but I was determined to stay. I loved my life there.
Russia’s system of socialized medicine is much like our Veterans Administration system. Patients don’t choose their doctors; they are assigned. Despite my pleas for a female doctor, I ended up with Gennady, who was a research fellow at the institute.
I learned that getting help with mental health issues in a foreign language and country is not easy. In Russia, patients are often seen by several doctors, who stand around and talk to each other as if you’re not there. It was weird at first. There’s little privacy. Despite my knowledge of the Russian language, my doctors were not very familiar with American culture. They kept telling me to go back and live with my parents. I explained that in our society that’s not always welcome.
But there were plenty of things to like about Moscow’s medicine. Medications were cheap. Doctors were free. Gennady made house calls sometimes, after work, just to see how I was doing. That’s normal in Russia. And I got used to their collective way of treating patients, appreciating the “two heads are better than one” mentality.
Gennady and I talked a lot about ethics and philosophy. The Russian doctors are appalled by the American medical system. They ask, “How can profits be made off of those who are ill?” It’s capitalism, I explain. I accept it. I have to.
Not all went well with Gennady’s medical treatment. I ended up with a rare medication-related side-effect known as a microendonoma, a benign growth on my brain near the optic nerve that could potentially have left me blind. Fortunately, it was discovered and taken care of, but I was shaken up and returned home to Nevada.
Back in America, mental health care is complex. Unlike their Russian counterparts, American psychiatrists usually warn patients about medication side-effects, but it’s not a given. I was nearly three months’ pregnant when a local pharmacist — not my doctor — told me psychiatric medications can be highly detrimental to an unborn child. I had no clue; no doctor had ever told me.
On the positive side, the doctors point out that mental health issues are not tragedies and can be treated with proper care. They tell patients to go get a life and a job. They don’t expect patients to spend their lives in bed, as many do in Russia. But relationships between patients and psychiatrists are like none other in the world of medicine. It can take a long time to build up a relationship with a doctor.
And then, once you’ve moved cities or changed insurance, it’s suddenly over.
I call Gennady instead. He understands that, for someone like me with mental health issues, life can be scary. I get anxious easily, and he knows what to say to console me. Our phone calls also provide a strong sense of continuity, while relationships with other doctors have come and gone.
Much of the world unfortunately looks down upon Russian psychiatry, but I can say this: Globally, the field of psychiatry is complex, a combination of both art and science, and filled with a lot of advice. It is influenced by such things as cultures, affordable medical care, patient addiction issues, and good relations between doctors and patients. Psychiatrists often have nothing to go on besides the word of their patients.
Many of my American friends who lived as expats in Russia in the 1990s have fond memories of exciting careers that led to big profits. Me? I never made money back then, but I took away another Moscow treasure far more valuable: a lifelong doctor-friend whom I haven’t seen for 10 years, but who’s there just the same.
There’s a Russian proverb that translates to: “You’re better off with a hundred friends rather than a hundred rubles.”
I know that’s true.
