The Doctors of Tokuda Hospital


How many of you sitting reading this dread going to the doctors never mind shudder at the thought that you might end up in hospital. How often do you sit and think about that dreaded phone call to tell you a loved one is ill. I know it happened to me. Last year I was just about awake when my sister called me. She had the news that my father had been taken into intensive care. He was in respiratory arrest and of course I dropped everything and went home to Northern Ireland.

I travelled most of the day leaving Bulgaria at six in the morning, to land in Northern Ireland at seven thirty that evening. What I saw when I got there horrified me. My father who is in his seventies lay uncovered in a bed with no- one there to shield his dignity. I was only grateful that he was sedated and was hardly aware that I was there. I was left standing there for about thirty minutes before anyone even noticed I was there. Keep in mind I had contacted the hospital that morning to make them aware I would be arriving at that time.

So I'm standing there left wondering A. What had happened that my father was here in the first place. B. What was going on now. So I stood and I waited for another thirty minutes before a nurse approached me...... He asked me who I was, then looked shocked when I laughed. I explained that I was the daughter of his patient and could he please give me an update on his condition. He told me that I would have to speak to the doctor, I waited another three hours to be told he would not be able to see me that night I should come back tomorrow. This story carries on like this for almost six weeks, fighting to talk to doctors, fighting to get results of tests. Doctors making unreal statements like and I quote this " your fathers brain is older than he is" instead of giving me the very real diagnosis that my father was suffering with demintia. Making appointments to talk to me and not turning up for them. I know many of you out there have very similar stories to mine.

In this article I will introduce you to a team of doctors who have a very different outlook on how they treat not only their patients but their families as well. I personally have been through a lot here in Bulgaria with my own personal health problems also I have had the misfortune that both my daughters have been ill from a very young age. It has been stressful, disheartening, depressive and loaded with anxiety. Then more by good luck I fell upon Tokuda Hospital and a company called Treatment Bulgaria. Little did I know then my whole life, and perspective of Bulgarian health care was about to change.

Hopefully in this the time it takes for you to read this I as a writer will be able to show you that I have found doctors who's humanity is very much part of their treatment for their patients. They are people we only ever turn to when times are difficult, we are confused and scared. When we need someone to say, " it's ok I can help you" and they are happy to do that. The thing that gets me most of all and it will become very apparent in the doctors I introduce to you in this story. They want nothing back, they are happy to watch you leave knowing that they have done everything in their power to help you. They ask for no thanks, they want no thanks they get everything they need from knowing that you are feeling better and hopefully by the grace of God they will never see you again. You may think that is a funny thing to say, from their point of view if they never see you again its confirmation to them that they have done their job to the very best of their ability.

From my previous article some of you reading this will already know who Dr Valrie Kulev is and what he has done for me and both of my daughters. Our story isn't one of a kind he has changed the lives of many patients who have had the good fortune to be under his care as a doctor. What we as patients seem to miss a lot of the time, although these are extraordinary doctors, they are also extraordinary human beings. They must be because without question or doubt they very much give all of themselves to their job and the demands it commands from them.

Dr Valeri Kulev
I have had the pleasure of having the opportunity to chat with Dr Kulev a couple of times over the last month. We discussed a lot of ENT related issues, he was happy to not only answer my questions about his specialty but also about his drive and commitment to medicine. What being a doctor means to him as a person.

Here is just a few of the questions that I had the opportunity to ask him.

"What motivated the decision to become a doctor and then on to surgery?"
"I have always had an interest in biology and chemistry and at a young age was faced with the dilemma to become a vet or a doctor. Over time my interest grew greater in becoming a doctor. While in university there was a degree of pier pressure as all the men were becoming surgeons so it was almost expected of me. I then when on to do an internship at an ENT department, along with suffering similar problems as a child made the decision for me."
" what case has effected you most in your career as a surgeon?"
His answer was not what I was expecting, you can see in his expression and his eyes that he carries every case with him.

"In the branch of ENT no two cases are the same, Ranging from the minor illness of young children to the more serious aspect of oncology. Each is as important as the next and each very much has its own bearing on me as a person. The complete satisfaction for me as a human being, is knowing you have the knowledge and skills to help that person. Be it a choking child and watching them breath again, to meeting a patient who has recovered from cancer"
" What is Tokuda Hospital to you?"
With a definite warmth he described " Tokuda Hospital, has given me the opportunity to put all my medical training into practice. Also the team that has become the ENT department function very much like a family. The management of that family brings one hundered precent of each doctor in the department to the patient
" From my own obersavations, I see you relate to children very well. Who do you find it easier to work with?"
With a definite twinkle in his eye " working with children is easier, the key for me is to become their friend more than their doctor"
Something tells me listening to him the child is very much alive inside him!

"what makes you get up and go to work each day."
His answer here astounded me as a person and as a writer. I can understand the drive and passion for his work here and his answer for me spoke volumes.

"My motivation will sound very strange to you, but it's because I love my profession. It's this love that makes me feel morally, ethically happy and complete. I am totally dedicated to my job"
" How does your family feel about what you do?"
" My profession is very hard on my family, they find it very difficult to deal with the demands that my profession puts on me and my time. Although I do my very best to increase my time at home, of course it is very difficult for me"
I spoke with a colleague of Dr Kulev and their description of him I thought couldn't have said it any better really

Dr Kulev is a beautiful man and a beautiful person
Now if I was to talk with the colleagues of a few of the doctors in the uk how many of them would make a statement like that about them. I am almost certain if any I could count on one hand the amount.

The passion in his voice when he talks about his job is difficult to miss, also impossible not to feel. I could almost see the burning deep within him for his vocation In life. I can safely say this is not a man who has become a doctor because it's a good job that pays well. This is unfortunately the story with most doctors in the uk now. This is a man who became a doctor because of a love of medicne but also a deep routed need inside him to reach out and help another human being. When he meets someone who needs his knowledge, skills and compassion to get through a difficult time in their life, this for him is impossible to ignore. When he achieves this and he watches that person recover it is all he needs to gain complete satisfaction within himself. Totally selfless and eternally humble person.

The ENT team at work.
Now Dr Kulev is not a doctor who works alone, he is part of a very successful ENT team at Tokuda Hospital. I can honestly say although we were under his care, the impression was very much one of the whole team has a vested interest in seeing you recover. They all care and they very much function as one unit, with almost the feeling of a family welcoming you in. It is never to much trouble, no question is a silly question. In fact from my own experience with the team there, the more questions you ask the better. Then they have a stronger confirmation in their minds that you know and understand what's going on.

This is a story of an extraordinary man, who is very much driven by his need and passion to reach out and help people. Most of the time at a personal cost to him self, it is not one of a kind in Tokuda Hospital. I found out through my own experience, while my daughter was under the care of Dr Kulev. I mentioned to Violeta, the lady from Treatment Bulgaria who was helping us get through all the procedures for my daughters surgery, that I was having problems myself. I explained my own problems to her, these consisted of being diagnosed with ichemic heart disease at thirty six. Although I had been put on medication for the condition and changing my lifestyle completely by losing fourty kilograms, stoping drinking and cutting down my smoking my condition was not improving.

She took me to see a lovely doctor called Dr Traikov. He was very kind and made time to see me between dealing with an emergency and operating. It was quiet late on the evening that my daughter was admited to the hospital for her surgery the next day. He made me feel comfortable straight away, although I was aware he had only a short time I never felt like he was rushed. In fact if I'm totally honest here it was very like walking into a room with an old friend. It had that kind of comfortable feel around him, he asked me to explain my issues and I did. He ran an ECG, echocardiogram also a physical examination the news that followed next elated me and astounded me at the same time. He told me that my heart was functioning normally, yes I had tachycardia but that could be controlled with a very low dose of betablocker which I was already taking. He told me to stop all the other medication I was on there was no need for me to take it, he went on to explain that he thought I had a problem with my thyroid. I could have hugged him, not quite sure how he would have felt about this. It was like someone had lifted this huge heavy weight off me that I had been carrying for almost two years. He spoke with Violeta and I left walking on cloud nine. Violeta explained that I needed to see an endocardiologist and she would try and arrange the appointment the next day. I didn't mind I was still on cloud nine. We headed back to the ENT department to finish up the paperwork needed for my daughters surgery. While we waited outside the department a doctor came to speak to Violeta. As I watched from a distance I could see the conversation, my Bulgarian is not what it should be but I understood the conversation enough that she was almost pleading with him for an appointment to see me. He smiled at her and explained he had stuff to do on the ward but if I could wait twenty minutes he would be happy to see me then. Yes you can get up off the floor, these doctors will make time to see people who need their help. So far I have introduced you to three believe me there is more to come. So we finished up with my daughters paper work got her admited to the ward and went to see Dr Lozanov.

After meeting him, he asked me to explain my problems, there is something very evident here in this statement. These doctors are happy to listen to their patients talk. Dr Kulev took his time to listen to my many ongoing problems with my girls, and is still happy for me to go and ask his advice or if I have questions about my youngest daughter as she is most probably facing surgery with him in a few weeks time to stop an ongoing hearing problem. Dr Traikov who made me feel like I had known him for years and even though he did not have time to waste I never felt like I was a burden to him. Now Dr Lozanov who again was happy and content to listen to my problems. Violeta explained what Dr Traikov had told me also that I had approached my G.P about two years previous to this complaining that I felt like I had a lump in my throat. He examined my thyroid glad and agreed with me, the right hand side of my gland was larger than my left, he wanted to do an ultrasound to see what was going on inside. Now in the uk I would have waited four to six weeks for an appointment for the ultrasound, not here it was done then and there.

Within twenty minutes I knew what exactly was wrong with me. I had three lumps growing on my thyroid and I have Hashimotos disease. I have a knowledge of medicine, but had no idea what this was.

Dr Lozanov gave me an explanation as to what Hashimotos disease is how it affects the body and what to expect in the future. He prescribed me the only drug on the market at the moment to treat the disease and told me that the lumps on my thyroid would have to be monitored closely as they can grow quite quickly. He also gave me follow up appointments for the following month. After returning home with my eldest daughter, during the period of her recovery I started having problems swallowing. I contacted Violeta and explained these problems she told when when I brought my daughter up for her post operation appointment she would take me to see Dr Lozanov again.

Four days later I was back at the hospital, my daughter was recovering well, so we headed to see Dr Lozanov. I once again explained my problem, he understood completely and told me his recommendation was to have these lumps removed as soon as possible. I was to have my throat checked to make sure that it was not an ENT problem. This check was done the same day by Dr Kulev, who is fast becoming a family doctor. Once we had the all clear from him we went to see another surgeon called Dr Vesselin Marinov.

Dr Vesselin Marinov
After meeting Dr Marinov for the first time, my initial impression was wow he's really easy to talk to and friendly. He made me feel at ease with the same comfortable grin that seems to be infectious in this Hospital.

At the time of seeing Dr Marinov he was running between surgeries, not that I ever would have known. He happily took me through the surgery and explained the cut I would have on my throat. Never once did I feel rushed, I had time to ask him anything I needed to. This was a huge comfort and relief, to meet another surgeon in the same hospital who was just as kind friendly and reassuring as Dr Kulev had been with my daughter and I.

My surgery was arranged for the twentieth of March, he gave me his direct contact details and assured me if I had any questions to contact him directly.

This was a first for me a doctor who was happy to talk to me out of office hours, I can honestly see you all reading that twice. You read it right the first time I had his direct contact details and yes if I had any questions to call him. Now how many times does that happen in the uk. The details of the surgery would be to long to but in here. I have to say that I came through it in little or no pain. A little pain relief the day of surgery and none post surgery. Dr Marinov came to see me just after the surgery and explained my scar was a little bigger than he'd expected and went into details as to why. That's wasn't the only time I would see him that evening, he came back to check on me a few times that evening.

He has an extremely open feeling about him, practically like nothing troubles him and being a specialist is very much part of him. Also it's generally a reward also when you're specialist isn't hard to look at. He explained that the drain in my neck would be removed and I would be discharged on the Sunday. The surgery had little effect as to say I carried on working, doing Dr Kulev's interview for another article.

The whole journey was pretty much flawless. For the second time in my life which has been extremely difficult, and filled with anxiety the team of doctors there has proved to me on so many levels that they are certainly the hidden gem of the Bulgarian health care system.

The care during my operation and the still on going after care from Dr Lozanov and Dr Marinov has stayed with me in such a way I will always be grateful to them both. For not only did they find and rectify my health problems, they also ended two years of anxiety, stress and suffering.

Thanks to them both I feel healthier and more alive than I have felt in a very long time.

I had the great pleasure of spending some valuable time talking with Dr Marinov. Talking about his chosen speciality but also how the demands of being a surgeon affect him and his family.

Here are just a few of the questions I had the good fortune to ask him

What made you decide to become a doctor and then on to surgery?
I am a second generation doctor, both my parents are in the medical profession. At an early age I was brought into the medical world, going to the hospital with my mother I became very interested in pediatric surgery and illness. It was always in my sub consicous to become a surgeon almost like it is part of my genetic make up. It was my dream to be a suergon and I chased my dream, for me the dream has come true it's not just a job to me but a hobbie
How do you deal with the demand of being a surgeon and balance it with your personal life
It is very difficult, I have a wonderful understanding wife and a beautiful son who is almost five. My wife's understanding makes it a lot easier to meet the demands of my job. My personal life has to be planned, I plan one weekend off a month but it's never the same weekend. It has to be this way because the demands of job are high. I am responsible for my paitents, it's not the job of the doctor on call it's mine. Last year while I was on holiday with my family I had to return to Bulgaria to deal with a difficult sitatuation leaving my family in Greece, and once I was happy I had done everything I returned to my family. It is extremely hard to keep a good balance between surgery and family life.
Here it became very apparent it's extremely difficult for him to balance his home life with the demands being a surgeon makes on him. It's very clear both are very much his heart.

Have you ever had one particular case that has stayed with you? If so why and what bearing did it have on you as a person?
A lot of interesting cases come across my path as a surgeon, especially oncology. To watch my patients recover is very precious to me and very patient is a special case. I could never come out of a surgery and say that was a really good surgery, they all get the very best of me at the time. Everyone is specific I love to treat the patient and have a friendly understanding with them.
I have to say I very much felt this as his patient and still do now. Something comes very clear here as I'm writing this, looking back over both doctors answers to very similar questions the answers are very similar both in what they say and how they say it. All I can say is they are very focused on how they make their patients feel and every case that they work on comes to make up part of the doctor they have become.

You have a very comfortable persona with your patients do you find that helps your job as a surgeon or has it hindered it at times?
I believe in keeping a very friendly contact with my patients. They give their life in your hands, a good surgery is not only the procedure but very much the surgeon. All of my patients have my personal number, sometimes I will deal with in excess of forty phone calls a day. This is ok with me I'm here for them.
How do you maintain empathy with difficult patients?
Fear is the biggest cause of difficulty a lot of the time. I keep good contact with the patient and their family as much a possible they must feel like you are doing everything in your power to help them.
After spending a while with Dr Marinov both as his patient and chatting with him about being a surgeon and a doctor the feeling here is that he is very much his job. His personality leaks compassion, strength and understanding. He also very much gives an air of confidence in his skills and methods, from those he uses to preform his surgeries to how he interacts with those in his care. He's not just your surgeon but a friend and protector. He will do everything in his power to bring you through what ever it is that you are going through. You can almost see the soles he carries with him in his eyes, each of them make up the exceptional surgeon that he has become.

So there you have it, take everything you know about doctors in the uk and forget it. The doctors of Tokuda Hospital work with such a level of compassion and understanding for their patients that it's almost difficult to believe unless you have seen it or been part of it. These extraordinary people have taken patient care to a whole other level, and it stays with you as a patient. Most of all as the mother of two young girls being able to put that trust there and know that they will do everything they can to look after, protect and help your children well for me that's just priceless.

Joanne Nicholas

Posted 28Mar2015