Urban Legend

I've been working in delivery quite often lately. Some days are busy, some are fairly quiet, and there are those days when all hell breaks loose. One morning, I was working the day case list, IVF, D and C's (dilatation and curettage) and other sundries. During a lull, I was sent upstairs to delivery to perform an epidural because the anesthesiologist up there was preparing for a C-section. I told the midwife that I would do the epidural after my colleague induced anesthesia (since that is the stage when Murphy's Law invariably strikes and help is needed). She was visibly disappointed, but understood my reasoning. 

That epidural was not to be. From one of the rooms I heard a senior obstetrician yell, "We've got an abrupted placenta here, let's get her to the OR fast!". Placental abruption is when the placenta has separated from the uterus. This is a true emergency, because fetal oxygenation may be compromised and there may be significant bleeding. Both mother and child are in mortal danger.

The mother, an obese bedouin woman was indeed bleeding. Since the maternal airway, especially in an obese parturient is often problematic, I asked the other anesthesiologist to delay his C-section, and help me get this one underway.

Induction was no problem and I gave the obstetricians the go ahead. The operation was uneventful until they began the extraction of the baby. Often, the assistant must apply pressure to the upper abdomen thus pressuring the upper end of the womb to help the primary surgeon extract the child. At this point, the maternal heart rate dropped to below 40. I administered IV atropine and the rate rose and hovered around 50 while blood pressure was normal. I apprised the obstetricians of the situation. "I think that there's a lot of pressure on the vena cava, get that baby out quickly (please)!" The obstetricians were straining, but the kid wouldn't budge. 

The obstetricians, both female (very capable docs, with limited upper body strength, however) seemed to be tiring. Then, I had an idea.

"Rose (not her real name), move your hand please."

In place of the assistant, I pressed down on the upper abdomen through the sterile drape and leaned in. I'm no body builder, but I applied just enough leverage and the baby slid out, finally.

Looking at the monitor I noted with satisfaction that the heart rate was back up.

Ever since then, the OB/GYN's (with whom I have an excellent working relationship) have been approaching me with some measure of awe. 

The story has quickly become a local urban legend. Funny, I don't feel any different.

Accidental Hero

Like everyone else in this country, I was glued to the television all day. Despite having worked 24 hours straight on call and total exhaustion, I just couldn't go to sleep. So if this post seems a bit incoherent, please forgive me. I was compelled to watch Gilad's homecoming. Like many, I was incensed by the insensitivity of the Egyptians trying to cash in on a scoop with this clip of Shalit being interviewed by an Egyptian Cow. The interview was conducted without the consent of the Israeli side. The claim that Gilad consented is trite. He was still in the mindset of a captive. But in retrospect, the Cow did us a great favor. This unassuming young man has emerged a bona fide hero. He was kept in solitary confinement for over 5 years, he is emaciated and malnourished, lacks vitamin D due to the lack of sunlight, and had some obvious injury to his left hand. Surprisingly he seemed in good spirits. In addition it seems to me that he did not develop the Stockholm Syndrome. 

He kept his wits and answered eruditely to all questions. Even when the Cow tried to trap him into a political question about working to release Pali prisoners, he said the right thing: That he would be happy for their release provided they stop their violence.

I was astounded. After 5 years of contact only with his barbarian captors and with no opportunity for intelligent conversation, this remarkable young man showed the world his true mettle.

If a hero can be defined as an ordinary person performing extraordinarily in extraordinary circumstances, than I posit that Gilad Shalit is a hero. What joy for all of us, but especially his family to have him returned. Despite my own reservations concerning the prisoner swap, today is a day for joy. Tomorrow we can debate and argue about the price we paid for his return. The contrast with the vile thugs and murderers that were released is blinding. (No, I will not sully my blog with images of those vile fiends.) Shalit is thin and pale. The terrorists are well fed and tan. They had family visits, good food and excercise. Shalit had none of these. So let's just state for the record, our enemies are war criminals, barbarians, amoral and despicable. What comforts me, is that with Gilad's return, we received a treasure, while the Hamas and the PA received a heap of crap.

I was also happy to see that Gilad upon arrival in Israel dressed in his uniform. I intuitively feel that it is important that he make a necessary gradual transition from a military life to a civilian one. He is, after all, still a soldier. I was proud to see the symbol of the tank regiment we have both served. I hope he is still proud too.

Of all the emotional images today that literally brought me to tears, this one is my favorite:

It is the very first moment of the first embrace between father and son after over 5 years. It is a very powerful image precisely because we don't see their faces. And that makes it all the more intimate.

Gilad Shalit, comrade-in-arms, fellow citizen and fellow Jew: Welcome home. I salute and embrace you, an accidental hero.

Over The Abyss

נוטה צפון על תוהו תולה ארץ על בלימה
(איוב כו, ז)
He spreads out the northern [skies] over empty space; he suspends the earth over nothing.
(Job 26:7)

Deja Vu.

Two years ago, during the Succoth holiday I posted about the connection between Gilad Shalit and Succoth. This time the rumor and the hope seem to lead to freedom, God willing. How fitting, since Succoth celebrates the freedom of the Children of Israel from the Bondage of Egypt. The whole country is overjoyed with the news. No one can be apathetic to the suffering of Shalit and his family. Yet the joy is bittersweet. It is tainted. Because to gain his freedom, we have to release over 1000 vile terrorists. We know our enemies, they see this as a victory, and it will spur them to kidnap again. It seems that one Jew is worth 1000 Muslims. But not one of those savage barbarians is worth even a hair on Shalit's head. While we celebrate and cherish and sanctify life, they celebrate, cherish and sanctify death. Choose life, we are commanded. If Shalit has suffered Job-like tribulations, I cannot say, but he has suffered. And our leaders have, finally, chosen life for Shalit.

One thing I have in common with Shalit: I served in the same tank regiment (the "Barak" regiment) during my service over a decade after the Yom Kippur War. I imagine that soldiers of the regiment today have been raised as I had, on stories of the tragic destruction of the regiment as they stood almost alone against several Syrian divisions. The horrific tank battles on the Golan Heights and the halting of the Syrian onslaught have since become legend.

Two years ago, just before Succoth, a book was published that described the true story of that regiment during the war. The title of the book "Al Blima" (Over Nothing, or Over the Abyss) is taken from Job. The rather esoteric passage describes the ancient cosmological architecture of the world. But "Blima" can also mean "halting". And in military terms, there is a type of battle tactic (krav blima) that aims to halt the enemy to enable one's forces to regroup. So the title holds that double meaning. The book describes in excruciating detail, the actions of the regiment even down to the individual tank and soldier. One might find this tedious, but there is tension because the tale is true. Almost all the officers and tank commanders were killed or wounded yet the regiment held the enemy at bay. There is also interesting criticism of some of the decisions of the upper echelons. In particular, Gen. Yanosh Ben Gal (then the commander of the sister regiment) was criticised for disobeying an order to reinforce the Barak regiment with one of his battalions. To his credit, Ben Gal had the fortitude to answer the criticism in an on-line forum that appeared shortly after the book was released. He explained that he was closer to the action than his superior officers, and he realised that the battalion would have been sent on a suicide mission. So he wanted to maintain his strength for the battles that were sure to follow in his sector of the Heights. Of those battles is the famous "Vale of Tears" battle where Israeli and Syrian tanks were intermingled on the battlefield in what could only be described as hand-to-hand combat in tanks. The savage battle ended in an Israeli victory, but left many scars.

"Al Blima" overturns our concept of the demise of a regiment. Its greatest contribution is that it sets the story straight and returns honor to the name of the regiment, because the regiment was not destroyed, it did not falter nor did it fail. Rather, like the Phoenix, it arose from the ashes, and with replenished manpower, participated in the offensive that finally drove the Syrian divisions back and defeated them.

I am proud of my service in the "Barak" Regiment, and I hope that Shalit is too. Though I suspect that he might feel, justifiably so, that we failed him by letting him languish in that Hamas hell for so long.

Coincidentally, Saul Bellow's first novel "Dangling Man" was translated into Hebrew as "Al Blima". That book describes in diary form the frustrations of an unemployed man waiting to be drafted just before WW II. Gilad Shalit has been dangling over the abyss. And now, he has been pulled up, back into the arms of his loving family, and the embrace of a relieved nation.

Missles

I've let this blog languish for a few months. Not for lack of anything to write, rather my sloth is due to sheer fatigue. I'm working as hard as ever so there is no lack of subjects: The doctors' strike, the nationwide protests for social justice (whatever THAT means), interesting cases, etc... But it is the latest round of terror that has stirred me from my semi-self-imposed slumber. That, and the fact that I'm on vacation and have had a chance to recharge my batteries.

Last week we invited a friend to join us at the pool at our local sports center. When we called to confirm her visit, she was in tears. Her son was on the bus that had been attacked by terrorists along the Egyptian border. He suffered only scratches, but he called his mother to tell her they were under attack...and that he loves her. After hearing that he had only minor injuries, she told him to keep his head down and help the wounded. Only after, when my wife called her did she break down in tears. One of the heroes that day was the driver, who kept his head and raced towards safety.

Since then, all hell has broken loose here in the South. Air raid sirens, missle attacks, dead and wounded. I called the hospital and offered to come in to help, but they said that everything was under control. Yesterday, coming back home from my mother-in-law, my wife, two sons and a nephew were caught in an attack. The sirens wailed. My wife stopped the car and they all got out and hit the ground waiting for the missle strike. They waited an eternity for the explosion, and my wife recited the "Shema" about 10 times. When it finally hit, it was at the other end of the city. Shaken, they continued home unharmed.

When I look at the various news sites, I am struck by the fact that most of the conflict and misery in the world occurs where arabs and muslims are involved. Such a barbaric, infantile, and backward people. When will they grow up?

With neighbors like these...

Who needs enemies?

The Egyptians, don't ya just love 'em? The majestic pyramids, the flowing nile, the inspiring mass demonstrations for freedom. Can't get enough of 'em. The Egyptian border army just loves to send us work in the form of multiple trauma victims.

Sudanese and Eritreans fleeing the horror in their own countries, seeking asylum, hazard the long trek to less than open arms here in Israel. This unwelcome is preferable to the treatment in Egypt,  where en route they are robbed, beaten, raped and killed. Those, like my most recent patient, manage to get to the border only to be shredded by machine gun fire. Those wonderful Egyptians, sometimes they wait for the hapless victim to cross the border, and sometimes they don't, in which case they dump the body on our side of the border. That way, the Israeli taxpayer can foot the bill for their treatment.

The latest victim of Egyptian hospitality was a young  African man evacuated by helicopter. In the Trauma room, he had a pulse, barely. He had gun shot wounds to his abdomen, left leg, right arm, and just to add insult to injury, one bullet ripped through his genitals.

We rushed him into surgery, the surgeons did damage control, stopped the bleeding and and resected damaged bowel. Despite packed cells, plasma, thrombocyte and crystalloid infusions, he wasn't stabilizing. "He's bleeding somewhere else",  I said to the surgeons. I put the chest film on the screen, normal. So, no bleeding in the chest cavity.

We removed the drapes and found blood dripping from the leg and the forearm. The orthopedic surgeon came in. The x-ray showed that the midshaft of the femur was totally pulverized. There was a pulse in the lower leg, so the artery wasn't damaged.  Ortho stabilized what was left of the femur with an external fixator and the bleeding stopped. Vascular came in to find the ulnar artery torn. That was ligated and finally there was no more bleeding. We took the patient up to the ICU in stable condition.

Yep, those lovable Egyptians. Not only are they hospitable, but they are great shots too!

Do NOT jump to conclusions.

Warning, scenario number 4 may not be appropriate for all viewers...

Happy Passover!

I'm reposting my all time favorite matzah video: