2024-03 Israel

Israel 43,

Hi Everyone,

Yesterday and today were about the same so I will combine them into 1 dissertation. I had an evening shift on Monday, 3:00 to 11:00 finishing at 12:00 and returning to the hotel at 12:30 and a morning shift today, Tuesday from 7:00 to 3:00 returning home at 5:30. Long days with little time to recuperate between shifts. Tomorrow I will sleep in as I only begin at 3:00. I am at a new restaurant on the beach for dinner and a beer with enough time to write my blog and keep you up to date with my work.

I worked in Bat Yam last evening and in Richon Lezion for the day shift today after 5.5 hours of sleep. Both teams as usual were delightful to work with. Quick, efficient, pleasant, respectful to the patient, I can never say enough superlatives. I hope that they have the same comments about me.

1 case was a 48 year old male with severe chest pain, profuse sweating, pain irradiating to the arms and jaw, an obvious MI. We had to work quickly as time was of the essence if we were to get him to the hospital on time. Usually we have a driver, an experienced P-M, a junior P-M and me. In this case we lacked the junior so I had do both act as the physician and the junior P-M. We did the usual, history, physical, IV, EKG, oximeter. We then quickly gave, oxygen, ASA, heparin, and a pain medication. The patient started to improve immediately. We raced to the hospital with sirens blazing. The complication could easily have been ventricular fibrillation , asystoly and cardiac arrest. The P-M emailed the EKG to the hospital which showed a Q wave, an elevated ST segment and a reversed T wave, an obvious acute MI. The medical team including a cardiologist were waiting for us in the medical ICU in the ER. A cardiac echo was done immediately and after exchanging the monitoring, the patient was whisked to the cat (catheterization) lab for an angio and stent or bypass if necessary. We saved him with a rapid diagnosis and immediate institution of the appropriate treatment with no waste of time which could have cost the patient his life. Amazing!!!

For the 2nd case we were dispatched to a poor area of town. We had to carry our equipment up 4 flights of stairs as there was no elevator. The P-Ms kept asking me if I was OK. The patient was a 40 year old female, schizophrenic, who had tried to ‘jump out of the window’. The P-M spoke quietly to the patent, calmed her down, gave her a sedative and spoke with a psychiatrist by phone, By that time things had cooled down and as the patient was no longer in acute distress we decided to leave her in the company of her mother. Here is the sad part of the story. On the wall was a lovely picture of the patient’s mother, who was present, in her beautiful white wedding dress with her handsome husband standing in front of a nice new white car. Also on the wall was a picture of the whole family with their 5 young children. In the bed room was the husband in bed with a wheel chair bedside the bed. He had obviously had a stroke and could barely move or talk. On the couch was another daughter with obvious mental problems. Another picture showed a son with a grandchild who seemed to be doing well. We spoke to the mother at length who with social services was coping the best that she could. With this on her shoulders, I don’t know how she gets up every morning to face the day.

Another case today was a 45 year old woman who threw herself on the railway tracks in an attempted suicide. The conductor of the train saw the woman and was able to stop the train in time before running over her. The police were called and took her off the tracks. When we arrived, things were quite stable. The P-M spoke to the patient at length. She was not married but had 1 child and was known to be depressive. The P-M called the psychiatrist for instructions. In these cases, as there is a risk to the patient, we are authorized to give the patient a strong sedative and to take the patient by force with the police if necessary. With the P-Ms support by talking gently to the patient, we were able to convince her to come with us to a psychiatric institute where she is known and where she could have proper treatment.

Just another day in paradise…..as the song goes.

Love,

Brian