Israel 38,

April 24, 2024,

Hi Everyone,

I just finished an 11 hour shift and I was just asked to do a double shift for tomorrow. I think that they are short physicians to work on the ambulances. I have been here for 10 days with MDA and I think that I am beginning to get reasonably well known among the P-Ms who may be asking for me. Tomorrow, I will be up at 5:10 to leave at 6:00 arrive at the MDA station at 6:45 and do a double shift until 11:00. It is almost like I am back at the RVH as a resident. Anyway the P-Ms are very nice to work with and the work is exciting as you can see for yourselves in my blog.

I am sitting out at a restaurant on the beach in Tel Aviv. I am at a low table on the sand with my legs stretched out under the table. I think that I ate here with Dominique 10 years ago. It is pitch black, with no stars out this evening. It must be 25K with a slight breeze, to cool things off as it hit 37K today. The restaurant speakers are playing American/Israeli modern music, not too loud, just nice enough to enjoy the evening. The boardwalk is packed with people strolling along. People are still playing volleyball on the sand.

I am getting used to the types of call that we receive. Elderly people with chest pain, shortness of breath, stroke, not feeling well with no obvious signs, car accidents. We take a history, do a routine physical, do an EKG, test for glucose, put on a monitor and oximeter and BP cuff, start an IV and then transport to the hospital at the speed necessary depending upon the urgency.

One child swallowed a big candy that probably got stuck in his throat and then passed. We reassured the mother and took the child to the hospital for observation. One 40 year old man had right upper quadrant pain referred to the right flank or perhaps the other way around. He had a low grade fever. We gave him an IV analgesic and the pain went away. He decided not to go to the hospital and was ready to sign a release. When I got the translation, I told him that he needed to come with us for an ultrasound as he either had a gall stone or perhaps a kidney stone and the pain would return in 2 hours. He asked me how sure I was and I answered 100% sure. I guess that my white hair convinced him. He came with us to the hospital. The P-Ms were impressed with my ability to convince him to come for investigation and treatment.

The last patient was a motorcycle accident. My shift had ended but I wanted to go anyways. The fellow was riding a Kawasaki 750 and slid on the pavement. He was wearing a helmet, shorts and a t-shirt. That is the standard dress here for motorcyclists. He had a bad burn on his arms and legs, what we call road rash. He was lucky not to have broken anything. We took him to the hospital for a clean up. I told him that I have had a bike for 50 years and that he should be wearing leather or goretex. Maybe I made an impression on him.

I have visited several hospitols including Tal Eshalon which is ranked 9th best in the world. Very, very impressive especially for a tiny country like Israel. We also picked up a patient from a nursing home/palliative care/rehabilitation center. Wow. I never saw anything like it. It resembled a 5* hotel on hospital on steroids. And this was a public institution! We are really far behind in Canada and have a lot to learn from the Israelis and their standard of care.

I just finished a plate of mergaieze with veggies and a beer. I am listening to Marvin Gaye, the temperature is just right, my mouth is burning from the spice so I will treat myself to another beer, and an apple crumble with ice cream. Why not, I ate virtually nothing today, need to re-vitalize for tomorrow.

Love,

Brian

I will put in the pictures tomorrow or on Friday

Israel 37,

April 23, 2024,

Hi Everyone,

Last evening I spent the Passover Seder with Rochelle and her charming family. Passover is usually a happy time for Jews but this year our happiness is subdued due to the ongoing war, the failure of the return of the hostages after 6 months and the problems which we who live in the diaspora are enduring. I never thought that at 74 years of age that I would be volunteering to go to war. Nor did I ever believe that I would witness the antisemitism that we are witnessing in Canada and all over the world. Who are our friends? Who will stand up for us? How have we let these vicious antisemites into our country and why is our prime minister not doing anything? Don’t worry, Mr. JT, an election is coming and there will be a ‘reglement de comptes’. I like the French expression better. What kind of nonsense are they teaching at the universities? How are the students of today so poorly informed about history? At many Passover Seders, a place setting was left empty in memory of the hostages.

Today, being a holiday in Israel, things were very quiet with MDA. I worked a morning shift at the town of Lod. At one point we raced at breakneck speed, 150K to get to patient with bradycardia (a slow heart beat of 40/min). Can you see the dichotomy? We brought him to the hospital on time and saved him . He was originally from Holland, was born in 1940 and came to Israel in 1964. He spoke English fluently. He remembers the liberation of Holland when the Canadians came marching in. My father was stationed in Nijmegen during the war for some time before crossing the Rhine into Germany.

Love,

Brian

Israel 36,

April 22, 2024,

Hi Everyone,

I did emails, laundry and blogging that took some time to catch up. Yesterday I did an evening shift, 3:00 to 11:00 in Yevneh where apparently there is a nuclear plant. The town is very pretty with nice new 10 story apartments. I worked with Dan with whom I have been before. I got a phone call from Moshe, the head of MDA who told me that he would like to do a shift with me as he has never seen anyone get so many ‘good’ cases. Last evening was no exception.

We were called to an apartment to see a 3 year old boy who was having seizures. It was a 4 story walk up and we had to bring all our rather heavy resuscitation equipment. The child was having seizures and so of course was not conscious but breathing ok. We gave him a shot of anti seizure medication which slowed things down. The seizures were due to a fever so we cooled him down with a cold towel. We carried him to the ambulance and I held the oxygen mask on his face for 20 minutes. Once again I was impressed with the efficiency of the service and the kindness with which our team spoke to the parents.

Our next case was a truck vs truck accident. We sped to the scene at break neck speed doing 140K, at 10:00 at night dodging traffic. The motorcycle MDA fellow was there as well as the fire department. There was nothing left of the front of the truck. I don’t know how the man survived. He was pinned between the door and the dash board. The fire men inserted a machine that we would call ‘the jaws of life’. It was a large piston, attached to a generator .It pushed the door open and lifted up the dash. The patient was conscious, not in too much pain and was on his cell phone. We put him onto a stretcher and brought him to the hospital. In no time he had multiple IVs, oxygen, blood tests and x-rays, CT scans. I spoke to the orthopaedic surgeon. The patient was lucky as he only had a simple femur fracture that would require a rod. There were no vascular or neurological complications.

I finished my shift at 11:00, drove back to Tel Aviv which took an hour so they did not give me a shift today. I had not eaten supper so I went to a bar on the beach and had fries and a beer. I watched the end to the Barcelona-Real Madrid soccer game. There was a goal with 2 minutes to go making the score 3-2. There was a lot of cheering so I guess the favourite team won. Tonight I will go to Rochelle’s for the Seder. I told MDA that I didn’t want to do an evening shift today as it would probably be my only chance to do a Seder in Israel although I was invited to one 53 years ago with my friend Arnon.

Love,

Brian

Special forces training, running up a sandy hill in 25C

Israel 35,

April 20, 2024,

Hi Everyone,

I worked hard for the last 5 days, hanging on inside of an ambulance, so I decided to take it easy yesterday. I woke up at 8:00, rather late for me, and spent the next few hours catching up on emails and writing my blog. In the early afternoon, I took a walk on the beach for 2 hours. Swimming has been prohibited up until last week. There were signs everywhere but this did not prevent people from going into the water. I would swim out to the breakwater and back, which is a 20 minute swim, on days when the water was calm. On other days, if there were breakers, I would do some body surfing. Yesterday, the life guards were out so the prohibited signs had been removed. Some beaches were black flagged so you could not go in the water there or you would be whistled out. Some beaches are for swimming and others are reserved for surfers, kite surfers and wind surfers. It was blowing 15-18 knots past the breakwater and there were sail boat races. The breakers were coming in, 3-4 feet high. I swam out 100M to where the 16-18 year olds were. They seemed to know the good spots for waves. If you see a wave coming and swim fast, you can catch it just before it breaks. Eventually, it will catch you and break on you. The hard rippling water and thunderous noise as it breaks on you are thrilling.The wave can carry you about 20 feet before it passes over you. It gets to be like a drug, you just have to keep returning for more.

Last evening I was invited to dinner at my cousin Richard’s place in Rehova, 25K from Tel Aviv. We first went to synagogue, a place that I have not been to in 60 years. The service was orthodox, as the women sat separately. There were many English speaking worshipers there from the US and Canada. I recognized many of the hymns and read the English translation. I met Richard’s family for the first time. He came to Israel when he was very young and served in the arm as a tank commander. He has 4 children, 1 of whom is in the army now. Everyone takes the current situation in their stride. This is what living in Israel is all about and you have to just accept it and get on with your daily life.

Love,

Brian

Israel 34,

April 19, 2024,

Hi Everyone,

Yesterday I worked in Richon Lezion, a town near Tel Aviv. One again, after a slow start we ended up being busy all evening. I started my shift at 2:45 and finished tired at 11:00, an evening shift. We got an urgent call while driving in the ambulance. The driver who is also the leading para-medic on the team was a very experienced driver. He put on the siren, Rrrr rrrrr and wey yew, wey yew and wup wup varying the siren and tone at different times. We were in a race against time in a vehicle that drove like a Ferrari. We weaved in and out of the traffic, on the side walk, in between cars, on the mid line, on the opposite side of the road. Cars got out of our way. We hit speeds of 120 in town. I filmed part of the ‘race’ through the wind shield. For the team, this was routine, for me it was really stimulating….!

When we arrived, the motorcycle, the BLS and an ACLS ambulance were already there. The woman, 80 years of age had collapsed on the sidewalk, She had time to call herself an ambulance with her emergency button. We were 12 P-Ms to take care of the patient. We gave her cardiac massage, pumped , intubated, started an IV and gave her Adrenalin several times. We got her back to life, but she re-coded in the ambulance and expired in the hospital. It was a good team effort but at her age, she didn’t have a chance. I was very impressed as usual by the professionalism and the team work. Although we were 12 present, 1 person took charge and everyone else followed instructions. It is amazing how they work together. They are quiet, very fast and very effective. There is no panic. Everyone knows and does their job in the most efficient manner. We could learn a lot from their way of working and handling an emergency. A crowd had gathered on the street to watch us but this in no way distracted the P-Ms

The last call of the evening was a semi emergency. We were called to an apartment where an old, over weight 75 year old man was having trouble breathing. The couple lived in what appeared to be a moderately price building with their son. I was not prepared for what I was about to witness. The entrance to the building was nicely tiled. The elevator was clean. We opened the door to the apartment and the state or the apartment was horrible.

The people were hoarders. There was 3 feet of refuse piled on the floor in the kitchen, living room, dining room, halls and bedrooms. There were bags of clothes, food, broken furniture, lamps, everything that you can and accumulate in 20 years. The patient was sitting on a sofa. I don’t know how he got there. We had to move stuff aside to clear a 1 foot wide path to get to him. 4 of us lifted him onto a wooden chair that we dragged through the stuff to get him out side the apartment and onto a stretcher and into the ambulance.

The man was obese, didn’t speak much, was dressed in sweat pants and a sweat shirt. He had his whole medical file neatly typed out from a previous hospital visit. What was amazing was, in spite of the surroundings, he was clean shaven and relatively clean. He was not dirty in his appearance and did not smell bad, although for protection we all wore masks.

The 2 P-Ms on my team were young girls in their early 20s. 1 was a recent grad, the other was still doing her studies and wanted to finish the army and go into medical school. I had never seen anything like what I had just witnessed. They had! Once again I was amazed by their professionalism. They were not judgemental at all. The patient was a human being in distress. They treated him in a kind, dignified and respectful manner. We did all the usual, cardiogram, oxymeter, blood glucose etc. We made him comfortable. They spoke quietly to him to reassure him. They are very well trained for all types of circumstances. This is their job and they know how to react in an efficient manner.

The whole country functions this way, quiet, no fuss, seemingly easy going but extremely effective. They of course have constant stimulation from their neighbours. I just learned that Israel attacked Iran last night. I think that there will be some excitement here today. I am not worried. We are ready for them.

Love,

Brian

I will send the ambulance drive later

Israel 34,

April 19, 2024,

Hi Everyone,

On 1 of my shifts I met a urologist from Chicago who was also doing a stint with MDA. He is staying in a hotel 100M from my hotel. We arranged to meet for dinner 2 evenings ago. He is vegan and needs a gluten free meal so I let him choose the restaurant. Yes, I even ate at a vegan restaurant!

The restaurant was in the Neve Tsedek area of Tel Aviv. We walked there and sort of got lost on the convoluted streets, passing through the Florentin area. Neve Tsedek is an older area that has been completely renovated. It has upscale restaurants and shops and is more expensive to live in. Florentin is probably what Neve Tsedek used to look like before it got gentrified. The streets are very narrow and the area has 1 cafe and restaurant after another. It caters to the student, young adult and artistic crowd. Usually I don’t like graffiti but this type was really good quality art work. The food at the restaurant was wonderful.

Love,

Brian

Israel 33,

April 17, 2024,

Hi Everyone,

I was up at 5:30 this morning to join my MDA team at Bat Yam near Tel Aviv at 6:45. The hotel is kind enough to supply me with a light breakfast before leaving. Although the morning started quietly, we were busy all day. As usual, as soon as we finished 1 call, we received another one, never returning to our base for a rest.

I met 2 young high school students who were volunteers with MDA and may continue in the medical field. Both would like to come to Canada to ski with me one day. The driver was a medic with a lot of experience. The para-medic who was responsible for the team was doing his first shift with MDA. I was very impressed with his professionalism. In multiple cases, in what I would consider to be stressful situations, he was able to control the atmosphere by the calm way in which he took control of the situation and had an immediate calming effect on the patient. He knew how to speak with the patient and immediately gained the confidence of the patient. The entire staff present, as well as family and friends were put at easy by the way he spoke and at the same time, his direct and competent actions. The other p-m was still in training with MDA and is in the IDF. Eventually he will be a p-m with the army. This will of course involve more trauma cases. He would like to go into medicine in the future.

I have been in Israel for 5 weeks now. I am very impressed with the Israeli population. Israel has managed to integrate people coming from all over the world. Most of course are Jewish, however their beliefs vary greatly from secularism to the very religious. They have 1 thing in common, which is their dedication to Israel. In spite of the war which has gone on for 6 months, life continues as usual for most people. We have rocket attacks everyday but the people are not tense and seem to take it in their stride. I like the way they great each other in a friendly manner. They seem to be very together as a nation in spite of the serious political differences. They are sorry for the lack of understanding in other countries, but rejoiced when they received the help given to them by the US, GB, France and even certain Arab nations during the rocket attack by Iran.

Love,

Brian

FLACK JACKET, just in case

Israel 32,

April 16, 2024,

Hi Everyone,

Today I was given the option to go to Siderot. It is small city of 40,000, south of Tel Aviv, 1.5K from Gaza. Given the proximity to the ‘action’ there was no way that I would refuse. I was up at 5:00 and with the help of Waze, arrived in Siderot 1 hour later. The MDA base is much more relaxed and does not usually get the same type of cases that I saw yesterday. I was introduced to the team and made my own breakfast. Everyone was very friendly and asked me numerous questions about Canada. They were excited to hear about my case from yesterday.

The cases that I saw were very routine, mild chest pain, dizziness etc. Over the last few days I went into many houses and apartments. I was very impressed with the buildings. They are very modern with large tiles on the floors and balconies. The furniture looks to be moderately priced and very modern. The places are very well kept. At 1 point during the day we went to a very ultra religious village. It was horrible. The houses were not kept well and there was garbage everywhere. Very disappointing and shameful.

Siderot was terribly struck on Oct 7. They terrorists crossed easily into the city. Over 100 people were killed. There were many wounded patients, too many to treat. There was gunfighting in the streets as the police and IDF tried to respond. The 40,000 residents were evacuated several days later to hotels in Eilat and other places. They could only return to their homes 3 months later. Over 250,000 Israelis still can not return to their homes in the north due to Hezbolah shelling. This is never reported in the western press. They are only concerned with the plight of the Gazans. It makes me wonder who fired the 1st shots on Oct 7, the Palestinians (Hamas) or the Israelis. Many of the Siderot residents suffer from PTSD and will continue to do so for many years. The P-M that I worked with was on duty that day.

bomb shelter/safe house in the street

Israel 31,

April 16, 2024,

Hi Everyone,

Yesterday was my 1st real day for working with MDA, Magan David Adom. I receive my orders in the evening as to where I will work in the Tel Aviv area. My 1st assignment was in an area called Holon a 20 minute drive from my hotel. I have learned to use Waze which is very effective in Israel.

I was assigned to an ACLS ambulance. The driver, Rancho is a senior para-medic with many years of experience. A junior para-medic, Shilit was present as well. We were busy all day. As soon as 1 call was finished another call came in. We started work at 6:45 and did not finish until 4:30. We did at least 6 calls during the shift.

In Israel the 1st responder is often a p-m on a motor cycle. A BLS, basic life support ambulance is called for basic resussitation. They can do EKGs, give oxygen, take bloods, BPs, do CPR including shocking the patient if required. An ACLS ambulance can do more in depth diagnosis and treatment including giving major medications. There is also 1 ECMO ambulance, made in France, with an ECMO machine that I will describe later.

My 1st case was rather simple, a DOA that required only paper work. We had several other cases, requiring more advanced care and transport to a hospital. We had 1 CPR case that required cardiac massage and shocking. We saved the patient and he regained consciousness.

We then had 1 case that I have never witnessed before and will never forget. The 1st responder and BLS support team had already been called. They were giving cardiac massage when we arrived. We intubated the patient who had already been shocked to restore his rhythm. ECMO was then called. They are only called for CPR if the patient is under 65, salvageable and the cardiac arrest has been witnessed.

ECMO was called and arrived in another ambulance with 3 physicians. We were still doing CPR. They produced a machine that went around the patient and was able to do extremely effective chest compressions. A doctor then prepared a sterile field in the groin area. He then placed needles in the right femoral vein and artery. This was followed with wires that went up the vein and artery. A 1 cm tube was then inserted into each vessel. These tubes were connected to a portable heart-lung machine to take out the venous blood, re-oxygenate the blood and replace it in the artery. I didn’t even know that such a machine existed.

The patient miraculously regained consciousness. The fire department was called as we could not get the patient and all the equipment into an elevator. A hook and latter truck raised a platform to the 2nd floor. The patient was placed on a hard portable stretcher and moved onto the elevated platform. The platform was then lowered to the awaiting ambulance and transported to a hospital. We later learned that he had undergone an angiogram and will probably require a bypass. The LAD, the main cardiac artery was 99% blocked. ‘Been there, done that’ and played hockey 3 months later. I think that Israel is much more advanced than us for doing advanced CPR in the field. There training must by much more involved than ours.

Love,

Brian

ABSOLUTELY UNBELIEVABLE, miraculously saved the patient, what heroes.

Israel 30,

April 15, 2024,

Hi Everyone,

After my training with MDA, in Jerusalem, I had 3 hours to spare before meeting my cousin David. I took the light rail train from the main train station to the old city. It always amazes me from visiting Europe and Israel, how these countries can a build an inexpensive 4-6 car surface, light , electric train at a low cost with no fuss or bother. It is beautiful, efficient and quiet. Why do projects take so long and are so expensive to build and run in Quebec. Need I answer my own question?

For those of you who have not had a chance to visit Israel, the old city of Jerusalem is quite amazing. The history of Jerusalem dates back 2000-3000 years. The 3 religions, Christianity with its variations, Judaism and Islam, for better or for worse have their origins here. The old part of the city is walled and has undergone considerable renovation since I first visited her in 1979, 3 years after the 6 day war. The streets are very narrow with cobblestones. Very few cars can navigate the passageways. All of the famous prophets walked these streets at some point in time. The original city is in many places much below the surface. The ‘dust of the ages’ has accumulated to raise the level of the city as is true in many old cities.

The city is divided into 4 sectors, the Armenian sector, the Jewish sector, the Christian sector and the Muslim sector. Due to the war, sadly, the city is empty of tourists. The shops and the cafes are empty. There is no business being done here.I have been here many times in the past, so the jewelry and ‘authentic’ clothes don’t interest me. I stopped to have a coffee late in the afternoon to call Marion and congratulate her and Jeremy on their new born son. I was alone in the cafe. In some ways I am of course drawn to the old city. Although there is no danger walking here and I never feel uncomfortable, I know that there is tension among the various religious people.

Of course, even though I am Jewish, and have no religious affiliation with Judaism, I wanted to see ‘the western wall’. You may of course ask me if I have no affiliation with the Jewish religion, why am I here? I think that I have answered that question on several occasions in my blog. The plaza in front of the wall is beautiful. The part of the wall that is visible represents the western wall. It runs about 100 meters and is probably 10 meters high. This represents only ⅓ of the height of the wall. The original temple was about 500 meters long. It must have been magnificent. Israel has done a fantastic job of excavating below the wall to see the ancient structure without either disturbing the wall or the mosque. I may visit this another time.

I met my cousin David at 6:00 at a small market. I have not seen him since 1972, when I returned from France the 1st time. He was 9 and I was 23 and he was staying at my grandmother’s house in Trout Lake. We have both changed since then. 10 years ago, we renewed acquaintances on the internet as he was doing some research on our ancestry. Our grandparents came from the Russian Empire, now Moldova, Rumania, Lithuania, Belarus, Russia and Ukraine. They lived in shtetles, in very poor conditions and left due to the pogroms that killed 1.5 million Jews from 1880 to 1917. The programs only stopped with the Russian Revolution to be replaced with another form of anti-semitism.

David and I are diametrically opposite to each other on the religious spectrum. He is very religious although not Haredi, and spent the greater part of his career as a rabbi in the Air Force. He now does IT research with the government. In spite of our religious differences, we got along splendidly together. We went to a particularly kosher restaurant where the Italian style food was delicious. If you want to go to a good restaurant in any country, you can always count on Italian style food. We exchanged family stories and laughed and joked with each other until rather late in the evening. He has 8 children and his sister has 9. There are a lot of grandchildren. I bid him farewell with a promesse to meet again later in the month. He lives just outside of the Green Line in a religious village. We spoke a little about politics and the future of Israel, but like all the Israelis, no one knows what to do and what a good solution would be to the I-P problem.

SI worked with MDA just outside of Tel Aviv on an ambulance which was fabulous. I was up at 5:30 to make work on time. I don’t have time to tell you my adventures so I will combine 2 days in 1 tomorrow. Tomorrow, I will work in Siderot, 5k from Gaza…..Don’t worry, I will be fine.

Love,

Brian

soldiers are everywhere in Jerusalem

A photo of Yeminite Jews, 16 and 14 with a child