Spain 2026-07

Spain 8,

Sept. 26, 2026,

Hi Everyone,

Last night and today were not great. I somehow developed a prostatitis/cystitis/UTI/lower urinary tract infection probably from the cold water that I swam in. I was up all night, peeing every 10 minutes with dysuria (burning), frequency, nocturia, but no hematuria (bleeding).

This is old man’s or a young women’s problem. Needless to say, I got very little sleep. I did my washing quickly as I was running out of clean clothes and headed off to find medical care. The local pharmacy would not give me ‘antibiotica’ without a medical prescription. Meaños where I am staying, does not have a clinic, so I drove to Pontavedra 30 minutes away. All the streets are blocked off due to the race, which made parking rather difficult. The first hospital that I went to specialized in gynecology and paediatrics. They laughed at (with) me as I was neither the correct sex nor the correct age. They sent me off to the university hospital.

The ‘University Hospital’ was situated at the top of a mountain overlooking the city. Obviously, they don’t expect a large walk in clientele. The efficiency lies somewhere between Israel and Canada with a tendency towards the later. The triage nurse saw me within minutes and immediately placed me on a stretcher. I got undressed and put on a hospital gown. 1 hour late a nurse came in and took my vital signs. 1 hour later a resident came to see me, took a complete history and physical exam and then went to give her report to the ER doctor. He immediately ordered a complete blood test. The resident told me that the results would be ready in 3 hours.

Everyone was very kind and helpful but I had no intention of waiting another 3 hours. I told the resident that I was a ‘urologue’ and that I really only needed some Cipro and I would be off. She understood, returned soon afterwards with a prescription and asked me to sign a form written in Spanish. It was probably a release form. The hospital took my insurance card and didn’t charge me a cent.

I took 2 pillS and am feeling much better. I finally found a local high quality restaurant, 5 minutes from my hotel. The food is very reasonably priced and very plentiful. I have learned to only order a main course which comes with a salad and bread. I order the local wine by the glass and have been very impressed. None of the restaurants open before 9:00 pm and most people come to eat at around 10:00 pm

I will be up at 6:00 am tomorrow to drive to Pontevedra and secure a parking spot. I must register for the relay at 8:00 and the hang around until the afternoon for the relay race. We are 4 participants in a mixed team and each of us must do the super sprint, 37m swim, 10km bike and 2.5 km run. I am the oldest in my group. Surprise! Surprise!

I had no time to take pictures.

Love,

Brian

2025-03 Israel

Israel 19,

April 8, 2025,

Hi Everyone,

It is 36C with cloudy skies, muggy and humid, not at all the weather that I am used to in Tel Aviv. Today was a boring, quiet day with MDA also what I am not used to with the ambulance service. We got our first call at 11:30. We arrived at a nice apartment building in a nice area of Tel Aviv and were shocked by the condition of the apartment that we entered. The couple were hoarders, something that I have only witnessed once in the city. Israelis, even if they are poor, are very clean in their personal apartments. This was an exception. There was rubbage piled up everywhere although the apartment was not particularly dirty. The lady appeared to be about 40, obese weighing 130 kg and lying in bed. Her husband was my size and cleanly dressed. There was a child of about 5 years old, sleeping. Why she was not at school is anybodies guess. We spoke with the woman for a while. She was in no acute distress although she thought that she was in anaphylactic shock from something that she ate yesterday. We convinced her otherwise, reassured her and left her in the care of her husband. What kind of future does the little girl have with parents like this?

The second case was a drug addict that was sleeping in front of a supermarket. She was in no acute distress and not a danger to either herself or the public. She did not want to come with us. The manager wanted us to take her to the hospital by force but we had no authority or reason to do so. We left her and eventually she will find her way home.

The third case was a 63 year old female who had just had an MI, cardiac arrest and resuscitation 3 months ago. She had chest pain that was resolving. Her EKG showed new changes. She refused to come with us to the hospital. 2 of the paramedics spoke with her for 1 hour to try to convince her to come with us. They always have incredible patience with patients. Her Phillipino helper had called the ambulance as she felt that her condition was deteriorating. At one point she asked the paramedic who I was. He introduced me as Dr Brian from Canada. The woman spoke English fluently. I reinforced the point that she had EKG changes and needed to come to Tel Hashomer for further evaluation including an echocardiogram and cardiac trops. She told me that she is afraid of hospitals. I then saw her looking at my chest scar. I told her that I knew from personal experience what chest pain feels like. I explained to her that I am also afraid of hospitals as a patient but sometimes you just have to go. She said that she would like to consult her rabbi, Reb Bal Shem Tov. I told her that it was not necessary as I had already consulted with the Reb and that he had sent me here from Canada to take care of her and have her come with us to the hospital. She laughed and then agreed to come to the hospital in our ambulance. The conversation with me had not taken more that 3 minutes. I later told the paramedics that I thought that had looked at my white hair and decided that I must be right with all my experience in these types of cases. Little did I know…..

Love,

Brian

Modern buildings in Tel Aviv. The architects here are not afraid to be original in their design.

2025-03 2025

Israel 17,

April 6, 2025,

Hi Everyone,

Today was my first day with MDA, Magan David Adom, Israeli civic ambulance service. We do not go to a war zone. Military ambulances take care of war casualties. I was posted at the MDA base in Raman Gan about 30 minutes from Tel Aviv. I was not posted there last year. I was introduced to my 3 paramedics. One was an experienced driver, 1 girl was 19 years old and in training and 1 was 28 years old and has done ambulance service with the army. I was up at 5:30 and had a quick breakfast as the hotel had generous supplied me with a breakfast and lunch to go. With Waze I had no trouble getting to the ambulance base. I have to be at the base at 6:30 to check the medications on the ambulance. They let me check all the medications and although every was written in Hebrew, I was able to make out ok.

Our 1st call was rather simple. A 16 year old girl with tachycardia probably due to stress. We went through the usual routine of a history and physical exam. The patient was not in acute distress. We brought her to the hospital for monitoring and further treatment if necessary.

The 2nd patient was an 84 year old lady with COPD, asthma and diabetes. She was on oxygen chronically. We took a history and physical, started an IV, EKG, blood sugar, temperature, blood pressure, blood oxygen level, pulse, resperation. Her temp was 39 C so she probably had a pneumonia with an exacerbation of asthma and COPD. She was wheezing. We gave her Oxygen, placed her on an ambulance chair and carried her down 3 flights of stairs to our ambulance and brought her to the hospital.

The 3rd patient was a 45 year old patient, overweight who had fallen down the stairs. She was sitting, leaning against the wall in severe pain. She had an open fracture of the lower tibia and fibula, bleeding with her left angulated at 70 degrees.

We started an IV and gave her fentanyl for the pain. She calmed down in a few minutes. We were then able to straighten out the leg and splint the fractured leg to the good leg. We covered the fracture with a bandage. We lifted her onto a sling and then placed her onto a stretcher. Present was a BLS ambulance (basic life support) with 3 paramedics and a ACLS ambulance (advanced cardiac life support) with 3 paramedics and me. It took 6 of us to carry her down 3 flights of a narrow staircase to get her into our ambulance. Then, with sirens blazing, we rushed her to the hospital. The treatment on arrival at the hospital was instantaneous.

I have nothing but good words and praise for the paramedics. They are calm and very kind to the patient and family. They are extremely well trained. They follow protocols which make them efficient and effective. No one ever gets excited. They always know exactly what to do to help the patient. Israel is very well served by the paramedics of MDA.

The 2nd patient was accompanied by her daughter who rode in the ambulance with us. She comes from New Jersey and is in Israel for 3 months to visit with her mother who was the patient. She bought her husband with her to Israel. He was in a wheelchair as he had a traumatic brain injury 12 years ago when, as a pedestrian, was hit by a car. He had 7 brain operations and has obvious deficits. I don’t know how she has the courage to face the day when she wakes up in the morning.

After my cases, I bought a pair of Nike running shoes to replace the shoes that I destroyed on the IDF base. MDA requires closed shoes so my sandals were not acceptable. Great, I needed a new pair of running shoes anyway. My old pair at home are 10 years old. Boy, have running shoes changed in 10 years. These new shoes bounce when I run. Maybe it will help me win more triathlon races. I can’t wait to try them out when I run this week.

Love,

Brian