2025-03 Israel

Israel 23,

April 13, 2025,

Hi Everyone,

Yesterday was a quiet day. I spent the morning getting caught up on my emails. I like to classify my emails every day or so or the total number becomes unwieldy. I owed a few friends a return email. I then went up on the terrace and studied Hebrew. Progress is slow as usual but I give myself credit for trying. It was too cool for swimming and the beach was virtually empty. The sky was blue with a little breeze, the perfect weather for walking around and visiting Tel Aviv. There are always new neighbourhoods to visit.

There are facebook websites called Sword of Iron and Volunteers for Israel where anyone who is a member can post things. There is a useful amount of information about what is going on in Israel. Often one can find places to volunteer for the day or for a week. A lady made a posting for volunteers who were looking for a seder to attend. All of my relatives here were either going away or were having a seder with their in-laws. I decided to accept the invitation and brought a box of Belgian chocolates. One of the volunteers staying at Maxim’s was also invited so we walked over together, a 10 minute walk.

The seder was fabulous. The lady was originally from Montreal and had been living in Israel for 40 years. She is a professional comedian and travels the country and the world giving performances in English, French and Hebrew, an incredible accomplishment. Her husband was an accountant from London. My friend was from Ottawa and has lived all over the world. There was another lady from Montreal who had a long career with the Canadian government. The last fellow had an NGO that helps new immigrants adapt to Israel, finding them jobs and apartments. All together it was a highly intelectual group. It is rare that I meet people who have travelled and even lived in as many or more countries as me. Except for one person, we were all on the better side of 68, a real group of genuine real live hippies from the 60s. You can imagine the conversation or maybe you can’t.

The seder was brief as planned, even shorter than our seder in Montreal. Boray Pree Hagoffen and the meal began. We started off the evening with an orange wine that resembled a dry port wine followed by main course of brisket, salmon and salad. For desert we had cheese cake. The wine and conversation flowed until after midnight although I had to leave at 10:30 as I had to get up at 5:30 for work. The lady’s husband did all the cooking, a first quality home cooked meal.

This morning after a 3 day break a was back to work with MDA in Ramat Gan. I had a new team that as usual was very competent. The driver was an experienced paramedic who had spent time in Gaza and Lebanon. He carried a pistol which is common for the driver. We go into many different areas of Tel Aviv, rich and poor and we are never sure what we can meet. Although I have never had an incident in 2 years, it is reassuring. Although I am well trained after my 3 days training with Krav Maga, in orderto disarm an assailant with a gun, knife or baton, I would rather not have to put my lack of experience to the test. The chief today on our mission had 8 years experience with MDA and had just finished his medical training as a physician. He is in the process of deciding what specialty that he will do. I tried to convince him to do urology. Rounding off the team was a young girl who is still training to be a paramedic. The chief let her do the initial history and physical exam of the patient. Afterwards he gave her a lot of teaching in the ambulance, reviewing the case.

Our 1st case was an elderly female in the last staged of breast cancer. The physicians had stopped active therapy and she was having palliative care. The paramedics discussed the case at length with the family to get an idea of what they wanted for their mother. In the end we decided to bring the lady to Tel Hashomer for further palliative care.

The 2nd case was an elderly man of Yemenite origin. In 1948 Israel brought 48,000 Yemenite Jews to Israel in an operation called Magic Carpet. These Jews had lived in Yemen for almost 2000 years. However the antisemitism had become untenable after the foundation of the State of Israel in 1948. 800,000 were forced to leave their homes in Arab countries from 1948 to 1950. They had been living in these countries for 1000 years and left in 2 years with no compensation and not a word from the UN. The man didn’t feel well and all of a sudden, without warning vomited ‘coffee grounds’ all over himself and the floor. Coffee grounds often means partially digested blood in the stomach indicative of internal bleeding. The family, consisting of 6 people didn’t bat an eye lash. They just cleaned it up as if nothing had happened. The floors in most Israeli apartments is made of tile for large plaques of marble 75×75 cm making clean up much more simple than had the floor been made of wooded lattes. We transported the patient to the hospital.

The 3rd case was an elderly man with shortness of breath. He had some crackling at the base of his lungs so we diagnosed that he had congestive heart failure. We gave him 40mg of a diuretic, furosamide and transported him to the hospital. On arrival at the hospital, he voided a large amount of urine and felt much better. His shortness of breath had disappeared and his colour was much improved.

The 4th case was an elderly man who apparently had bradycardia, a slow heart beat. When we arrived he had a high blood pressure but no indication of bradycardia. He was in no acute distress and was not short of breath or had chest pain. We spoke to his family MD who will treat him as an outpatient.

I am writing my blog in one of my usual haunts called Mikes Place. They serve comfort food and the place has big screen TVs on the wall. There is football everywhere. It resembles some of the bars that you find in American ski resorts. On certain nights there is live entertainment but not tonight. I just spilled my bear, missing my ipad and cell phone so the waiter kindly offered me a refill.

Love,

Brian

My hippy friends

MDA paramedics and Tel Aviv

Mike’s Place

2025-03 Israel

Israel 20,

April 9, 2025,

Hi Everyone,

Good and hopefully wonderful news. The 4 month old baby that we treated 2 days ago has woken up with apparently no neurological deficits. It may however be some time until they see the long term outcome of the event. At the very least, we know that he is on the right track. In my mind, there is no question, the chief paramedic on our team who by his quick action, under difficult circumstances, saved the life of the child. Kol Hakavod. Way to go!

The news from around the world is getting worse and worse. Trumps tariffs, which have not been thought through by anyone who understands world economics, is wreaking havoc on the stock market in the USA, Canada, the EU and Europe. Now, even his billionaire henchmen who surround him, and lavish praise on him are having second thoughts as their portfolios decrease by the billions. No European country will ever trust the USA again. The good will that has taken 80 years to build since WW2, has been destroyed in one fell swoop, by one powerful man. Trump is 99% wrong in all his policies but may be 1% correct in his Middle East policies. He has announced that he will have direct talks with Iran in 3 days on Saturday about Iran’s nuclear policy. Iran has announced that the talks, which will take place in Oman, will be indirect through mediators. Has Trump misspoken and will he back down? I doubt it as it would cause him to lose face which he is not like him even if he is wrong. Here in Israel we are watching, this holding our breaths, with caution and hoping for the best outcome. One way or another, Iran must not acquire nuclear weapons.

Last evening I went to Bat Yam, a suburb of Tel Aviv for dinner with a friend who I met at Sar-el. We had dinner in a beach restaurant overlooking the beach. I ate a fish called mullet which I have only eaten once before here in Tel Aviv. It was delicious.

We had a quiet day with MDA today. The 1st case was a lady who called the ambulance because she had an anxiety attack. The paramedics spoke with her for 1 hour. When it came time for her to come with us in the ambulance to the hospital, she went into her kitchen and brought out a pot of soup that she insisted in bringing with her in the ambulance and to the hospital. This is absolutely not forbidden. A neighbour came over to try to convince her that she could not take the soup with her. In the end, we were forced to leave the lady and her soup behind at curb side.

The 2nd case was an 18 year old girl that had an episode of tonic, clonic epilepsy. This was her first episode and the parents were obviously very frightened. The epileptic fit had finished by the time we got there and had only lasted a few minutes. Her VS were normal as was the EKG. She had not fever. We brought her to the hospital for a full neurological exam, blood work and a CT scan.

The 3rd case was an elderly Russian patient who didn’t feel well. She only spoke a few word of Hebrew. The paramedics did the best they could to get a proper history from her with signs and gestures. They are very patient with patients in these cases. There were changes on her EKG with no discernible chest pain. We took her to Tel Hashomer for further evaluation including blood work, serial EKGs and tropes.

The 4th case concerned a 30 year old female patient who was crying, yelling and had broken a glass in the stairwell. On further questioning which took some time, we were able to conclude that the entire family including the husband, the mother and the father were partners in a totally dysfunctional family. There may have been a court order that a judge had ordered house arrest for the husband and that the wife, who was the patient, had to stay and look after him. Go figure. The police were called for back up but they did not interfere with us. Eventually, after much discussion, the woman came with us to the hospital for stabilization. I was able to talk to the policemen who were motorcycle cops. We got to talking about motorcycles and they were quite impressed that I own a 1973 Triumph 750cc Tiger.

Over the last few days, I have really seen a cross section of Tel Aviv society. If you walk on the beach in Tel Aviv, you falsely may get the impression that everyone is tall, beautiful and in good shape. Once you leave the beach however, you can be surprised with what you see. Some people are overweight. Many of the apartments are somewhat run down. Some apartments are beautiful from the outside and in the lobbies , but the individual apartments are not well kept at all. There is a large immigrant population with different ideas of cleanliness and neatness than our own. Of course, that is what makes a society.

Love,

Brian

Bat Yam Beach

An older and poorer area of Tel Aviv

The fruit and vegetable stores are always good

Motorcycle cops with their permission to publish. Who is the little guy in the middle with white hair?

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