Today I had a 9 to 5 shift with MDA which was a 1st for me. The 1st case involved a middle aged female patient with mild chest pain. We did the usual MDA work up before deciding that this was not an acute coronary syndrome. We gave her pain medication but no nitro. We then transferred her to Sheba Medical Centre for further evaluation and treatment.
The 2nd patient was a young man coming from Russia with his mother by plane. He presented with a rash (urticaria).We were called to rule out an anaphylactic reaction. The patient was in no acute respiratory distress. We brought him to a paediatric hospital.
The 3rd patient proved to be much more difficult in both complexity, diagnosis and treatment. The patient lived in Jaffa an Arab/Muslim neighbourhood which is renowned for crime but can be visited without fear during the daytime. A neighbour called the police to intervene with an elderly female patient exhibiting a psychotic, aggressive reaction. She was screaming and accusing her neighbours of many atrocities. The police called us for further evaluation. We spoke to the patient through a locked door which she would not open. The police then banged on the door to no avail.
After an hour of persuasion she consented to open the door. She would not settle down or allow us to bring her to hospital. We are not allowed to administer antipsychotics medication or to forcibly bring her to hospital unless she is a danger to herself or to others. This was not the case. We then called for back up which consisted of an MDA nurse trained for patients in psychosis. After 1 hour of discussion, the nurse called a physician for advice. The physician ordered antipsychotic medication to be administered by force if necessary. The police held the patient and the nurse gave her IM Haldol which calmed her down enough to allow us to bring her to the ER for further treatment. The entire process took 3 hours.
This evening I listened to a talk organized by Sar-El at Maxim Hotel. An Israeli, originally from Ethiopia gave an interesting rendition of his early life in abject poverty in a village in Ethiopia. The Israeli government arranged for a large scale rescue of the Ethiopian Jews to Israel. These people considered themselves to be Jewish and were unaware that a Jewish community existed elsewhere in the world. There customs were far different from modern Judaism. The religious leaders in Israel forced them to undergo a Jewish conversion which was very insulting to them. After 1 or 2 generations they have inter married with the resident Israelis and have been accepted into the community. The speaker, with no education, studied hard, served in the army and eventually became a professor.
I am at Mike’s one of my dinner hangouts. Once again I was served by a waitress who was originally from Ukraine and recognized me from previous visits.
Last evening I decided to eat a light meal. I ate the usual soup at Maxim’s accompanied by my usual glasses of red wine. I had an orange and an apple saved from breakfast so I asked for a yogourt, mixed it with the fruit and made a fruit salad. Not bad for a guy who once boiled an egg and burned it.
I had a great team today with MDA, very efficient and kind to the patients. We had 3 cases of note as well as several cancellations for unknown reasons.
The 1st case was a 60 y/o lady who often comes to the hospital for a COPD exacerbation. This has in no way diminished her smoking habit. This time she had shortness of breath and a tightness in her throat due to perhaps an allergic reaction. She had quite a character and had us laughing all the time. She insisted on giving us candies. We brought her to the ambulance and initiated treatment with ventolin. Her condition improved rapidly and we transferred her to the hospital at a regular speed.
The 2nd case involved a 50 y/o worker who was suffering from minimal chest discomfort and palpitations on a construction site. We took a history and physical exam and placed him on an EKG monitor. His EKG was normal as were his VS. Nevertheless we transferred him to a hospital for monitoring, tropes, possibly an angiogram and holter monitor to rule out an arrhythmia.
The 3rd case was much more exciting. We were called to a rehab centre where a 70 y/o male patient who had suffered a stroke, was now presenting with the tonic and clonic contractions seen in acute epilepsy. He was unconscious of course. The team worked extremely quickly. We installed an IV and gave him an anti epileptic medication. We then placed an oro-pharyngeal tube in his mouth to keep him from swallowing his tongue and to help him breathe better. We gave him oxygen and monitored his EKG. We rushed him to the hospital with sirens blazing. A report was emailed to the hospital. The physicians were standing by, awaiting our arrival. A stroke can mean either an intracerebral clot or a bleed. A CT scan will tell the difference and ‘clot buster’ medication can be administered if a clot is present. Time is of the essence to limit the brain damage.
I am now siting in one of my favourite restaurants on Dizengoff Square where all the action is in Tel Aviv. Dizengoff Square is really a circle. In the middle of the square, there is a fountain lined with photos of the Israelis who we lost in the war. This is very similar to what I saw 2 years ago when pictures of the hostages were present.
Trump and Iran are still trading missiles with some falling on other Arab states. For the moment, Israel is sitting on the sidelines but that could change any minute. France is out in FIFA World Cup with England and Argentina advancing to the finals. Mesi is openly very pro Israel so it is obvious which team we are routing for.
After completing my blog on the terrace yesterday, I went down to the beach for my daily athletic event. I swam to the breakwater twice, a distance of 1k and then ran 5k on the beach. Some people have told me that they have been stung by jelly fish so I will have to be more careful with my swim. I wear swim goggles so I should be able to identify one before getting stung…
I purchased a day ticket that allowed me to go back and forth from Tel Aviv to Jerusalem for 24 hours as well as to take unlimited trips on the local bus and light rail system in both cities. I met my cousin, David, in Jerusalem in front of the City Hall. The trip to Jerusalem takes 45 min and the light rail trip takes 10 min. I first met David 50 years ago in Trout Lake at my grandmother’s cottage and renewed acquaintances with him 2 years ago. He was a rabbi in the Israeli Air Force and now does IT research for the government. We are diametrically opposite on the religious spectre and still get along superbly. We went to an upscale restaurant in an upscale mall and had a wonderful dining experience together. I broached the political subject of the solution to the current crisis hoping naively for incite or an answer. Unfortunately at the present time there is none. I personally don’t think that Israel will strike Iran first unless Trump asks them to do so. On the other hand, Iran is striking Middle Eastern countries at will on a daily basis. I am scheduled to fly back to Canada on July 22. I have made a decision to stay and work with MDA if rockets are flying in Tel Aviv before I leave.
Today I worked an early shift with MDA. We had multiple false starts that were cancelled before arriving. The 1st case of note involved a 44 y/o worker how had a heart attack and cardiac arrest on the 5th floor of a building under construction. The white, BLS ambulance arrived first. The patient was in ventricular fibrillation requiring shocks twice. We learned of this before arriving, by the web. We ran up to the 5th floor with all our heavy equipment. They don’t let me carry anything probably believing that it would be too much of an effort on my part. They are right, 5 floors at full speed is enough cardiac exercise for me.
On arrival, the patient had partially regained consciousness. We did the usual routine, IV, EKG, oxygen, blood sugar, BP, pulse, fluids etc. We placed the patient on a back board for precaution. 6 of us then carried the patient down the stairs to our ambulance. We rushed the patient to the hospital with sirens blazing.
The 2nd patient was a small child with a possible anaphylactic shock from peanuts. This was not really the case but we took the patient to the hospital with appropriate monitoring for precaution.
I met several people at the Maxim daily cocktail, one of whom is a French-Israeli author and film maker of note. He has a Wikipedia page describing his accomplishments. That is my next goal. We exchanged emails and formed a WhatsApp group. Perhaps this will help me to advance my book sales.
I had an early shift today with 3 paramedics, 1 of whom I worked with last year. He is a physician who has completed his army service and is currently doing a rotating internship. He is considering doing ether paediatrics or paediatric surgery. I have him some advice. If he is intellectual he should do a medical speciality such as paediatrics. If he is good with his hands, he should do paediatric surgery. He will do a rotation at Schneider Paediatric Hospital and then make his decision. Today he gave me a brief tour of the hospital which has 1500 beds. There must be an endless supply of beds here as I have never seen anyone wait for more than 5 minutes in the ER and they appear to do a triage and hospitalize the patient very quickly.
The 1st patient was an elderly male, 76 years old. He was extremely skinny, lying in bed, on chronic oxygen therapy. On arrival in the apartment, I perceived a definite smell of cigarette smoke. We examined the patient who had shallow rapid breathing and many crepitations in his lungs. His EKG and BP were relatively normal. We gave him a treatment with ventolin inhalation and IV paracetamol and his condition improved. We then transferred him to the hospital.
The 2nd was a 77 year old female who had tripped on a small rug in front of her bed. She was lying on the floor with a deformed hip and her foot turned outward indicating a fractured hip. There was very little room to manoeuvre between her and the wall. We took a sheet off her bed and skillfully slid it under her. We collapsed the stretcher to a position 6 inches off the floor. We then lifted her onto the stretcher holding onto the sheet.
The 3rd patient was an elderly female of unspecified age. She was lying on the floor, obviously dead. We took an EKG which was flat lined. These people come from very tough stock. The husband was present, gave us a brief history, showing no emotion at all. He then took a picture of his deceased wife murmuring ‘this will be the last picture on my beautiful wife.’ In these cases we do not bring the patient to the hospital. The apartment was the most beautiful apartment that I have seen in Tel Aviv. There were floor to ceiling window giving a wonder view of the city including the sea. The floor was made of her black granite.
We had a couple of other cases which were cancelled on route that I need not describe.
Tonight, I will be dining with Vicki and her son for Shabbat. I bought a nice bottle of Italian wine from a wine merchant who was originally from Lyon and had been living in Israel for 44 years. I presented myself as a Francais-Anglophone from Canada who had lived for several years in Reims. He told me that the situation for French Jews in France is terrible. They are attacked from the left and the right wing as well as by the Arabs. They dare not wear a Magen David in public for fear of being beaten up. The ‘centre’ does nothing to protect them. Many Jews from France have purchased property in Tel Aviv and Natanya. Many others are considering leaving. What is this world coming to? Why should Jews living outside of Israel be blamed for Middle Eastern politics. Can you imagine if someone in Canada punched a Quebecois in the face for what the French did to the Hurons 300 years ago!!
Today I did my 1st shift on an MDA ambulance. The day started off slowly and ended up even slower. I was with a very good team so the shift was fun anyway. One of the paramedics was doing his last year of training. He had already done his 3 years of military service and then spent 2 years travelling around the world. He is hoping to get into medical school the following year.
The 1st call was reported to us as a drowning. While racing along to the beach, the call was cancelled as the would be patient started swimming. The 2nd call was for a lady unconscious but breathing and lying on the street. On the way to the scene, the call was cancelled as the lady woke up and walked away.
The 3rd call was a terrible tragedy. We were called to one of the wealthiest neighborhoods in Tel Aviv. The house was a beautiful white bungalow on a large property that was in the process of being renovated. We were told that a young 22 year old man was unconscious on the floor. The family had not seen him since the evening before. When we arrived it was obvious the man was dead and had been dead for several hours as rigor mortis had already set in. There was a computer with several screens on the desk and empty bottles of psychiatric medications near by. The young man was a Muslim and in service with the IDF. His father was away on business, apparently a CEO of well known bank. The police, 2 motorcycle ambulances, a white BLS ambulance and us in a yellow MICU ambulance were all present but there was nothing to be done except to pronounce him as deceased. I can say no more. We were all saddened by the apparent suicide.
The 4th call evolved an elderly woman living in a hospice. She had a severe history of cardiac disease and had had a stroke in the past. Her medical history, type written on 3 pages was given to us. We made the initial diagnosis of septic shock and did the appropriate management, IV fluids, epinephrine, history and physical exam, etc. She appeared to improve in the ambulance on the way to the hospital. On arrival, she was transferred to the hospital stretcher, placed in an ER room and had medical attention with physicians and nurses immediately. In Israel, I have always been impressed with the efficiency of the medical system when we bring a patient to the hospital.
The last call at 3:00 just as our shift was ending was a psychotic patient who had stabilized so the call was cancelled.
I returned to my hotel and went down to the beach. There were 1meter waves making swimming difficult. I swam ¾ of the way to the breakwater and back twice. Going out any farther would have been dangerous. The life guards were whistling people in if they swam out too far. I then ran 5k on the beach in less than 44 min.
I took a short nap and then went to La Mer restaurant to eat and watch the Egyptian – Argentina game. The place was packed with chairs and tables extending out onto the sandy beach. There were at least 1000-2000 fans present. Everyone was routing for Argentina especially after the incident which occurred after Egypt won their last game. The Egyptian coach ran onto the field after the win with a Palestinian flag saying that the team had won the game for Palestine. Politics are not supposed to be allowed at World Cup tournaments, but the incident was ignored by the refs. Egypt erected a huge high wall between Gaza and Egypt to keep the Palestinians out. I guess that he forgot about that wall. The restaurant was dead silent after Egypt took the lead with 2 goals. I was still hopeful that Mesi would prevail with goals. He did not disappoint us. In the closing minutes of the match, Argentina took the lead with 3 goals winning the match. The place went wild with everyone celebrating and congratulating each other. What a win!!
I struck up a conversation with a gentleman sitting beside me at the table. His name is Mikolaj Zalasinski and is a famous opera singer. He has been invited all over the world to be the lead singer in several operas. He will be singing in the opera, Tosca in the Tel Aviv opera house. He will try to get me invited as a guest. They have been practicing for several weeks. I love opera and will be very excited if he can get me a ticket. He was very impressed that I wrote a book about Israel. Apparently, his grandmother is Jewish.
I slept for 8.5 hours so I think that I am all caught up from sleep deprivation from the time change and my 36 hour voyage from hell. As they say, no pain, no gain.
Last evening I wandered over to Mike’s one of my favourite brasseries on the beach. It was a warm 23C with a cool breeze, just right to have a beer, in a pub, with the Med in the background, and watch the Norway-Brazilian football World Cup match. I was at a table with a family of Brazilians who had made Aliyah to Israel many years ago. They were very friendly and expressive but unfortunately it did not help their team win the match.
At the Maxim Hotel, you are free to sit at almost any table as the hotel caters to volunteers. I played ‘Jewish geography’ with a lady who was originally from Montreal and now lives in Toronto. She grew up in the CDN and CSL areas and we had many common acquaintances. I then spoke at length with a lady originally from South Africa and who now lives in Australia.
I spent the rest of the afternoon on the beach doing my usual activities. I am really a beachcomber at heart. In my spare time there is nothing more that I would like to do. I am not really very intellectual at heart. I was 30C with a slight breeze and only the occasional 2 foot breaker. I swam to the breakwater, 500m there and back with ease. The life guards must be getting used to me swimming out that far as they didn’t whistle me in. I didn’t hear a whistle anyway and I was the only one out swimming that far. I then jogged 5k on the beach knocking off 2 min from my time yesterday. If I continue at this rate I will be down to 0 in 3 weeks which is impossible if you do the math.
I bought a Magnum ice cream bar at 3:30 and got so excited by the prospect of eating an ice cream on the beach, that I got carried away and dropped my credit card on the sand. A ‘kid’ picked it up and spent 135 shekels ($65) before I could cancel it. It must have been a kid, as a pro would have made an attempt to empty my bank account. The store got the thief on their camera and I will review it later in the week. I don’t know if they have ‘wanted dead or alive’ posters here.
I am at the La Mer Restaurant overlooking the beach eating my 1st solid meal in 3 days. I really have not been hungry and except for breakfast, have only consumed liquids. There is a live band here to encourage me as I devour a margarita pizza and a local Maccabi draft beer.
Tomorrow, I will do my first shift with MDA so you can expect a full account of my cases.
The sirens went off at 6:40 in Tel Aviv and all over central Israel. I learned my lesson from last time when I was in Eilat, and put on a pair of pants and a fleece before heading out to the shelter. Everyone in the hotel stood in the stairwell for the 10 minutes that the sirens were going off. We learned later that the Houthis had fired a ballis I wandered over to Dizengoff Square for a late dinner last night and am doing the same tonight. On the circle are several restaurants, three of which I frequent often for dinner. Except for a few grandparents who are taking their children and grandchildren for dinner, I am well past the average age here. Great, I love to be with 20-30-40 year olds as it makes me feel young again. I am always shocked when I walk past a mirror and see a reflection of myself with wrinkles and white hair. I skipped grey and went straight from blond to white after my bypass, 12 years and 15 triathlons ago.
Last year and again this year while at the laundromat and waiting for my clothes to wash and dry, I noticed a storefront gym with young people doing shadow kickboxing without actually fighting, accompanied by loud rock music. Everyone seemed to be sweating and enjoy themselves so I decided, why not, maybe I will give it a whirl. With my 3 days of training in krav maga, why not try a new challenge. I spoke to the instructor who invited me to come to a group class this morning.
There were about 8 of us in the group class, mixed men and women, the oldest of whom could not be more than 35. Great, I felt really at home with the group. We donned 12 oz gloves and then stood in front of the boxing bags, quite heavy and hung from the ceiling. Each of us had our own bag. The instructor then went through different moves of punching and kicking the bag. For each round of 3, he added a new kick or punch. We then moved on to weights with a bar. Most of the students took 30 lbs weights. The instructor gave me 10 lbs to start. He told me to take it easy as this was my first lesson. After lifting the weights we did a series of push ups and sit-ups. Most of the students did 10, 3 times. I was ok for the sit ups but to my surprise, I could only do 5 push ups at a time. I will have to practice before my next session next year. I may consider purchasing a punching bag and gloves at home for my basement.
I came back to the hotel to change into my bathing suit. I learned my lesson yesterday and reserved a beach chair at 9:00 before going out for my kick-boxing lessons. The chairs are hard to come by at 12:00 which I found out yesterday. It was at least 35C today with a slight breeze. There was not enough wind for sailing or kite surging. My usual routine is to lie on the beach chair for 30-45 min and then take a dip in the sea. Today, I felt enthousiastic after my boxing lesson, so I swam out to the breakwater twice, a distance of 1 km.
I ate my Magnum ice cream cone and then went for a manicure in a shop near my hotel. The lady was really nice and did a great job on my nails. It was only the second time in my life that I had a professional manicure.
continuation from paragraph 1,
We learned later that the Houthis had fired a ballistic missile at us. The ballistic missiles are much more dangerous than rockets or drones. They obviously are being given to the Houthis from Iran. Well they asked for it and they are going to get it. The missile was taken out over the water by the iron dome and no damage was done to Israel. However this cannot continue to go on forever without punishment. Trump is again meeting with Iran this Saturday. Neither Iran nor Trump will back down on Iran’s nuclear strategie. Iran has so much oil that they really don’t need nuclear energy unless they are contemplating using it for making a nuclear bomb. If Iran gets a nuclear bomb, every country in the Middle East will get a nuclear bomb. This is like having babies playing with fire. It just won’t work if the world wants to have another generation of children. One way or another, be it through diplomacy or war, the nuclear capacity of Iran must be destroyed.
On this happy note,
Love,
Brian
Dizengoff
my kick boxing instructor
Sirens went off at 6:40 am due to ballistic missile fired by Houthis
Last evening when my new friend Boris and his wife left, 2 young girls sat down next to me. As usual, I cannot forego striking up a conversation with fellow patrons sitting at the bar. My opening line this time was ‘are you American?’ As they were both speaking English and were clearly not English or Australian, American was a safe bet. 1 young lady was here for a short visit. The other lady came after Oct. 7, and has been here for 1.5 years. She started a website on Facebook called Sword of Iron, Israel Volunteer Opportunities. It is a very successful website and has become the go to website for foreigners looking for opportunities to volunteer in Israel. I consult the site almost everyday and often read about the volunteering experiences of fellow travellers. I told her that I write a blog on a website and have been documenting my stay of 2 months last year and 1 month this year with the IDF and MDA. She was most interested in my experience and took note of my blog site. She also encouraged me to write my blog on her website which I will do ASAP. It may drive more readers to my site as well as helping me in the sale of my soon to be published book. I have decided that the proceeds of the book will go directly to MDA.
This morning as usual I was up at 5:30 am in order to get to my base on time. The hotel prepares me a breakfast to go as they only start serving at 6:30. It takes me 20 minutes to drive to the base but 45 minutes to return due to the heavy Tel Aviv traffic at rush hour. Rush hour here seems to be any time after 9:00 am to 7:30 pm. I worked with 2 paramedics with whom I have worked before on several shifts as well as the chief paramedic who is very experienced and according to his employees, has seen and done everything. They defer to him for his opinion on many cases. The cases were very simple today so I will not go into details.
The 1st case was a Californian lady who married an Israeli and has been living in Tel Aviv for several years. She is a runner and was suffering from a severe acute groin injury. She could not get out of bed due to the severe pain. We gave her an analgesic and muscle relaxant and her condition improved. I think that she has a coxo-femoral inflammation in her hip. I had a similar condition last month and could hardly walk. The radiologist gave me a cortisone shot in the hip joint under ultrasound guidance and I was better in 15 minutes. She will probably have the same treatment.
The 2nd case was an elderly patient with minimal chest pain that quickly improved when we arrived. He didn’t require transportation to the hospital.
The 3rd case was a young man with a cardiac history. He had midline abdominal pain. We brought him to the hospital for an u/s to r/o an aneurysm which was an unlikely diagnosis. I think that he has a semi acute pancreatitis and will have the appropriate tests.
The 4th patient was an elderly gentleman with mild chest pain. In cases of chest pain we always to the routine tests in the apartment and in the ambulance and then transport the patient to the hospital.
Today we finished on time at 3:30. I said good-bye to my colleagues and we took the usual selfies. I invited them to contact me if they ever come to Canada. I promised to take them skiing if they come in the winter or to go sailing on my boat if they come in the summer.
I cannot leave Tel Aviv without making some comments on the Israeli drivers. I actually find the drivers to be quite civilized as long as you follow the rules. They accelerate fast but rarely go more than 10-15 k/h above the speed limit. They are very much respectful if you have the right of way. On the other hand if you don’t have the right of way, forget about making a turn or changing lanes. It is faster to go around the block. Waze is superb here. Without Waze I could never get from A to B. There are too many one way streets and the streets go in circles rather than straight lines. Signalling is theoretical here if you want to change lanes. The horn is a most important part of the car and is used very frequently. I think that most drivers can hit the horn faster than they can hit the gas peddle. There is a green 2 way lane for bicycles, scooters and small motor bicycles. You must not make the mistake or walking in a green lane. They don’t expect you to be there and will give no quarter. They is virtually no J walking like in Montreal. Pedestrians have a green little man on the traffic light allowing them to cross. This very well respected both by cars and pedestrians alike. Pedestrians will stand for several minutes waiting for their turn to cross even if there are no cars in sight. There are also pedestrian cross walks in the middle of the the street with no lights. Cars jam on their brakes if they see a pedestrian showing an indication of wanting to cross. I rented a small Kia for getting around. You must have a small car here as parking is at a premium here and the parking spaces are very small. Israelis can get into much smaller spaces than I would willing to try. I mostly walk here for short distances or take the bus. A young man rolled down his window and asked me if I wanted to sell my car. He was disappointed when I told him that the car was a rental.
I am sitting outside at a table in a sushi restaurant. The sushi is ok but rather expensive for what you get. It is 20C, very pleasant to eat outside. I am alone at a small table writing my blog. As usual on a Wednesday evening, the restaurants are full and I had to visit several ones before getting a table, as many to the tables are already reserved. People really know how to enjoy themselves here.
Today once again I had a great team with MDA. I had worked with one of the paramedic last week who is in her training period. I had a driver with whom I had worked as well as the chief of the station. It was like a reunion and I was happy to work again with these highly skilled paramedics. I learn something on every shift and this shift was no different.
Our 1st case was a simple elderly lady with an aspiration pneumonia. She was on IV antibiotics at home and was not improving so we transferred her to the hospital.
The 2nd case was much more exciting. We got the message that there had been an explosion in an apartment building. We could see the smoke rising in the air in the distance. We put the siren on and sped to the building at breakneck speed in the city. When we arrived, the firemen with fire trucks had already arrived. The police were there and there were already several ambulances present. This was a very poor area of town with many new immigrants from Africa. The lady was cooking with propane gas and the tank of propane exploded. The entire front of the apartment was blown out on the street. The firehoses were out and the firemen had already entered the building. If there is one job in the world that I would never do, it would be a fireman. I told that to the paramedic who smiled and said that they have to be very brave. In the end, there were 2 persons injured, not too badly and they were taken away in the first ambulance that had arrived.
The 3rd case was a trauma case that was bad, but could have been much worse. We got an alert that a child had been injured by a pipe and had a penetrating chest wound. We put the siren on and sped to the case. We were doing 150 km/hr breaking my previous record of 140 that I filmed last year. I have never gone so fast in an ambulance. I filmed a lot of the journey and will try to put some of it on my blog in the future. I was not wearing my seat belt as the paramedics usually don’t wear one behind the drivers. When we turned a corner I almost flew… When we arrived, the father had picked up the child and placed him in his truck on the front seat. The 11 year old boy was walking in between 2 buildings when a 2 meter rod, 2 cm in diameter had fallen straight down from the 3rd floor. The child penetrating chest wound 2cm in diameter and 2 cm deep in the anterior triangle of the neck above the clavicle. I never saw someone work as fast and as efficiently as the chief. He examined the wound and then covered it with a bandage. He then secured the arm to the chest with a bandage to prevent movement to the upper arm.
In trauma cases, the paramedics must stabilize and move the patient into the ambulance in 10 minutes. The case took 7 minutes and we were off to the hospital. The metal object had penetrated the skin and muscles but not the lung or chest cavity. The clavicle was visible. The child was very lucky. Had the rod struck his head, 4 cm away, the injury would have been fatal. The rod missed the subclavian artery and vein by 1 cm. That probably would have been a fatal injury as he would have bled out. We did not suspect a neurological injury as the child could move his arm. This will require further testing at the hospital. The child was extremely brave. He did not utter a sound of complaint. He will have a CT scan and surgery immediately on arrival at the hospital. The physicians in the ER were waiting for him when we arrived as we can message them in advance of the injury.
The last case was simple fractured or sprained ankle that we transported to the hospital.
I am sitting in a restaurant at the bar, eating supper, drinking beer and writing my blog. Wine in a restaurant in Israel is very expensive so I usually drink beer. I am at Dizengoff Square again at a different restaurant. Dizengoff Square is packed with people even on a Tuesday evening at 10:00 pm. The vibe here is indescribable. I like to sit at the bar when I am alone as often it gives me a chance to talk to my neighbours. I struck up a conversation with a charming couple who were originally from Soviet Union but have lived in New York for 40 years. He was a urologist in Russia but is now a pulmonary specialist after some retraining. His son is a urologist and does robotic surgery. His name is Boris. He laughed when I told him that I was named after my grandfather Boris but my mother refused to call me Boris Morris. Hence the name Brian Morris, very Anglo and dignified.
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.
gobriantravel 