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 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 Israel

Israel 18,

April 7, 2025,

Hi Everyone,

I wore my Nike running shoes for the first time today and they were wonderful. I was bouncing all over the place each time I took a step, it was a wonder that I didn’t just fly away. I will try running with them in a few days.

I had a new team at MDA today but I was posted on the same base. We checked the ambulance at 6:30 and had our first call at 7:00. We walked up 3 flights of stair and found an 85 year old woman in bed, short of breath. The woman was already on oxygen. The room was 10ft x 10ft. We somehow lifted the patient onto a stretcher. The stretcher is made so that it can turn into a chair which is easier to manage. We then carried her down the stairs to the ambulance and took her to the hospital. She was oedematous and probably in congestive heart failure.

The second case was an elderly man in the very religious sector of Tel Aviv called Bnai Brak. These people have 6-10 children so you see children running around everywhere. It is a shame but religious areas in Israel are often over crowded, run down and dirty. There was garbage everywhere as if people don’t care about cleanliness. The man was short of breath from bradycardia. His pulse was 46 meaning sinus bradycardia, an athlete or a heart block. He was in no acute distress so we took his VS, gave him oxygen and monitored him.

We were on our way to a hospital when we received an emergency call that a child had fallen into the water and was unconscious. When we arrived, the child had already been brought down stairs and 2 paramedics were giving CPR. In a child you give heart massage with your thumbs. They were bagging the child with a mask and oxygen. There was a discussion among the paramedics and it was decided that we had the most experience with children. While continuing with CPR, we transferred our elderly patient to another ambulance and took charge of the child.

The chief paramedic in my ambulance was amazing. He took charge immediately and gave orders to the other paramedics in a calm but direct fashion. We did an EKG and found that the child was flat lined. In this case, defibrilation is not indicated. He got an IV access by directly putting an IV into the knee. He then delivered adrenaline. The ambulance took off at full speed to Schneider Children’s Hospital which is a major children’s hospital in Israel. While the ambulance was moving, he intubated the child which is not an easy manoeuvre to do in a 4 month old child in a moving ambulance. I was very impressed with his work. He obviously has had a lot of experience with infants.

The physicians at the hospital were waiting for us to arrive. By the time we arrived in the hospital we had a pulse with a heart rate and a blood pressure. The chief of the ER took charge immediately. After a few moments, the child started to breath spontaneously but they continued to bag him for support. The child’s pupils were dilated but maybe not fixed which would indicate brain damage.

We left at this point and as usual with MDA, we usually don’t know the final result of our work. The mother looked to be between 25 and 30, ultra religious with a long dress. She had left the child next to the sink for an unknown period of time and for an unknown reason. Somehow the child had rolled over and fallen into the sink, and drowned. We could not find out how long the child was not breathing. The first ambulance was on the scene within minutes and CPR was done immediately. Brain damage begins 4 minutes after a lack of oxygen and is irreversible at 10 minutes. A child can sometimes last longer.

The chief paramedic was sitting alone in the ambulance writing out his report. I went over to him, touched his shoulder and told him that he had done his best. I know that he appreciated my words of support.

The woman sat in the ambulance with us staring ahead with absolutely no emotion. She never spoke or cried. Her husband arrived at the hospital just after us. He was dressed in ultra religious clothes. He also expressed no emotion. The woman will never forgive herself for the 1-2 minutes of inattention. The child is in God’s hands now. Unfortunately, there is no God.

Our last patient was a 6 month old child with a first episode of epilepsy probably viral related. The child had stopped convulsing when we arrived and was waking up. We brought the child to the nearest hospital for further evaluation and treatment.

All in all it was a busy, emotionally packed day.

Love,

Brian

Paramedics

Tel Hashomer Hospital, the 8th best hospital in the world according to Newsweeks evaluation. The country has 9 million people. University of Toronto is 3rd in the world. McGill is in the 90s. It is not surprising if you read my last evaluation of McGill.