During my second day in the hospital they allowed me to do a 24-hour on-call, which to be honest I could see the ICU Head Nurse and some of the ICU attendings thought was too soon. I was also a bit worried, but calmed myself by remembering that Penn gave me a 24-hour on-call on my very first day there, and somehow that went OK. In the end the call passed without a hitch, and the head nurse was even complementary at the end, so with luck I’ll get to do some more.
But to the question of how the war affected the type of clinical cases we see..
The most obvious way is the casualties directly related to the war: we have a soldier from an elite secret unit with a gun shot wound to the abdomen who had fairly complex abdominal surgery and procedures to fix his pancreas and intestines; a civilian who got shot in the jaw, and unusually got arterial vasospasm, suffering a stroke as a result (thankfully he’s recovering well from it); an elderly lady who was shot in the abdomen and also doing well; and a young man with a rifle bullet to his eye and chest (same bullet) who will also live.
But then there are the people with less direct injuries from the war. Like a gentleman with previous psychiatric history, who locked himself in the bathroom for several days, refusing to leave because he was afraid of the rockets raining down. Eventually he ended up with a severe life-threatening infection on the ICU, which in a sense wasn’t caused by enemy fire, but in another sense was.
In the third circle I’d include the people affected by how the war changes medical practice. So during my on-call I got a phone call from a colleague about a lady he wanted to refer to the ICU: a lady who had had a kidney stone blocking her urinary tract which then got infected. She had undergone a straightforward procedure to unblock the ureter in the OR, but now was becoming septic, had been re-intubated in the post-op recovery room, and had had an arterial line inserted, and he (or rather his attending) wanted her in the ICU. I went to assess her, and in the normal course of things I would have brought her to the ICU, especially as we had 4 free beds. However with the ongoing war and a risk of many casualties arriving at any moment, the calculus had changed. I had been instructed to be very careful about not filling beds unless we had no choice. So in the end I (and my attending) decided to manage her in the recovery room overnight, hoping that she would improve enough on antibiotics over a few hours to be extubated and sent to the floor, protecting our ICU beds. In her case this worked out OK, and the following day she was sent to the floor.
Another similar example is to do with C-sections: There is an operating room next to the labour suite, used for cesarean sections, especially in urgent/emergent cases where you can’t take the woman all the way to the main ORs. However given the current security situation, the instruction came not to use that OR, and bring the women to the main ORs, irrespective of whether the C-section is urgent. I don’t know whether this is because we don’t want to lock up our staff far from the OR/ED/ER where they may be needed, or if the Labor Ward OR is outside the bomb shelter protection (I think it might be), and so the staff wouldn’t be safe. Either way, this is obviously less ideal for women delivering babies.
And on the topic of delivering babies and inconvenience, we now have very few deliveries at all in Barzilai. Most women have chosen, understandably, to drive further north to deliver further from the rockets. Whilst the labor wards in every Israeli hospital are in bomb-proof areas, I can completely understand that being a little further away is attractive, but that itself means being further from family, and has it’s own price.
Moving away from clinical matters, our list of visiting VIPs continues to grow. After my first day catching a glimpse of Avigdor Lieberman, on my second day the president of Israel, Itzhak Herzog visited the ICU, with all his security entourage. I hesitated, but after one of the residents got a selfie with him I overcame my shyness and asked if he’d agree to be photographed with me. Later on, Yuri Edelstein, former speaker of the Knesset and minister of health, visited the ICU. He was actually a familiar face as he’s a friend of my in-laws in Hertzilia, and we had a brief but warm chat before he had to run off with all the top brass. Then today we had a delegation of the leadership of the Koran Hayesod who came from abroad to show the support of world Jewry.
That support, and the support I’ve experienced myself has been absolutely fantastic. I’m very grateful to all the friends from all over the world, and colleagues at Penn, who have reached out with such kind messages. I also wanted to say a particular thank you to everyone back in the community in Bala Cynwyd (Philadelphia) who have been so supportive of Ayelet and the kids. I still am in awe at how she manages to look after them alone, with everything going on, but the way that everyone has come out to help, with food and childcare and company, has been fantastic. So thank you from the bottom of our hearts.
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