“Kibbutz Galuyot” (Shaare Zedek chronicle, week #2)

“Kibbutz Galuyot”: “Ingathering of the exiles”, one of the cornerstones of the return to Zion in the modern State of Israel. This is evident everywhere you go in this small country. At Shaare Zedek Medical Center, the 3 attending physicians in echocardiography hail from Buenos Aires, Paris and Bucharest, the CCU Director is from Johannesburg, a cardiology fellow  is from Tbilisi, an interventionalist is Australian and an echo tech is from the ancient Jewish community of Cochin, India.

We are an interconnected people that have been “globalized” since 2 millennia ago. During my first week, I was peripherally involved in the care of a terror victim who was later discharged. The following  week, our son-in-law Eli was on a business trip to India, setting up telemedicine centers to provide ICU coverage for rural hospitals in the US. In Bangalore, he picked up Kosher food to take along to Udaipur, near Pakistan. Coincidentally, the  local Chabad Rabbi/Shochet is the brother of that same terror victim. The Rabbi asked Eli to pass on his thanks to all the doctors at Shaare Zedek for saving his brother.

Legions of foreign workers have converged on Israel in recent decades for semi-temporary employment in construction, agriculture, food services and home care. A Sri Lankan live-in home health aide  was brought to the ER one night in a confused state. The elderly man he cared for had called paramedics after the aide had complained of chest pain and dizziness. (Impossible to overlook the poignancy of this role-reversal.) While I was evaluating him with the residents, the aide had a cardiac arrest. After rapid defibrillation and resuscitation, we escorted him to the cardiac catheterization suite where the on-call team was waiting. To commence the emergency procedure, demographic data had to be entered into the image-archiving system. Due to the rapid triage, his name was still unknown, so a “John Doe” name had to be entered: The nurse typed in “Ploni  Almoni,” a biblical term that appears in the Books of Samuel, Kings and Ruth, translated as ” such and such”. The Sri Lankan aide’s occluded “widow-maker” coronary artery was then deftly opened with a stent threaded through his wrist artery.

Meanwhile, a devoutly Orthodox Jerusalemite had been brought to the cath lab from the ER with a less urgent condition. Seeing that  the on-call team was still busy with the first patient, the on-call  senior attending cardiologist began setting up for the procedure without assistance, gathering and preparing the sterile  drapes, catheters, IV tubing and dye. What would be unusual and  impressive in the US is actually fairly typical in Israel.

A strong spirit of collaboration permeates Israeli medicine. During many invasive procedures, a second physician is present, freely commenting  and providing appreciated suggestions to the primary operator. During one catheterization procedure, 2 additional cardiologists were hastily summoned from the clinic to confer on the findings before an intervention was performed. There is a weekly interdepartmental Grand Rounds to which the entire professional staff is invited. At these conferences, at least 5 different experts present their work. One week’s topic was medical marijuana, hosted by the department of pediatric neurology. Subspecialists spoke on epilepsy treatment, psychology, basic science/ neurobiology, and pain management. I was frantically typing all the new words into Google Translate, then scribbling the definitions into my old-school spiral notebook.

I had stepped through the looking glass into an alternate life, albeit transient, with many parallels to my usual routine. My morning drive to the hospital was much longer than my suburban NJ commute. Every morning I noticed something new on the rugged hills along highway 443. Sunbeams emanating from broken cloud cover illuminate the scenes: recently built settlements, old Arab villages with minarets, greenhouses, a line of cars on a tangential dirt road leading to a military checkpoint, a pristine paved road that runs alongside the Separation Wall for the exclusive use of security vehicles…

I befriended Kamal, a Shaare Zedek cardiology fellow from Ramallah. His morning commute to Jerusalem through multiple military checkpoints takes up to two hours. His nightly return to Ramallah, with no check points, takes twenty minutes. Upon completion of training, he hopes to relocate to “Australia, Dubai or the USA.” Anywhere but the Levant.

Observing life in Israel, one often experiences cognitive dissonance. We saw a Hebrew-language production of the 1960’s anti-war musical “Hair” , staged at the  Cameri Theater in Tel-Aviv just across the street from the Defense Ministry on King Saul Boulevard. Presumably, most of the 20, 30 and 40-somethings in the auditorium had previously endured 3 years of compulsory military service and had close relatives still in uniform. How much do they know about America’s agonizing Vietnam experience? How does a musical that was so popular with our arm-chair anti-war protesters resonate with this militarized/ victimized audience?  We baby-boomers grew up singing all the protest songs, but as privileged children of the middle class, we were many degrees of separation from families of GI’s. Unfortunately, Israelis are much more closely connected  to the  ravaging effects of war. The Age of Aquarius came and went, but the bloody conflicts are still with us. Dear God, when will the sun shine in?

Friday afternoon of our second week, we enjoyed the warm spell at the old Tel-Aviv port, our grandsons Eitan and Ezra riding their scooters on the smooth banked promenade while  the adults ate Sushi overlooking the Mediterranean. A serene secular cosmopolitan experience just hours before the Sabbath.

About the Author
Dr. Goldschmidt , a graduate of Columbia University, is an American cardiologist who resides in Teaneck, NJ and Atlantic Beach, NY. He is the proud grandfather of 4 Sabra boys who live in Modiin. He volunteers one month a year at Shaare Zedek Medical Center in Jerusalem, teaching and practicing cardiology.
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