GRWM — Miluim Edition

Get ready with me for another round of miluim. I serve in a unit that provides frontline medical support in combat theaters of operation. Depending on the mission, that can mean point-of-injury care for armor and infantry crews, battlefield evacuation to definitive care, or Multi-Casualty Incident management in forward operating areas. 

Deployment: Two Weeks Out

From the outset of the latest round of fighting in March it seemed likely my unit would be activated. Though my dates of service remain uncertain I have been asked to prepare for a short deployment sometime in April. I have not yet been briefed on the mission, but I organize the things that I know I will need, regardless of the conditions. I ensure my combat gear is in order and charge everything that requires a battery. I focus on minimizing the weight and size of my personal items, yet allow myself a kindle and a paperback book for Shabbat. I deliberate as to my coffee kit because it is heavy, but ultimately pack it because there are limits as to what I am willing to endure. I forgo snacks because as usual I trust the Army to feed me, and as usual I am certain I will regret that decision.    

In the weeks before deployment I make time with each member of my family individually. A hike, off-roading, time in the gym or a bite to eat. My wife and I talk and connect about everything. Everything except the elephant in the room. That stays in the closet for now.

Deployment: One Week Out

The dates keep shifting. There is a cease fire, there isn’t a cease fire. Mission is on, mission is off. I rearrange my work schedule according to the latest information but always with the caveat that nothing is final yet. My schedulers take it all in stride. The Israeli workforce is used to this.

While deployment dates remain uncertain, gradually more details of the mission emerge. I am being attached to a light medical evacuation crew. Essentially a mix of fighters and medics and me – the physician- designed to rapidly respond to Mass-Casualty Incidents in which the point-of-injury medical crew is overwhelmed. We will operate out of an abandoned building somewhere inside the operational zone. I have done versions of this mission before, and am familiar with the routine and expectations. With a clearer picture of the mission, I can finally pack accordingly. My bag is heavy. I have learned from prior to deployments that “less is more”, yet somehow I always bring too much. I complete the army’s mandatory blood transfusion refresher course, and brush up on trauma protocols. Remote damage control resuscitation, hemorrhage management and airway algorithms once again occupy my thoughts.

Deployment: Four Days Out

The medical crew — two medics and me — joins an online mission briefing with our commanders. This seems useful as it is based on the experiences of a medical crew who just completed a similar mission. We receive final deployment dates and I begin mentally organizing the days ahead. The mission is expected to last a week, and I am encouraged. A week is manageable, and I feel lucky that I am not being deployed for a longer stretch. I want to serve. At 54 years old I am well past the opt-out age for Miluim and no one is twisting my arm to remain active, yet I am glad that this is a short mission. I think to myself “nothing bad ever happens in a week”.  

For a few hours, everything feels settled.

Deployment: Three Days Out

I receive a message from my commander instructing me to disregard the previous evening’s zoom. The mission profile and dates are once again subject to change. Instead I am instructed to present to the unit’s mobilization area at a specific date and time and will only receive final orders then. So I reorganize my gear once again, this time for flexibility rather than specificity. This, too, is part of miluim.

Deployment: One Day Out

Shabbat. I expect to deploy tomorrow, though I tell very few people. The mission could still be delayed. Nothing feels certain and the uncertainty is the hardest part. War is inherently unpredictable, but having no idea of what I am walking into tomorrow is playing on my nerves. I try to subdue my anxiety and enjoy Shabbat at home, but on some level my head is already somewhere else. I am eager to begin because the sooner I do, the sooner it will be over. I benefit in many ways from my time in miluim and even at times even enjoy it, but the day before deployment is often the worst. Worry and fear intrude my thoughts. I bless our children on Friday night with extra intention, just in case. I cannot help but to recall blessing them the same way on the morning of October 8, 2023 when leaving for my first deployment of this war. The kids are older now, some of them are themselves in Tzahal, and they are used to my coming and going on short missions like this.  I think it seems normal for them, though for my wife and I it is anything but.  Routine maybe, normal absolutely not.

Deployment Day:

05:30

As I leave the house early in the morning I wake the kids for final kiss and share a few moments of quiet with my wife. We have been through this before and do not need to say much. After 25 years of marriage we know what the other is thinking and try to keep negativity to a minimum. I reminded her that I will be gone for only a week, and work on convincing at least myself that “nothing bad can happen in just a week”. She helps me load my car, and we say goodbye. Before backing out, I spend a few moments in the driveway looking at our house and thinking of those I love inside, missing them already. Then I start driving north.

09:00

I report to the storage depot and meet the medics and commanders for final instructions. We will be providing Mass-Casualty Incident support and evacuation triage. We sign-out our medical gear. My bag is massive. I inventory everything carefully: intubation kits, chest tubes, surgical airway equipment, hemorrhage control gear, medications. I check batteries and pack spares. I review the expiration dates of every medication. Then I reorganize the entire bag according to my own preferences, memorizing where every item sits so I can find it in the dark. Afterward, I walk the medics through the layout so they can do the same. Just before crossing the border we will receive 2 units of blood for transfusion along with a new blood warmer for which have yet to received formal instruction. Supposedly that will be forthcoming. In the meanwhile we watch some instructional videos on YouTube to gain basic familiarity.

11:00

We head to the Armory and sign-out rifles.  Mine is a short barrel M16 — the Israeli mikutzar. The rifle is basic, nothing fancy, iron sights only. I have on occasion signed out newer M4 rifles with advanced optics, fancy rails and various bells and whistles, but this mikutzar is the gun I consider “mine”. I know this specific weapon well, and have carried it on most of my previous deployments. I don’t mind having a more utilitarian gun. I am a physician, not a rifleman and am unlikely to use it.  Besides, I’ll only be deployed for a week and “nothing bad ever happens in a week”, right?  My only customization is a gun light and a nice sling. After assembling those and a quick function test I am ready to go.

13:00

13:00 We load into several vehicles and head to the range, with a stop for lunch (shwarma in a laffa) on the way. At the range we meet the remainder of our company and then zero our weapons and run a few shooting drills. I recognize several of the guys from my previous time in Lebanon, and we get reacquainted. At this point in the war, these men are reservists only on paper. In practice they are professional soldiers.

15:00

We run medical drills for the rest of the afternoon, the focus being Multi-Casualty Incident management. This includes hemorrhage control techniques, transfusion priorities and triage decisions. We finally receive the instruction we were anticipating on the use of the blood warmer system, and we incorporate that into our drills. It had been a while since my last drill, even longer for the medics, so the training is critically important. We do not know it yet, but over the next week we will care for a number of casualties and in my estimation we did so professionally, efficiently and effectively.  

20:00

We prepare to cross into Lebanon. I have time for a last call with my wife before we load up on the Humvees. Strangely, by now my anxiety has mostly faded. I know I will be deployed for only a week and by repeating the mantra, I have semi-convinced myself that “nothing bad can happen in a week”. Of course I know this is not true. Terrible things can happen in an instant and I have walked away lucky from bad situations before. I can only hope my luck will prevail once again.  As we cross the border in the bright moonlight and traverse the Lebanese mountains I whisper Tefilat HaDerech with extra intention. I am calm and focused as home and family fade behind into the distance.

Postscript

The author and his medical crew have has returned safely from their deployment. They were involved in the treatment and evacuation of two injured soldiers, as well as the return to Israel of a third who tragically did not survive.