A doctor's story: Awaiting the wounded

By Dr. Avraham Rivkind. Dr. Avraham Rivkind is head of the department of
general surgery and the trauma unit at Hadassah University Hospital in
Jerusalem
Copyright (c) 2002, Chicago Tribune

July 14, 2002

When a human bomb goes off in Jerusalem, I know within seconds. I wear two  beepers and a cell phone, even to bed. Nearly always, driving my own car,  I  can beat the first ambulances to the hospital, even if I'm asleep when the first call comes.
The sirens blare as ambulance after ambulance pulls up in front of the main square of Hadassah University Hospital. I wait outside, with dread in my heart. As the doors swing open, my greatest fear is that one of my own four children or my next-door neighbor's will be lying there among the terror  victims, so many of whom are only kids.

Our enemies choose their targets to maim our youngsters. They strike at pizza parlors, school buses, frozen-yogurt kiosks. The medics make their own quick decisions in the field: The worst patients are brought to Hadassah  Hospital, the only Level I trauma center from the Jordan Valley to  Beersheba. I'm in charge of that unit.

My first job is triage, instantly evaluating which treatment each patient is to receive: being hurried onto the trauma table with a dozen top medical  experts surrounding him, wheeled away to surgery or brought to the regular emergency room for care.  I listen to the reports of medics, I look at the patients, and I touch them. My medical training in Israel and the United States, years of experience, intuition and sometimes help from the Almighty--something we're not embarrassed to talk about in Jerusalem--help me make these life-and-death decisions.

The medical challenges are daunting. Victims with blast injuries can seem perfect on the outside but may be burning up inside. Several weeks ago, I kneeled over a beautiful young woman  named Shiri Nagari in the hospital parking lot. I asked her how she was feeling, and she  answered that she was OK. But I felt that something was wrong. She was slowing down. I ordered immediate intubation to create an airway. Some of my colleagues thought we needed to spend time on the patients with more visible wounds. But her chest X-ray confirmed my hunch: a white butterfly on the black background. Shiri's lungs had exploded. The same loud wave of air that smashes your eardrums can compress the air in your lungs and send it to destroy the organs in your abdominal cavity. Three concussive waves do lethal damage when a bomb explodes in an enclosed area.

We rushed Shiri to our trauma operating room, always left empty for emergencies, and opened her up: blood in her chest and abdomen, a  liver torn apart. No matter how much blood we pumped in, she couldn't survive. I'm 52, and like most Israelis I serve in the army too. I have seen my share of tank injuries, unrelenting cancers and traffic accidents. Shiri's death was the first time I ever cried at losing a patient.

I dread telling the patient's parents, but that is also part of my job. Even less dire pronouncements are tough. Recently, after a terrorist attack in the open-air market in Jerusalem, I had to inform a victim's wife that we had amputated his leg. His wife flew into a rage. That's an anger I'm familiar with. I'm always coping with my own anger that we can't pull off a miracle for each patient. Concussive injuries are only part of the damage caused by urban bombings. We have been treating damage to the brain, lungs, bones and heart caused by nails, bolts and ball bearings packed into the high-velocity bombs.

Adi Hudja, only 14, had more than 40 metal objects in her legs from the suicide bombings on Ben Yehuda Street last December. She was bleeding uncontrollably from her wounds. On the spot, we came up with the idea of trying a coagulant for hemophiliacs still not approved by the U.S. Food and Drug Administration, certainly not approved for trauma. It costs $10,000 for a small bottle, but it worked. Six months later, she's coming for therapy three times a week in Hadassah's Mt. Scopus Rehab Center, and she's learning to walk. Next year, maybe she'll be able to go back to school too. She's the same age as one of my daughters.

Clock is ticking

No matter the sophistication of medical care, speed counts. Most of the thousands of procedures we surgeons in my department do each year are elective, but trauma is different. Our chief trauma nurse, Etti Ben Yaakov, always talks about the "golden hour" we have to save our patients' lives. She's right. The clock is ticking from the obscene sound of the blast. In the trauma center, I am assisted by a remarkable team of doctors, nurses and technicians. Suicide-blast victims almost all need multidisciplinary care.We need to figure out who's going first: the neurosurgeon, the vascular surgeon, the general surgeon, the orthopedic surgeon, the facial surgeon?

Even in the middle of the night, doctors and nurses and technicians and cleaning staff arrive at the hospital without even being called. Who will do the anesthesia? Hands fly up: Our entire operating room staff is ready for an unscheduled shift. Every decision I make is informed by my core belief that every patient wants to live. Sometimes this credo forces me to try so-called heroic surgery when everything seems lost.
In October 2000, Shimon Ohana, an 18-year-old border police officer, was declared dead in the field. But I asked the ambulance driver to bring him to the hospital. Some decisions are hard to make in the field. I uncovered him, we opened his chest cavity and began to work. He came back to life but remained in a coma for 17 days. At last, he woke up.

Today, he is a fully functioning young man who trains dogs and loves computers. He lives in Beersheba, but he often comes to Hadassah Hospital for follow-up care or to encourage our other patients. I can't resist hugging him: He's my continued reminder that we can't give up hope.

Everyone treated equally

The lines of ambulances, inevitably, bring a fair percentage of Arab patients. We can't tell whether they are perpetrators or victims. Even if we could, it wouldn't matter: Everyone who enters the Hadassah Hospital courtyard is treated equally. And yes, I have operated on terrorists. Once, I was awakened at 2 a.m. on the Sabbath to do emergency surgery on a terrorist who had been injured while he was being apprehended. I had
seen the grisly results of his bus bombings. More than any other question, friends and visitors and even patients want to know how I feel using my medical training to save the lives of these mass murderers.

Because I'm a doctor, a believing Jew, a human being, I would never allow a patient to die whom I could save. But this saving of life is more than my medical requirements: It's a mission. By fixing the holes in their chests and bellies, I'm making a statement that I'm not like those forces of darkness that want to engulf this country in blood.

Do they understand? I haven't the slightest doubt that they do. They thank me. They look at me differently. I and my people are no longer the demons of their ugly propaganda. And they suddenly comprehend what the
American women of Hadassah who established our hospital and most of the hospitals and clinics in this land with no regard for race or creed understood 90 years ago.

The Hadassah motto is taken from the prophet Jeremiah who cried for the "healing of my people."

The healing of all peoples is the only way to rescue the future of this region.

Copyright (c) 2002, Chicago Tribune

 

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What this War is not about

Speech given by Deputy Minister of Immigrant Absorption, Yuli Edelstein
at a rally just before Pesach 2002


FRIENDS.......

I come here from a country at war to tell you how much your concern and solidarity means to us, and how very much we need it today—more than ever.

For if you are afraid of what is happening to us, your fear is valid. If you are troubled about our being able to find a quick way out of this mess, your concern is well founded, and if you are anxious over how much longer we can hold out, your anxiety is understandable.

In the past year and a half, Israel has absorbed the most devastating terrorist onslaught in the country's history, and experienced a deep economic recession caused both by the terrorism and by the global economic slowdown.

Statistics paint a very disturbing picture...one terrorist attempt or attack an hour over the past year and a half..... and the harsh day to day reality is even more disturbing.

I really don’t have to tell you the details of what is happening: you all know and empathize with our pain. But what may be harder for you to understand, is the devastating sense of loss, bewilderment, disorientation, and even despair we experience each day.

We are engaged in a war unlike any other, except possibly, the first one—the War of Independence-- 54 years ago.

WHILE I THINK I know what this war is about and how we got into it; I AM SURE THAT I KNOW what this war is NOT.

This war is NOT over territory. This war is NOT over settlements. This war is NOT about Palestinian self determination: I WISH IT WERE.

Most of us were sure that this war is over territory. And all of us acted as if this war is over territory—but it’s not. I WISH IT WERE.

Prime Minister Barak also thought this war was over territory. So, acting without a parliamentary majority and well outside of any conceivable national consensus, he conceded ALL the territory the Palestinians presumably claimed. Never mind that this territory is also claimed by Israel. Never mind that this territory was first captured in a defensive war after, Jordan, which everyone understood never had any right to this land, ignoring clear Israeli entreaties, attacked us from yet a third front in 1967. Never mind that this territory was promised to the Jews by the mandatory authority- Great Britain, And certainly, never mind that this territory was promised to the Jews by the God of Abraham, Isaac, and Jacob.

Ehud Barak offered the Palestinian Arabs an independent state to consist of 97% of the land which everyone thought to be in dispute (Yehuda V’ Shomron (the West Bank)) and 3% of the land no one thought was in dispute (pre-67 Israel). He did this—to my horror and to the dismay of the vast majority of Jews in Israel-- because he was hell bent on settling the dispute and because the dispute, we all knew, was over territory. So it follows that if we give them the land, we thereby terminate the dispute. Most disputes, after all, can be settled by total submission.

But the Arabs refused the submission, spurned the concession, and refused to take the land.

They refused, because in return, they would be required to let us Jews live in peace--in Israel. This they were not prepared to do. And when Barak made his grand and naïve, if well intentioned, proposal for total submission, Arafat did not trouble to make a counter proposal: he just started this war. Yasser Arafat and the Palestinian Authority proved that they are not interested in making peace and that the Palestinian state to which they aspire is not one that would live side by side with Israel. Rather as former Prime Minister Barak now puts it, it's "one that will replace Israel."

This war is about one thing and one thing only: whether or not the Jewish people will be able to live in Israel, in peace.

And let me tell you war is no fun. Daily, our people are murdered for such provocative acts as going shopping, eating pizza, driving home after work, and generally trying to go about the routine of conducting our daily lives. No, war—and especially this war—is no fun. But at least, it presents clear choices. A war aimed at our destruction will either be won or lost.

I prefer to win.

At stake is our existence as a sovereign nation, our independence, our way of life, our culture, our birthright, and our very lives.

Today, everyone in Israel understands this—everyone except those few brittle ideologues who cannot bear to change their perceptions to conform with the empirical reality.

And if we now understand that this war is NOT a war over territory, we must change our coping strategy to confront the stark, empirical reality. We dare not act like this is a war over territory. We dare not concede territory, dismantle settlements, distribute yet more arms, or sanction violations of agreements —not now, never never again.

This is a war for our survival!

I don’t have to tell this audience of dedicated Zionists that this war has many victims. You all know this, you cry together with us, you share our pain, our agony. We are in a war of barbaric brutality on the other side which respects no conventions of humanity, to say nothing of civilized decency. Our children and women are murdered not by accident, not by gross negligence, not even by wanton callousness—but by cold blooded, premeditated design: for children and women are the targets of choice.

But the greatest tragedy of this cruel war, it seems to me, is not the loss of life and limb. The greatest tragedy of this war is the loss of hope for a better tomorrow any time soon. It was this hope which we cherished so dearly. It was this hope which always kept us going. It was this hope which seemed to justify our sacrifice. And, it was this hope which prompted us to ignore the clear signals of danger, to rationalize the rampant corruption of the Arafat regime, to disregard their violations of agreements, to rationalize their assembly of illegal weapons. It was this hope which encouraged us to ignore the hate being instilled in Palestinian children and it was this hope which caused us to turn a deaf ear to their loud and triumphant declarations of Jihad.

And it was this hope which they betrayed and which they took from us.

Yes, I come from a country at war, a country without hope for a solution in the foreseeable future. And this is what makes this war almost unbearable and what makes your support so critical and appreciated.

We desperately need to feel that we are not alone. That our brothers and sisters are with us. That you understand our torment, our disorientation. And that you support us unswervingly in our will to live as Am Yisrael in Medinat Yisrael... in Eretz Yisrael.

That there is no immediate solution makes us sad, but at the same time it also makes us even more resolute. For if there is no solution in the near future, there is also no alternative.

We are not going anywhere because we are home.

Where we need your support most, it seems to me, is with our morale. It is debilitating to live with this unabated terror which evidences no pattern. Every neighborhood has mourners and every family escaping direct harm must wonder how long its luck will hold out. Gatherings such as this are very important to us and we appreciate your coming here before Pesach to demonstrate solidarity.

This is an extremely hard reality but it must be faced! We owe it to ourselves and those who follow to at least learn some lessons for the future.

1. First, we must enforce any agreements reached fully and from the start. When the PA started violating the agreements and trained more “policemen” than allowed, we said nothing. When it accumulated more arms and of a different caliber than allowed, we said nothing. When it allowed terrorist organizations to accumulate arms we said nothing. When later, it did not dismantle terrorist cells, we said nothing. When it coordinated and cooperated with terrorist gangs, we said nothing.

2. Terrorism cannot be tolerated or ignored: it must always be punished so that it is deterred. The deployment of a terrorist gang on its way to blow up more of our children which, thank G-d, is caught and stopped is an act of terrorism and must be punished. We must not measure terrorism by the number of bodies or limbs or blood. When a terrorist blows himself (or now, herself) up, the family rejoices, is treated as a hero and is rewarded. (The terrorist, we are told, is very busy in heaven.)

This must be stopped. To the contrary, I would propose that the terrorist's family home be blown up—wherever it is- The would-be terrorist should know that his loved ones whom he leaves behind while he gallivants in heaven will suffer—not benefit. When terrorism erupts, all other processes must be ceased. We cannot ignore it because it is inconvenient and will throw things off the track. When there is terrorism; there is no track!

3. We must act according to objective, verifiable empirical evidence and never out of wishful thinking. The entire Oslo process was a flight of fancy. It was built on wishful thinking: that the Arabs are really prepared to accept us. It was built on cynical miscalculation: a strong Arab dictator, with no tradition of human rights, will stamp out terrorism. It was built on false assumptions: the Palestinian Arab Society has the same inherent respect for process and agreements that we do.

And if Oslo was a flight of fancy; Camp David was the crash landing. No more wishful thinking, no more cynical miscalculations, no more assumptions about the nature of the Arab society or its value system. Cold, hard, verifiable empirical induction.

4. We must be very wary about reaching agreements with tyrannical regimes. Wars are never fought between democracies: it takes a dictator to so manipulate the popular will that the public goes to war voluntarily. Certainly, any arrangement with the Palestinians premised on their tyrannical rule would seem problematical. I for one, would need much convincing to support it.

After our meeting here today I will return to a country at war. It is not easy or comfortable, but I am proud that I belong to that generation which is waging the struggle for Jewish sovereignty and feel it a great privilege to be part of the Jewish people. We did not wait 2000 years to give up after 50 and I did not overcome the Soviet KGB to succumb before the Fatah.

My country is at war, but it is a country more united each day. A country that understands its role in history and the importance of its contribution to our Jewish destiny. A country that will not waiver in its resolve and will not fail its mission. You are part of that destiny and your support strengthens that resolve.

After I was freed from Soviet prison, I learned that many Jews around the world added an extra matzah to their Passover seders to represent the Jews of the Soviet Union who were enslaved by a modern-day Pharoh bent on destroying their Judaism. I can’t tell you how much it meant to me to know that Jews around the world were one with their Soviet brothers and sisters.

This week we again sit down to our Passover Seders while we face a tyrant committed to our physical destruction. Rather than add an extra matzah to our table, let’s add a little extra meaning to the seder’s closing words – L’Shana Haba B’Yerushalayim – Next Year in Jerusalem. For next year all of the world’s Jews should be able to celebrate in peace in Israel. And, just as we triumphed 3,000 years ago, together we will triumph once again today.

Thank you!! Chag Sameach
 

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Arafat’s major post-Oslo blunders have left the PA in a mess

Abdeljabbar Adwan, a Palestinian analyst, wrote this commentary for the Lebanese site "The Daily Star "

http://www.dailystar.com.lb/opinion/24_07_02_c.htm


To understand what is going on today, it is necessary to go back and review some of the contradictions that played a part in creating the present situation.
 
When Palestinian President Yasser Arafat returned to Gaza as head of the Palestinian Authority (PA) ­ after spending many years as chairman of the PLO ­ it was inevitable that he would pass through a phase of utter confusion. The difference between the pre- and post-Oslo phases was too great not to affect him in some way. The only way he could have remedied the situation then was to open up to the people and allow them to take part in the Palestinian decision-making process.
But Arafat did not do that. Instead, he concentrated first on politics, and then began alternating between diplomacy and violence. The result of this schizophrenic behavior was the destruction of Palestinian life.
Arafat first returned to Palestine through the Rafah checkpoint in Gaza. His men who had grown up on a diet of sacrifice, believing that they would one day liberate their native land from the Jews, preceded him. Yet they did not return as liberators to Gaza and Jericho ­ much less to Jerusalem, Haifa and the West Bank.

Their return was only made possible courtesy of the 1993 Oslo Accords that provided them with arms and money to ensure Israel’s security. They hoped the agreement would eventually lead to something bigger.
It was clear from the very beginning that the two sides would interpret the terms of the Oslo agreement differently. Despite this, it was difficult for Arafat to sell the agreement as a victory that would lead to the liberation of Jerusalem, building an independent homeland on all the territories occupied in 1967, and the return of Palestinian refugees. But the circumstances that resulted from delaying the implementation of the agreement forced Arafat to raise these slogans once again while looking down the barrels of Israeli guns.
Without delving into the reasons why, it can be said that the Palestinian (and Arab) street believes in armed conflict, and revels in the sound of gunfire. When Israel began procrastinating in carrying out its obligations under Oslo (from the PA’s point of view), Arafat’s popularity among his people suffered ­ especially after the PA’s corruption and administrative breakdown became obvious.

What was important in this respect was that neither Arafat nor the PA made the effort to clarify the provisions of the Oslo agreement to ordinary Palestinians; they failed to convince the people that there were ways to take advantage of the agreement. They also failed to inform them of Oslo’s limitations.
That was the biggest and most crucial dilemma Arafat faced. The Palestinian leader found it easy to repeat the same old rhetoric he was used to even while he was sleeping, eating and moving about courtesy of the Israelis.
This failure and lack of awareness resulted in increased popularity for Islamist movements, especially Hamas, which cunningly combined criticism of the PA with comprehensive social and military programs.
At that point, Arafat had a choice. He could either have confronted the Islamist resistance movements or he could have improved the PA’s performance and opened up to the people. He could, of course, also have resigned. Yet he continued believing that he could somehow turn the situation to his advantage by using the threat posed by Hamas to scare the Americans and the Israelis into hurrying to his aid and implementing the Oslo agreement.

The result of this policy, however, was that Arafat fell into another trap. Israel began demanding that he implement the agreement from its perspective by fighting terrorism and destroying its organizations and infrastructure.
Arafat now found himself in a real bind: If he confronted the resistance, he would ignite a Palestinian civil war. If, on the other hand, he failed to implement Israel’s interpretation of Oslo, then it would have no further use for him. That was the theory. The reality was even worse. If civil war had broken out, it would not have been clear-cut: many of Arafat’s supporters hated Israel and secretly supported the resistance, although their official responsibilities dictated otherwise. But failing to deal with violence allowed Israel to implement those Oslo clauses that gave it the right of hot pursuit of militants inside PA-controlled areas.
When the situation deteriorated, Arafat’s Fatah Movement was forced to go along with popular sentiment by publicly endorsing the armed struggle and suicide bombings. More schizophrenia for the Palestinian leader.

No one knew whether Arafat controlled the suicide operations, was aware of them, distinguished between them, whether he really wanted them to stop when he condemned them, or whether he was in control of anything at all. It was clear at that point that the worst possible thing had happened: Suicide and other operations had spun out of control and were thus working against the interests of the PA.
When Arafat returned to Gaza carried on his men’s shoulders, he brought back with him the style of governance he had gotten used to: taking care of all affairs of state personally and on a day-to-day basis. The Palestinian leadership structure he put into place was just an illusion, and the bodies elected by the people were marginalized and prevented from making the decisions necessary to improve the situation in the Palestinian areas. The numerous Palestinian security organizations had no clear instructions on where their responsibilities lay.

Suddenly, we began hearing that Arafat’s private security detail was the instigator of resistance operations against Israel and was coming under Israeli aerial bombardment. Palestinian Preventive Security, meanwhile, lost all its headquarters but very few of its men. The same happened to all the 17 different Palestinian security agencies, none of which had been issued with instructions on what to do when Israel decided to invade cities, towns and refugee camps. Should they have confronted the Israelis? Should they have shed their uniforms? What about their weapons? Should they have arrested the militants Israel was after?
This tragic state of affairs was another result of the schizophrenia affecting many security commanders and officers. It would be interesting to know how many men from each Palestinian security branch are currently under arrest by the Israeli Army, which announced that it has either arrested or killed all the wanted people on its lists.

Another major headache, which was lying in wait for the returning Palestinian leader, was the PA’s poor financial situation. The Iraqi invasion of Kuwait had dried up all Arab and Palestinian sources of funding for a PLO that had already sustained huge losses because of poor planning and rampant corruption. The PLO and Fatah were thus in need of funding.
The Oslo agreement provided for the salaries of PA employees and security personnel. But not all Fatah’s men were given jobs; the movement was still in need of funds. To remedy the situation, use was made of government money, such as customs and tax revenues. This in turn increased corruption and (since little can be hidden in Palestine) undermined the reputation of the PA and its leader.
Arafat himself needed money to buy the loyalty of his supporters and consolidate his grip on power, so the only source for this money was through Israel.
In this surreal and contradictory fashion did Arafat paint the picture of his relationship with the Oslo agreement. Even now, he is still putting the finishing touches to this schizophrenic work with more contradictions between what he says and does.

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