When I’m not treating Wisconsinites, I’m in an Israeli ER

Two years ago I took a job as an ER doctor at Assuta Ashdod University Hospital, halfway between Tel Aviv and Gaza, in the first new hospital in Israel in 40 years. I do not know why I am OK with this, far from my comfort zone. Wrestling with language and with life and death under time pressure surrounded by hot-headed Israelis with the added bonus of an occasional rocket attack in a real war.

I sit in the empty hospital cafeteria looking out two-story windows at the courtyard. A simple dinner after a long shift. Bread and jam, cucumbers, tomatoes and something between cream cheese and sour cream that we don’t have in the States. I call my wife Anne in Milwaukee to exchange stories. The sirens went off today. The ER was on standby for a mass casualty incident. Rockets rained down from haters in Gaza. With each barrage the people of Ashdod ran for shelter. The Iron Dome missile defense system intercepted, amazingly plucking hundreds of deadly bombs from the sky. Ashdod was spared a mass casualty for now. The system worked. In the ER we saw household injuries from the scramble for shelter. A broken nose. A broken rib. A lot of raw nerves.

Jeffrey Green, M.D., Milwaukee, is an emergency medicine physician who splits his time among Assuta Ashdod University Hospital in Israel, the Milwaukee VA Medical Center, 5000 W. National Ave., and Mercyhealth Hospital and Medical Center in Walworth County. Green has traveled at least a dozen times between Israel and Wisconsin since February 2018.

Then interrupting mid-sentence in the dining hall comes a familiar howl, The Siren, starting low, then screaming out in a long mid-alto wail.

Over the courtyard I see a round white flash in the sky. I hear distant explosions as I run through the lobby and head for the bomb-proof wing of the hospital, with its iron shutters and massive concrete walls. In my fortified call room I finish the bread and white stuff (that’s actually roughly the name in Hebrew) and phone Anne back.

I am not rattled by this rocket attack. I feel safe in the mothership, my bomb-proof hospital. Under the Iron Dome – such an overconfident name for a patchwork of missile launchers.

There is no dome. The next day Ashdod was not spared. A rocket got through and struck downtown during rush hour, killing a young father and generating the familiar chaos of blood, broken glass, gridlock and frantic phone calls.

Since dividing my time between Ashdod and the Milwaukee VA Medical Center I am often asked at both locations what is different about ER practice over there on the other side. So much is exactly the same. Human anatomy and physiology, love for loved ones, the inevitability of illness and injury, the finality of death. But so much is different.

Jeffrey Green, M.D.

It is a generalization and a legendary stereotype but I will say it – there is a layer of courtesy and privacy and distance amongst Americans that is often stripped away amongst Israelis. A layer of gloss and politeness. Insulation between what Americans are feeling and experiencing and the feeling and experience they convey to others. Nowhere is this more apparent than in the human drama of the emergency department. Comparatively, life in Israel is raw and life in America is processed, packaged and disguised.

It is known that at times a line in Israel becomes a swarm of people unable to contain themselves in a proper queue, from which only the most aggressive and assertive will get served. This is life in Israel. It adapts poorly to the emergency department, where patients and family members repeatedly come from the bedside or the waiting area to the physician workstation to inquire on their progress. When will I been seen? I’ve been here for four hours (we check the computer, it’s two). Meanwhile can I get meds/X-rays/food/cigs/a second opinion? I say things over and over, like: “I am running as fast as I can and all the time we spend talking about your long wait is keeping everyone here from getting care.”

But then when it’s their turn and they get their care we bond and become like family. When the visit concludes with a diagnosis and a plan and relief of their pain or nausea or worry, or maybe not relief but a better understanding of their plight and the limits and choices of the emergency department, then they open their hearts and the lack of insulation is a good thing. Thank you letters, bakery and candy boxes are frequent. They love that I am American and I love that they are Israeli and our paths have crossed here.