Back to the trauma: the severe attacks once again shake the gates of Zedek Israel today

The entrance to the emergency room at Shaare Zedek Hospital in Jerusalem is almost always busy.

A worried mother pushes a stroller with a crying baby in it, an adult with the help of a walking stick tries to hurry and get in line, an ambulance arrives with an injured person from a car accident, his family members in the car behind them.

The population of Jerusalem and the surrounding area, in all its shades, stands here at the gate, entering and leaving.

But in the last month and a half, more than 50 wounded from various terrorist attacks also passed through Shaare Zedek.

Since October 24, when a stabbing victim was evacuated from the city's Givat Hambatar neighborhood, wounded from shootings in Kiryat Arba, and from trampling and stabbing attacks have been treated here.

Just last week, 23 wounded people arrived at the hospital from the attack at the entrance to Jerusalem and from the explosion in the Ramot neighborhood, where they fought for the lives of the late 16-year-old Aryeh Shechopek and the late 50-year-old Tedsa Tashuma, who eventually died of their wounds.

On Tuesday of this week, the female fighter who was injured in a stampede attack in the settlement of Kochav Ya'akov in Benjamin also arrived at the hospital.

"Wounded from terrorist attacks come here all the time, this is already our routine," says Sara Goldberg, deputy head nurse and in charge of emergencies at the hospital.

"After all, there has been terror of knives and trampling here for a long time. But when there is an explosion it is more significant, because there are more wounded. The information from the field is less clear, and there is a mess, and we must continue to function."

Quite a few of the staff members were also here in the 90s, and treated the wounded of the first intifada.

In 2000, with the beginning of the second intifada, Sara was a nurse in charge of intensive care in Shaare Zedek.

"During the intifadas, I lived here almost in the hospital," she recalls.

"Event followed event. At first we get scared, but after a few events we get used to it. We would hear there was an explosion and calmly go down the stairs. Not out of disdain, God forbid, we were just used to the feeling."

At the entrance to the emergency department (emergency medicine department - the emergency department) hangs a picture of the late Dr. David Applebaum, former director of the department. In 2003, Dr. Applebaum was murdered in the infernal attack at Cafe Hillel in the German colony in Jerusalem, along with five other people, including His daughter Nava, deceased. In Sarah, who worked with him regularly, the attack in which he was killed left a deep scar.

The scene of the explosion of the explosive device at the entrance to Jerusalem, November 2022, photo: Oren Ben Hakon

"Dr. Applebaum would always come to the hospital when there were attacks.

Sometimes even in pajamas.

He was very charismatic and very significant here at the hospital.

That day we waited for him and waited, and he didn't come.

This section, when someone I worked with and would deal with during an emergency and in many events, injured himself - it scarred me to this day."

She is 54 years old, a single mother of 4-year-old twins and an 11-year-old boy. Last Wednesday morning, she was still at home, before a shift.

"They called me to inform that there was a multi-casualty incident (ARN).

I told my son that he was not going to school, and to stay home instead, and I left for the hospital.

Our staff is very skilled, and we have very clear lists that are used by those who momentarily do not remember what they are doing, but with all the preparedness, this week we saw staff members breaking down.

who ask for help.

Like we knew where we were getting into, but we didn't really know.

"From our point of view, it was not such an RAN.

Because what differentiates a multi-casualty event from a trauma event is not only the number of patients, but the level of injuries.

And here were two in critical condition and two in moderate condition.

There is something about work that unfortunately makes you get used to certain levels of injury.

To shock us in the 1990s, an event of 50 casualties was needed.

And there were, unfortunately.

This time we didn't know at first if it was an ER or not, we knew there was an explosion, and even some unconscious patients arrived, who didn't know who they were.

"From our point of view, anyone who is not identified in such an incident could be the terrorist. This will not change the way of treatment, but we must identify the injured, know who they are, and provide an answer to the family members who start to arrive. And when there are two mortally wounded, they receive treatment in a trauma room and surgery and social support for families, and receive many resources from the system.

"I know the job and know how to function, but events like this sharpen the senses. My eldest son is dealing with the fact that I am a single mother. He has to think about what he does if something happens to me. These are thoughts of fear."

The treatment, she emphasizes, does not end when the event ends in the arena.

"After an explosion, there are more anxiety victims. About 15 anxiety victims came to us at different times, and more injured from the incident. Someone who discovers that they have shrapnel in their hand, someone with a noise in their ears, someone who realizes that they are having an anxiety attack. This is different from knife terrorism."

Sara still maintains contact with a wounded woman who was stabbed in an attack in Gush Etzion a few years ago.

She closes her eyes, remembering how she sat outside the operating room when the girl was operated on, praying that the knife would not move until they took her out, so that the injured woman would not remain paralyzed.

"When he arrived in recent weeks wounded with a stab wound in a similar place, we already understood that he would be paralyzed. You see all the time how significant every attack like this is.

"And no matter how busy you are, or how much you are used to working at such events, you cannot get used to an event where a child's father is called to the hospital, and told that his son was killed in an attack. Or to tell the family that the father was killed. Many staff members asked for mental support intervention. Veteran nurses too. Nursing staff members in an operating room, for example, are used to seeing difficult sights, but a terrorist incident does something different. It's a threat to our normal lives. And it's good that a nurse can say she needs help, and get it."

The head nurse Naama Bagrish.

"Even the cleaner who came to clean the trauma room cried", photo: Oren Ben Hakon

"With every terrorist attack, the heart shrinks"

Last Wednesday morning, 23 injured from the explosion of the explosive device at the entrance gate to Jerusalem arrived at the hospital.

Aryeh Shchoupek arrived in critical condition, and died the same day.

The following Saturday, Tedasa Tschuma also passed away.

The other injured from the attack have meanwhile been released from the hospital.

Aryeh's friend, Elhanan Biton, who was injured with him, was released at the beginning of the week.

A week after the attack, on Tuesday, another wounded man, in his 60s, was released.

On the same day, an IDF female soldier who was injured in the Benyamin stampede attack arrived at the hospital. The staff, who are still absorbing the shock of the attacks, had to continue their treatment routine. Naama Bagrish, head nurse at the Malrad, already thought she had gotten used to the attacks, but according to her, "with every attack, the heart contracts again ".

To gain experience, Naama and Sara compare numbers of injured and types of injuries from previous attacks that were defined as high-casualty incidents.

The shooting attack at the Rabbi Center yeshiva in 2008, in which eight yeshiva students were murdered and dozens injured, the collapse of the tribune in Givat Ze'ev in May 2021, where a boy and a man were killed, and about 180 were injured, and more.

This is how it goes in a hospital in an explosive city, they would both say with a hint of sarcasm.

The routine is made up of patients who suffer from stomach pains, breathing difficulties - and also from victims of terrorist attacks who arrive with system collapse.

"We got used to it," emphasizes Naama.

"It's crazy that we describe a knife attack as 'normal'. Everyone is injured, and there were people who arrived with very serious injuries. But in an attack like this there are one, two, maximum three wounded, until the terrorist is neutralized. When there is an explosion - it's crazy.

"I think that the explosion attack on Wednesday, unlike all the knife attacks, caught us mentally off guard. At first, no one could tell if it was an explosion or not, and when they thought at first that there was another explosion, we were very afraid of where it could develop.

We haven't been to this place in many years, and it affects the staff.

One of the nurses arrived and said that she was in the car in front of the bus, and heard everything.

She is an old nurse, knows the job, but knew how to say that she had PTSD (post-traumatic stress disorder), and she got help."

Naama, 50 years old, married and mother of five, started her work as a nurse at Hadassah in 1995.

Three months after she took office, in February 1996, a suicide bomber blew himself up on bus line 18 in Jerusalem.

Exactly one week later, another terrorist carried out an attack on the same bus line.

45 people were killed in the two attacks, and many dozens were injured.

Naama, then a young nurse, found herself caring for dozens of victims of an attack.

"Then I didn't have any support factors," she recalls.

"I would fall apart, cut off. I sat and cried, until members of the staff recognized that I was in crisis. In the attacks this time, I felt that I had a mission to make sure that no one was in the place I was then, as a young nurse."

The attack at the Merkaz Rabbi yeshiva in Jerusalem, 2008. "Event followed event, at first we get scared, but after a few events we get used to it", photo: Lior Mizrahi

She actually had a day off last Wednesday, but realized that her help was needed at the hospital.

"I grabbed my belongings and went to Jerusalem. It was not an easy trip, from the house in Gush Etzion to Jerusalem. There were a lot of traffic jams. But they told me about a sister who had a very hard time, and I heard that they thought there had been another explosion, and I realized that they needed me.

"I recognized in these nurses the Naama of 1995. They sat and cried, like I cried then. I told myself that today it was my job to pull them out of the crisis. When the treatment of the wounded was over, I suggested that each of the staff members talk to a trauma psychologist. Digest what they experienced. This is not an event Easy. Even the cleaner who came to clean the trauma room started crying. She wasn't in treatment at all, but saw what was left in the room after - and broke down. She also got help. These are things you don't think about until they happen.

"I treated so many wounded people from so many incidents, and the body developed a professional habit as well as a mental one. But when there is a tragedy like this, when you see a boy who you know is going to die, it takes you back to other times. For me, it mainly reminded me of the attack on the Rabbi Center, in which many were injured Boys, and we took care of them for hours.

"And there is also the family aspect. In the 1990s I was single, and I told myself that I would protect myself from terrorist attacks, and that was it. Now I have many 'arms' that need to be protected, and this intensifies the fear and anxiety. You start to think about whether you should give this up Or else, to protect myself or my childhood."

"We were at the peak of madness"

Dr. Shira Dorot, who is currently completing her surgical residency, happened to treat the wounded from the attack on Wednesday. She is 38 years old, married and a mother of three, and has been working at Shaare Zedek for six years. Until she entered the operating room with Aryeh, she had no idea that it was a wounded person from an attack When she found out - she cringed.

"Everything happened on the fly," her hand movements hurried.

It wasn't clear if it was an ER or not, there was a bit of a mess, and they asked me to come down to help in the ER.

"I wasn't wearing clothes for the operating room at all, I just put on a gown like this, so as not to get dirty, because sometimes we put in an infusion in the emergency room. So much so that I thought it was not serious, and we didn't really understand the magnitude of the event, when in fact we were at the height of madness. I saw that not everyone manage to manage the situation, and I wanted to help them.

"Dr. Alon Shortz, director of the trauma unit, asked me to come treat one of the wounded.

I stopped by the bed of the injured man, and started treating him with another female doctor.

We quickly realized that he was losing signs of life, right in front of our eyes, and we went into catastrophe mode.

We started advanced resuscitation, to the point of heart massages.

We saw that he was a young boy, still without facial hair, still a child.

We killed ourselves on him, I can't define what happened there in any other way.

"Treating trauma is like a roller coaster. There is something that works well, and it's gratifying, and then the situation deteriorates again - and you fall. As soon as the boy regained signs of life, we decided to fly him to the operating room. He received lots of blood transfusions, underwent advanced resuscitation, but was unable to recover.

"It was only after I removed a screw from his stomach that I realized it was an attack. You are a caregiver and you must work like a machine, otherwise you cannot continue. But caring for young people in such a situation is always difficult, and when we informed his parents of his death, a piece of me came out to them. Then they sent me an article about the attack , and when I saw his face it connected me to the child in my hands, and it hurts a lot."

Since her surgery internship began, Dr. Shira stopped watching the news. "I don't want to associate the faces and events of those whose lives I tried to save.

It hurts too much.

We are here to do as much as we can, save the world as much as we can.

Connecting afterwards to people, families, stories, is very difficult."

Despite the attempts not to get involved, in order to keep herself at work, she heard from Elhanan Biton, a friend of the late Aryeh, who was seriously injured in the attack and was released to his home this week. Elhanan said that he fell to the ground together with Aryeh during the explosion, and tried to save him. "He said How he tried to drag them both out of the smoke and mayhem, and my heart broke.

It's unbelievable how he managed to function in the delusional situation he got into.

"I can't say that I work completely calmly. I am completely exhausted. When I sit in a cafe or spend time at a concert, I think what I will do if something happens and I have to take care of dozens of people. You are always in work mode. I was an accompanying doctor at the New York Marathon, before Two weeks, and someone collapsed there too. I found myself doing CPR in the middle of the marathon.

"So we are there in every moment of life, and my way of dealing with all the difficulty is to arrange everything in my head, and to be ready for everything. I will not walk around without a pen on me, so that if necessary I can improvise and use it as a tube to push a chest drain. But after a big event, me and the people in the department Stop for a moment, drink coffee, talk about what happened, and go back to work.

"After all, we will get out of the trauma, but the State of Israel is waiting for us. The emergency room is full, the department is full, and we have to return to duty for those who come with a stomach ache or a headache. So I need these ten minutes, to take a breath, talk about what happened - and continue. We have no other choice."

Director of the security department, Yoni Shimon.

"You just focus on what needs to be done", photo: Oren Ben Hakon

Dr. Todd Zlott, director of the Malrad, agrees that an event such as Wednesday's attack brings him and his team back to the memories of the second intifada.

The fact that he has seen quite a few injured throughout his years of work, helps him, according to him, to maintain relative composure in handling the incident.

He usually arrives at the hospital early.

But last Wednesday he was still at home in Talpiot, when an MDA paramedic called his personal phone. "This was before I received the report from the hospital.

With all the traffic jams, I arrived within 10 minutes, and started receiving patients myself.

You have no choice but to treat.

You think mainly about work, and when the stress is over, you go on and try to get back to your routine as quickly as possible.

"We see the victims, and we remember what happened 20 years ago. Today I am more sensitive to the young staff members, who are dealing with something like this for the first time. I know that I have to take care of them, see that they are okay even a week after the incident, talk to them. There are some who don't They manage to sleep at night and carry with them a very great difficulty, and then they are given psychological help."

"There is no time to stop and think"

Back to the MD, which is currently running as usual. Nurse Naomi Amsalem is going through blood tests on one of the patients. She goes behind one of the curtains, gives the patient a sedative and promises that the doctor will come to check him again soon.

She is 39 years old, has been in the medical center for 19 years. Until two weeks ago, she was a deputy nurse in charge, now she has decided to reduce her workload in order to take more care of her 3-year-old son. She moves from one patient to another with ease, radiating tenderness and confidence. But her eyes are dull. , she will tell later in a whisper, she is alert, fearing to hear that the next boom has arrived. Since the attack at the entrance to the city, she begins each shift with a refresher of the equipment list, making sure she knows where everything is placed, so that she can function if a similar incident occurs, God forbid.

She was on duty on the day of the attack.

She was the one who answered the phone at 07:10, when an MDA operator called to tell him that there had been an explosion, and that the injured would be taken to the hospital.

"It took me a second to understand exactly what he meant. I asked him, 'What do you mean by an explosion, a gas balloon?'

But he said they don't know. After a minute he called again and said it was probably an attack.

"At that second, you don't think back, about what happened 20 years ago. But after the event is over, you understand what happened here. I experience the sadness that happens around me, and I'm usually very immune. But since last week, I feel different. We handle quite a bit here Injured from stabbing attacks, it has already become a kind of routine. But stabbings are not like an infernal explosion. When you work in the emergency room or in trauma, it is difficult for you to monitor patients. You treat one, the other, and move on, because there are many more patients and there is no time to stop, think and digest.

"On Wednesday, there was a phase where we were all working under pressure, and more and more patients were arriving. I went outside for a moment, and then a woman who was being treated in the emergency room, regardless of the attack, approached me and asked if I could check what was going on with her blood tests. She approached me several times, and I I knew I wasn't available for that at the moment. I didn't understand how she doesn't see what's going on around her and doesn't understand that she has to wait."

Over the years, Naomi says, she learned that she had to numb her senses to continue functioning.

"I know that what makes me feel good is to go home, hug my son, talk to my mother or a good friend, and carry on. Unfortunately, I've learned over the years that the pain penetrates at that moment, and if I want to continue functioning - I have to get it out quickly. Otherwise I can't handle the job.

"As a single mother, I think more about my son. Last Wednesday, I was supposed to take him for a ride on the light rail for the first time. But I felt that it was very wrong to enter the city center on the day of an attack. We stayed at home and played, continued our routine, but I was not quiet."

The consequences of the continuous treatment of victims of terrorist attacks can be seen in many of the hospital's employees.

Vigilance expressed in hasty hand movements and eyes running everywhere, wondering where the next event will come from.

"The incident in the field ends quite quickly," says the attorney Anat Meler, "but in the hospital it is an unfolding event that continues long after." Anat has been working here for 11 years. On a daily basis, she coordinates the work of the social workers in the children's wing, but on the day of the attack, The sabotage moved to the front of the ER.

She is 42 years old, married and the mother of three daughters, and was at home when the explosion happened.

When she heard about the attack, she rushed to the hospital.

"We always have something to do at events like this," she says, "We open an information center, and we have to accept the families who come and are anxious, we have to accompany the injured. There is no shortage of things to do. When there is a big event, there is also a very big mess. You don't know how many are injured They're about to arrive, what's really going on. Compared to a one-off incident, with major attacks it takes time to understand what you're dealing with, and how you can make order and reduce the pressure."

Initially, due to their serious condition, the hospital did not know the identity of the two critically injured.

According to the procedure, Anat accompanied the security coordinator at the hospital to search their personal belongings and inform their families that they were in the hospital.

"I know that I am there, in the moments that burn the families, and that whatever I say or not, will be etched in their memory. And this moment, when you pick up the phone to your mother and tell her, 'Come to Shaare Tzedek because your son is here,' will remain a part of the story of these families for the rest of their lives. You are not Can't detail anything on the phone, but you know you're waiting for them with good news from a new life.

"We stand at the door and wait for the family members, and we were there when they informed the parents of the late Aryeh that he was killed, and also when they informed the family members of the late Tedsa, who passed away earlier this week. I am still in contact with the community in the area where he lives, to help the family members. When this attack comes Makes everything even more difficult."

The director of the security department, Yoni Shimon, is hard to move.

An energetic 38-year-old guy, married and the father of two daughters, with seven years of experience in Shaare Zedek.

In June 2016, on the second day of his work at the hospital, the late Hillel Yaffe Ariel arrived there, after a terrorist broke into her home in Kiryat Arba and mortally wounded her. Despite resuscitation efforts, she died at the hospital, aged only 13 and a half.

"It was my first boom, and I realized where I got into," Yoni puts his hands on his knees.

"I remember at the end of that day I got home and I didn't stop hugging my daughter. That was my first event, and then there were many other shootings and attacks, during which you just focus on what needs to be done. This means bringing in the wounded, keeping the curious away and securing the entire plaza The emergency, which becomes prey."

He remembers how after the 2017 stampede attack on the Commissioner's Palace, soldiers came to say hello to their friend, and confidently identified that one of them was carrying a loaded weapon.

"If a shot was fired in the square, it would be like another terrorist attack. Our job is to secure this square. After all, even if a terrorist is injured, they will bring him to the hospital for treatment. The police are supposed to make sure in the square that he is not carrying any grenades or explosive belts, but we are the ones who put it in at the gate - and have to check it."

When he recalled the events of last Wednesday, the flow of his speech stopped.

The look on the face of the boy Arye, who arrived at the hospital after the injury, and of his father, who wept softly after receiving the news of his death, does not let him go.

"I was on my way to the hospital when I received the message about the explosion. There was an eternal traffic jam from Ma'ale Adumim, where I live. On the way, a car met me, and when I explained that I was the security director at Shaare Zedek, they cleared the way for me.

"When the first injured people arrived, I was already here. We received a message about another explosion in Ramat, and some anxiety-stricken people arrived. Then Anat, the social worker, came to me and said that we needed to identify an unknown person who was in the operating room, and that there was a bag with his wallet and clothes."

He closes his eyes tightly, pauses for another deep breath.

"I got to the operating room, and I got dressed in operating room clothes. When I entered, I saw a boy lying on the bed. It was Arya, whose name I can't get out of my head. Such a beautiful boy. I saw how the team fought for him. I took the bag with his equipment, when his phone rang. The monitor said 'Mom.' It broke me.

"I entered the office with the bag, and everyone looks at me and asks me, 'Why do you have red eyes?'

I realized that I had to reset, because I had a role. We opened the bag, and saw ID cards with his name on them.

"Suddenly, his phone rang again, and the display read 'Mother' again. Anat answered and told her to get to Shaare Zedek, and then we would update him on his condition. From that moment on, I could not leave him. I accompanied him to the mortuary. I also accompanied his father, who would identify him, and that was A difficult moment. You see a father crying like a baby. Such calm, quiet crying, when he understands what he is going to see but still wants to drag out the time that he does not yet know for sure that it is his son. I had a thousand other things to do, but I asked others in the department to do the It's in my place, and I stayed with the father.

"Usually I don't watch news broadcasts in the evening. But this time it was important for me to see the report from the funeral. I knew what I was going to see, and I had the need to sympathize with Aryeh's family. It doesn't usually happen to me, but I took this event with me further ".

batchene@gmail.com

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