MDA Day 1: Finding Love and Joy in the Midst of Disease and Death

Today I had my first shift in Magen David Adom (MDA). I could barely sleep the night before.
This is certainly not the first time I’ve been expected to perform under pressure. I’ve competed internationally in Taekwondo against some of the best competitors in the world, but rather than costing pride, a mistake on an ambulance could take a life.
I woke up at an early 5:40 am and headed over to the central MDA station. As I walked up to the door I ran into two of my friends from the 10-day Magen David Adom course in Jerusalem. The three of us bonded over an unspoken shared anxiety.
I found the ambulance driver that I had signed up for and introduced myself to him. Within a few minutes we were off with our first call.
An Asian man (Canadian) had been feeling nauseous and requested an ambulance from his room at the Dan Panorama hotel to the hospital. We all immediately assumed that it was some snobby tourist who had a stomachache and was willing to spend quite a bit of money for a lavish taxi ride. We arrived to the hotel and traveled up to his room. Upon opening the door I hear from inside his hotel room the sound of a waterfall of vomit. Following by coughing and spit. We remain outside his room for the next 15 minutes as he continued to empty out whatever his stomach had to offer into the toilet. I was absolutely disgusted, but made sure to hide it.
We put the patient on the stretcher (chair position) and brought him down to the ambulance with his wife. Throughout the ride he had a vomit bag up to his mouth and was puking into it. The medic told the driver in Hebrew that he was not experienced with taking blood pressure and so asked me to do it. I’ve taken people’s blood pressure many times. You’ve never truly taken someone’s vital signs until you’ve done it speeding through traffic with an Asian man puking his stomach out into a vomit bag while his wife consoles him and the driver is yelling incoherently in Hebrew.
Since they may be the only tourists I meet on MDA, I told his wife that I was from Minnesota. She looked at me and asked me, “Why are you here??!!” Needless to say, food poisoning in a foreign country does not promote a repeat visit.
Once we dropped him off at the hospital. The medic asked me what would be a comforting thing for him to tell patients in English when he drops them off at the hospital. I told him the first two phrases that came to my head, “Feel better” and “get well soon.” I told him that those were the best I could think of even though they both seemed either too Hallmark or put too much pressure on the patient returning to health.
Next we went to a man’s apartment where we received a call saying that he had fallen and needed to be taken to the hospital. We pulled up and his neighbor (who called) led us to the man’s room and we slowly led the old man down to the ambulance. The driver asked the old man who smelled strongly of alcohol, if he drank vodka and he responded, “sometimes” (great answer). We learned that the fall occurred four days prior on Thursday, years ago he had a serious spinal injury, he has Parkinsons and moving his left arm caused excruciating pain. I took his vital signs, on the pain-free arm, and we took him to the hospital.
Next, we got a call for a transfer from a hospital to a nursing home. No drama. Basic taxi service. We showed up to the hospital where we encountered our patient standing upright and walking around. He told us he was feeling 100% fine. The medic whispered in my ear that the only reason they transfer people this healthy is if they have mental problems. As we were about to leave one of the nurses ran out with the bottom plastic stand of a razor asking the patient if it was his. He said he didn’t need it. We took him to the nursing home with no issue. Two hours later I learned from my medic that our patient had the razor in his pocket. I looked at him and exclaimed, “but that man had psychological issues…” He responded that the man simply didn’t understand where to put his belongings. Still kinda freaked me out.
Next we were called that we were going to transfer another patient, this time from a nursing home to a hospital. We arrived to the nursing room and watched them place the old woman on to the stretcher. She began to go into intense uncontrollable seizures. Nobody did anything. I looked around and pointed out the obvious to my medic, “umm…she’s seizing.” The driver turned to the nursing home doctor and asked him to give her some medicine. The doctor told us that she always seizes when she’s taken away from her bed and that all she wants is to get back in her bed. In my head I’m thinking, “Who cares!! If she’s faking it the drugs won’t hurt her!” After a lot of bickering we are able to get the doctor to supply her with drugs…which doesn’t help. Her entire body continues to seize. She voids her bowels. We take her into the ambulance and she continues to seize for a while, until the medic sits next to her, holds her hand and comforts her in Hebrew. The intensity of her seizures diminishes greatly. Why couldn’t I have done what he did and comforted her?
This woman had been taken away from the safety of her bed. She was frightened.
In the past few hours I had been thrown out of my own state of denial of the frailty of the human body. I was afraid to comfort her, because I was afraid of her condition. That was my mistake. We all fear death, illness, growing old but that fear only becomes truly dangerous when it is debilitating to our psyche. For this woman, her fear consumed her and caused those seizures. For me, my fear caused me to lack the ability to console this woman at a time when she needed someone the most.
I (we) need to get over these legitimate, yet unnecessary, fears that hurt us and keep us from helping those in need.
I look to the ground and see the three trash bags of her belongings that we are bringing with us to the hospital and it didn’t take me long to realize why we are bringing so little and in disposable plastic bags. Very soon she will shuffle off this mortal coil.
Seconds after, a song on the radio comes on. No, I tell myself. It can’t be. That irony would be too cruel. “Always Look on the Bright Side of Life” from Monty Python’s Life of Brian is coming from the radio.
The medic and I both looked at each other, and smiled. I realized, this is what comedy was made for. Comedy emanates from these moments of darkness.
Watch the original song here:
We had a long break of 45 minutes where we had nothing to do. Our driver took us to get falafel, but I wasn’t hungry.
All of a sudden we got a call. A 72 year old woman was unconscious and needed immediate help. They told me to put the defibrillator, ambulance bag and oxygen tank onto the stretcher because of the speed in which this call must be done. We ran into the home, with me holding the defibrillator and ambulance bag. Her worried family surrounds her body. Immediately the driver says that he’s going to start CPR and so we begin to take out the equipment. Why did the driver say that before checking whether the woman was alive?
I found that out an hour later. The driver explained that he noticed the family was Russian and was aware that their culture would not accept the truth if he had walked into the room and straight-out told them that their grandmother was dead. They wouldn’t have let him leave, because they wouldn’t be able to accept the fact that he couldn’t do anything. They would have assumed that he was responsible for the death, because he did nothing to help her.
The driver begins to check the pulse with a stethoscope (none). He checks rigamortis of her jaw to see if she can keep her mouth open.
He hasn’t said anything. The family begins to yell that he can’t start CPR, that she was miserable and had been in hospice dying of cancer. He says that he has to start CPR because there is no DNR, and they argue that they know her wishes.
A few minutes later he breaks it to them that she is dead. Not in the most sensitive way (telling them that although they told him she has been this way for 30 minutes, it’s more likely 45 minutes and they should have called earlier).
We call the police and begin to wait for the police to come and print out a death certificate with an asystole printout.
Suddenly, it dawns on the family that their loved one is dead. I watch a crying mother hug her son in tears. Cigarettes are taken out and lit. The room now smells like death, feces and cigarettes.
I feel myself getting emotion and my eyes watering seeing the pain on their faces. This person may be a nobody to me, but she means so much to the people around me. I turned around and walked through the house.
The police doctors showed up and shook the hand of the driver. They quickly set up the heart monitor and printed out a flatline.
We walked out to the ambulance. Our medic told me, “not the best way to end your first shift Aaron. Should have had a birth.”
What a comically dark thing to say.
Life is full of times where we want to taste the sweetness of love, but are met with the bitterness of loss.
Today was one of those days. I saw pain, illness, fear and death.
But what else did I see?
I saw the sweet signs of love. Lots of it. Hidden like a stream in the nooks and crannies of harsh rocks.
Where did I see love?
Let me count the ways.

  1. I saw love when the puking Asian Canadian man’s wife rubbed his back and told him it would be ok when he was suffering from food poisoning.
  2. I saw love when that alcoholic Parkinson’s patient’s neighbor cared enough about his friend to not only call MDA and lead us to the man’s room, but assist us in background history and moving him down the stairs.
  3. When we dropped off the patient at the nursing home I saw a group of elderly women doing an exercise where they all danced to Israel music. I saw joy in their faces as they danced with wooden sticks in their hands, while others clapped to cheer them on.
  4. I saw love as I learned of how my driver had been so keenly aware of the cultural stigmas around death and told the Russian family that he would perform CPR, without checking to see if the woman was alive or not. In order to be sensitive to their culture and emotions.
  5. I saw love as I watched a husband visit his wife in the nursing home and feed her because she was physically unable.
  6. I saw a form of professional love for care when the driver of my ambulance ordered the nursing home doctor to supply our patient with an anticonvulsant rather than assume she was faking it.
  7. I saw love when my ambulance team sat down with the grieving family and made small talk with them about their careers.
  8. I saw love when I talked to my fellow medic about Israeli culture and the impact of American culture at length. As well as when he bought me a coke because the cashier told us that they wouldn’t accept my credit card.
  9. I saw love when I watched our medic holding that seizing woman’s hand and comforting her the whole time through the ambulance ride.
  10. I saw love when the driver proudly recounted to us how the police came in and gave him a hearty hand shake and warm greetings because they recognized their friend.

Love appears in the most unexpected places…all you have to do is open your eyes.
I hope that over my next five weeks with Magen David Adom I’m able to approach my job with both optimism and realism.
Five points for Gryffindor if you find my squinting face in the midst of all the faces of the other Magen David Adom 2013 Overseas Volunteers