Two years and counting

It’s just a little bit more than two years since Deborah and I made that life-changing step on to a plane at Heathrow. Two years of new experiences, new people, new food, and a new perspective on life. I think it’s safe to say that the novelty of change has worn off, unless I make a conscious decision to think about where I am. The momentary buzz of excitement, pride or disbelief garnered from a drive through Jerusalem, or past Nablus, or even while looking at the Hebrew signs and labels in the supermarket, has given way to an absence of any sort of emotion at all. It’s become exciting when packages come in English, not because the Hebrew is difficult to read any more, simply because it’s a novelty. It’d be very nice for every day to feel amazing and special but of course that is both unrealistic and paradoxically impossible – how can every day be special? I suppose that this is the epitome of the Zionist dream, to simply live here and feel normal.

Far more exciting for me than the two year mark after aliyah is the one year mark in the army. That means that I have less than 6 months to go, and if I had enough energy left, I’d count down the days, hours, minutes and seconds. Plenty more of the same thankless stress, lying soldiers who want out and are willing to waste my time to get it. More outbreaks of disease, because unless I physically go and wash the hands of every soldier, they will continue to poo and then eat without a second thought, or cough out their infectious mononucleotic sputum into their hands before manhandling the carcinogenic cyclinders of dried tobacco leaves that belong to their friends (which are seemingly part of the compulsory equipment of every young soldier. They will continue to rub their viral conjunctivitis infected eyes, sneeze into the air, drink from the bottle of the soldier with the cold sore, and fail to report to me the case of whooping cough until another ten soldiers have already caught it.

My first group of soldiers completed their training and has already spread out to the battalions across the West Bank and borders of Israel – leaving Deborah and me a fantastic opportunity to have a holiday last week.

The giant balcony of our fab room at the Daniel Hotel, Eilat

Time trials in a Mazda 2 - the abandoned runway we happened across at Arad

From left to right: Deborah and a camel. Hiking in the wilderness of the Northern Negev desert

We started with a lovely weekend with my cousins on Kibbutz Degania Bet by the Sea of Galilee – blooming with flowers, blossom and animals at this time of year, along with a chance to enjoy the hundreds of Nigerian and South African tourists who have come by the coach-load to be Baptised in the Jordan River – Big J style (although I don’t think he came on a coach). From there, we headed down to the Dead Sea, where we hit the jackpot. A still-unused engagement present promise from Deborah’s sister and brother-in-law (Rob and Amanda – thank you!), plus my birthday presents from them and Deborah’s parents (thank you too!), provided us with a last minute booking for two nights in a top room in the five star Daniel hotel, with meals. Too cold to walk down to the Dead Sea for a swim? (Well, it is at least 2 minutes walk)... No problem! Just enjoy the Dead Sea pool of heated water pumped up specially to the hotel. All the fun of the floatiest body of water in the world, without stones, dirt, or a risk of feeling remotely cold. Don’t feel like sitting in the beautiful sunshine in public? No worries, enjoy the private sun beds on the private balcony, with its uninterrupted view of the Dead Sea and Jordan, with enough room to build a house (seriously, the balcony was bigger than our apartment). Even though we’ve been married for almost two and half years, the hotel still managed to throw in a bottle of wine as an engagement present...

Jordan, Syria and the Red Sea, from Eilat

Gaza from Israel

On the way back to Jerusalem, we made a significant detour across the country to Gaza, where Deborah had her first taste of voyeur tourism; driving around the local villages in search of the famed Calendula and Anenome fields of spring, and exploring the sand dunes and fields of the northern Negev desert – 70 years ago barren wilderness and now a key part of Israel’s agricultural industry, we managed to fit in a view visits up to the border, and even an army base (much less of a novelty now than it used to be...). After a compulsory visit to Ikea (because what holiday would be complete without a trip to look at mass produced furniture), and Kika (the Austrian rival) we spent a day or two in Jerusalem to continue my DIY attempts in the apartment (almost ready for painting now!), and finished our week of recuperation in Eilat – Israel’s answer to Las Vegas (or Blackpool).

So, back to work. Hooray.

While sending my soldiers out to fight, I have successfully been able to pass the buck on an array of irritating soldiers whose complaints just don’t make sense. For example: the guy who believes he has developed reflex sympathetic dystrophy – an extremely rare neurological disorder subsequent to nerve damage after a sprained ankle; even though he has no positive findings on examination whatsoever, except for excruciating pain when anyone so much as breathes on his foot. But oddly, he walks without a limp, and can even manage to run to get a place in the lunch queue... When I have a soldier who doesn’t feel his treatment is working, I no longer need to worry about him coming back for follow up with the same complaint; I simply tell him to, ‘Give it a month. If it doesn’t improve with these tablets/exercises/exemptions/rest days/massage/other placebos, come back and see me.’ All in the knowledge that one month from now, he will be on a base far from here, either harassing some other poor overworked shmuck, or trying to harass him and realising that he can’t get an appointment.

What does all that mean? Two things. The first is that in a few days, the nightmare will start all over again, with a new intake of new soldiers. Another group of several hundred lost souls plucked prematurely from their mothers’ breast, or in the case of those who deferred army service to go travelling in South America (a rite of passage for young Israelis these days), saved from the brink of mental destruction secondary to cheap Columbian crack, will arrive to have their existences physically and mentally changed for eternity. Another group of little children who will quickly learn how to pretend to be something they’re not.

The second thing, which troubles me far more, is that it appears the army has broken me... or built me, depending on the aim of medical training. I have learned that much as I would like to have a regiment of happy, healthy soldiers, grateful for their care and enjoying both the military and the medical experience, it’s simply not going to happen, and the only way to maintain my sanity is to embrace that fact. When you’re treating a community of young healthy people, most of their complaints will go away with or without me. And the ones that truly need a doctor often won’t get better anyway. If the knee still hurts even though the examination and imaging say nothing’s wrong, then either:

a) You have a sore knee, or

b) You’re lying

...so there’s no point in another referral to the orthopaedist, and letting you out of training will only delay your physical fitness and reduce your ability to fight. I could spend the next ten minutes explaining all this to you, ending in a nice haggle to decide how long your exemption from carrying heavy weights lasts for, or I could be a rude, abrupt (Israeli) doctor, tell you ‘Ein ma la-asot’ (There’s nothing I can do for you), and then shout ‘Next!’.

Thus, the English doctor has adapted.

What I would say this time last year	What I say now
Hello, I’m Dr Adam, how can I help you?	Yes, what’s the problem?
Is there anything else that’s bothering you?	Only got time for two problems. Choose the most urgent, and you’ll need to make another appointment for the other things another time.
I know that you’re here now because of the genital itching, but I see from your notes that I saw you last month with some mild headaches after long periods without drinking. I explained to you that it appeared to be as a result of mild dehydration, and said to come back if the problem didn’t resolve. How are you getting on now?	[Quickly reviews notes, spots unrelated problem, doesn’t ask the patient and hopes that the patient won’t mention it, suggesting either the problem has resolved, or isn’t bad enough to warrant any further time-wastage.]
This tablet is both a painkiller and an anti-inflammatory drug, so it’ll help with the pain in your knee and also your sore throat. You can take it up to three times a day, with or after food ideally. Only use it when you need to, and don’t feel that you need to finish the course.	This’ll help. Up to three a day with food. Ask the medic if you have any questions.
The pain in your chest is caused by a muscle strain. It can be a bit scary, but it’s very common and will go away in a few days. Do you smoke? There’s nothing to worry about just yet - your heart and lungs are very healthy; and will carry on being healthy if you can stop smoking. Have you considered trying to quit? Let me explain the damage cigarettes do to your health...	It’s just a pulled muscle which will feel better in a few days. But if you don’t sort out your smoking problem then in the future you might be talking to me after your heart attack, or about your cancer treatment. If we find the cancer before it’s too late.
Do you have any questions?	Next!
Hope you feel better. Have a good day!	NEXT! Put your socks and shoes on outside, I need to see the next soldier.

These ‘modifications’ have done wonders for my figures – seeing around 30% more soldiers per hour than two months ago. But what little joy there was in treating a self-limiting overuse-related muscle sprain before (I know, I know, there, there, it’ll be ok. Poor thing.) has been surgically excised from my day to day treatment by the constant pressure to see more people, and the horrible realisation that so many of the soldiers are at best exaggerating, and at worst, lying.

In a different field of army experience, I reached a new realm of food in recent weeks. After months of rushed meal times and the occasional missed meal because of a late clinic or meeting, I some time ago discovered the kitchen store, a walk-in fridge kept under lock and key, where the wonderful army basics of chocolate milk, cheeses, jam, vanilla puddings, even the occasional yogurt with some genuine fruit somewhere inside it, are kept. As somebody worth keeping sweet, the kitchen staff is only too happy to grant me free access to this room at my whim. I’ve never been a fussy eater in my life, and although I’m very careful at home to eat healthily, I long ago resigned myself to the fact that my army diet would be somewhat limited, with some semi-literate half-brained pleb responsible for ordering the required foods for a base the size of a large village. Initially, it was a real treat having free access to treats, filled with sugary E-number goodness. Only when I stumbled upon a much less-used kitchen store (which is so unpopular that it is kept outside, without any sort of lock or protection, did I discover that it is in fact possible to eat well in the army... another walk in fridge holds a weekly supply of fruit and vegetables; even the occasional luxury goods of avocados, peppers, aubergines, sharon fruits and oranges. I don’t know if it’s an indicator of my advancing age, or the sheer overdose of carbohydrates and fats in 12 months of army service, but never before has the sight of a vegetable selection filled me with so much excitement. Like a ten-year old boy stealing apples from the farmer’s tree in 1935, I can be seen in the hours of darkness scuttling away from the kitchens, pockets stuffed full of prized pickings to fill my stomach and fight off scurvy.

Juicy tidbits from the medical file

Although the events of real medicine are not a regular experience on my base, they have accumulated over time. A few weeks ago I was thrilled to evacuate my first patient with a real prospect of a broken spine to hospital, after falling from a height during an exercise in the middle of the night. Due to various other activities the same night, instead of my usual proper ambulance, I was dispatched in a real army one – the big scary sort with bullet proof walls and no windows... and barely enough space for a patient, let alone a medical team. As we hurtled through the West Bank, driver taking the corners at (excuse the pun) break-neck speed, gun in lap, intubation kit on standby, patient strapped to a solid board with collar on, I almost had a feeling of purpose. But then his CT scan turned out to be clean, and I’d just lost a night’s sleep because of a cry-baby.

The last time I had a legitimate referral to hospital was when a soldier had spent his day painting a room, without thinking to open the windows. When he left the room, feeling suitably sedated and high on fumes, he lost his balance just as he failed to notice the steps in front of him, falling to his doom, with a head injury, a few chipped teeth, and a nice little hole in his cheek. The rest of him was fine though – his head broke the fall nicely. I could rant for ages about the comedy of errors that pursued (for example, receiving an order to send the ambulance to another base without its doctor because there was already a doctor there... meaning that for the next 3 hours there would be an ambulance without an complete ambulance team, and a doctor without transport), but instead I’ll just moan about the fact that the idiot was wearing a different soldier’s dog tag. Of all the ridiculous things I’ve seen in the army (and there are many), never before have I ever seen anything so appallingly irresponsible. As a result, this guy’s medical record is completely clean, while some unsuspecting friend of his has a record of a traumatic brain injury.

Before I sign off, I want to add an insider’s perspective on the latest events of the Mid-East conflict. I’d love to divulge the full details of the atmosphere and beliefs of the army and their policies, but of course I won’t. What I will say is that things are steadily and relentlessly coming to a head with Iran. In the past few days, the first specific evidence of research into nuclear weapons has been discovered. In other words, the first really good reason for a pre-emptive strike on arguably the most dangerous regime in the world, has surfaced from the depths of rumour and presumption. On the same day, Obama has once again backed down and contradicted all the previous statements of the US defence secretary, congress, and his own office, by declaring that Israeli military action against Iran will damage the United States. Because as we all know, America needs its oil far more than we need to prevent a nuclear holocaust.

Closer to home, this weekend has seen a massive rise in violence on the Gaza border, which started just a few hours after one of my home-grown soldiers was severely injured during an arrest mission in Hebron; while re-arresting one of the murderers released as part of the Gilad Shalit deal (after being involved within just a few weeks in further terrorist activity), a second terrorist cut the soldier’s throat with a Stanley knife. Credit goes to the commander’s quick-thinking first-aid actions that undoubtedly saved the soldier’s life (he’s currently stable in hospital after a severed carotid artery), and according to the current version of events, to the soldier who after having had his neck cut shot dead the first terrorist and incapacitated the second. Since then, dozens of rockets have been fired into Southern Israel from Gaza, landing in and around the Eshkol area (where Deborah and I were flower-hunting last week), and Israel has assassinated another big-wig Islamic Jihad terrorist.

And once again, I remain in the ironic and disconcerting bubble. While the world seems to erupt around me, I gratefully remain in my base, deep in the middle of the West Bank, just a few miles from the terrorist hot-bed that is Nablus, and do not hear a peep. Deborah came to visit this weekend while I was on standby in the base. We ate, we slept, we had a beautiful walk in the sunshine looking at the rare irises, calendulas, and a myriad of other flowers, the dozens of lizards, caterpillars, spiders and other bugs, we climbed a hill to enjoy the views of the Jordan Valley, and the rolling green hills of Israel in the spring, in the perfect 23 degree warmth and light breeze.

I think I’ll oil my gun tomorrow.