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.

Happy families

Many people have commented that the blog has gradually taken on a negative tone over the recent months. It’s not the most surprising turn of events – life is difficult for both of us, while I’m in the army. While I’m on base, Deborah is home alone while I work endlessly with dozens of repetitive medical cases. Long hours, irritating lack of facilities and resources, ungrateful patients. When I come home, we endeavour to make the most of our time together, but that time is very short, and once I recover from the fatigue of a long period on base, it’s time to start getting stressed about the imminent return.

I’m writing this on a plane from Manchester to Tel Aviv. When the opportunity arose to take a week off while my soldiers were in the process of transferring between bases, I decided that I would seize the chance to see my family. No friends, no locum work to raise cash, just some quality family time, to break up the would-have-been 13 months between parental visits. Deborah has started work in Shaarei Tzedek Hospital now, which is great news in every way, except for the fact that it means she hasn’t been with me on this trip.

We’re coming up to the two year mark since we made aliyah; a good time to stop, take note of where we’re heading, and so assess if we are who we want to be, doing what we want. On paper, we’ve achieved all our dreams, including those we could only have hoped for: we both have the jobs we dreamed of, own a home in Jerusalem, have made great friends, speak the language, and can be proud of the fact that we took the plunge, came to Israel, and as the cliché goes, are helping to build Am Yisrael.

But something is missing.

With the exception of those people most inspired and motivated by faith in G-d, as time goes by, ideology fades. It’s difficult, for example, to ration my showers to a couple of minutes to save every drop of precious water in our arid land, when some Israeli-born soldiers are quite happy to wander off to answer a phone call, without turning off their shower first. It’s difficult to work 100 hours per week for a salary less than half that I would receive in the UK, when so many Israelis ask me for advice on how to get work permits abroad. And I’ll never come to terms with watching ultra-orthodox men drop litter on the streets of Jerusalem, the holiest place in the world for them, when I wouldn’t dream of dropping a piece of paper even in the slums of Manchester.

I can’t tell you what is missing from life – but something is affecting our fulfilment. Is it lack of purpose? I don’t think so – even here we can both confidently declare that our jobs give something to the country and the wider population. Is it financial security? No – we’d definitely be better off in the UK, but we aren’t struggling either. Is it gratitude? Perhaps in small part - now especially, during my army time, I dearly miss the simple ‘please’ and ‘thank-you’ of a happy patient.

One thing that is clearly missing – family.

We were under no illusions when we made aliyah. We knew we were leaving family behind; but for a greater good and a bigger picture – to create our own family here in Israel, so that future generations could grow up at home, with their families close by. Our own deprivation would be a small price to pay so that one day our children might grow up close by – even if our kids might not get to spend every weekend with their grandparents, at least we could spend time with our grandchildren one day! Plenty of other people have gone through the same thing... but sometimes the timing is better; they may move when the kids are already a little bit older. Perhaps they have family in Israel, or parents who can visit every month or two.

Whatever the reason, suddenly the distance between our parents and us has been profound. From babysitting to teenager advice, from moral support during labour to help deciding which school to send them off to, we have lost a very useful commodity! All that said, despite the tone of this email, Deborah is NOT up the duff; the plan still remains that we wait until my release from the army, and have a once-in-a-lifetime year trip before we start settling down and trying for sprogs. However, as our friends start to be fruitful and multiply, at home and in the UK, we’ve found yet another reason to appreciate good, loving and supportive parents. Despite the difficulties and frustrations of living in such a special place (no, not Liverpool), at the very least it gives us an appreciation of family that so many people just take for granted.

There are many questions and choices ahead. A lot to decide, and a lot at stake; do we stay in Israel, or come back to the UK? If we come back to the UK, how long for? But whatever our outcomes and wherever we end up, we will have tried our best.

It could be me....

You may recall that I earlier mentioned my reasons for choosing to come to the base I did, based primarily on the frequency of the visits home. There are several bases like mine based around the country, each one for a different Battalion, each one a training base for the new soldiers to arrive.

My second choice was a base down in the south of the country, between the city of Be’er Sheva and the city of Eilat, deep in the desert. The perk of my base is that it’s fairly close to Jerusalem, and a three hour bus journey gets me home, whereas the other base is at least 6 hours’ bus travel. On the other hand, the other base has a swimming pool, and a daily flight to Tel Aviv, meaning that the journey home would only be about three hours... as long as I managed to get a place on the flight (and overlooking my environmental principles).

In the end, I left it to fate, and ended up here. A good friend of mine went to the other base – a new immigrant from Russia, just engaged and due to marry in a few months, and a thoroughly nice bloke.

Two weeks after I arrived on the base, occurred the terrorist attacks in the south of the country that resulted in the current tensions with Egypt; in short, a group of terrorists from Gaza entered Egypt, travelled south, and infiltrated Israel close to Eilat. Armed with Kalashnikovs, grenades, surface-to-air missiles, and various explosives, they started to attack traffic on the roads – targeting two civilian buses taking people north from the Red Sea. In the resulting gunfight when Israeli troops arrived at the scene, several Egyptian policemen who had also responded to the attack were killed. Though it is still not clear whether they were killed by the terrorists or by friendly fire from Israel, their deaths have resulted in a massive uproar among the Egyptian population. Even though the Egyptian government does not view the deaths as an act of aggression, the population has rioted, attacked the Israeli embassy, and held regular demonstrations calling for Israel’s destruction. Nice.

I learned on my gap year here many moons ago that it was no surprise to find friends involved in terrorist attacks. I lost a British friend to a suicide bomber in 2002, and myself have had some very blessed moments – for example, when I caught my bus with less than a minute to spare, only to hear that the next one had been blown up, killing twenty people. When I found that a friend had just missed the first bus targeted in the Eilat attack, I was of course relieved, but it was not a life-changing moment.

This week, I found out that the attack happened in the catchment area of my second-choice base. The result: at the precise moment of the attack, while I was sitting in a conference about follow-up of radiology in the army with a load of the region’s bureaucrats, my friend was scrambled to the scene in his ambulance.

As the first medics, they quickly entered the scene and began to treat the multiple wounded, identifying those with no possibility of survival and treating the rest, as per the protocols drilled into us during our training.

Within a short time, the gunfire started. The terrorists had set an ambush, killing innocents and then waiting for the army to arrive. Powerless, weaponless, and outnumbered by the terrorists, the medical team ran for cover and hid behind rocks, waiting for infantry to arrive. As their armoured ambulance was sprayed with bullets, and civilians lay bleeding on the floor, there was literally nothing to do.

In time, backup arrived, the threats were neutralised (not before they tried to shoot down a helicopter ambulance with a missile), and none of the medical team were badly injured (although an infantry soldier of 20 years old lost his life).

My friend’s experiences hammered home two things to me; ironically, I’m the one in the dangerous base. We have both armoured and unarmoured ambulances, we never leave the base without at least one weapon, and my roads are amongst the most treacherous in the region from a traffic point of view. It was just the decision of G-d that I’m here and not there. Despite the mundane intensity of much of my clinic work, it taught me to remember that there could be a time when I’m in that position.

Several months ago, an old friend of mine came to visit from the UK – a Christian girl I knew in University, who came on a ‘study trip’ to learn about the Israel-Palestinian conflict, and the area as a whole. We only had time to meet for a short period, but it was a very difficult meeting; I had come from my base, in uniform, complete with my weapon; and immediately that she saw it, the look of dismay was evident. As we talked through the group’s itinerary, it became horrifyingly obvious that the group was receiving a warped view of the entire situation. From the trip to graffiti on the ‘apartheid wall’, to the art displays of the ‘victims of occupation’, to the very fact that their guide the entire time was a Palestinian, their choice of accommodation primarily in Arab areas, and the lack of time spent in any main-stream Israeli society, it became so clear to me how easily people can be shown a story from one view point and develop a sincere impression that they understand ‘the bigger picture’.

After a walk around, I took her back to her group, who were touring the Old City. As we approached, most of the group simply turned their backs and refused to look at or talk to this mercenary of the illegal Zionist occupation of Palestine. Two or three graciously managed to smile and say hello, and one even shook my hand. As my friend pointed out, it takes a great deal of courage for a pacifist to shake the hand of a soldier holding a semi-automatic  machine gun. She also pointed out, ‘if you just put down your weapons, there wouldn’t need to be any fighting’. Apparently.

When I arrived to my position on my base, I made the decision not to take a weapon. I decided that, as a doctor, who declared both at graduation, and at my swearing-in ceremony to the army, that I will treat all humans equally, friend or foe, carrying a weapon would be a paradox.

As the United Nations stands to hear a Palestinian declaration of independence, my base has ascended to full alert, in anticipation of the potential chaos that may ensue. As my colleague more than 50 miles from any disputed territory drives around in an ambulance with matching holes on each side where bullets passed through, I’ve made my decision. Next week, I shall sign on for a weapon, at least until things settle down, and I will feel no shame. If our enemies cannot respect the sanctity of life, they could at least respect the rules of international warfare and the Geneva Convention, that state that medical personnel and vehicles cannot be targeted. While Hamas used ambulances to carry weapons for exactly that reason in the Gaza war of 2006, I will continue to honour my pledge to protect human life.

Including my own.

A few highlights of the first months as an army doctor

Arriving to base for the first time

As my bus wound through desolate barren hills, past the occasional goat, rock rabbit, and dried-out skeleton of a bush, in the distance, I could see a large, developed army base – complete with an area for tanks, a formal reception and inspection area, and a nice stone wall with a sign reading ‘Welcome to the Regional HQ of 900 Battalion’. My bus pulled up, and as I descended, I confirmed with the driver that this was indeed my base. “No! You’re the next stop”.
So, we departed, and turned off the narrow winding road on to a narrow winding single-track. Some 5 minutes later, we arrived at a very much less impressive base. So as to prevent provocation of the extremists who try to kill us, most army bases in the West Bank, including mine, are intended to be temporary structures – every building is brought on the back of a lorry, and so the base is in effect a collection of static caravans, with pipes often running over the ground, electric cables overhead, poor drainage, and worse food (though still significantly better than on my previous base). The base is fairly cramped, and extremely hot. Nestled between hills on every side, there is virtually no wind, and in a desert below sea-level that means the night time temperature rarely drops below 30 degrees in the summer.

I quickly found the clinic, and wound my way through the crowds of new soldiers, all waiting to have their arrival checks. It was quickly clear that there would be a lot to improve in this clinic – the thick grime on the door handle to the treatment room gave the impression that no one had EVER cleaned it – by the looks of shock when I pointed it out to the staff some days later, I have come to the conclusion that the impression was correct.

My room is, of course, a caravan, but a relatively nice one – I share it with the Dentist and mental health officer (a very useful guy; thanks to his existence, I don’t need to see the depressions, suicidal ideations and psychoses, all of which would take up my entire working day and prevent me treating anyone else – the mental trauma of coming to the army means that a lot of people go through at least some level of emotional distress). As a result, the room is relatively clean, and has over the years been developed into a bachelor pad – dart board, TV, fridge, kettle... even real beds brought by my predecessors and then left behind.

The toilets are quite an experience – I’m blessed to be one of the elite few who can use the officers’ toilets... but that isn’t saying so much. I truly don’t understand how people manage to create such utter squalor in such a short time – from the sinks blocked with toilet paper, to the faeces in the showers, the tap snapped off the wall and so on. The kitchens are pretty good (with one exception... read on), but the dining rooms are appalling, with kitchen staff demonstrating a lack of a single synapse – they will put out a tray of food (sausages for example), carefully prepared in the army’s strict sanitary conditions, but will not think to put a serving implement in. Then, when a hundred soldiers come in from the field without washing their hands (because their commander is too lazy or stupid to point out to the lazy or stupid soldiers that it’s lazy and stupid not to wash hands when you’ve been crawling around in a field with wild animals), they pick up their food with their bare hands. Worse, they may fish around to find a better sausage, contaminating everyone else’s food simultaneously. But it doesn’t really matter – the swarms of flies who turn up for every meal time make sure to spread the diseases just as efficiently – and the kitchen staff are too lazy or stupid to request a spring be put on the door so it doesn’t remain open for the flies to come in.

The Health Inspector

There is one person appointed to look after all aspects of public health on the base – he does a daily inspection of the base, and needs to report hygiene issues before problems arise. Unfortunately, in my life I have never met a less adept person. In a base full of hundreds of pompous, overconfident soldiers and arrogant captains and commanders, an introverted Ukrainian immigrant of 20 years old, mentally incapable of functioning in any sort of emergency capacity was dumped into a role that some logistics manager somewhere else erroneously felt was unimportant enough that it wouldn't matter if he was incompetent. For months, the situation has been deteriorating on the base, the rates of disease rising, and no one doing anything about it. That is, until the new OCD doctor arrived...

Don’t have a cow, man!

One of the many little annoyances on the base are the wild cats and dogs who have made the base their home – with a plentiful supply of food from soldiers who throw food on the floor, or don’t bother to close bins, the base makes a nice little place to live. Unfortunately, conflicts regularly arise between soldiers and animals, and not necessarily through the usual Israeli mentality of treating the cats like vermin. Many soldiers have come to me with bites and scratches, either when trying to feed the animals (which is a punishable offence) or by random encounters – like opening a bin to find a petrified cat inside, or running around a corner to find that a dog is running in the opposite direction. Every single time, I need to refer to the soldier to the ministry of health for a rabies evaluation, and to complete forms on the exact circumstances of the incident. I decided to try and pre-empt this problem by requesting from the senior commander of the base that we get rid of them. The conversation went like this...

Commander: Well, we’ve had a few gather-ups in the past, where we take them all out of the base; it’s fine for a while but we always get another load back eventually.

Adam: Well, how do they get back in?

Commander: Through holes in the fence!

Adam: Isn’t it a bit concerning that we have holes in the fence big enough for dogs to get through, when we’re 10km from Nablus (a hotbed for Palestinian Terrorists)

Commander: [Looking at Adam with confusion] I take it you haven’t seen the cows then...

(Note: I’m assured that the fence has been fixed before publishing this on the internet)

Building a more efficient leadership dynamic

I expect by now you’re getting a good picture of the nature of the base, and the army in general – there are many people who lack initiative, but more importantly, many more who have initiative but no chance to put it to any use. Only a truly motivated commander wants to have a busybody newcomer making suggestions for things which have no obvious immediate benefit, but that take time, effort, or money. Why fix a fence when no one’s tried to get through it in a long time? What does it matter to him if I have more forms to fill in because of animal scratches that are probably harmless? Why put soap by the sinks when it’ll only get used and then need to be replaced again?

The perfect example of this, to my sorrow, is the expulsion of one of my better medics – his platoon commanders (all aged around 21) felt he was taking too many people to see the doctor, and disrupting too much training by giving people exemptions while waiting to see me. From the medical point of view, if someone has a suspected stress fracture for example (something very common in the army), then it is vastly preferable to give them rest, see if the pain subsides, and assess them again, rather than irradiate them and find nothing. From the commanders’ point of view, they would much rather the soldiers trained until the last moment, and only when in agony, get checked out. The result is that most soldiers would be fine, but the small number with real stress fractures would then require such a long recovery period that they may not be able to complete their training. So, they deal with the problem in the way that bests suits them – remove the good medic and bring a more timid one, who won’t stand up to the commanders, and will request fewer appointments with the doctor. It also means less work for me, but a real chance that more soldiers will suffer more significant medical problems.

And so it suddenly becomes clear – people who are more incompetent, lazier, more obedient and less forward thinking have a better chance of staying in their position and ascending the ranks of the army.

There are, however, exceptions to every rule. Our new deputy commander is one of them.

The commanders of the base are actual adults, not hyped-up 21 year olds with big egos. In their 30s and above, they have in their 15 years or more of experience all served in wars, commanded combat units and battalions, before eventually rising to the level of the training base. As a rule, they have an air of authority and command respect. Each one will decide for himself how to conduct business with the senior staff – some remain ‘at distance’, meaning I call him commander, he calls me doctor, some will be on first name terms and call you in for a coffee and a chat. The deputy commander’s role is to basically do all the crap the commander doesn’t want to – logistics, maintenance, disciplinary issues etc.

As a fellow newcomer, I decided that the deputy might be a good person to approach to try and sort out the appalling lack of sanitation on the base, before the next epidemic. Straight-faced, permanently serious and quite abrupt, he struck me as someone who took his job very seriously. As we sat and I reeled off a list of the urgent repairs and basic requirements that were lacking on the base, his listened intently and wrote every single thing down. At the end, rather than negotiate with me what I felt was really important and what could wait, he immediately started to sort things out – the public health soldier who doesn’t seem to do anything was pulled in for a meeting with us both, an inspection of all the areas I’d mentioned was arranged, and deadlines were agreed for fixing the issues. I couldn’t believe it – someone in the army, in a senior position, expressed motivation, authority, intelligence, and most of all, genuine concern for his troops.

Unfortunately, his level of commitment to the rules and responsibilities stands on every single level; little perks that were acceptable with his predecessor are no longer okay – if I miss the bus home because of a sick patient, previous commanders would allow the ambulance to take me to another bus stop to get a different bus (rather than wait hours for the next one). This commander does not feel that is a good enough reason to dispatch the ambulance, even if it means I may not get home. On the one hand, he’s quite right – the ambulance isn’t a taxi. On the other hand, GIVE ME A BREAK! It’s a ten minute drive, and if they need the ambulance, then it’d already have a full staff.

Shabbat in the Army

Two weeks ago I experienced my first Shabbat in the army – that is, the first weekend I spent on base, on standby in case of war or major incident. The workload is very variable – it could be totally silent, looking after the relatively small number of soldiers remaining on the base that particular weekend, or it could be chaos, as the only ambulance ready and waiting in a large area.

The weekend started with a briefing Thursday night where each division (medicine, logistics, catering etc) presented their plans for the weekend – naturally, 80% of the meeting revolved around food. The main issue was due to the fact that the majority of soldiers present belong to Netzach Yehuda (I’m going to write a whole section on them in time – although they deserve a book for the amount of chaos they create) – a strictly religious platoon for soldiers who have taken on themselves the highest level of orthodoxy; as a result, they have a super-kosher dining room, prayer-time built into the timetable three times a day, compulsory fasting on fast days (where everyone else has free choice), and a total absence of women in every aspect of their army service – they require a male doctor for example (although I know of no place in Judaism where modesty overrides preservation of health). The blind decision was made by the kitchen staff that  for Shabbat all food would be prepared and served in the Netzach compound (they have their own fence to ensure a full separation), and the regular soldiers would go there to eat. A small level of insight would have ensured they would therefore check that there would be no women on the base, who would as a result have nowhere to eat... but of course that was not the case, my medic was a female soldier, as were several other staff that Shabbat. The commanders of Netzach would not even agree to allow the women in to collect takeaway food (which I would have vetoed regardless – the idea of isolating a few soldiers from everyone else on Shabbat, a time when everyone eats and relaxes together, was physically repulsive and in my opinion a disgrace). Eventually, a compromise was made – two dining rooms would open, one for the super-religious, and one for everyone else.

Alongside the driver, the medic and a major incident coordinator, I had fun making the most of the potential free time; the plan was to spend the Friday having a drive around the region as a ‘getting to know the region’ tour: as our standby could require driving to anywhere, including Nablus (where we treat Palestinians after traffic accidents etc), the local settlements and Bedouin tent villages, and all the roads in-between, it makes sense that I should know the names and locations of key sites and flashpoints. The fact that a nearby settlement had a beautiful outdoor swimming pool that was free for soldiers was beside the point entirely and absolutely not the reason we wanted to get out of the arid, feculent base. Honestly. Ahem. In the absence of the clinic commander, the deputy commander of the entire base was the only person who could authorise the trip – and once again his dedication to the mission threatened to throw a spanner in the works – calling us in for a meeting, we had to present not only the reason for the trip, but a full specific itinerary of precisely where we would go, where we would turn around, how long the trip was expected to last, and agree to make no stops, to enter no other army bases, nor to enter any settlements. The purpose of these rules is still beyond me, given that the result of the trip was a ready ambulance, full of staff patrolling the exact area it was serving, rather than having a staff dispersed across the base, and an ambulance unattended.

Somehow, despite not leaving our ambulance during the trip at any point, we returned happy, relaxed, and all an unusual shade of sunshine glow.

Friday night is the highlight of Shabbat for many people – tired from a week of intense work, returning home to sit down, eat, talk and rest is a really special moment, and I was very curious to see how that atmosphere would transfer over to the army. Entering the usually revolting dining room, I was amazed at how the Shabbat atmosphere permeates everything – the tables were all set, salads and drinks on the tables, challah (Shabbat bread) ready on the table. Around 100 soldiers were eating with us, most of whom weren’t religious (the very religious ones having been isolated). Nonetheless, the respect for Shabbat was profound – no one started to eat – everyone waited without being told until the last people had arrived – I was ‘voted’ by way of shouting ‘The Doctor!’ by the soldiers to make Kiddush and hamotzi (the blessings over wine and bread), which was quite a privilege in the presence several far more senior commanders, and a good number of soldiers far more religious than me. Arrogant and pretentious as it sounds, it was nice to feel that my work is appreciated by the soldiers I treat, even though they often seem so irritated that I didn’t send them home or discharge them from the army. Thankfully, the deputy commander sitting directly opposite didn’t seem to notice our red glowing poolside faces.

The rest of Shabbat passed smoothly, and uneventfully – meaning that I was almost ready to enter the next week of insanely busy work, despite having only had 12 hours to see my lovely wife.

Deborah's bit

Meanwhile, back at home Deborah’s concerns about the competition building at work between Israel and Manila proved to be well founded – she’s now in her last few days of work on the projects and feels deflated and disappointed. Personally, I think the timing is wonderful. The job came along at a perfect moment in Deborah’s life, where she needed to adjust to life in Israel, while simultaneously losing her husband to the army. It gave her freedom to work as she wanted, while being available to sort out our mortgage, and to adapt to the new lifestyle. And the job has continued up to just a few weeks before she takes her first steps as a hospital pharmacist in Israel, after some freedom to refresh her knowledge and get ready for the next big step. It’s never easy losing a job, but if it has to happen, the timing couldn’t be much better. And she made sure to get her complimentary Rosh Hashanah present from the office before she leaves. That’s the most important thing.

Life in the armpit of nowhere

After four months of living together, working together, sleeping in the classroom together, sleeping in armoured personnel carriers together, and playing on iPhones together, our group has finally split. As you’ve seen from the previous blog entries, it hasn’t always been easy. Sometimes, in fact, it’s been really difficult. Coping with a high pace of learning in a foreign language with people in the top 0.5% of the population in terms of IQ (a pre-requisite for them getting scholarships for medical school from the army), while not getting enough sleep, and living next to the Georgian soldier whose personal hygiene and eating habits are possibly the cause of most new species of bacteria discovered in the past century, has not always been an enjoyable experience. 18 hours days followed by a weekend poring over reams of small-print Hebrew medical and military literature has at the very least been as difficult as University, and probably more so with my old and tired brain.

Getting to the end of the course was certainly not a sad moment. Of course, it was tough to say goodbye to the people who had effectively been my friends and family for the past four months, but as we expect to see each other at various conferences, mass casualty incidents, and wars, it was more of a ‘lehitraot’ (see you soon), than a ‘shalom’ (goodbye).

Graduation

The end of the course arrived and we celebrated with a fancy graduation ceremony. Family, friends, the surgeon general of the army, various commanders, and all the ecstatic people who we would shortly be replacing, came to celebrate the end of our training.

The IDF, like most militaries in the world, holds discipline and efficiency in high regard. Unlike most militaries in the world, the IDF tends not to actually do very much to encourage either. On the one hand, it makes sense that we spend our time learning military skills and medicine, rather than learning how to march in perfect unison. On the other hand, when a number of soldiers (including several seemingly dyspraxic ones) march for the first time in their lives 24 hours before their graduation ceremony (pretty much the only time 99% of soldiers will ever actually march anywhere), it’s inevitable that the outcome will not be impressive.

With hundreds of guests lining the yard (including Deborah, my cousins Beryl, Pinchas and Dina, and Deborah’s auntie Paula), we took to the march, in time to a very nice recording of some generic military marching music presumably recorded some decades ago when the IDF still used military orchestras. In true Dad’s Army style, we set off – some on the left, some on the right – some hopping on one leg until they could figure out which one everyone else was using. Having received our new berets just a short time before the course (in my case about three minutes before – each battalion has its own colour scheme, and therefore each doctor had to arrange somehow for someone to deliver the appropriate uniform in time for the ceremony), most had their beret leaning to the right, one or two to the left. Some were completely devoid of rhythm finishing one step behind everyone else. But, it looked okay in the pictures, and ultimately, unison marching simply wasn’t the point of our course.

So, after some considerable time standing in the Israeli summer sun in full uniform, with a thick wool cap on my head, listening to various speeches and pep-talks about how great we all are, (why they didn’t just say dulce et decorum est, I do not know), we patronised the audience with some formation marching creating words like ‘Thanks’, ‘IDF’, ‘Medical Officer’, and finishing with a somewhat deformed Star of David, before throwing our berets in the air in cheesy American-college-graduation-style fashion.

With that, our course was complete, and Deborah and I departed on a week of compulsory holiday (where the army forces you to take leave at a moment convenient for them, so that you won’t ask to take it at a later date that doesn’t suit them entirely). In a remarkably small time, we managed to pack in a lot of fun – hiking in the Galilee, camping in the Golan Heights, white water rafting on the Hatzbani, eating in posh restaurants on the riverside, picking avocados on the roadside, swimming in the sea of Galillee and a bit of compulsory DIY in the few remaining days.

Up until a few days before the end of the course, none of us knew where we would be based for the next 14 months. Many of us wanted to head to infantry units, where we would be isolated, involved in the management of military operations, logistics, hygiene on base, wartime preparations, and once in a while a little bit of medicine. Many wanted an easy life where they could work 9-5 in a cushy clinic near mummy and daddy. Some wanted a nice in-between, and that is precisely what I went for and what I supposedly got. I was proud to be appointed the doctor of ‘Kfir’ training base, the home of one of the IDF’s anti-terrorism battalions, and as such, will spend the next year of my life with the hundreds of soldiers starting out on the course of a fighter.

Arriving to the base for the first time was in itself an experience. Based very, very deep in the West Bank, I was expecting a veritable fortress surrounded by enemy eyes – and was amazed to see that the reality was very different indeed. As my bus wound its way through the hills of the Judea, starting in Jerusalem and heading North East, I realised just how utterly desolate the West Bank is – with the exception of a few clusters of tents of the resident Bedouin population, still living without electricity (except the occasional generator), and a handful of green Israeli settlements, there really is nothing here. In fact, I’m writing this while on the bus home, and right now I’m stopped at an army base on a hill top – I can see miles in every direction, and there is simply nothing here. No roads, no infrastructure, no villages, nothing except barren yellow hills; just as the whole region was before the pioneers of the 19^th and 20^th centuries created Israel.

Eventually, we arrived at the base, surrounded on all sides by hills, with no sign of human habitation outside of the base except our over-ground water pipe, serving the base with 50 degree water throughout the day, and a suspiciously placed Bedouin tent-village, conveniently in easy reach of said water pipe.

By coincidence, my first day on the base, was also the first day of most of the new influx of recruits, who were arriving throughout the morning. As I entered the base, I saw a mix of excitement (in the 1% of the population who had dreamed of this day since childhood), and sheer panic and depression (among the 99% of the recruits who hadn’t yet left childhood). Hundreds of children in green uniform roamed the base before me, not knowing where they were meant to be, many away from home for the first time in their lives, some scared to use the toilets or drink the hot water, many on the verge of tears because the phone signal in our valley is too poor to check Facebook some of the time. As I tried to find my clinic, weaving through the kids, the excruciating heat bringing tears to my eyes, I realised that my placement may not be as straightforward as I had anticipated.

I had had some very noble plans for my arrival at the base. I even made a list of things to do and when.
- Face to face meeting with each medic – get to know them, explain my ideas for the efficient management of the clinic and hear their concerns
- Tour of the base – learn where things are, useful contacts, emergency protocols, evacuation routes
- Tour of the area – learn where our neighbours are, where our enemies are, what danger spots are present
- Meet the commander of the base and talk through my role
- Face to face meeting with the doctor from the sister base a few kilometres away (more on that in due course)
- Face to face meeting with the commander of each platoon to make introductions.

As the saying goes, the best laid schemes yada yada. Within 4 hours of my arrival, I had abandoned all hope of complete most of my goals, at least in the near future. Instead, I was sitting at a desk seeing my first patients, working with a computer program which would be infuriating at the best of times, even more so due to the fact that when we had had our training session on how to use this program, there had been a catastrophic failure of the entire computer network. Trying to differentiate between patients, I could categorise them into the following:

- Panic attack
- Fake panic attack
- Fake medical condition (doesn’t want to be here, ‘Motivation Zero’)
- Fake medical condition (wants to be here, mummy doesn’t want him to be here, instructed him to write ‘Rare Bowel Disorder’ on his medical declaration)
- Joint pain which bizarrely started after a 40km hike with a 30kg back pack
- Serious medical condition (that absolutely should not have made it to an elite fighting unit, but somehow managed to slip through a hole in the net big enough that a dead terrorist with one leg would get through)

Throughout each day, the timetable is fairly standard – I see routine cases in a supposedly organised fashion from 0830 until 1800. Of course, at the same time, I’m permanently on stand-by for emergencies; so many times have I been in the middle of dealing with a patient with, for example, diarrhoea, when the alert comes in for a suspected heat stroke. Everything stops, I run to the emergency room (which is literally that, not a big fancy department, but another little room in a little caravan, with a bed and a few drugs in it... and the obligatory rectal thermometer – both a diagnostic tool and a preventative measure against soldiers faking heat stroke – and we wait for the soldier to be carried in on a stretcher by another four soldiers who have just run across the baking desert to bring him to me. Many times have I wondered how many soldiers suffer from heat stroke as a result of running to bring in a soldier suffering from heat stroke.

Inevitably, every day, my clinics run late because of cases like this. So I’m lucky to finish my clinical day before 2000. Then of course, I start the paper work, blood result processing, letter writing, follow up of difficult cases, and so on – all in Hebrew, and all on a fantastically slow computer running an intricate and temperamental computer program. Needless to say, the emergencies carry on throughout the night and as I also cover the region’s roads (our ambulance is the only emergency vehicle permanently on standby in the region), there are plenty of urgent things to do. This week saw a lorry fall off the road, three scorpion stings (including two, yes two, to soldiers’ heads – learning to sleep in the desert isn’t instinctive), anaphylaxis after a hornet sting, and a school bus of children that had rolled over. The anaphylaxis and the school bus were in fact false alarms (because people are stupid), but nonetheless resulted in all the stress and panic of emergency situations until proven otherwise. So, all in all I’m lucky to work less than an 18 hour day.

As the weeks have passed, many of the most problematic soldiers have been excreted from the base, to my immense joy. The logic of keeping a soldier who doesn’t want to be here defies me – the odds of such a person developing into a champion of the battlefield are slim to nil, and through his 8 months as my patient, he is likely to return time and again with aches and pains, various complaints, requests for referrals – anything he can think of to get out of our baking-hot caravan park in the middle of nowhere. So slowly but surely, the work load seems to be slowing. Most nights are undisturbed, and having learned which of my medics are fantastic and which ones are utterly inept, I can now filter the ‘emergency’ phone calls at 3am, knowing when to trust the medic and run, or when to grill the medic with a list of questions to whittle down the diagnosis from ‘massive arterial haemorrhage’ to ‘cut finger on piece of paper’.

I’m not alone on the base, although it often feels like it. Technically, there are four ‘senior treaters’ between two big bases – one paramedic, and three doctors. Paramedics are a fairly new investment in the army – people (usually women) who are trained up to be fully qualified paramedics in a relatively short time, in exchange for selling their souls to the army (much like the apprentice doctors who learned medicine for free in exchange for working like a dog without a salary for the next several years). The paramedic is there as an emergency on call resource – either when there is more than one emergency simultaneously, or when I’m not around for another reason. The problem is she also covers the other base, and various training exercises in the region. So, it’s rare she’s actually here, and even rarer that I or my medics know she’s around – and therefore the work still falls on me. In addition there’s technically a second doctor here – the commander of the clinic – a women who outranks me and can order me around, and who is leaving in 2 months. As a result, she seems to treat a remarkably small number of people, doesn’t split up the ‘days off’ evenly between us, but like most bosses, seems willing to take credit for anything good that happens under her authority. The big question is who will come to replace her? A good hard-working doctor who believes that work should be split evenly would effectively half my workload, but only time will tell.

Of course, the hardest aspect of the entire experience is the lack of time I get to spend with Deborah, who continues with her editing work. It’s a great job in terms of its flexibility (working from home and choosing her own hours and to an extent the amount of work she takes on), but results in day after day home alone. Soon, Debs will start working as a pharmacist in Shaarei Tzedek, one of the best hospitals in the country, and so we are both looking forward to her getting back into her vocation. But in the meantime, she continues to write and edit Q&As on obscure medical topics, such as ‘What is the best type of shoe for someone with Crohn’s disease to wear’ or ‘How many times a day should someone with eczema need to take a pee’. The work is divided up among a few editors in Israel, supervised by a regional manager, and super-supervised by a big-wig manager in the USA. At the same time, another office in the Far East does similar work for far less money, but with far more heinous errors in the English. So a stressful competition has developed between the two centres, each trying to achieve better results in less time and with no guarantees of long-term job security. As far as I’m concerned, Debs should sit back and enjoy the ride, in the knowledge that she has a pharmacy job just around corner (covering maternity leave for someone who should be due to pop in a few weeks), but being the good conscientious worker that she is, and keeping in mind the possibility that she may work two simultaneous jobs (neither being full time), she’s getting sufficiently stressed to keep our blood pressures up.

As my only time to write the blog is now during bus journeys, I must sign off now – no more battery. But there’s a lot more to tell – hopefully in the next installment...

M*A*S*H

It was tough. Possibly the toughest thing I’ve done. 4 months of:

- 18 hour days – waking up at 6am to clean the toilets that had been made revolting by other courses (most of the doctors on the course are sufficiently OCD to ensure that the toilets remained more or less a uniform colour)

- Mind-numbing lectures, entirely in Hebrew – for example, our two-day course on occupational medicine, learning all about how to distinguish chromium poisoning from cobalt poisoning, just in case someone decides to start mining underneath the base and storing heavy metals in their bedroom.

- Atrocious food - really, atrocious - I’m not a fussy eater, but somehow they managed to make even the humble cucumber revolting by either leaving in the sun too long, preserving it in what I can only assume was formaldehyde, or drowning it in garlic salt). Want a boiled egg? No problem. But it came from a chicken who probably died in 2008, and has since been gamma irradiated and stored in an airtight jar in a hot warehouse. If the odd bitter taste and slight black colour of the yoke doesn’t put you off, the botulism will. Don’t get me started on the scrambled egg (from egg powder) or the shakshuka (from egg powder)... or the soup (from soup powder), the potato mash (from potato powder) or the salad (from salad powder... probably).

- Commanders who did their best but were ultimately little kids on power trips. Some of them were great – the overall boss was a doctor whose experience justified his role. But most were age 21 or so, just about managing to grow some stubble, and lacked a hint of common sense. Like the time I was reprimanded for checking my gun was safe and unloaded before returning it to the warehouse (as is obligatory), because I hadn’t been ordered to, and because the commander (and everyone else) had forgotten about it.

- Exams – exam to assess trauma care = fair enough. Exam to assess communication skills = fair enough. Exam to assess ability to deploy a field hospital = fair enough. Exam to assess the differences between different types of helicopter = borderline. Exam to assess the understanding of legal obligations of the state and army after a soldier is exposed to a trace of asbestos = pushing it. Exam to assess details of what to do in the event that our field hospital is attacked by various methods = scary. Week in, week out, exams. Some logical, some medical, some based on out-of-date 200 page books about the old army structure, which we must still be examined on because no-one has been bothered to make an updated version with the correct information in it. So I know all about the central care clinics of the old days, but as they don’t exist anymore, no one has checked if I know how it’ll work in the next war.

- Life in the field. The big field exercise is a blog entry in itself. So much to say... see below.

- Army mentality. It would be unfair to say that the army was more ridiculous and irrational than every other organisation and company in Israel. It isn’t; it’s just that the army is so big, all of that ridiculousness is confounded. For example, not long ago I required a new felt tip board marker during a classroom exercise; having discovered that such a valuable commodity was not kept in supply in the classroom cupboard, I went over to the logistics department to get another one. After a 5 minute debate, I left empty handed; unless I could return the empty old one (to prove I did indeed need it for classroom activity), I would only get a new one if I had attained the rank of lieutenant or higher. In addition, here are the three golden rules of the army that apply at all times.

- The law of time

It’s reasonable that punctuality is important both to ensure efficiency, and discipline. But what happens if one completes the task early? This is something that we experienced many times; an exercise that finished early, a lecture that finished early, or even a lecturer that failed to turn up. Logic would suggest that we use the extra time to work on a different project, or move some other activity forward to allow us to finish our day earlier and get more sleep... or even go home! But the law of time suggests otherwise. It dictates that if something is due to start at 1700, it must not start earlier, as this would not comply with the law of time. If our day is due to finish at 2215, it must not finish at 2200 – as this would severely impact on the reliability of the law of time... it could have vast and never-ending consequences on...er... the law of time. Thus, the self-fulfilling prophecy of punctuality and subsequent wasted hours continues.

- Wet is clean

It’s very difficult to clean a floor that hasn’t been scrubbed in years. Grime, caked on mud (and probably excrement), and a bad paint job that means most of the floor is cheap army paint anyway, preclude any possibility of truly making the toilets feel like the risk of catching a significant disease is low. Inspections of cleaning are made immediately after the allotted cleaning time is over (needless to say, if one finished early, the law of time is activated, and one will automatically reclean the same area, to avoid the risk of being sent off to clean some other, more filthy area, until time runs out). So how can a commander know if the room has been cleaned? Simple! It would be wet! Therefore, a bucket of Israel’s precious water, flung over a toilet and the surrounding floor, and haphazardly cleared away, is sufficient to pass the commander’s inspection. Heaven forbid you wet it too early, allowing drying time, or much worse, make the effort to squeegee away all the water... as clearly, the room would therefore be dirty again.

- Being confused with police

During officers’ training, all soldiers wear blue lapel tags on their shirts. Symbolically, this represents the real officers’ lapel markings, supposedly hidden beneath, which are then exposed when the blue is ripped off by the course commander during graduation. Unfortunately, this means officers sometimes get confused with military police, the useless vermin who spend their lives giving soldiers fines for having scuffed shoes or a wonkey badge. Army doctor = loved. Soldier in officers’ training = loved. Military Police = Hated. Quite amusing to see how many people seemed to glare until they discovered I wasn’t looking to give them a ticket. (We were told a rather amusing story of a military police officer who was assaulted some years back, when he tried to give a soldier a fine for having muddy shoes. The soldier had just returned home from the immense stress of the Lebanon war, sleep deprived and physically drained; when he was stopped by the officer, he snapped. Good for him!)

Life in the field

Part of the course involves a week of very high-level strategy training. In conjunction with other courses – such as the commanders’ course, we took part in a full-scale war simulation, where Israel had (once again) been attacked by Syria. Needless to say, I’m not exactly going to publish on the net details of who, what, how, why, where... or in fact anything else that bears any military significance (although Syria probably know all that anyway), but I do want to tell you about...er...being close to nature.

After days of preparation, planning, meetings, maps, logistics and so on, I joined a unit as their medical officer as Israel went to battle. It all started in the middle of the night, with a nice sleep out in the cold night air, underneath the stars, hoping that the scorpions weren’t feeling too pissed off and that the hypothermia would ease off when we started our moonlit hike with heavy backpacks and M16 assault rifles. It was a long trek towards a virtual enemy, through swamps, razor wire, mosquito hotspots and the small but nonetheless significant risk of taking a wrong turning and entering a minefield. We had approximately six hours to reach our destination before sunrise.

A few miles into the hike, something rather unfortunate happened. My stomach gurgled. In itself, that wasn’t such a problem. But it happened to be the battle horn of Operation ‘Adam ate something that wasn’t prepared in sanitary conditions’. After 30 minutes, my stomach was so bloated that not only had I opened my belt, but also all the buttons on my trousers, and was eyeing every tree we passed for a suitable place to...er... deploy my troops. But responsible for hundreds of soldiers, on a tight deadline which influenced the entire mission, there was no way to stop, and no way to leave the group. Onwards we trod, through the night, no end in sight and no time for a break.

A couple of hours later, luck dealt me a good hand while dealing someone else a harsh one. A vehicle in another unit overturned, leaving several injuries and resulting in a halt to the mission. We buried ourselves in the grass, silenced the radios and waited for an indefinite period, while one of my colleagues dealt with a compound fracture and arranged evacuation of the injured. My chance had arrived!

I snuck away from the group, holding my cramping stomach in one hand and a first aid kit in the other (gauze being the only option available to me...) while climbing over the rocks and tall grass to the ruins of an old building 50 metres away. It was the perfect location – open to the elements from above, but surrounded on all sides by the remnants of a wall, currently at shoulder height, offering sufficient privacy without the risk of walking into a rats den. I found my spot, began to prepare, when suddenly...

“Freeze! Identify yourself!”

Yes, of all the places, in the dozens of square miles of wilderness in which we roamed, I had chosen a spot around 5 metres away from a covert spying unit, complete with night vision, just on the other side of the low wall. Did I care? No I did not.

Some time later, feeling much happier, and lighter, we continued on our way into battle, complete with the boyish fun of real tank fire, live bullets, and helicopter evacuations of my virtual patients.

So, here I stand at the end of the course. I have been placed in a base in the middle of the wilderness between Shechem (Nablus) and the Jordan Valley, where I will spend the vast majority of the next year of my life. More to follow soon...