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 Some logical, some medical, some based on out-of-date 200 page books about the old army structure, which we must still be examined on because no-one has been bothered to make an updated version with the correct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...

It’s medicine, captain, but not as we know it

Just over a month ago, I reached the end of tironut, or basic training. It had been a few weeks of not-so-intensive learning, nearly edible food, and teenagers dressed in khakis carrying M16 assault rifles around. We had lectures such as ‘why are drugs bad for you’, and ‘sexual assault: naughty naughty’, and we came to terms with the arduous task of cleaning up the squalor of the animals who share our base. We ended with a passing-out ceremony which, due to the size of our platoon (6 people), felt more like an intimate meeting with the boss than a pledge of allegiance to the state.

The next week, we moved on to the juicy stuff – starting with ATLS (Advanced Trauma Life Support) course – a world-wide programme run to a set syllabus, taught in the lovely fluffy western ‘criticism sandwich’ style, with phrases like ‘you did that procedure very well, but next time try to put the needle in his chest, not his eyeball...but otherwise it was very good’, or ‘I liked the way you intubated the patient, but traditionally we tend to only do that when the head is still attached to the body. Although your approach is still very valid’.

Gradually, we moved on to the Israeli adaptations – specifically, MTLS (Military Trauma Life Support) – essentially the same idea, but geared more to the realities of military medicine. Suddenly, the scenarios we faced changed from a driver who fell asleep at the wheel to a platoon of soldiers who had been ambushed and were spread over a wide area, with a combination of gunshot wounds, blast injuries and external bleeding... while taking into account the possibility that a Palestinian terrorist is still looking at you down the barrel of a gun. The pressure thus increased tenfold, and the learning curve began to steepen.

After one week of super-intensive trauma learning, we began “carap sadir”, the acronym meaning “Regular Medical Officers’ course”, the course that will occupy my time between now and the summer, with an array of different things to cover. Of course, there’s been (and will be) plenty more trauma learning, but at the same time, there’s a lot more medicine to learn too – how to write sick notes, how to prescribe paracetamol to a soldier pretending to have a headache, and how to tell the difference between a haemorrhage and ketchup. But besides from the medicine, seriously, there is an insurmountable amount of additional knowledge to take in. Ultimately, the role of a combat doctor is extremely broad. Aside from treating the injured people (on both sides, incidentally), we also play a large part in deciding evacuation routes, locations of field hospitals, helipads and safepoints, as well as all the training of medics and first aiders, public health and vaccinations... we’re even responsible for testing the water each day (after a tactic in recent years of poisoning soldiers with arsenic). So, in addition to learning how to deploy a medical unit, how to stock and maintain an armoured personnel carrier, and how to triage a mass casualty event, we are undergoing training in navigation, topography, communication and all sorts of other things which I unfortunately can’t elaborate on. Which is a real pity, because it’d make the blog extremely interesting.

The biggest issue is without question the language. Having coped pretty well for over half a year working in Hebrew, I didn’t expect the army to be that much tougher than I was used to already. But, as it happens, the army doesn’t speak Hebrew... it speaks Army Hebrew, which is worthy of a whole dictionary to itself. The number of abbreviations in daily use is just incredible. Unfortunately, I can’t give specific examples on t’interweb, but I’ll attempt to create the atmosphere through English. I’m not a doctor. I’m a Umo (Unit medical officer), and I don’t work in a clinic, I work in an Ugs (Unit gathering station). One of my jobs as a Umo is to maintain the Fog (forward observation group) which, if in one place for some time, is known as a Fos (Fog static). My CM (chief medic) is responsible for maintaining the mass (medical supplies). My boss, the Imo (Important medical officer) answers to the Chmo (Chief medical officer), who is the boss of Mad (medical division). So, if there are any problems with the fos – let’s say that the fog needs some more mass but the CM is a lazy AH, and so it isn’t fit to be classed as a fos at all, then the umo should probably speak to the chmo, via the imo, assuming that when the umo sat with the cm, no good outcome was achieved.

NOW, imagine all that, in a foreign language, for 18 hours a day. It’s not easy. Especially when you then need to learn radio codewords for the different roles.

So, if there are any problems with the apple – let’s say that the window needs some more banana but the tissue is a lazy AH, and so it isn’t fit to be classed as a window at all, then the bottle should probably speak to the flute, via the cello, assuming that when the bottle sat with the tissue, no good outcome was achieved.

The group itself is a mixture of native Israelis and immigrants – the Israelis are all scholars – in other words, fresh out of their internship year, wet behind the ears, and setting out at the beginning of a 5 year military service (in exchange for the army funding their degrees). Most importantly, we get to come home almost every weekend, and even one evening during the week, provided we’re happy to get up at 0430 to get back to base in time. This is a significant improvement on the original terms of service, whereby I can expect to come home for two weekends a month (although this could still be the case after the course), but on the other hand, this is the first time this course has been run residentially, rather than a cushy home-each-night format. Slightly irritating when I could have been on the last course if the army had been a little bit more efficient, but at the same time, I’m glad to be with a fab group of people, and the extra half year has certainly helped my language skills.

So, what about outside of the army? Deborah continues to work from home, while tentatively starting the search for pharmacy work to get a foot in the door. Much as we hate the separation while I’m in the army, it makes the days we have together much more special (provided I’m not studying for exams, or writing a blog). But, we have some very exciting news... no, she’s not pregnant.

Last week, we signed the contract to buy our apartment! Before anything else, it’s important to stress that things work backwards here. First you sign the contract and pay a deposit. Then you get the mortgage bank to pay off the previous owner’s mortgage, and only then do we obtain possession of the apartment. So, the show isn’t over yet. But here’s the story so far...

Back in December, we were leaving our apartment to head back to the UK, when our neighbour stopped us on the stairs.

“Is your landlord selling your apartment?” asked the sweet Russian lady. “Er... not that we know of. Why?” replied the suitcase-laden British couple. “Because I just found an advert for it online”.

We called him straight away, and were reassured when he told us it was clearly a mix up, and he had no intention of selling. But, to be sure, when we got to the airport and logged on to the net, we found our apartment, with full description, and our landlord’s contact details.

To cut a long story short, he maintained the lie throughout, constantly reassuring us, and explaining that he was trying to sell his car, and the website made him put up an additional advert, so he used our apartment just for the sake of it. Sounds perfectly reasonable to me... So we asked an Israeli friend to call and enquire as an interested buyer, and the apartment was very much for sale, and apparently available immediately from the end of our lease.

Ultimately we decided to jump in at the deep end – and somehow we obtained mortgage approval, and when we told him we had a budget, suddenly his attitude changed.

“Well, I don’t want to sell it, but I’d like to help you and Deborah get settled here, so I suppose I’d sell it to you, as a favour... but don’t tell anyone else because it isn’t really on the market”.

5 months of playing his little game later, and we have signed the contracts for our first ever non-rented home. And the best bit: if all goes to plan, we won’t have to move, and we already know we love the place.

So, as we start to come to terms with our new obligation (a hefty mortgage payment each month), it just remains for me to wish you Yom Haatzmaut sameach (Happy Independence Day) – Israel is 63 years old this evening, and it is to that I owe the pleasure of a day off from the army. Israel precedes its independence day with the annual memorial day for its fallen soldiers – the dark before the dawn, as it were. As I stood among a thousand soldiers this afternoon for a minute’s silence in honour of the 25,310 Israelis who have fallen in battle and terrorism in the past 63 years, and then moved on to sing Hatikva (The national anthem), it once again sunk in that Deborah and I are living in a dream. Moreso in my current role than ever, we can make a difference. We can save human life, show compassion, and fight for something we believe in. The dream may be a tough one, more like a nightmare at times, but thank G-d things are moving forward, both in our own personal life, and as a nation, and we can’t take that for granted.

I leave you with this link; an interesting short blurb in honour of this little country’s birthday.

http://www.janglo.net/index.php?option=com_adsmanager&page=display&catid=99&tid=145876&utm_source=MadMimi&utm_medium=email&utm_content=Janglo%3A+Independence+and+Greatness&utm_campaign=Janglo%3A+Independence+and+Greatness&utm_term=See+Janglo_27s+full+article+in+honor+of+Yom+Haatzmaut

One month in – life in the IDF

Today marks the one month anniversary of the day I put on my uniform for the first time and stopped being a civilian. I'm sure my last post, just a short time before I said goodbye to Deborah and headed off to a complete unknown, expressed the fear and anxiety we were both feeling; I felt as though we were facing a giant grey wall, no idea what would be on the other side, where life would head, what would happen. A mix of excitement at reaching a stage I had been anticipating for years, and doubt caused by the myriad of stories and experiences our friends and the media prepared us for. From the pointless menial tasks (like sweeping a sandy floor before stacking sandbags on it), to the gruelling physical exercise, to the appalling food, the overall impression given to us was hardly a positive one. In addition, I was, on some level, distracted by doubts about the ethics of being in the army. Pro-Israel activists always stand by the army in every way; whenever there is a civilian casualty or death, they can always provide some justification or explanation, while on the other hand, the Anti-Israel activists will always lambast the IDF and everything associated with it – such as the UN report condemning Israel and Hamas jointly for war crimes during Operation Cast Lead in Gaza. It so happens that just this week, the writer of the UN report has retracted his condemnation (http://www.bbc.co.uk/news/world-middle-east-12949016), but for the past year, many people including myself, have wondered to ourselves, "Is this really bias against Israel, or is the IDF really committing atrocities?". In short, entering the army and seeing the truth, with my own eyes, without doubt about misinformation, could make me prouder than ever to be part of this country, or could shake me to my core.

My Tzav Hityatzvut, or call-up order, was for March 8^th 2011. The letter told me a place, a time, and various things to bring, like running gear, while also requesting that I shave my head, bring a bank card, and take note of what the army would provide me with, so I can fill in the gaps (we get socks, but not underwear; they provide T shirts, but only two of them, which is hardly enough for living on base a week at a time). So, before 6am, Deborah and I set off for my 7am arrival at Givat Hatachmoshet. We were among the first arrivals, but it soon became apparent that I was the only guy – of the hundreds of people attending the centre that day to be shipped off to Bakum (see below), the average age was 19, and every single person was a girl. We were slowly processed, and I was pleased to find a single other male, who also appeared to be significantly older than the rest of the group. As it later turned out, we were the two Jerusalem doctors being drafted that day; the other guy, Ilia from Georgia, has ever since been a roommate (and I will fill in those stories as the blog progresses).

One long coach journey later, we arrived at Bakum, a massive army centre where every new recruit passes along a factory production line going through various tests and interviews, such as dental photos and X rays, DNA testing, vaccinations, financial interviews, finger and hand print recording, and basically every other imaginable test available in order to identify/incriminate us in case of need. We were assigned our uniform, including rigidly uncomfortable boots and unhemmed trousers (the secret is to use an elastic band at the bottom of each leg and tuck the end of the trousers in; so they will always be the correct length). Gradually, more and more older-looking men gravitated together, and by the end of the day, a small group of 6 immigrant doctors had formed, from UK, US, Australia, Russia, Georgia, and Ukraine. We were piled on to a bus with various other soldiers heading off to their various destinations, and eventually arrived at our new home; the headquarters of training for the medical corps. Straight off the bus, we were greeted by the commanders of our basic training.

Basic training in the IDF is a very broad term, covering everything from intensive courses lasting several months, with gruelling hikes and complex training at one end, and our basic training at the other. Consisting of a few weeks of mild-mannered lectures, teaching us that drugs are bad, sexual assault is bad, Syria is bad, and army food is good, combined with a few Dad's army style runs and push-up sessions, I didn't exactly find the training to be one of the most challenging eras of my life. But, the decision to give us a gentle intro was a conscious one, based on the relative old-age of our group (24 - 32 years old). However, there is one common feature throughout all basic training in the IDF. Distance.

Distance is the phrase used to describe the act of separation between the cadets and their commanders. It dictates that commanders are always treated with respect, are never referred to by name, and must always be addressed with 'yes commander', 'no commander' or 'three bags full commander'. They are never allowed to joke with us or smile, and can never chat informally with us, until the end of basic training, and the 'breaking of distance'. Sounds reasonable? It would be, except that our commanders were all 19 year old girls. They were, in fairness, very good at their jobs, knowledgeable and confident, and seemingly undaunted by the fact that they were disciplining people who weren't far off twice their age. Most of them were actually very sensible with their approach towards us, in essence explaining to us early on that they know we aren't 18 year old Israeli brats who need a kick us the arse to learn a little discipline, but mature adults who have clearly already learned how to work hard and who have some level of knowledge regarding Israeli culture, given that we have graduated, survived on-calls, and chosen to move to a foreign country. But, predictably, there were also those who played their role to the letter. The most significant example of this was during a lecture off-base. Having finished two hours in a lecture room, we were ordered to make our way to the waiting bus for the hour-long journey home. Using our grown-up initiative, we decided that a quick visit to the bathroom en-route would be prudent, and arrived at the bus ready to go, perhaps 90 seconds later than they estimated. We were reprimanded and told that it was not our place to decide when to go to the bathroom. We should have reported to the bus, waited for our commander, requested approval to go to the bathroom, then, assuming approval would have been granted, headed back into the building, battling against the crowds of people leaving the lecture, to head back upstairs, to the now-fully-occupied toilets. The conclusion – basic training is simply not the place for independent thought or common sense.

After 3 weeks of such discipline, combined with exams checking that we knew which ends of our M16's to look down, we graduated from basic training. This normally very powerful ceremony, where we pledge our allegiance to the state and to the armed forces, to uphold democracy and the values of the IDF, is overseen by a high-ranking commander and normally takes place under the Israeli flag, attended by hundreds of soldiers, family and friends. But when your basic training is so specific as to cater only for new immigrant doctors, the power of hearing dozens of voices reciting the pledge of allegiance is replaced by the humour of hearing a tiny group of people each reciting the pledge in their own foreign accent twangs.

After the ceremony came the all-important breaking-of-distance moment, where our commanders suddenly become our friends, smile and chat, and flirt. That'd be great if we were the usual 18 year old guys passing out, but for most of us, the commanders simply metamorphosed from kids dressed up as commanders, to just... kids.

Six old men, six olim, six doctors, from six different countries, ready to move on once more, but this time with a greater understanding of the massive, sluggish, irrational machine that is the IDF.

Basic training has not been the most challenging time of my life; in fact it's felt like a nice, gentle introductory tour of the army, letting us get a taste of the things to come. It's completely eradicated some of the major fears that come with army service (although, of course, not all), and even after a month, seeing myself in uniform, wearing the tags of the medical corps, gives me a strong surge of pride. I am truly starting on a path that will make me an Israeli, and give me a chance to contribute to a cause I really believe in,

This time, I'm not heading into the unknown quite so much. Just moving forward.

The end of life as we know it

Time doesn't ever seem to get any slower, and it's truly scary to realise just how much time I've let slip since my last blog update. Each day flies by, even the ones where I look back and ask myself 'What did I achieve today', and don't answer because I know the reply will make me more frustrated.

Little wonder then, that the blog has fallen behind. In truth, there's a lot to tell, although I'm not sure how much is blog-worthy; but as the ultimate intention of writing the blog was not to make a sensational novel, rather to make a record of the trials and tribulations of aliyah, both for ourselves, and for those who may one day follow in our footsteps, I suppose I'll endeavour to plod on.

I'm writing this on a plane, on the way back to Israel after an impromptu visit to the UK for the unexpected funeral of my uncle Leon z"l. I truly stand at a turning point in life, and the emotions and feelings that course through me are profound. In five days' time, I will commence my 18 months of service in the Israel Defence Force.

This is a moment I have dreamed of for a decade; to be part of something I believe in; to live and work and fight for something bigger and greater than me or my future; to contribute to freedom, democracy and Zionism. To feel part of the pioneers who re-created the Jewish state; to protect my people and proudly proclaim 'Never Again'. For ten years, I have seen pictures, heard testimonies, read stories of life in the army, and I wouldn't let anything stand in the way of that.

Gradually, reality can creep up on you. I was under no illusions of the difficulties of life in Israel or the army, and I knew what I was letting myself in for. But what neither I nor Deborah anticipated is that our goodwill and devotion to our country may not necessarily be reciprocated, or at least may not be clearly shown.

It's several months since I turned up for my first meeting with the army - back in about November I was called into the recruitment office in Jerusalem, where a very friendly and polite child (well, perhaps 18) interviewed me on every aspect of my life, from my religious views, to my hobbies, to my kindergarten, before sending me on for a physical where a large Russian lady criticised my hairy naevi, and finally on to a psychometric exam where I had to match up the funny shapes. Some weeks later, I was summoned to the medical corps HQ near Tel Aviv; the 3 hour journey each way for a ten minute meeting in which I was told very little was somewhat frustrating, but at least I found out that I would start army service in April, giving me a chance to notify work, family and friends, and create a plan for the next few years of my life; that said, I was advised to call 2 days later to get the exact date.

2 months later, much nagging, and wasted phone calls, I was still not informed of a start date; with just 12 weeks until Passover (one of the main Jewish festivals, this year in late April), and various friends and family planning to visit, it became clear that I should cut my losses, and assume for the worst - so all flights and holidays were booked up until the end of March, just to play it safe.

When I was resummoned to the base, with a few days notice in late January, I finally got some info; a salary, details of the appalling terms of my annual leave and home leave, and a start date of March the 8th, because the stupid woman who coordinates all army doctors forgot that there was a special doctors course I needed to do first, before the normal call up date. Without apology, regret for the inconvenience and waste of money to my friends and family due to be visiting in March, I was informed that this was unchangeable. In addition, I was advised that I can expect to see Deborah every other weekend, and one evening a week for the week I don't get home at the weekend, assuming I'm close enough to Jerusalem to get home in time. Oh, and that I'm entitled to 15 days of leave each year.

In one day, it became clear to me how much life had changed; all the decisions and plans I had made before marrying Deborah, which were panning out beautifully, were no longer what I wanted in life. Feeling for the first time like a machine owned by the army, with no consideration for my personal life, let alone that of my wife, I was drained and powerless. The goodwill on my side, to do my bit for the country, was irrelevant, because at the end of the day, one still approaches the army with the resentment and anger of someone forced into compulsory service, unsure of what the future holds, hearing horror stories from ex-soldiers of hygiene, food, corruption and battle.

And for what? It's a rhetorical question, as I know precisely what it's all about. But why me, and why now? As my friends around us become more established, pop out babies left, right and centre (though mainly centre), do we have the patience to put life on hold for all this extra time?

Gradually, I have accepted what lies before me, and perhaps some of the excitement has come back. I'm sure that I will become a stronger person through the experiences ahead, and perhaps a stronger doctor, too. Deborah will be looked after by our friends around us, and I expect that 18 months will fly by if I'm kept busy. The next time I write a blog entry, I'll be a solider.

If the law in an ass, the police must be law holes

Two police experiences over the past 12 months.

I like to consider myself a law-abiding citizen. I have, from time to time, be known to speed; once I think I reached 82mph on a motorway, before I realised and promptly reduced my speed to the much more legal 77mph (allowing the 10% margin for error on the police radar speed traps). As I routinely get overtaken by BMWs doing 120mph, and watch numerous women in 4x4s chatting on their iPhones while smoking and applying lipstick, while simultaneously breastfeeding their children, I feel this must put me at least above average when it comes to citizen obedience. And, to be honest, I kind of like being a good boy. It’s nice to think that you aren’t doing anything to risk the safety or convenience of those around you, and it’s even nicer to think that you can sneer at those people who ruin this world for the rest of us, by not adhering to the laws we are all meant to live by. How unfortunate then, that the Israeli police force have reduced me to a common criminal.

Israel seems to think that America is right. About everything. Ever. Need to increase efficiency in the educational system? Send a delegation to New York to look at how they deal with inner city school kids (because New York is known for its obedient school kids and calm atmosphere). Worried about the 2% increase in costs of maintaining the socialised health care system, one of the best in the world? Bring over some US health care consultants, who manage the most overpriced and inefficient health care system in the world. Need to make some stupid laws that have absolutely no relevance, logic, or application in real life? Take a US highway code and translate it into Hebrew.

Deborah and I were on our way to dinner. It was just after our Hebrew course exam, and we decided that we would celebrate. We got off our first bus, walked to the pedestrian crossing, and waited. Being so well planned, there is no button to press to declare that you are waiting. There are no sensors monitoring the flow of cars so that the lights will change when no cars are coming. But, the government have to spend our money on something, so they employ two pigs to sit in a car on a dark side-road, watching and waiting, ready to pounce on any unsuspecting victims. People like us, who lose patience while standing for minutes at a time, watching as no cars come or go in any direction. People who see their bus pull in and pull out of the bus stop, while they remain stood on the spot, all because the stupid arse of a little man is quite happy being red, and has no intention of turning green at any time soon. In fact, he won’t turn green until the traffic light turns red. And the traffic light, as we all know, will only turn red when he sees that a dozen cars are on the way, all waiting to get through.

So, we look, and we wait. We look again. No cars. Anywhere. We cross. And immediately are confronted by a particularly small girl, dressed all grown up in a police uniform, just like a real person, who gleefully gives us both jay walking tickets.

But that isn’t the worst of it. That’s just the beginning.

My parents came over to visit recently. We had a fantastic schedule all sorted out for their visit, the highlight of which was taking them up North to see the beautiful countryside, places we might want to move to after Jerusalem, and best of all, to take my dad to a vegetarian village in the middle of nowhere, with lots of cats. (Basically dad’s Garden of Eden).

Keen to spend more of our tax money on pointless endeavours, we were pulled over at midnight in the middle of the countryside by a particularly small girl, dressed all grown up in a police uniform, like a real person (sound familiar?), for a routine check. No problem, you smile, you give over your license, and half a minute later, you carry on your journey. Not this time.

I handed over my UK license, but made the mistake of speaking in good Hebrew. As a result, I received an interrogation about when I came to live in Israel – nine months earlier at this point. After disappearing off with my documents for a while, she returned, smile on face, and said, “Adam, you’re driving illegally. Step out of the car”.

According to the little brat, a foreign license can only be used for 6 months after moving to Israel. I told her that was incorrect, and in fact it is valid for 12 months. I quoted pretty much every aliyah organisation that gives information on these matters, and even checked some online at that point to show her – the Jewish Agency for Israel, the United Jewish Israel Appeal, Nefesh B’Nefesh, the Association of Americans and Canadians in Israel, and numerous blogs and advice websites, all state that the license is valid for one year. She checked with her boss, however, and confirmed that in fact, all these organisations were giving out wrong information. I should print out and keep all the documentation from these websites, because I would need it 6 months later when I attended for my COURT SUMMONS.

When I explained this to mum and dad, I almost had to physically restrain my parents who were about to assault a very obnoxious little girl, but while I was doing so, at midnight, Deborah called our driving instructor. He was very helpful, and got out of bed to check the website of the Ministry of Transport....

We all breathed a collective sigh of relief when he confirmed that, clear as day, the Ministry of Transport website states that ‘New Immigrants may drive on a foreign passport for up to 12 months from entry into the country.’.

Time for an apology from the police woman, and to be sent on our way? No.

“I don’t care what the Ministry of Transport says. We are the police, and we go by police law, it's different”. Those words actually came out of her mouth.

So, to cut a long story short, we persuaded her not to impound the hire car that was registered in my dad’s name, and she changed my police appearance that she'd originally set for 48 hours time on the other side of the country, to the next morning, down the road. This gave me just enough time to print out information from the ministry of transport, and www.gov.il, stating that I was in fact driving legally, and that she was simply an idiot.

The bottom line, the next morning all was resolved, the court summons was cancelled (supposedly, although in fact they forgot to do this until I called a few weeks later to check), and she got woken up by the captain for a proper yelling. But, even then, the police failed to do their job – I was informed I must give in all the tickets and documentation to the station, thus removing any proof that the incident ever occurred, and hence stopping me making a complaint against them.

“I’d like to keep copies for reference, until I know that everything has been cancelled. Could I make photocopies?” I asked.

“No, the machine is broken.” Replied the commander.

“What about the fax machine that you just received my passport page on?”

“No, that doesn't copy. And anyway, isn’t my word good enough for you?”

No, Mr Policeman, your word means nothing.

Getting a little perspective; the cultural divide in medicine

When I write a blog entry, I try hard to capture the essence of the emotion of the experiences of what we’re going through at the time. That isn’t easy, and it’s all the more difficult when writing about events that happened weeks, or even months, earlier. After my last blog entry, several people emailed and called to effectively share their condolences at the difficult time we were going through. Grateful as we are for the concern, perhaps my blog painted a harsher picture than reality. The human psyche is afflicted with what they call ‘loss aversion’, whereby our instinct is to recall the negative aspects of life, and ignore the good stuff. The perfect example is when stuck in traffic on a motorway; you always notice when the lane next to you is advancing while yours is static, but it’s only when you realise the same car has overtaken you three times, that actually your lane is moving just as quickly, just at different moments.

So, I think that the negativity of the blog was for two reasons – one was loss aversion – the sudden awareness of what we are missing. But the second – simply that I didn’t want to ruin the build up to the progress in our lives... In honesty, while I was writing about the difficulty finding work and our financial situation, I had already started work; while talking about the two weeks of cleaning our new home before we left it again, we were already back, settled and living.

Shortly after our return from the UK, Deborah and I both passed the so-called ‘entrance exam’ to medical ulpan – a special course for new immigrants to learn the specific parts of the language required for working in our field. The general rules for attending are:

1. Must have moved to Israel in the last ten years

2. Must be a doctor or similar medical professional

3. Must have a good knowledge of Hebrew prior to starting the course

4. Must commit to 5 hours of lessons every morning, 5 days a week, for 3 months.

One would imagine a group of medics from all over the world, keen to learn the necessary vocab in order to start work here and manage to not kill people due to confusion between anatomical and medical terms. All sounds pretty straightforward, no? No.

In order to run the course, the government require a minimum of ten people. Due to the fabulous organisational skills and publicity of governmental bodies here, no one seemed to know of the course's existence, except those who really shouldn’t have been there.

At the entrance exam, for example, we met a RETIRED pharmacist and his daughter, about to undertake a computer management course at the age of 19, neither of whom could count to ten in Hebrew. Although they were accepted on to the course, they had the good sense to turn it down and await something which might actually benefit them in some way. Knowing the phrases ‘gastric banding surgery’, ‘duodenum’, ‘anal fissure’, ‘Fragile X Syndrome’, ‘Oedipus complex’ and ‘porcupine’ (no idea why that last one features in our vocabulary list. But it does), is generally-speaking less important for the average Israeli immigrant layperson than ‘house’, ‘food’, or ‘Do you speak English?’. I remember being given a book of alternative useful phrases for the world traveller, many years ago, which included in six languages the phrase, ‘Excuse me, I am bleeding profusely. May I please use your belt as a tourniquet?’. Again, not one of the most commonly used phrases, but important in certain circumstances nonetheless.

So, as the lesson stands now, we consist of:

• A general physician (which is the non-demeaning way to say unspecialised good-for-nothing; me)
• An unlicensed pharmacist (Debs)
• An unlicensed gastroenterologist approaching retirement
• An unlicensed cardiologist approaching retirement
• A psychologist
• 2 dentists
• A retired French fireman
• A sports management consultant
• A Maldovan health care assistant, who frankly, produces enough hilarious moments in our lives that she deserves her own blog
• A physiotherapist

Making a total number of 11 – just enough to run a course; which is why they lowered the ability level to... well, nothing. So instead of a dynamic group of medics learning about trauma terms and drug names, we whittle away many an hour with our psychology-obsessed teacher talking about the origins of the Oedipus complex (I know I’ve mentioned it twice – it comes up at least 3 times each week in class and therefore deserves several mentions), why men never ever ever become anorexic (apparently), why gay men look after themselves better (apparently), why fibromyalgia really exists (apparently) and how glucosamine can help, and finally, what the origins of the Oedipus complex are.

The rate of learning is rapid – we cover hundreds of words every week, and the vast majority are very useful, either in medicine or in the general world; if not learning the phrase for ‘central crushing chest pain with radiation to the left arm’, then at least ‘drain blockage’ will come in useful for plumbing calls, if not for angina pectoris. Failing that, did I mention that we learned about the Oedipus complex? We follow a loose agenda, and learn whatever words come up in conversation, and as a result, my vocab list can cover everything from ‘immunosuppression’ to ‘chamelion’, on one page.

Given the informality of the Israeli educational system, we are all free to interject and add in our own experiences and beliefs, for the benefit of the others in the class. It’s just as well, because it means that when our teacher tells us that the urethras connect the kidneys to the bladder, and a single ureter takes the urine out to the fresh air, we can point out that she is in fact spouting crap. On occasion though, our class democracy backfires. We had a heated debate recently (sparked by our Maldovan comrade) over the dangers of various colourful fruit and vegetables, namely pomegranates and carrots. Yes, carrots. Our inferior British medical system neglected to tell us that pomegranates are potentially lethal, as they can ‘thicken the blood’. But that isn’t nearly so scary as carrots, which are notorious for ‘altering the chromosomes in one’s blood’. Appalled at these glaring omissions in the Western medical syllabus, I asked what the mechanism of injury to the DNA was. “I don’t know, but in my opinion, carrots are really bad for the chromosomes.”. End of debate.

But in the same time period, much more has been happening than just ulpan. At the end of July, I finally started work, just 2 weeks after getting my license.

I’m working for a chain of private clinics that do something really unique in Israel, but which has revolutionised the health care system here. Filling a gap between primary care and emergency medicine, we are a walk-in centre, but with our own instant laboratory, radiology department, orthopaedics, gynae, and minor procedures. Patients don’t need to wait eternity in an emergency department, and the health insurance companies don’t need to pay a fortune for an unnecessary hospital attendance. Seeing up to 500 patients a day at a high turnover, and with the option to refer the few really ill ones directly to hospital, we have become an intrinsic part of the medical system. So much so, that we keep having NHS managers popping in to pry and work out how they can set something similar up in London.

Starting work in Israel was never going to be straightforward, but moving from the freedom and incredible support of the NHS to a private clinic with such a massive turnover was in itself a massive challenge. For the first time, I wasn’t at the bottom of a ladder of people, working in a team who could always advise me on what to do next; instead, each patient was my own, I can order whatever tests I want when I want, and from start to finish, no one else will interfere... unless I get really stuck and call the boss at home. In fairness, there’s always support when it’s needed, but at the same time, in a private clinic, time is money, and so finding a balance where you stay in control and don’t ever put anyone at risk, while still meeting your quota of patients per hour, is not easy when you need to pop out and call someone for advice. Now, try getting used to that system, while working entirely in a foreign language. Finally, and most importantly, don’t forget that you’re dealing with the largest Jewish population in the world.

Chest pain: A case study

A UK patient

Doc: How are you?

Patient: My chest hurts.

Doc: Where?

Patient: In my right armpit

Doc: When did it start?

Patient: Yesterday, when I was drunk and fell onto a railing outside the pub

Doc: Any shortness of breath?

Patient: No, just pain where this big bruise is.

An Israel patient

Doc: How are you?

Patient: Doctor, I’m in the worst pain of my life. I have this central crushing chest pain in my right armpit, which came on during exertion, shortly after I fell from a height onto a sharp metal railing. Please could you do an ECG, Troponin, and a full blood count? Also, I’d like a chest X ray, because I had a cold last week and want to make sure it hasn’t gone to my chest. Oh, and while I’m here, please could you check my thyroid function? I put on 6 ounces last month. Do you think I need to go to hospital for a CT scan? Or can you do that here?

The sad thing is, in private medicine, where patients can be stubborn, often the patient will get what they want, within reason, even if it isn’t medically justified, or in their best interest. Why? Because, as I learned the hard way, trying to reason with them just wastes valuable time while more patients build up. And the more a patient waits in line, the more they feel they’ve ‘earned’ a longer consultation, and the more justified they feel in asking for even more obscure, pointless, and dangerous investigation. All of a sudden, the whole modus operandi of a doctor has been turned on its head. No longer do we ‘treat the patient, not the illness’ – that is what family medicine is for. In an urgent care clinic, we very much focus our efforts on the matter in hand. ‘If it’ll kill her tonight, treat it, if she’ll still be alive next month, send her to her GP’.

At the end of the day, it makes perfect sense. Allowing ourselves to be slowed down by timewasters not only puts other patients at risk, but also effects business. But it’s hard to get used to saying ‘What’s brought you here today’ instead of ‘How are you?’, which invites the patient to list non-urgent problems too. It’s even harder to refrain from saying at the end ‘Is there anything else I can help you with?’.

So while I’ve been having fun in my clinic, Deborah has also been sent to the grindstone, after finding work in a local pharmacy as an assistant, while awaiting her impending licensing exams. On paper, the job is perfect. Five minutes walk from home, dispensing meds, learning the system, the practicalities of pharmacy here, and the necessary lingo. So what’s the problem? In reality, she has become a shopkeeper’s slave, organising handbag displays, aligning bottles of shampoo, unpacking deliveries. Like me, she gets to enjoy the front line of patient exposure here; for example, the woman who arrived after closing, covered in hair-dye with a towel round her shoulders, begging to be let in for an emergency; upon entering, she handed three pages of repeat prescriptions, all due to run out that evening. And all for 30p over minimum wage... which means that she can afford to buy a cup of coffee each half hour. But, it’s work, and the money adds up (extra large double latte with cream and chocolate sprinkles please!), and in reality, until she gets her license, it won’t be easy to find anything that pays better with any relevance to her training. Almost all of our friends from the first six months have landed comparable jobs, or jobs that pay equally appallingly but with greater risk, like building work, cleaning, or telesales. Many remain unemployed, and make do on the £200 monthly unemployment benefit, with top-ups from mummy and daddy. Some have gone off to the army, where they will not need to spend a penny for the next however-many-months, while earning... well, pennies. And one or two have already packed up and moved back to wherever they came from.

To supplement the hours, she’s also started some online work ‘categorising clinical trials of oncology drugs for their unlicensed uses’. ROCK AND ROLLLLL!

In terms of daily routine, things have really settled down for us now. Were it not for the fact that we are juggling three jobs between us, mine being based on a 4pm to midnight shift most weekdays, and are both spending 25 hours a week in education, with 3 hours of commuting each day, life would feel quite normal. But as things are right now, I get home for 5 hours a day, of which I try to spend every moment sleeping. When I see my wife, we’re either in class, or she’s fast asleep. Until ulpan finishes in 2 weeks, we won’t be exactly living a normal married life. But on the plus side, it’s very difficult to argue with each other, when the only conversations we can have are about carrot-induced chromosomal defects, and we both share exactly the same views on that.

The first trip back to Exile

We were forewarned before aliyah, and several times afterwards, that one of the most difficult times for an oleh is that first visit back 'home' to the UK, or wherever (s)he came from.

A few days after finishing our language course, and after what was ultimately two weeks of cleaning and tidying, we said goodbye to our first EVER real marital home, leaving it in the hands of a friend/lodger, and headed back to the UK. The intentions: 1. See new babies (Debs’ first nephew and my 2,416^th niece). 2. See rest of family. 3. See friends and go to a friend’s wedding. 4. Make some money by working a bit!

For months before we left, Deborah was so excited to see the new Baby Joshua, yet I was hardly brimming with the excitement of going back – primarily because I was scared that we would realise what we were missing.

As our Jet2 budget plane with its plastic seats and amputee-only legroom came in to land in Manchester, we looked out of the window to see our old haunts – my student days in Fallowfield, the Hilton Hotel from our earlier dates, country walks in the Peak District and Winter Hill. And we landed to be met by eerily pleasant weather. The sun was setting, people were out in T-shirts, and the ground was dry! Someone had stolen Manchester. Probably a Scouser.

As we moved around the country, from Manchester to Liverpool to Chester to London to Manchester to Liverpool to Lake District to Liverpool to Manchester, we both suffered somewhat from the grass-is-always-greener syndrome; although of course, it literally is when you come to the UK from the Middle East.

The first shock was when I went into a bakery in Manchester. I queued up in a line (queue and line are two words that don’t feature prominently in Israeli culture), and when I got to the front, the smiling woman said, ‘Hi, what can I get you?’ So shocked was I not to have been greeted with ‘What?’ that I commented to her how nice her manners were. And these little miracles continued for the duration of our stay; cars that indicate before they turn, drivers who give way at give way junctions and people who say ‘thank you’ when you hold a door for them. Using bins is the norm, not the extraordinary, and most smokers are considerate enough to obey the law and go outside while they kill themselves.

Of course, despite our rapidly improving Hebrew, street signs, newspapers and adverts in English are so much easier to understand, and the cars were on the correct side of the road!

As we saw more people and places, it really struck home what we were missing. My nieces and nephews had all grown, although thankfully did seem to remember who we were. Our old homes were as inviting as ever, and Deborah’s cat Rupert still moped about on the grass (he’s famous by the way – you can see him on Google Maps Street View. Moping about on the grass.). The countryside from the luxurious high speed train seemed greener than ever, and the food in the supermarket was cheap! On top of all this, it hardly rained the whole time we were there.

After a week of seeing friends and having fun, it was time to earn our keep, and so we each went off to the temporary jobs we have taken for a four day stint of ‘damage limitation’, that is, to try and balance the books in some small way after half a year of unemployment, and to make a meagre attempt at retaining some small element of medical/pharmaceutical training (respectively) before it all seeps away through lack of use. So, having only been back in the UK for a week, we each commenced a week of real life – commuting, working and earning. One would think that long days of high pressure work, with little time to ourselves, rushing to get there in time, stressing over sick patients in unstable conditions, eating out of a plastic pot in a hot staffroom while Wimbledon / World Cup / other mind-numbing activity plays on the TV, would not be considered a good life. But bizarrely, after a long period of feeling useless and at a loose end, this was exactly what we both needed; I never really realised how important it is to have a purpose, albeit temporary, and coming back from the end of a long day, feeling that you had worked hard and earned the money that will feed and house you, is something we take for granted.

After three weeks in the UK, it was time to head back to Israel, but no more information about our long or short-term future than when we left – still waiting for licenses to start work, still with no idea of when the army will call me, not knowing whether we were going to start our medical ulpan or not, not even completely sure if our apartment would still be in the same position we left it in, we headed back into the unknown.

Despite the loveliness of seeing our family and friends, our trip back still felt a little bit like a kick in the teeth. A reminder of what we had given up. While we try to avoid getting into debt by buying cheaper vegetables, our friends are buying houses and nice cars. While we concentrate to get the gist of the news, to find out when we can collect our gas masks in case Ahmadinejad decides to try and destroy the world, our friends stress about whether to buy the iPhone 3G or wait for the newer model. Only yesterday, a couple of our close friends announced that they had decided to move to the US; and although we hate to hear it, and hate to see them give up on Israel, we understand why. Life here is more difficult than other places. It takes a lot of effort and a lot of courage.

But, despite all this, we don’t have a regret in the world. It’s tough, and it’s sometimes daunting being here. We are living a dream that, even if it doesn’t work out and we decide to leave, would have haunted us both for the rest of our lives if we didn’t give it a go. And we both know that until we give ourselves a real chance here, feel what it’s like to live here as a true Israeli, to work, pay taxes, vote, serve in the army, own a home, and even bring up a child, we’ll never really be in a position to judge and decide to live anywhere else. Like it or not, this is home. Sooner or later, for the Albert family to grow up in their homeland, where they descended from, where their forefathers lived and thrived, someone will have to make these sacrifices. We recently met for the first time some elderly relatives here who knew my great grandfather; they told me that he always dreamed of coming to live in Israel, but it never happened for one reason or another; it’s an honour to be the ones to attempt to make the dream come true.