Early in 2016, after several years of planning and anticipation, Dr. Howard Goldschmidt of Teaneck, NJ took a month off from his busy interventional cardiology practice at The Valley Hospital in Bergen County, NJ, and used the time for what he called a “mini-sabbatical” at Shaare Zedek Medical Center. While there he performed trans-esophageal echocardiography procedures, his specialty, and taught medical residents and fellows in cardiology and emergency medicine. He also wrote a number of very interesting blog posts about his experiences, which he discussed in an interview on the Nachum Segal Network (pictured, above), and which we are proud to share with you here.

Kruter_NSN_190Sunday January 31: My first day of work at Shaare Zedek Medical Center in Jerusalem, where the work week begins on Sunday and ends Thursday afternoon.

I depart the city of Modiin in my rented Hyundai hatchback (nice handling, weak engine) travelling on highway 443 along the 1948-1967 border, the back road to Jerusalem through the Judean Hills. The road is an ancient east-west trade route, mentioned in the books of Joshua, Samuel and Maccabees. After just a few miles, I pass the gas station where a soldier was stabbed to death in November. A few miles further is the turn-off for the small settlement of Beit Horon, where a 23-year-old woman was stabbed to death last month. The highway itself is safe, an observation balloon with dangling video cameras looming above. As 443 ends, the traffic slows. The “City of Gold” is visible in the distance. The 20-mile trip takes 45 minutes.

Already possessing a temporary medical license, I am rapidly processed and issued an ID and a lab coat. The heart center occupies the entire 10th floor of the building, cardiac surgery in one wing and all cardiology services in the other wing. The echocardiography laboratory is equipped with state-of-the-art Phillips equipment, donated by the US Government.

My arrival is welcomed, because one of the three echocardiography attendings is on-service in the coronary care unit this month and another will be on vacation for part of the month. Within an hour of my arrival, I am performing a transesophageal echocardiogram. I am able to explain the results of the examination to the patient’s family in my halting Hebrew. The remainder of the day is spent reading echoes, joining teaching rounds in the coronary care unit (conducted in Hebrew) and performing a stat echo in the cath lab. Later in the week, I teach the first year cardiology fellows and observe a Mitraclip procedure in the cath lab. Kosher lunch in the employee cafeteria (chicken, Moroccan meatballs, salad bar) costs 7 Shekels ($1.75)

The geopolitical strife and terror are part of the everyday experience, but yet are not a subject of ongoing discussion. On my second day, I was interpreting echocardiograms performed earlier in the day by one of our technicians in the ICU. On one study, the patient’s diagnosis included the familiar Hebrew word for “injury” (“peeguah”) and a second, unfamiliar word : “dihkeera”; this required Google Translate: “stabbing.” I glanced back at the patient’s name and recognized him as a victim of an attack in the northern Jerusalem neighborhood of Givat Zev. Thankfully, he is making a full recovery.

Shaare Zedek (“Gates of Righteousness”) is an inner city hospital with over 1000 beds between its two campuses. A large percentage of its patients are Arabs from all over the Jerusalem metropolitan area and beyond. On my third day, a patient was emergently transferred to the CCU from El-Mokassed Hospital in East Jerusalem. El-Mokassed is located in A-Tur, an Arab village at the top of the Mount of Olives, where, needless to say, Israelis are unwelcome. The patient presented with acute MI on a day when their catheterization laboratory was unavailable. He was given thrombolytic therapy prior to transfer. He was brought from East Jerusalem to our CCU by an ultra-Orthodox paramedic, then whisked to the cath lab so rapidly that the nurses knew him only as “Adon (Mr.) Mukassed.” Could an Alawite be treated in Aleppo? I doubt it.

As Friday afternoon passes, I enjoy the view from our 9th floor porch of the Judean Hills to the southeast. Let’s all pray for peace.

HG

“Kibbutz Galuyot”: “Ingathering of the exiles,” one of the cornerstones of the return to Zion in the modern State of Israel. This is evident everywhere you go in this small country. At Shaare Zedek Medical Center the three attending physicians in echocardiography hail from Buenos Aires, Paris and Bucharest; the CCU Director is from Johannesburg; a cardiology fellow is from Tbilsi; an interventionalist is Australian; and an echo tech is from the ancient Jewish community of Cochin, India.

We are an interconnected people that have been “globalized” since two millennia ago. Last week, I was peripherally involved in the care of a terror victim who has since been discharged. This week, our son-in-law Eli has been on a business trip to India, setting up telemedicine centers to provide ICU coverage for rural hospitals in the US. In Bangalore, he picked up kosher food to take along to Udaipur, near Pakistan. Coincidentally, the local Chabad rabbi/kosher butcher is the brother of that same terror victim. The rabbi asked Eli to pass on his thanks to all the doctors at Shaare Zedek for saving his brother.

A strong spirit of collaboration permeates Israeli medicine. During many invasive procedures, a second physician is present, freely commenting and providing appreciated suggestions to the primary operator. During one catheterization procedure, two additional cardiologists were hastily summoned from the clinic to confer on the findings before an intervention was performed. There is a weekly interdepartmental Grand Rounds to which the entire professional staff is invited. At these conferences, at least five different experts present their work. This week’s topic was medical marijuana, hosted by the department of pediatric neurology. Sub-specialists spoke on epilepsy treatment, psychology, basic science/neurobiology, and pain management. I was frantically typing all the new words into Google Translate, then scribbling the definitions into my old-school spiral notebook.

I have stepped through the looking glass into an alternate life, albeit transient, with many parallels to my usual routine. My morning drive to the hospital is much longer than Teaneck-to-Ridgewood. Every morning I notice something new on the rugged hills along highway 443. Sunbeams emanating from broken cloud cover illuminate the scenes: recently built settlements, old Arab villages with minarets, greenhouses, a line of cars on a tangential dirt road leading to a military checkpoint, a pristine paved road that runs alongside the Separation Wall for the exclusive use of security vehicles…

Events here lead to cognitive dissonance. Sunday night we saw a revival of “Hair” at the Cameri Theater in Tel-Aviv, across the street from the Defense Ministry on King Saul Boulevard. Presumably, most of the 20, 30 and 40-somethings in the auditorium had previously endured three years of compulsory military service and had close relatives still in uniform. How much do they know about America’s agonizing Vietnam experience? How does a musical that was so popular with our armchair anti-war protesters resonate with this militarized/victimized audience? We grew up singing all the protest songs, but as privileged children of the middle class, we were many degrees of separation from families of GI’s. Unfortunately, Israelis are much more closely connected to the ravaging effects of war. The Age of Aquarius came and went, but the bloody conflicts are still with us. Dear God, when will the sun shine in?

This afternoon we enjoyed the warm spell at the old Tel-Aviv port, Eitan and Ezra riding their scooters on the smooth-banked promenade while we ate sushi overlooking the Mediterranean. A serene secular cosmopolitan experience just hours before the Sabbath.

Shabbat Shalom,

Howie

P.S. Thank you to my partners at Valley Heart Group for covering my practice.

Out of existential necessity, the military is a dominant institution in Israel. On the walls of my grandsons’ preschool classrooms, up-to-date photos of the prime minister, the president and the military chief of staff are displayed side by side. The Chief of Staff, General Gadi Eisenkot, is frequently quoted in the media. (Can you name the incumbent chairman of the US Joint Chiefs of Staff?) Streets in Modiin are named after famous generals.

The majority of Israelis serve three compulsory years in the IDF after high school. This experience informs their style and (sometimes brusque) demeanor later on in the workplace. Minor functionaries in banks, post offices and utilities can be very authoritarian.

The information technology industry here is driven by veterans of the elite Intelligence Unit 8200 who have served a five year stint. While these whiz kids lead the world in software, telecom and microchip development, their penchant for security tends to slow the flow of information. Commercial websites may require users to employ three levels of passwords for mundane transactions.

Those who have served in combat units (including our son-in-law) continue in the military reserves into their 30’s, serving one to four weeks a year and longer during wartime. This service is happily embraced by most employers. This week at Shaare Zedek Hospital, the catheterization lab is short one cardiologist who was called up.

My late uncle, a long-time employee of the Haifa municipality, often derided Israel as a “police-state.” But living in a police state is part of the cost of living when surrounded by carnivorous enemies. Here, it would be unimaginable for a cell phone manufacturer to withhold encryption codes from an ongoing criminal or counter-terrorism investigation. (Forget about the rule of law and privacy rights, just remember that “The business of America is business”: To maintain its market share, Apple is willing to be an accessory after the fact to criminals. The greatest cheering for the Iran deal came from the multinational mercantile giants, happy to replace the ailing Chinese with newly-accessible Persian trading partners.)

The importance of the military sector is recognized even by ultra-Orthodox fundamentalists who personally decline military service. Because of their anti-Zionist ideology, their synagogues omit the weekly Sabbath prayer for success of the Israeli government. However, many of them do recite a separate prayer for the welfare of Israeli soldiers. Recently, there was acrimonious Talmudic debate between centrist and right-wing rabbis regarding whether first responders are obligated to care for a mortally wounded terrorist before attending to a stabbing victim with lesser injury. The prevailing opinion was to let the medics use their usual rules of triage.

Even though it has claimed fewer innocent victims than the first and second intifadas, the current wave of terror has its own unique, noxious stench. Previously, the exploding attackers self-destructed along with their victims. Heightened security measures have since eliminated the threat of suicide bombs. Assailants are now armed merely with kitchen knives and personal vehicles, but must be countered with deadly force unleashed by soldiers and armed civilians. Teenage Arabs, infected by internet-borne rage virus, launch their suicidal assaults like Hollywood Zombies. These undead adolescents approach checkpoints or enter supermarkets knowing they are soon likely to die in a hail of gunfire. They are dispassionately neutralized as soon as possible, but the damage is always severe; this repeating scenario is demoralizing to the soldiers and the populace. A surgeon amputating a smoker’s gangrenous limb can emotionally compartmentalize the task, but can a twenty-year-old border guard (and his family) remain unscathed after dispatching a jihadist the age of his siblings?

Perhaps these considerations prompted Gadi Eisenkot to declare last week that the IDF’s rules of engagement do not mandate emptying a magazine into a teenage girl wielding a pair of scissors. Predictably, this call for restraint from a four-star general was poorly received by the political right-wing and settlers in afflicted areas, who must live with both PTSD and “pre-TSD.” Bibi waited on the sidelines for several days before finally endorsing his military chief’s controversial statement.

In the month we have been here, there have been numerous attacks. Two young men have died in the last week, the most recent one in the 24-hours since I wrote the first draft of this piece. This morning, as I was leaving the ER internal medicine unit to head upstairs to cardiology, the cardiothoracic surgeon who heads the trauma team rushed past me to the shock room. I put this out of my mind, but later on heard the terrible news.

A few nights ago, as I drove by Ramallah on Highway 443, the radio reception switched from Israeli pop music to an English language Palestinian news broadcast. Following a report on one of the recent attacks, the announcer added that “the current Issra-aily aggression has continued without stop since October.”

HG

I am a “biblical Zionist romantic,” a term I read on a museum wall exhibit-caption.

In the 2nd Century BC, the Israelites, lead by Matathias, Judah and their Maccabees, launched a revolt against their idolatrous Greek oppressors. Their successful military campaign is the basis of the Hanukah story. The
Maccabees went on to found the Hasmonean dynasty, which ruled Judea for two centuries.

The Maccabees came from the town of Modi’in. Between 1948 and 1967, the area was a rubble strewn wasteland. Construction of a new city began in the late 1990’s, applying the most modern concepts in rational urban planning, with careful attention to green space and controlled traffic flow. (Coincidentally, one of my patients is a retired professor of urban planning who consulted on the project.) My daughter Alyssa and her family live in one of the high-rise towers in the center of town, walking distance to the mall and high-speed train station. Debbie and I were lucky to find a one month rental in the building next to Alyssa’s.

Lying approximately half-way between the two cities, Modi’in has easy access to the historic/religious/spiritual/political capital of Jerusalem and its antipodal counterpart, the edgy, cosmopolitan economic capital of Tel-Aviv. High in the Judean Hills, Jerusalem’s streets are lined with limestone buildings, pale European Jews, dark Middle-Eastern Jews, black-and-white attired Haredi Jews, Arabs, Christian Monks and armed soldiers. Low by the Mediterranean, Tel-Aviv’s famous early 20th century Bauhaus buildings (designed by German refugee architects) are complemented by post-modern skyscrapers. Its avenues are populated by artists, hipsters, and secular bourgeoise high-tech workers. Wall murals/body art, sculptures/piercing are everywhere you look. Depending on our mood, we alternate our night-time leisure hours between the two cities at opposite ends of Highway 1.

Open Google Maps on a touch screen, then spread your fingers on the map of Israel. Two thin lines mark the 1948-1967 Jordanian border north of Modi’in. Move your finger and note that the nearly parallel lines converge in some places to a single border, the often cited “Green Line,” and diverge in other places to delineate a patch of (former) “No Man’s Land.” The lines begin in the northern Galilee region and squiggle downwards to the Judean Desert, south of Jerusalem. Modi’in proper lies completely on the Israeli side of the border. Its smaller sister-city, Maccabim, is entirely within the old No Man’s Land. Across the Green Line is the upscale, lushly landscaped settlement of Hashmonaim. Unlike its mixed secular-religious neighbors, Hashmonaim’s residents are all orthodox Jews, including many immigrants from the NY metropolitan area. Its security gate is closed for the 25 hours of Sabbath. Hard to imagine what Judah and Matathias would think of all these nuanced distinctions.

We are magnetically drawn to different locations in No Man’s Land. Alyssa’s in-laws have a place in Abu Tor, one of the few mixed Jewish-Arab neighborhoods in Jerusalem, just south of the old city. Overlooking the picturesque Dormition Abbey on Mount Zion, their apartment on Ein Rogel Street (named for the nearby site of King Solomon’s coronation) is in a row of buildings constructed after 1967 in No Man’s Land. Just north of the old city, local legend has it that in the 1960’s, a nun residing in the Notre Dame Monastery on the border accidentally dropped her dentures out her window into the bushes of No Man’s Land. The UN arranged for Israeli and Jordanian border troops to temporarily “stand down” while the teeth were retrieved.

One Friday morning, we toured the western shore of the Sea of Galilee. Jesus lived and preached in the fishing village of Capernaum, where a massive 4th century synagogue stands at a site which may have housed his synagogue in the first century. At the edge of Capernaum, a Greek Orthodox sect built the multi-domed Monastery of the 12 Apostles in 1925. This beautiful Byzantine-style structure was left empty and inaccessible between 1948 and 1967, as it, too, lay in No Man’s Land.

The object of my biblical Zionist romantic attention is of course, the land of Israel. This love is shared by the majority of the Zionist, post-Zionist and anti-Zionist Jews I have met during my many visits. But, the land is also loved by the thousands of Christian pilgrims who visit every year from the US, Europe and Asia. They eagerly disembark from jumbo tour buses at a multitude of holy sites. Over the years, I have been inspired by their devotion during my visits to the old city’s Church of the Holy Sepulchre (with my son Ari on a long Shabbat afternoon in the summer), Bethlehem’s Church of the Nativity (with Ari and Noah, necessitating much ‘splaining at the IDF checkpoint when we tried to drive back into Jerusalem), Augusta Victoria Hospice atop the Mount of Olives, the Monastery of the Cross in Jerusalem, the Church of the Annunciation in Nazareth (with my teenage tour in 1973), the Sisters of Sion Monastery in Ein Kerem (magnificent views, very weird tombstones), The Basilica at Emmaus, the Monastery and vineyard at Latrun, and the Church of the Beatitudes in the Galilee. (At one time, I considered becoming a guide for Jewish tourists visiting Christian holy places and vice versa, too.)

Should the ISIS caliphate succeed, these treasures would be destroyed in short order. Consider that, aside from the two mosques on Haram-al-Sharif, there are few Muslim holy sites in Israel. Their venerated historical traditions with regard to this land are limited to military victories and Muhammud’s single visit to Jerusalem. Under both Ottoman and Jordanian rule, Jerusalem was relegated to dusty undeveloped backwater status.

More about Dr. Howard Zvi Goldschmidt: The Goldschmidt family has a long association with Shaare Zedek Medical Center. Dr. Goldschmidt’s grandfather, Carl Goldschmidt, was a member of the board in the 1960’s and was posthumously honored at an annual dinner. His maternal grandfather was a classmate of Shaare Zedek’s second director-general, Dr. Falk Schlesinger, in Hamburg, and hosted him in New York. While in Israel, Dr. Goldschmidt and his wife Debbie stayed in Modi’in, where their daughter and son-in-law and three grandchildren reside.