Saturday, September 13, 2014

Meeting the doctor who saved his life

"You see," Zlotnick says. "One day, a boy becomes a man, and he is a man from A to Z whenever he does what needs to be done, without thinking twice. This is the foundation of our country, these youngsters who don't stop regardless of the circumstances. I helped him to continue to live, but everything that has happened since then, and whatever happens in the future, will be solely because of him."

Bat Hen Epstein Elias..
Israel Hayom..
12 September '14..

It is a Saturday night in mid-July in the Gaza Strip. Confused and in excruciating pain, Lt. Amos is lying on a stretcher. Two days ago, the 23-year-old entered Rafah. Now, he isn't quite sure where he is. Deafening noises are all around him. Soldiers are running to and fro. Vehicle engines are roaring in the background. Voices are crackling over communication devices. The noise of a helicopter landing nearby drowns out all the other sounds.

Amos feels his stretcher being lifted off the ground. He is passed from one pair of hands to another, and is set down on the floor of the helicopter.

"Head injury," someone, perhaps a doctor, yells nearby. "He's conscious. His condition is stable."

The doors shut and the helicopter takes off. Amos is short of breath, dazed and in pain. Everything feels as if it's closing in on him.

Somebody takes him by the hand. His injuries trigger more pain. Amos begins to lose control and feels himself screaming.

In his confusion, Amos tries to get up and leave. He wants to be out there, in the field, with his troops. He is unaware that he has a serious head injury and that shrapnel has penetrated one of his eyes and one of his hands. He came here to fight, to be in the field. He feels he is losing his sanity. Then, silence.

Last week, we visited Amos at the head injury and rehabilitation ward at Sheba Medical Center at Tel Hashomer as he waited excitedly to meet the doctor who worked to save his life in the helicopter.

Maj. (res.) Prof. Alex Zlotnick, a 42-year-old anestheologist at Soroka Medical Center in Beersheba, comes smiling into the room. Amos shakes his hand warmly, and the expression on his face says it all. The doctor looks at him carefully.

"Yes, now I can tell that it's you," he says. "You might have lost a bit of weight. I saw you during the intense fighting, and I can also tell it's you by the injuries. It's very emotional for me to see you like this, standing on your feet."

He pats Amos on the shoulder.

"The way I look at it, you are a very special patient, because I got to see you in those initial moments in the field and again now," he says.

"Usually, my work is limited to the operating room, and afterward, the patient is transferred to another department and I don't get to follow up on their situation. It's rare that I see the results in the long term, as I'm seeing now. This is the best part of my job. It was worth putting in all those years in medical school and interning just to see these results."

On the evening of July 19, the third day of the ground incursion into the Gaza Strip, Amos, an operations officer in the 401st brigade in the Armored Corps, was on the outskirts of Rafah. His mission was to help locate underground tunnels. His outfit had been deployed in the area for two days.

"This was the first time that I had engaged in operational activity in the Gaza Strip," he said. "Until that point, I was only involved with training. We had to move forward quickly with our tank, take positions, and make sure to provide cover fire for all of the infantry units and special forces operating in the area.

"We worked with the Givati forces, and from the beginning there was a good feeling, a sense that we are fulfilling our mission and that everything was going according to plan. There was excellent cooperation between the forces, both among the battalion combat teams and the troops that came to us from other battalions. The first part went smoothly from our vantage point, because we advanced pretty well with our tanks and it took us just a few hours for us to arrive where we needed to be.

"There was an overall sense that there was nothing that could stop the advance of the Armored Corps. I won't say that we thought we were invincible by any stretch of the imagination, because that would mean we fell victim to a sense of complacency. You know there is risk, and that there's danger involved, you know the enemy is on the ground. That's obvious. We didn't think the place was empty. But the overall feeling was there was nothing that could stop an entire battalion of tanks moving forward."

Amos does not remember the moment when the anti-tank missile slammed into his tank.

"I don't even remember those few minutes before it happened, because they were very routine and uninteresting," Amos says, almost apologetically. "It's not as if we came into an area and said to ourselves, 'OK, this is where something is definitely going to happen.' We were on the standard level of alert. We were protected. We combed the area to see if there were enemy elements nearby."

He similarly does not remember his comrades administering first aid and calling for help.

"Everyone I asked said that my evacuation from the tank was done in a professional manner," he said. "So I know that my boys did their job in the way it's supposed to be done, even though they were very scared. But I don't remember any of this. After Rafah, the next thing I knew I was in Soroka, staring up at the ceiling as I was being wheeled into the hospital."

"That's quite all right," Zlotnick says. "There's no chance you would remember anything. I'll fill in the missing picture for you." They both laugh.

Zlotnick says that when the call came through, "it was obvious that what was needed was a quick evacuation, but you don't really know to what extent the reports are accurate. In many cases, the reports we get from the field aren't precise, because what people see from the field changes once the evacuation takes place. We were told that the wounded soldier received first aid on the ground, and that now it was our turn."

"The helicopter landed very close to the border with Gaza," he says. "Everything happens so fast, you only have a minute to be on the ground, no more. The area is vulnerable to enemy fire, mortar shells are flying in every direction, and at any moment we could also fall victim ourselves. The information we receive is very limited.

"I may have said three words to the doctor on the ground. He told us that we have a soldier who suffered head injuries, and that he was conscious. That's it."

Turning to Amos, Zlotnick says: "We hooked you up to the monitor to check all the key bodily measurements. A quick check showed us you suffered shrapnel wounds in your hand and eye, but the head injury became apparent very quickly. As soon as we lifted off you began to lose your composure and tried to get up. That's a sign that your brain suffered injuries.

"Those kinds of situations, where one loses control, are very typical whenever someone is on the verge of losing consciousness. I saw that your condition was deteriorating, so I decided that we needed to put you on a respirator immediately. That was the only thing that could have saved you under those circumstances."

A six-minute helicopter flight stood between the Israel-Gaza border and the landing pad at Soroka. Those six minutes, during which Amos lay in the helicopter surrounded by Zlotnick and a team of combat medics, were the most critical minutes of his life.

Zlotnick understood that Amos needed a tracheal intubation, in which a tube is inserted into the patient's trachea to enable him to breathe. The medical crew in the helicopter held Amos down so that they could anesthesize him before the intubation.

"This isn't an easy thing to do in a helicopter because it's constantly moving and the room we have to work in is quite small, but we didn't have any other choice," Zlotnick told Amos. "We had to do something at that moment, otherwise we would have lost you. The intubation is important for keeping the flow of oxygen to the brain going, preserving normal blood pressure, and keeping blood and oxygen to the brain. For those who suffer head trauma, oxygen and the free passage of air are very critical."

Zlotnick inserted the tube successfully.

"My day job is anesthesiologist, so I do this thousands of times every year," he says. "I'm experienced at it. Immediately after I inserted the tube, we hooked you up to the oxygen. Your condition stabilized."

At 7:30 p.m., the helicopter landed at Soroka. Amos was in a serious but stable condition, and was rushed to surgery. Zlotnick accompanied him to the entrance to the hospital.

"I feel that if you, as a reservist doctor in the army, come to the same hospital where you work on a daily basis, then the communication is much better," he said. "People there know that I deal with head trauma and head injuries, so they trusted me. We handed you over to the hospital's doctors, and I went back into the helicopter and we flew back to the base to be on call.

"Immediately after I landed, 15 minutes later, I called the hospital to check up on you. You were in surgery at this point, and this was very important, because whenever you're dealing with head trauma, time plays an important role. The quicker we reduce intracranial pressure, the quicker the brain recovers.

"The staff at the hospital did the job in a timely, quick, and effective fashion. I saw this a few days later, when I returned to work at the hospital and saw you in intensive care. You may not have been fully conscious, but your condition was much better. I monitored your situation."

"The operation left a great deal of room for optimism," said Dr. Amit Azriel, a neurosurgeon at Soroka.

After surgery, Amos was treated by orthopedists and eye specialists. He underwent another operation, to remove pieces of shrapnel from his eye.

"I don't know how to explain it, but when I woke up [from surgery], I immediately realized what was happening to me," Amos says. "Maybe it's because during the treatment there were instances during which I was conscious. I don't know. But I understood that I was in a complex situation, and that my mission was now to find a way out of this situation. I still didn't quite grasp the full meaning of the word 'rehabiliation,' but I knew that I would come out of it. I didn't feel any regret, and I didn't feel any fear."

Meanwhile, Zlotnick was swamped with work.

"This was a very difficult period," he says. "We had a lot of work to do, more than usual. We had to cope in a situation that was somewhat problematic. Many of the anesthesiologists were called up by the army. We also had a situation where Soroka was at the front in terms of administering medical aid. Even after I completed my reserve stint, I was still having dreams at night that I was in a helicopter, treating wounded soldiers."

After 10 days at Soroka, Amos was moved to the head trauma rehabilitation unit at Sheba Medical Center in Tel Hashomer.

"My friends from the battalion told me about the injury and the treatment, but this is the first time I'm hearing all the details," an emotional Amos tells Zlotnick. "And this is important to me, because this gives me closure."

"I apologize for not coming to visit you more often in the hospital," the doctor replies. "We were just drowning in work."

"I really appreciate everything you did," Amos says.

"My parents learned of you and heard your name for the first time days after I got to the hospital. They didn't have a chance to meet you and thank you in person. I told them I'd be happy to talk to you when my condition improves. I knew I wanted to meet you. I'm very happy this was made possible.

"I know the work done by the medical teams on the ground is the main reason for my speedy recovery, and the reason that I'm here now, in relatively good condition. There are other doctors in Soroka who treated me when I was unconscious, and once I complete my rehabilitation, I will also want to see them. I received excellent treatment throughout."

Amos is working hard to recover from his injuries, growing a little stronger each day of the lengthy rehabilitation process. He hopes to meet the goal he has set for himself -- to recover as if he had never been wounded at all.

Seven other soldiers wounded in Operation Protective Edge are hospitalized alongside Amos with head and brain injuries of varying degrees.

"There is a great fear that after significant head trauma, there will be deficiencies in numerous areas of cognitive function, so the team that treats the wounded here is a multidisciplinary staff," says Dr. Ofer Keren, the head of the head trauma ward. "We pay special attention to all of the functional elements, so the rehabilitation process is a long one. The goal is to restore the patient to a functionality as close as possible to the level he or she had before the injury."

Overall, 45 wounded soldiers are currently hospitalized at Sheba, many of them arriving after initial treatment at other hospitals.

"A kind of fraternity has been created here," says Amos. "I think many of us want to return to the army. Even those who don't still know they want to continue to help and to give of themselves whatever is necessary so this country can continue to live on. I know this is what I want, and I'm on my way there."

Amos' room in the ward is spacious. On the wall hangs a letter of citation he received from GOC Central Command on Independence Day. There are also pictures of him at various times -- fraternizing with his friends while on civilian leave; standing on the roof of a tank, looking out over a military training session while holding the Israeli flag. One picture shows him with IDF Chief of Staff Lt. Gen. Benny Gantz during a visit to the hospital.

Amos has not been back to his home in Jerusalem for almost three months, since leaving in early July for a battalion exercise, from which he was deployed straight to Gaza.

"I won't say that I wouldn't be happy if I was sent home," he said. "But I feel quite at home here in terms of the people around me, and from the standpoint of the love and support I get from the army, from friends, from people.

"From the start, people around me have helped me believe this [rehabiliation] is a piece of cake for me. They've helped me realize that it happened, it happened to me, and it's not easy, but we'll get through this. To see my commanders come out after weeks of fighting on the ground and instead of going home they travel straight to Sheba, this doesn't leave you with many options. You have to rise up.

"I think this is something that is very unique to the 401st Brigade, which carried out its missions very well but didn't forget the wounded soldiers. My previous battalion commander came to visit me immediately [when I was first hospitalized]. The current battalion commander came to visit a bit later, after the fighting ended.

"There's something very empowering in all of this. I gain a lot of strength here, so I'm not as eager to go home now as I am to do other things."

Amos makes sure to receive regular updates on what is happening with his comrades in the unit.

"I heard about how the brigade fought during the operation, after I was wounded, and how they succeeded in completing their missions," he said.

"They were directly involved in neutralizing two tunnels. Indirectly, they participated in the destruction of five other tunnels. They also took part in a large number of encounters with terrorists, and they led all of the brigade-wide attacks throughout the course of the operation.

"I was proud to have a role in this during the initial stages, and I was proud of my troops who soldiered on and did a wonderful job. I'm happy to have belonged to this thing."

"After I was wounded, my mission changed. My mission now is to recover. I'm very optimistic. I'm taking stock of what I have and of the progress I've made with a great deal of happiness and anticipation and motivation to rehabilitate completely and make a full recovery."

As each day passes, Amos celebrates one small victory at a time. The wound in his hand has healed. He is now capable of speaking coherently. Today, he can bend his finger more than he did yesterday. He is now able to tie his shoelaces without any problems. He derives strength from his family, who are constantly by his side, while instilling in them strength of his own.

"This is work that is done on a daily basis," he said. "There are things that improve faster than anticipated, and there are things that need more work. But I'm going on this journey in the right way. I can complain about what a poor, unlucky person I am and how I'm in pain, but I don't feel that way at all."

Before the doctor leaves, Amos seems curiously child-like for a moment.

"Take care of yourself, hamudi [my cutie]," the doctor tells him. Amos looks down briefly, unable to conceal his bashful smile. He promises to keep in touch.

"I have another six months until I complete military service, but I think that it would be very satisfying for me to get closure if I can return to the army and complete the company officers' course," Amos says.

Now it's Zlotnick's turn to look at Amos with admiration.

"You see," Zlotnick says. "One day, a boy becomes a man, and he is a man from A to Z whenever he does what needs to be done, without thinking twice. This is the foundation of our country, these youngsters who don't stop regardless of the circumstances. I helped him to continue to live, but everything that has happened since then, and whatever happens in the future, will be solely because of him."


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