Coexisting through suffering

It is not easy to read a book about children with cancer. Descriptions of a seriously ill child's symptoms and medical treatments are not what you would call light reading. In This Narrow Space, Dr. Elisha Waldman, a pediatric oncologist and specialist in pediatric palliative care, shares the heartbreaking stories of children suffering an illness that is always a parent's worst nightmare. The sub-title of This Narrow Space is “A Pediatric Oncologist, His Jewish, Muslim, and Christian Patients, and a Hospital in Jerusalem.” This gives the reader a clear preview of the book's focus: While it is a book about a pediatric oncologist's experiences treating critically ill children, it is also a book about Israel, Israeli medical care and Israeli society, with all its different cultures and religions. Waldman spent seven years as an attending physician in the Hadassah Medical Center's Department of Pediatric Hematology-Oncology. Although he ultimately decided to return to the US, where today he is the associate chief of pediatric palliative care at the Ann and Robert Lurie Children's Hospital in Chicago, his experiences at Hadassah had a profound effect on him and inspired him to write this thought-provoking book. An idealistic young doctor, Waldman grew up in suburban Connecticut in what he describes as a “fairly observant home.” The oldest son of a Conservative rabbi, he went to a Jewish day school, which not only taught him Jewish tradition but also instilled in him a strong love for Israel. He spent his four years of medical school in Tel Aviv and then returned to the US for a pediatric residency and a fellowship in pediatric oncology. In his early 30s and single, Dr. Waldman began his professional life in the States in a small pediatric-oncology practice but stayed only a year. He struggled to cope with the deaths of young children who did not survive despite all of his efforts and that of his colleagues, and began to question his faith, wondering how God could allow children to suffer and die. At this point he decided to take a two-week backpacking trip in order to think and read. IN JULY 2006, he was sitting in the airport in Guatemala on the way back to the US when he heard the news that war had broken out in Israel. “This was all very worrying, and not for the first time did I think that my place was there, doing whatever I could to help.” He began to think seriously about making aliya. It seemed just the right time for a life change. By the time he landed in the US he had made his decision – he was moving to Israel. In March 2007, he began working at Hadassah. There he encountered the Jewish-Arab coexistence he believed in when he met both Jewish and Arab doctors and nurses caring for Jewish, Muslim and Christian children who were suffering from life-threatening illnesses. He was surprised to see so many Palestinian children coming to an Israeli hospital for medical treatment. “I am initially surprised at the number of Palestinians who come to Hadassah for treatment. I am also pleased. It's my hope that positive interactions between Israelis and Palestinians in a cancer clinic will lead to greater understanding and communication in non-healthcare settings as well,” he wrote. “I'm also fascinated by the idea of getting to know a people who are so close to me geographically but who feel so far away politically and culturally. I know that health services in the PA [Palestinian Authority] are not as developed as they are in Israel, and that children with cancer need the kind of specialist care that is unavailable there. But I had assumed that most Palestinian parents would seek medical care for their children in Jordan or Egypt. Some do, but significant numbers of Palestinians bring their children to Hadassah as well as to other medical centers across Israel.” Waldman was pleased, but as time passed, he began to realize just how much he did not understand about the intricacies of treating severely ill children in a region fraught with conflict. With violence and terrorism being daily occurrences, the doctors treating children from Palestinian villages had no control over whether their patients would be able to return for their next appointment. There were times when the Palestinian Authority would not allow sick children to cross the border from Gaza into Israel, even though the children could not get the same care in a Gazan hospital. He had trouble understanding how the PA could not allow children with life-threatening diseases to get the care they needed in Israel. THE EXPERIENCE of having to deal with such an obstacle while trying to save a child's life was challenging and frustrating. There were other difficulties, such as medications that the Israeli Health Ministry had approved and the Palestinian Health Authority did not, which meant that the Palestinian children could not be given a specific medication because the PA Health Authority would not pay for it. This put the doctors in the surreal situation of having to recommend one medicine to the parents of an Israeli child while explaining to the Palestinian parents of a child with the same illness why their child could not take that medicine and would have to take an alternative. These were situations Waldman had never encountered as a pediatric oncologist in the States and they were both a professional and personal challenge. In This Narrow Space, Waldman describes many details about his young patients and their illnesses and the difficult process of making decisions about their treatments together with their parents. He works hard to communicate with the parents of his patients, even when there has to be an interpreter present because they do not speak Hebrew or English. He puts a lot of thought into how to explain the child's illness and treatment to the parents and to the children themselves, depending on their age and ability to understand. Waldman shares many of his own thoughts and feelings, including his dreams of a Zionism of coexistence and acceptance, something the hospital represents, but at the same time he still has preconceptions about some of his fellow Jews. At certain points in the book, Waldman expresses stereotypical views of Jews who are religious or live in settlements. While clearly a sensitive, talented and professional doctor, he is not as open-minded as he tries to be. I would like to believe that if he had stayed in Israel longer, he would have come to understand the people in those Jewish groups with whom he did not agree. This Narrow Space is an enlightening and informative book. It gives the reader a perspective on Israeli society that is not often documented. The first few chapters may feel like an uphill climb, but as you will see, it is a worthwhile climb.

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