Jerusalem's coronavirus frontlines: The fight is for life
Behind the scenes in Jerusalem’s coronavirus wards
By MAAYAN JAFFE-HOFFMANHadassah Ein Kerem coronavirus unit(photo credit: MARC ISRAEL SELLEM)
One. Two. Three. One. Two. Three.A team of 10 nurses and doctors stand around a COVID-19 patient. His eyes are glassy. They are open but staring nowhere.Beep. Beeeeep. The sounds of the machines screech in chaos. One nurse squeezes an oxygen pump. Another tries to shock the man’s heart back to life.“It happens every couple of days that within minutes, I walk in and we have to resuscitate someone,” says Dr. Philip Levin, director of Shaare Zedek’s general intensive care unit and now in charge of a coronavirus ICU, too. “When the pandemic was at its peak, every day we received seriously ill people. They would come in on ambulances and be intubated right away.”DR. PHILIP LEVIN, director of Shaare Zedek’s general intensive care unit, heads the coronavirus ICU. (Credit: Marc Israel Sellem)The team members are rushing but calm. They work together, one administering an injection, another taking blood. The man is in his early 60s. He was diagnosed with COVID-19 and developed a blood clot in his heart, which led to the heart attack.The team miraculously manages to save his life. Then they move on to other patients.The coronavirus intensive care units at Shaare Zedek and Hadassah University (Ein Kerem) medical centers in Jerusalem are some of the busiest in the country. The capital has seen the highest number of patients since the start of the pandemic, and it is home to the sickest sectors – the Arab and haredi communities.On Tuesday, the Health Ministry reported that 5.3% of haredim screened for the virus tested positive, and 6.8% of Arabs, compared to 2.1% of the general public. The city continues to have close to 2,000 active cases.“I think the uniqueness of Hadassah is that it is in the midst of two highly infected populations,” explained Prof. Sigal Sviri, director of one of the hospital’s medical intensive care units and its largest coronavirus intensive care unit.She said that during the first wave, most of the hospital’s patients were from the haredi areas of Jerusalem. There were hardly any Arab patients. Then, “one of the most surprising phenomena over the summer months was that more Arab patients came in from east Jerusalem. We were one of the first hospitals to realize the increasing infection among this population, which later spread north to the Galilee.”At around the same time, Shaare Zedek also started to see a spike in Arab patients. But recently, said Levin, those numbers started to decline, and beds in the coronavirus ICU were once again filled with haredim – “mostly obese haredi men,” he noted.SHAARE ZEDEK, a public-private medical center, is among Israel’s busiest – while facing budgetary challenges. (Credit: Marc Israel Sellem)Levin said that just as many women as men contract coronavirus, but fewer develop severe cases of the disease.Now, there is a fear that as the number of haredi patients starts to dissipate, Arabs will once again enter the hospitals’ wards – as mass weddings have resumed and more than 10 Arab cities and towns have become orange or red.The Ministerial Committee on Declaring Restricted Zones agreed to a closure on the northern Druze village Majdal Shams. The religious community settlement of Merhav Am in the South and Arab local council Bu’eine Nujeidat in the North were also red.Do medical personnel get angry at these populations, who often choose not to follow restrictions and end up in their care?“I don’t get frustrated – I stopped getting frustrated at some point,” Sviri asserted. “I am here to save lives and treat whoever I can treat. The only thing that bothers me is that it is difficult in these societies to look after the elderly and vulnerable – the patients who have decreased immune systems and chronic diseases that predispose them to critical illness. It is not so much that positivity rates are high, but that they need to do a better job of protecting their people. Every life matters.”AS STAFF improve their knowledge of treatment best practices, there are more success stories. (Credit: Marc Israel Sellem)FOR THE nurses in the unit, the animosity and frustration has also started to dissipate – but it wasn’t always so. Rachel Ben-Shalom, who has been working in the coronavirus ICU since the day after it opened, recalled that when hassidim wanted to travel to Uman for Rosh Hashanah, “I was angry.”“At the end of the day, we have to manage it,” she said. “The hospitals were crowded, bursting with patients, and it was difficult because we would have restrictions and people would not keep them for the sake of everyone’s health.”She added that sometimes she is disappointed because she knows the country could beat this plague if everyone would comply. But, ultimately, “every patient who comes in, I don’t treat them as a haredi or Arab person – I treat them as my patient.”Devora Kirshenbom, chief nurse at Hadassah, described the situation as “sad.” She revealed that she has watched brothers and sisters die, parents and grandparents from the same families who had infected each other. There is not time to think or breathe during such a difficult period, Kirshenbom stated, let alone to take the time to be resentful.“But the public does need to take responsibility,” she stressed. “Everyone put on a mask.”Hadassah is also currently treating Palestinian chief negotiator Saeb Erekat, who at the time of this writing was intubated and experiencing COVID-19-caused organ failure. A lung transplant survivor, Erekat caught coronavirus about a month ago. Since then, his condition worsened and he sought care at the Jerusalem hospital.Hundreds expressed outrage on social media that Hadassah would take in such a patient, an individual who has been virulently anti-Israel. But Sviri, who witnessed firsthand a protest, attended by dozens, held earlier this month outside Hadassah against providing treatment, said simply, “Every person is a person, every human being is a human being, and if they are transferred to our care, they will get the best care.”A "get well soon" balloon is tied to the bed of a coronavirus patient. (Credit: Marc Israel Sellem)She said that doctors and nurses, especially in Israel, are taught early in their careers to “cut ourselves off from these considerations.”She recalled how on one of her first shifts some 30 years prior there was a terrorist attack in the city and some Palestinians had tossed over an Egged bus, killing many and wounding even more.“The emergency room was full of people screaming and shouting,” Sviri recounted. “There was blood everywhere. I was new and they asked me to treat the terrorist. I was nervous and in shock, and did not know what I was supposed to do. I remember that after I stabilized him, the surgeon came in – the terrorist’s ear was torn off during the incident – and the surgeon sat there for an hour and a half and sewed back the terrorist’s earlobe perfectly.”She said she asked him how he could do such an act so calmly and confidently, and he told her: “Because I am a doctor and this is a patient.”“If someone wants to prosecute [a terrorist], blow up his house – this is not my job,” Sviri said of herself. “I am not a judge or prosecutor. I am a healer.”HADASSAH MEDICAL CENTER chief Prof. Zeev Rotstein notes that the majority of his staff is from the area and therefore staff members have to be extra cautious not to get infected in the capital. He screens them every two weeks to ensure they have not caught the virus. But he said that, at the same time, there is a feeling of “brotherhood and sisterhood” among the staff members and their Jerusalem patients, which drives them to serve.He said that while certainly the staff is there to heal the sick, they also see their role as providing comfort and allaying fears of those who come in for treatment.In the coronavirus era, doctors and nurses wear full personal protective equipment that covers their faces and hands and could turn them into anonymous workers. But even as they appear as white ghosts or spacemen, Rotstein stated, they work hard to show emotion, to hold the patients’ hands and support them.Hadassah and Shaare Zedek have rolled out a number of remarkable programs to assist their patients through the crisis.In July, Hadassah became the first known hospital in the world to use recovered coronavirus patients to provide humanitarian support for those currently infected with the virus. The volunteers, organized with the help of haredi nonprofit Yad Avraham, visit patients in moderate or serious condition who would otherwise be in isolation.Both hospitals are part of a program to allow family members to enter coronavirus wards when patient health deteriorates or sometimes for special occasions, such as visiting their parents before their wedding or other life events.Hadassah collected plasma from recovered patients and, working with a local biopharmaceutical company, has created and is testing a commercially produced plasma-derived immunoglobulin serum for COVID-19. Initial results are promising.But the stories remain tragic and traumatizing. One Shaare Zedek nurse told the Magazine that she is responsible for working with new moms with coronavirus, who deliver babies who sometimes have to be transferred to COVID wards; or sometimes the moms have to be transferred to COVID wards, but the newborns do not. Mother and child are separated from one another in their first days.A patient named Benny, also at Shaare Zedek, said that a month ago he called Magen David Adom because he was not feeling well. When the medical workers arrived at his home, they tested him and found he was positive. Since then, he has been in the ICU. His wife was also infected.In a small room at the hospital, two nurses attempted to move a large haredi man up on his bed to improve his breathing. He was a huge man, so they counted to three, then lifted him together. He started to cough, choking on his own spit.Hadassah’s Ben-Shalom told of a patient who was wheeled into her department with such fear in his eyes. He could not talk because the virus was strangling his lungs, but he just looked at her and his eyes begged for help.“He was 56-years-old and he was terrified,” she said.He has since survived and been discharged from the hospital.Hadassah Ein Kerem coronavirus unit (Credit: Marc Israel Sellem)Levin said that during the peak of the last wave, the hospitals were truly bursting at their seams, and sometimes it felt like they would break down – but they kept on going. He said it was especially challenging at his hospital to find appropriate staff to work nights.The total number of serious patients in the country this week hovered around 500. At various points there were more than 800, including hundreds who were intubated.Sviri said the medical center maintains one nurse for every two patients, and the staff gets few breaks. Ben-Shalom said that while this is true, she has started to get used to the situation.“In the beginning it was new for everyone, and it was hard to handle it,” she stated. “Now, I think I have learned. We are less scared. In the beginning we suffered in the PPE. Now, it’s OK.”She is grateful to be employed, she added.They have also better learned to treat the sick patients, she continued, and therefore there are more success stories. Moreover, the hospital provides staff with psychological support one-on-one or in groups to process what they are handling.Levin said that Jerusalem hospital staff members are in a mutual WhatsApp group where they can talk and share best practices. And Ben-Shalom noted that a silver lining has been getting to know doctors and nurses from across hospital departments, which would not have happened in normal circumstances.Still, there is always anxiety over catching corona. Levin is 57 and admitted he is scared of catching coronavirus – this despite only one person becoming infected in the unit since the start of the pandemic.“In the beginning, I was nervous,” Hadassah nurse Ilana Reece told the Magazine. “But I realize I am protected here.”The hospitals, of course, have taken a hit financially from the crisis. Rotstein said his hospital is still in negotiations with the Finance Ministry over reimbursement for the coronavirus care it has provided, as well as compensation for money lost while it focused on the crisis and closed down elective surgeries and other nonessential medical care.“We have a government with many, many ministers and aides and clerks, and we are in the middle of a pandemic, and still hospitals have no assurance, no confidence, that the salaries of our staff will be paid – not to speak of other expenses,” Rotstein revealed.The medical center had started pulling itself out of a historic financial crisis that left it bankrupt shortly before the pandemic and was on target to pay off its debts and even make money before corona. Now, Rotstein fears it will spiral backward.“There is no Israel without Jerusalem, and there is no Jerusalem without Hadassah,” he cautioned.The head of Shaare Zedek, Prof. Ofer Merin, has complained of budgetary challenges resulting from the crisis too, as well as budgetary inequalities between government-funded hospitals like Hadassah and public-private medical centers like Shaare Zedek.Will the winter be worse? Do Jerusalem’s hospitals fear a third wave?“We’ll see what happens as things start opening back up,” Kirshenbom said. “We are worried, yes. You give a finger and people take a hand,” she said of the exit strategy. “This is Israeli culture.”But Kirshenbom noted that if there is another surge in patients, Jerusalem’s medical teams will be ready to serve.“I can tell you wholeheartedly that we are doing everything we can.”
