Reviews Personal views

Soldiering on

BMJ 2006; 333 doi: http://dx.doi.org/10.1136/bmj.333.7573.865 (Published 19 October 2006) Cite this as: BMJ 2006;333:865
  1. Ora Paltiel, associate professor (ora{at}vms.huji.ac.il)
  1. School of Public Health and Department of Haematology, Hadassah-Hebrew University Hospital, Jerusalem, Israel

    Like you, I have many personal views. But personal views are set aside during working hours, which comprise most waking hours. These views are reserved for my family and friends, around the kitchen table or in the living room. They have no place in the hospital.


    Embedded Image

    A casualty in north Israel

    Credit: JACOB SILBERBERG/AP/EMPICS

    In the department where I work personal views are irrelevant. The patients, with acute leukaemia, myeloma, lymphoma, ITP or TTP are fighting for their lives. The fight outside is beside the point. About two thirds are Jews, some native born Israelis, some refugees from Arab countries, some Holocaust survivors, and some survivors of Stalin's reign. Right now five of our inpatients are Arabs (three Palestinians from the West Bank, and two Israeli Arabs from the north of Israel). All of them felled by platelets too low or too high, white cells too immature or lymph nodes too large. Who knows if they are rooting for Olmert or Nasrallah, Hamas or Abbas? We are all rooting for the neutrophils to go up, the fever to go down, the platelet count to normalise.

    Where I work personal views are irrelevant. Who knows if they are rooting for Olmert or Nasrallah, Hamas or Abbas?

    I'd like to be able to say that all of our judgments are purely medical, but occasionally we do have to debate issues of insurance coverage, drug availability, or whether to send a patient with a borderline neutrophil count home. Perhaps he will be delayed at a checkpoint and arrive septic, or even worse, not arrive. When I lived in Canada we had similar considerations, although the issue there was snow. There we were reluctant to release a leukopenic patient for fear his/her return might be delayed by a blizzard. Climates can be political, economic or meteorological but in all cases they may affect clinical decision making.

    Five years ago, personal views were set aside when we came in to make rounds at 6 am on our patients the morning of the funeral of our colleague Dr Shmuel Gillis, originally of Sunderland. He had been shot to death the previous evening on his way home from the hospital. Although the hour was late and his daughter was celebrating her bat mizvah (12th birthday) he had run to see a Palestinian patient who, after years of infertility, had delivered a child thanks to his care. At 9 am, after examining all the patients and making sure they were safe, we went out to the hospital parking lot to hear the eulogies. Coworkers, family, friends, and patients wept in despair, Jews and Arabs alike. Although half a decade has passed, none of us has quite recovered from this loss, not the least my colleague from Beit Jalla (a Palestinian town across the valley), Shmuel's friend.

    I have lived in Israel for 14 years. During this time the region has seen peace treaties, political assassinations, intifadas, troop withdrawals and, as I write these words, a war. I can honestly say that patient care has never been compromised by these cataclysmic events. In the past few weeks both Jewish and Arab patients from the north of the country have been difficult to discharge. Arab and Jewish towns alike have been barraged by Katyusha rockets, making our hospital in Jerusalem a safe refuge, despite the food, the MRSA and ESBL.

    My own personal view is that we should be allowed to live in peace—but it seems that other people view things differently. But there is really no time for personal views. People are sick and need to be looked after.

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