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Saturday, Nov 22, 2008
Young women working as medics in Jerusalem divide their lives between bloody mayhem and the rituals of adolescence.
Jun 7, 2002 | Jerusalem medic Shira Bitansky struggles to describe the first time she responded to the scene of a suicide bombing. Inexperience and a gush of adrenaline blurred her memory of the events, but certain images linger. She can recall the smell of burnt flesh. Bodies hastily draped with bystanders' clothing. Her hair sticky with someone else's blood.
That night last December, Shira was drinking beer with friends in a downtown pub when two explosions several blocks away sent her running into the street, wobbling atop a pair of chunky platform shoes. Within minutes, she was herding victims into ambulances, bandaging the wounded and comforting the victims of shock.
Her most vivid recollection: a policeman shoving a plastic shopping bag toward her. "Take this," he ordered. Inside, she was told, was a severed hand. She tossed it into the nearest ambulance and continued in the fray. All told, 11 people died and an estimated 180 were wounded.
That first bombing, Bitansky says, "was the most traumatic thing for me ever." She sits on a worn sofa in the basement headquarters of Magen David Adom (Israel's version of the Red Cross, "Mada" for short), wearing a uniform that looks like an oversize smock. "It was a mess, and I didn't know what was going on or where the bombs went off. I wasn't in uniform, and everyone was yelling at me to go away because I look young."
Bitansky, a Jerusalem native, is young indeed -- just 18 -- and one of 21 young women, most not yet out of their teens, who work here as full-time medics in lieu of their compulsory two-year military draft. As members of Sherut Leumi (National Service), a civil-service program for girls, they were given the option to volunteer in day-care centers, special schools or nursing homes. Instead they chose one of the grisliest jobs short of combat. Jerusalem has always been the epicenter of terrorism, and a Mada trainee here does not remain a novice for long.
"I knew what I was getting myself into. I wasn't intimidated," Bitansky says. Inspired by high school biology courses and syndicated episodes of "ER" (George Clooney made her swoon), she first cruised in the back of a Mada ambulance as a 15-year-old volunteer. These days, she sits up front, often second in command after the driver. "Truth is, I knew I'd have more work," she says. "There's something very addictive about it. It's a rush. You're saving lives. It's not like sitting in an office and typing things up like I might've been doing in the army."
The initial trauma of her first pigua (Hebrew for "attack") -- a double suicide bombing coupled with a car bomb -- lasted about two days. Six months and several attacks later, Bitansky is dry-eyed and matter-of-fact about her duties. It is that first moment, when a rookie disembarks from an ambulance into bloody chaos, that often serves as a litmus test of the trainee's nerves, she says. Some are overcome by the carnage -- whether it's from a bombing, a shooting or one of Jerusalem's 20 car accidents per day (in this country, automobiles claim more lives than terrorists) -- and succumb to shock right there. Some quit the same day. But according to the girls, the majority are quick to develop an immunity to death and destruction. Without it, they say, they couldn't do their job.
"As soon as you get [to a pigua], you see arms, you see legs, you see pieces of human beings all over the place," says medic Ilana Steinberger, 19, who volunteered her first year of national service in the surgery ward of Jerusalem's Hadassa Ein Kerem Hospital. "People are going nuts. They've got body parts in their hair.
"One man I saw was screaming at the top of his lungs. He'd lost his whole hand," she continues. "Every time I go I always think, how could a human being do this? You get there and just can't comprehend it. But two seconds later you have to click out of it and go to work, and that's it. The emotions have to come afterward."
Medics are forced to make a series of critical choices under duress: Do they rush in despite the threat of multiple bombs? If it's a case of a terrorist on a shooting spree, has the shooter been, to borrow a term from Israeli police, neutralized? In such scenarios, Mada procedure calls for all personnel to don helmets and flak jackets, but in the ensuing madness, many forgo the cumbersome accessories -- and personal safety -- to evacuate the wounded.
To avoid overlap, an ambulance crew of two to four attempts to stay together as they work a scene, combing a triangular area with a primary goal: to scoop up the patients and run. In the first sweep, training dictates that they must not stop to perform CPR -- or any other treatment that is at all time-consuming -- on a victim who's stopped breathing if there are others, badly wounded but still alive, who can be saved. In extreme cases, those who could've been saved must die.
"That's one of the things that really bothers me," Bitansky says. "But you have to continue, you have to keep moving, because you could save someone else instead of focusing on this one guy that may already be dead because you don't know what's wrong with him."
If a victim is bleeding heavily -- from a half-severed arm, for instance -- medics must judge whether a tourniquet is necessary. The procedure puts the entire limb at risk of amputation (after 20 minutes the constriction causes cells to deteriorate), but doing so may save the patient's life. If a tourniquet is applied, the exact time the final knot was tied must be written somewhere on the person's body, usually the forehead. If a marker isn't available, medics scrawl it in blood.
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