Double Exposure

Elisha Waldman, 2014 BLR Nonfiction Prize Honorable Mention

In the midst of the latest outbreak of hostilities between Israel and Gaza, the Department of Pediatric Oncology at our hospital in Jerusalem feels haunted. Not, as one might think, by the ghosts of former patients, but rather by the living, who walk the halls as if uncertain of their place in this shifting world. On the first day of the ground incursion I examine a patient of mine, a sixteen year-old boy from East Jerusalem with a massive bone tumor in his shoulder, which is growing larger despite therapy. Perched on the edge of the exam table, he pulls off his shirt as I stand in front of him. Just below the base of his throat hangs a gold medallion in the shape of what some would call “greater Israel” and some would call “Palestine” covered in stripes in the colors of the Palestinian flag.

I try to focus on the huge, misshapen tumor protruding from his shoulder, clearly progressing since I last saw him. But the medallion, a glimmering statement of more extreme Palestinian aspirations, leaves me disconcerted. The more I try to ignore it, to not think about its inherent message, the more I am distracted by it. I gently probe the tumor with my fingertips, judging its growth, silently guessing at how much longer this young man has to live. He looks down, only once briefly looking up at me, pained eyes in a gray, emaciated face. What can he be thinking? Out there he is a young Palestinian, struggling with his people’s aspirations. In here, he is dying. Is his glance a question, pleading for help? Is it suspicion and anger at my failure to provide a successful treatment? Or is it complicity, understanding – a look that says that I understand you are trying, and I understand I am dying, and that despite our mutual struggle we both know where this will end? I am not sure I want to know the answer.

As it is, the world as experienced through the lens of pediatric oncology can at times seem as unreal as a fever-addled dream. Now, with the Middle East once again convulsing with violence, we, the staff, patients, and families at the hospital, find ourselves trapped between unreal worlds. Like images on film that has been double exposed, the denizens of our department register as multiple, simultaneous forms, images nearly identical yet oddly shifted, each blurring into the other, and it is not clear which reality needs to be addressed more urgently.

I look again at the tumor and ask about pain medications, trying to focus on the things I can control. But inside I am sick and angry. I ridicule myself for behaving as though the sum total of his problems can be solved with a few pills of morphine.

Outside the room, I run into Sara and her mother. Sara is a one year-old girl with a recently diagnosed brain tumor. She also happens to live in an Israeli town just two kilometers from Gaza that has borne the brunt of many rocket and mortar attacks over the past several years. I remember a conversation not long after her daughter’s initial diagnosis, the mother crying: is it not bad enough to raise a child under constant fear of rocket fire, that now one has to raise her fighting cancer at the same time? As I pass Sara in the hall I tickle her, eliciting the usual squeal.

How’s everything? I ask her mother. My casual question feels more loaded than usual. Is it a generic “how’s it going?”, the sort of question we all ask hundreds of times a day expecting only a ritual “fine” in return? Am I asking as a doctor — do I mean how is Sara since her last treatment? Or do I mean how are things on the edge of the fighting, how is it now that you sleep in the shelter with the sounds of rocket fire just across the fields? She whispers, “okay”, but her bloodshot eyes appear to be answering many impossible questions at once.

Later the same day I am doing medical rounds with my team when my phone rings. It is my commanding officer in the reserves: he tells me to go home and organize my gear, as we will surely be called up if the conflict spreads. I hang up and return to rounds, but now my mind is racing. I try to focus on the resident presenting the patient at hand: overnight vital signs, relevant lab values, major changes. I try to lead a discussion, make a few teaching points, develop a plan for the day. But a part of my mind has already fled the scene, trying to remember where I left my army kitbag, if my boots are with it, whether I have enough clean socks? As a relatively new immigrant, this is my first potential call-up to active duty. As I check chemotherapy orders I wonder, what does one pack for a war?

Despite the serious nature of our work, our department is generally a place that teems with life: pediatric oncology enjoys an overall survival rate of roughly eighty percent. An effort is made to support of kid-friendly atmosphere, with clowns, arts-and-crafts, music, video games. This is especially important given the diverse mix of patients and staff in Jerusalem, representing virtually all segments if Israeli and Palestinian society. But these days that atmosphere amounts to no more than a thin veneer barely masking the underlying turbulence. Now, in every patient room, in every treatment area, the television screens continuously show images of airstrikes on Gaza and rockets falling on Israeli towns. At the front desk, the radio runs constantly, as the secretary—forcing a smile—arranges a patient’s next appointment. All the while she remains glued to the radio, distraught about her husband who was summoned from bed at three in the morning, unable to tell her exactly to where he was going or when he would return.

Two days later I hear that the doctor with a particular infantry unit has been killed in the fighting. I am stunned: he is a close friend from officer training school. After some frantic checking I discover that it is not him, but rather another reserve medical officer with his unit who has been killed. I feel a wash of relief, quickly checked by the realization that a doctor and a soldier has been killed, a man much like myself who until only a week ago was surely running rounds in his own department before being mobilized. I realize that with a single phone call this could be me.

I move through the day in a haze; the balance between the different aspects of my life thrown off kilter. I struggle to find a way to simultaneously play so many roles at once: physician, soldier, civilian, colleague, Jew, Israeli, American, human.

And then there is Musa, a ten year-old boy from Gaza who had the great misfortune to be diagnosed with leukemia about a week before the current round of fighting began. Because he has an uncle who lives not far from Jerusalem in the West Bank, his family initially obtained a pass to leave their home in Gaza and to come to our hospital for treatment, with the thought that they could stay with the uncle after the intensive treatment. After two weeks of therapy, Musa responded well and is now at the stage where he would be discharged home to come in once or twice a week for check-ups and outpatient treatments. However, the pass he and his mother obtained specifically allows them passage only from Gaza to Jerusalem, not from the West Bank to Jerusalem. With the fighting underway they cannot return home to Gaza, nor can they go to their uncle in the West Bank.

Although Musa sits just a few miles from his uncle’s home, he is trapped in the hospital. As we round in the mornings Musa strolls the halls, smiling at everyone and giving me high-fives in passing. Like a Palestinian version of Tom Hanks’ character in The Terminal, he is trapped in an administrative limbo, only this is no movie, and there is no real humor in the situation.

My final visit of the day is to the child in the room at the end of the hall, our hospice room. It is evening, and through the picture windows at the end of the hall I can see lights twinkling in the village across the valley. I remind myself to call friends with whom I have dinner plans to let them know I’m running a bit late. I enter the room and smile, using my limited Arabic to say good evening to the father sitting at the bedside of a young Palestinian boy from a village on the outskirts of Jerusalem.

Propped up in the bed, bloated from steroids and barely responsive, he has been treated as an outpatient for some time, but now his brain tumor has become too much for his parents to bear alone, so they have brought him to the hospital for his final days.

I give the boy’s arm a squeeze and say hello, though at this point I am uncertain whether he hears me; he is already breathing the wet, slow breaths that indicate death is approaching. The nurse who would normally assist with translation is busy, so I sit at the bedside next to the father, resting a hand on his son’s arm, trying to convey in body language what I cannot in speech.

We sit in silence, listening to his son’s heavy breathing and to the soft drone of the news in Arabic coming from the television speakers above our heads. After a few moments I glance up. The television is tuned to a Palestinian station, and the images are of the damage in Gaza – buildings destroyed, children injured, parents crying. I look back down, continuing to sit in silence with the father, my hand massaging my patient’s, his son’s, swollen arm, wishing things were different.