Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, use the Radiology Reprints form at the end of this article. REVIEWS AND COMMENTARY

Recollections of a Radiology Resident at War1

䡲 EDITORIAL

Olga R. Brook, MD Rambam Health Care Campus Haifa, Israel Summer 2006

W

Published online 10.1148/radiol.2442061881 Radiology 2007; 244:329 –330 1

From the Department of Diagnostic Imaging, Rambam Medical Center, POB 9602, Haifa 31096, Israel. Received October 20, 2006; accepted January 29, 2007; final version accepted March 20. Address correspondence to the author (e-mail: [email protected] ).

Author stated no financial relationship to disclose. 姝 RSNA, 2007 Radiology: Volume 244: Number 2—August 2007

e work diligently in our hospital—the Rambam Health Care Campus in Haifa—and are used to seeing the worst medical problems in everyday practice: horrible road accidents, devastating oncologic problems, and horrific congenital problems. But nothing prepares one for war—it defies professional detachment. For me, it all started at the swimming pool. Our happy family was gathered together after my night call at work. My daughter was learning to swim, and today’s lesson was particularly successful. I was immersed in thoughts about the swimming course, sitting with her in the snack bar drinking orange juice. In the midst of my thoughts, I suddenly saw a growing crowd surrounding the TV set. Something was happening, and it wasn’t good. Everybody was dialing on cell phones. This was fruitless, as the phone lines were dead. When I finally succeeded in getting through to the fellow radiology resident on call at our hospital, he barely knew that something of importance had happened. Even though this first rocket attack was initially quite a scare for all of us, very quickly calm was restored. This response was probably because of lack of experience with such occurrences. On Sunday morning, 3 days later, I peacefully sent our children to child care and went to work as usual. Nothing told me that I would not see them for a week. At 9:30 AM, we heard the first boom. Then another. And another. I realized that this was not just a noise to be ignored. This was different. And quite close. Everybody was running. I went to the place where I needed to be—the trauma room in the emergency department— bringing with me a

portable ultrasonographic (US) unit from the radiology department. As information started to pour in, we brought in two more US units— one was clearly inadequate for the mass-casualty event that was developing in front of us. I thought about my children and husband—all of us in three different places. Cell phones went dead with the first boom, so I could not even check up on them! But I had to put aside these thoughts about my family and continue working. A rocket landed at a railway depot, instantly killing eight workers and injuring others. Within a short time of the attack, ambulances with injured civilians started to arrive. Men covered in ashes, crying for help at the emergency department—all this had to be pushed to the back of one’s mind to focus on the task at hand—US examination after US examination after US examination. We had to perform US under the most trying circumstances—in full light, with all sorts of background noise— but focused assessment with sonography for trauma (FAST) is a part of the primary assessment of trauma patients; thus, we had to do our jobs nonetheless. After attending to the first wave of injured people, we returned to the radiology department. There, everything was running like some intricate machine—patients were sent to the computed tomography (CT) suite, to the radiography room, back to the emergency department, up to the operating room, and transferred to the surgery department to make room for the next injured people to come. The head of the radiology department at our hospital and the chief technologist were conducting this orchestra, according to the severity of the patients’ injuries, availability of rooms, et cetera. It was a very complicated but critical job that ensured that everyone received proper treatment in the necessary order, without leaving a patient in an 329

EDITORIAL: Recollections of a Radiologist Resident at War

unstable condition waiting outside the CT suite doors. With one glance, I realized I was needed for a new assignment—reading conventional radiographs. Except on this day they were not so conventional: a variety of complicated fractures, shrapnel throughout the body, so many phone calls to relay yet another piece of vital information to the treating physicians, a moment before it is too late. This was a new sort of radiology— shrapnel radiology. As radiologists in a tertiary trauma center, we treat all sorts of casualties: falls from heights, road accidents, and gun and knife injuries. But shrapnel radiology is different. The rockets are packed with small metal pieces designed to inflict injury in as wide a range as possible. For depiction of all the pieces of shrapnel, conventional radiographs were usually not enough. Many patients needed to undergo totalbody CT to reveal the routes of the shrapnel as they pierced through the body. The external trauma may have been minimal, except for burns in some cases, but inside it was impossible to predict how much damage the shrapnel may have caused, even for the best diagnostician. The same metal pellet may lodge near the point of entry or penetrate the entire body, depending on how far the person was from where the “Katyusha” rocket landed. (“Katyusha” is a multiple rocket launcher that is able to deliver a devastating amount of explosives to a targeted area in a short period of time, although with low accuracy.) Attending radiologists left their usual workplaces to augment the hardest-working unit—CT. Most of the patients underwent full-body CT, which, in many cases, included CT angiography of the carotid and peripheral arteries. Two attending radiologists, one specializing in body imaging and the other in neuroradiology, sat next to the technologist at the CT console and determined the need for additional CT studies as each scan was completed. Immediately after the scanning, both radiologists worked simultaneously to facilitate the immediacy of the report.

330

This was just the beginning of the war. As the weeks went on, we passed through different stages of dealing with the situation: fright, anger, exhaustion, and joking. We even got used to the booms, planning our time so that we would not be out of the building at around 3:00 PM—Nasrallah’s time. (Hassan Nasrallah is the head of the Hezbollah organization in Lebanon.) The mood worsened when helicopters with injured soldiers started to land at the hospital’s helipad. We hardly knew when they would arrive, how many there would be, or how badly injured they would be. Even worse, at times we received a message that injured soldiers were on the way. We waited for hours for the casualties to arrive; then when nobody came, we heard news of yet another family’s grief. For me, it was especially difficult, because my brother was on active duty, as soldiers called it, abroad. It was horrible to encounter acquaintances in the emergency department. Israel is a small country, so nearly everyone knew someone who was injured. For the first time, I had to perform focused assessment with sonography for trauma on a doctor I knew. He was so badly injured that at first I could not recognize him. But when I filled in the identification for the US examination, I recognized the name. My family had to evacuate to the homes of relatives in another town once my husband and I realized that it was quite impossible to stay in a shelter with two small children. This was horrible for me to contemplate—my family had to leave, not to say flee, our home, because of bombings, but at least I knew that they were in a safe place. I slept most nights at the hospital whether I was on call or not. There were substantially fewer buses running in the city (my husband took the family car), and bombings sent me down to the shelter too often to be able to rest at home. Naturally, the regular workload was reduced; many civilians left the city, so a lot of time was spent idly waiting for the next helicopter, siren, or boom to come. Our working mode was changed

Brook

to accommodate the reality. In the morning, there were sufficient staff members available to perform promptly and thoroughly all needed radiologic work-up. At night, the on-call resident was supplemented by the attending radiologist, who stayed at the hospital the whole night to work in the CT suite, and an additional resident for US and CT. This augmented workforce was able to handle the intake from one helicopter with injured people, but when more patients than that were expected (such as when rockets landed in the city itself), then calls were made and many more attending radiologists, residents, technologists, and secretaries came from home. These frequent calls naturally caused fatigue and exhaustion among the personnel. My coping mechanism was to dive into research and study, although I was not very successful at this. It was nearly impossible to concentrate on anything besides the war. I am a chief resident, and particularly during this time, I was called on to help the other residents. Most of them needed rest, some days off from work, to have a break between such trying duties. Others needed psychological support. Another needed help with transportation. I tried my best to accommodate everyone, but it was not always possible. As soon as the cease-fire went into effect, my family came back home. My 15-month-old son called his father “mama,” as he was the main caregiver for him during the prior 5 weeks. My 5 1⁄2-year-old daughter could not get to sleep by herself. I still heard sirens and booms with every unexpected noise, but I was confident that this too would pass. This experience has reconfirmed for me that the work I do—reading radiographs and CT scans and performing US—is immensely important. Acknowledgment: I thank Ahuva Engel, MD, for her continuing support and assistance.

Radiology: Volume 244: Number 2—August 2007

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