Death of a Soldier
Sabra: Any Jew born in Israel, or before 1948, Palestine. The term alludes to a tenacious, thorny desert plant, known in English as prickly pear, with a thick skin that conceals a sweet, softer interior. The cactus is compared to Israeli Jews, who are supposedly tough on the outside, but delicate and sweet on the inside.
I had been a junior resident for a few days. For the first time in my budding career, I was the one who gave the orders and had the answers. In the training program that I had chosen, the faculty was not intimately involved in the minute to minute care that we gave our patients. We were given an awful lot of leeway, which sometimes led to mistakes being made. On the other hand, by the time I made it to junior resident I felt quite comfortable assuming a supervisory role. I knew senior residents and faculty members who would respond to my calls if I needed help. I was ready.
On a Friday evening we got a call from the Emergency “Room.” I say “room” because this institution had the third busiest emergency department in the country. There was one nurse who sat at the front door. Her only job was to ask a few questions, after which she decided, on the spot, to which side of the building that patient should head to. We had a total of fifty exam rooms, and even at four in the morning there was never an empty bed to be found. Patients were scattered in stretchers and wheelchairs over all the hallways. There was no privacy; noise and chaos were the order of every day.
I loved it. Half of these people were going to die within hours if they went without diagnosis or treatment. The pace was exhausting. It was not unusual for me to realize, at 3AM, that I had forgotten to eat all day. I had a couple of close friends, nurses in the ICU (which was located, as most ICU’s are, right above the ER) that would see me stagger in and would jump into action. A piece of burnt toast and a packet of the Jell-O that we fed patients on restricted diets would be my sustenance until dawn. A royal meal as far as I was concerned, and for dessert I always got a neck rub. I was energized.
The call came at 4AM. A young man had a fever and a sore throat. Not the kind of patient that we would be summoned for, except that his fever was at 104 degrees, and he looked ill. I told my intern and students to take a nap, that for sure I could handle this situation.
He was not just any young man. He was about five foot ten inches tall; obviously in great shape; clearly strong as an ox. He was bright and articulate. I noticed an accent. I asked him where he was from.
“I´m from Israel. What we call a sabra.”
I knew what a sabra was, since I was married to a Jewish woman in those days. Before I examined him, I bombarded him with questions. There was something about him: a supreme air of confidence; an aura that you only see in people who have been through a lot and know enough about life to take it one day at a time.
He had been a paratrooper in the Israeli Army. He had fought in two wars. During one of his jumps, 80% of his squadron had been shot by an Egyptian battery before they hit the ground. His country was grateful to him and had kept him employed after he left the military. He was very vague as to what he did: he only said that he traveled a lot.
I had to force myself to stop talking and start to examine him. I could have listened to him all night, or what was left of it. As the exam progressed, I became increasingly alarmed. When I finished palpating his abdomen, I asked a nurse to bring me a syringe and a needle. I was not going to wait for the lab to run a blood count on him: I would do it myself.
I smeared a drop of blood on a glass slide, and patiently stained it. When I placed it under the microscope, I got the answer that I feared. Millions of abnormal white blood cells were swarming the field of view. My charming, intelligent, brave new patient had a severe, and in those days incurable, form of leukemia.
One of the hardest conversations I have ever had to start. This man came to see us because he had a fever and a sore throat. I had to tell him that he was going to die; soon. I sat next to his stretcher and placed my hand over his right wrist, where the nurses had just placed an IV line.
I saw your blood. I do not have the lab result back, but I am sure that you are seriously ill.
He did not flinch. He looked at me, straight in my eyes, as if he were trying to reassure me.
“Is it leukemia?”
I nodded.
He placed his head back on the stretcher. He looked straight up at the ceiling.
“Doctor, you want to know something? All my Army training; all my jumps; even when I saw my friends get killed left and right after we left the plane… I knew that I was going to survive.”
I nodded.
“The past three weeks I have had this feeling…¨ He paused and stretched himself.
“I knew that I was going to die. I understand. I will be OK.”
I asked if there was any family with him.
“My girlfriend and another friend brought me here.”
I went out of the room; I asked a nurse to bring his friends in. Within a minute two tall, strong, strikingly elegant and beautiful women were led to me by the nurse. I introduced myself and asked them to follow me into the exam room. I repeated my diagnosis and the grim prognosis associated with it.
Again: they did not flinch. They asked me if he could be transferred to Israel. I thought that it would not be feasible. They spoke in Hebrew amongst themselves. The women left, they said to notify other friends. I drew some more blood and called the hematology resident.
I was able to get two hours of sleep. After I showered, I went to his room, now a real room with a hospital bed within the hospital. Several sabras greeted me. I wondered if there was a single person in Israel that was not bright, strong, with stunning looks. I realized that if I were ever involved in a conflict, I would want any of these people, even the women, next to me.
There were many questions. My patient went first.
“I have a son in ___ (he mentioned a South American country). Will you call this number for me?”
He handed me a piece of paper.
“I would do it myself, but my wife’s family will hang up if they hear my voice. They are immensely powerful. I cannot even go to ___ in order see my child. Ever.”
I began to put two and two together. He would not tell me what he did for a living, except that he worked for the state of Israel. He still looked like a soldier; an intimidating one. He did not have a steady home. He was banned, officially, from a certain country. It was clear that he did not work for the Israeli tourism agency.
I left the room. I had the hospital operator dial the long-distance number for me. Whoever answered hung up on me when I mentioned his name.
I walked back to his room. His girlfriend took me aside; she had a request.
“I would like to have his baby. Can we get a semen sample and freeze it?”
One of the most unusual requests I have heard. Ever.
I told her that he was receiving toxic medicine. That I had no idea how the medicine would affect his sperm. That I did not think it was a good idea. I came close to asking her if I could keep looking at her for a few hours. She smiled and patted me on the back.
The women left. I explained to my soldier about the medicine that he would receive, and its multiple side effects. Again, I got no facial expression. Just a look of gratitude.
“I like you. Thank you for being so nice to us. We do not know anyone here. You care.”
The last words I heard from him. I gathered my troops to finish rounding on our other patients. When we got back to his room, we found him unresponsive. People with leukemia have low platelet counts and are prone to bleeding. He had bled into his brain. A swift, painless, merciful end to a fearless life.
I called his girlfriend. There were no tears. She said she would make the arrangements.
Three weeks later I got a letter from her in my hospital mailbox. In perfectly even handwriting, she thanked me for everything that I did. She said that it was too bad that we had not gotten better acquainted. She signed her complete name, followed by a drawing of a small heart. The tough sabra, letting me see how delicate and sweet she was inside.
I can still see their faces when I think of them. They make me smile.
