Annals of Internal Medicine
Healing the Enemy: The Personal Narrative of an Israeli Surgeon
T he Syrian patient lying in front of me was near the
age of my eldest daughter. He was actually quite a
handsome young man, although this was not evident
when I rst laid eyes on him. Shrapnel had ripped a
gaping hole in the right side of his face, and he had a
fractured mandible. A bullet had entered the left side
of his larynx, shattering his thyroid cartilage and perfo-
rating his pharynx, nally exiting the right posterior
neck and leaving an oozing crater through which I
could easily feel the fragments of what I thought was
the transverse process of C6.
This young man was one of the lucky ones in a
conict that has been raging just beyond our borders
for more than 3 years now and has claimed the lives of
190,000 people. The hospital in which I work in north-
ern Israel has treated more than 350 wounded Syrians
since the beginning of the hostilities. Sounds of the war
can clearly be heard from our side of the border, and
the occasional stray shell falls in Israel. Who can say
how this will end?
His name is John Doe, aged 20, and I would not
publish his real name even if I knew it. Doing so would
not only breach patient condentiality but might also
endanger him in the future. For many of these patients,
although they might tell us their names, we understand
that their presence in Israel is considered treasonous in
Syria. Receiving treatment in Israel not only violates
Syrian laws, but survivors also violate social mores by
returning to their homes after collaborating with the
enemy, Israel. Thus, although I remember their faces
and medical stories, I am not privileged to be able to
contact them in the future to follow up on their recovery
or treatment as I would be with most patients.
John Doe's medical condition is both miraculous
and serious, which is almost always the case for our
Syrian patients. Remarkably, all major blood vessels on
both sides of his neck had been spared and he had
survived his wounds. After surgery, he spent a few days
in the ICU for recovery, after which he was transferred
to room 10 in the surgical department at the end of the
corridor. The three rooms at that end of the ward are all
large rooms, and they are currently occupied exclu-
sively by Syrians. In fact, more than one third of all pa-
tients hospitalized in the surgical department today are
Syrian. Making my rounds in one of the hospital's mini-
enclaves of Syria is not an unpleasant experience, be-
cause these patients are often polite and well-behaved.
In contrast to what one might expect, I have not expe-
rienced any hint of conict or trouble with them since I
began treating them in early 2013.
As an ENT surgeon, my schedule can sometimes
be hectic with unexpected emergency operations. Fri-
day night is when I hope to be disturbed the least, but
still I drove willingly to the hospital when I received the
telephone call about John Doe from Syria. As health
practitioners, our team learns from and is challenged
by the wounded Syrians and their care is an invaluable
opportunity to hone our medical skills. Unfortunately, I
ON BEING A DOCTOR
cannot say that there was an absence of grumbling and
complaining in the OR that night. We all see enough
emergency surgeries as it is, and some believe that car-
ing for these wounded Syrians compromises the care of
our own regional population. Others fear that we are
enabling them to return to ght in a conict that might
eventually end up turning against Israel.
When I walked into the hospital that Friday night, I
passed no worried family in the waiting area as I rushed
to the OR. I asked myself whether we treat them any
differently because we are less accountable. There will
be no heartbroken family to whom we break the bad
news if things do not go as planned. There is no threat
of a lawsuit. In a way, this unfortunate reality is liberat-
ing. Perhaps such a lack of accountability is similar to
how physicians practiced medicine decades ago. My
answer to my own question is that we are no less ded-
icated to their care than we are to those we care for
throughout the year from our own region in Israel. I
cannot explain this; it is just what we do.
It is a strange world I live in, both from my own
perspective as a Jewish Israeli who made aliyah when I
was only 12 years old and from the point of view of
other health care providers with whom I work. I have
two doctors on my team who studied medicine in Da-
mascus. Both men are of Druse origin from the Golan
Heights, and their families were Syrian citizens before
1967, long before these doctors were born. The Druse
of the Golan Heights are permanent residents of Israel,
but some have maintained ties with citizens of Syria.
The politics are complex, but my colleagues are not
political people. They are doctors caring for patients,
regardless of ethnicity, origin, religion, and all other so-
cially constructed barriers.
How do they feel about unexpectedly becoming
responsible for the care of these Syrian patients, many
of whom are injured in erce combat? If my colleagues
still have family in Syria, are the Syrian patients on the
side of their family members in the present conict? I
do not know the answers to any of my questions. I do
know that my doctors just get on with their jobs without
complaint, and we do not discuss it. This is how I, and
many of us, survive in such a troubled land.
All of my life, I have been told that Syrians, not
unlike those whose lives I am now saving, are my ene-
mies. They live in an enemy state that I am not allowed
to visit as an Israeli. Their grandfathers were possibly
among those who tried to divert the Jordan River head-
waters to deprive the young state of Israel of water. But
are we not all simply victims of our circumstances?
When John Doe rst arrived at the hospital after
being transported by the Israeli Defense Forces from
See also:
Celebrating the ACP Centennial: From the Annals
Archive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
2015 American College of Physicians 389
ON BEING A DOCTOR Healing the Enemy

the border, I feared that he would die within a few days. possible that, through our unplanned and unnatural
Then, like a proud father, I watched him stroll up and relationship, we are laying the foundations for future
down the corridor in the surgical department. Is it con- peace?
ceivable that he might return to his homeland and
sometime in the future nd himself aiming a deadly Peter Gilbey, MD
weapon at me, one of my colleagues, or my loved Galilee, Bar-Ilan University, and Ziv Medical Center
ones? Would he not remember our kindness and inten- Safed, Israel
tionally divert his aim even if, for the sake of his com-
rades, he had to pretend that he still hated us? What Savannah E. Spivey, BA
does he really feel about us? What indoctrination has University of Georgia
Athens, Georgia
he been subject to, and how irreversible is it?
If I have learned one thing from this experience, it
Requests for Single Reprints: Peter Gilbey, MD, Ziv Medical
is that we do not have to be enemies just because we
Center, Rambam Street, Safed 13100, Israel; e-mail, peter.g
have been told to do so. This might be naive, but could @ziv.health.gov.il.
this resource-rich treatment of Syrians in our hospitals
not be a bridge between our countries? Is it not Ann Intern Med. 2015;162:389-390.

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390 Annals of Internal Medicine Vol. 162 No. 5 3 March 2015 www.annals.org
Copyright American College of Physicians 2015.