Poetic License: Surgeon, Oncologist (And Poet) Treats Victims of Sexual Abuse

Dr. Sagit Arbel-Alon has just published her first book of poetry.

“You have everything / beautiful blue eyes / kind face / husband / home / fine dishware / respected profession / family, touch wood / people who love what you are / lavishing.”

This is the opening poem in the newly published, debut collection by Sagit Arbel-Alon, “Out, Standing” ‏(Carmel, in Hebrew‏). Arbel-Alon has everything she mentions in that list. She’s an obstetrician and oncological gynecologist, and director of the multidisciplinary Bat Ami Center for Victims of Sexual Abuse − which she also founded − at Hadassah Medical Center in Jerusalem. She also does volunteer work for Doctors Without Borders. The daughter of Supreme Court Justice Edna Arbel and Uri Arbel (a retired Israel Defense Forces career officer), she shares her elegant home in Reut with her husband of many years, Eyal Alon, an aeronautical engineer whom she met while serving in the army. The couple has four children and an abundance of friends. Also, Arbel-Alon is a superb cook.

There is also something else, which paints this perfect picture in different shades. The last item she notes at the end of her list is “a hole in the gut / from which to write / poetry.” That “hole in the gut,” from which such beautiful writing emerges, also explains Arbel-Alon’s most outstanding quality: an infinite ability to contain the suffering of the entire world, stemming from an extraordinary capacity for empathy and compassion. Moreover, this woman with the blue eyes and the pleasant face always feels herself to be “outside the circle” − the literal title of her book in Hebrew.

Arbel-Alon is one of those rare physicians whose diagnostic prowess and ability to give the cancer patients she treats the worst possible news, or to heal the wounds of a baby girl who has been sexually assaulted, has not yet covered her heart with a crust of insensitivity, as happens with many experienced doctors. In her case, the opposite process is at work: the human suffering she encounters at every step of her professional life heightens her capacity to feel, and to distill her feelings into moving poetry. For her writing, in 2009 she was the recipient of the Life’s Verse literary prize (in memory of Prof. Ofer Lider), awarded by the Weizmann Institute of Science.

“People say I am a double agent, both a physician and a poet,” she notes.
Now her first collection of poetry has been published, with the generous assistance of her teacher and friend, the poet Agi Mishol. The book also has a blurb by writer Zeruya Shalev: “In precise language, and with rare emotional power, sensitivity and compassion, the direct poems of Sagit Arbel-Alon tell about moments of grace and closeness in a world filled with pain, about brief encounters and about partings without end, about love that has no home and home that has no love.”

“Poetry is the first language I learned,” Arbel-Alon says. “It was my great fortune that this was the language in which my mother spoke to me. My mother read me poetry, not stories, and that is also the first language in which I spoke to my children.” When she was young, her family knew she loved poetry, she adds, and her room was adorned with poems she cut out and pasted on the walls.

"As a girl and adolescent, books were truly my best friends,” she relates. “Maybe that is why I identify so closely with the writing of Judith Katzir, with her literary friendship with the characters in her books. Beyond that, her vulnerability seems to resemble mine. But it’s a vulnerability I also discern in many other places.”

Arbel-Alon notes that she has “gone to the most bizarre places imaginable in order to try to diagnose cervical diseases early. Wherever there is cervical cancer, someone did not arrive in time − either the woman or the physician ... My youngest daughter, Michal, told me [before Sagit set off for a cervical clinic in Cuzco, Peru]: ‘I really expect you to teach me a few words in Quechuan and that you will connect with the female shamans.’ When I got back from Peru, she asked me what I had learned. I told her I learned how to say ‘lower your pants’ and ‘spread your legs.’

“This year I was in South Sudan. I went with two physician colleagues to treat patients who have a mysterious ailment called ‘nodding disease.’ It’s a type of epilepsy in children. We went to South Sudan to conduct a genetic study of the disease. We slept in indescribable conditions and we met wonderful people.”
As a teenager Arbel-Alon was a volunteer with the Magen David Adom rescue service, but had her heart set on studying literature. She was a teacher-officer in the army. After undergoing a vocational analysis, and in the wake of a heart attack her father suffered, she realized that medicine was her calling.

She met her husband on a train journey during her military service. It took some time for them to become a couple, but that chance meeting left her determined that the tall, good-looking air force officer would become her husband. They married even before she began medical school at Ben-Gurion University of the Negev. He was working at Rafael, the arms development authority, and lived in the Galilee town of Carmiel; she shared an apartment with other students in Be’er Sheva.
Afterward, they moved to the Hatzerim Air Force Base, where Eyal served. Their son Yoav was born in her second year of med school; a second son, Dor, when she was in her sixth year; Yuval, a daughter, when she was an intern; and Michal came into the world when she was already a practicing physician and the family lived in Reut. “I loved med school, I enjoyed every minute,” she recalls.

The inner self

After completing her studies she decided to specialize in gynecology. “I gave a lot of thought to my area of specialization. But the realm of women’s medicine has everything: surgery, endocrinology and internal medicine. It’s complex and interesting,” she explains. “That is the intellectual answer to the question of why I chose gynecology. The ‘inner’ answer is that it was the golden opportunity of my life to ‘make friends’ with the woman within me, because even though I was already the mother of three children, I didn’t yet know she was there. You know, this is the first time I have spoken about that aloud.”

What is the meaning of that friendship?

“I think it is a great gift to be a woman, to see things more wholely and more softly, the connection between inner and outer, the boundary between clear and unclear.

Of all the things I would give to my beloved Eyal, I would not give him the gift of being a woman.”

What was it like before you befriended the woman within you?

“I don’t really want to remember, but I think I was unable to come to terms with women’s distinct sides. I was partly a tomboy, with a need to lead. Not in the sense that I feel today, when it comes from a place of quality and empowerment, but to lead from a place of power, which is something else entirely. I think I totally ignored the feminine parts in me. I was amazed when someone told me − I was already 30 at the time − that I am a sensual woman. I was completely unaware of that; I was unable to come to terms with those elements.”

After doing a residency at Wolfson Medical Center, Holon, she and the family − which then consisted of three children − went to Rome, where Arbel-Alon specialized in oncological gynecology at Umberto I Hospital. Some of the loveliest poems in her book evoke this period, among them “Rome” − a work of passion which reveals the process of discovering her sensuality as she experienced it: “I cannot remember where, if at all / You kissed me and from what covering / We tried to part / Nor the words / That accompanied your fingers / In whispered Italian ...”

For whom was that poem written? Whom are all the poems of love and parting in the book addressed to?

“My answer is that it is a mistake to read my poems from an autobiographical perspective. My poems are written from a place that is not biographical, from that hole in the gut I talked about.”

What is that hole made of?

“I think it derives from something that all poets have in common. I refer to the kind of loneliness you feel even when you are surrounded by people. The ability to walk on the seashore when it is packed with people and feel alone in the world. It’s the ability to be within a scene and look at it from the outside. But it is also the same sensitivity that prompts you to look at the other’s suffering.

“When people say I am a double agent, I take it to mean the sensitivity that enables me to identify with the suffering, but also to isolate elements within it and look at them from the outside. That first poem, like many of the poems, spoke itself, and when I looked at it afterward I said, ‘Wow, that hole in the gut.’ It’s the same situation in which you wake up and smile for no reason or are sad for no reason. That’s the place from which the poems are generated, the non-biographical place.

“So I am very amused when people try to read my biography into the poems. I am capable of imagining. I am capable of writing to lovers who are imaginary to more or less of a degree, and of taking a tiny glimpse and making something big out of it, but the spectrum of feelings is all mine. I can’t attach it to an image, apart from the image of a very close friend I had who disappeared from my life. It is the parting from him and the pain of that which appears in my poems and disappears, only to reappear again.”

Who was that friend?

“A very, very good friend with whom I had a dialogue of the kind that, if you are lucky, you have once in a lifetime − someone very close to me. I was 20 when I met him. I didn’t have a romantic relationship with him, but I experienced a very great love. Then, after 11 years in which we were extremely close friends and raised children together, he went out of my life without a word of explanation, and the parting from him − which was forced on me and for which he gave no explanation − is a wound that is constantly with me. The strongest element in life is how we grow from a wound. For some reason, I understood at a very young age that life is very, very short.

“I’ve had my share of dramatic events around me, such as my mother being shot when I was five. Well, she wasn’t necessarily the target, but she was hit by a bullet in the leg. She was pregnant with my sister at the time. But from the age of zero I have lived as though there is no tomorrow. On the one hand, life is so short, yet it also must be very meaningful. It’s as though I have an inner imperative. In one poem I write about traveling with a physician and being told about some disaster that happened, and he becomes very introverted while I command life to continue. I see this as a very potent insight that I received at home. I look at my daughter, who tells me, ‘You get up in the morning to face all the difficulties with joy.’ I feel that fusion very strongly inside me. That is what leads me to be in the wound, to scratch in it, but to grow within it all the time [through my writing]. It’s not something I wrote out of awareness. When I look at the book in retrospect, it is only then I understand that this is what I wrote.”

Do you remember having that feeling as a girl, too?

“Of course. What did I connect to when I read poetry? To that solitude and grief. That is where I am, in those places. I think many people flee from sadness. [Journalist and writer] Yigal Sarna wrote that I am an expert in many types of suffering, and he is right. I have the ability to contain pain, suffering and terminality.

Where people take fright and move away − that is where I am. That leads me to occupy myself with cancer, with sexual assault and to go to the ends of the earth in order to deal with suffering that people flinch from.

“As for the loneliness, I can say that in the past I experienced it abysmally. It was a yawning abyss. It comes because you do not feel completely understood. Even though there are people who understand you around you, subjectively you feel you are not completely understood. Once I told my parents, who accompanied me to the operating room, that even at the moments of greatest happiness you are alone, because only you can contain that happiness. I have wonderful parents and amazing sisters, but still I feel alone.”

Affair with poetry

Arbel-Alon started to write poetry quite young, but “the first poem I dared to show others” was written when she was 18, after a good friend of her father’s was killed. Her affair with poetry was broken off for the six years in which she and her family lived in Rome, next to a vast park, Villa Ada. Yet in that stunning setting, she suddenly felt she was no longer capable of writing. “I grasped that poetry, which had been part of me ever since I can remember, was not available to me. I understood that I was blocked. I returned to Israel and went to a bibliotherapy workshop to release it.”

Back in Israel, she was appointed a physician at Hadassah University Hospital, Ein Karem, and the family built their house in Reut. Others might have made do with a very full career in oncological gynecological surgery, together with being a wife and mother and writing poems in their spare time. But Arbel-Alon was simply incapable of resting. She cast her net even farther and became a volunteer with Doctors Without Borders, which involved going to remote places to provide medical aid.

The feeling that haunts her − that life is long but time is short − is given ironic expression in her poem “Wisdom.” “There is so much that is wise in this poem,” the iconic poet Haim Gouri remarked after reading it.

Arbel-Alon writes: “I read ‏(somewhere‏) that it’s important to live each day as though it’s the last of my life / So I got up early and left / For work, went shopping, / Folded laundry / Emptied a dishwasher / Collected feelings for a poem / Sliced a salad for dinner / Showered, told another / Bedtime story / Said good night, gave a kiss.”

As a physician, she is sometimes called upon to tell a patient that time is short − “though I never tell them how much time they have. I don’t decide for them what to do. I listen, provide information, always let them decide for themselves.” She adds, “I asked myself what I would do if I learned that I had a very short time left to live − weeks or months. The conclusion I reached, which I also expressed in a poem, is that I would go on living my regular life.”

Six years ago, Arbel-Alon decided “with other doctors” to establish the Bat Ami Center ‏(the name is from the motto of the Hadassah Medical Organization, which comes from Jeremiah 8:22‏) to treat victims of sexual assault.

“It is an acute center,” she says. “The first center, which was established in Wolfson, in 2000, was also the first to place the victim at the center. As soon as the Wolfson unit was established, a team here mobilized and did the same thing on a volunteer basis for years, until the center was created thanks to a small subsidy from the Health Ministry and from donations. The staff consists of social workers, physicians − gynecologists and pediatricians − and nurses who have specialized in this field. We also bring in the police.

“In the center at Hadassah we encounter the greatest pain: Sexual assault is really the backyard of our society. No one wants to hear about it. The statistics say that one of every four women has undergone sexual assault − and I am not talking about sexual harassment, I am talking about real sexual assault, in which violence is used to force sexual contact. It is very frequent, yet it is not talked about and no questions are asked about it.

“The staff at our center is in the process of changing procedures. One example is the matter of questioning. I ask every woman who comes to my gynecological clinic or whom I treat in the hospital ward or via Doctors Without Borders whether she has undergone sexual assault. It used to be that no one was asked that. It’s like a button that was waiting to be pressed. They spill out the pain they have carried without anyone asking or knowing [about it]. So many women are waiting for someone to offer them a hand. I say women, because I am a women’s doctor. It’s not that there aren’t men. We are now spearheading a procedure in which every woman who enters a hospital will be asked [about abuse]. We are trying to break a conspiracy of silence. If the conspiracy is broken, there will be fewer attacks. It’s the secrecy that empowers the assailants.”

Who treats the men?

“If we need to treat an anal injury we bring in surgeons, but in other cases the same team that treats women treats men. I do not allow gender discrimination, not even in this area. The whole hospital has mobilized in support of the center. Just think that Hadassah, which is having a hard time surviving [financially], is maintaining a center that brings in no profit and offers only mercy. When people rail against the private medical service in Hadassah, they should remember that it has units that do not exist in any other hospital in Jerusalem.”

What have you learned from your work in the center?

“First of all, to bear witness. Not to judge but to listen with an open heart to a story which might sound hallucinatory. It is easier not to believe, so as not to take in all the evil in the world. On each occasion I think I have heard the most complex and shocking story possible, but there are always new surprises in terms of the complexity of the stories and the human evil that erupts.

“Sexual assault shocks people viscerally, because it is not a decree of fate − it stems from human evil. You can stand by a teenager, a girl, a woman, a man, a boy only if you are there with all your heart, only if you are able to listen and see the dark and the hurt. Beyond which there are professional steps to be taken, such as collecting forensic evidence and preventing pregnancy or sexual diseases. We solve many cases by means of DNA testing. I specialized in physical cancer, but I’ve spent a lot of time dealing with human cancer − social cancer created by the human species.”

And when you get home, are you constantly afraid for your daughters?

“To begin with, I am not an anxious person, thank God, and I am not one of those who sits around fretting, but I definitely hear myself saying, “Be careful of alcohol,” which is a catalyst in these cases. I probably give more warnings than an average mother.

“Sometimes I don’t sleep nights. I treated a girl who was raped by her father. A young girl with gorgeous curls, like my daughter, and full of life. She reminded me very much of my daughter. She was 12. We asked her if there had been ejaculation. She said, ‘He spilled into my hand. Ugh, it was disgusting.’ I didn’t sleep nights for half a year. I dreamed about that girl for half a year. The poem in the book about the man who is driven by force is about that man.

“The treatment of the mental aspect [of sexual assault], the post-trauma, never finds expression in the health systems. There is no support for secondary trauma. We have no funding for it. Between a quarter and a third of those who come to us are children. The youngest girl I treated at the center was a year and three months old, with a vaginal tear. Together with one of the younger doctors I had to stitch her vagina, and I just didn’t stop crying. I felt as though the blood had drained from my face. The oldest patient who came to the center was a woman of 95. I wasn’t the one who treated her.”

Was she raped in an old-age home?

“Apparently. We don’t know about most of the cases. If only 200 cases a year come to Bat Ami, and one of four women is assaulted, the main problem is the curtain of silence, and that is what we are trying to fight.”

Do you get many men and boys?

“There are some men. They come from the whole social spectrum. There are more youths and boys. We used to be concerned that people from various communities wouldn’t come [to the clinic], but we have patients from the ultra-Orthodox community and the Arab community. They rely on us to be discreet. There was one Haredi man, married and the father of three children, who was so afraid of his milieu that he put his wife to bed first [before coming to the clinic]. In the case of men, we have a male social worker − the amazing Ido. I told the Haredi man that a woman was on duty that night, although maybe he preferred a man, but he agreed to let me examine him, because the most important thing for him was to get home before 5 A.M., before his wife woke up. So you realize that people understand that there is someone [here] who manages things, and that makes for a strong social and human statement.”

Do you understand the urge to attack?

“It is an urge to violence. What is the urge to violence and control? That is too big a subject for me to explain. What’s most important for me when a victim arrives is to give her back control, for things to proceed at her pace. To decide who will talk to her and who will not talk to her. We are obliged to report [what happened], but first of all it is she who decides whom she will talk to, and when.”

That’s where you and your mother, the Supreme Court justice, are alike. You both encounter so many types of human evil.

“I think that what’s alike is a refusal to accept the evil. I don’t want to be the manager of anything − what’s important is to spearhead change.”

Next week, Arbel-Alon will go to Harvard for a course in medical leadership. “The ability to foment processes that change reality, that is where my interest lies,” she explains. “Maybe I will also be able to raise funds for the Bat Ami Center.”

Unusual military response

Last month, Haaretz published Arbel-Alon’s poem “Doctors Without Borders” in the original Hebrew and in English translation by Vivian Eden. The poem is dedicated to Dr. Yousuf Shatat, from Hebron. Its title is the savagely ironic opposite of what it describes. The poem prompted a large number of responses on the Hebrew website, many of them very emotional. Arbel-Alon received hundreds of letters, most of them identifying with what she wrote.

The poem is about a doctor who tries with all his might to get through roadblocks manned by “those you see / [as] the occupiers / ‏(Among them my sons − perhaps − who were raised to good deeds‏),” in order to save his daughter, who has been injured in an accident. “Your voice is still steady as you try to persuade / The commander / The officer / That she’s just a child / That you’re just a doctor / Her father / Who can’t stop the hemorrhage. / A muezzin’s howl bursts from your chest / And two chairs away from you / I too renew the vow.”

The poem actually relates a true and horrific story, based on an incident Arbel-Alon encountered as a member of the Narrative Project of the Palestinian-Israeli Bereaved Families for Peace forum. “In that framework,” she explains, “we met with a group of Palestinian doctors. One of them told the story of his 12-year-old daughter, who was injured, not by our forces but in a road accident. He got the news while in the intensive care unit in Hebron, but he was not allowed to dispatch an ambulance and the girl died of her injuries. I received hundreds of letters and messages, and I have been tormenting myself for three weeks for not yet having replied to them.”

The most moving response was from the ultra-elite army unit in which her son, Dor, is serving. “I was already editing one of the last drafts of the [poetry] book, and Dor told me that he wanted to take a copy with him to the unit. He told me they were lying in their tent, the tough fighters of the elite unit, and reading poetry. On the Friday on which the poem that caused such a stir was published in Haaretz, I came to pick him up at the entrance to the base. The soldiers came over to tell me how lovely the book is, and how moving. I felt like I was in seventh heaven. Daring fighters telling me this about a book of poems. When we got home, I opened the duffle bag to take out the dirty laundry and saw the draft of the book amid the uniform.”

For my part, I think the most heartbreaking poem is the one that gives the book its title, “Out, Standing”:

You are not made of the stuff of
The most popular girl in the class
And it’s not that you’re not funny or witty
Also good-hearted, a looker
And pleasant

And when you enter the hall first
You hug
In case no one sits
Next to you

Clinging to the wall
Guarding against barbs of abuse
That stick in “Stop being
right all the time”
They love you
Even if you haven’t yet learned how to spot
All the signs ...

And when your eyes fill up
And you examine the starkness of your loneliness
So old and familiar

I pull out a promise from the deja-vu archive:
When you are older
You will choose the class yourself.

Arbel-Alon: “There’s an argument in our family about whom the poem was written: my older daughter or the younger one. I am letting the argument run on, but the truth is that it’s about me, though every woman who writes to me says it’s about her.”

And did you get to choose the class?

“Yes, and I continue to choose every day. The moment I stop being moved and rejoicing in what I do, and in myself as the one doing it, I will go and look for another class.”

Tomer Appelbaum