Almost Too Tragic to Be True

Dr. David Appelbaum, who since immigrating from Cleveland in 1981 saved thousands of lives as an emergency medicine specialist, was killed at Cafe Hillel with his daughter, on the eve of her wedding.

Chanan Sand visited his new apartment in the Rehavia neighborhood of Jerusalem at least four times this past week to make sure everything was just right for the day he would move in with the woman he was planning to marry Wednesday night.

But the Ikea furniture he had picked out with his fiance and the bedding she and her mother bought in America are not going to be put to use in the uninhabited apartment, which is only one of the many voids created by the deaths of Sand's fiance, 20-year-old Naava Appelbaum, and her father, Dr. David Appelbaum, 50, who were laid to rest in Jerusalem on Wednesday.

Naava and David - the American-raised head of the emergency room at Shaare Tzedek Medical Center in Jerusalem and founder of a network of emergency medical service clinics - were among the seven Israelis killed in Tuesday night's suicide bombing at Cafe Hillel on Emek Refaim Street in Jerusalem. They went out for hot drinks the night before Naava's wedding, which was supposed to take place at Kibbutz Ramat Rachel in the Jerusalem area.

David, said colleagues and acquaintances, was an intensely dedicated doctor who revolutionized the way emergency medicine is practiced in Israel and treated victims of almost every terror attack in the Jerusalem area over the last two decades. He was also described as an unusually caring, attentive and energetic man, and as a knowledgeable and committed Jewish scholar.

David's oldest daughter, Naava, followed her father's model of devotion to others, spending time with children who have cancer as part of her National Service duty. She was described as sweet and studious, fun but not frivolous. Her father recently said she was such a good daughter that she had never once given him cause to raise his voice.

The timing of their deaths seems almost too tragic to be true. A Jerusalem emergency room chief returns from New York, where he lectured at a September 11 commemorative conference on how hospitals should deal with mass casualties, and is killed in a terror attack the night of his return. A young woman goes out to a cafe with her father and is blown up nearly beyond recognition the night before her wedding.

The enormity of the double loss was reflected in the eerie wailing of the many thousands who attended the funeral Wednesday. The crying intensified every time the eulogizers refered to the wedding that was never to be. David "was supposed to stand under his daughter's chuppa," said former Ashkenazi Chief Rabbi Yisrael Meir Lau at the funeral, "and is now lying, not standing, beside her."

But the atmosphere at the shiva house a few hours after the funeral was low-key and intimate, with family and close friends - including a couple who flew in from London for the wedding - gathered in the living room and right outside the Jerusalem house. On the patio, the hubbub was created not by mourners but by the journalists crowding around pictures of the young couple and copies of the wedding invitation. The grief of the household was expressed in the traditional Jewish signs of mourning - including tearing clothes and sitting on or close to the ground - rather than in the public anguish so evident at the funeral. The eldest of David and Debra Appelbaum's six children, 24-year-old Natan, padded outside in his socks with two long gashes torn in his red-and-white checked shirt; Debra, wearing a jean skirt and colorful head scarf, brought out a low plastic stool to sit in the balmy afternoon air once most of the reporters had left.

"We're not hysterical people," said Moshe Spero, Debra's brother, "but we're very emotionally torn." Moshe, Debra and their brother Jonathan all live in Israel, along with their parents, Iris and Rabbi Shubert Spero, whose family helped found the Jewish Orthodox community in Cleveland. Shubert Spero led the Young Israel congregation in Cleveland for 32 years, preaching aliya from the pulpit and immigrating to Israel with his wife about 20 years ago. His family had earlier built a day school, yeshiva and mikva (ritual bath) in the Ohio city.

`We'll never recover'

David Appelbaum's death will have an impact on everyone who lives in the Jerusalem area, said Dr. Todd Zalut, who began working with David more than a decade ago at the Terem network of emergency clinics that David founded and directed. Since last July, Zalut - who immigrated from Chicago and lives in Efrat - has been working with David in the Shaare Tzedek emergency room, where Zalut is assistant director.

"There's no question that we'll never recover" from David's death, said Zalut. The emergency care at Shaare Tzedek and Terem "won't work at the same level as it has in the past," said Zalut, "and everybody in Jerusalem will suffer for it."

Back in the United States David's home base was Chicago, where he studied in the Skokie Yeshiva with Rabbi Aaron Soloveitchik. Dr. Larry Hirsch, who has worked with David in emergency care since moving to Israel, said he still remembers David walking around the yeshiva with a big tape recorder to tape each of the rabbi's lectures. David later moved to Cleveland, where he went to medical school and met his wife Debra, and they immigrated to Israel in 1981.

David "was the perfect synthesis between very, very high-grade medicine, and dedication to the study of Torah and being a talmid hacham [Torah scholar]," said Rabbi Meyer Fendel, associate dean at Midreshet Moriah, a girls' seminary in Jerusalem where David was teaching Jewish medical ethics.

Once David moved to Israel, he initiated at least three major improvements in the country's emergency care: treating heart attack patients before they got to the hospital, establishing and directing Terem, and bringing the American electronic patient tracking system to the Shaare Tzedek emergency room. "David revolutionized things in a lot of areas," said Hirsch. Indeed, thousands of people owe David their gratitude, Prof. Jonathan Halevy, director-general of Shaare Tzedek, said at the funeral.

Around 1980, David co-wrote an article that was published in the prestigious New England Journal of Medicine demonstrating that patients had a better chance of surviving heart attacks if they were given the clot-buster agent streptokinase before they even got to the hospital. David began equipping ambulances in Jerusalem with the medication so that paramedics could start the IV, sometimes while the patient was still lying "on the couch in the family room," said Zalut. "The faster the person gets the medication, the better the prognosis," he said, adding that Jerusalem "was really the first place in the world" to adopt the practice, which it carried out throughout the 1980s and most of the `90s. It was only five to seven years ago that a new solution - angioplasty - began replacing the clot-busting agent, said Zalut.

About a decade later, David began running emergency care clinics of his own. Hirsch remembers emergency treatment a friend of his received in Jerusalem in 1989, when there was no X-ray or lab equipment at the emergency medical center and his friend, who needed stitches, "was just bleeding onto the floor for a good half hour." But then David got American investors to help finance his project, which he called Terem, a Hebrew acronym for "immediate medical treatment." There are now four Terem clinics in Jerusalem, and one each in Ma'aleh Adumim, Modi'in and Beit Shemesh - all with a high standard of care and a cost of no more than about NIS 200, compared to a hospital emergency room's minimum cost of about NIS 500, said Hirsch, who works in the Tel Hashomer ER and on a Jerusalem ambulance.

Last month, the Shaare Tzedek emergency room stopped using a handwritten system to track its patients and became the first hospital in Israel to use a sophisticated electronic tracking system, a device commonly used in America that David applied here. "He was trying to build the department like we would have it in America, trying to bring American medicine to Israel," said Zalut. The system streamlines patient care, indicating the patients' problems, their treatment, and which doctor is taking care of them. Doctors can log on to the tracking system from different parts of the emergency department, and can also look at a board that displays the information stored in the computer network and highlights any abnormal test results in red.

Sometimes, David's loyalty and professionalism exceeded the expectations of his fellow doctors and his friends. About five years ago, the husband of a long-time friend of David's was hospitalized with liver problems. The doctors had basically given up on him, Zalut recalled, and called up the man's wife to tell her the end had come. The wife called up David - who flew with the sick man to America and arranged a liver transplant there. That man has now outlived the doctor whose quick action saved his life.

Perhaps it was David's unfailing pursuit of improvement and constant eagerness to help others that made him seem invulnerable. "Sometimes there are people who really, really earn the characterization of being invincible, immortal," said David's brother-in-law Moshe Spero, a psychologist who lives in Beit Shemesh and also works at Shaare Tzedek. "You just think they're always going to be there for you, always going to help you."

But from the moment Zalut heard about the bomb Tuesday night, he called David's cell phone to see if he was on his way to the hospital - and received no answer - it began to be clear that David was not going to be helping anyone else. Naava and her family had been busy making last-minute wedding arrangements - attaching ribbons to the place cards for 800 guests, making up the seating plan - when David decided he would "take his Navaleh out" for a late-night trip to Cafe Hillel, and then bring back some drinks for everyone who was still working on the wedding plans, said Iris Spero.

Zalut called Debra, who told him that her husband and daughter had gone to a cafe near the bomb site. Zalut started calling the Jerusalem hospitals to find out if his co-worker was among the wounded. When no one reported seeing David at a hospital, Zalut called people at the scene and asked them to see if he was at the cafe - not as a doctor this time, but as a victim. Within a few minutes, David was confirmed dead. Later that night, Naava's body was identified as well.

`The perfect grandchild'

Out of 19 grandchildren, it was Naava who was "like the perfect one," said Iris Spero, 73. "She's the child every mother hopes to have. She never caused any aggravation to her mother and father, excelled in her studies; she was beautiful, serious in everything that she undertook." Naava wanted to study genetics and maybe chemistry at the Hebrew University of Jerusalem, her grandmother said.

Naava met Chanan Sand, 19, in the Ezra religious youth group three years ago, where both were advisors. They started dating two years ago, and have barely been out of each other's company since, said Sand's longtime friend Avrumi Gross, also 19. Sand, who is from the Har Nof neighborhood of Jerusalem, chose to study at the Ateret Cohanim yeshiva in the Old City at least partly because he wanted to be near his fiance, said Gross.

Naava's liveliness and excitement transformed Sand, said Gross and Yoni Maisel, 19, another longtime friend of Sand's. "She was a very fun person," said Maisel, "very alive."

"From the minute Chanan met her, three years back, it was a different Chanan," said Gross. "More responsible, more fun, more lively. It was amazing what one person can do for another person." Sand was excited about "every little thing he bought for the apartment," said Gross. "It just was a click at first sight."

So far, Sand - whose father said he insisted on giving Naava her wedding ring in the grave - is having difficulty talking about the sudden need to replace his anticipatory joy with unheralded despair, his friends said the day of the funeral. "He's devastated," said Gross. "He will be able to talk to us, but right now he's not in a talking position." They said they came to the house of mourning "hoping he'd be here," but to no avail.

For the surviving Appelbaums, the wedding dress still hanging in Naava's closet signifies one remnant of her presence that cannot be forgotten. Naava was "an angel in life," her 22-year-old brother Yitzhak said at the funeral, "and a bride for eternity."