Ayala Van Dijk is a nurse in the “Internal Medicine Outbreak A” ward at the Hadassah Medical Center in Ein Kerem, Jerusalem. That’s the formal name for what’s been dubbed “the coronavirus ward,” one of four wards that were hastily set up an old, half-abandoned wing. Exiting the ward, she removes the heavy protective gear she wears, and points to the marks it leaves left on her face: pimples, grooves in her skin, and redness. The gear also causes Van Dijk and her colleagues to experience other things all too akin to their patients’ symptoms: accelerated heartbeat, perspiration, shortness of breath and sores.
But the greatest difficulty she and the other members of the “coronavirus ward” medical staff experience is the loneliness: their own, but mainly that of their patients.
“It’s the greatest lesson of my life, and it’s a lesson about loneliness, the loneliness of the patient, of the family, of the staff members. The hardest thing is to see people suffering alone, people who have raised families all their lives and in the end they find themselves alone. And the only thing you can give them is a caress and to call them by name, so they aren’t nameless, anonymous. It is moving [for them], but it’s only a drop in the ocean of what a person needs,” Van Dijk says.
Last week the photographer Eli Atias and Bruno Lavi, the senior deputy director general of Hadassah and an amateur photographer himself, came to the coronavirus wards, documenting the medical work and the patients who agreed to be photographed for long hours.
“There was a feeling of something historic, the way you take pictures during a war,” says Lavi. “The first feeling is sadness. People come from all over the country, who were pulled out of their lives. They were fine, and suddenly they’re alone. They didn’t plan for this moment.”
They chose to take the photos in black and white. “There aren’t many colors there,” Lavi explains. Following their photographs, Haaretz met with the coronavirus teams in the hospital.
Volunteering on the coronavirus wards
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All the dozens of workers in the Hadassah coronavirus wards volunteered to be there. “I felt that I couldn’t stay home and keep quiet while a battle was taking place in the hospital, in a place where I have the knowhow and ability to contribute,” says Van Dijk, who until the pandemic outbreak worked as the head nurse in the urology department.
“Everybody working here called and said that they want to work with the coronavirus. There’s a feeling of a shared fight,” adds Dorit Oriah Shurka, head nurse at two of the coronavirus wards, whoho until a month ago was a head nurse in the emergency room and the urology department. “My children say that there’s a biological war and Mom is one of the soldiers.”
All tell about their own fears and those of their families about their work on the ward. “I don’t know if it’s a defense mechanism or a story that I tell myself, but I’m not afraid because here I know that everyone is sick and I know how to be careful, and the mission that I’m performing supersedes anything else.” But on second thought she adds, “But if, God forbid, my son catches the coronavirus, maybe I’ll think differently.”
“I’m not afraid of becoming infected,” says Dr. Kharouf Fadi, the head doctor in the ward. “I’m young and chances are that I’d get over it easily, but I don’t want to become infected because that would keep me away from work.”
Van Dijk, who worked as an emergency room nurse during the period of frequent terror attacks and Operation Protective Edge in Gaza, finds differences between then and now: “There’s an element of a lack of self confidence. When there are terror attacks you know that you’re at least in a safe place and you do everything you can to help the injured. Here you yourself are at risk.”
In Hadassah, in contrast to the position of the Health Ministry, the decision was made to periodically test the medical teams. The hospital explains that the tests give the staff confidence. “I tested negative twice and that gives me a sense of confidence. I’ve been here for a month already and I’m apparently managing to protect myself,” says Van Dijk.
Members of the medical staff tell of the unusual difficulties the coronavirus patients experience, mainly the loneliness. “As a nurse I always look for the strengths of the patient’s family, I encourage them to stay in touch. Here the situation is different. I’m the one who has to cut him off from the family. I’m the one who has to explain that he can’t meet his daughter,” says Oriah Shurka.
“They’re closed in and isolated and there’s a very heavy emotional burden. They’re intensely preoccupied with the question of whom they might have infected. There’s a feeling of responsibility and of guilt. We have to contain that, to give it space,” adds Van Dijk.
“We’ve always taught our staff to foster personal contact, to encourage the families to come. Suddenly just the opposite is the case: no contact, no families. It’s something completely new,” says Lavi.
“I think that because they’re alone, they’re weaker,” says Fadi. “It affects their psychological state. Even in death, the families have to part via FaceTime and that’s very hard.”
The ‘infected smartphone’
Recently Hadassah, like Tel Aviv’s Sourasky Medical Center (Ichilov Hospital), decided to allow family members to visit patients in critical condition in order to part from them. “Although it’s through masks and you don’t see much, it’s better than nothing,” says Lavi.
Other means of relieving the loneliness are “the infected smartphone,” in other words, phones that are used by the residents, as well as computers and exercycles. On Sunday the hospital finished printing large stickers with the faces of the doctors and nurses. The staff attach the stickers to the chests of their isolation suits, so that the patients can know what they look like behind the masks and tell them apart.
The first patients in the coronavirus ward were mainly young people in mild condition. In time they were replaced by older patients with more complex conditions. To date, the ward has handled eight pregnant women who returned to the ward immediately after the birth. They are kept apart from their newborns, not even allowed to touch them. They can however pump breast milk, which does not contain viruses. The milk is taken from the coronavirus ward to the neonatal wing in special bottles, according to precise procedures, by a worker trained for the job. In one case the staff donned protective gear in order to be with a new mother while she watched her son’s circumcision on Zoom.
The rules for treating the coronavirus patients morph based on the research and experience of doctors from all over the world. Most of the treatment in the wards that are not intensive care units consists of supportive care. Occasionally the doctors employ experimental treatments and medications, including various types of antibiotics, advanced treatments for inflammation, anti-virals and chloroquine tablets, normally used to treat malaria, whose effectiveness is controversial. “Actually there has recently been more talk about simpler treatments, like administering zinc,” says Fadi.
At Hadassah, people feel confident that they won’t reach the “Italian situation” in which doctors are forced to choose who receives ventilators and who doesn’t. “The fear is that we’re becoming smaller and smaller when compared with the growing needs, but meanwhile we feel that the hospital is trying to stay one step ahead of the event,” says Oriah Shurka.
“It’s hard for me to believe that it will come to that. It’s cruel and difficult thought,” says Fadi.
The patients whose condition deteriorates are moved to the respiratory intensive care unit, but most of the patients get better and are released to quarantine in a hotel sponsored by the Israel Defense Forces Home Front Command. The condition for release is an absence of symptoms for 24 hours. “The release is very emotional. They leave with masks and I stand in the doorway, no longer in full protective gear. Suddenly they recognize me. I give them a letter of release and they leave. There are some who I feel want to flee, lest we change our minds and close the door again,” says Oriah Shurka.
“Someone wrote us a thank-you letter, noting that all she sees is our eyes and eyebrows, and she has to complete all the rest from her imagination. She wrote that she hopes that she does so correctly, so that if she meets us on the street she’ll recognize us,” adds Van Dijk.
Dr. Fadi is planning to get married in less than two months from now. “We’ve postponed it for now, we’ll give a chance for this period to pass. The situation is serious but it’s under control, it will take time, but every epidemic ultimately ends.”