‘We’re Running Out of Options:’ Five Stories From Israel’s COVID Wards

Staff shortages, patients expiring quickly, families coming to say goodbye. A social worker, resident, nurse, physiotherapist and doctor tell Haaretz about the current treacherous wave of the coronavirus

The coronavirus ward at Shamir Medical Center, January 28, 2021.
The coronavirus ward at Shamir Medical Center, January 28, 2021.Credit: Hadas Parush
Ido Efrati
Ido Efrati
Ido Efrati
Ido Efrati

For almost a year, doctors, nurses and other hospital staffers have been living with the coronavirus in the extreme. Their exhausting lives on the front line include transitions from life to death in the space of a few hours, and the past month has only gotten worse. Here are five of their stories.

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Inas Shaaban, a social worker in the coronavirus ward at Western Galilee Hospital

“We had one very difficult case – a 46-year-old man who arrived at the ward in the middle of the night and died a few hours later. At 7 A.M. I received an urgent message – ‘we have a death.’ I got there and discovered that the man was from my village, Majdal Krum; he lived right across the street.

“His wife and two children were in quarantine, but they got special permission to come. They came in escorted by security guards and were received in full protective gear. The doctor gave them the news and they took it very hard. The woman fainted in the changing room” for personal protective equipment.

“I’ve worked in the coronavirus ward since the first wave, mainly with geriatric patients and patients on ventilators, from admission to discharge. The families are in a state of uncertainty because they can’t come and visit like in an ordinary ward.

With the families and staff I function fine. But when I finish, I go into a room and burst into tears. Then I dry my tears and move on to the next case.

Inaas Shaban

“I contact them if visiting is possible, no more than one person, and the relative enters in full protective gear. When a patient deteriorates and there’s a chance we’ll lose him, I invite the family for a goodbye visit.

“With the families and staff I function fine, the best in the world. But when I finish, I go into a room and burst into tears. Then I dry my tears and move on to the next case.

“That day, we had another death. The pace during this wave has been very quick. You talk with a patient, the next day he’s on a ventilator and the day after that he needs resuscitation. It’s different than the first wave.

“The coronavirus created distancing, and that makes it very hard. There’s a case I’ll never forget – an elderly couple hospitalized in different wards.

“She was 81 and on a ventilator in one ward; he was 84 in the geriatric coronavirus ward. The husband died and they brought in the wife to say goodbye to him; I could be with her and give her strength only over the phone. She got better and was released from the ward but died after being released.”

Dr. Dana Kagansky, a resident in the coronavirus ward at Shamir Medical Center

“This wave is different than the previous waves; I feel there’s more pressure. You have to understand that once internal medicine wards are closed to make room for coronavirus wards, the rest of the patients suffer too.

“If before there were eight internal medicine wards that received people with heart attacks or severe infections, the more COVID patients there are, the fewer wards there are to accept the others.

“We’re seeing insane overcrowding in all the wards. We don’t have enough staff. Last week, two of my patients collapsed in the same room and I had to give both of them electric shocks at the same time.

We don’t have enough staff. Last week, two of my patients collapsed in the same room and I had to give both of them electric shocks at the same time.

Dr. Dana Kagansky

“We don’t have enough ventilators and other equipment that’s suddenly hard to get because the number of patients in serious condition is so high. Management is doing everything it can, but it’s not enough.

“It’s frustrating on a number of levels. There isn’t enough equipment and staff, and the disease itself is frustrating too. We’re used to seeing patients who recover, not a 60-year-old who dies suddenly.

“Every day, people die in the ward who to me are very young. It’s very hard and I have moments of crisis. An hour and a half ago I left a resuscitation crying. I breathed for a few minutes and went back to work, but there’s no time to relax.”

Alex Rosovsky, a nurse supervisor in a coronavirus ward at Soroka Medical Center in Be’er Sheva

“I have all types of patients, starting from women who gave birth, adults with respiratory problems, patients with chest pains who tested positive for COVID, and sometimes young people too. Most have underlying conditions, usually diabetes or obesity, respiratory problems and heart problems.

“In the past month, people have been hospitalized who are little bit younger, and we’ve found that it’s a bit harder to bring people back after their situation has worsened. I’m sorry but sometimes there’s nothing to do about the virus. We provide supportive care and hope for the best.

“One case I remember better was a conversation with the family of a patient who came in for a farewell visit before the patient’s death, and during the conversation the patient died.

The family members are dressed in full protective gear and are crying. They can’t wipe away the tears under the protection.

Alex Rosovsky

“We have to realize how that looks: The family members are dressed in full protective gear and are crying. They can’t wipe away the tears under the protection. Except for a hug, there’s not much they can do. The coronavirus ward is the only place it’s possible to hug today.

“When I informed our staff that we were going into a coronavirus ward, there was real fear, but after a month there was a major change. People were calmer and realized that the devil wasn’t so bad.

“But it’s very hard to move around in the protective coverall. You’re wet from sweat all the time and people shower and change uniforms a few times a shift. It’s also hard to do an infusion with two gloves on; it requires skill, but we’ve learned to overcome it.

“The interaction with patients is also very different. The patient sees an alien in protective clothing and doesn't see my face – whether I’m smiling or crying.”

Nechama Hermon, a physiotherapist in the coronavirus ward at Shaare Zedek Medical Center in Jerusalem

“During the current wave, the patients are much worse in respiratory terms. We have women about to give birth, pregnant women and younger people. In the current wave, the illness looks more severe. The patients reach a more serious condition and there are a lot of patients in intensive care.

“The work is very intensive with respiratory treatments – weaning people off ventilation and the functional aspect. There are patients who are in very serious condition and it’s preferable not to do anything with them; only when the situation improves a bit do we enter the picture regarding respiration.

“A lot of patients die. You go to the ward and hear that there were two resuscitations yesterday and a patient died. There are days I show up and they tell me: ‘Yesterday, five died.’ It makes your heart skip a beat. Right after that I need to go to the patients, encourage them and tell them it will be all right.

A lot of patients die. It’s hard. Mostly it’s hard to walk down the street and see people ignoring the guidelines and saying everything is a conspiracy.

Nechama Hermon

“It’s hard. Mostly it’s hard to walk down the street and see people ignoring the guidelines and saying everything is a conspiracy. It’s not, and we see it every day. People are fighting for the patients’ lives.

“The treatment in the coronavirus ward is much more complex than in other departments. The minute an older patient is hospitalized their functioning decreases, even if it’s for a week or three days. It means that often they can’t return home if they live alone.

“The patients are also very confused, and because of the protective gear all the staff look alike to them. Sometimes I come to a patient who’s angry because he asked for something from the nurse and she didn't have time, and he thinks I’m her.

“Patients are hospitalized in the ward with a range conditions and they’ve been infected with the virus. For example, there are patients after orthopedic surgery who’ve tested positive for the coronavirus, there are patients after a stroke or hip fracture.

“There’s no time to give everyone the optimal treatment. We’re trying as much as possible, but a patient who in normal conditions receives a treatment for 40 minutes receives it now for 15 or 20 minutes.”

Dr. Tzvi Adler, a senior cardiac surgeon at the Rambam Health Care Campus in Haifa

“They mention the word ‘breakdown’ all the time and doctors in all sorts of places say ‘we’re not in a state of breakdown.’ I think that when it’s impossible to provide care for patients, it’s a breakdown.

“The Health Minister isn’t talking about that, they’re not really expanding the foundations of the health system in Israel. There aren’t enough beds and intensive care nurses. There are no basic solutions to improve the system. The base is already collapsing and the system isn’t providing the service it’s supposed to provide.

“During this period, use of the ECMO machine [a heart-lung machine for patients in the worst condition] is at its peak, and I think we’re on the brink of running out of options. People thought that it was a matter of equipment, but that’s nonsense. The bottleneck of the system is skilled staff – that’s what decides. Today we’re on the edge of our capabilities.

We’re on the brink of running out of options. People thought that it was a matter of equipment, but that’s nonsense. The bottleneck of the system is skilled staff.

Dr. Tzvi Adler

“Partly, this is expressed in that, today, all the ECMO units in Israel talk between themselves on a special WhatsApp group. When there’s a request for an ECMO machine at a certain hospital, they often turn to the group for help – it’s unprecedented. Sometimes there’s a request for an ECMO machine but we can’t find a hospital that can help, and then the case is referred to the Health Ministry.

“To transfer a patient on a ventilator is a complex operation; if they’re too frail they could die on the way. That’s why staff at a hospital that can accept another patient who needs an ECMO machine goes in a mobile intensive care unit to where the patient is hospitalized and connects him to the ECMO machine before the ride back. After being connected to the ECMO, the patient is put in the ambulance and is taken care of the entire way with the staff in full protective gear.

“In the previous round, we once brought a patient from Ashkelon to Haifa. You have to make your way through traffic jams while you’re in full protective gear treating a patient. Such patients very easily lose their pulse, and their prognosis and recovery is very, very poor.

“These are patients in respiratory breakdown who even with the most aggressive ventilation don’t manage to get enough oxygen in their blood. When the lungs don’t respond well to ventilation, they become heavy and swollen, and then the pressure of the ventilation rises and destroys them.

“That’s why there’s a certain level from which it’s impossible to ventilate a patient, and in these cases the connection to the ECMO machine improves the prognosis.”