An excerpt from Side by Side with Heroes: Stories of an Ambulance Medic in Israel.

The worst day of my life started out a normal day at Magen David Adom, the Israeli national ambulance service.

At the end of a long shift, I was in the washroom with my pants around my ankles. Suddenly, I heard a loud and unmistakable beeping from the loudspeakers, followed by the call for all drivers to go to the ambulances.

Pigua – an attack.

I ran out of the washroom, doing up my belt, into absolute mayhem. Everyone was hurtling toward the ambulances. Through the chaos, I glimpsed #60, my driver Dudu’s ambulance, and dove in through the side door. He took off while barking orders to put on flak vests. Dudu told me to stay by the ambulance, because the scene isn’t safe due to the risk of a second explosion targeting first responders.

Our ambulance flew down the street, past the central bus station, right into downtown Jerusalem. Suddenly, ahead of us loomed the smoking carcass of bus #14, my usual bus route. I ride that bus every day, and often at that exact time of day. Had I been back at the station earlier and caught the usual bus home, I may have been a casualty instead of a rescuer.

The scene was insane; people running everywhere, screaming, police and medics trying to get the situation under control … Ambulances in front of us, ambulances behind us, a long line of lights and sirens and foreboding. In the midst of it all, the patients … the bystanders … the bright June sunshine and surrealistic feeling of being in a movie. I threw the backboard on the bed with a collar and the resuscitation equipment. I was so calm; time felt like it was standing still. Suddenly Dudu was beside me, telling me to guard the ambulance with my life. He ran off with the bed, leaving me to wait and prepare the ambulance.

By the time the first patient came to me seconds later, I was ready. I watched coolly as two medics ran around the back of an ambulance with a bed. They were so out of control that their bed fell over and one of them fell as well. I wanted to say, calm down, you can’t treat patients when you’re under such stress. You need to keep your cool, or you won’t do anyone any good.

I can see this like a scene from TV: two medics in orange vests ran from the bus, pulling a bed with a man on it. His eyes were wide open, he wasn’t breathing but he had a pulse, and an orange oral airway in his mouth. The medics started to load him on the ambulance, but I told them I was waiting for my driver to bring patients. I leaned over and closed the patient’s eyes, but they popped back open. The medics put him in the ambulance anyway, and started trying to drive off. Dudu got there just in time and stopped them; he had another patient on a backboard.

Meanwhile, I was in the back alone with the patient, trying in vain to ventilate him. But his chest wasn’t rising, even though I tried repeatedly to open his airway with a head tilt/chin lift. After what felt like forever but was probably only a couple of minutes, Dudu came in the back with me and told me to stop because the man would not survive; he had no pulse. We took him off the ambulance and loaded the other patient instead, and as the bed was rolling out the back doors, I could see a vast pool of blood all over the floor of the ambulance. The patient had bled out and there was nothing we could do for him.

In an MCI such as a bombing, care is different: we try to save those people that have a chance of survival ahead of those that may not make it. There is a triage system, using a color code, so that we medics transport those who have a reasonable chance of survival. My non-breathing patient had suffered such traumatic bodily injuries that saving him was probably impossible; he had probably already suffered irreversible brain damage as well. On the other hand, the patient we ended up transporting is still alive.

Ariel is a twenty-year-old MDA medic who right now is recovering after surgery. When Dudu loaded him into the ambulance, the first thing I noticed was his face: green eyes with golden-brown flecks and a big puncture wound on his right cheek where a piece of metal or a nail had entered his body. Through a full-body check, I found a hole in his upper left chest by the clavicle, and another one in his inner right thigh by the pelvis. We cut off all of his clothes, and I found that his entire genital area was soaked in blood. He was terrified, and asked me to call his mom using his cell phone. I tried a few times, but to no avail – the whole cell phone network goes down during a pigua.

When we arrived at Shaare Zedek, there were dozens of people waiting for us; within seconds of opening our doors, doctors and nurses were helping us unload Ariel. There were tons of news cameras and journalists behind the crowds of medical personnel. Dudu and I ran in the doors to the ER just like you see in a scene from ER, the TV show. It was surreal. We ran into the crash room. I pushed myself up against the wall, trying to stay out of the way while Dudu filled out the MCI card with the patient’s info on it. A nurse called to me to come help as they inserted a catheter; Ariel was screaming and struggling, and I had to help hold him down. Finally, Dudu and I left, and once outside, the situation began to hit me.

I remember being in the ambulance and looking down to see my glove torn open on the palm, then hastily switching gloves. I remember the awful sweet smell of blood, in the ambulance, on my clothes, all over me. Sitting in the dead man’s blood to treat Ariel, blood on my pants and shirt, hands and shoes. Blood everywhere. I remember going down Ariel’s body with my gloved hands, feeling slivers of glass and metal trying to penetrate me as well.

As I stood shakily beside the ambulance, Dudu put his arm around me. He told me that I had done a good job, and that he was proud of me. This was the first time that Dudu really showed me affection, and I really needed it at that moment. He feels like my mentor here, and it felt reassuring to have his arm around me. It was also important to me to hear that I had done a good job, because when a patient dies on you, you always wonder what you could have done to save him. Dudu repeatedly told me that there was nothing I could have done.

When we got back to the station, we washed down the ambulance and all the bloody equipment. Time stood still as I carefully wiped red blood off the white bench. My arms were covered in dried blood, all the way up the forearm. Whose? I don’t know.

Will life ever be the same?

Sara R. Ahronheim is an emergency physician and the author of Side by Side with Heroes: Stories of an Ambulance Medic in Israel.