"There are decisions that must be made in the ER within seconds, and their meaning is the difference between life and death"
The dramatic moment when doctors debated whether to extract a bullet from a soldier's chest that was endangering him; the gut feeling of the doctor who saved the child and the split-second decision that allowed the family to say goodbye: work in ER departments in Israel requires doctors to make quick decisions during times of load and stress. We spoke with some of the senior doctors in the country who told about their unconventional professional lives. "The right decision can sometimes change the path".
Behind the closed doors of emergency rooms, life-changing decisions are made every day. Sometimes it is a matter of minutes, and sometimes there is no black or white: whether to leave a bullet in the heart of a soldier wounded in battle, whether to continue an investigation even though all tests look normal, or whether it is desirable to insist on treatment that will allow the family extra time to say goodbye? Four senior doctors we spoke with return to a significant moment when they were required to make an impossible decision, and tell about the professional dilemmas in moments of truth, ones that accompany them to this day.
The bullet in the soldier's heart
The team debated and decided that the bullet would remain in the soldier's heart. Prof. Gil Bolotin, Director of the Cardiothoracic Surgery Department at Rambam Hospital, recalls: "During the intense fighting in the North, a reservist soldier was brought to us in critical condition. He was shot in the chest and brought into the operating room during resuscitation efforts. My colleague, Dr. Majed Makhoul, who was on call that shift, performed a successful suture of the heart and managed to stabilize his condition. The CT scan showed that the bullet had penetrated the septum and remained lying inside the left ventricle.
We faced a difficult dilemma: whether to do the obvious and perform another dangerous open-heart surgery to extract the bullet while the patient was in a very difficult condition, or whether we should make the more complex decision: to stop, allow him to recover, but leave the bullet in his heart. We decided to wait. In retrospect, this turned out to be the best decision: within 24 hours the soldier was already out of bed. Today he has returned to studying and sports, and the bullet? It will stay there, for now."
The decision that allowed a family to say goodbye
Dr. Ron Brant, Director of the Emergency Department at Schneider Children's Medical Center, notes: "In the ER there are decisions that must be made within seconds. One of the dilemmas I will not forget was when a healthy girl arrived who had collapsed at home, apparently following acute myocarditis. After 20 minutes of resuscitation, the on-call doctor suggested declaring death, but I asked them not to do it yet, because there were small signs of hope. We decided to put her on ECMO. In the end, we did not manage to save her life, but she was granted another three months during which the family could be by her side. Sometimes even when it is impossible to change the end, the right decision can change the path."
Clinical intuition vs. test results
Dr. Natalie Kritz, a specialist in emergency medicine at Ichilov Medical Center, shares: "One of the dilemmas that was etched in my memory was when a young patient arrived with abdominal pain that initially seemed non-specific. Although initial findings did not clearly point to an emergency, clinical intuition led us to continue the investigation. Eventually, he was diagnosed with significant bowel ischemia that required urgent surgery. This case illustrated to me that in emergency medicine, there is no place to rely only on one data point, but on a combination of experience, critical thinking, and listening to the patient."
The price of saving lives
For Dr. Andrei Shopen, Director of the ER at Wolfson Medical Center, working in chaos is a natural state. However, the case of an 18-year-old who arrived with aggressive meningococcal infection left an indelible mark on his heart. "Despite rapid treatment, the bacteria caused acute necrosis in the fingers and toes. We managed to defeat the bacteria and save his life, but the physical price was scarring: the teenager lost both his legs and several fingers. These are the moments when this profession touches you in the most sensitive places of the soul, and you understand what emotional price it takes from us as doctors."
When stress hides a medical condition
Dr. Ahmed Naama, Director of the Emergency Department at Hadassah Ein Kerem, recalls a case with a 70-year-old patient: "Her children were convinced that her shortness of breath was due to extreme stress. However, during the examination, I saw that she was losing consciousness. I decided to intubate her immediately. Imaging tests revealed that the epiglottis had swollen to giant dimensions and blocked her airways. The decision to intubate her saved her at the last moment. After several days of treatment, she was released healthy, and to this day we are in contact."
