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Helping Them Pull Through

Dr. Yehuda Sabiner got his real education in the Covid ward

When Dr. Yehuda Sabiner arrived at Sheba Medical Center in February to begin his internship, the last thing he expected was to be told that he could refuse the post. It was the beginning of the coronavirus pandemic, but although there were not yet any cases in Israel, Sheba (also known as Tel Hashomer, after the Ramat Gan neighborhood where it’s located) had gone into emergency mode, creating the country’s first COVID-19 ward. “I was to start working in the internal medicine ward, but there was no red-carpet welcome,” says Dr. Sabiner. “Instead, the deputy department head told me bluntly, ‘We’re being transferred to manage the new COVID-19 unit. You have until tomorrow to tell us if you agree to join.’ There was no question in my mind — I was willing to go wherever I was needed, but I felt it only fair to first ask my wife if she was okay with it. The following day, with her consent and my rav’s blessing, I told them, ‘I’m in.’ ”

Not a typical way to start off a medical career, but then again, Dr. Sabiner isn’t your typical intern fresh out of medical school. Dressed in the full attire of a Gerrer chassid, he’s a product of Israel’s insular cheder system, with its intensive Torah learning and minimal secular study. Despite the need to add two grueling years of pre-academic courses to the already taxing seven years of medical school, and notwithstanding his family’s initial shock, he pursued his lifelong dream of becoming a doctor, without compromising his beliefs, chassidic lifestyle, or outward appearance.

A Friendly Face

Shortly after Purim, as the COVID-19 crisis unfolded in Israel with terrifying speed, it became evident that the timing of Dr. Sabiner’s internship in Sheba’s COVID-19 ward was especially fortuitous for the many chareidi patients hospitalized there. “Being in quarantine, with no one to advocate for them or even just to sit at their bedside, COVID-19 patients feel all the more vulnerable and frightened,” Dr. Sabiner relates. “For chareidi patients especially — and at times they made up over 60% of the ward—  seeing me naturally put them more at ease.”

Sabiner’s internship at Sheba meant that he was made aware of the dangers of COVID-19 at a relatively early stage. “When the coronavirus was still considered a problem that existed only in faraway China, and most Israelis were worried mostly about its effect on consumer purchases, Sheba Medical Center was already going into high gear, preparing a designated ward, protocols, and plan Bs for various scenarios,” he relates. “The COVID-19 department head, Dr. Gadi Segal, told us about conversations he’d had with Italian colleagues, who described an apocalyptic situation that we found hard to believe could occur in a developed country. But when I saw the extent of the preparation, resources, and manpower our cash-strapped hospitals were funneling toward COVID-19, I realized that we were in for something unprecedented.”

Before Purim, before social-distancing restrictions, many Israelis in general, and in the chareidi community in particular, were unaware of the extent of the danger. “By this time,” Dr. Sabiner recalls, “people returning from abroad had been instructed by the Health Ministry to go into voluntary quarantine for two weeks. When someone told me that Rav Yitzchak Zilberstein had paskened that those people should still go to shul to hear the Megillah, I requested an urgent meeting with him and started giving a thorough explanation how COVID-19 was spreading throughout the world. After about ten minutes, the Rav said to call the Hebrew Yated newpaper to place an urgent letter, instructing anyone who’d been in mandated quarantine to stay home and not go to shul due to the danger of infecting others.”

Dr. Sabiner put his own family into lockdown right after Purim. When the Health Ministry issued guidelines to close schools, the situation was not fully understood, and several chadarim and yeshivos continued to function as normal. “When I received a message from my son’s cheder that classes would continue as usual, I immediately phoned the principal and explained to him the seriousness of the situation,” he says. “The principal told me to speak to the cheder’s nasi, a very prominent chassidishe posek. Not long afterward, we received a new recorded message from the cheder that classes were canceled until further notice.”

 

No Changes

Dr. Sabiner has been in the COVID-19 ward for nearly three months now, but says he doesn’t think too much about the possibility of contracting the virus himself. “We’re very punctilious about following guidelines, and to date, the contagion rate among staff members has been very low,” he says, “In addition, everyone is tested for the virus before entering the unit, but I know that my wife and children have been extremely careful.” Yet he faced another concern that was out of his control: “Coming as I did from Bnei Brak [the first location to be put under full lockdown due to the rapid spread of the virus there among an extremely dense population], there was concern that I might be carrying the virus from there, so there were times when I was asked to stay over for a few days and not return home. I could have refused, but given the dire need due to the flood of new patients during that time, I readily agreed.”

Of course he wouldn’t have it any other way. That’s because healing the sick was always the dream of this intern with the long peyos tucked into his large black velvet yarmulke and the traditional Gerrer hoizenzocken peeking out from under his lab coat, from the time he was a cheder yingel living in Jerusalem’s Har Nof neighborhood.

Perhaps, he says, it even runs in the family. About 100 years ago, Dr. Sabiner’s great-great grandfather, Reb Chanoch Heinich Kristowsky, an Aleksander chassid, gained renown in his Polish shtetl of Pavenitz for caring for his countrymen who contracted the Spanish flu. He was exposed to hundreds of patients, yet never caught the illness and continued caring for the sick. In recognition of his selflessness, the Tiferes Shmuel of Aleksander zy”a changed Kristowsky’s surname to Malach, and that is the name that appears on his matzeivah.

Over the years, even as he transformed from class troublemaker to serious yeshivah bochur, Yehuda Sabiner never forgot his ambition, and one day, he confided the dream to his mashpia, asking why he should work so hard in yeshivah if he didn’t plan on continuing learning full time after marriage. “He wasn’t threatened or angry,” Dr. Sabiner remembers. “After hearing me out, he said, ‘Are you thinking of leaving yeshivah already now, at 16? Of course not. If you want to be successful in life, you have to be the best you can be, no matter what you’re doing at that point. I can guarantee that if you invest all your efforts now in learning, it will help you in the future, whatever you do.’ He was very smart, and I never regretted his advice.”

For the next few years, Sabiner focused all his energies on his shteiging, earning a reputation as one of the top bochurim in his shiur. But he was an honest young man, and at the meeting with his future wife, Racheli, Yehuda tried to convey that he wasn’t planning on staying in full-time learning, but neither the mechutanim nor the kallah, who was studying architectural design so that she could support her husband in learning, paid much attention.

And then, a year after the wedding, he dropped the bombshell: He wanted to study medicine. The product of a Bais Yaakov seminary and a chashuve family in Gur, Racheli was devastated. This was certainly not what she’d signed up for, and besides, whoever did such a thing?

“I was extremely distraught and didn’t know what to think,” she shares. “When I got over the shock, and after understanding the sincerity of his motivation, I told him to seek the advice of a prominent chinuch personality whose opinion we both trusted.” Racheli admits that she never believed her husband would receive the permission he was seeking, but she was wrong.

It was clear from the outset that the young Gerrer chassid wasn’t out to breach the accepted framework, but rather to fulfill a personal mission enabling him to perform chesed where it was sorely needed. Throughout the years, Dr. Sabiner consulted often with this rav, who gave him strict guidelines to which he adhered throughout his years of study. Thus began a rigorous two years of pre-academic courses to make up basic material, followed by seven grueling years of at the Technion Rappaport Faculty of Medicine in Haifa.

Attending med school as a married student is never simple, all the more so for someone who had so much catching up to do. And although there were stipends from the Kemach Foundation and the Toronto Foundation, organizations that assist chareidim who attend university, Dr. Sabiner credits his wife with shouldering most of the burden of parnassah and care for their growing family. “It’s no exaggeration to say I could never have done it without her. Thanks to her selflessness, and with a lot of help from my parents and in-laws, we were able to pull through.”

Seeing Dr. Sabiner today, clearly comfortable with both his colleagues and patients, it’s hard to imagine him as the self-described “outsider” when he began his studies at the Technion.

“On the first day of school, I was welcomed by the security guard who was sure I was the new kashrus mashgiach,” he says. Today, he can laugh about it, but at the time, it was agonizing. “From my sheltered environment I was suddenly thrust into a lecture hall with 140 fellow med students from all different backgrounds. They were chatting like old friends, while there I was with my hat and suit, on a hot summer day, feeling like a fish out of water. Added to that was my fear of failure. How would I ever pass the exams?”

Overall though, most encounters were respectful. “Seven years is sufficient time for people to get to know you. I found that when people saw that I was serious about what I believe in and was willing to sacrifice for those beliefs, they treated me with kavod.”

Dr. Sabiner has warm words for the Technion, which he said believed in him and provided him with all the tools he needed so that he could succeed on his own merit. “They were considerate and flexible. For example, they scheduled a test for Shushan Purim, a date that isn’t marked on the campus calendar, and they willingly postponed it.”

While fully focused on learning his coursework, Dr. Sabiner was diligent about setting set times for Torah study, even if in the most intense periods, he could not manage more than a brief daily seder. “I even had a ‘mashgiach’ on campus,” Dr. Sabiner quips. “One day, the former president of the Technion, Professor Peretz Lavie, saw me without my hat, and asked me where it was. I told him that I had nowhere to put it, so I’d left it at home. He said to me: ‘Don’t you dare make any changes in your lifestyle!’ ”

Better Outcomes

Without forgetting for a moment the tragedies suffered by our brothers and sisters abroad, Israelis have plenty to be grateful for. In an article published in Forbes in mid-April, Israel was ranked as the safest place in the world to be during the pandemic. Dr. Sabiner explains the relatively low death rate and very high cure rate in Israel on two levels:

“First of all, there is clearly siyata d’Shmaya. And on the level of hishtadlus, Israel was one of the first countries that anticipated the pandemic and so preparations were already fast-tracked in February. Additionally, Israel has a disproportionately large number of specialists who know how to provide ventilation. With limited space in its Intensive Care Units, most Israeli hospitals have a step-down unit in their internal medicine wards — beds that serve as ICUs for all practical purposes.

“And I think it also has to do with the fact that culturally, the Jewish People as a whole extol the value of life, and that means that Israeli doctors tend to gain more experience treating severely ill patients. We have far fewer DNRs, and are expected by the family to do all we can to treat patients, no matter how hopeless the case.”

Yoel Hareven, director of the International Division at Sheba, credits Israel’s military culture for enabling leaders in the medical field to think out of the box and continually come up with novel approaches to combat the pandemic, as the need arises. “As an example, our hospital’s director, Prof. Yitshak Kreiss, is a former Israeli army surgeon general, and many top Israeli hospital staff have served as senior army officers. And so we can call on shared values of discipline, order and an understanding of how things are best accomplished in times of tremendous stress,” said Hareven. “We’re constantly assessing and processing what’s working well and what needs to be improved.”

Sheba Medical Center, ranked by Newsweek as one of the top ten in the world, built the country’s first COVID-19 ward, receiving the ill Israelis who had been on the Diamond Princess cruise ship. As the situation worsened, the hospital built a separate coronavirus ICU within 36 hours. They also set up the first coronavirus-psychiatric ward, as well as the first dedicated maternity unit for COVID-19-positive women.

In order to reduce the risk of exposure to medical staff, about 80 percent of treatment in the COVID-19 ward is delivered from inside a tent outfitted with computer screens and connected to devices within the ward itself. Patients in moderate condition are given a self-monitoring kit that includes a wireless stethoscope and an infrared thermometer. There are also adhesive smart sensors that can monitor everything from cardiac output to the amount of perspiration. Contact with the doctors in the tent is made via computer programs and specialized medical apps that can be downloaded onto a smartphone. Where necessary, doctors activate robots.

Of course, many procedures, such as drawing blood, giving injections, intubation, and performing an ultrasound, necessitate a doctor on site. “In the first two weeks, Dr. Segal, the department head, was the only one who entered the ward,” Dr. Sabiner relates. “He remained there for an entire month, 24/7, even sleeping there.”

But then, as patient numbers swelled, Dr. Segal allowed entry to senior doctors, then residents, and lastly, interns. To reduce the danger of contagion as much as possible, all staff must wear a “spacesuit” — full head-to-toe protective gear. While standard face masks cannot safely accommodate a beard, by the time Dr. Sabiner was needed in the ward, the hospital succeeded in procuring a specialized hooded mask that’s beard-friendly.

The policy in the COVID-19 ward is to enter only when absolutely necessary, “but once we’re inside,” says Dr. Sabiner, “we can offer patients non-medical assistance as well. While not religious himself, Dr. Segal has shown great sensitivity to patients’ religious needs. He once asked me to help put tefillin on a patient who’d recovered from the critical stage of the illness.”

Dr. Sabiner describes his anguish at watching patients being admitted to the ward in mild condition, still able to walk and carrying a suitcase, and then witnessing their rapid decline — that’s because the virus often attacks the lungs before the patient is even symptomatic, and by the time he feels ill, his lungs have been irreversibly damaged. He says that one of the most heartbreaking features of the illness is patients dying alone. In the wake of those horror stories, Sheba’s director general, Professor Yitshak Kreiss, demanded that the COVID-19 team devise a plan to enable patients who are conscious to have their loved ones near them so that they won’t have to die alone. “Naturally, every case is judged individually, but the hospital has been doing its utmost to take care of the logistics and enable family members to visit and give chizuk, or, at least to say goodbye, in a way that doesn’t compromise their safety,” Dr. Sabiner says.

Ichilov hospital in Tel Aviv has also taken this approach, in contrast to many hospitals around the world that don’t allow family visits as a precaution against spreading the highly contagious virus. Ichilov officials opted to spare much-needed protective gear and implement other protective measures in order to give family members a chance to say goodbye. “The stories of patients dying alone are horrifying,” said Professor Ronni Gamzu, Ichilov’s chief executive. “This is our moral duty as medical staff and as human beings. No one should be allowed to die alone.”

While the no-visitors rule had caused a level of outrage against some US hospitals, as there is no one to advocate for helpless, often uninformed patients left alone in the COVID-19 wards, Dr. Sabiner describes the tremendous dedication of the nursing staff in his ward. “At great personal risk, they go from patient to patient, doing whatever they can to ease their suffering. They could easily attach a feeding tube and be done with it, but I’ve watched them devotedly feed patients, spoonful by spoonful.”

Yet, with Israel having one of the world’s highest cure rates, Dr.Sabiner has also witnessed open miracles, when patients who seemed doomed suddenly experienced a dramatic turnaround. “One patient who experienced a miraculous recuperation on Shvii shel Pesach told Dr. Segal, ‘I had my own personal Kri’nas Yam Suf,’ upon which the doctor instructed, ‘Write that in his chart!’ ”

Dr. Sabiner explains how patient care has evolved and improved as doctors gain experience and increase their knowledge. “We meet twice a day to discuss our findings and share information. We’re in touch with medical experts from across the country, and we’ve also been sharing knowledge with colleagues internationally. Yet there’s still a great deal that we don’t know about COVID-19. Learning through trial and error and having to constantly say ‘We don’t know,’ has been a humbling experience for us and for the global medical establishment as a whole.

“That said, we’ve definitely come a long way in terms of learning how to optimize patient treatment at every stage. For example, we now have lab indicators for the stage of the illness, which help us gauge whether a particular drug will be a benefit or a hindrance, and which indicate if more oxygen is called for, or if ventilation is necessary. Baruch Hashem, we’re seeing better outcomes, and with Hashem’s help, may the trend continue.”

(Originally featured in Mishpacha, Issue 810)

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