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Interview with Dr. Yaakov Ulano
Interview with Dr. Yaakov Ulano, Israeli senior trauma surgeon. Re: Suicide bombers, Park Hotel bombing and others, Laniado Hospital., YAAKOV ULANO:,My name is Yaakov Ulano. Y-a-a-k-o-v, U-l-a-n-o. I am a senior surgeon in the hospital, here, for the past twenty years. I arrived here from America, where I did all of my professional training. , INTERVIEWER:,What's it like working here, at _____ Hospital? [OFF CAMERA COMMENTS] ,00:01:36>>>, YAAKOV ULANO:,Laniado Hospital is, basically, a, in terms of America, a small community hospital. It is geared to be a community hospital, basically it does elective type of surgery. Although it has a very busy emergency room. And we do see a lot of emergencies during the year. It is not a university hospital, in any sense of the word, but we have people who are very well trained, who are here. Having been exposed to severe trauma, the mass trauma came as a shock to many of us because we were not trained to be fully trauma surgeons, in the modern sense of the word. We did our training many years ago. There are some of us who had been training more recently, and in trauma. But we all - like general surgeons in any peripheral hospital in the United States, do not make trauma surgery a specialty, until the Intifada has come and made Netanya on the front lines. Then we all have to become trauma surgeons very quickly. This requires, intensive training, retraining, seminars, either by the army or special units that are set up in different hospitals. For example, The University Hospital in Tel Hasomer next to Tel Aviv, has a special unit designed with very expensive, computerized models. In order to give people the ability to train in real life situations. Although it's not real life. [OFF CAMERA COMMENTS] , INTERVIEWER:,Where were you the night (Inaudible)? ,00:04:01>>>, YAAKOV ULANO:,My family, for the last twenty years, has lived in the community surrounding the hospital. So I am the closest senior surgeon to this institution at any given time. On Passover night, we were still in the midst of the evening prayers in the synagogue, which is about a hundred yards from the hospital, itself. My knowledge of the incident that occurred on Passover night, was first and foremost, by people who ran over to me in the synagogue, telling me that the ambulances were coming one after another to our hospital, which as I said was very close to where we were. Still, in the midst of our prayers. , INTERVIEWER:,And your reaction? Do you wear a pager all the time? , YAAKOV ULANO:,During this period of danger, even on the holidays and the Sabbath - although we don't use telephones on the Sabbath, in that religious setting, all of the doctors are equipped with cellular telephones and beepers. I was with both of them. And, at first I didn't believe that there was any problem when they came to tell me. Even my beeper and my telephone was off, that is how quick the whole thing occurred. Because the Park Hotel is approximately a quarter of a mile from the hospital. So, the ambulance system is so, is so effective, here, that they were bringing patients before the hospital was even aware that this was happening. [OFF CAMERA COMMENTS] ,00:06:11>>>,I was in the midst of the prayers in the synagogue, still, when we heard the sirens and people came running over to me, knowing that I'm a doctor in a hospital. And told me that ambulances were coming with great, repeatedlyl, with frequency. And at that point, I left the hospital - left the synagogue, and I ran to the hospital, which is right next to the synagogue, within a hundred yards. By the time I got to the hospital, which was only a few minutes after the actual bombing occurred, I already found the emergency room was filled with critically ill people. We learned later that what happened was that- the severity of the attack was not appreciated by anybody in the beginning. Because the entrance to the hotel was rather narrow. And the guests, who were present at the time, physically pulled the injured people to the door, and the ambulances
Interview with Dr. Yaakov Ulano, Israeli senior trauma surgeon. Re: Suicide bombers, Park Hotel bombing and others, Laniado Hospital., YAAKOV ULANO:,My name is Yaakov Ulano. Y-a-a-k-o-v, U-l-a-n-o. I am a senior surgeon in the hospital, here, for the past twenty years. I arrived here from America, where I did all of my professional training. , INTERVIEWER:,What's it like working here, at _____ Hospital? [OFF CAMERA COMMENTS] ,00:01:36>>>, YAAKOV ULANO:,Laniado Hospital is, basically, a, in terms of America, a small community hospital. It is geared to be a community hospital, basically it does elective type of surgery. Although it has a very busy emergency room. And we do see a lot of emergencies during the year. It is not a university hospital, in any sense of the word, but we have people who are very well trained, who are here. Having been exposed to severe trauma, the mass trauma came as a shock to many of us because we were not trained to be fully trauma surgeons, in the modern sense of the word. We did our training many years ago. There are some of us who had been training more recently, and in trauma. But we all - like general surgeons in any peripheral hospital in the United States, do not make trauma surgery a specialty, until the Intifada has come and made Netanya on the front lines. Then we all have to become trauma surgeons very quickly. This requires, intensive training, retraining, seminars, either by the army or special units that are set up in different hospitals. For example, The University Hospital in Tel Hasomer next to Tel Aviv, has a special unit designed with very expensive, computerized models. In order to give people the ability to train in real life situations. Although it's not real life. [OFF CAMERA COMMENTS] , INTERVIEWER:,Where were you the night (Inaudible)? ,00:04:01>>>, YAAKOV ULANO:,My family, for the last twenty years, has lived in the community surrounding the hospital. So I am the closest senior surgeon to this institution at any given time. On Passover night, we were still in the midst of the evening prayers in the synagogue, which is about a hundred yards from the hospital, itself. My knowledge of the incident that occurred on Passover night, was first and foremost, by people who ran over to me in the synagogue, telling me that the ambulances were coming one after another to our hospital, which as I said was very close to where we were. Still, in the midst of our prayers. , INTERVIEWER:,And your reaction? Do you wear a pager all the time? , YAAKOV ULANO:,During this period of danger, even on the holidays and the Sabbath - although we don't use telephones on the Sabbath, in that religious setting, all of the doctors are equipped with cellular telephones and beepers. I was with both of them. And, at first I didn't believe that there was any problem when they came to tell me. Even my beeper and my telephone was off, that is how quick the whole thing occurred. Because the Park Hotel is approximately a quarter of a mile from the hospital. So, the ambulance system is so, is so effective, here, that they were bringing patients before the hospital was even aware that this was happening. [OFF CAMERA COMMENTS] ,00:06:11>>>,I was in the midst of the prayers in the synagogue, still, when we heard the sirens and people came running over to me, knowing that I'm a doctor in a hospital. And told me that ambulances were coming with great, repeatedlyl, with frequency. And at that point, I left the hospital - left the synagogue, and I ran to the hospital, which is right next to the synagogue, within a hundred yards. By the time I got to the hospital, which was only a few minutes after the actual bombing occurred, I already found the emergency room was filled with critically ill people. We learned later that what happened was that- the severity of the attack was not appreciated by anybody in the beginning. Because the entrance to the hotel was rather narrow. And the guests, who were present at the time, physically pulled the injured people to the door, and the ambulances, which arrived very quickly at the scene, took everybody that they saw. Not realizing how many there were, took everybody they saw, one after the other, to our hospital, which is a community hospital the size of relatively average American peripheral community hospital. And the result of this was, since we are so close to the Park Hotel, that the emergency room very quickly filled up with critically ill people. When I arrived, there were already several people who were on respirator machines, that they already had tubes put into their chest - their lungs, rather, to help them breathe. And some of them had intravenouses that were going already. And at this point, being one of the first senior physicians on the scene, it became my job to decide who to treat first, among all of these, with the staff that was available. ,00:08:22>>>,I should say that very rapidly, the hospital began to fill with doctors. Volunteer, doctors, even those who are not part of our staff but work in the city of Netanya, having heard about this, through various methods, or just the noise itself, came directly to the hospital. So very quickly we had a relatively large staff to try to deal with this. Laniado hospital, being a community hospital, we have the ability to operate on three patients at a time and to take care of, medically, a number of patients. But severe problems like neurosurgery, gastro surgery, cardiotherasic surgery, heart and lungs, we have the ability to deal with them, only on an emergency basis, but we don't have the facilities here to put anybody on a cardiac bypass. The result of this is that we have to think about who we can transfer, triage the patients as quickly as we can if their stable, to neighboring hospitals. And the ones that are not able to be transferred we have to take them to our own operating room.,00:09:37>>>,And this is what the decisions were had to be done, very quickly one of our senior physicians, whose job is, in all of our practice sessions, to stand outside, when the ambulances arrive, to greet the ambulance, triage the patient, and to see if he's - to go into a predesigned system a very severely injured, or moderately injured, or just lightly injured patients. Each one was directed to a different part of the hospital. ,I should add that the hospital, for many years already, because of the situation in Israel that is rather unique, practices on a regular basis, how to deal with mass trauma. In the present climate, we're also dealing with the possibility of biological, chemical warfare. And we are all fully informed by the Ministry of Health, and the army, as how to deal with these types of events, god forbid they should occur. , INTERVIEWER:,Let's go back and describe the scene, as you arrived, from a medical perspective and also as a human being. ,00:10:57>>>, YAAKOV ULANO:,As a physician, especially as a surgeon who had been trained in residency, and in trauma, we always have a certain aloofness that has been ingrained into our souls so to speak, how to look at people who are seriously injured, in order to maintain the distance that's necessary to make difficult decisions that are life and death decisions. A particular incident - tragedy, I would say more, of finding ten or twelve people in the emergency room all seriously injured at the same time, is very overwhelming. But one does not have time to let one's emotions even start to play a role in this type of situation. So, you go from one to the other. We were also dressed in our festive clothes for the holiday, at that time. Which very rapidly all became filled with blood, even though we would change gloves very frequently, from one patient to the other, it was just impossible because of the nature of these types of wounds that we had to deal with-not to be covered with blood during this whole procedure. So it was quite a sight. ,The types of injuries we had to deal with were also very difficult to evaluate. Because the terrorists used a very -un-inhumane technique of adding to the bombs, thousands of small ball-bearings, as well as nails, which fly out, each one of them, as a missile, which causes severe damage through minimal entrance sights. So it is very difficult for a surgeon to evaluate where the injuries are. One has to go through the usual procedures that we learn, about how to take care of patients. But, at the same time, we also know that time is of the essence, and we have to get certain patients out of the emergency room to other institutions, which did not have a - this overload, at the time. And some of the patients seemed to be quite stable, at the time. Later we learned that they had nails or ball bearings in their brains, or had cut through the intestines. But they still had to be sent off because there was no alternative. You could not possibly evaluate everybody, fully. Anybody who deals with trauma knows, that one patient comes in severely injured to a hospital, can fully utilize or require most of the services that the hospital has in order to take care of him. When you have multiple patients in this situation. The procedures had to be done very, very quickly. And, as I say, as a peripheral hospital, with the knowledge that is limited to people who are normally working in a peripheral setting. , INTERVIEWER:,Can you describe the kind of injuries that came in that night? ,00:14:41>>>, YAAKOV ULANO:,The types of injuries that we had to deal with, personally, here that we did not send off, or - were people who had limbs that were literally severed from them. It was the first time in my career, that I'd ever seen somebody come in without an arm, or without a leg. The orthopedics department dealt with them in the emergency room, and later took them to the operating room, the patients came in, in shock with blood loss. They were treated very well. We had to deal with a small baby that had a severe injury right through the eye, and through the brain, and also an abdominal stomach injury. We had to, according to our usual protocols, take this small baby to the operating room, open up the abdomen to see - make sure they weren't bleeding to death inside - the child was not bleeding to death inside. Knowing full well that we were not, at that time, capable of dealing with a brain injury. The child, subsequently, died on the table. IT was the first time I had seen a senior, experienced, trauma surgeon cry, who was taking care of this baby, at the time. We also had to deal with a elderly man who had one of these ball bearings that went through his heart, and his blood vessels that were in the chest. It was a very difficult injury to evaluate, and that patient died in our hands. We also had to deal with a young lady in her early twenties, who had similar type of injuries, that were involving, both the stomach cavity as well as the chest, with a major heart injury. And she also died on the table.,00:16:34>>>,Other things, that were less important, we were able to take care of - regular injuries to the intestines that require some type of intestinal removal, and connections, these were not problematic. Subsequently, we learned that many of the patients that were sent from our institution, to other hospitals, had the nature of the injuries that they eventually died, even after several weeks. So whereas the initial death toll of the Park Hotel was 17 or 19, when the whole few weeks passed, there were already over 30 people that died from that, making it the single most lethal terrorist attack that Israel has known. , INTERVIEWER:,Do you ever think about that expression, there by the grace of God go I? Did you ever wonder, why was I spared? ,00:17:55>>>, YAAKOV ULANO:,As a religious person, we always understand that our destiny is not in our hands. We are always thankful if we are not part of a terrorist attack. Everybody would be. We heard stories that were from people who were in the middle of the terrorist attack. How one of them survived because a napkin dropped on the floor, when everyone else was standing up at a certain part of the Passover ceremony. And because she bent down, everybody around her, and her family, was killed except for herself. ,One of my patients that I had to operate on was a very big man, and had a weapon on him, at the time, as many people in Israel do carry weapons. It's not a very dissimilar situation when we were children growing up in America, watching The Wild West, when everybody packed a six gun. I don't own one, but I thought about it many times. People do have them. But in these type of settings, they are very little help. He explained to me that his friend, who also had a pistol, saw the terrorist, suspected that it might be a terrorist but he was walking back and forth and had a certain garb that made it difficult to really identify him as somebody who could not, maybe, be part of the group that was there. At the Passover night, there was a hotel where many people were not from the same family. So nobody really knew who everybody was. And he told me that his friend had decided, already, that it was a terrorist, and was about to pull out his gun when the bomb went off and his friend was killed. He was dead. , , INTERVIEWER:,Do you fear that moment, again, anytime something like this could happen again? , ,00:20:21>>>, YAAKOV ULANO:,We are all aware that terrorist attacks could occur at any time. That's part of the whole idea of terror. That it puts the population in a setting where they're never sure of themselves. We know that many of our friends, whose children may live in areas which are much more dangerous than Israel, are very worried about their children, and their children are not, ah, always doing well because of this. Whenever we drive on roads that are, perhaps, not the most central roads, we also understand that something could happen. We try to live our lives as normal as possible, with the understanding that at this time, in Israel, the -the terrorist activity is such that, it's interest is to maim and harm the maximum what it can, of the civilian population; women, children, it doesn't matter who and how. We all know that there are many episodes already, where terrorists have gone into houses and killed children in cold blood. This is something that's the worst kind of possibility that you could imagine, and certainly for the American mind. But it is something that Israelis have to deal with on a daily basis. One does not go into a restaurant, today, without there being a guard sitting at the door. And one knows that maybe the guard is not going to be able to prevent something from happening. That is the way Israelis are living, on a daily basis. , , INTERVIEWER:,What about as a physician, as a surgeon, coming into work? Are you on edge, or on alert, or just in a hyper sensitive state because you're living under this pressure of what could happen at any moment? , ,00:22:49>>>, YAAKOV ULANO:,We understand that when we're working now, in Israel, that we always have to be prepared for the possibility that some disaster might occur. I recall, several months ago, when I got a call from the -medical director of the hospital, that the security system has received a warning that there is a terrorist in Netanya, and that I should stay around the hospital. Within ten minutes the ambulances were on their way, because a bomb had exploded with a suicide bomber in the middle of the, of the marketplace. We had to deal with people who died under our hands. We had to deal with people who suffered from very grave post traumatic stress disorder, for many months after that. ,In addition to all the injuries that they have, we know that this is always a possibility, we're always carrying our communication systems with us. It doesn't matter when. Twenty-four hours a day, seven days a week. And this is the way we live in Israel today, in every hospital, every aspect of Israel is the same way. Nobody is immune to it. , INTERVIEWER:,What I am getting at is, how has the whole situation traumatized you as a professional, or you as a person? ,00:24:25>>>, YAAKOV ULANO:,I don't feel that I've changed very much, or am under a tremendous amount of stress because of this particular situation that we are in. There is no question that when the terrorist attacks were coming very frequently in Netanya, life was very, very unpleasant, to say the least. Because we were dealing with very, very difficult situations. And we knew, from the outset, that very likely we would have to take care of patients that we were not really equipped to take care of them, in terms of our experience. And that they might die under our hands. Which is a terrible thing for any type of a doctor to have to deal with. [OFF CAMERA COMMENTS] ,00:25:37>>>,As far as the, the fact that the attack occurred on Passover, which is for the Jewish people throughout the world, a very important night. Regardless of how close one is to the observance of the various commands in Judaism. Almost all Jews associate themselves with the Holiday of Passover, with the unleavened bread, the matzah. It's rather a universal - universally observed holiday, among Jewish people. Having had this experience, which is supposed to be a - which destroyed the joyous aspect of our holiday, because Passover celebrates God's redeeming the Jewish people from the slavery of hundreds of years in Egypt, in a very dramatic, emphatic way, after which there was a revelation on Mount Sinai several weeks later, when the Torah - the five books of Moses was received, the Ten Commandments. ,After we got home, after many hours, I got home and then we had to start the traditional Passover ceremony, which itself takes several hours. And it's supposed to be done in a very joyous way. But we just went through a very traumatic experience, and people died, and we saw people who were very seriously injured who will never go back to their families again in a normal way. So the question in our minds is, really, how can we deal with this, and how to, how to run the ceremony. ,00:27:16>>>,I also came back to find that my fifteen year old son had been, also in the hospital for several hours, wheeling patients around the institution, which I was not aware of. And I realized, at that point, that the celebration that we do on Passover is not because everything today is fine, and that the world is in a sublime state of -of peace. The purpose of Passover is to recognize that there is a God who intervened on behalf of the Jewish people, at some point in history, and we believe He continues to intervene. And that is what gives us the joy of the Passover night. And even though we had to experience such a terrible event, on Passover itself, that certainly contradicts the idea that we were taken out of bondage, etc., because we still find ourselves in the same predicament, where people are running after us and chasing after us. We understand that, that essentially God showed us that he is with us. And this gives us the strength to continue on. , INTERVIEWER:,[OFF CAMERA COMMENTS] Imagine a hundred years from now, what do you think will be the future? What will be the fate of the Jewish people? , YAAKOV ULANO:,You really want me to answer that question? , INTERVIEWER:,Yeah. ,00:29:16>>>, YAAKOV ULANO:,[PAUSE] At the present time, the State of Israel is in a very difficult situation, that's quite clear. In fact I don't think there's been a time since the incipience of the State when world opinion has returned so strongly against this small country. The fate of the Jewish people, per say, I personally believe will come out fine. When, and at what time, and under what circumstances, I don't think it's for us to know. We hope that the present State of Israel will be part, and continue to grow, and that we should be able to see that all the work and efforts, and spiritual and physical strength that Israel has demonstrated, over all the years since its existence, will be the basis of a country which will flourish for the Jewish people. And it will be a light for the nations which is the way it was supposed to be, initially. ,How this will all work out, in the present setting, I don't think anyone has a real answer to that. We have to believe always, as Jewish people, that we have someone watching over us. And that somehow or other this situation will, will come to a good end. How, I have no idea. , INTERVIEWER:,Amen. [OFF CAMERA COMMENTS], [END OF INTERVIEW]
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