Gallstones for car pulleys 21/6/2008 by me

The preoccupation in medicine with technology, clinical trials, evidence-based medicine and high degree of specialization have created in me a new version of Hippocratic Oath- If I wanted to be so technical and so gadget oriented, I would have become a car mechanic, or any sort of engineer. Instead, I wanted to work with people, their perceptions, behavior and bodies in relation to that.

Sometimes there is a gap of realization between the analogies and metaphors one gives and real life situations. And, my car was soon to prove the realization of my new oath. I was driving from Beer Sheva to Jerusalem on road 40, with a 32 degrees celesius weather and my AC on. Thirty minutes into the drive, the AC stopped working, and a bit after that, I began to hear a squeaking sound. I looked at the my engine temperature reader, which was normal. I stopped to check if I had flat tires, and then opened the hood to see smoke coming out of the “engine.” I blindly put in more water and oil into the car, and chose to drive it to the next town- Ahuzzam. I find that when I stop by the side of the road with a broken car, people seldom stop to help me.

With a steering wheel stuck in one place, unable to turn a complete left or right, I pulled into Ahuzam, a town I knew nothing about apart from its sign. Couldn’t my car have broken near Rahat where I spoke the language and knew that I could manage with the inhabitants there? I parked my car under the shade near the very entrance of town, took out a neurology book, read a case about essential tremor. Thinking about tremores, my car was shaking by when it made the noise, and as I pulled up, it also shook. The only number that I had to call to tow my car was back in Beer Sheva, a 45 minute distance traveling by car. Some cars drove past me, and when I rolled down my window to ask for help, none of the drivers seemed to respond. I went back to reading about essential tremor. Even if I figured out what was wrong with my car, I did not know how to fix it. Perhaps I should call the towing truck back from Beer Sheva, and pay the 500 or 600 shekels for the task.

I put down my case files book and decided to ask for a towing truck near Ahuzzam by going to a house that was right across from where I parked my car. It was a one floor house, with a garden that was not well kept. Two men were sitting in the yard, one with a kippa in his 40s, and another one in his 20s. Shabbat was approaching, as it was around 3 pm. A woman inside the house was cleaning the floor at the entrance, pushing water out to the stairs, down to garden. Another man pulled up in his peugot white car, and dropped two young women in their late teens and a boy around the age of 11. The man was in his late thirties, well built. The boy wore black pants, had a black kippa, had “dangly shreaded pants” and “two long side burns.” Was this town religious? Was this family religious? Was I going to get help as an Arab woman?

“Go talk to Yoram, he might be able to help you,” said one of the two men sitting in the garden. Yoram was the father who dropped his three children off, and he came with me to check my car. I opened the hood, taking a look into the car. After a few seconds of having his body bent into the hood, he took out a torn belt on the sides. he said, “It is the belt, it is torn, see? It is connected to your AC and cools the AC off,” he explained. “No wonder,” I said, “My AC stopped working before the car begin to make the strange noise.” I asked if there was a car mechanic that I could call to help me out. “Why? It will cost you so much money, all you need is to buy a belt and replace it. We will go buy from Kiryat Gat, it is not far from here,” Yoram explained.

Was I going to trust this man with my car? Or was I going to pay 600 shekels to have my car towed to Kiryat Gat? It was easy to go back to my car, sink into my case files book about essential tremor while waiting for the towing truck to come. I went in the car with Yoram instead, trusting that he was going to take me to Kiryat Gat, and that we were going to buy the right belt to put it in the car. What followed was my usual fear of being asked where I was from, and who I was. Yoram was surprised to find out that I was not Russian, in fact, I was Arab. And, I was equally surprised that he was half Arab and half Jewish. His mother was Moroccan Jewish, and his father was from Lod, where he was born and raised. He spoke both Arabic and Hebrew, and while his father called him Yousef, he went by Yoram from the Torah. He was a truck driver who delivered commodities to stores in Jerusalem and previously, the West Bank. He had three children, the oldest of whom was studying in college to be a teacher and to be married soon.

“Do you have children? Are you married?” Yoram asked, as I timed how much time it took us to reach Kiryat Gat. “No, I am not,’ I said, taken aback by suck a personal question to me, feeling now that I was more vulnerable without a husband, with a broken car. I could feel my body tensing up. Thankfully, we arrived to Kiryat Gat, and went into a store where I paid around 30 shekels for the belt and then borrowed two “English keys” from a friend of Yoram’s, who was a car mechanic.

“It is so easy to fix, it should take a few minutes and then you can go back on the road,” he said. He sounded optimistic and that gave me hope to reach Jerusalem rather than return to Beer Sheva. He then continued to add, “Ihna Fallaheen (we are peasants), we know how to fix cars.” What followed was a about thirty minutes of me bending down into the car’s hood, placing the belt on the bigger pulley, while Yorm, placed under the car, struggled to place the belt around the second pulley that I could see from the top. It did not work, and Yoram’s optimism and determination to fix a minor problem seemed to wane.

An 18 wheeler truck driver pulled up- a man in his mid forties, well built, with a white beard, came to the car as Yoram stood up to explain to this friend what happened. The old man, who told me his name was Marco, got gloves from his truck and another tool and directed Yoram who was once again sitting under the car how to place the belt.

“You speak Arabic?” Marco asked me after I said my name. “Yes, I do.” “You are Christian?” he asked in Hebrew. Again feeling vulnerable, I said, “Yes.” “Tu parles Francais?” he asked. “Oui, ma famille est francophone. Comment ca ce fait que tu parles Francais? (Yes. my family speaks French, howcome you speak French?)” I asked. He answered my question with a question in Arabic, “Sho bitfakrey be el wadey ( what do you think about the situation?” “Well, I hope I can get the car fixed to get back to Jerusalem,” I answered, not sure what kind of situation he was referring to. “La wadey el bado wow el yahood ( the situation of the Arabs and Jews)”, he clarified in Arabic.“I am going to be a doctor and like you are fixing my car, I fix people’s bodies, regardless of who and what they are,” I answered.

He leaned forward against the hood again, screamed at Yoram in Arabic, “La ya ahbal mish hek (No idiot, that is not the way to do it). You need to pull it stronger.” The instructions continuesd with a high tone, “No place the belt here, I will put my hand on the small pulley. No stupid, not like this. No the belt is the right size.”

The roughness of Marco’s instructions reminded of my rotation in surgery. I once scrubbed with a surgeon who I knew loved to teach students and residents. And I got to be part of an appentectomy with a first year resident doing the operation under this surgeon’s guidance, much like Yoram was trying to fix my car under Marco’s guidance. I remember the older surgeon screaming at the young one, “No that is not how to tie the knot, now that is not how you cut, you need to learn to do the operation with your right hands eve though you are left-handed.” Teaching how to do surgery in medicine and how to fix parts of a car were very similar. At the time, I appreciated how the senior surgeon was willing to teach, and how the young surgeon was willing to take the instruction, no matter how rough it might have sounded.

“Well we disconnected the AC from your engine, you can drive home and try fix the belt there. It is not fitting here,” Marco concluded to me. “I am driving a bit up north till Kiryat Gat, you can follow me with you car,” he explained.

How does one leave a gift to Yoram, to a fallah? I did not know but Shabbat was near, and I had bought a bouquet of flowers in Beer Sheva to take back to Jerusalem. I left it for his wife, and followed Marco on road 40 until we parted ways. “If the car breaks down, you can call me,” he said, giving me his cellphone number.

Thankfully, the car drove slowly but surely back to Jerusalem. And later the next day, as I took it to the car mechanic, he pulled a pulley from under the car, “This is broken and will have to be changed.” Yoram was not wrong- there was a reason why the belt could not fit from the bottom. I took home with me the broken pulley and placed it on my desk. Some patients take back their gall stones once their gall bladders are taken out.

I find it easy to take a car apart, to take a pulley back home, to replace a belt in a car because it has very little meaning and is replacable. What I cannot get over in medicine and what I find most challenging is the humanity of both I and my patients- we both have feelings, and unlike a car, I cannot map out what goes on in the mind of my patients. That might be the essence of the healing art of medicine.

I remember reading once a book about emotional intelligence, and in it, Daniel Goldman, explained that based on the latin root, “E-Motion meant to move away, that our emotions moved us, to fight, to flee, to love, to hate and so on.” In medicine, those deeply rooted biological e-motions, are numbed during procedures, and yet it is because of those e-motions that a patient feels something is wrong and comes to see the doctor. Medicine defines this as “symptoms”.

I would like to take home with me more than broken pulleys, torn belts, and I want my patients to take home with them more than gallstones extracted from their gallbladders.