1. The first steps
During my internship at Hadassah, an accident occurred that critically
influenced my entire professional future. Friday, January 18th 1957, on
my way to the Department of Medicine, I slipped in the rain and fell. I
felt instant pain in my left hip and could not get back on my feet.
People on the street helped me, and I continued slowly on my way to the
hospital, limping all the way. I started my routine work - drawing
blood samples, preparing patients’ charts for rounds with the
Professor, and similar chores. While doing all this, my limping became
more obvious and arose general attention. Dr. Shlomo Rogel, at that
time a medical resident and later professor and well-known cardiologist
in Jerusalem, insisted that I get a radiogram. Finally, against my
wishes, he sent me to the radiology department. The radiogram showed
fracture of the femoral neck. I was not permitted to get up from the
table. I was immediately transferred to the Emergency Room and was
operated on that same day. Dr. Makin, chief of the orthopedic division,
fixed my broken bone using a Smith-Petersen nail that remained in my
body until the hip replacement in 2003. During the operation a number
of complications occurred. As a result, I remained in the hospital for
a whole month, and in a convalescent home for another month. For four
months I was not permitted to use my left leg, and had to walk on
crutches. The curriculum of my internship was modified, to enable me to
be in “easier” departments during this difficult period.
Just at that time several resident positions became available in the
Department of Surgery and a tender was announced. The candidates were
interviewed in the Lecture Room of the Department of Surgery - the
famous “shack” in the yard of the Ziv Building. Not
doubting that my chances were excellent, I applied for the job. Judging
from my student record and my performance as intern, there was no doubt
in my mind that my residency position was assured.
When the judges’ decision was announced, the results amazed me. I
was not accepted. The shock was beyond description. I felt that a great
injustice had been done to me. I did not understand what had happened
and could not accept the verdict. True, all the candidates were good,
and the number of positions was limited, but still, the fact that of
several available openings not one was offered to me, did not make
sense. To me it seemed a terrible distortion of impartiality. For the
next 29 years, long after recovering from the shock, the puzzle did not
stop mystifying me. In 1986, when I had already been Chief of the
Department of Surgery for 15 years, I happened to visit Professor
Theodor Wiznitzer in Tel Aviv. We were drinking coffee and telling
stories. In 1957, when the candidates for the position of resident were
interviewed in Hadassah, Wiznitzer served there as a senior surgical
resident. During the interviews, he entered the shack several times
with some information for the senior surgeons and stayed for a while in
the room. In this way he had an occasion to overhear some of the
reasoning in favor and against the various candidates. When the
candidate, Dov Weissberg, entered the room limping and supported by
crutches, all the favorable impression from his good work as intern was
forgotten in an instant. The judges saw only the limping intern
supported by crutches, and nothing beyond. “Can this disabled
young physician be a surgeon?” was their only thought. My fate
was decided once and for all. From this moment on I had no chance to be
accepted for a residency in Hadassah.
Had I been accepted in Hadassah, my career would probably have
developed differently than in fact happened. Had I been... But whatever
happened, had happened and it was irreversible. The senior surgeons
remained my friends and through letters of recommendation and phone
conversations helped me obtain a residency position. But not in
Hadassah. This was the way that led me to the Rambam Hospital in Haifa,
Department of Surgery “B”. Chief of the department, Dr.
David Erlik (later Professor Erlik, founder of the Abba Khushi School
of Medicine in Haifa) himself went through surgical training in
Hadassah and all the senior surgeons there were his friends. Their
recommendation was enough to ensure being accepted to his department.
Indeed, this time there were no difficulties, and the tender was a
simple formality. Because of my recent fracture, my military service
was postponed for one year, and I could start the surgical residency
immediately after my internship (Fig. 3
Fig. 3. The Graduation; the author first from right.
One day in January 1958, just before the end of my internship, I went
to Haifa for an interview with Dr. Erlik. He showed me the hospital and
invited me to see some operations. The schedule for that day included a
porta-caval shunt, a major and new operation. Dr. Erlik was the first
surgeon in Israel to have performed this kind of operation
successfully, and it was interesting to see him do it. I stood behind
him and observed. One of the side-lamps obscured part of the operative
field, so I shifted it slightly to the side. While I did this, the lamp
hit the main headlight hanging from the ceiling, covered with a special
opaque pane. The pane broke with great noise and shreds of glass fell
in all directions. It was pure luck that no glass fell into the open
belly. I wanted to bury myself on the spot. But Dr. Erlik tolerated the
accident with patience and humor. Wasn’t this accident a sign
from heaven, an omen forecasting the upcoming developments in Rambam?
* * *
I completed my internship in Hadassah on January 31st 1958 and on
February 1th started the residency in Surgery. The Rambam Hospital had
two Departments of Surgery: “A” and “B”.
Department “A” took care of general surgery only.
Department “B” (that of Dr. Erlik) handled, in addition to
general surgery, also urology and vascular surgery. The background of
this state of affairs should be explained, because it sheds light on
Dr. Erlik’s distinctive personality.
In 1948, after the creation of the State of Israel, the British
Hospital in Haifa became the Israeli Rambam Government Hospital. At
that time the hospital did not yet have a separate urology service.
Patients with urologic problems were treated, as in many other
hospitals, in the Department of Surgery. To aid in the development of
the hospital, a decision was made in the Ministry of Health, to open a
separate urology service. Dr. Erlik from Hadassah became the chief of
this new service. Due to his past experience in Hadassah, Erlik was
equally proficient both in surgery and in urology, liked both, and had
not the slightest intention of cutting himself off from either one of
these branches. From the beginning, as the new chief, he admitted to
his unit patients with both kinds of problems – general surgical
and urologic. The new unit became not just a urology service, but a
full-fledged Department of Surgery, with urology as part of it. In
retrospect, the Ministry of Health recognized the fact that two
Departments of Surgery are better for the Rambam Hospital than one and
acceded to the new reality. But Dr. Erlik did not stop there. At that
time a new branch of surgery started developing - vascular surgery - a
novelty that appealed to Dr. Erlik very much. Within a short time this
branch also became part of Dr. Erlik’s department, which by now
had changed its name from Urology to Department of Surgery
“B”. In later years, Erlik performed the first successful
kidney transplantation in Israel. Accordingly, his residents had an
opportunity to learn and gain experience not only in general surgery,
but much beyond. And not just an opportunity; there was simply no other
way. The program required more effort, but provided greater experience.
Surgery flowed in Dr. Erlik’s veins and his grasp of it was
all-inclusive. He never hesitated to perform important, life-saving
operations in any anatomic region outside of his domain. Chest surgery
was not out of bounds, although he never studied it. I remember a
soldier brought in as an emergency. He was wounded in the chest. Blood
was flowing freely through the tube drain placed in his chest. The
young man, with blood pressure near zero, was close to death. Without a
moment’s hesitation Dr. Erlik opened his chest. The lung and
pulmonary vessels were torn, and there was no way to stop the bleeding
without resecting the lung. Erlik caught the pulmonary hilum (root of
the lung) with his hand, pressed on it firmly and placed several heavy
sutures on the entire mass of tissue, without trying to separate
between the pulmonary artery, veins and bronchus. The bleeding stopped.
He placed some more sutures to make sure that the bleeding would not
restart. When the patient’s blood pressure began to rise, Erlik
cut off the lung beyond the sutures and removed it from the chest.
Then, in a voice expressing great satisfaction, he said: “This is
the way to do a pneumonectomy”. To all present it was obvious
that he had never before performed this kind of operation. He probably
never even saw one being done. Indeed, this was not the way to do a
pneumonectomy. But the bleeding did stop, and the soldier recovered and
was discharged from the hospital. Many surgeons, among them chiefs of
departments who had never learned how to do a pneumonectomy, would have
stood there helpless, while the patient exsanguinated. But not Dr.
Erlik. Erlik judged surgeons according to their performance in the
operating room. He classified them either as “surgical
stuff” or “non-surgical stuff”. If there ever was a
physician made of “surgical stuff”, it was Erlik.
Dr. Erlik demanded absolute discipline and promptness. I remember the
appendectomy of Dr. Fliegelman, chief of the Department of Psychiatry
in our hospital. Dr. Erlik made the diagnosis while examining him
outside of the hospital. The operation had to be done immediately. It
was afternoon. Dr. Erlik was busy with some other business, which
influenced his mood unfavorably. I was in the hospital on first call
for emergencies. Dr. Erlik called me and demanded that the patient be
on the operating table at 5 o’clock. Exactly at 5. I did all I
could to complete the examination and bring the patient to the
operating room on time, but an unexpected obstacle prevented me from
achieving it: Dr. David Barzilai, a senior physician (later, chief of
the Department of Medicine), decided to obtain an electrocardiogram
before the operation. Due to some technical problem, it was impossible
to make the EKG machine work and Barzilai, stubbornly refused to
transfer Dr. Fliegelman from the Emergency Room to the operating suite
without an EKG record. I told him that Dr. Erlik wishes to have the
patient on the table at 5 o’clock, wants to start the operation
exactly on time and is in bad mood. “Do you want the Chief of
Department to undergo an operation without
an EKG record?” asked
Barzilai with derision. To my answer, “Yes, this is what Dr.
Erlik ordered”, Barzilai did not even bother to answer. At 5 p.m.
exactly Dr. Erlik entered the operating room, but the patient was not
there: he was still waiting for the EKG in the Emergency Room. With
shouts of rage Dr. Erlik ran to the Emergency Room and Dr. Fliegelman
was immediately sent to the operating theater. Without
an EKG. The
operation started after 6 p.m. and throughout its entire course I felt
Dr. Erlik’s anger.
* * *
When I came to the Rambam Hospital, all the work on the service,
including emergencies on our days on call was done by three physicians:
Dr. Singer - deputy chief of the department, Dr. Schramek - senior
surgeon and Dr. Levin - second year resident, one year ahead of me. I
was the fourth to join the team. Occasionally we had an intern for a
month, but unlike Hadassah, most of the time there was no such luxury
in Rambam. Just then Dr. Singer left for a sabbatical year in the
United States, and all the work in the department of 45 beds, plus
emergency calls, was carried on by the reduced team. To make the
picture complete, it should be clarified that in those years, the
Emergency Room of the Rothschild Hospital in Haifa was open for
emergencies only one day a week, and the Carmel Hospital did not have
an emergency room and did not accept emergencies at all. In 1958, the
Emergency Room of Rambam Hospital was the busiest and carried the
greatest burden of all the hospitals in Israel. There were, as I
mentioned, two Departments of Surgery in the hospital, each with two
residents. The nights on call were divided equally between the two
departments. As senior surgeon, Dr. Schramek did not take emergency
calls in the hospital (he was on second call at home). Each one of the
four residents was, therefore, on emergency call every fourth night.
When one of the residents was called to the Armed Forces for reserve
duty (which accumulated to several months per year), we were on call
every third night. No one thought that the Emergency Room should have a
team of its own, or, at least one surgical resident just for itself.
Nights on call were hard. The single surgical resident set into a
perpetual motion was cruising between the Emergency Room, the operating
room (emergency operations) and both surgical services, taking care of
IVs and other urgent matters there. Today it is difficult to imagine
the war-like situation that prevailed in the Rambam Hospital in those
days. Many times, the work in the operating room went on
uninterruptedly until morning hours, and through the windows one could
see the rising sun, while no one attended to the Emergency Room, where
patients were waiting...
I remember one early morning following a 24-hour period of
uninterrupted work, I was assisting Dr. Schramek on a lengthy
operation. In the midst of it, I fell asleep. I woke up from a roaring
shout of Schramek in Yiddish: “Weissberg, shluf nisht
(don’t sleep)!”. It was a rare occasion that a surgical
resident actually slept while on a night duty; usually my bed remained
untouched. On the day following the night duty, came the usual routine
of morning rounds, drawing blood samples, operations, admitting new
patients, and so on, until late afternoon or evening hours. In view of
this intolerable situation, we went to Dr. Erlik to complain. We asked
for a solution, which would make our work a little easier. His response
was short and typical: “You don’t know how lucky you are,
that you have something to do”. That was it. At the time we found
it difficult to understand the great wisdom in Dr. Erlik’s words.
Yes, I really mean it. Please, try to imagine for a moment people who
have nothing to do. There are many. I know them and pity them much more
than those young surgeons (including myself) who have no time to be
bored. On our free evenings we found time for recreation, company,
studies and hobbies. Indeed, I did have girlfriends, saw plays, read
books and scientific journals, and more. Anyone who cannot bear this
load, perhaps should not be a surgeon... Is this the way it
should be? No, certainly not. But this is the way surgery was taught in
the past; the way generations of surgeons have grown. And one can live
with it. However, if good results are to be expected from such exertion
and stress, two prerequisites must be fulfilled: friendly atmosphere
and feeling of progress
The senior surgeon in our department, Dr. Alfred Schramek worked hard
and demanded a lot, not only from others, but from himself as well. He
was broadly educated, had a fine sense of humor, spoke several
languages fluently, loved music and understood literature and art. One
could converse with him on any subject. In short, an intelligent
person. But he was hard to work with, did not excel in politeness and
in gentleness, and I, the most junior member of the team, felt it well.
Dr. Dan Levin, although only one year ahead of me, let me feel his
seniority at every opportunity. The atmosphere in our department and in
the entire hospital was unpleasant and gave me the feeling of
deprivation. Dr. Yaakov Singer, deputy chief of the department, was
patient and friendly, but this did not help me when he was studying in
America while I was trying to adapt to the uninviting environment. I
recall many incidents that exemplify the Rambam atmosphere at that
time. A patient with multiple injuries was hospitalized on our service.
His broken leg was in a cast. Dr. Steiner, chief of the Department of
Orthopedics was supposed to decide when to take the cast off. When the
time came, Dr. Erlik ordered me to remind Dr. Steiner, which I did. Dr.
Steiner gave me a scorning look and quietly said “good”.
Then he waited patiently. On the day when Dr. Erlik made bedside rounds
(“Grand Rounds” – twice a week), and when the entire
retinue was in the 20-bed ward, a deafening noise of an electric saw
burst suddenly in the room. It was Dr. Steiner, removing the cast. This
was his way to demonstrate displeasure. Dr. Erlik stopped the rounds,
approached Dr. Steiner and asked him what happened. To this Dr. Steiner
answered: “Your junior resident gave me an order to take the cast
off. That’s all”. Apparently the way I addressed him was
not sufficiently polite, or, perhaps he preferred to be invited for a
consultation, so that he would decide what to do, rather than being
reminded what had to be done. But instead of pointing this out to me,
he preferred to make this theatrical demonstration. Dr. Steiner had his
own peculiar sense of humor, not always pleasant to his victims.
The Department of Orthopedics did not always have a resident on night
call. Minor orthopedic emergencies were taken care of by the surgical
resident, who called a senior orthopedist when needed. One evening I
was called to see a patient whose leg was in a cast; his toes had
become blue and swollen. The cast was apparently too tight and the foot
was in danger. I opened the lower part of the cast with an electric
saw, to relieve the pressure. I had seen this many times done by
experienced orthopedists. The patient’s foot improved
immediately. The next day, Dr. Steiner, short of staff, needed
assistance on an operation, and I was sent to help him. After the
operation he turned to me and said: “I would like to thank you
for your help...”. Certain that Dr. Steiner was talking about my
help in the operation that we had just completed, I answered:
“Not at all, I will gladly help, whenever you need”. But
Dr. Steiner kept talking: “... for your ‘wonderful’
help in opening the cast last night”, and continued criticizing
my way of releasing the pressure, which apparently was not done in the
best possible way.
With regard to the feeling of progress
, the situation in Rambam
surprised me greatly and gave me much to think about. Basic teaching
methods, such as clinical sessions, bedside rounds with instruction,
and preparation of subjects for seminars and lectures, in Hadassah were
taken for granted. In Rambam of 1958 they simply did not exist. The
active method of teaching introduced in Hadassah by Dr. Nathan Saltz,
based on the North American residency training program, was initiated
by William Halsted at the end of the nineteenth century. It put
emphasis on active teaching and gradually increasing the responsibility
of the surgeon-in-training (resident). There was an explanation for the
lack of similar training program in Rambam: “You see how busy we
are; there is simply no time for lectures and discussions. Treating
patients comes before anything else”. This was certainly true:
hospitals do exist first of all for the purpose of treating patients.
However, even simple clinical or technical questions asked during an
operation or at bedside rounds, were left unanswered, with a curt
“I don’t have time now, let’s move on”. In
short, I came to the Rambam Hospital to learn surgery, and after a
short while, I had the feeling of marching in one place. One typical
incident clearly illustrates the prevailing situation and the reasons
for my frustration.
I had worked already for several months in the department and assisted
in many inguinal hernia operations. On the day of the incident the
operating schedule included, among others, two boys, 6-year-old twins,
both with an inguinal hernia. Dr. Erlik was supposed to operate on both
of them, and he chose me to assist him. While we were scrubbing for the
first operation, I asked him whether I might operate on one of the
boys. Dr. Erlik was visibly shocked by my question. His wet hands, one
holding a scrubbing brush, stopped in midair. His eyes, greatly
surprised, fixed on me while he asked: “Weissberg, are you
crazy?! You want to operate on a hernia? A hernia is a serious
operation! You have to learn first how to do it.
”. If Dr. Erlik
was shocked by my question, I was not less shocked by his answer.
During my internship in Hadassah I had already operated on a hernia. It
was customary that a hard-working, good intern who was interested in
surgery, was rewarded toward the end of his rotation either with an
appendectomy or a herniorrhaphy. Of course, this operation was done
under the supervision of a senior surgeon, but it was the intern who
performed the operation with his own hands, and thus learned. Due to
the close supervision, the patient was not endangered in any way. The
supervising surgeon (in my case Theodor Wiznitzer) was at the head. Had
there been any difficulty, he would have taken over and completed the
operation by himself. There were no such fancy games in Rambam.
* * *
Dr. Erlik had a number of principles with regard to surgical technique.
One was the need for a sufficiently long incision at every operation.
He insisted that a surgeon should have plenty of space available with a
comfortable approach to all structures and a possibility to accomplish
the purpose of the operation without compromising the patient’s
safety. He pointed out jokingly that an incision heals from side to
side, not from end to end. This principle is worth remembering now, in
the days of minimally invasive surgery, when the tiniest possible
incision is pursued above all other considerations. Without denying the
advantages of minimally invasive surgery that did not exist in the
1950s, I often see surgeons, some with considerable experience and
knowledge, who struggle helplessly with abdominal or thoracic organs
because of their difficulty to reach some remote corner of the belly,
sometimes causing great damage to tissues. All this, in order to avoid
an incision of adequate length. The size of the scar seems more
Another of Dr. Erlik’s principles was related to the resection of
the thyroid gland. A common complication of this operation is damage to
the recurrent laryngeal nerve
, the nerve that controls the muscles of
the larynx. Injury to this nerve causes speech impairment and must be
avoided. While operating on the thyroid gland, some surgeons separate
this nerve to protect it against damage. Dr. Erlik claimed that looking
for the nerve and dissecting it may be harmful; it is preferable to
avoid injury by staying away from it. His results with thyroid
operations were excellent, and I do not recall a single case of injury
to the laryngeal nerve in our department. One day a well known surgeon
from Boston visited Israel. Dr. Berlin was world-famous in the field of
thyroid surgery. He insisted that it is essential to dissect the entire
length of the recurrent laryngeal nerve, to see it clearly and thus
protect it. Dr. Erlik invited Berlin to operate on one of our patients.
Dr. Berlin demonstrated his technique clearly, and skillfully separated
the nerve from the surrounding tissues. Everything seemed in best
order. However, after the operation, the patient’s voice was
hoarse, and a laryngoscopy 1
demonstrated paralysis of one of his
vocal cords... This was the first time that I have seen both, how
to separate and protect the recurrent laryngeal nerve, and this kind of
complication. For many months we joked at the expense of the famous
visitor. Apparently Dr. Erlik’s principle was worth more than the
elegant demonstration of the nerve.
* * *
There was a general frustration among the residents. Our progress was
far too slow, and we all felt immense starvation for operating. Itzhak
Horowitz, a resident in the Department of Surgery “A” and
later chief of surgery in the Rothschild Hospital, was two years ahead
of me in training. Toward the end of his third year in surgery, he was
still not permitted to do a cholecystectomy, and Itzik was
“hot” to perform it. During one of his nights on call, a
patient entered the Emergency Room. She complained of abdominal pain,
vomited, and her abdomen was tender in the proximity of the
gallbladder. The diagnosis of acute cholecystitis due to gallstones was
clear. Horowitz had waited a long time for such a case, and his course
of action was planned well ahead of time. He declared that the patient
had acute appendicitis, wrote this diagnosis on the admission chart
and, according to routine, took the patient to the operating room. Dr.
Schramek was on second call at home, but Horowitz decided not to inform
him about the case, at least for a while. He asked me to help him on an
”appendectomy”. At that time all
abdominal operations in
Dr. Erlik’s department were done through vertical incisions.
Contrary to many surgeons, Dr. Erlik preferred this incision to all
others. This fit exactly Horowitz’s plan. While realizing that
the correct diagnosis was acute cholecystitis, he made the incision in
the lower abdomen on the right side, as for an appendectomy. As soon as
the belly was open, the appendix was found to be normal, as expected.
Horowitz resected it, then said “let’s see what’s in
the gallbladder”, and extended the incision upward. He found the
gallbladder inflamed and full of stones, and started the resection.
When this was nearly completed, he asked one of the nurses to call Dr.
Schramek and to inform him that during a routine appendectomy an
inflamed gallbladder was found and had to be resected. “Perhaps
he wants to come, although it is not necessary. I can manage it by
myself”. By the time Schramek arrived, the gallbladder was
already out and the abdomen almost closed. Horowitz said:
“Schramek, there is no need for you to scrub in, the gallbladder
is already out”. Schramek was flabbergasted. He barely managed to
utter the words: “Horowitz, what have you done?!
cholecystectomy”, answered Horowitz, calm and relaxed. He did not
show any signs of emotion. Eventually, this entire incident passed
without further turbulence. I was too timid and too new in the trade
for such tricks, but even much later, I have never reached this level
of abusing the regulations.
During the first year of my surgical residency (not an internship
anymore!) I was permitted to do appendectomies, but never a case of an
inguinal hernia, hemorrhoids, varicose veins etc. Obviously, a
cholecystectomy was beyond discussion. I worked in the Rambam Hospital,
with an interruption, for a total of nearly two years. During the
second year, likewise, I have not done any of these operations, that in
the spectrum of general surgery are considered “minor”,
except for three operations of inguinal hernia. These were awarded to
me through the kindness of Dr. Singer who consented to help and
instruct me. Appendectomies and three
inguinal herniorrhaphies - this
was the total surgical experience that I managed to accumulate during
two years of such hard labor in the department of surgery. I felt I was
walking in one place and wasting time.
I had enough of the Rambam Hospital and did not want to stay. But what
could I do? I went to meet some of my former teachers, chiefs of
several surgical services in Hadassah (general, thoracic and others).
Conversations with them clarified to me ultimately that my way to
Hadassah was blocked. If I was unhappy in Rambam, whose fault was it?
Perhaps I was not good enough. And if I failed in Rambam, why should
they risk it and take me on? But I believe that there was one other,
major reason for their reluctance to specifically accept me
in Hadassah: it was their concern not to offend Dr. Erlik. There were
plenty of other candidates whose acceptance would not offend anybody.
Eventually I realized that my efforts in Hadassah were wasted; there
was no point trying there. Should I start looking for a residency
position in other hospitals in Israel? As a matter of fact I worried
that a position in some other hospital might not necessarily be better
than my present position in Rambam, but still, I tried. Several
department chiefs in Tel Hashomer and in Beilinson answered my
inquiries: “You have an excellent residency position in Rambam.
Why are you looking for a job?”. Again, the same suspicions and
the same reasons for not accepting me, as in Hadassah. There remained
two options: to resign myself to the state of affairs in Rambam, or, to
give up surgery and specialize in a different branch of medicine.
Or... there were before me physicians who went to specialize in
the land of unlimited possibilities - the United States of America. The
most striking example was Dr. Saltz from Hadassah. He did not really
“go” to the United States, as he was born in New York, but
he took his surgical residency there. I personally saw the truly
impressive results of his training. I started inquiring among my
friends who have spent various periods of study in North America, and I
obtained a lot of valuable information and some good advice.
In order to work in the United States as a physician, a foreign medical
graduate must first pass examinations both in medicine and in English,
to satisfy the requirements of the American authorities - the ECFMG.
To expedite matters, I decided not
to take the full advantage of my
one-year postponement, but to leave the Rambam Hospital as soon as
possible and get over with my military service. I contacted the
military authorities and informed the Surgeon’s General Office
that my disability is over. I feel well, I function well, and am ready
to serve. Within days I was notified that the next Medical
Officers’ Course is expected to open in October (a couple of
months ahead), and received an order to return to service. I parted
from my colleagues at Rambam with good feelings, we maintained contact
and remained friends.
The Officers’ Course started on October 8th 1958. It was
enjoyable and, unexpectedly, quite interesting. Part of it was military
training, but a considerable portion was spent in the various
departments of Tel Hashomer Hospital (later renamed Sheba Medical
Center). From time to time I participated in operations and learned.
For the first time I saw that clinical and surgical problems can be
approached in different ways in various departments, and that these
differences are discussed freely, rather than dogmatically dismissed. I
learned to set broken bones and to immobilize fractures in a cast. I
particularly enjoyed seeing lung operations elegantly executed by Dr.
Yehuda Pauzner (Fig. 4
Fig. 4. At the Officers’ Course; in the center Prof. Spira and the author holding a bottle of brandy.
After graduating from the course, I spent a short holiday in Eilat - my
first visit there. Following that, I served in various units of the Air
Force and took a course in Aviation Medicine. In parallel, I took
emergency calls on weekends and nights in the Rambam Hospital, for a
fee. In addition to the income, these calls helped me stay in touch
with surgery and with the hospital.
In the beginning of 1960, due to some obligation on the part of the
Israel Defense Force (IDF), the Medical Corps was supposed to provide a
military physician who would work for one year in the Rambam Hospital
as part of his military service. Dr. Erlik realized that after having
spent eight months in his department, I had experience in taking
emergency calls, could assist in operations, and could no doubt work
more efficiently than some newcomer who had never worked in surgery
before. Therefore, he requested from Col. Dr. Baruch Pade, the IDF
Surgeon General, to send to Rambam not just any military physician, but
me. Dr. Pade objected. According to the administrative routine in the
Medical Corps, I was supposed to serve in a field unit and was not
entitled to the “treat” of spending one year in a hospital,
without committing myself to an additional period of service. But, when
Erlik wanted something, he knew how to insist. No one could refuse him.
To fulfill his wishes, I was sent to serve in Rambam for one whole year.
The first six months were to be spent on the neurosurgical service.
This was new to me. During the years in the Medical School and in my
internship I never spent any time on neurosurgery, and this was my
first opportunity to learn something in this field. The sole resident
who worked there, had just left in rage after a fight with the chief,
and Dr. Eli Peyser remained alone. I came to fill the vacuum. Besides
the chief, I was the only doctor on this 14-bed service, always full,
all its patients seriously ill.
Dr. Peyser was a difficult person, short on patience, exploding easily.
However, he was a very good surgeon and an excellent teacher. He taught
me how to perform a thorough neurologic examination, management of
trauma to the central nervous system, and more. He instructed me in
reading articles relevant to our patients’ problems and invested
great effort in my education. As his only resident, I participated in
every single neurosurgical operation done in Rambam during the 6 months
I spent on his service. However, as the only junior member of the team,
I was on call every day and night, seven days a week. On days without
operations, I could leave the hospital, but had to be within reach by
phone, and not too far from the hospital. I found out to what
ridiculous situations this can lead, when I was called from a theater
in the middle of a movie. In the hospital they knew my seat number and
called the theater. My girlfriend went home (she did not want to stay
and watch the movie alone), while I went to the hospital for an
emergency operation. A rather unpleasant experience.
For the remaining 6 months I returned to the Department of Surgery
“B”. During my absence, Dr. Singer returned from the United
States, and the general atmosphere became more tolerable. Also, the
surgical team had expanded by a couple of new residents and I, as an
old-timer among them, felt a certain superiority.
There were rumors that Dr. Singer may accept a position of a department
chief in the Rothschild Hospital. During a coffee break, this
possibility was a subject of conversation. When I uttered a few words,
Dr. Yaakov Assa, a new resident, asked me with some derision:
“Are you also interested in applying for the position?” I
felt embarrassed, and did not know what to say. Instead of me, Dr.
Erlik answered in Russian: “Nie tot soldat, kotoriy nie khochet
byt’ generalom” (One is no soldier, if he does not desire
to become a general). Suddenly, I felt like a victor, because even at
that early time, there was a glimmer of hope in the depth of my heart
to become one day chief of my own department. Erlik understood this.
While working in Rambam, I learned to keep Dr. Erlik in the highest
esteem. Today I understand that he was one of the greatest surgeons I
ever met. In my memory he remains engraved as a man of great wisdom and
integrity, made of the most distinguished “surgical stuff”.
He was a man of impeccable character, utterly devoted to his patients
and always ready to support his pupils. All those who managed to endure
his residency program, have reached important positions in surgery;
many became professors and department chiefs. Also, one should remember
that Dr. Erlik was the decisive factor in founding the Medical School
in Haifa and its first dean. Without him, establishment of this
important institution would have been delayed for many years. A great
man (Fig. 5
Fig. 5. Dr. David Erlik, 1960.
Observing inside of the larynx through a specially devised instrument.