Cheating Death

In an unconventional war, Avi Rivkind saves lives using unconventional means.

*Note: in keeping with our mission, the Hot Zone is putting a human face on the Israeli-Palestinian conflict. We'll profile doctors, victims of the violence, journalists and artists -- one from each side. In focusing more on the human picture than the political one, we aim to present a clearer portrayal of the scope of the conflict.

ISRAELI DOCTOR

JERUSALEM -- He was struck by her beauty, and by the fact that there was not a visible wound on her entire body -- not a single mark.

It was her color that got Avi Rivkind's attention.

"You need to be Chagall to describe her color," Rivkind says. "It was not white, gray, yellow--something was wrong with the color."

He told her everything was going to be okay, but he knew it was a lie, even before he opened her chest cavity in surgery. Her lungs had exploded and the compressed air that was in them had decimated other organs. Within five minutes Shiri Nagari was dead.

"She was just 22 or 23, long, blond hair. So beautiful," says Rivkind.

The memories are so powerful that Rivkind, the head of the surgery and trauma units at Hadassah Medical Center in

"It was blast trauma," says Rivkind, who has become the world's premier expert in identifying and treating these kinds of injuries. He describes it as the shock wave from a bomb or explosive which passes through the human body, leaving a path of destruction through its sheer force and velocity.

Shiri Nagari happened to be on a bus in Jerusalem at Patt Junction in June 2002 when a suicide bomber blew himself up. She and 19 others (including the bomber) were killed. (A memorial Web site for Shiri can be found here.)

Rivkind couldn't save her. It's a memory that will not give him peace. But he has saved thousands of others, including both victims and perpetrators of acts of terror resulting from the Israeli-Palestinian conflict.

Hadassah's trauma unit has one of the lowest mortality rates of any center of its type in the world. Out of 8,000 patients from 1999 to 2003, Hadassah had only a 2.1 percent mortality rate, compared to 6.7 percent for Level I trauma centers in the United States.

Rivkind says there are two primary reasons for the kind of results he gets. The first: commitment from all levels of staff, from administration to the doctors and nurses.

"Everyone works day and night 365 days a year -- including weekends," he says.

Rivkind himself says he wears two beepers and a cell phone all the time--even to bed. When awakened from a deep sleep he says he can usually beat the ambulances to the hospital by driving himself.

Rivkind says the second factor is that senior people always treat the patients.

"In cases of trauma," he says, "the show is run by senior guys. Whether it's big or even just daily stuff, you get the heads of departments here. To the best of my knowledge, you don't see the head of surgery involved in trauma cases in the United States, but we do it here."

He also says that doctors are encouraged to improvise -- in ways that would send malpractice-obsessed American medical administrators through the roof. "We improvise, it works," he says. "We're dealing with saving lives. We don't have time for committees or double-blind studies."

Unconventional warfare, Rivkind muses, requires unconventional medicine -- like the time fourteen year-old Adi Hudja came into the Trauma Center with 40 metal objects in her legs from a suicide bomber packed with bolts, nails and ball bearings.

"She was bleeding uncontrollably from her wounds," Rivkind wrote in an article. "On the spot, we came up with the idea of trying a coagulant for hemophiliacs still not approved by the U.S.

Rivkind says there are malpractice concerns in Israel, but they don't pose the same kind of legal obstacles they do to medical practitioners in the U.S.  "We're not jumping down from the eighth floor," says Rivkind, "but we're jumping down from the first floor. We are landing on our feet. Our patients are landing on their feet."

Some of that is certainly helped by Hadassah Medical Center's brand new, state-of-the-art, $50 million dollar trauma facility.

While the center was being built, Rivkind insisted on a VIP trauma bay, complete with a bullet-proof door, that many people, he says, thought was unnecessary.

Israeli Prime Minister

"We improvise, it works. We're dealing with saving lives..."— Avi Rivkind

"The second time we did a life-saving procedure," he says of Sharon's care. "It was so smooth it was unbelievable -- no problem. Although some people might have been just a little more nervous because of who we were working on. For me, he was like any other patient, but it was like a vision that came true that someone of his stature needed the room and it was ready. I think everybody in Israel is happy we have this room."

But Rivkind says it doesn't matter if it's the prime minister or a terrorist -- he and his staff are there to save lives.

Hassan Salame was responsible for masterminding the #18 bus bombings in Israel in March 1996 that killed 44 people. Salame later was wounded in a shootout with police and was brought to Hadassah's Trauma Center. Rivkind pulled the bullets out of his abdomen and saved Salame's life. (Now, he'll spend the rest of it in prison.)

"I feel sorry for them," Rivkind says of those responsible for the attacks that help to keep his trauma center so busy. "It's sad that they've arrived at such a magnitude of hate that they needed to do this."

Coming Wednesday: Palestinian Doctors 

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