One of the things I love most about portable ultrasound is how stupidly easy it is to learn. People sometimes think that I am bringing far more technical instruction than I really am. This is one of the perks of being the guy wearing the fancy-looking vest though; nobody knows how little skill it takes except for me – and it doesn’t matter.

With three 90-minute sessions we had finished the training for all the nurses and midwives that would be deployed to the field hospital. This was something to be celebrated, now everyone on site would have familiarity using the devices so physicians could spend more time in the operating room or triaging other jobs over doing the antenatal scanning.

Then came the question of where to take my talents next. For those of you who know me, the answer is obvious. Where else but the ICU?

So, on Tuesday morning of week two, I was guided into the critical care department. I was met by a few of the critical care attendings, all military men in uniform coming from anesthesia or medicine backgrounds. After a quick walk-through the department we sat for the introductory sugar-free coffee in the office and I got to meet another General. He was just as friendly and enthused as the head of maternity, and was extremely thankful and excited for our presence. We spoke about the probes before he took me on a tour.

Immediately as we came into the ICU, I was surrounded by beeps and bops of monitors. It looked as well equipped as the unit I worked in as a resident, the only exception being the use of paper charts. I’ll admit that walking through I felt an odd melancholy as I was thrust back into the medical ICU at Pennsylvania Hospital. In an odd way I felt at home.

Their ICU was a mixed unit, meaning they have medical, surgical, neurology, and other disciplines all housed in the same unit. Management of these cases was often done in conjunction between the critical care attendings and the subspecialty teams needed for that particular case.

In little time, everyone who was interested gathered around one of the patient beds and I took the critical care attendings through a rapid fire session on what we call the RUSH protocol for hypotension in critically ill patients. All four of them got involved holding the probes. As attendings, they had some experience with the tool but didn’t use it with regularity, so even in one session I got them to feel more comfortable with the device. Some of my other team members from the surgical division got involved as well, and we were able to split into two groups. After we wrapped up, I sat back in the General’s office and one of the attendings picked my brain about other uses for the device, specifically to measure pressure inside the brain, which was something I never had to do before.

‘It may be possible, let me look into tonight and see what I can find. When I come back tomorrow we can find a patient and try out some techniques,’ I said.

Sure enough he was right. I read through some journal articles that evening in the hotel and found there was good data out there to support a technique to measure the width of the optic nerve behind the eye as an indicator for pressure in the skull. After touching base with my brain-folk back in the US (thank you Eli and LJ), I learned how to do the scan and brought everything ready for the next day. This is the beauty of ultrasound, a few articles and Youtube videos are all you need to get started.

The next day I joined the team in the morning for rounds, and we identified good cases to scan in the late morning. We had more staff and students joining in this time around, and got to do a lot of good teaching. In the end, our patient with concern for raised cerebral pressure was unavailable for us to try the optic nerve scan, but I was able to walk them through how it’s done.

After we wrapped up, one of the newer faces approached me. He was a young guy, probably around my age.

‘Hello doctor, I am from the Emergency Department and came by today when I heard about this teaching,’ he said. ‘Any chance you can bring this training to our division as well?’

Music to my ears.

‘Inshallah!’ I said.

So the next day, I met my third General, the ED chair, and we rolled out another training program for the emergency room. The whole day was spent bouncing from triage bay to triage bay. We covered all of the major scans with different staff based on their needs, and overall had a great day with an excess of handshakes and complimentary hot beverages. I was thanked a million times before I left. 

This was the overall theme of my two weeks in Jordan. Everyone everywhere was friendly. Everyone showed me love. Everyone seemed to think that I was a glowing beacon of humanity for bringing something which could help the mission and the people of Gaza. The well wishes came at a good time for me.

This was the prologue though, the pre-game, and the real journey would happen without me. I was blessed to get all of the praise with none of the pain that was inevitably coming for all those staff members who would dance with the horrors of war.

In my time outside the hospital I even made some friends. I went on a guided hike with a group and met two women from Syria, now living in Turkey, who were in town for a humanitarian conference. The conference was just wrapping up and they were on leave, so we spent some time together in the evenings. I met their colleagues and friends, most of whom were also Syrian and now worked in the humanitarian sector in education or protection. Many of them had worked in Syria, Iraq, Yemen, and Lebanon. You won’t be surprised to hear that they all reeked of burnout and existential frustration. ‘Nothing seems to change.’ ‘I wonder if we are making any difference.’ ‘I am thinking of leaving the sector after ten years.’ These were the common threads in our conversations. It seems I was not the only one going through a transformation.

In comparison to them though, I had a passport and career that allowed me to go anywhere I wanted. Not everyone is so lucky: the day after I finished in the Emergency department, I went on a month-long vacation through Jordan, Turkey, Tunisia, and Egypt.

While I was away, there was a big ceremony with the king unveiling the hospital and bringing some media attention to the project. This was a double move: on one hand it helps to press the groups involved to make things happen in expedient fashion in order to not disappoint the head of state, and on the other, involving the king helps to ensure that there will be more backing to get the project implemented without hindrance from any of the warring parties as they both maintain good relations with the crown.

The Jordanians were very smart to maintain neutrality in that sense. Yes, they had a spiritual and ancestral tie to Palestine, but they were also keen not to get blown up along with the rest of the region as tensions escalated. I was in Jordan during the pager and walkie-talkie explosions in Lebanon, and the ballistic missile strikes from Iran. The day after I left, Tayseer sent me a video that he took of the night sky, showing missiles flying from Syria and Yemen towards Israel over Jordanian airspace. Yes, a little unsettling, but in a way it told me that this was the place I was needed most; Philly has more than enough doctors.

As I write this, the hospital still sits in the lot at the medical campus in Amman. Formal and final approval from those at the highest level finally came in last week after some delays in securing the military grade barricades to protect the facility from nearby shelling. The world being where it is, it’s unclear whether we’re heading towards ceasefire or greater war, and where that will leave our hospital. Only time will tell.

Thanks again to whoever is reading. This was an education based project primarily, with less interesting patient anecdotes and more of my internal ruminations on life, liberty, and the pursuit of happiness. With regards to my cocoon: the vacation did me well to chill out and remember that life is an awesome journey, and the schedule has now taken shape for the coming year with a lot of cool things on the horizon. Watch this space; the wings are taking shape.

Best,

Juan