Elective in The Oncology Department, Shaare Zedek Hospital Medical Centre, Jerusalem
Shaare Zedek Hospital is located next to Har Herzl in southwest Jerusalem and is the fastest-growing hospital in the capital. The hospital has 1000 beds and treats over 600,000 patients a year in over 30 inpatient departments and 70 outpatient clinics. In 2014, over 22,000 babies were born in Shaare Zedek, more than any other hospital in the Western World (1).
I spent three weeks in the Department of Oncology at Shaare Zedek, with the generous support of the Jewish Medical Association. There is a friendly electives coordinator who helped me arrange the elective. My objectives were to gain a deeper understanding of the diagnosis and management of the malignancies; to learn how these conditions affect the lives of patients of different cultures; and to practise speaking to staff and patients in Hebrew and improve my vocabulary.
My time was split between the oncology ward, outpatient clinics and departmental meetings. On the ward, there were weekly ward rounds with Dr Amiel Segal, the Director of Inpatient Oncology, and also Prof Nathan Cherny, head of palliative care. I was included in the ward rounds and doctors went out of their way to explain what was going on and to ask me questions. I used the ward rounds to learn as much Hebrew as possible, and found the medical Hebrew surprisingly easy to pick up. The ward staff were very friendly and I was constantly fed coffee and cakes by the head nurse!
The outpatient clinics were an opportunity to learn about the diagnosis and management of the common cancers, mostly breast, bowel and lung. I spent time with five different consultants, each with a unique approach, and learnt a lot about communicating difficult news and patient-centred management plans. I also had the chance to take my first ever history in Hebrew, and with some difficulty I succeeded in gathering a full history of a patient recovering from a colonic resection due to cancer. I was also encouraged by one consultant to read a paper from the Israeli medical journal Harefuah, and so I spent the next week reading my first Hebrew paper, on the treatment of bowel cancer with peritoneal metastases with cytoreductive therapy combined with intraperitoneal hyperthermic chemotherapy. These experiences gave me a lot more confidence in communicating and learning in Hebrew and using every patient encounter as a linguistic as well as medical learning experience.
There was a wide variety of departmental meetings that I had the option of attending. For my first few days the doctors were kind enough to speak in English for my benefit! Every Thursday morning at 8am there was a kosher breakfast with presentations about the latest clinical research in oncology and how it might affect practice. There was also a weekly gynae-oncology meeting, a breast cancer meeting, radiology meeting and nuclear medicine meeting, which involved the review of PET scans. The weekly ward meeting included very interesting discussions and debates about the management of difficult cases, for example a lung tumour which histologically was identified as a squamous cell carcinoma but also had a component of adenocarcinoma.
Yom Hazikaron was a special day with a ceremony outside the hospital led by Professor Halevi, director of the hospital. This was attended by many staff and patients and particular attention was given to those soldiers who died while fulfilling medical duties.
I am very grateful to the Jewish Medical Association for their generous support of my elective.
Eitan Mirvis Imperial College School of Medicine
Published in General News, on March 22nd, 2017