07.06.10

Deaf and alive

Posted in Uncategorized at 9:03 pm by admin

Strange to say I’ve never seen an ear consultant.Well strange if you were born deaf. Or at least I think that I was.Stranger to say that when I did see a consultant it was like Moses parting the water.My Moses is a lady and she is deaf..But strangest of all  was that I  opened a very closed and very large dark room that no one had been allowed into.Certainly not me.A room full of shadows and strange echoes.The decision to go finally to a consultant was to see if I was suited for a Cochlear implant.Till now I just bought hearing aids on my own.In time  they got bigger and better and my hearing go smaller and worse.So I had a solution or so I thought.No questions. I just wanted an answer; Yes or No.Was I suited for an implant? Yes or No.Thats when the shock set in.I was examined patiently and extremely thoroughly.I started saying things that I would never admit.All very clinical but gentle and humane.Then the clincher.The Professor saw me surrounded by her staff and she introduced them.I was a wee bit nervous.’Well your functioning and hearing are much worse than your hearing test would indicate’.'Does that mean there is something wrong with my brain?”Certainly not– If I talk loudly you understand. It is in your ears . We have to find out how you are incapacitated and then find solutions. ‘I must have looked blank.So she added, ‘ You are suited for the operation but that is the easy way out. We may be able to improve things without one.’‘Does that mean that you can make me hear better?”Of course, but first sit a few hours to do some more tests especially with the Communication Therapist.‘I went out with tears in my eyes.I agreed to make more appointments.Starting with the Communication Therapist.Went home and in the night alone it all became clear.I went through my mind what I was going to say.The Prof had said that it would include questions like do I avoid going to the theatre because I cannot hear?Yes I do and more much more.I cannot really hear what anyone says.I hear something as words.Somethings I cannot hear at all.I hear somethings as words but as if in a foreign unknown language.Sometimes I know the possible translation and can fit one in,sometimes I cannot.Every sentence is like in a process whereby I am fitting in the missing pieces and trying to store the next sentence to be processed.Sometimes I don’t manage.Sometimes I can re-synthesise missing sentences.Sometimes I cannot.If the person has a high pitch voice it is harder.Nigh on impossible.Low and booming is easy.Two people together is impossible.All this means that I don’t go to Theatres.But more than that.Much more.All the family meet on a Friday.I haven’t a clue what they are talking about.Not a clue.They think that I am rude or eccentric because I read a paper.Conversations are like watching fish open and close their mouths.But I am the one with my head under the water.Everything is muffled and distorted.We have a family custom of celebrating birthdays at restaurants.There I am the life and soul of the party .I speak and joke.It’s a monologue with a friendly crowd.The minute audience participation kicks in I am kicked out.Back into the real world with the goldfish.Certain people, very close would be amazed.I haven’t heard what they have said for years if at all.Not really ever understood them.There is a guy at work. I have worked with on and off 40 years. He tells jokes. He must think that I am his biggest fan.I’ve never heard one of them.He smiles at the end of his jokes.If it’s a good joke he laughs.So do I .Thats how I get by.I don’t trust him. I cant hear him so how can I?He doesn’t trust me because he must feel that I am very false.But all is unspoken and undealt with.Pity as I think that I would have enjoyed him.Something else that slipped by whilst I was coping.Coping that’s the name of the game.You noticed I said I think that I was born deaf.I didn’t know that people heard better than me.How could I?Every time I said ‘What?’. The answer was ‘You heard’.So if I heard it meant that I had to produce something so I guessed.I am a good guesser.But if I guess wrong then it’s a mess.So I learned to fudge.Never answer directly.Never compromise yourself with an initial answer that leaves you open.Keep things going so that you can verify quietly.Either let the subject drop into vagueness and then re ascertain or give vague answers or jokes to make sure that you are on the right page and on the right line.Make jokes about yourself, because you are going to make a fool of yourself anyway!I learned a new trick. To ask the person to ‘restate that clearly and slowly so that the point would be absolutely clear’.It gives the impression that there are a few possibilities that I can see and they cannot.I do it with a smile so not to intimidate the other.But it gives me time.So hear I am floating alone in a fog.I can hear others hailing me but it’s all very distorted.But I have coped.Quite successfully as a Therapist.administrator and even in local politics.How?Well firstly I can manipulate clarity and vagueness.I make sure that everything is clear to everyone.But as I can tolerate a certain level of vagueness once I know that everything is clear I leave people alone to function..I have leaned to pick up non verbal cues when things are going wrong.I make sure that any vagueness is only ‘allowed’  by me.There will be clarity when speaking to me and that I say serious things very clearly.It took me time to realise that it was confusing to work with me and for me.I come across a nice guy.Then a demanding one.So I cling to the ‘nice guy’ part by being nice and considerate. [Which I find easy as I do like people].Above all I smile. I smile a lot.I cope at work and in politics.But all this wrecked a normal family life.No spontaneity and lots of misunderstandings and anger.Sounds pretty miserable.When I started out writing I thought so too.But there are plusses.Quite a lot.I learned that people are nice. They can do horrible things but we all can.Leading this way of life means I can give more lee way to people and events.I have the skills to read things and the ability to improvise.I have learned that smiling is for others and its nice.Laughing is for all of us and we all love it.I laugh a lot lately.I have learned that determination is more than ability but you do need ability too!Experience is the best teacher.Whilst fudging and fighting I realised that I’ve done a lot.Got a lot.A wonderful family who I want to enjoy, a wonderful profession that I can still add to , a wonderful country that I want to change for the better and believe that I can.But to do this I have to do more than cope.I have to converse.I am ready.I look to my deaf Moses of the deaf to part the seas and take me across.Michael

07.25.09

THOUGHTS FROM AFAR

Posted in Personality, Contributors, CBT, Stress, Anxiety, Depression, Uncategorized at 2:41 am by admin

THOUGHTS FROM AFAR

I know almost noting about he American health system. But I am an Israeli, UK educated physician working in management dealing with mental health care reform.

So here is my twopenneth of thoughts.

I do know that no one buys a pig in the poke. Today’s medicine is expensive, incoherent and economically unsound. These conditions make a ‘tax led’ expansion nigh on impossible. 

I think that we should consider what can be done and how?

The driving force for change may be political. But change has to encompass both delivery and payment.

I will develop a theme that states basically that costs and delivery can and must be altered before payment can be tackled.

Payment is pivotal in the making of universality.

REFORM:

There is no such thing as reform in medicine. There are far too many vested interests, preconceived ideas and established practices.

To make life easy lets call the involved parties shareholders.

Shareholders must want change. The change has to be as a constructive evolution and not a threatening revolution.

There can only be small, graduated and, hopefully coordinated incremental changes.

All reform has to have both a strategy and tactics.

Each change must be seen as being beneficial to most and detrimental to none.

In other words every shareholder must see some befit before he will take some risk. The benefit must be tangible and the risk less than such. It cannot be the opposite.

DESIRES:

What do we want to do?

Most encouragingly all the shareholders agree about what they want and do not want.

They want comprehensive, coherent professional care.

They do not want to have their economic status threatened. The user does want affordable health care. The industry member wants to maintain their income level. 

So far so good.

So let’s take the first step that is accepted by all.

Lets just save money.

FISCAL PRUUDENCE:

 We’ll examine but two issues.

 

  1. Litigation:

    The cost of insurance coverage is enormous.

    We could offer an alternative coverage. The choice would be of the individual but the premium would be affected accordingly.

    We would need to set up a State Quality Monitoring Board[SQMB]. The SQMB initially would have the following powers:

    1. Arbitrate in all litigation concerning mal-praxis.
    2. Set maximum sums to be paid according to misdemeanor.
    3. Set and monitor accepted practices in utilization of ancillary medical diagnostic services.

  2. Reduced expenses:

    On signing to being in a program that is under the aegis’s of the SQMB the premium could be reduced if the patient also agrees to:

    1. Wherever possible, as the treatment of choice, use generic medications.
    2. That all laboratory services would be done in accordance with absolute, medical needs. Put bluntly, not because I may get sued or it would be nice to have the tests but because I need this test to do good medicine.

If we get this far, and we can, we will see savings.

So we can move to the next step.

EFFICIENCY:

Medicine is a system of services. More often than not the patient is not doing what he should. Quite often he is doing what he should not be doing, or could be doing it somewhere else cheaper.

As a rule of thumb the patient:

 

  1. Should know what he is to do.
  2. Be followed up to ensure that he is doing, as he should.

This means evolving a system of care that has a case manager.

This involves profound conceptually and structural changes in the delivery of medicine. 

As the patient is liable to have many needs his medical needs are holistic and should be dealt with at the community or primary care level.

The care manager should know:

 

  1. What is needed?
  2. Where is it best done?
  3. Has it indeed been done?

This means several things:

 

  1. We resort to the idea of the centrality of the Family Doctor.
  2. A nurse does the case working.
  3. Case management is a ‘medically based decision’. It is not fiscal. It is an essential part of an efficient delivery.

  4. Cases are managed at the level of the family Doctor.

    1. Referrals and recommendations are from and to him alone.
    2. The ‘specialist’ is redesignated  as a ‘consultant’.   

For this stage to work effectively the Family Doctor Practice should be reasonably large so that it can negotiate with experts and providers in the field. THE FAMILY DOCTOR IS THE TEAM LEADER .

The enlarged family practice should subscribe to the SQMB.

The setting up of the family practices would be the corner stone of health reform

I would consider favorably:

 

  1. That subscription to a practice would be:

    1. Per annum at a fixed fee with a basic health basket [Number of visits, hospitalization days, lab costs] per family.
    2. FFS above the basic basket. This aspect would be monitored and authorized by the SQMB.
  2. That the SQMB would offer assistance in negotiating between the Family Practices and between both insurers and other health providers [hospitals, labs and etc.]

IN THE FULLNESS OF TIME THE ENLARGED FAMILY PRACTICE WOULD BECOME THE CORDINATING BODY IN CHARGE OF THE PATIENTS COMPRHENSIVE NEEDS.

In other words we now have three well-delineated bodies:

 

  1. The professional hub – based firmly on the Enlarged Family Practice
  2. The administrative hub- based firmly on the state based SQMB.
  3. Payments – Private and non-private insurers.

UNIVERSALITY:

Only when medicine has been rationalized can it become universal. We cannot expect the State to foot the bill when the medicine is neither rational nor cheap. Medicine has to become professionally and fiscally rational. Only then can further decisions be made.

This decision is UNVERSALITY OF SERVICE.

The decision is twofold:

 

  1. Political.

  2. Fiscal:

    1. What is the State paying for?

      By my proposals the Sate would know what are the expenses involved.

    2. How does the State pay?

      This decision is purely fiscal. Medicine, as such, has no part in this discussion.

    3. How will the State know that I got what it paid for?

      By setting up and developing the SQMB we have the basis for an answer.

Universality has a temporal dimension. The SQMB should also be placed in charge of evaluating, developing and training professional man power so that future needs will be met.

In summary:

I suggest series of changes none of which threaten any one. A clear distinction should be made between means of payment and means of service. Limiting expenses in medicines, procedures and insurance coverage should initially reduce costs.  Service should be rationalized by developing in tandem the ‘Enlarged Family Practice’ and the ‘State Quality Monitoring Board’ [SQMB].

When costs and services have become coherent and rationalized the cost of universality of care and the political implications can begin.

 

02.07.09

Streams, screams, rocks and shocks

Posted in CBT, Personality, Stress, Depression, General, Anxiety, Uncategorized at 4:39 am by admin

ASHDOD UNDER FIRE:
In retrospect:
A child of the ‘60’s has a curse and blessing. We have musical ADHD. We think in terms of either song or film titles. Or at least that is my excuse.
Let me encompass my recollection my way. They are mine to encompass. They are personal. So, selfishly, I will present them to assuming that you too have my presentational preferences.

MOON RIVER: A song about a man and his river.

 

“Two drifters off to see the world. There is such a lot of world to see….
… But we are after the same, Rainbows end — it’s waiting round the bend —

Moon River and me”

 

Like a river we flow with our experiences.. Rocks like experiences become part of that river. We flow with it. Sometimes our river is placid. Sometimes it is a surging torrent casting all before it. Sometimes it breaks its banks. Experiences are forever entering the river. The river carries them along. Sometimes it does so with ease. Sometimes they cause eddies and turbulence. Sometimes the experience dams the stream. The dam causes flooding mud and devastation. Afterwards the stream is reduced in its vigour and richness.

 

But all in all the quality and richness of our river is the sum of our experiences and how we flow with them.

 

As we navigate the river of our life we are aware that we may hit a rock. That brings me to my next point of departure:

A ROSE BY ANY OTHER NAME: A Shakespearean quote used as a book and film title. It means so many things. But the bottom line concerns conceptualisation and reality.

At time of extreme stress we tend to a few things to cope.

  1. In acute danger we survive. We do so by either running, freezing so as to avoid attention or crying for help. They are highly efficient mechanism. We survived the jungle with these gambits. They do not need changing. They are certainly not a cause of remorse, shame or self-rebuke. When your life is at threat that is what you do. We secrete massive amounts of adrenalin. The adrenalin turns off everything that is superfluous. This includes thinking. At this moment we react. Adrenalin turns on everything that we need. I speeds our heart, it cools us with sweat, and it prepares our muscles to run. It causes us to cry, literally for help. Crying is a highly efficient way of gaining attention and help. Screaming is even more so. Most important it changes our sense of time. Past and future al virtually erased. The present is as if slowed down.
    At that moment our stream has stopped.. This stage is called fear. It is a distinct, well-coordinated reaction to a highly defined cause. Our life is in real danger.

  2. Immediately after the danger there is a stage of recuperation. The danger has passed. The adrenalin is still highly active. Time is still slowed down. It is still hard to think in our usual logical way. We are still in a state of arousal. It takes adrenalin a good few hours to burn off. Afterwards there is a feeling similar to a hangover or ‘crash’. We feel tired and listless. We may feel sad. It is the adrenalin. That is all. Our appreciation of time is still not as it was. We can drift back to the event. But now it is a memory. We remember the event as a memory. The memory can be vivid. The memory of our pain and fear can be almost as if they were re-happening. But they are not. The sadness and pain diminish slowly but surely. We all remember when we lost someone dear. Maybe through death. Maybe someone you loved very much loved you less. But we have all experienced the first day. As if there will never be another day. But there is. This is a real pain. The sense of sadness and tiredness is real.

  3. The recuperation becomes in the days to come a memory. It is an unpleasant memory. You have learned the hard way that your experience could have ended your life. A lesson learned the very hard way. You will be reluctant to remember. But you will be equally reluctant to endanger yourself in ant similar way. This is how we have not only coped but learned how to avoid danger.

 

Now what has this to do with “A rose by any other name”? Because these stages are blandly called ‘anxiety’, ‘depression’ or ‘adjustment disorders’. They most certainly are not. They are normal healthy reactions.

So what is anxiety? Anxiety is the fear of something unknown. Now I will say something that may seem odd. Please be patient with me. It is not the event that is the fear but the inability to know the likelihood of it happening. Anxiety is not merely the fear of something unknown. Anxiety is caused by the inability ascertain the likelihood of the event happening.

Let me give you an example. We all know that we will die. We are anxious obout death only when we are not certain that it is not imminent. Generally but always the sufferer can point to the cause of his anxiety. When he cannot as he has so many the same principles applies. The anxiety is the inability to say what the likeliness is.

We not only flow with our river of experiences. We navigate our river too. In our river here are rocks. We know that. They are only important when we do not know at what depth they are. If they are near the surface then the navigator is alert. He is anxious. If the rocks are defined then he suffers from ‘specific anxiety’. If he feels that there are undefined rocks but he cannot ascertain if they are not immediately imminent then the navigator suffers from ‘General Anxiety’. The shallower the river, the more it is blocked ‘upstream’ the closer the rocks are to the surface.

So what is depression? Depression is a sense of loss accompanied by grief and often anger. After, any event for better or worse, the river of your experience continues to flow. If you have left something behind that you wanted with you, there is a sense of loss. Your river of life has lost its richness and quality. This is true depression.

So you see life’s quality is about the depth and quality of our own river of experiences. How we flow with them. How we deal with events is called coping. Coping is a mixture of ability, expectation and complexity of the problem.

At critical moments when a bomb falls we can do but a few important things.

  1. Expectation: By carefully explaining what is happening to the traumatized person one can efficiently and effectively change expectations. In the early stages[ hours to days] it is generally more than enough to simply explain to the person what is happening to him as it happens. In other words to minimize his criticism of himself. Avoid the ‘name of the rose’ mistakes. Avoid labeling.

  2. Strengthen and enrich his ‘river of experiences’. Help him identify with the events, to feel actively involved in a struggle that he identifies himself with. To use examples in his past where pain passed.

If you can get into his river, help him enable the flow to restart then you have helped. To survive remember to get out of his river and back into your own.

11.09.08

Just For Judith

Posted in Personality, Diet, CBT, Depression, Anxiety, Uncategorized at 6:28 am by admin

 

‘She is a very beautiful lady. I have never really seen her. Just glimpsing the occasional glimpse. I have sent her letters and I  have received answers. Maybe one day I will see her.’

That incredible description was written by a Pharmacologist about receptors.
There was another beautiful lady,  by the name of Barbara. Her boy fried dedicated his Ph. D. thesis with these words  ‘To the beautiful Barbara’.
This how Barbiturates — the first ‘non natural’  sleeping pill came into being.
Judith is a beautiful lady too. She cares about her beauty. So she is worried about being overweight. This article is for her.
Judith knows that I am deaf. But strangely the conversation that invariably I did not hear was when my body spoke to me.
But this ’self deafness’ is the root cause of being overweight.
Normally your body says to us very clearly that you are hungry and when you ‘have had quite enough thank you’.
But you stopped listening a long time ago. So your body resorts to new strategy. It goes onto an emergency footing. It is as if your body no longer trusts you to look after it in a normal and regular way. In fact your body stopped talking to you. It adopted a new ‘independent strategy’.
And the new strategy is:
* Eat as often as you can. Grab snacks.
* Get on board as much high calorie food as possible.
* Eat as much as you can till you feel full.
Not hard to see why you are putting on weight is it?
How do you start listening and trusting what your body is telling you?.
Well you have a problem with that. Your body has lost faith in you. It is not telling you when it is hungry, really hungry that is.
Your body does not really trust you enough to again abandon it and it’s needs. Your body depended on you for a regular supply of calories. And you let it down.
You have to prove to your body that you are reliable.
You have to prove to your body that you are really listening.
But to do that you have to convince your body to speak to you again.
And that is quite a long process.

 

 

 

You can do it in stages.
* Start eating three regular meals at set times. The adage about breakfast being the most important meal of the day is true.
* Between meals religiously eat a fruit or raw vegetable.
After a while something interesting will happen. You will start feeling hungry. Just before eating you will feel hungry.
Congratulations. Your body is speaking to you. Don’t be too overjoyed. You have not entirely regained its trust. But your body will start telling you something else. It will start telling you when you are satiated. It is a different feeling from that of ‘being full’. At this point your body is prepared to rely on you to give it the calories that it needs at the time it needs them.
But if you want you can encourage your  body to speak. Chew slowly. Sometimes it is not too clear to you if yur body wants to calories or water. At each meal drink water as you eat.
We are almost there.
Now that you are talking to each other you can begin a dialog. But you both must be honest and open.
Don’t fool your body into thinking that it just got sugar by using an artificial sweetener. Be fair. Either use natural sweeteners or don’t use them at all. Sweeteners do not satiate your need for sugar. If you pull a trick on your body, your body will trick you in return. Just by avoiding all sweeteners, included in soft drinks,.
You can now set yourself a realistic diet that you can maintain.
My tip would be this. Never eat potatoes, rice or bread on a weekday. Eat vegetables instead. I won’t go into Glycine Index. Or even how beneficial exercise is.
There you have it, Judith. My letter to a beautiful lady. I hope it gives you all that you want.

 

 

 

 

06.20.08

An almost accidental Rambo

Posted in Stress, Depression, General, Uncategorized at 1:52 am by admin

 

I was sat watching Rambo.
Now what the hell has Rambo got to do with you?
Because Rambo really happened.  I want to tell as many people as I can about the ‘accidental’ Rambo I met.
I met Adi in October 1974. A tall almost emaciated Yeminite soldier. He was admitted into our Shell Shock Unit. He had been in a general Psychiatric hospital –where he had thrown the director into a decorative pool. To the directors credit he got out and threw Adi in the pool. Then he sent this misfit to our unit of complete misfits.
The shell Shock Unit.|
Adi was almost mute. All he would say was incomprehensible.
We could follow nothing.
So I gave him Pentothal. Until Adi we could always trace the cause of the trauma and recycle in a way that somehow made it ‘psyche-digestible’. But  Adi  just went berserk. In those awful long nights I was obsessed not by the mayhem that we were seeing. why was it not working? An injection then complete mayhem. Till then it had been the opposite.
I had to get Adi back…. and I could not.. Then one night I reasoned like this:-
Adi under Pentothal is virtually Psychotic. So why not give him an injection of antiPsychotic intra venously?
At midnight I phoned up my boss and asked permission. Tomorrow I would inject both Pentothal and an anti-Psychotic.
At eight in the morning we started. In went the Pentothal and we lost Adi again to his demons. In went the anti-Psychotc and Adi stated repeatedly : ‘Carol, how big he is. So small he is.’.That was it.
Nothing more. But something.
Like  all successful Pentothals Adi woke up. But this time I was at a loss as to what had happened. I asked him what  ” How big he was –How small he is.” meant? Who is Carol?
Adi simply looked amazed. “How do you know?” “Did I say that?” .
As in a very few other Pentothals we had gone to the wrong place in time. The ‘wrong trauma’.
With Ephraim we had blundered into Auschwitz.
With Mike, a hysterical blind victim we had found ourselves in a tank battle in 1971.
With Shalom we were in a Moroccan prison.
Adi had gone back to 1967— the six day war. …….
Adi had a son called Shai. Shai, his only son had died before the 6 day war started. In the 6 day war Adi was a non combatant. He was a driver of the Burial Corps. He was present when the Clergy tried to piece enough body parts to bury. Some times there was not enough. What there was they put in ammunition caskets and nailed that in the coffin and filled the rest was earth to make up the weight. Carol was Adi neighbour. There was barely enough of Carol, a very tall guy to put in the ammunition box. Adi sat by his neighbour, Carol’s, coffin all night. He asked Carol to look out for his dead son Shai when they met. He muttered to himself — well you know what….After all Carol was very tall and now there was not enough to fill the ammunition box.
Adi and all his unit had sworn to keep the secret of what happened when preparing the dead that week. The Chief Military Rabbi then asked them made them swear an oath never to tell. Honour the dead and their memory. But Adi had told. Under Pentothal. Six years had passed. Inadvertently he had told us. This in his eyes was unforgivable.
I want to jump forward a month.
We worked a lot in Adi and made real progress. The Chief Military Rabbi in the Yom Kippur War visited us. It was a warm spring afternoon. We sat on thee grass and the Rabbi answered questions.
Adi asked if what he had done was excusable? Adi was well known and respected. So there was a very heavy silence. The Rabbi turned to his two assistance.
“I now declare this a Rabbinical Court and we are now in session. Adi Chatuka cover your head.” The rabbi then placed his hand on on Adi’s head. ” This court absolves you from all your oaths that you took in 1967. This court absolves you from all guilt”
Adi said. ” Rabbi, these guys have fought hard for me , to help me, but no injection helped like this”.
We were all in tears.
But I have still to explain why Rambo?
What happened in 1973?
First a bit of history and a brief explanation.
The Egyptian were helped by the Sudanese commando brigade as they crossed the Canal. In accordance with Soviet doctrine they were doped to their eyeballs with Ritalin. The Sudanese were the bane of our soldiers existence . They were big, fearless with bulging ferocious eyes. They were unstoppable. Well almost unstoppable. Adi stopped one. But at what a price
Here’s how. ….
Adi was a tank driver. They were trying to stop the Egyptian advance. They were surrounded by Sudanese. The Sudanese were unstoppable. They were like a swarm of locusts. They were everywhere.
Adi’s tank commander was a greenhorn. This irritated Adi who felt he had a liability and responsibility. Adi wanted to get everyone home safely. He drove over Sudanese. He mowed them down. Adi was doing well. He was getting out of the mess. Then it went awfully wrong.
The tank commander was sat half out of the tank. A Sudani killed him. Adi went after the Sudani. Adi got out of the tank and fired a machine gun at the Sudani. The Sudani kept coming . Adi was screaming at him “Die — you are already dead.”  More rounds and still the Sudani is running. So with one long burst Adi cut the Sudani into two. But still the legs of the Sudani kept running. Adi past out and was mute.
Months went by.The treatment was working.
Adi then did something that  no other soldier of mine did. He went back into reserve duty. My mistake maybe but also fate played a hand.
Adi was posted to almost the exact spot where he had fought his Sudani. Then it was the demarcation line between the Israelis and Egyptians.
Adi dissociated. He saw the Sudani and Adi attacked. Adi was  running , weaving and firing as he advance on the now docile Egyptians. There was only one way to stop him. We ran Adi over with a command car. In the turmoil Adi was shot in the leg.
There was an enquiry. There always is. This one was fair. The investigators told me that Adi was a few yards from starting the war all  over again. There was grudging admiration for Adi’s soldiers craftmanship. My mistake was generously overlooked. The authorities let it pass.
I went to see Adi in hospital. The Orthopedic Surgeon asked me if this was another faked malingerers suicide. I told him that it was not.
No this was a real genuine fucking hero.
Adi almost started another war. But his own never ended. The Sudani never left him. He drifted. Adi was in and out of trouble. Often they wanted to put Adi in a closed ward. I stopped them. But it was getting harder. Adi’s wife and neighbours were all suffering outbursts and wild behaviour. Then one day the Police phoned. It was three in the morning. They were laughing at this lunatic that admitted to a murder.
“Did he murder someone?” I asked, a bit nervously. The reply was negative ” Only some Sudani” .Accompanied by more laughter. I said OK — tomorrow we’ll put him into the closed ward and I put the phone down.
Then it hit me. So I phoned back to the Police. ” Are you sure that he said  a Sudani?”—” Yes very sure” was the answer.
At three thirty in the morning I got Adi out of the holding cells. ” You realise that the Sudani is dead — no more night mares”. I took him home. Nothing sensational. We were both very tired –of everything.
Things got reasonably manageable but never any where like normal. Adi made a living as a Taxi driver. Very rarely I saw him.
One day a journalist came to my clinic. She asked if what she had heard was true?  —- A taxi driver had told her his story without identifying himself. He had picked her up as a fare by the clinic. How did she find me? Adi had said that whenever he felt bad he would drive by the clinic. He knew if things got really bad he always go in. That was enough for him.
Adi’ s wife died of cancer. So did Adi. They are all together with Shai, Carol and the two Rabbis.
Wars are fought and payed for by heroes. But heroes who did not ask to be heroes. Adi was an accidental hero and a great guy.
I don’t know what this did to you. If you think on Adi for a minute —  that is good.
I sent this to people I know well, people I don’t know well, people that will understand and people that will not. If anyone is offended — well I am sorry.
I simply wanted to share and honour Adi. I hope that you do too.