Elisha Waldman, This Narrow Space:
A Pediatric Oncologist, His Jewish, Muslim and Christian Patients,
and a Hospital in Jerusalem
Pietro Bartolo and Lidia Tilotta, Tears of Salt:
A Doctor’s Story (Norton, $25.95)
The practice of medicine at its best – preventing and curing diseases, relieving pain and easing human suffering, helping families manage grief – is almost by definition noble, with a built-in potential for heroism that few other professions enjoy (comparisons to the practice of law come uneasily to mind). Of course, not all medical practitioners realize their potential for heroism. But the pursuit of the heroic is at the heart of two doctors’ recent memoirs: This Narrow Space: A Pediatric Oncologist, His Jewish, Muslim and Christian Patients, and a Hospital in Jerusalem, by Dr. Elisha Waldman; and Tears of Salt: A Doctor’s Story, by Dr. Pietro Bartolo and Lidia Tilotta.
Dr. Waldman, an American-born physician, worked for seven years as a pediatric oncologist in Israel at Jerusalem’s Hassadah Hospital, where he treated young cancer patients amidst the complexities of Israeli society, rigidly divided between Jews and Arabs. During the migrant crises of the 21st century’s second decade, Dr. Bartolo served as first medical responder for the waves of refugees from Africa and the Middle East arriving on the remote Mediterranean island of Lampedusa, a part of Italy but closer to Tunisia than to Sicily and the Italian mainland. Bartolo was featured in the award-winning 2016 documentary film Fire at Sea, Fuoccoammare in Italian.
Of the two memoirs, Dr. Waldman’s is the more layered. Treating young cancer patients in Jerusalem is part of a larger story of Waldman’s move from the United States to Israel, termed aliyah in Hebrew, a kind of religious and spiritual homecoming. His memoir involves both his spiritual quest to know and better understand his Jewish religious faith and his more pragmatic efforts to fit into Israeli society, which he found bewilderingly in its complexity. At its core, Dr. Waldman’s memoir entails his search for himself and the place where he thinks he belongs.
Dr. Bartolo, by contrast, maintains few doubts or second thoughts about who he is or where he belongs. He grew up on Lampedusa and, after studying medicine in Sicily, returned as a young doctor to practice medicine on his home island, at a time before it became a focal point in the migrant crises of the 2010s. His story, as told by himself and co-author Lidia Tilotta (and ably translated from the Italian by Chenxin Jiang), consists of one incident after another of unflinching work in the face of constant emergency conditions, as he tries to save the lives and ease the pain of migrants to Europe seeking to escape turmoil elsewhere in the world.
* * *
Elisha Waldman, the son of a Conservative rabbi, grew up in Connecticut. As an undergraduate at Yale, he majored in religious studies. Zionism was a crucial part of his upbringing. He traveled often to Israel as a youth, and spent four years in medical school in Tel Aviv. He explains his decision in 2007 to return to Israel to practice medicine: “Where better to explore my faith and identity than in the country that I had been raised to think of as my other home?” (W, p.24).
Upon arriving in Israel, Waldman went to work immediately at Hadassah, one of Jerusalem’s leading hospitals. His accounts of his efforts to provide care and comfort to children afflicted with cancer are touching. We meet many of his patients. They come from both Jewish and Arab families. Only a few are cured. Most die. Waldman could speak to his Jewish patients and their parents in his rapidly improving Hebrew, if not in English, but had to work through a translator with most Arab patients and their families.
Whatever the language, finding the right formula for communication with his young patients and their typically distraught parents proved consistently elusive. The art of effective communication, Waldman notes, is not part of a doctor’s formal training, yet success as a pediatric oncologist depends on it. “And it is there that we so often fail,” he writes. In Israel, the additional factors of “multiple cultural and religious traditions, the incendiary politics of the area, and language differences can make effective communication seem almost impossible” (W, p.70). Waldman wondered whether his Palestinian patients saw him as “another occupier, a foreign transplant who has come to take their land” (W, p.65). With his attempts to show empathy to his Palestinian patients and their families, he hoped to represent to them a “more compassionate, more liberal side of the Zionist enterprise” (W, p.65).
One graphic example of the rigid the divide between Arabs and Jews in Israel occurred when Waldman had his initial meeting with an American-born Orthodox Jewish father of a child cancer patient. Waldman’s trusted female assistant, Fatma, an Arab for whom he had great respect and an excellent professional rapport, was also part of thediscussion. Afterward, the father took Waldman aside and told him that he was “a little uncomfortable with an Arab being in charge of my son’s care” (W, p.87). The astounded Waldman wanted to tell the father that this insult to a cherished colleague and friend was the “opposite of everything I came to Israel for, everything I believe the state should be” (W, p.87). But because the man’s son was to be his patient, Waldman had to tread lightly. “This is what the Zionist dream has become,” he writes despondently. Two American Jews “sitting in Jerusalem, taking positions on the merits and trustworthiness of an Arab woman with roots in this city that go back centuries” (W, p.88).
The heart-breaking cases Waldman must deal with also raise the omnipresent question that he returns to throughout his memoir: how can the God Waldman wants to believe in allow these young people to be afflicted by this frequently fatal disease? Why must these innocent children suffer this cruel and unwarranted fate? His initial reaction at being exposed to so much suffering was to give up on God. “Why not simply abandon the idea of God, when so much evidence would seem to point to the impossibility of His existence?” (W, p.129). But he fell back on the notion of “process theology,” a notion he had studied as an undergraduate which posits that God is good but limited: “Although He has a will in this world and wishes only for good, there are certain things He cannot accomplish because they are beyond His control” (W, p.130).
Process theology conforms in an odd way with how Waldman looks at his role as a doctor: “I want only the best for my patient, I do my best for them, but sometimes it’s just not possible to achieve the miracle they are hoping for” (W, p.130). Waldman’s experiences with his young cancer-afflicted patients led him to sense that there is “some force, whether it’s an omnipotent divine being or the irrepressible human sprit, that gives life meaning . . . And despite the sometimes harrowing things I see, my faith may wobble but it doesn’t ever fail completely” (W, p.126-27).
Largely unsuccessful in answering the overriding theological question of why “terrible things happen to good and innocent people,” (W, p.126), Waldman realized a more immediate and tangible success in establishing Israel’s first palliative care unit at Hadassah. The concept of palliative care, he explains, has generally been understood too narrowly, consisting strictly of measures to provide end-of-life dignity and comfort. But there is a more holistic approach to palliative care that focuses upon providing a “broad spectrum of support for children and their families, regardless of the patient’s prognosis” (W, p.186). A palliative care team might be called to “help think about particularly challenging symptoms, such as complex pain management or sleep issues. Sometimes we are called to help patents and their families with difficult decision-making regarding treatments or interventions” (p.168).
In 2008, the medical profession in the United States recognized the holistic approach to palliative care as a separate medical subspecialty, with its own training programs and board certification. But the approach was largely unknown in Israel. When Waldman pitched the idea to Israeli colleagues, the initial reaction of many was skeptical. “So you basically just talk? . . . That’s so American” (W, p.186), one told him. Others, especially within the oncology department at Hadassah, were intrigued. Waldman took a leave of absence from Hadassah to take training in Boston in holistic palliative care. He returned to Israel eager to advance what he had learned in Boston, and went on to become the country’s leading proponent. He also engaged in fund raising in the United States to create facilities at Hadassah and elsewhere in Israel for the holistic approach to palliative care.
But Waldman’s efforts to institutionalize holistic palliative care in Israel ran up against several realities of Israeli life, among them a series of draconian cuts to Hadassah’s operating budget and an ensuing staff strike at the hospital. Waldman became concerned that the funds he had raised for palliative care were being used for general hospital expenses, and was never able to get a clarifying answer from hospital administrators. His efforts also coincided with a major civil conflict in Gaza and Jerusalem, after three Jewish teenagers had disappeared near the Gaza village of Hebron. Three Israeli teenaged boys thereafter captured, tortured and killed a Palestinian boy in East Jerusalem, seemingly an act of revenge, and right wing Jewish thugs took to the street, beating up anyone who looked Palestinian or Arab.
By this time, Waldman had also found the woman of his life, a fellow American living in Israel. When he received an offer to set up and run a palliative care unit at a highly respected New York teaching hospital, with the job security he didn’t have in Israel, it turned out to be an offer he couldn’t refuse. In 2014, Waldman and his future wife returned to the United States, leaving this reader feeling let down after being immersed in the heart-rending particulars of his interactions with his young cancer-afflicted patients in Jerusalem. Today Dr. Waldman is chief of the division of pediatric palliative care at the Ann and Robert H. Lurie Children’s Hospital of Chicago.
* * *
Pietro Bartolo is the son of a fisherman, one of seven children. As a boy, he learned from his father the skills needed to survive and succeed in this challenging line of work. He begins his memoir with an incident at sea in which he nearly drowned, when the future doctor was 16 years old. The trauma never left him. He didn’t know it at the time, but his subsequent life would be “scarred by a capricious sea that spits out living or dead bodies at will” (B, p.14-15). His memoir is a series of short anecdotes, not arranged in chronological or any other discernible order, in which his interactions with migrants arriving on Lampedusa are interspersed with accounts of his youth and personal background. “Tears of salt,” the book’s title, refers to how saltwater winds and breezes mix with one’s own tears. Such tears flow frequently when Bartolo proves unable to save a life, or mitigate an injury or pain of refugees, typically fleeing terrorism, civil war and political unrest.
Libya is the common departure point for most of the migrants arriving on Lampedusa, with a hellish desert crossing preceding a hellish journey across the sea. The migrants’ ordeals are difficult to understand unless one has made the trip, Bartolo explains:
The heat is stifling. You are crammed onto a pickup truck, and if you so much as sit in the wrong place, you will be thrown out and left to die. When the water runs out, you are reduced to drinking your own urine. Finally you arrive in Libya and think the nightmare is over, but it has only just begun: ill treatment, prison, torture. Only if you manage to survive all of this do you finally make it onto a boat. Only then, if you do not die on the open sea, will you arrive at your destination and begin to hope that your life can start all over again (B, p.23).
The first wave of migrants began to arrive on Lampedusa in the first quarter of 2011, at the height of the Arab Spring. Arrivals continued throughout the decade and surged a second time in 2015, in part as fallout from the civil war in Syria. Two horrific shipwrecks took place near Lampedusa within days of one another in October 2013. The first, with refugees from Eritrea, Somalia, and Ghana, caused nearly 400 deaths. The second, involving Syrians and Palestinians, resulted in 34 deaths.
One of the survivors of the latter shipwreck explained to Bartolo that when their boat capsized, he was carrying his nine-month-old daughter in his arms and trying to keep his three-year-old son and wife afloat. With no help arriving, the man was faced with an irrevocable choice: if he kept treading water, all four of them would drown. In the end, he opened his right hand, and let go of his son. He watched his son “disappear forever under the waves” (B, p.48-49). Although a doctor is “not supposed to let his patients see that he is overwhelmed,” Bartolo could not help weeping with the man. “I did not have it in me to hold myself together” (B, p.49), he writes.
Equally horrific is the story of a boat that arrived on Lampedusa in 2011. Although the passengers seemed distraught, they also did not appear to have abnormal physical symptoms. But in a freezer normally used for storing fish, Bartolo inadvertently stepped upon several corpses, mostly young people. The young bodies were “naked, piled on top of each other, some with limbs intertwined. It was Dantesque” (B, p.144). The victims had clearly been beaten and the traffickers had threatened and intimidated the survivors into silence. For days afterward, Bartolo writes, “I could think of nothing else . . .When I thought about the brutes that did this, I saw red” (B, p.146).
As a witness to this level of inhumanity, Bartolo, although religious, is impatient with the type of ruminations on faith that run through Waldman’s memoir. His response to the question how and why a loving God can allow large-scale human suffering is blunt:
God? God has nothing to do with this. It is human beings who are to blame, not God. Greedy, ruthless human beings who put their trust in money and power . . . those who are willing to let half the world live in poverty, who sanction conflict and even finance it. The problem is human beings, not God (B, p.120).
The 2016 documentary film Fire at Sea, the work of distinguished film director Gianfranco Rosi, turned out to be a proverbial godsend for Bartolo, who had been looking for a way to tell the world more about the migrant crisis on Lampedusa than what was contained in quickly forgotten news clips. The film sets the dangerous sea crossing against everyday life on Lampedusa. Bartolo saw the film for the first time in Berlin, where it was a finalist in the Golden and Silver Bears competition. It was precisely what he had been seeking: a “raw, unequivocally clear message that would shatter all the lies and prejudice surrounding this issue, awaken the public conscience, and open people’s eyes” (B, p.143). The film was “not just a documentary: it was a complicated narrative told at a measured pace and in hushed tones, but with captivating power and subtlety” (B, p.142).
In the memoir’s personal background anecdotes, Bartolo recounts how he grew up in the post World War II era, a time in Italy when the sons – and, to a lesser extent, daughters — of fishermen, farmers and factory workers could for the first time realistically aspire to be doctors, lawyers, engineers or teachers. Bartolo’s father, adamant that his son should not follow in his footsteps as a fisherman, sent him to boarding school in Sicily because Lampedusa lacked a quality secondary school. While in boarding school, he met his future wife Rita. Returning to Lampedusa after Bartolo completed his medical studies in Sicily was a difficult move for Rita. The couple had three children, two girls, Grazia and Rosanna, followed by a boy, Giacomo, and Bartolo provides his readers with glimpses of each.
Looming inescapably in the background of Dr. Bartolo’s personal and professional stories is the island of Lampedusa, “[b]reathtakingly beautiful and breathtakingly remote” (B, p.18). Lampedusa is not an easy place to live, Bartolo acknowledges, a “small piece of the earth’s crust that broke off from Africa and drifted toward Europe. As such, it is something of a symbolic gateway between the two continents” (B, p.186). The island was arguably the most welcoming spot on earth for incoming refugees during the last decade’s recurrent refugee crises. Although there is no hard proof that it was so welcoming in large measure because of Dr. Bartolo’s efforts, readers instinctively feel that this is the case. In 2019, Dr. Bartolo was elected to the European Parliament as a member of the center-left Democracy party and now may be found as frequently in Brussels and Strasbourg as on Lampedusa.
* * *
The migrant crises of the last decade may have fueled ugly xenophobia, hyper-nationalism and racism among large swaths of Europeans. But they brought out the heroism in Dr. Bartolo, which seems to jump off every page of his brutally forthright memoir. Dr. Waldman’s efforts to bridge the seemingly intractable divides of modern Israel in caring for cancer-afflicted children are also heroic, but commingled in his memoir with his quest to find his inner self. In different ways, each memoir constitutes a reminder of the nobility of which the medical profession is capable.
Thomas H. Peebles
Prospect, Kentucky USA
February 10, 2020