Today is the worst day. They bombed another school. The kids are not dead. They are burned — alive. Dying. Babies. Sorry, this is graphic. I don’t think that people really, truly understand how bad things are. What I saw there was so indescribable. I realized I needed to take pictures and document and little videos because nobody would believe it unless I did. The primary thing that I did there was triaging and mass casualty. This is not advanced I.C.U. care. We often never got there. The longer I stayed there, I realized that my role wasn’t being a physician. It was being a witness. I started a WhatsApp group where I shared reflections and stories almost like a diary or journal entry. Reflection Update 14: This is worse than I ever could have imagined. Shrapnel pulled from a 1½-year-old baby’s chest wall. Gloves for every helping hand is a luxury. Hemostats being sterilized via alcohol and betadine, if you’re lucky. Dr. Nabil and Dr. Mohammed have barely slept the last 48 hours. They do not have all the tools. Their gowns are not waterproof. The electricity goes out regularly, but they have tag-teamed case after case, and just keep moving. The capacity of the hospital was supposed to be between 150 and 200 people, and there were 700 patients in that hospital. Last night was bad, depressed skull fracture. His father tapped me on the shoulder many times, asking what I thought. This kid sat upright with no pain medicine as they washed out his shrapnel wounds. Small child with a blast injury/ traumatic brain injury. His odds of surviving are little. Every time I do not think it could get worse, it does. Today Deir al Balah, the area I’m in, was bombed, resulting in a massive mass casualty event at the hospital. I lifted a dying little girl in my arms off the floor when I got frustrated waiting for a gurney and realized she was going to die on the floor at my feet. The girl, named Farrah, was 12 years old, but about the size of my 10-year-old daughter. I can still feel her arms around my neck as I type this. There were a few more kids that died today. One in his father’s arms. This is a father cleaning off his son for the final time. A mother holding the shoes of her child. I don’t know if he’s alive. There was no time to process. We only have this many machines. We only have this much space. We only have this much gauze. I don’t have enough blood to hang for blood transfusions. I don’t have enough fluids to get this person’s blood pressure up. And so, the decisions were made second to second, and we tried our best. This nurse’s name is Warda, which means flower. My man Anas, always ready with some nicotine. Alaa, an I.C.U. nurse and the chef of the I.C.U. He may understand a quarter of what I say and vice versa, but I love him. Every health care provider is living in two worlds. Every time an ambulance pulls up, the first question people ask is, “What neighborhood was it where the bomb dropped? Was it where my family was?” Turn on the news. Massive explosion in crowded area in Khan Younis. It’s going to be busy. A little girl lay on a cardboard box. I lift the cardboard box. That’s when I see the penetrating chest wound. Hell, she’s going to die right here in this spot. Today, I’ve watched all the things I theoretically learned about burn patients in my training and education, happen right in front of my eyes in a matter of one day. I will never forget this image for the rest of my life: siblings.
