Jerusalem life
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* Janice R. Halpern

I heard the sound of three sirens. When there are two sirens, one rising whine interweaves with the other, catches it, and intensifies the sound. Two sirens can be melodic, a children's two-part round bouncing off stone walls. Two sirens can mean two ambulances called by chance at the same time. Two sirens, if one has an interest in harmony or perhaps counterpoint, can be quite pleasant.

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/171/5/486/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/171/5/486/F1)

Figure. Photo by: Fred Sebastian

Three sirens, however, make the heart stop: it is the sound that comes after a suicide bombing. Jerusalem is too small a city to have three ambulances travelling at once, unless there has been a mass disaster. Three sirens are the herald. Sometimes you can hear the explosion itself; I did, once. I was hanging laundry on the veranda, squinting in the brightness of the Mediterranean sun ricocheting off white Jerusalem stone walls. Explosions can be many things, though: construction noises, backfiring cars, the fireworks set off at Arab weddings, children playing with firecrackers. That time it was a bus bombing. I held my breath, waiting, while the sirens rose and fell. It was a terrible sound.

Between the bomb and the sirens, there is always an eerie, silent moment as everyone waits. Then comes the cacophony of cellphones. Für Elise starts, then Yankee Doodle, something from Riverdance, Hava Nagila. And the frantic voices: *“Are you alright?” “Do you know which bus he was on?”*

My first patient here in Jerusalem was involved in that bombing: thrown from the driver's seat, he landed on his back, stunned at first by the sound and later by all that he saw and felt. Did the suicide bomber know that a fellow Arab was driving the bus beside him? My patient had seen other physicians to treat the assault on his body: his bruised back, his diminished hearing, the whistling sounds that never ceased. He came to our psychiatry clinic, one might say, because he was suffering from an assault on his senses. The sights, the smells, the sounds and the sensations haunted him. Over and over he revisited the scene that had met him when he crawled from the bus: scattered body parts, rag-doll children. Worse, though, was the stench of burning bodies and the sickening feel of someone else's disembodied flesh flung upon him, which now would not let him be. All his senses were on fire.

In a Jerusalem besieged by terror not only physical sensations have intensified. Friends and family of victims have unearthed deep wells of kindness and heal their own pain by helping others. One couple, in response to the murder of their thirteen-year-old son, help siblings of terror victims rediscover joy. The dedicated young volunteers who run their camp programs were themselves inspired by the loss of friends. They have developed exquisite skill in dealing with bereaved families. With the bombings in their fourth year, however, some are beginning to feel out of their depth: “We know how to help families, even those who have lost more than one member in a single bombing. Now we are seeing the same families suffering more losses. We don't know how to comfort them.”

Volunteers rush to join the Red Star of David, the Israeli counterpart of the Red Cross. Most paramedics here are volunteers. I meet with a new group of recruits, who are just beginning to learn resuscitation skills. They worry most about whether they will be competent; cautiously, they expose their uneasiness at the gruesome scenes they know they will have to face. Soon they will learn to cloak their fears in black humour.

My most recent patient can scarcely leave her house. She was once a confident young woman, but her imagination has been ignited by the explosion she and her family survived. She fears her children will be snatched from her home; the bars on the windows aren't strong enough. She cannot shower without her husband nearby, cannot sleep without the lights on. When he is near, or when she sits with me, the nightmarish images fade. She shows me the newspaper photo of her baby son, enveloped by fire, just before they were evacuated to separate hospitals.

Religious Jewish families now commission local scribes to write Torah scrolls in memory of murdered relatives. My patient tells me of a friend whose story is even sadder: a mother of two small children, both murdered in another attack. During the Torah dedication ceremony, she imagined her children leaping and dancing, perched atop the parchment. Where sense failed her, she found comfort in the spiritual.

Springtime in Jerusalem delights the senses: the fields push up masses of scarlet poppies; cyclamen spring effortlessly from cracks in rocky walls. Trees bloom here in unlikely shades of lavender and azure, their fragrances a sweet surprise. The pomegranate flowers, metamorphosing into bell-shaped fruit, promise a sweet summer. An ad appears in today's newspaper: “Our Day Camp: The camp area is completely walled in, with an armed guard at the entrance.” I imagine joyful shouts, peals of laughter, swelling and tumbling over shimmering stone walls.

**Janice R. Halpern** Psychiatrist Toronto, Ont.