A Doctor's Duty in a Palestinian Prison Camp in Israel

Ishay Lev, MD

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In This Article

Tuesday

Usually, the medics read out loud the prisoners' various complaints, and we would decide together on the appropriate immediate treatment or have the prisoner come in for an examination.

This morning, there was a disagreement. One of the prisoners had been complaining of a swelling in his neck. His medical file showed that another doctor saw him recently and dismissed it as a swollen gland. I told the medic to drop it and continue to follow up. The medic insisted that I see the prisoner -- "something did not look right to him." I was a bit irritated, as this specific medic always thought that something was wrong. Finally, I had no choice but to respect his wish and include the prisoner on the day's consultation list.

Around noontime, the prisoner arrived. He was a young and peaceful looking guy with no complaints, other than the lump on his neck that had been growing there for a few months. He was brought to the prison a few weeks ago. He decided to see a doctor, because for more than a week now, he could feel the lump growing. He complained about this lump once to a Palestinian doctor before he came to the camp and said that he had been administered an intramuscular injection -- he doesn't know of what...the lump was very small then.

As I laid eyes on the mass on his neck, shivers went down my spine. There was a large swelling on his neck, about 5 cm in diameter, immediately above the location of the left thyroid lobe. When he swallowed, it didn't go up. When I felt it, it seemed soft -- but with a hard peripheral core -- and immobile. I sent the patient to do an immediate ultrasound and thyroid function test in the nearby tertiary hospital serving the inmates' needs -- the Hadassah Medical Center.

I managed to forget him completely until a guard, 2 hours later, pushed the ultrasound results into my hands. The handwritten note said that they found a lesion suspected of replacing the left thyroid lobe with increased blood flow and many enlarged lymph nodes around it. The mass was not completely cystic and had no apparent calcifications.

When I told him what had been found, it seemed that the potential significance and gravity of the finding did not penetrate the cultural and language barriers. The next day, I found that the prisoner had been discharged. In prison his life might have been spared, thanks to the tertiary medicine that the prisoners were getting.

As for treatment in his own Palestinian village -- I wasn't quite sure whether he was going to see a doctor again -- what was I supposed to do now? A long line of prisoners compelled me to move on and leave things to be taken care of by others.

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