← This Is Actually Happening
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- [00:00]
Wit Misseldine
Wonder plus subscribers can listen to exclusive episodes of this Is Actually Happening by joining Wonder in the Wondery app or on Apple Podcasts. This Is Actually Happening features real experiences that often include traumatic events. Please consult the Show Notes for specific content warnings on each episode and for more information about support services.
- [00:29]
Travis Milline
All of a sudden this like super intense bombing starts happening very close, you know, well within a block of the hospital and kind of felt like we froze in place, you know, took a step to our left, a step to our right, step forward. Like trying to figure out like, where do you go that's safe in this scenario? And you know, within a few seconds you're like, oh, there is nowhere that's safe.
- [00:58]
Wit Misseldine
From Wondery. I'm Wit Misseldine, you're listening to this Is actually Happening episode 382. What if you spent four months as a doctor in Gaza?
- [01:23]
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- [01:54]
Wit Misseldine
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Travis Milline
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- [02:19]
Travis Milline
Find out more@capital1.com sparkcash plus terms apply so my parents initially met somewhere in Palestine. I'm not actually sure exactly where. My dad is from northern Wisconsin and my mom is from Holland and I think they just both happened to decide to kind of go with this sort of reshaping your life. Go to a kibbutz somewhere in Occupy Palestine. You know, going there, you know, at a very young age, I think like 18 or so. My sense it was kind of, you know, more of a hippie communal type of thing that they were seeking out. And so you'd work hard for a while, make friends and then you go travel to one of those friends countries and kind of a good way to meet international people and kind of get New life experiences. And then I think from that point, you know, they stayed together, got married, eventually ended up staying in the. In the States in southern Wisconsin. I was born in Stevens Point, Wisconsin, 1983. Home life was great growing up, I would say, you know, things were very stable. Middle class, income, family, and, you know, dad was a pilot. Mom mostly stayed home, but she was also a nurse. Supportive parents, you know, making sure we had good Midwest work ethic, you know, feeding and watering the animals on the farm and things like that. While we were growing up, we didn't have like a working farm, but we would still have to break the ice in the morning for the animals outside in the winters. Um, you know, still have to shovel the barn out. You have all the manure. Had an older brother and a younger brother. Like, I was kind of the. The peacemaker in middle school. Very shy, very awkward, very uncomfortable. You know, had a few close friends, but shy and quiet and reserved. Spent a lot of time just solo in the woods. I was mostly a farm kid. We, you know, had guns, so we would, you know, hunt or just be shooting. And then when it wasn't hunting season, we'd often be fishing in the river. You know, because my dad was a pilot. There's definitely an emphasis that we had on traveling and getting life experiences that I think a lot of other people aren't privileged enough to get, because we could take some trips to some faraway places, cost efficiently. You know, went to South Africa as a vacation, certainly went to Europe a number of times, and then 15 or so parents took us to Israel. We also spent a small amount of time in the West Bank. You know, was able to see that transition going from Israel to the West Bank. You know, once we were through and into the west bank, you know, the buildings very much changed and everything became riddled with bullets. Is kind of what I remember most. You know, the edges, windows had bullet holes, the roof, you know, you could see bullet holes. A very stark difference crossing that border. The other thing I certainly recall seeing is, you know, when we were in Israel is just like how militarized it was. Like a huge proportion of the population was just walking around with, you know, machine guns on their back, you know, an Uzi kind of over their side, a handgun tucked into their belt. And that was very, very normal feeling. My feeling was that the main reason they're taking us to places like that or, or to South Africa at that time was just to see the great disparity in living conditions and wealth and just kind of open our Ey you know, what the rest of the world was like. It had the effect, I think, that they, you know, wanted and you know, making us, you know, really appreciate the privilege we had. You know, I think high school, I really had no direction. I was a reasonably good student, but didn't have any specific desires and carried through into my first years of college. Just really wasn't sure, you know, where I was going. But my junior year in college, I decided to get a degree as a paramedic. I was able to finish up my bachelor's during that time and got my paramedic license and hatched this plan to also take the mcat, go to medical school, see where that took me, applied to medical schools. I really wanted to be out of the Midwest, you know, because I was dating my high school sweetheart at the time, you know, had to also pick a place that she had a future in. And so she ended up going for a PhD in toxicology and, and so I ended up in Blacksburg, Virginia, the very first day of medical school. You actually kind of walk in through this gauntlet of booths that the local churches have set up where they try and get you to become part of this church and part of that church and you know, at the time was an atheist and was kind of put off by like just how religious this school was turning out to be and the community was turning out to be and made it hard for me to, you know, find like minded friends. The following year I wanted to make sure that there was some representation of non religion there and so made my case to have I think the Church of the Flying Spaghetti Monster at the following year's welcome for a new class. I remember it being funny to me is that rather than allow that, they just decided to not have any church recruitment at the welcome bays. They would not teach anything about abortion. And so we kind of had to get in guest speakers to, you know, teach us the required curriculum for medical school, which this school would not teach because of the quote unquote controversy. And this is a required, you know, education for medical students. But certainly our school is opting out of having anyone talk about abortion at all. Even our embryology teacher was not allowed to speak to that. I would definitely say that there was a bit of a change around that age just in that like I felt a little bit more confident being outspoken, you know, and did start having some more strongly held beliefs about the world from the get go. I was aiming for emergency medicine as kind of what I wanted to specialize in and go into and Went through most of medical school, really loving my rotations in emergency medicine. But, you know, in the end, I decided anesthesia would probably be the most satisfying, interesting, you know, fun path to go on to become an intensivist. The next step in life was residency. Ended up doing that in Portland, Oregon. My wife at the time was gonna, you know, also come out shortly after, but she kind of ended up just essentially ghosting. Just kind of heard less and less. You know, she would say that she's just busy with her dissertation, and then kind of one day just stopped entirely. I'm not sure exactly what was happening with her or, you know, with us, but one of the things I always wondered if it played a role was that she had, you know, some really intense bipolar. And certainly when someone goes into a manic episode, this is something that's not unheard of to just kind of disappear and completely reshape your life and so kind of have this, like, surprise divorce occur. Over my first six months of residency training, you know, I had this Midwest upbringing where we didn't really talk about emotions much, so really didn't know how to handle this. Wasn't sure how to talk to friends about relationship stuff. You know, went on to fellowship in the icu, and then I had kind of my next life stressor, basically right before graduating and starting my first job. The woman I was dating at the time, we met in residency, she was a intern. I think I was a second year resident in the neuro icu. She was like a, you know, very gifted, talented, hardworking person who is certainly capable of masking anything that's going on in life. As, you know, we're often kind of required. To do right in medicine is to kind of put your own stuff aside so that you can work with other people's needs. And so didn't really have any particular warning signs beforehand, but she committed suicide. The relationship was lovely. Everything was wonderful. And, you know, this ended up happening basically right after an argument. And so there's like a lot of guilt on my side that kind of just crushed my spirit. I feel like it just kind of put me into, you know, a very dark headspace, deep depression. One of the things that changed in me is kind of learning that it's okay to reach for support, to ask your friends for help, but it really feels like no one can understand that is what it feels like at the time. After that, you know, it was just an attending. I, you know, worked on general ORs, worked in the cardiac ICU and joined the ECMO team. Basically in March of 2020. And then the pandemic hit. We're doing lung bypass predominantly for, you know, really severe Covid cases. Covid was very stressful. Just kind of being on the very front line of the pandemic, I guess. My first international experience was in Honduras, and then to India, and then early Covid. I did a contract in Curacao in the Caribbean. Basically, this very small medical company won this, like, massive contract to basically hire an entire hospital staff to fly down to Curacao and be available for when the outbreak occurs. You know, their health system is amazing. Their hospital is, you know, top line. And one of the most interesting things that came out of that, I thought, was just who happens to be available to do a long contract like that on a very short notice? It's a lot of very interesting and opportunistic people. There were some folks that were excellent. You know, there was someone else that stole the whole hospital's supply of propofol. You know, another person ended up exposing himself to some nurses in the ICU late at night. So it ended up being this, like, hodgepodge of, like, the worst people ever and some really excellent folks who just happen to be free. And there is a very interesting group of people who go into that line of work. And some of them are amazing, clinically wonderful activists. And then there's other people that, you know, are just so bad or don't have their licenses or have these really big white savior complexes kind of going to anywhere with this idea that you are better at whatever it is than the local community, and you're there to save them from whatever plight it might be at the time. So there was a couple people on that trip to the Caribbean, like, you know, again, that, like, talked about the island like it was this destitute, impoverished place that had a decimated healthcare system and all this, when, you know, in reality, almost everyone on the island speaks four languages. The medical system is top tier, right? They have all the specialties you could need. In honesty, it seemed better than my hospital system back home. And yet, despite that, there was certainly people on that trip that very much had this mentality that they're here to teach these poor folk, you know, how to do medicine, how to take care of COVID I think in a lot of times in this work, your. Your job is to come in and assess how you fit in and where or if you are useful, whether that's an educational component, whether that's just being clinical. But anytime you go anywhere, I feel like that's Your. Your first job is understand the scenario. So I was in Curacao kind of the spring, summer of 2020, and, you know, I did some local contracts in Southern Oregon. And then I think it was in 2023, I went to Nigeria to do this cardiac surgery trip. At this point, I was starting to kind of formulate this plan that I was going to try and do, you know, this kind of humanitarian aid work for some of these larger, legitimate organizations like Doctors Without Borders, Medglobal, bigger groups that are going into more dangerous areas. So kind of taking it one step further than what I had. And so I had applied broadly to all these organizations. You know, I was in the midst of interviews when the attack happened on October 7th. You know, that reignited a war that's been going on for many, many, many years now. And there was a huge need all of a sudden, in international aid and humanitarian work. That's kind of what led to my first deployment. First one was with Medglobal. At the time. This was the Rafah crossing. You could bring kind of as. As much medical equipment as you could carry across. So I had, I don't know, 8 to 10 huge suitcases just packed with everything I could possibly need to do my job for, you know, a few weeks, and had really been very thoughtful about this list and, you know, talk to people there to kind of see what they were short on. And that happened to be May 6 that we were going to cross. And May 6 is when the Rafa border crossing got bombed and destroyed. So we were about a half hour away from that border crossing. Everyone had to turn back around. All trips from then on were canceled because there was no longer a crossing to get into Gaza. And so, you know, basically everything got put on hold until a new crossing was established. And so there was about a month there where kind of no one was going in or out. And then eventually this new crossing was established, the Karim Abu Salem through Jordan. But the difference now was that you're not allowed to bring supplies in anymore and now only bring two bags with you. And each deployment is now going to be one month because they're severely limiting the number of people that are let in or out. The first time going in, I think everyone just has lots of anticipation. Again, there's been so much buildup, so there's just a lot of anxiety, I think, amongst everyone about will I get allowed in? Will there be some attack that stops the convoy? Yeah. And then finally you make it to the actual militarized crossing and you cross the border from very prosperous place where you have everything you could possibly want to. Just like decimation. Every building is bombed out. People are all, you know, walking. There's, you know, the rattle of gunfire in the distance. And, you know, one of the things that really struck me my first day there was, you know, the intensity of the bombing. You know, at that point, I had seen all these videos of buildings being blown up and it kind of felt like there was like a bombing here, a bombing there. But, you know, it turns out like in the first day you're there, I mean, you're just hearing explosions constantly and gunfire constantly in the, you know, helicopter overhead with its machine gun. Like, those things are just like so present, you know, that even getting to our safe house, like within the first 30 minutes, like the windows are shaking from compression waves from nearby explosions. And so immediately you're thrown into this fairly intense situation. The interesting thing is, you know, within 20 or 30 minutes, like you're just adjusted. You know, you're not flinching from a pressure wave. You kind of have already an understanding of what's close, what's far. You just kind of immediately adjust to this as a new normal.
- [17:46]
Wit Misseldine
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- [18:50]
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- [19:30]
Travis Milline
The organization I was with specializes in medical evacuations and also doing trauma stabilization. Their kind of usual format is to position a very rapidly deployed field medical point as close to the front line of fighting as possible. But in Gaza, there's no front line, right? It's just this indiscriminate bombing all around you. And so there's no spot to really set up a field hospital. And so the more efficient thing to do is just integrate into someone else's emergency room. And so that was kind of what our job was when we got there was to go to this hospital, figure out what their needs are, and then, you know, figure out how we fit in. It ended up just that we were working pretty much exclusively in the ERs doing trauma stabilization. It's pretty overwhelming when you first get there. The hospitals say they have a 50 bed capacity, but, you know, they may have hundreds of Haitians sleeping in the hallways, on the stairs. Like nearly every square inch of the floor is occupied. And so it's just kind of this general chaos and mayhem that's going on around you 24 7, like people talking loudly, people, you know, walking through a crowd with a cardboard box with someone on top of it. And so it's just kind of like this immediately very stressful environment. This first hospital we're at was fairly small. And so it's pretty easy, you know, over the next week or two to kind of really feel very useful. Everyone there speaks English for the most part. And so from a medical standpoint and a social standpoint, it's very easy to integrate in with the healthcare workers there. And, you know, then we kind of had this, you know, rude awakening. This was only our second or third day at the hospital. And I remember myself and one of the nurses on our group were walking between two buildings to the er, and all of a sudden this like super intense bombing starts happening very close. You know, all the pressure waves and things we had felt in the past were from fairly distant bomb blasts. And these are, you know, well within a block of the hospital. You know, these far away explosions don't really elicit much of a fight or flight response, but these ones that have like, that close of proximity induce this immediate fight or flight and kind of felt like we'd froze in place, you know, took a step to our left, a step to our right, a step forward, like trying to figure out, like where do you go that's safe in this scenario? And you know, within a few seconds you're like, oh, there, there is nowhere that's safe. You shouldn't leave the hospital because there's bombs out there. They bomb the hospital. So that's not safe either. So like, where do you go? And so, you know, of course we're just like, well, you go back to work. And so we just headed down to the er. So this was the start of the Nuserat massacre, which had a very different news story in the US as compared to what was happening there. The story that was on CNN and that was, you know, in the news was that there was this dramatic rescue of four Israeli hostages. But for us on the ground, it was one of the largest mass casualties, I think, of the war there. You know, the place where these hostages were rescued from was busy, right? This is, you know, within the quote unquote, safe zone. And so this area is just packed full of displaced people and markets and all this. And then there's this just really intense bombing and air coverage and all this in these super busy areas. What that resulted in for us was 1000 or so injuries and deaths. I think the official figures at the end were somewhere around 300 dead and 700 injured. For context, I think America's largest shooting mass casualty was a Las Vegas shooting where there was some 500 patients. The contrast here, right, is that the largest mass shooting in the US was some 500 people shot with a individual bullet generally being distributed to five super modern hospitals with trauma systems, tons of on call staff who can come in for just such an emergency. And then you contrast that to what is going on here where you have a 50 bed hospital that's already overrun by hundreds of patients. And then all of a sudden you're going to add 700 more acute patients to this already overrun hospital who have all experienced, for the most part, explosive injuries, a gunshot. You kind of have a good idea of what injuries might be internally and what kind of workup is needed. But explosive injury, you're looking all over, you know, people might be peppered with, you know, hundreds of pieces of shrapnel. They might have no visible external injuries, but severe internal injuries. So just kind of a very time consuming and difficult to diagnose population that just shows up en masse to this hospital. There's clearly a very stark difference in the news in the west versus what's actually happening on the ground there. We've all heard of and seen enough of the gratuitous violence there. But the situation on the ground relative to what I saw before going there, is so, so, so much worse. And just in general we have a very distorted picture of what is actually happening there. You know, in this most basic sense, the numbers we're all used to seeing is the number of dead. And so they'll, you know, say, oh, 10 people killed today, you know, in a house bombing in Alma Sea, which paints, you know, like a small piece of that picture that, you know, there may have been 10 dead, but there may also be 40 people with life altering injuries along with those 10 dead. 10 doesn't seem like a big number, but 50 or 60, you know, severe injuries on top of those 10 dead paints a very different picture, a much more enormous impact than what we're fed, you know, and also kind of how these things played out, right, the news story, this was like this heroic rescue and to everyone on the ground there, it was this horrific massacre of children, women, men. You know, it's about half kids there. And so anytime you have a big mass casualty, it's about half children. That was obviously like a big eye opener to how bad things can get and was also, you know, a good metric for the rest of our time there. You know, it turns out that, you know, yes, that was a enormous mass casualty, but that's pretty much all we did in our couple of months that we were there was just take care of mass casualty after mass casualty after mass casualty. Sometimes it was multiple per day, sometimes it was just one big long continuous one. And you know, for this Nusrat massacre, you might see a patient do a procedure on them, you know, life saving intervention of some sort of literally just kind of turn around and there's the next person there to be seen, like on the floor, you know, literally right behind you, or perhaps you're even like squatting over the top of them because there's not room to be anywhere else. And you know, this many patients, the floors are just covered with blood, you know, both the patients who's laying there and the person who's there before them. And so yeah, it wasn't uncommon to like take care of one patient, turn around, do something, turn back around and that patient is gone. And you don't know like did they die? Did a family member drag them off to a, you know, an imaging or what happened with them? You don't know. It was just like this really frantic pace of basically just walking around and looking for a life saving intervention that you could perform that was fast and, and simple. So that was the main kind of medical piece that you really did there was just look for and identify these life threatening injuries. It's a really indescribable scene, like just how overwhelmed it is and how everyone kind of like will grab you hoping that you'll see their daughter or son before you go see whatever is you're on your way to see. First patient I remember that came in from that was like this 10 or 11 year old girl that was basically missing her jaw, you know, so just had her upper teeth and everything below that was, was gone. Bleeding a lot obviously from that injury. Awake, stoic, but like choking on teeth and blood that are there. And so the only intervention for her was to scoop out the teeth that, you know, she was coughing on and about to inhale and then literally had her just stand up and told her to go sit in the corner next to two dead men who had showed up with, you know, severe, I think head injuries and just had her sitting in the corner between these two dead men. And you know, notify the ear, nose and throat surgeon that we have your first patient to see. There are, you know, so many patients that we took care of and saw that I can barely even register anymore. But things I can recall right is like you don't, you know, have gloves, so you might have one pair of gloves that you're using for the hour of this experience and multiple patient interactions. There's no sterility, so you're having to put chest tubes into, you know, someone's chest, you know, without any sterile field at all. You know, just working in the most appalling conditions, providing as good of care as you can, knowing that it's dramatically less than what they deserve. You know, over the next couple months there was lots of really intense injuries. You know, the ones that stand out to me were the burnt babies. There was kind of a period of time we were at a hospital a little bit further north than the main one we were at. And there was a lot more intense and close to the hospital bombing there. So essentially every explosion you heard, you'd run down to the ER and then work a mass casualty. And for whatever reason there it felt like the earliest patients that would show up would be usually babies, usually with 90 to 100% body surface area burns, fingers that were charred black, often taking their last breath. So that would be your first patient you'd see. You, you know, end up declaring them. You see 20 other people with horrific burns and injuries and amputations. You finally get all of them squared away and sent off to the next hospital or, or wherever, take a big breath and then all of a sudden someone comes running in with the next burnt baby because there was a bomb that you didn't even hear, you know, that happened at the end of this mass casualty. And so here comes another wave. Some of the other horrific cases that I recall is there was two kids at different times that were essentially severed in half. I'm not sure if it was explosives or by like building falling on them, but you know, they arrived completely alive, conscious. But you know, the very first thing I remember having to do with that first kid that showed up like that was, you know, essentially trying to figure out like how to unknot the rest of his body. You know, where did the leg go? You know, where did this bone go? Literally we had to like pick him up in the air and kind of twist the legs around and try and put him in an anatomic orientation as like the first thing just to get him onto a bed and you know, start the care going. You know, there's so many other horrific license like that that are just kind of a constant day to day. The other interesting thing about that experience, I think that was unique with that group that I went with, is they were doing medevacs. And so at the time the netsareim corridor, which separates the north and the middle areas was kind of a no go zone that was completely closed. And the north doesn't have many functioning hospitals. And so if you were sick up there and needed, you know, a higher level of care, you needed to come down and you know, there's thousands of patients that need to come south and you know, a couple per week or every other week they're actually being allowed. And then, you know, when it came time to actually do these, you know, this is, this should be about an hour drive to go round trip. But these transports would often be 12, 16 hours because the IDF are in control of your red light, green light. And so they tell you exactly where to be and when. Eventually they'd say, okay, go ahead and pull ahead, you have a green light. And then you'd actually get up to interact with the IDF and you know, right, we're in a soft skinned ambulance, you know, very obviously looking like we're medical. And before they would come interact with us, they'd wait for a tank to show up to, you know, point its barrel at you in your ambulance before the soldiers would come out of their bunker to like check your IDs and stuff, or they'd set Up a machine gun nest on either side of you with their machine guns pointed at you. The soldiers, remember on one occasion, just stood directly in front of the hood of the ambulance, pulled his rifle up, took the safety off and just pointed at my head and just held it there with his finger on the trigger, eye on the scope and just held it there for like five minutes. And then he would take two steps to the right and focus it on the driver. Just like tons of intimidation and miserable representation of humans. You know, just because you want to go pick up a five year old girl who has leukemia to get her treatment, you know, they might see that five year old girl as a terrorist, as their leadership has said on a number of occasions. And so I don't know if it's a game to them, it's if it's just intentional, you know, who's calling these shots? You know, are these just a bunch of stupid 18 year old kids who know nothing in life? I don't know exactly what their motivations are other than it's very consistent. You know, on one occasion, you know, one of the convoys was rammed by a tank and a bulldozer. On two other occasions they actually shopped the rear vehicles and they know exactly who I am. Right. This is like a weeks long pre approval process to say Travis is allowed to enter the ambulance, he will be the passenger, he will be arriving at this point, at this time. But because everyone to them is a terrorist and you're just there helping them, that perhaps you are also the enemy to them. As you stay there and work directly with the local teams, you get to know them, kind of start getting to know everyone's family story and hearing everyone's story, right? You become good friends with someone and every single person has this story of how their brother was bombed 20ft in front of them, you know, and how they might lift up their shirt and show you like their shrapnel injuries from when their brother was killed in front of them. Or they might point out, you know, the nurse with hollow looking eyes, you know, last night had his family home bombed and 20 of his closest family members died. You know, just shows back up to work because what else is there to do? And so you hear these stories, you know, over and over again from, you know, everyone you, you work with. And it's really like a wonderful group of people. It's incredibly generous, very, very welcoming. Everyone is really looking out for the international staff. It felt like, you know, one other thing I noticed was just how good the medical students are and Just the medical staff in general, you know, because they've been dealing with this stuff for so long, they are just very efficient clinically, really, really excellent. You know, even a young medical student has probably put in more test tubes than a trauma fellow, you know, here in the US has because, you know, they might be doing it three or four times a day. So really impressed with the students like their residents. Just the level of competence and, and speed and skill is like very impressive. You know, you make really close friends and it becomes really difficult to leave. You know, kind of like a survivor's guilt. You have friends that want to leave whose families are maybe outside of Gaza and you know, in the end just have to leave them there in this horrific situation and there's, you know, nothing you can do to help. So that first tours, it was intended to be a month long. But both because the situation on the ground and because our desire to stay, most of our group ended up staying for a full two months. The leaving process, I guess it was relatively straightforward to us. Just kind of a reversal of the entry. Lots of bag searches and things like that. And then yeah, within 12 hours you've gone from this area of decimation to the airport in Amman, Jordan and you know, someone's complaining about their Frappuccino from Starbucks, they got too many pumps of vanilla in it. You know, there's air conditioning on, There's a Boeing 787 taxiing down the Runway and it's just really dissociating to kind of see, see those two things so close together. You know, one place where, you know, there's very little protein in the market and you know, everyone's losing weight and people are resigned to their deaths to an area of just extreme excess. You know, actually on the flight back from Jordan to the US I remember sitting next to someone and they ended up to have a very different viewpoint on Gaza than what I had believed, that everyone there was a terrorist and you know, was totally okay with everything that was happening there and thought it was very deserved and remember having a very heated discussion for the entirety of that flight with this guy and felt like by the end of the flight it had changed because he was now speaking to someone who had recent first hand experience and I had pictures to, to show him and stories to tell and I think he was surprised to hear and a little bit disbelieving to hear a lot of the stuff at first until I showed him photos and videos of what a day to day looks like there. But yeah, so went back to Portland, Oregon. Took a couple of months off of work. Just needed time to decompress. You know, one of the things that I stupidly believed is that I wouldn't get ptsd, that that was somehow like a choice. Obviously I've been trained and I, I know that that is not the case, but somehow it still felt like it would be a decision. And so it was a little bit surprised at first when I realized that like, yeah, loud noises would invoke this fight or flight response that might think that, oh, here come the patients, that there was just a loud bang. I'm gonna expect to see some really horrific stuff in the next few minutes. You know, jets flying over, any violence on tv, even in like cartoons was not something that I wanted to see and see. I was like, oh, wow, okay, I do have ptsd and, you know, I do need to work on this and figure out how to deal with this before I return to regular work. You know, like everyone there, all that they want is to live and for their family to live. And so you kind of see what's really important in life. Kind of really reinforces that family, friends, like those kind of connections are some of the most important things in, in life. And so I think that kind of changed my perspective a lot when I got back also because, you know, I was single when I went out on this first trip and when I came back, I kind of immediately realized that, you know, there was this person that had been supportive and caring and, you know, there for me the whole time as a, that I was there, you know, a close friend and kind of realized that, you know, this is someone I was in love with. So, you know, once I had a partner and someone that was definitely going to be affected, you know, their life is now entwined with yours. And so now all of a sudden you have someone else to discuss this with. That's really difficult because it's a huge weight to put on someone else, you know, especially early in a relationship. So, yeah, we had a lot of conversations about returning. You know, I ended up not returning until July of 2025. Ended up choosing a, you know, a different organization to go with that had kind of a more open ended approach and more of a solidarity approach. And you're kind of much more integrated into the social fabric. Stay at the hospital if you want to take the Ministry of Health bus home and to work, you can, you can do that. So you're not putting yourself in a UN vehicle to travel around. So a bit of a different approach than kind of every other Group. This trip, kind of a different situation now at this point, I think there had been a two or three months of absolutely nothing being allowed in. Food, medical supplies, nothing. And, you know, people were already starving prior to this. International Criminal Court had already put out arrest warrants for Netanyahu at this point for using food as a weapon of war. People are starving. Everyone is very skinny. People are really desperate for food. And if you're not highly privileged, then you have to brave these GHF aid sites and, you know, take the risk of your life to go and get a bag of flour. And so what's happening is you're having thousands of people just trying to feed their kid or whatever showing up to these aid sites. You know, they stage in a certain spot and then they're told that they can move forward, right? So it's this kind of highly organized process. And almost every time that an aid site opens, there's a mass casualty. The story that, you know, the people give from returning from these is that the Israeli army, who they can directly see is the ones shooting them. And so this trip was a little bit different just in that, you know, the first one was all explosive injuries, and this one was predominantly gunshot wounds from very skinny adults seeking food. And so we still had the mass casualties. The mass casualties, instead of being explosive based, were now almost exclusively single gunshot wounds. And, you know, it really felt very intentional. This wasn't like mistakes that were being made. These were single gunshot wounds. So someone behind the scope of a rifle deciding with each individual shot to take a life. You know, aim at this person's head, pull the trigger. You know, on some days it would be predominantly headshots. And on other days it seemed very clear, for example, that they were aiming at the scrotum. So you'd have this disproportionate number of people that would come in with gunshot wounds to the scrotum, which, you know, obviously you don't typically see. And so, yeah, that was kind of the tone of this trip was a completely starved population being shot with sniper rifles. It was only different, you know, in these gunshot wounds and kind of how brazen they were and how dehumanizing they were. Gunshot wounds to kids, heads like that was not an uncommon thing, I think, down to two and a half years old or so, shot in the head. And so, you know, this wasn't anyone just targeting adult men, for example, seeing that there are people out there who are making a decision to shoot a kid in the head. Two years ago, I wouldn't have thought that that person existed in the world, you know, or if they did, they were a very small proportion of the population. But to kind of see it happening en masse, there was very eye opening. It's not a rogue soldier certainly doesn't feel like that. Especially since it happens day in and day out for long, long periods of time. Then you never hear about any repercussions. And so, you know, huge proportion of these folks need to go to the operating room. The amount of supplies and resources that an OR case takes is very huge. And then you stack on top of that the fact that they are starving. There's no protein left on them, there's no fat left on them. And so not only do they, you know, have this injury and they have to get this surgery, but they have to heal afterwards. And the body just can't fight off an infection if there's no protein. The wound won't close if there's no protein. And there's literally just no protein in the market. The only thing that really exists in the market is rice. And so the number of post operative complications is just really immense because, you know, we don't have the right antibiotics, we don't have the right nutrition to heal the wounds, we don't have the right things for sterility. You have a scalpel still. But all the other stuff that makes surgery safe doesn't really exist. People kind of talk about how, you know, international workers, one of the benefits of being there is that you may kind of act as a shield in a way and that, you know, the Israeli army doesn't want to cause a bigger international stir by killing international workers. Certainly not from America with their, you know, their greatest ally. And so yeah, it definitely felt like there is this protection. But there was an event at the end of my time this summer that kind of made me really feel like, you know, we really did have a protective effect on the hospitals. Kind of over the two months that I was there, there are less and less and less healthcare workers that are being allowed in. You know, eventually by the end of my time there. The organization I'm with is the only organization that's still operating in that hospital. All the other ones have just been denied entry now. And so it comes time for my last day. And so we're in the hospital. We work predominantly on the fourth floor. And so we're up on the fourth floor and we're, you know, saying our goodbyes to like friends we made and you know, colleagues. And then it's time to hop in the car and leave. And basically, as soon as we left, maybe 10 or 15 minutes later, the hospital was directly attacked. And it was actually hit four times in total. And the spots they hit are exactly where we had been about 15 minutes before. And so it very much felt like they were just waiting for us to finally step away and have the hospital completely emptied of anyone who could cause an international incident and then went ahead and attacked it, you know, of course, because that's, you know, where we had said our goodbyes. We still had friends that were, like, standing right there, you know, when it happened. And, you know, that's where our colleagues all work. And so they were all directly injured or killed as a result of these bombings. It was really a horrific feeling because in that moment of highest need, you're leaving. But, you know, in those scenarios, you're not supposed to just return to the hospital, right, because they're actively bombing it. So there's nothing that we could do other than be frustrated and wish that we could return to, at least provide comfort, help out medically in any way we could. You know, like, just go back to be with our people. Just a lot of text messaging and phone calls being like, hey, are you alive? Are you alive? Are you okay? Most of the people I knew were just injured. Not a lot of people were killed. But there was one group of kids that I still don't know about to this day, who. They basically lived on the fourth floor landing on this outside stairwell. And on occasion, I'd go up there and just kind of hang out. I think they were all kind of like 16 to 18 years old, five or six boys. And so we would kind of just pass my phone around, which had Google Translate on it, and we would just kind of chat for an hour or two via Google Translate, and I would head back inside to do my work. And the spot on that stairwell that was bombed is exactly where they spent their days and nights, So I don't know what happened to them.
- [46:51]
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Travis Milline
You know, when Israel was asked about what happened there, they said it was both an accident and then later that they were attacking a Hamas camera that had been set up. You know, which from my perspective, having spent time in both of those stairwells in those locations, like, that isn't the case. Like, I hung out there. It's just a stairwell and people that hung out there, again, kids, and they hit it four times, right? One time is an accident. Four times in exactly the same place is obviously a very, very intentional attack. You know, if you talk to the vast majority of all healthcare workers who have been there, if you ask them, did you see any evidence of Hamas in the hospitals, the universal answer is no. You know, even Nasser as an example, right? I lived there for two months. And certainly you don't see people with guns inside the hospital. You don't see anything other than patients. You know, I think as a government, right, they want to protect these areas for the people, too. So they need these hospitals up and running to be an effective government. So, no, I certainly didn't see Hamas didn't interact with anyone that was. Hamas certainly don't think anyone would say that they are either. And, you know, even if you interact with someone that's well armed, for example, you don't know if they're just like a local family that is kind of protecting their blocks from being looted, or just an individual happens to have a Gun or if that is, you know, someone in the military or that's someone who's contracted to protect the A trucks as they enter. You just don't know who anyone is. After coming back last year, yeah, lots of ptsd, you know, maybe like three months of that. And I think a lot of that was just due to the imagery, the injuries that you see and the horrors that you see. And so, yeah, first, first year, because of just kind of how severe and horrific you know, these hundred percent body surface area burns and severed limbs are like, yeah, very traumatic. This year felt a lot different. Much less explosive injuries, much fewer burns. So the PTSD from explosions certainly was less. But you know, I think probably the bigger thing to deal with was the kind of moral injuries. And this is from knowing what needs to be done in a life threatening situation, but being unable to deliver that same level of care. You know, an example I would give of this is someone comes in as part of a mass casualty, is short of breath and so you're suspicious that they have a collapsed lung. But during one of these big events. And the supplies in this scenario now after three months of full blockade, are incredibly limited. We had someone who I think just needed a chest tube and we could have just put it in, but we didn't have enough staff to help calm this person down, attach them to a monitor, get an IV in them to give them sedation to then cut open their chest and put a tube in it. Nor did we have the needles to simply decompress this collapsed lung. And so in that scenario, the only thing you could possibly do is pin them to the floor and cut them open, wide awake. Because, you know, I did have a scalpel on me. But in this scenario, the guy was, you know, just so stressed and so unable to breathe, he was literally like kind of rolling around on the floor like a, like a crocodile, just struggling for breath. And you know, we weren't able to do anything for him. And you know, there was only two of us trying to physically pin this person into a position while he's already like laying on top of other patients and rolling around. It was just like an impossible situation to control. Then he arrests as a result of that and didn't survive what should be a completely survivable, treatable injury. And so knowing you have the skill, knowing what you need to do, and just not being able to actually do it definitely creates moral injury. You know, there's also moral injury for not treating pain right. And you know, pain medications aren't allowed in either. As you take someone through a painful surgery, it does not feel good at the end of their surgery to wake them up and have nothing to give them for pain control. Or in the case of this chest tube, collapsed lung situation, the next patient we had like that. We did just do that. We just essentially just were able to pin this person to the ground and open their chest up while they're just awake, relieve the collapsed lung, have him calm down, and then move on to the next person. Of course, there's even moral injury from. From doing that. So, yeah, lots of moral injury for everyone who's just trying to provide a standard, because you just don't have what you need to meet your moral code, your ethical code. And so you're. You're forced to do something that's substandard, and you know that there's negative outcomes from doing it in this worse way or using poor equipment. And, you know, then if some complication come up, it feels like it's a direct reflection on you. And so there's certainly guilt associated with that. As far as PTSD goes, you know, I felt like I probably fit almost every single box on the diagnostic criteria. Intrusive memories of distressing events, avoiding reminders of those things, negative perception of the world, responding to loud noises with a kind of a hyper vigilance. A lot of it is what if. Yeah, or ruminations on guilt or like, you know, if I had read up on this or that, would this outcome have been different? If I was less burnt out, would I have been more focused and caught something that someone else had? And it's definitely a troubling thing to think of. And, you know, I think once you're back in the relative safety of the U.S. it's kind of really hard to even believe that these things happened. And so, you know, once you return, of course you want to be an advocate for the Palestinian people and tell the world about what's happening there. And then you come back to the US and kind of no one wants to hear it. People don't accept you to be a speaker at the hospital. It kind of feels like you're being gaslit a little bit like that your experience, you know, wasn't real or that they weren't as bad as what you perceive them to be. The world organizations are all reporting genocide. They're all reporting famine, war crimes. There's universal agreement amongst every healthcare worker who has gone and returned about what they're seeing. And so it's just really frustrating to see the silence here. And, you know, silence was Something that I feel like I probably used to accept. Now I, you know, I'm definitely seeing, you know, and understanding this silence as complicity and silence as something that's directly causing harm now. And so it's really hard to talk to, like, an academic hospital and be like, hey, I want to give a grand rounds on this, and then to have that grand rounds canceled because, you know, you're going to talk about Palestine or Gaza. I feel like the sense of helplessness is kind of magnified when you return, because when you're there, you feel like there's lots of important roles that you have. Not just like the medical piece, but, you know, the human piece. Just directly showing support to them is important. You being able to, like, listen to their stories is important. And then you return to the US and it's very hard to kind of figure out a way to have an. An impact coming back. The things I've found to be most restorative, there's kind of just returning to normal, trying to do the things that you used to do and get used to the fact that what seemed like very, very tiny, insignificant problems when you first get back, you know, eventually become your big problems again. You know, I just did, like, cognitive behavioral therapy, pointing out any cognitive distortions that you have about the world that maybe aren't actually true and kind of correcting some of those things. So I think that was a big part of the therapy side of it. But a lot of times it takes, you know, a month or two for things to land and for you to really start processing the stuff that happened, because you do block, you know, a lot of these moments out. You know, a lot of people who leave have this guilt from leaving. And so just kind of forgiving yourself, you know, knowing that this is as much as you could do with the resources that you have available, forgiving yourself for the things that you didn't have control over, and seeing people do this to people, you know, acknowledging that you didn't have control over those things. I think one of the things I would say about this dehumanization is I obviously felt it last year in that, you know, that there's someone behind a switch that's dropping a bomb on something. Often, I think they probably don't know exactly what they're dropping a bomb onto or shooting their artillery at. So there's this kind of indiscriminate attacks, right? And so a person is one step removed from the person that they're injuring, right? So they don't see the results of their attack. Like the Apache helicopter pilot doesn't see the result of the rockets he just launched into the. This building. So there's some separation between the perpetrator and the. And the fact it's not excusable but like, understandable that like, someone could do that. Right. There's all sorts of social experiments that show that regular people can and will do that in, in most scenarios when they can't actually see the person they're injuring. But this year I felt like what changed is, you know, there's no one between the guy who's looking down the barrel of his gun and the person in his sights. It's a lot harder for me to conceptualize the volume of people that are seeing the direct result of what they're doing, still doing that. It's just kind of unfathomable to me that that exists. I think I have a more accurate worldview and a more accurate view into just what propaganda is. And, you know, how it looks different on either side of that from directly experiencing both sides. I may have thought in the past that the world is mostly good and finding people who would do this kind of thing would be uncommon and there wouldn't be that much like evil that exists in the world. But I feel like this kind of experience really makes me feel like there's a lot more wickedness that exists in the world than we acknowledge. And, you know, we can see that by you give people a gun and an indoctrination, they'll do just about anything without remorse. It feels like gives me some insight into human nature and that perhaps my beliefs about people are not very accurate before. So in, in the last few weeks here, I think since October 10th, there's been a ceasefire now, which is a wonderful first step, but from my perspective, it's a very garden hope right now. A couple of the big features there were, of course, like, returning of the hostages, resumption of aid, and the ceasing of firing upon people and from friends who are over there. The air attacks, the bombing, the artillery shelling is, is still very much present, but, you know, less now. Aid, I think, came in for maybe a day or something like that in a reasonable quantity, but was very quickly tiered back to something as about like a sixth of what had been promised. And so, you know, as far as a ceasefire goes, it's kind of just scaled back the attacks. It's just scaled back the starvation a little bit. So the, the whole situation is still exactly the same. It's just now under the name of ceasefire and is, you know, a little bit less intense of bombing, shooting and things like that. But there's certainly been airstrikes within the safe zone. On Friday of this week, I'm actually traveling back to Jordan with a hope to enter Gaza. The hope is to enter the following Tuesday. And it's kind of unknown to me exactly what the conditions will be. But obviously just because of the lesson, bombing and shooting and the closure of the GHF sites, I think the acute trauma load will be lower, but the kind of more elective stuff I imagine will start to increase. Finally, there's a ceasefire. People can kind of start returning to some, you know, version of normalcy and be like, okay, now I got to get in and see a doctor. So at some point that that process will start happening also. But where we're at in that moment, that's kind of hard to say. Of course, the hope is that it's lasting. The hope is that reconstruction equipment is allowed in. They can start rebuilding their lives. The hope is that the ceasefire leads to a lasting peace. You know, the hope is that, you know, reopen their medical system and get, you know, a free flow of aid back in. But again, yeah, I'm, I'm pretty guarded that any of those things will appreciately change. Foreign.
- [61:41]
Wit Misseldine
Featured Travis Milline if you'd like to reach out to Travis, please find his email address and socials in the show Notes from Wondery. You're listening to this Is Actually Happening. If you love what we do, please rate and review the show. You can subscribe on on Apple Podcasts, Amazon Music or on the Wondery app to listen ad free and get access to the entire back catalog. In the episode notes you'll find some links and offers from our sponsors. By supporting them, you help us bring you our show for free. I'm your host Wit Misseldine. Today's episode was co produced by me, Andrew Waits and Aviva Lipkowicz with special thanks to the this Is Actually Happening team including Ellen Westberg. The opening music features features the song Sleep Paralysis by Scott Velasquez. You can join the community on the this Is Actually Happening discussion group on Facebook or follow us on Instagram Actually Happening on the show's website thisisactually happening dot com. You can find out more about the podcast. Contact us with any questions, submit your own story or visit the store where you can find this Is Actually Happening designs on stickers, T shirts, wall art, hoodies and more. That's thisisactuallyhappening.com and finally, if you'd like to become an ongoing supporter of what we do, go to patreon.com happening. Even 2 to $5 a month goes a long way to support our vision. Thank you for listening. If you like this is actually happening, you can listen to every episode ad free right now by joining Wondry plus in the Wondery app or on Apple Podcasts Prime. Members can listen ad free on Amazon Music. Before you go, tell us about yourself by filling out a short survey@wondery.com survey.