by David Landau
A former close aide still fumes when he thinks about the days and nights between the two CVAs. “Among all the people around him, wasn’t there a single one who could have stood up and shouted, ‘What’s going on here?! Have you all gone mad?! He mustn’t be discharged from the hospital!’ Instead, he was discharged after a day and a half. The doctors told him, stay close to Hadassah. But on the Friday [December 30] he told the security detail, ‘Yallah! To the ranch!’ ”8 Marit Danon is more indulgent. “Look,” she says gently, “he’s got the security people with him all the time. He’s an elderly man. I think myself that in times like that a person needs the embrace of his loved ones.”
Professor Lotan of Hadassah explained that the wait was at the prime minister’s insistence. “We wanted to do the procedure as quickly as possible,” he says. “But Hanukkah was at hand, and in accordance with the prime minister’s own decision and desire, the procedure was postponed for two and a half weeks. And for that period it was decided to give him Clexane, the blood thinner. When he left here [Hadassah], we were sure he’d stay in Jerusalem. But he wanted to light Hanukkah candles with his grandchildren.”e
After the little handover ceremony at the office in Jerusalem, Sharon had left for the ranch.f At 5:00 p.m., the Shin Bet paramedic administered what was to be the last Clexane injection. Sharon watched television in his room and snoozed a little. After 8:00, he asked to be put through to Weissglas, then to Adler, then to his military aide, General Gadi Shamni. He asked Shamni to put him through to the chief of staff, Dan Halutz. His last call was to Maimon, the cabinet secretary. The duty secretary making the calls thought she sensed something strange in Sharon’s voice. “I’m putting you through,” she said to Maimon, “but listen to him. He doesn’t sound right to me.” Maimon felt the same. He called Sharon’s daughter-in-law, Inbal. “Yes,” she said, “we’ve seen it.”9
At around 9:00 she called in the paramedic, who took his blood pressure and found it far too high. His speech seemed slightly slurred, and he said he felt a weakness in his left side. The paramedic, following standing orders, wanted to have Sharon taken immediately to the nearest hospital, Soroka Medical Center in Beersheba. He phoned his superior, a Shin Bet doctor. Inbal and Gilad meanwhile phoned Dr. Segev at his home in Tel Aviv, who said he would set out for the ranch immediately. Gilad said he didn’t want his father to be taken to Soroka. The Shin Bet doctor instructed the paramedic to do what Dr. Segev said.g
Sharon went to the bathroom and collapsed. The paramedic decided not to wait any longer and asked the Shin Bet security team to evacuate the prime minister as quickly as possible. The bodyguards came running in with a stretcher, while the ambulanceh backed up toward the front door. Now, though, incredibly, they discovered that the stretcher was too small to carry Sharon. This delay took another fifteen or twenty minutes. Eventually, they got him into the ambulance. Just as the doors were closing, Segev drove up. He got into the ambulance with Sharon, the paramedic, Gilad, and Inbal, and it drove off to Jerusalem. The time was 9:53 p.m.
Ten minutes into the drive, one of the Shin Bet detail suggested they transfer to a helicopter to cut the time to Hadassah. But Segev said the jogging around might be harmful. He knew now that Sharon was having another, more serious stroke. His left side was paralyzed. But he was still conscious and responsive, and Segev said nothing that would cause him more anxiety. When Maimon phoned to ask whether everything was all right or whether he should effect the transfer of authority from Sharon to Olmert immediately, Segev replied, “Everything’s all right. No need to do anything special.” Maimon duly informed Attorney General Mazuz and Olmert that the prime minister was functioning.
Ten minutes out of Jerusalem, Sharon began vomiting. By the time they reached the hospital, his eyes were closed, and he had ceased communicating with those around him. Maimon, waiting at the hospital as Sharon was wheeled in behind hastily erected screens, now asked Segev for a fuller account. Within minutes, Maimon phoned back to Olmert and Mazuz and told them Olmert must step in as acting prime minister at once.10
Half an hour after Sharon’s admission—by this time television teams, local and foreign, were setting up in the hospital precincts while police and security men swarmed around belatedly “sterilizing” the area—Hadassah’s director, Shlomo Mor-Yosef, announced that the prime minister had suffered “a significant cerebral episode.” He was now in a drug-induced coma and on a ventilator. Maimon announced that authority had been transferred to Olmert. Ten minutes later, Professor Mor-Yosef came out again to say that the prime minister had undergone a scan that showed bleeding in the brain and was being taken to the operating room. The deputy director of Hadassah, Dr. Shmuel Shapira, delivered the next update. Sharon was suffering from massive bleeding in the brain, he said, “and everyone knows what that means.” This time, it seemed, neither the doctors nor the aides were gilding the lily. The nation’s two chief rabbis called on the public to pray and to recite Psalms—the ancient Jewish recourse in times of grave crisis.
Hadassah’s two top neurosurgeons, Felix Umansky and José Cohen, both immigrants from Argentina, began an operation on Sharon’s head that was to go on through the night and not end till 9:30 on the morning of Thursday, January 5. The purpose was to stop the bleeding and to drain the blood that had gathered and congealed. At 4:45 a.m., a CT scan showed that the main hemorrhage had been stopped but there was still bleeding from other, lesser sources. The operation resumed. In the morning a bulletin described his condition as “serious but stable.” At midday Mor-Yosef said Sharon would stay ventilated and deeply sedated for seventy-two hours. Only then, after he was gradually taken off the sedation, would the doctors be able to assess his true condition.
The subtext was painfully clear. In not-for-attribution briefings to the reporters, the doctors spelled it out: The damage to the brain was extensive and very probably irreversible. Sharon’s career was over. The only question was whether his life would continue, and if so, at what level of mental and physical capacity.
The next day, Friday, January 6, a CT scan showed new bleeding, and Sharon underwent yet another operation, this one five hours long, by Umansky and Cohen. Mor-Yosef announced that while the right side of the brain was damaged, the left side was intact. Cohen, however, in a Friday night television interview, firmly discounted any unwarranted optimism. “To say that after such a serious trauma there will not be any cognitive problems is just not to recognize reality,” he explained.
The following week, the doctors began reducing the drugs that kept Sharon sedated. Day by day the dose dropped, but Sharon did not awaken. Mor-Yosef reported that Sharon had moved his right hand, that he had responded to pain stimulus. Again he seemed to be holding out hope, without real grounds. On January 16, heartbreakingly, Gilad called the doctors to his father’s room to see for themselves that Sharon responded when he heard a recording of his grandchildren’s voices and laughter. He had blinked and opened his eyes, Gilad insisted. He had even wept. But by the time the doctors came, Sharon’s eyes were shut again. “This was the impression of family members from movements of the patient’s eyelids,” the hospital explained. “The medical significance of these movements is unclear.”
Outside experts were less equivocal. “The fact that Sharon opened his eyes has no clinical significance,” said Professor Martin Rabey, head of neurology at Assaf Harofeh Medical Center near Tel Aviv. He and other neurologists explained that patients in vegetative condition were sometimes capable of opening their eyes and even responding to certain stimuli, such as the sound of their own names. Some were even able to laugh or cry. “For some reason,” said Rabey sourly, “they are not explaining this, and, unfortunately, they are allowing people to get their hopes up.”
Rabey’s remark reflected the veritable firestorm of criticism that had been raging against Hadassah within the medical profession since Sharon’s second CVA. “VIP syndrome” had run riot, in the view of the critics. On the one hand, Sharon’s chances of recovering from
the first, minor stroke seemed to have been prejudiced by overtreatment: many experts both in Israel and abroad believed that the angioplasty posed an unnecessary risk. For a non-VIP aged seventy-seven, who had lived his whole life with the heart defect, it would probably not have been prescribed. On the other hand, a non-VIP would not have been allowed to postpone the angioplasty for a fortnight, would not have been allowed to return to work just days after the minor stroke but would have been ordered to rest, and would not have been allowed to spend his nights out of range of the hospital. In Sharon’s case—thus the critics—all these wrong decisions served one single and medically illegitimate purpose: to play down, in this preelection period, the gravity of his condition and project him to the electorate as working and functioning normally.
Haaretz stoked the controversy by revealing on January 10 that Sharon had been suffering from cerebral amyloid angiopathy (CAA), a weakness of the blood vessels in his brain that made the danger of a hemorrhage even greater. This significant information had been withheld from the public at the press conference on December 26, the paper wrote. Was that because CAA, fairly common among elderly people, was a condition associated with Alzheimer’s disease—the last thing the Sharon camp needed the voters to learn about before the election?
Reznick of Haaretz reported that a senior doctor at Hadassah—unnamed—termed the decision to administer Clexane despite the CAA “a gross mistake.” Other doctors agreed. “If Sharon’s doctors knew he suffered from CAA, they should not have given him blood thinners,” wrote Professor Amos Korchin, head of neurology at Tel Aviv University. Hadassah itself, increasingly beleaguered, insisted it would not fight back against its critics while the fight was still ongoing to save Sharon. Two months later, Hadassah’s director, Mor-Yosef, conceded that the press conference on December 26 “was not well-advised … We said what we believed needed to be said. There was no manipulation, though, certainly not deliberate.”
Sharon’s condition took a sudden turn for the worse on February 11. His vital signs began to waver, and doctors noticed a telltale swelling of his abdomen. He was rushed into surgery, and some twenty inches of gangrenous intestine were removed. Again his life was in danger, but again he pulled through and resumed his vegetative existence. After three months, he was moved from Hadassah to a rehabilitation center at Tel Hashomer hospital near Tel Aviv. There, still protected around the clock by bodyguards, he remained. Every day, save when Omri was in prison, one or the other or both of his sons spent time with him.
“Would Sharon want the treatment he’s getting?” Professor Korchin asked in an article in Haaretz soon after the second stroke. Another neurologist, unnamed, asserted unequivocally that the second brain operation, on January 6, was unhelpful and superfluous. “The first operation was carried out to stanch a massive hemorrhage. Two of the top neurosurgeons did everything they could. In my opinion, there was no point or purpose opening his skull a second time.”
Other doctors questioned whether even the first operation had a realistic chance of saving the brain. Another example, then, of the “VIP syndrome” that dictated every facet of Sharon’s case? The surgeons were summoned to await his arrival. He was on the operating table within minutes of his admission. Says one seasoned medical observer: “If Buzaglo [the Israeli version of Everyman] had arrived at Hadassah in the condition in which Sharon arrived, he would not have survived long enough to undergo the first operation. By the time the hospital had gotten itself ready to perform it, the patient would have died.” Another senior physician at Hadassah proposes “Israel syndrome” rather than “VIP syndrome” to explain Sharon’s treatment after the second stroke. Buzaglo, too, he insists, would have been operated on at Hadassah if his family, having been made aware of the risks and likelihood of permanent cognitive damage, had demanded it. Sharon’s identity was not a factor in the medical decision making, this physician asserts.
In most other countries, he says, that would not be the case. Patients in Sharon’s condition would not be sent to surgery. Certainly their families’ wishes as regards the possibility of surgery would not be canvassed by the hospital staff and would not influence the decision making. Israeli society and Israeli medicine are different in this respect, for better or for worse.
Perhaps Sharon and his family would ultimately have been better off had the stricken prime minister not been treated. That question remained both hypothetical and irrelevant, as did the questions that surfaced periodically over the years in Israel and abroad as to why he was being “kept alive.” Israeli law and Jewish ethics provided no alternative once his life had been saved.
“The moment a patient’s pulse stops, you focus solely on saving him,” Professor Lotan reflected four years after Sharon’s CVA.
In 99 percent of such cases, resuscitation efforts fail, and the patient either dies or else survives with such massive brain damage that you say to yourself, why did I do it? People lie unconscious for fifteen years, and meanwhile their families are ruined. The wife can’t remarry. The financial burden is overwhelming. The children’s lives are destroyed. And you say to yourself: At the end of the day I did more harm than good to the patient and his family. But it’s not our task as doctors to take such decisions … As a doctor, I am obligated to save lives.
If I could turn the clock back, what would I do? Well, we’re all wise men after the event. But if I could, I would schedule the procedure for sooner and keep him in Jerusalem, under twenty-four-hour observation, until then … Of course I have failures in my work. But this was the most traumatic episode for me. Especially because Sharon was at the most flourishing moment in his career, a moment of hope for all of us.11
* * *
a Sharon’s vision was impaired in one eye after he suffered a detached retina during an airplane trip while serving as leader of the opposition. Omri confirmed this in conversations for this book. He confirmed, too, that the Sharon team was able deftly to head off public discourse around this matter. The public, in fact, was largely unaware of the prime minister’s reduced-sight problem, although vision professionals, watching closely how Sharon held his head, did discern his virtual non-use of one eye.
b The term “angioplasty,” which usually refers to catheter procedures for unblocking heart valves and arteries, is also loosely used for this form of procedure, a patent foramen ovale (PFO) closure.
c Manufactured by Sanofi-Aventis; marketed in the United States under the name Lovenox.
d Writing in Haaretz two days later, Yossi Sarid, chairman of Meretz and leader of the opposition during Sharon’s second term, described his monthly meetings, required by law, with the prime minister:
Now it is permissible to reveal what we really talked about in those regular security briefings. You’re going to be surprised: The first ten minutes were devoted to the security briefing; then we went over to enjoyably pulverizing various politicians from various parties—both his and mine—and then we swapped gossip about our families. He talked about his sons and I about my sons and my daughter, and we would cluck and coo together over our beloved grandchildren. He loved talking about them. His face would light up. He was the ultimate family man. I am convinced that the fates of Omri and Gilad in the labyrinth of their various investigations affected his health (“Eulogy for the Prime Minister, Not for Sharon,” Haaretz, January 6, 2006).
e The eight-day festival started that year on December 26 and ended on January 2.
f Hanukkah had in fact ended by then. Sharon had spent three of the eight nights at the ranch: Friday night, December 30–Sunday night, January 1.
g Segev denies that he told the paramedic to wait till he arrived.
h Part of the prime minister’s motor convoy.
ACKNOWLEDGMENTS
Three people have given me their constant, unflagging support during my years of work on this book. Toby Eady, agent and friend, was critically present at the conception, when Sonny Mehta, the chairman and editor in chief of Knopf, contemplated an informed, clear-eyed
look at the life of Ariel Sharon. And he has been present throughout the laborious gestation, always concerned, always cheering, always inspiring confidence.
Jackie Landau has been more than a loving, comforting, sustaining wife through this period of our lives. She has been an active collaborator on the project from the outset, a judicious editor, a stern but constructive critic, and throughout a devoted partner.
Shira Philosof was efficient and discerning as my research assistant. She was actively involved in every aspect of the work. As we progressed, slowly and—thanks to her—methodically, she became my counselor, confidante, and friend.
The unfinished product needed two brilliant editors to whip it into shape. Juliette Mitchell lopped it down to reasonable size with a briskness that belied deep and subtle sensitivity. Dan Frank, at Knopf, applied his deservedly famous skill and authority to the prose, to the arguments, and to the structure. With a light, empathetic, but rigorous touch, he elevated my efforts to an altogether higher plane of cogency and readability.
My dear friend Jerrold Kessel read the manuscript in an early and prolix form. He was dying, and he wanted to review ideas that we had often discussed together. His advice, as always, was trenchant and caring. I miss him every day. The book is dedicated to his memory.
I discussed some of the ideas at an early stage, too, with a much-admired colleague who was taken from us tragically: Peter David of The Economist. In his understated but incisive way, he offered astute and erudite insights.
I am hugely beholden to my colleague from Haaretz Yossi Verter, the foremost political commentator in Israel, as much for his forbearance and his unfailing humor as for his vast fund of knowledge and understanding.