Top US neurosurgeon volunteers hard-won wartime expertise at Sheba Medical Center

As soon as world-renowned American neurosurgeon Dr. Teodoro Forcht Dagi learned of Hamas’s devastating October 7 attack on Israel, he contacted Sheba Medical Center near Tel Aviv saying he wanted to come and help in any way he could and stay for as long as needed.

Although Dagi had not previously worked or volunteered at Sheba — Israel’s largest hospital — he was aware of its excellent reputation.

“I have tremendous respect for the hospital and have some acquaintance with how it plans for military-civilian contingencies having to do with my particular work in trauma and mass casualty events,” Dagi said.

“I know of the neurosurgery department here and the neurosurgical departments in Israel in general, and I know their quality,” he said.

Dagi, who lives in the Boston area, is a professor of neurosurgery at the Mayo Clinic College of Medicine and Science. He was trained at Harvard Medical School and Massachusetts General Hospital, and Johns Hopkins.

Between 2005 and 2018, Dagi chaired the medical school at Queen’s University in Belfast, Northern Ireland, rebuilding it after the Good Friday Agreement peace treaty that ended the “Troubles.” The sectarian violence that lasted between the late 1960s and late 1990s killed more than 3,500 people and injured thousands more. Dagi has also worked in other conflict areas, such as Kosovo.

Dagi, who is Jewish, has a particular interest in head trauma and has consulted internationally on battlefield injury. He is an editor of several journals including the Journal of Special Forces Medicine, and in the past was a flight surgeon and taught flight surgery courses for the IDF.

Physicians at Sheba appreciate his stepping up to assist where needed and contribute his decades’ worth of expertise. The hospital has been treating many of those injured during the war sparked by Hamas’s murder of 1,200 Israelis and taking 239 hostage.

“We’ve been very fortunate to have [Dr. Teo Dagi] join us. He has provided us a tremendous amount of knowledge, experience and support,” said Sheba neurosurgeon Avital Perry.

“He’s also provided that to the families who see that the best in the world have come here to Israel to provide care for their sons and daughters who have made immense sacrifices for the country, and now they are getting the best care they can get in the world by people like Dr. Dagi. It has given them a tremendous amount of confidence in the treatment we’re providing,” she said.

On a short break from rounds, surgery, and planning meetings on  November 7, Dagi sat down at the hospital for an interview with The Times of Israel. The wide-ranging conversation spanned from treating military neurosurgical injuries to the lessons Israel’s healthcare system can learn from other conflict areas, to how Israelis express hope.

One of the things you are doing at Sheba is helping to strategize in terms of dealing with war injuries. What does this involve?

The thing about military neurosurgical injuries is that they need to be relearned in every generation because we don’t have continuous warfare. So every generation learns principles of head injuries or spinal injuries that enter the brain and the spinal cord, but their management changes from time to time and you can couple those to the military technologies that are being applied.

For example, today you have injuries not only from bullets but also from improvised and non-improvised explosive devices. On the one hand, many of them are more survivable because they are lower-energy projectiles than bullets. On the other hand, the risks that they can confer are of infection from the scene in which a soldier lies waiting for evacuation, and from secondary complications that have to be very carefully managed. Intracranial pressure (ICP) is terribly important to control from the beginning to prevent secondary injury. Another thing we are now aware of more than ever before is the frequency of vascular injury. Therefore, we use angiography to study the arteries of the brain to make sure that no aneurysm could cause a future bleed.

What about spinal cord injuries?

Bulletproof vests help a lot, but they don’t exclude injury. The principles of treating spinal cord injuries are similar, but you don’t worry about ICP. You do worry about combined injuries, so every time you have a patient with a wound to the torso or the head, you also look for spinal cord injury.

With all the risks for complications, is there a specific window of time within which a person with one of these injuries must arrive at a hospital?

Unlike with stroke, it’s not a question of a window. You would like to get people as quickly as possible to definitive and comprehensive care to lower the risks to the patient. There’s no such thing as real first-aid for head injuries. You try to do everything that you can to get the person to a hospital with all the necessary assets as quickly as possible.

Israel has devoted critical resources to training and provisioning teams to evacuate patients and get them to good, comprehensive hospitals as soon as possible. There were cases on October 7, in which there were unfortunate delays, but that was very much outside the usual sphere of combat care that exists in Israel.

Do you have any thoughts on what the Israeli healthcare system may face long-term as a result of this war?

Israel is used to relatively short combat. It comes to an end relatively quickly. It’s not that there haven’t been terrorist attacks and similar things, but they are bound in time. What I suspect we’re going to see in Gaza from everything that I read is what the Americans and British encountered in Southeast Asia at the end of World War II, which is long, painful, hand-to-hand combat. I don’t think Israel is accustomed to that.

In Israel, people circulate in and out of the army. Because of this rotating between military and civilian life, a new balance or equilibrium will have to be found. In addition to treatment for physical injuries, people will require different kinds of care. Israel’s got to develop an integrated response to this.

What were the effects of the Troubles in Northern Ireland on the health system there?

There’s a medical side and a social side to my answer. On the medical side, I came after most of the work in Belfast on injuries had already been done. The work that was being done was to rebuild the medical schools.

On the cultural side, even years after the Troubles, Protestants did not feel comfortable going for treatment at the Mater, the Catholic hospital in Belfast. Similarly, Catholics did not want to go to the Victoria Hospital, which was Protestant. I had many friends who felt themselves at the intersection of the cultures.

The Protestant head of surgery at Victoria, for example, was amazing and probably did more to help the victims of the Troubles than anybody else. He was the subject of an assassination attempt [after the peace treaty]. The IRA felt his presence could not be tolerated. The cultural hostility was promulgated for a very long time.

What can be done to prevent something like this happening in Israel? The Israeli healthcare system has historically been an island of cooperation and coexistence between Jews and Arabs.

You can’t compel people to be happy in their surroundings. All you can do is treat people well, with kindness, and with consideration for their needs. I think that is being done well at Sheba, and from what I can see it is successful. I can’t speak for other hospitals in Israel because I haven’t been working in them.

In another part of my life I spent time in Kosovo, where people would tell me, “If you’re a Serb, I don’t want you operating on my child because you’ll kill him.” It was the same if a Serb suspected me of being Catholic. It was a similar situation if people thought I was a Muslim.

I have never gotten a hint of that here.

Is there something you think is unique about how Israelis think about and express hope?

In English, when people hope for something, it’s not something that they can do very much about. It’s passive.

There isn’t an exact translation for hope in Hebrew. It’s not the same valence. In Hebrew, it’s something beyond hope as it is understood in English. You have to do more than just hope, you have to act to get a result. You have to work at it. It starts with the motivation, but that’s not the end. It’s a resolve to do everything you can to get the results you want and need. I see this very much reflected in Israeli society.

How do you see it reflected day-to-day at Sheba?

I see groups of kids coming and trying to cheer people up by playing music. I see people going around giving out candy and cakes. I see people stopping to talk. I see small kindnesses. People caring for one another always makes a difference in the way people feel and their inclusion in society, because this is a time that people inevitably feel very lonely.