The December 2007 inaugural issue of Rambam On Call shared news of generous investments by Friends of Rambam in RHCC'S 5-10 year, $300 million Vision of Adam development plan.

Five months later, hopes and plans have turned into initial actions on – and in – the ground. The Emergency Trauma Center's fortified new roof has been poured. Moreover, an exposed parking lot and cluster of obsolete bungalows have been demolished to free up 16 dunams (16,000 sq m) of land for construction of a 3-level underground parking garage whose deepest level can be converted within 72 hours into a 750-bed emergency hospital fortified against missile, chemical and biological warfare. The parking garage's reinforced ceiling will provide the foundation for the proposed new Children's Hospital, Cardiology and Oncology Hospital, and Biomedical Discovery Tower.   

All this activity began appropriately in the Hebrew month of Adar (March) when according to the Purim holiday tradition, everyday reality turns upside-down. Rambam strives for a paperless work environment, else announcements flooding employees' mailboxes in that month alone would have generated enough paper to insulate the planned new structures: ER has relocated temporarily to basement facilities; the Municipality has rerouted traffic in the hospital's vicinity; your pardon is begged for construction noise and vibrations, the brief disruption of medical-gas supplies, the closure of on-campus parking. . . .

In compensation, the always lively Rambam campus has become even more exciting. Vivid orange or yellow polyethylene debris chutes snake down the exteriors of buildings under renovation. Bright yellow excavators, bulldozers, cement mixers and cranes crunch and roar and whir. Corrugated tin fences catch the sun. The gouged ground deepens and widens while pyramidal mounds of newly dug dirt rise, which  – this being Israel – have necessitated work stoppages while several unearthed Byzantine-era mosaic floors have been salvaged by the Antiquities Authority.

At the calm eye of this creative storm is dapper and apparently unflappable Col. (ret.) Ariye Berkoviz, Head of the Engineering Department, who brings to his overall supervision of the project a career-military background with responsibility for overseeing all building and development programs of the Israel Defense Forces (IDF).

Several times a week since May 2007, Mr. Berkoviz has presided over meetings that bring to Rambam about a dozen of the currently forty professionals at work on the project: building and landscape architects, civil engineers, and infrastructure specialists responsible for such aspects as acoustics, air conditioning, electricity, elevators, fire safety, plumbing, and waste disposal. 

At these meetings, the neatly arranged seminar table's coffee packets and plates with two kinds of cake squares are pushed aside by participants to free up space for laptop computers and unfolded floor plans. Prof. Rafael Beyar and his executive team make the macro decisions, but Mr. Berkoviz and his forum of experts make the thousands of micro decisions that go into designing and building a 21st century medical center – and nothing escapes their attention. Today, they are refining plans for the underground parking garage and emergency hospital: How will we protect the medical-gas lines against exhaust fumes and vandalism and prevent internal corrosion? How many permanent and how many portable toilets should there be, and how will we integrate them with 1,500 parking spaces? How will we ventilate the underground facility in times of peace and war and place the vents so that they won't swallow dropped car keys? How will the emergency hospital's laundry and garbage be collected? 

Anticipated completion dates for the Sammy Ofer Underground Hospital and the Ruth Rappaport Children's Hospital are the summers of 2010 and 2011 respectively