JERUSALEM - Bracha Toporwitz, a 26-year old resident of Jerusalem, was returning from prayer at the Western Wall with her husband and three children last night when an intense blast ripped through the bus she was on, killing 20 people and wounding 120. The carnage was the result of a suicide bomber who blew himself up at 9:15 p.m. last night.

Toporwitz awoke to a scene of wreckage - bodies strewn on the ground, children screaming uncontrollably, their skin blackened by smoke. All around her, people were dying, and for no reason.

Today, Toporwitz lies in a bed at Hadassah Hospital, her face dotted with red shrapnel marks, green and blue tubes strung up, across and through her body. She is silently mouthing a prayer, perhaps thinking about her children. Toporwitz's 6-year-old daughter walked unharmed from the bus. Paramedics found her 5-month-old baby uninjured, shielded beneath a dead body. Toporwitz's mother explains that "the middle child has not been found."

Toporwitz lurches upward. She was unaware that her 2 1/2-year-old child was still missing. "Take something from this," moans Toporwitz. "Take something to connect with God. Even if it means just a smile. We must connect with God." An hour later she will be informed that her child is dead.

"Look at her face," screams Toporwitz's mother, holding her arms up in supplication. "How can they (Palestinians) say they want peace? They don't want peace!" Her remarks underscore the greatest challenge to the doctors at Hadassah Hospital. It is not enough for them to put bodies back together. They must confront the feelings of fear and hatred that undergird the cycle of violence. Sutures alone cannot heal the fighting. Healing begins with our doctors' ability to affix hope to the lives of the patients who are wheeled through the hospital doors each day.

"The violence must be headed off young," says Barbara Safer, PR director for Hadassah, who explains that the hospital's emphasis on treating psychological trauma is a "new concept." What Barbara is saying and what anyone who gives the matter any thought realizes, is that a culture of terrorism is plainly a matter of conditioning. Each day, young Palestinian and Israeli children witness the brutal and arbitrary destruction of their families. Their parents, their lives, their sense of other possibilities dissolve. These lessons are learned young and tend to stick. In an environment where hope twists inward, feelings of hurt and confusion explode in brutal and arbitrary acts of violence.

So, how can doctors help patients cope with the violence around them? "We explain that it is normal to feel fear, anger . to have nightmares," explains Rachel Blumenthal, a social worker at Hadassah Hospital. "We try to get them to focus on surviving, on the need to be strong."

That is the message that patient Dadash Michal has been telling herself since last November, when al-Qaida operatives detonated a bomb in the lobby of the Paradise hotel in Kenya, where she was taking a family vacation. Bandages are still wrapped around her forehead, left ankle and right arm. She attends rehab every day. She cannot take a vacation, fly or ride a public bus. "I am home," says Michal. She pauses for a moment of contemplation. "But it is not secure."

Nonetheless, Michal stays. She has a hope that is reflected in the diverse working environment at Hadassah Hospital, where Arab and Israeli doctors work side by side, treating the wounds of Israelis, Arabs and Palestinians. "If there is one thing about this institution, it is that there is a ray of hope," says Dr. Charles Sprung, whose words embody the dream of Israel.

On most days, though, the hospital where he works is littered with the bodies of people who have been programmed to destroy.