"I get by with a little help from my friends," by MSIH blogger Tamara Kliot

With classes done and exams in full swing, we have an opportunity to reflect on what has happened over the past 5 or so months. We have learned about the important enzymes that allow us to metabolize nutrients and sustain life, the battle that occurs inside us every time we are invaded by foreign pathogens, the intricate design of cells in different parts of the body, the bacteria we should love and hate, the true meaning of statistical significance, and ethical dilemmas physicians face on a daily basis. It has become pretty apparent to me that the fact humans function so well on a daily basis is a miracle. While it’s crazy to think we have learned all this in one semester, I knew I would be studying these subjects. This is medical school after all.

I knew we were complicated creatures, but I have witnessed another level of our awesomeness these past few weeks. Finals are not the most relaxed time for students. The elevated cortisol levels tend to bring out the worst in people. However, that has not really been the case for my class. It was clear from the beginning of school, that people were interested in collaborating. Classmates would share resources they were using, notes they had compiled, or Anki flash cards they had made with other classmates frequently. When classes ended and exams began, I assumed people would be MIA and only surface on exam days, like any other exam period I had experienced in undergraduate.

Since classes have ended, I have been blown away by the amount of generosity that has gone on. People sharing notes, resources, and uplifting videos in our Facebook group. I am constantly getting notifications about this new resource or PDFs or question banks or YouTube videos or outlined notes. While it’s hard to keep tract of what I could be using at times, but its comforting to know we are all working toward the same goals together. In addition to sharing resources, people have also been sharing their time. Classmates have made a concerted effort to check in with each other to see how

people are handling the stress of finals. It’s pretty amazing to see how invested people are in our success as a group, not just the individual.

I’ve been told going into medicine is like running a marathon. You cannot sprint, you have to pace yourself. Even though running and taking exams are individual sports, they are much easier when you have a team of individuals to help keep you honest with your training.  With four exams down and one more exam to go, there is an end in sight. We are about to cross our first finish line in a series of many races and I am incredibly grateful for the team I have here in Beer Sheva.

I mean, how hard can crossing the finish line be when you have people like this in your life?

"Finding Family in Friends," by MSIH December blogger of the month Tamara Kliot

Studying medicine abroad is exciting! There are always new places to explore, people to meet, languages to learn, cultural norms to adapt to, and things to discover. The opportunities to procrastinate studying for biochemistry or immunology are abundant. However, with the ending of classes and beginning of exams, there has been a noticeable shift in how people are allocating their time. Priorities are shifting as that list of important information to review continues to grow.

While having fun and taking “mini-vacations” are important stress relievers, it is easy to lose sight of that when you are in the thick of studying. It is easy to isolate yourself in a study fortress and spend your time surrounded by books and watching videos on metabolic processes. It is easy to forget to be a human and spend time with friends and talk to family.

I was reminded of this when my Israeli neighbor wished me a Happy Thanksgiving. He was the last person I expected to hear those words from, but he forced me to stop and think. Thanksgiving is my favorite holiday because it's an opportunity to spend time with family and reflect on the things we are grateful for. Living in Israel, it would have been easy to forget to celebrate or even acknowledge Thanksgiving. It is just another day in Israel and in many other countries for that matter. We had had a busy week, multiple quizzes to study for, and a paper to write; the last thing on people’s minds was Thanksgiving.

But as Thanksgiving continued, it was not just another day in Beer Sheva. Some of our classmates had the forethought to organize a dinner at Butchery to celebrate the end of first semester classes and well… Thanksgiving! It was a fabulous time with delicious food (tons of meat!) and amazing company. It was fun to see our non-American classmates get in the spirit of Thanksgiving as well! The night was filled with stories, laughs, and celebration (we did just finish one semester of classes!). I learned so many new things about the awesome people I am lucky enough to call classmates. It was a great way to recharge from a long week and reminded me that I do in fact have a family here in Beer Sheva, people I call friends and accomplices in this adventure we call medical school. 

"A Very Beer-Sheva Thanksgiving" by MSIH first year blogger Becca Siegel

On November 26th, 2015, several medical students from around the world celebrated Thanksgiving dinner in the Middle East. In Beer Sheva, Israel to to be exact.  I am pointing this out because it is notable in many respects. First off, the very fact that a group of people who regularly spend upwards of eight hours a day together would want to spend their few off hours together is quite amazing. Secondly, in a little city, in one of the smallest countries in the Middle East, students from all over the world sat together and had a meal because there was a lot to be thankful for.

We had just taken our last microbiology quiz of the semester. We were a few days away from our very last class of our first semester of medical school. We had survived. We had somehow managed to move to a brand new country, learn a brand new language and start medical school, all in one fell swoop.

Together we ate delicious food and we made nerdy jokes about mycobacteria and we toasted to a circle of people who could one day be called “doctor”.

Happy Thanksgiving from the class of 2019!!!

Now on to finals.

"Lost in Translation" by MSIH first year blogger Rebecca Siegel

A few days ago, when I was walking home for class, a man asked me for directions in Russian. I know that he was asking for directions, not because my Russian was sufficient to decipher his intention but because he was pointing to a tattered map. From what I could tell, he was looking to get to the post office, which was pretty much a straight.

I tried to communicate that it was straight ahead in every way I could. I attempted in Hebrew. I attempted in English. I made a line with my finger on his map. I mimed a person walking forward and finding a post office.

Nothing worked and with each attempt he looked progressively more frustrated. I also felt frustrated because I knew what he was going through and I was powerless to help. I too was a stranger in a strange place. I knew exactly what it was like to say the simplest thing over and over again and not see a look of understanding on the face of the person that I was talking to.

            To me, this is one of the greatest assets of going to medical school in a foreign country. The very fact that we know what it is like to struggle with being able to communicate and understand basic things is what is going to make us good doctors. Not understanding is hard.

            So here’s to my classmates who have known the true horror of taking a bite of a would-be-delicious breakfast parfait, only to find they had purchased sour cream and not yogurt at the grocery store.

My very resilient classmates who have double, triple and quadruple checked the bus map, only to find they were now farther from their destination then they started.

Together, we have learned intimately what it means to need help and lack the words to ask for it.

My peers and I represent a class of physicians who will understand that it is not the responsibility of a patient to communicate in ways a physician can understand. It is on the doctor to hear a patient’s explanation and figure it out.

"Clown College" by MSIH first year blogger Rebecca Siegel

           On Wednesday evening at 3:47, a typical first medical student rummages through her backpack, to prepare for her next class. She sits in the break room on the sixth floor of the internal medicine building at Soroka hospital. She takes out a biochemistry textbook and put it’s on the floor beside her backpack. She takes out some highlighters, flash cards, and a binder full of printed out slides from immunology lectures. She still hasn’t found what she is looking for. She pulls out a tutu and then continues to rummage until she finds a Santa hat.  “Finally”, she mumbles. It’s time for class. 

Welcome to medical clowning. Meet Dr. Amnon Raviv, the only self-proclaimed only personal in the world to have a PHD in medical clowning. He is a clown, a real-word superhero, and the instructor of this very special course. He is a human sigh-of-relief for people battling serious illnesses all of the country. On any given day he can be found in an oncology ward, belting out an upbeat western style song about colon cancer, or in the surgery wing, helping a 5-year-old boy make a list of what dreams he would like to have during surgery (before summoning in the anesthesiologist and reading the list of dream-demands aloud).

As we leave the class three hours later, I feel a little overwhelmed by how lucky we are to have Dr. Raviv. We are students of empathy and active listening. We are tutu clad care takers. And for three hours every week, we are allowed to reclaim some of the idealism that made us want to practice medicine in the first place.

       It’s time to practice. One student is the patient, one is the doctor and one is the clown. Dr. Raviv tells us that the patient is a small child who is getting a shot, but feels quite scared. The clown tries to make bird noises and funny faces in order to distract the child from the shot. Dr. Raviv stops the exercise.“ The child is afraid of the shot”, Raviv explains “and you’re not going to help by ignoring the shot.”   They try again, only this time the clown jokes about the shot. He pretends to give it to the nurse, to himself, even to the wall. “Better”, Dr. Raviv says. Slowly we are starting to understand. 

"A Guide through Dissonance: 2015 Physician's Oath Ceremony," by MSIH first year blogger Jay Berkes

MSIH Physician's Oath Ceremony 2015

The fact of medicine as an institution has not been lost on any that have passed through its doors. The least of which are first year medical students, whose ambitions of practicing medicine have not yet been co-opted by the demanding processes of the education and the career. Our view of medicine is still one of reverence, the ideals of which don’t just sit propped on one mountain to be climbed, but on peaks and in valleys throughout an entire range of challenges. They remain there, revered, and in places of importance because we are the type that enjoys challenge.

A good challenge, though, must be accompanied by its goal. Or some reminder of its goal. For me, this reality was the highlight of the master’s degree I completed shortly before coming to Israel. I studied business administration, the result of which is a ticket to business ownership or organizational management in some form. In one class we discussed whether or not management was a true profession, bound by a code of conduct, a license to operate, a professional governing body, a foundational education, and a duty to serve. These requirements are necessary to generate a fairly explicit agreement with society, one in which the members of a profession will exercise trust and control in the provision of their service, maintaining equity within that societal agreement. Of course, the field of management isn’t bound by these requirements. So do they not have a place within a societal agreement? Of course they do, and in the absence of a professional governing body or a license to operate they must rely solely on their education and their duty to serve. Those two things, and especially that duty to serve, become the daily reminder of the daily challenges offered in management.

So where does that leave me, three months into my medical education, still wrapped in the importance of the pursuit of becoming a physician? And what is the guiding reminder of that goal?

First and foremost, I hold onto that duty to serve, a fundamental part of my interest in medicine, and a fundamental part of my future profession. And while that should be enough, the rigors of the educational process provide more than enough distraction from the foundation. Every pursuit of knowledge is wrought with that dissonance, the dichotomous fight between awareness and ignorance. Awareness to the details of root memorization, creative processing, and the larger end goal of application. Ignorance to the discomfort of effort, in the trenches of detail and the finality of that big picture. The difficult realization, of course, is that merely surviving such dissonance isn’t enough. Surviving on the merit of scientific knowledge, and graded application, will produce competence, and at the every least it will have produced a physician that has succeeded in entering into that fairly explicit societal agreement (complete with licensure, a code of conduct, and the acceptance of a professional governing body). But a code of conduct is not an oath, and medical competence is not the only goal. Something else is needed.  

At MSIH and Ben Gurion University, like hundreds of institutions around the world, we take a Physician’s Oath at the start of our medical studies to guide us on a path through that dissonance. With Dr. Shimon Glick, a founding member of BGU’s Faculty of Medicine and a leader in the practice of medical humanism and medical ethics, we learned that this oath and this ceremony is in place to bear on us the responsibilities and duties, and not just rights, of medicine. Started over 40 years ago, at this school, this practice aimed to make “change agents” of the BGU’s first medical students, working to upgrade the medical care and health of patients and communities, from the very start¹. 

For those of us that have chosen a foreign country to enter into a difficult profession, with a focus on a discipline (Global Health) that is not widely understood, the Physician’s Oath is a guiding hand, a statement of our duty to serve, and a reminder to be agents of change for the benefit of our patients and our communities.

I’ll use it as my guide when the dissonance gets too loud.

Reference:

1.      Glick, S. M. (2003). White coat ceremonies—another commentary. Journal of Medical Ethics, 29(6), 367–368. http://doi.org/10.1136/jme.29.6.367

"I Ask Fish for Dinner, Learning Hebrew in Medical School," by MSIH first year blogger Jay Berkes

Hebrew ulpan teacher Michal. 

Hebrew teacher: How was your weekend? (Eykh hayah sof hashavua shelcha?)

Me: I ask fish. (Ani mevakesh dagim.)

Hebrew teacher: What? (Mah?)

Me: I ask fish. (Ani mevakesh dagim!)

Hebrew teacher: You ask what? (Mah ata mevakesh?)

Me: Fish (Dagim)

Hebrew teacher: What did you do? (Mah ata asita?)

Me: I ask fish, and I eat fish. (Ani mevakesh dagim, ve ani ochel dagim.)

Hebrew teacher: Ahhhh, you cook fish. (Ahhh, ata mevashel dagim.)

Me: What? (Mah?)

Hebrew teacher: You cook fish, not ask fish. (Ata mevasheldagim, lo mevakesh dagim.)

Me: I cook fish? (Ani mevashel dagim?)

So goes many of the interactions in my first year Hebrew class. Despite the daily reminder that I couldn’t hold a conversation with a four year old, though, learning Hebrew is an interesting little side project. From practicing the phlegmy throat sounds required for certain letters (think lechayim here) to understanding necessary phrases (where is the bathroom?) to reading and writing, I spend my Hebrew class periods bouncing back and forth between giddy joy that I know something and complete confusion at what’s going on.

Easily the hardest part of learning Hebrew while in medical school, of course, is the fact that medical school tends to get in the way of free time. And learning a foreign language, like training a dog, requires consistent daily practice in your free time. But with such a busy course load, it’s difficult to mentally switch gears into Hebrew learning mode. Luckily, two days a week we have a 2 hour class at the end of the day set aside for such training, and switching gears is just kind of forced on you.

While it’s a little tiring, and progress can be slow at times, learning Hebrew does help me feel slightly cooler when I order falafel or hummus. And as esoteric as that sounds, little victories are the bedrock of learning a new language. It’s easy to forget that when you hang out with anyone from a European country and hear them interact in 2-5 different languages, fluently. It’s also a little difficult to build up a cache of little victories of spoken Hebrew in Israel because so many Israelis are also fluent in English. If I had a shekel for every time I’ve tried to use Hebrew to buy groceries only to get a reply in English, I could probably go grocery shopping twice this week.

Polyglot jealousies aside, learning Hebrew adds a very interesting dimension to my medical school experience. To me, Hebrew represents another world of mystery here. Histology allows me to dive deep into the tissues of the body, and I get to see how nutrients squeeze their way to bone cells. Biochemistry allows me to draw out a map of how molecular interactions allow me to use energy. Immunology lets me see how the body defends against a bacterial infection the same way ancient armies fought battles. And Hebrew gets me further down the path of expressing myself and understanding others in a very novel way. Especially when ordering falafel.

With that said, my day of studying is over and I’m pretty hungry. I think I’ll ask some fish for dinner tonight. 

My New Golden Rule, by MSIH's first year blogger of the month Jay Berkes

Procrastination is usually pretty fun.

That’s what I was thinking this morning when I was riding through the hills outside of Beer Sheva on one of the many mountain bike trails that surround the city. I should have been studying for the upcoming microbiology quiz. Or the upcoming histology quiz. Or the upcoming immunology quiz. I probably should reviewed gluconeogenesis for biochemistry, and I definitely should have looked back over my notes on recombinant DNA technologies for molecular biology.

But, procrastination is fun, so I kept riding. And after our two week break for the Jewish High Holidays, I’ve rediscovered the importance of little vacations like that.

Nitzanim Beach Weekend

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When you imagine your own personal getaway, the one in the forest, or on the beach, or in the city you’ve always wanted to visit, you do it for the solitude. Your own kind of solitude. You might do it for peace and quiet, or you might just do it for the difference that isn’t in a daily grind. It’s a grass-is-always greener thing, and it’s usually hyperbole. But hyperbole, like procrastination, is fun.

For me, solitude used to be the promise of efficiency; a window of opportunity. “If I can just get away, I’ll finally catch up.” It’s probably why I spent three weeks in a cabin in the mountains of southern Colorado studying for the MCAT. Or why I regularly spent my summers during college 1200 miles away from home…sorry, 1931.21 kilometers away from home. It might even be why I moved to Israel to attend medical school. But my break from school over the last couple of weeks has helped me understand what I really need out of little vacations.

---

As one of the many non-Jewish students at MSIH, with no previous links to Israel, this is my first time experiencing the High Holidays. In the days leading up to our break they were explained to me as a new year celebration in September (Rosh Hashanah), a day where no one eats or drives (Yom Kippur), and a week where everyone eats their meals in little wooden dwellings outside of their houses (Sukkot).

After being welcomed with open arms into a Jewish household for a Rosh Hashanah feast, talking with new Israeli friends about the importance of self-reflection during Yom Kippur, and seeing little beautifully constructed huts pop up throughout my neighborhood I began to get a little more perspective on the traditional undercurrent of the High Holidays. Specifically, the concept of teshuva (תשובה), which literally means “return.” In respect to the High Holidays it means repentance, and the ten days between Rosh Hashanah and Yom Kippur are especially focused on teshuva.

I’d never heard the word before a couple weeks ago, and I’m still a little fuzzy on the details, but I understood it as a kind of returning to your original nature, or refocusing on your real self. Personally, I’m no longer a practicing member of any religion, so I applied this idea of returning to your original nature and refocusing on your real self to the primary religion in my life: med school.

---

Mountain biking north of Beer Sheva

Moving to a new country is jarring. So is starting professional school. Put the two together, and it’s easy to get overwhelmed. Our first 6 weeks included an accelerated emergency medicine course, hours upon hours of studying Hebrew, being introduced or reintroduced to some heavy scientific topics, and the many tedious details of securing housing, utilities, groceries, and school supplies.  Throughout those 6 weeks, the holiday break became more and more of grass-is-greener type of window of opportunity; a promise to catch up on the growing list of “things to review.” By the time the break arrived, though, that list had grown so long that it became its own source of stress. I was overwhelmed with class, and I was overwhelmed with break…Until this concept of returning or refocusing started weaving its way through my mind…On one bike ride it reminded me of how inspiring the desert scenery is around Beer Sheva. On one hike it reminded me of how the challenges of medical school are easily trumped by the excitement of learning. And when I shadowed one of the orthopedic physician assistants in the emergency department it reminded of how rewarding patient interactions are.

Nico and Raphy duking it out in Krav Maga. 

My true nature, and my real self, is the reason I came to medical school. Whenever the stressors get too great and I begin to lose sight of that reality, I’ll just need to make use of little vacations to help me return to that reality. Whether that means doing an extra Krav Maga session with my classmates, camping out on the beach for a weekend, or taking the occasional nap, I know that returning to my original self will help check things off my list much more effectively than worrying about how long it’s gotten. And I have my first High Holidays to thank. 

My new golden rule for the next four years: Plan to Procrastinate.

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