Holy Days by blogger of the month Jessie Seiler

As a student at MSIH, you’ll be offered opportunities to attend Shabbat and holiday dinners with families connected to the school. Take them all, even if you’re not Jewish and you’re nervous about what to wear, what to bring, and not knowing the prayers. I wouldn’t have given this advice a couple of months ago, not being much of a fan of holidays. So here’s an explanation for my change of heart.

I know this is supposed to be a blog about the experience of the first years at MSIH, so I sincerely apologize for the fact that this installment begins in Israel, but then heads back in time to a week I just spent in Portland, Oregon. 

To make up for it, I’ve included a few photos from classmate Justin Hylarides, who has a real skill with a camera.  These are shots from the class trip to Jerusalem, which I missed for the trip to Portland. But after my short holiday, I made it back to sandy Be’er Sheva. I promise the blog post will remain more or less rooted there the whole time.

 To start in the middle of things: A few days ago, I was very, very jet lagged. It’s a long trip back from Portland to Israel, and my trip out there was exhausting, so I spent all those long flights as little more than a sentient pile of comfortable clothing with ear plugs, an eye mask, and an endless appetite for free airplane wine. But I was happy to be back at school, and the timing couldn’t have been more compelling: I had arrived just in time for the holidays. In the middle of unpacking and greeting friends and trying to wrap my reluctant, complaining brain around the quantity of class I had missed, I accepted an invitation to attend Rosh Hashanah dinner with a member of the MSIH faculty, a doctor. And on top of my jet lag, yes, I was indeed nervous about what to wear, what to bring, and not knowing the prayers.

But I shouldn’t have been. It turns out that my general rule for these things – dress as if you’re going to visit your grandmother – holds up fairly well here; that you’re allowed to ask your host if you should bring anything; and that nobody expects you to magically be word-perfect on the prayers of a faith that isn’t yours. That’s not why you’re invited.

I’m not a religious person and my sense of holiness is a little vague, so holidays in the States sometime felt to me like very isolating times. As a kid, I associated them with not seeing my friends for a few days, since they were being whisked off on vacation by their parents or staying behind closed doors for what I could only assume was the torment of spending hours and hours with extended family, soberly playing board games and reverting to the behavior patterns of their childhoods. So I went a little nervously to the Rosh Hashanah dinner.

More than anything, it was a family meal. Sure, the host offered a couple of prayers at the beginning, and we all used the traditional greetings and words wishing each other a good new year. But beyond that, it was really a time for these four generations of a family to be together. We talked about the youngest member of the family, the great-granddaughter, who slept through the whole meal. Somebody made gentle fun of one of granddaughters, who is shy in English and apparently very forthcoming in Hebrew. Pictures were taken and shown off, courses came and went, and conversation flowed in Hebrew and English.

Through the haze of jet lag and the stupefying effect of a delicious and very long meal, I realized that I had been asked over for a holiday by a complete stranger. We don’t often consider doing that in American culture. But how special is it to invite somebody into your home? We do it so often on mundane occasions – the repairman comes around to fix your washing machine, or your friend drops by to pick up that book you promised her – that we don’t see it as being that big of a deal. But we know it’s different for holidays. All the traditions your family has spent generations accumulating are there to be shared with a stranger. All the closeness and intimacy of a family gathering are being observed by an outsider. When you bring a stranger to your home for a holiday, you’re inviting them to join this intimate moment of communion: communion both between family members and between what is human and what is holy.

Which brings me back to my reason for missing the class trip to Jerusalem, on top of several days of class. Oregon is ten time zones away from where my classmates were attending class lectures and histology quizzes and important meetings, and I was there for my brother’s wedding. My brother and I weren’t really raised together. Being invited to the wedding wasn’t like being invited as a stranger to the Rosh Hashanah dinner, but I would still be seeing family members I hadn’t had a chance to be with since I was very young. I would be defining my place in this family by attending the wedding.

I could talk about how beautiful the occasion was forever, but I’ll try to be brief. To see my brother and new sister-in-law stand together and make a promise was to witness a miracle, and the act of adding my blessing to those of their other family members and close friends was the closest I’ve felt to holy action in years. Because to be included in a wedding like that is to be invited to a holy day. You come together, everyone gathers close, you sing or speak or whisper a blessing out loud and hope that it comes close to the one that is moving through your heart, mind, and whole body in a way you could have sworn (because you’re a medical student) was reserved for your blood alone, and something about your coming together to celebrate, thank, and bless offers protection, comfort, and joy.

It was a much greater moment of communion than what I would be experiencing in a few days at the Rosh Hashanah dinner, but it prepared me for it: to see the holy and the human, and to accept a place in a community when you’re invited in.

So that’s why my advice to future MSIHers is to go to all the holidays they can. Because attending a brother’s wedding and being invited to a holiday dinner have a lot in common with what it felt like to be embarking upon a public health program, or what I imagine meeting a new patient for the first time will be like. It’s about learning how to accept a generously offered place next to somebody new or in a new world and family, at a moment when something holy is happening.

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Metaphors in medicine, and a night hike in the desert by blogger of the month Jessie Seiler

We know that the heart is one of the simplest medical metaphors we encounter. It rushes in excitement, it skips beats in anticipation, and it nestles beneath our right hand as we make pledges and promises. So the metaphor’s pretty good, really. But your heart pumps blood, not feelings. It’s lumpy, but not in the way you used to draw it as a child. It stops and starts, but those events aren’t romantic in real life.

I haven’t always been a fan of metaphors. They feel like a way of smoothing over the details that don’t match your personal view of whatever you’re describing. They’re tiny lies, lazy shorthand, and so easily nothing more than clichés.

And isn’t it weird that so many metaphors are attached to our bodies? After all, we’ve all got a body. Why aren’t they easier to describe to each other?

But metaphors are useful, and I wasn’t surprised when we encountered some other medical metaphors during our first full week of classes. Our first immunology class was full of them, and they were pretty helpful. Everything has a character. The helper T cells are sneaky and manipulative, not killing infected cells themselves, but rather directing the actions of others. B and T cells have long memories, remembering old wounds and infections and fighting them off more robustly each time they sense them crossing our borders. And in autoimmune disorders, the whole finely tuned immune mechanism turns upon the body it is otherwise perfectly suited to love and protect.

My discomfort with metaphors aside, I like describing the world, thinking about it, and sharing it with other people. Which means that metaphors are a part of my life.

Speaking of which, we went on a night hike on the Thursday evening following our first full week of classes. About 45 minutes south of Beer Sheva is the small desert town of Sde Boker, famous for being the retirement spot of choice for David Ben-Gurion. Even to an outsider who knows little about Israel, the community is obviously built around a powerful idea: the metaphor of life in the desert. 

Ben-Gurion saw the appeal of the metaphor himself:

“The desert provides us with the best opportunity to begin again. This is a vital element of our renaissance in Israel. For it is in mastering nature that man learns to control himself. It is in this sense, more practical than mystic, that I define our Redemption on this land.”

More practical than mystic in its conception, maybe. But you get a healthy dose of the mystic, too, standing at the edge of the canyon’s cliffs as the moon rises, listening to the wind shearing through the river valley below.

We waited until full darkness to take advantage of the almost-full moon, bringing our headlamps with us to shine light on only the most precarious stretches of the path. We stopped once to visit a water reservoir that our guide claimed was over 2,400 years old, and again to gaze at an unremarkable bush. Young men would pluck a supple branch of this bush, tie it in a knotted circle, and leave it for their beloved to find. If she enjoyed his attentions, she would return it to him with the bow untied; if not, she’d leave it where she found it.  Metaphors, again.

The rock walls of the canyon were warm after the long, hot day, but the air was chill and refreshing. Our guide told us about the flash floods here, though you can tell just by looking around that the water comes through hard and fast. Nothing here is in a straight line: curves and dips and valleys are everywhere. We walked on and on, speaking sometimes and sometimes in silence, on a path lit by the moon and our trust in our guide.

After a couple of hours, we stopped once more to scramble up a rocky hill off the path for a higher view. I decided to stay on the main path, since my feet were being gross and sweaty, which made my Tevas a little slippery on steep inclines like this one. My classmates ditched their bags next to me, and I stretched out on the sand to sip water and wait.

As they climbed away, I thought about the body and its metaphors.

How happy I am, to have legs that swing out and land steadily, bringing me to new places by strange routes: skin that shields me and warms up pink in the sun, a barrier with a perfect combination of protection and permissiveness: arms that embrace and lift and reach, always up and out: a brain with a will to learn and to seek adventure, to descend these moonlit canyon walls and scale them again.

How happy I am, to have a heart that beats calmly as I hear my classmates shuffle up the rocks, that relaxes and slows into the fresh silence as my back might relax into a good stretch, and that springs high with happiness to hear my friends returning just a few minutes later. It pumps blood, and it pumps feelings. The metaphor is true.

How happy I am, to have metaphors for the feeling of having a body, the experience of health, and the path of medical education. 

Emergency medicine: killin' it without killin' anybody by first year blogger Jessie Seiler

Many of the members of the class of 2019 seem to have arrived in Beer Sheva with a wide range of skills to recommend them as friends, classmates, and future doctors. A few of us speak a bazillion languages each; pretty much everybody has traveled widely; we are all pretty great at getting out of our comfort zones. While my own total lack of Hebrew coming into this experience made me a little nervous at first, my envy really focused itself on the students who came in as EMTs or with other first-responder training. Without so much as a summer lifeguarding under my belt, I was concerned to see that we were scheduled to start emergency medicine courses immediately upon arrival in Beer Sheva. Most alarmingly, we’d be sticking our new classmates with peripheral IV catheters by the end of our third week in country. You’re going to want to poke around on the Internet for a second to see what one of these looks like. And now my alarm makes sense, right?

Anyway, orientation passed and Real Day 1 rolled around, with intensive Hebrew for several hours in the morning and emergency medicine right after lunch. After a lecture on the basics of CPR with our whole class, we broke off into four groups, each under the guidance of an advanced Israeli medical student.

“My job is to make you legit,” our TA announced. After reviewing the lecture with us, he moved on to demonstrating the basics of CPR on a mannequin, explaining each move and stopping to answer what I’m sure were hilariously inept questions, at least at first. With an hour to go in the class, he let us break into groups and begin practicing ourselves. It was pretty fun!

The drills became increasingly complex as the days passed. Some choice moments:

“I brought a friend with me. I don't want him to feel left out. So I invite him to perform CPR with me!" (Get ready to make your friend do all the chest compressions for you, because it gets pretty tiring after a while.)

“CLEAR!” (Just as exciting as in the movies!)

“Hnnnnnnrrrrrgggghhhhhh.” (This is the sound you make as a fake trauma victim to demonstrate how very much you’ve just been hit by a car.)

And then, one fateful day, just when we were allowing a little swagger to enter our step: “You are all going to place IV catheters today, and it will be fine.”

 After watching some recommended videos on the procedure the night before our big day, I experienced some quiet and thoughtful moments in which I listed all the possible ways I could potentially end my classmate’s life the following afternoon. As far as I could tell, they really all seemed like one-in-a-million chances. Some were elaborate, and even a little ridiculous, but I couldn’t stop them from swirling up: what if there’s an earthquake the second I’m getting in there and her arm gets really bloody and infected? What if I puncture and then sever the vein entirely? What if I’m concentrating so hard on not messing up (and she’s got her head turned away to avoid looking at the bloody mess I’m making) that I don’t notice the approaching tiger? I calmed myself with the thought that there aren’t tigers in medical schools pretty much ever, and that our TA (whom we had all come to trust entirely) would be hovering mere inches away.

And you know what? It went really well, for pretty much all of us. No deaths, no total failures, no tigers. I got the catheter into my classmate’s vein, she was able to successfully stick our TA (who generously offered his own veins in place of mine, which are slippery and lack team spirit), and then we all went out for a celebratory beer.

Being at MSIH means working through stuff together, and it’s not just biochem problem sets, the maze of hospital and university buildings, or the serious issue of buying sour cream when you wanted yogurt because your Hebrew is pretty bad just now. It’s also the feelings of trepidation and uncertainty that come with starting a new thing in a new place. There are obstacles, and they require a willingness to step outside of your comfort zone, a clear sense of purpose, and the right people by your side.   

And I have to say it: so far, so good. I chose MSIH because I wanted the experience of going to medical school with the type of people who would choose MSIH. And now that we’ve passed through the experience of placing IV catheters into each other, I think that was the right way to go.