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. 

Shana Tova! by Aviva Friedman, blogger of the month

A common Jewish phrase, usually at the end of the Passover seder, clearly elaborates where we hope to be next year: "Next year in Jerusalem!" Since the Jewish new year is upon us tomorrow, and since our class trip to Jerusalem was last week, I guess you could say it was already last year that we were roaming her streets. The novelty of traveling - and bragging about traveling - to Jerusalem for a day trip has yet to wear off. Our 1.5 hour bus ride through the Negev’s dusty desert scenery was filled with off-key singing and plenty of opportunities to catch some Z’s as the scenery slowly greened and our bus mounted the hills of the golden city. Unfortunately, due to ongoing security concerns, we were unable to visit the old city and her sites. Instead, we were treated to an alternative city tour, starting with some fascinating global health presentations by Hebrew U’s graduating MPH class at Hadassah Hospital, followed by a visit to the Knesset (Israel’s parliament), the windmill, a stop at a must-see Jerusalem lookout, and of course, Mahane Yehuda (aka the central shuk). When my Hebrew teacher asked me the next day what my favourite part of the trip had been, I turned into a giant cheeseball and said that it was spending time with new friends (I bet it would have been the rugalach if I could eat it, though).

As the new year rolls in, we take part in an ancient Jewish tradition: we eat. Besides the traditional dinners that many of us will attend over the next two evenings either with our own or our adoptive families, we will dunk apples in honey to symbolize our wishes for a sweet year ahead with even sweeter friends for the journey (there I go again!). So, though I told my Hebrew teacher today that what I want in the new year is good grades, what I meant to say is that I hope for a wonderful new start filled with only laughter and joy and success for everyone around me. Good grades wouldn’t hurt either. 

As we say in Hebrew: Shana tova u metukah! (Have a happy - and sweet - new year!).

A little bit of second year before our break! by Baila Litwak

            

Hof Yanai

            At MSIH first year is split into two semester filled with basic sciences like molecular and cellular biology, biochemistry, and microbiology. In second year we start anatomy and instead of semesters we are taught in blocks, one class at a time. For about a month we learn the ins and outs of a single organ system from the normal anatomy and physiology to pathology and pharmacology. After the success of passing 10+ classes over the course of two semesters, we get a taste of second year - we learn two organ systems before leaving for summer break.

            All year I have been looking forward to organ systems where we can focus on one topic rather than trying to balance 6 different ones. The boring science classes are behind us, we have learned an unbelievable amount, and are now equipped with the knowledge needed to delve into the medicine of the human body.

            Second year seems much harder than first because there is a great deal to learn in each organ system and we move quickly to cover it all. Every few weeks a block ends and there is a final, which makes the year exhausting. The school eases us into the organ systems by giving us two of the easiest ones to knock off at the end of our first year, endocrinology and hematology. The transition between second semester and endocrinology was great. After about a month of finals to close our second semester we finally had a break for a couple of days.

            Since endocrinology started I have been busy studying and having fun. Two days into endocrinology we had the day off for Yom Ha’student, student day. There were pool parties with DJs and performances downtown with some of the biggest names in Israeli music. The next day we finished our first week of endocrinology and I, along with 9 other classmates, headed to one of the nicest beaches in Israel to camp out for the night.

Beer Sheva Light Run

Sunday was Lag baomer and there were bonfires lighting up the entire city and Macabbi TLV won the Euroleague finals so there were parties in the street all night. On Wednesday I volunteered in Teddy bear hospital, an event held for 200 local kindergardeners and their teddy bears who underwent X-rays, surgeries and eye tests among other things so that the kids could learn about the hospital and not fear it in case they every need to come in. Thursday was the second annual Beer Sheva light run which started once the sun had set and the music, excitement and glow paint filled the air.

            Beer sheva is a college town that always has fun things going on. I am looking forward to the interesting organ systems to come and all the other experiences coming our way.

- by Baila Litwak

Goats, Garden and Graves, by Sakal Kiv

The desert surprises me, particularly the Negev. You find so many things that you would not expect to see here. Who would have known that people drive out to the middle of the desert for fresh farm-raised tilapia or goat’s cheese? When we stayed for a week in a desert farming community, we saw red-ripe tomatoes (yum!), crispy bell peppers (mmmm!), and beautiful flowers being grown out there. The Cambodian agricultural students there told me, “It is amazing the skill they have to make things grow out of the desert, in our country, we just defecate on the ground and something grows, yet we haven’t really learned to fully take advantage of even that.”

A few days ago, we had another unexpectedly pleasant time in the desert. On the way to Sede Boker (which, until this trip, I had incorrectly heard and thought of as “Stable Care”), our friends took us to a kibbutz where they raised goats for cheese and milk. The kibbutz even gave out samples for us to enjoy! My kids especially liked watching the goats being milked. I had expected that they would be milked by hand, but instead, they were all hooked up to a milking machine like the ones used for dairy cows—a real-life Mister Rogers Neighborhood experience.

At Sede Boker, we walked around the garden where David Ben-Gurion is buried next to his wife, Paula. Our kids had a wonderful time walking and playing with each other there. It was a beautiful place to be, quite shaded and cool and full of lush, green things growing out of rock. On our class hike when we first arrived, I remembered looking up from the valley of Wadi Chaverim at night and seeing the lighted garden and wanting to visit, so it was good to have the chance. It is a very fitting resting place for Ben-Gurion, a visionary leader who looked beyond the desolation and saw its potential, something that is becoming more and more a reality today.

After our walk, our kids played at the playground (I love it how there’s one of these everywhere!). Then we finished the evening with a dinner and conversation between friends. Sometimes it astounds me, especially when I take time to think about it, of all the momentous events that have taken place here. This desert is where Abraham raised sheep and received divine promises, where Elijah sought refuge in a cave and heard the Whisper, where some of the last great cavalry battles took place in the Sinai-Palestine campaign against the Turks, where David Ben-Gurion kept a home and lived and worked, and where some of the best medical students the world has ever seen are being trained. When I think of all these things, I feel blessed to be here in the Negev desert with family and friends. - Sakal Kiv, blogger of the month