"Back in Beer Sheva," by MSIH first year blogger Tamara Kliot

Coming back from break is always a transition. It takes time to get back into the study grove, let alone get yourself back on the right sleep schedule. Jet lag is rough and a constant battle between when you should and could go to sleep. Balancing that battle alone with the introduction of new classes can be a challenge, but that’s part of the package when you decide to go to medical school in a time zone 10 hours ahead of home or decide to create a home 10 hours ahead of where you grew up. However you see it, time zones are hard to traverse. I guess that’s something most of us interested in global health will grapple with for the rest of our careers.

Luckily, we had some engaging lectures to start off the semester. We had your typical physiology, pharmacology, and genetics classes. However, we also had the opportunity to participate in a Mind and Body 3-day elective facilitated by Dr. Haramati. This elective was focused on self-care practices, such as meditation, and could not have come at a better time.

Medicine is an intense profession that requires a lot of time and effort invested in learning and even more on other people’s problems. It’s stressful and overwhelming at times. Doctors are known to be the worse patients and it’s a widely held belief that they don’t always take care of themselves properly. This elective was a good reminder of this and introduced or re-introduced students to practices that they can integrate into their schedules.  Mind and Body also allowed students to connect with each other in a different space (more literally than physically because we were in our normal classroom). It forced many students out of their comfort zone, but the result was empowerment.

With week one done, jet lag almost beat, and the opportunity to hear about the fun things my classmates did over their 10-day break, I can honestly say I am excited to be back in the B7 and ready for what this semester has to offer. New classes, modules (I’m especially excited for nutrition and disaster relief), global health speakers, experiences, and adventures to come. There is also a lot of familiar things that will make this semester easier than last. We’ve come a long way class of 2019 and I am excited to see where we go and the opportunities we find to push our own development as future doctors in the next couple months.

"Surviving Exams" by MSIH first year blogger Tamara Kliot

We finished our first semester exams and are currently on break. As I flew back home, I couldn’t help but think, that means I’m 1/8 an MD! For many of us, this day felt so far away. Exam grades are trickling in and second semester of medical school is becoming an approaching reality.  I have been able to reflect on this past semester with some distance between those intense weeks of eat, sleep, study, exam, repeat. Here are a few tips to survive first semester exams (to future 1^styears)!

1.      Draft a Supportive Team

The amount of information you are expected to know come finals is well, to say the least, a lot and a bit overwhelming. It is close to impossible to catch all the important details mentioned in class and studying this vast amount of information is much more fun when you are around other people. Find a few people in class that you can study with, be it talking about material you don’t understand, reviewing the stuff you know, teaching each other concepts, or just sitting next to each other while you each work in complete silence. Exams can be overwhelming and isolating, but it doesn’t have to be if you find the people you work best with and develop a plan. Check out this fun picture a friend drew while I was studying immunology! I will never forget the unique mechanism Tuberculosis uses to evade the immune system.

2.      Visit the Shuk Often

It’s really easy to fall into unhealthy eating habits during finals. I don’t know why, but I’m always craving large amounts of sugar and salt when exam time rolls in.  Cooking becomes more of a hassle and vending machines seem like a good alternative. Going to the Shuk is an awesome way to fill your refrigerator with brain food. With tons of fruits, veggies, and meats there is bound to be something you will want to eat. Going to the Shuk is also a great way to stay connected with reality, since its always bustling and full of life on Friday mornings. There’s no better snack then fresh strawberries from the Shuk to jumpstart your studying, I’m mean just look at them.

3.      Take Breaks, Unplug, and Recharge

You can’t study all the time. You’ll burn yourself out at some point. Take some time to “do you”. Be it hosting a meal with friends, having dinner at your favorite pizza place, playing bananagrams (my personal favorite), going to the gym, running  through the Narnia of Beer Sheva, or taking a trip to Jerusalem to learn more about infectious disease control. Figure out what you need to do to recharge before exam day and make time for it. Check out everyone’s’ smiles on a mandatory study break our class had in Jerusalem.

4.      Find a Good Study Spot 

When classes end and self-structured studying becomes your 9-5 (or much later) job, its important to find a place where you can focus and work, a place that fits your study habits. For some, studying at home is great, but for others leaving the distractions of their apartment is important. If you like to draw things out, find a classroom. If you like to talk it out, find a public space or coffee shop. If you like complete silence, check out the libraries on campus. You might have to get a little creative during Shabbat (as the library and many other places close), but finding a place you can study consistently is crucial for exam success.

5.      Practice, Practice, Practice

No matter how well you think you know the material, practice is key. We have a lot of NBME (National Board of Medical Education) style final exams and there are loads of practice questions you can do that are written like the ones you’ll see on the final and again on the Step 1.  The only way to stay calm and destroy finals is by knowing your enemy (the exam) really well. Don’t be scared and throw yourself into questions as early as possible. You’ll be thankful you did later.

"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?

"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.

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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.

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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.

Maybe Medical Students Shouldn't Always Look Before They Leap by Jessie Seiler

My roommate, also a first year MSIH student, just knocked on my door to ask if I had noticed whether the gate to campus we typically pass through was open when I passed by it this afternoon. I hadn’t wandered close enough to be sure, I told her, but it looked shut down from the street. On most days, we pass through an air-conditioned security office on our way to class, showing our student IDs and opening our backpacks for a cursory search. But since it’s Shabbat, and because we’re somewhere between Yom Kippur and Sukkot, we weren’t sure if that particular security check point would be open.

It’s a pretty trivial detail, right? But it’s the type of question that gets tossed around a lot. As first years, we’re still getting the basics sorted out here, and even though things are mostly manageable, we’re getting a sense of what it’ll be like to be in over our heads. Not in a bad way, necessarily. But we’re taking on a daunting task, and there will be times of uncertainty and struggle. We’ve all managed to find decent housing, but one of my friends is struggling to get an internet connection installed. Another has a defective student ID card, one that won’t magically open doors or unlock gates. My two roommates and I tried a few days ago to replace the ancient, exhausted laundry machine in our apartment, which resulted in a minor holiday-eve plumbing emergency. And another classmate was asking me today if I had a solid sense of how much we need to know about the cytoskeleton.

I had no advice to offer on the cytoskeleton, and I was pretty useless during the plumbing emergency, spending the 30 minutes or so when the water wouldn’t stop coming out of the wall taking photos (one of which I’ve included) and laughing merrily about it (my reaction to too many perilous situations, maybe). But lots of people here have good advice to offer about all sorts of situations. I can easily imagine that question about the cytoskeleton being answered in a half a dozen ways, with some of the experienced MSIH upperclassmen suggesting four extra-curricular textbooks that are guaranteed to have, between them, all we need to know. Another student might suggest a series of videos on the internet, and another will probably shrug and tell us to just attend the lectures and take decent notes. Yet another will tell us that we should be spending the first few weeks of school forming close friendships with our classmates and traveling around Israel, since we won’t have the time for that during our second year. And another student will dismiss that as ridiculous, pointing us instead in the direction of studying daily, even now, for the USMLE exam we won’t be taking for close to two years. In any case, it’s always good to ask questions. But we’re finding that we have more options than we can possible evaluate, along with the fresh requirement of sorting through all of them with a grain of salt at the ready.

So how do first-year medical students make decisions? And now that I’m worried about that, how does anybody?

Science done well seems like it’s mostly right, most of the time, for most people. When your doctor prescribes you a drug, her assumption is that you will react to it in the way that pretty much everybody does. But we all live within an unknown distance of a fault line that runs right through the best of our reasoning and experimentation. People with allergies to life-saving drugs are well within the seismic zone, but the rest of us know it’s there, too. My classmate with the inactive ID card, for example, is having one of those crazy experiences, something slightly outside the realm of the average: after all, the other 36 of us aren’t having the same problem. But she could also fall somewhere else on this crazy experiential spectrum. Maybe tomorrow, she’ll marvel at how lucky she is to find 200 shekels on an abandoned stretch of sidewalk.

Most of us fall somewhere within that average range of experience, most of the time. Most of us will win some and lose some. Which is fine, but we all also have to make predictions about how the future will go: will I make the bus if I run, or should I wait for the next one to avoid the possibility of getting stuck in the rain? If I try this new thing, will I like it, or will I wish that I had stayed with my old favorite? Should I take a risk or play it safe? So it’s not just first-year medical students who might be having a hard time making decisions. We all crave the knowledge of what others are doing, and we all want to learn from their experiences, good and bad alike.

So we solicit advice. These Be’er Sheva supermarkets have better produce and more reliable hours; this coffee shop sometimes gives discounts to students; go out with your classmates every time you’re invited to something – no, wait, stay in and study, because you really do need to know a ton about the cytoskeleton. And with this advice, we make decisions, hoping that we fall into the range of mostly all right experiences that most people have, most of the time.

Or maybe it’s not always like that. Maybe decisions can go one of two ways. You can test drive twelve cars, then go back and pick the seventh one you tried: compared to the others, it was the best option, and you’ve heard a lot of good stuff about this make and model. Or you can fall in love with a car you see on the street one day and put your money down, then and there, trusting in the car and yourself and your capacity for hard work to make this decision pay off. Maybe that’s how you have to do it, if what you’re looking for is something truly spectacular, something entirely outside of the ordinary. Something like a career in international health.

If you don’t know how far you are from that fault line where our experience stops being any decent guide, then you might as well take the leap. And if all first-year medical students, and all people, really, are going to find ourselves in over our heads at some point, at least we can choose how we get there, and who we have beside us.

Anyway, it’s Sukkot break! My classmates are scattered around the country, and indeed the world. I’ve included a picture of the strangely empty Caroline house lawn, one of my favorite campus spots, which I am sharing today with just one cat. It’s a little quiet, but it’s a nice change of pace, too. This is my last blog of the month, so you’ll get somebody else’s perspective on the first year experience at MSIH next week. Thanks for reading! Shalom, y’all!

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.

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. 

Saying "Good-bye" to Israel and the 1st Year of medical school...until August by blogger of the month Maia Reiley

I had thought that the days after our exam would be a leisurely time to go to the pool, read, eat lots of falafel and hummus, tie up loose ends, and pack a few things to take back to the US. Instead, it has been a hectic couple of days trying to get the apartment squared away so that we can move out in August, running around to the clinic and pharmacy, squeezing in last minute visits to the people with whom I've grown close over the last ten months and generally feeling guilty about any time not spent preparing for something else. Hectic is not to say bad, though. I finally have my very confusing vaccination history figured out, I took a practice mefloquin pill to make sure that malaria prophylaxis won't make me hallucinate, I can (guiltily) leave the rest of the apartment logistics to my roommates, and I took a lovely walk to the outskirts of Beer Sheva with the mother and daughters of a family I've gotten to know. The northern part of Beer Sheva is on an incline, so if you walk up past the neighborhood of Ramot Bet, you can look out across the desert landscape and appreciate the uniqueness of the city. There is also a hill to hike up, but the children had school the next day, and it would have taken too long. Sorry for the lack of picture; you'll have to come see it for yourself before the mayor's aggressive urbanization overtakes the view.

I'm waiting for my flight to New York to leave now. Today is my first time departing from Ben Gurion airport, and what an experience it is. Waiting in line to check in, I noticed some fun cross-cultural interactions, like a returning New Yorker yelling at an old lady for trying to crowd him in line. I'm not sure how long he's been in the country. Maybe he never got off the tour bus if he hasn't figured out that, in Israel, there is nothing abnormal about people fighting to get ahead in line.

A word to the wise: if you are leaving on a busy Thursday and you have visa stamps from any of the countries surrounding Israel, you may want to show up even more than three hours ahead of time. I suspected there would be delays as soon as the young man checking my passport and boarding pass said “so, tell me about Egypt.” Rather than joining a general line for security, the airport attendants check the sticker on your passport and direct you to a specialized security line. Although there were only about fifteen people ahead of me (“how efficient, this will go quickly,” I thought), due to the extremely scrupulous inspection of every carry-on item, this turned out to take the better part of two hours. Luckily, there was no reason to detain me, so I made it through passport control and got to my gate a full ten minutes before the scheduled boarding time. Sadly, though, this means that I don't have the chance to hang out by the fountain in the center of the airport and send lots of “thank you” emails and irritating “guess what completely mundane thing just happened, which I find suddenly fascinating because I'm stuck in the airport” texts to people.

Oh well, with that, I must say good-bye to Israel and my first year of medical school. I'll be back in August for more adventures. 

Taking time to enjoy the sights, and the cats, amidst the crunch of finals, by Blogger of the month Maia Reiley

That dazed feeling of being nearly done with 11 months of what you always wanted to do…

We have one more week of class before our final final, and I know that the collective sigh of relief our whole class breathes will be tempered, at least from my corner, by a tinge of sadness. I will be grateful not only that it will be over, but also that it will have happened.

Back to the present moment, though. It is springtime in Beer Sheva (well, high summer by any normal person's thermometer), and there are a thousand kittens to mark the season. Leaving the hospital, going to the SuperSal or the vegetable stand, I will infallibly be surprised by some tiny cats making tentative steps from under a ramp or behind a railing. This type of unsolicited cuteness exponentially increases the amount of time I spend running errands.

Here is an example:

In other news, we took a trip North and saw some very pretty sights, including the Baha'i gardens in Haifa and the ruins of Caesarea. Although I love living in Beer Sheva and the unique perspectives it offers, seeing a beautiful city on a hill overlooking the ocean reminds me that I eventually want to move back near the water.

As an illustration of why, here's a throwback picture from Passover. We took a few buses down to Dahab on the Sinai coast to learn to scuba dive. The Sinai is basically a barren wasteland, in which I wouldn't want to wander for 40 minutes, let alone 40 years, but the Red Sea is a miraculous paradise full of beautiful life forms. As this year wraps up, I am already looking forward to returning to the Sinai and planning new adventures in this amazing part of the world.

But for now, back to the coagulation cascade.

Teratoma's, Trips, and Theme Parties, by blogger of the month Shauna Dunton

I held a teratoma in my hands and there was hair and teeth inside of it. Did I get your attention?

For some of us non-science majors like myself, Pathology lab was the first time we were able to touch and inspect human organs, and because it was a pathology lab, we were able to see different manifestations of cancers, hemorrhages, and ischemia. I think our class was most impressed and intrigued by the organs with teratoma’s that were passed around. I find it so important to be able to shorten the time gap between learning material from a book or a lecture, and being able to see first hand manifestations of what you are learning, and this class really did an excellent job of that.

 Our class recently embarked on an organized trip to Sde Boker where we visited a satellite school of Ben Gurion University, called the Jacob Blaustein Institute for Desert Research, along with Ben Gurion’s hut and his final resting place overlooking Zin Valley. I think we all felt it was important, as recent residents of southern Israel, to understand the vision Ben Gurion had for populating the South and also to know something about the research that is going on in this area. Yet, if these things don’t intrigue you, the views of Zin valley alone were certainly worth the short bus ride to Sde Boker. As a resident of Beer Sheva, I often don’t feel like I am living in the Negev desert, except when there is a sandstorm of course, and it’s always humbling to see the nature that defines the area in which you live.

March is a very exciting month at MSIH, and although I promised more “from the classroom” material I must also gush about the things going on outside the classroom. First of all, Purim was last week and our class celebrated it in full style at the main campus’s purim festival while stuffing our faces with Hamentaschen, which are (traditional for Purim) triangular shaped cookies filled with dates, figs, apricots, chocolate and sometimes even Halva. The costumes were quite extraordinary and MSIH was aptly represented as well.

Every year, MSIH has a formal called MSIH prom, complete with a full dinner, photo booth and open bar and this year it was spectacular. All four years of MSIH were together at last (the fourth years have just recently come back from being abroad for their global heath rotations) and we were able to mingle and dance the night away in what was an unforgettable night.

Thanks for reading!   Blogger of the month, Shauna Dunton

Fiddler on the Roof, by blogger of the month Sam Nesemann

The other week we went to see a production of Fiddler on the Roof that two of our classmates were in.  It was a fun time and a good showcase of the amount of time you have to do things beyond medicine.  Medical school isn’t a walk in the park, but it isn’t a death sentence either.  You have time, if you use it wisely, to explore hobbies and passions other than medicine.  I’d argue that it helps keep you balanced and allows you to learn more easily.

In global health we are presenting the research that we did last semester.  The presentations were good to solidify the knowledge we had gained and a great opportunity to practice advocating (which, as future global health physicians, we will probably be doing quite a lot). Our instructor can be tough, but she has an incredible wealth of experience, knowledge, and skill for us to learn from.  Overall, second semester is moving faster and there is more to learn, but it’s still a really great experience.  Plus, you are in Israel, which, to me, is an incredible bonus.  - blogger of the month, Sam Nesemann

"Every day is Valentine's Day at MSIH", by blogger of the month Shauna Dunton

Valentine's Day

The middle of February marks our 6th month of attending the Medical School for International Health, of living in Be’er Sheva, Israel, of knowing and growing very close with our classmates, and of being far away from our loved ones at home.

Our time here is truly flying by.  We have learned so much and we have gotten so close to one another in such a short time.  In fact we have become so close as a class that we find any excuse to spend more time with each other which is quite incredible considering we spend eight hours a day with each other at school already, not to mention that most of us live together. For example, we recently celebrated Valentines day together as a class by having a “breakfast for dinner” Valentines Day Feast complete with card signing for each and every student in our class. There were heart shaped pancakes, french toast dyed pink, and loads of loving glances at one another as you might expect at such an event.

In other news, this past Thursday, two of our classmates played in Light Opera Group of the Negev’s production of Fiddler on the Roof. It was an amazing production and about half of our class came out to support them in this great endeavor. The acting and the dancing were spot on and I know we’ve all got those catchy tunes still stuck in our heads a week later.

Fiddler on the Roof

Last but not least, on Monday night a group of woman from all years of MSIH put on a spectacular production of the Vagina Monologues. I had watched a production of the monologues performed at Colgate University where I went for undergrad, but as another student in our program pointed out, it was quite powerful to see this production done by an array of multi-talented women that are all going to become doctors.

Vagina Monologues

You might think at this point in my blog post that we may not realize that we are here to study medicine, but believe me, we do! I will elaborate on all the things we are doing in the classroom in my next blog post.

Until then, lehitra’ot!                                                 - Shauna Dunton, 1st year blogger of the month

Global Health Clinical Session and Umm Batin, by Sam Nesemann

Last week we had our weekly clinical class (pictures attached).  It’s about three hours or so of observing/interviewing patients every Wednesday morning.  This time it was during a sandstorm, which, if you come here, I’m sure you’ll get to experience for yourself.  We started off meeting a Bedouin man who told us about some of the Bedouin’s cultural history.  Then we headed to the local school to talk with the principle about education in the community and the superintendent happened to be there and joined us as well.  Later we were able to sit with a woman who used to work at a local clinic before her funding was cut.  She explained the difficulties imposed on her in regard to providing care now.  We asked things like, “can you go to the people’s houses or have them come to yours to at least educate them?”- something that would seem perfectly acceptable back home.  Unfortunately, in her community, this would be considered very inappropriate and isn’t an option for her.  These clinical sessions are all so different and all really valuable.

On a second note, there are also some pictures from our trip with the kids from Umm Batin.  Umm Batin is a small town about 20 minutes from Beer Sheva.  A few of us go there each week to teach english to the Bedouin children who are fantastic.  They are funny, smart, and we have a lot of fun teaching and playing soccer.  We took a trip up to Superland (a small theme park) this past week that they were all really excited for.  

Unfortunately because of rain the previous day, the park was closed once we got there.  Instead of being disappointed, they were totally unaffected. It was really impressive to me, thinking to myself that the teenage me would have probably complained quite a bit about the situation.  We’ll be heading there again one of these weekends though and I’m sure it’ll be a good time.  - Sam Nesemann, blogger of the month