Research and Medical School, by blogger of the month Aaron Dobie

Loading cDNA into liquid nitrogen trays for long term storage.

A cool and unexpected part of my first year in medical school has been participation in new types of medical research. Since arriving in July I’ve been able to participate in two different research projects – one qualitative and one quantitative. The first was an ethnographic case report on in-home quadriplegic care in the Golan, a region roughly three hours north of Beer Sheva.

            Early on in the fall semester, Dr. Seema Biswas (referenced in Jonah Kreniske’s 24 September 2013 blog post) arranged for eight students in our first-year class to visit one of her colleagues in a community health clinic in the Golan. The doctor in the Golan had a number of patients whose stories and conditions cast interesting lights on different topics in Global Health. Fellow classmate Baila Litwak and I interviewed a quadriplegic man whose parents quit their jobs six years ago to be his full time caregivers. We performed the interviews in their home and we were able to see the man’s medical setup – respirator, feeding machine – and talk to his parents about their story. The community doctor had trained the family how to use all of the equipment and it was powerful to see the well-functioning links between a robust primary care system and the people it’s designed to serve.

The liquid nitrogen tank

            My other research experience was more quantitative. In college I never had the chance to do any hard bench science research but was always interested in learning some of the lab techniques that I learned about in various classes. One morning in the fall semester I got to talking with our biochemistry professor (emeritus) Dr. Nava Bhashan (who, as a side note, wrote MSIH’s problem-based-learning biochem curriculum with actual cases she’s encountered over the years as a clinical biochemist). I knew that Dr. Bhashan used to do research on the cardiovascular effects of HIV antiretroviral therapy and I asked her if she knew of any similar research projects going on at Soroka Hospital. Without hesitation she whipped out her phone, made a couple of calls, and arranged a meeting for me the following week. I ended up talking with Dr. Ran Taube who runs a lab looking at the molecular mechanisms of HIV transcription. With no HIV vaccine visible in the nearby future, his research elucidates and proposes ways in which latent HIV within the body can be re-activated so that the body’s immune system (along with concurrent antiretroviral therapy) can actually “see” and clear HIV infected cells. Dr. Taube was fine with me shadowing in the lab and during January I put in four 20 hour weeks after school in which time I learned many lab techniques: cell culture, lentiviral gene transfection, RNA extraction, cDNA reverse transcription, and PCR.

View of Soroka Hospital one night after leaving lab

In the end I decided that simultaneous research and medical school wasn’t going to work for me but it is definitely an option for so-inclined future students. There is a lot of interesting research happening around the BGU campus in Beer Sheva and I think both of my experiences illustrate the close knit community of students, professors and researches at Soroka Hospital and MSIH. 

-blogger of the month, Aaron Dobie

My unexpected oasis, by Britany Weissman, November blogger of the month

View from the sixth floor of Soroka Medical Center.

Four months after arriving in Beer Sheva, I have begun to appreciate a patch of greenery in the desert. This green oasis exists within the borders of the Soroka Medical Center campus.  Soroka is unlike any hospital I am familiar with back home in New York City. Other, more familiar hospitals are comprised of one or two vertical buildings with different wings and extensions added over the years.

In contrast, Soroka is a sprawling, beautiful campus, similar to a compact college.  There are various small buildings, each with a different purpose, providing different services. The courtyard connecting these buildings is covered with trees and green grass.  Real flourishing grass. Not the astroturf which “grows” in front of my new apartment building in the Dalet neighborhood.

Our days in medical school are long, occasionally ending as late as 5:00pm or 7:00pm.  It is refreshing to step out onto the beautiful green lawns of the hospital campus to absorb the sun’s rays, and appreciate the scenery.  The lawns of Soroka reveal a microcosm of the diversity that makes Beer Sheva and the Negev region of Israel so unique.  At any given moment, one can see patients and loved ones, doctors, nurses, students, Jews, Bedouins, and one or two Beer Sheva cats, all enjoying the fertile relief of this lush spot in the desert.  Patients on stretchers are being transported, hospital employees drive carts of freshly laundered sheets, and students bike from one building to another.

Sometimes, the floor to ceiling windows in our classroom are open, allowing warm breezes and streaming sunlight from this beautiful green patch in the desert to infiltrate our room.  There is a communal sigh of disappointment when the professor closes the window and curtains to make it easier to view PowerPoint slides.

The weather in Beer Sheva has been beautiful these past few weeks.  The temperature has fallen from the painfully hot days of July and August to comfortable temperatures in the mid 20s°C or high 70s°F for Americans.  I know that cold weather awaits me when I travel home this winter, and I will have to reacquaint myself with down coats, boots, and gloves.  Even in Beer Sheva there has been a change.  I felt raindrops falling on me in the desert for the first time.  For now, however, I will continue to enjoy the warm Beer Sheva sun from the green grass of the Soroka Medical Center.  - Britany Weissman, blogger of the month

What matters most, by Jonah Kreniske

A gentle breeze wafts in from the balcony, sliding through my open door and bringing a welcome chill. I step out and rest my hands on the iron banister. In the distance I can make out the hills of Ramot, barely lit by a low, rust colored moon.  My neighborhood, Gimmel, winds out below me. Undulating Hebrew and Arabic beats from nearby apartment complexes mix with the usual classic rock standards from Coca bar up the street.  If it were daytime, you would hear the Ethiopian children across the street playing in the yard of the New Immigrant Absorption Center. But it is almost one in the morning, and they are sleeping now. I should probably be sleeping too. Instead, I’m standing here, breathing in the city. From my balcony I can see Soroka Hospital. A shining invitation to the unwell of the desert night, it is a slice of sleek modernity in the dusty streets.

The past month, in that hospital, has been a whirlwind introduction to our new lives as physicians in training. We have met our classmates and together we have absorbed myriad lectures, and trudged through hours of intensive Ulpan. Now, in this rare moment of relative calm, I look across at the maternity clinic, and I wonder if someone is being born behind those walls. It’s comforting to remember that life begins here. On Monday, walking past the ER to my first class, a weeping woman swept past me. Glancing towards the ER doors she had burst out of, I saw another woman writhing on the floor. An ambulance had just arrived. Never have I heard so much pain in the voice of another human being as I heard in the cries of that woman outside the ER, on my way to 8am class.  At Soroka we see what we might push to the back of our minds in another context. We see illness and death, birth and health, side-by side, tipping weights on a human scale.  

“Good medicine is not about killing microbes, it is about keeping human bodies in balance,” one professor reminded us. On the hospital campus, in the tireless work of the physicians and nurses who pace its halls, and in the aspiring faces of my classmates, I see the will to maintain that balance. In the struggle to provide care, I see the physical manifestation of the compassionate instinct that I would like to believe is somewhere in all of us. As I step back into my room for the night, I know another long day of classes awaits us in the mounting heat of the morning, but I also know that this day will be another small drop on the side of the scale that matters most. - Jonah Kreniske, September blogger of the month

The Puzzled Self, by Elon Richman

I saw a movie recently called The Night Train To Lisbon. In it there was a powerful line:

"When we visit a place or we're with someone, we leave a piece of ourselves that can always be returned to and rediscovered."

Keeping that in mind.

Jonah and I walk home from an enticing and satisfying dinner at Big Kahuna Burger and look up at the Soroka skyline beside us.



“And there’s Soroka looking as beautiful as ever,” he says.

I laugh and turn to him “Beautiful? I mean the lights make it look impressive but I don’t think beautiful is the right descriptor.”

He replies, “I think it’s beautiful that human beings would invest that [gestures toward the hospital] much energy, time and resources into the health and well being of each other.”

I hope I never forget that.

I hope I never forget that there is an everlasting balance between the soul and brain of medicine. That at times we view the body as a machine and at times as a person. At times it is a vessel of knowledge, and at times it is a knowledgeable vessel.

But it is always both.

And I hope I remember that I’m leaving pieces of myself wherever I go. They’re reminders of who I once was as well as gifts for those who will carry me with them.

We’ve spoken recently of class trust and bonding, the idea that within all of us lies the capability to receive a piece of another and hold it forever. It’s up to the individual to decide how much responsibility to accept. We’ve even acted on that trust with poking and maneuvering of sharp needles in the dermis of our neighbors.

           

         

                                     

Yet receiving another is just a step closer to self-realization. What is the process by which we accept others? How do we reflect another’s piece back to them? How do we see ourselves in another?

Through self-reflection and self-observation we can begin the undertaking of amending the mental framework by which we give and receive. Not that any person is faulted in their judgment, but acceptance is a lifelong journey that those of us studying global health have the privilege to explore more deeply. It’s the vast diversity of human existence that makes us hungry.

And acceptance IS important; it’s impossible to know one’s self without knowing and exploring others. The doctor is a teacher, and by this very notion should understand more than any not just the fundamental machinery of the body, but the additional enigma that is the human experience.

Time is infinite, but it allows for specificity, and now is as good a time as any for us to begin realizing what it means to give, accept and trust.

I continue walking home after marinating on Jonah’s insight and stand before the expansive skies of Abraham’s Negev. It’s dark, and a feeling of semi-fiction makes me question the brilliant stars, “What will I remember? What will I forget? How can I be the man, the doctor, that needs to assist in repairing the world?”

Funny, they say there’s no sea in Be’er Sheva, yet the winds echo the crashing of ocean waves. And with them comes an answer:

Try your best.

-Elon Richman, August blogger of the month

Small Victories, or How I Learned to Stop Trivializing and Love the Travail, by Seth Morrison

This past week was a week of small victories. These undersized accomplishments demand no recording in the great history books of noble deeds, and I myself will probably forget about them entirely within a single trip around the sun. In other words, it was an average week. But, I have been learning over the past several years and up to now not to trivialize these small victories. One must grow to love the ongoing travail of life that together they comprise.

If you care to know what these victories were, read on from here. If not, skip to the paragraph beginning with, “As you can see…”

During the week I…

Was pleased that I owned a wool coat for a stretch of some wet, chilly weather in Beer Sheva,

Answered a question about the wet, chilly weather in Hebrew to a neighbor who asked me as he was leaving his apartment,

Saw a different neighbor, Meir, in the Soroka Hospital cafeteria during lunch and understood (mostly) what he was telling me in Hebrew about visiting his elderly mother in the hospital,

Found out that I escaped the first semester of medical school without failing any exams,

Cooked a three-course dinner for a group of six, the most people I have ever prepared a dinner for by my own efforts,

Improved my tiny apartment room by installing several hooks in various places to increase its storage capacity, and bought a desk lamp to prevent premature eye damage from late nights studying with insufficient light,

Finally got working cell phone service again after the first company I used cancelled my account with them, for no apparent reason, back in December, and called family members in America for no extra charge,

Received a compliment on work done on a scientific literature review project that I thought would surely be disappointing, at best, to the professor,

Learned a bit about childhood development at clinical observations in a pediatric specialist’s office,

And, I finally came to understand the overall treatment regimen for patients infected with tuberculosis—a subject that had perplexed me—thanks to a stirring lecture by Dr. Alkan.

As you can see, I won’t be winning prizes, grants, medals, or any other accolades for my doings in the week of January 27, 2013. but, the beauty of that lies in the fact that I still thought it was a good week despite its ordinariness and not receiving any exterior recognitions for it.

I think it is all too easy for a medical student to go down the well-trodden path that many people of letters end up on. They come into their education like children—idealistic, wide-eyed, empty vessels ready to be filled—and many leave like Faust—devoid of the purpose and ideals with which they started, floating on the breeze toward they know not what. They leave laden with knowledge they have not a clue how to most meaningfully employ toward good ends.

Here is what Faust said after he’d finished his course of study:

[Night: in a narrow high-arched gothic study

Faust, sitting uneasy at his desk.]

Faust:  Have now, alas! quite studied through

Philosophy and Medicine,

And Law, and ah! Theology, too,

With hot desire the truth to win!

And here, at last, I stand, poor fool!

As wise as when I entered school;

Am called Magister, Doctor, indeed—

Ten livelong years cease not to lead

Backward and forward, to and fro,

My scholars by the nose—and lo!

Just nothing, I see, is the sum of our learning,

To the very core of my heart 'tis burning…

What then? all pleasure is fled forever;

To know one thing I vainly endeavor…

And then, too, nor goods nor gold have I,

Nor fame nor worldly dignity—

A condition no dog could longer live in!

And so to magic my soul I've given,

If, haply, by spirits' mouth and might,

Some mysteries may not be brought to light;

That I may know what the world contains

In its innermost heart and finer veins,

            (from Faust, A Tragedy, by Johann Wolfgang von Goethe, 1808)

Perhaps I have no authority to speak of such things, as I am yet at the incoming end of the educative transaction, but then again perhaps thinking about them now will deflect me from this regrettable path. It helps me to remember the words of Dr. Viktor Frankl, who wrote, “Man does not simply exist, but always decides what his existence will be, what he will become in the next moment.” So, my prayer for the class of 2016 is that we would not get lost in the directionless mire of the daily grind, that we will learn to appreciate and act on the insights that even the most mundane of weeks can bring, and that we will not succumb to the Faustian temptation of narcissism by the time we’ve reached the home stretch. Amen. - blogger of the month, Seth Morrison

So… I’m a doctor now, right?! By blogger of the month, Ross Green

November 16, 2011

Hello again! I’m glad to see that my not-so-entertaining blog last week didn’t scare you away from reading my next entries! I’ll try to be more exciting, I promise!

This morning, for our second time this month, we traveled in groups of five to clinics around the city. In our Clinical and Global Medicine course we have been learning about patient interviews, mostly including pediatric patients and their parents. These clinical visits have been a great way for us to put this learning into action! Especially since ped’s is an interest of mine, being able to talk and interact with them has been a lot of fun!

Last week, our group visited the טיפת חלב clinic. In English this literally translates into “Ross’ Clinic”… just kidding… it translates into “Drop of Milk”. When we arrived we were greeted by a member of the first graduating class of our school, Dr. Eric Haas. We were first briefed on the types of patients that we would most likely be seeing. These clinics consist of well patient visits of expecting mothers and newly born infants, in order to do routine checkups and ensure that everything is going well. We were only able to speak with two mothers, but they were both very easy to speak with (partially because they spoke great English… always a plus!) and willing to answer all of the questions that we had. They both had really cute little babies, both luckily healthy for the most part. I was named the head of our group because of my level of Hebrew, but luckily I dodged the bullet (no, there were no more rockets if that’s what you were thinking) and was able to stick to just English this time.

This morning we combined with one other group and visited the Soroka Pediatrics Department. First of all, it was nice because we didn’t start till 9, so I was able to sleep in an extra hour! Sleep here is worth more than gold, or falafel (which are both legitimate forms of currency here), so I took advantage of every extra minute I got! Since we were in the hospital we wore our white Soroka physician’s coats and medical student ID badge, which really made us look and feel like doctors (at least in my eyes). Being the only Hebrew speaker I interviewed a shy little 4 year old girl and her father, who didn’t speak English. It actually went really well too! It’s surprising how much more of a language you know than you think, but I definitely impressed myself (yes, I am currently patting myself on the back and typing this sentence with one hand) and was able to have a great conversation with them! The little girl was very shy, but she told me that she didn’t like the color green so I think that was really why she didn’t want to talk to me very much! The rest of the morning went really well, and I believe that I got a lot out of what we did that will hopefully help me in the future!

Oh, one more thing! This doesn’t relate so much to MSIH but since it’s my blog no one can stop me from writing about my personal life! Two of my best friends made Aliyah (moved to Israel) and have been going through the process of preparing for their army service. This includes “tryouts” for any of the combat units. As of a couple of days ago they were BOTH accepted into צנחנים (Paratroopers) which is a very historically prestigious unit here in Israel! It has been really nice moving so far away from home but still having two of my closest friends nearby! Granted, once they join the army it’ll be very difficult to see them, but I’m really proud of them and wish them the best of luck! STAY SAFE!- blogger of the month Ross Green