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.  

Second Semester musings, by Sam Nesemann, blogger of the month

Sam, Justine and Chase at the Physician's Oath ceremony

These first few weeks of the second semester have moved incredibly fast.  The classes keep us (or at least me) much busier.  This place is amazing though.  It’s already getting warmer.  The winter itself only lasted about 2 months and was extremely mild (nothing like what we would have back home in Wisconsin.)  

Because of the previous cold weather and the higher amount of classwork (just finished a global health module on nutrition that I highly recommend to any future students), there’s not too many extracurricular things to comment on right how.  However, this coming week a good amount of first-years are heading to Budapest, the second years are putting on a second annual talent show, and there will hopefully be some hiking or camping in the South.  

We did get to go to Umm Batin again today.  Umm Batin is a town about 20 minutes outside of Beer Sheva that has a mostly, if not completely, Bedouin population.  We go there once a week to teach English and it is an absolute blast.  The kids are great, some are very very smart, and, for the most part, very well behaved.  We teach for about an hour and a half and then play soccer, basketball, or whatever is happening that day.  The kids love it and it’s a really good opportunity for them, especially those who wish to go to college in Israel or the States.  

This is my first blog, so I’m still figuring out what to write about/how to write it.  I think this is mainly for the benefit of prospective students. So, I’d like to say a few things to you if you are reading this as someone looking into MSIH.  A lot of people asked me why I wanted to come here before I left, and they asked in a tone of concerned incredulity.  The question was often followed by something like, “you know there’s a medical school 2 hours away right?”or something about how dangerous this area of the world is.  There have been several occasions after arriving here that I have been taken aback by the sensation that there is no other place in the world I would rather be.  I’m sure it’s not for everyone, but I can’t think of any other school I would rather be at MSIH

- Sam Nesemann, 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

A Day Twice Reflected, by blogger of the month Elon Richman

Today was long.

I woke up at 7:30 am to attend three and a half hours of intensive Hebrew language where our teacher drills us and drills us with verb conjugations and nouns. Its a steady barrage of “what the are you saying” and “will I ever really be able to have a conversation with someone in this bizarre language without sounding like a child.”

After a short lunch, I am warmly greeted by five hours of “this is how you treat the absolute worst case scenario that ever could possibly happen to a human being” and a repetitive series of mouth to mouth resuscitation with age old alcohol wiped plastic dolls.

When I think about the work that awaits me over the next four years of medical school, I begin to tremble.

I’m walking home from yet another ten-hour day and look up at a fiery bright orange sky remembering that momma said there’d be days like this. Days of stress and uncertainty. Days when I didn’t wake up on the right side of the bed or I’m just having trouble seeing the big picture.

So I think I’ll try today again.

I wake up to a cool morning. The light is shining gently on yet another peaceful Be’er Sheva dawn as the city churns and people leave for work. I sip green tea, eat fresh bread and look off my balcony at the doors of Soroka who readily await my arrival.

On my way in, I take a detour towards Coffee Time where the barista knows me and doesn’t need to ask my order. We smile and greet each other with a cheerful boker tov and I’m off with my warm coffee. That first cup of muddy black Turkish brew hits my lips and blesses me with the gift of God’s strength and energy.

I’m ready.

It’s now Ulpan time and Nava, our charismatic and oddly humorous teacher, gives us the tools to describe our world around us (both in the streets and behind hospital doors).  I notice my language progress from the last few weeks and smile at the entirely wide and new array of people I can communicate with because of this tongue.

During lunch I talk with my classmates and we laugh over food and more coffee. Conversations vary and I’m thankful to rest my mind for an hour and change before going to the next series of lessons. As we walk to Emergency Medicine at around 1 o’clock, it’s hot, but my body thanks me for the warmth after being inside for so long.

We arrive. It’s time to start pumping adrenaline as information is hurdled at us and we’re encouraged to think on our toes.

“Head trauma? Infant Foreign Body Obstructions? Safety first!”

I arm myself with knowledge. What pleasure it is to feel readiness and confidence as I imagine jumping at the chance of aiding those in distress. Bring it on.

6:00 rolls around and I’m off school. I swing by the pool and lunge head first into the engulfing waters. The intensity of my workouts keeps me alive, pulling at the water and pushing the limits of my body slightly further every time. I sense the resistance against me as I glide through. Even better is the clear mind and feeling of euphoria after a full hour of intense swimming. It’s like meditation, concentrating so fiercely on my activity until the release, when tension is put to rest.

I’m walking home now against a fantastically beautiful Be’er Sheva sunset. I smell the plants. I touch things. I feel my feet steadily kiss the sidewalk as I walk home with a clear mind.

I reflect on my accomplishments from today and excite my nerves with tomorrow’s prospects. What new Hebrew words will I learn? What new restaurant should I try?

I think about this weekend. What will I do? Who will I see? What new place can I discover?

There are so many ways we can view our day to day lives in medical school. It can be a stressful rush of chores and appointments, or a beautiful array of sensation and life. It’s easy to lose sight of why we’re here.

My advice? Smell more plants, touch more things, talk to more people. When you find your balance starting to sway in the wrong direction, take notice and readjust. Bring everything back to the present time.

Don’t dissolve the day’s powder in a glass and drink. Instead, let her breathe. Smell the essence, taste the bitter and sweet, and live forever in the infinitesimal granules of every moment.

The late Israeli comedian Talia Shapira once said wisely:

.התחילה כבר החיים ,לב שמת לא אם

If you haven’t noticed, life has already begun.  -Elon Richman, August blogger of the month

Homebody, by blogger of the month Elon Richman

So its like this.

People have noticed that I regularly draw a house on my ankle. It’s simple: a square frame, triangular roof, a doorway and a rectangular chimney with smoke from the top (its lived in).

I don’t draw on myself because I’m bored in class. Its a meaningful reaffirmation and a statement of my self respect and self love.

Wait, what?

While working at a coffee house in Tel Aviv I decided to come up with ideas for tattoos. Something basic, not too crazy, and preferably a picture that I could design and even tattoo onto myself with household materials (that last part was / still is very questionable).

So I drew. First it was Mr. Peanut, then a bear with a cigarette in its mouth (morning shifts are long) and finally a house.

Why did I draw this simple house?

At first the house reminded me of my home in Miami, a beautiful 1920’s, Mediterranean style abode where I spent my childhood and fondest memories. It made me homesick. 

But then I remembered that I came to Israel to see if I could actually feel at home in what I’ve always considered my second country.

Finally I asked myself: What is home?

Is it where you grew up? Where you’ve lived most of your life? Where people know you? Is it where your friends are? Your family? Is it the place where your dogs are? 

What does it feel like to be at home?

I concluded that the home is not necessarily a specific place. It is where one feels complete and whole, a place from where warmth and comfort generate. 

Where do those feelings come from?

When faced with these kinds of existential questions I tend to turn toward my learnings in meditation and Buddhist philosophy. From that perspective, it seems to me that warmth and completeness arise from within.

Warmth and completeness from within.

That means it doesn’t really matter in what specific location you put yourself. Home is a mindset and can be created in any Bedouin capital in which you may happen to be. All you need are the right tools to build it. Personally, I build with friends, love, routine, a good mind and a sweet patio. 

But everyone has different specifications.

Now, I’m not saying I’ve never felt “homesick”, but feelings are transient. Missing a place means its special, but it doesn’t mean that you must be there or that it is the only place you belong. If one can feel truly present, other homes will have less of a grasp (by present I mean feeling in touch with both the outer and inner environments. Its hard).

We’re all building houses in Israel. So as you continue to form the structure of your life here, think about the roof that’ll protect you from hard times, think about the walls that will keep in the warmth and think about the windows of perspective from which you would like to look. 

And make sure your door is open for guests.

So now, every time I sit down and put my feet up, I see the house and remember that my body is my home and the vessel by which I experience it. I redraw it every day and reaffirm this message to myself: 

Home is wherever I am. 

Home is wherever you are.  - blogger of the month, Elon Richman