"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?

"Finding Family in Friends," by MSIH December blogger of the month Tamara Kliot

Studying medicine abroad is exciting! There are always new places to explore, people to meet, languages to learn, cultural norms to adapt to, and things to discover. The opportunities to procrastinate studying for biochemistry or immunology are abundant. However, with the ending of classes and beginning of exams, there has been a noticeable shift in how people are allocating their time. Priorities are shifting as that list of important information to review continues to grow.

While having fun and taking “mini-vacations” are important stress relievers, it is easy to lose sight of that when you are in the thick of studying. It is easy to isolate yourself in a study fortress and spend your time surrounded by books and watching videos on metabolic processes. It is easy to forget to be a human and spend time with friends and talk to family.

I was reminded of this when my Israeli neighbor wished me a Happy Thanksgiving. He was the last person I expected to hear those words from, but he forced me to stop and think. Thanksgiving is my favorite holiday because it's an opportunity to spend time with family and reflect on the things we are grateful for. Living in Israel, it would have been easy to forget to celebrate or even acknowledge Thanksgiving. It is just another day in Israel and in many other countries for that matter. We had had a busy week, multiple quizzes to study for, and a paper to write; the last thing on people’s minds was Thanksgiving.

But as Thanksgiving continued, it was not just another day in Beer Sheva. Some of our classmates had the forethought to organize a dinner at Butchery to celebrate the end of first semester classes and well… Thanksgiving! It was a fabulous time with delicious food (tons of meat!) and amazing company. It was fun to see our non-American classmates get in the spirit of Thanksgiving as well! The night was filled with stories, laughs, and celebration (we did just finish one semester of classes!). I learned so many new things about the awesome people I am lucky enough to call classmates. It was a great way to recharge from a long week and reminded me that I do in fact have a family here in Beer Sheva, people I call friends and accomplices in this adventure we call medical school. 

"A Very Beer-Sheva Thanksgiving" by MSIH first year blogger Becca Siegel

On November 26th, 2015, several medical students from around the world celebrated Thanksgiving dinner in the Middle East. In Beer Sheva, Israel to to be exact.  I am pointing this out because it is notable in many respects. First off, the very fact that a group of people who regularly spend upwards of eight hours a day together would want to spend their few off hours together is quite amazing. Secondly, in a little city, in one of the smallest countries in the Middle East, students from all over the world sat together and had a meal because there was a lot to be thankful for.

We had just taken our last microbiology quiz of the semester. We were a few days away from our very last class of our first semester of medical school. We had survived. We had somehow managed to move to a brand new country, learn a brand new language and start medical school, all in one fell swoop.

Together we ate delicious food and we made nerdy jokes about mycobacteria and we toasted to a circle of people who could one day be called “doctor”.

Happy Thanksgiving from the class of 2019!!!

Now on to finals.

"Lost in Translation" by MSIH first year blogger Rebecca Siegel

A few days ago, when I was walking home for class, a man asked me for directions in Russian. I know that he was asking for directions, not because my Russian was sufficient to decipher his intention but because he was pointing to a tattered map. From what I could tell, he was looking to get to the post office, which was pretty much a straight.

I tried to communicate that it was straight ahead in every way I could. I attempted in Hebrew. I attempted in English. I made a line with my finger on his map. I mimed a person walking forward and finding a post office.

Nothing worked and with each attempt he looked progressively more frustrated. I also felt frustrated because I knew what he was going through and I was powerless to help. I too was a stranger in a strange place. I knew exactly what it was like to say the simplest thing over and over again and not see a look of understanding on the face of the person that I was talking to.

            To me, this is one of the greatest assets of going to medical school in a foreign country. The very fact that we know what it is like to struggle with being able to communicate and understand basic things is what is going to make us good doctors. Not understanding is hard.

            So here’s to my classmates who have known the true horror of taking a bite of a would-be-delicious breakfast parfait, only to find they had purchased sour cream and not yogurt at the grocery store.

My very resilient classmates who have double, triple and quadruple checked the bus map, only to find they were now farther from their destination then they started.

Together, we have learned intimately what it means to need help and lack the words to ask for it.

My peers and I represent a class of physicians who will understand that it is not the responsibility of a patient to communicate in ways a physician can understand. It is on the doctor to hear a patient’s explanation and figure it out.

"Clown College" by MSIH first year blogger Rebecca Siegel

           On Wednesday evening at 3:47, a typical first medical student rummages through her backpack, to prepare for her next class. She sits in the break room on the sixth floor of the internal medicine building at Soroka hospital. She takes out a biochemistry textbook and put it’s on the floor beside her backpack. She takes out some highlighters, flash cards, and a binder full of printed out slides from immunology lectures. She still hasn’t found what she is looking for. She pulls out a tutu and then continues to rummage until she finds a Santa hat.  “Finally”, she mumbles. It’s time for class. 

Welcome to medical clowning. Meet Dr. Amnon Raviv, the only self-proclaimed only personal in the world to have a PHD in medical clowning. He is a clown, a real-word superhero, and the instructor of this very special course. He is a human sigh-of-relief for people battling serious illnesses all of the country. On any given day he can be found in an oncology ward, belting out an upbeat western style song about colon cancer, or in the surgery wing, helping a 5-year-old boy make a list of what dreams he would like to have during surgery (before summoning in the anesthesiologist and reading the list of dream-demands aloud).

As we leave the class three hours later, I feel a little overwhelmed by how lucky we are to have Dr. Raviv. We are students of empathy and active listening. We are tutu clad care takers. And for three hours every week, we are allowed to reclaim some of the idealism that made us want to practice medicine in the first place.

       It’s time to practice. One student is the patient, one is the doctor and one is the clown. Dr. Raviv tells us that the patient is a small child who is getting a shot, but feels quite scared. The clown tries to make bird noises and funny faces in order to distract the child from the shot. Dr. Raviv stops the exercise.“ The child is afraid of the shot”, Raviv explains “and you’re not going to help by ignoring the shot.”   They try again, only this time the clown jokes about the shot. He pretends to give it to the nurse, to himself, even to the wall. “Better”, Dr. Raviv says. Slowly we are starting to understand. 

"A Guide through Dissonance: 2015 Physician's Oath Ceremony," by MSIH first year blogger Jay Berkes

MSIH Physician's Oath Ceremony 2015

The fact of medicine as an institution has not been lost on any that have passed through its doors. The least of which are first year medical students, whose ambitions of practicing medicine have not yet been co-opted by the demanding processes of the education and the career. Our view of medicine is still one of reverence, the ideals of which don’t just sit propped on one mountain to be climbed, but on peaks and in valleys throughout an entire range of challenges. They remain there, revered, and in places of importance because we are the type that enjoys challenge.

A good challenge, though, must be accompanied by its goal. Or some reminder of its goal. For me, this reality was the highlight of the master’s degree I completed shortly before coming to Israel. I studied business administration, the result of which is a ticket to business ownership or organizational management in some form. In one class we discussed whether or not management was a true profession, bound by a code of conduct, a license to operate, a professional governing body, a foundational education, and a duty to serve. These requirements are necessary to generate a fairly explicit agreement with society, one in which the members of a profession will exercise trust and control in the provision of their service, maintaining equity within that societal agreement. Of course, the field of management isn’t bound by these requirements. So do they not have a place within a societal agreement? Of course they do, and in the absence of a professional governing body or a license to operate they must rely solely on their education and their duty to serve. Those two things, and especially that duty to serve, become the daily reminder of the daily challenges offered in management.

So where does that leave me, three months into my medical education, still wrapped in the importance of the pursuit of becoming a physician? And what is the guiding reminder of that goal?

First and foremost, I hold onto that duty to serve, a fundamental part of my interest in medicine, and a fundamental part of my future profession. And while that should be enough, the rigors of the educational process provide more than enough distraction from the foundation. Every pursuit of knowledge is wrought with that dissonance, the dichotomous fight between awareness and ignorance. Awareness to the details of root memorization, creative processing, and the larger end goal of application. Ignorance to the discomfort of effort, in the trenches of detail and the finality of that big picture. The difficult realization, of course, is that merely surviving such dissonance isn’t enough. Surviving on the merit of scientific knowledge, and graded application, will produce competence, and at the every least it will have produced a physician that has succeeded in entering into that fairly explicit societal agreement (complete with licensure, a code of conduct, and the acceptance of a professional governing body). But a code of conduct is not an oath, and medical competence is not the only goal. Something else is needed.  

At MSIH and Ben Gurion University, like hundreds of institutions around the world, we take a Physician’s Oath at the start of our medical studies to guide us on a path through that dissonance. With Dr. Shimon Glick, a founding member of BGU’s Faculty of Medicine and a leader in the practice of medical humanism and medical ethics, we learned that this oath and this ceremony is in place to bear on us the responsibilities and duties, and not just rights, of medicine. Started over 40 years ago, at this school, this practice aimed to make “change agents” of the BGU’s first medical students, working to upgrade the medical care and health of patients and communities, from the very start¹. 

For those of us that have chosen a foreign country to enter into a difficult profession, with a focus on a discipline (Global Health) that is not widely understood, the Physician’s Oath is a guiding hand, a statement of our duty to serve, and a reminder to be agents of change for the benefit of our patients and our communities.

I’ll use it as my guide when the dissonance gets too loud.

Reference:

1.      Glick, S. M. (2003). White coat ceremonies—another commentary. Journal of Medical Ethics, 29(6), 367–368. http://doi.org/10.1136/jme.29.6.367

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!

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

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

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

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

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

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

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

Ben-Gurion saw the appeal of the metaphor himself:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Visiting home and traveling..my summer break before starting the second year of medical school by blogger of the month Maia Reiley

After spending a few days with friends in New York, I flew home to Maine, and immediately started preparing for the next leg of the very exciting journey that medical school is turning out to be. Visiting home is one of the wonderful things about traveling and living in a foreign country, and the result of habituating to a new country is a sort of reverse culture shock upon reentry. JFK airport greeted the newly deplaned arrivals from Israel with several well marked lines to stand in, depending on country of citizenship. The airport attendants loudly, enthusiastically, and repeatedly made sure that everybody knew which line to stand in, how to open their passports to the proper page, and how to present their customs ticket. While efficient, the process seemed insulting. After nearly a year of pushing and shoving and generally fending for myself to achieve anything from getting on a bus to opening a bank account, going through American passport control felt very foreign. 

Other experiences proved to be more welcoming in their simplicity. I could plug my computer straight into the outlet, instead of playing a balancing game with the outlet, plug converter and power cord. I could understand everything being said around, about, or to me. It is very nice to be able to have a conversation with instead of getting the general gist of questions and either smiling and nodding and saying thank you, or smiling and shaking my head and saying no thank you.

My few days in the city of well organized lines have been followed up with a refreshing stop in the land of no lines at all, which can also be called the land of nearly no people, or, in google-able terms, Brooklin, Maine. My family just calls it home, though.

The next stop will be Iquitos, Peru. One of the perks of attending MSIH is the likelihood of meeting other students who not only want to do the same things as you in their free time, but who will also make a plan do these things and follow it through. The current thing is a summer internship in a city off the Amazon that, apparently, can be reached by plane or boat, but not by road. Because I don't particularly enjoy cars or driving, this should be great. I wonder what the local practice is for standing in lines, though. 

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. 

A reflection on the first year of medical school: A dedicated professor, small class size and themed dress by blogger of the month Maia Reiley

Today was our last exam. Goodbye to the 6^th floor of Soroka, goodbye to Caroline House, goodbye to the hallways of Deichman, until we start (or technically, continue) 2^nd year in the fall (well, late summer)! The last few weeks, we have been studying hematology with Dr. Moser. He is a very dedicated professor and also a bit of a hero. Shortly before we began our hematology block, he returned from a mission to supply medical care to people in Nepal who had been affected by the earthquake. One day during lunch, he was kind enough to give us a presentation on his time there and field all sorts of questions about the reality of being on a mission. When he is not giving a lecture, he often sits in on other professors so that he can use our classroom time more efficiently when we have a session with him. He is also a vocal supporter of problem based learning, so here is some visual documentation of students teaching students.

One of the nice things about having a small class is that when you walk out of an exam, there is always someone waiting outside. Although most people will say they don't like to talk about the exam once it is over, I think we all benefit from a feeling of solidarity. Even if you are the first one out of the room, there is usually a professor or a proctor who will ask you how it went, what your next block is, or where you are going for the summer. Generally, we all wait outside and chat, then head off to celebrate or pick up whatever we dropped when we entered exam mode. Some people basically had their bags packed and headed to the airport after the test, so today's post-exam hangout doubled as a time to give out hugs and promises to catch up when we see each other in August.

At some point during the last semester, the class go-getters decided that we should have themed dress up days. Yes, this is medical school. Obviously, for our hematology final, we were all supposed to wear red (get it, red like blood?)

Here we are, a little over ¼ of the way to being licensed doctors...

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

It's nice to know that we always have the beach and each other, by blogger of the month Shauna Dunton

This will be my final post as blogger of the month, and it will touch upon a common theme in all of my posts which is that the best thing about MSIH is really the people. The best advice I can give to the entering class next year is that your best resource is each other.  The students in your class and also in other years of MSIH truly have your back and want to see you succeed and constantly work towards making changes in order for everyone to have a better, more effective education and experience at MSIH. I took a long road to medical school and I have seen many other educational systems along the way and I can assure you this is a unique feature of this school.

We have just finished a tough month of finals and have already begun Endocrinology, which is our sole focus for the next month. I can pretty much speak for all of us in saying that we are excited to be starting systems and can’t wait to see what the next year brings.

A big group of us went to Palmachin beach, just south of Tel Aviv, to go camping and get some sun and relaxation in before we started our next class. The weekend was complete with shesh beish, football, a nice fire, human pyramids and an unexpected private fireworks show put on by other campers on the beach. It’s nice to know that we always have the beach and each other. - blogger of the month, Shauna Dunton

Physicians for Human Rights, by blogger of the month, Sam Nesemann

This past weekend my roommate, Kyle, and I went to the West Bank to shadow doctors working with PHR.  PHR stands for Physicians for Human’s Rights.  They travel to the West Bank and Gaza providing healthcare for people who are underserved.  The experience was incredible.  We all met outside Tel Aviv and drove in in two vans.  We first arrived at a sort of municipality building and were introduced to the town.  We then drove to a school where each doctor set up in a room to see patients.  Drugs were brought in the van and a pharmacist set up on the second floor.  I followed an internist from Belfast up to the third floor with a translator who I had just found out knew of my sister as they have a mutual friend from University in Scotland—small world.  The cases we saw varied from normal tonsillitis to an 8 year-old boy with blood pressure of 160/80, and a young girl with no eye-brows, eye-lashes, and losing more hair with normal thyroid hormones.  Too many people to see set up shop outside the rooms and a few tried to push their way in each time the doors were opened.  At one point the Mayor came in to personally thank the Doctor and have a picture taken with them.  I don’t know if he did it with every doctor, but I would assume so.  The entire time, a guard from the town was helping us with translating more cultural nuances, and advocating a bit for himself by asking for medication for a peptic ulcer in a seemingly half-joking way.  We worked for several hours without a second for a break.  I helped where I could (which wasn’t too much since I’m still a first-year) and shadowed the rest of the time.  Once we were finished we headed back to the municipal building and had a dinner with all the doctors and several people from the town.

The experience was an incredible opportunity to get a taste of a global health experience.  I HIGHLY recommend to any future students to jump on the opportunity to volunteer with PHR.  - blogger of the month, Sam Nesemann