Being Married in MSIH (Part 1: The Student's View) by Nathan Douthit

As I sit here and ponder what to write, I am reminded of all the questions I had when I was preparing for starting at MSIH. You know, crucial things, like, “Will there be Dr. Pepper?” (Sadly no, except for on rare occasions.) “Will there be other people from the south?” (Again, mostly no, except for a classmate from Texas, which is basically its own country anyway.) “Will the language come naturally?” (Absolutely not.) But the most important question I had was, “Will my wife be okay?”

Now let me preface this with a comment, there are a variety of marriage situations that students come to MSIH with. Some are married with their spouse back in the States. Some have a spouse who can do work from a remote location, like Israel. Some are able to immigrate, and their spouses can work or study in Israel. Some, like my aforementioned Texan friend, have four children whom they homeschool, and stay plenty busy. In some marriages, both spouses are students! My wife, Kate, and I, are in none of the above situations.

We were married for 366 days when we left for Israel, being basically newlyweds, leaving her Stateside wasn’t an option (since I’ve been here I have been thankful every day for that decision. Few other classmates have even heard of chicken and dumplings). Also, her degree is in Human Development and Family Studies, which I am sure has some viable vocational opportunities from a remote location, but she did not have such a vocation. We are not really interested in becoming Israeli citizens and have no children, so we weren’t really sure what we were getting ourselves (but more specifically, her) into. However, it has truly been a great experience for both of us! I want to briefly detail what it is like for the student in the marriage, and my lovely wife has promised to submit a post later sharing what it’s like for the non-student spouse.

The bad news first, and it is accompanied by a newsflash for the incoming students. Medical school is difficult. It requires substantially greater amounts of time devoted to the academic pursuits than did my bachelor’s degree. The first and most important thing I learned as a married student is that my life had to be more structured. We usually spend every day in class from around 8-3 or 8-5. On top of that, in order to succeed many additional hours are required. Medical school is a little like one of the many microbes we learn about. The conditions in Be’er Sheva are perfect for that little nasty academic to proliferate and completely overgrow your life. Since my wife and I decided that our marriage is more important than my education, I had to learn to structure my life. I want to set aside plenty of time every day to take care of her, help her, and hang out with her, since she’s my favorite person. That means, for me, almost every spare moment is spent studying. During the mid-class 15 minute breaks and the breaks between classes, I strive to remain in my desk, trying to knock out as much studying as I can. During lunch, I finish in 20 minutes so I can spend the next 40 in the library. I do all this so that by the time dinner comes around, I can put my books away for the evening, and enjoy my time with my bride. Also, Friday is a no study day for me, and Kate and I spend the whole day together. It is such a pleasure and much needed rest!

Now the good news. I live with my best friend. She is so helpful to me, taking care of so many different things so that we can be together. I’ll let her tell you more about her activities when her blog post comes, but suffice it to say she pays our bills, buys our groceries, does our laundry, cooks our food and does so much more. Remember, these mundane tasks are no small feat in a new country! I have no hesitation in saying I am one spoiled student. Of course I help with those things when I am home and they need to be done, but she is usually way ahead of me. I also am the envy of classmates when I bring my home-cooked lunches to class with me. We love to entertain, so my wife is good to share the wealth by inviting over other classmates to eat dinners with us. I would not trade being married to her for anything in the world.

So, in a nutshell, this post is directed to the nervous married student, who is bringing his or her spouse along and not sure what they will do. Don’t worry, as a student, with a little discipline, you’ll be fine. Your spouse will be fine as well, but I won’t spoil Kate’s post. Look forward to it in the days to come!  - blogger of the month, Nathan Douthit

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

At the museum under our noses, by Seth Morrison

History of Medicine museum, Faculty of Health Sciences, Ben-Gurion University 

It is quite remarkable what a medical student can learn simply by walking through the corridors of the BGU-MSIH medical school campus. There, a wealth of medical historical knowledge has been built into the very walls of its interior spaces. Thus, it is really an effortless undertaking for any medical student with a curiosity to understand the origins of their profession to simply walk and read through these exhibits. A total of an hour or two spent perusing them is sufficient to attain the beginnings of a well-rounded medical historical education from ancient times to the modern era. It was with this intention that I purposefully took to these corridors one day to see what I could find, and what follows here is an account of my findings.

The ancient Egyptians practiced a form of medicine in keeping with their mythology, incorporating various rituals surrounding their deities into their treatments. There are many different unique remedies that were used on patients, including hippopotamus fat and human excrement. The Nile dwellers also acquired more knowledge of bodily organs than other contemporary civilizations due to their routine procedure of embalming the deceased.

Medicine in biblical times drew on the religious traditions in the Bible and Talmud. The Hebraic practice of medicine was fascinated with life and death, a result of the veneration of mankind imbued by its creation in the image of God. The basis of Hebraic treatment was mainly social and personal hygiene: 213 out of the 613 mitzvot (precepts of God) are related to health in some fashion. Some of the surviving rabbinic texts, like the Mishnah, reveal a stark similarity of issues to the ethics of modern medicine in the polis: the rabbi criticized physicians for over-commercialization of their services and failure to attend to the poor, and drew a hard line by saying that refusal to attend to the poor is tantamount to homicide.

The basis of Greco-Roman medicine was Galen’s Four Humors. A “humor” is not a joke or jest, but the term applied to a bodily fluid. On their account, an imbalance of these humors was the etiology behind every disease, and they determined each person’s temperament: either melancholic, sanguine, phlegmatic, or choleric. Additionally, Hippocrates was the leader of a rationalist school of medical thought in Rome, and the Hippocratic corpus descends to us from this period. This corpus, we know, provides the ethical foundations for our modern practice of medicine in the West. And have you ever wondered where the medical symbol of a serpent wrapped around a staff derives from? It comes from the myth of Asclepius, the Greek god of medicine, who apparently carried such a staff.

Medicine in the Islamic world was also heavily influenced by Galen and the Roman rationalist school. The best hospitals in the world during the Middle Ages were said to be in Cairo, Baghdad, and Damascus. Many brilliant thinkers emerged from the Islamic world. Rhazes (d. 925) wrote the first accurate clinical description of measles and smallpox. Avicenna first suggested the contagious nature of tuberculosis. Maimonides, a prominent Jewish philosopher and physician, was a physician in the court of Saladin in Cairo in the late 12^th century and his fame extended into every great civilization of the time.

In medieval medicine, the term “physicus” began being applied to the academic doctors who philosophized about medicine more than they spent time treating people. Galen’s theory of humorism remained the dominant one, although there were many elements of folk medicine brought into the mix during this period. Observation of the characteristics of urine was the primary diagnostic test, and bloodletting was used as a treatment for a variety of ailments. Many odd elixirs, balms, tinctures, tonics, pills, and potions were given to patients to take, one of the most common being theriac, which had a long list of ingredients including viper flesh. Medieval doctors were not known for their effectiveness in healing. In fact, they were often derided for their impotence in jokes like this medieval poem:

Said time to the fool, be a physician,

and kill people for their riches.

You will have an advantage over the angels of death,

for they kill mankind for free.

This history may seem dry to some, but meaning always follows from reflection. It is given here merely to consider that there are many things to discover about the medicine of the past, and understanding where we came from is not a trivial pursuit. In reading these exhibits and inspecting their historical artifacts, I was reminded of the Hunterian anatomical gallery at the University of Glasgow and seeing its cadaverous collection of centuries-old anatomical specimens. It was there that I first became interested in the early roots of modern medicine.

In the end, it is unlikely that any hospital department head or patient of mine will ever be dissatisfied with me as a physician if I don’t know something about Vesalius or Boerhaave, Galen or Willis, Harvey or Hunter. Nevertheless, even though these things are inessential, I would think myself to be missing something vital if I was completely oblivious to the fact that, as Newton admitted, “if I have seen further, it is by standing on the shoulders of giants.”   - blogger of the month, Seth Morrison

for more information on the MSIH, visit our website at http://www.cumc.columbia.edu/dept/bgcu-md

On Hitting One's Stride, by blogger of the month Seth Morrison

The shuk in Beer-sheva

Once upon a midnight dreary,

while I pondered why I moved to a foreign country,

a strange sensation struck my psyche.

Was it elation, bliss, or gladness?

Lamentation, grief, or sadness?

None of these it was,

though for them many an instance gave just cause;

Instead the passion rubbed the middle,

defied assurance, like a riddle.

My heart had gathered all peaks and vales under its tent,

at long last found contentment.

This describes my recent progression through a set of phases people often experience after moving to an unfamiliar and less comfortable place than wherever it was they came from. Although the individual durations of each vary, it is said that one progresses through four phases in total:

1) the honeymoon phase,

2) the resistance phase,

3) the understanding phase,

4) the assimilation phase.

The honeymoon  period occurs when you first begin living in your new environs. The differences in culture and surroundings are still novel and intriguing. Every day is sweetened by new experiences and relationships.

When the honeymoon period wears off, the resistance phase sets in. This is when the question “What on earth am I doing here” is a perpetual elephant in the room. Small, relatively trivial trials and tribulations of daily life compound to appear as a massive, unsolvable problem. Second-guessing the decision to uproot and move increases in daily frequency, just as reversing that decision is decreasing in feasibility. My resistance phase hit its final climax last week, when our class of 2016 was taking final exams and simultaneously a four-day rainstorm hit Beer Sheva and all of Israel. I usually enjoy rain after having lived in Washington state, but Beer Sheva has a peculiar phenomenon some students have been calling “mudstorms.” This is what happens when rainfall and the fine Negev desert sand blown up by the wind mix in the air to create a clay-like mud vapor that tinges the horizon brown and coats any object that stands in its path, as though the desert wind god had taken up abstract expressionist painting. Consequently, the mental trauma of test-taking and dreary weather blended to produce a potent concoction of gloom that made me ask that question above a few times more than was comfortable.

This week, as I wrote about in my January 14^thpiece, the final exams were a thing of memory, a fleck of dust in my rearview (provided I passed them all, some scores still pending). It was during this week that I had my midnight insight, realizing that I had passed on into the understanding phase, and thus had gained some contentment to moderate the initial highs and subsequent lows of the preceding months. It was a week of reconnections with friends, such as an evening dinner and conversation stretching late into the night. It was a week of re-enculturation, such as spending a morning shopping for produce with the locals in the shuk (market). And, this week the skies cleared and temperatures rose all week long, as if God had revealed the bright Israeli shemesh (sun) to mark a promising new beginning for our class.

Blue sky in Beer-sheva

The assimilation phase has not yet set in and mustn’t be rushed. It’s both reasonable and prudent to give it ample time and space to develop on its own schedule, for that final phase is measured by a rate of furlongs per fortnight, not inches per instant. For now, my stride has been hit, and I have some work to do.   - blogger of the month, Seth Morrison

2nd year cardiology! by 2011 blogger of the month Nicole Magpayo

Second-year medical student Nicole Magpayo (seen second from right) couldn't resist sending us this post, to give prospective students a glimpse of second year.

She writes "As we get back into our normal daily routine of classes, 2nd year MSIH students continue with medical Hebrew classes. This week we were taught Cardiology physical exams and performed them on each other!"

Jaffa, by January blogger of the month Seth Morrison

There are few feelings quite as nice in the life of a student as the feeling of completing a round of semester-end final exams. When these are finally over, as they are now for our class of 2016, it is like a colossal weight that is lifted off the shoulders. This new-found freedom does not set in instantaneously after stepping out of the examination room, however. The pain lingers for about a day afterwards, like the residual aches a trekker feels in his thighs upon setting down his burden to rest by the campfire after traversing a high mountain pass. Then, after that day has passed, ever so gently the new freedom sinks into the soul as softly as a butterfly alighting on an outstretched palm. The world seems fresh and new, full of color and potential.

Fresh air is breathed by lungs that have known little else but stagnant, indoor, dusty Beer-Sheva air for the previous several weeks of reviewing. Once again the senses are reawakened, and the singing of birds and smells of the earth are noticed and appreciated. Of course, this spirited jubilation is always short-lived in the life of a medical student, for the rounds of intense study, exams, and interspersed periods of liberty are cyclical in nature.

It is in these interspersing periods of relative liberty that I most enjoy setting off on some new small undertaking. This, I think, helps to re-sharpen dulled corners of the mind and to find again fragments of knowledge that you forgot you knew. The undertaking could come in many shapes, sizes, and durations. It need not be doing some noble deed or philosophizing until a brilliant epiphany into the nature of existence is attained. It could be something as simple as walking next to a river, attending a symphony performance, visiting a museum, reconnecting with a friend, or writing a letter to your grandparents. Nearly anything that lies without one’s regular sphere of activities invites contemplation for those with a curious intellect.

So it was with this in mind that, after the completion of one semester and seeing the looming advent of the coming one just around the corner, I set off to spend a weekend in the seaside town of Jaffa on the southern skirts of Tel Aviv. Jaffa is renowned for its oranges (which I did not get the chance to try and which are currently out of season anyway), but it certainly had much more to offer than fruit. The town, possibly the oldest port in the world, is beautiful. Indeed the name, Jaffa/Yafo, comes from the Hebrew and Arabic words for beautiful (יפו in Hebrew). It is perched like a fortress on the side of a jutting hill facing the sea like an amphitheater, and has a density of art galleries that rivals any historic old city. Spending my weekend there achieved the desired effect many times over: it allowed a plethora of new and returning insights to sink into my brain. I watched fishermen bringing in their catch in the afternoon twilight. I saw an African-Israeli family celebrating a wedding in the town’s lovely hilltop gardens.  In the evenings, I heard the Islamic call to prayer belting from minarets, trailing through the chilly winter air, and then mixing with church bells chiming from nearby steeples. In short, the town’s idyllic charm and rhythmic, undulating ebb and flow of life set the mood for a relaxing and inspiring weekend, which was just the lift I needed to be reinvigorated before beginning a new chapter in Part One of my MSIH tale.  - Seth Morrison, first-year blogger of the month

"Get the best from the worst" by December blogger of the month Ashley Voroba

A smart person gave me a piece of advice during the recent conflict:

Get the best from the worst.

It’s not really the same as “make the best of it,” or “when life gives you lemons, make lemonade.”  It’s a little bit different. 

While most of my classmates went home following the announcement canceling school, I stayed in Israel.  For a lot of reasons.  The biggest reason was that I never had plans to go home for Winter Break in the first place (since my mom is coming to visit).  Another reason is that I didn’t really feel the need to leave. Most importantly, I knew I wouldn’t get a drop of studying done back in the States.

I think it took me about a week to really get my head on straight after everything that happened.  Living in uncertainty and feeling powerless takes a toll.  For days after the ceasefire, I compulsively checked the news, holding my breath as I hit “refresh” on Ynet’s update page, looking for an answer to the simple question “why?” and knowing I wouldn’t find it.  I checked no less than three news sources each day, feeling unable to really trust any of them to be accurate or unbiased.  By now my news consumption has dwindled nearly to pre-conflict levels, though I think I’ll never really look at news the same way again.  I was reminded during the conflict that while journalists strive to portray the accuracy of an event (some more than others), there is no such thing as “the truth.”

Returning to Be’er Sheva after the conflict was strange.  Most of the people I know here had left, making it seem very quiet.  And suddenly I had nothing but time.  No classes, no exam schedule announced.  I forced myself into a routine of waking up early and trying to study, though I wasn’t really sure what to study for.  Thankfully, a few friends were still here, and I think we helped each other return to sanity and normalcy.

I’m not sure I was able to exactly follow the advice I received, but I did squeeze some great things out of my unexpected free time.  I finally made it to yoga (in Hebrew) and found time for spin class (also in Hebrew).  I bought some cold weather necessities like a space heater and an extra blanket (yes, it really does eventually get cold here).   I spent some time exploring Be’er Sheva and the Old City.  And I found the best spots in the library for studying, places with windows and quiet.  Living with uncertainty is part of life here, and I think I’m learning to be ok with that. 

Maybe that is the best from the worst.  - Ashley Voroba, December blogger of the month