Monday, August 30, 2010

Emergency Medicine… also, the problem (and strange freedom) of illiteracy

John in a collar

Soroka from MSIH section

Jakob backboarded
Our Emergency Medicine course started soon after we arrived. For five hours in the afternoon we have been hearing lectures about all manner of terrible traumas and bad situations that can befall someone, followed by drills. In the drills we practice CPR, relieving chocking, trauma treatment, and history taking. We have been told that the reason we are taking the course is that, in Israel, all doctors and even medical students are expected to have a certain competency in emergency medical treatment so that, should an emergency present itself, we could stabilize a patient until paramedics arrived.

The lectures are interesting and the drills are enjoyable. I’d never thought of it in these terms but when learning this sort of thing, you’re not learning how to save someone’s life. You are learning how to keep them from dying faster. If Humpty Dumpty falls off his wall and I’m watching it happen, all I can do is keep his shell and yolk intact enough so that a doctor in an OR has enough to work with to put Humpty Dumpty back together again. It is an interesting place to think about existing, philosophically that is. In reality, I’m quite sure I would not be thinking about it if I was actually stabilizing someone’s cervical spine and trying to tell someone how to stop the bleeding from a partial amputation.

It hits me now and again that this course will likely be the last practical, and immediately useful (immediate being an important word there) medical knowledge that we’ll learn for a long time. Between the end of the EM course and the end of the first year, we’ll be in our basic science courses which, in all likelihood, not teach us how to assess if someone is in shock.

Speaking of shock, I have assessed myself and I’d say I’m not quite there. I’m talking about culture shock. I think there is one thing in particular that is staving off my culture shock at the moment, and that is that I am largely illiterate. Yes, Hebrew continues to confound me. I can understand a word here and there but most of what is said to me, and almost all of what I see written around me is mysterious. Perhaps if I could understand what people were saying, or read their billboards, I would be much more shocked by everything.

I learned to read in first grade. That is the last time I could not read or write something besides my name. Obviously, I can’t remember how that felt but, really, it probably felt great since I had people (read here “parents”) to take care of that pesky reading and writing stuff for me. Right now? It feels terrible. At times, it is embarrassing to be unable to speak to or understand what someone is saying. At other times it’s just humiliating. Because it isn’t just illiteracy, I can’t speak many times. I think of it as being mute. And that is an even more unique feeling. I don’t like it. But there is one thing that several people have told us since we got here that is pertinent here: Don’t despair. OK, I won’t. I will continue to stare dumbly and trust that a smile and a shrug mean the same here as it does in the United States until such time as I can effectively say, “I’m sorry I can’t speak your language, but is that falafel really 600 shekels?”

Yes, despairing is no good. And I’m not despairing. In fact, I was having such a terrible time one day that my Hebrew teacher, Nava, let me sit with her after class and go over some problems I was having. After our meeting, I was very encouraged if mostly because she reminded me several times that I am only a child when it comes to Hebrew. Also, and this is just an aside, she often tells our class that she can’t explain all the strange sounds contained in Hebrew because, “It’s a language invented by shepherds and people who run after animals.”

As the title mentioned, I have experienced an unexpected benefit from feeling like a mute, totally cut off from the locals. For some reason, I feel completely comfortable singing out loud with my iPod. I have never done this before. When I lived in New York, I might have been able to get away with it, but my Midwestern sense of propriety keeps me from foisting my singing on innocent bystanders. Here, I feel almost as if, since I can’t understand them and they probably can’t understand me, I can sort of do whatever I want and pass it off as completely normal – like, “oh, that’s what Americans do… walk about singing like madmen.” One evening I was walking through the hospital campus and realized I was doing my best Jeff Buckley impression as I listened to “What Will You Say” on my iPod. It was full on without a shred of self-respect. The Muslim women I was passing at the time barely glanced, not even breaking their conversation. Again, I’m chalking this up to feeling like I can get away with it, but I might be going crazy. I’ll monitor my condition every few minutes and notify you of any further deterioration.

Diversity. It was promised before we came and I can tell you it is here. At the hospital we walk the halls with Russians, Ethiopians, Bedouins, Israelis, and a lot of other folks I can’t identify yet. One might expect that diversity at any hospital but Be’er Sheva reflects it as well. I have been attending the local Catholic church here and it is also a picture of the uniqueness of this area. I attend on Friday nights, which is a popular night for a large group of immigrant workers from southwestern India (the state of Kerala). They are a particular sort of Catholic referred to as Saint Thomas Christians. They are part of the Latin Church but use an Eastern Rite Mass. What does all that mean? Doesn’t matter right now. What I want you to know is that this plays out in an interesting way. The priests here have allowed the Indians, mostly women, to incorporate pieces of the mass they would celebrate at home with the one that is celebrated commonly at the church here. So, the words of the mass are in Hebrew, the Scripture readings are in English, and several responses are sung by the women in (what I think but am not sure) is Malayalam. On Sundays, there is an entirely different group of people who show up. They are Israelis, Americans, Italians, Indians, and the priest is French. Somehow everyone finds a way to communicate and they are all intensely warm and welcoming. It is a hopeful picture.

I bring up religion because one of the lessons I’ve learned about Israel and the people here is that politics and religion are the first thing people talk about instead of the thing they avoid. OK, maybe not the first thing, but I have been surprised at how easily these things have come up in conversation with the local people I have been able to talk with (in English of course). Because I am such a son of America, I will leave it at that and spare you the specifics of what I’ve heard. The last thing I want to do is start talking about religion and politics.

I think I should end by summing up my impressions of Israel and our journey toward the end of orientation and the first day of medical school proper. “Interesting” is the only word I can think of. One can fancy themselves a wordsmith yet they will always be at a loss when they have something important to say. One of the things I found in my (former) career as a writer is that someone has always said what you want to say, and usually they’ve done it better. So, something my Hebrew teacher Nava said comes to mind. It isn’t a summation. It’s just good advice to end on:

“Open your ears and open your eyes… it will be a very interesting trip. This is a crazy and harsh country… but that’s the charm of it.”