Tuesday, August 31, 2010

On new digs, Kafka, and getting to it

Soroka at dusk.

Here I am, tapping a vein.

Jonathan does his thing.
One of the biggest worries since we arrived has been securing a place to live. It’s not as straight forward as you might think. There is a lot of walking around, a lot of sweating, and a lot of waiting for people to show up to open places.

We all filled out housing preference forms before we left so the folks here could arrange apartments and houses for us to view. However, as often happens, what you thought would be a good idea changes once you are “boots on the ground.” People changed their minds (me), couldn’t make up their minds, or just went ahead and arranged for something before they got here, bypassing the whole thing. So, there was another series of housing requests put out and a string of apartment viewings set up by our liaisons in the evenings.

So, after a day full of Hebrew and Emergency Medicine, we would meet for extended tours of apartments. I say extended, not because we were seeing so many apartments, but because – even though it had been arranged beforehand – the landlords, as a rule it seemed, would never be at the appointed place, at the appointed time. There was a lot of waiting. Time is a relative thing here. This is one of the things I have learned in my short time in Israel. For example, the Hebrew word for “noon,” our Hebrew teacher explained, does not mean 12 in the afternoon. It means 12 to 3 in the afternoon. So, asking someone to meet you at noon could turn in to a long wait.

This is all part of getting used to living in a totally different culture, but after a long day of class and an evening of uncomfortable walking and waiting, you just want someone to show up on time. But, it is what it is and we dealt with it. As the days dragged on I was more and more afraid we (I threw in with two other first-years) would not find a suitable apartment. But just when hope was at its lowest, we found a place. And none too soon – one of my future roommates was already without a sublet, the other was about to lose his, as was I. (Many of us were unaware until after we’d already been here for a couple of weeks that our sublets did not last through the entire month.) It is a nice place not far from the hospital with cool air and new furnishings. Really, all I wanted was a place to be comfortable and I think we found it.

I must say here too that our liaisons did a great job of making sure we were squared away before we signed our contract. Daniella, one of our liaisons, went to the rental office with us and struck things or added/demanded things as she saw fit. First, we never would have been able to read the contract (because it was in Hebrew) but it was also useful to have someone advocating for us.

With every problem that gets solved, another pops up. With the apartment found, I needed to get an Israeli bank account to write checks for the rent. I wanted to avoid getting an Israeli account but there was no way around it. It was recommended that we go over to the bank on the BGU campus to open our accounts. I’ve opened and closed a fair amount of bank accounts in my time. I’ve done a lot of banking in general. But I’ve never seen anything like this bank.

By appearances, the bank looks like any other bank you would find in the US. But that’s just a set dressing. The reality is something totally unknown. There is a dimension where the mind of Franz Kafka creates and controls everything. This bank was conceived and given life in this place. By some accident of science and sin of physics, this dimension temporarily fused with our own and this bank slipped through and plopped down in the middle of BGU’s campus.

One afternoon I went over to open an account. I found a modest line when I arrived and took my ticket. Other MSIH students were already waiting and some arrived after me. After waiting for an hour or more, a bank official came over and asked if we were “a group.” Some of us tried to explain that while we were all in the same school, we were all independent operators looking to open checking accounts. The official said that would be impossible as she did not have the manpower to handle so many of us. The fact that they had several hours to closing time was not reason enough for her to let us stay and open accounts.

We were invited to crush in to her cubicle and make appointments to open accounts. There were easily 15 of us there. She said she could handle 4 people the next morning, maybe 2 the next day in the afternoon. Any more would just be more than she could schedule. Already it seemed odd to me. We were asking to hand over money to them but that didn’t seem to be very important. A proper scheduling that would allow us to wait for interminable periods of time seemed to be her objective.

I was able to get one of the 2 spots in the afternoon. When I arrived for my appointment, the woman I’d made the appointment with was not there. However, there was another group of about 7 MSIH students. One of our liaisons showed up and there was much discussion apparently pertaining to why the bank would not let us open accounts. These discussions seemed to be acts of futility. I waited for about half an hour or 45 minutes until the lady I had an appointment appeared suddenly and informed us that it would simply be impossible to open accounts today. I protested that I had an appointment. No, she reminded me, I was already there yesterday morning and opened an account. No, that was not me, I answered. Yes, she said.

Our liaison took over the discussion. There was more excited talking and she eventually turned to me and said I had an appointment and I was to wait where I was for a booth to open up. However, the other students were not so “lucky.” They could not open accounts.

There was another 30 minutes of waiting. The lady appeared again and directed me and another student to a cubicle. I wasn’t sure if this cubicle was where an account would be opened, or if it was just another place to wait until we could be sent to another cubicle. A man sat down at the desk across from us and barely responded to our “Shalom!” offerings. I knew this man. I’d been to this bank to exchange money and this had been the bank employee who’d arranged the exchange. It had taken 42 minutes exactly. (Which is really nothing – one student told me a mad story about exchanging money at this bank and in the middle of the process, the employee dropped everything to repair a DVD player.) Inwardly I groaned. I knew I was about to be staring at him for quite some time.

After clarifying with him that the other student and I did not want to open a joint account, he began the process of opening her account. He hardly spoke throughout the process. He never asked her a question other than to see her passport. There was a lot of typing. There was a lot of printing things out, throwing them in the trash, printing out more things, coloring stick men on them and hanging them on my refrigerator. There was grumbling at the computer screen. There were phone calls, extended conversations with passersby, much laughing, some screaming, more crying, and gnashing of teeth. We were required to make plans to take him to dinner, then let him break the plans while he told us he’d found someone cooler to hang out with. Then there were forms to sign. Two metric tons of paper were delivered to the bank exclusively reserved for our signatures. Once that was done, a three legged race took place. At the finish line we were given our new accounts and promises that we would receive our bank cards and checks in due time.

In all, I was at the bank for three hours. It’s never been that hard to give my money to someone so they can take it and do what they want with it until I need it.

One more thing about the bank: I was given online access to my account and told that the English site was self-evident when you visited the website. A few days after opening the account I went to the website and could not find the English site. I was able to log in to my account pasting the prompts in to Google Translate. But once I got in to the account I could not navigate my way around. Google Translate started to get more and more what I’ll call “unstable” in its translations. I gave up after it translated one of the menu options as “successful teaching herpes!” (Based on my previous experience with the bank, that might have actually been what the option said, but it was too much to handle… and the exclamation point is not my addition. That was really in the translator.)

The Emergency Medicine final exam was held on August 27. It consisted of a 2 hour written exam and a 2 hour OSCE exam which is a clinical exam made up of “action stations” where we were required to show off our BLS, PHTLS, and history taking skills. For two days previous the TAs for the course kept the classroom building open for us to come by and practice any of the drills we wanted. From what I can tell, the test went well for all of us. It seems I should have more to say about our first big medical school exam but I don’t. Know why? Because I’m too excited about something we did that amounted to a little over an hour of drill time three weeks into the class… We got to put in IVs!

I knew we would get to do it and I was anticipating it for some time. In part, I was nervous about sticking someone over and over as I fruitlessly searched for their vein. The other part of me was really excited to do something so medical. It seems a simple enough thing to do, but when you’re about to be the sticker instead of the stickie, it’s a pretty exciting thing.

The TAs talked us through the process step by step. We were given fake limbs to practice on and told what to look for when we hit the vein. Quickly we were out in the hall actually doing it on our partners. Like a vampiric picnic, blankets were spread on the group and small groups of us huddled excitedly watching one classmate poke another classmate. In my group, the first person to go got it on her first time. Then I laid down and Jonathan, one of my roommates, did his thing on my vein. I want to make this completely clear: he was a total pro at giving IVs. I’ve had a few IVs and blood draws in my time and Jonathan was the fastest, most efficient, and most painless administer of the needle I’ve experienced. I was well impressed.

The rest of my group went. Everyone tapped it on the first try… except for me. I had to stick my partner, Claire, twice. When Claire had done it, she actually went all the way through her partner’s vein but was able to draw the IV back up and in to the vein… very neat to watch her do it. When I first stuck her and didn’t hit pay dirt, I thought I might be able to do the same thing, but I’d missed completely. I was nervous the first time (I mean I was stabbing someone after all) but the second time I was more so. I’d failed once and I didn’t want to have to keep hurting Claire. I also just wanted to do it correctly.

We switched arms. I knelt down, went through the procedure, and chose my vein. It was a good one. Huge. Obviously juicy. Beautiful. I palpated a few times for good measure, stretched the skin, chose my angle and told her to prepare for a pinch. I put the needle in. Blood appeared in the needle and I was in. Tapped the vein. It was satisfying to do it but after the drill, the afterglow was even better. I wasn’t alone in in feeling that somehow we’d crossed a threshold in our time here. It felt like a significant first step toward bigger and better things.

Putting in an IV is certainly insignificant as far as the range of medical procedures (if you can even call it that) we will learn are concerned. But learning how to do it, and actually doing it, wrestled my mind into another place and reminded me that I am not just back in school. I am in medical school. We are in medical school. Those things we’ve had done to us and for us by doctors over all these years? All of those healing activities? We’re going to do those things someday soon.

It’s good to be reminded where you are now and then. But once you know where you are, you need to know you belong. I have to confess, I still have trouble believing this about myself. I’ve spent more than a month with the class of 2014 and I am impressed. I am impressed with the sort of lives they’ve led. I am impressed with the sort of students they are. And from my roommates to the rest of my class to the second and third years I’ve met, I am impressed with them as people. I am humbled and thankful to be in their company.

August 29 was the first proper day of classes. That is, we had Histology and Biochemistry. It’s really started now. A few things I want to remember as I begin are: I need to remember to keep calm when it gets hard, because it will. I need to remember to laugh at the way places like my bank do things, because it’s not going to change. I need to remember to breathe deep. I need to remember to focus on what’s important and let the incidental fall away. I need to remember to drink water. I need to remember to treat myself to falafel. I need to remember to give myself the good medicine of fellowship with friends on a regular basis. I need to remember that as hot as Be’er Sheva is, the places that need our help are probably much hotter so I better get used to it. I need to remember to help and to ask for help. I need to remember that I don’t know all the things I need to remember and so I need to keep an open mind.

On my way to our first day of classes I thought of something Robert Louis Stevenson said. He paid tribute to the physicians he’d encountered throughout his life by writing the following as a dedication for his book “Underwoods.” I think of it as a description I hope can be applied to me – to all of us – someday when we are the doctors in the sickroom:

“There are men and classes of men that stand above the common herd: the soldier, the sailor and the shepherd not unfrequently; the artist rarely; rarely still, the clergyman; the physician almost as a rule. He is the flower (such as it is) of our civilization; and when that stage of man is done with, and only remembered to be marveled at in history, he will be thought to have shared as little as any in the defects of the period, and most notably exhibited the virtues of the race.  Generosity he has, such as is possible to those who practice an art, never to those who drive a trade; discretion, tested by a hundred secrets; tact, tried in a thousand embarrassments; and what are more important, Heraclean cheerfulness and courage. So it is that he brings air and cheer into the sickroom, and often enough, though not so often as he wishes, brings healing.” John Powers, MSIH first-year medical student