FALL2011 - Columbia University Medical Center

eflections
So whenever Jared passes on the content for a new
issue of the Balagan, it’s the same: the flood of
email sits unopened for a week; I will myself to
open up an old edition; I delete the content on one
of the pages–and then I stare. For a long time.
I’ve usually been up to some design task ever since
I started my formal education in architecture in
2000, and yet eleven years later, I still hesitate
on that first stroke. It doesn’t matter how many
times I’ve put pen to paper before. The white page
still needs to be overcome, and not infrequently, it
wins, leaving me feeling uninspired at best–more
often, just plain stupid.
Now, I am in the third year of studying a polar opposite
discipline, and yet I experience a very similar
tabula rasa moment almost every day: an attending
physician asks a question, and my only utterance
is a drawn-out monosyllabic plea for rescue.
The irony doesn’t escape me, and the concern over
future ineptitude doesn’t either. I’ve told others
that the most attractive quality about design is the
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MSIHNEWSLETTER@GMAIL.COM
THE TRIANNUAL MSIH STUDENT COUNCIL PUBLICATION
FALL 2011
REFLECTIONS 1
by THE BALAGAN EDITORS
FALL MISSIVE 2-3
by DR. MARK CLARFIELD
JOLLY TALIE’S RHYME TIME 4
by TALIE LEWIS
EMBRACING THE PARADOX 5
by BRAM WISPELWEY
INDUSTRY IS THE ENEMY
OF MELANCHOLY 6-7
by ERIC BRANDON
SABABAGRAMS 8
love-hate intimacy with the not-yet-existing, but
I’m beginning to think the entire basis of medical
education is to keep us uncomfortably close with a
similar entity: the unknown. I apparently haven’t
drifted too far from that stupefied state I had tried
to reserve for white space and empty templates.
But those eleven years haven’t left me without recourse.
At times when I suffer severe designer’s
block, instead of searching for another source of
inspiration (copying someone else), I look back at
my old work to find some hideous project that I’m
ashamed I ever brought into the world. I suppose
it’s the equivalent of finding an unflattering childhood
picture… but worse since you can’t blame
your design on a bad hairstyle trend. Finding that
prior mistake gives me a strange hope that I’ve
grown or matured in some way; architects endearingly
call this phenomenon ‘designer’s remorse’.
It’s hard to notice incremental change, and especially
in these formative years of medical education,
we need to know that we’ve actually progressed
to find the strength to move forward. At a
recent shabbat dinner, some fellow classmates and
I somehow came to discuss the original facebook–
the one MSIH produces for each incoming class. It
was then conveniently produced by our host. What
followed was a strange blend of psychological torture
with downright comedy, and I have to say, I’ve
never seen Asher Bercow truly embarrassed until
that evening. While it was difficult to hear, I am
glad we revisited these statements, because I had
just found the written equivalent of that horrendous
residential unit I was responsible for during Intro
to Design in the spring of 2001: gaudy, naïve, but
well-intentioned–and a good reminder that I’ve
learned a thing or two.
TRYING TO FIGURE IT OUT 9
by JARED BRAZG
The Medical School for International Health is a joint collaboration between Ben-Gurion University of the Negev and Columbia University Medical
Center. The Balagan is a student-run publication, and the views/statements expressed within are not reflective of the school or its administration.
STUDENT GROUP SPOTLIGHT 10
by CURRICULUM COMMITTEE
MAN SWIM 11
by HANAN ATIA
MEDICAL LINGUISTICS 12
by DR. DOV FRANKEL
PHOTOS 13
HERE IN MY BOMB SHELTER 14
by KADY GOLDLIST
THE FUNNIES 15
by JEREMIAH GROEN
WHO’S WHO: NAVA 16
by JASON TOEWS
Without solicitation, this has been the most retrospective
set of submissions from a group of prospective
physicians that The Balagan has ever
seen. Students from almost every year–and an
alumnus–have each written their reflections on
how they have come to be where they are. Though
I believe the pieces in this edition will bring forth
more appreciation than embarrassment, I believe
the sentiment behind them is similar to my personal
need for a frame of reference. As physicians, we
don’t have portfolios containing our prior works as
evidence of our progress; writing of our experiences
provides an intentional way to place a landmark in
our professional careers.
As one of the editors of The Balagan, I take great
joy in feeling that we’ve somehow recorded a
growth chart of our classmates. It’s our equivalent
of the small scratches on the doorposts of homes,
quietly charting the growth of the children living
inside. This is now the fifth edition of this strange
love-child between three MSIH students; it has recently
acquired a fourth parent (welcome Ariella!),
and I have to say, this child has grown as well–I am
particularly proud of this issue.
So as we start another school year, if I can humbly
offer a word advice, it would be this: trust the process.
I will still feel incompetent and inept when
I start designing the winter issue, but I know that
the first stroke I make carries with it the weight
of cumulative experience–all my prior triumphs
and failures. If I’ve managed to convince you that
design and medicine might not be so dissimilar,
perhaps you’ll be reassured that despite the highs
and the lows of life at MSIH, we’ll make it out of
this process as competent, capable doctors.
And maybe you’ll write.
Here’s to another year.
Daniel Rhee
Class of 2013
EDITORS: JARED BRAZG, ARIELLA KRONES, DANIEL RHEE
COPY EDITING BY NICKI BRODIE

AN UPDATE ON MSIH FROM DR. CLARFIELD
THE BALAGAN
GREETINGS
It is once again my pleasure,
at your editors’ request, to provide
the BLGN with a (slightly belated) New
Year’s missive. I especially want to express my
gratitude to the editors of this fine publication for the time and effort
they have put in to ensure that it comes out. Many thanks to Jared
Brazg and Daniel Rhee.
Of course I first want to welcome our incoming students and I do
hope that they are quickly settling in. As I mentioned at their recent
Physician’s Oath ceremony, I am full of admiration for the members
of this class for all of the usual reasons, plus the fact that despite a
(too) exciting intro to our neighbourhood, you have all decided to stay
here with us. As we say in Hebrew, “kol hakavod“, or in English,
“more power to you”!
Over the next couple of months, usually together with Dr. Alan Jotkowitz,
I will be meeting with each of the first year class to get to
know you better as well as for you to make our acquaintance. One
very positive aspect of our small school, which I very much value and
encourage, is the “short distance” between students and faculty.
Returning to the above-mentioned ceremony, not only did I enjoy our
speaker Prof. Basil (Boaz) Porter’s inspiring and entertaining remarks,
I really loved the skits, movies and songs put on afterwards by the
students. I haven’t laughed so hard in a long time. Keep it coming.
THE GOOD
(news)
With respect to our longstanding
collaboration with Columbia University,
we were privileged within the first month of
the school year to have a visit from my co-director
Dr. Richard Deckelbaum, as well as from Dr. Lynne Quittell, the
head of our admissions committee. As always, we benefited from
their presence, advice and fine teaching. We look forward to their
speedy return.
Over the last year we have made a number of curricular changes
and are working on others. Some of these modifications resulted
from consultations with students primarily, but not exclusively, via
the Curriculum committee (chair, Dr. Alan Jotkowitz) and Global
Health Group (chair, Dr. Tzvi Dwolatzky) as well as from the feedback
surveys (see below on this delicate subject).
Regarding the curriculum we have added new course coordinators
for immunology, pharmacology, medical anthropology and clinical
days. I think we have all seen tangible evidence of the improvements
made and thanks go to the students who took the initiative to work
on the curriculum committee. In addition, we are continuing our
visiting professors program. Dr. Lynne Quittell has recently visited,
and will likely return to contribute to our paeds clerkship. We are
currently enjoying the presence of Dr. Ken Prager from Columbia,
and Dr. Steve Sharf of the University of Maryland will teach in the
2
FALL 2011

AN UPDATE ON MSIH FROM DR. CLARFIELD
THE BALAGAN
respiratory system and internal medicine clerkship. Dr. Adi Haramati
from Georgetown University will also be arriving to teach physiology.
And from north of the 49th parallel, Dr. Michael Gordon of the
University of Toronto will contribute his expertise in both geriatrics
and medical ethics; Dr. Howard Bergman from McGill University
will visit as well.
In keeping with our goal of maintaining high academic standards,
while at the same time helping students who might be having some
trouble with their studies, faculty will be meeting earlier and more
frequently with those who might find themselves struggling. While
this initiative will be coming from faculty, we of course encourage
any student who feels the need for help not to hesitate to ask for it
at anytime. As well, as do many schools in the US, we are carefully
considering offering (for free) a USMLE voluntary refresher course,
which would take place over a few days towards the end of 2nd
year. For those interested, we will be giving you tentative dates as
soon as possible so you can make travel plans accordingly. Details
to follow.
With respect to resources, even in these difficult economic times,
we have managed once again to find extra resources to encourage
and aid students at different levels. For example, we just met
to discuss the applications of those who applied for a need-based
scholarship. As we did last year, the associate director of students
affairs, Dr. Asher Moser, will carefully consider all applications and
will divide up the funding available as fairly and equitably as possible.
Announcements about these grants will be made shortly.
Returning once again to student support, while we have helped the
Student Council activities with funding from time to time over the
past years, this year I wish to announce that a budget of 10,000 NIS
will be made available to the council for appropriate activities. (For
technical reasons, requests for this funding will have to go through
our offices, and must always follow University guidelines as to what
we are allowed to support). That being said, we think that in this
way the student body can plan and budget their activities early on
and provide the school administration with a budget plan for the
upcoming year. I want to take this opportunity to thank Talie Lewis
and her able crew for their work on Council. We very much value
your contributions.
As I think we have made clear over the years, MSIH is also very
supportive of the idea of students attending and presenting at relevant
conferences–both in Israel and abroad. To this end, we have
also found resources to encourage such activities. This year we have
raised another $5,000 for such support: $3,000 for attendance
at AMSA meetings and another $2,000 to send students to the
upcoming GHEC meeting in Montréal. Of course it must also be
clear that we can only allow students who are in good academic
standing to miss classes and attend such meetings. Criteria will
be drawn up and shared with you in the coming months so that
members of the student body will know how to access these funds.
THE BAD
(a cloud on the horizon…)
As mentioned in an earlier email, there continues to be a dispute
between BGU and Kupat Holim Clalit (which
owns Soroka Hospital) about payment for
teaching rendered by Soroka doctors
to the University. This problem
involves the whole Faculty of
Health Sciences (both He-
brew language medical school and MSIH). This is a recurring event
that has been resolved each year without seriously affecting teaching.
We do believe the issue will be resolved again this year, but
there is a slight chance that teaching may be disrupted for a short
time. We are making contingency plans just in case. Just today I
learned that this problem has been solved, at least for this year and I
expect a more permanent solution to be worked out for future years.
THE UNNECESSARY
(as in, should be….)
For those saintly MSIH students who religiously read all messages
from the school, and respond–both frankly and with alacrity, and
those who thoughtfully fill in every one of Liora’s surveys, you can
skip this section. For the 99% of you others, please read on...
With respect to feedback surveys, unfortunately despite reminders,
the overall response rate continues to be quite low. This poor showing
puts an unnecessary obstacle in front of the school’s attempts to
gather feedback, digest it and act upon it. I once again appeal to your
own enlightened sense of self interest. Being the evidence-based kind
of folks I know you all aspire to be, it should not be necessary to
point out that biased results which emanate from poor response
rates may actually be worse for the process of ongoing improvement
than no results at all. So once again, please take pen in hand (or
more accurately, phalanges to keyboard) and take a moment to
help us help you.
With respect to emails, I also want to appeal to you all once again
to read the messages from the school and respond expeditiously. As
well, allow me to remind you that those of you who forward your
bgumail to another system (gmail, hotmail, etc) will miss some
important missives. We really have no other way to get in touch with
you. While I know how many of these irritating little messages we all
have to cope with each day, and I am sympathetic to complaints that
we are all inundated all the time, we do appreciate your cooperation
in this domain.
IN CLOSING
I am, like you, very distressed that some of our less-friendly neighbours
from Gaza have just recently decided to lob missiles our way
once again. I know that many of you find this very disturbing. We
will of course do whatever is in our power to keep you safe in your
studies, and provide you with as much guidance and support as possible.
We’ll get through this difficult period–together.
On a happier note, again, I want to thank the editors of the BLGN
for inviting me to address you through its colourful and stimulating
pages. Please allow me to wish our Jewish students a belated Happy
New Year, and for those of you who fasted, I hope it was an easy
one. For those of you who don’t, bon appétit!
We have a terrific student body. I continue to be amazed by your
variegated backgrounds, your energy, idealism and strength of purpose.
As your faculty, it is our privilege to help you to become the
best doctors you can be.
Yours sincerely,
A. Mark Clarfield MD
BGU-MSIH Director
3
FALL 2011

A MESSAGE FROM OUR STUDENT COUNCIL CHAIR
THE BALAGAN
jolly talie’s rhyme time
On behalf of this year’s Student Council crew
I’d like to take this opportunity to formally welcome you
To what will no doubt be a challenging but hopefully uplifting year
adding unique dimensions to our future medical careers
Just to remind you -
MSIH’s Student Council, in summation
facilitates and informs student/administration communication
SC members meet every four weeks
to discuss what is/will be happening and what could be tweaked
To give you an idea of what the new SC has done thus far
we have had one meeting to feel out what will be on this year’s radar
There, SC members shared what was happening with their individual initiatives
and also turned our attention to some topics that were a bit more deliberative
We discussed issues including switching to Deichman, extending library hours
and what might be the most productive and realistic uses of our powers
To find out all that was discussed at each student council/administration meeting
please visit the student council section of the student website for some minutes-reading*
I will also do my best to send out monthly updates of what we are doing
to ensure that those who want to be, are kept in the loop-ing
And if at any point, you would like to attend one of our documented gatherings
All meetings are open, so feel free to come and add some chatterings
Aside from that, always feel free to contact me via any channel
if you feel you have an issue that student council can handle
Other than that, I hope you enjoy your studies
and hanging out with your fantastic MSIH buddies!
Your Rhyming Student Council Chairwoman,
Talie
*http://sites.google.com/site/msihstudents/Home/student-council-1/administration-and-student-council-meetings
4
FALL 2011

A SECOND YEAR’S THOUGHTS ON THE EXPERIENCE OF DISSECTION
THE BALAGAN
How to reconcile a corporeal violence, no matter how
respectful the intention, with the need to honor and
respect the human body? An answer to the dissection
conundrum seems to lie within the related and
paradoxical macrocosm at the heart of the physician’s
profession: maintaining the distance necessary to enable
objectivity and dispassionate decision-making,
while not sacrificing, but rather enhancing humanism
and empathy. The temptation to move toward one
side and away from the other is significant; within the
culture of medicine, we all know which has the stronger
pull. Indeed, the temporal empathy statistics are
decidedly dismal.
“It’s self-preservation!” we might exclaim, submitting
that great beneficiary of the Enlightenment, individuality,
in defense of our desensitization. But to insist on
this is to endorse the idea of doctor-patient interaction
as a zero-sum game, one in which compassion is
bestowed only at the expense of our emotional stores.
Surely there must be ways of exposing ourselves to
the deepest secrets of the human body, to every internal
and external crevice, without losing our tenderness
toward human dignity? To witness the gruesome
strainings in the last throes of toxin-induced tetanus;
to stand by as cells betray their primordial purpose
and ravage their sustainer; to lose contact with another
intellect and personality as beta-amyloid deposition
reaches a critical threshold; to confront Shakespeare’s
“infinite malady”, syphilis, as it insidiously corrupts
mind and body—without becoming callous?
Perhaps belief in an affirmative answer to these questions
begins with human dissection during the early
stages of medical education. As the first test of our
ability to resolve experiences of desensitization and
deep thoughtfulness, it provides a foretaste of what it
means to be both a professional and a compassionate
practitioner. The cadaver’s condition may no longer
exceed the biological, but ours—and that of our future
patients—certainly does. And so we instinctively
recoil from that first glimpse; that first cut into a human
state that awaits each of us. But soon enough it
becomes easier, the existential shock fades, the scent
of formaldehyde becomes familiar, and we shake off
our initial unease. The body begins to resemble not
so much a grandparent as an organic closet full of machinery
to be scrutinized and committed to memory.
A healthy distance is now in danger of becoming disconnection.
And it is no wonder: the liminal, in-between position
can be quite uncomfortable. Maybe this is why there
remains a temptation to preserve and inhabit stable,
simplified positions—intellectual, political, moral—at
moments when it seems too vexatious to understand
or accept a complexity. Intuitively, a threshold is a
dangerous place to make one’s stake. And choosing
to embrace an outlook that spans both objectivity and
compassion is to acknowledge cognitive and emotional
dissonance at a time when we are searching
desperately for clarity in thought and purpose. But
clinical medicine is not about seeking what is comfortable
or feels natural; it is about societal service and, at
its very foundation, using reason and limpid judgment
to become the fiercest of patient advocates. It is about
embracing the paradox.
Embracing
thE ParadoX
Bram Wispelwey
Class of 2014
5
FALL 2011

ADVICE ON NOSE HAIRS AND LIFE FROM A FELLOW STUDENT
THE BALAGAN
Industry is the Enemy of Melancholy
“The West was made by violent, uncomplicated men, and it is
this strength and simplicity that I try to recapture in my pictures.”
Sergio Leone
Early in the Fall last year, Jared asked me to interview Dr. Hershfinkel, our
histology professor for the BLGN’s “Who’s Who” faculty interview, but I
couldn’t come up with any questions other than “what is your favorite microscope”?
Am I really going to ask her that? No way. So he had to find someone
else to do the interview, but that didn’t mean I was off the hook.
Now again he has asked me to write something ‘funny’, and I told him I can’t
be funny under pressure, “No I mean, write something introspective.” Oh,
God, introspective? But I don’t want to be the introspective guy. “Whatever
man, just do it, you have all of Sukkot before your next class even begins.”
Ugh, fine, whatever, maybe I can come up with something.
Here’s what I’ve learned: you have to get out of your apartment.
You can stay inside all day, every evening, but whatever it is you’ll be doing
will just be a bad imitation of life.
Here’s what happens, I mention it because I’ve fallen in to this trap before
as well.
It’s late at night, and you start picking your nose. Now you have finally managed
to get that really hard to reach booger, you’ll notice you have more nose
hair than you used to, wait, when did I start getting nose hair? I pull on it, and
when the coarse nose hair comes out, greasy, sturdy, and short, it’s satisfying,
but maybe I should get a nose hair trimmer? Oh, there’s a good one I see
here on Amazon. Three weeks later, it arrives in the mail.
Wait, did I just spend three hours reading reviews
on Amazon for the Groom Mate Platinum XL Nose
and Ear Hair trimmer? I don’t even really have any
nose hair.
Spending Thursday nights researching nose hair
trimmers is the nadir of human existence, but
you’ll console yourself “I have no energy to do
anything else” (bullshit). And I’m tired of plucking
the hairs out with my fingers, and so I bought
it. Stop spending evenings reading bullshit on the
internet, go outside and play! Do you want to
spend your twenties in a dark cave, asphyxiating
on the smell of your farts, as you stare at a glowing
rectangle reading your email and the New York
Times? Your time spent on the internet is a selfannihilating
vortex.
We are in our twenties for such a short time! You, me, everyone should be
making love, sitting in perfumed gardens aside placid fountains, whispering
love sonnets into the ear of his or her true love, with dulcet harp tones sounding
just beyond sight. The guy with the dark eyebrows on the groom mate
package has probably never worried about hair in his nostrils.
6
FALL 2011

ADVICE ON NOSE HAIRS AND LIFE FROM A FELLOW STUDENT
THE BALAGAN
Sure, life in medical school is rough. I woke up for my test yesterday morning
with my stomach in knots. Was it fear or maybe something I ate? No, it
was definitely fear. Still on my toilet, but with only 8 minutes before the test
was about to start, I was squeezing my hardest for something to come out,
I could hardly bear it.
But when I sat down to take the test, the knots untied and I felt fine. And in
the evening I could share that toilet anxiety with some other students whose
stomachs also were aching in just the same way. We’re all in this together.
But if I stayed home last night, I probably would have started reading the
reviews for a cordless, electric, lithium-ion battery powered trimmer (which
is not necessarily better than the Groom Mate).
This essay isn’t supposed to be a deep meditation on happiness. Maybe there
are some life lessons here, but I just want to give an account of a good day.
The best moment though was some time in the afternoon in the gym. The low
row machine was empty and I put the pin in the 70kg hole and pulled, after
a half hour or so in the gym my muscles were filled with blood, and I glanced
at my arm. My cephalic vein was bulging out of my right bicep, and nothing
else made me as happy that day as seeing that big blue vein.
Nothing I read on the internet, or pictures viewed on some unimportant acquaintances
photo gallery, has provided any satisfaction close to that time in
the gym, not before or since.
David Brooks writes, in Wandering Mind is a Sign of Unhappiness,
What psychologists call “flow” immersing your mind fully in activity has long
been advocated by nonpsychologists. “Life is not long,” Samuel Johnson said,
“and too much of it must not pass in idle deliberation how it shall be spent.”
Henry Ford was more blunt: “Idleness warps the mind.”
Alain de Botton also observes in On Distraction,
The obsession with current events is relentless. We are made to feel that at
any point, somewhere on the globe, something may occur to sweep away
old certainties—something that, if we failed to learn about it instantaneously,
could leave us wholly unable to comprehend ourselves or our fellows. We are
continuously challenged to discover new works of culture—and, in the process,
we don’t allow any one of them to assume a weight in our minds. We leave
a movie theater vowing to reconsider our lives in the light of a film’s values.
Yet by the following evening, our experience is well on the way to dissolu—
tion, like so much of what once impressed us: the ruins of Ephesus, the view
from Mount Sinai, the feelings after finishing Tolstoy’s Death of Ivan Ilyich.
A couple times a year I get a newsletter from my high school, and it always
ends with a quote from the founder of the school: … Everglades High School
seeks to produce graduates who “believe that they are in the world not so
much for what they can get out of it as for what they can put into it.”
… The west was made by violent and uncomplicated men.
Men who didn’t think too much. Men who didn’t spend
half their life reading the news. Men who didn’t obsess
over their nose hair. If we’re going to get anything done,
it will happen when we turn off the glowing rectangles,
and go outside. The Negev will also be made by uncomplicated
men.
Eric Brandon
Class of 2014
7
FALL 2011

SHOUT OUTS TO MSIH
Congrats to Isaac Hatton on his marriage
to Camille, and to John Powers on
his marriage to Katherine. Welcome,
spouses, to Beer Sheva!!
Props to Eric B. for making pasty look
(almost) cool.
Dear Andrew-babe,
How’s our baby doing?
THE BALAGAN
Love, Tim
PS Sorry Andrea...
Jeremy L, Thanks for trying to fix our
diploma.
-A statistically significant
percentage of the
MSIH student body
Congrats to 2013 for making it through the
boards and to the wards...
Nelson!
Thank you for bringing coffee everyday
for morning report. It really helps me
stay focused on what the doctors are
talking about.
- JB
An Pham-
What did you dress up as for Halloween?
Thank you Renata, queen of books.
-Hanan
Dear Minsoo, Thank you, thank you,
thank you for being you.
- Rachael
Dear PG Un,
Why don’t you sleep at night? I hear milk
and cookies help. Ill leave some by the
window for you. Cookies for silence. It’s
a deal.
Love,
Sleepless in B7
Dear Eliezer Ben-Yehuda,
Make up your mind and choose ONE English word
for Kikar!
-Ross
Dear Tootsie Pham,
Thank you for being our social/cultural/musical/
sartorial/dionysian fuhrer.
With love,
Humanity
Dear Miriam and Shelly, Thanks for the new
wardrobe.
––-Obviously Me
Kyle and Jayla,
Congratulations on the arrival of the little guy!
We all look forward to meeting Luke. Shall he
be as spoiled with baked goods as we all are.
-Class of 2013
Hilary, I will NOT defect from the United States!
Stop asking!
Forever, Caitlin
My Buddy, Sarah D! Here’s to better-than-lastyear
adventures ahead! Thanks for sticking it out
with me since Day 1! You are the coolest.
Your Pal,
Renatalove
Shout out to Real World Eilat. Thanks for keeping
it...real?
To Becky, Natalie, Avi, and Heather:
Thanks so much for joining Hatoulim Akshav!
You’ve made a difference in the lives of dumpster
cats everywhere.
- Debbie
Q: What did the grad rocket say to the iron
dome?
A: No seriously...
I. Have. A. Restraining. Order.
Dear Nicole,
Slichha!!! Some time has past and all
of my repenting during the Hag has
made me feel even worse for hitting
you with my car. I didn’t quite know
what to do at the time, so I just stood
by and watched some random women
pour flavored-water on you face to
make you stop crying. I hope it helped
your leg!
I must say though that I feel like you
were walking across the street a little
too slow, as if you had a long night in
Tel Aviv the day before and I feel like
the blame is not all mine!
I hope that you can forgive me for
my half of the blame. Enjoy the large
check from me for all of your joyriding
cab rides that the government
is forcing me to pay for! I hope your
friends enjoyed the free rides!
-The lady that hit you
Dearest Spencer,
We miss your sweet dance moves. Please
come visit us more often.
Love always,
Einsteins.
To All Professors:
*applause*
- Jason
Dear Al F. Minoos,
Keep trying and you’ll make it. Practice
always makes perfect. It’s so cool that
you have your own camel, too. Metsuyan!
Love,
AL. F. PLOOS
Dear Nave,
Inviting me out for drinks with that accent,
” ehh,, you want to go to the manngaaa?”
gets me through each week.
Thanks achi,
Tony
8
FALL 2011

A THIRD YEAR’S PERSPECTIVE OF THE WARDS
THE BALAGAN
TRYING TO FIGURE IT OUT
Certainly with all of the intricacies and details inherent
in medicine, some method of simplification was called
for. Entering my third year of medical school, I’ve noticed
that the most basic shapes – squares, circles
and triangles – have all played an essential role in
my learning.
It’s early in the morning and I’m having trouble focusing.
My nephrology professor notices this and sketches
a box on the whiteboard. He draws a line down the
middle and divides two categories of kidney disease
by criteria. Suddenly the distinction between nephritic
and nephrotic syndrome becomes tangible. And it
helps because when I’m pondering whether minimal
change disease is nephritic or nephrotic in nature, I
just need to recall how that square was drawn and on
which side of the shape that given disease fell. Maybe
the reason why geometry is one of the first subjects we
learn as kids is because we end up referencing it for
the rest of our adult lives.
I’ve learned to think in shapes. I see triangles containing
the “step-up” and “step-down” medical therapy in
the treatment of Crohn’s disease; the circles of a Venn
diagram bubble to the surface of my mind and simultaneously
include and exclude criteria of bronchitis
and emphysema in COPD. It is the contents of these
geometric simplicities - the complexities of any given
illness - that we are then expected to take with us to
the clinic, and use them to help our patients.
When I arrive at the internal medicine ward to begin
my first day of clinical rotations, I bring with me more
tools. I glance down and notice the round bell of my
stethoscope, the triangular head of my reflex hammer
as it extends beyond my coat pocket. I’ve spent decades
in the classroom preparing for this day and I
feel ready.
I approach my first patient. She is younger than the
other people in our ward.
Just twenty years old, this young Israeli girl has just
recently finished her national service. We talk, and
as I take her history she describes to me the onset of
her symptoms.
That night I go home and for the first time in my life
I feel my assignment is real. I scramble excitedly
through the pages of Harrison’s Manual of Internal
Medicine recalling her symptoms and relating them
to her history. Abdominal pain, fever, diarrhea, nausea,
vomiting. In my notebook, I draw bubbles and
boxes and connect them with lines all of which result
in a flow chart indicating to me that the most likely
diagnosis of my patient is some sort of infection. We
should give her fluids and wait for cultures to come
back before initiating any other treatment. My attending
agrees with me and I feel stoked. However, four
days pass and our patient shows no signs of improvement.
On day five, her condition begins to deteriorate.
She has developed fluid in her abdomen and chest
and has begun to have difficulty breathing. Suddenly,
I feel as if I am failing.
I’ve had this feeling before. Sometimes when I’m back
in my hometown of Seattle, my friends like to present
me with some strange constellation of symptoms
they’ve had and seek my advice. The thing is - and I
often tell them this - there are just about forty billion
things that can go wrong with our bodies. I’m at the
beginning of a lifetime of learning and maybe I know
a handful of those things. At this point unless one of
them has Shingles, it’s really tough to diagnose anything
with any confidence at all. They should probably
go see a real doctor.
More than three weeks have gone by since my first
patient’s admission and I have followed her from x-ray
to ultrasound to paracentesis to laparotomy and she is
still without a diagnosis. She has undergone an invasive
surgery, and there are still no answers. In other
words, the physicians don’t know which shape she fits
into either, and this scares me.
Today in our ward there is a sense of urgency. It’s
been twenty-five days since our patient’s admission,
and I watch as my attending physician presents our
patient’s case to a team of other doctors. A gastroenterologist,
a surgeon, and the head of our department
are all present. They sit around a square table bouncing
ideas off of one another discussing the differential
diagnosis. They won’t give up. And I see now that it’s
all of the uncertainty in medicine that probably drives
most physicians, and even though it’s just the beginning
I can sort of feel it driving me too.
The meeting comes to a close and I go to visit our
patient. She is sitting up in her hospital bed and manages
a smile as I approach. I notice a tube draining
a cloudy yellow liquid from her abdomen. We talk
more, but the yellow fluid distracts me. I try and place
the properties of the serum – where I might have seen
it before – but I’m overwhelmed, and in that moment
no shape can rescue me. It turns out that there is no
geometric reference for real medicine. It’s going to
take a whole lot more before I begin to figure it out.
Jared Brazg
Class of 2013
9
FALL 2011

AN UPDATE FROM ON OF OUR STUDENT GROUPS
THE BALAGAN
MSIH,
The Curriculum Committee is entering its
third year, and we couldn’t be happier with
the progress we’ve made and the support
we’ve received from the student body and
administration. This year we have three
new members: Missy will be joining us as
a third year rep, Adam as a student council
liaison, and Chris Brown as a first year rep.
We have some really big changes that we
will be pushing for in the coming year and
we will continue to work with the administration
to make MSIH a better all-around
medical school.
We sent out a letter in the beginning of the
year detailing our accomplishments from
last year. We’d like to highlight a few of
those and give some small updates on how
the changes have impacted current students.
To begin, there has been a major
change in the overall structure of the microbiology
course. Dr. Lobel, together with the
administration, has helped shift the course
from an anatomically based structure to a
pathogen-based course. First year students
began learning this course with bacteriology
and will progress with virology, parasitology,
etc. We understand that the course
is still not perfect, and we will continue to
work with the administration to improve
this course. Pharmacology, too, has been
revamped and will place a stronger empha-
sis on antibiotics to help prepare students
to excel both as doctors and on the Shelf
and USMLE exams. Immunology has a
new course coordinator and we would like
to thank Dr. Eli Lewis (future Israeli Nobel
Prize winner) for his dedicated efforts with
this course.
Second year students just finished the cardiovascular
system and could not be happier
with the 75-minute class-scheduling.
The administration is aware of the students
preference, although it is up to the discretion
of the course coordinators to shift to
the newer system. We are hopeful that with
time, all of the coordinators will make this
switch to benefit the wishes of the student
body.
We have big plans for the year ahead. We
will continue to address the students’ needs
and work with the administration to reach
compromises that benefit us all. We hope
to be able to further improve the current
curriculum while placing greater emphasis
on USMLE preparation. We will continue
to push for bigger and better changes to
ICM, Hebrew and communication, as well
as many other minor and major changes to
improve our overall curriculum.
Wishing you all a successful year,
Missy, Lara, Emanuel, Adam and Chris
10
FALL 2011

PRACTICAL INSTRUCTIONS FOR THE OCCUPATIONAL HAZARDS OF MSIH STUDENTS
THE BALAGAN
“Negev Security Authorities in the Negev
insist that chlorinated water may be good
solution to protect from terrorist threat”
Ehud Ravitz, YNETNEWS
Homeland security authorities in the Eshkol region council,
along with police authorities in major southern cities including
Beer Sheba and Ashkelon, have declared being submerged in
water and moving around a good self defense technique against
the incoming grad rockets that have been pounding southern
Israel in the past few days. The original idea, implemented by
a handful of Ben-Gurion University medical school studying at
the school’s American medical program, was actually started
as a daily self improvement and exercise routine. In addition
to the obvious cardiovascular benefits of the exercise, the students
also mentioned that they often watch the lifeguard as he
looks at “anything EXCEPT the pool as he DJs the university
pool complex.” The swimming routine, officially named “Man
Swim,” is generally performed by the young men during the
hour where the other students eat at the violently overpriced
Fake Aroma in the hospital–around noontime on weekdays.
Despite the seemingly excluding and offensive name, females
are welcome to partake if they can keep up with the “legendary
pace, symmetric strokes, and offensively tight swimwear” says
Hanan Atia, vice-cosecretary of team Man Swim.
Little did the students know that their aquatic routine is the
safest and most effective way to prevent injury and acute death
once that code red siren is heard, an event that seems to be
becoming more and more common in the south of Israel during
these difficult times. “Honestly, we just do whatever Bram
does,” Man Swim’s gentleman ambassador David Mills was
quoted saying confidently, early yesterday morning in a phone
interview.
M A N
S W I M
Hanan Atia
Class of 2014
The handful of gentleman are known to swim so fast and so
efficiently that even if the terrorist projectiles were traveling at
150,000 km/second (roughly half the speed of light), the swimmers
still wouldn’t get hit by the rockets or by the debris. Man
Swim’s head of security operations, Emanuel “the detective”
Ebin explains how this is possible–“It’s complicated but let me
break it down for you. Essentially, if we swim fast enough we
are technically not even at a certain point at a certain time, this
delightful physical phenomenon is what protects us from the
projectiles. Think of trying to catch a photon as it travels from
the lightbulb to the wall...fucking impossible....Only downside
is that the sheer kinetic energy we gain in the water causes
instantaneous evaporation of the water immediately around our
skin, so the DJ at the pool needs to refill the water on biweekly
basis. Sucks for him.” When questioned about the water wastage
involved in evaporation of the pool’s water, the DJ-lifeguard
responded “Emm, ehh, its also nicely. But, eh its also not so it
much it’s from together”–Ynet article translation branch is still
trying to figure out what exactly he meant by the odd collection
of meaningless words.
Upon hearing clips from Ebin’s most recent interview about
breaking the sound barrier within two swim strokes, Man
Swim’s head physical trainer David Kawior has strongly
claimed he is fully responsible for the physical capabilities of
the swimmers saying they would be “worthless self-hating
physically atrophied diabetic nothings” if it hadn’t been for his
expert guidance.
Y-Net interviewer Yotam Greenberg inquired with the team
about potential additions and/or guests to the Man Swim,
vice-co-secretary Atia insisted that “we let few guests into Man
Swim because once we teach them the secrets they may use
the power to perform evil. On occasion we allow Jared to join,
but we insist he wears a florescent pink bathingsuit in the event
we need to put him down. He never complains though because
he says the ladies love the confidence...” Atia also added
that some individuals are banned from Man Swim– “Thomas
is never invited because of concern that he will hypnotize and
kidnap David Mills, one of our cutest and most fashionable
swimmers.”
The swim team’s coach, captain, founder, CEO, COO, CFO,
public relations officer, and czar-fuhrer Bram Wispelwey expressed
his opinion in a bizarre fashion by just repeating the
words “Bro” and “Gunner” frantically until the interview came
to a close minutes later. Soroka Chief Neurologist Eran Shegali
says Wispelwey has sustained “significant central nervous system
damage [due to] accelerating at such an unexpected pace.”
Being the fastest swimmer of the four, Wispelwey has been said
to sustain enough cerebral damage and physical deterioration
per swim to turn him into a live replica of the famous “Simon
Birch” by the time he is expected to graduate in 2014.
11
FALL 2011

A MESSAGE FROM AN ALUMNUS
THE BALAGAN
MeDICal
lInGuISTICS
Dov Frankel MD
MSIH aluMnuS
It was another day in the ER and all was calm, when medic 17 rolled
through the front door. I was sitting at my desk writing orders on a
patient that I had just seen with chest pain and shortness of breath.
I could feel the stretcher roll past me and make out the agonizing
moans of the patient reverberating through the emergency
department. As the ambulance crew transferred the patient from
stretcher to gurney in bed 15, I could hear a commotion begin to
stir between the patient, nurses and paramedics. There were two
cardinal rules which I was taught early on in my career to try and
keep order in the ER; 1) Running in an ER is never OK unless you
are on your way to a code blue or trauma patient. 2) Try to keep the
noise level to a minimum if at all possible. I decided to meander
over to bed 15 to see if there was any way I could help and possibly
bring some order back to this tumultuous situation.
Raised in Montreal and having studied medicine in Israel, I have
become pretty fluent in several languages. Growing up we spoke
French, English, Yiddish and Spanish, as my mother is from South
America. While in Israel, I became fluent in Hebrew and picked up
some Russian and Arabic. Needless to say, many of these languages
come in quite handy at times in our high volume, high acuity Urban
ER.
As I approached the patient’s room and offered to help, the nurses
turned to me and said “even you, Dr. Frankel can’t help with this
one. This patient is from Ethiopia!” It was at that moment that
I turned to the patient, held their hand, looked them in the eyes
and said “Indemineh”. Yes, that’s right. In my fourth year at BGU, I
was lucky enough to do my international rotation in Ethiopia and
actually picked up some Amharic. Well, as you could imagine, the
room went dead silent, the patient immediately relaxed, laid back
in his bed and had a tear trickle down his face. Needless to say,
the priceless look on the nurses faces when I continued my basic
medical interview in Amharic until we got an official translator on
the phone. I am recounted of this story almost on a monthly basis
when we get the occasional patient from another country who
doesn’t speak English.
Being the Assistant Chief of a large busy Emergency Department
requires lots of skills not taught in residency. BGU prepared me
to rise to the challenge under various hectic situations. Taught me
never to forget that the patient you are treating is first and foremost
a human being. When you treat your patients the way they deserve,
you not only develop a better rapport with your patient, you are accepted
by your nurses and peers as a compassionate physician who
truly cares about his/her patient. With these fundamental skills, you
could accomplish anything and it is thanks to BGU for teaching me
these lifelong lessons that I have gotten to where I am today.
12
FALL 2011

GOT PHOTOS? SEND THEM TO:
msihnewsletter@gmail.com

A FIRST YEAR’S INITIAL THOUGHTS ON LIFE IN BEERSHEVA
HERE IN MY
BOMB SHELTER
OF A HOME
Hello, I am 22 years old and I recently started medical
school in the Middle Eastern desert, where I live in a bomb
shelter.
דואמ םיענ
The beginning of medical school is like a Foreign Body Airway
Obstruction (FBAO). It makes you choke, question
how you got to that point, call for help, and only after some
outside assistance and the right push can you breathe. My
outside assistance came in the form of a wise third year who
once told me, “no matter what age you are or experience you
came here with, Beer Sheva will change you.”
At the time when I was told this, I could already foresee
much change ahead in my life. Now, I have no doubt that
this wisdom applies to each and every MSIH student no
matter if you completed the Peace Corps in Senegal, lived
in Australia studying molec bio, or assisted with surgeries
in Nepal. I mean, academically, I can even see the push
for changing our accustomed ways. We go to class Sunday
through Thursday, we learn from teachers who pronounce
the word chemical “ההה-emical” and, wildly enough, we
don’t learn anatomy until second year! Crazy, I know.
Living overseas from family and friends for a certain length
of time really can change anyone. However, I still see many
similarities between med school and undergrad that make
the transition a comforting experience.
THE BALAGAN
Firstly, I am aware that there are more women in the world
than men, but this statistic really loves to follow me wherever
I learn. I went to school at Sarah Lawrence College [SLC]
in Bronxville, New York. No, it is not an all girls’ school, but
the ratio of men to women is 30:70. Indeed, in my class at
MSIH there are many more women than men. This gross
imbalance has become an enigmatic comfort in my life.
Secondly, SLC is an incredible school where class sizes
never exceed 60 and students are not allowed to declare a
major. MSIH is also an incredible school where class sizes
never exceed 45 and there is opportunity to study beyond
the curriculum through a global health lens. These intimate
classes are crucial to my learning experience. Every morning
I get to walk into class smiling at the faces of my fellow
students. Together we feel like a family with the common
goal of entering the humanistic field of medicine.
Thus far, it is safe to say I have slept every night in my
bomb shelter with an obstruction-free airway. Here, I feel
extremely comforted to know that I am not threatened by
any rocket attack that hits our town and that I have and am
receiving the best possible education for me.
בוט הליל
Kady Goldlist
Class of 2015
14
FALL 2011

THE FUNNIES
comes with the territory
THE BALAGAN
by Jeremiah Groen
Class of 2012
find them all!
15
FALL 2011

WHO’S WHO: AN MSIH STAFF INTERVIEW
Tell us about your childhood. Where did you grow up?
I was born here in Israel 68 years ago. My parents moved
here from Russia and Czechoslovakia before the Second
World War. My father was a police officer and was transferred
around a lot, so I grew up in various places all over
Israel.
How did you decide that you wanted to become a Biochemistry
professor?
After finishing my Bachelor’s and my Master’s, I moved
to Be’er Sheva with my husband. I found a job at Soroka
working with children with metabolic disorders. It was
through this work that I was inspired to pursue a PhD,
which I got from Hadassah in Jerusalem. The subject of
my PhD was glycogen storage disease. Because I was
already a biochemist working in the clinics at Soroka, I
was asked to become a professor when BGU’s medical
school was established. I’ve been teaching
biochemistry to medical students ever
since.
What do you love most about
Biochemistry? What was
your inspiration for getting
into the field?
I consider myself a
clinical biochemist.
My interest in research
flowed from
a desire to answer
the clinically relevant
questions that
were raised during
my time helping
those with metabolic
disorders in
the pediatric wards of
Soroka. The connection
between the knowledge
and patients and knowing
that my research may tangibly
help those kids is what inspired
me.
What do you think is the most fascinating biochemical
pathway?
My recent research has focused on glucose transport, focusing
on the effect of oxidative stress on glucose transport.
We’ve also discovered that abdominal fat is a lot
more dangerous than subcutaneous fat in those with
diabetes. We’re trying to correlate the amounts of macrophages
in fat tissues with the incidence of disease. But
I’ve actually recently passed the age of retirement in Israel,
so one of my associates has taken over my research.
Are you involved in any international medical endeavors?
Yes. In Nepal, there is a big problem with doctors leaving
to practice medicine in other parts of the world. There is
a new medical school in Kathmandu that trains doctors
from rural areas of Nepal. They don’t have to pay tuition
– it is not for the rich people. The graduates return to
THE BALAGAN
with prof. nava bashan
the rural areas. I recently spent two weeks training the
professors at this medical school. In fact, they’re now
using many of the same biochemistry materials that you
are familiar with!
Rumor has it Dr. Lewis was once your pupil. Is this true?
Indeed. Before switching to focus on biochemistry Dr.
Lewis spent three years as a medical student here, and I
was one of his professors.
Do you have a family?
I do! I have three children and six grandchildren.
Yofi! What are some of the biggest differences between
teaching Israeli and American students?
American students are a lot more gentle. They come to
me at the end of the course and tell me “thank
you, we enjoyed the course!” They don’t
fight. The Israeli students tend to be
a lot more aggressive. Another difference
is that the American
students come with much
more previous knowledge.
We have twice as much
class time to teach the
Israeli students the
same material that
we teach you.
Do you have any
pets?
If you came to my
house right now this
is what you’d find.
A cat in my bedroom
that can come and go
through a little door.
It’s name is Leni. We are
also currently doing some
dogsitting.
What is your favorite holiday?
I think it would be Passover, because family
comes together and the weather is marvelous.
For me the most important aspect of holidays is the
time with family.
Besides teaching us, what do you enjoy doing in Be’er
Sheva?
I enjoy walking in the desert. There are marvelous wadis
and such to explore. My dream had always been that
when I retired I would get an apartment
in Tel Aviv. I’d spend the mornings on
the beach and the evenings at restaurants
and listening to live music. But
I’m still here! A lot of it has to do with
the work.
Toda raba!
interview by Jason Toews
class of 2015
16
FALL 2011