The Medical Aviator's Review

Mortality and other trivial things...

2009-09-22T00:23:00.005+03:00

In this, the 3rd month of my medical residency, I find that I am learning lessons beyond science. The technicalities of medicine are thick, that is for sure, but the art of connecting with someone in a profound moment has been a pleasant surprise to me. I am not the kind of person to enjoy "touchy-feely" moments and often I will be the first to back slowly out of a room once someone starts crying. But there is something curiously satisfying about dealing in human mortality. The kind of lessons only learned at the border of life and eternity are found in the most unusual places and times... perhaps the least unusual is in a hospital. We expect deep insights on life to come from a place of healing, and often times death, but nobody expects them elsewhere in our daily lives. Please don't allow me to write melodramatically here, I do not want to write about the fast-paced ER or the operating table where lives almost always hang in the balance. Instead I want you to practice the art of bringing out the good and the eternal in everyone around you.

Simply put, we do not experience life as a brotherhood. Something inside us (I am addressing this to Americans mostly) tells us that we value things too differently to express the ancient good in public with strangers. What do I mean by ancient good? The next time you wake up feeling happy and you go to work or out in society, dance a little jig or sing a little tune and see what happens... $100 says that the people that see you do it will smile, laugh, or even join you! That is the ancient good. We all understand what you are expressing and we want to be a part of it. The ability to recognize good is lodged deep in our souls (perhaps because we are so inclined to do evil). But with that one moment of joyful expression you have instantly shared a common purpose with us and that brings people together. (And for Christian believers, letting out this ancient virtue is not only satisfying, but is commanded from you).

Unfortunately there is a less enjoyable side to the ancient good... that is our basic drive to preserve life. With an extreme minority of exceptions, almost everyone would do something to save the life of a stranger sitting next to them if the need so arose. We know it to be right, and it's irrefutable. Some of us would be petrified with fear, but the drive to save that life would still be there. We want life. Mortality prevents us from having it, right? (I would argue here that death is not the opposite of life, only the absence of it, but that would take an entirely new post. Perhaps later.) I digress. The point is that this kind of experience isn't so different from the first, we instantly share a common goal. We connect in our desire for life. Whatever the outcome, we go through it together. Sometimes it turns out badly, other times we can celebrate, but we always remember and learn in the end. As a resident physician, I gratefully experience this daily.

The lessons of connecting with people on a base level do not come easily, but the opportunities to do so are more abundant than we have convinced ourselves to believe. We all strive for the same things; happiness, peace, rest. We all honor the same qualities; true courage, bravery, generosity. The only difference are the ways we contrive on our own to get there. And we have made up some stupid and almost always harmful schemes of trying to attain a clear conscience on our own. So the challenge I offer today is... Do not let your fear keep you from expressing the ancient virtues that we were meant to own. We have been given the grace of God and that alone is reason enough to act on those ancient truths. If you do... you will share life in it's fullest with strangers around you.

Sacrifice...

2009-05-07T22:52:00.006+03:00

A whole year? Really!? Wow, who would've thought I could go that long without Blogger.com deleting this stagnating thread? I'm glad they didn't toss my posts... my attitude towards life and everything else has changed and grown over the last 5 years. If I lost the record of it, I wouldn't see the change as sharply. Anyway, I'm glad to update you today blog, since I have great news.

For the last year we've seen nearly everything change. The economy, wars, leaders, even our culture have experienced drastic shifts. For many of us, what lies in the near future, makes us apprehensive at best. A growing sense of mistrust sits in our gut, waiting for the hammer to fall. Most of us are hard-working, independent types who know the value of looking out for family, self, and one another. I say most because until this year, I would not have considered myself hard-working. Sure, I've accomplished much in school and abroad... but my attitude was that of folk my age... "What's in it for me?" Entitlement is the word the pundits on the TV assigned to the phenomenon. And I will confess... I am guilty of entitlement.

Why have many people developed this tumor of selfishness? Is this anything new or is it a theme of the fall of humanity? I'd say it's both. I won't attempt to defend the disposition at all, but maybe an analysis of why we are suddenly overwhelmed with a "me" sentiment is in order. What does it mean for the future? How can we change? And with a few speculations of my own, perhaps the few who really see the problem can do something about our "Entitlement".

It seems to be a new issue, but I know better. Selfishness is the original sin after all. We've carried it since the dawn of mankind and it has wrecked everything we have ever done on our own. So why does it feel like a new problem now? Are we really being selfish, or are we genuinely entitled to something better? For ages man has tried to improve his condition, make work easier and remove obstacles. To our credit we've made great strides, the overwhelming number of them have occurred in the last century... most in the last 30 years. How does working hard to improve our circumstances make us selfish? In itself, it doesn't... but we've reached a tipping point of comfort. Waiting in uncomfortable circumstances has become a non-option. The routine of instant results has trained us to expect them in every facet. In a time when literally everything is a few clicks of the index finger away, why wouldn't we expect more? I see it all the time in the hospital. A patient will refuse to see that the best solution to his problems is long-term lifestyle change. Instead he seeks the instant, easy to swallow pill because... well, it's easier.

I've brought all of this up today because I see it as the root problem in our culture... and I've had a change of heart. In this last year of no job, and what seemed no clear purpose, I've craved work. Any work... I cleared brush and trees in Ireland just for food in return and it was the most satisfying experience I have had in a long while. The effort made me grateful. And for the first time in a long time, I was willing to do anything just to give back. God rewarded me with a task I would have scoffed at a year ago. This last March I got a residency in Family Medicine. I am grateful. It isn't what I would have chosen, but that's exactly my point... if it's not what I want, but I still work hard to give back to my people, then it is worth so much more. Sacrifice for others is the definition of love. And that, my friends, is not easy.

My generation has forgotten these lessons, or was never taught in the first place, but God will teach us again with the difficult times ahead. They are coming. My hope is that our record, the history of my age, will not say we were a selfish generation, but that we repented and humbled ourselves to the difficult work God gives us.

Keep the fight.

Adrift...

2008-05-04T18:11:00.008+03:00

A week has past and I have tried multiple times to write about something worth reading. Call it writer's block, call it laziness, or perhaps lack of direction... I imagine all three play a large part. When I see the blank page in front of me, all of the infinite combinations of words log-jam in my brain. Endless options, some more exciting than others, linger on the tips of my fingers. Still nothing flows out of my mind. My expression fails. "Why is this so difficult all of a sudden?!" I shout behind my eyes. "Just write about anything that fits! I can make that blank page into anything I want..." So in this issue of The Aviator's Review... How do we choose to fill a blank page?

It's no secret that the end of medical school came and went not too long ago. For the last 4 years my life's path has been set in the Hippocratic stone. The 4 long years of lessons on how to act in every situation, and often how to act in general, are ending now. Choices during my training rarely required exploration and often defaulted to one answer because I knew to stay the course. In those times I knew the where's and when's of upcoming years... until now. Finally, the question of what to do next is unclear again. Life set down a blank page.

All of us have experienced turning points in life, the moments when we realize that our lives will not be the same. The course becomes unclear and choosing a direction can be like setting out to sea without a map. Some of us live for this come-what-may kind of adventure, others fear the unkown, and some never even look to the sea... but I still believe that all of us crave the freedom that an unknown future holds. For the exact same reason, nobody reads the end of a chapter before reading the beginning.

We love stories.

"I can make my blank page anything I want." ...or at least that is what I'd like to believe. The truth is I can't create just anything. Some stories will never be put to paper by my hand, and more importantly, I am not the author of my life. Some ideas, however great, will be left unwritten because I have an expiration date. My life will end someday and my chance to fill the pages will be over. Many ideas and opportunities exist, but the time is short... We only get one story to write. Choose your course well, use the small starlight in the sky that the Almighty places on your way to guide you, and never be afraid of an open horizon.

Filling in the gaps...

2008-02-21T02:01:00.015+02:00

Due to my tendency to drop off the grid entirely at times, I have left a large 8 month gap of unwritten blog in the Aviator´s Review. Last May I left you in a cliff-hanger of sorts with my departure from Israel and the end of an era. For 8 months no words crossed the pages of The Review. No stories and no thoughts to share could be found. I like to think of myself as a story-teller and one to seek out stories worth telling. What happened next? Where did I go? Could this be the end for our intrepid hero!?... Well, here are the lost accounts of the past year....

-- They call NYC the city that never sleeps... probably because the never-ending brouhaha that ensues on the streets every night is nearly impossible to sleep through. With a cast of characters as theatrical as any on Broadway, I am entertained and educated everyday on my new neighborhood streets. Harlem... 145th and St. Nicholas.... third stoop from the deli... second floor. Light years away from any place that I have lived before, I find my ability to adapt stretched to it´s limit. Nonetheless, I am accepted here as many foreigners before me were welcomed to the new world. Maybe it´s their way, maybe it´s me, or maybe... I find that we are not all that different.

Everyday I sit on the subway on the way to the hospital and, in typical New York fashion, try to ignore the tapestry of humanity in front of me, but I am too captured by it´s beauty and sorrow to think of anything else. All of these different colors and cultures stitched together, sometimes unwillingly, in such a close way takes the work of centuries. Each new wave of strangers adding a new shade to the works.

The emergency rooms at Harlem and St. Luke´s hospitals also fill with a parade of histories both old and recent. If you pause for just a moment, you can see where their stories wind together in those few hours. I say a few hours, but really I mean a continuous shift that never really seems to end. This fall I have worked more than any year previous, but everyday brings that crisp edge of a new beginning that only comes with days truly seized. The orchestrated chaos of the ER gives me a chance to laugh, argue, and sometimes grieve with this band of characters. Days, nights, and all hours between. It´s an experience that I haven´t found anywhere else save maybe a good book or story. I hope my story is as well written when the end comes.

Ciudad de Oro

2008-01-20T23:03:00.000+02:00

After many months of putting off documenting my recent adventures (of which I have had plenty), I find it ironic that the easiest place to write to you all is situated at 11,000 feet in the Peruvian Andes. Here I am again, miles from home in a small tienda that leaves one puzzled at how the internet could even reach such a place. This little obscure room connected to a much bigger world of obscure rooms sends my imagination running. So from my eccentric room to yours, I am glad to be writing again.

In order to polish up on my Spanish before working in the hospitals here, I enrolled into a language school here in Cuzco, Peru. The city itself has taken on a role of tourism, but you need not wander far before reaching a place that time has long forgotten. Just yesterday I rode a bike 7 hours through some of the roughest and most overwhelming terrain available at 11 thousand feet. The mountains swallowed the clouds as the afternoon rain pushed to no avail against them. Boulders and crevasses marked the narrow trail that clung to the side of cliffs hanging in those same clouds as we rode down. I tell you this, that I have never seen such a creation in all my life. The scenes in front of me seemed so distant and holy that they, for me, became the foreshadowing image of what will someday come.

I enjoy telling you all my adventures, it gives me a sense of pride and accomplishment. But when I see things in this world like those mountains, I realize that I have accomplished nothing. It is only Him who creates that can achieve the end.

Know that you too are one of His greatest achievements and you are loved more than mountains. Hope for the day that is not yet here and in Him who will make it so... because if it is anything like the Andes we will not want to miss it.

The Road Behind...

2007-06-15T23:47:00.000+03:00

Here we are. After months and months, the long road of life has brought us all to the place in which we now stand... or crawl... or perhaps lie unconscious.
No matter which direction we have chosen or have had thrust upon us, this is where we are. Regardless of which path you currently travel, or the scenes it takes you through, a quick look around to gather your bearings or even to appreciate the scenery could do you some good. For the past 5 months my road has zigged, zagged, and sometimes fell out from under me, but nevertheless I am now here. It's time for a good look around....

For those of you now concerned for me, I am fine... despite a few metaphorical bruises here and there. In fact, two weeks from now I am moving back to the States. So this day marks the beginning of the end for my Israeli medical chapter and it is a very welcome change. However, I can't help but look around with a bit of... I hesitate to call it this... nostalgia. Here I am at the point that I have wanted to be for last few years and even though it was difficult, I suddenly find myself stopping at this waypoint, looking back at my desert with tired eyes, catching my breath saying, "Well...(gasp).. that wasn't...(wheeze).. so hard."
In fact, in a masochistic way I feel ready to take on almost anything now as long as it is something around the next curve. Even though I am tired, this place has taught me and pushed me so that I would become stronger and I can't help but be grateful for dusty ol' Beersheva.

A professor once told me in a survival lesson that a man can live weeks without food, days without water, hours without shelter, minutes without air, but only seconds without hope. Wherever you stand on the path, there is always hope even though the road ahead is unknown. Love and help one another as so many of you have done for me. Someday I will get the chance to help you in return.

May the road rise up to meet you.
May the wind be always at your back.
May the sun shine warm upon your face;
the rains fall soft upon your fields and until we meet again,
may God hold you in the palm of His hand.

Over the knife...

2007-01-29T16:47:00.000+02:00

Alright, it seems I am once again long overdue for an update. It's the story of my life... my time moves just a bit slower than the world around me. Good old smalltown living taught me that. Medical living, however, has a different rhythm and will not slow down for anything. Surgery in particular is a blur. Everyone has their specific job and they all work like a Nascar pit crew. Since the last time you heard from me I have moved back to Jerusalem and started work in the operating room. Here's my review...

Many of you know what it is like to go under the knife for an important surgery or procedure, but it's that period of time when you were blacked out on the table that few people know much about. In fact, most of you probably recall only a cold room with bright lights just before the anesthesiologist counted to three. Believe it or not, several hours passed in that room full of sharp objects and I'll bet you have the scars to prove it. For the past three weeks I have been watching over those patients unfortunate enough to need an extra hole in them. Today I want to tell you about my experiences over the knife.

It's fascinating to me in this day of lasers and beams of all kinds, that we still rely on a sharp piece of metal to cure disease. It gives me great satisfaction that the world's most educated men and women use a tool we all know how to use. Obviously the catch is knowing where to cut and when, but there is little more to know since the goal is only to find what you are looking for and cut it out. In the operating room last week the surgeon spent a good 30 minutes just rooting around in some guy's abdomen with his hands looking for a tumor. Along the way he would point out the various vital structures and tell me to hold them off to the side. You don't need to know much to hold a man's liver up... just a strong set of arms since you are likely to be that way for several hours.

Surgery takes much patience and, in my opinion, the mind of a mechanic more than an academic. One of the docs in the OR actually reminds me of my dad in his hangar fixing planes... He takes his time, says very little unless speaking to himself, and is meticulous about the end product. Even the room itself brings back pieces of my childhood memories in the air shop. For starters, there is a central table that can hoist the patient up, down, left, right, or even upside down and hold him there. All kinds of colored fluids eventually cover the floor in the same mosaic pattern that an uncovered engine leaves behind. Tools, and even a few power tools, lie everywhere in the room. Sharp ones, blunt ones, and some that I still can't imagine what they could be used for. Finally, the music...

One of the most profound things in life is the way music can enhance even the most forgettable of memories. In surgery, music... any kind of music really... steadies the tempo of a hectic operating room. It places everyone in time with each other, even the patient's heart monitor seems to match the beat. Everything outside of the room disappears. What kind of music can do this you say? Well depending on the type operation, we've gone with everything from Bach to Abba, and Norah Jones to Britney Spears. (I've got to tell you, there's nothing more entertaining than seeing two very serious ex-Soviet surgeons rocking out to Britney's "Oops, I did it again." Oh the irony.)

My time in surgery has passed by all too quickly, but I won't be sad to move on to something else. The chance to see something entirely different was a much needed break. However, getting caught up in the ultra-competitive, long-hours lifestyle can be tempting... But I want something that will take me to the ends of the Earth, not the grand medical centers of the western world. Life as a surgeon would only pin me down, and I've got to follow my dream. It is hard to pass up the opportunity for all the power, prestige, and money, but if there is anything I have learned from cutting people open...

it's what is on the inside that matters.

O little town of Bethlehem

2006-12-29T22:10:00.000+02:00

If one were to spend Christmas away from family, he might think the next best place to celebrate would be in Bethlehem, the actual birthplace of Jesus. Many people around the world wonder what it must be like in that little town every 25th of December and perhaps consider making some sort of pilgrimage one of these years. I'm sure that in all of the commercial hub-bub of the Western World, many become disillusioned with the holiday altogether. They feel that if they could only be where it actually happened, then they might have a true picture of Jesus. Well, this year I was stranded in Israel and the following is the true account of a Christmas in Bethlehem....

I always find it odd that Jesus was born in the West Bank. Of course things weren't the same politically two thousand years ago, but I still can't help but wonder if the conditions in which people lived were similar. The striking contrast between the sides of the green line wall is enough to take you back at least a few hundred years. These poor Christian Palestinians living in Bethlehem do what they can to get by, but the certainly don't have it all. It's easy to imagine a manger as a decent place to sleep when looking at the rough-cut buildings without power or water. We walked from the check-point to Manger Square admiring the dark buildings lined with strings of lit Christmas lights.

The square itself had as many people as it did lights. The crowded little place hosted people of all kinds. Arabs, Americans, Europeans, monks, priests, pastors, and weirdos all bustled around the vendors who were selling everything from hot drinks and food to glow in the dark baby Jesus's. The only thing they have in common, and I stress the only thing, is that baby born in a barn two thousand years ago (who incidentally was not glow in the dark). It was a bittersweet sight to see. Jesus, and the purpose of honoring Him that night, was the only thing keeping the peace. So many sects and ideologies with lots of historical baggage gathered in one place can at times bring out the worst in people. A few years back there was even a monk who stabbed another monk over some ridiculous ritual infraction. I thought we were supposed to give grace more freely now that we have been given so much.

My goal for the night was to keep warm with as many foods and friends as possible. The first item on the menu was a tasty..... er.... drink? If you can imagine hot runny oatmeal that tastes like cinnamon and coconut, you can imagine sachleb. It's a very middle eastern drink and is best served on a very cold night. Next, I rustled up some very tasty falafel with all the fixin's. Freshly fried chickpeas in a pita with spices are always a good Bethlehem dinner. I was sorely disappointed with a street coffee while waiting to get into the Church. Fortunately for us we had a German with us who had just received a package from his little village grandma that was stuffed with holiday cakes and chocolate. The Christmas Award for best food goes to the Germans hands down (or should I say Hans down... Ha!).

The crowds around the church prevented us from going in, but I didn't want to go in anyway. Jesus was born outside under a giant star, I wanted to see as many stars as I could. On the walk back to the check-point we could finally see the sky and it was full of stars. The night sky always has a way of making me feel small and important all at the same time. I always lose myself in the same way one stares into a flame. Along the road carolers sang outside of a Christian Arabic Bookstore. They sang all of the classics... in Arabic of course. Even though singing along was impossible, their music added a feeling of hope to my walk under the stars. Hope for them, their land, and ultimately hope for all of us. I know that sounds grandiose, but Bethlehem is an island in a dark place. If they can sing about the hope that Jesus brought with Him on the dark lonely night so many years ago, then I can at least take some courage to face the fading darkness.

If you find yourself stranded in Israel some day years from now perhaps Bethlehem is worth a look, but the best way to honor Jesus's birth is to remember the way he lived... be generous and gracious to everyone you meet. Love one another, because everyone should be welcome in the family of God.... even until next Christmas!

Strength and Honor,
T

Pandelerium...

2006-10-12T17:36:00.000+02:00

Ladies and Gents, after many months of silence on my part, the MA review is back. For those of you that are further out from my loop, I have been in an epic struggle with my nemesis the USMLE for the past 5 months and have not had the presence of mind to write. My life has passed quite slowly and nothing could be deemed writable anyway, unless you would like to read about Tsutsugamushi fever and the like. This is a war of attrition against this obstacle in my life, filled with thousands of trivial facts and whoever loses nerve first will fail. He's a crafty fiend that USMLE, but in the end I will emerge victorious because he.... is just a test.

In the meantime, I have moved into my third year (final year in Israel) and onto the hospital wards. This has been my inspiration for writing to you.... the absolute insanity of a hospital wing. People in general are strange enough, but when we group their tired, poor, and huddled masses together we get one thing.... pandelerium (one of my favorite made-up words to describe odd and sometimes funny chaos). If a medical student learns anything in his third year it is that interacting with patients only compounds the difficulty of medicine. The following is an example of a typical patient interview (keep in mind that this discussion in my broken Hebrew and a mix of other languages from the neighboring beds):

Me: Good morning. How are you feeling this morning Mr. Johnson?

Mr.J: Eh!? What?

Me: I SAID HOW ARE YOU FEELING TODAY?

J: No, I already had an X-ray.

Me: I SAID HOW... nevermind. My name is Tanner. I'm a medical student here and I need to take some blood and ask you a few questions. OK? Good.... What brought you to the hospital?

J: An ambulance, what do think brought me here!?

Me: I mean, why did you have to come to the hospital?

J: Oh... I have this pain in my pinky, but I'm really alright.

M: (confused) Your pinky finger? That's it? I see. Let me ask you a few questions....

(Begin long and exhaustive interview)

M: Well, Mr. Johnson from what you are telling me... you should be going home soon. Let me just check you out with a quick physical...

(Physical Exam)

M: Erm.... Mr. Johnson... Has your belly button always been the size of a grapefruit? Has your heart always sounded like a machine gun? And what about the purple and green polka-dots all over your chest, does that raise any concern for you?... Any little red flags going up with that? Any at all?

J: Oh, I forgot to mention that. But my pinky really hurts... Fix it.

M: Sigh....

SO as you can see folks, people are indeed strange. Sometimes I feel like this is veterinary medicine and I am the poor guy walking around asking horses where they hurt. With some patients a one way trip out to the pasture sounds very tempting, but I guess treating even the oddest of people gives hope to all of us.... even me. I have only one request.... if I ever get sick, put me out to pasture.

Living Well

2006-05-14T22:21:00.000+03:00

My contribution to a friend's collection of essays on "What is living well?":

Living well? My first gut response tells me that living well means living in a place that pushes me to fight evil and be happy about it all the while, but I get the feeling it might be more complex. After all, that's the trick to life isn't it? Finding a place on Earth where we can truly find peace with ourselves and others yet still battle the darkness. Looking for it takes most of our lives and if we are fortunate maybe only a couple of decades, but most of us just quit looking after a few short years. All that aside, my idea of a life well lived goes a little something like this...

I'm going to stick with finding a place that you love is a key part of living well. My well being has always been attached to the land I'm living on for some odd reason or another. Maybe it's the left over pioneer genes in my blood, or maybe it's just the need a wanderer has for his own home. Either way, my world experiences have taught me that there is nothing that can compare to having a place that always waits for your return. If I can find a spot that nobody else in the world can take or ruin without stepping over my dead body first, then I am living well.

Finding someone to share it with is also difficult. Not only are people vastly different, there are also billions of them. Fortunately, we can narrow the field a bit by subtracting those that want to see us dead, don't speak the same language, and/or the communists. And even still it is hard to find someone to love. We are all too familiar with this problem and much to our chagrin, living well is dependant on love.

Lastly, finding a noble battle to fight is also necessary to living well. Unfourtunately, finding one of these isn't all that tough. Fighting for the side of the oppressed, the weak, or the sick gives a man purpose. Don't get me wrong, it hurts him to do it.. hurts like nothing he's ever felt. But if he has the courage to do it, the pain only lasts a for a fleeting moment. After changing the world a little bit, he can come home to his stretch of land, take some satisfaction in the good he's done, and ask God's grace to cover everything else.

That about covers it. I'd be very grateful if I could end up with those three things... I'd live well.

A picture is worth...

2006-05-07T18:57:00.000+03:00

Several of you out there have written me to see if this blog is dead... well it isn't. The only trouble is that I haven't got anything new to write about except school trouble. Sooo, it's my new objective to have something fun by the weekend. Thanks for the interest, I'll make sure you get your patience worth. Until then here are several thousand words....

Never a dull moment...

2006-04-01T23:15:00.000+03:00

Alright folks, here is the post that I have tried to avoid for the past few months. I'm surrounded by it everyday, but honestly I think you might have more information than I do. A cab driver brought it up with me in conversation yesterday while returning home from the grocery store. I read about it in the papers. My neighbors take the day off to go do their civic duty. What am I talking about? The elections... both Israeli and Palestinian.

A few days ago Israel held national elections and much to my surprise the voter turn out was the lowest it has been since sometime in the 1950's. This seems odd to me in light of the outcome of Palestinian elections, but the results of Israel's voting ended up somewhat favorable anyway so I'm not going to complain. The structure of the Knesset (Israeli congress) is not on the electoral system, which means if a certain party gets 1% of the popular vote, they get 1% of the available seats. This also means there are several parties to keep track of. The two big winners of this year, which together make up about 50% of the legislative body, are Kadima (in Hebrew means "forward") and Ha-Avoda (or "the job"... the labor party). These guys are centrist in their politics and compared to Hamas on the other side of the fence, they are a decent choice. I imagine that they will still pursue even more settlement pull-outs and move towards the two state solution. Way to go Israel.

As you probably know by now, the Palestinians are now officially under their Hamas elected leadership. Hamas won 44% of the Palestinian Authority's seats in January and just a few weeks ago put the elected officials in place. This came as a big surprise to the polls, the world, and even Israel... although I think that Israelis were significantly less surprised. The ideology of Hamas is hateful, uncooperative, and only marginally concerned with the development of their impoverished piece of territory. However, this is only a piece of the problem. I feel that with a recorded terrorist group in power they will soon see their own people suffer further because of pulled funding from around the globe. The West Bank was in a bad way to begin with, and Gaza was worse, but without the support of wealthier countries to help them get a stable infrastructure (good schools, food, and hospitals) all of their hateful politics will strangle any hope Palestine had of becoming a nation.

Obviously this summary is very condensed and the issues are much more complex, but I feel like I owed it to myself to write about it since I live here. We will see what becomes of it over the next year, but for now I am content to ignore them all and get back to creative writing.

What's in a name?

2006-03-12T12:22:00.000+02:00

Once again the time has come for my monthly installment of thought. I really would enjoy writing more often but the fact that there are still only 24 hours in a day doesn't allow for it. I've been petitioning the Committee for Time and Gravity Regulation of the United Nations for a 29 hour day, but for some reason they won't return my calls. So for now we all have to make due with rare jewels such as today's post.

In the past couple of days I have learned several interesting distinctions between words that I previously thought were interchangeable. For example, a fire truck and and a fire engine are not the same thing! If this challenges the very fabric of your universe as it did mine, you are now wondering what could the difference possibly be? In short, a fire engine has the water and a pump for all of the hoses. The fire truck, however, has no water and usually carries extra equipment or a huge ladder. Boggles the mind, I know.

The second realization was that pipe cleaners, you know the furry little arts and crafts wires, are actually used for cleaning smoking pipes! Maybe everyone else has discovered this already and I am way behind in Arts and Craft studies, but I still found it facinating.

And lastly, this is one that I have known for awhile, but I pointed it out to a friend... Farms and ranches. A little piece of info that I always took for granted. It's obvious right? Farms grow crops and ranches raise cattle. Then of course there are your various kinds of minor animals like chickens that can live on both, but I think a distinction can be made.

So there you have it... proof that I am officially losing it. Nah just kidding. Enjoy the simple things today everyone.

Never Blue with Bluegrass

2006-02-19T23:37:00.000+02:00

Last time I wrote to you, I said that this post would tackle something a bit more eccentric or informing. After spending so much time here in Israel, I have a temporary dislike for the eccentric middle-eastern quirks. Writing about informing matters will only get me on to the subject of Hamas winning the Palestinian elections and make me mad. Either way I will only be complaining and ranting. So, we're going to go in another direction... homeward. The sounds I have been hearing for the last few months haven't been those of angry middle-east yelling or the sounds of heart monitors in the hospital. No, instead of those all too familiar sounds I have heard the healing sounds of Bluegrass.

Bluegrass not only is good for the ears, but it is also a medicine for a homesick, tired Texan who has a ton of work to do. After spending some time digging on the net for musicians both old and new I found that the fiddle has incredible motivating power. The strings instantly put the urge to do hard physical labor in my bones. Coupled with the banjo's tempo, bluegrass is the musical equivalent of caffeine and adrenaline.

Now, I realize that studying isn't exactly physical labor, but at this point in my education I'll take any sort of motivation. On top of it all, the songs aren't just notes played into a can. Bluegrass has based itself around such wholesome subjects that one actually becomes a better person by listening. I don't know of any other genre that is exclusively written about Jesus, real love (for family, friends, and the weary), peace, and Home. That's it. If there is anything to learn from that fiddle, it's that outside of those few precious things... there's not much else to listen to.

Keep playing the notes strong folks.

The Prognosis of Worry

2006-01-15T10:15:00.000+02:00

With an entire month between my last post and this one, I sincerely hope that I haven't lost the few readers that I had collected last year. The news in brief is that I had an excellent Christmas vacation with my family in the other Holy Land... Texas. Never before has it been so hard to return to school. Every minute on the flight back to Israel felt like a step in the wrong direction. I had no strength to last another 6 months, but in my heart I know this is where I am sent. So I will continue writing to you as often as I can because it brings me hope that hard times don't last forever. The good news is that I passed the Endo test! It's a small miracle considering that I didn't study at all over the break for it.

A common theme that I have noticed in my conversations with classmates, friends, parents, and everyone else is that of self doubt. Whether it is me questioning my own choices or just listening to the fears of a fellow trooper, I seem to have hit the saturation point for irrational worries. This is a newly developed habit of mine and I don't approve of it, so as a therapy for me I will write about how stupid it is to worry.

The reasons behind all of the anxiety range from A-Z and I won't embarrass myself by posting them. The outcome of worry, however, is the same for all of us.... nothing. Except for a few more grey hairs and an increased risk for a heart attack, worry gives us nothing. Our quality of life drops almost immediately once the worry begins and doesn't let up until we choose to let go of it. And this is where we as friends step in. Be a constant reminder to those around you, even if you have to say it out loud, of this.... Whatever is in front of you will pass away and rot with or without you, so be brave because we have nothing to lose. Do what is right and be grateful for the time you have already had, leave the rest in the hands of the One who owns it.

I hope that I have encouraged you. Next time I will review something a bit more interesting and eccentric. Until then be brave.

Crossing the pond... again.

2005-12-08T18:32:00.000+02:00

First off this week, I want to thank everyone reading for sending me all of your kind support. Your letters and prayers get me through the tough days and for that I thank you. From time to time I will post various concerns, but for now a good memory and tremendous motivation is what I could use most. Now on with the show...

Ten more days stand between me and two glorious weeks in Texas. It must be ten because I've counted and recounted the scratch marks on my prison cell wall and every time it adds up to ten more days. Getting back to the ranch for Christmas with my family and girlfriend is all that I can think about lately. However, it always seems like a dream until I'm on the plane leaving the ground. So today in review I give you the Trans-Atlantic Flight...

24 hours of torture is the price to pay (on top of a good chunk of $$) for the two weeks of holiday at home. First, Israeli airport security is how we say...uh... thorough. I don't even bother packing anymore until I am past the gauntlet of x-rays and interrogations. Second, if I am unfortunate enough to get a middle seat, there will inevitably be two fat old men on both sides who encroach upon my very expensive armrests. What should be a comfortable seat turns into a cold border war rivaled only by the likes of North and South Korea. And third, sleep is impossible but also unavoidable. The time spent in a haze of waking exhaustion gives me the chance to ponder how difficult it must be for the airline to add a bit of cushion to an airplane seat and how rewarding it must be to travel with a baby.

In all fairness, air travel has come a long way. No longer are we stuck with one or two unbearable movies, but we now have a selection to choose from and meals aren't as uniform either. Although the food could still stand to be cooked by a living human being instead of an assembly line, at least the attendants dish it out on an hourly basis. Hunger is nonexistent but boredom makes for a great appetite anyway.

The moral of this story is that no matter what the airline throws at me this year, I will endure it for my family and friends, for Christmas, for Texas, and for freedom! Safe travels to you all. See you soon. Merry Christmas.

The War on Christmas

2005-12-01T17:36:00.000+02:00

Since today is Dec 1st, I feel no guilt in starting a review about Christmas. Usually it would be about warm feelings and family memories, but I'm afraid that I have a more important issue to address.

John Gibson, an opinion anchor on Fox News Channel, wrote a book called The War on Christmas and it posts concerns about the trend in recent years to phase out Christmas from the public world. John's (and my) beef with political correctness is not a new one and this addresses only one facet of a much larger problem, but it's a place to start.

The politically correct (PC) crowd started this war when they influenced stores and businesses around the country to replace "Merry Christmas" with "Happy Holidays" and "Season's Greetings". They state that the phrase using the name of the holiday is offensive to the minority so we should now impose restrictions on when and where this holiday is observed, even though 85% of Americans claim to be Christian of some type. Songs in school pagents have been cancelled, employees have been reprimanded for using the Christmas phrase, the colors red and green have been banned from streets in Plano, Tx for this part of the year. What?!? Since when is Christmas illegal and when does being offended mean the majority can't celebrate a holiday we love in public? I for one will say "Merry Christmas" to whoever I feel like and if they don't like it then they can hate me for all I care.

Let me turn the tables for a second. For the last year and a half I have lived as a minority in a predominantly Jewish and Muslim country. When their holidays roll around do I sue them if they say various holiday related phrases to me? Does it cause me to feel unwelcome in stores that celebrate them or alienate me from the people that do? NO, of course not! In fact, I have never felt more welcome in homes and families that I visit than on holidays.

So what is this? Is it really about making sure that people don't feel offended or unwelcome? Or is it one more step in the subtle secularization of America? I know what I think.... Merry Christmas everyone.

Postum Primum

2005-11-27T15:06:00.000+02:00

Since I only got around to introducing myself in the last post, I will not try to tackle something complex in my first real post like politics, medicine, the meaning of life, or the reason why paper will always be better than plastic... No, instead I want to really show you, the patients, why medical school can kill you.

You must be thinking, "Sure medical school could kill someone... being around all of those sick people." That's not what I mean and really not even accurate. The public must know of the absolute agony that the lowly med-student is put through on a daily basis. Now, don't get me wrong... humiliation is a very effective teaching tool and if there were a way to inflict physical pain with each wrong answer, I'm sure we'd be looking at the finest students in the world. It's the enduring drawn out suffering that takes years off of our lives and turns even the most altruistic optimists into the arrogant misers that roam the halls of hospitals everywhere.

Waiting for the axe to fall... an upcoming test becomes the last day on earth. Everything revolves around it because we have had the fear of the-man-who-pretends-to-be-God put in us. If we do poorly, we will have to answer to the man in the long white coat. For some of us, that day of reckoning is coming soon in the form of what we affectionately call The Monster. The USMLEs.

The USMLE is the Olympics of medical training. We work our tails off to compete in the test for limited residency spots and only the best gain exactly what they want. Will we triumph and gain the respect of millions who look the white coats as noble heroes.... or will we land that 4 th place spot and get nothing? Don't let any cynicism fall in the path. Be ever prepared for the worst (because in medicine the worst is frequent). And lastly, always stop to encourage the lowly med-student. Until then we will slave away in order to preserve... if not gain... our sanity.

A word from the author... That's me.

2005-11-27T05:15:00.000+02:00

I finally did it. After much holding out, I decided to jump on the Blogging Bandwagon to see if this new trend is really worth all the hype.

For starters, introductions are in order.... ahem.... My name isn't really important since you either know me already or you don't care.... not to mention that there many of you crazies out there who should never know my name. With a name or without, I am at the moment in a medical school that trains doctors for third world operations aptly named MSIH (Medical School for International Health). Clever huh. The real kicker is that I moved out to the deserts of Israel to learn here. Needless to say living here is HARD and the medicine isn't any picnic either. They say that the road to success is paved with.... uh.... I don't remember what they said it was paved with but I can think of some choice words for it. Somehow at the end of the day we manage to get by, my class and me.

So the point of all this is to perhaps mantain my sanity in this circus of a country. If anyone wants to hear the daily trials and opinions of a Texan pilot stranded in the Negev desert, I'm your man. This is only the the beginning...