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Friday, December 19, 2008

Trying to keep track...

It's a few days before an enormous endocrinology exam, the last one before our precious 10-day Christmas vacation and I feel like I need a few more of me to keep track... A new beginning, for one, and the good old friends are flying back in one by one with nothing but fun and games on their minds, meanwhile my desk awaits back home, with handouts, books, and highlighters strewn in a chaos worthy of wartime and scarred battlefields. Thoughts and prospects of Christmas shopping, the lunches, the dinners, the invitations and family obligations. And so little time...

Thursday, December 11, 2008

Where Else?

Where else? Two cars parked bumper to bumper on the highway shoulder in the middle of an unlit, pitch dark 18-kilometer stretch of road between two 6-meter high concrete walls, that we affectionately call "Tarik el Matar" or "Road to the Airport". Between the two cars were a family or a group of friends (I couldn't stop and ask, after all...) peacefully chilling, smoking the nargileh (hubble bubble), popping fava beans and peas and crunching chips on a plastic picnic table. Peacefully, that is, with our notoriously well organized and safe traffic whizzing by at speeds in excess of 100 Km/h. Call that comfort and peace? What about safety? Traffic police? Common F***ing sense?? Sometimes I wonder what goes on inside these people's minds, but hey... Welcome to Lebanon right?

Saturday, December 6, 2008

Look who climbed out of his burrow

Jiyyeh, Lebanon - August 2003
Picture Taken: August 24, 2003 - 2:54 pm

On a sandy beach in Jiyyeh, South Lebanon.
Caught on good old fashioned 35 mm film.

Friday, December 5, 2008

Ladies and Gentlemen, Your Future Doctors! (Part II)

If you haven't already done so, please read Ladies and Gentlemen, Your Future Doctors! (Part I)

The Problem With Medical School "Bookwormindia" (Thanks La Colleague!)

You can sit here for hours and preach to me about how crucial a doctor's knowledge and mastery of the science involved in the medical profession is. In fact, there would be little sense in disagreeing with this statement, and saying that the sheer volume of knowledge expected from us is overwhelming would still be a gross understatement, as any medical student would tell you. That knowledge, however, or rather acquiring that knowledge in so little time, comes at a price... One needs to stop and look back at what this knowledge takes away from us. Outrageous! How can knowledge and learning be detrimental to one's character?
If that's what you're thinking then I need to clarify that it is not knowledge that is doing all this harm. Like I said in part I of this long dissertation, our system inexorably favors the competitive bookworms over the less studious, but very often much more passionate learners, who have come to terms with the notion that there are other things to do in life than sitting and rocking in front of an anatomy textbook, chanting names of muscles and nerves in a trance-like state reminiscent of some of the worst psychotic disorders known to man (oh yes, we've all seen it). And by other things I mean anything, really, anything that would conceivably help build character, that would take the mind away from books, grades, and class ranking for even a few hours a week, in other words, things that would make sure that this or that person would be able to function even minimally well in situations that don't involve regurgitating information on a multiple choice exam answer sheet. But no. Who needs these activities? I mean God forbid someone spend a few hours a week at the gym to keep in shape, a few half hours (you can use this as a unit if hours just seem too long and dramatic for comfort!) relaxing on a marginally comfortable bar stool sipping on some good old scotch with some good old friends, or, at any rate, doing anything they wouldn't be able to put on their CV... And God forbid this knock one a few places down the class ranking!!! How, please answer me, HOW, for the love of God, can one make such an enormous sacrifice upon the altar of well-being, culture and sophistication!!? This is so sad... for I believe it is these mundane, stupid things of everyday life, that stupid senseless motocross hobby you took up, that passion for photography that keeps kicking you in the back of your mind whenever your see a beautiful lady or a stupid leaf, or whatever you can think of, to do in self-administered free time, it is these things that make a person who they are.
So who are your future Doctors? Well, with few exceptions, they are the most self-absorbed, grade/ranking-oriented, cynical hyperlearners you can imagine...

Cynicism in Medical Students... An Early Beginning and a Head Start

What is the image ascribed to a medical student? What image does someone who knows nothing about the inner workings, shortcomings, and catastrophes of our medical system, hold, concerning a medical student? Well that someone should conceivably say that a medical student would have to be someone with passion towards helping others; an at least minimally altruistic, minimally passionate human being with some minimal notion of respect for life, humanity, and healthcare ethics. I mean, these, after all, are good traits -among others of course- for someone to have if they have chosen medicine as a career. Somehow, for us insiders of the medical world and community, however, it is difficult to maintain the idealistic image of medicine that we have developed as teenagers, especially as we progress further and further along our training and pick up bits and pieces of disappointment, mishaps and gaffes along the way. There is absolutely nothing wrong with this phenomenon, and I'm sure that even the most passionate volunteer healers will agree that something is bound to be lost. You see or hear about a patient being thrown out of a hospital in a less-than-dignified manner because his insurance would not cover his expenses, you see a breach of confidentiality here or there, etc... and you start thinking, maybe this isn't such a perfect world after all! Let's call this the theory of disillusionment for later reference (I have a theory! go figure!).
The degree of disillusionment varies among students, depending on character, personality, and personal background... nothing to worry about, as this is a well documented change experienced by medical students around the world. As I've read in a British Medical Journal somewhere on the net, in study results, cynicism arose among medical students most often a result of patient deaths leading to feelings of general helplessness, or of students observing their once idealized mentors and superiors conduct themselves in manners not becoming of their highly respected positions, etc... getting down and dirty, so to speak. But most importantly, feelings of general cynicism tend to begin mostly in med III and med IV, when students are put in charge -under supervision- of patients and become an integral part of the healthcare system. What one really needs to worry about is the end result, the view and status of a medical student's mind as she/he gets ready to begin practicing medicine. Let me explain.
So what's the problem in my class? In my very humble opinion, most students are in the wrong discipline for the wrong reasons. These have chosen medicine as a career for all the wrong reasons, by their own acknowledgment. Here are a few of these reasons as sampled from our proud Lebanese society's norms and standards: Q: why did you choose medicine? A1: I had the grades to get accepted, so why not? A2: It's a good investment, I want to be rich! A3: It's prestigious! and I'll leave the rest to your imagination. The thing is, none of these reasons, when amalgamated with other, more 'legitimate' motives, would be branded the 'wrong' reason to go into medicine. Even a student with high hopes and passion for helping others, for example, can still legitimately relish the prospect of being called a doctor and being treated with the respect associated with this truly prestigious position. After all, it is only fair that recognition be granted to someone for successfully completing the strenuous exercise of discipline, perseverance, and determination that is the medical curriculum. However, it is when the only reasons behind one's choice of career are the wrong reasons, that arise the problems of cynicism, among a plethora of other issues that I will not indulge in enumerating and debating. And going back to the question at the beginning of this paragraph, It is my answer that with the inadequacy of these motives, cynicism among our prided medical students begins to set in as early as, or even before, the undergrad years. Now if we consider my theory of disillusionment to be true, this becomes problematic. When even the most initially passionate medical students come to the end of their training with little, and sometimes no passion left for their chosen career, what can be imagined for someone who has been completely oblivious to the feeling of passion for medicine since their early undergrad years, for someone who had entered the field of medicine with absolutely no passion for it to begin with? Here's what you get: you get future doctors who scoff at even the most simple and basic prospects of medical ethics when they are presented to them. You get future doctors who arrogantly and scornfully scoff at even the most simple and basic of human rights! A doctor who has no sense of responsibility to human rights as basic and primal as a human being's right to choose what happens to their own body after they die, whether they wish to donate their organs for life, or resent the idea of being harvested like a carcass, the choice of wording depending on their own, personal, visceral (no pun intended) beliefs or views concerning the prospect of organ donation. This is just a mere example of the outrage that went on in one of the TWO medical ethics lectures that we were given this year. Just two? yes. Two lecture hours on medical ethics, in grand total. For comparison, our Clinical Parasitology exam in a few days' time is on 22 lecture hours. And that's just ONE of FOUR CP exams. This so clearly illustrates the seemingly deliberate inadequacy of our ethics teaching system, that I will not write another word to explain it.

What's to Hope for

At the end of this long, useless rant that sadly but surely no one will hear, let me just say that I can only hope that decisive action is taken by the Medical Community, and especially Medical Admission Boards, against this phenomenon that is destroying the essence of our profession.
On a more personal note, I can also hope that the more passionate students are rewarded with a better experience in the clinical years, because my one, sole surviving, waning measure of excitement so dearly depends on it.

3 measures of disappointment, 6 of complete and utter disgust, and 1 sole surviving, waning measure of excitement...

Thanks for reading

Thursday, December 4, 2008

Time to reassess...

"The best things in life are free!" Really? Even for the 6 year old begger who stopped me today to ask for a sip of water from my bottle that had been simmering in the car for 2 days?!
All the feel good messages fly in pieces once you're confronted with the face of a sweet little girl, selling flowers on the road, anguishing in thirst and hunger, while you've been complaining about traffic and how you're never going to make it on time to catch that episode of "Ugly Betty" you've been waiting for... :"The best things in life are not to be taken for granted"!

Wednesday, December 3, 2008

Midnight Breeze

It’s midnight. At the end of what has been an interminable day, I find myself thinking of something I promised myself I would forget. Breaking a rule, here, but I’ve been hoping and waiting, waiting for some kind of an explanation. So long, I’m not so sure anymore... would it ever come, or ever be enough? Would absolutely anything be enough for me to understand, enough for me to want to call her, want to see her, enough for me to miss her? The cool midnight breeze glides in and dances across my skin as the dim orange light immerses the room in a somber mood. There’s not a sound out there. The sobering feel of a cool glass of whiskey gently resting against my face, as my eyes close ever so slowly, sets alight this crystal clear thread of unbroken thought that I’ve never even come close to experiencing. The flame peacefully kindled by the serenity I’ve managed to find in a sad broken watch that died in exactly 4 hours, 28 minutes and 25 seconds on the nineteenth of some month, a while ago... Somehow I look at it and see all the time, all the years and years and years I’ve held on. I have never seen a watch run so fast. I’ve been losing so much time. And then it hit me! I had never been able to see things so clearly before, and my clouded thoughts have never come out right as I endlessly tripped on words, making a mess of knowing what to say, when or how. But not today; all is frighteningly lucid to me, and it has occurred to me just how naive I had been... I want to tell her... but would it be worth it? Would it be worth the reactions, the judgment, the implications and assumptions? Why reopen a healing wound? I’ve been realizing just how meaningless words can be, how fruitless and hollow they can be. What would they help in achieving? Absolutely nothing? Absolutely everything? Surely they won’t change a thing. But I can’t help but think of how they would touch her, because for what is an absolute first in an appallingly long time, I’m not trying to be guarded.
No matter how things may turn out, it’s 14 minutes past midnight on my broken watch, and here are my meaningless words:
I never thought we’d be here...

Wednesday, November 26, 2008


Kaslik, Lebanon - June 2007
Picture Taken: June 28, 2007 - 5:30 pm

She gazes into the sea; I can't help but imagine... There, towards the horizon, is where she wants to be.

Tuesday, November 25, 2008

The Girl in Gray

It was a beautiful morning, and I had found myself a seat next to a 7th floor hospital window to peer out of. The city looked small, with only a few rooftops carving into the horizon. The intense, yet hypnotizing turquoise hue of the Mediterranean was playing with my senses. The voices and clatter in the crowded room seemed to fade as I started to imagine stories and serendipities for the minuscule people. I gazed and wondered... What's that down there? Oh look, up there! a plane! I wonder where they're going...
And there she was. Way down there, tiny, and making an easy, yet elegant stride of what any other woman would make a complete mess of, holding more scholar paraphernalia than one would care to describe. She caught my eye, her charming gray outfit contrasting against the yellow tiles as she made her way through the plaza. I wonder where she's going...
She holds her phone to her ear and disappears into the crowd... Is my phone ringing?

Blind Item

When an immigrant worker goes looking through the garbage, a cell phone in hand... Only in Lebanon!

Sunday, November 23, 2008

Of Hidden Treasures And Taboos

- Venturing into the BEIRUT SYNAGOGUE, November 2008.

-Inside the BEIRUT SYNAGOGUE, November 2008.

Beirut synagogue awaits restoration
Hussein Dakroub • Associated Press • November 22, 2008 • From Lansing State Journal

One of Lebanon's sole remaining synagogues was set to get a restoration that has the rare blessing of all the factions in the divided country - even that of the anti- Israeli Hezbollah. But the global financial crisis has scuttled the effort for now, leaving the Magen Abraham padlocked, badly damaged and rife with weeds.
The synagogue, like the country's once-thriving Jewish community, fell prey to the savage 1975-90 civil war. Once the fighting ended, the few dozen Jews who remained could not maintain the proud old structure.
A $1 million project set to begin in November had been organized by the Lebanese Jewish community to restore the two-story ramshackle building, which is now surrounded by the gleaming new skyscrapers of Beirut's downtown building boom.
But potential overseas Jewish donors who were to provide the bulk of the funds said the reconstruction would have to wait because of the hard times brought on by the global financial crisis, said Isaac Arazi, leader of the country's tiny Jewish community.
"I'll wait for two or three months. If no money is forthcoming, I'll launch a fundraising campaign in America and Europe for the rebuilding project," he told The Associated Press.
The building's need is acute. Garbage, empty bottles, broken glass and shattered roof bricks are scattered on the synagogue's floor. Wide cracks cover the walls and stairways leading to the second floor.
But the Stars of David inscribed on walls have been left untouched, as have the Hebrew writings, even though Muslim militiamen had apparently used some of the building's rooms as offices during the sectarian fighting.
The 65-year-old Arazi pointed out that as many as 22,000 Jews lived in Lebanon in the mid-1960s. The number dropped to 15,000 at the outbreak of the civil war in 1975 and by its end, a mere 100 were left.
During the conflict in which 150,000 people out of a population of 4 million were killed, Beirut's main Jewish neighborhood, Wadi Abou Jmil, fell under the control of Muslim militias battling their Christian counterparts.
Jews did not take part in the fighting. But the violence forced many to emigrate. The trickle turned into a flood when the community became a target of Muslim militants two years after Israel invaded Lebanon in 1982 and occupied parts of the country and briefly Beirut.
Eleven Jews were kidnapped and apparently killed during the hostage-taking spree of the 1980s that targeted foreigners and Lebanese alike in Beirut. The bodies of only four were recovered, bearing the marks of torture.
Muslims displaced from other parts of the country gradually moved into the shattered old streets of the neighborhood that had once been filled with Jewish shops, until much of the area was razed in the rebuilding projects of the 1990s.
Liza Srour is the last Jew living in the old neighborhood, in a small flat in one of the few old buildings remaining.
"We had Christian, Sunni, Shiite and Druse neighbors with whom we had an excellent relationship," she said.
There was rare consensus among Lebanon's fractious factions that the synagogue should be restored, although none has offered up any cash.
Lebanon's Western- backed government, which includes Hezbollah's representatives, said it welcomed the restoration of the synagogue because it is a place of worship.
Even Hezbollah, the militant Shiite Muslim group which refuses to recognize Israel's right to exist and has fought the Jewish state for decades, backs restoration.
"We respect divine religions, including the Jewish religion," said Hussein Rahhal, Hezbollah's media chief. "The problem is with Israel's occupation (of Arab lands), not with the Jews."

Saturday, November 22, 2008

ahh the distractions...! It's like a jungle in here!

These are my last-ditch efforts to finish up studying for my virology exam on Monday (that's after tomorrow!) And one would think, after my 7 years experience taking exams, that I would know that studying with "Survivor Man" sounds in the background courtesy of my favorite Discovery Channel is just about as feasible as threading a needle on a bus on the perfectly paved roads of our beloved Beirut! I need a break. Here's a great idea! I'll go stretch my legs on a long late afternoon walk to the kitchen and check out what the fridge has in store for tonight... A few apples, an old steak, and not much to drink... owell. On my way back "home" it's getting dark, and I hear faint voices and squeals in the living room. Intrigued, curious, but all too wary and suspicious, I slither up to the door as silently as I can, crack it open (no, it's not squeaky you Hollywood freaks) and spot my mom (who is a teacher) with her 15 year-old private pupil. I could hear the poor little thing squeak and whine, his tiny brain clearly overwhelmed with more french words and metaphors than anyone could possibly and humanly handle. The air is filled with a thick, white fog making visibility a dodgy matter. Oh no wait it's just cigarette smoke... I thought I had smelled something. Just some second hand smoke and cancer to go with your education my son!! enjoy...
I make my way back home with difficulty, after all, it got dark after the long minutes of vivid and adventurous exploration...

She Meditates...

Jiyyeh, Lebanon - June 2007
Picture Taken: June 23, 2007 - 5:54 pm
Small and Lonely, humbled by the vastness of the sea.

Friday, November 21, 2008

Ladies and Gentlemen, Your Future Doctors! (Part I)

85 students in our class. That's 85 doctors to be released into the "general circulation" in 2 years time. 85 healers, who will be trusted with people's lives and well-being. Patients beware!

Our society has become overcrowded with physicians. It is my firm belief that the system, and access to a medical education, and, more importantly, to the coveted Doctorate of Medicine, has been commercialized and secretively downgraded to a level that compromises the very essence of medicine. How do I know this? I don't, so call it a conspiracy theory if you want to. But if we look carefully at recent trends and attitudes, the kinds of medical students that currently populate our classrooms, as well as the quality of health care that we obtain as patients, observe as students, and, eventually, will provide as physicians, an image so vivid is painted of the shortcomings of our system that one would need to be blind to overlook it. Here's what I'm thinking about.

The Quintessence of the Medical Profession in Jeopardy: Medical Doctor vs. Healer

We're a smart bunch (smart is debatable, and will be discussed later but let's call it smart for now). There are more overachieving students per square meter in a med school lecture hall than in any other lecture hall out there. Oh, do I sound too affirmative? If I do, at least allow me this: there are more overachievers per square meter in my class than in any other class I've ever been in or even heard of. The steps taken by the system in selecting the precious few that will be given a chance to graduate as doctors are many, and there is no denying that everyone, or almost everyone that is in this class deserves to be here. Right?

Well... I'm not so sure... I think here lies the problem; here, we need to stop for a few seconds and file a few definitions. What are the selection criteria? Exactly how does one define an overachiever? According to 1 definition or the other, or still the other (be careful which one you choose!), is this person truly fit for a career in medicine?

What is my point? Very simple. There is a vast vast difference between: (1) someone who is smart enough to go through high school, undergrad, and 4 years of medical school and pass with very high, if not the highest, grades, and (2) someone who is simply fit, overall (grades, compassion, personality what have you), for a career in medicine. Allow me to say that to bridge this gap with the assumption that everyone in a medical school classroom has probably been selected by people who knew what they were doing, and therefore that this student will probably make an excellent healer, would be making a serious mistake, one that would undermine the meaning and prestige ascribed to the medical profession. It is this sad, sad mistake that our society is making at this time.
But Who Cares What People Think?? Oh how I wish it were that simple! It is the sad reality that our trusted, self-proclaimed world-class (remember?) administrative process does NOT make the aforementioned distinction. Allow me to elaborate. Simply put, ours is a system in which the most adamant of bookworms thrive, because ever since my sophomore year, the exams we've been given have been relentlessly trying to test how many times each student has gone through the material in the ridiculously short time that they've been given to prepare, and therefore how many senseless insignificant details a student can cram in his or her mind during the final minutes before entering the exam room. This applies to every single course we have taken. I mean I would completely understand this in anatomy, neuroanatomy, and histology, to name a few but they have even made it work in the logical realms of statistics, biophysics, and physiology.

More to follow in part II

Of societies and conservatism...

She remembers a time when she was asked, not so discretely, if she had a tampon to lend:
-No, but I have a pad if you'd like...
-A pad? No! they're too bothersome, you still use pads? how archaic!
Flash Foward two years later, (today), she's shopping for her good ol' pads at her regular "hypermarket" (since in Lebanon a supermarket is barely up to par, and so you wonder what's in a name, and you then wander into the semantics of nightclubs, supernightclubs and supersupernightclubs but I digress...) And so she's in her hypermarket and she checks the tampons "collection" and to her surprise there's only one kind, in a somewhat sketchy cardboard box. What's the point you ask?

The great U.S. of A vs. the Hyper Lebanon societies:

On one side you have a society where girls are overpowered and so they will shout on the streets that they're pms-ing and that they use tampons and who needs a man anyways?
On the other side you have a conservative society where girls are all virgins (or appear to be) and they're all too scared to use tampons whether because they're truly virgins and misconceive tampon usage or because they're just too scared/ashamed to reveal that they're not virgins to begin with... And so there's no market for Tampax, Playtex, Ohne Binde... But you can bet money on finding a whole two-three shelves for Always with wings, ultra, fresh, overnighting... BUT, still still you need to be extra careful when you buy your pads because God forbids a man sees you carrying them! And yes believe it, the first thought that will come to mind is: "she has her period, how disgusting!"
And so we delve into a slightly off topic rant: Why is it that in Lebanon a woman who has her period is considered sick? "yiiiii sorry sakhneh, je peux pas nager!" (translation: "yiiiii sorry, I'm sick, I can't swim!") It's a regular physiological response, albeit annoying at times, but it's a sign of good health and fertility! Oh no she can't fulfill her wifely duties! she's sick...
Long story short, as a med student, I prefer pads because tampons might cause toxic shock syndrome and tend to be less hygienic if not removed constantly.
However, however, it seems like a futile and mostly personal issue to choose between pads and tampons, and women should have the option to favor one or the other, but to the day, this is not the case in Lebanon and this by itself is a reflection of a very complex, hypocritical society where women are still second class citizens.

Thursday, November 20, 2008

Courtside bench down memory lane

Badaro, Lebanon - November 2008
Picture Taken: November 20, 2008 - 3:37 pm
Chill... very well written :)
Went by my high school today. I graduated from this school in 2001.
This bench was not there during my high school years. Someone's getting old...

Where everybody knows your name!

And so it's med school: the politics, the lovestories, the friends, the teachers, the stress, the bookwormindia! she seems so entertained, it's a whole community! and yet, she remembers happier times, when she was able to attend to her own personal matters, when she thought life revolved around the things she was aiming to reach!
It all seems lost now, with every passing day, her focus, her passions, her self fulfillment! She has to take into consideration the community, the gossip, the backstabbing, the rumors, the hypocrisy! And so she wishes it's new year's again to take that same resolution, to detach herself from that community...

3 measures of disappointment, 6 of complete and utter disgust, and 1 sole surviving, waning measure of excitement...

So is med school everything I expected it would be? a sad, resounding NO... I remember a time, some 10 years ago, when this was everything I wanted, everything I ever dreamt of accomplishing in my senseless quasi hedonistic existence.

My journey In a nutshell: I wasted 2 years of my life "trying out" in the French system, to no avail. 3 years spent in undergrad, another year lost waiting for application periods, both for undergrad, and medical school admission. And now, almost two years into my medical curriculum. Yes, I've been going to classes and sitting for exams for 7 years. SEVEN YEARS, and I'm not done yet! "Wow, I heard people say, you must be pretty determined"... well, now, I would say: "one wonders, really". But why?

I wouldn't know where to start. So here are my jumbled and chaotic headlines and axes of thought: Do I begin with the ridiculous abuse that we're put through? with these unfathomable characters that professors and outsiders call our classmates?with the self-proclaimed world class, but the sometimes patently absurd administrative process in (my) medical school? the list goes on... Short questions with long, or no answers. so read on...

Wednesday, November 19, 2008

...and to a prosperous journey

...Each in his/her direction... dare we look ahead?
well let's look back at these words and think of these times after the hands of fate have done what they chose was right :)

Outside her box lies the real world

It was an after school ballet class. Nothing out of the ordinary. And then it struck her! There they were the ballerinas, with their imperfect bodies and their imperfect faces, sweating and smiling! They spoke to her with their shortcomings as if they were saying: "no the real world is not all plastic yet!" And so she felt content...

Let there be Light!

This is it. Here's to writing five years from now when life would have sent us each in his or her direction.

...and God divided the light from the darkness.