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Dialyzing in a War Zone

I was born and raised in the city of Hebron in the West Bank, the part of historic Palestine that is governed by the Palestinian Authority. I recently graduated from Hebron University School of Medicine, established in 2019. Here is a brief description of what it’s been like to study medicine here over the past six years.

To many, the existence of a medical school in Hebron comes as a surprise. Yet, under the shadow of military occupation and adversity, our education continues—demanding, unyielding and intimately tied to the realities that shape our lives.

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A True Exam Room

I recently accepted an opportunity to work in a new clinical setting. I now spend one day a week at a harm reduction site that serves people who are currently using or have used drugs within the past 12 months.

To my surprise, I’d passed by the nondescript brick building housing the site countless times. Clients come in to a room known as the “exchange”—a large space where they can make a cup of coffee or a bowl of oatmeal, grab some snacks, trade used needles or pipes for clean ones, or pick up a hygiene kit or a new T-shirt. Social workers make the rounds to assist folks with these tasks; as the clinician, I meander and chat with the clients, introducing myself as a doctor and offering to help them with any medical questions.

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Thank You, Betty

It’s dark outside. I get out of the car and rush into the emergency department. I’m a fourth-year medical student, and this is my last shift here.

I walk in, place my coffee on the table—dangerously close to the keyboard—and open up the electronic medical record. I’m surprised to see that there isn’t much going on. Just one new patient—a woman with some back pain.

Great, another lumbar pain–probably muscle strain, I think. I’ll give her some acetaminophen and a lidocaine patch. That ought to do the trick. It usually does.

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Stranded

“Wait here,” Dr. X said. “Someone will come and set up your next appointment and give you a copy of your lab results.” So I sat down on one of the plastic chairs, took my Kindle out of my purse, and waited and waited in the exam room. The staff must be busy, I thought.

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The White Socks

No, that title is not a misspelling of Chicago’s baseball team, the White Sox, but the germ of an idea that started with literal white socks. When I was a teenager, kids could be critical. Heaven forbid if you wore white socks with blue slacks, like blue jeans. Oh, the horror!

Thankfully, time marched on, and recently I was sitting in an exam room with my husband, wearing blue slacks and white socks. A health-care professional walked in, and she was wearing blue scrubs and white socks. That exam room visit led to a hospital stay for my husband. As I was sitting in the hospital waiting room, I noticed that all of us in one corner of the space were wearing blue slacks and white socks. How refreshing.

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Naked and Seething

I should have paid attention to Red Flag Number One, which was having to provide my insurance information four times. Twice is normal—once when making the appointment and again when you show up for it. Four times is excessive; that was my first clue.

I also blew past Red Flag Number Two, which was the most dark, dismal, uncomfortable waiting room I’d visited in years. Patients were crammed into uncomfortable chairs with little to no space between them. Everyone in the room looked stressed and unhappy.

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Returning to Slea Head

Halfway round Dingle Peninsula rises dramatic Slea Head. The narrow coastal road hugs the cliffs, makes a sharp turn, and continues on through the amazing green landscape.

Rumbling precariously along that road, our coach driver, Martin, playfully warns the students we might fall off the cliff at any moment. We’re nearing the end of our Ireland study abroad trip, so my wife and I ask Martin to stop and let our students photograph the stark, roiling Atlantic; the distant Blasket Islands; the gulls buffeted by the churning, cold winds. Last pictures. Last glances across the steel-gray surge.

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Mine and Theirs

Forty-five years ago, during a sabbatical at a solo practice in a rural village in Wales, I learned to push back against office conformity.

The British National Health Service (NHS) had a prescribed set of colors for exam room furniture that they undoubtedly bought in bulk and provided as part of their support for general practitioners. Most offices I visited during my nine months with the NHS had standard-issue exam rooms.

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Appearances Can Indeed be Deceiving

It was long enough ago that I can’t recall why (did I change jobs? did my doctor stop taking my insurance?), but I was forced to find a new ob-gyn. Anyway, this would be my first female doctor, which promised to make the annual visit more comfortable.

Indeed, “comfortable” seemed to be the byword of her practice. The tastefully appointed waiting room with its soft lighting, vintage botanical prints, and soothing pastels looked more like a Laura Ashley living room than a conventional doctor’s office. There was a nicer than usual selection of magazines, too, I noticed. I sank appreciatively into a cushy floral armchair to wait my turn to meet my new doctor.

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The Yellow Brick Road

Follow the blue brick-patterned rug to Elevator G. Press the button for the tenth floor. Stop at the check-in sign. Wait behind the do-not-cross-this-line sign. Finally, it’s your turn. They strap a white bracelet on you—after you recite the secret passwords: Greta Garbo. 9/18/1905. 3135331.

Then you sit. You bury yourself in your phone, trying not to drink in all the misery around you. Everyone has something. Everyone is waiting. Everyone sits with their head bowed. Three seats down a guy is snoring—rip-ragged, chain-sawing, full-out snoring. No one wakes him.

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