"You Should Have Met Me Before..."

I'd been hearing great things about a certain patient, a young woman, but my previous attempts to meet her had fallen on bad timing.

I always get a little nervous approaching a patient for the first time... I never know who I'll be meeting, what state she'll be in, especially at the early stages of diagnosis.  Overwhelming emotional storm?  Breakdown?  Confusion?  Denial?  Contradictory, shifting affect?  All of the above? Will she even register our introduction, or -- often as not at this early stage -- will she mistake me for a physician or nurse, and set forth a litany of disjointed questions about medicines, central catheters, fevers? 

But yesterday morning, there was G, smiling, inviting me into her little corner of the outpatient clinic.  Is this a good time? I ask.  Of course!  Why not? is her immediate answer.   She is already succumbing to the soporific effects of the meds she's received, but with little encouragement she gushes into a brief description of herself.   She has this job and that hobby. She is involved, engaged, active.  

You should have met me before.  I was the athletic type.  I used to run, do aerobics all the time. I was a teacher, I had a whole class of kids, ran a whole educational program.  I love art, love to write.  

I'm trying to keep up, listening at 100 km/hr.  I tell her we can offer her art therapy, bibliotherapy.  Meanwhile I'm noting all the was's and used to's.  That part has me a little worried;  she's only just begun treatment, and she's already left central parts of her identity behind.  She is clearly a doing person -- and for now, she is not doing, therefore she does not feel fully herself.  I can relate, all too well.   

I weigh my options.   Do I remark on the used to's, thus beginning the teeniest intervention without having had the time to really meet her, or do I let it go and make a note for later?  

Her oncologist steps in to inquire about her general welfare, and I gain a few more minutes to think, listen and decide.   I am impressed with how readily and directly she describes the recent state of her digestive system.  After all, he may be a physician, but he's a guy, and she's a young woman... who seems to understand the value of accurately reporting her physical state.

He goes, and we resume our conversation.  Meanwhile, I've made a decision.  You're still a teacher, you know.  You're on a break from teaching, but you're still a teacher.  And it really shows that you're an energetic, athletic person, despite all these tiring treatments.  We move into a brief discussion of what it means for her to be forced into this unwanted break from her active life.  At this first glance, she seems to know exactly what her limitations are, and what she still can do.  She is eager to move forward while she can.

I want to learn some art techniques, and I want to meet the bibliotherapist.  We should get started, right away.   But for now you'll have to excuse me, I'm a little stoned from all these drugs, I think I'm falling asleep...

I tell her it's been a real pleasure meeting her and excuse myself.   Her enthusiasm and optimism are contagious, and I find myself smiling as I exit the room.  I'm so happy to finally meet her,  I mention as I pass her oncologist. What a fantastic person. 

He looks up.  Don't get too attached.  Looks back down at his paperwork.

A sudden rush of air, and all that contagious enthusiasm has collapsed.

He means well.  Maybe he was just trying to look out for me, or for himself.  And yes, I am aware of the dangers of her illness.  But getting attached is part of the work.  I can't do my job without it.

Anyway, it's too late.

Keep the balance,

ALN

Roller Coaster

It's been a time of extremes.  Chanukah was fantastic - fabulous wedding, the kids (even Blondini Boy) were lovely bridesmaids / flower-kids.  Lots of celebrating, Sheva Brachot, and all those wonderful wedding things.

Then Chanukah starts winding down, the IDF winds up... and our nation's young adults -- my teenage cousin, his girlfriend, their buddies -- are going up in jet planes,  or planning down on the ground, risking their lives while our nation's kids and adults are hovering under bus stops and in shelters.  

The U.N. can condemn all it wants.  So can France, and whoever else.  Enough is enough.  Once again, Hamas is using their own citizenry as cannon fodder, and their willingness to do so is terrible for them, and ultimately, even more terrible for us.   

Hamas wants us out, wants us dead.   They say as much, all the time. But we're here.  To stay.  

Even those families who have been temporarily forced out of their homes -- in Sderot, in Ashkelon -- will be back soon.  Meanwhile, their kids did not return to school this morning along with their fellow pupils around the country.  Instead they are hovering within their houses or taking physical refuge in the homes of relatives, friends and strangers around the country.  Where does the psyche take refuge?  I do not know.

I look at that ubiquitous map, the one outlining Kassam ranges, and take note that we are within 50 kilometers of Ashkelon, only slightly beyond the farthest estimated capabilities of the longest-range weapon Hamas has amassed -- for the time being.  If you've never been here, you might have a hard time envisioning just how small this country is.  If you already live here, I don't need to explain.

I oppose war, hate violence, condemn mass destruction, and most of all, detest the thought of pain and suffering enacted by one group of humans on another.  But enough is enough.   We've been saying this for too long, while those ominous lines denoting Hamas' weapon range expand outward from the front page into our front gardens, our own front line.  

Enough is enough.

ושבו בנים לגבולם.

(For a recent report / opinion, please read one of my favorite blogs, A Soldier's Mother, here).

Keep the balance,

ALN

Let Them Eat Cake

Just a quick line, before the whirlwind packing process that precedes a family wedding (fancy white flower girl dresses, contingency dresses (note color of previous), little hair doo-dads, extra tights, more extra tights, needle and thread, etc. etc. etc...)

Last week I hosted colleagues from our school's senior staff for a presentation on the implementation of the new Hospital  Obligatory Education Law, which is finally going into effect some time in first few months of 2009. According to our school tradition, the presenter prepares a light meal for all of us to enjoy before the evening's program, and in addition to the soup, bread, and cheeses I had prepared a couple of chocolate cakes.

I went upstairs where That Guy I Married was getting the offspring into pajamas.  They had not failed to catch the freshly-baked cake aroma wafting through the house (and it wasn't even erev Shabbat), and asked whether they would be invited to partake.  When I was little, I told them, my Mommy was very concerned about not having us eat sugar, so she never let us have the cake she made for guests or work meetings.

Without missing a beat, Elder Princeski retorts, 

Mommy you're not going to do that to us, are you?

Followed by the inevitable, Mommy, you should blog this!  Either of those rejoinders would have convinced me, but really, I was planning on giving them some anyway...

(Sorry, Mom - I know your intentions were good).  

Shavua tov, a good week, and, of course, a huge mazal tov to N & M!

Keep the balance,

ALN

Be'er Sheva: One Principal Rewriting the Status Quo

(Read this post first if you haven't yet caught my posts about last month's in-service in Be'er Sheva).

We are traveling by air-conditioned bus, having driven Road 60 out of Be'er Sheva and east onto Road 31, north of Be'er Sheva, toward Arad and the Dead Sea.  We have now turned right off the paved main road and I wish we were back on it, since all this bouncing along an exceptionally bumpy dirt road, even at 20 km/h, has made me completely car sick.  As I snap photos out the window, I am trying not to throw up all over the vehicle's well-preserved upholstery.

Welcome to the pezura.  The word pezura -- פזורה -- is Hebrew for dispersion and refers to approximately half a million dunam (equivalent to about 175,00 acres) of unrecognized land, containing 50,000 unlicensed houses, and many, many more people, spread throughout the desert.  Within the Negev there are seven recognized Beduin towns:  Rahat, Tel Sheva, Kseifa, Arara, Segev Shalom, Houra and Laqiyya, and half the southern Beduin population lives within these towns (reference here).  As for the the other half, they live throughout the Dispersion, where there are no electricity lines, no water pipes or central sewage systems, no garbage collection.  With very few exceptions, there are no official schools. 

In the middle of all this brown, dusty emptiness is one exception, a literal oasis of a school. Amal is Arabic for hope, and the Amal School is aptly named.  Kids from kindergarten through high school arrive here every morning by bus, from all over the pezura.  The long, dusty road is literally in the middle of nowhere, and if a child misses the bus, he misses school for the day.  

We are welcomed at the entranceway and led across the school's courtyard --  an expansive pebbled area containing trees and a paved central area -- and into the library, where drinks and cookies have been set out for us.  

The school principal enters and apologizes for not having met us at the gate. He introduces himself as Khalil Elkorm, now in his twelfth year as school principal, and his twentieth in the Israeli Education ministry.*  

His presence fills the room as he launches into an energetic talk about his educational philosophy, the main thrust of which is that schools must find a variety of ways to educate, beyond the traditional frontal teaching style, and that any new educational program, as good as it may sound at first, must be tested and adapted to the needs of the children in system, before it can be thrust upon them.  

Over the years, Khalil has helped to establish after-school enrichment programs, hot meal programs, and an on-site medical clinic so that the parents will be involved in their children's education, without compromising all that has been accomplished by the sectarian and tribal conflicts that would work in opposition to Khalil's educational priorities for his 650 pupils. When asked how he deals with the intergenerational conflict that must arise between these modern-educated children and their conservative parents, Khalil described in further detail how he learned the hard way, that the school must guide the parents, and not the opposite, or change will never happen.

Following our talk Khalil brings us to the kindergarten area, fenced off from the rest to give these youngest pupils a chance to have their own safe space before moving up to first grade.

Unlike the camera-savvy grade-school children who have already mobbed us, begging to be photographed, these little ones are still shy and wary of visitors, but after a few minutes their smiles break through and they are happy to have us watch them solve problems in small groups.

Back in the courtyard, Khalil explains that it is election day in the local towns.  In honor of this event, a group of older girls are conducting mock elections, standing in two straight lines as they wait to cast their vote the ballot box.

I'm pretty impressed by their ability to stand there patiently, and wonder how much of it has to do with the teachers observing along the sidelines, or whether, as girls, they have just gotten used to being told to wait their turn.  I think about the ramifications of what they are doing.  How many of these girls will actually get to vote in an election in their lifetimes? They face so many hurdles:  As women in a men-dominated society, and as an under-recognized minority living in unrecognized areas. 

Khalil is clearly very proud of his school and its accomplishments, and for him this means rejecting his society's status quo.  "His" girls are already voting, even if their votes will not influence this year's election.  

Keep the balance,

ALN

_____

*  Khalil gave me his full permission to be featured here.

Be'er Sheva, in Retrospect

It's been awhile.... all good things:  Family wedding coming up, work presentation last Sunday, and other details I won't bore you with.

If you're a regular reader here (kudos to you!) you're aware of my in-service training last month at Beit Yatziv, a continuing education center for teachers, located within a historical neighborhood of the southern desert city of Be'er Sheva.  It was my intention to blog live from down there, but they kept us so busy (classes from 8 am to 10 pm), with some rest and lots of food in between) that I couldn't keep up.  It was also very clear at the time that those moments between classes, lectures and workshops were digestion time for the brain.  The few posts I did managed from there are available here, here and here.

Meanwhile (yesterday afternoon, in fact) we met to kick off this year's series of bimonthly workshops on multiculturalism in the work place.  I and several others were pleased to learn that the emphasis of our discussions will not be limited to Jewish-Arab -- and other religion- and race- considered -- relations, but will also focus on organizational issues and the discrepancies between the hospital/medical organizational culture and our own educational culture within it.

Not all of the staff participants of the bimonthly meetings were present at Beit Yatziv, and the opposite, but as we begin this new series of meetings, the experience in Be'er Sheva remains at the forefront of my mind, with the field trip to the surrounding Beduin areas at the locus of that experience.

I'll begin with where we did not go.  We did not enter any private homes or tents.  With the exception of school children, we did not meet "ordinary" Beduins.  We met some of the exceptions;  the role models, the risk takers, the mould breakers.  All of them are well known in their respective communities, respected by some and resented by others, for daring to go against the grain and change the status quo.  In the next few days I'll introduce you to them, one at a time.  Stay posted.

Keep the balance,

ALN

Ruby Tuesday

OK, so I'm putting this up on Monday night, in anticipation of a long Ruby Tuesday with no room for blogging.

Winter is definitely -- sadly -- not yet in full swing here in Israel, which means no rain, as of yet (with the minor exception of the rain that overran my friend N's gutter system).  At least we have succulents, and some color remaining, here and there.  Presenting this afternoon's garden tour:

Tuesday morning addendum:  Are the Heavens laughing?  Twenty minutes after posting, it started to rain.  Didn't last long, but still...

Keep the balance,

ALN

"Maybe I Should Write About It..."

I know, we're not supposed to have favorites.  Or at least, we're not supposed to show them.

But I won't lie to myself, or to you.  I have favorite patients.   And they're not necessarily the sweetest ones, or the friendliest ones, or the ones that always draw a crowd of staff members and volunteers, because they're so darn cute.

OK, I like those patients, too.  I love them, really.  But they aren't my favorites.

My favorite patients are the ones who tell their stories, share their lives, plunge the depths, with an authenticity that astounds.  It expresses itself, often as not, through a mighty silence, a reclaiming of their lives via quiet refusal, or restrained acknowledgement.

T is nineteen years old.  He was meant to have graduated high school last year with a diploma and a qualifying certificate in electronics, but he didn't make it back to school to finish his senior year.  

Meanwhile his hair has grown back, springy dark corkscrews that he still feels a need to hide under a baseball cap.   During last week's visit he was short on patience, fasting before a procedure, so our conversation was brief and centered around Spanish football teams.

This morning, though, T is feeling much better, sitting in Outpatient waiting for his regular check-up, and --surprise -- he wants to talk.   I ask him about the Sidge festival two weeks ago, a holy day for Ethiopian Jews, during which they celebrate aliyah and gather to pray for all Jews to return to the Holy Land.   T claims not to know too much about it, then changes his approach.  

What kind of respect do you think olim deserve? he asks me.  Point blank.  Immigrant to immigrant.   No beating around the bush, and no whitewashing.  

I think immigrants like me, from the United States, get a lot more respect than immigrants like you, from Ethiopia.  

He responds by giving me one of his fantastic smiles that announces:  At last, the truth comes out!  We discuss the discrepancies, the race-based unfairnesses.  We don't get into too much detail, since T is the type that likes to hint at things before laying his trust on the line.  With him, you gotta earn it, over and over.

You know, when we get here, they don't even recognize our university degrees.   No, I did not know that.  I also had no idea that T attended school for the first time only after moving, at age twelve, from his rural village to the far away city of Gondar.  He's telling me this, and I'm imagining a preteen, illiterate village boy falling like Dorothy into a foreign world whose very name sounds nearly Tolkien.  In Gondar T studied math and learned to speak a few basic words of English, though this barely helped him two months later when he arrived in Israel.  My mouth was already too old to learn to speak right, he explains, sticking his tongue out and demonstrating the difficulties he had, shaping that adolescent mouth into the words of yet another set of foreign sounds.

How many times can one kids move?  Multiple times, it turns out.  Once in Israel, he moved from an absorption center in the South to a development town in the Center, to a dormitory trade school along the West Coast, and then... leukemia.  Back down south for treatments. Recovery, and back to school.

Relapse.  

New hospital, new people, new living situation.  T recounts each step but leaves the details behind.

I'm sitting there, trying to follow all of this while keeping track of the number of times he moved in a span of six years.  So far I've counted seven.

Eight, he corrects me, and hints that there were more, prior to his family's move to Gondar. He pauses.  I've been thinking, maybe I should write a book, about all those moves.  

Pretty impressive idea for such a private person.  You'd be good at that, I tell him. Especially since you've been through things no one else has.  He faces me with that intense glance of his. What do you mean?   

He's not looking for me to tell him something new, of course.  He's testing me.  Not as a rebellious teenager, but as someone who has been through so much, he's almost given up believing that anyone else could get it. Especially a Western immigrant like me, with my light skin and state-recognized diplomas.

Well, you're different from most of the other people around here, I continue.  For one thing, you come from a different place, and you can't hide that.  Everyone sees it, right away.  

Now T is staring. What else? he says, waiting, so I continue.  

Beyond that, you've been through all of this.  You know what to expect -- the treatments, the tests, the pain, the complications.   You understand the threat hanging over your head, better than you ever did before.   I pause.  But there's one more thing, the most important thing of all.

He looks astounded, transfixed.  

You're different from other people.  Your personality is different.  You see the people around you;  you see a lot and you notice things.  But you don't jump to open your mouth and talk about it.  You keep your observations to yourself, until you know you can trust someone, and then --  maybe -- you share your thoughts with that person.

His expression says it all:  This revelation, this conversation, is the real thing.  This person might just get it, just a little... so maybe sharing one's inner thoughts and feelings is worth the occasional risk.  

(It's a risk for me, too, not having a direct way of understanding T's thought patterns until he --  or I -- voice them.  A serious misreading of his emotional and cognitive process would only have further isolated him by enforcing his belief that others cannot understand him).

Later on, I offer to help T start the writing process by typing into the computer as he narrate. He hesitates.  As with everything else, he wants to think about it first, on his own, and get back to me. 

We agree to discuss the option the next time we meet.  

Keep the balance,

ALN

HH #194 - Counting Down (or Up, Rather) to 200

I missed it, but you shouldn't.... HH #194 over at Shiloh Musings.  Enjoy!

ALN

Occupation As Balance

(No, not that kind of occupation.  I truly, honestly do not know how to address that topic in this forum, or with which vocabulary, and so I leave it aside).

Why I don't call my good friends more often than I do?  This evening I picked up the phone and dialed my friend N, and rediscovered how fantastic, how comforting it is to have those conversations and compare the day-to-day... The freshly-discovered gutter leak in the newly-purchased house;  the parallel laments over negligent school systems long-overdue for an over-haul;  our mutual agreement that the Obamas' extended family support system will only benefit them as a young, busy, professional couple preparing for the next busy stage in their lives... and on and on.

The conversation reaches that inevitable topic:  work, motherhood, how to do it all and keep the guilt minimal, the multi-tasking maximal, and everything in between relaxed and stable enough to keep everyones' lives together and whole and enjoyable.  

N works a much longer day than I do and gives her husband A a lot of credit for his super-husband abilities, especially in recent years, but reminds me of what it takes to reach household stability.   Sometimes one of them is down, sometimes the other.  But they know to take it in turns.  Both she and A cannot both let themselves feel drained.  

Or, as N put it, If that space is occupied in the house, then I know I can't be there... That is, she understands she has to stay upbeat and hold on to the energy level until A can get it back again, and then she can let her end drop a bit and let him pick up the slack.  

It's not always going to happen.  Within our own four walls, I know there's no guarantee that the two of us aren't going to hit some kind of simultaneous slump;  it just might happen, and it sometimes does.  We both get tired, cranky, past our peak.  Then maybe it's time, as it was last night, to just go upstairs and hang the laundry together, instead of trying to figure out whose turn it is.

Occupation as balance?  Maybe, if we can just hang on and take it in turns.  Hang in there, N.

Keep the balance,

ALN

Live: Parlor Meeting with a Candidate for Head of Our Regional Council

Here's democracy in action.  

I'm sitting in my neighbor's living room, and about 30 additional neighbors have joined us here to meet with Moshe Dadon, a candidate for our local Regional Council (mo'etza).  Unlike the major cities, where voting took place a few weeks ago, our area goes to the polls in January to choose its new Regional Council members.

Moshe grew up in the area (Moshav Luzit) and has served as the Regional Council secretary for the past four years, so he knows the system from the inside.  He described growing up among the chicken coops, and seeing the agriculture lifestyle fall by the wayside as the years went by. The area's needs now are completely different; he noted that much of the moshav property formerly used for agriculture is now factories.

Moshe describes himself as "very green - not in terms of money, but the environment" (It wasn't clear what he means by this, as some of his later statements indicated that he has a poor understanding of certain environmental issues).  He understands that many people are flocking to the moshav expansions for the quality of life, and are not agriculturally minded. He realizes that municipality taxes have been rising, but are not nearly at Jerusalem levels, and that all the local illegal building is only hurting all the citizens because they cannot benefit from improvements if local tax money is not being put back into the system.  

Moshe pledges the following:

1.  Taxes collected locally, stay local.  All tax monies collected for the moshav expansions (of which there are many) will go directly back into moshav coffers.

2.  Sliding scale taxation.  Everyone should pay arnona, including residential buildings, local businesses, quarries and other industrial properties, according to their ability.  Anyone who qualified for a discount will receive one accordingly.  The Arab sector, which has been neglected until now, will also receive the amount entitled by law.  

3.  Financial independence.  The general dependence on the system for financial support is unjustified and has to be changed.  Every community can then become independent and make its own decisions according to its needs.

4.  Infrastructure.  By law, 5% of tax money collected by the Regional Council is designated for internal development;  that means 12 million shekels has to be distributed every year to the local municipal governments, for use as they see fit.

5.  Primary Education.   The local educational system should be run locally, by a professional with a doctorate in education.  Most of the local population is religious, and any new local school would have to be religious and include all the children in the surrounding local moshavim.   Until now, our religious school system has not provided a good education, period, and many families send their kids to a different school district.  

6.  Secondary Education.  High schools in the area have been closing, but the local population is growing and we'll need to develop a series of local high schools here in the area. Competition is good for education, as it is for everything else.  By law, only the head of the Regional Council is entitled to choose where kids go to school.  At this time we have 4000 high school students, and the system doesn't have room for new students, even if it were a good system and people were willing to send their kids.

7.  Transportation to School.  For now, funding from other budgets, such as the building budget, to fund school buses for local kids.  There is no governmentally funded option for transportation for high school-age pupils.   Children need to go to good schools, locally, such that there won't be a need for transportation.  School buses are a temporary measure until we have good schools in the area.  Pupils can't succeed if they spend hours on buses, and there's no equal opportunities for all citizens until we have quality local schools for everyone.  We don't have time to wait.

When it was pointed out that building all these schools will take time, he didn't have a clear answer, except to improve the existing schools.  One neighbor offered a temporary solution of not having kids for the next few years, which got a few laughs but underlined the seriousness of the issue.  Moshe grew up in the system, continued to be involved in the local education system after his high school graduation, and sends his kids to the local schools, so he is aware, from the inside, of just how bad it is.

When asked about the decision making powers of the local municipality versus the Council regarding expansion issues, he spoke in favor of allowing the municipal council to receive tax monies and make most local decisions.  Regarding division of properties, especially public and moshav properties, he cited a local example of a town within the region that wanted to build a swimming pool with public develop monies, and the Regional Council refused to grant permission.   

A participant described one local conflict regarding the use and upkeep of moshav property, an issue which has put residents of our Moshav extension at odds with the decision-makers of the moshav's municipal council, with no legal redress... As this neighborbor pointed out, this type of conflict usually stays on a minor and limited level, but the same problems tend to repeat themselves, and our current expansion has only brought the issue to the fore.  Moshe did not provide a clear answer regarding this issue.

Regarding the protection of nature conservancies, Moshe supports expanding into parts of those ares for the benefit of the local populations.  He cited the building of a new school as one example.

Moshe has pledged to bring educated, reliable and honest workers into the Regional Council, and here he was asked regarding the type of people he would, indeed, bring with him.  (It has been said that our local government has become bulky and corrupt over the years, and I can testify to the number and quality of shiny cars in the parking lot).  

Moshe responded by pointing out that there is one person in the regional government overseeing all 180 local kindergartens in the region, with a similar situation for the primary schools...  "No one person is a workhorse."  A neighbor responded with cynicism, that the only department in the council that returns phone calls is the Collection Department.  Generally, those present at the meeting did not express satisfaction with the so-called reforms he claims to have made until now.

Moshe referred to a total rearrangement of the governing system, especially the educational system, and that in his view this includes, among other things, encouraging older workers to retire, and having others transfer to departments where they are needed.  "If one doctor is no good, do you blame all the doctors?"

He continued to refer to poor air quality, although he offered no clear solutions.  Prior to this, he claimed not to understand the connection between electricity and the quality of the environment.   Regarding a specific road in the area which has been declared unsafe and whose legal status has remained unclear for years (the road remains open but the police sometimes distributes tickets to those who travel on it), he offered no clear answer, except to point out that the Regional Council has been trying to resolve the issue.

Moshe's closing statement (summary):  We have the opportunity to develop the area, to give everyone an opportunity and quality of life.  The problem is not as other candidates will tell you, that this or that individual bureaucrat is responsible.  The money is the issue.  If we want to develop the area, our money has to go to the right places;  quality education for everyone, and local development.

* * * * *

On Wednesday, another candidate will be coming to impress us.... stay tuned.

Keep the balance,

ALN