When in a strange land, laugh

UNMC graduate studies student Raheleh Miralami re-enacts the horror of finding her hair dryer does not work in America.

UNMC graduate studies student Raheleh Miralami re-enacts the horror of finding that her hair dryer does not work in America.

Comedian Yakov Smirnoff rose to stardom by summing up the incredulous, wide-eyed experience of being an immigrant in America with the catchphrase, “What a country!”

Likewise, many of UNMC’s international students can weather culture shock the way successful fishes out of water always have — with a sense of humor.

Raheleh Miralami, a UNMC graduate studies student from Iran, has been through it. She’s been in this country for a couple of years now, so she’s a veteran. But she wishes someone might have given her a head’s up (American slang; a forewarning) on some of the craziness that comes with being an international student in America. “Nobody told me,” she said.

So now, she’s telling everyone. And, yes, laughter sometimes ensues. She and other international students laugh at their situation, laugh at themselves – and, they occasionally laugh at us, too.

Miralami gave a presentation during UNMC’s recent International Student Orientation, entitled “U.S. customs, culture and culture shock.” First, she said, upon arriving in America, you are in euphoria. Everything is beautiful. You’ve never seen anything like it! But, it didn’t take long before Miralami was coldcocked (American slang; to be unexpectedly punched in the face) by reality.

“My first problem?” she said, queing up the next PowerPoint slide. “It was this.”

The American electrical outlet.

Not even Jackie Chan (top left) can defeat the American electrical outlet.

Not even Jackie Chan (top left) can defeat the American electrical outlet.

First of all, what in the world WAS that? And, let’s face it, it’s tough to think of the U.S. as the greatest country in the world when it can’t even run your hair dryer.

“The voltage here is 110,” she said. “The voltage at home is 220.” (Cue Michael Keaton as Mr. Mom: “220, 221, whatever it takes.”)

The coins don’t have numbers on them, the dime is smaller than the nickel, what’s up with that? And no metric system! How heavy is a pound? How far is a mile?

When it’s 40 degrees out, what does that mean? Is it cold? Is it hot?

Uptown, downtown? What?!

And, let’s not even get into “football.” But, since you brought it up, the even crazier thing is this: “Some houses have a special room decorated to watch the football.” (Yes. It’s called a Husker Room. What, is that not normal?)

Anyone else out there notice anything crazy about this country?

international students 007

You mean the ball is not round, and they throw it with their hands, and they call it “foot” ball? Ohhhhh! This country is SO confusing!

One young man raised his hand. In his hometown in China, it is socially acceptable to just stand around on the sidewalk at 2 a.m., whereas in America, people tend to find that unnerving.

Yes! Someone asked, “Why is everything closed when you want to go out to dinner at 11 p.m.?” (Hey, we’re also cultured in this country. Taco Bell is open. We’re not savages …)

At times it feels like international students may as well have landed on another planet. So what do you do? It’s taken so much, financially, emotionally, all the work and effort and everything else, to get here. You can’t sulk home. It’s time to get tough. It’s time to adjust.

(Strangely enough, it turns out that even after adjusting, many international students find themselves going through a “reverse culture shock” upon returning home. Presumably by going to bed before midnight.)

Americans are fat? Hold on, let me get this down.

So, “What’s up, partner in crime” means “Hello, my friend”? Hold on, let me get this down.

So, how does one adjust? The first step may be to realize that people here in the United States don’t necessarily speak English. They speak American. If you’re going to succeed in academia, you’d better figure that out.

Reheleh’s mentor-to-English phrasebook:

  • “I’ll have to think about it” = “No.”
  • “You might want to consider this” = “Do this right now.”
  • “That’s interesting” = “I can’t think of anything else to say.”
  • “Sounds great” = “It’s … OK.”
  • “It’s not bad” = “It’s bad.”

Then, there’s dealing with Americans. They’re different. You’d better prepare yourself for American culture, so let’s go over the stereotypes.

Americans love food. (Yes, no other people in the world enjoy their food or put social or cultural significance on mealtime like Americans do. Though, to be fair, in other countries they may not get quite as euphoric about curly fries.)

Americans are very passionate when they talk; they love to talk and will talk about anything. (Another trait unique to America; I’ve never seen anyone have a passionate, animated, garrulous conversation in any language other than English, have you?)

Drive around and around until you find a parking space closest to the door? Wait a minute, that's not a bad idea ...

So they drive around and around until they find a parking space closest to the door? Wait a minute, that’s not a bad idea …

Americans are very religious. (Because obviously, they’ve worked out that issue everywhere else in the world.)

Americans want what they call their “personal space.” (What are you looking at?!)

So now that a group of scientists have a set of preconceived notions to cling to, we’re ready. The next step in the process is the “mastery” phase. It’s where you adjust to your new surroundings, and everything is OK (American slang; it means “OK”). You get involved. You make friends. You find your way. It may seem a long way off, but you, too, will get to that place.

And then? Then, we will explain football.

The ball isn’t shaped like a ball. They use their hands but call it football. And the coach carries a cat for some reason.

Sigh. Americans …

What a country!

Surgical Boot Camp at UNMC

(To the tune of Piano Man)

It’s 9 o’clock on a Friday morn. The regular crew shuffles in.

They’ve all matched into residencies, but just before they begin:

Chickew…record scratch: BOOT CAMP.

A three and a half-week, elective course for M4s to hone their surgical skills just before graduation.

Did I mention it was optional? And that all 20 UNMC students who matched into surgical specialties opted to do it?

boot campers

Here are the overachievers with boot camp organizer Dr. Wendy Grant on the far left. Surgical Resident and Alex Trebek wannabe, Dr. Jeff Carson, is on the far right. On the first day, Dr. Grant buys them camouflage hats and labels them with the students’ last names. They can wear the hats during the month, but Dr. Grant asks for them back just before the end. On the last day of boot camp, she returns the hats back with “Dr.” before their last name.

They could be sleeping in, going out, traveling abroad, goofing off, wandering around, but they’re not.

They’re in the basement of the cadaver lab, tying knots on the incisions of donor bodies. Knot after knot after knot so that when called upon to suture in the operating room, they don’t freeze. Start to shake. Or worst-case scenario: get passed over from someone who does know how.

Surgical boot camp, now in its third year, was designed by Wendy Grant, M.D., from the Department of Surgery. She organized it to give UNMC students a leg up (or would it be a hand?) when they begin their careers as doctors later this year.

“Knot tying is the most basic, fundamental surgical skill,” Dr. Grant said. “If everyone who comes through here can be called on to tie a knot on their first day, whether it’s right-handed or left-handed, they’re ahead of the curve.”

You won’t catch Dr. Grant barking at students to “drop and give her 20” knots, but instead sketching a pancreas on the white board and peeking over the scrub-donned shoulders of her students with pride.

Thanks to those who donate their bodies to science, this course gives students the most accurate representation of what tissue will feel like in the operating room. Ortho students focus on the bones and joints. Obstetricians and gynecologists zero in on the uterus. ENTs and neurosurgeons concentrate on the head and neck.

“It’s the ultimate simulation,” said Ben Grams, who matched into general surgery at UNMC. “Having the cadavers makes it so much easier to learn as opposed to looking in a book.”

Jeremy Hosein, who matched into neurosurgery in Colorado, is practically boy scout status after tying so many knots.

“I’m 1,000 percent better,” he said. “We’ve each now tied a couple thousand knots.”

It’s not all knots. The mixture of advice and teaching comes from faculty and residents in many areas of surgical specialties at UNMC. There’s also the Laparoscopic Skills Olympics and of course, Jeopardy, held in the Medical Services Building.


With categories like “Things that are Red?” (Solo cup not being an acceptable answer) “The Number After 2,” “It’s Not a Toomah,” “Orders in the OR” and “X-ray,” it’s hard for the students not to have fun. After four years of non-stop studying, they relish the relaxed environment of “boot camp.”

“It’s an opportunity to reconnect with everybody,” said Jennifer Dwyer, a soon-to-be urological surgery resident at UNMC.

Dwyer brought the bagels and coffee for her team on the day of Final Jeopardy. After correctly writing an order to “administer a fluid challenge to a 19kg child who is hypotensive,” she and her teammates were stumped by what foreign body was pictured on an X-ray.

Fishing bobbers, guessed one student? Nope. Another student shouted an answer that can’t be printed in this blog. Nope. The answer was magnets. Giggling ensued.


Tom Brush holds up his team’s answer to a surgical Jeopardy question.

Their final exam was a double elimination bracket of tying 10 knots with fine suture. For many, having to do so will never be a part of their everyday lives, but it was a skill they thought impossible just three and a half weeks ago.

They opted to be here because they know it’ll make them better.

That, and it’s fun.