Tuesday, May 22, 2018

A Stroke Of Magic

Staying true to the source material while trying to recreate the same emotional response in the reader is to me the biggest challenge of writing a new blog.

Sometimes it is easy and sometimes it takes exploitation of the infamous 'Creative License' to accomplish this task.

On rare occasions though, something so remarkable happens that all I need to do is recount the exact sequence of events, with no added spice whatsoever to justify why the story needed to be told.
I spent the month of April working at the University of Chicago.

Established first in 1890, UChicago or UChi as it is sometimes referred to is a premier educational institute that ranks among the best in the world.

The list of famous alumni to be associated with the university is enviable, and the medical center by no means lag behind the competition.

Home to the latest in cutting-edge research and some of the best doctors in the country UCM is certainly living up to its mission to be 'At the forefront' of medicine.
I didn't sleep a wink the night before I was scheduled to start, but my energy levels were still at an all time high the next morning.

Even the 1-hour 45-minute journey entailing 2 buses and a train did nothing to deter my enthusiasm.

Things looked promising and it helped that for once I looked pretty handsome in the picture on my ID:)

The university campus is huge, and for a first-time visitor, it can be very confusing to navigate through the 4 units that comprise the medical center.

It is easy to spot someone new to the university complex.

These individuals usually have the same expression on their faces, a mixture of wonder and confusion and more often than not, they would stop you to ask for directions, especially on how to get to the 'Au Bon Pain' on the second floor of the Mitchell building.

In case you were wondering, the 'Au Bon Pain' on the second floor of Mitchell is the most commonly used reference point while being directed to a particular location at the hospital.

I know this because I played the role of the confused visitor nearly every day to perfection for almost 2 weeks.

Not to discount the fact that I mis-led quite a few patrons into believing that I actually knew where the 'Au Bon Pain' on the second floor of Mitchell was.

More often than not I would run into these individuals a few moments later on at another floor and pretend that the person who misdirected them earlier was an estranged twin brother of mine.
Getting used to the layout of the hospital was only a small thing.

On two separate occasions, I walked through alarmed doors inconveniencing a whole bunch of busy people, I often got locked out on stairs without re-entry, ending up walking down several flights just to get back on the ground floor, once I took the wrong bus and ended up travelling 16 miles in the opposite direction and then there was an incident when I thought all my stuff had been stolen, only to find it on another level a few hours of anxious frantic searching later.

It is not that I was clumsy, which I am, the truth is, I was pretty overwhelmed.
Something that defines medical education globally is an emphasis on developing good bedside manners.

'A doctors hands must possess a healing touch' one of my favorite professors in India would say from time to time.

She hated it when we used gloves to examine patients except when it was obvious that they had a contagious process going on.

'The palm of your hand can be more efficient than a thermometer to gauge how your patient is feeling'.

My life as a doctor so far is a testament to what she said.


When sincere, all it takes to make a lasting connection with a patient is a gesture as simple as holding their hand.


Lying in a hospital bed puts you in a very vulnerable position, and I did not understand the full extent of it till I ended up in the ER about the same time a year ago.


That experience taught me that ordering all the right tests and medications are important, but making sure the patient feels comfortable and supported is equally important, if not more so.
A stroke can manifest in many different ways.

It is one of those conditions that can confuse a clinician with weird presentations and we are constantly reminded on a day to day basis to have a high index of suspicion for strokes in patients with unexplained mental symptoms.

When Ms.J was brought to the emergency room at the university with a sudden onset of unexplained confusion, her doctors were spot-on with ordering a CT scan of her head.

A large cerebellar stroke adequately explained all of her symptoms.

She was the first patient assigned to me during my rotation.

On my way to see her, I did my best to not walk through any alarmed doors, for the most parts of the 10-minute walk I made the right turns and the fact that I passed by elusive Au Bon Pain (you know, the one on the second floor of Mitchell) served as a reassurance that I was slowly settling in.

I double checked the door before entering the room to make sure that I was abiding by all necessary precautions.

It was only me and the patient.

Ms.J still appeared confused.

I tried explaining to her who I was and what I was there to offer, but my words didn't seem to register.

I moved closer so that she could hear me better and unknowingly pressed down a little too hard on the side rails of the bed.

A loud alarm went off from the bed alerting the nurses outside who rushed into the room.

'Doctor, you should know better than this, one of them said before turning off the bed alarm'.

I was mad at myself, the nurse was right, they were busy enough already to have to run around turning off false alarms all day.

My shoulders slumped and my head drooped, I was disappointed.

Now aware that I wouldn't get much of a history from my patient, I turned to take my stethoscope out of my white coat pocket.

As I fumbled around Ms. J gently held my hand.

I turned to look at her and for a moment the confusion was gone.

She continued to hold on to my hand without letting go, nodding her head slowly, it was as though she was saying to me - 'I know you are overwhelmed, but hang in there a little longer, you're going to be ok'.

I smiled and stood there a while.
Those 30 seconds were the saving grace for the rest of my rotation.

I don't mean to say that everything went on smoothly from that point onwards, I took my time to understand how the system worked, but just like Ms. J's path to recovery from the stroke, I slowly and surely got better.

My attendings at medical school always focussed on how important it was to make the patient feel supported in a time of illness, I wish I could share with them this story of how my patient did the same for me.

Until Next Time.

TGV

Sunday, December 31, 2017

Poems, Prayers & Promises

"I don't think I'm going to complete my project in time guys". Sherin said.

I gave credit to her, at least she was thinking about work.

'Biriyani House' was packed that afternoon, we had walked over for our final lunch together of 2014.

The loud clanging of utensils in the background only served to heighten the chaos inside the main dining area, we had to shout in order to be heard.

Work-wise it had been a largely unproductive week.

Coming to the office on the days between Christmas and the New Year was a challenge in itself.

It is essentially a very confusing period between two long holidays.

Karthik and I blamed our diet and briefly gave up our high protein sprout based lunch, we also started taking coffee breaks every 15 minutes but nothing was helping.

"Maybe we shouldn't talk about work guys". I suggested.

Most people on the table nodded in agreement.

Then there was an awkward silence.

That's when I realized one of the weirdest things about work lunches - It is so hard to find anything else to discuss other than work.

I tried to think of something we could talk about that didn't include deadlines, review articles and powerpoint presentations, but clearly I was drawing a blank, we all were.
I could sense us all taking turns staring at our glasses on the table and at the kitchen door hoping our food would arrive soon and put an end to what seemed to be the longest break in a conversation ever.

"Any plans for the new year"? Anita asked Karthik.

Karthik took his signature deep breath.

We watched his lungs expand anticipating his reply.

Microseconds before he could exhale our biriyanis arrived.

After that he didn't really care much about the question.

I am sure at this time that he was sick of eating those sprouts for so long, new year could wait, this was biriyani time.

By the end of our meal, I knew what everyone was up to we all were looking forward to different things

One tradition stood out from the rest.

Ankita was waiting for an email.

Yes you read it right, she was eagerly waiting for an email.

We obviously demanded more details.

She told us about a Swiss-German gentleman she had met few years ago who worked for an international organization. His work involved traveling around the world.
These were not always pleasant places to be, he was often deployed to troubled areas and war zones.
This guy had been everywhere, Libya, Somalia, East Timor, the Middle East.
He tried to collect as many email addresses as possible of all the people he met along the way.

At the end of every trip, or whenever he found time in between, he would update a draft in his inbox detailing his best experiences from visiting a country or meeting someone who left a mark.

At the end of the year, on December 31, he would send the email out to everyone on his address book.

He had been doing this for a long time and the number of people on his list had only grown bigger in time.

She looked forward to reading his email every year since she first met him at a conference in college.

When I asked her why she liked reading his letters, she said it felt as though she was a part of something bigger, and one day she hoped to write a travelogue of her own.

The same day I decided to dedicate a blog post at the end of every year just as a reflection on the most important things that happened to me in the preceding 12 months.

So taking a deep breath like Karthik always does, with no biriyani around to distract me, let me give you a review of 2017.
You will not believe how I began this year.

Chances are you probably think I am making this up.

But I promise you, this is how it went down.

The last thing I did in 2016 before leaving for work was say a tiny prayer and publish my last blog post for the year.

It was unusually peaceful in the ICU.

The telemetry monitors were quiet, the phones weren't ringing, I periodically checked my pager to see if it was working, but it lay silently in my pocket.

My resident and I seemed to be headed for a uneventful call.

At 11:35 PM, to be polite, the toast hit the floor-jam side down.

Absolute chaos ensued as a patient awaiting transfer out of the ICU suddenly stopped breathing.

The monitors went crazy, the phones rang off their handles and the pagers didn't stop beeping.

"You should switch" The nurse yelled at me noticing my chest compressions were becoming weaker.

I wiped the sweat of my brow and switched with my colleague.

"And by the way, Happy New Year everyone" she said.

I paused to catch my breath and looked at the clock in the room, it was a 12:03 AM.

There was no time to celebrate, our attempts to resuscitate the patient continued through the night and I wish I could say he made it, but that would not be true.

That night was just the beginning of a very eventful year.
Watching Dead Poets Society many years ago as a teenager was a turning point in my life.

One of the most unforgettable scenes from the movie is Robin Williams' Carpe Diem speech.

"They're not that different from you, are they? Same haircuts. Full of hormones, just like you. Invincible, just like you feel. The world is their oyster. They believe they're destined for great things, just like many of you, their eyes are full of hope, just like you. Did they wait until it was too late to make from their lives even one iota of what they were capable? Because, you see gentlemen, these boys are now fertilizing daffodils. But if you listen real close, you can hear them whisper their legacy to you. Go on, lean in. Listen, you hear it? - - Carpe - - hear it? - - Carpe, carpe diem, seize the day boys, make your lives extraordinary."

Carpe Diem became the motto of my life.

I always knew it wasn't possible to make the most of every moment in life, but this year I realized that sometimes its okay to not be okay.

The peaks and troughs of life are unpredictable, but neither last forever.

Things always get better, even if they may not get fixed or return to how they used to be, we will always find a way to be okay again.

Its only a matter of time.

Everything passes.
We begin most of our days as residents with a 1 hour classroom lecture on the 12th floor at the hospital.

Theres usually a new quote written everyday on a white board facing east.

Its something I look forward to everyday.

Some of my friends take it seriously while some others have a little fun with it every now and then.

I laughed out loud when I read this quote last year by a no longer anonymous friend of mine.

'The worst part about kissing a perfect ten is how cold the mirror feels on your lips'.

For the past month though the quote on the white board hasn't changed.

'Be kind whenever possible, it is always possible' - Dalai Lama.

And in time some of the more mischievous ones among us decided to draw what looked like an orc with a sharp pointy tail and 2 horns next to the quote.

The longer the quote stayed up on the wall the more I read it and the more I realized that kindness is a choice.

It occurred to me that even in the most impossible of situations you can decidedly choose to be kind.

This is something I want to carry over with me to the next year.

And yes, kind or not, I got rid of the orc drawing next to it :)
And finally for the best thing that happened to me this year.

If you have been following this blog from the start you will know that cupid and I have a long history.

Our friendship has been tempestuous and yet hilarious.

After avoiding me for years and following a series of missed shots, the cute little angel took aim and fired an arrow that went straight through my left ventricle.

Love came to me at a time when I least expected it, but when I needed it most.

And like it is said, love changed everything.

My brother once theorized that age 30 is the best year in a persons lifetime.

Why is he always right?

2017 was a roller coaster ride - Scary, exciting and incredibly fast.

But all things considered it was defnitely one of the most important years of my life.

I had good times and some hard ones too, opportunities presented to me and brought along different challenges with them, but the best part was that through it all I continued to change, learn and grow.

And for all of that and more, I thank God.
When I started blogging many years ago, finding a name for my blog was a huge challenge.

After days of brainstorming with a very good friend of mine, I decided that my blog would be named Poems, Prayers and Promises.

It is actually the title of my favorite John Denver song.

But sadly for me, the name was already taken, and a few weeks later I chose to call my blog 'The Sentimental Idiot' instead.

At the time that this post gets published you are probably in the middle of your own favorite New Years tradition. 

Whether it is dancing to the sound of our favorite music, raising a toast hoping for a better year, or making resolutions, our New Years traditions are essentially poems, prayers and promises of different kinds.

As I sign off on the last post for 2017 with a few lines from the song, I thank you too for being a part of this sentimental idiots journey and I pray and hope that 2018 will bring happiness, hope and love your way.

I have to say it now, it’s been good life all in all, it’s really fine to have a chance to hang around.
and lie there by the fire and watch the evening tire
while all my friends and my old lady sit and pass a pipe around.
And talk of poems and prayers and promises and things that we believe in.
How sweet it is to love someone, how right it is to care.
How long it’s been since yesterday, what about tomorrow
and what about our dreams and all the memories we share?


Until Next Time

TGV

Thursday, December 7, 2017

Where The Light Shines Through

Steve Jobs' biography is an interesting read.

It is evident from page 1 to 656 that Walter Isaacson went above and beyond to present a fact based, accurate depiction of the Apple co-founder’s life.

The book is brutally honest.

I finally got around to reading it on a short weekend trip to Chennai. 

While I’m normally a non-annoying co passenger, my fellow patrons on the bus were often distracted by my loud exclamations. On many occasions, I found myself pausing and saying out loud things like - ‘No way, there’s no way he did that’.
In the end though I found Steve to be an interesting, complicated and controversial personality, all at the same time.

One thing I could not deny was his unfathomable passion for everything that he put his time and money into, it was palpable in every page of the book.
Whether it was him aggressively marketing Steve Wozniak’s circuit boards or pushing the Apple II’s team to the limits of exhaustion, his drive was incredible.

It is easy to see that he was not really motivated entirely by financial gain, I was moved when I read about an instance during the early days of Apple’s formation where Jobs cried after Wozniaks father accused him of trying to take advantage of his son.

After he was fired from Apple the first time, Steve founded another computer company-NeXT, the biggest surprise in the book came to me while reading the chapters detailing this phase of his life.

I had no clue that Steve Jobs owned Pixar at one time.

He bought it from George Lucas and invested 5 million dollars of his own money into it primarily because he was blown away by the innovation he saw at the company.

NeXT although ambitious was not successful and Steve was on the verge of bankruptcy, he had decent offers to sell off his stake in Pixar but he didn’t do it.
Pixar continued to lose money but innovation didn’t stop.

Everything changed when they made the world’s first fully animated movie about a bunch of toys that come to life at night.

Steve did eventually agree to a merger of the company with Disney, but terms of the the deal included a clause that put all creative aspects of production in the hands of the people at Pixar.

I’m not a very big fan of animated movies, but I love Pixar.

Over the years the studio has produced some great movies, films that combine state of art animation with stories that can stand up to any live action drama.

There is usually something to learn in all of these films, both for kids and adults.

Carl and Ellie in ‘Up’ taught us about lasting love, Woody, Buzz Lightyear and Andy continue to demonstrate what real friendship is like with the Toy Story franchise, and who would have thought that one of the best depictions of parental love in cinema would come from the same studio in the form of a story about 2 clownfish named Nemo and Marlin.
This blog is about another Oscar winning Pixar production.

'Inside out' is a fascinating movie for many reasons, I consider it one of the most innovative projects made in cinematic history.

Pete Docter redefined storytelling in animated movies through this feature.


The story revolves around a 11 year old girl named Riley, but the main protagonists are actually her emotions - Joy, Sadness, Fear, Disgust and Anger, 5 characters with 5 different personalities residing in her mind.

In the beginning most of Riley's memories are happy and ‘Joy’ dominates her emotions.

So 'Joy' is pretty much in charge of all her feelings.

'Sadness' is an unwanted emotion and the others kind of bully her all the time.

When Riley’s dad suffers some losses in his business he moves the family to San Francisco and that’s where her life changes signficantly.

With every bad experience 'Sadness' starts to grow and her happy memories begin to decline, naturally all the other emotions in her mind blame sadness for this untoward turn of events and isolate her even further.

On one particularly unfortunate occasion 'Joy' goes to the extent of trying to delete one of Riley’s bad memories and both ‘Joy’ and ‘Sadness’ get pulled into a maze of some kind and Riley is left with fear, disgust and anger to manage her feelings.

As one may expect this does not work out too well for her.

As Joy and Sadness navigate through the maze of Riley's memories they come across one incident that changes Joy's perception of Sadness for ever. 

More on that later.
I have written about my love for Switchfoot’s music many times in my blogs.

Jon Foreman is a modern-day poet and prophet.

Their latest album that came out in 2016 was called ‘Where the light shines through’. 

I didn't get the reason why the band chose 'Where the light shines through' as the name of their album, not even after listening to the titular song a bunch of times.

Then one cold Sunday afternoon while on another bus ride the song revealed itself to me.

Here are the lyrics from the chorus.

'Cause your scars shine like dark stars
Yeah, your wounds are where the light shines through
So let's go there, to that place where we sing these broken prayers where the light shines through
The wound is where the light shines through
Yeah, the wound is where the light shines through’


I once read somewhere that some of the nicest, most kind people in the world are the ones who have been treated very unfairly in life.

And I have actually found this to be true from my own experiences.

The first people to rush to your aid when you are in need of help and support are usually the ones who have suffered immensely in their own lives.

It is almost as if the light within them shines through the scars of their healed wounds.

Which brings me back to the movie

While Joy and Sadness are trying to find their way out of the maze in Rileys mind, they bump into a memory of a ice hockey game where she goes from being immensely sad to extremely happy after her friends and family rush to console her.

Thats when joy realizes that if not for sadness, empathy would be non existent.

If Riley's parents couldn't empathize with her sadness they wouldn't able to make her feel happy again.

Although all our pursuits in life are centered around our desire to be happy, sadness plays an important role in our lives too and we shouldn't fear it.

And if we can't keep it from coming our way, we should embrace it remembering that even sadness does not last forever and that our wounds are where the light shines through.

Until Next Time.

TGV

Saturday, November 25, 2017

The Little Wins

One thing I really missed about our first year in medical school was our classroom.

I mean it, literally.

It was this beautiful well lit oblong room with cross ventilation that could challenge the 'Hawa Mahal' in India.

80% of our subjects in year 2 were based on patient care and so they moved our classes to an odd square shaped room in the basement of our hospital.

It was dark down there and it took 10 overhead lights to keep the room sufficiently illuminated.

The acoustics were terrible, even with a microphone some of our loudest teachers were barely audible at the back benches.

To keep a class engaged was no easy task for the speaker. Not especially for a visiting psychiatry professor with a voice so soft, even dolphins had to strain their ears to listen to him speak.
Dolphins are the best listeners!
The first 45 minutes of his presentation are still a blur to me, I don't even remember the topic. But, from the 46th minute onward I began to pay attention.

'What is love'? He had asked the class, and seeing that no one was volunteering an answer, he picked on me.

'Excuse me sir'? I looked at him with a confused expression.

'What is love'? He asked again.

Of course he thought I knew the answer. 

People had been asking each other this question from before the time fire was invented, but little did they know that a second year med student had all the right answers to all of life's big mysteries.

Before I could speak he interrupted me.

'Let me rephrase, Why do we feel love'? He asked, an even more complicated question, as if the first one wasn't hard enough.

Please don't ask me why I said what I said.
Maybe I was in a trance or something.
But this was my answer.

'Its the dopamine sir'. I said.

'When the dopamine level in our brains increase we feel love'. 

There was silence in the room.

No sooner did the words come out of my mouth did I realize that I had said something extremely stupid.

I felt like kicking myself, but you cant reverse words already spoken, or split milk right?

Thankfully my friend Shruthi stepped in and saved the day.

'It's all about emotions', She said, and the psychiatrist who appeared as though he was in a coma after hearing my answer quickly regained his composure.

The lecture ended with a Q & A.

But by now, nearly every single person in the room was exhausted to the point of passing out, except the speaker himself and me, my head was still reeling (from all the dopamine inside it I presume).
Dopamine Pills
Shashank wanted to ask him what the topic was, but some of us managed to keep him from doing that.

We didn't want him to think we were a class full of imbeciles (Shruthi excluded of course).

In order to redeem myself I stood up boldly.

For the second time that day everyones eyes were pointed straight at me.

I asked him my question.

'Of all the patients you have seen in your life, is there one that stands out'?

I could feel the hate of my peers in the room.

This was the last session of the day, only 7 out of the 10 lights inside were working, the topic of the presentation was unknown to most of us, the speaker was surely a dolphin in his past life and in addition to bumming everyone out with my love is equivalent to 'dopamine levels in the brain' theory here I was prolonging the process with my ridiculous questions.

He took a very deep breath, quite akin to the deep breath of a dolphin underwater.

Then he took another one.

And another.

'Maybe there were many patients who stood out in his practice' I thought to myself as he dove into his fourth deep breath, utilizing every single alveolus at his disposal.

'Every patient of mine is special and I have learnt something from each of them'. He said.
It was a good answer.
Ambulatory medicine is not everyones cup of tea.

It is not as exciting or intense as working in the in-patient setting at a hospital.

But that being said, traditional medicine is best experienced at the clinic.

Establishing lasting relationships with patients is possible only when you have a chance to follow up with them regularly, that happens more often in the clinic than at the hospital.

Some patients religiously keep with up their appointments.

This blogpost however is about a patient who was actually quite the opposite.

When I saw her name on my list last November for the 5th time since I started , I told myself she was not going to show up.

Even though I had never seen her in person, I was familiar with her voice.

We often called her over the phone to ask if she wanted to reschedule and almost always the call went to her voice mail.

‘Hope you have a blessed day’ thats how her recorded greeting always ended.

After closing the visit of my penultimate patient, assuming I was done for the day, I started putting my things back into my bag.

That’s when the something unexpected happened.

I looked up at my screen and the white light next to her name turned yellow and then green.

She had finally made it.

I was excited to meet her and it showed when I walked into the consultation room.


'Hey! How have you been'? I said enthusiastically.

She just smiled back at me.

'I wanted a refill on my medications'. She said as I sat down.

'No problem' I replied and we carefully went through all of her meds one by one.

She never stopped smiling the entire time.

After I signed the last prescription, she got up to leave.

'Thanks, you have a blessed day'. She said in her characteristic style and began to walk out of the room.

'Forgive me but why weren't you able to make it to your previous appointments'? I asked her just as she opened the door.

It wasn't a great or important question, quite like the one I asked the psychiatry professor at my medical school more than a decade ago, but I wanted to know the answer.

She closed the door and sat back down on her chair.

She looked at me for a second and started talking.

'Anxiety is a terrible, terrible thing to live with doctor'. She told me, Still smiling.

'On some days it is hard just waking up and getting out of bed'.

'You want to go back to sleep but you know in your heart that ain't gonna happen'.

'The first time I cancelled I just couldn't put my feet on the ground, but thats ok because the second time I was able to get dressed'.

'But then the thought of driving all the way up here paralyzed me, you see I have not driven my car in a long while.'

'The third and fourth time around I was able to drive a few blocks but then I had to rush back home because i hadn't been out in such a long time and it was scary'.

'But thats alright'.

'I am here today doc, I am here'. She said smiling even more widely.

'I got up, I got dressed, I called my nephew and he drove me to your clinic'.

'3 small victories in one day'.

'Isn't that something'? She asked me.

She didn't wait for me to answer.

'I am hoping that next time, I will be able to get here on my own'.

'It may not seem like much doc, but being able to do these little things is a big deal for me'. She said.

I was left speechless.

I learnt something from my patient that day.

She taught me how important it was to be happy for the little things we accomplish everyday.

The things we struggle with on a more personal level - our fears, our phobias, stuff known mostly only to us that the majority may find trivial, or unimportant or even a little crazy or weird.

The big moments deserve to be celebrated and they will come our way eventually, but we don't live from one major accomplishment to another, no, a large chunk of our lives is spent in the in-between, one day at a time.

So the next time you wake up in the morning with a smile instead of a frown on your face or work out for 30 minutes instead of 20, or show up to work on time or keep your neighbors dog from freaking you out, remind yourself to take notice of it, do a little dance, click your heels, or hug somebody, have a glass of wine or a piece of cake, if none of that appeals to you just be happy and congratulate yourself for doing something that you struggled with before.

Take a little time and celebrate the 'little' wins in your life and let them set the stage for the bigger victories that are headed your way.


Until next time, hope you have a blessed day too.

TGV