Lavender Crocs

 He was standing by the shelf when I first saw him, dressed in a pair of old gray shorts and a faded red tee with grease stains all over it. As I walked towards him, he moved his eyes around shiftily. It instantly caught my eye. What was he doing? He seemed familiar and I wondered if he was from the auto repair shop down the lane. He stood there, unfazed, even as my gaze fixed on him. 

It was then that I saw a pair of lavender toddler crocs in his hand. He picked up a yellow pair as well, looked it over, replaced it back on the shelf. Then continued to stare ahead, sometimes looking down at the lavender ones in his hand. I walked past, continuing to wonder. 

As I made my way over to the first open counter and laid down my groceries, I could still see him standing there, staring up ahead or looking around. For a wild moment, I wondered if I should notify someone.

I finished paying for my groceries, loaded the cart, and turned around to leave. Just then, I saw a woman join him. Presumably his wife. She grabbed the pair of lavender shoes from his hand, turned it over to look at the price tag. She shook her head vigorously and walked away as his head hung low. As I stood there transfixed, I saw the man walking away empty handed, with one last glance at the lavender crocs he was looking over for his little one. 

End in Mind.. - Part I

 I have been maintaining a log of some memorable patients and families - some I would be happy to never set eyes/ears on, and some I would love to see outside of the hospital under different circumstances! So here goes. 

But first, a disclaimer: This post, I dedicate to the people who have died on my watch. The identity of the individuals have been changed to maintain privacy. I will share this in 2 parts. Ideas and opinions expressed in this post are my own, shaped by my own experiences. They do not reflect the opinions of my colleagues who may have had entirely different experiences than me under the same system and at the same time. 

1.       Mrs. K – 60 yo delightful lady from Ghana, suffering from widely metastatic cholangio-carcinoma. I had been taking care of her for 2 whole weeks, before she started slowly slipping away. It was challenging to navigate family dynamics between a jerk husband and her devastated sisters. Unfortunately, healthcare doesn’t recognize the power of the human heart; just a worthless signature on the dotted line. The husband was the legal surrogate healthcare decision maker. The one word of advice I kept getting from my supervising Attending was to not get involved in family dynamics. That wasn’t a part of my job. My job was to take care of Mrs. K. What baffled me about this way of thinking was the underlying assumption that taking care of Mrs. K physically and emotionally, was mutually exclusive from enforcing that her dying wishes were honored by the surrogate decision maker. I will never make peace with the fact that I could not reassure her that her wallet and her diary, wrapped in a red plastic bag that she kept under her pillow, would not fall in her husband’s hands, but would be delivered to her 11 yo daughter. When she finally passed on and I was called to the bedside to pronounce her dead, I walked in with as much dignity as was expected of me and asked the husband to step out as I did a confirmatory exam. I finally pronounced her dead at 2:47 pm that afternoon, walked out the door as her husband stepped in, and promptly collapsed. Her sister, who was standing quietly by the door, walked over and tightly held my hands. For what seemed like an eternity, we could not speak, mutually connected in our shared angst at what had transpired these last few days. Finally, she helped me to my feet. And in that split second before her husband came barging out, I pushed the red plastic bag in her hands, as she looked me in the eye one last time and quickly walked away. 

2.       Mr. Mandeerf – 77 yo gentleman also with metastatic cholangio-carcinoma, but presenting very differently from Mrs. K (I won’t go into the clinical details here of course). This guy came walking into the hospital. Very walky-talky for the first few days of his stay. And then it started. A slight ache here. A little bleed there. And so it went, until we all realized it was time for the dreaded family conference. Typically, this can take varied forms depending on how close or far apart you are on an emotional/intellectual scale with the family members. The tone of these meetings completely depend on the temperaments of the family members. I have witnessed several meetings where entitled families think it is their birthright to yell/kick chairs/ and in general behave like uncouth hooligans (“Dozy old bugger”, as Celia from the new Netflix drama might say). Anyhow, for Mr. Mandeerf, his family was his wife and 2 grown up sons. One living here but sometimes working out of Minneapolis! The other one on phone from New York. The nicest family I have interacted with by far! Not to mention that having a gorgeous son in the room never hurts! I have often wondered whether it was because of my fondness for Mr. M and his wife or the presence of their son that made me spend disproportionate amounts of time with this family! Countertransference is a thing, people! 

Anyhow, what I remember most is the family conference I had with his wife and sons. The Attending was happy to let me drive the conversation because I was the one who knew the family best. Prior to the meeting, the Attending went over the exact algorithm for breaking bad news to families. We had a signal planned out for when I needed him to intervene. I took a deep breath and walked in. Mrs. M was sitting on the couch by herself, so I sat next to her. Gorgeous son drew up a chair right up close and had his brother on speaker phone. For a moment I considered asking him to move back because I was having trouble catching my breath (no kidding). I didn't. My Attending sat in a corner. I looked down at my notes and then I looked at Mrs. M and took her hand, unsure where to begin; and the most wonderful thing happened. I had the near-perfect conversation with this family, helping them decide whether to switch their loved one to comfort cares or whether to continue pursuing aggressive measures. And I did it without actually following the algorithm that I had learned by rote. It just came so easily to me. I felt  comfortable in that space, in my role, in my shoes. It just felt right. And I realized it wasn’t me. It was them. How a family meeting will go, completely and totally depends on the family we’re interacting with. Our role as physicians is not to enforce; not to project our opinions; but simply to listen and to provide enough information for the family to make an informed decision. That is all. That is as simple as it gets. Only not.. 


More on this in Part II. 

It was the best o times, it was the worst of times...

Disclaimer: LONG post!

“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us”  - Charles Dickens

Truer words couldn’t have described my first year at Duke. Oh, what a roller coaster ride this has been. I am finally at a good place in my head where I can sit back and reflect. Not get angry. Not feel disillusioned. Not lose hope. For sure, it has been a mixed bag of experiences. And at the end of long weeks and longer nights, overworked weekends, missed family dinners, 80+ hours of constant physical/emotional turmoil every week for the last 40 weeks for more, I am finally at a spot where I can stand back, take a deep breath, and finally begin to share my journey.

An insane amount of time has passed since I last wrote down my thoughts. As some of my readers might be knowing, I am now training to be a Neurologist (this year I’m training in Internal Medicine). I have longed to be where I am today. I have worked so hard to be here. And I never for a moment stopped to wonder what I am giving up in the process, what I have or will sacrifice along the way. I only focused on getting here because this is what I wanted so very much! So, when I was recently asked this question, it startled me! It made me uncomfortable. And I haven’t stopped thinking about it ever since. I’m a little taken aback by how viscerally I reacted in that moment. Not as if I keep my acerbic wit all fueled up, just in case. So, I wasn’t able to slither out with the smug satisfaction of a handy repartee! But I cried to myself that night, something I can’t remember having done in many years! The truth is I started thinking of myself, of this endless journey I am on, of my own loss of self over different relationships (some completely worthless to begin with!), and of the loss of my Dad. I guess it might have been because after a stressful day at work, I broke my glasses earlier that evening without a spare one in store! Or perhaps, I was just feeling sorry for myself. Whatever it was, I realized that not talking about something doesn't necessarily mean it’s gone. So, here I am today. 

There is one particular moment from the tv show Scrubs that has always fascinated me. JD bolts down the hallway to the jarring notes of his code pager. Two seconds later he is seen vying for a safe space in a supply closet with his co-intern. It was only during the recent ICU rotation that I realized how legitimate those feelings were. I could finally relate to the despair, the urge to bolt, and yet being frozen to the ground in fear of failing.

Flashback to the med school years (which now seems a lifetime ago), I remember sitting through a cardiology small group meeting one afternoon. We were learning to recognize ECG patterns and come up with differentials. At one point when we were shown a ventricular fibrillation pattern, (as sinister as it gets), the resident asked what we would do. And I remembered that moment from Scrubs and thought we could run the other way of course! From where I stood at that moment in time, handling a hypothetical cardiac arrest situation seemed easy, even funny enough. I laughed to myself. 

These last few months have been a lesson in humility. A reminder of my own inadequacy in this long path to finally becoming a doctor. I have had my fair share of hiding in metaphorical closets of course. I have often chosen simpler cases which required minimal effort on my side. Other times I have deferred opportunities to others who were more excited than me. I have struggled with a desire to impress versus an inherent fear of failing. And I have shamelessly exploited the privilege of my position in the larger scheme of things: I am a resident. Let me ask the Attending. 

I have learned to give up on the extra half hour of early morning sleep, to be able to pour over patient charts. I’ve learned to juggle a million things in a way that also ensures steady state learning. I’ve learned to dress so as to accommodate any and all medical paraphernalia on self at all times. But most of all, I've learned to spend the last moments of a regular hospital shift, saying goodbye to my patients for the day. I did not know back then, as I do now, that I would soon learn to depend on my patients for a glimmer of hope. I did not know that the constant grueling reminders of one’s incapability and the long struggle that lies ahead, would instantly wash away in the comfort I would find in their words. That I would find my safe zone in their presence soon enough.

But, as I mentioned before, it’s been a mixed bag really. There were times when I was so angry and so ready to explode, and I did. There were times when I have cried over the loss of a patient and have had a family member console me! There were times when I have entered the hospital wishing someone was dead so I didn’t have to deal with his angry family! It has indeed been a crazy roller coaster of a ride. And now of course, here we are in the midst of a global pandemic! These are difficult times. These are scary times. Unprecedented. Once in a life-time kind of thing. I would like to think that I am making a difference by fighting the good fight. There are some who are hailing healthcare workers at the front lines as heroes. And there are some who are disgusted with everything and everyone healthcare, as always. To them I say, please come do our jobs for us if you think we are incapable. It’s easy to raise your voices from the comfort of home. Please try spending one day in my shoes. Just one fucking day..

So, you see, I have come a long way. Slowly, piece by piece, I learned to maneuver my way around the maze with customary aplomb. Overnight, almost spectacularly, I found myself in a new terrain, where I was confidently admitting my own patients, proposing plans that went largely unedited, and discussing treatment choices with families at the bedside. Almost overnight, I found myself turning into the doctor, and the person I have worked so hard to be.

Of course, right now there are multiple layers of buffers in place to protect us from our own ignorant fervor. But I am the first contact for my patients; and I will/have felt the personal weight of my assessments in very intimate ways. I have been called upon to take decisions of unthinkable impacts and I did not know what to do. But I always (mostly) tried to do what’s right.

And that, I imagine, is the force that has sustained me and all my friends through these years, and I hope, will continue to sustain us for a lifetime as physicians. Through all the long hours and missed holidays, through times of indecision and misjudgments, through petty resentments and frustration, through lost relationships - as we watch our lives pass us by - there has been this palpable certainty humming blithely underneath it all. We are still standing with our heads held high, because we believe we are here to do right by our patients. This is what inspires us, grounds us.

Of course it has been frightening, even blatantly miserable at times. We’ve witnessed tremendous suffering, known vulnerability and helplessness, and been privy to human frailty in its ugliest of forms. And not a single day has gone by when we have not been yelled at or walked all over by rogue family members in some form or the other. 

But we have chosen this journey for a reason. Even when we have to stand by and be easy targets, even when we are over-worked and sleep-deprived as I am right now, even when I’m wondering if I can/should explode and I have. Even in those vulnerable moments in training, I hope we have the foresight to make good calls, the wisdom to seek out others when we need them, and the fortitude to always run in the right direction.

P.S -  Just a heads up - Since I now find myself with some free time on hand for a day or two (!!!), I will post stories of my hospital encounters here. So keep an eye out, for those few who're still interested! 

Man in the realm of nature

There’s a mallard duck that visits my backyard every summer. It never ceases to amaze me - the fortitude with which she sits for 28 straight days, come rain or snow, until a batch of chicks arrive. And then she goes marching off to the lake with her parade. And each time, I am left feeling helpless at her plight - for each time she gets stuck, trying to maneuver her way out of the fenced yard, even though she has been doing this for a while. And each time I am left wondering at the evolution and origins of man. 

We started pretty small too, didn't we? What is amazing is the fierce rapidity of brain size growth within a very short span of time. We started with simple tools made of stone, and we are now in the 21st century, in total and complete control of the universe that stretches ahead and around us. 

I have always marveled at man’s ability to stay on top in the realm of nature. So, when I walked up to the rim of the grand canyon and saw this sight for myself, at first sight, never was I more certain of the power that man commands over nature, and the intensity with which he unleashes it around him. 

But then again, never before have I been so uncertain either. 

In a fast paced world, where resources are being depleted by mankind at a rate never experienced before, this is as good a time as any other to stop and to think. 

How do we really fit in? Where is our place in the realm of nature?

As long as mankind looks forward to a better life, there will never come a day when we decide we have done enough. We will always seek to improve. Research goes on and on endlessly, to make the world faster, better, and more efficient. It is this tenacity hardwired within the human psyche that pushes us in an inexorably upward trajectory. And the further it advances, the more humans expect from it - an endless vicious cycle of desires. 

So, as I stood on that rim, in search of the incredible, something caught my eye. An epiphany of sorts that engulfed me with such overpowering force that for a second, it took my breath away. 

I believe that these two pictures together tell the complete story. While at first sight, man’s place in nature appears overwhelmingly unquestioned, the second one is in stark contrast. What I wanted to capture was not only the enormity of the landscape around me, but also man's place in it. How small, how inconspicuous mankind is; how majestic is nature! It does place mankind in its true perspective, doesn't it?

This post is a part of Write Over the Weekend, an initiative for Indian Bloggers by BlogAdda. 

And it won The Badge! :)

Back again :)

To begin with, let me give you a status update that is long overdue. I bombed the MCAT but I still got in! Yes, I made it through! I’ll be starting medical school this August :) So, before I get back to the grind again, I’ve been traveling and trying to live out my dreams. I spent a good 2 months at India visiting family. I’m traveling within the U.S. over the next week. And then, I’ll be traveling to Europe for a month or so. It’s been great to finally have the time to breathe, to pause and take note of all that’s important to me. The last couple of years were a nightmare of sorts!

And because I so crave attention all the time, I’m going to copy-paste an email that one of my interviewers sent me after the acceptance:

“  Dear Ms. Roy,

"Let me just say at the outset that this is the most motivated, most unique, most interesting, most qualified, and most delightful applicant that I have reviewed or interviewed in many, many years." These were my opening remarks following our interview and I am happy to see that the committee agreed with me. Congratulations and I hope you decide to join our class...I know you have much  to contribute. Best of luck in all you do.

Da. Cu. M.D.”  (I’m not including the entire name for privacy)

Interesting side note about the interview with this doctor: We discussed everything under the sun, - including: Shakespeare, WWII- asia pacific chapter, Rohington Mistry and ‘A Fine Balance’, Indira Gandhi (!), how children don’t get to write letters anymore, Henri Cartier Bresson, Indo-Pak relations, Ukraine-Russia etc etc. - in addition to a lot around ethical scenarios in medicine. His final question (which is apparently common in interviews but i had no clue!) was : "what do you want the epitaph on your grave to say about you?"

I might have seemed rattled as I mumbled something about me never being in a grave but if I did, it would say, "she walked the talk." And I couldn't stop having nightmares after this horrifying answer! But in the end, one silly answer didn't matter, I suppose :)

The entire experience has been surreal. I came to know sometime last November of course - but the reality of it is only now sinking in. As I browse through student forums and find the applicants still struggling to get a foothold, most having been rejected this cycle, I cannot help being overcome by such gratitude as I have never felt before! This was a difficult journey. The uncertainty of it all was deeply overwhelming. But I made it. Oh thank God I made it!

But my success came at the cost of losing a lot of ‘friends’. I’ve never been good at making friends. It doesn't come easy to me. I’m not the most ‘likeable’ person. Never have been. So, whatever bridges that I did manage to build in the years that I have been here, now seem to be under water! 

There were some who would regularly call/meet with me every week to find out the results of my interviews. And finally when I got through, they all vanished! Just like that, all gone! Were they rooting for me to fail? Why?

Then there’s the other category of people who have gone out of their way to ‘celebrate’ my success. And at each such gathering, have made it a point to ask me how many interviews I got because anything less than 5 screams mediocrity (?!!); they tell me how they know of people who have made it through Harvard and the top med schools; how Minnesota wasn't in the elite league at all! 

And finally, there’s the third category of people who congratulate me and then go on a rant about how the medical profession is littered with corrupt practices, how I shall never be accepted by the ‘white’ fraternity, and how terribly wrong this decision was! 

It astounds me - not one person genuinely happy or proud of me. 

Except for the people who matter to me, of course. But they don't count, do they? :) I already know how they feel. 

I know I shouldn't bother with the random population of the world, the herd of mediocres and how they feel about it. But sadly enough, as always, I do..Anyhow, as I have been grappling with this, I have come to the realization that it is not ‘them’; it’s me. It has always been me. I have been so insecure about my relationships, that somehow or the other, and mostly inadvertently, I end up butchering them. Either in the way I talk or behave. Something about me puts people off. I have, of late, been thinking seriously about it. And I realize there’s something so black inside of my heart. I want to turn it inside-out and wash the mud off. And even as I do, it starts building up again. So much bitterness inside of me. How will I ever be cleansed?

Anyhow, let me end on a better note by attaching some pictures from the India trip. They make me smile. 

So long! I’ll be back soon!

Pieces of me..

One more week before D-Day. It’s astounding, how the outcomes of a 5 hour test determines what I will or will not be doing for the rest of my life! It is frustrating at so many levels, I have lost count now. It’s one thing competing with millions at a national level when one is a starry eyed 18 year old. But I am way past that age, am I not? Over time, the rosy idealism of the 18 year old has slowly given way to real-world considerations. And fear of the unknown now prevails. All pervading. Nauseas. Because you truly understand what’s at stake here. 

Anyhow, with the G away for 2 weeks, it was getting lonesome. So I took off with my camera last evening. And I figured I’d post a few pictures of what I saw. I guess the beauty of these pictures lie, not in technique, but simply the fact that they were all taken at home (except the railway tracks - 1 block from home). That’s what I love about the camera. It takes seemingly mundane objects and transforms them into something magical.. Not to sound narcissistic or anything :):) but I do hope you love them as much as I do :) Enjoy! 

Note: These were taken as part of a class assignment. We had to take pictures of everything that we saw, things that define us etc. There are many more. But I'm just posting some of my favorites ones here. 

This one's special. The red and gold jewelry signifies my 'Indian-ness' and the fact that  I am married. Plus, these earrings  are from my grand mother's wedding (passed on to me)..

Candles that I light every evening... Dad's picture in the background

My old guitar, now yellowed over time..

This gorgeous babe lives in my backyard with its family!

Shadows cast by the rising sun.

Taken in the back yard right after an afternoon shower.

One block away from home. I love this picture. It reminds me of the long journey ahead. 

Dreams....and then some!

As I begin to write today, I cannot help wondering who all will be reading this post. I have allowed my space here in the blog world to be so completely obliterated, and I have no one to blame but myself. I would have said that I missed being here. But the only reason I can miss being here is because I chose, every day, not to be here, right? So, I’m not complaining. But really, if there’s anyone still around, I have to say that it has been one hell of a long, uphill climb since I was last here. So let’s begin at the very beginning.

Back in 2011, when I last wrote, I was in the process of getting a masters degree in healthcare administration and hating every moment of it. Thereafter, I joined a hospital here in the Twin Cities as an Administrative Fellow, in the quality assurance and clinical effectiveness department. This was a much coveted position and I was happy to join. But then…ah! 

I had to leave. It was killing me, the mediocrity. It was becoming too miserable for godforsaken reasons. I quit a very well paying job with nothing lined up but the hope that someday I’ll come through again.

Oh I could continue this way; come in day after day, work like crazy, be driven by fear not passion, and go back home unhappy (having a weird boss didn't help much!). And I could kid myself into believing that I am doing a fantastic job; that the results I produce are outstanding; that I am creating value in spite of never being appreciated for it. And I could continue doing this day after day after day without giving a rat’s ass, just to be able to collect my pay check at the end of the week. But that’s not who I am. That is just not who I am. I left because I refused to treat myself this way; I left because I deserve better.

But I was scared. Oh I was so scared. To become a dependent again.. To not know what’s in store. But I am grateful for the support that I have. Without it, I would be lost.

You know, for years I have been wandering around, trying to figure out what is it that I really want. And yet again as I shake free from the ties that hold me down, I cannot help thinking that it’s about time I found some that simply bind and not gag…

 You see, starting afresh is not easy. It means an uphill climb from the bottom of the hill. I am no longer eligible to apply for a clinical residency, due to the time gap. So, if I want to practice medicine here in the U.S., I will have to go through the entire process again. In other words, repeat med school once again! 

Some people laughed in disbelief. Some thought I had gone crazy (with grief, at not having children!). Most, however, thought it was a very brave thing to do! To them, I say - there’s a very fine line between being foolhardy and being brave. This is neither. I hope this is neither (we'll find out soon enough!). This is simply being true to oneself. This is simply being able to follow my dreams. 

The G and some close friends have cautioned me about the uphill climb ahead. To quote a very dear friend (from his email):

“One word though, following dreams is indeed important, but be sure not to get blinded by your projection of the self. Visions of the self are usually distorted, dramatic and then they can be destructive. Growing up is to learn the balance between (i) privilege:following your dreams and (ii) doing what needs to be done even though there is no pleasure in it. These two things are hardly ever the same. All the best for this new endeavor, follow your dreams, do what needs to be done, have a perception of what is more important than others, keep the self and the drama in check, and i am not speaking to you if you still smoke.”

:) :) ;) ;)

I realize that there is no fear in ascent. The only real fear lies in remaining where you are. So, here I am today. After 2 years of quitting my job and working like a dog, I am proud to say that I just submitted my application to med school. 

More on the journey thus far in later posts. 

"It’s time to trust my instincts, close my eyes, and leap!
“I'm through accepting limits ''cause someone says they're so..
Some things I cannot change; But till I try, I'll never know!
It's time to try Defying gravity
I think I'll try Defying gravity
And you wont bring me down!”