New Beginnings

As I sit to write this post, I have taken the first official steps of a new chapter in my life : My Residency. It has been a wild couple of months of documentation, visa application, apartment hunting and packing. But I have managed it and today I sit here, a to-be-intern in Internal Medicine starting June 29^th. Lets recap what all happened since the last post I uploaded….

1)      Receiving my contract letter: I think I spent most of the time after 20^th March celebrating that I matched. It was only when I received my contract letter in the first week of April that it started to sink in, that I had officially finished medical school and was now going to enter my post-graduate training. It was exhilarating and scary simultaneously.

2)      Statement of Need (Ministry of Health Letter): Have things ever been smooth in this USMLE journey? Trust this application to stick to the pattern. It took an exact 2 weeks, countless phone calls, a quarrel with the assistant, a trip by a friend, two trips by my mother and a shitload of time spent on the Delhi-bound flights and the airport, to finally have my letter in my hand. I think at one point I started thinking contingency plans – miss orientation, make up by using vacation time, reshuffle my Step 3 prep plans, etc. etc. etc.

3)      ECFMG Application for J1: That moment when I received an email from ECFMG saying that my CV was incomplete will be etched in my head forever. I was literally counting seconds, telling myself that I’d be able to apply for my visa on time, when out of nowhere comes an email that blindsided me by initially giving me no clue about what was incomplete. This was during mid-May and keeping with the timeline mentioned on the website, I was hoping to get my visa papers by June 3^rd. Thereafter a Visa interview date within a week and hopefully my passport in my hand a couple of days before I was scheduled to fly out. That email pushed things back by a couple of days and I started wondering whether I’d have reschedule my flight from India. ECFMG however turned out to be a sweetheart and sent me my visa papers within a week. By the third week of May, I was on the US Consulate website looking up interview dates.

4)      Visa Interview: It was just so typical that I laughed when I realized that when I had to select a date, the first available date would be 10 days down the line; previously, first available dates were within 2 days! But, once I snagged a date, everything went pretty smoothly. The interview was the shortest one I’ve had ever (not that I’ve had a lot of interviews). When the officer said, “Visa Approved” I couldn’t stop smiling. Was there a chance I was going to get rejected? I don’t know. I’d like to say I was 100% sure, but hell, it is an interview. Of course I wasn’t sure!

5)      Packing my bags: Have I ever mentioned that I hate packing? I do. I am not a light traveler. If I could get a wish for myself, it would be to train me to pack light. I need so many thigns that are my own, I get restless if I don’t take them (shampoos, body wash, nail clippers, hairpins, body lotion, home slippers, two combs, two towels, three napkins…that’s just a few things). Ultimately I don’t end up taking a lot of clothes, bottles is what snags most of the weight. Point is, I hate packing. I keep making lists and adding stuff to them. I’m not the biggest of persons – petite is so apt for me, it’s not remotely funny. So when I have to manage 3 bags and a carry-on laptop bag/haversack, I also hate changing flights. When luggage is checked in up to my final destination, I have a glow on my face that probably feels like I won the Nobel prize or something! I also hate arguing with the groundstaff for overweight baggage. Ughh!! I began packing my bags for a supposed 3- year stay over a month back. The saga ended 5 minutes before I left for the airport. Can you believe that?! If I were a sane person, I’d probably dedicate 3 days to packing and be done with it. But then, whoever said I was sane? I’d open my bags and then just leave them open because I got bored :-P ha ha!! I’m delighted that I managed to wade all my bags to the apartment here in one piece (and I mean me, not the bags).

6)      The first 2 weeks of June: There seems to have been a touch of fantasy and incredibility whenever I thought about sitting on the flight to the US. How can I, me, this little girl manage to do it all, make the move, shift to a different country (and continent) on a one-way ticket with no return date, to actually work in a hospital? I couldn’t even imagine coming to an empty apartment and going home shopping to turn it into a home. I couldn’t imagine driving a car on the wrong side of the road with a New York State license. I couldn’t imagine growing up. Finally. And then, strangely I also could.

My mind has been thinking too much. So many unanswered questions hit me simultaneously, I find it hard to just let go and enjoy. When my first flight took off the runway, I took a deep breath and told myself, “You’re actually doing this!” When I was at the Abu Dhabi airport during my stopover, I said, “It is happening. My immigration to the US is happening right now and I can’t get out of this.” When I reached JFK, I didn’t even bother to feel delighted at my favourite airport in the world. I was telling myself that this decision and this next step was going to be a great one and I would flourish.

There comes a time when all you want to do is get out of your childhood home and try to be your own person. That feeling is the one of growing up. I’ve always felt that I needed that – staying on my own, looking after my own apartment, paying my own bills, doing my own grocery, cooking and cleaning, making my own financial decisions and at the same time, doing well professionally. When you do medicine in India, you don’t really get to do that. Post-graduation basically restricts your life to the hospital – you go to the cafeteria to eat, you have the common maid to do your laundry, you have a shared hostel room that you never see because you’re stuck in the wards. You mature professionally but you never really get to evaluate your own self.

Girls my age have gotten married and have kids too. But did they ever think that they wanted to be themselves for some time and make sure that they had grown up in their own eyes? That is what I’m looking for and hopefully, at the end of these three years I shall have an answer J Until then, I’m going to enjoy the Rochester spring/summer because it doesn’t last for more than 3 odd months and after being here in January, I know how depressing winters can get.

To remind myself of how beautiful this place can be:

Where Did I Match?

UNITY HOSPITAL, ROCHESTER NEW YORK IT IS!!

And the suspense ends. Rather, it ended about 5 days back. I'll be flying into a beautiful city with some really friendly citizens and I shall look forward to about 6 months of 3 feet of snow :-)

Now that I have had 5 days to breath through and make myself believe that this is actually happening, I'm delighted. I'm a part of a distinguished and delighted group of to-be interns who matched this year. I am one of the few who can look back at Match Week with a fond smile and pat myself on my back and say," Mission Accomplished". I can look at the past two years and say, "Successful Journey". Whoever said that its the journey that matters and not the destination basically never reached the destination. I can't imagine feeling so at peace and satisfied about this journey if I hadn't matched.

But, back to where I matched. Rochester. have I mentioned that I have a thing for everything British except their cricket team? I love their accent, I love the names that they give places, I love their authors, I love their Royalty but I can't imagine wanting to live in England. Eureka!! I get to go to Rochester! Where every name is British, where the houses are so far apart, I get a good rural English feel, where I can stay in a place called Carriage Glenn and behave like I'm so English Royal myself and still get my dose of the USA :-)

I probably chose the worst month to go to Rochester during my interview season - January. But I had to see how bad the snow can get! They say the city blooms in the summer. Guess it is my turn to find out. I'm already excited, nervous, scared, happy, confident yet not so much....it's a myriad of emotions and feelings. One thing I know for certain, I'm actually glad I did not match into a Prelim position. I know I probably would not have said this 2 months ago when I was so intent on wanting Surgery. But the peace I'm getting by knowing that I am in this wonderful program for 3 years and will get out with an Internal Medicine degree under my belt, makes me sleep well at night and makes me calm. Really really calm :-)

I've actually been going through all my interview conversations with the faculty in my head since Friday. I'm glad i had the chance to tell them everything about myself - academics, personal, professional....everything! I can proudly say that they liked me enough to consider me for their program :-) what a confidence boost!!

I'm doubly excited because I even have a friend who matched at Unity. I mean, how cool is that? On Saturday, I just got this message saying,"So guess we have Unity in common, huh?" and I couldn't stop hoping against hope that it really meant what I thought it did.

And it did :-) ha ha!!! I think these three years are going to change me for the better. I can already see myself become more sure about myself. Being in a place like that, not too much city, not too much village, is going to be so great. And I'm so going to become an outdoorsy person. I promise. I'll only be able to utilise 3-4 months for that, so I'm going to make the best of it. No more lazying around :-)

Whew!! Lots of documentation to do, a family trip to be scheduled, packing to begin, house-hunting to start and an international drivers' licence to be applied for. USA baby, here I come!!

MATCHED

So, now that this journey has reached its first major milestone, I’m going to stop worrying, relax and write a post. I can’t get my head around the fact that I have matched and come 07-17, I will be PGY-1 resident at some awesome program in the United States. All that worry, indecision, regret, hopelessness, guilt, the awesomeness of the interviews has reached the end.

The worst part about applying for residency in the US is the long long journey. While my batch mates here, took one entrance exam, got ranked according to their marks and then participated in counselling rounds to get the specialty they wanted, I had to wait a year before I was even eligible to apply. Where they just took a single exam, I had to take 3 nine-hour exams, one of them in the United States. While they studied in the library of our medical school, I was applying for electives and experiencing the brilliance that the American Medical system is. Its been a whirlpool of all sorts of emotions. Worth a movie really. Or at least a book – The Hitch Hiker’s Guide to the Match J

I have questioned myself at numerous times throughout these past two years. The first time: when I got my first rejection for a clinical elective. I probably disguise a bit my own low self-confidence in the form humility, but I was asking myself why I even thought that any university would love to have me there. Then came a great moment, when Yale sent me an acceptance into their Infectious Diseases clerkship. I could see my plan forming a little bit, moving a couple of steps.

And then it stopped again. No more acceptance emails. I needed at least one more elective to get the minimum required US Clinical Experience (USCE). And nothing. One fine day, I get an email from Harvard saying I was accepted into their elective. The elective that clashed with my Yale dates. I had to reject it. I remember saying to my mother on the day I left for the US, “if I get one more elective, it’s a sign from God that this is the path I’m meant to take.” Harvard decided to smile upon me yet again and offered me a second elective, this one at none other than Mass Gen Hospital. Yes, during those two months, I felt pretty great about myself.

The USMLE exams are a whole different ballgame. Studying for them was tough, yes. But, sitting through an 8 hours exam for the first time ever, is enough to knock you flat. I knew I didn’t do fantastically well on it. When I got my score, I knew it was good. But that’s just what it was. Good. Not the best, not awesome, not the see-the-score-read-the-eras-profile kind of score. When I took the Step 2 CS, I was sure I had given it everything I had. I wasn’t sure whether it was enough though. I think everyone needs to take this exam once in their lives. It is so real and so strange. I was pretty sure I was going to fail it, actually. Because I thought my cases were weird. Now I know everyone says the same thing after coming out of this exam. I was most petrified of that result. The moment I saw that ‘PASS’ written on my score report, I started crying. That was a first. Crying because I felt like I’d gotten some major victory under my belt.

It was after this result that I went into a sort of manic mode. I decided that applying immediately would serve me best. I ended up taking the Step 2 CK as late as I possibly could, but still early enough that I’d be eligible to apply in Match 2015. That exam was a disaster. When I came out of the Prometric Centre, I knew I would be questioning what went wrong in my head, when I decided to take this whole USMLE plan through. Even now, I feel a mix of relief and disappointment when I think of my CK score.

My next questioning moment was when I applied to fewer programs than everyone else in the same boat. When I was doing my research, it made sense to me, to apply to programs that could see me as a potential candidate. Why should I apply to a program that said they wanted 3 months USCE when I had only 2? Why would I apply to a program that was situated in a place I knew I’d never stay in? So, yes, it all made sense at that time. After MyEras opened and people started getting interview calls from everywhere, I questioned all of that rationality. What harm would it have done to apply to a few more?? When I got my first interview call, I was delighted. Again, this plan appeared to move further towards its destination. Then came the stop. Nothing more for almost 1.5 months. I started thinking back-up plans, avoiding my own thoughts to avoid my own questions and wondering why at 24, I couldn’t even believe that I was 24 years old.

Going to the interviews was nerve-wracking to say the least. I had half a mind to not get into that US-bound aircraft. I was more than happy to run away and figure out something else for myself. I had to keep playing all those morals I had learnt from Harry Potter and Lord of the Rings in my head to give me courage to face this head on. It did not matter that I actually had fun at the interviews, met new people, made conversations with students from all over the world and felt great about my chances. When I came back, I had another disaster heading towards me – my ECFMG certification.

Once you get your degree, you send ECFMG (the Dean’s Office for International Medical Graduates) a copy of that degree. They look through it and then send a form to your medical school, asking them to verify stuff from their side. The school is supposed to do this and then resend the form to ECFMG who finally verify your medical credentials and issue the ECFMG certificate. As has been the pattern in my USMLE prep, this took ages. I had to get certified before the last date of Rank-Listing. Phone calls to ECFMG and trips to my medical school did not seem to fasten the process. That was the first time, I decided to bury my head in the sand and just let go of this dream. It was sort of my fault that this process did not happen earlier, right? If I’d planned things properly from the very first day of my internship, I’d have spent a happy February with nothing to worry about. Instead, I spent sleepless nights and frowning days, avoided talking about the future even when my parents pushed for it, dove into fiction as if it were my last tank of oxygen. When that certificate was issued 6 days before the last day of Rank-Listing, I felt like a phoenix rising from the ashes. I was reborn. At least now, if I did not match, it would be because I wasn’t good enough. Not because I didn’t have the documents in place.

You’d think that believing something like that, rejection because you’re not good enough, would be a blow to your mental health. But, I’d rather have a failure that I could blame myself for. Maybe this is a little childish, but it gives me a sense of clarity to think like that.

Now, lets come to Match Week. Frankly, I did not believe that it was really happening, All that I’ve done, the electives, the exams, the interviews still feel like a dream. I’ve never thought that I could be brave enough to do it all, so looking back, it doesn’t seem real. I couldn’t believe that I would match because of this whole dream thing. I mean, how could it really happen right? How could a dream just become reality?

I had a sleepless Sunday night. Having avoided the thoughts for the whole day by keeping my mind busy, I couldn’t bring my mind to calm down during the night. I was jittery. I had to attend a new OPD, shadow a new consultant on Monday. That always makes me a little nervous. Add on these nerves, and I was pretty gone. I jumped at the opportunity to convert this OPD day into a research day instead. Then I plugged on my head phones and listened to music and buried myself in the records section of the hospital. When evening came though, there was nothing else left. No defence mechanisms that could suppress the thoughts of not matching and having to deal with SOAP (the post-Match Supplemental Offer and Acceptance Program). When you are in a time zone that’s 9 hours ahead of the US, it sucks to participate in the SOAP. You can’t be physically present for any interviews that might come your way. You have be up all night to make sure you at least get a skype or telephone interview. And you have just 2 hours to accept an offer. This goes on for 3 whole days. If you are at an institute like mine, where you are busy all day from 7 am in the morning, this is a nightmare.

It goes without saying that I did not want to have to go through SOAP. But, I couldn’t stop stressing, couldn’t stop thinking. And then fate decided to intervene. The wifi connection at my house decided to give way. Completely. And it refused to right itself. Suddenly my thought were torn from having to participate in the SOAP to whether or not I would be able to even see my Match status in the first place. I had to make the decision to come back to my hostel room and rely on the so-s- wifi here. That relaxed me a little. For a while I had to think about arranging transport to the hostel, my food requirements, etc.

Of course, the moment I got to my room and set things up, the jitters came back. This time, good old site-load helped me through. I couldn’t open the NRMP pages fast enough, there was no message anywhere saying that I had/hadn’t matched. That made me believe I hadn’t matched of course. So I went onto the SOAP link. And it said: You’re not Eligible for SOAP.

There is only one reason why you go from being SOAP Eligible on the Friday before Match Week to being SOAP Ineligible on the Monday of Match Week. Several agonising minutes later, I saw the message that calmed me to numbness, such a strange numbness I think I floated out of my body and saw myself sleeping peacefully for the next three nights in that hostel room bed.

CONGRATULATIONS! YOU HAVE MATCHED!

I think in the line of major achievements, this by far trumps everything. I don’t know where I’m going to my residency. I know that the places I interviewed at, I loved. So anything I get will be awesome and make me happy. I can’t ask for any more. What I can do now, is reflect on how this journey helped me grow up a little. I know if it hadn’t been for this decision, I would never have ventured out of my own city. Instead, I flew all over the US twice in the past year and am now spending a month in Hyderabad by myself. I would never have been capable of believing that I can meet new people and make new friends, and not feel out of place. I would never have known that I do have the mindset and belief to see myself through anything.

I never believed that I’d ever take the path less trodden. Robert Frost’s “The Road Not Taken” had struck a big chord back in school. But I never thought I’d embark upon something like that. You always hear stuff like, challenge yourself, get out of your comfort zone, the success you achieve by going straight ahead is never sweet enough. But do you actually do it? I’d like to believe this me doing that. Yes, I always wanted to get my further education in the US. But I saw myself going through SAT/GRE and getting into some academic program there. When I got into medical school, those dreams were buried by the wealth of knowledge there was, to accumulate.

I never liked Frodo Baggins in LOTR. I felt he was too dark, too depressing in his journey to destroy that Ring. I understand him now. Yes, my life was never in danger, I did not have to worry about the basic necessities of life in this journey, but it was a journey that questioned me, a journey that put obstacles in my path, a journey that challenged but did give some respites.

I have always loved Harry Potter for facing challenges head-on and getting through it all. He was the first to say he always had help, but what use is the help if you don’t have the courage to stand in the battlefield? I had to dig deep into my own stores of courage, gather every dialogue from both these series that shaped my childhood. I might still not feel very worthy of any new achievement that may come my way. But, I know that if I could snag a residency in the US, be the first from my entire family to do it in medicine and feel proud of myself right now, I will be able to do anything I want in the future.

My family and God, thank you so much for supporting me through this and allowing me this opportunity. To my Idol, the late Kalpana Chawla. You talked about a journey from a small village in India to the stars. You have always been my inspiration, from the time I had a photo of the whole Columbia Team stuck to my study table, to every interview where I talked about you and your incredible journey. I hope that this leap I am taking from my own small city to the Land of the Free will help me build my own new dreams and reach for my own stars.

I matched! Game, Set, Match J

Phillip Hughes : Too Soon?

When a person dies before the ripe old age of 60 years, it's called an early, untimely death. It doesn't matter what the cause may be - myocardial infarction, stroke, accident, cancer, or murder. An untimely death is always associated with "he didn't deserve it", "he was so young", "how could this happen?", "miss you forever", "in our hearts forever" and so many of these phrases.

That is exactly what is happening today since the breaking news that Australian Cricketer Phillip Hughes could not survive the injury he received from a bouncer. For a better part of today, I've been confused. First there was a "No!! NO!!" moment, followed by a "but it's simply not true" moment followed by a big lecture to God for ignoring my prayers since Tuesday (yes, I am arrogant enough to believe that God does what I ask him to). Then, after all that, came this confusion. Confusion because I still can't digest the fact that I will never see his name in the national team batting line-up; confusion because I almost expect him to walk out on the Gabba pitch next week; confusion because he's just 25; confusion because I don't consider cricket a fatal game - you may lose an eye, but a life?; confusion because I have watched this player bat since his international debut and I find it hard to believe that I will not be able to see how his career shapes up; confusion because the completeness of death makes me wonder whether all these "you're forever in our hearts" phrases are just empty or face-saving or soul-saving.

I feel that saying all this is our way of saying, "I'm guilty I never thought more about you during your lifetime. Trust me, now that you're gone, I'm so going to do it." I shall be the first to admit that I never thought about Hughes unless and until he actually played in the international team. I am a fan, but I shall not follow the careers of players day in and day out. So hearing the news of his injury made me feel guilty. Maybe if I had paid more attention, this wouldn't have happened. Crazy thought, but something to think about. Then, when he was battling for his life yesterday, I prayed that he survive. Because that was the least I could do. Amongst, the absolute dread of a news like today, I felt guilty for sending up a prayer only when it was the only thing that could save him. I felt guilty for not appreciating this wonderful cricketer as much as I should have before. That got me thinking, is this what is actually the message in peoples' "RIP" thoughts that plaster all the social networks? When a life is cut short, do we feel guilty because we thought we had all the time in the world to appreciate and thank that life? After all, I probably would've said stuff like," You're an amazing cricketer, a fantastic batsman and have been a great part of the team that I love, hope the new path you choose be as successful as the one you're leaving", when he retired. But, who knew, it would never reach that stage.

I've always been a little sensitive about the issue of death. I simply cannot understand why it has to happen. So when somebody so young (just 2 years older than me!) dies, I question nature and it's ways. He did not even get to say good-bye. And, that right there, would hurt his near ones more. He left in the morning to play the game he loves, was probably delighted when he reached his 50 and thought he could even reach the 100. And then out of nowhere, this bouncer decides to trick him. Next thing you know, he's down and gone, and all he must've realised is that he got hit. That's it. No life flashing in his eyes, no last words, just nothing at all. You almost wish he'd regained consciousness to at least let him know that he would be missed, loved, prayed for and thanked for being who he was.

Let's thank him and his talent for those 3 amazing international test centuries to his name, for being a part of the national team, for being such an amazing talent, for his contributions to his state and club, for being the person he was to his family, friends and team mates, for giving fans like me something to cheer about. I wish you hadn't gone away. I wish you were going to play next week. I wish I could watch you open the innings for eternity. I wish the only reason I never got to see you bat again, was because you weren't selected into the final 11. Now, that option seems so much easier to deal with than what we've been given.

Our only solace is that the last thing you ever did was play the game you love and score that 63. That number will never ever be the same again.

  That's how you'll always be....a great life, a great career :-)

Laparoscopy

On this weekend, I had the opportunity to attend a workshop on Basic and Advanced Laparoscopy. We were taught everything about Laparoscopy from the very beginning - how to hold the instruments, what the instruments are, how to suture stuff inside the abdomen, working the instrument with what you see on the camera in front of you, hand-eye co-ordination, where and how to put the ports in....all the stuff that you want to know before you just plunge into Laparoscopic surgeries.
Thing is, I've always watched Laparoscopies. Easiest surgery to watch actually. It is an Air-conditioned OR (yeah, I guess I've started using a lot of American terminologies now. If I plan on doing my residency there, makes sense to use their words instead of ours), you can sit on a comfy stool to watch and you have as good a view of the organs as the operating Surgeon. It's pretty damn amazing. After all, it is tiring to watch a 5 hour surgery standing tiptoed, in a crowd, straining your neck from here to there to get a better view.
So back to the workshop. We started with the Endo Trainer. Its a plastic box with holes for the ports. They keep stuff like plates of peanuts, sugar cubes, Polo pills, match sticks and plastic gloves in it. The instruments go in through the holes. You can get really good training in picking those peanuts up, moving them from one plate to the other. The sugar cubes are a little tougher. You have to stack them on one another. The 2-D image in front of you doesn't help a lot in that. The match sticks and Polo pills are the worst. You have to pick a pill and then loop it into the match stick that's stuck down on the rubber padding. Not as easy as it looks! We also got to learn and practice intracorporeal suturing on the same. I, apparently did not have great instruments. But, wow, was that tough!
The key to good Laparoscopy is to stop working with your hands in your head. This is just my thought. I'm just a beginner. But, from what I saw and did, I realised this. When you learn a new language, for example, you always tend to think in the language you know well. And then, you translate that thought into your new language. It's only when you start thinking in that new language that you actually learn. That's the same principle with Laparoscopy too. You can't keep thinking of how you'd separate tissue or suture an incision with your bare hands and then use those methods with that instrument. You have to allow that instrument to be your hand. The needle-holder is not going to be this 20 inch long instrument that you directly hold and just plunge inside. It's going to have a long handle, a different grip and, most importantly, a really small area to move in. Unless and until you can think in terms of moving the needle holder and picture it as a part of your working hand, you can never get good with Laparoscopy. That needs patience, practice and perseverance.
I personally had a great time. I realised yet again, how much I LOVE surgery, love being inside an OR. I also learnt that I am good at this. Day to day practice and I could make myself really really proud. I like looking back at things I've done and marvel at them. I like saying stuff like, "Wow!! You go girl!". I can do that in Surgery or any surgical field. It's great to know that the love I'd felt during my Casualty posting was not a one time thing. I know I love this and I get a feeling I can get really good at it too.
I thank my luck that I had this opportunity so early on. Experiences like these help mould the clay of my confused mind into a beautiful pot. There is a long way to go, but I'm taking small steps. And, I get a feeling that the beautiful piece of art is not very far off :-)

I'm Back !!

It has been over a year since I made my last entry. Things got very busy after I came back from rural posting in Shirur. We then started with all the heavy postings - Medicine, Surgery, Ob-Gyn. That was followed by a nerve-racking USMLE Step 1, Step 2 CK and Step 2 CS preparation. Amidst all of that, I had the opportunity to complete 2 elective rotations at Yale-New Haven Hospital and Massachusetts General Hospital. I visited my Uncle in California, saw a little bit of LA for the one day that I was there for my CS examination, made a return to New York (this time with my best friend) to fall in love with it AGAIN (why do you do this to me New York?!), met some wonderful people, made some brilliant and funny friends, learnt from smashing residents and Professors, grew up a little (not so much though :-P ), carried all my baggage alone everywhere (trust me, that is my greatest achievement - you know why, because only today morning I dreamt that I left my check-in bag at the security counter at the airport. I was running across the entire length 10 mins before my flight took off, just to get my bag. Such a relief to get up and realise I was in bed, at home and that my airport story ended 3 months back!), gained weight (that was second achievement. a whole 2.5 kg!! in 2 months!) and basically wanted to come back home, but so did not at the same time!!

People do many more things in the time that I spent in the USA, than I did. But, then, looking back, I loved the relaxed life I lived there. Yes, I worked. In New Haven, I was in the hospital from 9 am to 5 pm. In Boston, I was there from 6 am to 6 pm. But, I roamed about, I read, I studied, I watched FRIENDS all over again, I developed newfound love for The Big Bang Theory, I found Chipotle (oh holy God! I loved their barbacoa so much, it hurts to remember it now. Please please take me back there now!!), I loved Boston (that's saying a lot because, frankly, I dreaded being alone in a city without any new friends) Yet my first weekend out in the city, I knew I was going to love it, with all its rain, sunshine, snow and wind. Oh yes, I experienced my first ever snow fall :-) As beautiful as it looked from inside the house, it was tough to walk out there. People may laugh saying, "So excited about snowfall of all things?!" But, hey, I live in a tropical country. The day I left for the US, the temperature here was a whopping 40 degree Celsius. If I see snowfall, I'm going to enjoy it and call it beautiful.

After my posting in Shirur, I'd realised that I don't go beserk with new surroundings. I adapt, without any complains. In fact, it takes me months to realise that I actually enjoyed the change. During my time in Shirur, I never once thought of the stay as wonderful, enjoyable or easy. I just did what I had to do. I had lots of time to ponder (oh yeah, I did, lots and lots of it. My best friends will attest to that.) It was only maybe months down the line that I looked back at that month and classified it as 'Good. I managed to live on my own.' It was the same with my US trip. During that time, I didn't really believe it was amazing or bad. I just went along with the flow, week by week, ticking things off my list. It is only now, 3 months down the line, that I look back and say "wow, I really did it. And I enjoyed every moment." That probably gives me most hope about the kind of person I shall be when I fly out of my homestead.

So what is next up for me? I have decided to go the US way. I'm currently compiling applications, putting together Personal Statements, looking up programs to apply for. If things all work out, next year, at this time, I shall be working my ass off at some wonderful hospital. If things don't, well, I think that is a story for another post. I get the feeling that I'm sounding happy and optimistic in this one. Let's keep it that way :-)

It feels so good to be back. I'm sure I'm going to spend an hour or two going through my old posts, reliving some memories, good and bad. I've missed writing so much. I'm glad I forced myself to take some time off and do this. Now, of course, I shall be itching to write my next post.

p.s. the title of this blog finally makes complete sense!! I've officially become Dr. Pranjali. I'm still not used to it. My parents have to keep reminding me to add that 'Dr.' before my name :-P


Adding a picture of my Italian Brunch In New York. A tribute to the love I developed for eating. The white stuff is the best ever cheese I've had in a long long time :-)

When You Learn

I learnt a thing or two about myself over this weekend. I don’t know whether to think it is just my thought process or whether it is human nature in general. I will be keeping it in mind now on.

About a month back, I bought a new smart phone. An HTC 8X. The thing about me and phones is, I am never too sure of which one to buy. I never narrow down on any one. My way of buying phones is – go to the shop, go through the collection, compare the prices, see which one suits my personality. 3 days later buy one. I don’t know whether this way is wrong or right. It is my way. I also end up using my phone till the very end. I manage to find every reason to keep on using the tattered-looking model as long as I can.

This year, after my results, I could have asked for a new phone straightaway. Exactly what all my friends did. I thought, my current model is good, let’s continue with it. Until, those days came, when the model started going to pieces. I started with an online screening of phones. And there it was, that HTC 8X. Standing tall in that California Blue matt finish colour, the Windows Phone tiles emitting an eerie glow, that big screen telling me to come get it…..It had everything I wanted and more. The only issue was its price.

I have never stubbornly asked for anything. I am always practical and adjusting (at least where phones are concerned :-p). This time however, I had to fight tooth and nail to get what I wanted. I wasn’t sure I was getting it, until the very last moment, when that guy finally opened the box. I still remember that moment. I fell in love. Again. With my HTC 8X. With my Blue HTC 8X.

Over the past month, I have been so careful about this phone. I wash my hands before touching it, I clean it every weekend, that screen may have gorilla glass, but I still put a scratch guard. There is a fixed place in my bedroom for it (away from dust, dirt and any danger of falling down). I can spend hours just looking at it as it gets charged. Yes, I can be passionately in love and possessive about something. That’s the first thing I learnt.

This weekend, as a part of our Annual Family Trip, we visited Della Resort in Lonavla. Wonderful place by the way….there’s an Adventure Park there and I did all that there was – Ziplining, Rock Climbing, Rapelling, High Ropes, Zorbing, Reverse Bungee Jumping, Archery and the Arcade games. Lots of fun in lots of rain…getting wet in the rain is an out-of-the-world feeling!! Everything went well, until Lunch time when my phone stopped working. It refused to start. And it kept vibrating every 40 secs. Charging did not help, it worsened the condition. And there went my awesome happy mood down the drain. All I wanted to do was get back to Pune and repair that phone. I couldn’t stop worrying about it. I couldn’t stop thinking about it. My phone was sick and I was helpless. The feeling of helplessness is the worst feeling in the world. I had thought of not taking this phone to Lonavla. I regretted not taking that thought seriously. I just wanted my phone switched on. I didn’t care about the data, I didn’t care about the formatting. I just wanted it show signs of life. Signs of being around for some time more. I couldn’t sleep for two whole nights. In fact, as the end of our trip came closer, my tension, apprehension and jitteriness increased. I don’t know how I managed to sleep through that Sunday night. I had to get to the Service Centre on Monday. Whatever happened.

They called yesterday and said that phone had been repaired. There had been water there, so my warranty period is over now. All my data is lost. But, you know what, I don’t care. I don’t care about the contacts, I don’t care about the videos, the images, the songs, those notes I keep on my phone. All I care about is seeing my phone in a working condition again.

What did I learn? You love your phone, right? Don’t test it and its tolerance capacity. I might call myself moderation personified, but when it comes to the things I desperately love, I am an Extreme. In every way. I also learnt that I can desperately love something. I can be desperately worried about something. I can be desperate about something. That scares me and makes me feel good about myself too. When you feel too much about something, you are more liable to get hurt, more liable to harbor grudges, more liable to senseless action. That is scary. But, when you feel too much about something, you are motivated to work at it, more dedicated towards it, you don’t lose yourself when things go bad. That is a part of the recipe for success.

I am more of the Moderate and the Extreme. But, I have the tendency to become an Extreme. Do I need to work to change this? Only time will tell….  

When Doctors Act Like Patients

One would think that the years of study we put in to become Doctors would make us better prepared to face any health situation that confronts us. Since the pathophysiology, the symptomology, the complications, the investigations done and the treatment needed have been encrypted into our minds, we would in fact be the most resilient and calm patients or patients' relatives. Yeah, that is just a myth. We are humans. And we have every right to create a scene and fear the worst, when our own health is concerned.

As an occupational hazard in our profession, we are capable of being exposed to anything and everything. It is our  responsibility to protect ourselves against the worst of  scenarios. The most common is, of course, the needle pricks. It has been 4 months of Internship now, and I've managed to get two already. Both experiences contributed to my post today. I feel more confident about handling such situations now, but in the spur of the moment, I acted like any non-medic person would. That is scary. That spur of the moment action or inaction.
We are taught to maintain basic precautions - gloves, covered shoes, masks, glasses, lab coats, etc. We are also told that there are certain norms to be followed to protect ourselves. One is, never recap a used needle. NEVER. More than half of the needle-pricks occur when we try to use our own heads and recap needles. Two, always push the used needle into the plastic cover on the bed. That keeps everybody out of danger. Three, wear gloves. Yeah, that's what I wrote first, but that is just so important!
I want to record my second experience here, because I learnt more from this one. I was posted in Skin (I don't know what it is, there isn't much love lost between me and the subject) and had to put an iv cath for a patient. I'd previously taken a sample of his for HIV testing, so I was wearing double gloves, a mask and doing everything I was supposed to do. While taking the cath to throw it, I felt it pierce my gloves. On removal of the gloves, I looked for any kind of injury on the skin of my palm. There was none - no blood, no inflammation, nothing. I washed my hand, there wasn't any burning either. I thought I'd caught the needle just in time.
That was a mistake - Never think there is no prick. Go to the Medicine guy responsible, immediately.
I didn't think about it too much until next morning, I saw an  inflamed spot. At 4 am in the morning. And then everything got twisted. I started  panicking. I wanted to cry and scream....I wanted to call up my resident and ask her about the patient's HIV status. Having seen the patient, I kept thinking, there was a possibility that he could be positive. And I hadn't taken that PEP dose immediately. My sleep disturbed, my mind shaken, I  spent my morning trying to decide what to do. Ultimately, it was decided, that I should go and do that patient's Tri-Dot test any way, instead of waiting for his report. Before doing that, I took the first PEP dose. That moment, when I was waiting for the lines to form on the strip, was most frightening. I could imagine more than one lines on that strip. I had prepared myself for the worst, because I was so sure that was going to be the case. When only the control line came up, the surge of relief that went through me, filled me with a new life, really. Next day, the patient's report also came as negative. Phew. Close call.
This whole episode made me think. I've learnt about HIV and HbsAg since I was in second year. I've learnt that the chances of contracting diseases like this are pretty slim, that once you take all the necessary measures, you don't need to think much. I've learnt all about the pathophysiology, the spectrum, everything there is to learn, at UG level. This is enough  to know that what I was faced with, did not put me in danger at all, especially after that Kit test. Yet, I panicked. Yet, I feared the worst. Yet, I traumatised myself and my parents and my two bestest friends. I told myself, it couldn't happen to me and yet, it was happening. What was the use of all that knowledge then? It didn't matter that I was a doctor. I could easily have been an engineer or an archeologist or a parent. My reaction was a purely human reaction - a scared person, faced with the possibility of a different life. It is like facing a tiger in the middle of a forest - in those initial seconds, it doesn't matter whether you've been researching tigers all your life or whether you're thrown in front of him by mistake. This fear, this panic....it's a part of the innate response of our body. Innate - present since birth. However trained and educated we get, this response always gets the better of us when faced with danger or death.
And at such times, doctors end up acting like patients....

Monday Blues

The title of this post is actually wrong. It hasn't been just Monday blues. It has been All-Week blues that earned a boost-up today. I was truly happy and at peace yesterday- the one Sunday when I did not have to look at the sight of that Dermatology building. Hmm...it's been a sad week.
The elective posting is supposed to be the only one in which you have a say. I had a say in it. I was so sure I wanted to take Psychiatry as my elective posting that there never seemed any two ways about it. I don't what went through my mind in those 5 minutes before I went and selected my Internship batch that made me call up a senior of mine and ask, "What should I take? Skin or Psychiatry?" And I don't know what induced her to change from her previous answer of Psychiatry to Skin. She did change her answer though. I changed my mind though. And now I regret every bit of this 15 day torture.
Maybe it is that building. The building houses Paediatrics also and we all know how much I 'enjoyed' that posting. Or maybe it is the lack of space - 2 crowded OPDs where the 6 residents barely manage to fit it (talk of fitting in, there is also an examination table, computers and stools for patients), 2 wards on the 2nd floor of the building where again they've managed to fit in 7-8 beds each for male and female patients. Or maybe it is the lighting- there's hardly any....it is so difficult to look for veins to put intracaths into in improper light. Or maybe it just the residents- they look so bored and not-so-happy with what they are doing, there isn't enough enthusiasm for us left.
I remember how my ENT posting went. When the nice guy gave us work, he gave it with a smile and positive look. We did it in the same way. When the frustrated girl gave us work, she wasn't delighted with the results. In Ophthalmology, the residents and we had a mutually happy relationship. They helped us, we helped them and ultimately patients went home happy. In here, I am just plain bored. They are bored too. I guess, in their defence, if you had to work in the place that they work in day in and day out, you'd get bored too. Still.
All the work that I do is take labs, put caths and take pus culture & sensitivity samples literally everyday. If not taking those samples, I go trace them. TRACE. I hate that word. It means having to walk all the way across the campus from one end to the other and back. On days when I have to pass by the cute resident in the Orthopaedics OPD, it seems more tolerable. But that's just two days out of the whole week. Oh yes, the whole week . That reminds me of the start of this unhappiness. We are 4 interns posted in Skin right now. There are 2 units so 2 interns in each unit. We decided we'd put a rotation for all 4 of us so that we'd have to come only 3 days each. The one person who came would complete the work for both units. The residents did not agree, so we've barely managed to put a rotation in the unit itself. My Unit is 'fantastic' though. They need both of us there. One to take the labs, the other to trace them. One to stay in the wards, the other to go hunting for a xerox shop to split their books/ xerox books/ bring some forms from the co-operative store. God, such a pain.
So, for the past week, I've been going and sitting in college. I and my co-intern alternate between the work and sitting in the library, in case they ask to see our faces. Yes, i'm finally studying and all, but this is so frustrating. I was so glad on saturday when my work was done and I could run home to a Sunday. That Sunday came and went and today, it was back to being glum, angry and in a foul mood.
July 6th, when shall thou come??

In other news, Brazil beat Spain 3-0 in the Confederation Cup 2013. An ardent Spanish Armada fan, I don't know what hurts more- that they lost, that Brazil scored 3 goals or that Spain did not even have a goal on the match sheet. Hmph.

How's The Internship Going?

This question is the most obvious and the most commonly asked of me wherever I go. Today, I have the time to ponder on the perfect answer to it.
Hmm...so, how is this internship going? One thing is for sure: I'm enjoying this phase only because I have my friends with me (and by friends I mean, people I like, call friends and who also work as much as I do). Working in a hospital can be a lonely feeling....you are working with and under residents, who you can have no choice of. Right now, thanks to the delay in the Entrance examination results, we are short of Junior Residents. That means that our Senior Residents are quite frustrated with the amount of work left for them to do and, in turn, we, the Interns suffer, because we need to work more than usual and also do all the petty jobs there are. In such a scenario, if you don't have decent people to work with you, pour out your innermost emotions to, have a laugh with and remind each other of your plight, life sucks.  That's where, I have been lucky enough.
Of course, there are people called 'cutters' in our batch too. The word is used to describe an intern who wriggles out of the work assigned, usually to study. Such a person is usually more thick-skinned than the rest of us (as interns, you have to be thick-skinned to survive the mental ordeal in SGH), has absolutely no conscience to provide a haven for guilt and loads the rest of us with extra work. In my batch, we have about 3 such people. We've been able to distance ourselves from them, but time and again, fate just plays into their hands instead of ours. Currently, there are 4 of us, who've sort of decided to stick together, because we work well together. 3 of us were together in the Orthopaedics posting and we had a blast. The fourth girl joined us during our ENT Rotation and we managed very well. We decided to do day duty during our Csualty &Trauma rotation. We've left that place with the Chief Medical Officer saying that our team of four was one of the most sincere and hardworking lot he's seen in a few years. Such a nice compliment to hear!
So, going back to the question: I shall be biased now because of the Casualty rotation. Upto the start of Casualty, internship was fine. Paediatrics was over and done with (that itself is such a liberating feeling. I realise it now when I go to the building and there is no reason why I should need to enter it), Orthopaedics was fun and signed off, Otolarhingology (ENT) created a few issues regarding the Interns' rotation but we scraped through and Ophthalmology just proved to be my favourite yet again. So far, so good. Apart from the ENT completion signatures, I had all the others and things were good. I particularly enjoyed Ophthalmology. All that I ever did was measure the vision of patients and take labs, but I'm so completely in love with the subject, I enjoyed that bit too :-)
My hate for Casualty began during Orthopaedics. On our Emergency days, the intern had to sit in the Casualty and do the preliminary of the Ortho patients. Obviously, that was NOT my favourite job. The Casualty Interns posted at that time weren't more than acquaintances of mine. Seeing them run around here and there like freaking doctors, added to my negativity about the Casualty. I used to get this helplessness sort of a thing watching them. I used every opportunity to run away to the ward. There was lab work, blood issue calls, the HIV-HbsAg testing and trips to the OT to help out the residents a little. I did not sit at all, but I got that helpless feeling out. I felt better about myself. It worked for me.
This attitude carried into the start of my Casualty posting. On day one, I did not want to start the posting at all. I wanted to run away from the place and hide myself in some tiny little corner of the world where nobody would find me. But, by the end of the day, that thought itself was hiding in some deep dark corner of the world.
Looking back, this has been my best posting till date. A 12-hour day duty, managing more than 80 patients per day (all sorts - malingerers to psychotics, chest pain+breathlessness to assualt, alcoholics to RTAs, dog bites, cat bites, pig bites, monkey bites....everything) is not a joke. We did not get time to sit. My whole diet was ruined because my ages-old routine of 4 meals a day at fixed intervals was kicked out. There was a point when I almost collapsed there due to exhaustion. But, amidst all this, I loved every moment of this duty. My fear of putting an  intravenous catheter, a Ryle's Tube, a Foley's....everything was dealt with. I'm more confident of myself now...I managed to put my CPR skills to good use (finally, the BLS, ACLS workshop can be properly thanked :-) ). But, if there is one thing I enjoyed more than anything else in the world, it was the Minor OT. We dealt with all kind of wounds....my mattress and simple suturing has flourished during these 15 days. I love doing it all. Such a constructive way of getting rid of all the frustration and anger that boils inside you when you have to listen to 10 relatives per patient asking you 10 different questions. I had realised long back that I love surgical work. In these 15 days, I have also realised that when a patient comes with complaints of chest pain+breathlessness+hypertension, I lose interest. Its so obvious that Cardiaology is so not my thing. The area of the CMO dedicated to Surgery and Orthopaedics was my home, my go-to place when things got out of hand. I could calm myself down, doing the preliminaries of those patients, setting their wounds right, giving them hope that things would become better.
We had all sorts of patients - suicidal attempts (I and a friend sutured a wound in 3 layers - the only one in these 15 days :-) ), cases of castration, hit-&-run cases, accidental machinery injuries, self-poisoning for all sorts of reasons....I got a look into the kind of life people are forced to lead. That was disheartening because, when you have all the luxury in the world, some people don't even have 10 bucks to make a case paper. Old men with BPH complaints came from afar and refused to go back, because they had no fare. Aged women travelled for 2 days to come here and be told that they should have come 2 days before or after....that part of a direct view of reality made me depressed. I will do something for such patients in the future, because, they deserve every bit of it.
The casualty is an excellent place to learn. Medicine, Surgery and Orthopaedics residents are always there and they always managed to teach us a little something. Yes, this 15-day posting was wonderful. So much so that now it is over and I have this vacant feeling. My elective posting is Dermatology and it's back to being an intern doing all the menial jobs. I'm still in that mode of activity and multi-tasking. It is going to take a long time to get back to my usual job. Ha ha ha. Check this out. On day one, I had already hated every minute of that Casualty. Now I actually miss it. He he!!
So, how's the Internship going? It's going well. I'm enjoying it and I've learned quite a bit :-)