A thought is like cotton – it can be processed hundreds of times and each time it becomes more refined.

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Celebrating Spring in NY!

It is my puppy Ladoo’s 5th Birthday today!

This is a momentous occasion for me. Why? Because I never thought I could love another as much as I love Ladoo. He is my first love, and it is absolutely unconditional love. I wrote about Ladoo’s First Few Months and looking back makes me realize that our bond has grown stronger as the years have passed. At first, my role was to be his mom. Now, my role is to be his buddy, confidant, and playmate. I have no experience with children. I am the youngest cousin of about 20 cousins on my Dad’s side…holding a baby and raising one has been a limited activity. So, bringing Ladoo home was a first of many experiences. There are so many memorable moments we have shared in the last few years, nevertheless, here are my Top 5 Moments with Ladoo.

5)  Discovery about other animals in our neighborhood – the first time he recognized a cat, a rabbit, a bird..it was like seeing his world expand exponentially in his mind. A new sense of being for Ladoo!

4) Teaching him to give a “high Five” – best trick ever…it is his favorite!

3) Discovering the snow – first snow at the age of 9 months old was another mind exploding experience for Ladoo. Since then, he has a love-love relationship with snow & ice…the more, the better!

2)  Holding Ladoo for the first time – he was a little larger than the size of my palm – vulnerable, scared, and yet excited.

1) Every night when he cuddles up next to me I am reminded that love is a universal language. It crosses all man-made and nature-made boundaries. And, I am thankful for having Ladoo remind me of this each night!


In other news, I had a fantastic lunch at Shake Shack in celebration of Spring’s Arrival in NYC! Sharing a meal with a good friend + beautiful weather + good food = fantastic memories! RR and I decided it was a burger kind of day and seeing as I have never eaten at Shake Shack, today was going to be the day! So, I took a bite of my Mushroom Burger..and it was delicious. The ‘Shroom Burger is a deep-fried portabella mushroom stuffed with cheese…you know this spells warm, gooey, flavorful burger. Definitely worth the trip & wait (approx 30mins!) on the line. As is well known – great minds think alike, and in NYC, we all thought it was a perfect day for lunch in the park. How did you celebrate your Spring?

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Nashville, the City & Culture

I am back from Nashville, Tennessee! I have been to the Southern part of the US before, namely New Orleans, LA, so I expected the southern hospitality & great food. And Nashville stayed true!

We visited Nashville primarily for a professional conference, but secretly I was hoping to enjoy a little bit of the local fare and flavor. We were truly able to indulge ourselves in all sorts of foods, from fried green tomatoes with Pimento cheese to Duck Tater Tots to Shrimp & Grits. It was all delicious. However, my food star is given to the Chicken & Waffles at M’s Restaurant and the Beignets at Old Hickory Steakhouse.

Lets start with Chicken Waffles, because we literally started with the Chicken & Waffles as appetizers…the chicken was supremely spicy & crispy in the non-KFC true to southern form crispy way; once the chicken was placed on the freshly made waffle & drizzled with sweet warm maple syrup, the combination of flavor was exquisite. If I could, I would eat this once a week for the rest of my life – it is that good! If we started waffles, we can end with Beignets. How does one describe a Beignet? Think about the softest, fluffiest pillow in a home store, then pretend it is food & sugary sweet – that is a Beignet! I remember eating these in New Orleans, roughly 14 years ago, and eating them again was like finding a part of my childhood again. I encourage everyone to try Beignets at the earliest possible, but they must be Southern because otherwise it is just deep fried dough without the magic!

Other memorable events from trip – listening to a talk about Blogging! (who knew?), motivational speech by Jeffrey Wiese, and of course Savannah’s Candy Kitchen. Most importantly, I shared some lasting memories with my co-Chiefs, so a big thank you to the my institute’s Admin & my co-Chiefs…this was a great trip! Check out the pics!

PS – Did you know I ate 2 of my 25 foods from Huffington Post, and I visited a new city/state in the US!

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Airport make over

I love airports! I especially love airports when I’m starting a vacation…they are the gateway for an escape, the portal to all the possible adventures ahead! However, the excitement really surfaces after all the checking-in procedures, security screenings. Then comes the waiting for boarding. Of course, there are some airport memories of being stranded, crowded into one waiting area, sitting on the floor waiting, frantically looking for an electrical outlet to charge my handheld device, and the worst is the loud ambient noise. So, after many mistakes, I have learned to be self sufficient (as much as possible). I carry many entertainment possibilities in case I am stuck. What is in my bag? A book, a magazine, deck of cards, chocolate, ear phones, charger for my phone (which thankfully doubles add my kindle charger), and if it is a really long flight I keep my journal!
Today, I was pleasantly supposed at the LGA Delta Terminal D . They have done a fabulous job remodeling of this area. As soon as you cross through security, there are the traditional food halls. But the boarding gate area is impressive. It has bar stool seating and Las Vegas style individual table seating with iPads! You can peruse the internet, read news, catch up on flight details, all the while using the adjacent outlet to charge your own device. Best part…you can order food that will be directly delivered to your computer table or your seat in the airplane!!!! How awesome is that? I could order a café latte, a roasted turkey panini, and brownie to be delivered to my airplane, while I waited for boarding. The cost was not too unreasonable, panini for $9 + coffee for $5 + brownie for $4. Now, I didn’t actually order this because I was a sucker and bought my lunch at the food hall before i discovered this. But definitely something I am willing to try. The cost is really proportional to the comfort of having the food delivered. Is it for everyone? No. But it is an innovative idea and I am impressed with the use of technology to make it happen. What else is super cool about this terminal? Because everyone is so well distracted, the ambient noise is lower and you can actually take a nap in the corner. So no more boredom or frantic searching for an electric outlet for this girl…at least not at Terminal D!

PS: I am headed to Nashville, so stay tuned for some news from the home of country music!

White Lilly

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Sharing Bad News

In Medicine, we prepare for everything, think about all the possibilities, especially the  worst case scenarios. As health professionals, we are required to “break bad news.” Some people can deliver the message with finesse, while others struggle for many reasons.  Many reasons are cited for physicians struggling, including limited education in medical school, limited training in residency, limited amount of time, and worst of all limited thought. I defer in my observations. I think breaking bad news is a process that is affected by many factors beyond those mentioned above.

I think physicians are influenced heavily by their personal experiences, preferences, and personality traits. Sharing a sad moment with a patient comes with a lot more personal involvement than expected. If a physician has healthy family members, never experienced the death of a loved one, or the toll of an illness, they have limited knowledge about the emotional experience that comes along with hearing bad news. On the other hand, if a physician has suffered an illness or experienced hearing bad news, they will be much more attuned to their patient’s emotions. For example, a female physician who has experienced the loss of a pregnancy will be much more reflective in her approach to a patient with a miscarriage. Can a male physician who is single, young, and has limited experience with pregnancy loss, be as reflective? It is difficult to say.

How does a physician’s grieving process influence this scenario? It is well known that people have varying ways of grieving – some will talk it out, cry it out, while others will remain quiet..they will grieve in the private. Some physicians may not be able to decipher the patient’s preferred method of grieving, or be able to put aside their own preference. A physician who is extroverted and willing to share their emotions with a room full of strangers, will likely expect their patient to be the same way. While, the other physician who is stoic and grieves in private may not expect the patient to grieve that very moment. Does one physician break bad news better than the other? Likely not.

Along with the method of grieving, personality traits have a vast influence in everything we do. As young children we are taught to identify our most descriptive personality traits. Yet, as physicians we are expected to put aside this sense of identity when approaching patients. This is difficult, if not, impossible. A person cannot fully “leave their personality at the door.” It is even more difficult to put personality traits aside. For example, compassion cannot be taught in medical school or residency…it is a natural reaction. The gestures of compassion without the emotional backing comes out as awkward as a hug from a distant cousin who you are meeting for the first time.

It is difficult to make a step-wise recipe for talking about bad news with a patient. To overcome the barriers of personality and experiences, I have started creating a collection of tips I have observed or experienced in this process. This collection is a loose skeleton for the conversation because the process evolves as the conversation moves forwards. Some of the tips I have collected:

  1. I find that a calm, quiet area is helpful – I move the patient to a room, a corner, even if it is just the quieter end of the hallway. This gives them a hint that I want to discuss something important with them.
  2. I ask the patient their preference – would they like me to share the news with them alone or do they prefer family to be by their side?”
  3. I keep it short and simple…”from our conversation and the data I have gathered, I believe you have ___ or you maybe developing ____
  4. I pause. I stop. I count till 20. This is the most important step. A moment of silence speaks volumes. I have seen the benefits of letting the patient sit with the idea for a few seconds. It helps them process. Then, I wait and watch. Everything that follows this step is dependent upon the patient. If they cry, let them cry; if they are screaming, let them scream for a few seconds; offer a glass a water or tissue if able to. If they look at me with anticipation of more information then I continue; if not, I ask them “would you like me to continue?” I try not to share numbers or statistics or plan of care at that very moment (unless emergent surgery or intervention is required) because they are usually not in the state of mind to understand the procedure or treatment. I give them breathing room.
  5. Then I ask – I want to help you get through this- is there anyone you I can call or inform for you?

Breaking bad news can be very difficult for the physician. As we observe another human grieve, the emotional toil can be great, and it is further increased by the insecurity and uncertainty of what is to follow for the patient’s treatment. On the flip side, the act of actually grieving with the patient can be therapeutic because those moments of silence lets me focus on only one person – my patient. I know that I may not be able to heal them, but I am standing by them as they venture into a difficult time. I wish the process could be renamed from “breaking bad news” to “Sharing” bad news, because that depicts the true sentiment.

“There are many truths of which the full meaning cannot be realized until personal experience has brought it home.” – John Stuart Mill

White Lilly

 are many truths of which the full meaning cannot be realized until personal experience has brought it home
Read more at http://www.brainyquote.com/quotes/quotes/j/johnstuart121327.html#3vB6gioY5wMQZSJy.99
There are many truths of which the full meaning cannot be realized until personal experience has brought it home
Read more at http://www.brainyquote.com/quotes/quotes/j/johnstuart121327.html#3vB6gioY5wMQZSJy.99

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Anticipatory Jumble

Sometimes I have a feeling that I can only describe as “anticipatory jumble.” It is a mix of anxiety, excitement, capriciousness, vulnerability, and optimism. It is usually antecedent to an event or change in my daily life. A month ago, I remember feeling similarly as I drove to Albany, NY for the first time. I anticipated that the month would be full of discovery – self & other – and it truly met that expectation.

Through my time with the NY-ACP as a Health Policy Resident, I was able to appreciate the time, resources, and knowledge required for the greater good. The activity of analyzing and researching the proposals for new legislation provided me with a deeper knowledge of NYS health resources as well as forthcoming changes. By the end of the month, I felt confident in my ability to understand the legislation proposed and brainstorm the anticipated effects on the vast population (whether that be physicians, New Yorkers, or both). The opportunity of participating in NYS Budget updates and closely monitoring the ongoing Budget discussions was both intense and interesting.

As part of a team, I learned abPicture1out collaborating with other members and stakeholders to assure positive results from our work. Being able to appreciate and consider the various perspectives is one of my newly honed skills. I have a greater appreciation of State legislators (Assembly & Senate) and their ability to keep the benefit of their constituents as a central focus to all discussions. I also realize the power of the State legislators to make change happen.

Most importantly, I experienced the power an individual has in bringing attention to a worthy cause and stimulating the process of change to benefit the greater good. This month was challenging in many ways – personally, emotionally, and certainly professionally. I view it as an opportunity to succeed in ways I never imagined. I leave this month with the same “anticipatory jumble” as I continue my clinical training. Why? Because, I anticipate many exciting possibilities on the horizon!

I am very thankful to my team at NY-ACP, my supervisor (LL), and countless others who were instrumental in making this a memorable experience.

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We were waiting outside eagerly. As soon as we crossed the threshold, the wonderful aroma of chocolate, flour, and sugar took over. We knew we were in for a real treat at Levain Bakery. V and I had decided to finally check out this bakery renown for it’s delicious cookies and artisan breads. We were not disappointed. We ordered a dark chocolate chip and a dark chocolate-peanut butter cookie. The cookies were amazing…rich with chocolaty flavor and surprisingly warm. Two accompanying lattes were a perfect match. Finding this hidden gem on Huffington Post was destiny…since I love chocolate and the warm cookies on a wintry evening are a welcome change. Will we return for more cookies?  Certainly for special occasions because they fit the mark well. If you happen to be in NYC- Upper West Side, make sure you take a detour and try this place!!


One-on-One with a NY State Senator

We walked into his office and saw the impressive oak table surrounded by five conference chairs and one traditional executive chair. It was a room that exuded both power and humility, and very representative of its occupant – Senator Kemp Hannon. Senator Hannon is my local NYS Senator from the sixth district in Nassau County, and he is also the Chair for the Senate Health Committee. He is regarded as the spearheading force behind both the re-authorization of the Health Care Reform Act and the development of New York’s Assisted Living Program. He is also credited with helping enact several public health programs, including Child Health Plus, Family Health Plus, the Elderly Pharmaceutical Insurance Program, and insurance coverage for autism, prostate and breast cancer screenings. These are Public Health programs that provide access to medical care for NYS vulnerable populations – the pregnant women and children. So it is no surprise that I was excited to meet him and get some one-on-one time to discuss legislation and life in general.

I met Senator Hannon at his fundraiser two weeks ago (see On Seasoned Legislators) and my impression was that he is an astute and well-read legislator. Upon meeting him today, I confirmed that impression, and added that he is humble and keen to understand the concerns of his constituents (such as me!). We talked about a range of subjects – from residency training to the practice of medicine to even ice-boating on the Hudson. He showed us his private entrance into the Senate Chamber – and it was very awesome! As our meeting proceeded, we voiced our concerns to him regarding proposed bills that effect healthcare. We spoke about the citizenship/immigration bill for International Medical Graduates, the need for funding more Primary Care practices in the under-served areas of NYS, the importance of continuing to promote Primary Care practices by reimbursing the visits at an appropriate margin, and of course the shortage of Primary Care Physicians expected in the future.

Through out the conversation, I felt that it was a constructive dialogue where he (and his wonderful staff) listened to our concerns and asked clarifications or greater details about the concerns we were bringing to their attention. They all seemed genuinely interested in understanding the process required to obtain a medical license in NYS. We even shared personal stories of the struggles physicians undergo (such as my parents) to acquire medical license in the U.S., especially if they are an International Medical Graduate. The conversation was brief but insightful.

As we were getting ready to leave, Senator Hannon said thank you. That was very surprising to me. I knew that we were taking time away from his very busy day and wanted to make sure we expressed our gratitude. But I was taken aback when he expressed gratitude for our visit and sharing information. I suppose it reflects the relationship he wants to build with his constituents.

Our visit with him was wonderful. This experience may very well have been a once-in-a-lifetime opportunity for me. I will certainly regard our meeting as a highlight for not only my Advocacy month in Albany with the NY-ACP, but also my residency training.

Check out the pictures!


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