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

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the Outsider and the Pioneer

I love NPR…and everyone morning I tune into NPR on my drive to work. This morning, I did just the same. Only difference this morning was that there was an ongoing interview. A sweet, confident, young female voice that was describing what it means to be “an outsider” and “a pioneer.” I loved her answer:

“I sort of refuse to be an outsider, even though I know that I very much look like one to a lot of people, and I refuse to view myself in such terms.” – Mindy Kaling

It was like I had found a soul-mate/idol in a complete stranger. When women are in power positions or ethnic “minorities” such as Indian/Asian/African American/Hispanic achieve cultural successes/break cultural limitations, they are touted as pioneers. On the same token, they are considered an “outsider” by their own group & by the society. But here, we have a young, strong, talented, South-Asian woman stating that she never considers herself as an outsider or different. As an immigrant woman, I know the difficulty through which my family has strived to assimilate with the “American” way. And now, after the days of playground bullying & picking have long passed, I too am proud to say that I am not an “outsider.” I do not require special recognition for tasks that would be considered mundane or expected for the “American way.” I deserve recognition for making society proud & fulfilling my responsibility, but I would be skeptical if someone were to say “as a South Asian [or female] you have accomplished _____”. Because, in America, our potential is not dictated by our ethnicity, gender, or background, instead it is dictated by our own talent & tenacity to fulfill our dreams. So, like Kaling says, “I think that it’s insidious to be spending more of your time reflecting …and talking more and more in smart ways about your otherness, rather than doing the hard work of your job.”

Read more about her interview here!

PS – I have not watched her show, but I will certainly now!

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Cross Roads of Fear & Responsibility

As a first-responder, there are many times when we arrive at the crossing of fear & responsibility. Responsibility for the safety of our colleagues, our patients, and ourselves. While the fear that my own safety can be compromised is very jarring. So, what does one do when you come at this cross-roads? How does one manage the combination of responsibility pushing me towards taking action to secure the safety of others and fear that I might be posing a danger to myself.

For anyone in a first-responder role at any point in their life, the answer is pretty simple: go with your gut. It is a split second reaction that can potentially salvage a domino-like cascade of poor outcomes. If I am assuming a leadership role, I do not know whether I would account for my own safety above that of my patient(s). The physician in me is trained to be benevolent, a problem solver, a quick thinker. Above all, I am trained value the idea that my patient needs help above the idea that they are a threat to me. I cant help but ponder whether this is reality?

Do other first responders think similarly?

As much as my instruction is to run away, I know that we would gravitate towards helping our patients because that is our most valued role as physicians. I remember back to the various stories during national emergencies such as Hurricane Katrina, many stories emerged where health care professionals placed their safety aside in order to stay by their patients’ sides. Or the nurse in Texas who died protecting her patients from a psychotic man. We are not a unique species in this matter. We all know stories of pets (especially dogs) that stay by their owners’ side till the end. What is it that inspires this level of responsibility and selflessness? Especially, when our physical safety is compromised to a large extent.

When I hear about the atrocities and maleficent acts on the news, it makes me angry. Angry because I know that our species is capable of graciousness and generosity. It also angers me to think that these heroic stories are not repeated frequent enough so as to infiltrate our world with thoughts of goodness.

I leave you with one request…when you wake up tomorrow morning, just go out into the world with this saying

 “Pace e Bene” – St. Francis of Assisi

*This blog entry is dedicated to all my co-residents & first-responders – you are all my heros!


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A little bit of southern love

The other day I was craving some good Southern brunch! Hence, V & I decided that a brunch with chicken waffles, cheese grits, and good friends would be the ideal celebration of all things Fall! So, we invited some friends over to BK to spend an afternoon dining at Sweet Chick!

If you have never been to Sweet Chick, it is a must eat in Williamsburg! (check them out here)

What makes Chicken & Waffles so delicious? Perhaps it is combination of sweet & savory with soft & crispy. The ideal southern fried chicken is spicy, tender on the inside and crispy on the outside. I have tried to make fried chicken, and I failed miserably. So, I am very appreciative of a perfectly fried chicken. The waffles of course have to be soft, warm, and just like small pillows. But, what makes Sweet Chick so wonderful is their lemon butter! I had never tried lemon butter before & I was pleasantly surprised by this addition to my waffles. It brought the freshness of citrus flavor that really adds dimensions to the meal.

Were the Chicken & Waffles at Sweet Chick the best I have ever eaten? No. That crown goes Nashville, TN. Nevertheless, we have found a local favorite Southern spot for this comfort food and I couldn’t be happier!

Sweet Chick

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Support a Primary Care Physician

I remember the day I felt like I was a “doctor.” I was rotating through my Ambulatory Clinic – a resident staffed facility that sees patients that have Medicaid or self-pay for medical care. What does self-pay mean? Well, for one reason or another, they are unable to qualify for Medicaid and are too poor to afford health insurance. (Yes, we still have this population in today’s post-ACA era.)

Back to that glorious day. I was excited because my patient’s blood pressure was finally in control. Her hypertension was an illness that had plagued her for too long. The satisfaction of helping my patient accomplish this long-term goal is inexplicable. I shared the sentiments of Rocky (movie character) as he completed the famous climb. Chronic illnesses are a marathon & not a sprint. And achieving control over it was equivocal to reaching the finish line. This feeling convinced me that I wanted to be a Primary Care Physician (PCP). As I began understanding the art of Primary Care, I realized that a significant portion of it was influenced by Health Policy. I became interested in policies related to financial compensation of Primary Care Physicians and its effects on population health. I learned that under Obamacare Medicaid reimbursement had significantly increased! It was a reason to celebrate…finally NYS would not be the third-lowest state in Medicaid reimbursements to Primary Care Physicians. For every $1 given by Medicare, Medicaid would also give $1 for the same diagnosis (up from $0.42). This is known as Medicaid Parity. And, it would certainly increase the PCP workforce for NYS, which means that our patients would have more time with their physician per visit. Wonderful news, right? Of course! But I forgot that all good things come to an end.

Starting January 1, 2015, Medicaid will no longer reimburse at Medicare levels. This translates into a 58% decrease in reimbursement for Primary Care Physicians from Medicaid. Under the environment of Medicaid expansion, our patient population will need increasing numbers of Primary Care Physicians. In a recent NY-ACP survey (April 2014), 46% of PCPs indicated that they had recently began to see Medicaid patients by enrolling in the Medicaid Primary Care Pay Parity Program. The same respondents said that they were likely to accept fewer Medicaid patients in 2015 (approx 40%) if the Parity Program was not extended. This potential loss of physician workforce is expected nationwide because the Parity Program was a federally sponsored initiative. It also effects population health because decrease in physicians causes increased wait-times for diagnosis & treatment of illnesses, increased patient to physician ratio, and of course decreased allotted time per patient.

This is where my Health Policy conscience rises up and urges me to spread the word. It is imperative that patients and physicians advocate for continuing the Parity Program because we need good physicians to take care of our population. We cannot afford to lose physicians at such a critical time when our Medicaid population is expanding significantly. It would a significant missed opportunity if these patients go undiagnosed or untreated. If the goal of Obamacare is to improve the health status of Americans, we need to encourage and retain PCPs, so that we can help our communities be healthier.

If you are interested in supporting the Parity Program, there is legislation in the US Congress “Ensuring Access to Primary Care for Women & Children Act” (S.2694) that looks to continue the federal funding through 2016. I urge you to at least read & become knowledgeable about the legislation before you decide to support or refute it. Medicaid Parity Bill in US Congress.  If you want to Support: Click Here!

“He is the best physician who is the most ingenious inspirer of hope.” – Samuel Taylor Coleridge

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Another year older, another year wiser?

I saw an elderly couple – they were walking on the sidewalk with hands interlocked as she used a cane to help her support herself a little more than her husband could offer. As time has passed, I find elderly people so much cuter and wiser than ever before. It brought me to thinking about my experiences over the last year. Being another year older begs the question whether I am another year wiser?


Things I know:
  1. I can eat 3.5lbs of Hershey’s kisses over 1 year.
  2. Love is a verb.
  3. An extra moment of calm can resolve conflicts that seemed out-of-control.
  4. Be thankful.
  5. Weekend getaways are a wonderful ideas.
  6. Sleeping is a luxury as I grow older.
  7. Nature is beautiful.
  8. Fate always deals me a new puzzle to solve.
  9. Parties are more fun to plan than to clean up after.
  10. Cake at 2 AM tastes better than cake at 10 AM.

Things I don’t know:

  1. How does it to fly with my own wings?
  2. When can I start my yoga classes?
  3. Will I run a 5K this year?
  4. What makes people hateful?
  5. What makes people fall in love?
  6. How does the Earth go round without falling off it’s axis?
  7. How long is the galaxy?
  8. Does my puppy know that I can understand his language?
  9. What is world peace?
  10. Will I be just as curious next year?


I dont know if I am a year wiser. But I hope this time next year I have another list of “Things I know!”


Thanks world!

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Awkwardness in the Waiting Room

I pretended to read my magazine, but I could feel the lady across the waiting room observing me intently. She was trying to figure out what my Hospital ID said…was I a doctor here? Was I a patient here? Was I visiting a family member? It made me feel a little unsure about my place in the waiting room of my physician.

Last time I felt this awkwardness dates back to my Intern year & my very first Code Blue. I was the first one at the Code and I felt awkward telling the much more experienced nurses what to do, after all I was just the Intern. Furthermore, it was my first week at the job! I was not confident in my own skin & identity. Today, I felt a bit the same.

 I had purposely left my white coat in our office because I did not want to play the role of a doctor. It was time for me to be the patient. However, I carried my ID (unknowingly) and it added more weight than I had expected. The thing about doctors is that they are terrible patients. I admit it! It begs the question…why?

If I don’t see it, it doesn’t exist. Have you heard this theory? It is very popular among children. The idea is that if I don’t face my shortcomings in health on a routine basis, I can go on pretending that my health is perfect. Physicians do not have time to see their own physician because that requires a multitude of scheduling maneuvers between the patients, the physician, the other physician, and the almighty luck. So, we instead treat ourselves for minor complaints, or we curbside our colleagues, or we just delay that appointment (the good old – I have a  sick patient I have to care for). My observation is that when other busy professions can make time for their doctors’ appointments, can physicians make a much more concerted effort to care for themselves as well?

I am not sick! I know that I have to cut back on my sugar but I am not sick! Sounds familiar? To me, sounds like some of my patients who have a tough time coming to terms with being “labeled” with an illness. It is usually because labeling reflects a deep vulnerability. I admit that sitting in the waiting room, as I was being watched, made me feel vulnerable. I felt that somehow I was letting my patients down by not being an all-star, Xena-like, physician… a physician with perfect physical and mental health. Patients do not ask me whether I am healthy or whether I follow my own advice.  I subconsciously ask that of myself. The “labeling” is more jolting to me than it would be to my patients. I am sure if I told my patient that I forgot take my medications today, they would not think less of me as a physician. In fact, we might even form a pact to reach our goals together. But to achieve that, I have to keep myself anchored to the idea that I am not Xena. I am a human. And just like every other human, I will have health concerns that need to be addressed timely.

So, my advice to all the fellow Xena-like or Hercules-like physicians out there – be real with yourself and go see your primary care physician. Be proud as you wait in the reception area because you are setting a good example for your patients. After all, sometimes the best medicine is the one that comes for your doctor (and not you).

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Happy birthday America!

It is America’s Independence Day ! Happy birthday America!  Summer is one of the best seasons in America because all regional differences are put aside and America celebrates. This fourth of July,  V & I decided to head to a local eatery which served southern food.  For me,  nothing spells American more than the Southern home cooking.  We headed out to a place called Biscuits and Barbeque in Mineola,  Long Island. It is a housed in a smal trailer attached to a permanent kitchen in the back.  As we entered, the chalkboard in the restaurant listed the desserts.. turtle pie,  peach cobbler, key lime pie,  coconut cream pie,  and good old bread pudding. I knew right away that this was theplace for me!  Underneath it all,  it said BYOB… how could celebrate an American night without enjoying some local brewed beer.  We chose our window booth and the lovely Southern waitress approached us. We took one look at the menu and already knew what we wanted…Chicken & waffles with honey butter, smoked bbq chicken (half) with cole slaw and grits,  of course our starter was a country biscuit with sweet onion gravy. 

Let me tell you.. the food was delicious!  It took us less than ten mins to finish our country biscuit.  And we absolutely cleaned both our plates. I had the smoked bbq chicken. ..It was tender, well seasoned,  and truly made to perfection.  The restaurant takes pride in its bbq sauces…I tried them all: Texan kick with Chipotle peppers,  Louisiana bourbon,  Memphis whiskey,  and the original southern smoked bbq. Who can go wrong with all those additions?  When it came time for dessert, we wondered whether we were being gluttonous? Then we realized that indulging in food is very American as well.  So we ordered the turtle pie. .. oreo cookie chocolate crust with chocolate cake and chocolate mousse center.  Delicious! 
We capped the evening by watching some beautiful but very illegal fireworks in front of my apartment building. (Truly American! )
The evening made me wonder…How would you define the American spirit? We all have our takes on what it means to be American.  But what does it mean to embrace the American spirit? 


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