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


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New Year = Old & New Books!

I realize now that I have been going through “book malaise” towards the mid/end of 2015. As the winter has rolled around, I realize I am missing dear books. I started 2015 with a bang – reading a lot and hoping to get through a list of books. Somewhere along the way, a greater distance between myself and my darling book-list. Why? Maybe the moving, graduating, traveling, and getting married interrupted the routine a bit. However, January is back and so is my great expectation of finishing another set of books this year! And, like always, V provided me the inspiration by giving me a phenomenal book to read – The Shed that Fed a Million Children  – more about that book a little later! So, after being inspired to read a whole lot, I have managed to narrow down another list. Yes, some of these books I did not get around to reading last year. So if they sound familiar, they are.

2016 Reading list:

 

In full disclosure, I should state that I have successfully finished two of these books (In Spite of the Gods and The Shed that Fed a Million Children) since they were truly started in 2015, and I loved them both!  (check out later posts for reviews on those books!)

Here’s to another attempt at keeping up with a New Year’s Book List!


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The Common Indian – Story 2

“He is really nice to me. My first husband used to get angry and hit me a lot, especially when he would drink. He died – he drank himself to death.” This is Lila. She is young, beautiful, and a wise sage at only 32 years old. Her life experience makes her a lot older than her numerical age. She was born in the eastern state of Odisha in a “small regular village – cows and farmland.” She moved to Delhi with her then husband at the age of 16 years old, where she lived on the streets before moving to the slums outside of Noida. It was not long before her husband started drinking and became unemployed. Within that year, she had her first child and decided that she would not raise her daughter in this poor slum – so, she left her infant daughter with her in-laws in Odisha ot be raised without her presence. She returned to find her husband gone and her effects sold, likely by her husband in exchange for alcohol. After being on the streets again, she started working in local houses and restaurants to wash dishes, clean bathrooms, and mopping floors. Having saved enough to move back into the “tenement housing,” she describes evenings that consisted of verbal and physical abuse from her husband. After hearing this, I could not help but compare my life at the age of 18 to Lila’s. I was living in perfect happiness going to college, deciding what color my bed sheets would be, and what I should do on Friday night with my friends. This thought line is does not cross into the realm of homelessness, abuse, domestic violence, and unsafe living conditions.

As I spoke with Lila, I became more appreciative of her strong will and character. She had two other children (daughter and son) but had to send her daughter to live with an aunt in the village because she feared for her safety when her husband was intoxicated. Lila describes her husband’s death as both traumatic but also liberating. She cared for him as he slowly became weaker, jaundiced, and unable to eat or drink anything. He eventually passed away in her arms. After his death, she describes finding the strength to live on her own with her infant son. She continued working, was able to get a small shack of her own, send money home to her daughters, and began planning to send her son to school. Eventually, she re-married. This is where I see her eyes light up. I can appreciate the happiness that her current husband brings her. She describes him as “patient and calm. He never yells at me, even if I argue with him, he still does not yell back. He works hard during the day and cares for my son like a true father. He is a good man.”

When I ask about her daughters, there is sense of melancholy. She explains that she misses them a lot – only visits once a year. When she calls on the local phone, they are too shy to answer, especially her older daughter. “My middle one is smart. My oldest one is timid. I think she is a lot like me when I first got married. She quietly listens to everyone and never says anything back, even when someone is yelling at her or being unfair.” Similar to any mother, she has many concerns about the future of her children – their life, their education, and their marriages. On the forefront of Lila’s worries now is her older daughter.

“I worry about her. She is going to be 17 years old, living with her grandparents. It is not safe for an unmarried young girl to stay at home in the village. I constantly worry that someone may hurt her. So, I think we are going to get her married soon.”

There is a long pause as Lila finishes wipes off the jasmine oil from her fingers, likely thinking about the future.

When I ask her about the future wedding and her gift to her daughter, she explains

“I have nothing to offer, except this advice: do not be afraid of anyone, especially her own husband. In marriage, she needs to speak up for herself and not allow her husband to hurt her, like I did. You see, I am not educated. But she is. She knows more than me.”

Humility and concern are probably the most apt traits to describe Lila. Her life would make the average person angry with the world, yet she lifts her head and moves along, perhaps for the sake of her children. It makes me happy to think that she has found a partner who can help heal the deep wounds. She is certainly a testament to the human spirit, and I pray that Lila’s path forward is filled with more happiness than her past.


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The Common Indian – Story 1

The twinkling lights of Marine Drive glowed in the dark. U maneuvered the car with the ease of a skilled surgeon. He could map the arteries that supplied the heart of downtown-Mumbai and avoid the veins that were congested with traffic. He had seen it all. Born, raised, and bred in the humid air off of the Arabian Sea, U took great pride in introducing his city to us. He showed us the Chowpatty Beach and explained that the life and times of Mumbaites were chronicled in the sands of the Chowpatty. He pointed up towards the glass towers erected by the Ambanis, Mittals, Tatas, and other socialites. He proudly offered to introduce us to the music scene of India from the comforts of the backseat – pop, jazz, hindi new & old, classical, rock, hard rock, metal, hip hop, and of course instrumental. He was proud. But when it came time to talk about himself, he was reserved, almost timid.

U tells his story in a concise and uneventful manner. He does not divulge details unless asked. He does not offer stories unless prodded. And he certainly does not occupy by mentioning frivolous facts about his “mundane life.” Ironically, V & I were most interested in knowing him and his story. We had seen plenty of shiny ivory towers and its surroundings. We wanted to know more about the life and heart of Mumbai – its people. So, after much querying, we discovered that for the past 8 years, U works as a driver for a popular luxury hotel. He lives on the outskirts of Mumbai and takes the commuter train into the central/downtown Mumbai, approximately a 40min train ride, and then walked 15-20 mins to the hotel. Here, he changes into his uniform, cleans his car, and finally receives the assignments for the day. His shifts are supposed to be 12 hours at a time – starting at 7AM or 10AM. However, this particular night, he is assigned to us and thus working overtime while providing us the night tour of Mumbai. And, what a tour it was! With the reflections of the city’s tall glass buildings in his eyes, he said “I was born here.” As his voice trailed off, I wondered whether he wanted to say “this city belongs to me and I to it.” There is so much more to the story of U, and this visit only provided a small glimpse of the true Mumbai and its Mumbaite. The rest of the stories are saved for our next trip.


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We are the world

It is a momentous week – world leaders are getting together for the UN Summit week, Pope is visiting NYC, and Autumn is finally arriving. For me personally, this is momentous because I remember being excited about the UN Millenium Goals and now I get to witness the reveal of the Global Goals!

What is different between then and now? Well, I am older, the UN week is still the world attention holder, but the goals have become much bolder! The new goals are fantastic because they push the limits of the nations’ leaders to achieve these goals. More importantly, they include topics that were left to the wayside the last time – responsible consumption & production, life below water & on land. I am enthralled as I think about being part of a generation that can witness the achievements of these goals. Of course, the obvious caveat is that many of these goals are closely dependent on the mothers of all goals: peace & justice – leadership from strong institutions.

UN Global Goals

As you notice in this pictograph, peace & justice are listed as goal #16, while the plan is completed by the goal of creating global partnerships. This is such a vital distinction because the success of achieving these goals is soundly dependent upon our ability as humanity to unite for peace and justice. One cannot be achieved without the other –

“Peace without justice is tyranny” – William Allen White

When we listen to the news on the radio or peruse through a magazine or the lonely newspaper – everyone notices the headlines. Based on today’s AP News headlines, I created word cloud (helped by worditout.com). Of course the usual common words are predominant – day of the week, politics, Congress, news; however we should take notice of the following words: Syria, US, military, combat, Russian, injured, war, missions, flee. We seldom come across words like peace, happiness, camaraderie, partnership.

WOrd Cloud

It is clear that the state of our world is not adequately depicted here. I recognize the commonly accepted explanation that unhappy news sells while happiness does not ignite a fire. However, we should ask ourselves whether each of us is truly doing our part in cultivating a community that is inclusive and tolerant of differences but not injustice. We need stability to achieve all the goals outlined above – and stability is achieved only in areas where justice prevails. Each continent of our world is affected by instability. The Global Conflict Tracker is a tool produced by the Council on Foreign Relations, and take a look at their prediction of conflicts for 2015:

Conflict map

To the folks who believe that nations should focus on their individual priorities – think about this: is there any denying now that conflicts on one continent are affecting the interests of all? We are no longer the citizens of individual countries – we are global citizens. When the dividing lines of mother nature’s geography do not amount to any effectiveness, why do we still allow political and religious lines to divide us? If we are to achieve the goals of zero poverty, zero hunger, we need to educate our next generation. If we are to achieve educational goals, we need safe places for our children to study, eat, live, and prosper. These children will look to us to provide by example – the example of peace, justice, industry, and acceptance.

Reading furnishes the mind only with materials of knowledge. It is thinking that makes what we read ours. – John Locke

Does each of us have to go out to a warn torn corner of the world? No. We need to find the opportunities in our own towns and cities to promote each of these goals. Work as a mentor or teacher, help build a community garden, urge your companies to invest in the local resources to decrease unemployment, donate materials to build food pantries & home, and most importantly, bring awareness!

The world is round – a globe – thus our efforts of achieving these goals should be global!


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Atlas Shrugged

“I am a doctor…a doctor. I went to medical school, not computer or business school.”

Does that sound familiar?

Of course it does! As a newly minted attending, I can say that I have heard those words from my former attendings and my colleagues during residency. We have to understand that those words mask a growing sense of frustration, apprehension, and sadness. They are reacting to the perception that the skills they spent decades on perfecting are less valuable in the eyes of the payers. At this time, the doctors think their ability of checking boxes and responding to electronic alerts is significantly more valued than their ability to coach a patient through surviving cancer or taking their medications everyday.

Everyone likes the feeling of belonging, of using their skills for good. If you asked a pastry chef to spend half his time billing his customers rather than creating a cake that rivals the beauty of famous paintings, I assure you the chef would quit that job. (Fortunately, they could move into Brooklyn and open another gourmet Bake shop! :-) )

Now, imagine the frustration of a physician asked to rush through a patient visit, only to spend more time completing notes and clicking more check boxes. Those lost moments are precious for patients and physicians. There is a thread that ties a patient and physician together – it is made of mutual respect, appreciation, understanding of values, and most importantly time. Today that essential thread is a little thinner. A part of humanism is simply lost in the hustle between patients. There is increasing recognition that healthcare provider burnout and stress is surreptitiously plaguing our healthcare industry. We see the effects on the looming/anticipated physician workforce shortage.

You may wonder – is the solution to simply increase patient time visits? I am not sure that would singularly resolve the qualms of modern day patient care.

I think the solution is still to be discovered. In thinking of the solution, my eighth-grade physics project comes to mind – the task was to create an insulation system for an egg so that when it is dropped from the 2nd floor, the impact forces are disbursed and the egg remains intact. So, imagine a patient’s values being the center egg, the expertise of primary care and sub-specialty physicians being the bubble wrap immediately surrounding the egg, and the skills of the interdisciplinary clinic team being the box and package filling that help the egg bounce on impact. Without any of these materials, the egg is bound to crack, and thus we are bound to betray the values of our patient. In order to come up with the solution, we need to recognize that each of the healthcare providers involved have skills that are interdependent.

The team as a whole has to provide for the patient. A physician cannot solely manage the patient, the EHR, the electronic tasks, the prior-authorizations, the billing, all the while screening the patient for cancer and depression. The physician’s abilities will falter and patient care will suffer from the fall. A physician needs time to reflect on the patient’s concerns and read between the lines of patient’s questions. And, we can’t simply require physicians to partner with non-physician providers to complete these tasks, especially when as a society we provide limited resources for that joint venture. Patient Centered medical homes and Advanced Primary Care models are moves in the right direction. However, we do not have the complete solution. I suspect that the solution of the future will be amenable to the needs of the patients and healthcare providers alike.

As we navigate the sea of healthcare delivery, it is important to realize that our paths maybe uncertain but our motivation should be united. For the healthcare leaders of the world, this is the most opportune time to be innovative because small progress will lead to great achievements.

Thought is the wind, Knowledge the sail, and Mankind the vessel. – Augustus Hare


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To the Future Chief Residents…from a former Chief Resident.

It is the end of yet another year, another training, and another phase – Chief Resident Year or as some like to refer it to as “Chiefdom.” This has been one of the most rewarding and trying years in my training for many reasons. First and foremost, the trust that is bestowed upon a Chief Resident is truly remarkable. We are asked to mentor the residents, lead the changes and foresee pitfalls of innovations in the curriculum, educate students, staff the hospital & clinics, and most off all be the person that others can count upon.

I learnt that there are three glass balls in the air at all times: the interests of the residency program, the residents, and the patients. And as chiefs, we need to find the perfect pattern to juggle them and keep them from falling. There will be times when one ball is beginning to descend too low but vigilance can help restore the cycle.

There is no such thing as a “perfect schedule.” We labored over the resident schedules. Spent multiple weeks and countless hours daily on the scheduling of residents. And just when we thought we had perfected the schedule, it was not long before an error was identified. I learnt that perfection is not feasible, but striving to resolve the problem that occurs is very doable. Errors are made frequently – acknowledging and working to resolve them earns more respect from our colleagues and juniors than perfection.

As a manager we gain knowledge about confidential projects and conflicts, whether that involves residents, medical students, attendings, or the institution. Maintaining this confidentiality is the responsibility of a leader and showcases the character of a chief resident. It is a responsibility that is not to be taken lightly.

Working with others is not easy. We are always taught to “play nice in the sand box” but not really taught what to do when conflicts arise. And believe me, conflicts will arise and difference of opinions will be voiced. Our reaction to them is judged as much as our involvement or instigation of the conflict. After making mistakes and learning from those of others, I offer these words: take a deep breath in, write down your initial reaction, then destroy the paper. Come back a few hours later (if time is of the essence, a few mins later) and think about it – remember that it is our task to resolve the conflict in the most respectful manner. I can’t say that I always practiced this, but when I did, it helped me navigate a challenging course.

Looking back at this year, I was lucky to have wonderful co-chiefs and program leadership, who have helped me grow both personally and professionally. This was a once-in-a-lifetime opportunity, and I am very thankful for it. To the future chiefs, I only wish you the best and hope you enjoy this year as much as I did.  To the residents (and graduates) of our program, I am very excited to be your colleague and proud to work beside you as we strive to make a difference in our patients’ lives.

 


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Summer’s Arrival and Our Departures!

So, summer 2015 has arrived and it is a wonderful beginning! Each Summer, I am excited about traveling, basking in the sun, and eating delicious local food. And this summer is promising to be just amazing. So check out the story of my latest Departure, and stay tuned for the Top 5 Hot Spots in each of the cities we traveled!


Vacationland, aka Maine!

We landed and saw that our rental car plate read “Vacationland” and we LOVED the sound of that! The winter had been long, at times pleasant, but still quite harsh by most standards. So, we decided to go further North to celebrate the beginning of summer – Maine! True to all accounts, it is a beautiful state with wonderful food, friendly people, and a corner of the ocean! V & I had 4 days to introduce ourselves to Maine – 2 in Portland and 2 in Kennebunk Port. We had such an amazing time, that it is difficult to narrow down to our top 5 spots for Portland & Kennebunk Port, but not impossible. Here we go:

Eventide Oyster Co. (Portland, ME) 

When I think of Maine, I think of lobsters! And when I think of Lobster Rolls, I think of Portland! And now, I think of Eventide. This little restaurant on Middle Street is surrounded by super hipster & edgy restaurants. I like my lobster rolls to be well seasoned, more than just mayo & lemon, and this place does it right. The lobster meat is served in delicious non-traditional butter rolls, reminds of the the dough in pork buns!  The portions could be slightly bigger but the sides we ordered completed the meal nicely.  Definitely try the cole slaw and bbq cauliflower – yes, they barbecued their cauliflower perfectly!

Street and Co. (Portland, ME)

This is a FANTASTIC restaurant in Portland, ME. If you like seafood, pasta, and dipping artisan bread in the left over sauces – this is the perfect place for you! The aroma is wonderful (if you like the smell of garlic & olive oil roasting) and the ambiance is that of a busy kitchen! The seafood is fantastic – some of the best shrimp linguine (I’m from NYC – I have had shrimp linguine before) and definitely a whole-roasted Branzino that reminded me of Capri, Italy! The dessert is something to make room for – we had the chocolate torte and it was decadent. If you are a non-chocolate lover, perhaps go for something different! Seeing the popularity of the restaurant, reservations are strongly recommended! This is a restaurant that will give the top NYC restaurants a run for their money.

Peak’s Island (Peak’s Island, ME)

Off the coast of Portland are clusters of islands. One of the main ferry stops is Peak’s Island. It is a cute fishing village with make-shift beaches and lilac trees that make you feel at home. It is a great 1/2 day-trip to take if you are in Portland. A visit to Peak’s Island is not complete without a stop for ice-cream at Down Front. The staff is friendly & willing to help you decide from multiple options. Our favs were Wild Maine blueberry and Raspberry Rocky bear. Make sure you take a beach blanket, sunblock, and sunglasses!

White Barn Inn Restaurant (Kennebunkport, ME)

The Restaurant is beautiful, the staff is knowledgeable and courteous, and most importantly the food is delicious! White Barn Inn is known for their ostentatious dinner selection – the chefs are absolutely amazing and their pre-fixe dinner is sure to please. The careful selection of wines and perfectly cooked meats are easy on the palate. There is a live piano player who is talented and creates a wonderful ambiance for dinner! The restaurant is a renovated barn and exudes rustic vibes to keep your experience truly Maine-like. Needless to say, White Barn Inn is among the 1,000 places to see before you die!

Overall, Kennebunkport is the quintessential summer town with rows of shops and art galleries, only interrupted by cute restaurants and novelty ice cream parlors. There are many places to try a bite to eat – one of our favs was Tia’s Topside Restaurant with its waterfront porch and outdoor space heaters – even a brisk night becomes perfect!

Lobster Shack (Cape Elizabeth, ME)

In a few words: DELICIOUS Lobster Rolls by the sea. V & I were visiting Portland Head Lighthouse, and hoping to grab lobster rolls for the well known “Bite into Maine” food truck, alas, they were not present! So, we decided to venture to another light house and find a secret lobster shack, called Lobster Shack! The restaurant is a small casual place with a huge outdoor picnic table area. The lobster rolls were amazing, portion size was large, and view was beautiful. We also tried THE BEST Strawberry Rhubarb Pie ever. I know that they are known for their lobster rolls and as they should be. But if you happen to go on a day when they are serving their strawberry rhubarb pie, please do so!!

Portland, Maine has so much to offer that V & I are sure we have missed things. We cannot wait to visit the other wonders Maine has to offer. This was just the beginning, and what a wonderful introduction to Maine indeed!

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