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


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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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Jhumpa Lahiri’s The Lowland

CT prj-0922-lowland001.jpgDamp & humid air fills my lungs every time I walk out of the airplane and onto the tarmac. It is the first and most cherished sign that I have arrived in India. I have fond memories of my childhood in India, which is probably the reason why I gravitate towards South Asian books & authors. Through these works, I have an opportunity to revisit parts of my own childhood. I hope to build a deeper connection with the land that has given me an identity and perspective different from the “Western” world. But most of all, I look to learn something new about my heritage, my culture, and the history of the land of my ancestors. And Jhumpa Lahiri has always delivered on these requests.

Lahiri’s latest work, Lowland, is a walk down memory lane with exquisite insight into the struggle of the individual and society. The attention to details is a treat! The book is an opportunity to observe the a time of great confusion and opportunity for Indians. The 1960-1970s was a time of revolution, a time of anarchy, but also a time during which this young nation arrived on the world platform. The underlying immigrant story of Lowland is similar to many immigrant stories we hear today – a young man leaves his family behind in India to attain greater education and pursue a career in America. However, she narrates a perspective we are not familiar with – the story of the family left behind, the family struggling to make their normal again, the family that has been changed forever by the opportunities and tragedies of this era. The way in which Lahiri links the lives of 6 individuals within a family and 4 generations is truly amazing.

This is a must read book for all those who enjoy an intricate story about family ties and generations, mixed with the Indian flair!


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Gender and the Roles

Gender roles – these words automatically revert me to thinking about the structure of a household. I imagine a 1950’s home with the children are surrounding their father as the wife ensures that the supper is laid out for the family. Take a look:

Gender roles have always been society’s attempt at maintaining the security and happiness of a household by designating responsibility to each member of the family. This has largely been questioned by many organizations and leaders. As we make our way in the 21st century, many of us believe that gender roles are archaic and few of us in the “developed” world apply these principles to daily life.

In an NPR-Morning Edition story, I was surprised to find that we subconsciously apply gender roles! New research has shown that gender roles are not only applied in household or workplaces, but during various levels of education, especially college/graduate education. In a recent database created by Benjamin Schmidt, a professor at Northeastern University, male and female teachers were evaluated by students (total of 14 million reviews!). The resulting text was stratified by gender, meaning that each adjective used to describe a teacher was recorded based upon whether it was used for a female or male professor. The study results can be viewed Here – an interactive chart showing the frequency of adjective use for female or male professors, also stratified by discipline of the student (ie. Philosophy, Fine arts, Economics, etc). As NPR reports, Schmidt found that “men are more likely to be judged on an intelligence scale, while women are more likely to be judged on a nurturing scale.” Through this review, Schmidt did not find a difference between genders for the overall rating of a professor. In a separate 2014 study, Schmidt also contemplates the idea that online-students were likely to rate male professors higher in comparison to female professors. Albeit the n of this study was low (43 students participated), the combination of the two study begs the question whether we subconsciously carry our gender roles with us beyond the boundaries of our home and office?

Since the turn of the century, we have seen the rise of female leaders in all disciplines, so much that perhaps we may elect a female US President within the next decade! In the 1990’s various small studies reviewed children’s perception of gender roles. It would be interesting to return to this field and compare the perception of gender roles among the children of today and 20 years ago.

1950sWhen it relates to medicine, the study of gender roles and perceptions is significantly pertinent. Physicians and patients are uniquely compelled into creating a strong relationship based upon the patient’s trust and confidence in a provider’s ability. If the provider is unable to attain and secure this confidence, the two can suffer from an unsatisfying patient-physician relationship. One can imagine that this influences the ability of a physician to encourage patient compliance, adherence, and satisfaction with treatment plans. As we venture into more complex medical management, the effect of gender roles is more likely to emerge to the surface.

Thus, the conversation continues for another day, year, or decade!


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Picking-up the Pieces

Calm, well-mannered, and overwhelmed. Those are the three words I would use to describe CS. He is the average patient in our Resident Clinic. He has struggled in life – migrated to America with hopes of pursuing a better life, lived away from his children, suffered through the passing away of his wife, witnessed the passing of his brothers, more recently his father, all the while working hard to make ends meet for himself and the family of a close friend who also passed away. CS has always been busy taking care of others. Until, this past May. He suffered a heart attack. He survived.

He is very thankful for it. But the day after his discharge from the hospital was his toughest. He came home to an empty house, and sat at the dining table wondering how does he go about “picking up the pieces” of his life now? It was time for reflection.

In Medicine there are many transitions – patients transition from their homes to the hospital (and back to home), medical students transition to being interns, interns transition into senior residents, and residents transition into attendings’ roles. Each road has many speed bumps along the way. Yet, the transition for patients from hospital to home is probably the single most unnerving experience because the patients are now “on their own.” Some patients receive variable degrees of family and social support, and others have no one to offer support.

Part of the ongoing discussions of Healthcare reform is the idea that patients discharged from the hospital should have close follow-up. As physicians, we focus on the clinical side of this transition – medication reconciliation, follow up of tests or radiology, consultant appointments, and avoidance of further visits. One aspect of transition that we may gloss over is the social support.

Let’s go back to our story with CS – he is grappling with adjusting to life outside of the hospital. When asked, his primary anxiety relates to surviving a life threatening event that can occur again. If I swap places with him, this is very daunting! Also, his limited outside social support is a reason for concern. Limited finances do not grant him financial security during his recovery time. He mentions medications that he needs and appointments he should follow-up, but he does not spend more than few minutes on those details. He is anxious about maintaining life after hospitalization.

In our current primary care set-up, we are not given the time to think about this adjustment, or help our patients find their way during this recovery period. The days when a patient could go home and be cared for by his/her family have significantly changed. Physician focus is narrowed due to time or work-flow constrictions. But the truth is, CS can call his PCP or Pharmacy to clarify medications, but he doesn’t know who will alleviate his anxieties. He doesn’t have a person standing by him through this transition. Primary care is holistic care. And, sometimes it requires us to step-out of the role of the doctor and into that of an advisor and counselor.


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New Books in the New Year

2015 is here!

The days of 2014 have disappeared with what feels like the blink of an eye. It truly an amazing year, as amazing and heart warming as they come. I have much to be grateful for this year and am humbled by those around me.

One of my goals going forward this year is to indulge in more books; you know, delve into reading outside of work. Looking through the NPR Books of the Year list, I was awestruck with the amount of writing that happened in 2014! Also, the list made me want to take many months off of work to just read every book I could get my hands onto – alas, that is wishful thinking. As ambitious as my heart desires to be, I have to remain realistic. So, I have decided that I will aim to finish 6 books this year (acutally, there are 7 because I love Atul Gawande so much!). And the winners are (drum roll..):

 

So, as I look forward to 2015 – with all the memories to be made and celebrations to be had – I also look forward to exploring new worlds unbeknownst to me.

(PS – stay tuned for some book reviews!)

 


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Happy Holidays

It is the week before Christmas and I can see the excitement in the faces of children. Each year, I help out with Operation Santa – it is a tradition. I like traditions because it brings a sense of stability in a world that rapidly spins around us. In our busy schedules, I find it difficult to give back to our communities in the ways that I was taught as a child – food lines at homeless shelters, tending to the sick, passing out gifts to those less fortunate, or making cards for the children in the hospital. To compensate, we have decided to join the Operation Santa brigade! It is organized by the Unites States Postal Service – celebrating the 102nd anniversary of the Letters to Santa program as it continues to fulfill the dreams of children nationwide. More than 100 years later, postal employees, volunteers and organizations remain committed to making children’s Christmas wishes come true.

In order to enjoy this tradition, (and others), V & I set aside a whole day of holiday fun! We decided to truly absorb the spirit of the holidays in NYC before Christmas. And, like other tourists we walked to St. Patrick’s Cathedral, gazed at the giant Rockefeller Center Tree, indulged our taste buds at the best Chinese restaurant in NYC – Wu Liang Ye, and then buzzed about at the Lego store & another toy store in Times Square. We were truly busy little bees! To be honest, Operation Santa is just a reason for V & I to go on a toy shopping spree!! And, being in a toy store is always fun. We look at all the new toys & the old ones. Of course, I glow at the sight of the dolls with all the beautiful dresses and long hair.

The best part of the holidays is being with those I love the most. Hearing their excitement and laughter is the best gift I can receive. The delicious food, the cozy warmth of a fireplace, and the sight of snow is an accessory to the beautiful image of sitting with family and friends.

From my family to yours, Happy Holidays! May you be surrounded by loved ones and laughter as we step into the New Year!

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