Feeling thankful

When you are surrounded by people who believe in you, who root for you, who care about you; you feel blessed. I visited my work family from uptown today and here's my message for you-I learned so much from you and you played such a big role in making me the Neurointensivist that I am today. Thank you for your generosity of spirit and mind. Thank you for taking every aspiring trainee under your wing and helping them learn how to fly. You will always hold a special place in my heart and I hope you will remember me fondly for many, many years to come.
Keep on doing the amazing things you do-providing the best possible care for every patient you encounter, inspire generations of physicians to come...I feel blessed and honored that I had a chance to work with you!

In the evening, I attended my first graduation ceremony as an attending. It felt good and nostalgic. I was a resident not too long ago. Graduation day-is a day that stands testimony to all the promises of a wonderful future, to all the hopes and dreams of being the best that you can be for all your team members. It is a day of reckoning, a day filled with gratitude and a day which will remain etched in your memory for years to come. I am learning so much from all the residents and fellows I have an opportunity to teach. I can't feel thankful enough for this opportunity.

I love this feeling of gratitude and hope that my heart only grows more grateful each day. I want to keep paying it forward, today and everyday!

Something positive everyday

It's easy to get caught up in the daily hustle and bustle of life. I was rummaging through some of my old posts and I realized that I hadn't written for a while. But it didn't seem like a while...It's like catching up with an old friend, you pick up effortlessly from where you last left. Can't be thankful enough for that.

How can we think about something positive everyday? If we were able to make one positive change for every patient in the unit, that would be a start. It would be a tough start though but if we don't think it how will it actually happen, right? It could be as simple as stopping unnecessary gi prophylaxis or starting appropriate feeds or providing some sunlight to as as nuanced as mobilization on a ventilator, or timely extubation or spot-on resuscitation or relief from suffering...but something positive for each patient everyday.

A big thank you to my extended family!

When I was graduating from medical school in India and moving for residency to the United States, one of the things that I thought I would really miss would be the amazing connections I was able to establish with the nurses and ancillary staff I worked with. They cared about whether I had eaten something on call or not; helped me find scarce supplies in overcrowded wards; gave me insightful lessons on patient management or procedures using their years of wisdom; let me know how proud they were of me and they blessed me to become an awesome physician.Throughout medical school; I had seen some wonderful residents have that relationship with the staff and I knew when I grew up I wanted that to be a part of each day at work for me.

During internship I was able to transition into a new healthcare system with a few minor hiccups. The staff I worked with, the nurses, social workers, unit secretaries, cleaning crew, physical therapists, occupational therapists, speech therapists, nursing assistants were all so welcoming and ready to help a young intern learn the ropes. They made me feel at home. As I moved to another city and a new hospital to start my residency I was once again happy to find an extended family. Every single day at work, these people made me feel special, made me believe more than ever that I could be the best physician that I wanted to be. They worked with me through easy and difficult situations. I can't imagine stabilizing patients without all the nurses chipping in whether it was their patient or not, averting rapid responses, creating beds in step-down units, running around to get labs and meds, lending a hand for transporting patients to urgent scans or being the first responders when patients or families were not happy and bridging communication gaps and alerting me when communication needed to be bolstered. I miss them all. The NSU nurses played a huge role in helping me find my calling. As my first rotation in Neurology, no other rotation could have made for a more formidable first rotation. They were patient with me, they helped me learn the system, they taught me stuff that no textbook or journal could have, their work ethic put any signs of fatigue in me to shame. I loved working with each and everyone of them. Even when I was not in the unit, I would go hang out in the unit just because I found it to be the most comforting place in the hospital. Of course, the fact that the little break room in the middle of the unit would always have giant cookies, cupcakes, chocolate, coffee and great conversations were just added bonuses.

When it was time to move again, I couldn't help but feel sad. I was not going to see these amazing people for a long time. These people who inspired by taking pride in their jobs and brought hope and smiles as they cared for patients each day. But all the kindness and caring they shared with me made the transition easy and I was able to find another extension of my family as I started fellowship. This year has taught me a lot about myself. The first year of this fellowship has been intense both academically and philosophically and I am feeling a little introspective now as I start my second year. The nurses, unit secretaries, nurse assistants, physician assistants, respiratory therapists, cleaning crew, radiology technicians, eeg technicians, transfer center operators I am working with are a joy to work with. Through resuscitating crashing patients, running around like their lives depended on it to gather medications or blood products, to saying joyful farewells to patients who are getting transferred to the floor or rehab; to participating in some of the most difficult family discussions I have had to date..it almost feels like we have stories of triumph and tribulations together. Their work ethic is inspiring and the way they have all handled daily encounters with life and death is humbling. Their smiles, hugs, tear-filled eyes, drive and hard-work makes it a blessed experience coming to work each day.

As I write this piece, many vivid memories come to my mind, my heart is filled with gratitude and I want to say thank you to each and everyone of them. Just like any family that stays together, we have our disagreements, we have our differences, sometimes we take each other for granted, sometimes we just piss each other off but just like any family that stays together, every single time when someone needs us we have rallied together and given it our all. I feel we don't appreciate members in our families enough and don't say thank you enough. So, this blog post is a little thank you note and a little reminder that you all mean a lot to me as my extended family at work and make work fun and inspiring no matter how challenging the situations we face might be. I feel very lucky and want to thank God for giving me the privilege to work with such amazing people who believe in me :) 

Be kind to yourself

As a physician it is extremely easy being hard on oneself. We are perhaps our biggest critics; always striving to do better, to improve and to be perfect. It is difficult to distinguish between what is feeding our egos and what is boosting our self-esteem. Another tricky thing is trying to differentiate between what hurts our self- esteem and what hurts our egos; either way we find enough to be dissatisfied about. When I was in medical school I thought that a certain amount of dissatisfaction was a necessity; to egg me on; to prevent me from slacking, to help me achieve the impossible. As I am growing up as a physician, I am beginning to question this dissatisfaction. I don't know if that is what keeps me going or the sheer love for what I do and want to do. Medicine and death both humble me so much each day that if I were to let my ego take the brunt, then I'd perish because egos are fragile. Self esteem doesn't come from knowing everything; it comes from knowing that you will always strive to do the right thing; that you are not afraid to say I don't know but will always strive to find the right answer. Of course, not knowing the answer is annoying and being reminded that you don't know hurts but that doesn't mean that you hold on to that reminder and be harsh towards yourself. Instead those reminders are meant to make us grow in humility. I am only beginning to learn that I need to be kind to myself first if I wish to be kind to others. I need to forgive myself first for making a mistake before I can forgive others. As much as it's important to seek out knowledge, it's important to be kind to yourself and to others who are trying to do the same as physicians. 

Rounding with tablets and smart-phones

How is having all this knowledge at my finger tips going to change patient management? The power of reading and dissecting concepts and using the right tools at the right time will not change. Perhaps, the speed and accuracy of recall will. Perhaps, it's only fitting to have tablets and smart-phones at our disposal while rounding because the sheer volume of new literature is mind blowing and being able to answer that one pertinent question in a matter of a few seconds can make a difference. I am happy to say that I am part of a very connected world acutely tuned in to all that is new and all that is tried and tested. I can' help but feel proud of my generation for empowering all those who seek knowledge and help them apply their knowledge in timely manner.

Pride and Knowledge

Knowledge sure is power. It can make or break lives merely depending upon how it is used. Sometimes; I struggle to prevent knowledge from seeding unnecessary pride in me. It is a tricky slope. The higher you go, the mightier you feel and you can easily lose sight of the true purpose of gaining knowledge. I find learning medicine a very humbling experience. The more I learn; the more I feel there is to learn and perhaps; that keeps my pride in check. True greatness comes from humility and true knowledge should make you more humble rather than make your head swim in ill-founded pride. In medicine; knowing one's limitations and stemming ignorance which arises from those limitations is a constant challenge as much as fortifying and re-fortifying your strengths; thus medicine manages to always keep you grounded.

I ask fervently for the strength to always seek out new knowledge so I can use the best of my knowledge and skills to do the best for my patients and to tirelessly grow in humility and someday hope to emulate the great mentors I have been blessed to work with thus far and in the future.

My life really sin't that hard

I find myself feeling awful about complaining about small stuff in life whenever I see my patients. They are obviously suffering from much bigger problems than I could ever imagine and so many of them have an amazing attitude devoid of self-pity and bitterness. Then I wonder; what makes me crib about "small stuff"; stuff which I am sure anybody would love to trade for the bigger problems in their life. My patients are dealing with things I take for granted; like enjoying a bite of my favorite dessert (which incidentally has been changing quite rapidly; it used to be tiramisu; now it's creme brulee but my sweet tooth is becoming a little more than just fond of strawberry shortcake) because they can't swallow and will choke on their own saliva; a good night's sleep because they are too anxious or depressed about all the uncertainties of their future; they have to worry about even being able to transfer from a bed to a chair; about being able to have a bowel movement without an accident; they as much as I worry about being able to dream and live their dreams. I truly want to ask forgiveness for ever complaining about my life and want to be thankful to the powers that be for all that I have and will be blessed with now and in the future. May I never take anything in my life for granted.