Home is where you make it

Hi everyone. I am back to this blog after nearly two years. In that time, I landed a terrific job, moved continents, got married and became an aunt. So lots of things, as you can imagine have changed.

I recently visited India. If you're a Bangalorean, it is very difficult to like any other city in the world. Despite the crazy traffic, the lack of trees these days and the deteriorating weather; you can't help but continue loving Bangalore as we know it. My two weeks in Bangalore had me semi convinced that it was a dumb idea to move away from Bangalore. I absolutely loved the familiarity I was surrounded by, an innate sense of belonging in my motherland and simply the thrill of bumping into someone I knew at a nearby mall on any given day and hour. As an added bonus, I got to meet my 19 month old niece after over a year and spend most of my time in India playing with her and entertaining her. I got to satiate a lot of my suppressed food cravings from the past year (born appetite huh? wink wink)
So it's probably not surprising that I left Bangalore, my family and friends behind with a very heavy heart thinking home is where my heart will always be.

However, for the very first time yesterday after I landed in Uncle Sam's land, I felt a great sense peace and joy in returning. All the barren trees I left behind two weeks ago had grown young green leaves. I could not help but marvel at how fresh the air felt, how exciting the brush of the cold wind against my face was and generally how picturesque every scene during my drive back home from the airport was. I was met with friendly smiles and hellos by strangers helping me realize that I had returned to what was once a foreign land that had wholeheartedly welcomed and embraced me. Walking into my house, I felt a strange tranquility fill up my heart knowing that I had returned to something completely mine. In that moment, I realized 'home is where you make it'.

A beautiful view from my dining room

IF WORDS WERE ENOUGH

I don’t know where to start. Most of the times, I don’t find words to express the anguish and the irrevocable sense of loss I feel. Definitely not a void but still feels like a tiny part of the puzzle is missing. You were only a stranger. Our paths were not destined to cross. How they did, I look back at and there is a strange sense of unexplained happiness to that part of my life. It’s not love. It’s not respect. Nope, not even adulation. It’s a feeling that needs no meaning, a feeling forever frozen in the timeless layer of thoughts! Over the years, I’ve let myself be attached to a lot of things and people. You, my dear have been a notch above attachment. See, how I am at a loss of words and saying the same thing again and again? I know you’re not going to read this or perhaps ever understand how I feel. You probably don’t know how to reciprocate it either. You touched many lives the same way no doubt. However, I promise you that no one will ever appreciate your presence as much as I do (not only in my moment of loss and grief)

Wherever you are, know that I miss you so much that I cry sometimes and know that tears are not quite enough to bring you back. You are the bumble to this bee. But, do you remember me?

Harley? <3

USMLE - An IMG perspective

Stories are meant to be heard. So here’s mine:

Nothing spectacular but nothing ordinary either. After graduating near the top of my class from a medical school in South India, I decided to go the MLE way. This was a conscious decision made when I was as little as 14, when I was conversing with my best friend’s dad. An MD PhD, he completed his neurology residency training at Washington University in St Louis back in the 90s and headed back home to support his ageing parents. Forever an inspiration, this impeccable man provided me with the first glimpse of residency training in the United States through these second hand stories. In my third year of medical school, I got in touch with a senior who matched that year. She graduated from my college just a little before I joined. Her story was so inspiring that it pushed me to take USMLE a little more seriously. In that pursuit, I applied for an exchange program in my medical college. They sent a group of four every year for a 4-6week clerkship. My first tryst with medicine in the US came at the end of my final year when I was selected to attend this clerkship. It was an amazing experience for me and my attending very sweetly wrote me a WAIVED LOR two and a half years later for my residency application.

I took my step 1 in August four months after I got my degree certificate and I blew it! While my personal life was at crossroads and I can barely sit still for two hours leave alone 8 hours for an exam, I shall not find excuses for my poor score. I ended up with <220! I was so ashamed to share my score with other people simply because I was supposed to get a better score. (I apparently graduated near the top of my class) For about a week, I went into a shell and barely spoke to anyone. I doubted myself and felt so betrayed by my own self. The same senior who I spoke to long long ago in third year came to my rescue once again. I reached out to her and she repeated her story to me to reiterate how important it is to remember that scores aren’t everything. Hearing it from someone who had been through it motivated me to gather myself and move on. All this happened while I was emailing several programs for an observership. The hunt became more vigorous after I got my scores.  

Meanwhile, I joined work in September in a corporate hospital in my city which kind of simulates the American hospital system. I familiarized myself with electronic medical records and learnt the art of counselling and dealing with patients who asked more questions than their rural counterparts. Getting a humble salary was an added bonus because being 24 and bankrupt sucked! I continued to work rigorous 8-10 hour shifts everyday (7 days a week! I am not kidding) for the next four months while managing to prepare for Step 2 CK a little by little. By then I had heard back from one of the places for an observership which was available only in February and March. I immediately quit my job in December and focused on preparing for Step 2 CK for the next 2 months. My NBME scores were dwindling with each exam and I started panicking. However, I took my exam in the end of February for I had no choice (my tickets to the US were booked) and two days later, I was flying to the United States for the second time for my observership. I ended up with a score of >230. Honestly, my first thought when I saw my score was relief that I crossed 230 and then it was plain sadness that I couldn’t manage a stellar score. 

Since I had already done an elective, my observership went well. I knew what being proactive meant. I went early every day and stayed back to help the residents with new admissions. I updated their list every day, called labs for results and a couple of times offered to write notes for them if they didn’t mind. I wrote up a case report while I was there and my attending so kindly wrote me a waived LOR which a couple of interviewers later told me were very good for an observership. I made some great friends and enjoyed the entire experience minus a few glitches here and there.

While I was completing this rotation in March, I was also preparing for Step 2 CS which was due in mid-April for me. I found a few Skype partners and of course my roomie who was also observing in the same hospital (we went on to be great friends) to practice cases with. My fiancé (who is an IM resident) helped with a couple of cases and critically judged my performance which really helped.

As April approached, I was frantically trying to find another observership or a research position in vain. A friend of a friend recommended me to an attending she had worked with in her basic science lab, who was kind enough to interview me for a spot. Without a time and place, I showed up at the University one day to meet her (The attending was very busy and wasn’t responding to my emails). She spoke to me and was happy to have me over. Slowly I started building a clinical database based on her liver cancer practice. Within a week’s time, I was observing her in her clinic as well. Not long after, I requested very politely if I could have more participation in the clinic and she obliged graciously. Starting May, I was seeing her patients with her, examining them and writing notes under her supervision. While it is super hard to find such an opportunity, I believe I simply was there at the right place and the right time and was hugely lucky.

Diverging a little, I flew to Atlanta in the middle of April to take my exam. Contrary to popular belief, I didn’t think it was a disadvantage to take my exam in a place other than Houston! I felt comfortable with most of my SPs and cases. I received my result in mid-June and passed the exam with excellent performance in all three components with ICE being the highest (was a little surprising because I believe my communication is a little better than my medicine)

For the next few months I worked in the clinic and also did my clinical research side by side. I got a really good letter of recommendation from my attending. I worked till August (my visa ended) and came back to my home country.  Unfortunately, I was not yet ECFMG certified during application time because my college completely messed up the process despite starting it early in last December. (I don’t wish to elaborate on it). I applied on September 15^th without an ECFMG certificate but all my Step results, 3 waived US LORs, 2 Indian LORs, 1 oral presentation, 1 abstract accepted at 2 international conferences for oral presentation, 2 published articles (one case report and one original article), 2 to be published articles (one case report and a case series) and lots of hopes and prayers.

I received my first interview on September 17^th! I couldn’t believe my luck. It however slowed down terribly after that. Finally managed to land 7 interviews. I did reach out to a lot of friends and seniors who I hadn’t ever talked to. It was very heartening to hear back from ALL of them! A few were able to help. I also was officially ECFMG certified on October 9^th!

In the middle of all this drama, I got engaged officially in November in India. This meant there were a lot of internal personal conflicts (any Indian who is married can vouch for this – the tensions run super high during this time) and conflicts between personal and professional life. I had to send out a lot of emails to schedule all my interviews after November.

My first interview was scheduled for December 4^th! I was so nervous that I could barely eat anything that morning. However, the interview season breezed by with each subsequent interview being better than the previous one. Two of my abstracts subsequently got accepted for a poster presentation at the annual GI ASCO meeting which I was unable to attend because of Jonas (the storm which hit the east coast!!)

Starting February, I did nothing but think about my rank order list and study for Step 3! I took my Step 3 on 3^rd and 7^th of March and flew back home on March 10^th! Landed in India on March 12^th and two days later, I was opening my “Did I match” email from NRMP with bated breath sitting on the steps outside my house all by myself.  My entire life in the last 2 years flashed by in a minute. “Congratulations, you’ve matched!” The moment is bigger than you can ever imagine. My head was a cocktail of emotions. Emotions that I hadn’t let myself feel in a long while (lest I jinx it). You need to live it to believe it. Tight hugs and a couple of tears later, here I am sitting and recollecting my match timeline briefly with all of you.

My story may not be overly inspiring. However, people who matched with me will surely be able to relate to it all – the difficulties with finding observerships and research spots (I sent out about 600 emails and barely got any positive replies); simply getting a visa to go to the United States (I have needed 3 visitor visas so far for my 3 visits. I ended up with 6 months, 4 months and a 10 year multiple entry visa during my three attempts. It meant going to another city for the visa twice!); the delayed flights/crazy greyhound bus experiences; trying to justify to random strangers why you’re going to another country to learn advanced medicine when your own country has a shortage of doctors; being so broke that you would do anything to save a few dollars; refreshing even your spam folder every 5 mins during interview season; all the posts on forums asking for accommodation for their observerships when you had none and were freaking out about it; being picked up at airports by friends you’ve never met; simply trying to figure out how to reach your interviewing hospital which was in the middle of nowhere;  and most importantly, the only journey in which you’ll get help from your own competitors (there is good out there in the world, after all)!!

 

THINGS I LEARNT FROM THE MATCH:

• -      Don’t pay too much heed to what is written in the forums. More often than not, they may end up intimidating you and making you feel worthless. Realize that and absorb only the positive things you find (you get a LOT of useful info too and I am grateful for it, but don't make it your life) While people have shared their experiences, I feel they are uni dimensional. (Well, so is my opinion now). What works for one, may not work for another. Discover your own strengths and create your own story! 
• -      I wanted to be self-made and make it big all by myself. While it’s a noble idea, it can be a little retarded. When you need help, seek help. You’ll be amazed at how gracious and willing people are with help. Don’t think of it as a sign of weakness. It’s a strength to be able to ask for help at the right time (when the going gets tough). I am so very thankful for all the contacts, the help, advice and the encouragement I’ve received along the way from seniors and friends! Moving forward, I am going to help my juniors and friends and one day you will do the same. (It’s a chain reaction of sorts) 
• -      I made lots and lots of new friends from all over the world. It means lots of new perspective and ideas and understanding the old ones better. It helps you grow as a person. Keep them all very close to you for they become your support system for the next couple of months. Watch out for people who are pretending to help you while trying to intimidate you. You’ll find one or two of those as well. Learn to recognize them and maintain your distance from them.
• -     One of my biggest take away from this experience is that scores are NOT everything! Having said that, DON'T IGNORE YOUR EXAMS OR INVALIDATE A POOR SCORE. Even one stellar score can stand out in your application. Although I am no pro at this, I think programs can see right through fakeness. They’ve been hiring people for years now. Be true to yourself and importantly, just be yourself! If they don’t like the genuine you, it’s likely you wouldn’t enjoy working there. I cannot really comment on other aspects like year of graduation because I graduated in 2014. I can’t say much about how important research is either but it definitely gives you something to talk about at your interviews. Most of my interviewers wanted to know about my database and what kind of data we had uncovered. Nobody asked me about my observership.
• -     Communicating well is an art and most of us lack tact in the way we approach people. I see a lot of people on forums very crudely asking people for their credentials or expecting to get help instantly with observerships, research, IMG friendly program lists etc. NOBODY, I repeat NOBODY is going to spoon feed you with all the information, unless they’re close friends. Do your homework before you ask for help. Would you ever buy a gadget without doing a mini research on its features? Similarly, gather information on basic things like what the USMLE is all about, how many exams are there, how to take the exams, the requirements for foreign medical graduates, what observerships mean and how you can find them! EVERYTHING IS ON GOOGLE! (Heck, Google even has “how to make your girlfriend or boyfriend jealous!!) I haven’t mastered the art of approaching people yet. However, I’ve definitely gotten better with time.
• -      If, at the end of the day, you don’t match despite having a well-rounded application, don’t blame yourself. Luck has such a huge role to play in this. One of my friends who is very smart, funny, intelligent and kind with 240+ scores on both steps, published papers, adequate USCE and >7 interviews did not match. Sometimes, I wonder what I did to deserve this privilege of matching on my first attempt despite my below average scores. As they say, it’s not how hard you fall that matters but how hard you can bounce back from your fall that does. So, never give up if things don’t go your way – be it exams, observerships or the match itself. (You know who you are and I hope you're reading this! I truly hope the best for you for SOAP or the next season)
• -      Most of us leave behind our families and friends, come to the US with a heart full of dreams and aspirations. The struggle is very real!! However, believe in your dreams and most importantly, in yourself! If you don’t, how will someone hiring you believe in you?  I faced plenty of hurdles at each and every step of this journey! Very likely you will too. Some struggles smaller than the others. However, I learnt 'No pain, no gain' and the faster you learn to gather yourself and adapt, the better you are in this race. I’ve learnt to be very optimistic in this journey and it has really helped me overcome some difficult times in my life. As they say, tough times hardly last, but tough people for sure do! Find something to hold on to – it could be divine faith, love and courage from your loved ones or simply an unwavering belief in yourself and a good kind of destiny! 

PS:

1.      .  Thanks to Appa, Amma, my big sister and my BIL, my amazing fiance that I have recently fallen in love with (despite a whirlwind courtship for a few years), my parent in-laws, other family members, seniors and my best friends who have nothing but encouraged me for the last 2 years, put up with my tantrums and non availability always and believed in me when I lost hope and felt defeated.
2.         I don’t know where I have matched. I hope it is at my top choice. Irrespective of where I match, I believe it’s all about making the most of the opportunities that come knocking at your doorstep!
3.         I applied a little broadly (~150 programs) because I was sceptical of my scores. So not sure if its internal medicine or pediatrics for me (also, because it didn’t matter to me which age group I will be treating, as long as I can keep doing what I love – practicing good medicine; and being fascinated and challenged every single day of my life!) I had USCE in both (in University programs) and I interviewed for both (mostly community hospitals with good university affiliations!)
4.         I require a VISA!

   

Role model - aye or nay?

Recently at an interview, I was asked who my role model was. I didn't even have to think for two seconds to answer that question. Pat came my reply, so spontaneously that spontaneity may be put to shame. "When I was younger, I always looked up to my sister. So much of what she did, I tried to emulate in my own life." I distinctly remember being called her 'baala' (tail in Kannada) by all our common road friends because I would do everything she did and tag along everywhere like a little poodle.

While every bit of it is true, I am not sure if I really have a role model in my life at this point of time. Sure, I have dreams and I am working hard to inch closer but I think I mostly have my own idea of how to get there. Although I've heard and read a lot of inspiring stories, there is no one person I want to emulate at this point of time. I want to mostly focus on carving my own niche with all the good traits I've imbibed from various people and hopefully be a role model to someone who is in need of one.

As for my sister, growing up made me realize that we are poles apart in terms of personality. She likes cleaning (I hate it). I like cooking although my skills are questionable! (She isn't as fond of it)
She likes lazing around and I like my life outdoors. I still do look up to her for all the amazing and hard decisions she has been making in life. However, I believe I myself have grown immensely with all the experiences I've had and created an identity of my own. So much so that I am her venting machine. (Clearly my sense of humor hasn't grown yet) Call me her spine now, thank you ;) or maybe wings? 

Antibiotic Resistance - The New Age Pandemic

Can you imagine every person with a pink eye dying? Sounds ridiculously extreme, doesn't it? This is something our prospective children are staring at if the current trends progress. Antibiotic resistance is the new age pandemic and it is very real! Antibiotic resistance is spreading like wildfire, faster than an average man can comprehend. We've been reading innumerable articles on antibiotic resistance and how the future is bleak especially because organisms are mutating at a rate faster than the discovery of new antibiotics. The question however is, what are we doing about it?

A day ago, I decided to buy some antibiotics and tretinoin for my pustular acne that seems to have a mind of its own for the last month. (call it stress!) I was really appalled at how easily drugs are dispensed at pharmacies without a prescription. Of course, he had no idea that I was a doctor but gave me the tablets, nonetheless. The medications I bought need to be used extremely cautiously in a woman of child bearing age. Western countries do not dispense these medications without contraceptives because of the high teratogenic potential associated with them. Two decades ago, I wouldn't think its a big deal in our country. With the number of sexually active adolescents and young adults trending upwards, this awareness is paramount. Naturally, no instructions were given by the pharmacist. The only thing that was given was the tablet strips in the numbers that I asked them for. 

Our mindsets are such that we stop using antibiotics that are prescribed to us the minute we start feeling better. As doctors prescribing antibiotics, it is our most important responsibility to stress on the need to complete a course of antibiotics given because failing to do so, is leading to rampant resistance. 

We are facing situations where we have nothing to offer patients, not because they are suffering from terminal illnesses, such as a form of cancer, but even when they present with what should be curable infections due to pan resistanct strains of microorganisms that have forayed into Darwin's world. When asked, a forty five year old lady in the neighborhood admitted that she popped amoxicillin when she had a sore throat. Amoxicillin today is a household name in India. A little knowledge, however, is dangerous. Popping antibiotics for viral illnesses - against which these drugs are ineffective, has become an emerging trend. Self medicating is apparently the way these days due to sky rocketing health care visits. From medical students to health care personnel other than doctors, (nurses, pharmacists, physiotherapists etc) to the common man, everyone think they've read and learnt enough to treat themselves, unfortunately.

Patients prefer doctors who can provide instant cure. Doctor shopping is therefore a common entity these days. Practice pressures lead even doctors to prescribe unwanted antibiotics more often than not without procuring a culture sensitivity test. 

For a country that wants to climb the ladders of global ranking, we should have more stringent and uniform rules in place when it comes to dispensing medications. Banning over the counter antibiotics has checked spreading resistance in the west. For starters, our health ministry should try and implement it. For a country that is not doing any cutting edge biotechnological research, it's our duty as citizens to atleast preserve what we have if we can't create something new. 

The best solution however is prevention (which is better than cure!). Build your immunity and ward off infections by adopting healthy lifestyles. Preachy, no doubt but practical.

Mysterious marvel in Malleshwaram

I've never been one to write about temples or the likes. This one particular temple has absolutely entrapped my rapt attention. I happened to visit a temple in Malleshwaram last evening - Dakshina Mukha Nandeeshwara temple - a temple that was discovered at the end of the last century. Yes, you read right. Sources say that this marvel was discovered in the late 90s.

According to residents living nearby, the temple was completely buried and the land above it was a flat stretch. "Three years ago, a politician tried to sell this plot. But people objected on the grounds that the land should first be dug through to see if they could find something," says the priest, Ravi Shankar Bhatt. Due to mounting pressure from the locals, they got the land excavated. True to their intuitions, an entire temple was found beneath this land. It was in perfect condition, preserved by the thick layers of sand. The preserved structures included the deity, stone steps, pillars and kalyani (pond) when found. A few leaks they've had to repair. Carbon dating estimates the temple to be 7000 years old. This could possibly make it the oldest temple around. It could also mean history requiring reevaluation. Of course, nobody has yet confirmed these hypotheses.

This temple is built in two levels of sorts. While one level has the bull or Nandi (shiva's vehicle), the bottom level has a linga right underneath. Another staggering aspect is that when they discovered this temple, they found water flowing out from the mouth of the bull onto the deity. The source of this water is still a mystery. A kalyani right in front of the main shrine serves as a beautiful reminder of the architectural ingenuity of our forefathers. It is now home to over two dozen turtles and different kinds of fishes.

While I am not sure if I believe in the existence of God, I surely believe that temples are an unparalleled source of positive energy. You rarely come out of a temple feeling agitated. The temple folks haven't prohibited photography probably to promote the existence of this temple that people know so little about. Shrouded in mystery, this temple attracts a sizable population of devotees from near and far.

I recommend everyone around to go visit this place once, for in our own backyard lies a historical treasure which was once buried in the sands of time. 

Mein aur meri happy wala Maggie *

I spend a lot of time on the go these days. Yet it never occurred to me to pen down my myriad thoughts during these hours. But today, for a reason I cannot confess publicly, I decided to share my experience with Maggie noodles 

For many of us Maggie simply means childhood. The innumerable Saturday mornings spent in slurping strings of noodles, one longer than the other is a vivid memory. I can confidently say that for the kids born in the 80s and 90s, Maggie noodles extended into their adulthood. 

Davangere, a small college town has a number of these tiny noodle outlets attracting all kind of people. The most surprising one so far has been the 60yr old man who was enjoying his plate of fried Maggie, a delectable alternative to the usual one. It's not surprising that people haven't received the ban too well. I believe more than Maggie itself, it's the million memories and the nostalgia associated with it that would make it so hard for people like me to give up on it. 

Maggie is particularly special for me because friendships were formed over them. One of the most important person in my college years became friends with me at a Maggie joint. That memory would go down as my "before sunrise" moment - one of the most spontaneous ones in my life. Classes were bunked just to squeeze in a bowl of piping hot Maggie noodles. 

The ban on Maggie, albeit temporary, is so symbolic for me. The timing couldn't have been more right. It's almost like the end of an Era. It's time to let go of something that was meant to only get me through college.

* I hadn't paid attention to the spelling of Maggi ever until a friend most kindly pointed it out recently.