One Line a Day

One line a day. 

Today - exhausting. Went to an impromptu meeting with physicians in another department. Felt young, small, inexperienced and incapable. These things are not true. But the feeling cuts deep. I'm behind on work again. Makes me feel incapable, then helpless, then angry. 

How to be better? How to be better? Rings through my head, beats through me. And I try to steady myself - there's nothing wrong. Stay the course. Breathe deep and keep going. 

Today, the steady hand is wavering. I want to quit and give in to the everpresent doubts about the impossibility of my dreams. I do not want to try. I need to feel small and young and incapable. I'm embarrassed. 

But I know I can't....

That's all I have today. 

Goodnight. 

5 Years Later

5 years since my last post on here and almost 13 years since my first.

Reading those posts from 2007, I really do wonder at how false my memories are of myself at that time of life. A lot is omitted, a fair bit confabulated and the remaining blanks filled in with assumptions.

Since, 13 years ago (age 19) I have graduated medical school in India, completed a residency in Internal Medicine at a large public University Hospital in the US, learned to drive, learned to cook, fallen  in love with and married my husband - from the previously much maligned Chennai, worked 2 attending jobs and begun to enjoy one of them, moved 3 states in the US, passed my IM Boards, started the long, hard work of building a relationship with my new family, started the long hard work of healing from losing my grandfathers, learned to live apart from my mother, father, sister and other much loved family members, bought a house AND had a beautiful baby boy.

Holy Shit.

That's a lot. A lot of wonderful, stupendous, fortunate and glad things.

But here I am, back to blogging.

With a smile on my face, I can say...that the Tangent I've been on this time has been - just living life. It's been so painful, so raw, so difficult at times and to be honest - for a little while, I'd lost touch with the things and relationships that brought me joy. But writing here today, I feel like things are exactly where they should be. Even though my life has taken off in a direction I could have NEVER EVER predicted or chosen, I've been remarkably fortunate and enjoyed immense love.

How did I not see this all along?

Thank you. My gratitude is flooding me, this moment. From the place where it had gone to hide. Just, Thank You. 

:)

Fleeting moments of happiness/peace related to listening to music - the soundtrack of 'Once' and reading about Myelodysplastic syndrome from Harrison's.

I've been thinking about what I want from a career and what makes me happy. I don't dislike Medicine by any means - it really is fascinating. What I've found most stressful is probably the thing that most young, introverted professionals find daunting. Constantly interacting with people with different personalities and approaches to life. Like always, what's most important is to keep in mind what is important to me and keep doing thtat

I'm Back

Two years of residency, almost concluded.

Life has been turned on its head again. All this time, my two loves - writing and music have lain dormant under layers and layers of self-flagellation, doubt and pre-occupation with the millions of things that run through your mind when you forget what's important to you. 

Over the past two years I've felt intensely lonely while also falling in love with the man I will spend the rest of my life with. (I don't know if he knows this blog exists actually). Growth happens when you feel you're stagnant and not going anywhere - I've been told. Hopefully that's what has been happening during my two year hiatus. 

To tell you the truth - I cheated on this blog. I was seduced by the idea of a fresh start and of anonymity. I opened a Tumblr account - in which the entries seemed forced at best. I don't think I posted more than 3 times. 

A lot has happened - as is generally the case with the passage of time. Loss. Love. Learning. But I think the muses may be stirring again - rising out of a deep deep slumber. 

Let's see, where this journey takes us. The adventure continues. 

~~~~~~~~~~

Here are random musings: 

Cancer

From the point of view of the medical professional, cancer fits neatly into IV stages – each stage increasing the challenge of management and bringing your patient closer to facing death.

From the point of view of a human being – every case of cancer is a case of a life stolen by an aberration.  By something that cropped up surreptitiously, as if it knew that once its presence was known everyone around it would arm themselves against its very existence. Something that, despite the strict controls we place on every aspect of our lives, somehow slipped through and made it’s own plans.

The thing about cancer is, it slowly begins to take over. Any disease, really. At what point do you stop being a man and at what point are you defined by your disease? How divorced really, is the experience of sickness and the experience of identity? Can you separate the two and still have a firm basis in reality? Can you merge the two without losing yourself? What is the best way to treat a person with a disease – you don’t want to patronize, you don’t want to give undue hope.

Reminds me of Sheryl Sandberg’s recent post about her husband and people who tried to comfort her. 

~~~~~~~~~~~

More later. 

Romney Vs Obama ROUND 1

Tonight's much talked about presidential debate should prove to be at the very least, entertaining. I'm looking forward to hearing the candidates face off on the issues and to seeing whether the moderators of this debate can raise difficult questions and get the candidates to talk about the issues.

I need to figure out how to Live Blog!

New York City

I'm here. In New York. Finally.

Well, I've been here for some time.

I don't know if there is anywhere else where I feel so alive and free. It's really, technically, no different from any other large city. Overwhelming, enveloping, pulsating, alive - and entirely man made.
I think that's what is most magnificent - appealing to the gut egomaniac in me - that men and women - just like you and me - through the centuries (only 3 centuries) created this island city. It's a place that is so integrally human - where the human story seems to be the only story. What we can do with our minds, our hearts, our wills - the spectrum of what is possible, in one city. (I know this isn't true.  But somehow, this place evokes such grandiose thoughts). And somehow, though every tower of possibility, is guarded jealously by an innocuously well dressed receptionist - there is an illusion of dreams within reach.

I know this is all part of the hook, the thing that draws you in and leaves you, at some point - wondering what happened. How your pursuit of happiness got drowned in the humdrum and petty. And though that happens everywhere, in this city, that betrayal is magnified by the majesty of the towers that surround you - the suits - the constant motion. While your life, maybe, just stands still. People don't change because of a city - but here, everything feels sharper, leaner, meaner. Coming down to the bottom line - what is your value - what can you contribute, barter that will let you into the mad rush forward - or to a reservation at a more exclusive restaurant and an apartment with more breathing space. A man can easily live out the commands of his ego in this one city. From the street to the penthouse in a half a lifetime. That vertical climb. Seemingly up into the heavens - but really, part of the beautiful, man-made illusion that is New York City. After all, we're all trying to be E Pluribus Unum, no? Who says that magic isn't real? That men are not masters of mystery and illusion.

And yet, though there is obvious fallacy in this city - it is also so palpable and real. It breathes - all around you. And runs - in all it's beautiful ugliness. There's a subway system to transport those millions of dreamers from all over the world. A sewage system to carry their excrement to the sea - or wherever. Dark alleyways for bad things to happen. Rooftops for friendly gatherings. It's all laid out in front of you. And though, your experience at the end of the day, will be limited - just the fact that it's all there, in easy reach - but you can be as insulated as you want.....is enthralling. (And perhaps New Yorkers - with the taste of world's experience at their fingertips, are the most insulated of all humanity).

I know this is a rather ridiculous post - all larger than life, starry eyed and in love with something of dubious value and possibility. But it's a feeling of the moment. My current tangent :)

Which brings me to the picture at the top of the post.

I went to see Dark Knight with my sister today. And yes, we saw it in Queens - but seeing Manhattan getting blown to pieces like that, the bridges just falling away, the city being destroyed and then  with a theater full of New Yorkers holding their breaths - in absolute silence - then climbing up to the 18th floor just to see Manhattan rising majestically, reassuring in the sunset - what a moment.

Moreover, looking toward the setting sun and the horizon, looking over Queens towards the real life Gotham City - the greatest tower rising above the city - none other than the new WTC. Rebuilding from real life destruction and evil.

I don't know what it is about this place. Perhaps I'm under the combined spell of Christopher Nolan and New York, but I'm infatuated. Deeply.

Healthcare in America - Finally did my Homework

I am currently taking Dr. Ezekiel Emanuel of the University of Pennsylvania's course, Health Policy and the Affordable Care Act at coursera.org.

It's a pretty simple and well put together course (from Week 1, at least!) and most importantly - promotes independent learning through readings he provides with enough structure to spur critical thinking on these subjects. Once again, I wonder to myself, what I missed by not going to college in the United States. 

The following is my  response to his questions for the Week 1 homework assignment. I must say, what an excellent way to get you to think and use the data from this weeks readings. I never realized how much you can learn by just asking the right questions. Go Socratic Method!! 

I really want to write a post on the SCOTUS ruling and my analysis of it, as well as a post about a Bharka Dutt 'We the People' debate on the proposed Exit Bond for J1 Visa seekers to the US, but I'm too tired! And hungry. Blah Blah. 

In other news, I established today that I am an unabashed geek. I doubt that any of you had any doubt about that, but I fight it at times. Today, I embrace it. *Solemn look of resolve*

I love this class and my non-job profession even though it's causing me to age pre-maturely and be chronically single etc.

Here's the assignment. 

Describe the typical uninsured American in terms of age, employment status, socioeconomic status, race, health status, and duration of uninsurance. Public discourse often represents health care reform as being about giving access to the poor. Is this accurate? 

The typical uninsured American is a nonelderly adult. About 80% of the uninsured are adults, while only 19-20% are children. While the uninsured are distributed across all age groups, the largest group of uninsured Americans (32%) are young adults between the ages of 19-29. Many young adults are from families with at least one working person. However, because of low salaries, access to insurance is limited. Adults in the age group of 35-54 also make up an equally significant part of the uninsured (33% - Fig 4). Importantly, the typical uninsured American is of working age.

The typical uninsured American is part of a working family and has no education beyond high school. Specifically, although 77% of uninsured Americans belong to a working family (with 66% having a full time worker and 16%, a part time worker), 63 of 100 uninsured have no education beyond high school. This is significant because with rising costs of employee sponsored insurance ($13,770/year with workers now paying upto 30% of premiums), employers cover only 57% of their workers. Therefore, it is becoming essential that people are not only employed, but also competitive; with a higher degree of education.

The typical uninsured American is comes from a low to middle income family. This means that 9 out 10 uninsured persons have a family income of less than 400% of the federal poverty line. In fact, 40% of the uninsured are below poverty line and an additional 38% are between 100-250% of the poverty line. Further, 36% of those below FPL are uninsured, compared with 27% of 100-250% FPL, 13% of 250-399% FPL and 5% of those 400+ FPL. This is a clear indicator of the correlation between lower income and uninsurance levels.

The typical uninsured American is a minority race - meaning, a non-white American. Non-Hispanic White Americans, while the racial majority, have a 14% uninsured rate. Compare this to an uninsurance rate of 34% in Hispanics, 28% in American Indians, 23% in Black Americans and 18% in Asians. (Only 12% of multiracials are uninsured). This may be confounded by the fact that racial minorities have also have a lower income rate than white Americans.

The typical uninsured American has been without insurance for more than 1 year and is in worse health than the privately insured American. About half of the uninsured non-elderly have a chronic health problem and two times as many uninsured report being in poor-fair health as compared to the privately insured. Further, most uninsured persons (51%) have been without insurance for 3 years or more. The majority (72%) have had no insurance for over a year. Interestingly, in a 2009 study, 17% of the uninsured have had no insurance for less than 6 months.

Higher rates of uninsurance are related to lower income levels. Further, though 40% of the uninsured are below the poverty line, the remaining 60% of the uninsured remain above the poverty line and 77% of the uninsured belong to a working family.

 Health care reform is not solely about giving access to the poor, regardless of the tenor of public discourse. In fact, the higher rates of uninsurance amongst the poor are a symptom of larger problems in our health care industry and economy, namely, increasing costs, unfair insurance regulations and a weaker economy.