“Look at some place unusual”

On a flight across the Pacific to a new continent and disconnected from the world for 16+ hours, decided it is time that I write a blog post after six months.

I must say, Qantas has an impressive collection of movies and I was lucky to get three seats to myself, so it almost felt like I’m traveling on business class. With three pillows and blankets, I had a comfortable bed to sleep for 12/16 hours. It helps being only 3’7!” I definitely caught up on sleep after six weeks of inpatient service.

I am currently watching one of my favorite classic movies “The Sound of Music.” While watching the movie, I realized the last few months have definitely been quite an adventure.

As Maria sings, the words resonated with me: “What will these days be like, I wonder; what will my future be, I wonder?... It could be so exciting to be out in the world, to be free, my heart should be wildly rejoicing, oh what’s the matter with me. I have always longed for adventure, to do the things I’ve never dared, now here I am pacing adventure, then why am I so scared? … I am seeking the courage I lack. The courage to serve them with resilience, pace my mistakes without defiance, show them I’m worthy, and while I show them, I’ll show me. So let them bring on all their problems, I’ll do better than my best, I have confidence they will put me to the test…somehow I will impress them…I will be firm but kind… They will have to agree, I have confidence in me… I have confidence in sunshine, I have confidence in rain, I have confidence that spring will come again, besides what you see, I have confidence in me… I have confidence in confidence alone. Besides in what you see, I have confidence indeed.”

This year has been full of new challenges and adventures. Over the last six months, I have been training for my third half marathon in Houston summer heat with a goal running pace to transitioning from my first fellowship in genetics to pediatric endocrinology fellowship and traveling to new parts of the world.

Challenge. Courage. Confidence.

I have definitely seen lots of examples of this over the last three weeks on inpatient diabetes service as I admitted several new-onset type 1 diabetics, ranging from toddlers to teenagers. Overnight, parents and children need to understand diabetes and importance of treatment with insulin shots. They have to get the courage to check blood sugars several times a day and administer shots to their child or self. After about 48 to 72 hours, it is amazing to see how the parents/children develop the courage and confidence that they can care for diabetes and they are ready for challenges ahead.

It really makes you realize, we are all capable of doing great things even if faced with sudden or unanticipated challenges. We just need to develop the courage and confidence that we can maximize our potential even with challenges and adventures.

Since I am on my way to Australia to run the Sydney Running Festival with hopes that I can maintain a certain speed to avoid being disqualified, I’m going to end with the Australian phrase, “She’ll be apples!”

Navigating Through a System to Succeed On Your Journey

On the agenda for today’s meeting for the course “From Stress to Strength,” we discussed what would be the best way to provide parents with resources for their children with “disabilities.”

Have you ever wondered why some people succeed more on their journey? (Do not forget that you need to challenge yourself and work hard, otherwise you will not succeed.)

Multiple times, I have seen two children around the same age with the same genetic condition, but one child seems to be doing better, more independent and less developmentally delayed compared to the other child. As I take the history from one of the parents, I am amazed at how the parents are using more resources then I thought existed. The parents have the right attitude and they have maximized the healthcare system for themselves and support from the community and family for their needs. We do not need to use every resource, we need to use the best resources. How can we help every child succeed with or without “disability or challenges?” 

The medical field is structured on mentorship and collaboration to help our patients and advance medicine. None of us would be successful in the medical field without our mentors, coworkers, friends, and family. (You probably can’t successfully care for a patient, such as remove the appendix, unless someone taught you!) Your teachers/books play a crucial role in your success.

As I attended “Match Day” event this week at the medical school, it was refreshing to see everyone (medical students and their parents, residents, faculty, friends and family) excited about each medical students’ journey ahead. I could see and feel all the adrenaline in everyone.

I still vividly remember my match day from five years ago. As a medical student, I remember working hard and talking to lots of people for advice to match into pediatrics on Match Day: the day that medical students all over the country and around the world open their envelope that reveals where they will be training for the next few years. Initially, you feel like you are going to choose where to train: you decide on your favorite field of medicine, obtain letters of recommendation from your favorite mentors, fill out the application, interview around the country and then you rank the programs. After submitting your rank list, all you can hope for is that you match at the best program for you. It might not be your “favorite program” or “favorite city.” There is nothing you can really do to make sure you get your first choice. You really don’t have much of a choice but to make the most out of it and make sure you provide the best care possible to your patients.

Life is a journey, we make choices to succeed, but the end result is out of our control. Match Day is a great example of how we use lots of resources, mentorship, advice, and support to help embark on a new journey. It’s the same way we make choices in life: we consider options and make the decision we feel is best for us. How do we know if we made the right choice: college, marriage, career, job, friends, car, or house? The one thing we can do is use resources and guidance to make the best decision and maximize potential. Of course, we also need to find our inner drive and passion to help us continue working hard on our path. Once you embark on a journey, you need to work hard on the path that will hopefully lead you to more success! Don’t ever forget to be open to surprises and resources/guidance along the way.

As I care for patients, I hope to continue to provide the best care and guide patients and their parents with treatments, resources, etc. Over the years, I have learned that every child and parent needs to have care individualized to them. The same way, we all make different choices on our paths. Often, we realize that we are not using the right resources or maximizing on the right resource. It is hard to change habits, but it can often lead to great success and surprises.  

Remember: Be thankful, remember to thank those who helped you navigate through life to make you successful through your journey in life, whatever path you chose. Also, don’t forget, help others too. It can be as simple as a small compliment.

“Call me crazy, but I love to see people happy and succeeding. Life is a journey, not a competition.” ~ Unknown

Need a disguise on a 5 am run?!

Before leaving the house for a run at 5:00 am, I had a feeling someone would mistaken me for being a child. As I was waiting to cross the street, a car that was taking a left turn suddenly stopped, reversed, hit the brakes and the driver side window was slowly lowered. To her surprise, I was not a five year old running away. She apologized for frightening me and being anxious that I was a child. My response, smile and say "good morning!"

While attending a conference in Qatar this week, we discussed the importance of always being at your best behavior when interviewing to medical students. Not only during your formal interview but also in the hotel, airport, public transportation, etc. You do not know who you may be interacting with in the city and they may be able to play a role in you getting the job.  

I have lived in Doha for almost ten years of my life, hence I am not surprised that people remembered me. However, I had not been back for almost five years, hence I did not expect the waiter at Mandarin restaurant in Souq Waqif to ask if I had moved away or our dune bashing expedition land cruiser driver to ask me if I used to work at a particular place. 

I guess, I should always be at my best behavior, since I do not know who will remember me several years later. I'm probably a bit easier to remember compared to others. We should all try to "Be the same person privately, publicly and personally." As stated in Surah An-Nisa "They can hide (their deeds) from the people, but they cannot hide them from Allah, for He is with them even when they hold nightly counsels that are unpleasing to Allah. Allah encompasses all their doings." [4:108]

From Pessimism to Optimism

Over the last year, I have been fortunate to facilitate the course “From Stress to Strength.” This class is for caretakers of children with medical problems/disability/autism. It is based on the course initially taught at Vanderbilt called Positive Adult Stress Reduction.

“When the Caregivers Need Healing”
http://www.nytimes.com/2014/07/29/health/when-the-caregivers-need-healing.html?_r=0
http://www.ncbi.nlm.nih.gov/pubmed/?term=miodrag+autism

There are several sessions; I facilitate the last session called “From Pessimism to Optimism.”

Every time I prepare for this session, I find the audience very challenging, since I am empathetic for these parent. 

How can I facilitate a discussion on being optimistic, challenges in my life are nothing compared to these parents. I have always tried to be optimistic and look for solutions, but I cannot tell these parents that all your problems will be solved if you are optimistic. During previous sessions, I am listening to the struggles, caretakers complain about school not providing services, family and friends not being supportive including their spouses, financial struggles, feeling isolated from society since they cannot participate in events due to issues with their child, and unable to trust others to care for their child. THE STRUGGLE IS REAL!

Why should we try to be optimistic or even neutral compared to being pessimistic?
- Increases lifespan
- Lower rates of depression
- Lower levels of distress
- Greater resistance to the common cold
- Better psychological and physical well-being
- Reduced risk of death from cardiovascular disease
- Better coping skills during times of stress

Mayo Clinic: http://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/positive-thinking/art-20043950

As a physician, I was always taught to practice and preach evidence-based medicine. There is data showing that decreasing stress and being optimistic has health benefits while stress/pessimistic attitude has a negative effect on health. Most of us recall getting sick around finals (high stress)!

Before starting my session, I remind myself, everyone can try to be optimistic, no matter what the challenges are in life. In the end, we all want to be healthier, happier and try to live longer!

How do I train myself to be optimistic? I am going to share a few personal anecdotes.

1. Be thankful and forgive others
I was running my usual loop, suddenly I hear a siren, it is a police officer chasing after me since he thought I was a kid running away from home. I forgave him for chasing me while I was listening to Adele and running. I am thankful that our police officers care for the safety of our children, just in case if I really was a child running away from home!

2. What I can control and what I can let go of it.
I can control my reaction to comments and questions but I cannot stop people staring and reacting to me being different. If someone asks me my age, they are obviously curious if I am an adult, so I tell them my age and proceed checking out at the grocery store. The same way, if your child has a breakdown at a restaurant, you can ignore all the stares and focus on your child by trying to discipline or leave the restaurant. Do not worry about other people, they will forget in a few minutes.


3. I might be stuck in my grief, preventing me from finding solutions or challenging myself. Accept you have a problem and try to find a solution.
I cannot reach the hand sanitizer or patient’s bed to examine. I have got to accept that I am short and I will carry my stool with 50 other things in my hand. I don’t need to worry about my biceps at the gym (definitely my triceps since they arent being used); I use that muscle all day carrying a 7 lb stool.

4. Use my strengths in a new way to build my confidence.
Each of us has strengths. I know I am a friendly person, so I try to be personable and ignore the stares/obvious judgements and they quickly forget I look different.


5. Negative thought patterns to neutral or positive ones.
Change the words you use, instead of saying NEVER say POSSIBLY or DEFINITELY!

These are just a few things I can tell caregivers and everyone else to try. If you are positive, people will enjoy the energy around you. Your relationship with family and friends will improve. You will notice your children will be happier and surprise you on how much they can achieve.


I do not feel I am the perfect person to facilitate “From Pessimism to Optimism” since I am not dealing with their problems in their shoes. I just hope we can all try to be more optimistic, it will improve everyone’s health and maximize potential.

How do we decrease discrimination? “Public Minimum” vs “Private Maximum”

Last week I attended a study group at the Ibrahim Islamic Center in Houston and we discussed “private maximum” and “public minimum,” a concept introduced by Dr. Sherman Jackson for religious community.

The “Public Minimum” is the minimum it takes for someone to feel they are part of the community and “Private Maximum” is our own practice and principles.

The goal should be to have very few requirements to be part of a community and we should strive to be flexible/accommodating. People get excluded or feel isolated if we start implementing our own practice/standards, “private maximum,” on others. For example, if you show up to the mosque, church, temple or synagogue, then you should feel that you are part of the faith community no matter how “practicing” you are of the faith. Often, we put too many standards on others that we eventually isolate individuals.

On the surface this can be applied to everything in life. If we try to apply this in our daily lives, there would be less hatred and exclusion in society (disability, gender, race/color, religion).

The American Disability Act signed in1992 by President George H. W. Bush required wheelchair access to all public buildings, including restaurants, retail stores, hotels, and banks. It had a larger impact then most of us realize on increasing  “public minimum.” I have traveled around the world and specifically remember challenges we had trying to take my grandmother to a hotel or restaurant in Saudi or India. While living in Qatar, I had the opportunity to meet Ghanim and his mother. Ghanim’s mother realized the lack of wheelchair access in schools, malls and restaurants; hence she put lots of effort to increase access around the country. I definitely noticed the difference while living in Qatar!

Photo: Rick Guidotti, Positive Exposure

Our goal should be to make accommodations for those with “disabilities” and we should go beyond, make them feel accepted and part of community. I have been blessed with an amazing group of family and friends that always made me feel that I was part of the group. It has really impacted the way I approach things in life, optimistic and adaptable. There are lots of incidents that I could have easily been excluded, but I was not. I drove my own car in Saudi Arabia before most of my friends were driving and played sports, including my residency softball team with everyone double my height.

I have observed that parents with children who have challenges or individuals who are "different" often feel isolated or excluded from the community. The entire community/family/support system plays a role in embracing the family and child. This definitely plays a crucial role in maximizing potential for everyone. It also makes it easier for people to speak out about their challenges and obstacles. It will only lead to more acceptance and inclusion. Hopefully, less discrimination in all realms of life!

Welcome to Holland; Genetics Appointment?!

I am about to leave for my genetics clinic this morning. Patients are referred to us for lots of reasons: developmental delay, autism, dysmorphic features, family history of genetic conditions or cancer, hearing loss, extremely short or tall, intellectual disability, etc.

I always remind myself before seeing a new patient in genetics clinic that at least one of the parents have gone through lots of steps to finally make it to the genetics appointment to see us. The parent has already been through the five steps of grief: denial, anger, bargaining, depression and acceptance. If they have not accepted that the child has a problem, they would not have made it to their appointment.

Everyone is excited and proud of his or her newborn. They have big dreams – walking, talking, going to KG, graduating from high school, college, first job, getting married and having grandchildren. When the parent is first told that their child might have a genetic condition or simply developmental delay, parents naturally will want to deny it since all their dreams are suddenly shattered. Hence, parents might never make it to genetics or they will refuse testing to find a diagnosis.

How can I blame them for missing their appointment several years ago or not seeking help sooner? 

- As I hear the child's story from the parent, I often want to hug and comfort them and say you are doing a great job. We just need to work together to make sure the child grows up to reach his or her maximum God given potential. For now, I am going to leave you with one of my favorite poems by a parent that beautifully shares her journey.

WELCOME TO HOLLAND 

c1987 by Emily Perl Kingsley 

I am often asked to describe the experience of raising a child with a disability - to try to help people who have not shared that unique experience to understand it, to imagine how it would feel. It's like this...... 

When you're going to have a baby, it's like planning a fabulous vacation trip - to Italy. You buy a bunch of guide books and make your wonderful plans. The Coliseum. The Michelangelo David. The gondolas in Venice. You may learn some handy phrases in Italian. It's all very exciting.  

After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later, the plane lands. The stewardess comes in and says, "Welcome to Holland."

"Holland?!?" you say. "What do you mean Holland?? I signed up for Italy! I'm supposed to be in Italy. All my life I've dreamed of going to Italy."  

But there's been a change in the flight plan. They've landed in Holland and there you must stay. 

The important thing is that they haven't taken you to a horrible, disgusting, filthy place, full of pestilence, famine and disease. It's just a different place.So you must go out and buy new guide books. And you must learn a whole new language. And you will meet a whole new group of people you would never have met.It's just a different place. 

It's slower-paced than Italy, less flashy than Italy. But after you've been there for a while and you catch your breath, you look around.... and you begin to notice that Holland has windmills....and Holland has tulips. Holland even has Rembrandts. 

But everyone you know is busy coming and going from Italy... and they're all bragging about what a wonderful time they had there. And for the rest of your life, you will say "Yes, that's where I was supposed to go. That's what I had planned." 

And the pain of that will never, ever, ever, ever go away... because the loss of that dream is a very very significant loss. 

But... if you spend your life mourning the fact that you didn't get to Italy, you may never be free to enjoy the very special, the very lovely things ... about Holland.