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.

It ain’t easy to be a female physician, the struggle is real!

National Women Physician Day

February 3 has been declared as National Women Physicians Day in honor of Elizabeth Blackwell, the first woman to receive an M.D. from an American medical school in 1849.

I am thankful for all the amazing female physicians that have been my biggest supporters and mentors over the years. I would like to specifically thank my medical school classmates, co-residents, preceptors, and other female physicians that I have crossed paths with over the years. It ain’t easy to be a female physician, the struggle is real.

- Having a son sick at home while on call in the ICU

- 36 weeks pregnant and on call for 28 hours with three kids at home.
- Coming back to work as a resident with a 6 week old baby at home
- Pumping in the call room or clinic so you can make sure your son or daughter receives only breast milk.
- Repeatedly being asked your role by the same family and insisting to call you nurse, since they do not want to recognize that you are the doctor in charge since you are a female.
- Caring for your patient in clinic that needs to be admitted due to a severe asthma exacerbation and then realizing your daughter’s day care closes in ten minutes.
- Struggling to find coverage so you do not miss your daughter’s performance at school.
- Unable to find a guy who will accept and appreciate you, since guys are intimidated by girls who are physicians – how could they balance being a wife and mother along with a demanding career as a physician. (Giving up on getting married)

- Finally meeting the guy of your dreams and getting married but then you have to travel every month till you graduate from residency, long distance relationship while working 80 hours a week.
- Knowing that even with all the hard work you will put in to succeed, JAMA concludes "sex differences in academic faculty rank, with women substantially less likely than men to be full professors, after accounting for age, experience, specialty, and measures of research productivity."

These are only a few encounters that I have witnessed. I admire all these individuals for their sacrifices and dedication to their patients and families. You all remind me every day why I chose to become a physician.

Thank you!

#iamblackwell #nwpd

Everyone has an Incredible Story, It is About Overcoming Challenges

We are all faced with challenges in life; some are more obvious and others are easier to overcome. A flat tire on the way to work can be a challenge, since you are going to be late for an important meeting or 8 am clinic. ~ Do you call a friend for help, leave the car and Uber to work, or change the tire since you have a spare in the back. These are simpler obstacles that we face on a daily basis and sometimes we can easily fix it.

I work with patients and families with challenges that may not be as easy to overcome. With time, everyone figures out a way to navigate through life.  However, it is not always the most optimal way. This may be due to limited economic resources, lack of family support, undiagnosed medical problem, or cultural and societal biases.  

I am a vertically challenged (3’7”) South Asian American third culture Hijabi Muslim female. I have been dealing with challenges every day since I was a toddler. This has helped me gain some insight on dealing with challenges. I have also had the opportunity to learn from others. Everyone has an incredible story and it always includes people that have impacted/supported him or her in life.

Over the next few months, I am going to start blogging again and address a few of the issues that I believe impact overcoming challenges and specifically your child’s potential. My angle is going to be from my personal experience as a South Asian American but I believe it is also true for others.   

I would like to end with one of my favorite verses/stories from the Quran that always gives me strength to overcome my challenge.

[Musa (Moses)] said: "O my Lord! Open for me my chest (grant me self-confidence, contentment, and boldness). And ease my task for me; And remove the impediment from my speech, so they may understand what I say.” [Surah Ta-Ha; 20:25-28]