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] 

"Itsy Bitsy Doctor"

"Good Morning, I am Dr. Merchant, one of the doctors who will be taking care of you today. How is your son doing?...I'll be back with the team for rounds."

As I am walking out of the room, I overhear a conversation... "she is a short... dwarf... midget... small... grown-up... doctor!" 

At the beginning of my intern year,  it took me a while to get used to hearing that on a daily basis. I have grown up hearing that I am "short," but never reminded on a daily basis. Surprisingly, even in medical school, I did not hear it that often. This is probably due to most of my rotations being with adults. Also, I wasn't a main caretaker. 

Some of you must be thinking, how can she easily forget and move on with her day if she is repeatedly reminded of her challenge. Well, I have been hearing people talk about my stature for 20+ years. So hearing a comment does not surprise me. I enjoy hearing the different comments made by children, its a reminder of their innocence and curiosity of the world. Thats the reason I chose to work with kids! 

More to follow about my peds intern year... I am back to writing posts. 

Sometimes Patients Leave A Mark

Last week, a fourth year student excitedly came over to my Neurology course director to tell him about an interesting case with neurological findings. I got assigned the patient, and to my pleasant suprise I could take a full history since he spoke Urdu (I love being able to communicate with the patient without needing an interpreter - many patients only speak Arabic in Qatar). The patient did have intriguing neurological findings, but this is not the reason patient left a mark in me!

This middle-age gentleman was my first patient with cancer who had gone through intense chemo and radiotherapy over the last fourteen months. The gentleman told me his story with passion and emotion that I had tears in my eyes that were on the verge of bursting as I saw how he felt he is a warrior battling his disease. When I asked the gentleman if he had any family in Qatar, he replied saying that the doctors, nurses, and social workers are his second family that have supported him in fighting his cancer. He is blessed to have been working in a country that strives to provide medical care to any resident of Qatar without looking at their social status, especially since he could not have afforded this quality of health-care and chemotherapy. He is fighting metastatic renal cell carcinoma, which is known to have a relatively poor five-year prognosis.

After completing my examination and closing up with the patient, he wrote my name down in his diary and said that he will make sure to include me in his prayers as I strive to become a healer one day.

I admired this gentleman for his strength, will-power, and practical optimism towards fighting , cancer and acknowledging his blessings in life. Even though his family and children live across the sea, he fills that void with the "family" he has in Doha without complaining.

When we are faced with little challenges and all we do is complain and complain and complain about the little "hardship" we are faced with in life. Hence, I walked out of that room thinking I should appreciate everything I have and stop complaining about my neurology write-ups! :P

Ready for 4th year?

This week we had fourth year orientation/preparation for USMLE CS! Time to work on personal statement, CV, study for USMLE Step 2 CS and CK, and prepare for NYC - SubI and electives.

Majority of us have decided what specialty we will be applying for this September.

Now we are thinking about everything we have done in the last few years to add in our CV! I wish I had updated my CV in the last three years, it's quite a task to go through emails and papers to remember the dates for which I had volunteered at a certain conference, help organize a medical camp, and participated in big-sib program.

Yesterday, we had OSCE's and most of us left the OSCE thinking we need to do some more practice in breaking news, taking a more thorough history and making sure we dont forget to ask simple questions such as drinking, smoking, or medications and allergies. Oh and definitely not forget to wash hands, especially after our professor reminded us like 50 times!! Also, remember to think common is common, like in Qatar the most common car is white Land Cruiser! Nonetheles, we are much more confident now then we were during our first year OSCE's.

The first group has left to nyc for their clinical electives and SubI. I have one month of Neurology now and then I am heading to NYC for Pediatric SubI!

In 10 years, 20 years, 30 years???

I always thought getting into college would be tough, then maybe getting into medical school. Now, as I look back, I think those were much easier than getting into RESIDENCY! I guess every step just gets harder, but you learn and eventually make it!

Third year almost coming to an end: finished internal medicine, surgery and PEDIATRICS! and now doing Ob-Gyn! I have Neurology left, and then Im off to NYC for 2 months for my clinical experience in Peds in NYC! I'm EXCITED!!

My clerkships are a major part of my life as I acquire the skills and knowledge in the various fields, but we are also quite preoccupied in choosing our future. Our class is deciding whether we want to be a clinician, pathologist, radiologist, or a surgeon. It is a tougher choice than Id imagined. We have probably spent hours contemplating on our future. These are a few of the questions we are answering as we choose a field of choice:
1. Do I want to have a field with focus on academics, research, mostly clinical work, or a balance of them all?
2. How do I decide between all the fields I enjoyed(and maybe for some people hated)?
3. Should lifestyle be important?
4 Can I have time for a family with my career? Get married during residency?
5. Length of training?
6. Job in the future and where Id want to work?
7. Grades, research requirement for certain fields and competition?
8. Accept IMG's?
9. AND the MOST IMPORTANT Question: Where do I see and feel the spark? Do I have a passion? and What will I be able to do best?

For me, I have been thinking about pediatrics-genetics before I started medical school, but I was always ready to change my field if I saw the spark in another field. But I guess, my passion lies in peds-genetics!
Currently, the dream is becoming a reality as I am working on the paperwork for electives, discuss with faculty, and applications.

So where do I see myself in 10yrs, 20yrs, 30yrs? Well, as many of you know, I always say "wherever my life leads me! Im always open to new ideas and challenges!"

SURGERY!

As promised, my experience as a surgeon... as faculty say, "Medical students believe they need to do a procedure three times to claim they are experts." So I can call myself a surgeon for the time being, since I have seen and/or scrubbed in a lap chole, lumpectomy and appendectomy three times! :P

As I walked into the operating room on the first day, the nurses, doctors and nursing aid were all a bit startled, to say the least. I was ready to scrub in on the first day! I had my scrubs and all personal protective equipment ready to scrub into my first procedure - hemorrhoidectomy! After scrubbbing into the first procedure, I knew surgery was gonna be an awesome clerkship.

So far it has been great. On an OR day, the maximum number of surgeries I have scrubbed into is four!

Surgery is almost over, less than 3 weeks till exams.

What is it like to be a 3rd year med student?

Honestly, I am having the best time ever. I have a feeling, this is going to be the best year ever since I have been at Cornell. I have finished my 3 month medicine clerkship and now I am doing my 3 month surgery clerkship. And I just love it, even though we have to work longer hours!

It is a great change from daily lectures and weekly exams. The interaction with patients, learning to examine patients, reaching a differential diagnosis, ordering investigations and being able to scrub into your patient's operation really makes you feel like your hard work is important and does pay off! It's a great reminder and daily motivation to keep studying to become a great physician in the future.

My experience is probably similar to all of my class with a little bit of a twist. I don't think its a common sight to see a 3'7" doctor-in-training, especially in a Gulf country. Hence, people have all sorts of reactions. I have never really seen so many different facial expressions in my life and people turn around to look back at me, when I walk in the corridor of the hospital. I am used to people staring at me, clearly pointing me out to their friend or family, and making comments. But I have never had to face so many different expressions in one day. Over the years, I have learned to ignore and in the last three months I think I dont even notice it anymore since I have gotten "immune" to it.

The most common question I get asked is the obvious "are you a doctor?" In my head at 7am in the morning, I'm thinking "duh, why would I be in a white coat with a stethescope and badge-I dont think its Halloween season! and I dont think I look like a little kid playing dress-up!" I just politely answer I am a medical student.

Several times, I have had people approach me to take my picture. I politely refuse. I am always alarmed when someone suddenly approaches me with their phone and is like can I take a picture of you. With the era of all cell phones having cameras these days, I think someone could take a picture without even me noticing. But if you asked me, I have the right to refuse and escape quickly, hide between people in my team during morning rounds. I once had a lady quickly walk behind me after I refused and I made an quick escape. I believe she got by back, since I heard the click made by nokia phones.
"I wonder how would someone take it, if I asked a random person in the hallway to take a picture of them." -- I believe they would think I am a spy or a crazy person.

But one thing is for sure, patients have shown no hesitance to having me examine them and follow-up with them. Sometimes, patients will offer to move towards the edge of the bed, they will sit down on the chair instead of on the bed so I can examine them properly. While persuing medical school I had a slight fear about me getting around the hospital and interacting with patients. However, I also knew I would be alright, since my height has never been an issue and has never stopped me. And I guess I was right.
Also, patient's care about being treated properly and being respected, hence they do not care what their doctor looks like and who he or she is if they can have their health back.

USMLE mania!!!

I feel like the anxiety in our class is going to burst! Every time I turn around to talk to someone, we have only two things to talk about. The MOST important one is USMLE! We are discussing schedules, books, plans for studying, NBME, USMLE World, USMLE Rx, First Aid, BRS, plans after the exam, topics we love, topics we hate, and much more....

I put a schedule together in spring break and I keep going back to it and making changes. I think I am finally satisfied with it. I plan on doing intense studying 12-14 hrs a day and sleeping 8 hrs, this leaves me with almost no free time. Hence, I will have to totally isolate myself. :( Lets hope I pass with flying colors and do not go crazy! (Upperclass's have warned us that you will do some crazy stuff, just watch out and realize it is alrite and stop yourself from trying anything "new.") I have attached my schedule for you to see what is ahead of you. In 39 days, I need to review material covered in the last two years and more. Honestly, I have a feeling after it is done, we are going to feel ready for the wards with all the theory at our fingers.

Currently, we are studying Infectious Disease = Parisatolgy, Vaccines, TB, HIV, Meningitis... Have the exam Sunday, and then we have one more exam and we are done with second year!

Its the end of the year, so its always busy. International Evening April 23, Class of 2009 Grad May 6, Convocation Ceremony May 5, Medical Camp that offers free medical care to labor class in Qatar April 17, and more... ofcourse also USMLE!!!