Music Is In The Silence Between The Notes.

Music is in the silence between the notes.  Just imagine even the most renowned symphonies would be just noise if there was no pause between the notes. Life is just like that. If there is no sorrow, joy would not mean any thing. If there is no tragedy, happiness would be meaningless. 

If some one would remain euphoric all the time you would call him insane, if someone is always sad, you would think that he is "depressed". Life requires balance, that could only be achieved if you experience both spectrum. Sometimes it requires a touch of the other side to cherish what you have. Some people only realize what a blessing good health is, until they come out of an illness.

There is a short Urdu story by Azad. There was this man who found out that there is a place where you can go and trade ones worst problems. He went there and traded his chronic colic pain for bad arthritis. On his way back he realized how difficult it was for him to walk with this new ailment. .He had no choice  in the end but to return and get his old ailment back. They say that no one gets more than their share of bad luck, not an ounce more than they could tolerate, I guess it is true, maybe it is adaptation or I just hope that it is not  Karma! 

I write this because in the past one week I admitted two patients, both with foot pain. One person got an amputation the other had a simple infection. Surprisingly both were stoic. I made it  a point to ask both of them today how come they never had a complaint. They both said it could have been worst! 

Blog you later.

About the picture: Curves and different shades caught my eye in this frame as I was walking towards this building in DC. 

Irony!

Few years back I received a call from a lawyer in North Carolina. He was calling to find out if I wrote a letter in favor of an inmate. I knew the patient but I never wrote a letter on his behalf.

I asked him to fax the letter to me. It was a most interesting letter. The letter basically stated that this former patient of mine should be released from jail due to health reasons. I wish if this was as simple to get a "get out of jail" card from a doctor. My letterhead was forged using my business card and interposing the image on a copy paper. The terminologies and language in the letter were flawed and the context was way too simple.

I called the lawyer back and told him that I am not the author of this letter. He laughed and said he thought so. Out of curiosity I asked him what is he convicted of. 

He replied "forgery". 

Blog you Later,


About The Picture: I took this picture of a picture at Hirshhorn Smithsonian art museum by Tomas Struth of Pergamon Museum, Berlin.

Enough with Made Up Statistics.

46% of all statistics are made up.

I come across various times in a day when I am quoted statistics of some sort like "26.5% of patient develop heart failure after a single meal containing excessive salt" or "12.45% of medical errors are due to physicians".

I remember during my fellowship I was doing a breast biopsy. That was was my second biopsy procedure, my first biopsy was a success. The patient asked me how many have you done. I replied "lets put it this way I have been successful 100% of the times". She was pleased for a short time until I told her that this is my second time!

Sometimes I am amazed at the recall people have with these numbers. Now I am not so bad with recalling the numbers but some of my colleagues are just too amazing. So naturally I decided to make a note of these numbers and started to check these figures. I was amazed that 46% of the times these were wrong.  

So remember for next time, 46% of statistics are made up................ including this one :)

Blog you later.

Statistics are human beings with the tears wiped off.  ~Paul Brodeur, Outrageous Misconduct

About the picture: 100% Downtown.

Need Money For Weed?

Hardly a day passes by when I don't have to admit patients with drug related problems. I have seen almost all kind of complications ranging from anoxic brain injuries after Ecstasy use to brain abscesses after IV drug use. Acute myocardial infartions from cocaine to aortic aneurysms after meth. Addicts of all ages from 18 to 79 years olds, people from all socioeconimical backgrounds.There are already enough problems, why create some more. I wrote about this issue here  in the past.

On my last call I admitted 9 patients, six of those were drug related issues. These admissions are more complicated  as some of them are suicide attempts and some psych issues. Few of them are brought in by police and they are admitted for medical clearance, they later require transfers to psych facilities which are not easy to find.

Anyways just another day in paradise.

About the picture: This gentleman was at Times Square, I had to give him a dollar for this picture.

Illusions Of Healthcare, Uninsured.

I have two young patients, both with cancers. They need surgery, chemotherapy and radiation, and they need it now. We have a diagnosis and plan, unfortunately we can not implement it. The kind of surgery they need,  we are unable to perform those at our hospital. I can not transfer them anywhere because they are UNINSURED.  So they are stuck in limbo.

In this day and age where we are the most powerful nation in the world but some of our own do not posses some basic needs. I spent a lot of time talking to different hospitals but I am still waiting for an answer. So naturally I am frustrated.... this is quite an illusion of care. Maybe tomorrow is going to be another day.

About the picture: Luray Caverns, Virginia. There is water at the bottom of this particular shot which reflects the roof and gives you an illusion.

Super Doctor.

I was talking to a fellow physician and he inquired “how many patients do you see in a day” I said “maybe around 20”.  He smirked and replied “20 ONLY! I can see around 40 in a day and still have time to hit some balls”. Hmmmmm....... there is something fishy here at Smallville.

Few years ago I used to work for this company; I had no option but to see a huge number of patients. Sometimes my census would be around 40 or so. I remember one day that I got 26 new admissions. I took care of them all along with the patients who were already on my list. By the end of the day I was a tad confused. When nurses would call it would take me a moment to recall a patient. I would have to think twice so that I don’t confuse a chest painer with a GI bleeder.

You can see a lot of patients but I think it is not fair to the patient. As I always say it is just not about billing. You can not provide adequate care when you are breezing through your list. The goal is not just to see them but to make the right decisions. One way to see them would be to call 20 thousand consults and let other doctors make decisions for you or you can try to see them like you should and spend your whole day ……. and night seeing them all.

Devil is in the details…. If you are detail oriented and if you have a good system in place, then you decrease your chance of error. Believe me it is going to happen… you will make an error (Murphy’s Law) but the difference is the gravity of error.

So what is the magic number, various factors play a role when you consider the right number of patients to see. If you have midlevel support or you have residents, than you can probably see more but that is not the case for most of us. I think 15-20 patients per day is a fair number in a 12 hours shift in a hospital setting. I read  this article sometime ago at Today’s Hospitalist, it nicely breaks down various situations vs census of patient accordingly.

I call these doctors Super Doctors. It is like "look! It's a bird. . . . It's a plane. . . . No....It is a SUPERDOCTOR!” No patient can really identify what breezed through them. But just remember it takes only one kryptonite to bring down the mighty. 


About the pic: Not Krytonite, it is a Topaz at Smithsonian Museum at DC.

Birthday Party and "I Have A Sick One"

Birthday is supposed to be your day, you enjoy, relax and have fun with your friends and family. Statistically and according to my personal observation, people who have the most birthdays usually live the most.

Few days ago I had mine, somehow it doesn't look kosher if you try to take a day off. My birthday started a little early with a page from ER around 2 in the morning. They gave me routine greetings and put me on hold for some major announcement. Soon I was talking to a fellow physician who said those dreaded 5 words "I have a sick one". When you hear something like this you know you better get up and get ready. Someone is heading to ICU. 

I drove to the ER, dodging few deers (Yes real deer!) and reached there around 3 in the morning. This lady was really sick, she literally decided to throw the book at me. She saved all known critical medical problems for me specially for this day. That took few hours to stabilize. At the same time I was informed that a turkey gulper is waiting for me. Around thanksgiving I usually see one or two who decide to gulp a turkey without utilizing the mastication process which results in a turkey stuck in limbo in the esophagus.  Anyways patients kept on pouring in for the rest of the day without showing any sensitivity that it was my birthday. 

Later I went to the wound care center where my office manager Debbie was kind enough to bring this cake, 

due to lack of resources I had to use a scalpel to cut this cake. The rest of the day passed by pretty fast. I came home around 6 pm, pretty fatigued for the day but it was lovely to see my family and have a great dinner.

PS: No wounds were harmed while utilizing this particular scalpel.

Flu Shot, Did You Get One?

According to CDC (Center for disease control), flu 2010-2011 season started in October and it will peak in January. Current recommendations are that everyone above 6  months of age should get the vaccine. This year you don't have to get a separate vaccine, this year vaccine includes protection against 2009 H1N1, H3N2 and influenza  B  virus.

I got my Flu shot early last month at the hospital cafeteria, I was ambushed as I was on my way to get some food. Unfortunately my wife and our two daughters were not so lucky. So as we got out of the plane at Washington Dulles Airport, we saw a kiosk right near the baggage claim, personals over there were offering free Flu vaccine. My wife got a shot and the little ones got nasal sprays. Children were overjoyed when they figured out that they will get a "mist" rather than a shot.

Anyway I like this campaign, it is very effective and convenient. Don't forget to get your shot.

21% Medicare Cuts and Air Tran.

Some of my blogs get published at other online websites like here at KevinMD.com; I saw a number of comments at one of my recent post which I originally published it here. Some of these comments were thoughtful, some very critical and some very amusing. I would like to mention few here.

“I had a plumber come to my house to snake out a blocked sewer line. Two guys showed, and it took them an hour to do the job. The bill? $100.00 plus the cost of a new wax seal for the toilet bowl. You can’t say hello to a doctor for that kind of money. 

“Which is why they make about 500% more than plumbers on average. And they make that regardless of whether the job they do is phenomenal or not.”

“I don’t know about finances but patients are much more likely to say thank you after I teach them to SCUBA dive than after I save their kid’s life. They are also much more likely to pay their fees to the scuba shop for certification than they are to my office for vaccination of their infant.”

Well I can answer some of their concerns but I will leave it for everyone else to make their own inference.  

I recently traveled through Air Tran, I took a picture of this pretzel packet, I found the text very amusing and very practical on the other hand.

It is a possibility that with recent fear of 21% cuts to Medicare payments, we may just not have problems with finding treatment for our elderly, just like it takes forever for Medicaid patients to get an appointment. But we may also find little brochures in hospitals and doctors offices with similar language.

You Think You Got It Bad.

Usually I do not post these videos, but sometimes you see certain thing which make you wonder how. If you think that you got it bad you got to see this video.

Last Chapter.

My friend who inspired me start this blog died last week. I wrote about him here and here.

I was out of town when this happened. My motivation was really low to write anything. Around the same time I had couple of injuries, I tore a muscle and most recently a hand injury while running. So all of these events compounded to this recent hiatus.

I came back last night and I saw his family today. The problem is what can you really say? not much. Even if you say anything it does not change anything. 

He recently received Patriot Award, this award goes to employers who support their employees beyond basic requirements by law.  He was that kind of a guy.

A friend of mine says that the last chapter of life is the most difficult to write. His last days were full of bravado, courage and inspiration. I think his last chapter was too short, however it was most admirable. RIP.

About the Picture: Busch Gardens.

Computerized Progress Notes and CPOE.

Yesterday I gave a talk about computerized progress notes to some of our staff physicians. As we are now doing 100% CPOE orders, our next phase is to be paperless at some time in the near future.

I am very proud to say that our group of hospitalist are now 100% paperless. This includes computerized physician order entries, admission and discharge medication reconciliation and now progress notes.

I started doing electronic progress notes almost a year back. It was a challenge for the first few days but now I don’t think I can go to paper again. So these are some of the advantages I see in doing electronic notes.

• All the data you need can be pulled into your progress notes including labs, microbiology, radiology, vital signs, pathology and is updated automatically everyday.
• You don’t have to look for charts which are never there when you need them
• This makes it a one stop process, rather than first writing your note, place orders somewhere else and review data under 10 different tabs.
• You can see all your patients and than sit at one place and complete your charts.
• When you sign off, your partners can copy your notes and edit them and create a new note without inventing the wheel all over again.
• You can improve your coding as your note has more components.
• It is a much faster process.
• You can create your personalized templates and use them as needed.

Next stop history and physicals, if they become user friendly.

I Have A Question.

I was talking to a friend of mine, Dr Nawaz who has Internal Medicine and dermatology practice in Wesley Chapel, Florida. He raised a very good point the other day. He said a good doctor is skeptical; he raises questions, even for common problems. And that…..defines a good practitioner.  

He gave a very good example, he saw a patient who has been complaining of ear pain for some time. He was seen by various doctors and eventually was diagnosed with an ear infection. He was treated with antibiotics and what not. Patient finally came to him and he saw this patient in the clinic. His examination was not consistent with an ear infection. He ordered CT brain and found out that patient had a brain mass.

His point was that you have to ask questions even for your everyday problems. Every GI bleed is not due to an ulcer, every sore throat is not pharangitis and every chest pain is not because of a heart attack. I am not trying to say that you should order a brain CT for every earache, however, when we see a recurrent problem without any relief, you need to start asking questions fast.

As they say in medicine common things are common. You should not be looking for Zebra all the time, but you should know when you need to take your binoculars out. There is an unsaid rule in the ER, if you have recently discharged a patient from the ER without admission and if he comes back soon with the same problem, you got to admit him. Even if conventional wisdom says otherwise. We as hospitalist usually try not give them any grief when they call us for those admissions.

So the bottom line is that you should be ready to think outside the box, and more importantly you should know when too.

Dentist.

Maybe it is me but I am just not too crazy about dentists per se, do not take me wrong I am not too crazy about other doctors too when I have to see them as a patient. Anytime I go to a dentist (no names), I come back with a new problem.

So this time I saw him for a regular cleaning. I spent a good fifteen minutes with a dental technician and after she was done I saw a glimpse of my new dentist through my peripheral vision as he was always on my side. If I see him on the street I probably would not recognize him..... unless I see him from the periphery.

I found out soon I was in a precarious situation, I may loose all my teeth in the next 30 years, if I won't get my cavities filled out. Now 30 years is a long time. I was injected with five vials of Novocaine, which I think was a lot and still I was having pain. I was informed that the reason I am still having pain is because "certain Indian and Pakistanis have dual nerve supply". I was not sold with that idea because with that amount of Novocaine, the whole population of India and Pakistan could be anesthetized.

Anyway I was finally done with instructions to come back for some more...... I have more sensitive teeth now as compared to what I presented with but still I have to go and get all this mess fixed up or else......

Please tell me I am not the only one with this problem.

Death Valley.

A friend of mine Dr Rippe recently visited Death Valley, California. He shared this picture with me.  It is a strange. So I did some research this is what I found out.

It is favorite place for tourist, somehow this place has evaded me so far. It is a spectacular geological site. Strange and mysterious with melted rocks scattered around.  Pretty hot there with temperatures over 110 at times. Its favorite attraction is Racetrack Playa, known for moving rocks. There are these rocks which moves leaving behind tracks. 

For centuries people have not been able to figure out how these rocks move. Some theorist suggest that it is because of the rain, some say it is because of magnetics. Considering it is so dry no one really knows. It is a strange site and quite a mystery. 

If you know of any better theories do let me know. I found one explanation here. 

About the picture: Credit goes to Dr Rippe, thank you for sharing.

FCCS. Fundamental Critical Care Course.

For the past couple of days I have been busy taking a FCCS (Fundamental Critical Care Support) certificate course at Tampa General Hospital. It was a great experience in many ways. This course is directed towards hospital physicians who are non intensivist. The goal is to emphasize what needs to be done for patients who are in a critical state and what kind immediate critical support they need for survival in the first few hours when a critical care physician is not available. Dr Luis Llerena, a trauma surgeon conducted this course. His way of teaching was excellent and I would strongly advise other colleagues to attend his courses. 

This is specially helpful for our group which is moving towards a 24/7 scheduling and with plans to be available for code blues and rapid response situations. I believe that in the next 5-6 months we should be able to provide this service. As I mentioned before in a previous post, that is is a natural progression of hospital medicine otherwise hospitalist would be glorified internist.

The picture above shows an algorithm based on a study Dr Emanuel River, dealing with goal directed therapy in the treatment of sepsis, published in New England Journal of Medicine. This study gives a very simple protocol for a very complicated problem. There are numerous times we see patient being treated for severe sepsis with vasopressors alone with intravenous fluid boluses. 

All in all it was very educational and informative. 

Droid In The Room. Autonomous Mobile Robot.

When I was growing up I use to tag along with my older brother who was a big time Star War fan, we use to watch all kind of Star Trek episodes together. I realized later, that in the process I have been transformed into a Trekkie and technology enthusiast. 

So as I was starting my rounds today I had a Star War moment. I saw a R2-D2 like character from Star Wars roaming our hospital corridors. I shot this video earlier today of this contraption, AMR (Autonomous Mobile Robot) going on its merry way. This  is along the same lines as my post earlier regarding Tele-Neurologist. This robot is crafted by a company Swisslog, which creates solutions for logistics automation. So make way to your next generation carrier. By the way, I think my amusement overwhelmed its handlers today. 

This robot carries digitally locked boxes containing various materials. You push a button and it will carry the samples to the lab or carry medications to different units from pharmacy. You can call it to your station by pushing a button. It can open doors, get into an elevator and may even has a capacity to carry medications to patient rooms. Our hospital just started using this robot, it is not operational, at least as of yet, but soon it would be. It will assist in all kind of logistics and distribution jobs around the hospital. 

Everything has its pros and cons. This carrier does not require a 401 K plan nor does it require any benefit plans. Nor it would take smoking breaks or stop on its way for a chat. However, all automated devices come with their own problems. Hey I have an idea, why don't we combine AMR with Tele-Neurologist technology to provide automated service. Anyways be aware,  soon you may find my replacement entering patient's room fully charged and on four wheels with an Apple logo....... here enters IAli,M.D.

So if you have any doubts, tomorrow is already here today. 

Baby Crying.

I saw a patient recently, she had a fetal demise. I came out of the room in our OB part of the hospital, I could hear a baby crying at a distance along with other people chattering away. As I started to tell the nurse  what my plan is, she gently interrupted me and asked "did you close the door behind you" I said no. She said "No problem I will, it is just that I do not want her to hear the baby crying". 

It took me a second to realize her sensitivity to this situation., it takes a certain personality to be so kind. 

I wonder what other things we do without thinking everyday?

Snowbirds.

Yes they are almost here, they are coming in cars, trucks, planes and …… ambulances. They come from Maine, Canada, Massachusetts, Michigan … pretty much everywhere where the temperature is sub zero. I often kid around with my doctor friends from up north that whatever they do with their patients all year, we have to fix it in a very small amount of time. (I am sure they probably say the opposite).

Population of our city triples during winter. You can not beat the sunny weather of Florida neither can a hundred thousand people who swarm from every where.

On my way to the hospital you see tens of RVs jamming the road and people trying to move into RV camps. I had a patient once who was 93 years old, he drove all the way from Maine, and here I am, not even half his age and I try not to drive to the other end of the town.

Winter season has some very interesting dynamics. Especially patients who come from Canada, some of them get conned into buying travel insurances which get them nothing here. On the other hand some Canadian insurance would send a chartered plane with flight crew to pick their patients who need only a colonoscopy or even a cardiac catheterization.

You see a significant increase in your census; I realized finally that we are in the “season” when I ended up admitting 14 patients just last night and at least 35 pages. I have a love hate relationship with my pager; can not live with it and can not live without it.

Not so long ago some physicians in this area used to go on long extended vacations each summer, they worked as seasonal workers.

Anyway,  so for the next 5 months life is going to be very interesting....

  

Lemon Tarts.

She is in her late twenties very energetic and compassionate. She is always bouncing around from one patient room to another, along the way “trying” to boss around all the physicians.

The amount of energy she has is infectious, but looking at her you can never tell she had an open heart surgery just a few years ago. When you think about open heart patients, twenty year olds do not come to mind. It is one of those medical mysteries where we have no answer why she had coronary artery disease at such a young age.

Now she has a new lease on life. She is now married and has a young son. She says that she meets her son everyday like this may be the last day of her life. She has a very positive approach towards life. She thinks she had this ailment for a reason. She believe that through her people find strength and hope, when they see a person living a normal life despite going through this major surgery, they feel they can go through it too. It is true people can associate more when they have some thing in common.

There is no rhyme or reason as to why life has dealt these cards. You can sulk and make your life miserable. It is your choice to be a passenger or be a driver of your life

As they say if life hands you lemons, make lemonade or be smart make lemon tarts. 

About the picture: I am keenly aware that this picture is neither a lemon nor a lemon tart. But I should get credit for it being yellow.

1928 Cell Phone?

We are close to the weekend now, so I will try to keep it light.

I saw this clip on Youtube. CNN also ran a story about this. This clip is from "Circus"

a Charlie Chaplin's movie from 1928. 

You will notice a lady walking in the background while she appears to be talking on a cell phone.

The only problem is that there were no cell phones in 1928. So what is she doing? 

Hearing aid or time travel?

What do you think?

Tele Neurologist. Specialist On Call.

In a time not so far away, you just brought a friend to the emergency room with symptoms of stroke. Patient has developed right sided weakness and also complaints of slurred speech. ER physician enters the room and evaluate your friend. He recommends that your friend can benefit from thrombolytic therapy. Then he goes on to say that he would need a neurologist to make that call, however, there is no local neurologist on call. You start to get upset and…………….drum rolls…..

………and enters neurologist on wheels, this robot like device is being dragged in to the room by a nurse. On the monitor you see a doctor’s face. “Robot” asks you different questions, examines your friend with certain devices and eventually review your CAT scan of the brain while sitting miles apart. Finally he recommends that he concurs with thrombolytics. He orders it and the nurse administers the lytics. Soon your friend who was unable to speak a minute ago now is talking with you and moving his extremities. Finally you take a deep breath. You know what’s so peculiar about this scenario? THE TIME IS PRESENT, IT’S HERE.

I was invited today to meet with Specialist On Call (S.O.C). They provide expert consultation and evaluation for stroke patients. Their model is telemedicine, where a board certified physician is sitting at a remote facility and evaluates your patient. He makes recommendations appropriately, utilizing most advanced tools available through a computer portal.

This company provides specialty care to those hospitals which lack certain specialties. Like in our program we do not have a neurologist on call for stroke.  So patient who live close to our hospitals are taken to a remote facilities to be treated with thrombolytics.

 Initially I was apprehended by the presentation but after listing to the speaker he was able to answer most of our concerns. SOC was founded in 2005, they are currently working in 105 hospitals around the country and they are (Joint Commission) JACHO accredited. They guarantee a patient–teleneurologist encounter within 15 minutes and are available 24/7. They had 6734 consults in 2009 and recommended 380 thrombolytics. National average for cerebral bleed after thrombolytics is 6 %, they are at 4.5 %.  They recommend collaboration with local neurologist for post thrombolytic care.

Though it seems like a good alternative but it would require a comprehensive protocol before this could be implemented. There is a company in Georgia who is also using the similar device to fill in for nocturnist/hospitalist and so far they have seen good results.

I would appreciate feedback if anyone has been involved with similar projects. 

How Many Times Have I been Sued. Malpractice Lawsuits.

Recently I came across an article by Paul Levy, it mentioned a support system among doctors at Brigham and Women Hospital. This support system is in place to meet the physician who is being sued. They provide counseling and assist in anyway they can. I also received a report from a very good friend of mine, an interventional cardiologist Dr Raxwell about percentage of lawsuits among different sub-specialties.

When I initially moved to Florida, I was asked to meet a hospital chief of staff. During the interview process he asked me how many times have I been sued,  I replied none. He smiled and said “you want to say that you have not been sued, yet”.  

I have seen a large number of doctors struggling with insurance and lawyer issues that they can hardly live a normal life.  A colleague of mine was sued over a lipid-lowering drug by a 75 year old lady,  who had been her patient for over a decade. She asked the lady why? The patient said that she still likes her, insurance was going to award her the money that she thinks would not affect the doctor and …….. She is almost 80 year old and  likes to go to casinos.

Here is the report from AMA physician practice survey.

You should specially look at cardiovascular surgeons, 75% of them have been sued, 56% for the second time, almost 15% in the last 12 months and finally their number of claims per 100 doctors were 297%. WOW….

Knock on the wood, I still have not been sued… as of yet!  So what do you think. 

What If Walls Could Talk?

What if walls could really talk? Would you be scared? Would you really want to listen? What stories would they have. If walls talked would you be appalled, overjoyed or disgusted with their sordid tales. You could hear the resonance of  soft whispers among lovers and their promises to each other.

These fortifications may divulge your stories and secrets, stories about you, things you do not want anyone to know. On the flip side you may hear a hearty laughter from your childhood days.  full of fun as a child, sound of your innocent and pure laugh, not yet corrupted by social obligations.

Maybe you will cover your ears, as you can no longer bear to listen to these atrocious stories. Or maybe you will listen just a tad bit more to satisfy you innate curiosity.  You may not like yourself when it will remind you of the unkept promises and blatant lies. It may show your lack of integrity, gold standard test for integrity is not measured on the basis of our social interactions but by what you do when you are alone.

Or maybe it may remind you how much you are needed and what you have done for others.

 PS: I have been lazy about writing blog lately as I have not been feeling well.

About the picture: Field Museum, Chicago

My Friend With Cancer, Words of Wisdom.

Sun is cherished and romanticized the most at sunrise and sunset, so is birth and death. These are two focal points, which we rejoice and grieve the most, more than anything in between. A friend of mine is suffering from terminal cancer, I previously wrote about this few moths ago.

The last few days have been very turbulent and conflicting for me.  On one hand I have to face the eventuality of this situation and on the other hand I feel guilty because I can not control myself from thinking that what if this was me. I feel a certain bond with him as I have two daughters too of the same age. What would I have done? Would I have shown the same dignity?  I try to distract my self in other things so that I do not have to think about this.

I was sitting next to his bed just a couple of days ago. How do you answer when your friend ask you is there any hope when there is none. It is different when you tell a patient that they are dying, it is quite different when you have to say to a loved one. I held his hand and firmly informed him that this is the end of the road and controlled myself from showing my emotions.

But I am not writing today to tell you about how I feel, as someone said it once, regardless of how bad one feel for the other, you can never feel close to the despair the other person is going through.

This is what he said to me with shallow breaths and teary eyes for almost thirty minutes after I told him what I think. I got his permission to write this and I will try to quote him the best I can.

“One thing cancer has taught me is that the world is not about you. When you turn the world about you, your life becomes very difficult. You have stressful days and you have days of agony. When you decide that your life is about others, about friends, about relationships, your world becomes a lot easier. When you stop focusing on “me”, and start to focus on people and relationships around you, you world starts to get easier. That is tough lesson I have learned from my cancer.

He paused briefly, then continued "I am really into my 2 little girls, just like any father. I had a very touchildhood…. My life long goal was to have a perfect family. And to have kids, and to shower them with parental love more than which I ever got. With this mentality I started my family. If I would have known my life would take a sharp turn like this I would have never done it. I did not know I was going to die this young. Because I can not bear to think that my kids will miss and not look at me in their later lives. I do not want them to wonder where is daddy, when is daddy coming home?

My older one knows that what is going on. My relationship with her has changed. She is more quite. She gives me hugs everyday, the kind of hugs she did not give me before. Before she used to give me hugs which a typical 9 year old gives to her  daddy depicting “I love you so much”, in the past few months she gives me a hug which is more like “daddy I do not want you to go”, for a nine year old to go through this, is heart breaking.

I fight this disease because of my daughters. Your life should revolve around your family. Your should not sacrifice your family”.

Well I just want you to know buddy, the love and affection your girls have already received, very few children get it in their whole lifetime. 

A New blood thinner in 50 years. Dabigatran.

In the history of blood thinners, FDA has approved Dabigatran, a new blood thinner for the first time in fifty years. Dabigatran (Pradaxa) has been approved for strokes associated with Atrial fibrillation. It inhibits thrombin.

Warfarin is one the the best and most dangerous medication we have been using for decades for clot related problems. It requires constant monitoring. Unlike Warfarin, Pradaxa does not require periodic monitoring.  It carries decrease risk of bleeding as its counterpart. It will be available in 75 mg and 150 mg capsules. The cost is going to be an issue. It can be 10 times higher than Warfarin. I think it should be available in the next 6 months.

Well this is as exciting as it gets for us.

About the picture: On top of the ferris wheel at Navy Pier, Chicago. 

Doctors Are In For The Money!

I was recently reading an article at KevinMD, about doctors, that they are in for the money. Well I thought, to give you some perspective, I should list the jobs that I have done in my life, during my transition years.

In Pakistan I already finished my training after post graduation and I was running my own practice. However, once in the US I needed to do this all over again, so I was waiting to restart this process. The problem was that this cycle takes a year before you can get a position. So, I had about 18 months to kill. When I came to America, I did research with Dr. Harvey Priesler and Dr. Azra Raza, two of the smartest people I know in the field of Leukemia and Myelodysplastic disorders. I thoroughly enjoyed the experience but on the flip side the stipend that I earned only covered my studio rent in Chicago.

So I started to look for other jobs. I started my quest, beginning with trying to get off of a forced-vegetarian diet i.e., one of the cheapest meal prepared with garbanzo beans and diced tomato which takes only few minutes to cook. A friend of mine (who is now a high-risk Obstetrician in Detroit) tagged along and we stared to look for jobs. Our first stop was a pizza place. We filled out an application. There was a slot in there about education; we were naive enough to mention our qualification. They turned us down due to lack of relevant experience. My friend tried to argue that if he can deliver a baby, he can deliver a pizza without any problem. We lost the argument when the owner said that this oven works in a different way.

Finally I found a spot at a pizza joint. I delivered pizza for 3 weeks. It was the most stressful job I ever held. I used to park my antique car (my father bought me that car) in downtown Chicago and run up to deliver pizzas. The problem was that I got so many parking tickets that the net revenues were in the negative. After getting mugged and punched in the belly I was forced by my wife to quit that job.

Next stop, Chinese take out restaurant. I think the owner did not appreciate my talent. He kept on asking me to cut the vegetables faster and faster. I tried telling him that you can not be hasty, cooking is an art. He did not agree and I was given a pink slip along with garlic chicken on my way out.

Finally I found a job which I kept for over a year, carpet cleaning. I use to do high tech leukemia research with different clinical protocols in the morning and in the evening I use to clean carpets in the dead winter of Chicago. In fact the job was so “lucrative” that some of my other friends joined in too. One of them is now an Interventional Radiologist in Wisconsin and another one a Critical care Intensivist in Phoenix.  I will let you in a secret; I can still clean the carpets with floor stripping better than many, just do not tell my wife.

As I was diligently doing these two jobs I received a call from a program at Beth Israel Hospital/Harvard about an off cycle radiology position. They asked me to be there in 2 days. The problem was that I only had $280 in my account which would not have paid for the whole plane trip and stay. I told them I am busy for the next 2 days I can be there in 3 days. 

Greyhound used to take 28 hours from Chicago to Boston.  I got in a bus within 12 hours and made my way to Longwood Avenue in 28 hours, changed into a suit at a restaurant at Fenway park. It was a very humbling experience to be cleaning floors one day and standing at Harvard Medical School the next. Finally I got this position, during my stay there I learned so much from Dr. Sughra Raza, Dr. Janet Baum and Dr. Brook Longwood. They all made a significant impact on my professional life. My career started to shape up from there one..... and here I am.

Well so there it is, you be the judge.

About the picture:  Not mine!

Charity Waters.

Charity Water is an NGO; which supplies clean and safe water to developing countries.

Ideas mean nothing, unless you act on them and this young guy decided to act on it. It was originally founded by Scot Harrison, a young socialite, a nightclub promoter and fashion events organizer out of New York City.  After living a life of self indulgence, he decided to do the opposite of everything he had done in the past, and do something for others. He traveled to Africa with a charity organization and never really left.

The idea started three years ago, it was to provide clean water which you and I drink every day; which is not available to 1 billion people around the world. Within three years this charity organization has collected 13 million dollars through 75,000 donors. In Africa millions of kids travel miles barefoot just to get water, these kids should be spending their time in school rather than looking for water.

Scot started with nothing and on his 31^st birthday he asked all his friends to give him $20 dollars each, 700 hundred people showed up which enabled him to make 6 water wells in Uganda. At his 32^nd birthday he asked people to donate $32, his team was able to collect $150,000 which went towards obtaining clean water for hospitals in Kenya. On his last birthday, Charity Water was able to collect 1 million dollars. The best thing about this organization is that 100% of your donations go towards the cause. Administrative cost is funded by major corporations.

Maybe for his next birthday you can give him a gift. Maybe you would decide to choose a different organization, but do choose one.

I remember this analogy about a man at the beach; he was throwing back starfish which were doomed to die on the beach. Someone shouted sarcastically at him “you can not save all of them, there are millions of them”. He looked back at him, tossed another one at the sea and said “made a difference to that one”

So just make a difference in someone's life, if it only means one life only.

About the picture: Sunset at one place, sunrise somewhere else. 

Hatred. Tyler Clementi.

Pablo Picasso said once about abstract art “Many people say they don't like my art because they don't understand it. Well, I don't understand Chinese, but that doesn't mean I don't like [it]”. 

We all fit somewhere in the spectrum of life, dull, bright, dark or translucent. Just because we do not understand something, it does not mean that we should disregard it or show contempt, unfortunately we do. We tend to dislike things which are different, some more than others. Our degree of contempt accelerates, depending how different the polarity is.

Things which are not comprehensible to us, start to plague us. Not so surprisingly our level of disapproval starts to grow depending how different something is. Our fear from darkness seeds from the sole reason, our inability to see in the dark. In darkness we are still the same, objects around us stay still but our fear of unknown and loss of control make us anxious. Our demons go away as soon as we turn the lights on. As usual when we can not perceive, we succumb to fear. 

Alien ideas, actions and concepts induce different reactions from everyone, some are not affected at all and some shows extreme agitation and some become phobic. It is so easy to detest something, much easier than trying to understand or rather accept the differences.  It requires no effort to go with the flow, however, accepting contrast need a conscious effort.  So, we decide to follow the same old route lets hate, let’s hate other faiths, beat the gay guy, make fun of how you look, and in fact hate anything which is different. 

Recently I read about Tyler Clementi, a promising musician at Rutgers University. Tyler jumped off a bridge after he was targeted for being gay. Clementi was one of many who are bullied everyday for being different. I took care of a victim of hate crime once and it was not pretty. Please spend sometime and view this link, this was sent to me again by my friend from Italy who earlier sent me this post too. Gays and lesbians are one of the many groups who are targeted for being different. History has taught us we do not discriminate in our hatred like we do for our affection.

I am not trying to make a political point nor is this an attempt to undermine any religious belief. My point is the human aspects of this tragedy. Someone lost a loved one just because he was different. You can not harm someone just because you like red and he likes blue. Millions of people are suffering because they either not look like you, worship a different God, have different facial profile or a different skin color.  Next time if you decide to go with the flow, take a hard look at yourself and see how different you are from the person next door. It is not about being tolerant; I think this is about acceptance…….you do not have to be like me, I like the way you are.

About the picture: Colors of life.