What a difference 12 years can make!

 My last update was posted in March 2013.  In April 2013 I became pregnant and life took off like a speedboat.

I originally wrote for my own sake, and to share with my sisters.  I will always share with them, but I write now also so that my kids can know from my perspective what life has been like for me.

Let's start with my first pregnancy.  I went in April 2013 to San Francisco for a glaucoma meeting to present a poster.  It was fun and interesting, and I got to visit Ajit mama and my cousin Roshan.  I look great in those photos - luscious hair, great skin.  I got to go to dinners sponsored by medical device companies and ate lots of good food.  My body somehow told me I had no interest in drinking alcohol and it was a strong pull.  It wasn't an aversion, it was just a strong disinterest.

Soon after I got home from that visit, K and I flew to Durham to close on our dream starter home.  Lovely neighborhood, lovely 3 BR home close to work, our own property (and not in a high rise like in Chicago!).  We signed the papers for the house and were given the keys.  An hour later we were allowed to enter the home so we puttered around in a store for an hour then unlocked our new home.  As we entered a wave of nausea hit me.  

The previous owner of the house didn't exactly clean the house so there was debris from her move.  We cleaned the best we could.  We bought trashcans and a shower caddy, and vaccumed the best we could.  We slept on sleeping bags on the carpet of the master bedroom.  Each morning I awoke grumpy and nauseous.  I blamed the dust and constant cleaning.  I was also incredibly hungry and unlike Chicago most places in Durham closed by 8pm and we couldn't get pizza easily.

We got back to Chicago and I spent another day in clinic nauseated.  I decided to take a pregnancy test when I got home.  I had told Kishan my plan and I think he had a premonition of how that test would come out so he brought home dinner that evening.  

The urine hit the stick and that might have been the fastest change to PREGNANT the test ever showed.  The story continues soon, I hope!

A Good Day

I will probably long for times like today in the future so I might as well mark it with a post.  I just finished my in-service exam today and so FINALLY the pressure to be studying is off.  I'm starting a new rotation on Monday and get 2 days of operating a week, plus a busy half day of lasers.  I have the next 3 months to be selfish and squeeze some fun out of Chicago before I move into my dream home in my dream city for my dream fellowship program.  So much peace now and so much excitement to look forward to... I'm just so content right now.

Today I watched a Hindi movie when I got home, Parineeta.  Pops has been recommending it for a while and finally I had time that I could spend at my own discretion so I watched it.  It was pretty good.  It was quite similar to Devdas but with a happy ending.  Oops did I give it away?  Well it was enjoyable enough.  Deddy tends to like movies with a strong female protagonist and while I do have a growing respect for Vidya Balan, I'd argue that this movie did not have a particularly strong "powerful woman" theme.  It had a faithful, steadfast woman.  The story centered more around a ruthless businessman and his son's understanding of where he stands in the world and what relationships should mean the most to him.  I did appreciate that Vidya Balan's character said things like "You can't say things like that.  You are crossing the line." to the male lead's father... but scenes where the male lead slaps her and calls her unrepeatable names - it's borderline unwatchable and feels unforgivable.  At least when the male lead gets his head straight and comes back for her, she should give him some grief for it and get more than a hug and "I'm sorry" eyes from him.  Well, it's not my life.  The story is based on a book anyways.  More recent Hindi movies do show women standing up for themselves (and not just letting the misunderstandings carry on as they are silent standby victims) and that's a good thing.

By the way, when I was flying back from India I watched English Vinglish and loved it.  Just the right amount of everything.  And a far cry from what I had to endure watching on my way to India in 2009 when I was going for wedding shopping -- it was called Saas, Bahu, Aur Sensex and it was downright awful.  Ooh another movie I saw recently that I had hopes for was Aiyya... Rani Mukherjee's "comeback" film.  Gosh it had so much potential but it went WAY off the deep end near the end and what could have been light and fun turned into just plain creepy.

OK!  Gonna get back to hanging out doing whatever feels right.  Ahhh so nice...

Ha! And I said I'd come back from a hiatus in my last post which was a year and a half ago!  Ha!  Well, I can try again can't I?

Interestingly I chose the name Scleral Spur just before I started Ophthalmology residency by opening the Fundamentals book of our textbook series to a random page and pointing to a word.  Of all words, I got scleral spur.  And what came from that?  I became glaucoma fellowship-bound.  Funny how these things happen.

Well, I really do feel like my dreams came true with this match.  My level of thankfulness was off the charts on December 19th (Match Day) when I found out that I not only matched (not matching was a fear that had crossed my mind) but also got my first choice.  I don't remember ever being so happy and excited by the results of an application process.  I've learned quite a bit along the way but I'm happy not to be applying like this ever again.

This might be dramatic but it feels like life may be starting now.  I want to live in a house.  A detached one with 2 floors and a front door leading to the ground.  I am done with highrise living.  Unfortunately with real life comes real decisionmaking.  Like mortgages, attorneys, applying for full medical licensure.  When does the work stop?  Sounds like never.  In fact, it sounds like the un-fun work just sort of continues in one form or another for infinity.

That's ok.  It's happy work and I'm thankful to have the chance to do it.  Hopefully I can keep up the happy work of this blog too. :-)

Back in the Game

After a long departure I am back.  So here's how things went.  I read obsessively the first half of the year.  The second half of the year I reviewed it all, and felt constant fear and pressure to keep going so I could do as well as I could on OKAPs.  OKAPs came on April 16, and now they're over.  The results are supposed to come in a few weeks.  The last month and a half I took vacation, went to a research meeting and presented a poster, tried to better my clinical skills.  Admittedly, I've been lax with the reading, picking up a book or a journal for just a few minutes daily.  I think my brain was just tired of studying.  My eyes would cross at the sight at yet another article talking about the benefits of Avastin or Lucentis in yet another neovascular disease.

Today, some switch flipped in me.  The fire is back on.  Maybe it was this attending that came to speak at Grand Rounds today.  She spoke with this quiet force that left me in awe.  It was a lecture on research, and she took no excuses for not being productive and doing great work.  She was good.  OK, I'm back in.

I'm glad its finally June and its finally hot outside.  I'm glad I'm feeling energetic again.  Time for some ice cream, then to work.

Digimon, digital monsters

Hi!  I'm back.  My mom and dad were in town this weekend (drove up from the homeburgh!) and it was great.  I've been feeling a little tired and in need of TLC and their (albeit short) time here hit the spot.  They seemed to be happy to have come too.  They didn't think the place was a pigsty (yahoo!) and they just made the home a cozy happy place.  Mom also made a ton of awesome food and I feel full and happy.

Today I took mom and dad to the ophthalmology department to show them around.  I did a quick exam on my mom's eyes and saw early cataracts.  OK so everyone over the age of 40 has some degree of cataract but it's always a shock to know that rules that apply to the general population also do apply to my mother, who in my mind is always perfect.  You know?  It's weird.  I kind of wish I didn't even look.  At the same time though, it reminds me of why doctors in general tend to be a little lax about their own health, and sometimes even in recognizing problems in the health of their close family members.  It's "patients" who have the messed up health, not any of my own!

Back to reading, like usual.  Happily though. :-)

Cross my heart...

I should be reading but I need to get some things off my chest.

1.) Today I did my first intravitreal Avastin injection.  If you understand that, you know that I mean that I injected medication into a patient's eye.  Can you believe it?  I hardly can.  Most patients, upon hearing about "an injection in my eye??" are bewildered and interested at the same time.  Kids in elementary school used to give their word in an agreement by saying "Cross my heart, hope to die, stick a needle in my eye."  Meaning... that sticking a needle in the eye was the second worst thing a kid could think of aside from dying.  Well, it's not nearly as bad as dying, and in the case of severe vision loss, sticking a needle in the eye is actually a very necessary and helpful thing to do.  I hope to check up on this gentleman and find out that he's doing much better.  I also hope that in the future I am less nervous and shaky with the steps.  I can do it!  I just need practice.  This is what I've been wanting to do in life... and I plan to do it very well.  What a day!

2.) Had an ethics conference this evening as well.  It was interesting to say the least.  One thing I learned about and am still pondering is the political movement to change physician reimbursement into a payment per patient episode of care instead of the current fee for service structure.  This would mean, possibly, that one patient episode of care would encompass 1 year worth of care by a certain physician for a certain condition.  A glaucoma specialist seeing a primary open angle glaucoma patient would be reimbursed a fixed amount for caring for this particular patient.  This reimbursement would not change whether the physician elected to do 4 OCTs (optic nerve/retina imaging modality) that year or none at all.  This puts the decisions regarding allocation of testing and other resources squarely on the shoulders of physicians.  Those physicians who want to maximize efficiency towards profit will likely try to test as little as possible or even prescribe the cheapest medication if this is factored into the payment. 

While on one level putting pressure on physicians to deliver cost-effective and more efficient care sounds like a good way to stop our unbelievably high level of health care spending in this country, I'm troubled by the idea that our culture doesn't seem ready for this kind of change.  Americans, including myself, gravitate towards and outwardly express desire for the latest and greatest medicine and technology.  By pushing the idea of cost-containment, will we be squashing innovation and use of medications that may be good (but that are very expensive)?  It's a lot of responsibility to put onto physicians, something that may require all physicians in the future to hire consultants just to help with cost-benefit analyses.  And perhaps its a bad thing having physicians involved in semi-financial decisions like this.  Will it erode patient trust for physicians if they know that they may not be getting tested in certain ways because the physician will lose money by ordering it?  People don't seem to be bothered by being over-tested, but they sure do holler (and sue) over undertesting.  How will this play a role?

It's a lot to think about.

3.) It's getting late and I'm getting sleepy.  It's been a long day.  I will try to update more often.  Lots going on, lot to talk about.  Until then, goodnight.

Boom Boom Pow

Hi!  Still here!  Working hard but right now I'm hardly working so I thought I'd update.  Just got back from the gym.  Felt good to get the old blood pumpin. 

Work is going ok, just the feeling of always needing to learn more is always weighing on me.  It feels like second year of medical school all over again, complete with unbelievable amount of notetaking and knowledge volume that needs to be memorized before TUN TUN TUN - OKAPs.  Back then it was Step I.  Apparently the OKAP is just as big a test.  Sigh.  I guess I'll keep on chuggin along... it's gotta come to an end sometime.  All the stuff during M2 year felt overwhelming (and often was accompanied with the feeling of "when will this actually be important to me??") but by M4 year, all the repetition of the stuff made me feel more and more comfortable with it.  I actually had some confidence during intern year with applying the material.  So I'm hoping a similar thing happens with ophthalmology... except much faster, because I'm over this feeling.

What's interesting here in ophthalmology residency is that I not only have to learn the book-type material, but I also have to hone surgical skills.  It's something that attracted me to the field in the first place -- the fact that I'd be providing (what I thought of then as) comprehensive - medical and surgical - care of the eye.  And it is true, to a point.  Well anyways, I've had 1 wet lab so far in addition to my several trips to the OR for retina cases... and it's not very much like breast or abdominal surgery.  The suture isn't even visible by the naked eye; you need a microscope to see and work with it.  Every tie is an instrument tie (you don't / can't tie it with your hands).  You have to get used to moving your instrument up / down / right / left in a way that's different than just using your naked eye.  Somehow the scope makes it a bit of a challenge to learn these movements.  It's really neat, but like I said, I've got a lot to learn.

How's that for repetitive themes?  I'll try to stop talking so much about how much I have to learn.  Maybe I can even mention the cool things I've learned instead.  Ok, I'll do that.

Lollapallooza was this weekend and it was fun to at least go just outside the fence and watch the jumbotron and listen to the music.  Maybe next year we can buy tickets and go.  The weather right now is sunny and hot - to die for!  We've been keeping the windows open almost all weekend and it's been a great way to get a taste of the outside while we're inside working.

I'm missing the fam while they're away in Canada, but the pics they're sending me from over there are great.  Every pic looks like a Bob Ross (Joy of Painting!) original with a family member of mine in the foreground.  Haha it's great.  I'm looking forward to having them back so that I can call them whenever I want again.  Not having them in the States has taken a major part of my daily life out of the picture!!

Quick story about Bob Ross's Joy of Painting -- when I was little I watched Sesame Street A LOT.  In fact, at times eating was a no-go unless SS was on.  Well as I grew older (and after I learned to feed myself and turn on the TV myself) channel 13 (PBS) was my go-to channel.  And certain afternoons they played these marathons of Joy of Painting.  I'd be disappointed but at the same time transfixed by Bob Ross's soothing voice and the beautiful creations he made.  And EVERY time -- I fell asleep.  Like clockwork.  I'd always find myself waking up when the credits and music began to play.  A couple of times I was sick and stayed home from school... and his show would be the beginning of my afternoon naptime.  It's a nice memory.

OK!  More later!