The First Day

Palak Shah MD

I’ve had a lot of firsts in the last 30 years. Some of them mundane, some of them exhilarating, all of them necessary. Pertaining to this journey of medicine, however, there are no more numerous firsts as my “first days of school:” preschool, kindergarten, elementary school, junior high school, high school, college, graduate school, medical school and now….residency. I took a two-year hiatus from writing and reflecting because I needed to and wanted to. The whole point of this introspective journey and its public exhibition was to not lose my humanity. So then, in the past 2 years, have I regained what I thought I lost? I’m not sure, but in going through something harrowing and difficult as medical school and finally arriving at the end point of matching into my desired field in my desired location, I’ve realized, the journey feels a little cheapened without proper rumination concerning what it is I achieved and what was yet still left to achieve. In becoming a physician, my voyage may be finished from the vantage point of when I first started this blog some odd years ago but in so many ways, it is only just beginning. So here we go again as… “boats against the current, borne back ceaselessly into the past [and future].”

My Fail-safe

World War II Memorial

Word War II Memorial

A couple of weekends ago, I embarked on a spontaneous road trip to Washington DC. Having just completed 3 months of surgery, the surgery shelf, and my Step 2 CS, there were areas of my life that felt a little repressed from the iron heel of medicine. Escape doesn’t even begin to describe what I craved.  My friends were gracious enough to cancel their last-minute plans and take me on a tour of the sites. However, I often felt a little at odds when touring all of the war memorials. A waterfall, a statue, or  slab of stone erected in commemoration of an individual who long ago sacrificed their life for a cause doesn’t seem to do the sacrifice any justice. Of course, there’s no adequate repayment for anyone that gives up their life for a principle, but, all the same, it still feels a bit hollow.

Washington Memorial

Washington Monument seen from the Lincoln Memorial.

Upon walking through the World War II Memorial, we unknowingly approached a gathering to recognize the anniversary of D-Day, that fateful day where exactly 71 years ago, thousands of free men stormed the beaches of Normandy in a seemingly impossible mission to overtake the Nazis in the hopes of liberating Northern Europe. Perhaps being enshrouded in those stone pillars, ceremonial canopies, and golden stars signifying deaths in combat with those that survived the conflict fostered a deeper sense of appreciation and breathed life into the past, elucidating the magnitude of what it was that was being memorialized.

Even as I sauntered through history in Washington, I failed to recognize my own past. Five years ago at this time also marks a personal milestone for me: the start of this blog. With the myriad of photos I’ve taken and books I’ve read and posts I’ve written, this creative offspring of mine has far outgrown its purpose of simply documenting the trials of one person tackling graduate and medical school, but developed into an outlet and haven for reflection and expression. It’s been my fail-safe, something I’ve reverted back to in both times of indecision and uncertainty and moments of anticipation and exhilaration. Five years strong, I never really imagined I would ever have so much to share or revel in. Shah Blah Blah was supposed to be just for me, really, but in the end, it became the better version of me, perhaps grittier and far more eloquent than I could ever be in real-time.

Jefferson Memorial

Jefferson Memorial

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Dissecting Grief

My rotation through Internal Medicine started off with a month-long stint in the Intensive Care Unit (ICU). Names were often misleading in the hospital regarding what types of patients you were going to encounter; I would see patients strolling into the Emergency Room for the common cold and another patient with trauma and major parts of his hand missing to the “low-key” walk-in outpatient clinic. However, the ICU was perhaps the most aptly titled unit I had rotated through, and the experience was intense in more ways than one. Where I was often used to seeing ten different patients with one acute problem elsewhere, I now saw one patient with ten chronic problems here. Looking back now, the entire month was one big blur where days bled into one another, quick rounds turned into endurance-testing marathons, and one dysfunctional organ system precipitated the downfall of another, like dominoes.

The ICU renders itself as a gateway for the acutely and chronically weak, patient’s whose lives are literally placed in the mercy of a higher power: what that power is depends on who you ask. I would be lying however, if I didn’t admit that the ICU has a distinct aura of holiness. Family members often tiptoe and whisper in profound deference to the medical team and to the patients as if the patency of the patients’ airways depends directly on their ability to minimize all sound. All who enter seek antidotes for their crisis, a distress composed of both physical and emotional elements and sometimes, the emotional masquerading as physical. Replace the pews with endless stretchers, the stronghold confessional with a curtain-veiled bed, and a priest cloaked in black bearing a cross with a physician shrouded in white bearing a stethoscope. Trade religious fervor for actual fevers, church bells for code calls. Some find God in a stained glass, we see god in a CBC. What we lack in offering salvation and moral and spiritual guidance, we make reparations for by providing physical and mental relief often in the form of pharmacological deliverance.

However, just as prayers are often not enough, so are the limitations of science. What do you do when your knowledge is failing, your faith wavering? When you’re forced to make a home out of a barricade? Continue reading

Keep Calm and Think Zebras

The Tempest was one of the first plays I read while taking a crash course on all things Shakespearean in college. Prospero is a commander of nymphs, an engineer of enchantments and a conjurer of magic that is exiled onto a tropical island, using his talents for his own needs whether they be for vengeance or protection. Taking the opportunity to seek retribution upon a ship carrying those that banished him, Prospero, through the aid of his nymph, turns a placid sea into a roaring storm, capsizing and shipwrecking all on board. The pace of the emergency room often seems determined in the same capricious manner.  One minute, the day’s moving at a snail’s pace with non-urgent patients meandering in with a sore throat or two and minor discomfort, taking time for granted, when without warning, we’re slammed with a wave of burst appendices, pulsatile aneurysms, and aches from every inch. The divide between calm and chaos can be a fickle one, gossamer at best, and while we’re all attempting to maneuver our own way through Prospero’s devices, it’s easy to underestimate the full force of tumultuous tides when you’re in the midst of tranquil waters.

Six weeks of psychiatry followed by six weeks of emergency medicine resulted in twelve weeks of two very different types of chaos. One was more of an inner turmoil while the other presented as an outward maelstrom, while both settings challenged me to maintain my own course. The ER served as our habitat for most of both rotations (three weeks of psychiatry consults), where we identified the patient, evaluated their relative level of distress, and tried to extract a thorough history of present illness. However, that’s where the paths diverged. In psychiatry, we were taught to chase the stories—any significant life changes occur recently?, what caused your relapse?, can you tell me about your childhood?— while emergency medicine coached us to chase the symptoms—where is the pain?, when did it start?, how would you characterize it? 

Nevertheless, both fields advised us on becoming oriented to being disoriented. Some 20 years of lecture experience were swept by the wayside as I entered my first rotation, before I could even register how to transmute everything I learned in the classroom to the clinical setting. You stand helplessly as each and every day your comfort dissipates like ether from your clasp, doing the best with what you know and what you do not. The true wonders of medicine can’t be appreciated when it’s your first day as an MS3 against the gaggle of interns, fellows, and attendings who swiftly seem to know it all and do it better. Continue reading

The Eye of the Beholder

We’re taught to forever believe that there is never a price too high for our sanity, as if being normal is a prize all on its own. For all its acclaim, what exactly is sanity? It has to be more than just being not insane. I like to believe that somewhere between sanity and insanity, there’s a place where the music isn’t jarring or somnolent, but just right; a push-and-pull collateral between gaudy and subtle, stringent and supple, rare and overdone. And while assessing the state of being sane is slightly more complex than preparing a steak (says the vegetarian…), our minds merely do not operate at two different levels but on a continuous spectrum. Six weeks of enduring the psych wards in one of the busiest hospitals on the east coast made me realize that stipulating normalcy is like trying to standardize what people see when taking a Rorschach test; what is orthodox to one is unorthodox to another. Thus, the act of defining often becomes futile in face of all the components that defy the very definition.

The psychiatry field has taught me, if nothing else, that normalcy, not just beauty, is in the eye of the beholder; often times a diagnosis can be more of a question than a statement as no two bipolar, suicidal, or schizophrenic patients are ever the same. What started off as a frustrating aspect of psychiatry actually turned into something I appreciated in the field, as it is not only more engaging for a diagnostician, but helps you understand the intrinsic diversity each patient showcases regardless of their blanket diagnosis.

Schizophrenia is not just Leonardo DiCaprio weaving a world of his own on Scorsese’s Shutter Island, it’s also the 20-year-old student that has no change in expression or movement, and sits silently in the corner. Depression is not just immeasurable grief for unknown reasons, it’s the woman who learns to subsist for the past two years but still carries on with her daily routine. Bipolar is not just Bradley Cooper dramatically substituting drugs for love in Silver Linings Playbook, it’s an individual that is trying to grasp onto some form of stability without grandiosity and theatricality. Continue reading