Tuesday, April 12, 2016

Chapter 3: The one with the night medicine admitter

                The alarm goes off at four but all it does is remind me that I have to get out of bed; sleep has eluded me today. That glorious sunlight is the reason for this, it has been taunting me from the moment my head hit the pillow. “Come out and play Zeeshan, the weather is great and everybody is enjoying it!” Yeah yeah, I know.
                The shower is scalding hot  – nothing else will do for these weary bones. I stand there surrounded by steam and pray for a quiet night. A chance to nap for an hour or so…yeah that would be amazing.
                I catch the subway right before the doors close and tuck into a corner with my coffee and burrito. A man gets on at the next stop and implores everybody on the train to help him out with a dollar; times have been hard for him. I’ve heard his pitch countless times over the past three years while watching the track marks grow up and down his arms. Today is the first time I have seen him in three months and my sigh of relief is surprisingly loud. A few stops later I give him the burrito and step off the train.
                Lisa hands over the Schnook [1] pager as if it is demonic hot potato. “There’s four pending from Episcopal [2] and the ED has 30 in the waiting room, I’m sorry!” I know she feels  bad for me but it still can’t stop her from having a slight hop in her step on the way out.
                The night unfolds as promised: all four of those patients arrive at the same time. Things get frantic but after a little while it settles into an organized chaos. The emergency room hates that I try to fight every admission coming in and my night admitters hate me for caving in all the time. I never even have a chance to miss that burrito.
                In between this madness I get a call from a surgery intern on the other side of the hospital about a patient with chest pain. He is alone and wonders if I have the time to help him out.  I grab my papers and start walking, it feels good to stretch my legs. The patient still has chest pain when I get there and the nurse has just printed the EKG. Not too bad I think before realizing that tucked in the corner are some ST elevations. The patient sees how wide my eyes have become and starts to worry. I tell him everything will be fine and call Cardiology; a short while later, we wheel him to the Cath lab.
                Ten minutes pass and I am back in my fortress of solitude; the episode is all but forgotten. These admissions aren’t going to do themselves now are they? The night goes on and moments later I am staring at the sunrise over Philadelphia; beautiful.
                I hand over the Schnook pager and say hi to the heart patient on my way out to the subway. He is doing fine but a little annoyed that breakfast isn’t here yet. So am I.



[1] Schnook is a german word meaning "a person easily duped; a fool." Its the title we give to the person accepting medicine admissions at my hospital...because we are easily duped into accepting admissions.

[2] One of our smaller community hospitals; a lot of our admissions come from the Emergency Department (ED) here. 

                

Friday, February 5, 2016

Chapter 2: The one where it's lost in translation

      "Interpreter of Maladies" is a brilliant collection of short stories by Jhumpa Lahiri, but you do not have to take my word for it - it won the Pulitzer Prize for Fiction in 1999. My favorite story in the book, "The Third and Final Continent," is tucked away as the final chapter and tells the story of an immigrant from India as he tries to make it in the new world. Ms. Lahiri does a fantastic job in conveying his struggles but for me the story shines because it describes to some degree the tribulations that my parents went through when we first came to the United States. I am also technically an immigrant, I was seven years old when we left India, but I barely remember my life before America and while there might have been some growing pains, they were quickly forgotten. My parents are the ones who had to do the real fighting in a new land where the language was unfamiliar and the customs seemed so strange.
      Thus it should come as no surprise that the immigrant experience holds my attention more than most topics. I have always wondered what it must have been like to come to a new country and leave everything you have ever known thousands of miles behind. What if you don't speak the language? How can you get by when you can't even communicate with the people of your new land?
      Ask and you shall recieve.
      I landed in Vietnam with big expectations of myself, chief amongst them being that I would be able to assimilate quickly and easily. Travel is not new to me and usually conversation can be had without any big problems. I figured that a smile and a well delivered Xin Chao (hello) would go a long way. What I forgot to take into account was the fact that this time around I would be primarily working instead of sightseeing and would be far away from the tourist part of town. It is really easy to talk to people when you are on vacation, most of the time they are as well. Its a different story when you try to lead a normal life away in a whole new city.
      My first day of work went well enough, everybody was really friendly and welcomed me with warm words and embraces. All of the physicians and nurses spoke english and thus I had no problems communicating with them. At lunch time however, things started to change and I realized that I wasn't in Kansas anymore. Away from the restrictions of the ICU, everybody started to speak more candidly and very quickly in Vietnamese. I was by no means ignored, in fact everybody did their best to include me in their conversations. But the problem was that talking casually in English was not something that my gracious hosts were accustomed to and each time I tried to interject the conversation became painfully slow. I began to feel lonely.
      As the days carried on the feeling of isolation began to get deeper and deeper. There were never any major events where I felt that the people of my host country were actively rejecting me, instead it was the insidiousness of daily life that caused the problems. On the walk to work I pass by numerous street side food stalls yet ordering from them is insanely complicated. The standard Bahn Mi contains pork and trying to get one without it is really difficult in this part of town. Persistance pays off and I can usually get a fantastic egg only version of it but eating it reminds me of how much easier it is to do all of this back home. In fact everything is easier back home, why leave?
      Being homesick is a terrible malady and it had hit me full in the face. I did not expect this at all, I mean I love to travel! This was supposed to be an adventure in a far off land! Everyday I wake up thousands of miles from home without any idea what the day might hold....so why do I want to be in Philly so much? I imagine this is what every immigrant goes through, except on a much grander scale. Here I am being antsy about a temporary stint abroad whereas other people, like my parents, have left everything behind to come to a new land and see what it brings.
      This homesick feeling became unbearable and thus one day I decided to quell it and went on a hunt for the best Indian food in Ho Chi Minh City. A lot of my colleagues at work recommended a place downtown and off I went. "Tandoor" is a fairly high end restaurant and I felt at home from the moment my waiter, Mohammed Safi, said Salaam to me.  He realized that I spoke Urdu and immediately began talking very rapidly to me in our home language. I was shocked that somebody so young, he couldn't have been older than 25, was so far from home and so I asked Safi about how he found himself in Vietnam, it was a pretty fascinating story.
      Safi is one of ten children from a very poor family in Bangalore, India. He did fairly well in school and had plans to go to university but his family's financial situation demanded a more immediate way to make money. He spoke fluent english, which was a testament to his intelligence, and he heard that this would be a very usefull skill for him if he went abroad. He signed up with a job agency in his hometown and boarded a ship without any knowledge of where he was going to end up. The job he was hired for, being a tourguide in Singapore, did not work out and so he set off on his own. Thus at the tender age of 22, he found himself in Vietnam and ten days later had a job at Tandoor; he had been working there for two weeks when we met.
      To say that I was blown away by this was an understatement. Here I am griping about being homesick while Safi literally left his home not knowing where he was going to end up and no plans on going home in the foreseeable future. When asked how he had the courage to do this he told me "Zindagi meku ithar lahi, mujko malum nahi kyun. Gharku tho wapis nahi jasaktha, sablonge mere kaam se khana khare. Ithar rehjaunga, dhekinge kya hoinga. Inshallah sab kuch thik ho Jainga, ye din bohoth lambe hai magar sal kafi choteh hai." Translation: "Life brought me here, I dont know why. I can't go back home, everyone there needs the money I am sending back. Godwilling everything will be ok, these days are long but the years are short."
      The immigrant experience is a truly fascinating thing. Driven by great need they willingly leave everything behind and enter the great unknown. As Americans we romanticize the journey of the immigrant yet forget that it is inherently a very lonely story with many bumps before the dividents come in. This was the path that my parents took and I finally have a little bit of understanding into how difficult it was. I am now more impressed with my parents, and immigrants in general, than I ever was.
      I am not an immigrant to this wonderful country, my experience will never be as harsh or scary as Safi's. Therefore I should not spend a single minute pining over home, especially since I will be back there soon enough. This is an adventure, I'm going to start treating it like one.

Wednesday, January 20, 2016

Chapter 1: The one with the Visa issues, gonna need tissues


     I have never been able to sleep well the night before a big trip. My mind races with tasks that are not yet accomplished and I end up spending the night worrying about all the different ways the trip will go wrong. Jitters...man I hate them. Turns out that this time around the jitters were completely justified: I messed up in a bad way.
My flight to Ho Chi Minh was supposed to leave on Saturday, January 16 at 3:30 PM.  I arrived at JFK at 1 PM and found myself at the back of a very long queue at the China Eastern Airlines check in desk. Naturally, since I am a millenial, I used this opportunity to pull out my external brain and started texting my family and friends. Everybody was really excited for me and I was beginning to get really psyched for the trip. My mother was of course terrified and was really hoping that I would just cancel the trip and stay home. She almost got her wish.
     It started with an innocent text from my sister, Khatija. "Got everything in order? Visa all set to go?" I had a pretty good laugh at that, of course I was ready, I AM BORN TO TRAVEL! But what did she say about that visa? I sent her a quick message and asked if she was joking about the Visa.
     NOPE.
     I had read online that Vietnam had Visa on arrival, meaning I did not have to do anything in advance. Turns out that I was completely wrong. As my sister explained to me, Visa on arrival only meant that the visa would be processed once you got to Vietnam but in order to get processed, you needed a Visa pre-approval BEFORE you got there.
     I was DEVASTATED! It was 2 PM by this point, which meant that it was 2 AM on a sunday in Vietnam and no government office was open. I briefly contemplated getting on the flight and just figuring it out as I went but the airline advised heavily against it. Apparently Vietnam has no problem deporting you the moment you land and it has been known to happen on a very regular basis. I begrudgingly called up the people at Chase (since I had booked the flight via credit card points) and they set me up for a flight that departed in three days, on the 19th.
     To say that my trip back to Manhattan was depressing would be an understatement. There was a distinct gray tinge in the air and I felt terrible in every way imaginable. How could I be so stupid? Who in their right mind forgets to get a visa? Is this a center for ants??? All these questions and more kept boring into my mind as I rode the A train out of Queens and into Manhattan. The circuitous route that the train took felt like a great metaphor for the way this trip had gone so far...and I wasnt even out of the country yet!
     The day after I was rejected at the airport it started snowing in Manhattan. Instantaneously the city transformed into a magical snowglobe and my sadness seemed to whisk away. I felt compelled to walk/dance my way through the perfect snowy central park landscape and arrived unscripted at the gift shop at the Tavern on the Green. My hands were freezing and it seemed as good a place as any to warm up. The cashier at the gift shop saw my snow covered outline and let out a good laugh, he knew I wasnt there to buy anything but welcomed the company. Through the course of our conversation, I brought up my visa bungle and he gave me his sincerest condolences. As our conversation kept going he became more and more apologetic towards me and it was then that I realized that I was done being upset about this.
     The whole episode got me to thinking about how unplanned my journey into medicine has been and thus far things have somehow figured themselves out. I should have gone straight from college into medical school, but I decided to try my hand at selling cars first. Once I got into medical school I was convinced that surgery was the way to go and I did everything humanly possible to get myself into it....only to back out at the last moment and commit to internal medicine. Within internal medicine, I knew that cardiology was my destiny yet I found myself gleefully applying for pulmonary and critical care. And here I am, ready to start fellowship in 5 short months and the thing I am looking forward to the most is what unexpected turn I will take next.
     I returned to the airport on January 19th and this time I was prepared. The flights were uneventful and before I knew it I had arrived in Saigon. I reflected on the wierd detour that I took to get here and realized that at least I got to experience a proper winter in the city, who knows, it might not snow again for a long long time. But the past is the past, lets have some fun in Vietnam!