So you’re a doc, a foreign cuisine and Corona happened (After vaccinations)

As you may know, I have been a strong advocate for COVID vaccination throughout the pandemic.  On 8th December 2020, a 90 year old from Coventry became the first person to be vaccinated in the NHS. Following that, the campaign for mass vaccination was gradually rolled out to everyone in the UK and with a huge success rate. 

Collectively, we let out a big sigh of relief when the vaccine was introduced to us, following its clinical approval by WHO. It came as a ‘first break,’ from the crunching back pain we were starting to struggle with from the physical and emotional burdens of various sorts that were piling one after another over us. I applaud each of my colleagues and all the essential workers for holding their face up and showing up to work diligently despite those struggles gripping them on their backs. 

In my daily practice, without fail, I have encouraged all of my patients to get vaccinated.  I would say the same for my colleagues. We got vaccinated first ourselves, as we were the primary line of defense between an infected individual and the rest of the community. As I may have mentioned, some of us did have some degree of reservations, as the nature of urgency by which the vaccine had to be developed meant it probably didn’t go through enough rigorous examinations for the risks it might potentially cause versus the curative aspect the drug was providing. At the time, it was important that we kept the faith in our scientists, the field experts and this miracle drug, ‘the vaccine’ they had invented. History says, faith in them saved thousands of us from death, disabilities and deformities.  

Amidst the first wave of pandemic, we were desperate to take control of the situation. From the dreadful outlook charted by the steeply rising death tolls. Morgues couldn’t hold enough corpses. Deaths in communities were slow to report, as some had passed away, alone in their homes while trying to stay away in isolation from clasps of Covid. We didn’t know anything about it, for what felt like ages in the beginning. A lot of things we did learn were picked up from watching vigilantly around us. As it happens in the world of medicine, tallying symptoms, signs and parameters of one patient with another.  Unfortunately in most cases those that died. Why did that patient die? What can we avoid, what can we do to prevent it, how do we know if someone is heading towards a late stage, at what point do we embrace ourselves for it and notify the family? What can we learn from this case so we can save another. 

Only later when they discovered COVID transmission was mainly air borne, it confirmed the suspicion my colleague was raising, why two unrelated wards were having covid outbreaks. The air vents were connected. 

We have come to a time now where we no longer fear COVID to an extent we did in the first wave. We have learned as many of the variants as we could have, about this constantly mutating virus itself and the changing vaccinations combinations we had been administered in the period.    Outbreaks of flu are getting more common and causing more admissions of the aging population now and as clinicians, for COVID we are more focused on infection precautions like personal protection measures & isolation for 10 days. 

We have entered phase 4 of the trial in a sense. Like that for most medicines available out there in the market. Phase 4 trial for any drug means, this is a period where the drug that has proven its efficacy, has been licensed for use by relevant control boards for intended purpose will now be studied on its effects- mainly long term risks and benefits. This is the period where data will be coming in and collected in mass about the minor/major adverse effects/ side effects experienced, complications and sequelae secondary to it. A drug may have completed its phase 4 on research however one can assume phase 4 in the clinical world runs forever. A drug may have certain side effects for a small duration period but may have a completely different adverse effect after years of use on the same patient. By virtue of collective toxicity over prolonged use or by modifying effect of some other medication he might be using concurrently or by adaptation in some forms by his genetics or as his function of organs changes. For example with age our kidney function deteriorates physiologically. That is why our guidelines even for first line drugs after many years of use often changes. When the data collected after long years maybe even decades, prove that the harm outweighs benefits in the contrary of beliefs, it has to be. The drug will either be taken off the market then, used in other diseases where success has been crucial for patients or as a specialist prescription. Every medicine you take comes with a leaflet of  its intended use and series of effects. 

There had been uproars about violation of individual liberties in many instances. Including government mandated vaccinations that was rolled out for frontline workers with patient facing jobs, with risk of dismissal in most cases and possible redeployment if there was resistance. Legal enforcement of activities as such have led and continues to lead communities marching against protest for breach of their human rights. I must say, although I had never been a big supporter of those marches, especially if it meant less vaccinations in the community at the time of outbreak, mandation by law with no redundancy plans for those who wish to leave spoke volumes of where we stood in roles in the scheme of big picture. In world war one, 97% of British soldiers were inoculated with anti typhoid vaccination. Articles I have read infers that most did not know they had the right to refuse it. And although it prevented deaths and infection by typhoid at the time of sanitary status of the wars; military approaches for domination, affirmation, experimentation without consideration of individual choice and rationale for refusing it in the name of greater glory for the service of mankind, is unacceptable. How many have been trialed since? Ideal candidates of the right age in full physical fitness in a controlled environment. The risk here is reinstallment and propagation of the same behaviour in future, mass human trials, without a second of thought for ethical implications of it? 

Most of us experienced local pain, fever, headache and general myalgia with our vaccinations. Similarly, some people had allergic reactions. It is important to remember these vaccines act by modulating your immune system so these effects were to be expected. Most effects were noted in the first few months as that is when immune system is maximally activated against the insult. The later effects, if any because of these insults,  may take time to show. There have been circulating reports of various adverse effects experienced attributed to Covid vaccine although the argument is, they could possibly be related to covid 19 infection itself or subclinical infection prior to vaccination as well that he/she did not demonstrate any symptoms of. Blood clots were detected quite early. Studies are now showing, there has been an increased incidence of neurological conditions like guillain barre syndrome, bell’s palsy. Some reports of inflammation in the muscles of the heart. People’s story of their own experiences with vaccinations are coming forward. Like its impact on fertility after experiencing menstrual irregularities, generalised fatigues, recurrent headaches etc. Accounts from brave whistle blowers are coming forward. There is ongoing world wide surveillance and reporting of the adverse reactions, which I hope will be duly studied before dismissing as mass hysteria.

It is important to be transparent, now more than ever, to keep communities’ faith in our profession, and our continuing faith in scientific advances, pharmacological companies, world leader platforms and the government. And most importantly, it is vital that people standing in power including the government work on their approach to reinforcing the means of ‘greater good’ with respect to individual’s liberty in mind. Endemic, epidemics and pandemics are part of human history. Like seasons have their cycle and place in nature, unless there are outbreaks of bio hazards due to human errors, we should expect nature will find us surprises along our course.

So you’re a doc, a foreign cuisine and Corona happened. (Why the beginning? )

‘Hey doctor, did you forget to change your face mask?’ Our nurse in charge stopped me before hopping from one cubicle to another cubicle to see COVID patients. ‘Oh, sorry’, I replied immediately, laughing at my forgetfulness. Remembering the time, in the midst of a pandemic when I splashed water in my face without realising I had a mask on.

It is February 28th/2023 today and ‘No, COVID hasn’t gone away yet’. But as I have claimed before, it isn’t as intimidating as it used to be. Juggling your memory again, ‘remember that time? December 2019? When city of Wuhan in China first went into lock down to control the deadly virus from spreading elsewhere.’

I started writing amidst of pandemic waves. Overtime I have talked about lots of things. The beginning of all these parrot tale was a silly story which I have mentioned before. Basically I had a dream. I don’t remember the details of it now, but I do recall ‘sort of being instructed to write’ and ‘sort of being introduced to this title’ and, ‘feeling good about scribbling something in my dream that I have no clue what it was.’ The memory of it is all vague, it has been more than a year. But I do remember mentioning to my ex saying, ‘I feel like I need to write about this, about this pandemic’, that morning. I don’t know if he has any recollection of it. People have all sort of dreams. My friend mentioned once she had a dream where she was a flying ninja fighting crime in the city. Like who sees that? Is that normal? Something about this one though, it planted a sincere and undying motivation, almost like a promise to myself, to sit in front of laptop and start hitting the keys every chance I get, no matter how tired or lazy I felt. I didn’t know where to start but I had to. Am I religious? I don’t know. Is there God? I believe there is. In that case, do I think it’s God’s message then? Certainly not, I wouldn’t go that far. Bonkers! Experts believe, ‘dreams are revelations of your subconscious minds.’ Maybe, somehow I found a way to tap into mine that night.

It was a work at first. I didn’t want to jot the bleak situation of hospital capacities, circumstances of deaths with the virus infection, forlorn eyes of mourning individuals, resentful words of grief stricken families, hateful comments with racial slurs, fears for own health & families safety and physical/emotional burnouts; but those were the realities. Re-living the emotional experience whilst writing when I could push it and shove it down, like an adult, never to be spoken about; may have been an option but I chose not to do so. 12- 13 posts down the line, writing became more easier, sort of a way of venting to express myself and I suppose at that point, it started becoming a selfish endeavour to save myself.

My intention in some ways was also to give ‘the readers’, a peek of life of a medic. A glimpse away to lives inside hospital walls, the ups and downs we face in our career living up to our responsibilities and in our personal lives; in a hope that you see these individuals not just as a professionals but also as a son or a daughter, your friend or your colleague, your uncles or aunts or your father or mother. That you are kind to them. ‘Yes every profession deserves a kindness’, I am not here requesting any more ‘just at a level you would give any individual at your standing.’ The world seems to have forgotten that as a medic in our profession, ‘we deserve some humility and respect too’.

‘No, it is not right that you curse the nurse in front of zillion other patients when she is not answering your call. She is looking after 9 more patients on her own and, is currently on a drug round. ‘

‘Yes, he does have right to not forgive you after the temper tantrum you have shown for your quote *had a bad sleep*’.

‘We do have every right to refuse to treat you as a doctor as you have a right to be refused being treated by us’.

‘Please cover yourself. It is basic human decency. Not to flash your breasts or penises when we are specifically not examining those parts’.

‘We will attend you, however there are long list of patients waiting before you, unless it is a life threatening emergency. We need not tolerate emotional or physical intimidation because you want to jump the queue’.

And most importantly. ‘No you do not get any excuse to rain down on another individual just because you are sad, lonely, angry or in pain.‘ Would you have tolerated it, if it happened to you in your profession? Why are we any different?

I ask you, would you kindly see me or my colleagues beyond our stethescope on our necks and our badges reading ‘doctors’ and accept us like any other individuals in society with running clocks of our own private lives? Just as you? We are men and women in careers, each one of us with our own personalities and a background of running commentary. Would you see us as humans too? Yes we have certainly adapted to restraining our emotions but we still feel. Your expressions whether its happiness or anger, affects our days. At the end of the day, we do take a lot of emotions back to our homes. We do need a period to switch off, unwind, hit the power button and recaliberate ourselves. It is not fair to be expected to be available 24/7 like movie industries portrays our commitment to profession should be like. It is not fashionable, as it seems. Please don’t expect us to stay another hour individually for your service especially to vent about receiving minimal service and threatening to leave.

The number of hospital admission have sky rocketed compared to 10 years ago in the NHS, I am sure so is the case all around the world. Quality of life has improved on various domains of people’s lives including work environment but I am not sure if that has been the case in our profession. My seniors could argue ‘our lives is much better now’ but, that would be like me arguing ‘quality of children’s lives is much better now’. Children now don’t even know if they are humans or goats. And schools are entertaining drag shows to kindergartners. Look where we are standing in human history.

On 13th March, Doctors in England are doing a 72 hour mass walk out as an industrial action for pay restoration. In the past, I had commented in my post that doctors and nurses were being paid less in significant percentage than they were being paid in these profession, years prior. My phone is blinking continuously now from constant messages posted on junior doctor’s forums, mainly sharing information from different trusts that are releasing intimidating messages to their employees suggesting their will be consequences for their actions. Disciplinary actions, loss of pays. So, everyone including me who has just joined a new hospital in a new rotation are basically sitting on hot seats now.

I came across a very interesting post on tiktok. (Oh yes, since I have returned from Nepal. Now I have started using tiktok. hahahaha). The post (Huw Corness) on 02/Jan 2023 reads ‘When I qualified as a nurse in 2010 my basic hourly wage was £10.83 and freddos were 10p so I was paid 108 freddos an hour. The nurses who qualify now start on £13.84 an hour and freddos are 25p so they are paid 55 freddos an hour’. I hope this gives you some idea of why it is necessary to stand in unity for support. Not to forget, our profession undoubtedly is a big chunk where tax revenue comes from.

You don’t have to necessarily support the cause. I will agree there are plenty jobs which deserves more limelight than us. That I have utmost respect for. But I hope, you will keep in mind when you enter the hospital premises next time that these are the professionals that are trying their best to their jobs, to provide you with help that you came seeking for, at their doors. You are not a prisoner unless of course you were brought in handcuffs by the police. As much as we treat you individually and with respect, please’ remember to reciprocate.

So you’re a doc, a foreign cuisine and Corona happened. (Bye bye 2022. With love. Part 6)

There was a time when thinking about attending social functions like dinner, birthday parties, weddings; I had to gauge ‘is it worth it for the loss of my day for laundry, netflix and personal time.  Should I catch up on my sleep till late morning or make arrangements for the trip? Would the day be better spent catching up to my emails? Darn, my exam is only a few weeks away. I feel quite tired, I don’t think I will be able to enjoy it even if I made a show.’  Only a few absolutes were in my list that I wouldn’t allow myself to talk out of; everything else was secondary to the job/career. No thoughts were involved. ‘Thinking, then overthinking’ that was a downhill slope I was trying to avoid. 

A friend of mine who has been back to training from her career break went awol on us for a few days recently on whatsapp. Very unlike her. When we caught up, she said, she felt she was starting to experience burn out again. Good thing is, she was recognising the signs early. We didn’t mind. Amongst us, all of us have been in that place. Where we are trying to focus just on the task forward, a step at a time, everyone else & everything else will have to wait for us to have that space. The other said, she has been assessed. Would need at least 16-24 private sessions with psych to help her through it ‘depression and burnouts’. 60£ an hour. ‘Nhs waiting list is long. I had to go private. But even if it is around 1K, which will be more expensive with additional sessions, I don’t have the time’. All of us knew it was going to be hard when we entered the profession. All of us felt it would be manageable. Sometimes, it’s evidently proving more difficult than we expected. I feel blessed to have this support network of friends in the same profession as I am. Someone to speak our minds clearly with, someone who understands when one of us quotes, ‘I just feel bitter sometimes. Sometimes I feel I hate my job’. 

 ‘Easy things that I shouldn’t even be stressing about like the thought of waking early and not being on time for work stresses me out,’ my roommate said. ‘Even in my dreams I am chasing after the bus. I feel sad at the thought of it.’ Again, I can completely relate to her. Sometimes I wake up from sleep having heard the oncall bleep go off, at home, when I am off duty! Sharing  experiences like that to one another, trust me, earns you good long term friends. If you haven’t yet found it, there you go. One of the main advantages of our profession. I am soon going to be a bridesmaid for a beautiful bride-to-be, who I met first as colleague 5 years ago, 2 hospital jobs prior. 

Lots of lives changed due to the pandemic. In many ways mine too. I feel like, had it not pushed me to the edge, I would have still been a foolhardy person trying day & night to soak up all the stress, suppress all the frustrations and continue. I would have tried to put on a brave face as well and signed up to more hospital  training for ‘resilience, time management, working under stressful environment’ perhaps while losing internal integrity of myself. We all have read, friends of the deceased say ‘we didn’t have a clue. He was always on time, smiling and cheerful at work’. There are always subtle hints, I think, but we are too busy looking more into them.

I completely unrooted myself from one country to integrate into the society of a different country, navigating through my life while accepting English will be my tongue from here forward. In a profession of learned and intellectual individuals with graduates from Oxford, Harvard  when language fails, it is hard to avoid the first judgement. Inevitable, I would say. ‘So we push ourselves way harder, maybe to prove our worth’ I seem to agree with Dr Gabor Mate on this. Confidence overtime feels dimming down slowly, trying to fit in, in all the boxes.

I don’t think it was ever about resilience; the world I have seen, things I have been through, the degree of patience I had to have to be here where I am. I know the word very well. I have pinned the main issue  now; for me problem was  losing my head space to think, feeling trapped in a continuum and losing my own identity. Coming from a family where my parents were; farmers then into the military, trust me when I said ‘I am stressed’ I was swallowing my pride asking for that help. I wouldn’t have. If I hadn’t realised, everything that was inside me was manifesting around me. I think the pandemic did do me a big favor in that sense. And looking back I only take that experience as a big learning phase about finding myself. As my friend did, I am now able to recognise the early signs.

Of course, NHS is ever so busy. And the job is stressful as 99% of my colleagues would agree. Here is the catch, hadn’t it been so stressful, would everyone around us not have pursued it? What I mean when I say it, being an eye opener, was finding out where my limit of stress tolerance was, what are the red lights for me, what do I need to watch out from here forward? And having been through it now, what could I have done, what can be done to avoid similar in future. 

I managed to get the support I needed from my superiors and the training programme director in time. This is why choosing a region to train was very important to me and I advise, should be the main thing a graduate should be looking into. I doubt if I was a trainee in the West Midlands, I would have got the same level of help. With a lot of trainees deferring themselves from the system, hospital trusts are trying to be more accommodating now to trainee’s needs but it often seems to be optional, not necessarily the case with the system being in pressure to run 24/7. Nevertheless I would advise, please reach out, one would never know where and what help you can get unless you ask. Hopefully you will at least find someone to signpost you.

My returning objective now back to work and to training  is to protect my headspace at any cost. Of course to pass the exam, pass the year but also to aim to completely segregate my professional from personal life. It can be difficult, unfortunately we are not computers to hit the refresh button, but knowing this is a ‘must to do’ is helpful.  One thing I have done to secure this is, I am returning back as a trainee at 80% part time. 20% ‘out’ is to work on my personal goals. I am a person outside of my career with lots of roles; as a daughter, a sister, a friend, a girlfriend, a neighbor. To have what I want to keep while making sure I maintain at top of my productivity, cutting down on my hours was a necessary sacrifice. Particularly because this is also the time I have chosen to work on being a better version of me. Carve out those gaps that makes me feel insecure about myself. Like culinary skills. I may not become a chef but at least be able to cook a few healthy lunches/dinners to invite friends over right? Instead of ordering takeaways every time? How am I Nepalese without knowing how to make dumplings? Definitely, this year I will be investing in driving.  Then I could just drive myself anywhere, take myself to beaches, sightseeing, for the long drives, my family to picnic, road trips.  Moving around and packing my life into boxes wouldn’t be so much hassle anymore. And then there are lots of travel plans. 

I follow Jim Rohn’s motivational speeches on various topics relating to achieving success and living a better life on Youtube. The man speaks of nothing but golden words. Even his random utterance is probably worth a thousand dollar bill for commoners like me, filled with life changing advice. Just the other day I was tuned to one of his videos where I heard him say, ‘the major question to ask on a job is not what are you getting but what you are becoming?’  ‘Focus on your personal development. The major key to your better future is you’. He had emphasised.  ‘Work on your attitude, philosophy, personality, language, gift of communication, work on all your abilities’. 

There are hours of brilliant speeches out there from him. Here are other quotes from his talk called ‘Recharge your mind’, that I have copied here which I will use as mantras to guide my future.

‘You can’t change the winters, you can’t change the seasons but you can change yourself. You can get wiser, stronger and better’. 

‘Learn to take advantage of the spring. You got to seize it with your own two hands. There is a sense of urgency here. Don’t waste your springs, don’t just let them pass, pass, pass hoping time will pass.’ 

‘And in summer learn to protect, nourish and to do battles with your enemies. Some of the enemies are outside, some of them are inside’. 

I feel confident about continuing to sail my life to a positive direction. No babies in the plan for another year, no rings in the finger, paying salary, yeah I can buy myself flowers… I feel more accepting of myself ‘as a whole’. I appreciate the concoction I have become with fusion of both the worlds, absorbing best of the both countries across the globe. I don’t feel threatened anymore thinking my uniqueness as my weakness, like my ex used to say ‘exotic’, I have discovered in my eccentricity there is in fact power. Overall standing here in 2023,  the picture forward looks amazing. This is definitely a year for me, to march forward and conquer. Be the queen I was born to be.

So you’re a doc, a foreign cuisine and Corona happened. (Bye bye 2022. With love. Part 5)

So, I had a chance to visit Nepal during my 6 month break. The trip was short but had an amazing time. Met family and friends, went around for small trips to my favorite places. Good to know those places hadn’t changed much, kind of gives a stability to one’s memories for flashbacks. Like saying, ‘remember Mangalbazar where we used to sit down around durbar square for local tea? Yeah let’s go there’. Had momos ‘nepalese dumplings’. Lots of them everyday as much as I could. Anything else could wait another year or so if I didn’t get to stuff in this time! Cousins and related brothers & sisters had all grown up. Most of them were taller than me, some of them I couldn’t even recognise at first instance. Boys were all husky & hoarse with one or two sprouts of beard and moustache here and there. As for most mongolian asian men, that will be the most any of them will grow. But Omg their skins were clearer than mine! Girls that were once very much tomboyish now were very feminine with curvy bodies, long hairs and nail polishes & acrylic paints. Made me laugh and almost choke on my food at a party when I heard one of those boys now training to compete for Gurkha recruitment saying to his other mates, who are also his cousins, about the girls he was interested in. A couple of them! Particularly one he wished to court around to get attention and his plans for marrying her. Basically locking her into a relationship before going away! The way these boys think! Hahahaha. I am rooting for him but at the same time, a part of me also doesn’t want the girl to fall for him because I know where this route most often ends. Not uncommon for boys being head & heels in teens, jumping into marriage and then on his late 20’s or even 30’s sprouting other half of their brain; developing maturity and saying, ‘That was a foolish decision. We have nothing in common (after having children!). I have met the right woman now whom I want to marry’.  All good if he had the guts to come out open and be honest, but he thinks ‘as long as two women don’t meet’, he might be able to wing it off as long as it lasts. 2 wives in 2 different countries. Not just tragic for women, trust me, often tragic for men too.

Watched my girls all grown up, be adult women with their babies on laps. Got a ‘baby fever’, I think my hormones really got a good kick from my ovaries, protesting my stand against ‘overload of cuteness’ production. Feels like the instincts are kicking in now slowly, I didn’t think that would ever be the situation when I was growing up as a full fledged tomboy. Only ever held babies by choice in the past couple of years. Before that, I always had excuses. Don’t know how I ever got through pediatric rotation staying at least a meter away from them. I guess the trick was, always to pair up with a colleague who had powerful maternal skills and let them handle the baby while you chatted to their parents, do the charts and other things. 

They are wonderful moms. It boosts up a slight confidence in me now observing them. They tell me they don’t know anything about taking care of him or her but it seems to me they are doing a fine job. A little panicky now and then, a little anxious but all fine. Each one of them married great partners, all of whom seem to be wonderful dads. Most of my girls  met their husbands in medical school, others while in training and one pair since high school. So, knowing their husbands as friends since when I was a teen myself is very reassuring. It was an even more wonderful feeling in a sense that not only did I watch my girls be mothers and take these roles as adults but, I also had the opportunity to see colleagues/ friends assume their roles as fathers. Those girls were crazy, innocent at the same time, smart but a little socially challenged compared to other girls our age. And we did oh so many many stupid things. Did many happy dances, had cold wars… The list goes on and on. School was fun, thanks to the girls. Didn’t matter how tough it was, we pulled each other, shared notes together, covered for each other’s absences and when we passed each year we celebrated hard. Our big celebration being, sitting down with a few bottles of alcohol, drinking and dancing. Locking down the main girls dorm so that none of the crazy hens got out in the middle of night. Sometimes we’d go out for fancy dinners burrowing eachothers clothes, each one of us working on the other’s hair straightening or curling it. Oh my friends are definitely still crazy!  They still got those eyes but now, they have learnt to camouflage it better. A part of me was a little worried, they might have changed, but nah! We just got more babies in the picture. 

A twang of mild jealousy sure! Genuinely very happy for them but reminded me of my own little heartbreaks, bites away from my self worth and began questioning each one of my decisions. Took some days to reevaluate where I stand and,  I have come to the conclusion that, ‘I am actually glad I did not achieve some of these milestones. I will reach there when I am meant to get there and honestly, I don’t feel ready now at all. I don’t doubt anymore I will make a good mother. The world feels a better place having met amazing new parents who are genuinely great humans’.

‘When I made those goals, I was young. I didn’t account for my circumstances, for the hurdles I was going to encounter, the faded lines of the lanes that would cross on one and the other, here and there. I didn’t account for the times I had to stop to rest, to redirect myself, to self-talk and to keep pushing forward. There is no reason for me to feel that way, my friends’ journeys are not mine. We had different beginnings, throughout lives we have different paths and we will have different endings. Had to knock my head a little to tell myself ‘Don’t be a loser like that. Jealous of your own friends? Did I hear you were a little jealous of your own ex as well? Why? No, no, don’t be one of those losers. Passing time gossiping about others, catching on each other’s legs. Don’t waste time like that. Be happy for them. Work on your own insecurities so, you don’t give yourself a reason to feel that way’. 

And that’s the thing. ‘Working on my insecurities.’ As I have confessed many times before, I felt, my mind was all fogged, jumbled in a mess. It was like a cluttered room where I collected one more thing, dumped it there and just closed the door behind. Anxious that the room existed, even more anxious at the idea of sorting it out. Being back in the place where I previously was, with my friends who are very much the same;  reminded me where I came from and who I was. It helps, doesn’t matter what the mess looks like or the extent of it, but to know where at least the start of the mess is, because all you then do is follow the string and untangle it slowly. I see the problems here, here and here. What can I do for the solutions? What is my priority? What am I willing to lose for what I have to gain? What is it that I want? 

It’s okay, if you don’t know what you want for yourself yet. I will advise you to follow a route, keep track, rather than being absent minded and being nowhere. At least that way, by rule of exclusion, you will know whether the route you are following is definitely what you want to pursue. Goal at the end is finding happiness. To each of us, our definition of happiness is very different.

So you’re a doc, a foreign cuisine and Corona happened. (Bye bye 2022. With love. Part 1 )

Hello year 2023! I hope you bring health and happiness to everyone around the world. I am grateful to year 2022 for amazing memories with friends and families, for my emotional well being & mental space; to be able to  recuperate and find myself again. As I filled in the diary with a list of resolutions yesterday, I realised I was getting bolder with my ambitions and positively confident of the future; there was almost a moment of ecstasy when I felt for the first time in many years the haze in mind had completely gone. For the past few years, I had been feeling like I was walking just on muscle memories following a repeated routine, like there was a fog in my vision, there was a mental block in my clarity. And irrespective of the days and hours I took to repair my thoughts, to put them in words, to study myself under a magnifying glass, to self heal, to be in-charge again; it felt as though I was patching a leak over and over again. Waking up in the morning of 2023, I feel like a fresh new tire, ready to roll. 

At some point in my life, I started to develop this tradition of reflecting on the last days of the year. Looking back at my last post on the blog, I recalled some conversation I recently had with my parents about the rights of women. ‘It is wrong’, I had said while watching another news report of an Iranian activist walking on the street in protest for abuse against women. ‘You shouldn’t concern yourself with this’, my dad had said. ‘It is wrong. Yes. We all agree there is a culture of domination against women in certain countries but you also have to understand that these women are used to wearing hijabs and to their places at home, mosques and in society. For years. They were in acceptance of the restrictions implied to them. If it is in their religion, you and all people should learn to respect it.’ I didn’t understand why there was a question of respect raised here. I didn’t personally agree I was disrespecting anyone or their religion. So I was commenting to my dad ‘No, I didn’t mean…’

But in the middle of the conversation, my mom stopped me. She said, ‘I hope it works out for them. But compare an arabic woman, Iranian lets say to a western woman here. Decently dressed to one with a piece of rope between their bottoms and walking on the street. She may say, she didn’t intend to grab attention but oh she will. Dressing provocatively like that. Too much freedom, a dress like that if it’s even a dress speaks for itself speaks for her attitude. It makes a woman lose her values. Between those two women, who do you think has my respect? Who do you think I will stop to think again before I say anything or speak to? Religion is respect, it grounds you to society and its values’. ‘Mom I understand that, I am not saying walking naked down in public is okay, I am saying…’ ‘Stop’. Both of my parents  made a face which over the years I have come to understand means ‘no further discussion from here’. When I was a kid, any further from this would have got me some whooping, now I am an adult woman. Still, I keep quiet. 

It’s hard to explain the frustration I felt, the discrepancies I felt of women’s value there, in parts of my country and here. There I used to feel like saying, ‘Oh come on, step up, fight for yourself’; here I feel like saying ‘Oh come on notch it down a little’. I was not surprised mom shut me down, but a little disappointed that she did. When she taught me my whole life, never back down what you believe in. Without saying, ofcourse, how you dress matters. But one should be able to wear whatever one is comfortable with. It would be nice to walk in shorts without having 1000 eyes on you when it’s hot and sweaty and sticky inside pants and it’s 29/30 degrees outside. Everyone has legs, it is only legs. I have just recently got back from my holiday in Nepal. Not that I didn’t know, but it hits different. Re-acknowledging the truth of how different people’s attitudes are in the world there and here. I wouldn’t feel safe walking alone at 8pm there. Here with our work rota, I used to have to walk 2am in the middle of night at home. And it still felt safer than there honestly.

Half an hour down 2023, Ukraine has been attacked by Russia, miles and miles away. While most people in most countries are at home enjoying a feast, young adults are hanging out at pubs and teens are partying at the clubs; nuclear weapons are being tested and military troops are getting organised somewhere else. An impending doom is looming over everyone’s head ,‘world war 3 is coming’ like Trump says. It has been a constant hum on the background in our routine lives for most part of 2022 I suppose. I hate what these world leaders are doing but again, wasn’t it inevitable? Looking at how the world was running for many years? There was a power play, mostly on one side. Scavenging for resources. Like every force in nature, balance needs to be restored and eventually nature will find a way.  It is sad, for humans, they are their own predators. Knives, Bombs and guns. Only humans can slaughter millions of themselves in one go. A rampaging elephant could have only murdered 5-6 people at most. She has found her perfect tool. Although wouldn’t you say, did hail plenty fury on us this year? With floods & droughts, wildfires, earthquakes and storms. Videos of the great blizzard of 2022, Buffalo New york are still circulating. Hope and pray, she calms down. And 2023 will see none of those.

AS for the war, it should not be the way to go ahead. But I salute men who have lost their lives for their countries. I salute even Putin for standing in his corner. There is honour and pride. Maybe this is military blood on me. But the world will hate him and Zelenskyy like I will, if we lose our lives & our loved ones all around the world because countries of 2 leaders could not come to an agreement in their dispute of a territory and could not shake their backs off & free their hands off the puppet masters. Ego is not the same as pride. Especially after the years we had in 2020 and 2021!

Restrictions are again being imposed by numerous countries on international travellers from China where cases of COVID have rapidly risen again after Covid quarantine & rules were lifted in the country. After 3 years of lockdown. Cannot believe how people there were coping with it? If you have followed my diary, without a doubt you know, I was in shambles.  It was sad watching updates on social media platforms showing people screaming out from their windows in apartments from one block to another, the drones constantly hovering around on the watch, people being forced to still remain inside. Thought finally it was getting over and here we go… Good news is ‘living with covid policy’ seems to be working here in the UK. Even with patients in hospital admission, most of those who have tested positive are usually incidental. I am more worried of a flu than COVID now. Honestly 🙂

You do You (So you’re a doc, a foreign cuisine and Corona happened)

So, on my last visit, my dad said to me ‘when you go back to Nepal, would you give a call or have a chat with our neighbour’s son who is also a doctor. I met his father and we had a talk. I said, I will let you know. You also know him. I think he was a few years senior to you.’

‘No, I don’t’. I replied, cautiously and also a bit surprised because it has been quite a while since any of my parents wanted me to meet someone. I did drop a hint some months earlier when I was with my ex that I might be dating someone outside our nationality and/or race. Mom wasn’t so keen to listen more after that but Dad sounded quite open minded at the time. ‘As long as this person is hard working, trust worthy and is a family person’, he had said. And oh boy was I glad at the time, cause honestly he ticked all the boxes.

‘Why don’t you give him a call?‘ I said to my sister, who is 2 years younger than me. Currently in a relationship with her long-term boyfriend of 6 years, also Nepalese. ‘Dad said you’, she replied ‘and you are older’. ‘But you keep asking me to fix you with doctors, here is your chance’, I insisted. ‘Whoever it is, I have said my daughter will keep in touch’. My dad answered putting a pause to our conversation. ‘He comes from a good family’. He said.

My sister looked at me and winked suggesting one of us should probably take the chance. Of course at this point we are not too serious to actually be invested on it, but unlike other times when we would absolutely be deterred by the conversation of finding a husband, this time we are not. Dad seems to have taken it as a positive hint and was quite glad he brought up the topic at right time when both of us were in the room. Sort of like, he was giving us the opportunity to speak up now if we were seeing anyone as potential partner. She was quite. My sister and boyfriend both haven’t introduced themselves to each other’s family and it is difficult to explain ‘but there are certain things’, that might make them both fail on their parent’s checklist, only a Nepalese would understand. And of course I was quite myself. A little relieved I suppose that my parents don’t know nothing about my previous relationship. Otherwise they would be hammering me constantly on talking about details and questioning on my decisions.

I didn’t take the name. But I did say to myself, ‘why not? No harm in talking right?’. Who knows, I might land in Nepal today and get married the next week. They say ‘marriage is in written in hands. When it happens, it happens.’ One of my best friends recently got engaged after just knowing the guy for few months. ‘You know how it is, we are from same culture and tradition. We understand each other, we know our expectations, our values match and we had a connection’, she said. I understand. I completely understand, now more than ever. Although I did comment ‘I still think it was too soon.‘ One of my friends who was brought up in UK but had a Turkish ancestry said, ‘I value my family and family life. I have so many cousins and extended family. It would be nice if she could be a part of it as well. If she was from other nationality with different beliefs, she would feel displaced at home.’

Problem is, it is like finding a needle in haystack, searching for someone who is your absolute fit. I will say, I did look into dating sites hoping to find an Asian match but there were more European faces than Asians! And ones that did have inclusively Asian population looked far too strict with their beliefs and criteria. And also sort of felt like, if you did start to speak to a person, you should absolutely be committed to the relationship. Be ready with a garland on your hand because soon you are going to be Missus from Miss… I don’t know why it gave me a little chills, I should be fine with that right? Because so far my dating history has been, ‘Go to a date and Woah! committed! My dating app doesn’t even last a week. Here 3 years for you, yeah am fine with ongoing 4 months with you.’

‘Don’t pick the first bag you see when you go shopping!‘ Mom says. Either I am being very lucky finding what I exactly want right away or I got problems.

‘Of course he wants me. He has been with so many girls. And now he knows, I’m a good girl and I make a good wife. But I feel like, I jumped too fast in this relation. I haven’t dated other people. I don’t know and I don’t think I’ll ever know if there is other person somewhere meant to be for me’. My friend vented her insecurity. ‘I don’t want to make a wrong decision. But its too late. Don’t jump in a committed relationship girl. I am telling you from experience’.

It seems like we are all worried about ‘making wrong decisions now days than deciding on our feelings. Would you blame us? ‘Everyone is traumatised at our age’, my other friend commented. ‘Something in their past, something from their previous relationship. I don’t know. Honestly I’d rather be alone. I am a modern woman yes but I also have traditional values. I want a man to be still a man, to make me feel protected, provide for me, be strong so that I feel feminine at least sometimes. I like being a woman. But the way it is going looking at my dates, they want me either to be their mother. I should have more or stable salary for them so they can take rest or not even work & support them financially. I am expected to cook and clean after I come back from my shifts while they sit on sofa and enjoy TV. On top of being a wife. Listening to them vent out constantly 24/7, support their mental health issues. Look pretty, keep the romance alive when they don’t even try. And that is if they even want kids. The idea of responsibility just knocks them out. And in case if they do, there’d be one more big baby I’d have to take care of. It’s all about them. What about us? Honestly all I need is a sperm donor. Even if I am in a relationship, he’d free to go out and have fun. It’d be just for a name sake.’

I suppose the conversation did take a little dark turn after sometime. Although I did kind of started laughing remembering Southpark Season 20 where Eric Cartman has this theory about ‘men being used to milk semen and write jokes in mars’ by women. Watch it. It’s very funny and that’s quite a dark sense of humor but looking at how situation is going on, I do agree most men and women, at least our age seem to be carrying out a lot frustration against each other.

We all got issues and we all got responsibilities. How much of your issues am I willing to make mine, depends on how much I am going to vest my energy on you? And how much will you vest on me? Of course one end is always shorter but to what extent? I look back sometimes and remember 2:00am calls walking at night from work to home. He was sleepy but he always wanted me to make a call. I suppose his end was always shorter but I did try too from my end. I did take 4 hours trains walking from stations to stations alone by myself after work hours, putting alarms in between so I don’t doze off and miss stations.

I guess what we all are looking for, is that right person our heart and soul truly wants to hold on to. And a reciprocation of effort. That men and women now days and our age, honestly are too scared to put. Without reciprocation, it only becomes an energy draining process.

There is a very good video circulating now in Instagram from Teal Swan where she says, ‘For people who have a hard time with boundaries and for people who call themselves empaths its actually the same childhood experience. It’s that in childhood you’ve got an unpredictable adult. And that, unpredictable adult whether you’re consciously aware of it or not, presents enough of a risk to you that you have to be hyper attuned. Because every move they make or don’t make , has some implication for yourself. So what a lot of people don’t like learning about emapths is that because of this traumatic type of childhood experience they learn how to pay hyperattention or hyper attune to anything in room that is not ok. That’s why you are never gonna meet somebody who’s got this thing who’s like ‘you know, I just love being around people, because I feel amazing,’. Cause they’re gonna walk in room and instead of attuning to person who is happy, they are gonna attune to the person who’s got the issue. Because that’s where the risk is. In case you wanna know why empaths always feel like crap. That’s why’.

I wonder if my choice are subconsciously skewed as well. Maybe I too have an empath personality that makes me attuned to looking at faces with stories. One forgets survival often comes with traumas. When I had first joined a dating app, I started chatting with this lovely guy who after a couple of days, called me crying, barely breathing saying he felt very depressed and he didn’t know what he was going to do that day.

Wonder if the answer is, we don’t look for someone like us. We look for someone opposite in personality. Someone that balances us out in some ways. I was very happy in my relationship with my ex. Despite our issues. Till this niggling feeling came around whispering ‘Is he really the one?’ And of course later came the major things I could no longer over look. Normally I would make my decisions with my heart and my brain. I have always been very cautious person all my life. But 4 months ago when I went on a date, I went by with an impulse. I did really feel maybe I did meet my match. ‘Take a chance’, I said to myself. Now I wonder whether it was the empath in me and I question whether I was really ready to be in a new relationship.

‘He will use you and leave you the second he is back up on his feet’, my friend warns me.

I absolutely adore this person. This person, I am dating. He is so smart, I can’t even understand half the things he says. He has been through so much, but he is still trying to do his best. He is strong, is a fighter, dreamer but he is lost at a difficult place. I am trying to be here for him as much as I can. But when he calls me from the pub at 02:00am from some place out of my reach talking about how he hates his life, sending me one or two words message only now and then between few hours, keeping me awake and anxious for his safety; I don’t know. I worry, I hope he doesn’t drive but when I hear women giggling on the background; honestly I don’t know. ‘Leave him’, I recall my friends say. For some reason, they all disapprove of him but the empath in me is reluctant to let go. A voice in me takes his side and says, ‘they don’t understand what he is going through, you know it well’. But when he tells me, ‘you had a very sheltered life didn’t you?’. I am speechless. I don’t deny it, I did. But he doesn’t talk to me because he doesn’t think I’ll understand. He is bitter, for some reason bitter to me.

In some ways I am a little worried now of my choices. What if I am predisposed without second doubt to pick up on certain personalities of people all steps of my life? I’d rather be alone. To protect my emotional health. To avoid emotional rifts coming my way, everyday. As one of patients said ‘All my friends got married. Some of them settled. I did not want to settle. Life is too short‘. I am scared. Scared shit! Apologies for the language. But how long do you stay scared for. At some point, you got to take a chance. For now, its a gamble. May be this is beginning of our love story or a start to another. Who knows? 😉 At least one thing is certain, I will no longer wait on things to happen waiting for my boyfriend/ partner to make his way on our plans. I will no longer look back and miss on the days I couldn’t attend the parties, the night outs, or the movie times. I will never miss out on ‘me’ time anymore because I am no longer a kind of person who invests too much on relationships. NO. I will keep living my life and keep my focus on life goals, if our plans align ‘you are welcome’. If not; Ciao, Adios!

Question is NOT ‘are you right for me?’. Question is, ‘Are YOU right for me?’

So you’re a doc, a foreign cuisine and Corona happened (August is here. )

(August late post)

So August is here. Most of us had have our end of year evaluations and managed to pass out with flying colours. I did gloriously too with a little help of ‘Covid derogations’ application. Which basically means, some of the tick boxes I did not achieve this year did not not hold me back from progressing to next year because it was assumed that part of the training was affected by the pandemic. Example getting a certain number of clinics for the given year. Since a majority portion of our outpatient appointments are still functioning as only essential slots to avoid face to face contacts which would mean less learning opportunities for us.

Some have managed to find hospital accommodations to live in by now, some of the junior docs are still probably looking for mates to share a flat or the house. Hopefully still not living B&B to B&B or couch surfing at friend’s dragging a massive plastic bag of clothes living a hobo life. Lets see; a PJ, a blanket, a towel and 2-3 days of work uniforms? Sounds about right. Lets lump it all aside in one corner, everything in place just a few fumble away in a plastic bag. When you finish a row of night shifts at one hospital on the 2nd of August and are expected to work the same day for the next placement in an entirely new setup in a different hospital on the 2nd; you will be doing that too. But, worry not my friends. Soon you’ll have days when you will be sitting on a fancy restaurant on a fancy outfit having a fancy meal on your hard earned pay check.

ARCP as in ‘the end of year evaluation’ of trainees usually happens on last weeks of June or first few weeks of July. Nothing really to worry about if one is keeping in track with their portfolio and ticking checks left and right on number of cases, procedures, feedbacks and so on. But can be quite a struggle if you are not determined enough to sit down and work on it between or after shifts or have a dedicated few hours at least once a week just allocated to it. In a way for doctors in training in UK, we breathe our life in and out around our ‘portfolios.’ It is evidence to show career progression and without proof on it to back the competency levels, no one will pass the year.

‘Portfolio’ is quite a work. From my experience, more when you are new to the hospital environment; especially when you are new to the training system. It really helps if you are an extrovert and have great people skills but that does not mean introverts won’t get anything done. It will take you a little longer time to catch up on pace but you’ll get there. This year alone, we needed 12 people to sign us off in a category called ‘Multisource feedback MSF’ which is sort of like a character statement where our colleagues would be asked to comment on us on our communication skills, attitude, team player role, reliability/punctuality and leadership. These feedbacks will be from combination of people from different job roles apart from the doctors like nurses, pharmacist, health care assistants, physiotherapists, patient flow coordinators etc. We needed 4 multi consultant (MCRs) report on our performances, 4 ACATs (acute care assessment tool) where we present 5 cases each to our on-call consultants for our evaluations and additionally, 4 CBD(case based discussion) or minicexs-where we again discuss history, examination and management of each individual cases we saw in depth. On a rough estimate, by the end of year, those were at least 9-10 consultants we were following around in and out of our rotations to get our sign offs. The number maybe even more, if you are unable to get the same consultant to sign you off on multiple forms.

Undoubtedly it is going to be a tough year if you are under a sore eye of even one consultant, especially in a small DGH (District General Hospital). Trainees talk, trainers too. You’d be surprised how much of chitchats and dramas flows from floor to floor between meals, between clinics and between ward rounds. A whisper about a medical student here and it has reached a consultant’s ear on the other building top floor by the day’s end. Be careful of what you say and especially as a foreign trainee with thick accent ‘be careful of how you say it’. Control your pitch. Do some humming exercise if you have to. Control your flow of your speech, aim to articulate as distinctly as possible. Count seconds between words if you have to. And if its the pronunciation that comes out as naturally harsh expression not because you mean it but that is how you speak in your natural mother tongue language; for example if the words you are speaking is a throat sound which may not be as softer tone as from chest vocalisation almost a whisper like British people are used to… follow it with a big smile. Trust me watching that smile, adds a whole different meaning to the sentence you just spoke than listening over phone or without your facial expression on equation. There are other cultural aspects too to approaching a conversation that you will eventually learn as a foreign grad. For example it took me quite a bit time, to set the loudness of my voice to adjust to a conversation. Naturally I have a soft voice. In my culture, you always address your seniors with lower or softer voice. Being loud is considered a sign of disrespect. Now that in UK’s setting, may be perceived as lack of confidence. Children here are encouraged to speak up from a young age, there is levelling of hierarchy to encourage good learning environment. Confidence is about expressing thoughts, being heard and getting a feedback in some form suggesting given view was acknowledged. In setting I was raised and taught on, its unidirectional flow, almost always. I remember, during my initial days in the job in UK, I was being constantly asked to be louder when I was presenting or handing over. I often felt a little frustrated. It felt as though it was disrespect to me because I am being asked again and again to repeat myself. But looking retrospectively, I can see where the problem is. And as I tried to adapt, I started going the other end, practicing to be louder which I didn’t realise with my accent was posing another problem. I was starting to sound rude to people when all I was trying honest to god was to just dial my tone to right decibels. ‘Smile.’ Trust me, it works great as non verbal communication method to support gaps where you might be lacking. Although, I do have to let you know my high school teacher once said to us, ‘as girls/women one has to be very careful of how openly one smile at others. It might send a wrong message’.

It does makes a big difference to have a right environment setup where trainees are supported well with their requirements without hustling day and night for a sign off and where the trainers/ consultants are approachable & encouraged to help trainees meet their competencies as part of an educational process.

Some seniors readily agree. Mostly the ones, who themselves have just come out of the system and are well aware how tedious it is to get these little checks. Some will out out rightly reject you and want you to prove yourself more before they can make a comment, which is fair. Only problem is, in ever changing and busy world of NHS, consultants are barely on same shift on 2 days in a row. The case you saw last with them they may not be able to recall next time (probably after 2-3 weeks) in which instance they may ask you to repeat the same process again. Also need to be aware, if they were only visiting/locum consultants you may miss an opportunity for sign off as visiting consultants are not responsible for your training.

I cannot stress enough how important ‘People skills’ are in our profession whether with patients, with colleagues or with seniors. Especially in a profession like surgery where everything you are trying to be is almost a copy of complete persona of your supervising surgeon- the posture, the movements of hands, the precision of scalp incision, the steps of procedurals technique, the suturing skills etc etc and, everything you will grasp is a perfected skillset handed down after years and years of practice. And although it is not 17th century unlike when The Chameberlen family hid their discovery of forceps for 5 generations within themselves and devoid the world of marvels of their important discovery; having just an average level of rapport skills will prove to be unfair disadvantage. Remember world of Medicine is still a learning environment. You are a teacher and you are a student.

One has to make sure, they get a good educational supervisor allocated for the given year. Luckily for me, I found out on time that I could request the deanery to reallocate me the same supervisor I had last year. A supervisor’s job role is a big responsibility in a sense that the allocated consultant will be the mentor/the guardian for the given trainee’s entire year. He/She will have a big role guiding the trainee through their career development keeping a close eye on their portfolio while advising and supporting them on both personal and professional levels. My supervisor has gone out and beyond to help me this year and I am really grateful.

I have handed my job responsibilities, signed off my outcome sheet for this year and now, am sitting on a chair on a bright afternoon day at 1:30pm on a weekday having morning tea. The black week has come and gone and the consultants seem to be feeling more settled in trusting the new doctors with their job roles.

As most of were leaving current hospital placement to other, we delivered some cards to our seniors thanking for their support. ‘It is hard to see you guys leave every year.’ Our consultant said. ‘You only start remembering the names by midyear and by the end of year most of you would move away. You get attached. Then you have to do the same thing again with new trainees. Year by year’.

Anyways, for me ‘August is done’. No more portfolios, no more on-calls and night shift for few months. No more exams, courses and seminars. I have been picking agency shifts to pay my rent and stay afloat as and when I can and that is all. The freedom of picking your own time to work? Nothing beats the feeling! I am really glad that HEE have now taken more steps to provide opportunities to trainees to take career breaks and get into part training programs. A couple of my colleagues have also recently applied to go 80%, 60%. Training is UK is really long compared to anywhere else in the world. Going part time will add extra years. But I suppose most of are at that phase in life where we all feel, as long as their is some progression it is alright.

As I may have explained before, one no longer needs to fill those extensive forms to prove one falls in the certain quota to be accepted for the breaks or part time programs. It’s a great start. Both for trainees and NHS. In past years trainees have been leaving NHS left and right to work in private sectors or to work outside in different countries. Australia used to be most popular destination. Now my colleagues are leaving for New Zealand, USA, some of them are even going to middle east. A couple of them are thinking of changing career paths. So, yeah, for both of us, it is a good start.

As for me, with all this time in my hand now, I need to crack on slowly with my little list of things to do in life. Sort out the clutters slowly, clear my diaries to make room for more plans. Finally, finally I feel like I am ready to embrace my 30s. 20s went so fast. Its like that 2 years of COVID most of us were not ready to accept that we had lost it in one click of a finger. Time equates to memories, I think. When you look back and can’t remember much of what you did those years, you don’t seem to be able to track it. I suppose, I now understand what they mean when they say ‘its not about how long you live, its about you live it.’

So you’re a Doc, a foreign cuisine and Corona happened (How much can you give?)

My friend dm’d me some time ago with a message, ‘found an accommodation for £35 a day in Manchester’. And asked me whether this was right and if it could get any cheaper than that. I was actually quite surprised to see an advertisement even out at that price. From my previous experiences with many bed and breakfasts before and hotel stays for courses/conferences, exams and interviews; I hadn’t yet found anything cheaper than 50 quid in a decent place. And this was Manchester we were talking about. 

I looked into the site. Website looked genuine by itself to be honest, but one of the pictures used for the advertisement had a naked mannequin lying on the sofa in the sitting hall which was kind of strange. We use those kinds in our hospitals for simulation teachings. They cost thousands of bucks to be honest. Wasn’t really sure what it was doing in a regular  accommodation and the purpose of its display on the site. Whether they wanted to show that the stay was medical profession friendly, whether it didn’t occur to them at all that it looked like an eye sore sticking out of picture compared to the rest of interiors or it was possibly… there is no way of putting it out in a less vulgar way ‘a blow up doll’. So may be they were advertising some kind of kinky place? Haha. Who knows. Checked on google for reviews couldn’t find any, so advised my friend against the stay. 

He then gave me a list of set dates and requested  me to look for accommodation for his wife and her female friend. A 3 month tenancy is difficult to find. Most landlords want a tenancy contract of 6 months, as far as I know here in the UK. Understandably, as a landlord you want to be assured of a continuous source of income for a  fixed period and not have to deal with the hassle of refurbishing/ repainting the walls and redoing the carpets for next movers just after a few months. One would be mental to pour money down the drain if they are paying to stay in a hotel that long. Best way to get that length of stay is either in university buildings if you are a student or a hostel right? Staying in  hostels could still be cheaper even than 35£ I assume, depends on how many individuals you’d be sharing the space and the bunk beds with; but it comes with its own range of problems. For candidates preparing for medical exams, its not exactly ideal. 

I had to consider that they might struggle to pay the rent if it was anything beyond £40 per day. When I first came to the UK,  I lived in a shocked state for a period, converting all the zeros we had in Nepalese rupee to single digit or double digit in pound value. With 160 rupees you can survive a day in Nepal and for some people it is hard day labour pay! Watching it disappear  into a single coin of a pound is scary. None of my friends in Nepal  would ever believe me that I’m paying 1,60,000 Nepalese rupees to live on my own in a one bedroom flat per month. Nope. If I start converting the value of the cheapest burger in  McDonald to Nepalese rupees I will starve to death. I will never eat anything.

Doctors have good salary in Nepal compared to general population and they make a good living. Private works are bountiful, amount of hours you put in equates to amount of money back. A directly proportional relationship, because tax is minimal. But since the conversion rate to pounds is high, it equates to almost nothing in the UK. Both my friend and his wife are doctors and from upper middle class families. In Nepal, they have a decent lifestyle. So, without offending them, I was trying to figure out a way to give them an idea that living cost even for a few months with Nepalese money is going drill a hole in their bank accounts.

My sister once told me when she was new to the UK, she entered a local shop to buy a pack of gums. Came out of the shop, sweaty and quite perplexed after looking at the price tag on its little pack. ‘Hell No! 50 pounds!‘, she answered still in shock, when one of her friends queried why she had returned empty handed. ‘50p is not 50 Pound!‘, he then had to explain, breaking down the value of each currency into rupee equivalent so she’d understand. A pack has 5 gums in Nepal depending on which you buy. My favourite one come in many flavours, banana is my top choice. And it only costs like 5 rupee which is not even equal to one penny!

I wrote a message to him saying a bus fare in London for one travel will cost £1.55 which equals to Rupee 240 in Nepal. Just so that, he has a rough idea about how much money he would need to afford for rent and other expenses especially with travel in mind. The academy his wife and friend were coming to join for studies could only afford limited stay for weeks, rest of 2months they’d have to look.

Finding rent for friend is hard. Trust me, finding rent for a friend’s wife and her friend is even harder. Especially , if you have never spoken to friend’s wife or her friend before. Of course it would have been better if they could find other similar people to live with from the academy and rented a house together which I did suggest. Because prospect of finding spare rooms for 2 women, who are used to certain lifestyle, in a country with very contrasting social dynamic than they were used to, is going to be a headache. And there is that trap of course where ‘a favour for a friend is a favour, a favour for an extended friend becomes a complaint’.

There have been stories about new foreign doctors having to sleep in parks, walking along the town strolling their suitcases hopelessly from hotel to hotel door in COVID times, when all the hospitality services were suddenly forced to shut down. It will never come down to that with me around, but a little planning guys before hand for your own shakes would be good.

I live an hour away from Manchester where they’d be staying. It is going to cost me 70 quid for train travel alone ‘one way’. Had it been in Nepal, my mom would have said ‘what is the fuss? Go get your friend. It is only 1 hour away and have them stay here!’. One- I don’t drive Mom. Second, I cannot travel back and forth with that money, I could leave them that money so they can stay in B & B in Manchester for the night. Because, travelling back and forth is going to cost all of us fortunes especially if they have to attend lecture everyday! And third, I work so many hours, if my guest can cater for herself that is fine, but 2 guests, with one master door key is a nightmare. I do not want to land lord’s mobile again. And, and we know what happened to my cousin? His friend stayed with him rent free for so long while he was doing him a favour and one day just walked out with all his bank cards!

‘This is a country where a man does not pay for lunch, children don’t pay for their parents in restaurants and people who invite guests don’t pay for their guests in party. In Nepal, we are generous’. She makes a disappointed face.

‘But, look how expensive everything is here! If I pay for my 3 friends lunch, even if they eat only 20£ that is 60£ add mine it is 80£. And you know, for that 80£ how hard I had to work? For an entire day? I was on a train at 06:00 clock in the morning, I was back at home at 01:00am! And 20£ was just train fare’.

‘Yes I know. I know. It is like the systems were built in this country to divide friends and relationships. To break families into nuclear so that you earn more tax out of each household. I mean who kicks out children off their home at 18? Because they are getting expensive to feed? You should look after your brothers and sister. And they should look after you too. You were not raised like that. You will always have each other. I didn’t have anyone.’

‘I know. I know’. I just nod along her comment when she is like that. Remembers some things about her past and makes odd statements which apparently are supposed to be her words of wisdom for me. While I scroll past comments of strange people requesting money for charity, colleagues and acquaintances I have never sat down with to have coffee before asking for random favours, junior medical students querying about plab exams and visa requirements in UK. Mom is finally off her phone after chatting with her relative and is now inquiring, if we can make some donation to a local school in her village again.

A part of me is like ‘Stop. You grew us up with 11 children in our house. None of whom are grateful to you now. Not to you that is fine, but not even to us. When it was us, who had to share a quality of our lives and major portion of it to them. When there was never enough to eat for us because you were hoarding the whole village in one roof.’

But I cannot. She had some ambitions she ventured out to do but never really quite got there. She dwells on things she couldn’t do, couldn’t achieve and missed opportunities on.

There is no limit to how much people will take away, if you never learn to tighten your grip and force yourself to stop. Mom was always a people pleaser. Never could say no to her friends and relatives. She was crossed, didn’t speak to me the whole day, when I gave only her half of my first stipend. My first stipend! The other time, when I did give her full 2 months stipend money she donated it to that local school in her village. Like honestly, she starved us, her children, many times (money context ;)). I never had pocket money to spend off on anything when I was growing up. But she never could say ‘No’, if anyone asked for help. Sat down late nights crying, unable to pay our private school bills because they wouldn’t return her money on time. Her own sister had swindled her off all her inheritance and her husbands by extension while her children were studying in private schools under our roof; and now had just booked a flight to Nepal because they had swiped all the house’s rent too. But she is thinking of some charity?

It’s funny. She thinks I am about to reach some success point. And keeps asking me, when I am about to earn ‘loads of money?’. Hahaha! ‘You need to buy yourself a house’. she says. ‘It is a good investment. Paying rent all your life is not good’.

How do I explain to my mom and her relatives that despite earning 4,80,000 Nepalese rupee  a month, I’m not saving any. Every one back in the country believes I am living rich fancy lifestyle now that I’m earning in pounds. They expect that I donate generously without request, offer help in any forms, fill in my granny’s shoes after my moms, keep the family name. Stop right there. Yup. I am her daughter and my father’s daughter. But I was raised differently. I learned, I can say ‘No’. I owed no one, I had no obligation to please anybody. I am where I am, of effort I have put in. Of support from my family. Only people I will be generous will be to my family and only handful of my friends, by choice. I am not being selfish. I am just being fair. It would be great if people liked me for what I am, I am a good person, I will be a good fellow but, if there is one thing I am not trying to be is ‘people pleaser’.

In my bank account— after about 1000 for rent and utilities, 800 for mortgage, £10 for Tesco phone bill, £20 for BMA membership, £7 for Apple subscription, £45 for hobby subscription, £9 for insurance, £60 for monthly food shopping, £79 for a Pastest exam subscription, £448 for exam, 70£ for travel. I had about 400£ to spare. I go out and there 100£ is easily gone. A little shopping on clothes- another 100£. My time and effort costs me a lot. Especially with the lifestyle we have as medic.

Unless one is used to lifestyle here particularly ours it is quite difficult to make them understand. Like why wouldn’t I visit my friend’s wife on Manchester? It is one request for that friend but for me it is a handful of requests I am juggling with. Will people ever learn to be grateful for effort I am investing on? A couple of hundreds here and there. I am genuinely hoping I don’t become my mom. ‘Money is like dust’ my dad quotes often, ‘it is important to know the value but it is not everything’. I try live by that principle. It is a thin line though isn’t it? I watch him counting pennies closely, one by one, out from his little purse every time we go to shop for milk together. It is difficult, isn’t it? To learn ‘never to be too selfish, at the same time never to be too kind’. I am learning all that experience by experience too. Be careful when you extend your hand friend that they don’t grip your arm and drag you down. Kind people get hurt the most.

So you’re a doc, a foreign cuisine and Corona happened ( Only beginning ‘dear doctors’)

Most of the trainees are 24/25yr old when they join their foundation year and start earning their own salary. Almost like a zebra in a herd of horses, it’s easy to  spot a year one especially in their first few days at job. They are chirpy with their eyes gleaming with enthusiasm, appear quite confused doing random things and of course are a little nervous. You can hear them sigh often, chuckle often, ask a number of questions and follow their senior house officers on every step they take  from the ward to the cafeteria. 

Soon after a few weeks,  they will learn how to get over their imposter syndrome or move along despite feeling one and be excellent and independent at their jobs. Until then, the nature of the job will beat aspirations, confidence and eagerness they came with out of their system. Some of them will return home in the first week following their oncall or ward cover, crying. And they won’t be the first ones.

Unfortunately no one is immune and sooner they realise that even a brilliant registrar had a story when she went back home, she broke down to tears after her night shift hearing her husband ask ‘do you want cereal or oatmeal?’

‘Too much decision to make!’. She exclaimed. There have been times when consultants have drowned in sobs with a never ending pile of pending reviews in middle of ward round. Deep breath *** It will be fine.

‘We are perfectionists working in the most imperfect environment’, as my senior said. The sooner they accept, the job is a continuum of 24/7 hours, you can only do the best of the hours you have, you have to handover and there will still be patients waiting to be seen when you come back to work tomorrow; the sooner the cogwheel will start running smoother. It’s a skill. A very difficult one to learn, that everyone of us is trying to master. 

No one works harder than the foundation year trainees in the hospital. Ward rounds/reviews, constant bleeps, discharge summaries, intravenous cannulation, taking bloods and dealing difficult patients. If you are in a medical school and thought school with constant exams and boring long lecture hours was difficult, buckle up kids, you are in for a shock. 

The day you receive your first check, you have to reward yourself. Better do. When you count it to hours pay, for the stress/ anxiety you experienced it equals to nothing. But nevertheless this will be your first check that you have received after years long of dedication to medical school, the times you had to stay in studying while your friends went out to party, when Davidson was your date for Valentine and you slept next to it with the smell of papers and highlighters. Oh the look of every word highlighted in the book. ‘How stupid was I?’ didn’t that nullified the whole purpose of highlighting?

Most of the foundation trainees are possibly the youngest in age among the lot of  doctors in the hospital. Freshly baked batch out of the uni. Some of them wouldn’t have held a job apart from a few shifts here and there for extra pocket money; have had no sense of self responsibility dawning upon them prior to this job and still were having maximum support from their parents. Yes, they are in their prime in their early 20s but technically were still a student. Praying everyday to pass the finals, not knowing after those last papers, the world completely changes. 

Extra bills, relationships, mortgages and personal ambitions on top of a medical life. The trajectory it takes from there will feel out of control for a while. In some of our cases, I suppose longer than ‘just a while’. Take a deep breath. Welcome to real life! Look at your rota and plan your days, save enough for a down payment on a mortgage and get your debits sorted. 

Luckily a medical life has a lot of advantages over other jobs. The cup is half full. You have colleagues of similar age. Going through the same problems you are. Potential friends, maybe a lifelong. You will help each other with the solutions, be a shoulder when the days are chaotic and on good days, to be out and have good laughs. They share your similar intellect. Advantage is, you never have to explain a situation twice, they might possibly be the only one who picks up on your jokes and there are good chances your hobbies are similar as well. You are ambition driven, you were trained for the past 4 or 5 years to be that way. There is a goal for every rotation for every year of your progression to achieve that you can timeline against to feel some degree of accomplishment. And there is a luxury of immediate confirmation for job well done. In the form of a patient’s thank you or a positive gesture. An instant gratification that I know people are dying for in so many other jobs. And if your career stops progressing at a consultant level, the job itself, whether in the form of stress, interesting cases, mini treats like that or the challenges it comes with; to be constantly striving to be better can keep you amused. 

However, while being in a pack with ambitious individuals and readers, it is important I feel, not to jump down that rabbit hole. Know what you want as an individual. Just because you are a doctor and achieved your goal of many years does not mean this has to be your only focus. Life doesn’t stop here. Why can’t you be a teacher, a painter or a comedian? You have only started earning your own name with your title, you still have years of life and possibilities before you. Stop being industrialised. Be an individual. You don’t have to run to be a consultant right away if you don’t want to. You will be doing this job for life long, you can’t do it, if you don’t love it. And if you want to change directions it is okay. I have seen consultants start again as a foundation trainee/ senior house officers because they wanted to change their specialities. I respect their decision and absolutely admire their bravery. It takes guts to start again from scratch, give away the power you were used to and rebuild again. 

I know I will learn more . It will all come to me. It is a skill and it is knowledge. Education only forms a small base of it. It’s years of practice, a number of cases, faces, diagnosis and commitment. ‘It will all come to you like muscle memories,’ like professors say.  

Life is only beginning here on your first day ‘dear doctors’. ‘Welcome. And follow us on the ward round please.’

A COVID pledge? (So you’re a doc, a foreign cuisine and Corona happened)

image source-Wikipedia

‘And Princess Margaret always had one in her fingers as well, all the time.’ Said my patient huffing as she made her way out of the building’s main door wheeling herself. Once she had parked her chair out in the open which seemed to be her usual spot, she started lighting a cigarette. I could really see how much she enjoyed puffing it. Igniting the lighter, curving her hand next to it so the wind won’t blow off the flame and taking a deep inhale; she was natural at it. Why wouldn’t she be? She had been smoking every day for past 50 years, had managed to knacker her lungs completely with it and now had a condition called COPD.  Chronic Obstructive pulmonary disease which is an irreversible lung condition at her stage. She took a really long breath to suck the nicotine in. I didn’t think she still had it on her. I mean, the physical reserve to inflate her lung that much. She was in a state, where she needed oxygen permanently at home, for at least 18hours a day. She couldn’t move from room to room if she exerted herself because of breathlessness. And her face, mainly her lips and ends of her fingers were sort of discoloured blue, an unhealthy-looking tinge of colour one develops when their body has been deprived of oxygen for so long.

‘This is one of the very few things I can still enjoy in my life now’, she said.

‘If she hadn’t been smoking that long and was addicted to it, may be there would have been so many other things she could have still enjoyed.’ I thought to myself. Knowing ‘Love of her addiction’ is killing her and despite that, choosing to continue on it; it is hard for me to not wonder what is going in her mind.

She tells me, she started smoking very early at beginning of her teens. Now she is in her late sixties and in a nursing home almost wheel chair dependent in majority of her activities; the cocktail of nicotine, tar and the chemicals has managed to destroy her life. ‘At least I always had my cigarettes’, she remarked, taking a puff and blowing out the smoke very slowly in the air, amusing herself with the cloud of smoke it created. ‘It was a thing you know at that time. All of my friends use to smoke. Everyone had a pack with them, everyone was offered one wherever they went’.

I don’t like the cigarette smell. That doesn’t mean I haven’t tried myself either. Like most children whose parents smoked, I was introduced to it quite young as well. My mom used to be an avid smoker. I guess she developed her habit by following a trend of accepting gifts and complimentary stashes distributed to soldiers very commonly at those times. Naturally the troops wives had access to what their husbands had. ‘Marlboro’ used to be her favourite. As children, when as we saw a cigarette box with bright red on a white colour, we knew it was ‘good stuff, had been imported and either dad or one of her family members who was in the army had sent it’.

There might have been many reasons why smoking became a trend and still is. ‘Advertisement’ comes in mind first. We all know how intrusive and invasive they can be in our everyday lives. An add everywhere in newspapers and billboards, add celebrities into the pictures with their fancy gowns and chic smiles; there you go a generation of brain washed teenagers and young adults who look up to their role models and are desperate to be a part of the rage. ‘To calm the nerves’ as was told to the soldiers, it was mainly sold as an anxiolytic. Papers and the studies preached its wonderful effects too, leading general public to believe ‘it was safe’. Following these slow movements into individual people’s hand, in the world wars the popularity peaked, in few weeks it became sensation. Then a social tradition. ‘To offer a cigarette to a guest or friend as a part of social courtesy’.

I came across a cigarette advertisement made in 1950’s in YouTube. It plays “Doctors in all branches of medicine, doctors in all parts of the country were asked ‘what cigarette do you smoke Doctor?’. Once again, the brand name most used was Camel. Yes. According to this repeated nationwide survey, more doctors smoke Camels than any other Cigarette.”

Imagine the confidence of the company in using ‘Doctors’ as part of their lure to the public. It alone proves how accommodating we were as a profession of cigarettes in our lives then that it used to be acceptable for hospitals to allow smoking in bays and while on consultation with doctors.

It was only much later the long-term effects of smoking was discovered. Lung conditions like emphysema, bronchitis; cancers of various origins like lung cancers, oral cavities/nasal airways, bladder cancer and disease of blood vessels, heart etc.  Anti-smoking campaigns started more vigorously world-wide as result. Strict rules were then imposed and enforced on tobacco companies with heavy taxes, prohibition of smoking was announced on general public areas and now, even what used to be my Mom’s favourite at the time; Marlboro cigarette on its pack mentions ‘smoking seriously harms you and other around you’.

When she learnt passive smoking can be more dangerous than active smoking, my mom left her habit for good. She caught on time about its adverse effects from few minutes of government broadcasts that would often pop on news channel. We were then no longer asked to go and light the cigarette for her. Kind of missed not having to, for some reason it felt exciting thing to do at that age. Initially, it was hard for her to say ‘No’ when they continued to arrive in gift packs and in fancy boxes. But she pushed on her determination and helped some of her friends to quit smoking too. She hasn’t smoked for many years now.  

In Nepal, people mainly used to use firewood to cook. It still is the case in many places. Cities mostly use gas while the villages are still dependent on it. ‘Food tastes better even rice on it’ my mom used to say when she prepared it while blowing air on the stove through a long metal pipe, coughing constantly with irritation. When Joey uses the firewood stove at his place now, to keep the house warm, I remember myself constantly asking her to use gas or the petrol fuelled stove. Most people in the village suffer from COPD lungs in remote parts of Nepal. I am glad, my mom gave up both, smoking and cooking on smoke before damaging her lungs irreversibly. Cities aren’t exception now either with pollution from the vehicles.  If you haven’t been in the autopsy room studying lungs of a diseased Kathmandu resident, you would find it very hard to believe how much of smoke/pollution can affects lungs. Even the visible physical evidence is dramatic.

My patient can’t have oxygen at home because of the hazard risk with fire. Staffs are careful that she doesn’t sneak in any inside and would rather have her move about often as needed when she requests to. At this stage, our intervention is to only support her with oxygen. Cutting out on smoke now will not change her outcome. So, if she finds relief on smoking and feels this is one of the very few things she can now enjoy in life, she should be allowed to. And she is welcome to.

NHS offers ‘quit smoking programmes’ which we suggest to all of our smoking patients. Occasionally patients will spot doctors sneak out for ‘nebulisation’, a term we use to refer ‘smoking’. But knowing the adverse effects and impacts alone doesn’t always determine one’s choice. People choose what they choose for various reasons as long as it is an informed choice.

My friend once suggested ‘try smoking. I smoke now at least 3 times a day to lose weight’. I remember, the hype there was among the teen age girls then.

World Health Organisation (WHO) on its website mentioned ‘The COVID-19 pandemic has led to millions of tobacco users saying they want to quit’, with World No Tobacoo Day 2021 pledge.

This is a good thing. All the best.

A dog story for a tradition (So you’re a Doc, a foreign cuisine and Corona happened’

https://www.spreaker.com/episode/49496172 podcast link

‘She is 10 years old. Such a shame. It will be one of my biggest regrets. She would have made an excellent therapy dog’. A patient said to me over the phone talking about his Labrador.

“I was waiting in the hospital for my appointment, sat on a bench outside with her. When a young bloke sat next to me. He was shaking/shivering when he sat. And he asked me ‘Can I pat your dog?’. ‘Yes’ I replied, and after patting her for some minutes he completely stopped shaking and he looked like a different man. That day I thought, I must put her as a therapy dog. But with all this COVID such a same that she couldn’t.“

Although the risk is very low, by now we know that COVID can infect our beloved pets in close contact and vice versa. The symptoms are very similar to us; fever, cough, cold symptoms, shortness of breath, lack of energy, diarrhoea, vomiting, flu like illness. On 10th November/2021 GOV.UK published on press release ‘COVID-19 confirmed in a pet dog in UK’. After the press release and even prior to the press release there has been various interesting studies done surrounding impacts of COVID on pets and their pet owners. Some of the conclusions suggest very positive impact for the owners in terms of having a psychological support in form of companionship during lockdown and on pets-with more pet time from their owners for training and activities. BBC news on 12th March/2021 posted ‘Households buy 3.2 million pets in lockdown‘, mentioning that the main driving factor for rise in the ownership was the ‘social isolation.’

Other studies shows, there may have been a handful of challenges to pet owners mostly in dogs in terms of coping with stress of behavioural problems with their pets, accessing pet services as needed and food supplies. While on the pets especially dogs; less out door exercise and play time. Overall, all these researches on pandemic has highlighted again, why our human kinds has always been very fond of acquiring and keeping pets since time unknown. And how these fury friends continue to help us in many ways and have won special places in our heart.

Joey parents have a cocker spaniel. He has a beautiful lavish fury golden coat. Just like fresh honey stolen out of a bee hive, but a little darker shade. Very handsome little thing. They absolutely adore him. One of the family member is always at home to make sure he is not left alone and on the days they are at work, he dropped at the care centre, where he apparently has made some friends. When he returns from the centre Joey is always super excited. The first thing he does when he wakes up on the weekends is watch out of window to see if his little furry friend that is barely a year old is out on the garden or not.

When we were growing up, we also had a dog. Dogs’ actually. One passed away at about 15 years old and other passed away quite young at about 2 years. We got the second one some time later after the first one passed away, the only male pup from a litter of puppies. He was a gift to us from our relative, who had promised us one when Dorje (my dog) ‘s mom was still pregnant. He had said ‘if only there are male pups’. Luck for us and he had 6 fingers on each legs on his paws!

My mom is very fond of dogs. I suppose I was at some point too. I love them, but not to an extent to emotionally invest on one. It is a big commitment so I try not to get sucked into their bewitching innocent eyes. Someday? Yes may be. But I would like to very much have a Himalayan dog again if I did. The one I had before on both occasions. But Joey tells me after some research, obtaining pet passports, health records, vaccination status and with flights it will cost me fortune. And also introducing a whole different breed of dog to the UK will be a lot cumbersome.

Himalayan dogs are amazing. We call them ‘bhote kukur’ in Nepali. They are generally big dogs, with big broad rectangular heads, black beady or brown eyes, furry, usually on heavy black coats or with brown patches on a black coat. My first dog was call ‘Bhalu’. Because he exactly looked like a black baby bear cub! When I first held him, I could barely lift him properly. Even for a few days old baby, he had massive big paws, very sharp nails. The second one ‘Dorje’ was a quite small compared to Bhalu, but he was also very handsome dog nonetheless. He had light brown/yellowish distinct patches on a black coat around his eyes, on his tail, on his chest and on his paws. It took me a while to like him, but how adorable were his 6 fingers on front paws! 22 total fingers! He was special.

My mom has her own story about her dog. And as I would pass along my little tale and description about the dogs I had, she passed me description and the tale about her dog. And in some ways, the day Bhalu passed away was the story of our start of tradition.

Her dog name was ‘Sindhuli’. She was a very massive black coated dog like Bhalu was, a very beloved family member and a hard working herding dog. Her job was to work with herdsman and guide the cattle up to the highlands called ‘bukhi’ in the winter for grazing and then bring them back down the village after the winter had passed, when some vegetations would have started sprouting back to life. Her job also involved making sure the sheep and the cows didn’t strand far along the route on the way or while they grazed and to protect them from the foxes, wolves and other predators. When the herdsmen made their way to village, mom says, she’d be the first one to appear in the village. With a big bell ringing as it dangled in her neck, everyone then would know the winter had passed, their men and the herd were coming back home.

‘She was obedient. She did her own thing. She knew what her job was. But, one day, she didn’t return back on time. Then the men came with their drums, beating on it to make an announcement for the village’.

‘The dog of the Oak family‘, they said ‘has become rabid. It is heading its way to the village now. All people are to stay clear of the dog. It is very dangerous’.

‘We were shocked. We heard, she had fought with some wolves while on high land and was now infected. When she arrived, she looked dirty, beaten with hunger and exhaustion, as though she was walking semi conscious. Saliva was trickling down her jaws, her tongue was out, her eyes were sticky with clumps of pus/discharge in corners. She recognised us. Would growl when she would come across any strangers but to us, she was docile. But we were scared to go near her. Rabid dogs are mad, they are dangerous and people die… She sat on our verandah and made growling noise every time she heard any noise, mainly water. She was scared of water’. At this point, my mom was crying, wailing like a child that was re-living her painful experience. And while wiping my own tears, missing my a friend of 15 years, I held her hands trying to calm her down.

‘The villagers were scared. They all gathered and came to us saying, the dog was dangerous and had to be put down. There was no option. A dog dies in 1o days with rabies but no one could wait. So my uncle said, ‘I raised this dog from the day it was born like my own child. I hand fed her, I took care of her. She is a family. So if it has to be done, it has to be me’.

‘We lured her gently with a meat loaf to a tree’. Mom started wheezing taking rapid shallow breath unable to complete her sentence. ‘Tied her on it with a rope and my uncle shot her in the head.’

‘The look she gave to him and to us while she understood what we were about to do…’. I was concerned for my mom at this point because she was starting to look flushed with bluish tinge on her lips, her eyelids were swollen and the tears were falling down relentlessly. ‘I can never forget it. The look she gave.. She was so shocked; from the pain, not from the bullet that was about to hit her but from the treachery, from the disbelief of watching her own master/ her family turn their backs and be ready to take her life. Before the trigger went and we heard the loud noise, we watched her close her eyes in defeat. Waiting to be done… Oh what must she have thought, after all these years of becoming loyal, my masters are killing me’.

Mom blew her blocked nose in a piece of tissue and put her hand across her chest trying to control her breath. It was then, I understood the trauma of her loss was much bigger than mine by many folds even after all these years. She is in her early 50s now. She was merely on her teens then. At least, Bhalu passed away of age, it was inevitable. I had some time to say goodbye, I cannot imagine if I could have ever gathered enough strength to put him down, in circumstances like that.

Its a loss of friend after investing so many years of emotions even though they are ‘pets’. It hit me harder than losing a human friend. I didn’t know her that long as long as I had known my dog. So I completely understand the panic it must have created in pandemic with anxieties building up with lack of care facilities and delay in urgent services offered for pets. As far as I am told, most were classed as ‘non -essential’ travels/services. Studies have suggested, there aren’t any robust plans for situations like this COVID pandemic for our pets, who are now very integral part of our lives and societies. Shouldn’t we be working on one now?

I read some stories where people gave up their pets last minute because they were not able to take care of them. I hope they found right homes. Better to give in for adoption than to raise in abuse. I have regrets of my own not being able to give my dogs the right care, not being able to give enough space to stretch their legs in urban city. I could barely hold Bhalu when he ran, he was so powerful, he would drag me sliding from one end of the ground to the other. Eventually I’d have to let him go and return home with bruises in my elbows, legs and face. Then Mom had to go searching, before the whole neighbourhood started panicking seeing the giant running around chasing their little fufu and toy dogs. He was very troublesome. Had a big personality. Loud and very unfriendly to others. But I loved him, we loved him in our own way to pieces.

Impressions (So you’re a doc, a foreign cuisine and Corona happened)

https://www.spreaker.com/episode/49494970– podcast link

 I’ve been living in this flat for about 2 and half years now. And the only times I’ve met my landlord was one when I first took over the key and signed the contract and the second, was a few months earlier at the end of last year when I had locked myself out of the apartment and I needed the master key from him to get in. My first impression of him was, he was a lovely person and quite specific to points he wanted to put across. The second impression was, well I am not so sure. Because he looked kind of grumpy. Understandably because he had to drive on a sunny Saturday afternoon to open the door for a tenant and also because was sat out ready to have lunch when I happened to call. We all know how ‘hangry’ feeling is. As soon as he saw me, he headed for the flat door, unlocked it, got back on his motorbike immediately and drove home without even saying proper hi or goodbye. 

At that time my thought was, ‘well I’ve been living here paying my monthly bills for 2 and half years now so at least you could do me one favour smiling.’

But, by a strange coincidence I met him a few days ago as a patient. And now my whole impression of him has changed. 

I really didn’t recognise him until I saw his name and queried ‘are you my landlord?’. To which he replied, ‘if you are the person on your tag then yes I am your landlord.’ 

The person I saw a couple of months ago and was intimidated with happened to be quite charismatic, polite, kind man in his 70s who had come a long way in his life. It feels as though now after spending an ample amount of time with him, I have now looked into him ‘inside and out’. Still battling through a lot of hardships and pain everyday with his medical condition, he impresses me with his strength of character.

I really wanted to help him that day. Make sure he got the medical attention he was seeking immediately. Basically whatever I can do from my end. 

Sat in the bed, looking at the creamy beige painted walls of his property that I had made home for past years; I can’t help thinking now how different our perceptions of people are in different settings. How our interactions of minutes can leave a lasting impression on individuals and how changeable we are with our presentations and our effects according to our circumstances. 

I suppose in a way that meeting with him came as some kind of unspoken lesson for me, to be mindful enough to not judge a person based on a few interactions. And to be open enough to accept that the best version I felt from him that day was perhaps the real version of him. This reflection also came with an implication in my professional life. My friends say, my expressions are like an open book. My emotions easily shows off in my frowns, in narrowing/lifting of my brows and in my eyes. Sometimes I am hurt, sometimes I am bitter, sometimes I am happy and sometimes tired and frustrated. These are the emotions one goes through when one deals with a number of people as  a job on a day to day basis. ‘People affect emotions’. They are variables you cannot change, unlike following a routine in an office cubicle where you might have some uniformity to anchor on. Sometimes a patient will make your day, you feel like finally you have made a small difference in a person’s life. We ‘medics’ are suckers for an ego boost, desperate to please in service. Other times you have to remind yourself you are professionally obligated to serve. Doesn’t matter why the inmate was in prison whether for a rape or a murder.  So, gauzing my expression when I interact and /or communicate to a patient is an important skill I need to work on.

‘Oooh you have a perky butt’, a patient in his late 80’s recently commented on me. I didn’t know if I was to laugh, tell him off politely or just walk away pretending I didn’t hear. I just walked off. I had a laugh on my own later thinking to myself,  ‘Oh aren’t we naïve? To feel so protective of the olds like new-born babies with their pearly eyes and lost expressions when we know they may not be as innocent as they seem. They might be entirely different person or live very different lives outside these gates. Some, maybe we approve of. And some, maybe we don’t’.

Professionally we shouldn’t and we cannot judge. And although by human nature, instinctively, first impressions are what we depend upon, to determine whether a person is friend or foe; in a medical world, you will learn to tone down that intuition. I learned it is a skill that you must acquire to be a part of this profession.

Occasionally I meet these amazing people that I love listening to. It may be just 5mins of the day but the interaction leaves a lasting impression. ‘Oh I travelled everywhere. You got to. I have no regrets‘. One of my elderly patient said to me. And immediately then I thought that should be my motto too. I should at least see a couple of wonderful places while I don’t have commitments with family of my own.

‘I haven’t talked to my brother for so many years. But what could I have done, we had to run away, she was the love of my life. She still is.’ Other patient narrated his tale the other day and the way he said it. It was sad yet I was very happy for him at the same time. Difficult to describe those emotions together. He too said, ‘You have a photographic face. Very expressive face.’

Life is happening in the world out there and I too want to be a part of it. Follow the light.

All aside from the point, like our patients we do leave a lasting impressions in 5 minutes allocated time we have to spare them in a list of 15- 20 reviews everyday. It is important to ensure that as professionals we hold our emotions to ground no matter what time it is or the situation is. Our actions should prove that we are there to serve in their best interest. Our goal is to win their confidence to ensure that they adhere to the advice and the treatment given. It is important to build a rapport because, as a patient to their doctor they are emotionally vulnerable to us. Their medical history, mental health history, social history, personal details everything is open to us in our records. Yes, it is like as if we have seen them ‘inside and out’. And that is a lot of trust to give to a stranger.

We aren’t cold hearted with faded, dull and detached personalities. We are very much receptive of our surroundings and very attuned to your needs, we are just better at camouflaging it, being a third party and being objective so we can treat you better. Trust me outside the hospital premises, we too have our whole other lives rolling out.

I was supposed to give a month’s notice before moving from my flat. I am looking to move to a cheaper place which will be costing me half my monthly bill that I am paying at present. I love my privacy and this little flat, however I think at present it is wiser for me to cut back on my expenses than take an extra shift. I am telling myself, if I want to stop dreaming and start making things happen ‘this is the way to go’. The room I will be moving into is quite small, it is a single room in shared accommodation. It is going to take a lot of effort for me to adjust there. But, like everything it is one of those decisions I have to take as a part of accepting my adult life. We all can’t have a house with open rooms and a lovely garden in the suburbs of our own, otherwise who is going to pay the rent/mortgage right?

I contemplated for a while thinking whether it is  appropriate for me to give my landlord a notification now that I know what his situation is. Especially when there is a financial security to think of. But, I did end up sending the notification later. With my training ending soon in a few months, I won’t have any job to rely on for continuous income and any savings on expenses I could cut is going to be a big help.

I have packed my bags today for a ‘girls night out’. 4 of us are meeting after 1 and half years. We are all doctors. It is very rare for all of us to be off work at the same time. So when we do get an opportunity, we make the best out of it. We will be staying in some fancy hotel and be up all night chattering about our lives. Lot to talk about. And there is a free pool! I guess that’s the joy of being working and/or middle class person, when you work so hard to earn you party hard on your spend!!

(Apologies earlier version of this post was rough draft 🙂 )