“It’s the little things that you miss the most.”

During this last summer break for the rest of our MD lives, I am conducting research in Athens. I am researching the cardiovascular response to functional electrical stimulation in patients with spinal cord injuries. One of the patients that comes in is a “regular”. He’s quite animated and all of us researchers enjoy it when he comes in. The other day, he said something to us that I think only I fully understood.

“It’s the little things that you miss the most,” he told us. He described the ability to cough. He recalled how he initially was not able to cough strongly or cough up things. I zoned out a bit as I thought back to my experiences, but I caught the end of his discussion of the topic when he said, “I miss being able to do those kinds of things. People think it’s about the big stuff like walking, but it’s the little things that you miss: being able to cough, man.”

My mother and a good friend would describe how they had to give me water with a dropper. Another good friend told me how I once woke up in the middle of the night choking and gasping for air. When the nurses rushed there, they stuck a tube down my throat and removed a tiny bit of mucus present, due to pneumonia, which had been obstructing my airway. This was all when I was delirious and coming out of a coma. I don’t remember any of it. My ribs had broken off and had punctured my lungs and my throat and airways were constricted, which I assume were a side effect of the spinal cord injury or possibly due to other injuries.

I became fully conscious and able to form memories after I reached the Shepherd Center in early June. I could not speak above a whisper and after saying a few words, I would become out of breath and fatigued. Two best friends of mine who were always there with me told me that despite this, I made sure to talk to everyone who came in. I guess I felt rude not talking to people if they came to see me—some from far away. Months later, I would receive the encouraging compliment from my therapists, “Nice sneeze!!!” if I let out anything that was even barely audible.

For a long time, I was not able to eat solid food or drink normal fluids. My food was pureed like baby food and my fluids had to be thickened with corn starch. If you read my last birthday post, you may recall that that was when I was finally allowed to eat solid food and drink normal fluids. The reason my drinks had to be thickened is because normal fluids could go down the wrong tube, causing the fluid to enter my lungs (aspiration) and making me prone to pneumonia. As stated in the birthday post, pneumonia is the number one cause of death among people with spinal cord injuries and I already had it twice.

I stated in this blog post and in this interview that even a year later, I could not talk loud and I feared running out of breath whenever I spoke. Tonight while driving, I was thinking back to what our patient had said and about my own experiences and I decided to test out how strong my lungs had become. I remembered how I had a pretty good sneeze earlier that day and I was feeling pretty cocky. So I let out a loud shout and a yell with this song playing through my speakers. If you listen to the song you can see why that's ironic. I smiled.

It’s the little things.

Really?

I recently interacted with a surgeon and a therapist, both South Asian, on different occasions during appointments.

They were, as most people are, surprised to hear I'm going to be in my second year in medical school and that I already completed one year like this.

Then, they are even more surprised to hear that I am living by myself in my own apartment. And that I drive myself to where I need to go.

Is it really that hard to believe?

Things are different, but you adapt.

Mad cow

It’s interesting to sit back and watch how people react to certain situations.

“A lot of people get angry after they become paralyzed. They get pissed off at the world, at God, at other people,” I was telling someone the other day.

“You never really got angry,” he replied.

With a life-changing injury, extended hospital stay, paralysis, and a wheelchair come a lot of frustrations for which one cannot predict or prepare. On top of these things, nobody else can understand unless they are in the same situation. Thus, people in wheelchairs tend to be angry.

I remember one day, a group of us patients at the Shepherd Center with accompanying guests and a few therapists went to the airport to participate in a simulation by Delta airlines. We were shown how to go through security and metal detectors, get onto the plane, and get into our seats. After we went through security a second time, one patient asked his wife for his iPhone. She didn’t have it. He blew up. He was swearing at his wife and telling her how his whole life was on that phone and how he would never trust her with anything ever again. She apologized, but he just kept getting angrier. Everyone in our group was quiet. His wife went back to the security line to see if she had accidentally left his phone in one of the boxes. A few minutes later, he found the phone in his bag. I looked over at my brother and we both were trying hard not to burst out laughing.

I've heard about people becoming bitter and full of resent. After my friend's dad temporarily injured his leg in an accident and couldn't do certain things, he would get mad at his son if things weren't done perfectly. I explained to my friend how it can be frustrating and make people really mad when they are unable to do things the way they prefer. People don't like change. So one can easily see what effects a life-changing incident may bring.

When I was younger and going through my stage of teenage angst, my brother and my parents would often tease me about being easily irritated. That phase came and passed, as I’m sure it does with most people. Years later, my close friends would note how impatient I was: I would finish other people’s sentences; I would skip songs after listening to the first 15 seconds; I would get impatient waiting for someone’s response; I would get antsy waiting for exam results… I couldn’t wait for anything!

Things changed. Now, I honestly do not see the point of being angry or upset.

Why do we get angry? Are we that into ourselves? Are our egos that big and fragile that anything that goes against our opinions or what we believe or know makes us angry? Sometimes we get angry when we see or hear something happen to someone else. How productive is it, really?

I was talking to a friend of mine who was getting angry over something. I wanted to stop and ask, “What are you getting out of being angry? Is it helping the cause? Or are you just reinforcing the negativities?”

After going through everything, I’ve realized that life is too short to be angry. It seems like such an irrational and pointless use of one’s energy. When I see someone getting angry, I just smile. Things can be frustrating at times (as can be seen by my frustrations with school), and I can still be impatient at times (though magnitudes less than the way I was before), but anger is something I just don’t understand. It almost always causes more harm than benefit.

Raising voices makes people seem powerful and in control of the situation to themselves. The person who yells back usually tries to raise the volume by a few more decibels to try and become the one on top of the argument. In reality, it is not the one who gets angry over a situation nor the one who yells back that is strong, but the one who knows how to show proper constraint and compassion. All others are fools.

While anger is a general expression of insecurity to something, it can also be the result of being passionate about something. “I’m angry because I care.” Well, if you care that much about something, then use your energy to figure out a way to truly understand and change the situation.

Although things happen and we may not see the reason for them, one should learn to find solutions, to make things better. When things are seen or words are said that rub us the wrong way, this is just an opportunity for change. And if things, situations, or the words people say/believe cannot be altered, then that is fine. We should be secure with ourselves.

“In the midst of movement and chaos, keep stillness inside of you.” – Deepak Chopra

Since I was in the hospital a few years ago, people have asked why I laugh at things, even during inappropriate moments. My answer at the time? "If I wasn't laughing, I'd be crying." I continue to smile/laugh at things because almost everything in life seems so trivial, and there is nothing else to do but smile in this world.

Two Years. The scars remind me that the past is real.

I started writing a blog post last week about finishing my first year of medical school, but stopped writing after about half a page. I looked at the date and my mind got distracted.

It has now been two full years since my accident. Two years. Wow, it’s hard to believe. It’s hard to believe I’ve come this far. I never thought I’d make it.

Things have become routine now. I sometimes forget about the way I used to do things before my accident.

When I look in the mirror, I still see a scar.

The scars remind me that the past is real.

I have several scars that have faded with time—some not fully, though. I had two prominent scars on my face that were not a direct result of my accident, but were due to the hospital staff in Augusta strapping my face mask on extra tight because I deliriously kept trying to rip it off. It left two deep, dark scars on each side of my nose. The one on my right side faded within the first year after much scar cream, but the one on my left side is still slightly visible.

The gnarly scar on my neck is still there. I believe the back scar is also still there, although it has probably faded significantly, as indicated by this photo from one year ago:

Why am I talking about scars? Sometimes I forget about my situation until I see them, and then I remember. The scars hide a lot.

I finished off a year of medical school! It’s been a long year, but it has also gone by so incredibly quick.

When I think back to one year ago, all I remember is apprehensiveness surrounding the whole thing. My parents were still trying to convince me to not live by myself. They were worried about how I’d live on my own and how I’d do in school with everything I have to balance. Other people were concerned about the same thing. I felt like people looked at me with doubt. I was concerned about how my classmates would treat me and look at me.

Throughout the year, I doubted myself many times. I came in very confident and almost immediately got shot down.

There was about a one month period when a certain medication I started put me into severe depression. Once I discovered what was making me feel like that, I immediately stopped it. That was not a bright time. I wrote about it, but did not post it. I will post it here now ("Bulletproof"). I’m glad that only lasted a short while.

I had a few meetings with some faculty members at school. I told them that I was frustrated with things, and they told me how they were all impressed at how I was dealing with things, progressing, and how far I was going. That was certainly encouraging.

Living alone and going to medical school a year after everything I have known for +22 years was turned upside-down really made me “grow up”, so to speak.

During year one post-injury, I was coping more with my physical situation. Over year two, I dealt with my mental situation. I’ve never worked so hard in my life and I can confidently say I worked harder than any of my classmates and anyone that I know.

There were times when I told myself I was in over my head. There were times when I wanted to quit. I became so frustrated with things because everything was different. I wasn’t the same person. I spent a long, long time studying things. On our weekly quizzes and on our exams, my grades were definitely not reflecting my effort at all.

Or perhaps they were reflecting my effort, considering certain circumstances. I was pulling my hair out because I really wasn’t the same person at all. I did not have the same mind. The scar on my neck reminds me of my traumatic brain injury; it reminds me of the time I spent on the brain injury floor; it reminds me of all the times I was told to reconsider professions; it reminds me of why I had to work so hard to keep my dream alive of becoming a physician.

Thankfully, I made it through alive.

I’ve decided to live in the present as much as I can. These past two years have gone by faster than I have ever thought, and two more years will go by just as quick. No doubt, though, I am surrounded by constant reminders of how different I am, and I am also grateful because I feel like they have given me a new outlook on things. I’ve always liked challenges.

Bulletproof

[This was written in December 2010. This is not how I currently feel! I explained why I was feeling this way in my most recent blog post, "Two Years. The scars remind me that the past is real."]

Many of my blog posts have titles that are references to song titles or lyrics. People don’t usually catch them. I thought I would post a fan-made video of the song that is referred to in this title. Watch and listen to it afterwards if you like.

Almost every week in medical school, we come across a topic that reminds me of something. Occasionally, I’ll write about it, but I usually never finish the entry so I don’t post it. This past week we discussed something that I feel is important because I’ve seen it affect others.

Our case this past week was about a patient presenting with clinical depression. Depression is not being just bummed out about something. It’s not about listening to emo music and whining that nobody understands what it’s like to be a privileged middleclass adolescent.

Well, I don’t think I need to go into a full medical description of every single presenting symptom of depression. But as I sat in my small-group sessions listening and talking about this patient’s case, I realized the extent of the problem I had.

Bulletproof… I wish I was.

After my accident, there was a period when I was in denial. Just like everyone who has a spinal cord injury, I wanted to be that person who walks out of the hospital. As the days passed by, I grew weary.

Just like the patient in our case, I did not want to wake up in the mornings. In the case, the patient described it as she felt like she “should not wake up”. There was a neuropsychologist in the hospital that would perform assessments on me because of my brain injury. He would often ask me how I was managing, and I remember telling him every time that the mornings were the worst. I would wake up every morning not wanting to face the day. As the day progressed, things would brighten up and I would look forward to the afternoon and evening, because I always had friends coming by.

“Anniversary phenomenon” is when a rush of feelings is experienced on the anniversary of a traumatic experience. At the one year anniversary of my accident this past May, I really didn’t feel anything out of the ordinary. I felt like I should have felt more—felt anything—but that wasn’t really the case. I experienced anniversary phenomenon this past fall, just within the past several months.

Fall of 2009 is when reality set in for me. I saw the effects that this injury had upon who I was, my relationships with others, and my future. I had no joy in eating. Once again, whenever I went to sleep, I did not want to ever wake up. My closest friends saw this change in me. I usually love being around people, so one friend went out of his way to take me out and meet some of his friends. I got through it.

So, in fall of 2010, I started becoming restless again. Nothing I did made me happy. I did not find pleasure in eating or being around people. I hardly slept at night and I was losing weight again. At school, I did my best to look normal and smile. I was fully aware of my state, and I actively did my best to

[Unfinished]

Why are you driving that?

Little kid runs up to me, smiling and waving...

Little kid: [pointing to my wheelchair] Why are you driving that?

Me: Because I can't walk.

Little kid: Oh, are you tired?

Me: No, I hurt my back.

Little kid: Huh?

Me: It's because I hurt my--

[Little kid loses attention span and runs away]

So what's my passion?

I remember having a conversation with a friend late in my senior year of high school. She was talking about how everyone has a passion; everyone has something they need and love.

For her, it was music and singing. When she sang, it took her to a different place. She thrived on it and she would become restless and unhappy if she hadn’t sung in a while.

Having a passion is different than something you just like you do. It’s what gives you happiness and peace in times of turmoil. It’s what you wake up thinking about in the mornings. It’s what influences the planning for the rest of the day and for your future. It’s what interrupts your train of thought when you are trying to focus on other things. It’s what you go to sleep thinking about.

“So what’s my passion?” I asked my friend when we had the conversation. This was troubling me because it seemed like I didn’t have anything like that at all. I was just a boring blob.

I have one girl in my class now whose passion is writing, I would have to guess. She is an author and she thinks about writing all the time.

I was talking to another buddy in my class and he was saying how his friend recently got into an accident and is now quadriplegic. His friend was extremely active and had nothing else going on in his life except for just being outside all the time. My friend was saying how it would be extremely hard for his friend to adjust now because there is nothing else his friend liked to do. That was his life.

“Yeah, I can understand that one, man,” I said.

“I bet you can relate to that, for sure,” my friend in my class said.

I thought about my classmate's passion. He loves to climb. “Loves” is an understatement here. He lives to climb. It’s what he thinks about constantly. In class, he can often be seen watching climbing videos. Before med school, he spent a few years climbing around the country. His weekend plans now usually have something to do with climbing. He said he took leave from one dream, climbing, to pursue his other, becoming a physician.

I brought up this topic of passions with him. “Yeah, you need something like that. Or else you will go crazy. You need something that brings you back to that place of zen. That brings you back to yourself.” We both agreed upon that. I told him how I used to be working out, running, b-boying, swimming, or doing some other physical activity everyday and how much of a change it was to not be able to do any of that. I can imagine that his friend must feel dead and I reckon my friend would also feel that way if he could not climb anymore.

So was physical activity my passion? I was constantly thinking about health and working out and it always brought me peace. My days often revolved around what physical activity I was going to do that day. Instead of wasting time on Facebook like most people my age, I was reading health/fitness/nutrition blogs. So was that it? Was my answer that simple?

Back in high school when I asked my friend what my passion was, her response surprised me. She knew me really well so I trusted anything she would say. “People,” she said. “You are passionate about people. You love interacting with people. You would do anything for them.”

My close friends now can attest to that as well. Before the craziness of med school, I had a rule for myself: people come first. Even if I had an exam the next day or had to wake up really early, I would put my friends first if they ever needed anything. If someone was sick or emotionally troubled, they came first. Grades can be redeemed or repeated. Connections with others sometimes cannot.

“Regret for the things we did can be tempered by time; it is regret for the things we did not do that is inconsolable.” –Sydney J. Harris

I said “before the craziness of med school” because I have had to stop interacting with people as much. School keeps me occupied most of the time. Still, if I know someone is upset about something, I cannot concentrate on anything and I cannot sleep at all either. I want to know that they are doing okay. So, there are harms to this as well.

I guess this conversation I had back in high school comes as consolation to me. I know that I can still have the thing I am most passionate about. And I am not ashamed of my passion. Sometimes, it hurts me, but I wouldn't trade it for anything. As a future physician, I think this will help me.

What’s your passion?