Just say it

It has been a while since I have written anything on here. There are several reasons for that and I may eventually explain them. One of them simply is because I have been doing a lot of traveling and interviewing these past several months. I am also speaking at an event at the end of next week and am not even sure what I want to say. I guess I should explain why I am like that.

I do not think of things ahead of time. I do not prepare for interviews. Similarly, I do not have multiple drafts or blog posts or anything else I write. Many times, I do not feel like reading over what I just wrote, which may explain typos or other errors I may have. Just like my blog posts, I wrote my personal statement for residency in one sitting and then submitted it. I knew I could do it. I like it that way.

Why? How is this possible?

Because I speak from the heart. More importantly I am not afraid to show my vulnerabilities.

I feel like preparing things ahead of time or having multiple drafts of something will prevent me from revealing the truth. I do not want to second guess myself. If I say something, it is because I feel it.

Because of this, I do not get nervous when I have to speak publicly. I do not get nervous before interviews, no matter how important they may be.

I do not understand why people get nervous. If they are afraid of the consequences, perhaps of a certain interview or speech they have to give, they need not be. They are who they are; nothing more, nothing less.  If the interviewer does not like you for who you are, you are probably not a good fit there anyway. If one is worried about being judged by others, such as an audience, I must ask:  who are these people to judge you? How do they have a right to make judgments about anyone? They, too, have hopes, have fears and have loves. If the roles were switched, would they have the same concerns?

By fully expressing yourself a lot of times, you are not really showing you are unique. You are showing that you are more similar than they had thought and that they, too, have a secret life just like you.

Do not impress. Do not try to be anything more (or less) than what you are. I have found that by being purely honest and exposing my vulnerabilities—no matter how odd or weak I think I may seem at times—I am able to relate with others and they are able to relate to me. We spend too much time and effort trying to make us seem stronger and more impressive than we really are.

I do believe that this will help me in my future profession as a physician and that having this outlook may help others in their profession, but it should not stop with just our careers. With everything we do, see or talk about in life, we need to realize how connected we are to each other.

This is real. Life is real. We either live without regrets or we watch as it passes us by.

Acceptance: the final stage

This post is long overdue. I have wanted to write this for quite a long time, as can be seen by how long ago I wrote Stages Part 1, Part 2 and Part 3. I did not know where to start so I avoided it or told myself I would write when I had time to relax. I still do not know where to start or what to say and I have a few other things I really need to do, but I shall write. I do almost all my writing in one sitting and when I speak, I almost never have things prepared. That ensures that everything I write and speak about comes from the heart.

Acceptance.

Acceptance is the last stage in Kübler Ross’s model of the stages of grief that one goes through in dealing with something tragic or traumatic.

There were many times when I thought I had accepted things. I was okay. I was not angry. I didn’t curse the heavens. I was not bitter. If you have kept up with my blog from the beginning, you will see that that is true. I have been put in difficult circumstances but it is in these circumstances that I carry on with my life.

It is in these circumstances that I have found peace.

It is in these circumstances that I have found purpose.

Acceptance of my disability was not as straightforward as I thought it would be. First, I had to accept my own mortality.

I almost died. That phrase gets thrown around a lot by many people, but in my case, I really was just a few inches or a few breaths away from leaving this life. I am not sure what impression I would have left upon this earth if I had passed away four and a half years ago.

As many of you know, I moved out of my family’s home to my own apartment in a different city and started medical school one year after my accident. “I am ready,” I thought. I was hit with reality once classes started.

I had to adapt to living on my own. Life was different. Things took longer for me to do. I could not relive many of the memories I had made in Athens. Needless to say, medical school classes were a lot tougher than I had imagined.

“You cannot compare yourself to others,” a friend said to me after I told him how I was having a hard time. “You are different than all of them. In addition to overcoming the challenges and rigors of medical school classes, you also have a lot more to deal with. You had a significant injury and became completely paralyzed just a year ago. That alone is more than enough. That alone is more than most people can deal with.”

That consoled me a bit. I am not one to back down from a challenge and I knew this would be difficult. But just like I was blindsided by this injury, I was blindsided with what to expect. I carried on with my life by moving out and starting medical school as soon as I could not only for myself, but for everyone else. I knew I could do what I wanted to do. As I have said before, I am stubborn. But others did not believe that I could do what I wanted to do. This is not to say that other people did not support me in my endeavors. They just did not expect much of me. I knew, however, that in order for me to be considered an equal to the general population once again, their expectations of me would be much higher and that I would forever have to prove myself.

All through my first year of medical school, I worked hard. I pushed through any all obstacles. There were times when I fell onto the floor with no one to help me. There were times when I was depressed. There were times when I was frustrated with everything.

One Friday night, after receiving a harsh score on an exam, I found myself dead tired but unable to sleep. “What am I doing?” I asked myself. “I should not even be alive. I am living on borrowed time.” In my frustration, I came to an interesting realization:  I was not happy. I mean, I was outwardly happy as far as people could tell, but I was not living a life of peace and fulfilment. I spent every day studying. I spent most nights either studying or worrying about classes. I was not spending time with my friends or enjoying life. I could have died. I can die any day. All of us can die any day. So I asked myself, “Suppose I was told that I would only live for a few more months or a few more years. Is this how I would want to live life?”

That question, with all the thoughts and musings that came along with it, was a big turning point in my life.

I thought a lot about death. I saw a lot of sickness and death in the hospitals.

I accepted my mortality.

Next, I had to accept my life.

To be honest, I am not sure when or how that happened. As I said earlier in this post, I thought I had accepted things from the beginning. It was not until much later that I realized that that was not the case, though I knew from the beginning that I was different and that things would always be different for me. After I accepted my own mortality and the fragility of all of our lives, things seem to just fall into place.

In the summer between my first and second year of medical school, I underwent a sort of “enlightenment,” so to speak. I took a break from studying and the fast pace, goal-directed life of which we seem to all be a part. I spent a lot of time by myself in my apartment. I read for pleasure. I watched movies. I listened and I learned. Everywhere around me, there were things I had never noticed. In each moment, in each movement, in each breath, I was there.

As John Steinbeck wrote in The Winter of Discontent, “I wonder how many people I’ve looked at all my life and never seen.” From then on, I made sure to truly “see” everyone.

I moved on to my third year post-injury and my second year in medical school as a different person. My eyes were finally open.

During my second and third year of medical school, I found immense joy in everything that I did. I really loved being in medical school and doing everything that I was doing, especially interacting with patients. Learning things had a purpose for me. I could use everything I had learned to help someone else.

I overcame my insecurities and overcame my fear. I moved past thinking of myself as different from everyone else and knew in heart that I was the same as everyone else.

I am not sure how it happened, but it happened. How did I know I had accepted things?

I knew I was in a better place when I finally realized that I was genuinely happy and at peace with what I was doing and what I intended to do. I intended to take care of others. I had already affected and helped others in many ways over these past few years, but this realization was different.

When I accepted my life, I accepted one thing:  in everything I do, I will do my best to ease the suffering of others and I want each and every person I come in contact with to be better than me. I want them to progress and to be healed. I myself am paralyzed and have to live in a wheelchair but nothing would make me happier than to see others at peace with themselves. I would gladly volunteer to take the suffering of others upon myself.

I can now say that I have not only accepted by disability, I am thankful for my disability.

“'The two most important days in your life are the day you are born and the day you find out why.” – Mark Twain

Stages, part 3 (finally!)

I have been itching to write for quite some time now. A brief recap of what I have been doing: after completing the USMLE (United States Medical Licensing Exam) Step 2 in late August, I spent this past September doing an elective rotation at the Shepherd Center—the same place where I spent about three months as an inpatient after my accident in the summer of 2009. Being there brought back a lot of memories about which I could write plenty, but right now I want to write about something that I have intended to write about since I wrote “Stages” and “Stages, part 2: Anger” months ago.

As I said in the post “Stages”, the Kübler-Ross model’s five stages of grief are denial, anger, bargaining, depression and acceptance. I wrote about stage one, denial, and stage two, anger, already in the two posts linked above. Tonight, I will write about the next few stages.

“If I could at least get something—anything—back, I will be thrilled. Please, God, give me something back,” I thought to myself and bargained with God more than once. I imagined what I would do and how I would tell people once I had recovered. I wanted to take a photo of myself standing and giving high fives to my two best friends who also spent their summer of 2009 with me in the hospital. I would make that photo my Facebook profile picture. Maybe I would not be able to walk perfectly and I would have to use a cane. I would buy myself the coolest looking cane. I would have the coolest stories to tell people while looking wise and holding my cane.

“Man, this is going to make the best personal statement,” a friend said to me as I lay in my hospital bed. He, too, believed that I would be out of the hospital soon and running again.

In the bargaining stage, people usually bargain with a higher power. I certainly did. I prayed and vowed that if I was healed, I would forever be in God’s debt. I would be a changed man and I would always be righteous. Little did I know at that time, this is what everyone goes through.

I thought I was doing everything right. I was 100% confident that everything would be okay. I would be completely healed. I did not think anymore that I would wake up one morning and suddenly be completely and miraculously healed, but I did think that I would one day discover that I could move a toe or feel the warm water running over my legs in the shower.

Throughout this time, though, I never allowed myself to truly be outwardly and noticeably sad. There were some difficult times through which I had to go during the over the course of the first year after my accident. If I was 100% healed, if I could walk again, then none of this would be happening. Everything would be okay and everything would be so much easier. I would get what I wanted and would not have to struggle.

But, as the Lebanese writer Khalil Gibran said, “Out of suffering have emerged the strongest souls; the most massive characters are seared with scars.”

My family and friends were always looking to me for strength, instead of the opposite way around. So, rather than going through the typical fourth stage of grief, depression, I kept a smiling face. This does not mean I did not feel pain. As I wrote here, I did. But you could never tell.

As I was telling a close friend of mine and as many of you may have read if you have kept up with my blog since the beginning, my first year in medical school was a struggle. In addition to dealing with the rigors of a new medical college campus with a surprisingly more difficult curriculum than the main campus, I also had to deal with coming to terms with my disability and adapting to living alone once again.  Coming to terms with a something as big in one's life as a crippling disability is something that usually takes people many years. It was my choice to start medical school only one year after my injury. I did not want to waste more time and I did not want people to see me as more “disabled” than the disability I had already made me seem. So I carried on. Life was not stopping.

There came a time during my first year of medical school when I was struck with a strange yet honest realization. I spent most of my time studying. Even as things fell apart, things were not slowing down. I was not having fun. There was no time for fun. I realized that in all honesty and as morbid as this may seem, I could die soon. We all could.

So I asked myself, “If I knew I had one week to live, what would I be doing? Is this how I would want to spend it?”

I kept a smiling face. I looked at the bright side of things. I moved forward.

This is what I set out to do.

There are too many times we get locked in the third or fourth stage of grief, bargaining and depression. For some, this is a hole from which some never rise.



A turning point in my life came in the summer between my first and second year of medical school, the summer of 2011.

This post is getting fairly lengthy and I have not even concluded it properly yet. It is also time for me to go to sleep. For now, I will end it right here. I actually wanted to write about the fifth and last stage, acceptance, and I promise to do that very soon since I am eager to continue this. In the meantime, I provided many links above through which you can read and refresh your memory until then. And as a preview for the upcoming post and to see what place I was in at that time of change in the summer of 2011, here are two, more refreshing posts: “Clearing my mind” from August 2011 and “Balance” from September 2011.

I’ll leave you with a quote by one of my favorite writers, Chuck Palahniuk, that I actually made into an image and used as a wallpaper for my phone for the first year or two after my accident to give me strength: “It's only after we've lost everything that we're free to do anything.”

Amazing commercial

Ignore the fact that this is a beer commercial and just focus on the message. It's beautiful.

Always remember this

As physicians and, more importantly, as humans, the message in this video is something we need to always keep in mind:

The common bond that we all share

[Note:  I started this ten days ago on July 7 and just finished it today.  That's why it starts off the way it does.]

I’m going to just write something quick since I have to get some things done tonight and get adequate sleep before going to the hospital tomorrow morning for my rotation in the intensive care unit.

Today, July 7, is my birthday.  Birthdays are almost never big or special for me.  I usually end up just relaxing by myself.  The only really festive birthday that I will truly never forget was my birthday in the hospital in 2009.

A friend surprised me today with a few gifts on my birthday.  Because we had only recently met, she did not know the full story and details of what happened the day of my accident, the immediate aftermath or the following two weeks I spent in the intensive care unit.  After about five or ten minutes of me talking, my friend was in tears.

The things I explained to her were told to me many times by my family and friends since I do not remember anything from that time.  The sights and sounds that were described to me seemed to mimic the things I witnessed while in the “doctor” point of view in the intensive care unit last week.

One of my patients last week was in a coma.  The first thing I noticed as I entered the room was the smell of sterile chemicals on a backdrop of the slight smell of human wastes.  It all smelled too familiar.  This previously healthy, very young patient was not responding to light touch or loud voices but would react to painful stimuli.  She had been unresponsive for several days.  I was able to speak with her very concerned mother and brother.  The patient’s brother was very protective of his sister and told his mother a few times that he wanted to go through his sister’s phone, in case she had been speaking to someone who may have given her illicit drugs that could have caused her current state.  At one point, I saw her brother whisper something to her and kiss her on the forehead.  The next day, the patient was able to open her eyes slightly and nod her head.  The following day, I was thrilled to see that she was sitting up and speaking, though her insight on her condition was a bit cloudy.

The experiences in the intensive care unit last week combined with my birthday and my telling to my friend about my experience as a patient all really made me once again appreciate the fragility of life.

The patient who was in the coma had been previously healthy.  I, too, had been previously healthy.  We both had family and friends that love us and were very concerned.  Both of us had been in a very uncertain condition.  We both also appeared and smelled in an embarrassing way that we wish no one else could have seen.

These days, I see patients who are on the brink of death.  Just a few days ago, I was in the room while a patient took his last breath.

Death is a subject about which I have a thought a considerable amount this past year.

It is also a subject that we do not really discuss.  But I said in my last post that I would continue to be honest and that is what I am doing.

Have we become desensitized to death?

When I’m in the hospitals, I regularly hear people talk about a patient passing away.  It is usually just an acknowledgement of the person’s passing and then the conversation changes to something else.

“Why don’t the newscasters cry when they talk about people who die? At least they could be decent enough to put just a tear in their eyes.”  - Jack Johnson, “The News”

This inattention to the gravity of death is surprising to me.  I understand how regularly seeing and hearing about people passing away may make us insensitive to it and we do not let it affect us.  But we must not allow this make us numb.

I am not sure how many of you watched my last talk at MIST but in there I discuss the pride that we all have.  We all seem to consider ourselves invincible.  Illnesses cannot fall upon us because, quite frankly, those things are for “sick people”.  They are for “the other people”.  Death comes to these “other people”.  We cannot imagine ourselves lying in bed with multiple tubes and wires connected to our body.  We cannot imagine that the doughnuts and ice cream we love to eat may give us diabetes and that if we are still reckless and do not manage that, our kidneys may fail, we may go blind or our feet may eventually have to be amputated.

We cannot imagine ourselves waking up in a hospital bed and being completely paralyzed.

No, those things cannot happen to us.  Those are simply academic things that we learn about in medical school or that we see in movies or read about in books.  There is a dramatic finish and the person lives on in the memories of others.  Those types of things do not happen to people like me.

I would explain this more but I feel like this page from The Death of Ivan Ilych by the 19^th century Russian author Leo Tolstoy expresses this exceptionally well:

Death is something that is inevitable.  That is no surprise.  But then why does it surprise us?  Why do we shy away from this topic?

When we die, that’s it.  We are done.  There is no reset button.  There are no second chances.  A mere few years later, who we are and what we have done are completely forgotten.

Most of us never really think about this—and I mean really think about this.  What are we doing right now?  What does this exact moment mean to us?

You will never be as young as you were when I started this post.

The finality of our life is perhaps why it takes some people a few days before they can actually accept and properly grieve the loss of a loved one.  That person is gone.  They are never coming back.  I have so many memories of that person.  I can remember everything so vividly.  I remember the sound of their voice and the smell of their clothing.  I remember how they were so happy and surprised that one time.  I remember how sad they were another time.  If only I had another day to spend with that person, I would let them know how much they mean to me and how much I will miss them.  I never really let them know before and now it is too late.

We should not live our life in regret.

As I have said before:  love before it's too late.  Love before you lose.

The 6th century BCE Chinese philosopher Lao Tzu wrote in his work Tao Te Ching in regards to a soldier going to war:  "His enemies are not demons, but human beings like himself. He doesn't wish them personal harm. Nor does he rejoice in victory. How could he rejoice in victory and delight in the slaughter of men?

He enters a battle gravely, with sorrow and with great compassion, as if he were attending a funeral."

Media sources today are all disappointing.  We can only blame ourselves for that.  What happens when we hear about a school shooting or an attack when innocent people lost their lives, like in the recent Boston Marathon bombing?  The news sources focus on the killers.  Their photos are everywhere and the killers become household names.  Bluntly put, we glorify the killers.  We immortalize them.  This produces even more killers from psychologically disturbed and immature people who also seek their own version of glory.  And that is all we, as a society, talk about, too.

We do not focus on those who died.  We buy into the sensationalism and hysteria that is created and, in short, we let the killers and terrorists win as they become notorious and they cause us to live in fear.

The people who died become a number.  People, both locally and internationally, who die from diseases or attacks are not even given a second thought when we hear or read about them in the news.

We lose our humanity.

Each and every person we meet is just like us.  Every person around the world who dies is like us.  They, too, were once a child with joys, fears, insecurities and flaws.  They, too, knew friendship and betrayal.  They, too, knew love and heartbreak.  We all experience seemingly endless joy.  We all cry.  Our problems are not bigger than the problems of others.  Our pain is not any more special or significant than the pain of others.  It does not matter if we are rich or poor, atheist or Christian, educated or uneducated, a model citizen or a criminal.

We all want a second chance. 

We all wish we had more time.

Do not lose your humanity.  The next time you hear about someone—anyone—who is sick or dying, realize that that may have been us.  That person, or that group of people, lived, laughed, loved, feared, cried and experienced all the feelings we experience.

Article in London Link

I have been meaning to write another post but in the meantime, here is a little reading material! I am featured in the summer 2013 issue of London Link magazine. If it looks familiar, it's because it is the same interview that was on the Muslim Heroes web site.

The article can be read at:  http://issuu.com/londonlink/docs/llinkv3i4_web