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

My talk at TEDxGeorgiaTech

I know I told you all a long time ago that I would post this video of me speaking TEDxGeorgiaTech this past November.  I just found out a few days ago that it has been edited and published.

I must forewarn you again:  I randomly received a phone call asking if I was interested in talking just a few days before the event.  I was very busy that week in the neonatal ICU and had to come up with and memorize about fifteen minutes worth of material in a very short time.  So please excuse any mistakes!

I must say, though, that because I had only a short amount of time to think of what to say, I spoke from the heart.  The experience was quite cathartic

Thank you for watching.

Four years later

This is the blog post that I wrote after returning to my apartment from a long day in surgery on May 23, 2013.  This post seemed jumbled because I was extremely tired when I wrote it.  I could have written for about ten pages if I had not stopped myself.  That is why I stopped writing this and quickly posted up this Facebook status instead.  I am posting this now because I do not want it to become another piece that I write but never actually post.

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That day has come again.

Before I start, I should let you know that I did not sleep last night.  I say this because I ask for you to please not judge my writing.  I was up studying last night later than I had planned to be and when I went to bed, I could not fall asleep, even though I was extremely fatigued.  I slept less than two hours on Monday night and about four hours on Tuesday night.  I knew the reason why I had not slept much those nights, but what about last night? I gave up on trying to fall asleep and I got out of bed around 3:30 AM this morning and was at the hospital to round on patients before 6 AM. I got back to my apartment around 8 PM.

“Oh, man, look at that date,” I thought to myself last night.  “Tomorrow is going to be just like any other day, just like it always is.  I wonder if anyone will even remember.” I mean, only two or three people even remember my birthday without having to be reminded by Facebook, but that’s understandable.  No one would remember this day.

As my head today was swimming in a sea of surgical procedures, anatomy landmarks and the “heavy head” feeling that often accompanies lack of sleep, it hit me.  It has been four years since I was crushed under the roof my family’s SUV and my life as I knew it changed.  My next thought was, “Why haven’t I written anything lately?”  I used to write relatively frequently, even when I was busy. I reminded myself how I am really mentally fatigued these days whenever I return to my apartment.  I also noted how I have not had really strong opinions, thoughts or emotions on anything in particular so I haven’t really had anything to write about. 

Then I realized something else:  my subconscious mind has prevented me from writing anything new on here.  This blog is read by more people that I ever could have imagined and, though that makes me very humbled and surprised, it also set a mental barrier.  I think maybe when I realized that many people were actually paying attention to the things I wrote, I became self-conscious.  One of the things that I adhere to and that some readers have commented on and admire is that I am honest—sometimes brutally honest.  I share my inner struggles and inner feelings.  I do so for cathartic purposes and because though our situations may be different, many people I already knew and those I have met because of my writings are able to relate to what I say.  I try to be honest and say the things that people do not usually mention for fear of being vulnerable or judged.

I realized today that I have not been writing as frequently because I do not want to seem like a “tortured soul”.  That was foolish of me.  Anyone can see the type of person I am by talking to me and though I sometimes think about things that people do not mention, that does not make me abnormal.

I shall return to being honest.

Four years.  On the surface, noting things on a particular date and observing the length of time that has surpassed seems like a futile practice.  This day isn’t as profound as one would expect it to be.  Thinking back, I can see how different each year has been.  On the one year anniversary of my accident, I was still living at home in Snellville.  I had not moved into my apartment in Athens.  In fact, I was still bargaining with my family to allow me to live by myself there without roommates or assistance.  I remember I had already made plans to do something with friends that day.  I was consciously trying to act completely normal that day, as if it was just like any other day, not for myself but for those close to me.  I did that every day and never allowed myself to be any other way.

I recall when it had been about six months after my accident and I was at the Shepherd Center for outpatient physical therapy.  There was one person there who had been paralyzed for four years and then somehow he was able to move his legs, so he was able to qualify again for physical therapy and was relearning how to walk.  Another girl had been paralyzed for seven years, first from neck down until the ability to move her arms progressively returned to her.  She said a few weeks ago, her mom was helping her shave her legs when she shouted, “Ouch!”  The razor had cut the skin on the girl’s leg and, for the first time in seven years, she had felt it.  I remember telling my family and friends this at the time and we all said or thought, “Wow, four years? Seven years?  That is so long.  They must be extremely patient.  How did they even survive for that long?  What did they do?  How did they cope?”

I didn’t expect to feel anything today.  Instead, although I was busy, I had the opportunity to be with my thoughts and reflect—something I have not done in a while.

I have spent a significant amount of time in this “new” body.  I have relearned how to move around and perform my activities of daily living.  As hard as it was, I also relearned how to learn and organize my thoughts.  That is what the people who do not see me every day or have just read my blog may have noticed.  My classmates and the faculty members at my school have noticed something else I have had to regain:  confidence.

This is my last week on a general surgery rotation.  It has been very tough for me.  I spend my nights trying to memorize anatomy and then I spend the following day in the operating room getting asked increasingly difficult questions by the surgeon and getting embarrassed in front of the surgery team.  I am also consistently reminded of how different I am by the way I have to scrub myself in for surgeries and be positioned with the help of an assistant in front of the patient’s body in order to see and help with the surgeries.  It was not a problem before and I didn’t think it was going to be a problem until I saw the surgeon growing impatient with me.  I almost wanted to apologize for my disabilities.

Sometimes I wonder how people would act and treat me if I was able to always stand and interact with them at eye level instead of having to look up at people.

Four years is a long time.  As I say each year, I did not think I would have made it this far.

My old self and abilities are just vague memories now.

For a long time after my accident in May 2009, whenever I would dream at night, I would be completely able-bodied and walking or running in my dreams.  I remember lying in my apartment in Athens about a year and a half or two years after my accident and having my first dream where I was in a wheelchair.

I woke up really sad.

It’s strange.  Whenever I do dream now, it’s usually about me being a wheelchair, but also being able to walk normally.  I am not sure why I even have a wheelchair in the dream or how I know I have a disability in the dream because I am clearly able to ambulate on my own two feet.  I remember in one dream, I saw one of my hospital mates and told him how I just keep the wheelchair because my legs sometimes get too tired of walking.  In my latest dream a few weeks, another hospital mate, Chase T., and I were walking around and joking about things.

Hopefully one day, that dream will come true.

Still, to this day, people ask me if I’ve noticed any changes.  “Still the same?” they ask.

I smile back.  “Yes, still the same.”

That is usually followed by a brief look of pity on their face.  Then they force a smile and try to say something encouraging like, “It’s okay! We don’t know what the future holds.  Stay strong!”

I smile once again and nod my head in agreement.

I do not pity me.  Yes, it has been a long time and of course I do wish things were different.  There is not much that I wouldn’t give up to be completely healed and “normal” again.

But after a long time of being this way, I have learned to look past it.

As I move forward, I only wish that others learn to look past this, too.

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I ended this blog post quickly. But I ended it with a take-home point.  I knew I had too much to say and too many things I wanted to write about since it has been too long since I have done so.  I will write about all the other things in my head as soon as I can.

And because I've said that I usually have a song that I can associate with each of my blog posts, here is this post's song: