Behind the White Coat

Racist New Yorkers

It's amazing that you can be in New York City, in a liberal and diverse area such as Greenwhich Village, and still encounter the most uneducated, despicable, douchebags of society, who roll in from NJ in Daddy's SUV. (Nothing against NJ, except for specific assholes like these guys) ...

So it was this past Saturday night, we were at my friend Aizaz's bday party at Sullivan Room, which is around Bleecker and Sullivan. Afterwards we are leaving, and I went to swing by Mahmoun's for a shwarma since the line wasn't that long (I haven't actually been there in years, I'd rather go to Kati Roll, though we did that the night before... But damn that Kati Roll is good!).  So anyways, I get my sandwhich, am heading for a cab, and some asshole yells out of his window "Hey Osama!"  I lost it.  I was pretty damn drunk as well, and I was just so goddamn angry.  I started screaming and abusing everyone in that car, and wanted to throw my sandwhich at his freakin SUV in anger, but I was just way too hungry, and I luckily decided against it.  I was alone as well, in retrospect, lucky for me those guys didn't come after me despite my taunts to dare them to do so, being the retarded, uneducated scum of society they were (white boy Jocks from NJ).   It's just ridiculous that we still have to deal with this shit. Particularly on the streets of NY, and in the liberal and culturally diverse neighborhood at that!  I feel sorry for those guys.  I seriously still wish I could go choke those guys, but what good what that do I suppose....

On a brighter note, I have finally gotten rid of the piece of shit Krazr phone.  I am now a part of AT&T wireless, and am rocking a Blackberry 8310.  It is great. Especially coming from a useless phone that I had.. The verizon network was good, but the phone was so horrible I couldn't handle it. And having email and internet at my fingertips is too good to resist.  Of course the Iphone was an option.. But it was 500$ even with a contract, and they are coming out with Iphone 2 probably in 5 or 6 months, so why not wait? Besides, the deal I got was great.  100$ for the phone, AND he gave me 200$ to cover the fee for cancelling my verizon contract!!  The fee was actually only $150, so I basically paid 50$ for  the new phone.  Gotta love it!

November on the Wards

Wow.  Over a month since my last post!  I apologize for this outrage.  Things were going so well, but in between the month of November on the wards, and my spare time being taken up by sleeping, eating, drinking wine, watching prison break season 1, and facebook, I overlooked writing in my blog. 

As my month on the wards comes to an end, I have seen a lot of interesting stuff!  You non-medical folks may be bored by this, but it is quite interesting for us "med-nerds".  Take my one guy who came in with high fevers to 103, with headache and body aches.  No other symptoms really. He was sent home by another hospital ER, and told by his doctor he had a flu.  When I saw him, all his blood tests were normal.  Nobody seemed to know what was going on.  When examining him, my intern and I saw a slight vesiculopapular rash on his upper back and chest--small dark papules, that almost looked like chickenpox.  Then I found this 2cm, dark, swollen eschar on his left arm.  Right away I knew the diagnosis.  Ricketssialpox!  That's right.  A mite-born illness (the ones that live on mice), that is quite common in NYC.  Strictly diagnosed by physical exam. Started him on doxycycline, and he was better the next day!

We had another guy come in to one of the other teams with high fevers, headache,  myalgias, diarrhea, a petechial rash and thrombocytopenia on his blood tests (low platelets).  He had just come from Dominican Republic.  This was an easy one.  Dengue Fever!

I had another lady come in with swelling of her legs.  She also complained of muscle aches, weight gain, and headaches, and also had irregular menses.  On her exam, she was obese, had a lot of acne, swollen legs, a round face, and a lot of fat on the back of her neck.  Her blood tests showed hypokalemia (low potassium), and a high cortisol level with low sex hormones.  We did a dexamethasone suppression test, which was abnormal.  Given her headaches, we went straight for the brain MRI, and there it was. A sizeable pituitary tumor (part of the brain that makes hormones), consistent with Cushing's Disease!

And of course there is all the hype about MRSA (Methicillin Resistant Staphylococcus Aureus).  Despite all the airtime that MRSA gets by the press, I assure it has been around for many many years.  Even the "community acquired MRSA", meaning MRSA that healthy people get outside of the hospital, has been around.  And there is no disease called "MRSA".  That is simply the bacteria (just a very sly Staph bacteria that is resistant to many traditional antibiotics), that infects different things--cuts and wounds, urine, heart valves, blood, brain, etc.  It needs specific antibiotics to kill it (Vancomycin being the standard, which is intravenous, but many MRSA strains also respond to oral bactrim and clindamycin), and it can be very aggressive and life-threatning, but so long as you catch it early, you should be fine.  So don't worry about "getting the MRSA!" Unless you have a reason (cuts and injuries, indwelling catheters/lines, or prosthetic heart valves being the most common).   

Bombs Over Karachi

"I can see body parts strewn all over the road," said CNN''s correspondant, "There are dead bodies everywhere. ... It is a large-scale attack, by the looks of things."

The latest count as per Geo TV was 200 dead, 500 injured.  As Benazir Bhutto makes her return to Pakistan after 8 years in exile, she was recieved by thousands of people, and 2 suicide bombers.  One of the bombs was right next to her bullet-proof vehicle, which shattered the windows, rattlin the passengers, but thankfully left Benazir unharmed.  However the other 200 people who died, and 500 who suffered injury did not fare so well.  What kind of nation or polictical situation victims 1000 of their citizens and people for such mindless violence?  Under what ideals, religion, or political incentive validates such terrorism?  Wolf Blitzer called Pakistan's politics "Risky Business."  That is an understatement.  Benazir new of death threats before returning to her home soil, but does one ever expect to be so close to carnage, death, and chaos?  Pakistan's politics is hardly your run of the mill "democracy," it is more like anarchy that is attempting to find some sort of light at the end of a disturbing tunnel of violence, corruption, and political and cultural rivalry.  It pains me to see my home country amidst such chaos and bloodshed. 

Now people may have different views on Benazir's political stance and ideals, and her party's outlook for the future.  Forget about whether or not you support her or oppose her.  That is fine.  That is healthy politics.  Her return should have marked a forward step in the growth of Paikistan's democratic process regardless of what one feels about her.  But was she met with cheers, opposition, debate, voting, and democracy? No...  This was all overcome by two fucking suicide bombers.  This makes me sad.  And of course it is all over the news now. But in a week's time, it will be gone.  If something like this happened in America or the UK, I can't even begin to imagine the repercussions.  In Pakisan, it is has almost become a part of daily life in politics.... I am fearful for my nation.

As painful as it was, it almost humorred me hearing someone speak from London, regarding a bomb blast there that was followed in minutes by police, security, crime scene agents, in taking away the injured, closing off the area, collecting all the viable evidence, and starting the process of finding out what happened.  In Pakistan, they can't even protect the goddamn motorcade!  It was moving through a sea of people, slower than walking speed!  How the hell did they expect to stop a guy with a bomb coming right up to the car?  And after the incident, what?  Thankfully many injured (probably not all that COULD have been saved) were taken away  to hospitals.  And then what?  You think there is some CSI unit in Karachi to collect evidence? Please. Even if they did, what are they goin to do? Prosecute the Taliban? Track down those responsible for the bombing and put them in jail?  My friends, we are far and away from a country that holds any sort of legitimate democratic process.  My prayers go out to all those injured in this blast, and for that matter, victims of all the other mindless "political" violence that has-and will-occur.

Back Pain and Accupuncture

Wow, has it been that long since I wrote in my blog?  I guess after I got back from vacation I 've busy and preoccupied.  It's Ramadan for one, so I'm chronically tired and hungry.  Work is always busy, especially when I'm in the ICU for 2 weeks after a vacation. Bollocks! Then of course there is facebook, which I admit I am quite hooked on.  But isn't everyone these days? Anyway, a talk for another day....

I am in serious pain today.  I have problems with herniated discs in my lower back, and  I have pain pretty much everyday.  Once in a while, I'll have some muscle spasm and strain my back, rendering me cripple and quite useless for the next few days.  An "Acute Back" I guess you could call it.  That is exactly what happened 2 days ago.  How you say?  Despite everyone telling me "Sounds like you partied hard last night", and "Go easy with that wild sex Ali," the precipitating factor was not that glorious. I was simply going up the stairs, and felt a spasm, and then that was it.  Now I walk like a hunchback, with shooting pains from my back to my thigh.  Though it has been worse-- there were times when I couldn't move out of bed for 3 days!  All this from my herniated discs (L4-L5 and L5-S1 if you are curious).  I really need to get my ass to physical therapy, and maybe even some epidural steroid injections, or perhaps some alternative therapies ....

Speaking of alternative therapies, last week I actually tried accupuncture!   We had a seminar on it at work, and I volunteered to get some healing.  The needles are very tiny and thin, and tap right into the skin.  No alcohol or sterilization is done, you just stick them in!  The doc (he is an actual doctor who took a course, not a Shaman or anything like that) proceeded to pierce me from my back to my ass to my leg.  It was a very weird experience.  He first put a needle into my head, which is supposed to help people who have trouble sleepin because of some pain or ailment.  I barely felt the needle go in, it didn't hurt, but I almost felt a feeling of warmth and calm over me.  Was it my chi re-aligning?  Or just a brief sympathetic surge from my nervous system when I realized a needle had been stuck into my head.  Who knows....  He then put some needles in the lower back, again a slight pinch, but nothin else.  Then a needle went into my right hand, right at the junction of the thumb and pointer finger, near the MCP joint, which is a specific accunpuncture point for general pain relief.  It was strange, I felt tingling and parashtesias in my pinky finger and all over the right hand, which anatomically cannot be explained by what nerves cross where the needle was entered.  Then needles went into my buttock (yes he hiked up my shorts with all my colleagues watching to put one at the bottom crease of my butt....), and various parts of my leg.  One needle went in just next to where the knee is, and that was painful!  I felt this electric surge down my leg, like he hit a nerve.  A few more went in the leg and foot, and those also felt a little weird.  But it subsided.  Perhaps thats a good thing??  The other interesting thing is when the needles go in, you get this large area of redness that grows around the needle like a circle.  It is supposed to mean your body's response to the needle is a positive one, and you have good chi.  Some call it chi, others would call it inflammation.

The needles stayed in me for 20 minutes.  I felt relaxed, calm, and warmth.  (Again is that a psychological or bodily response to knowing I had accunpuncture needles in me?  I can't say)  Afterwards, I gotta say, I did feel better.  The pain was still there, but compared to before it was less, and felt kind of dulled.  It is like when you get lidocaine at the dentist, you can still feel something in your mouth, but it doesn't hurt.  This lasted for about 1 to 2 days.  Then the pain returned to my baseline daily pain... Nobody knows how accunpuncture works, but for certain things, it really does work!  Hey if it can relieve my pain, I aint going to ask questions....  Despite knowing the ins and outs of the human body, there are many things we can't explain.  Am I a believer in it now?  Well I'm getting there...

Then of course a few days later, I strained my back and boom, I was down for the count.   I called in sick for the first time ever during my residency!  I was unhappy to break my streak.  Today I am rolling around juiced up on pain killers, muscle relaxants, and my cane.  And not one of those pimp canes, but one of those curved old person canes... During clinic today, one of my patients looks at me and tells me "I'm glad your my doctor today.  You remind me of Dr. House!"

Back from Pakistan

Life was good when I was on vacation in Pakistan... I've gone silent for a while, mostly because I was so immersed in my great new life in Pakistan, even  though it was for a measely 2 weeks.  Probably my best trip to Pakistan I can remember!  How can you not love shaadis (weddings) in Pakistan?  My cousin got hitched, and it was basically 10 days of wedding functions, dancing, mingling, partying, and fun!  We also managed to have booze throughout the festivities, even though it is illegal in Pakistan, that is thanks to the bootleggers to supply us with our Johnny and Absolut.  I also managed to make it back to NYC single and un-engaged, much to the dissapointment of my many aunties back in the homeland.   So much happened, but lets see if I can remember some highlights....

The Mehndi was definitely the most fun function, as it usually is.  We spent several days before hand with my cousins and friends practicing out choregoraphed dances for the mehndi.  These were definitely the most technically advanced dances I was involved in.. I think in my old age of 29 now, I can't move and shake like I used to, so the rolls and kicks involved took a number on me.  Especially one move during a dance (to Josh Nal if you are curious), though executed beautifully at the mehndi, left me with a partially tore ligament in my thumb!  Now I am in a thumb splint for a few weeks.  But hey, it was worth it!! And chicks dig guys injured in dances, right?? Hmmm...

In my few days in Lahore, I managed to head out to the heart of foodland to Cafe Nisant, to have some true hardcore Lahori food... Taka-tak and Mughuz.. mmm... Taka-tak, which I thought was some sort of entrails, after I gobbled it down, realized it was Kidney and Testicles... That's right... Cooked on a Tava, and named after the sound it makes when they cook it with the metal spatulas, Taka-tak!  Mughuz of course, is Brain masala.... Sort of like scrambled eggs meets ground beef.... I preferred the latter to the former.  AND I didn't get sick! (The daily cipro saved me)

I also managed to sneak a peak at the Red Mosque, see a few madrassas, and run into several of the hardcore mullahs and Talibans who roam the streets of Islamabad.  Good thing I was sporting a beard, but I definitely kept my distance.  I also stayed out of trouble, even though 2 suicide bomb blasts occurred not too far from Islamabad while I was there and the brief arrival of Nawaz Sharif, which stirred up some commotion. Luckily I was gone before Osama's latest declaration of revolt of Pakistanis against the govt. So much anticipation and speculation with with these "elections" coming, Benazir's coming, and what not... But Paki's politics is a talk for a whole other day....

Now back in the U.S.  I miss seeing my family, good friends old and new, ghee infused parathas in the mornings, and servants and drivers to make my life lovely.  Now I sit here on call in the ICU, fasting for Ramadan, tired, and missing the homeland...

Losing Shit... What Rubbish!

So I am nearing the end of my trip to Pakistan... 4 days left!! It is quite sad since I have been having a blast at my cousin's wedding, hanging out with a lot of great fun people and family... The wedding is closing to an end, and has had everything from our kickass choregoraphed dancing at the Mehndi (from which I think I broke my thumb), to late night sessions of hanging out and drinking and dancing to great music.  But first, a funny story....

So I have a knack for losing things and being somewhat careless in certain situations... Or at least in the past (so I thought).  Before I came to Pakistan 2 weeks back, I was nominated on Facebook as "most likely to drop keys in toilet", because of all the times I've lost my shit... So the day I was going to Pakistan, I came back to my parent's house in NJ with my sister.  I had a lot of stuff to do in little time, so came into the house, and did a few things to finalize my preparations for my trip.  When time came to leave, I couldn't fucking find my car keys!  I had literally JUST arrived 20 min ago, and had NO idea what I did with them. I ransacked the car, unloaded the trunk again to look, went through the entire house, but nothing!  I then retraced my steps.... I got in, went into the closet to get a towel to wipe down my car, but nothing wasin the closet.... I went downstairs for a moment, but the keys were nowhere down there.  I even threw some shit out and thought could it be in the garbage?  I sneaked a peak in there, but there was nothing.. By now my dad found out and was furious. FUMING. (rightfully so i guess)... So he starts buggin out and I told him all the stuff I did.. He asked did I really look in the garbage? I said of course! He was like "are you fucking SURE?" He then dumped the entire garbage onto the floor, and plop... Out come my keys...  Fuckin A!  He was so happy with his victory, he wouldn't let me live it down... Anyway, I felt really stupid!

Fast forward a week or so... I am now in Pakistan, and have been raging with my digital camera taking pictures.. EVEYRONE has been relying on me because I am so mad with my photo taking.. The other day, I got home after the Mehdni, and could not find my fuckin camera!!  I KNEW I had it when I got home at 5:30am, because we took some pictures... But where was it? I looked EVERYWHERE. My clothes, all over my uncle's house where I am staying, in the car, but no camera.. I was freaking out. Lord let me find the camera broken and destroyed, I just want the memory card!!  After an hour, I just starting looking everywhere.. For some reason I looked in the little trash can next to my bed, which had some tissue in it, but nothing else.  But then I put my hand to the bottom (still not sure why) and there it fucking was!!  Turns out my cousin's fucking cat, who was making all this commotion in the morning, knocked the damn thing down into the garbage!! Jesus.. Can u imagine??  What kind of luck is this? You can only imagine after the keys and now the camera, what everyone has been ranking on me with... From now on, if I lose anything, the rubbish bin is the first place I'll look!

Back in the Homeland

I arrived in Lahore my first night to painful heat and humidity, and of course, load shedding (which is when they shut off all electricity every so often to save energy), which precluded the use of the A/C, ahh Pakistan!  I hopped on the motorway (the one true highway of Pakistan) and drove up to Islamabad, and here I am now.  Of course the day after I arrive there were two suicide bomb blasts in Rawalpindi (the nieghboring town to Islamabad), will it ever end?  Who knows. As we drove around I whizzed passed the Red Mosque, and my uncle pointed out to me several new pro Taliban Madrassas that are popping up, and you can spot those bastards on the street when you see them as well.  All you hear in the news is the impending return of the two ex-PM's Benazir Bhutto and Nawaz Sharif and what will become of General Musharraf, and the so-called fair elections to come.  Despite this, everyone feels impending implosion of our government, and the rise of the Mullahs is not such a far fetched reality...  But alas, that is a post for another day....

So far I have eaten all sorts of yummy stuff from Payas, to Haleem, to local paratha wraps, and my stomach has held strong!  But I am worried. My stomach is so weak, I always end up with Montezuma's Revenge at some point, partly because I can't resist eating all the good food, especially the stuff I'm not supposed to eat!  My Dad's recommendation (despite him being a Chairman of Medicine, there is absolutely on evidence to this tactic), is to take a tablet of cipro once a day as prophylaxis.  My supervising docs would kill me if they heard I was doing this, but I decided what the hell.  So lets see what happens! Stay tuned for updates on my GI tract...

My cousin's wedding festivities begin tonight.  So let the excitement begin.  And no people, I am not hear to get married nor to find a wife.  But hey you never know right? Stay tuned for updates!

Pakistan Zindabad!

This past weekend was the Pakistani Day Parade to celebrate our country's independance.  It is actually August 14th, but the celebration was strategically done one week after India's independance day.  It runs down madison avenue and ends at a little festival near Madison Square Park.  I haven't been in years, and happened to be eating in the vicinity, so I said why not stop by?  When I first got there, I was alone, and I was scared.  I thought I was suspicious looking, a bearded Paki on a cellie, alone, walking back and forth on the phone, but when I saw the crowd, I knew I was safe (from the FBI at least).  I could at least safely say that the National Security Alert went from Orange Alert, to No Alert that Sunday, as all the Pakis were convened in one location in Madison Square Park.  You also would be very unlikely to find a cab anywhere in the city!

The crowd was basically all the ghetto thugs and gangster wannabes from Queens and Brooklyn, shady Uncles (half of them probably cabbies), and families with lots of young kids, all wearing tacky shalwar kameez.  I think anyone that I know who was Paki wasn't there, or wouldn't go (which I guess is kinda sad, but I'm with them on this).  I managed to run into one girl I knew who I said hello to, and she was promptly like "Don't hug or kiss me!" I was like oh shit you are right, this is high profile area.  She was also telling me how many shady Uncles brushed up against her (maybe because she was in a sleeveless top, hai!). 

Finally my other friends showed up.  Certainly not a place to find one's future rishta I'll tell you that much.  They were even selling plates of rice and kebabs for freakin $15!! Are you kidding?  That was that.  We then went out to drink in celebration of our country's birth (yeah ok, we goin to hell).

On that note, Cafe Noir is a bumping place on Sunday.  It's a tapas joint with a little bar area in the front, with the doors and windows open, and a good crowd having drinks, with a DJ spinning.  Nice for a post-brunch Sunday late afternoon fiesta.  I recommend it!  After that we went around the corner to have a drink at Felix, also popping on a Sunday.  I lovin Sundays in Soho!  Our night ended at Chicken and Rice on 53rd and 6th, and even though it is Afghani, so many Pakis go there, we felt we were representing our people.

5 more days till the trip.  I better take my anti-malaria medicine tonight, and get my immodium and cipro ready to go...

Bearded Flying

Here's a story about a Muslim woman in NJ getting harassed with terrorist comments for wearing a hijab.    One would think (or hope) that by now, at least in freakin New Jersey (being a blue state NYC neighbor, and PACKED with Desis for that matter) that one could avoid such confrontations... But alas, the uneducated, pathetic scum of society still lurk at our front doorsteps....

Even for me, since I have been rocking the bearded look (purely for a change in image and to see how it runs with the ladies mind you--I aint going 'reluctant fundamentalist' on anyone), people make little terrorist jokes all the time.  Of course all these are people who know me in the hospital, and I'll laugh and joke with them.  But surely there is some underlying truth in their musings no?  I mean lets be honest, anytime someone sees a Middle Eastern or South Asian guy with a beard, the terrorist bell goes off in their head, whether they actually believe it or not... It is the day in age we live in, but it is the truth.. "That dude's a terrorist."  Say it or not, it is still processed!  This is proven by the fact that everyone (faculty, collegaues, social workers, my family) keep telling me to shave the beard before I get on the plane for Pakistan!  Some more jokingly than others, but all with some degree of seriousness. I suppose it would be wise to go clean shaven, not opening myself up to more "random searches."  I mean as it is I can't do curb side check-in because of "your name man!" as the clerk told me months ago.  But fuck that, why should I change because of the twisted racial views that have become the norm in today's society?  Besides, I'm in NYC, not freakin Texas. Otherwise I'd definitely have to be wearing my "I am not a Terrorist" T-Shirt. (It really exists)  Plus, if I go to Pakistan with my medical degree and a U.S. passport, I can fly back with a wife no problem.... If I go with a beard, that sets me up for two of 'em!

Though now that I think about it, being a bearded Muslim doctor definitely does not help my suspiciousness at the airport...
 

The Police to Daft Punk

I tell you it feels good to be on a month where I have weekends off. I almost don't know what to do with myself, it is a mini vacation every week! So in response, I try to go out as much as possible, see as many non-doctor friends as I can, and enjoy life while I can during my last year of residency... Because my fellowship is going to be even worse!

I went to two shows in the past 2 weeks. First was The Police, who performed at Giants Stadium. Now I wasn't a die hard Police or Sting fan back in the day, but everyone liked their music, and who can say no to what could be their last tour? So I snagged a ticket from a friend thanks to somebody who couldn't make it. The show was amazing! To think they are in their 50's and can still rock it the way they did is impressive. Not to mention Sting's voice which is probably as good as it has ever been. They played a tight set, with huge sound for just 3 guys, and overall it was a great show. The crowd, as expected, ranged from people our age, to people in their 40's with their little kids, to even some in their 50s! It was interesting, but the vibe was still good....

The second show this weekend was a tad different. Daft Punk! Now it was my first time seeing them live, but I've heard they put on a kickass show. And that my friends, they did do! They came out in this giant pyramid, which holds all of their electronic music creating gizmos within, and is basically these giant triangular HD screens facing us. They were wearing the standard Daft Punk helmets and jackets (how the hell do they see out of that thing?), and even threw in some neon glow from their suits later in the show. So combined with their amazing live musical creations, mixing, remixing, were a ridiculous light show and visual effects. The beauty of live electronic music is that they are recreating their songs live, so they can play with it how they wish, mix songs together, and work the crowd. I tell you it was an amazing show. Daft Punk live = Sick.