10,000 hours

April 13, 2011 § 1 Comment

I was taking the shuttle from Cambridge to the Longwood Medical Area yesterday afternoon with some of my classmates when my friend P started telling me about his ongoing research in a basic science lab, one that he started at as an undergrad.

“Is your work related to a specialty you might be interested in?” I asked.

“No, I’m just really interested in this stuff,” he said. “Some of the things that we’re learning in class, like the hematopoietic stem cells in the bone marrow for instance, are the kinds of things we study in lab. Did you know that red blood cells aren’t actually formed in the bone marrow, but rather in the aorta? The bone marrow is just where they end up right before their final maturation. And that’s the step that is clinically relevant too, of course.”

I was so impressed. “Damn,” I said. “You just took it to a whole new level.”

He laughed. “It’s where I invest my time.”

“10,000 hours?” I asked, referring to Malcolm Gladwell’s now oft-quoted argument that 10,000 hours of practice are necessary for mastering any skill set.

“Probably!” he said, chuckling. “Yeah I guess I meet the criteria for that.”

“What are we talking about?” interjected another friend, PK. “FABRIC?”

FABRIC is Harvard’s variety show celebrating the pan-African diaspora that the first years put on for prospective students during their revisit weekend. The show’s set for Friday.

P and I started laughing uncontrollably. “No,” I said, with emphasis. “We are not talking about putting in 10,000 hours for FABRIC.

But it wasn’t a completely ludicrous joke. Our event organizers had already emailed the class earlier in the week, informing us that our lives this week would be in the service of FABRIC and FABRIC alone. This is the week we really embrace Pass/Fail, the email had read. Understand that your organizers are basically medical school dropouts this week. Try not to tempt your friends with fun study nights in TMEC and postpone those wicked parties and romantic dates until after the show.

My dance team was already planning on meeting for roughly 12-15 hours for practice this week. Earlier in the school year, during our Epidemiology block, my class had Focused Exercises built into our curriculum. In the course of that month, the class transitioned to calling them Forced Exercises. There was a great sense of deja-vu as I plugged the times and dates for dance rehearsal into my iCal, the blocks eating up entire evenings at a time.

Yet, even though there’s a sense of insanity during practice, during rehearsal, I know that it’ll feel like it was worth it when we rock the stage on Friday. P, who’s working on a publication in lab, will feel it when he gets published in Nature or something.

Recently on a sunny Saturday, ten of my classmates gathered at the Arts@29 Garden learning space in Cambridge to spend eight hours together sketching a model under the tutelage of an instructor who had come all the way from Montreal for this purpose. I had approached the day with great apprehension and a slight sense of guilt for the fact that I was investing all this time in learning how to draw when I had other, perhaps more important commitments like Immunology, for instance. Yet, at the close of the day, when we lined a series of portraits on the wall, etched with eraser from sheets scrubbed with charcoal, I had a sense of bewilderment and awe at the fact that my classmates and I had actually produced art this sophisticated in one day. I could only imagine how far some of us could go if we kept at it, practicing every single day.

“Yeah, there’s no such thing as innate talent,” P said sagely. “People who say that someone’s born with it are really only saying that that someone has been doing it all his life.”

Preach it, P.

The Great Equalizer

April 10, 2011 § 1 Comment

I went to a symposium on medicine and arts at the Sackler Museum in Cambridge today, which marks my fifth day in a museum in the past two weeks. I’ll write more later about why I’ve become such a gallery groupie… in medical school. It was such a full day: dramatic readings of Sophocles’ Phloctetes and Women of Trachis, a tremendous narrative medicine workshop with Dr. Suzanne Koven, lunch at the Harvard Faculty Club, then an hour-long poetry reading by Dr. Rafael Campo. I left after that to spend the rest of the afternoon in Lamont Library with my Immunology notes for company.

We talked a great deal about pain most throughout the day. Coming off of a particularly emotionally draining week, I felt each discourse resonate and reify in my consciousness, building a solid element that I could grapple with. I had been thinking about pain quite a bit lately, and its role in the human psyche. Whether pain is worth it. Whether pain carries a sense of nobility or just plain degradation. Whether pain brings about clarity through an expansion of our experience or by blotting out everything inessential. But rather than present a grand conclusion about life and its tenuousness, I’ll offer three perspectives instead. (italics my own)


Pain has an element of blank;
It cannot recollect
When it began, or if there was
A time when it was not.

It has no future but itself,
Its infinite realms contain
Its past, enlightened to perceive
New periods of pain.

-Emily Dickinson


“I see no reason or need for my doctor to love me – nor would I expect him to suffer with me… I just wish he would brood on my situation for perhaps five minutes, that he would give me his whole mind just once, be bonded with me for a brief space, survey my soul as well as my flesh, to get at my illness, for each man is ill in his own way.”

-Anatole Broyard


For once in your life just let it go.

-Joan Didion in The Year of Magical Thinking

Metaphors in medicine

April 7, 2011 § 1 Comment

I spent the summer that I graduated from high school in Westchester County, NY at home, and got so bored that I got up one day, took the train down to the city and enrolled in a real estate course. I’m not even kidding. It was only a week long course, offered by NYREI, and I thought that it would be cool to be able to talk urban planning and the merits of brownstones over high-rises at fancy cocktail parties. For one full week, I sat through lectures and guest speeches by various brokers who drilled one concept into our minds: the importance of location, location, location.

It’s a trite, tired expression, but as I’m realizing, true even in medicine. At Harvard, we learn regular medicine, and then we learn social medicine (led by none other than Paul Farmer). In the former, we learn that a cell’s survival rate in the face of ischemia can be on the order of four minutes if it’s a neuron, to four hours if it’s a skeletal muscle cell. In the latter, we learn that a newborn’s life expectancy can differ by more than forty years, depending on whether he is born in Japan (82 yrs) or Swaziland (39 yrs). Absurd.

In pathology, we are asked to locate a right upper lobe infiltrate on a chest x-ray. In radiology, we are asked specifically to locate an opacity suggestive of a right upper lobe infiltrate. In first year, we are asked to locate bright yellow arrows on the film. I’m pretty good at this last one.

In an elective that I’m taking where I follow a patient longitudinally over the course of the year, I’ve been learning that even clinic locations can matter. Depending on whether Mr. C goes to his primary care clinic or his HIV clinic, both of which are manned by the same physician, he can expect different services. Depending on whether he’s seen at the BIDMC or the Fenway Community Health Center, he can expect different kinds of social support services, different lengths of clinic visits, different tests and different check ups.

Things are coming to a head around Longwood, as my class decides whether to grow up and enter the real world of apartments and houses, or stay another year in our dorm across the street from the medical school quad. Finally, one conversation about location that I can tackle!

“Thoughts for a Knowledgeful day”

April 6, 2011 § Leave a comment

After six years of being apart, I went back to visit India this past summer, and experienced an out-of-body experience for four continuous weeks. It was like the title of this week’s Desperate Housewives episode: Everything’s Different, Nothing’s Changed. My old city, Hyderabad, seemed bigger, but easier to wrap my mind around. The streets seemed busier and grimier, but more natural than I expected them to feel. I screamed a couple times when the driver took a left turn as easily we we take right turns at home, but quickly adapted. When I went to visit my old house, I walked past the same tiered gardens that had always stood, but the trees felt thinner and the shrubs felt smaller. Or was I taller? I ended the nostalgic tour with a visit to my old school, and as I walked through the great hallways feeling the shroud of time and distance making my visit insensible, I came across this poster that a seventh grade student had made and attached to one of the massive bulletin boards dotting the walls of the space:

House Poster, VPSPS

My first reaction was to laugh. My second reaction was to pull out my camera and snap a picture. My third was to take a step back and reread the essay in its entirety.

The essay, Instant Inspiration, at first glance, feels ridiculous. “Strength of character! Successful career! Magnetic personality! Commanding presence! – such words are fascinating indeed!” the author writes. “Many aspire to possess these qualities and even try to imbue them in their personality.”

But look past the hyperbolic language and terrible grammar for a moment.

“The mediocres who aspire to raise themselves to glorius heights should strive to bring out their potential and should struggle hard to overcome the shortcoming of their personality,” she (no boy can have such beautiful handwriting) writes. “The aspiring souls should drive this truth deep into their minds – that all the strength and spirit are within themselves.”

To contextualize this, Indian schools are built on a structure of competition and pure meritocracy where students will fight tooth and nail to get to the next step. Also, the student was probably commissioned by a teacher to make this poster.

Yet, here’s another piece, recently published (and spellchecked) in the New York Post:

“I think the desire to live a meaningful life is universal. To some people, it’s working toward a goal. To others, it’s enjoying every minute of every day. So what does it really mean to live life to the fullest? Maybe striving to win a Nobel Prize and going skydiving are just two sides of the same coin. To me, it’s not about achievement or self-gratification. It’s about knowing that you’ve pushed yourself, body and mind, to the limits of your own potential. You feel it when you’re sprinting, and when the piano piece you’ve practiced for hours finally comes to life beneath your fingertips. You feel it when you encounter a life-changing idea, and when you do something on your own that you never thought you could. If I died tomorrow, I would die feeling I’ve lived my whole life at 110 percent.”

No prizes for guessing who the author is – Sophia Chua-Rubenfeld. (Harvard ’15!)

No matter what you think about her Tiger Mother’s thesis, Sophia’s perspective is untouchable. And I like it. I like knowing that no matter how many miles apart, no matter the language familiar to our hearts, no matter the opportunities presented to us, there are things about the human condition that remain universal.

Yeah, I like that I went back to India, feeling like an anthropologist, only to find that everything was different, but nothing had really changed.

Lessons learned from puppets

April 5, 2011 § 1 Comment

I need to write a disclaimer before I begin this post. This musing is going to be about my NYC trip again, now nearly a month in the past. I’d rather not cast this observation as one reflecting in contrast, the relative dullness of my present life, as that is wholly untrue. There are a million stories from medical school that need to be told, and I’ll save those for another day. Instead, NYC contains multitudes, and that is enough.

It started on my BOLT bus ride from Boston’s South Station to NYC’s Time Square. I was sitting towards the back, in a window seat. The passenger list was pretty meager; indeed, from my vantage point, it looked for a bit as though we were going to have low occupancy and that I would get both seats to myself. A few minutes before takeoff, however, a large group of twenty Indian boys suddenly climbed in. From what I could tell, they were a college dance troupe that was heading to NYC for a local competition. They quickly filled in all of the remaining gaps in the bus. I have heard this idea before and support it fully, that people fill seats like electrons fill orbitals. Both adhere to Hund’s principle, or that both will occupy all available empty seats and empty orbitals first, before a second person/electron will look around, and seeing no other options, will decide to sit next to you. (This analogy is part of my ongoing quest to uphold science literacy in life).

So anyways, that happened, and I soon found a tall, serious looking Indian boy taking a seat next to me. He smiled, I smiled, and we didn’t say anything else. The bus took off, and I pulled from my bag, a copy of Norbert Elias’s The Loneliness of Dying. The book was on my reading list for an elective that I’m taking at Harvard where we discuss the role of philosophy, literature and religion in medicine (amazing). The bus ride was so relaxing. This was my first trip to NYC from Boston, and I had thought that the four-hour ride was going to be so difficult to sit through. But really, time felt immaterial as I sat there in the twelfth row. The New England countryside blitzed past my view in a blur of quaint transience, and the skies overhead were grey and soothing. I kept at Elias for twenty minutes at a time, before needing to put the book down and rest my head on the window, content to stare ahead and just be.

It was an hour and a half later when I finally lifted my chin and looked to my left, to see the cute Indian boy looking at me with a distraught expression. I stared at him for a moment in confusion. He looked seriously troubled.

“Is everything okay?” I asked.

He looked surprised. Then his eyes flicked to my book, so mine followed. I stared at the title for a moment longer before looking back at him and blurting out, “Oh I’m not dying!”

It felt so preposterous that I was more amused than anything. There was nothing about me besides the choice of reading material that would suggest anything but health and vitality.

My friend L and I later caught an off-Broadway production of Avenue Q that weekend.

I cannot remember a time I laughed harder in recent memory, but remember being especially struck by the closing song, For Now.

Why does everything have to be so hard? says Princeton.

Maybe you’ll never find your purpose, says Gary Coleman.

But then – I don’t know why I’m even alive! says Princeton.

The puppet cast then breaks into song. You’ll be faced with problems of all shapes and sizes, they tell Princeton, and you’re going to have to make a few compromises, but only for now. The refrain, for now, is repeated for a variety of situations: health, employment, joy, discomfort, friendship – for now. Sex, hair, George Bush – for now. Each time you smile, it’s only for now. Life may be scary, but it’s only temporary, ba-dum ba-dum, everything in life is only for now.

I came out of the theater feeling like something momentous, full of solemn gravity, or as much as a puppet show can really muster up, had just been delivered.

It’s an exhilarating thought. To think that the stressors affecting my life right now, all of the drama surrounding life and love, young romances, long nights studying for pathology, the new boots and new scarves I bought over the weekend, the occasional fights that I have with my friends, and the relationships I build with my mentors, that all of these various things that I spend time thinking and writing about are all temporary and ever-shifting is both gravid, and exciting.

So perhaps the boy in the bus wasn’t completely off-base after all. Perhaps it wasn’t such a farfetched thought that the young twenty-something girl next to him who alternated reading with quiet contemplation could potentially be dealing with something terminal. We’re all here, living in the moment. In the blink of an eye, the world can change.

And isn’t that just the craziest thing?

Art Nouveau, from Boston

April 5, 2011 § Leave a comment

The thought struck me on Friday when a few of my girlfriends and I got dinner at this classy French-Indian restaurant, Mantra, near the Theater district. As the daughter of parents who strongly believe in supporting the economy via patronizing every Indian restaurant in every city in every state in the United States of America, I consider myself an expert. I know what to expect, from the red and gold drapery and the tapestries of peacocks or buxom, scantily dressed women, to the obligatory “and would you like that spicy, medium or mild?” questions and the areca nut mouth freshener on the way out.

Here’s what I didn’t expect. I didn’t expect to be ordering Malai Kofta and naan under lasered mirrors and halogen lights. I didn’t expect to find a Naan bar crafted out of a former’s bank teller’s cage. I didn’t expect to go to the women’s restroom and discover that the doors on the toilet stalls were in fact, two-way mirrors. No, I didn’t really expect to find an Indian restaurant whose interior looked like a space that could negotiate the line between a nightclub and a modern art gallery.

I’ve been thinking a bit about art lately, of aesthetics and culture in general. When I was in NYC with my college friends a few weeks ago, I realized that I had developed Asperger’s when talking to people outside of the med school context. Though it wasn’t as though my curriculum always made it impossible to keep up with cinema, art and literature (I try to make sure of the exact opposite, when I can), I felt parched for culture in conversation. My stories stemmed from medical school, my analogies were of anatomy, my jokes reeked of G-protein receptors and pancreatic enzymes. It sucked.

Then as my girls and I were seated by a panel of Italian marble at Mantra, my friend G looked at the speckled and splayed pattern on the wall and said, “This reminds me of the colloid-filled follicles of the thyroid gland.” We laughed, and I shook my head, knowing that this was one metaphor that would never make it into mainstream expression. I knew that I’d never see such a comparison in Ian McEwan or Yann Martel.

But then I began to wonder why that thought was so wild.

Why is it that being scientifically literate isn’t given any credit in discussions of what it means to be cultured? Why don’t people read the New England Journal of Medicine as often as they read The New Yorker? Why not invoke the arterial thrombosis of gangrene instead of the stark palettes of Ad Reinhardt when looking at curtains for the home?

Recently, I visited a friend’s dorm room and recognized a Mark Rothko print on her wall, one of his classic color fields.

Rothko. Magenta, Black, Green on Orange. 1949

I’ll describe these rectangular blocks of color, hovering in a column against an undefined background as bringing to mind a strip of melana, the dried occult blood of stool, then the dead black color of necrosis, gallbladder-green, and the burnt orange of hemochromatosis. For the beige, however, I’ll defer to the stylings of James Franco. “The building is beige, but the shadows make it shadow-color.”


April 5, 2011 § Leave a comment

I had never even seen a production of the Vagina Monologues until I helped put it on at medical school. This was a source of particular shame, for in a previous life, my mother was an Ob/Gyn, and in my present life, I consider myself to be a progressive thinker and feminist. This secret guilt was further complicated by the fact that though AP Biology and I had a solid relationship in high school, the one unit that I just completely failed was the reproductive unit. So there were a lot of things to atone for when I decided to become a part of this event.

The final show itself turned out to be just fabulous, and we raised a ton of money for Rosie’s Place, a Boston-based women’s shelter for abuse victims. I read the concluding poem to the Monologues – Myriam, a recent addition to the play by Eve Ensler about a Haitian feminist and revolutionary, Myriam Merlet, who brought the Vagina Monologues to Haiti, but died in the earthquake. It was beautiful, and I consider myself really lucky to have been chosen for the reading. I won’t measure the impact of this production in simply the number of dollars raised, however, but in some of the following as well.

My Google search history reveals an alarmingly large number of search terms for vaginas, and artistically rendered vaginas, from back when I was coming up with a concept for a promotional poster. The most interesting one was this minimalist representation: ({}).  It makes me chuckle every time I see a pair of parentheses now, which is helpful for when I have to do tedious calculations for physiology and need a laugh to punctuate the long periods of somnolence.

The director of the Vagina Monologues told us actresses to wear all black to the show, with “a splash of color.” Everyone who did the latter chose to wear pink or red sashes and scarves, which is either a direct reflection of societal conceptions of girl-colors, or a subversion of the very same through such a frank embrace. I’m going to go with the latter.

So this weekend, during an NYC getaway, I came across Lee Krasner’s Gaea at the MoMA, and, before I even read the title on the cue card, immediately saw vaginas everywhere. If I could redo the Vagina Monologues poster all over again, I would use this dissonant background for the poster, without question. Despite naming it for the earth goddess, Krasner did not use any green or blue; painting wild and uninhibited arcs in pinks, purples and reds, and bringing to the front a feeling of pain inherent in childbirth, almost. It was such chaos, but I was drawn to it more than any other piece on the fourth floor. Our appreciation of art isn’t complete until we can marry it to our own past experiences, so I don’t think that this was any ordinary coincidence at all.

Krasner. Gaea. 1966

Finally, I think it’s crazy that women graduates of Harvard College continued to be awarded ‘Harvard-Radcliffe’ diplomas until 1999. 1999! I know that it reflects only a nominal enrollment in the historically separate women’s college, but the fact that it took until 1999 for Radcliffe College to be fully absorbed into Harvard University seems ludicrous. I think the Vagina Monologues have reawakened my inner feminist. I haven’t felt this much righteous indignation since Hillary Clinton’s nomination campaign! Perhaps I can soothe myself with some Krasner-inspired retail therapy:

Where Am I?

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