Thursday, August 17, 2017

zebra


I created this zebra piece (more than) a few years ago, but it remains one of my favorite pieces I've done. It wasn't meant to be a huge time-consuming project and took just a few hours to complete, which goes to show that sometimes the most fun works are the simplest ones. 

With this piece, I started out by lightly sketching an outline of the zebra with a pencil. Using a fine tip black sharpie, I then began lightly outlining the shape of the zebra using a stippling technique. The background proved to be an excellent color when it came to making the white colored pencil stripes stand out against the red. As always, I used Prismacolor for this. I was having such a fun time with the stripes that I wanted to have them sort of float off the zebra, which I think ended up creating an interesting effect since it drew even more attention to the pattern of stripes. 




Sunday, July 23, 2017

DIY marbled paper




This is one of those "wow, I can't believe that actually worked" DIYs. The steps to creating beautiful DIY marbled paper are insanely easy. My favorite part of this DIY, of course, is that it's inexpensive (and you may even be able to find most of these materials from around your house). It's too easy to find DIY projects that end up being more expensive than just going out and buying a similar product. This simple technique is a fun way to spruce up snail mail, or any handmade card, and gives expensive-looking results for next to nothing in cost.


I used washi tape on the backs of my envelopes/cards that I would be dipping into the shaving cream/food coloring mixture. The tape prevents the food coloring from bleeding onto areas of the paper that you don't want color, resulting in a clean product. The washi tape provides that protective barrier, and is easily removes from the paper without ripping it. For cards and envelopes, I used my favorite Strathmore blank cards and envelopes. For bigger sized paper, I used watercolor paper out of my Montval watercolor pad, as used in this DIY watercolor galaxy project.


My first set of cards involved purple and red swirls, and then I very quickly got carried away and used every color I had. I used Neon gel food coloring, which was a fun change from the usual red, orange, green, and blue.




Once the shaving cream + food coloring mix is prepared, just dip, remove, let sit for 30 seconds, and scrape off the shaving cream. That's it! Use your newly marbled cards and envelopes as greeting cards, invitation cards, place settings, or bookmarks. You could also gather a few different sized marbled papers and unique frames, and create a collection of 3 or 4 frames to hang in your home for some wall decor.


Friday, June 30, 2017

intern year: reflections and advice


Intern year is finally and officially over. For those unfamiliar, intern year is the first year of residency training, or post-graduate (from medical school) training. It's the first time many trainees go from being "just a medical student" to being addressed as doctor. So naturally, it's simultaneously thrilling and terrifying. Many of us have been waiting for this day for years. If the often-used analogy for transitioning from college to medical school is "like drinking from a fire hydrant", I'd describe the transition from medical school to residency like being thrown into water when you don't know how to swim. That brief moment when you're treading water and you feel like you may be staying afloat, only to be drowning seconds later is how a good part of most days that first year feel. But! As hopeless as the days may feel and as stupid as you may feel multiple times a day everyday, the hours and days and weeks and months do pass. And then it's on to the second year.

Psychiatry residency training is 4 years long, so I'm 25% of the way there. A measly percentage, but I'll take it. This year has been the most consistently challenging, tiring, and difficult-to-adjust-to year of my training thus far. By far. And definitely top 3 most difficult things I've gone through. That said, alhamdulilah (praise God), I survived. Somehow, to my amazement and confusion, I survived. For anyone out there starting intern year tomorrow (July 1st is the official first day of the new academic year), I have noted reflections and advice about the year that I am sharing in this post. It is absolutely an exhausting year filled with some incredible highs (successfully treating someone all on your own for the first time, a patient thanking you and really meaning it, a patient giving you a handmade gift) and devastating lows (losing patients, making mistakes, feeling like maybe you weren't meant to do this). I genuinely hope this post is able to offer insight and inspiration to survive intern year. 

Without further ado, here is a list of things I learned throughout my intern year in Psychiatry, in no particular order.

1. Recognize the system is broken. I read about a hilarious difference between July and June interns: July interns question their choice to become physicians, and June interns question humanity. This may happen more often in Psychiatry than other specialties, but I guarantee it'll happen regardless of specialty. Patients will tell you about unfair social circumstances that you will need to realize are beyond your control. It's humbling and depressing. You'll hit a roadblock in a patient's care plan that you can't get past, whether it's because the patient doesn't have insurance, or is homeless and unable to get certain resources, or because they don't have any family or friends you can reach for help. As a result, they won't be able to get the optimal care they deserve, and you won't have a good answer for when they ask "what do I do?". As a provider, you will learn the system is flawed and broken, and lets people fall through the cracks. You will realize there aren't enough resources to help your patients. You will learn  prisons have essentially become state hospitals. Regardless of specialty, you will definitely learn how severely limited access to healthcare is about to become. As depressing as this realization is, let this be an opportunity to learn where the system fails people (even if it causes you to question humanity) so you can help your patients and truly advocate for them.

2. Forgive yourself for not knowing and not being the best resident ever. As you can gather from the above post, learning about the inadequacies of medicine and the healthcare system is not encouraging. Add sick patients, being overwhelmed with how to put in (the correct) medication orders, writing notes, pre-rounding, rounding, rounding again, discharging people, admitting people, transferring people, returning pages, and everything else in between, and you will have days the only thing you look forward to from the moment you wake up is when you can get back in bed. This will make you less enthusiastic and happy obviously. It's ok to not be the best resident ever. Sometimes it'll just be about making it through the day. You won't know things, make mistakes, say the wrong thing, act the wrong way, do the wrong thing. Forgive yourself.

3. Practice self care. Obviously a priority for someone in the mental health field, but equally important for everyone. Practice self care. Your job will become even more miserable if you feel perpetually ill (although you will feel perpetually tired, but that's a different story). Try to eat well. Step outside once in a while. Call family and friends. Read something enjoyable. Watch a movie. Go out to eat. Do whatever helps you relax, but do take breaks and treat yoself. My self care involves going out of the way to get better coffee. So worth it.

4. Be kind. To patients, nurses, social workers, other residents, medical students, anyone and everyone. You lose nothing by being nice.

5. Advocate for those who can't help themselves. See point 1. You're the "expert" now (yikes) and very often someone's last resort. If you don't have the answers to their questions or can't provide the services they need, direct them to someone who can help. Be empathetic and helpful, even when the other person is being a jerk, rude, and is showing evidence of being in the hospital for secondary gain. Let the power and authority you have be for the betterment of patients' lives. Fight for them.

6. You'll feel like an MS5 for atleast 6 months, and this is completely normal. Especially if you don't stay at your home program, you will be lost and confused for atleast the first half of each and every rotation. You will have moments where you feel like a fraud, a fake, and will wonder a) how you even got into medical school, b) why anyone ever thought you were competent enough to graduate from medical school, c) how any residency program accepted you, and d) why your family didn't stop you from becoming a doctor because you clearly weren't meant to be one. You will have no idea what's going on at times, will be caught off guard by patients, and will sometimes feel less competent than the medical students when they're more familiar with the EMR than you are. It's ok. It finally started getting better and more comfortable for me around February (8 months in).

7. Get help when you need it. Everyone has gone through intern year and everyone has felt, at some point, the same as you (see point 6). Ask for help when you need it. One of the best parts of residency is no one is grading your performance. You get evaluated, but that's so your program can ensure you aren't largely deficient in something (like making sure you show up for work). Don't know an answer to your attending's question? Who cares. Don't know how to put in an order for Tylenol? Ask. Get lost on your way to the first day of a new rotation? It's ok. Feel depressed and overwhelmed to the point where it's affecting your work and well being? Ask for help. There is never any shame in asking for help and support. Again, intern year is hard. Ask for help.

8. Push through it. Just when you hit a block and feel like you literally can't make it, keep going. When you feel tired beyond belief, have been at work for 16 hours, are so hungry you're positive your stomach is auto-digesting but you can't take a break just yet, keep going. There have been so many times that I was convinced I wouldn't make it through. Your strength, grit, resilience, and commitment will shock you. When you do make it through your first day, first night, first call alone, first _____, recognize you survived and applaud yourself. What you're doing is far from easy. Recognize your perseverance. The only exception to this: don't hold your pee.

9. Get used to never getting enough sleep and always feeling tired. One of my attendings recently told me this doesn't go away even when you graduate from residency. Oh well. The sooner you get over never feeling fully rested, the less upset you'll be that you're never not tired. One caveat- make sure you're not anemic or something. Also, never underestimate the restorative power of a good nap and going to bed at 8pm.

10. Cry when you need to cry. I've gone to the bathroom to cry more than once this year. It happens. You'll feel better after a good cry, so just go do it for like 5 minutes, and then come back to your work and push through it.

Monday, June 19, 2017

mocha brownies with cafe latte frosting



Taking a break from Japan nostalgia to share these delicious brownies that make for a perfect Ramadan treat. For the last few Ramadans, I've been fortunate enough to either be on break for some part of Ramadan (summer breaks in med school, the break before starting residency), or be on a relatively relaxed work schedule (home before 5, and non-stressful rotations). This usually meant sleeping in as late as possible, and being able to stay up as late as I wanted. However, working through Ramadan this year has been a new challenge. Trying to stay awake after iftaar (dinner where you break fast) at ~8:30pm has been almost impossible. The food coma hits almost instantly, and I usually end up passing out on the couch before 10. After suhoor (the pre-dawn meal which I have to eat before ~5 am), I get to have a quick 45 minute nap before getting up as late as I possibly can to throw on scrubs and make it to the psychiatric ED by 6:45ish for my 12 hour shifts. 12 hour shifts during Ramadan have their negatives and positive(s). The negatives are obvious. The surprising positive has been that the psych ED is so busy that time ends up going by pretty quickly. By the time I deliriously stumble through my front door at 7:30pm, I chill for 30 minutes before H & I start preparing for iftaar (if he's home from work by then).



By day 2 of fasting this Ramadan, the caffeine withdrawal headaches had hit. I hadn't realized my daily caffeine intake had slowly been creeping up before Ramadan. While I have spent a lot of time daydreaming about a cold, smooth iced coffee, these indulgent mocha brownies with cafe latte frosting have hit the spot come iftaar time. Even without the frosting, these brownies are amazing and have a hint of coffee in both the brownie mix and frosting.



Recipe from Just So Tasty, with the following adjustments: instead of using 1 to 1.5 teaspoons of instant coffee granules in the frosting as the recipe suggests, I used about 3 for a stronger coffee flavor. Additionally, I baked the brownies for about 30 minutes (longer than the original recipe recommended).

Friday, June 2, 2017

japan 2017: mt. koya

Day 5:
After leaving the Fushimi Inari Shrine earlier in the morning (click here for more on that trip and our time in Kyoto), we went back to the guesthouse to pick up our bags, and headed to the train station. The majority of the day ended up being dedicated to travelling to Mount Koya, where we would be spending a night at a shukubo (Buddhist temple). Mount Koya is known as the world headquarters of the Shingon sect of Japanese Buddhism, so appropriately, we saw many travelers on the train with us whose trips up to the mountain were more of a pilgrimage. What originally started out as a monastery grew into the town of Koya. Now, the city houses 3,279 people and has a university dedicated to religious studies and over 120 temples. The ride from Kyoto up to the mountain was a long one and took us about 5 hours. We first travelled from Kyoto to Osaka with our JR passes, and then got on the Nankai Electric Railway in Osaka which took us to the base of the mountain. At the base, a cable car slowly took us up the mountain, with a bus taking us to our final destination: Shojoshin-in. The ride offered incredibly beautiful views, with plenty of sakura lining the train tracks. There ended up being a light rain on our trip up and the next morning, making the experience even more serene.


The ride on the Nankai Electric Railway to Mount Koya

View from the bus stop at Shojoshin-in

We arrived to the temple just in time for dinner. Dinner, or shojin ryori, consisted of traditional vegetarian monk cuisine that was prepared by monks. We were so tired afterwards that we ended up going straight to our ryokan and calling it a night. Morning prayer services were at 6:00 AM the next morning, and we were up pretty early before then. We watched the monks complete their morning prayer and I got a chance to take pictures of our ryokan in the daylight, as pictured below.

The front yard of our ryokan

The front of our ryokan, complete with sliding doors

The entryway/hallway

Our traditional bedding which was incredibly comfortable

Day 6:
After observing the monk's morning prayers, we walked around the area outside the guesthouse. Before we left Koya later that morning, I wanted to stop by a cemetery I had read about while doing my research for the trip. With the intermittent rain that morning and a bus route I wasn't too familiar with, I was losing hope that we would be able to find the cemetery and be back at our guesthouse by check out later that morning. To my surprise and excitement, the cemetery ended up being a few minutes away from where we were.


The Okunoin Cemetery is the largest cemetery in Japan. It also happens to be the site of the mausoleum of the founder of Shingon Buddhism, Kobo Daishi. Over 200,000 tombstones line the pathway to the mausoleum at the very end of a 2 km pathway. Because we were in a time crunch, we weren't quite able to make the entire 2 km walk. We stopped roughly halfway and had to walk back to the guesthouse so we could check out on time and make the trip back to our final destination- Tokyo one last time.








The most moss I've ever seen


The cablecar ride back down the mountain

Stay tuned for my fourth and final post in the Japan series- the brief return to Tokyo!