How it all went down. (III)

Day 4 is my live patient interview. It’s the last interview of the course, and the room is packed with doctors. The patient has chronic schizophrenia- her face is flat and she says very little. I sink my heels in the carpet to make myself wait for her responses- they are there when I give her time. We manage to cover all the important topics- psychosis, suicide, homicide, medications, living situation. After the interview is over, my interviewer grills me. She is rude and impatient, asking multiple questions in one breath, not waiting for my responses. At one point, I answer a question with “a couple of times a month”. She fires back, “How much is a couple- 2, 3, 10?” I am confused. Once the mock interview is over, everyone applauds. She tells me I did great. I walk out, still confused and upset.

Out in the courtyard, my friends confirm my suspicions. “This is what she does with everyone. That’s why there was such a crowd- people have been coming to observe ‘the drillings’.” The military psychiatrist has teamed up with the Bangladeshi doc and is teaching him to organize his notes. I join in, sharing my templates, dos and don’ts. Later he takes us out to dinner to say thanks. We run into others, some of whom stop to shake my hand and tell me how well I did. I feel better. Over Chinese food, we talk about families. Pictures of spouses and children are shared, fortune cookies read. The course is over.

Day 5 is a free day for us. My friend schedules us a massage and we meet for brunch. Sitting there on the patio with our iced teas and salads, we can almost pretend this is a vacation. The spa bolsters that feeling. My masseuse is soft spoken and gentle. I close my eyes and ignore the life size Buddha statue in the corner- it embarrasses me to be naked before the Buddha. When she turns me over, I notice the bars on the ceiling. “What are those for?” “Those are for the Ashiatsu massage. I use them for support when I do the massage with my feet.” Falling into the massage haze, I wonder if I’d ever let anybody walk on my spine with their feet.

That evening, friends from residency start flying in. I meet one of them for Ethiopian food. She’s working in community psychiatry as well- we exchange war stories. The restaurant owner mothers over us and scolds us for not licking clean our humongous platters of food. Chastened, we get leftovers packed and vow to eat them for lunch the next day.

On day 6, we show up for registration and to receive our exam schedules. I will be one of the people taking the exam at two different locations. After the vignette exam at a local University medical center, I will take the shuttle to a community mental health center for the live patient interview. The speaker, head of the board, urges us repeatedly- “Do not miss the bus. Do not decide to drive yourself. Please, please, please, don’t decide to put your photo ID in a new and special place.” All my friends have their exams at a single location. I try not to feel bummed. Instead, a friend and I go out for coffee and I get a new battery for my rarely used watch. I will need it for the exam- they gave us timers at the course, but beeping time keeping devices are not allowed at the exam.

That evening, four of us from the residency program meet up for an outdoor Italian dinner. We discuss jobs, goats, and fathers. Thunder strikes as soon as we put down our forks. The tea light draped tree under which we are sitting trembles. Fat drops of water hit the table. Determined to have our just desserts, we run to the ice cream shop, taking shelter under awnings when we can. The shop is crowded even in the rain, with the line snaking double upon itself. We end up leaving without ice cream. I drop my friends at their hotel and drive back very carefully. Tomorrow is exam day.

Posted in Psychiatry | Tagged , , | 17 Comments

How it all went down. (II)

Omaha airport, day 0/7.

The rental car is a Nissan Versa just like my first car. It makes me smile. I’m in Omaha a week before the exam day. My general psych graduation was more than a year ago, and I’ve decided to splurge on a board preparation course. To make up for the splurge, I’ve bid on a hotel that is not the designated course/exam hotel, and offers free breakfast, parking and wifi. Also, there are no nervous examinees staying at this hotel except for me.
The streets in Omaha are curiously empty. Its close to midnight. I check into the hotel and fall asleep into a deep, restless sleep.

Day 1. I register for the course at the boutique course hotel. There is complimentary coffee and tea, hallelujah. I grab a cup of coffee and take a seat close to the back of the conference room. People start filing in- a diverse group with very few white males. Next to me are an older Bangladeshi man and a beautiful woman from Kuwait who tells me Kuwait boards are just like US boards. The Bangladeshi doc tells me he’s been unsuccessful twice. We both shrug philosophically. Maybe third time is the charm.

A chime rings and the course director walks in. He looks different than he did in the course videos- he’s grown out his cranio-facial hair, but his voice remains soft, his tones dulcet- I zone out a lot. It’s a full day of lectures- most of them summaries of the written material. We’re told that day two will be more fun- there will be mock vignettes and live patient interviews. We are all scheduled for one of each, and can pay for more. We are encouraged to form study groups and study our peers perform.

By the end of the day, people are forming study groups. I hang back.

Day 2. At the morning workshop, they have invited a ‘practice patient’, an actor to discuss some scenarios. I volunteer for one. As I walk towards her and introduce myself, the actor/patient jumps off the chair and starts talking a mile a minute, walking, gesticulating, and grabbing my arm. I say her name a few times, asking her to sit, but she doesn’t. She’s pretending to be manic. [Manic patients can be hard to interview in a limited time setting, because they talk a lot and hard to interrupt/redirect.] She goes on to play out a few other scenarios, and we get tips on how to deal with each.

For lunch, I join two army psychiatrists, one of whom asks me if I have a study partner. I like her- she’s calm and collected, and I like how she talks. We team up and interview each other over case vignettes. At the end of the day, we head to the beautiful Old Market area for local ice cream. The streets are still empty, but there is a line at the ice cream shop. I choose a spicy tamarind ice cream. It’s delicious.

Day 3. I watch my new friend do a live patient interview. The patient, this time a volunteer, ‘real’ patient, has dissociative identity disorder. It’s a tough, controversial diagnosis. This patient, while calm, seems to be at the edge of blowing up in anger or dissolving in tears. The doctor does a wonderful job- she manages to explore the effects of trauma without digging into the trauma itself in front of fifty some people. I am impressed.

We go out that evening for dinner- I’m craving anything but shop talk. We discuss our families, training, teachers…and then we go back to talking about psychiatry. It feels good to talk to someone who is not a colleague, discuss cases, and talk about medications. I’m starting to feel more comfortable, and looking forward to my live patient interview on day 4.

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And how it all went down. (I)

This morning on my way to work, I received a text from one of my friends reporting that he had passed the oral board exam. Wha..congrats! But the results weren’t due yet! We had taken our exams exactly 12 days ago. At the orientation, we had been told that the results would be out in 4, maybe 3 weeks.

My hands itched to reply to the texts that started pouring in. As soon as I moved into the parking space, I hit reply. ‘Was driving. Going to get to a computer.’ I walked/ran into the office, turning on the computer even before I turned on the lights. My fingers were shaking slightly and I was having trouble typing. Still anxious, eh, some part of my brain noted. It seemed to take forever to log in to the board website and find those tiny floating words- Status-passed.

Most medical specialties have board certification exams. Some medical specialties have 2-step board certification exams, with a written and an oral exam. I took (and passed) my written exam exactly one year ago.

The oral exam is a different ball of yarn. Up until a couple of years ago, the pass rate for the oral exam has hovered around 60%. Medical forums in random corners of the internet are filled with horror stories about doctors who did not pass the oral exam once, twice, three times.

I read all those horror stories. I re-read them. The board prep course I took came with its own little section of horror stories. I read that too. None of that was helpful. What did help was Maria’s extremely well written tale of The Oral Exam, parts I-X. I read it on her old blog, and she re-posted it after one of my anxiety fueled tweets.

The exam as she and I took it will be no more in 2016. We were the last batch to take the exam in this format, where the examinees interview a real patient over 30 minutes, while they are observed by two examiners. There is a 30 minute presentation and Q&A after that. Other than the live patient interview, there are four vignette sections, with three written and one video vignette, each followed by a brief Q&A with different examiners.

I will attempt to imitate the best and share my experience of the exam in the next few posts. It may not help many future examinees, but may serve as an amusing reminder of what will be, at least for the next 4 years, a strange, strange exam.

Posted in Psychiatry, Work | 17 Comments

What makes a doctor happy?

Twitterverse is in disarray over this survey.

Every year, Medscape publishes a physician compensation survey. They also send a specialty specific survey to members- I received one for Psychiatry. A lot of people are surprised by the fact that physicians are not a happy group as a whole. The only people not surprised are likely physicians themselves.

Only half of the 20,000 odd doctors surveyed feel that their compensations are satisfactory, and only half would pick medicine again, given the chance.

More tellingly, only one quarter of internists and one third of family physicians would choose the same specialty. What do both these specialties share? Low salaries. But then, roughly half of pediatricians, who also have low incomes, would still choose that specialty. The most satisfied specialties are dermatology (high income) and psychiatry (low income). The most discontent were plastic surgeons (high income) and internists (low income).

Do you see a pattern there? Or lack of one? Apparently, mo’ money does not equal mo’ happiness. One of the things the happy specialties -dermatology, psychiatry, even emergency medicine- share is a better quality of life, as measured in terms of working hours, being able to do your job within/despite of the system, having down time for non-work activities, etc.

I also suspect that unhappy doctors are unhappy for two reasons- one, they are not able to do what they would like to do (more medicine, less paperwork); two, they feel they are not making the amount of money they should be making for the amount of work they do.

Which brings us to the next question- how much money is enough money? Several of the surveyed physicians felt that their salaries were not enough to cover their expenses. (I’m assuming that they did not simply mean their overheads.)

The doctors I know seem to have a lot of expenses. Most of them have a home loan, another home loan, two (or three) car loans, student loans (if they are younger than 40), a high maintenance romantic partner (and maybe an expensive ex), kids to put through school (and college, if they are immigrants), a expensive hobby, or two…you get the idea. Perhaps you’ve been there.

Money is like time. Your chores expand to fill all available time. Your expenses expand to fill all available money.

Current goal in life- don’t look for mo’ money. Spend money on experiences and not on goods. Keep expenses low.

Posted in Psychiatry | 4 Comments

Thoughts on the new job (in no particular order.)

I love what I do. I love seeing patients, love figuring out what’s going on, love working with them to get to a medication that works.

I hate ‘administration’. This is important to know, because I entertained delusions of being an administrator-clinician for a while. That is not me.

The existing evidence no longer applies. I’m seeing patients, lots of patients, every day. These patients do not fit the DSM criteria. These patients do not fit the profile for any one medication. Often, they come to me already on a combination of medications that reflect the desperation of clinicians past to try something, anything. Yet, these patients are not unique. They are similar. To each other. I’m starting to see patterns that I have no name for, but they exist just the same. I doubt these will ever make their way to the DSM-V, or VI. I have to find a way to document them.

For the past couple of weeks, I’ve considered going old school. Keeping clinical notes. Of syndromes, patterns that I see. What works. What doesn’t work. To see if a plan emerges. To see if I can help.

It’s going to be a long, interesting journey. I only hope that something useful emerges at the end.


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Hello, and a recipe

I thought I could live on Twitter. It allows me to work 10 hour days at four different clinics and still keep in touch with what’s happening in the world. It’s my newsfeed, entertainment, communication system and everything else rolled into one phone app.

It’s pretty darned hard to share a recipe on Twitter, though. God knows I’ve tried.

So here it is- a lotus stem biryani so delicious it made me write a blog post. 🙂 Loosely adapted from this recipe.


1 tbsp vegetable oil

1-1.5 lbs raw lotus stems

1.5 cup plain yogurt (greek or homemade)

1 tsp paprika

1/2 tsp turmeric

1.5 tsp salt

1 tsp fennel seeds, powdered

1 tsp cumin seeds, powdered

1 tsp powdered coriander seeds

1/2 tsp dried ginger powder

1/8 tsp mace, powdered

1/4 tsp powdered cinnamon

1/8 tsp powdered nutmeg

1.5 cups long grain basmati rice

1/2 tsp salt

1 stick cinnamon

3 small green cardamom pods

1 black cardamom pod

1 bay leaf

4-5 cloves

a handful of fresh mint

a handful of fresh cilantro

1-2 hot green chillies, minced

– Pre-heat the oven to 375 degrees.

– Start by prepping the lotus stems and the rice. You can find fresh lotus stems at most Asian/Indian grocery stores. Look for ones with closed ends, as they are less likely to have dirt in the veins. Cut off the ends, scrub clean in plenty of water, and boil/pressure cook in 2 cups of water until you can easily poke through one with a fork. Cool and peel, then slice into bite sized pieces.

– While the stems cook, take a saucepan and soak the rice in 2.5 cups water, salt, and the whole spices- cinnamon, cardamom pods, bay leaf, cloves. When it turns opaque (about 10 minutes), cook the rice by bringing it to a boil, covered, then simmering at low heat until all the water is absorbed. Do not stir until the rice is done, then fluff gently with a fork. Remove the whole spices if you wish. (If you’re new to cooking rice this way and want the grains to be completely separate like in restaurants, add 1 tbsp of oil to the water.)

– In a bowl, beat together the yogurt and all the other spices. You can add a little lemon juice to the yogurt if it’s not sour. The blended mixture should taste like a spicy tandoori marinade.

– Heat oil in a large non-stick skillet. Add the sliced lotus stems  and saute for 5 minutes until the stems are golden brown and somewhat crisp. Turn the heat to low and add the yogurt blend. Stir occasionally and cook on low heat until the sauce thickens and coats the stems. Taste and adjust seasoning.

– Coarse-chop the mint/cilantro/green chillies.

– In a 10 inch baking dish/casserole, layer the biryani. Spread half the rice in the bottom, cover with half the curried stems, half of the mint mixture, rest of the rice, rest of the fresh herbs, and finally the top layer of curry.

– Cover tightly with a couple of layers of foil/an oven safe lid, and bake for 20 minutes until the flavors blend. Serve warm.

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Hello, I must be going.

I’m still here.

The Vox blog had started as a reaction to homesickness, as a coping mechanism. Then I went back home. It was all the things I imagined it to be- delightful, overwhelming, confusing, bittersweet.

And now I’m back. Starting a new job, and in some ways, a new, less orphaned life. I’m not sure yet if this blog will continue to remain active- twitter seems to be easier to keep up with, and WordPress was never able to capture the charms of Vox.

I will keep this ID active so that it allows me to continue reading your blogs and leaving comments. And maybe add a post or two when the going gets tough again.

You can find me on twitter (@purplesque) and gmail (

Until then, my friends. Live long and prosper.

Posted in Uncategorized | 28 Comments

Home, and my mother’s white dumplings

It’s good to be home. I’ve been spending time cleaning out closets, reading my kindergarten report cards (”she needs to improve her conduct”- I, a 5 year old sociopath!), and cooking fresh vegetables from my mother’s verdant vegetable garden.

Summer Squash vine taking over the house

This time, I asked her to give me the recipe for her white dumplings, aka safed kofte. These were my absolute favorite growing up. Much like the laal pulav, these were reserved for special occasions. I would tiptoe around the kitchen, sneaking in a couple of dumplings straight out of the fryer before she smothered them with the rich white sauce. Rich, sophisticated, yet understated, it’s the perfect statement recipe.

The measurements below are approximations- I followed my mother’s style and did not meaure anything. Go ahead, take your chances with this one.

They taste a LOT better than this looks

For the dumplings:

3 medium potatoes, boiled and peeled

About a cup full of green peas, boiled

6-8 slices regular white bread, crusts removed (don’t use low-carb high-fiber type bread)

1/4 cup cashews

1/4 cup raw peanuts, skin removed

6 green cardamoms, seeded, seeds crushed (or 1 tsp powdered cardamom)

2 tbsp fresh cilantro, chopped

2 tbsp golden raisins

1 tsp cumin seeds

3 cups milk

salt and white pepper to taste

1 tbsp vegetable oil, plus enough for deep frying the dumplings

– Whizz the crustless white bread in a food processor to get soft crumbs. Set aside.

– Mash together the potatoes and peas with a little salt until you get a smooth green mash. Add enough bread crumbs (about half) to get a mixture that is soft, yet firm enough to fashion into balls.

– For the stuffing, chop 1 tbsp each of the cashews and peanuts into coarse crumbs. In a small bowl, mix these with the raisins, cilantro and cardamom.

– Heat enough oil in the fryer while you form the dumplings.

– Divide the dumpling mixture into 1/4 cup portions.

– Take the mixture in the palm of one hand and form a ball. Flatten the ball into a disc and put about a tsp of stuffing on top. Close the soft edges of the disc around  the stuffing and pat the ball between your palms to form a slightly flattened dumpling. Dredge the dumpling in the remaining bread crumbs and keep aside. Repeat until you have all the dumplings.

– Deep fry the dumplings in medium-hot oil, taking care not to overcook them. They should barely change color. Remove and drain on paper towels. Arrange in a platter.

– For the sauce, whizz together the remaining cashews and peanuts in the food processor/blender until they are powdered. Add any remaining breadcrumbs and the milk and blend again.

– Heat one tbsp oil in a heavy saucepan. Add the cumin seeds and wait until  they sizzle. Turn the heat to low, add the blended milk mixture, and cook on medium heat, stirring constantly until the sauce thickens, abut 10 minutes. Season with salt and white pepper.

– Just before serving, pour sauce on dumplings.

Served with naan, dal makhani and rice, this is a meal fit to serve a royal family.

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Going home.

It’s been 6 years. When we came to the US, I never thought I wouldn’t go back for this long. My sister had been in the country before me, and she visited home faithfully, once, sometimes twice a year. I thought I would do the same.

For reasons that are too complicated to go into, that didn’t happen. The first few years in the US, I was terribly homesick. Then I discovered Vox , and stopped feeling quite so lonely. The parents came for a visit, and the homesickness got better. I started watching Bollywood movies again, befriending desis on twitter without getting an ache in my belly. Even now, reading books about the diaspora is hard. As are the festivals. Every time I find a piece of clothing that I like, it turns out to be Made in India.

It’s time to go home.

Will I be able to come back? I don’t know. There is a job for me here, but the paperwork road is long and painful, and there are never any guarantees. My very expensive lawyer says so. It might be safer for me to just stay put and wait for my visa to come through, but I’ve chosen to take my chances and go home.

Family and friends want us back, permanently. There are jobs to be had in India. There is family. The monsoon. Chai by the roadside. And as a friend told me, ‘You will actually be able to afford help.’

I’m torn. Unlike most would-be immigrants, I did not come to the US looking for wealth. Unlike my husband, I did not come looking for excellent training, though it found me. I came looking for a meritocracy. And I found it, in a workplace where people do their jobs without asking for bribes, where medications aren’t adulterated, where cars stop for pedestrians. As scary as the current political climate is, America is still the most diverse country I know, and Americans the most accepting of people. (I say this having lived in the deep south for a year, and rural Appalachia for another three.)

Yes, I can probably make more money as a physician in India. But can I live this clutter-free life? Can I make a living without compromising my values? If I have children here, they will be American, not Indian. They will never identify with the rain, with Holi and Diwali, with dhotis and saris like I do. But they will grow up being able to practice what I preach, being able to learn that you can survive without being corrupt, that you don’t have to pull someone else down to get out of the bucket.

There are no good answers. The decision is still a couple of years away, until A finishes his training. In the meantime, I’m going home. If they let me back in, I’ll be happy. If not, I’ll extend this vacation and travel the world, until I find another place like this.




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What really happens at a Muslim community event?

Here’s an email sent by a non-Muslim friend, with identifying details changed.

‘The event was hosted by the Council on American-Islamic Relations (CAIR) and held at the local Muslim Community Center. There was a brief welcome address, a recitation from the Koran, a speech by a really adorable little girl of about eleven, who explained about Ramadan and fasting and what it meant to her in very practical schoolgirl terms.  Then there was a brief talk about Islamophobia, what it is and what to do about it.  The speaker very quickly went over some of the more egregious examples of anti-Muslim statements that are being made in the US today, emphasizing the need for people to remain calm, and reach out to others, and provide engagement and education.  This was followed by a panel discussion by three others; a representative of the Hindu community; a pastor from a Baptist church; and a rabbi from a reform Jewish synagogue.

And then it was sunset.  We were served a snack of dates, watermelon, and something like an egg roll to break the fast and heard the call to prayer over the PA.  The Muslims went to for the evening prayer (Maghreb) and others were invited to go and watch if we liked, or to go ahead and start dinner.  They announced that this year the dinner would not be Middle-Eastern or South Asian as it was in previous years, but Indonesian.  There was a sort of fried rice, chicken satay and a meat curry; there was also lasagna and salad and some sauteed vegetables. Our hosts made a point of telling us that there was vegetarian food provided.  (Meanwhile we are secretly disappointed that there was no biryani!)

I’m glad I went; my friend and I were feeling bad that more non-Muslim Indians had not attended, there were just about five of us, although many had been invited and at least one other had said she was definitely coming. There were quite a few Jewish people, ACLU leaders, other members of the inter-faith community.   I was delighted to see that my Democratic US Congressman was there, as was a staff member representing another Republican Congressman.

It was a relaxed and friendly social occasion, quite low-key, calm, and not tense, but there was an undercurrent of sadness. CAIR gave out little wallet-sized folded cards; they were entitled “Rights and Responsibilities of Muslim Americans” which included little tips for students on how to handle themselves in various situations. This broke my heart; the thought of little children having to carry these things in their pockets and learn how to deal with it when people insult their religion and call them names etc.  WHY should children have to learn such things?!’

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