T Minus 11 Days

On the desktop background of my Macbook Pro, I have a little countdown program running; counting down the days until our Objective Structured Clinical Exam or "OSCE". In 11 days, all the med students at McMaster will be tested on our clinical skills. It is the final exam before clerkship begins.

This semester has been incredibly stressful. My grandmother in India passed away in early October, which convinced my parents to fly to New Delhi immediately to handle the burial ceremonies. Indian funerals have complicated rites and rituals in which the eldest son of the deceased plays a prominent role (my father is my grandmother's eldest son). 

As a result, I've had to manage my parents' household (and our dog, Maya) while also managing my own apartment. Meanwhile, schoolwork has been piling on, ranging from the musculoskeletal system to neurology to psychiatry. Somehow I've managed to keep everything afloat, but it means that I haven't had the mental energy to update this blog in quite some time. I apologize for that; I love this blog and all the connections I've made through it, and I promise to update it every week from now on. I know there are going to be many, many fascinating stories to share in clerkship.  

I've been sustained through this difficult time by my two lovely roommates, Perry and Manreet. Perry is an enthusiastic and energetic first year who has been elected president of his class. He keeps inviting me to awesome social events, including the 2012 American election celebration event at the Phoenix (Gobama!), pub nights and "Screemers", a terrifying haunted theme park. Perry has also taught me how to cook; last week we prepared a delicious honey-mustard chicken dish together. Meanwhile, my other housemate Manreet is a second year opthalmology resident. His knowledge of retinal complications is eye-popping (sorry...). 

As clerkship draws closer, I look forward to starting my first rotation in Emergency Medicine. Then onto a short Christmas break before plunging into four weeks of child psychiatry. I hope that you (friends, relatives and random blog readers) are all doing well. 'Til next time! 

The Countdown Begins

Dear loyal readers of "Reflections",

Thanks for accompanying me on this incredible journey (through medical school and through life in general) over the past year. Many have contacted me wondering when the next update will be; to be honest, right now I am so bogged down in schoolwork that it's been difficult to muster up any creative energy. Fortunately, I am starting a new chapter in my life soon, a chapter that we can call "Clerkship". This will see myself and my fellow medical students become immersed in the hospital full time, rotating through a dozen or so specialties. Besides being an incredible learning experience, it will also be rich in creative inspiration, and without a doubt, I will begin blogging fervently again then.

Clerkship begins in late November. I'm counting down the days. Look forward to seeing you all then!

Death of a Beloved Mother

written by my mother, in regards to my Indian grandmother's recent passing. 

My husband and I were getting ready for bed in our Canadian home, when we received an unexpected phone call from India. It was our brother-in-law, who gave us the shocking news that Mummyji had suddenly collapsed and died. We were horrified to hear this, as Mummyji had always enjoyed excellent health.

Pradeep immediately began to make plans to leave for India, and I followed him three days later. The news of this unexpected death spread rapidly through Pradeep’s large extended family. Over the next few days, I joined my Indian family in the rituals surrounding the death of a beloved family member.

Yesterday, the main ceremony to honour Mummyji was held. The pundit came to our home and performed a havan that lasted more than two hours. Pradeep explained to me that each part of this ritual has layers of symbolism embedded within it, reflecting cultural meanings that date back thousands of years.

At the gathering that followed, I met members of Pradeep’s large extended family. Mummyji had been a much beloved member of this family, and so people came from far and wide to honour her. Many of the guests were well known to me, since I had lived in India for eleven years after our marriage. But some of them had not seen me since our marriage, nearly twenty-seven years ago. How much we’d all changed!

As I participated in the rituals surrounding Mummyji’s death, I reflected on the special relationship I had shared with her. I wondered how she felt when Pradeep originally told her that he had fallen in love with a girl from Canada. This match was so different from what she’d imagined for her eldest son. She and Papaji had already been searching for a suitable bride for Pradeep, but he’d refused to consider any of the young women they suggested. Now they understood why – he was determined to follow his heart and marry me.

We had a traditional Hindu wedding in Ghaziabad, where my parents-in-law lived. Mummyji didn’t speak any English and at that time I didn’t speak any Hindi. But she welcomed me to her home with a warm hug and a blessing for happiness.

I used to love to watch Mummyji prepare food. She would cut vegetables at lightning speed, with never a wasted movement. The meals she prepared were nutritious and delicious, and somehow she always made just the right amount. In the early days of her marriage, she and Papaji struggled to make ends meet. She became an expert household manager, stretching the family’s resources to the maximum.

Pradeep and I settled in Rishikesh, working as doctors in the hospital attached to Sivananda Ashram. After the birth of our first baby, Mummyji and Papaji came to stay for a few days and help out with our newborn daughter. I remember being quite fascinated by the way Mummyji took care of Sonia. To give her a bath, she’d squat in the bathroom with one leg extended, and then balance Sonia against her foot. After the bath she’d massage Sonia’s tiny body with oil.

She took care of me as well, cooking delicious food that followed Ayurvedic principles. After a pregnancy, a woman’s body is thought to be susceptible to dangerous cooling, and so foods that are heating to the system are given. One such food was a special form of laddu, made with the gum of a particular tree.

In 1996, after living for eleven years in India, Pradeep and I decided to move to Canada. I wondered if Mummyji would feel disappointed that her eldest son and his family were moving so far away. But she accepted our decision, and said that she wanted what was best for us.

At this sad time of Mummyji’s death, I find myself thinking about the relationship that we built. We were two women with such different backgrounds, but we were able to bridge the gap of culture and language through a bond of love.

A Letter from Paris

There’s nothing like a trip to Paris to give one a pounding headache. Not a headache induced by stress, but rather by a whirlwind of sightseeing and socializing. I’m sitting here, at the Alhambra Hotel, on a small bed with my Macbook on my lap and a bottle of Tylenol at my bedside.

It has been an intense but enjoyable trip, beginning last Friday night with a 7 hour plane ride to Paris. It was followed by a journey into the town of St. Hilaire in the province of Normandy. My mother, sister, cousin and I rented out a small villa surrounded by vast stretches of farmland. Over the course of the week, we explored ancient castles and towns. We also visited the beaches captured by the Allies on “D-Day”, a turning point in World War II. From our clifftop vantage point, we gazed down at the beaches stretching out on both sides of us. It was calm and peaceful, making it difficult to imagine 150,000 troops storming through blistering enemy fire. 

After our stay in the countryside, we headed to Paris and tried our best to absorb this massive, intricate city in the span of a day.

Despite the frenetic pace of the trip so far, I feel calm and content. These feelings are likely to vanish soon as I head into MF5, the final foundation in our curriculum. MF5 is notorious for having a grueling pace, packing in the musculoskeletal system, neuroscience, and psychiatry into twelve weeks. McMaster is famous for adopting an accelerated curriculum, but I can’t help but wonder whether three months is enough to adequately study these complicated topics.

I was given a colourful reminder of med school when I logged into Medportal, the interface we use to access our course information. The system has been totally redesigned, with this graphic at the top: 

Don't be fooled by the monsters' happy expressions; within a couple of weeks they'll be devouring us all. 

My mission now is to get back into "study mode". I'll wake up, go to lectures, and study. On the weekends, I will study. At night, I'll probably dream about studying.

Yet there will be those pockets of time, perhaps few and far between, when I'll indulge myself in some of the wonderful things about life: Hanging out with friends, going clubbing, blasting baddies on my X-BOX and taking my dog for a walk ... a dog who, in a short seven months, has blossomed from a tiny pup into a rambunctious adolescent. Unfortunately she has been struggling in her training. Both of us, Maya and I, have much learning to do. 

The Soul of Medicine

The Neuro Bootcamp is an intense 4 week program that immerses med students in the field of Neurology, a complex field of medicine focused on the brain and spine. The typical day ranges from 10 to 15 hours. Feeling discontented with the slow pace of Allergy Medicine, I signed on for the last week of Bootcamp, joining other students who had already been training there for three weeks.

It was unsettling, at best, to approach each patient with a sharp pin, with the intention of eliciting a pain response from their forehead, cheeks and chin. This was just one of a number of tests the neurologists used to assess the functioning of the major cranial nerves.

I've always had an interest in Neurology, and so it came as a surprise to realize that I am not meant to go into this field. While Neurology may focus on the brain, it focuses almost purely on the physical aspects of the brain - its electrical activity and chemical imbalances. We would see patients with acquired brain injuries, seizures, strokes, episodes of amnesia, and all kinds of problems that afflict the nervous system. Although I found myself fascinated by this at first, by the end of the week I sorely missed the human, feeling component of medicine. While we would ask patients about their balance and vision, we would rarely explore the emotional context of their illness - their fears, hopes, coping strategies and supports.

This emotional context is addressed primarily by the patient's family doctor or by a psychiatrist. This is done largely for efficiency: the Neurologist, as well as other specialists, face a large backlog of patients. They simply don't have time to delve deeply into the patient's feelings; their goal is to determine the physical defect and address it with medications or therapy, before moving on to the next patient.

I thought that I would like this - after all, I enjoyed reviewing my Neuro textbooks before starting Bootcamp. Unfortunately, the clinical reality of any given specialty often differs sharply from the student's interest in the subject matter. While the brain is fascinating on paper, in reality, Neurology means treating a narrow set of conditions on a "consult" basis - seeing each patient only once or a few times, excluding the development of a long-term patient-doctor relationship.

While I greatly admired the ability of the staff neurologists to "think through" their patient cases, I also realized that I would prefer a specialty with more emotion, more feeling. I think that my strengths are in connecting emotionally with people and being empathetic to their circumstances. These strengths are suited to a field that involves some aspect of psychiatry, which literally means the "soul of medicine". Although I'm not necessarily interested in becoming a psychiatrist, I do need to keep searching for a field that is naturally imbued with feeling and emotion.

Destiny's Call

A baby girl is born to a loving set of parents in a rural American town. She takes after her mother, with curious eyes and an infectious smile. Mom and Dad take their new daughter home, delighted that the arduous process of childbirth is over, and settle her into a room they’ve specially prepared.

At first, everything seems wonderful. The baby is responsive and full of energy. She giggles when she’s tickled and feeds without complaint. But after a couple weeks, her parents notice a slight tremor in her hands, which quickly develops into a jerking movement. The child becomes hyperactive, crying all the time and unable to sleep. A rash appears on her left foot and spreads rapidly upward, engulfing her leg in angry patches of red.

Mom and Dad, panicking, take their daughter to an Emergency Room after she has her first seizure. The doctors are unable to explain what happened, except to confirm that the girl’s brain is extensively damaged. Devastated, the couple take their daughter home and continue to devotedly care for her.

One year later, the mother becomes pregnant again. She wonders: Will this baby encounter the same problem? But this time her doctors conduct a blood test that confirms the presence of phenylketonuria, a rare condition in which the body cannot break down phenylalanine, an amino acid found in foods like milk and eggs. The baby is immediately put on a low-phenylalanine diet, escaping any damage to her body.

As the years pass, she grows up into a beautiful young woman and goes to college. While her dietary restrictions are frustrating, she is grateful to have avoided her sister's fate.

My class was shown a picture of the two sisters in a lecture last week. It was the younger one's wedding day, and she looked radiant in a beautiful wedding dress. Holding onto her arm was her sister, who wore a distant and unfocused expression. The simple existence (or non-existence) of a simple blood test had profoundly altered the destinies of these young women. While the married sister would go on to enjoy marriage, career, children, intellectual pursuits, the other would spend the rest of her days struggling with a severe mental disability.

We often frame our lives in the context of "destiny", the idea that certain events were preordained. But more often than not, one's destiny is determined by access to timely medical intervention; the C-section that saves a baby’s life, the antibiotic that kills a potentially deadly infection, or the vaccine that keeps influenza at bay.

One can't help but reflect on the millions of children ravaged by conditions that are now treatable, and wonder: What kind of lives could they have led? Who could they have become?

The Climb

On Friday afternoon, I finished up my elective in Allergy Medicine and headed back home, stopping by the Pancake House for a plate full of waffles. It had been an exhausting day - for some reason, I hadn't been able to sleep the night before. I've just moved out from my parent's house, and my apartment was an absolute disaster. Sitting there, staring out of the rain-streaked window, I felt like I was in a twilight zone - half conscious, not fully sure where I was. I also had a stomachache - by this point, I regretted the waffles big time.

It's been a challenging couple of months at med school, a relentless onslaught of training, tutorials and readings. Near the end of June, we all completed the OSCE, a clinical exam in which med students rotate between ten different stations. Actors pretend to be patients suffering from real conditions. Meanwhile, a doctor sits in the room and evaluates the student's performance. Some of the stations involve complicated ethical scenarios, a reminder of the Multiple Mini Interviews prior to med school.

At McMaster, our summer consists of 7 weeks of clinical electives and one week of vacation. My electives began in early July with Allergy Medicine - I've spent day after day performing skin tests, making tiny perforations on people's arms before applying small amounts of allergic substances. The Allergy team stores a vast variety of these allergens, from "horse epidermis" to a variety of tree nuts.

Yesterday morning the real challenge began with Emergency Medicine. I was fully prepared for some intense clinical action, but instead I spent two hours at the parking office trying to get a student transponder. Despite this initial setback, it was thrilling to step into the trauma unit for the first time. This is the heart of medicine, where doctors race against time to save lives. The unit is equipped with sophisticated equipment to rescue patients from the brink of death.

The day ended up being fairly productive. I improved my dictation skills, learned how to use the computer system, and interviewed a couple patients. At the same time, I felt intimidated by the seemingly endless medical details with each case, details that the ER doctors seem to have mastered. Sometimes, especially at the end of a stressful day, I look at the 5+ years of medical training in front of me and wish that I could just speed through it, somehow "zapping" all the information into my brain. It would be lovely to have a steady job and a regular paycheque.

Things that are keeping me sane: Playing with my dog (she's become quite a beauty), trash TV (namely "Desperate Housewives") and my family and friends.

All I need to do now is grit my teeth and keep pressing forward, step by step.

The Cloud Messenger

" I wouldn't blame someone for assuming that the concept of "true love" was just a myth invented by Hollywood. In the real world, relationships often fail. But my idealism about love, which spills over page upon page of this blog, is grounded in a true story that sweeps across the world, across racial and cultural boundaries. It's the story of how my mother and father met and fell in love.

In 1981, my mom was fresh out of her third year at Dalhousie Medical School. Filled with a sense of adventure, she set out for an international summer elective at the King George Medical College in the city of Lucknow, India. After 30 hours of travel, she finally arrived in the city - it was sweltering hot, dirty and crowded. Navigating her way around the college, she bumped into the Chief Resident of Pediatrics, who her directions and invited her to dinner. Feeling uneasy in these new surroundings, she gratefully accepted.

The Chief, who also happened to be my father, felt enamoured with this young woman and was eager to impress. He borrowed money, a scooter and a kurta (a knee-length shirt for men) from his friends. Their date that evening was replete with rich food and conversation, easily blossoming into a summer romance. Three weeks later, my father whisked my mother away on a breathtaking trip through the Himalayas, a vast mountain range that stretches across South Asia. They rode along winding roads by day and slept in small roadside cabins by night. In their own words, they both fell "madly in love".

Despite this, they were faced with a seemingly insurmountable geographic and cultural gulf between them. Neither of their families supported the relationship. When my mom boarded the plane for Canada, she thought she had seen the last of my dad.

Little did she realize that she was dealing with a most stubborn of creatures: a young Indian male, an individual born and bred in a culture that is fixated on the idea of romantic love. Over the next four years, my father wrote two letters to my mother every week, each one brimming with flowery reminiscences of their trip and dreams for their future together. He was inspired by "The Cloud Messenger", the famous poem by Kalidasa, in which a subject of King Kubera (the god of wealth) was banished from his homeland for neglecting his duties. Missing his wife, the subject convinces a passing cloud to carry special messages to her.

Every time my mother began to doubt the practicality of their cross-continental romance, another package would arrive from her own Cloud Messenger and assuage her concerns.

On the banks of the River Ganges.

In 1985, my mom and dad married one another in a traditional Indian wedding outside of New Delhi. It was a classic Indian production, replete with vibrant decorations, hundreds of guests, a dazzling variety of foods and even a white horse to carry away the bride and groom. The strength of their connection had overcome the reservations of their families , who in the end celebrated the wedding.

Soon after, my parents settled in the remote mountain town of Pauri, providing healthcare to the poor. They faced incredible challenges, including an earthquake that killed thousands. My earliest memories were forged in these mountains. I remember bathing on my front porch in a tiny blue tub with snow-capped peaks as my view, and eating hot roti bread fresh off the stove. While life may have been difficult for my parents, it was thrilling for my 3-year-old self.

Twenty-five years later, my parents still share a cup of tea every morning over wide-ranging philosophical conversations. They plan to move back to the Himalayas after they retire, to serve the poor once again. While their lives have been unpredictable, one thing has always been certain: Their bond is unbreakable.

Being a witness to this story has convinced me that true love is achievable, but that it requires effort and some degree of risk. As I move through my twenties, I can't help but wonder if I'll be so lucky as my parents ... or whether I'll end up a lonely bachelor who collects stamps and drinks his tea in the company of his cat.

I'm going to press "Publish" now and send this post off into the clouds. 

Rhythms of Life

Last week, my clinical supervisor called me into his office to deliver my final evaluation. He wore a stern expression on his face as he looked it over. “You did terribly,” he said in a frustrated voice before adding “Just kidding!” with a big smile. I shook his hand, and with that, wrapped up the third foundation of my medical studies.

For the last two months, we’ve been knee-deep in the renal and reproduction systems. Surprisingly, the kidneys are some of the most complicated organs in the body and inevitably a challenge for those trying to master their physiology. They involve a seemingly endless number of intricate mechanisms and functions, including the regulation of blood pressure, electrolytes and acid-base balance. It took several grueling study sessions before these concepts finally “clicked” in my brain. As part of clinical skills training, we’ve learned how to do a Pap smear on a model and watched a rather graphic video about childbirth.

Undoubtedly, though, my best learning has taken place in the clinic. I spend ten hours a week doing electives in Family Medicine, Hematology and Pediatric Neurology, which, in my opinion, are far more immersive and interesting than the monotonous pages of any textbook. Surprisingly, I’ve had several minor accomplishments. I counseled a woman about quitting smoking. She’s now trying out Champix, an effective new drug that diminishes nicotine cravings. I’ve also done my share of physical exams, finding a couple suspicious lumps on a routine lymph exam last week.

It feels good to immerse myself into a steady rhythm of life, a rhythm that involves solid study sessions, clinic time, lectures and tutorials. The day begins at 7 with a hot cup of tea and ends with a trip to a yoga studio, where I do plank poses and Downward Dogs in 40-degree temperatures.

I'm currently reading Dr. James Orbinski's "An Imperfect Offering", a fascinating glimpse into his life as a doctor with Medicins Sans Frontieres. I enjoy reading medical memoirs because they give me some perspective; that, despite seeming like I'll be in school forever, one day I will indeed be a trained doctor and able to pursue my dreams. 

Tomorrow we start bright and early with our fourth foundation, which will cover immunology and neoplasms. I'm looking forward to meeting my new tutorial group and tackling "Janeway's Immunobiology." By this point, I've learned how to study well and have become quite comfortable in the curriculum. I feel an urgent desire to get as much knowledge under my belt before rotations begin in November, when the real challenge begins. 

Somewhere

The old woman lies in her hospital bed room, emaciated and feverish. There are steel spikes in her throat, the consequence of a strep infection that makes it almost impossible for her to swallow solid food. Exhaustion soaks into her bones ... even sitting up leaves her tired. Days and nights blur together and time means nothing. Her only task is to sleep and eat, sleep and eat until she finally passes away.

Despite all this, she says that she feels a deep sense of contentment. She is surrounded by people she loves and always has a niece or nephew around to entertain her. Beside her bed is a large, double-paned window that looks out onto a street dotted with quaint stores and coffee shops. She remembers playing along this street as a child, when six hours could so easily be swallowed up with simple games.

But things are different now. As she moved from childhood through adolescence and finally into adulthood, her outlook on life steadily changed. She has become more of a realist. She doesn't see the world as boundless, but rather quite limited by the realities of flesh and blood. She has seen friends come and go, family members pass away. She has had profound personal experiences with aging, suffering, illness and now, finally, death.

And yet while many languish in pain and loneliness in the final chapter of their lives, she feels satisfied. Her life has been full of friendship and love. She followed her dreams, married the man she loved and raised a beautiful family. She devotedly took care of others for many years. Now, her children and grandchildren, nephews and nieces - and all the others whom she touched with her kindness - come to the hospital to be at her bedside. Now they take care of her, doting on her with small gifts and kind wishes.

Her faith in God sustains her. It's easy to look down upon another's religious or spiritual beliefs, to question their logic ... but for this woman, at this moment, her faith gives her great strength and optimism. She does not see herself just as a dying, physical being, but rather as a soul ready to escape its material confines and ascend to Heaven.

She will go somewhere where there is no suffering, somewhere where she will be rewarded for a lifetime of faith and service. 

True Love

My next-door neighbors are a beautiful young family with three small children. One parent has a natural green thumb, planting her flower seeds in such a way that her front lawn blossoms into vibrant hues of orange and yellow every spring. The other is an expert cook. She never fails to bake us a delicious blueberry pie on Christmas Eve.

My neighbors seem to go all out for every special occasion; on Hallowe’en their house is decorated with cotton spider webs and Styrofoam tombstones; on Christmas they place an enormous blow-up Santa near their front steps; and on Easter, their kids dress up as rabbits, dashing around in a frenzied attempt to find hidden chocolate eggs.

This beautiful, loving family would never have even existed fifty years ago. Because, despite their dedication to their children, the parents would have been socially ostracized for the simple fact that they are both women.

Across the span of history, gay men and women have often lived at the peripheries of society, shameful of their true attractions and fearful of being discovered. As a result, they have often married the opposite sex, foregoing the opportunity for genuine relationships and true love, aspects of life perhaps more celebrated than any others. How many relationships have been prevented by irrational stigma? How many soulmates have been kept apart?

I’m proud to call myself a Canadian because, on the whole, a Canadian has the reputation of being a moderate, someone who eschews the extremes for the middle ground… for common sense. We’ve allowed gays to serve in our military because we know that they are fundamentally just as brave and capable as anyone else. We’ve allowed them equal rights of marriage because we know that their feelings are real, that their relationships are genuine.

The world has no shortage of suffering. The Intensive Care Unit at the Hamilton General Hospital, where I train every week, is full of the sick and dying. While we may be young and healthy now – perhaps even feel invincible – we will inevitably be consumed by aging and illness.

Why then, in the midst of all this suffering, would we ever consciously choose to destroy the opportunity for love between two people? Love that might blossom and pass down through the generations, strengthening the fabric of our society.

We would only consciously make this choice out of ignorance and fear. Because once we truly make an effort to get to know and understand gay people, we realize that they love as deeply, feel as deeply and care as deeply as anyone else.

As spring arrives, I look forward to seeing my neighbours’ lawn blossom once again. I look forward to the excited sounds of children drawing chalk patterns on the sidewalk and playing their imaginary games. I’m not sure what the future holds for them; perhaps they will be very successful in life, or perhaps they will be hampered by failure and unmet expectations. Whatever happens, I know that they will be able to look back at their childhood, at their two moms, and say that they were truly loved. 

Maya

Day before yesterday, my sister, mom and I drove to Mississauga to pick up our miniature poodle pup from the breeder's home. A bubbly, middle-aged woman greeted us at the door and ushered us into her living room, where she brought out our pup. I was anxious for a couple seconds; what would she look like? Would she be cute? Would she be friendly? My questions were soon answered when the breeder came back into the living room carrying an adorable black female pup in her arms, with two soulful eyes and a tiny black nose.

Was she friendly? Definitely yes. The puppy leapt out of the woman's arms as she lowered them and literally attacked my sister and me with affection, jumping in and out of our laps and nuzzling her head into our open arms. She was a bundle of energy, a little spark of mischief that bounded back and forth across the room. I immediately felt a connection to her and a feeling that we'd chosen the right pooch. 

Of course, buying a miniature poodle pup (or any pup for that matter) may sound fantastic, but then comes the hard part ... potty training. Over the past two days, my mom, sister and I have taken tiresome shifts supervising the puppy and placing her on her special doggie pad right as she squats down to pee. I made the mistake of bringing her onto my bed with a full bladder - let's just say that my blanket went straight into the wash.

She also seems to enjoy chewing everything. A family friend came over with a Holter monitor strapped to his chest (for measuring heart function) and a long, thin wire that ran down into his pocket, where it attached to a controlling remote. Puppy didn't care that it was medical equipment - she grabbed that wire between her teeth and had to be forcefully pried off.

Then again, the advantages of owning a tiny, 8-week old pup far outweigh the negatives. This afternoon my Hematology shift at Juravinski was cancelled and I was feeling somewhat stressed and unwell. So I packed poochie into her crate and set off for Mac, where I introduced her to a bunch of friends. Never have I had so many people converge on me at once ... it was like I was carrying the Holy Grail. Even though the pup was quite shy, she didn't fail to make nearly everyone gush over her. 

But what about the name? We started with "Leela", an Indian name, and then jumped to "Kala", which means "Black" in Hindi before all deciding that "Maya" was splendid. 

All this weekend, friends are visiting one after the other to meet Maya. There's something about a puppy that is irresistible. Maybe it's the spontaneous energy, or the boundless curiosity, or the unbridled affection ... whatever it is, this furry little creature has injected fresh energy into our social lives. Within no time, Maya will be an adolescent. I plan to savour her puppyhood, and take her on several more trips to McMaster to meet new friends. I'm looking forward to being woken up in the morning by the cold end of her snout, and going on long runs together through Churchill park.

I feel a sense of connection and adoration for my new pooch, and I can only hope that she feels (or will come to feel) the same way. 

You Are My Sunshine

Check out this article in the March issue of Incite Magazine. Thanks to Jeremy Henderson for editing this. 

On Hallowe’en Night 2006, I dropped by Shoppers Drug Mart to pick up some candy for the slew of trick-or-treaters who’d soon be arriving at my door. I tied up my dog, Sunny, to a post outside. Unfortunately, my mind was so preoccupied with candy and costumes that I returned home without the dog. Suddenly realizing what I had done, I raced back to the shop… only to find her gone.

No one – not my neighbours, the shopkeepers, nor Animal Control – had seen a trace of Sunny. She had simply vanished. That’s when I launched a major search and rescue operation, plastering the whole neighborhood with “LOST” signs and offering a $250 reward for her safe return. About three days later, a woman called me, reporting that she’d seen a young man walking Sunny on Dalewood Avenue. I zeroed in on the neighborhood, leafleting every house with signs. Finally, I got a call from a man who said that he had picked up the dog because he’d thought she’d been abandoned. Within minutes, I was at his house and recovered my pooch, who nearly knocked me over with excitement..

This whole ordeal proved to me the strength of my connection with Sunny. We had been through everything together. When I first arrived as an immigrant from India, she was my only friend for a while, and never failed to comfort me with her wagging tail. When I would have a tough day, she’d always lick away my tears. Sunny woke me up in the mornings with the cold tip of her snout, demanding food and patting, and would later run with me through the forests.

By all accounts, it was a miracle that Sunny was ever born. Her mother was a huge German Shepherd, while her dad was a tiny spaniel. But somehow they mated and produced a perfect blend of their genes – a beautiful, medium-sized golden pooch with a very sweet temperament.

Nowadays, I find myself thinking more and more about Sunny. It’s been a year since she died of a stroke at age 14, and the urn of her ashes sits desolately on my bookshelf. Beside it lies a big silver spoon that I used to feed her sips of water as she lay on her deathbed.

As the frosts of winter thaw and the spring comes in, my family plans to plant a small tulip garden in our backyard, where Sunny loved to play. My mother wants me to sprinkle her ashes all over this garden. A part of me feels like holding on to the urn forever, and that losing the ashes would mean finally letting go. But I know in my heart that Sunny’s ashes are not her lasting legacy. The person who I am today was shaped and molded by her constant presence throughout my childhood. She helped teach me the meaning of play, of joyfulness, and most importantly, of unconditional love.

And so I will go out this spring and spread her ashes, watching with a mixture of sadness and joy as the barren soil blooms into vibrant reds and yellows.

Chasing Dreams

“So where do you see yourself in ten years?” asked my supervising resident pointedly. It was a Friday afternoon and we were sitting across from each other at The Barton Bean, the main coffee shop in the Hamilton General Hospital. Exhausted from a busy afternoon clinical shift, we were happy to cap off our working day with steaming lattes. Since our conversation thus far had been fairly light, this question struck me by surprise.

Medicine offers over fifty different specialties and sub-specialties, ranging from heart surgery to nuclear medicine. Before graduating, McMaster medical students complete five foundations in the study of the body and disease, followed by an 18-month “clerkship” period that, in my case, starts this November. As clerks, the students work full time in the hospital, rotating through various specialties to narrow down their own area of interest.

Then comes the “CaRMS” process, the bane of every med student’s existence, whereby they compete with one another for limited specialty spots. They have to fly all over the country, interviewing at different hospitals and clinics with the hope of being accepted into their first choice. Some specialties like plastic surgery and dermatology are highly competitive, while others (like psychiatry) generally accept all their applicants.

As a high school student, I was sure that I wanted to be a surgeon of some sort. The challenging and stimulating environment of the operating room as well as the opportunity to directly fix problems appealed to me. But as I’ve progressed through my first year at medical school, my interests have shifted to neuroscience. The brain – the hardware of the mind and soul – is by far the most complex, indecipherable and fascinating organ of the body.

A career in neurology, the study of the brain and nervous system, would obviously be the most logical career path. And yet, in my experience, the real clinical work of a neurologist consists mostly of treating a narrow set of conditions over and over again; migraines, seizures and strokes. It also requires the completion of the internal medicine residency, probably one of the toughest available. This residency involves several difficult years of stress and sleeplessness borne out of regular 28-hour shifts. Then come additional years of training specifically in neurology.

When I try to envision my future, I'm not sure I would want to continue training in the hospital past the age of 30. By then, I’d like to be settled in a beautiful red-brick house somewhere in Toronto with a big, overly-friendly dog, a loving spouse and maybe even a kid or two. For me, the true substance of life is family and friendship, adventure and exploration. I'd want to be sure that whatever career path I chose allowed me enough flexibility to cherish these aspects of life. 

Lately I’ve begun to consider family medicine as a possibility. Its flexibility and broad scope of practice appeal to me. I could imagine myself running a busy clinical practice, as well as doing some teaching, writing and travelling. Undoubtedly, I have many tough decisions ahead … But if I make these decisions based on true values and interests, then I think I’ll be just fine.

Heart to Heart

"Raman, it's time to see your first patient. Interview and exam," my supervisor said firmly, placing a thick file in front of me. It had already been three weeks since I started my hematology elective, and although I'd relished every moment, I had kept declining to see the patients on my own. The very thought of it made my stomach queasy. But now my supervisor, convinced that I was ready, was throwing me in the deep end.

I slung on a stethoscope and headed to Exam Room 6. The patient, an elderly woman in her 70s, was suffering from a rare blood cancer. Her chart had informed me that she'd recently come back from a skiing trip to the States, and so I broke the ice by asking her about her trip. Both she and her husband enthusiastically recounted their adventures on the slopes.

Flipping back to the medical interview, I started off with open-ended questions that became more and more focused. There was a beautiful moment in our conversation when I forgot my anxieties and fell completely in lockstep with the patient. Each question flowed naturally and spontaneously one after the other until I gained a deep understanding of her case. For those few minutes, I was fully immersed in the interview, all my attention focused on her words and expressions.

Communicating with others has not always come naturally to me. As a little boy I immigrated to Canada with my family and was at first painfully shy. Every time I tried to talk to someone outside my immediate family, I would become consumed with my own fears. As a result, conversations with strangers were uncomfortable and I would avoid them, becoming isolated and lonely. Someone in Grade 3 called me a "loner" ... racing home, I looked up the definition in the dictionary, hoping it was something good. After realizing what it really meant, I just lay on my bed feeling sad and frustrated. 

Once I hit middle school, I finally started to make more friends. But I've never forgotten the pain of shyness, and still consider the ability to connect with another to be one of the most miraculous aspects of life. In the clinic that day, I felt a strong connection with the patient, turning what could have been a series of routine questions and answers into a heart-to-heart discussion. While a mere medical interview is scripted and emotionless, a true "heart-to-heart" is spontaneous, imbued with trust and mutual respect. It builds the foundation for a productive and rewarding doctor-patient relationship.

After I completed the interview and physical exam, my supervisor walked in. "So how did he do?" he asked. 

"Oh he did just fine," the woman said. Her face lit up into a warm smile. The doctor nodded approvingly and handed me the next patient file. This time, I felt genuinely excited. 

By the end of my shift, dusk was falling. I had to hurry home to have a bite to eat before heading out to a medical school party. Over the course of the next four hours,  I managed to make new friends and also master the art of "beer pong". The hostess, a second year med student, affectionately dubbed me "Noodles" after the popular "Ramen Noodles" soup brand. As I chatted with my friends, we connected easily through laughter and stories ... person to person, heart to heart.

The Lost Decade

My great-great grandfather, William Ashburner, was a master English shipbuilder in the late 19th century. He specialized in schooners, swift racing vessels propelled by up to seven masts. A shrewd businessman and innovator, he earned himself a small fortune, investing it in a mansion for his family in the North of England.

Unfortunately the advent of steamships doomed the schooners to irrelevance and he quickly went bankrupt. He looked to the colonies for employment, quickly setting his sights on South Africa. He moved his family to the city of Johannesburg, where he took up work in the gold mines. Life was tough in this rugged new environment, but he and his ten children managed to thrive.

Unfortunately, his wife Anne did not. According to family legend, she went to her bed and “wept for two years”. She’d simply lie there all day, every day, crying constantly and barely able to do basic tasks like folding her own clothes. She was inconsolable, and the family was naturally devastated.

Reflecting back on this story over a century later, it's plainly evident that Anne suffered from clinical depression, a biological illness that affects millions of people. While effective treatments are available today, back then, all William and the children could do was watch their wife and mother languish in her bed.

I was reminded of this story last month after meeting a young woman, call her Katherine, who had been struck by severe depression for nearly a decade. She used to live a normal life, full of rewarding friendships and a meaningful career, but things changed after she delivered her first child. She would just spend day after day lying in bed feeling exhausted and empty. She couldn’t understand why; after all, she had a loving husband and a healthy new baby. On the surface, everything was wonderful in her life.

Doubtful about mainstream medicine, Katherine did not seek any treatment. Instead, she tried to plunge herself into a vigorous exercise routine, went on expensive vacations and devoured self-help books. And yet her depression raged on year after year until her life gradually fell apart, losing her job and falling back on a small disability pension. Where once she was an outgoing person, she now found it hard to even smile.

I met Katherine shortly after she was placed on a “Form 1” by her doctor, an order that forced her into a psychiatric ward. She had attempted suicide, an unsurprising consequence of a decade of suffering.

Her doctors quickly diagnosed her with clinical depression and put her on an SSRI, a potent class of medication that normalizes brain levels of serotonin. Within a week, Katherine reported a “burning” sensation of warmth in her chest when she saw her son. She was taken aback by this new, unusual feeling. But then she realized that it was actually the sensation of joyfulness, something she hadn’t felt for years.

Since then, Katherine has been discharged from the ward and her life has blossomed. She has reconnected with long lost friends and rediscovered her energetic, outgoing spirit. Whereas her eyes had seemed distant and glazed over before, they now sparkle with a happy expression, as if they are smiling right alongside her. For so long she had defined herself as an antisocial, sad person, while in reality, her real self had been imprisoned by mental illness.

Along with recovery comes reflection. Katherine looks back on the past decade with a deep sense of regret. So many years wasted, so many opportunities for new friendships and experiences lost. So many beautiful memories that could have been made. She barely knows her son, since she has been emotionally absent since his birth.

And yet Katherine could have avoided all of this suffering if she had just sought treatment at the first signs of her depression. What went wrong? While she herself may be blamed for her initial stubborn distrust of mainstream medicine, that decision was influenced by our society’s stigma of mental illness. So many patients fail to seek psychiatric treatment out of shame, feeling that it reflects some inherent character weakness.

But there shouldn’t be any shame. Just as diabetics must take insulin, so must clinically depressed patients take antidepressants. Both are biological illnesses in which pharmaceutical treatment is necessary.

In the past, the mentally ill were often crippled by their condition for their entire lives. Now, with appropriate treatment, Katherine has a bright future. She looks forward to doing all the things that she missed out on over the years, especially getting to know her son.

For the first time in over a decade, she truly feels alive. 

Grace Under Pressure

note: Any private details have been changed/removed.

The Juravinski Cancer Centre is a massive glass and steel building that dominates the Eastern part of the Hamilton mountain skyline. It is a hub of cancer-related activity, including research, treatment and supportive care. A massive 75 million dollar fundraising campaign has allowed its administrators to get their hands on every cancer specialist's dream machine: the CyberKnife Radiosurgery Robot, which can kill tumors with sub-millimeter accuracy.

I’ve been placed as an elective student with a hematologist, a specialist who works with disorders of the blood. I’ve been so impressed by his vast knowledge base, his compassion and skill in communicating with patients. A woman will come in with rapidly advancing leukemia, and he will sit down with her for twenty minutes and explain her entire disease in layman’s terms. He wants his patients to know exactly what's happening in their body, and you can just tell that they really appreciate him. 

The most inspiring case I’ve encountered so far has been a middle-aged woman with advanced multiple myeloma, a deadly disease that ravages the bones. Her skeleton is rapidly deteriorating, compressing her spinal vertebrae so that they squeeze against her spinal nerve, causing excruciating pain. She can barely walk and keeps falling, splitting open her lip on numerous occasions. Meanwhile she suffers from a serious mental illness.

And yet her husband takes care of her with incredible devotion. He sets an alarm to wake him up twice a night to take her to the bathroom, makes all her meals and drives her to appointments. He manages all her medications and has even taken temporary leave from his work to care for her full time. Unfortunately her pain and stress have destabilized her mental illness and her mood is a rollercoaster, flipping from severe rages to extreme dispair. But her husband doggedly sticks by, enduring her temper while continuing to provide care.

When I think of a superhero, I usually think of a muscly manly man dressed in tight spandex, but in my opinion, this slender, bespectacled gentleman is indeed a superhero. When he said that he would stick by his wife through “sickness and through health” on his wedding day, he really meant it. At that time, his wife was a healthy, beautiful woman. He certainly couldn’t have expected her to be ravaged by mental and physical illness. But he stayed true to his wedding vows, even while many marriages end because of far less serious problems.

What motivates him? Is it a sense of obligation wrought by religion, family values or culture? Or is a sense of loyalty innately embedded in his personality? Clubbing at Sizzle on Friday night, I looked over at all the hotties on the dance floor and couldn’t help but wonder: How do I differentiate the genuine from the superficial? And would I have the fortitude to stick by my spouse through years of illness? Looking at the husband, I can just sense a gentleness and wisdom in his expressions and words that tells me he is a caring person to his core. 

Seeing this couple struggle together through this hardship has also given me a sense of perspective on my own problems. Honestly, I've been complaining way too much lately. Yes, I’m sick again with a fever, stressed out and dealing with an inordinate amount of work, but my problems pale in comparison to theirs. They've truly shown “grace under pressure” and I hope I can find a little bit of this grace in myself as I deal with major challenges over the next few weeks. 

The Weird & the Wonderful

As my second semester or "foundation" here at McMaster comes to a close, I'm finally getting a good handle on my stress. I've returned to eating and sleeping well and doing other things besides working. For one, I bought an XBOX 360 and have now converted my bedroom into a gaming centre slash personal gym. After a hard day's work, I enjoy an hour or two of playing video games or pumping iron (not that it's had any effect on my measly muscles).

I've also taken up an elective in the anatomy lab, and now spend an hour with an anatomist every Wednesday afternoon. It's led to some weird and wonderful experiences.

"Raman, can you hold this for a sec?" the anatomist asked me last week, handing over a human brain. It was heavier than I expected and nearly slipped out of my gloved fingers. Eeek! Although at first I was paranoid that I'd drop it, I was also awed by the fact that I was holding a real brain.

The anatomist disappeared into a backroom and came back with a big plastic box. She cracked the lid and peeked in. "Ah perfect," she commented. Uh, what the heck was in there? She then popped off the lid and pulled out a whole human head, its features all squished together. Oh great! At that moment, I was second guessing my decision to take on this elective.

Oblivious to my discomfort, the anatomist launched into a lecture about the pituitary gland. Meanwhile I was wondering what to do with the brain; had she forgotten that I was still holding it? One of her colleagues passed by with a big smile. "Great weather out there, eh?" he said happily. The anatomist returned the smiled and nodded. Wait, here she was holding a human head, and all her colleague wanted to talk about was the weather? Only in the anatomy lab.

Getting to hold that brain was just one of the weird and wonderful things I've done in med school since returning from the Christmas break. Last week, my clinical skills supervisor brought out a life-like replica of a pair of human buttocks to practice rectal exams. "Just come from the side and slip your finger in," she explained, demonstrating the technique. Apparently I had quite the expression on my face, because she looked straight at me and said, “Hey, I didn’t make you choose this profession.” I was just relieved that I could learn the rectal exam on a model, and not on a real person ... but that too will come in time.

I've also been introduced to the unpleasant concept of “Fetor Hepaticus.” The doctors suspected that one of my patients had chronic liver disease. To help confirm the diagnosis, my supervisor asked me to smell the patient's breath. When the liver is dysfunctional, the breath takes on a characteristic "rotten and sweet" smell - "Fetor Hepaticus" literally translates to “breath of the dead.” In this case, my nose would literally become a diagnostic tool. Leaning in toward the patient, I took a good whiff ... Yep, diagnosis confirmed.

Like any job, medicine comes with certain downsides. Yes, those downsides may be smellier and stickier than what you’d encounter as say, a lawyer, but the upsides (like getting to hold that brain) are pretty awesome too.

Facing the Firing Squad

Yesterday was one of the worst days I've had in medical school so far. The week leading up to it was extremely stressful, packed with tutorials, studying, electives, shadowing experiences and other major time commitments. I found myself leaving the house every day at the crack of dawn and returning by 9 or 10 at night, grabbing a quick bite to eat before starting tutorial review. And then I would get a few restless hours of sleep before dragging myself out of bed to start another day. For whatever reason, all my major commitments happened to coincide to create the week from hell. 

On Monday night, I finally collapsed into bed at 2 am and decided to take a sleeping pill to ensure I got a good night's sleep for my clinical training the following morning. I rarely use such pills, and so it came as a shock when it totally zonked me out. I was asleep within minutes. It took every ounce of motivation to drag myself to the hospital. Our task was to do a basic interview with a “standardized patient”, or in other words, an actor hired by the university who pretends to be a patient. All the students (nine in total) sit in a group with the two supervisors and critique one another's performance. It's a little intimidating to be doing a mock interview as eleven people watch your every move (albeit, very nice people).

I happened to be the last to go. After three hours, I think everyone was a little bit impatient for the session to be over. My “patient" presented with severe exhaustion, but I'm pretty sure I was more exhausted than she was. I started doing a basic history, asking about when the problem started, what was happening at the time, what she had tried for relief, etc. etc. I had trouble concentrating and my interview seemed to veer way off track. I hadn't even gotten on to recommended treatments by the time the timer rang, abruptly ending the interview.

I looked to my left, at the assembly of nine students and two preceptors, all looking thoroughly unimpressed. Oh crap. The students had been instructed to be honest and critical in their feedback; after all, how else would you improve? Judging by how much I had just bungled up the interview, I felt like I was facing a firing squad.

Let's just say, I took a battering - a polite, Canadian-style battering - and it was totally deserved.

Right after class, my fever returned with a vengeance, and I had to drag myself through the rest of the day. It was exhausting and demoralizing.

Now I'm sitting at my laptop with a hot cup of tea, recovered and rested. I think the most important lesson I've learned from this experience is that, in order to be a good care provider, I really need to take better care of myself. A burned out individual exudes a negative energy that turns people off and may make patients less willing to open up about their problems. When I'm very stressed, I find it harder to feel and show empathy, and is that really fair for the patients? Sure, I can still do a good history and physical exam, but medicine should be about more than just checking the boxes.

So I'm putting myself on a regular sleep and exercise schedule, cutting down on unnecessary commitments and finding time to decompress every day. With any luck, this exhausted, burnt-out Raman will be replaced by a rosy-cheeked, smiling Raman within a couple days. And then I can hit the next interview out of the park and redeem myself. Fingers crossed.

Hottest Books, 2011 Edition

My Kindle was a godsend for me last summer while living in rural Quebec. Although speaking French, eating French food, and going to French school every day is so much fun (*cough*), it was a blessing to escape into English books every night. Sure, this was technically against the rules because the administrators wanted it to be "all French, all the time."

But since when do bad-asses like me follow rules? Without further ado, the best books I read last year!

MEMOIRS... 

I was blown away by Viktor Frankl's story of surviving the holocaust in his memoir Man's Search for Meaning. Not only does he recount his memories of Auschwitz, but also uses them to frame his inspirational philosophy: that we are all responsible for creating our own meaning in life. You go, Vik... You go.

I burned through Open by Andre Agassi and Chretien's My Years as Prime Minister. Both are honest and gripping accounts of the life of a tennis player and PM of Canada, respectively. It doesn't matter if you're not into tennis or the intricacies of the Canadian government (who is?). These books are great, period.

Then it was on to "The Heart and the Fist", the memoir of an ex-Navy Seal and Rhodes scholar. The Navy Seals undergo the most rigorous military training in the world, and Eric Greitens reflects beautifully on his experiences. If you don't buy a copy, he may just bust through your window one day and take you out.

FICTION... 

Lawrence Hill's "Any Known Blood" traces several generations of African-Canadians and their struggles with fostering a sense of identity in a society that disparages their very existence. (side note: I actually see the author around Westdale all the time!). The Game of Thrones was just epic, and only slightly eclipsed in entertainment value by The Hunger Games, about a post-apocalyptic world where one boy and one girl are selected each year to fight in a televised battle to the death. Fun stuff.  

The Poisonwood Bible is a sweeping and compelling novel about an American family that moves to a faraway land of poverty and "bare-breasted" women. And no, it's not about downtown Hamilton.

NON-FICTION...

Shortly before med school started, my reading became decidedly more medical. First was "Complications", a fantastic surgeon's memoir that reads more like a thriller novel, and then a fascinating book about the concept of neuroplasticity - how the brain can change itself.

Later in the year, I speed-listened my way through the Steve Jobs audiobook, which recounts the life and career of the quirky entrepreneur. What was Jobs' inspiration for founding Apple? "Dropping acid," he says frankly. Gee, maybe I should try that for blogging.

To wrap up the year, I devoured the Pulitzer-Prize winning "Emperor of All Maladie" - a biography of cancer. Really, it's more interesting than it sounds.

Happy reading!

Angel of Artsci Past

I suddenly became very ill last night, developing a fever of 102 degrees. I felt totally fatigued and could do little more than lie on my bed with a blanket wrapped around me. The house was cold and dark, and my parents were off dog-sledding at a resort a couple hours away. I can’t remember a time when I felt so miserable.

Fortunately my sister arrived home shortly thereafter. She made me some toast along with a hot cup of milk. Sitting beside me, she worked away on her laptop while we talked and joked. It felt so good just to have another person there, and in talking to her, I felt myself forgetting about my own sorry condition.

At the same time, I couldn’t help but wonder how so many patients in the hospital are able to endure weeks or sometimes even months of being bed-ridden. Often times they are so old that they've outlived most of their friends, or they just don’t have any direct family members. And so they lie in the sterile confines of their hospital room while their bodies fail them. Sometimes they cry out in the night for their mother or father, who are long dead. For most of the day, their only company is the nurse on staff.

Last semester, I was fortunate enough to be supervised in the hospital by Dr. Oczkowski, a young internal medicine resident. The doctor, or “Simon” as we called him, had a real gift with patients. He could walk into a hospital room with a very ill patient and make a connection within moments. He’d ask them how they were doing, explain their condition in a way that made sense to them, and joke around a bit. With a natural sense of humour, his patients inevitably felt cheered up by the end of his visit.

Simon also had an incredible grasp of medical knowledge, but I think his true gift was in genuinely caring. For the brief duration of his visit, he'd make it seem like his patient was the only person in the world. I think that the sick and dying cross a point in their illness when simple compassion and connection with another human being matter far more than any medicine or procedure.

Interestingly, Simon and I have led parallel lives in many ways. We both grew up in Hamilton, both went to the “Arts & Sciences” program at McMaster, both went on the Student International Health Initiative trip to India, and both went to McMaster’s medical school. I can only hope that I'll be even half as good a doctor as he is. 

Puppy Love

A couple years ago, Sonia (my sister) flew off to India with the intent of rescuing malnourished street puppies that had been abandoned by their mothers. She didn't have to look far. Walking down a side street of our hometown one day, she spotted a tiny black puppy lying in a ditch. The puppy, a female, was on the brink of starvation, her ribs displayed prominently through her emaciated chest. My sister tried feeding her a little piece of bread, but she was too weak to eat or even move.

Wrapping the small dog in a cloth and gingerly placing her in a cardboard box, Sonia took her to a local veterinarian, who turned his nose up at the puppy. 

"Why would you bother with a street dog? It will die anyway," he said. In India, street dogs are generally viewed with disdain, and it's almost unheard of for someone to adopt one as a pet. Instead, rich Indians have their pick of expensive breeds, which have become status symbols in a highly status-conscious society. 

But fortunately the vet agreed to give the puppy a couple of shots and sold my sister some flea powder. After giving her a bath, my sister discovered a star-shaped patch of white fur on her chest... and subsequently named her "Tara", which means "star" in Sanskrit. At first, Tara couldn't hold down anything more than water. But after recuperating for some time, she was able to start digesting heavier foods like milk and roti, a flat Indian bread. Covered in the white, chalky flea powder from the tip of her snout to the end of her tail, Tara managed to frighten the neighbours on more than one occasion.

Against all odds, my sister nursed the small puppy back to life with healthy meals, regular washings and countless patting sessions. She got a great sense of satisfaction when she took Tara back to the vet for another round of shots. The vet was shocked ... whereas the puppy had come to him before as an emaciated shell, she now had a shiny black coat of fur, sparkling eyes and boundless energy.

"This is a beautiful dog," he conceded.

Upon regaining her energy, Tara showed a particular fondness for shoes, sometimes grabbing people's chappals right off their feet. When my sister would discover some mischief - like a chewed up shoe or a missing roti - she would confront Tara, ready to give her a light smack. But the dog would leap into her cardboard box and cower guiltily... she was a master of the "puppy eyes", which made it virtually impossible to administer any form of punishment.

But as Sonia soon discovered, Tara still had the restless energy of the street dog, repeatedly escaping the property to go play in the streets. Although this bothered my sister at first, she eventually realized that it was only in the dog's nature. So she found a healthy compromise: Tara could run off every morning and then come back in the evening for a meal and a comfortable place to sleep. After two months, my sister returned to Canada, feeling like her mission had been accomplished.

Ever since then, Tara has become a fixture of our Indian neighbourhood. Not only is she popular with the children, but with everyone else as well - our prim-and-proper neighbours, the elderly, the shopkeepers... even the homeless. Each year, she greets a fresh batch of Canadians who travel to our Indian home (which doubles as a yoga retreat centre) searching for spiritual solace. They don't have to look far to find a miracle, because there's one that meets them right at the doorstep; a living, breathing, tail-wagging miracle.

Shortly after the rescue

Bath time

Healthy and happy

Puppy eyes

All grown up