Hanging in..

Has time stopped or rrea…ll…y slowed down?

It’s so hard for me to believe that it has only been two months since I started my residency. I was having this discussion with my co-worker and we agreed that it feels like we have been here for over 6 months or something! Since joining the program we have been given 3 assignments so far (that contain N number of modules that we have no time to complete) and we also answered a 8 hours long in-training exam that we were so not prepared for!

Being the master procrastinator that I am is not helping at all while I am under this huge pile of To-Do list. And although I am happy that I have been able to get myself to exercise every other week and eat healthy, every now and then I find myself holding a Pepsi can (not even diet Pepsi) or a delicious cheesy piece of pizza. Temptations!

My goal for the month is to be more organized while surviving over 80 hours/week inpatient rotations. I do have a schedule in place but the mystery is – Will. I. Be. Able. To. Stick. To. It!





Lonely nights

It has finally hit me. In this moment. Right here – I am homesick.

I miss my sugarplum, my family, my friends. Over one month in the ICU seeing people take their last breath, seeing some slowing succumb, seeing some get so close to the end and make it through to see another day – I am already waiting for the 3 years of my medical residency to end.

Isn’t it human nature to not be happy with what you have, to always want something more, something better? I have to remind myself how much I have struggled to get this far. I hope things get better for me with time.


The NRMP Gamble


Away I have been for I had to detach,
I was taken hostage by the “residency match”.
Been a while since I came here to ramble
as NRMP played my life’s ultimate gamble.

I rechecked and reviewed, re-upload and refresh.
did I do this right? Or make a mess!?
Oh the fear, the days weren’t sunny,
as I spent thousands on application money.

Then it’s interview season – I am braved,
My resume is long and my LORs waived.
With holes in my shoes and a MTB in my shelf,
Practice and practice…”so..tell me about yourself”

The travel halts, we hold our breath,
12th of March is now what we dread.
I wait exhausted, almost crashed,
Until lo and behold! “Congratulations! You have matched!”

Behind are the struggles, its time for celebration,
Mid-June, they said, we begin orientation.
We pack our bags, may be brush up some basic,
and like the last journey, hope this too will be EPIC! (pun intended)

The Sacred Place

“ [A sacred place] is an absolute necessity for anybody today. You must have a room, or a certain hour or so a day, where you don’t know what was in the newspapers that morning, you don’t know who your friends are, you don’t know what you owe anybody, you don’t know what anybody owes to you. This is a place where you can simply experience and bring forth what you are and what you might be. This is the place of creative incubation. At first you may find that nothing happens there. But if you have a sacred place and use it, something eventually will happen…”

#myfavquote. 🙂 #pnpRandom

Murmurs for USMLE

Heart Murmurs

One of my favorite moment as a medical student was when we were asked to listen to a patients murmur and identify it. “syssstolicc?paaansystolic?” “no..its diastolic” murmured students amongst themselves and then of course there was me – “I have no clue. They all sound the same.” How is this my favorite moment you ask? Well, our mentor watches us discuss the murmur and says “Even the most experienced cardiologist I know of has a hard time interpreting murmurs.”

And yet here we are lost between the lubs and dubs and hushs shuushhs!

There are 2 things you need to know about murmurs for all USMLE Steps – Characteristics (and of course, any associations with pathologies) and How they sound.

My first advice for you is write down all the murmurs with their important characteristics. Here is what I have in my notes:


  1. AS (Aortic Stenosis): Crescendo-decrescendo. Radiates to apex and carotids. Delayed and diminished carotid pulse. For Step 3, know when then valve needs to replaced.
  2. PS (Pulmonic Stenosis): Not a commonly tested murmur.
  3. MR (Mitral Regurg): Holosystolic. Radiates to Axilla. Note: Acute MR is Decrescendo.
  4. TR (Tricuspid Regurg): Holosystolic, heard at left sternal border.
  5. MVP (Mitral valve prolapse): Mid-systolic click and late systolic murmur
  6. HOCM: Crescendo-decrescendo. S4 gallop. Look for things like ‘Left ventricular hypertrophy (septum)’
  7. VSD: Holosystolic, heard at lower left sternal border. Look for ‘palpable thrill’.


  1. AR (Aortic Regurg): Decrescendo. Radiates to lower left sternal border. Wide pulse pressure (watch out for the difference between systolic and diastolic pressure)
  2. PR (Pulmonic regurg.): Not a commonly tested murmur.
  3. MS (Mitral Stenosis): Loud S1 and low-pitched murmur. Loudest at the apex. Diatolic murmur after an opening snap.
  4. Tricuspid stenosis (TS): Not a commonly tested murmur.
  5. ASD: Wide fixed splitting of S2. Mid systolic murmur, mid-diastolic rumble heard at upper sternal border

Now that you have murmurs and their characteristics jotted down, make a folder on your computer and add the commonly tested murmur sounds to it. In my case I listened to these audios several times a week before my test. I would play them in random mode and close my eyes. After every audio I would open my eyes and see which murmur it was. This helps A LOT!! You don’t need to know all the murmurs but only the common ones (AR, MR, MS, PDA etc.). If in case you need any of these leave me a comment in the common box with your email and I will forward you mine.

Till then – Happy studying!


#pnpStudy #pnpMedicine #pnpCardiology


Jab they met – III


January 8th, 2016. Saturday morning in Mumbai city.

Her phone buzzed and as always she was reluctant to check it. That emergency room nursing staff keeps dialing her hash number even when her shift was over. Sigh. The hospital — her second home. Every staff member there from the janitor to the security guard to the physiotherapist, everyone had become family.

The message on her phone wasn’t from her second home though. It was his first ever message to her. It posed a question wanting to confirm he had messaged the right person. And so they started talking. And within few weeks the talks moved from their favorite movie and hobbies to their ambitions. The strangers they were once soon became..no, not friends..I am not sure how you would define something that falls neither in the realms of friendship nor that of more-than-a-friend.

They couldn’t meet though..not for at least a month. Because they were about 12–14 hours apart by a flight that would have to go over the Arabian Sea and the Atlantic ocean.

January 26th, 2016: She took that flight.

February, 2016: She was little tiny bit hurt my now. She was a bit confused by his silence over the past many weeks. So much so that she wished she was far away in a different timezone again. Because to her the old days of staying up till 4 AM talking to him while he was about to finish dinner made more sense than the awkward silence she was facing now.

She remembers that morning of February 14th quite well..the frustration. This frustration soon transformed to confusion for a short time when she received a call from her roommate. Her friend said she has received pretty lilies, baby pink and red roses for her. Her friend’s description was followed by a query, “Who is Oran?”

She didn’t scan her mind for “Oran”. Because she knew two things: One — she has never heard that name/word before. Two — For some reason she knew he was the only person who would send her flowers. But she failed to make sense of all that was going on lately — Why the silence?

She was also fighting a sense of guilt at the end of that call. Because thanks to her building frustration, she had confronted him that morning for all that was bothering her. Come to think of it…it was necessary.

March, 2016: She was curious what he had in mind for her when they first met. To begin with, there was an obvious awkward silence between the two that he tried to break by saying, “You can talk now.”

And the silence continued.

He posed few queries and she noticed how almost every sentence was followed by a “Hmm…interesting.” from him. She knew by now that he was saying that because he had nothing else to say..or perhaps he was still busy learning how traffic moves on Houston’s roads.

Their first stop defied the usual rules of a First date. They went to Houston’s Museum of Fine Arts and admired art in the most immature and silly way possible. There were times she wanted to refrain from putting forward yet another silly comment, but she had promised herself that she will be who she is and drop down the veil of sophistication that she carried around at work. And yes, the awkward silence was finally broken.

Immaturity aside, she loved art and was happy about his impromptu plan to bring her there.

#PlumandPie #pnpLove