Second Puzzle!

This has become an annual thing for us I guess..lol!

Click Here to see the first puzzle we made. Scroll down to see our second 750-piece puzzle (because we couldn’t find a 2000-piece puzzle)

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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. 🙂

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:

SYSTOLIC

  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’.

DIASTOLIC

  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!

 

 

 

Jab they met – III

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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

 

The Walk – II

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That was perhaps the first time they held hands. Yes, it was the first time they held hands…and the first time he held her.

The weather was kind that day and the streets they walked on were lined with fancy big houses on either side. Each house with its own beautifully decorated garden. Wonder why they called the place Rice Village.

I don’t even remember what we talked about the whole time. Lots of things can be said over a period of 3–4 hours but I remember nothing (well, I do remember having waffles for breakfast and strawberries too..yum) — but nothing stands out as clear as the two of us in that moment.

For months I wondered how long will it be till my life’s puzzle pieces find their place. As the days rolled by there was no end in sight for the roller coaster ride I was in — the endless studying, the never ending series of uncertainties.

But at the end of that long walk one of those many lost puzzle pieces in my life found its right place.

Weeks later we were walking together again. This time at good old Central Park, New York. That was my first time there and I can never get enough of that place! He took me to Bethesda fountain and we sat their listening to a band that played nearby, watching couples pose for photographers, an Asian man asking people if they want a quick massage, a toddler stood amazed watching a man play what seemed like a harmonium.

“There is a similar fountain in France. They say anything you wish there will come true.”

“Have you been there?”

“Yes.”

“and what did you wish for?”

“You.”

And so she remembered something she read somewhere long ago — “Maybe God wants us to meet a few wrong people before meeting the right one, so that when we finally meet that person, we will be grateful.”

 

#PlumandPie

The First One – I

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Ever heard of love at first sight? Who hasn’t? No, no..that wasn’t their story at all.

But have you ever had that one image in your mind from the past that was just stuck in your mind as if you took a picture of it with your eyes and left it in your memory box? You left it there but you didn’t forget it. And every time it is out of the memory box it still felt as alive as it was the first time you clicked it. It could be the first time your parent left you at school and you cried, or a random image of your house where you grew up or a memory with a friend perhaps. It could be anything but it is so real and detailed that for a second you almost live it.

There he was — standing tall with that contagious big smile of his that she absolutely adored. And for some reason it’s one for those images that is stuck in her mind till date — as real as it can be. So much so that she can sketch it out.

They had decided to meet that day after few months of talking and confusing themselves over whether they liked each other or not. You see..the story is long but let me just tell you about the things that they would want to remember for good…

#PlumandPie

My fav. version of Whole Foods :)

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I absolutely love fresh farm vegetables and fruits! This picture is close to my heart because it always takes me back to the traditional vegetable market in India where my mom, my aunt and even my grandma used to buy groceries from for years.

Over the years many small and big supermarkets have come up in the area claiming to provide you with the best fresh vegetables and prices. Despite that the hustle bustle in the traditional market feels the same as I used to see it when I was a kid. My aunt or my grandma would take me here and I would keep complaining about how I don’t like walking on the muddy ground in the market (which gets worse during the monsoon rain).

There was this path grandma or aunt would follow – the same one every single time. First there was the onion-potato-garlic lady (sometimes her husband) who would sit between the most beautiful mountains of potatoes and onions and garlic! The 12 year old me would stand amazed and before I know it we had to move to the other vegetable stall. We would pass by a big stall that would always be covered with beautiful orange flowers and coconuts. It was a mandatory stop for those heading to the Hindu temple. And then came the vegetable shop, then some haggling/bargaining, some talks about how kids are doing or life in general.

Today life has moved on. My mom still likes going to the big traditional market but there are smaller ones that have come up near our apartment. My grandma is very old now, has schizophrenia and doesn’t go out much anymore.

The last time I was at the vegetable shop the shopkeeper uncle asked me “Are you (my aunt’s name)’s daughter?”

Me: “No, she is my aunt.’

Shopkeeper: “I see. You look alike. Your grandmother doesn’t come anymore. How is she?

 

Listening to: Breathe by Pink Floyd

“For long you live and high you fly
And smiles you’ll give and tears you’ll cry
And all you touch and all you see
Is all your life will ever be.”