Good NEJM articles on becoming a doctor

In the last two issues of the New England Journal of Medicine, there have been some excellent articles regarding becoming a doctor...1. Abraham Verghese's The Calling talks about how he came to choose medicine as a career and the importance of literature in developing as a physician (if you were my student, you can guess why I liked this one).2. Dr. Treadway's The First Day describes the experience of learning to take a good history and conduct a good physical examination and how learning these skills go hand in hand with developing compassion for patients.3. Sobel (a fourth year medical student) writes about the language of medicine one learns while a clinical clerk -- its great reading for learning to give the short presentation of your patient on rounds, to an attending or a consulting physician.4. Dr. Goldfinger (no, I do not think he is a proctologist) writes a humerous but pointed piece about the use of medical jargon and acronyms in medicine -- especially in students' presentations.

Match Results 3/18/2005

This is a quickie...

I remember the moment I found out where I was to spend the next four years of my life doing residency. I was working in a lab at the NIH. It was 3/15/2005 -- Match Day. I had been logging on to the Match website every few moments waiting for my news. It finally came! I had matched in Med/Peds in the Marshfield Clinic in WI. I remember going down and stepping outside the building. It was a cold morning. I called my mother in Panama and gave her the news. I posted a message on our school's clinical experiences web site that read:

Congrats to all of you out there that matched this year! I've heard from a few folk with their good news. As for me, I matched in the Internal Medicine/Pediatrics program at the Marshfield Clinic in Marshfield, WI. I am thrilled that I got the specialty of my choice. I am also thrilled that I got into the Marshfield Clinic -- a national center for genomic medicine as well as a major place with lots of fellowships and residencies.

I am sure we all share the same feelings of gratefulness to our schools' faculty and administration for all their support and help through the years that led to this day.

First Call Night in Ob/Gyn

March 14, 2004 8:35 pm

It’s the first call night. It’s been an interesting day. I came in at 5:00 am and found the night resident. He told me to hop to it! I had to have notes written on all the post-partum patients before the morning resident was to come in. Of course, I had already begun and he was pleased to know that I had the notes all done. We had a lady come in. She was not quite in labor but the fetal monitor showed that the baby’s heart rate was decelerating. In a flash, we were all in the OR and the morning resident, to whom we had not even had a chance to say ‘Good Morning’ was doing the C section.

Things slowed down a bit after that. Outpatient got interesting. A Vietnamese couple came in. The woman was having some back and abdominal pain. This was her second pregnancy. She was only 20. I did an H & P on her. As we monitored her, it appeared she was in the beginnings of labor. The attending physician was contacted over the phone. He instructed us to admit her. We did. I began writing labor notes on her, monitoring her progress over the next couple of hours. I was called to outpatient to look at another patient. About 25 minutes later, as I walked back to the nurses’ station opposite the L & D rooms, I noticed activity in my patient’s room – the Vietnamese lady. I rushed in to find that the baby had been delivered, by the nurse. Things changed so fast that not even the resident could get there from the call room a few doors down the hall. I watched as he sutured a tear in her vagina. Babies can come so fast!

It’s a couple of hours later. I just checked in on the patient again. She is sitting up in bed, her husband beside her. Their little baby girl is in a warmed crib. They are eating sandwiches and watching ‘Men in Black’ on television – just another evening. Imagine that! It was a pretty picture.

Last Friday was not so pretty. We were in outpatient and saw a 33 year-old G3P0. She had got pregnant after 10 years, after having lost her previous two pregnancies at 9 weeks – one a placenta previa and the other a miscarriage. She came in, this time at 9 weeks complaining of bright red bloody discharge. We checked her and she was rushed for a stat ultrasound, where it was determined that her fetus was no longer viable. Of course, she was very tearful. We admitted her to the unit and in a couple of hours took her into the OR for a D & C. It was kind of ironic. The D & C was being done by a 3rd year Ob/Gyn resident who was pregnant herself. A female medical student who was in call and myself, who stayed behind to watch this procedure were in the OR with her. When the anesthetic began to wear off in the OR after the operation and as we wheeled her into recovery, she sobbed uncontrollably “You took my baby. My baby’s dead. I want my baby. Why did this happen to me?” I had spoken to her for some time, comforting her before the D & C. She cried, believing that she might never get pregnant again.

As I stood in the OR recovery room trying to pacify her as she sobbed inconsolably, I thought of that verse from the Bible “Rachel weeping for her children and refusing to be comforted, because they are no more.” Who says OB is always a happy specialty?

First day in Ob/Gyn core rotation

3/9/2004 9:41 pm

Well, Psych is over and I was excited about getting started in ob/gyn. I was apprehensive about this rotation because: (1) I am a male and have limited exposure to female problems (no jokes, please!), (2) I do not have any children and have never witnessed a live birth and (3) I have not been around infants and small children a lot.

I arrived my first day at 5:30 am. Our scheduled time of reporting in was 6:00 am. However, I always find it useful to arrive in time to meet the night shift of nurses and get a heads up on what's cooking. We had one first-time mother (grava 1: Para: 1) ready to give birth. Since she had been there since midnight, it was decided to induce contractions with oxytocin (Pitocin). By about 6:30 am, the resident decided to induce artifical rupture of membranes (AROM). pardon the comparison but seeing the meconium-stained amniotic fluid flow out of the vagina was like watching Linda Blair vomit the green stuff in the movie 'The Exorcist'. By about 8:00 am, the baby's heart rate began to fall into the 80s. Interesting that for fetuses, normal HR is 120 to 160. Anything below 120 is considered bradycardia. Interesting contrast with adults where normal HR is 60 - 120 and anything above 120 is considered tachycardia. Anyway, after trying various things -- adjusting the position of the mother, discontinuing the oxytocin drip, a decision was made to do a C-section. Since this was my first day in the unit and I had never scrubbed in for surgery before, I was assigned the role of watching another medical student scrub in and told to observe everything she would do during the procedure.

The C-section was great. It was everything I had read and seeing the baby be drawn out of the opened uterus was the coolest thing I have seen yet. The resident did all the work, while the attending just helped. I had a great view and could see everything clearly.

We went to lunch afterwards and I had a pizza with lots of tomato sauce (I know, pretty sick of me, no?). The rest of the day was kind of slow. I developed either the beginnings of a cold or an allergic rhinitis and was sneezing all day. That was not so good. My first call is Sunday. It seems that in this unit, medical students are really encouraged to participate in delivering babies, procedures and the like. I am excited and looking forward to every day here.

Shock Therapy

It was my last day in psych and I got to see some interesting stuff. A patient in the unit who suffers from severe depression was found to be a suitable candidate for ECT. A nursing student (an ex-Vetinarian) and myself (an ex-Biochemistry) accompanied her from the unit to the Main Hospital where ECTs are done on the 5th floor. We chatted with the patient. She was nervous, even though this was the second ECT treatment she had received. Once in the room, an anaesthetist proceeded to administer Pentothal and succinylcholine and robinol. In addition, since she was being treated with benzodiazapines for her depression, Romazicon was also administered to lower her seizure threshold. She was administered 50 sec of 80 mA at 220 ohms resistance, which translates to about 176 volts. The entire procedure was followed on a monitor (to watch heart rate and blood pressure) and an EEG to follow the seizure activity. Because of the muscle relaxant, the patient did not 'jump off the bed' when the shock was administered. Furthermore, the major region of the shock was the temporal lobes bilaterally.

The patient regained consciousness soon afterwards in the OR holding room. She did not remember who the nursing student and myself were due to loss of short term memory. Overall, the procedure was nothing spectacular to watch. ECT is administered in a much more humane way these days with appropriate anaesthesia and limiting the major electric disturbance to the region intended. It is still a treatment modality of choice in certain refractory depression and even mania cases.

I talked to God today

Mentally Retarded and Emotionally Disturbed Children.

Today I got to spend several hours sitting in a class for ‘low-functioning’ mentally retarded and emotionally disturbed children. There were about 6 children in the class. One was a 12-year-old with Fragile X syndrome, another a 14-year-old with an IQ of about 60, a couple of girls – 9 and 11 with autism and mild MR with emotional disturbance respectively and a conduct disorder MR child (age 12). The level of the class was about that of a kindergarten class. Basically, the kids worked on tracing the lines in coloring pictures. They went over some flash cards of common signs (such as danger, poison, pedestrian crossings, etc.).

It was discouraging to hear that the two girls were raped as toddlers, one by her father (now in prison) and the other by several men at different times. Apparently, sexual abuse of the mentally retarded tends to be more common than of normal children.

It was interesting to interact with children suffering from disorders that I had only studied about in medical genetics and other courses. I had interesting discussions with their therapists and teachers regarding the goals for the children and the methods of communication. Most of these children have difficulties describing their feelings. Picture books and clever techniques are used. I felt a sense of admiration for the teachers and therapists that work with these lowest level of functioning children. Often the goal is simply to get the child to follow staff directions, to raise self-esteem and to help the child achieve the level of independence of function he or she is capable of, e.g. dressing themselves, toilet hygiene, anger management, etc.

In the afternoon, I got to talk to ‘God’. This was a 50-odd year old male who for the past 11 years has had the delusion that he is God. He does, however, also know that ‘here’, he is identified by the name that is on his official records. When he was brought in, he was paranoid, believing his neighbors and his wife and his doctors wanted to kill him. During the mental status exam, when I asked him to interpret the proverb, "People in glass houses should not throw stones" he laughed and told me "yeah, that's stupid, because the glass would fall on me!" He has since overcome this belief somewhat. He still maintains that his neighbors are trying to get him but he is content to ‘what goes around come around’. He no longer seems to manifest any homicidal tendencies. What is this person’s baseline function? What would be our goal for the inpatient treatment he is receiving? Today, he was due to appear in court. He told me he was going to tell the judge that he was ready to go home. Do we have any hope of convincing him that he is not God? Or should be just release him back into his situation when he is no longer a threat to self and others? I had some interesting discussions with his therapists and psychiatrist on these matters.

Child Psychiatry

Well, this past week, I have working in the childrens' psychiatric unit. At first, I was apprehensive since I have not been around kids a lot. I wondered if I would be able to relate to them and help them. The apprehension was soon replaced with a kind of sadness as kids matter-of-factly told me their stories. We had one kid who was admitted to the unit because he had thrown a chair at a teacher (in the US, you can forcibly admitted to a psych unit -- EOD -- emergency ordered detention -- if you are considered a harm to yourself or others; this kid fit the latter requirement). It turns out that he has a lot of problems, losing his temper and getting into fights with other kids and adults. The only person he does not fight with is his mother. When I asked him about his dad, he told me his dad was in prison. He last saw him 3 years ago and last spoke to him a year ago. I asked him if he missed his dad. He shrugged his shoulders and said that "a little", then added that he hadn't got to know him really well, since he had been in prison before and was only out for a short while before he was back in again. His problem: depression. Well, I think I would be depressed too! We are giving him anti-depressants and teaching him 'anger management' skills. Another kid has been hallucinating since the age of two! He hears whispers around him at all times, sees snakes and imagines his entire past. The prognosis for him is not good. He is a loveable, if somewhat hard to manage kid, but one who has developed the symptoms of schizophrenia very, very early. Of course, there are several mental illnesses in his family: schizophrenia, bipolar disorder and depression. That can't help. There are lots of stories to tell. Every child is a story, most of them not happy ones. I mean, how do handle hearing a 9 year-old girl tell you that she wants to kill herself because she bear to go on living? She even had a plan -- to slit her wrists. Interestingly, in this particular case, we could not find a precipitating stressor for the depression. Of course, there is a family history of depression, though none of suicide. There were many interesting cases.
I really came to love the staff who work there. They love the kids and discipline them too. The kids know that they discipline in love, so they love them back (that is, those kids that are capable of loving; we have some kids with attachment disorder, who do not know how to do that).
This coming week is my last week in psych. After that, I begin ob/gyn. That should be 'fun'. I have never seen a live birth before, so working in the L & D (Labor & Delivery) unit should be lots of fun. I also look forward to gynecology -- everything from routine pap smears and pelvic exams to surgery).

The Charles Manson Fan Club of 1

I just had to talk about this session this afternoon. The patient is a 20-something caucasian female, slightly obese, dressed in a T-shirt and jeans. She sat with a grimace on her face and pulled at her shirt sleeves, looking somewhat uncomfortable, somewhat anxious, somewhat depressed. The session blew my mind away. She talked about being a fan of Charles Manson. She sent death threats to another psychiatrist who hospitalized her over Christmas for suicidal ideation. She said to relieve stress she was thinking of doing something different... like smashing someone's head with a sledgehammer. Her therapist recommended she try smashing a watermelon first -- you know, just for practise and to see what she would have to deal with afterwords. She did. She set up the watermelon in her kitchen and smashed it with a sledgehammer. Somehow, this convinced her to abandon her plan because she says she's been cleaning out watermelon seeds and pieces from all over her kitchen for weeks now. Instead, she thought she might try jumping from a high point. I thought she meant bungee jumping, but further elaboration revealed she meant without a cord or a parachute. I surmised this when she said "the jump would be fun, but hitting the ground would hurt." Incidently, she brought in something she had sketched. It was a pencil sketch potrait of herself, drawn as Mona Lisa sitting in a bathrobe on a torn sofa. The Mona Lisa looked liked a photograph. I thought she must have been drawing it from a picture. She casually mentioned she had drawn this from memory. Of course, how much of this was shock value and how much of this was psychosis? Apparently, her body is like railroad tracks from the self-mutilation. Laugh if you will, but look behind you when you're walking home alone at night...

In the morning, I got a wish I had for some time. I was really interested in seeing dementia -- vascular, Alzheimer's infectious disease-induced... Well, I spent the morning in the geriatric psych ward. Fortunately (or unfortunately), I had been on call with my attending covering all the patients there both Saturday and Sunday, so this morning when I went to see them again, but this time with an internal medicine doc, I felt like I was meeting old friends. One of them -- a troubled 60-something year old female of mixed caucasian-indian descent came up to me and hugged me and woulnd't let me go. This, in the middle of the lunch room at lunch time. Whether from the meds she was on or from previous activities, her voice was heavily slurred and words came out agonizingly slowly. As she held me close, she announced to me and to all present, "Doctor, will you kill me please?" Then in a little louder voice, "Please doctor, kill me!" Finally, screaming while hugging me tighter, "Kill me, Doctor!" Okay. So I think I've seen enough dementia. There was one really cool thing though. Over the weekend we had seen this sweet little old lady with crippling parkinson's. Today when I saw her, she kept sticking her tongue out at me in a tic-like fashion. It took me a few seconds when I realized what I was looking at...tardive dyskinesia. And finally, there was the retired psychiatric Charge Nurse who over the course of her 40 years of service has probably trained half the psychiatrists in the state we're in. My attending spoke respectfully to her and told me later that she taught him and helped him a lot when he was an intern 20-odd years ago. Her memory has gone to pieces, but as is often the case in such dementia, when he quizzed her on some old psychiatric drug pharmacology, she spit out the answer even before I could hazard a guess. I'm enjoying the psych rotation... in a strange kind of way. Now when I walk in the mall, I see people differently...

More later...

The woman with no hair anywhere

I met an interesting pt during one of my weeks of rotation in psych. She appeared to be a pleasant Caucasian female. Moderately obese in either her late 30s or early 40s Some years ago, she was disgnosed with panic disorder with agoraphobia she was admitted to our inpt. facility here and received treatment. She is much better now. She recently gave birth. She has children from a previous marrage. Her ex-husband -a cocaine addict is having Paranoia and hallucinations.

When this woman had panic attacks, she was put on Paxel. Apparently. A rare side effect of this group of drugs ( the ssris) can be aloepecia totalis the complete loss of all hair. Sae has no hair anywhere! she has approached the makers of the drug for compensation but so far has got none. she was telling us how expensive wigs are to maintain if one wears them all the time as she is forced to do. She was an interesting person, telling us of her ongoing interests in sports. She takes care of a house of children and occassionaIly a psychotic ex -husband.

She was also reporting on another interesting side-effect of ssris. Vivid dreams and nightmares. Apparently. These are due to serotonergic activity.
I thought the unfortunate side-effect of aloepecia totalis was interesting and unfortunate, especially for a young female.

The Psychotic who predicted her death

This is the story of a dear patient. Sne was a cauc. Female in her early forties who was found orthe floor of her home in feces and filth. She was malnourished.when we interviewed her,she was actively hallucinating. She saw bugs, heard voices. In got to do the complete psychiatric interview on her. She was very interesting. A few days ago, in the early morning, she was found pulseless and not breathing. A code blue was called. PEA was identified and the appropriate procedure initiated. Forty minutes later, a pulse and respiration was re- established. We do not know how long she was down for. since the last person to see her active was a phleblotomist who came to draw blood @ 4:10am in the morning.

She was intubated and transferred to the icu as I write this. Will she make it? She told a nurse yesterday that today she would die. Depending on how long she was down, her brain has been deprived of O2 for a good while. Did she attempt suicide? If so, how? She told another med student yesterday that there were 2 people in the roomM with her (hallucinations). Did 'they' kill her?

Iain writing this update a few days later. The pt. is dead. She died in the evening after we all left the hospital. From the time she wss transferred to the lCU she never regained consciousness. We determined that she was breathing a little on her own, but otherwise there wss minimal brain function. We had her on 8 ug of dopamine to keep he BP up. Towards the end of last week, it was agreed upon by family and her attending doctors that she was never going to regain consc. Her pupils were fixed and dilated and she showed only primitive reflexes. Her relatives asked that we disconnect all machines. Her attending physician felt that this would be too aggressive and active a move. Instead, heopted to keepthe ventilator on. Towards yesterday evening the pt. began to develop a climbing fever. Nothing was given for it. This was the acute Cause of her demise.

This case was interesting because of the rapid turn of events, the psychosis and in the end, our inability to elicit a favorable outcome for her. It was a tragic story. I believe that everyone acted appropriately. However, none of us who participated in the case came away happy. We lose some battles in spite of everything.

Juvenile sex offenders

Thursday, February 05, 2004 Juvenile Sex Offenders – a first experience

It was an interesting day. I was scheduled to spend the day with Dr. B – a psychiatrist in the Adolescent Unit. I met him at 8:15 am in the unit on the 3rd floor and sat in on the treatment plan meeting. During this meeting, the psychiatrist, therapists and case manager (along with medical students, nursing students and a few other odds and ends) sit in and discuss the progress and plan of each resident. Before the session, I accompanied Dr. Bell to do an H & P on a patient admitted the night before. She was a 14 year old girl. She was admitted for feeling suicidal. I learned that she had been raped by her step-grandfather. She had marks on her wrists from where she has cut and mutilated herself in the past. During the treatment meeting, there were may interesting cases. There is a lot of history of abandonment, neglect, drug abuse and poor parenting. There are also a lot of examples of physical and sexual abuse. The unit we were in was the acute unit: where patients are admitted for short periods of time – upto a couple of weeks. This is in contrast to the unit on the 4th floor, where patients spend 6 months to a year. These are patients with no where else to go – they have been thrown out of practically everywhere else.

After the meeting, I went to the hospital to go psychiatric interviews on two consults for Dr. C (my attending). The first one was a 50 year old Black woman admitted for CHF, hypothyroidism, DM2 and gouty arthritis. She was cooperative and described being institutionalized when she was 11 years old because of physical abuse by an alcoholic mother. She was kept in various institutions until she was 17. The second patient was a contrast. He was a 46 year old white male with a relatively high level of functioning. He felt the human race was nothing but “technologically advanced cockroaches.” He was suspicious and declined to participate in the interview. I managed to get some information about him. He reports being allergic to Thorazine – “causes muscles all over my body to lock up”. He has been institutionalized and used drugs in high school. I wrote up the reports and took them over to Dr. C who by that time had returned from his talk in another city. He felt that the male patient must have been a late onset schizophrenia in view of his high level of functioning and intelligence. He explained that perhaps his animosity to the questions and his decline to participate in the interview was because of a sense of shame and feeling that people treat him differently because of his illness. When I asked him about suicide ideation, the patient had said “I’ve been asked that question so many times and I think it is a personal matter.” He denied homicidal ideation. And admitted to having been given Thorazine for the first time in a state psychiatric facility, I found out later. We also chatted about astronomy and Mars, since the patient expressed interests in those areas. I promised him a magazine on Mars.

In the afternoon, I drove in the snow and rain over to the other campus of our Bahavior Medicine facility on 59th street. This is the facility where the geriatric and juvenile sex offenders units are located. I spend the afternoon reviewing charts and reading about juvenile sex offenders. The first chart I read was the case of a 14 year old boy who had raped his 8 year old half-brother in a foster home. He had had anal intercourse with him. Later, to prevent the child from telling on him, he had suggested to him that he poison the entire household. When that didn’t take, he stole his foster father’s gun and gave it to the boy and suggested that he shoot himself and end his life. The boy eventually told someone and the patient was taken into custody and brought to this facility. His own history is interesting. He is the product of an incestrous relationship between his mother and his maternal grandfather. He was eventually taken away from his mother because of her abuse. He was physically and sexually abused by her boyfriends and male relatives. The stories of most of the boys in the facility – ages 13 to 17 were similar with elements of abuse and neglect. Interestingly, many of them sexually abuse boys 5 years younger than themselves in the same age and in the same way as they themselves were abused. I then sat in on treatment plan meetings, in which the boys were brought in one by one to a meeting with the therapist, the psychiatrist and the Charge Nurse. Besides myself, a social work student who works at the facility doing her practicum were also present.

Rather than be disgusted and feel hatred towards these boys, I felt a morbid curiosity. It is creditable that the state does not just lock them up and throw away the key. After all, they have committed heinous crimes and are in such small numbers that one might not want to invest resources in ‘fixing’ them. As a Christian, I struggle with the finality with which specialists and experts pronounce judgment on the future of these and other pediatric patients saying they are marred for life. The Bible teaches that one can be completely made anew.

I love what I do...

Competency

February 5, 2004 Competency

Today’s learning experience in psychiatry can be summed up in one word: competency. We were consulted on two patients. We were asked to determine whether they were competent enough to make medical decisions.

This pt. is an 88 year-old black female who has suffered 2 strokes in 2003. In Jan .2004, Home Health called EMSA and asked them to take the patient to the Emergency Room because herb lood pressure was elevated. More importantly. Her speech was slurred. This pt. had been living on her own all this time, by herself, with someone coming in to help her with groceries

The pt was admitted to our hospital a week earlier. Psychiatry was called to assess the competency of the pstient. I found her in her bed talking to an empty room. When I asked her any questions, she would answer but then she would keep talking.

Finally, I asked her if she knew why she was in the hospital. She said she knew she had a stroke. She emphatically communicated to me she did not want to go to a Nursing home. She wanted to go home, she said. When I asked her why she had refused to take injections. She got a bit agitated. She said that her doctor thought she was crazy. He was trying to give her medicine like Haldol for being crazy, but she was not crazy. She said she wanted to gone home.

Question: Is this woman competent? If we decide she is incompetent to make decisions, then we must release her to home. If on the other hand we decide she is incompetent She will be forcibly administered Haldol. What are we to do?

This case raises the question of whether an elderly person who is not choosing well is necessarily incompetent. She may not necessarily be choosing wisely. She also may not be the smartest kid on the block. However, all of us perhaps know some cantankerous old folks, fiercely independent who live life on their own terms. When do we infringe upon their autonomy?

I learned from my attending that one asks several questions, such as

Do you understand your illness, that you are sick and in need of treatment?

Can you understand the treatment options, their associated risks and benefits and what they mean?

Can the patient hold the information needed to make a medical decision in their minds in an orderly and rational fashion?

If the answer to any of these questions are ‘no’, then the patient is deemed non-competent to make their own medical decisions. It is, of course, highly subjective

Our second competency case was a 46 year old Caucasian male. He appeared highly intelligent but somewhat bizarre in behavior. He spoke with stilted speech and during the course of the interview would go from being friendly to clamming up and withdrawing from giving more information. When asked about medical issues, he answered, “I think it is personal” and would volunteer no more information. He used the same words and answer to several subsequent questions (preservation). If we changed the topic and asked about something else, he would answer in short sentences. If we talked about sports or astronomy (his interest), he would thaw out, but only a little. Lately, he had been refusing medications. When asked about it, he denied he had done so. My attending found him non-competent to make medical decisions.<

Both the above patients lost their autonomy in the hospital setting and would now have little or no choice in their medications, perhaps need to be restrained if they became uncooperative. I shall keep following the case to see if their consciousness resolves and they regain their competence

A case worker for the first case told me that if a person is found non-competent, then a state body called Adult Protection Services comes in to protect them from themselves. They may be placed in a group or nursing home. The philosophical ramifications of today’s experience were immense and gave me a lot to think about.

Drug reps and Pharmaceutical dinners

Wednesday, February 04, 2004 The world of drug reps and drug company sponsored dinners

I am learning that drug reps can be a great source of information. However, one has to learn how to ‘exploit’ this resource just right. I am not talking about exploiting them literally. I am referring to learning and getting as much knowledge as I can for the benefit of my patients. I had an interesting experience this afternoon. The rep from Zoloft came over. Since my attending was busy, I talked to her for a bit. She gave me a brochure that showed a study comparing weight gains with Zoloft compared to Paxil. The graphs showed that patients on Zoloft had a much lower weight gain than patients on Paxil. Okay; A hour or so later, the Paxil rep showed up. She spied the Zoloft literature on the table and asked me about it. I shared the results of the study with her and asked her about the weight gain issue. Well, she produced another full-color brochure with a different study comparing the effect of patients taking Paxil to placebo. Her study showed that patients on Paxil actually had less weight gain than patients on placebo. It was an interesting contradiction – the two studies showing opposite findings. The next day, the rep from Wellbutrin came over. She had some things to say about Zoloft and Paxil and compared them to Wellbutrin. I think that if one listens critically, one can learn quite a bit from the comparative assessment. Finally, I asked my attending what he thought about these drugs and what his experience was using them. All this coupled with reading the relevant chapters in Blueprints in Psychiatry made for a good pharmacology learning experience. Moral of the story: learning to critically evaluate facts, studies and such and drawing the best conclusions.

Today I also got to go to my first drug-company sponsored dinner talk. It was held at a fine restaurant in Bricktown. I arrived at the restaurant to find about 20 people. I sat with an elder Indian couple – husband a general surgeon and wife a psychiatrist at the VA. The speaker was an asst. professor from USC, LA. He spoke about the use of Risperdone in bipolar disorder. The talk was in PowerPoint and interesting. He made disclosure that he was a consultant and speaker for several drug companies. The food was great – lobster brisque, cold water lobster tail, cheesecake, pasta. I loved it. After the talk, we all went our separate ways. I kind of enjoyed being a medical student/future doctor this evening. One wonders about the ethics of such things. Surely, the good treatment and food softens one up a bit to the drug reps and the companies and products they represent. It probably doesn't hurt either that most of the reps are pretty, well-groomed (well nourished and in no apparent distress, but I digress) and seem to flirt and flatter a little as they deal with us. Maybe that's just marketing...

First week in Psychiatry

1/31/2004 2:38 pm

I finished my Internal Medicine on a Friday and began my psych rotation on Monday, Jan 26, 2004. The first day, I was asked to report to my preceptor, Dr. C at 8:00 am in the morning. This itself was a big difference from IM where we used to report at 6:30 am. Dr. C is the head of a department of Behavioral Medicine. The first day was kind of unstructured. He took me around to the Children's Inpatient unit, the Adolescent Inpatient unit and the Adult Inpatient units. We also got a glance at a special unit for mentally retarded children. I basically got to spend the day in the lounge outside his office. He could not let me in while he interviewed some patients as my presence would affect the dynamics of the interview.

The Department of Behavioral Medicine has several programs/units:
Child Psychiatry
Adolescent Psychiatry
Adult Inpatient Units
A special unit for children and adolescents with mild to severe mental retardation
A Chemical Dependancy Unit and
An outpatient facility that runs intensive throughout-the-day psychotherapy, psych-education programs.

In the afternoon I got to sit in on the outpatient day therapy sessions. They were in groups and the topic being discussed was dealing with grief.

During the rest of the week, I spent a couple of days at the Chemical Dependancy program attending the day sessions -- almost all of the therapy is done in groups in this unit, and studying the drug protocols in the charts. For alcohol dependency/abuse, the detox protocols consisted mainly of Librium and Clonidine. I was surprised to learn that Clonidine is used. I was told by a psychiatrist in that unit that alcoholics will often exhibit sympathetic respnses during their detox -- higher blood pressures, perspiration, tremors, and that Clonidine helps with this.

Since my days were so slow and I was not spent yet, I volunteered to join the staff that man the ER in the 3:00 pm to 11:00 pm shift. Apparently, that is when they get most of their admissions to the psych unit. I was amazed and appalled at how many people come in with suicidal ideation and even a plan. Amazingly, almost all of the people I saw in the first week there were females in the ages ranging from 13 to 25. One evening, after 4 such "I want to kill myself" cases in a row, I was somewhat encouraged when the fifth person I interviewed, a 31 year old Caucasian male said "I hear voices". I asked "What are the voices saying to you?" The answer: "The voices are telling me to kill myself. Here we go again...

I like working the ER because I am getting to see some florid pathology and I get to practise my ability to do the mental status exam and come up with the appropriate DSM-IV diagnosis.

More First week in Psychiatry

1/31/2004 2:29 pm

I spent a couple of afternoons during my first week sitting in on Treatment Team meetings. This is when the Treatment team consisting of the psychiatrist, case managers, psychotherapist and charge nurses present updates on each case to the psychiatrist. A plan is formulated in terms of time to be spent on the unit, med changes, therapy changes, etc.

I was absolutely thrown offbalance by the horrible stories I heard in the Treatment Team meeting of the Children's Unit. I was told stories of drug-addict parents, abandoned children, physically and sexually abused children (one child was sexually abused by her grandfather from the age of 6 months to 4 years of age) and drug babies -- children affected by their mothers having taken drugs or alcohol or both during the pregnancy, or of mothers using damaging medication while breast-feeding their kids.

One 2 year old was found on the streets by police, wandering by himself. When asked what his name was, he said "Motherfucker." He'd probably been called that so many times, he actually thought it was his name!
I have been learning about attachment disorders. I was so moved that I went out and bought a couple of books about it to learn more.
On a more practical note, stuff in the basic sciences that relate to this rotation are:
DSM-IV criteria for diagnosis, Mental Status Exam, The psychiatric interview, and mechanism of action of all the drugs -- antipyschotics, anti-depressents particularly.
More later...

Advice to the third year med student doing psychiatry

I finished 6 weeks of my psychiatry core rotation last week. It is Sunday as I write this and tomorrow I shall begin a rotation in ob/gyn. I wanted to sum up the rotation.

It was interesting that in this hospital, I was told not to wear my white coat and that I would probably not need my stethoscope, although I was to keep both items close by (in the car) in case I needed to a physical exam. Throughout the rotation, the procedures I learned were: the complete psychiatric interview, writing a progress note on inpatients, writing a consult note for hospital patients on whom we were called in for a psych consult, the Mental Status Exam, the Mini-Mental Status exam, contributing an evaluation to furnish materiel for a psychiatric evalulation of competency.

I got to spend time in: outpatient group and individual sessions with both the psychiatrist and therapists, medicine management meetings, inpatient adult, adolescent, childrens' and mentally retarded children with emotional problems facilities. I also got to visit geriatric psychiatric facilities and a special facility for juvenile sex offenders. I got to see take-downs, face-to-face evalulations, ECTs and pts. in various stages of mania, psychosis, depression.

I thoroughly enjoyed the rotation. My only peeve was that things were pretty slow and some days, there was precious little to do. I like to be busy and some days I wasn't very.

Recommendations for books and things: I highly recommend the Blueprints for Psychiatry 3rd edition. It has additional materiel and questions not found in the previous editions. For the PDA, I highly recommend the Washington Manual Psychiatry Survival Guide. This is a new program from Skyscape. It is EXCELLENT. It has discussion articles on each of the major disorders, an abbreviated DSM-IV, a drug formulary and full examples of every kind of note I needed. Buy it. It will not be a waste and you will not have to carry any other book or PDA program in your pocket.

I am looking forward to the next rotation...

New attending, different style

Hi!

I am in the last week of my internal medicine rotation. I have been fortunate to be able to spend this week with a new attending. He is double board certified in internal medicine and pediatrics. So far, my attendings have been pretty laid back. He is not. He is quite demanding and formal. However, it is great to work with him, as he really teaches. For example, over the weekend (yes, I had to come in on Saturday and Sunday this weekend), he sent me to see patients and asked me to write a SOAP note on them. Then he came down to see the same patients. Before seeing them, he asked me to 'present' the patient -- basically use my SOAP note to update him. The last part of the note is of course, the plan. He asked me what I wanted to for the patient today. This, by the way, was an unconscious patient in the ICU on a ventilator! Well, I gave him my plan. He told me to write them out on the yellow 'Physician Orders' sheet and then he signed them! It was pretty cool. I felt like I was managing the patient. Of course, not all my presentation went as well. Sometimes, I was completely lost. Well, rather than tell me what to do, he would ask questions. The answers led to the plan. For example, I wanted to get a CBC on a patient we suspected of having an infection. He asked me "What is the life span of a WBC?" To my shame, I did not know. He said, "Guess". I guessed 20 days. A 4th year medical student guessed 2 months. The answer: 4-6 hours. Oops!

Oh well... one can't get them all...

Internal Medicine Wards

Tuesday, November 25, 2003 BLS and the last few days on the Internal Medicine Inpatient Service
7:42 PM

I was excited about today because I was going to do the BLS course. I reported at 8:00 am and found that there were only three candidates for the course. The instructors, Heather and Lory were lively, humorous and gave us enough practice. We learnt to do CPR, remove foreign objects obstructing airways and use the automated emergency defibrillator. We worked with dummies of an adult, a child and an infant. At first, I thought, ‘I will never remember this stuff, especially in a panic situation where something like this might actually happen.’ Now I think I will. At least, I’ll remember enough to do some good.

We rounded with Dr. W again. As usual, he asked some questions to which D (another medical student) and me did not know the answers. Oh well, this is the learning experience. I wrote out the discharge orders for P C (a patient on the service) – my first discharge order! I was amazed to learn that this illegal Mexican in the United States received such excellent medical care, a free glucometer, insulin and all the treatment he received, even though he has no money to pay for any of it. I must salute the charity and generosity of the US healthcare system that can still support such cases in these days of expensive healthcare. At the same time, I wonder at the justice of a legal, honest hardworking individual who has some insurance having to pay for healthcare to the extent that it might bankrupt him or her.

The rest of the afternoon, basically we hung around with one of our interns while she gave us ‘busywork’ to do – look up a patient’s drugs in the computer, fill out some papers, etc. I spent the time reading a portion of a chapter from the Washington Manual on my PDA.

At sign-out, we had only 9 patients left on our service. Interesting to see if we pick up several tonight. Y (another intern) is on call. I hope to be able to round on several patients tomorrow and learn more about them to present to Dr. W.

Tomorrow is my last day on the Dr. K's service (one of our attendings) before I shift over to Dr. M (a pulmonologist and critical care specialist) on Monday – December 1. This will begin my second month in internal medicine. I still feel like my head is swimming and I don’t know anything. Although, during this past month, I have:
Learned to write admit orders
Learned to write progress notes – wrote LOTS of those!
Learned to write discharge orders
Learned to write scripts
Learned CPR
Attended two codes
Learned about the importance of preventing DVT in hospital patients
Learned about the 5 W’s of post-operative fever.
Learned about the evaluation of chest pain and its treatments.

This is off the top of my head. I have seen quite a few things – it is taking time to put it in perspective.

Sick student doctor

I have been busy wrapping things up for the semester. At last, it is over. It has been very busy and very tiring. Last weekend, my bullied body finally protested by contracting the flu. The timing could not have been worse - with my physical diagnosis exam scheduled for Monday. Anyway, armed with anti-flu medicine, I have got through it.

I should be going home on Friday this week. I hope, among other things, to re-discover the lost art of sleeping. Next semester, I have Pathology and Pharmacology to look forward to. At last! Real medicine.

Black Mondays -- Exam Day in the Basic Sciences

My Black Monday was a disaster this time. Our neuro test was hard. The class average was 54% (and here, 70% is passing). I got the 4th highest in the class: 64% which is not a passing grade. I can't tell you how dejected I am about that. I could make excuses about the test but I won't. The professor is going to add an 18% curve because he thinks that if practically the whole class fails, then something must be wrong. That will bring my grade to 83%. The highest (uncurved grade) was 80% -- Tim Duke, who has had 6 months of neuro in a doctoral program before coming here. In Epi, things did not go very well. I got 89%. In Genetics, things were good as usual: 97% -- one question wrong and I don't think anyone got it right.
Although I am unhappy with my results, I won't stop to do an autopsy, which often turns into a round of self-excusing justifications. Instead, I resolve to work harder. We have a long weekend coming up and I am going to invest my time henceforth more wisely and try to keep ahead of the group. I am sorry that my performance this exams were disappointing.

Woods are lovely dark and deep

The semester is indeed in full swing and the first bout of exams is over. I went to my Neuro (Neuroscience) teacher to get my grade. He was very serious and asked me if I was having difficulty with the materiel. I got very nervous. He then broke into a smile and showed me my grade: 100%. I was pleased. In genetics, I got 94% and in epidemiology, 93% too. Seems like it was a good day.

Yesterday morning I read 'Stopping by Woods on a Snowy Evening' by Robert Frost. I always read a poem or quotation the day after the exam before I start again, as a moment of reflection on the evaluation of past efforts. The last 3 lines have come to embody my attitude towards this whole affair. The woods are lovely, dark and deep.
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.

I am also exhorted by this quotation by William Carlos Williams, [1883-1963]:
Look, you're not out on a four-year picnic at that medical school, so stop talking like a disappointed lover. You signed up for a spell of training and they're dishing it out to you, and all you can do is take everything they've got, everything they hand to you, and tell yourself how lucky you are to be on the receiving end--so you can be a doctor, and that's no bad price to pay for the worry, the exhaustion.
Source: Williams, William Carlos. Letter to Dr. Coles. In Ballantyne J (ed). Bedside Manners: An Anthology of Medical Wit and Wisdom. London: Virgin Books; 1995, pp. 6-7.
Alright. I won't subject you to more of that.

These days I am gravitating towards ob/gyn or pediatrics in the 'what-do-I-want-to-be-when-I-grow-up' department. Ob/gyn because it is such a happy branch of medicine: most of your patients are normal and as the doctor, you almost always have good news ('It's a boy; It's a girl) rather than bad ('You have heart disease) in other branches of medicine. Plus, the pay is not bad either, especially if one goes into fertility procedures. Peds is attractive because of the children. Oh well, it's actually good to vacillate at this point because it motivates me to study everything seriously since I do not know what may be relevant to the future.

Basic Sciences -- Hectic morning and busy schedules

Hectic schedule? Actually, not at all! Compared to my previous semesters, this one actually has gaps between classes. The subjects are interesting. There are standard texts so there is no running around looking for materiel. Medical school is very unlike graduate school. In graduate school you want the latest paper and you are constantly having to peruse the research literature because texts become outdated almost as soon as they are published and a graduate student is going into the field and hence needs to know what is the current state of affairs. In medical school, one is more interested in learning standard and conservative treatment approaches to diseases. The basic workings of the various systems in the body is quite well known and only details - often at a molecular level are in a state of flux as far knowledge about them is concerned. So our texts tend to have much the same things they have for the last 10 years with certain sections revised to include new findings.
Being still in the basic sciences of the MD degree program, we do not go the hospital or see patients. This will not happen until the middle of next year. It is frustrating since that is why most of us came here to be doctors and work with people. However, I am happy to know what I am doing before I am in the hot seat. We shall not have much lab work this semester except a couple of sessions in the anatomy lab dissecting the brain, which should be fun.
So far, things are still picking up. I can feel the feeling of panic at the volume of materiel to digest creeping up on my slowly from the inside. However, I shall still find time to write papers. I have decided to devote my weekends to that job and do the hard studying for my medical subjects during the week. Hope the plan works on both fronts.

Physiology and Psychology

Well, the exams went very well. I thought I had given you the results. I got the highest grade in all my courses and with the help of a curve needed to bring the class average up, in physiology, I ended up with the absurd grade of 105%. I am only taking physiology, psychology and ethics while the rest of the class has biochemistry to contend with too, so I guess I have an edge. Since what we are doing in class is very basic, I have been reading extra sections of the texts (we don't cover everything in them in our courses, for some reason). I have been really enjoying the world of EKGs - how they work, what they mean and what they can tell us about events in the heart. Of course, the honeymoon lasted for about 2 weeks. By this point, the facts are coming in so fast, it is almost getting overwhelming. How does one hold all this in these little heads we have? In my nightmares, I imagine scenarios when a patient in an emergency comes in and I don't remember what to do. I remember that we studied it and I had it perfectly when we did the exam but it was too long ago and I don't remember everything ...
Pysch is a real bag of tricks. Have you ever read any of Freud's theories? They are really off the wall, in some places. Still, one must give the man credit for being the first to enunciate in some systematic form, the workings of the mind. Even his daughter became a psychoanalyst and contributed to the field. I hear that some of Freud's earlier work was based on his observations of his daughter (and given what he wrote about psychosexual things, that must have been a really 'special' family!). Anyway, can you imagine what teatime conversation must have been at the Freuds' house?
Okay, so you can see what my life has come to consist of. Well, I guess that when we get to the hospitals, it will be all physical work and no more sitting in classrooms for 5 hours to come home to sit at a desk reading for another 5-6 hours.
Well, I better get back to the studying. It's 3:00 am in the morning here and it is raining outside. I love it.

What is this life so full of care, we have no time to stand and stare

I have been busy preparing for upcoming exams (Monday). In anatomy, the section we are being tested on is the head & neck - by far the most complicated and difficult. You are right: anatomy and histology are fascinating subjects and I can imagine myself spending not just one 3 and half month semester but a whole year studying just those ... and still not exhaust the depths of the subjects. Unfortunately my feelings with our compressed semester schedules is summed up in the words of a poet whose name I forget:

"What is this life so full of care?
We have no time to stand and stare."

A Body of Work -- a poem based on cadaver dissection

A Body of Work by Vijay Aswani

Posted July 6, 2001 HMS Beagle -- A Biomed Net magazine. Issue 106

The Smell.
That is the all-pervading reality, the memory signature of the
experience.
Our cadaver is located near a window.
Sleep deprived, tense and brow-beaten
We are leaned over an open Atlas
- our wet and frayed road map to the body.
Tired gloved hands push and tease in blunt dissection.
Intrusive, invading, irreverent.
Where is the nerve?
Eyes dart from Atlas to the gaping hole in the body and back to the
Atlas
again.
Outside, the flowers waved and danced in a gentle breeze
Carrying their seductive scent to any willing partners.
A hummingbird's wings blur in a silent hum as it hovers over a nectar
pot.
A butterfly lazes over a bush of flowers.
A riot of color, of life, of unhurried pleasure.
Accusing eyes gaze at the stiff, lifeless, colorless flesh.
We only have half an hour more to prossect the pelvic structures.
Will we lose our grade?
"You've cut the tendon! What are you doing?"
Large angry eyes pin their accusation on the one with the scissors.
Meanwhile, the cadaver says nothing.
Outside, a bird arrives on the telephone wire above the bush.
Her tail dips as she cooes her love call.
From a nearby tree, another answers.
Joyful flapping of wings tell the story of a happy union.
"Can you show me the ischiocavernosus muscle?"
The cold, expressionless voice of the mentor demands.
Uh . . . um . . . fingers prod and probe. Eyes are cast away from the
voice.
The tension was palpable even if the muscle and associated nerve were
not.
The cadaver says nothing.
The mentor walks away in silence.
We stare exasperated at this collection of nerves, muscles and blood
vessels.
This puzzle in a human body box
To be cleaned, dissected, exposing structures of interest.
Outside, the flowers danced and dodged in the wind
Nature and life, color and song, process and movement
In lazy summer sunshine.
Outside.

Vijay Aswani holds a Ph.D. in biochemistry from the University of Bombay,
India, in 1992. In January 2001, at the age of 38, he decided to enroll in
medical school to work toward an M.D. He is currently teaching biochemistry
and studying medicine at the Medical University of the Americas, Nevis,
West Indies. This poem is what happens when a mature medical student
experiences gross anatomy after a life in biology and literature.

Hoping you pass the course with dignity

Well, I have exams on Monday in anatomy and histology and am in the throes of preparing a biochem exam to be administered Monday afternoon. Between the theory and lab exams, I am quite swamped and a little panicked. There is so much information it can be overwhelming. Ah, the joys of medical school! This is my rite of passage to the dream. I will endure and hopefully survive. Our histology professor put on the course syllabus as a last line: 'hoping you pass the course with dignity'. She is a small Tamilian woman from Christian Medical College, Vellore. In her first quiz, only 2 of the 18 in the class passed. I was one of them. In the second quiz, none passed. The quizzes don't count, however they don't forebode well for the upcoming Black Monday exam. It gives new meaning to her parting words on the syllabus.

first semester at medical school

I have settled back into the house and back into school. This semester is so busy I did not eat lunch at all last week. I am taking anatomy and histology and it has me running from pillar to post. My class schedule is: 08:00 to 11:00 am Anatomy 11:00 to 12:00 am Lunch (during which I prepare to teach biochemistry) 12:00 to 02:00 pm Histology 02:00 to 04:00 pm Biochemistry (which I teach)
In anatomy, we have lab twice a week - Mondays and Thursdays, instead of the lecture. We are five of us assigned to each cadaver. 3 of us work on one side and 2 of us on the other. Our group of 5 has decided to come in every morning and spend extra time from 7:00 to 8:00 am. In addition, we spent Saturday evening, from 4:00 pm to 10:00 pm working on the cadaver, with a 45 minute break for dinner. All this extra time is needed since the dissection takes time and we can never complete it and study it during the allocated lab time.
After all this, there is still the studying to do for histology (whose lab has not even begun yet) and some more studying of the clinical cases associated with anatomy. Needless to say, I am swamped with work. Of course, I am enjoying the many new experiences. Cutting a dead human being is the real initiation to medical school and I am happy to report that I am being initiated in full force.

On Sunday, I was so tired I didn't do anything. I had some coffee and a frozen pizza for lunch and that was all I ate all day. I hope I lose weight and given my schedule, I think I shall.

Amor Prohibido

 I was lonely.

I know: it sounds like the perfect setting (or excuse) for an act born of bad judgment. Her name was xxx. She was 33 and I, 58. This is our ‘story’.

I met xxx for the first time, I think, 3 years ago. My family and I had just moved to Buffalo, New York. For the first 4 years of marriage, my wife had been a stay-at-home mom, because our daughter was still little (5 to 9 years old, in thse years). The move to Buffalo was exciting for both of us. I was moving from working for a Clinic to being a professor at a University. I was going to be an Associate Professor of Internal Medicine & Pediatrics. I would practice medicine, teach students and residents and get some time to do research. My wife, Amy was excited too. She had always wanted to do a PhD in math and this was her chance. She had already been accepted into the program by the time we moved here.

Back to xxx. I came home one day from work and there was a shorter, black-haired, brown-eyed woman sitting on our couch with my wife. She had larger eyes and curly black hair that fell on her shoulders.

“Vijay! This is xxx. She’s in the math program with me.” Amy said this by way of introduction. xxx smiled and said ‘hi’. Amy was 42 at the time, and xxx looked much younger. I could not tell how much younger. She looked in her early 30s. From her appearance, she seemed Latin.

“Where are you from, xxx?” I asked.

“Oh, I was born here. But my parents are from --- (a country in Latin America.”

“Que bien! Gusto conocerlo.” I said, smiling.

“Vijay speaks Spanish, xxx.” Amy added.

Over the next 3 years, xxx would come over often. Mostly, Amy and she would sit together, chatting, or working separately on math in Amy’s office or the table in the hall. Sometimes, xxx would cook something (she loved to cook). She helped Amy clean the house a couple of times (“xxx loves to clean!” Amy would explain.) xxx always said ‘hi’ even when neither Amy nor Phoebe would acknowledge my return home. We exchanged a few words every now and then, sometimes in Spanish and sometimes in English.

Amy had other friends in the program, but xxx was the one that came over the most. In November, 2018, xxx had a car accident. The accident totaled her car. Fortunately, she was okay, except for some contusions. She came home.

“xxx! Let Vijay take a look at you! He is the best doctor I know. In fact, you should become his patient.” Amy was saying this to xxx as I stood in front of them. Despite our relationship falling apart, Amy had always maintained that I was an excellent doctor and my patients were lucky to me. She blamed my devotion to my patients for some of what destroyed our marriage.

Anyway, xxx became my patient. I treated me through her recovery from the injuries. I treated other issues that arose along the way. I would intermittently get texts from her with medical questions. This was not unusual however, as I allowed a lot of my patients to text me in this way. If I saw her at home visiting Amy, I would inquire about how things were going medically and we would have a little ‘office visit’ in our living room, with Amy acting as the chaperone.

Of course, our marriage was going from bad to worse. Towards the end, I would sit in my office in the basement of the house, where I slept at night as well. Amy and I spoke very little to each other. xxx was polite and caught in this awkward cold war.

Amy and I were divorced in January, 2020 after failed attempts at counselling. Amy and Phoebe did not move out until May, 2020. Phoebe was visiting her other mother in Wisconsin when Amy moved their things out and found her own place.

By then COVID was ravaging our country and the world. I volunteered as a doctor to help in New York City during the ‘surge’ – the explosion of cases there. I agreed to go to NYC for a week. When I mentioned this to Amy (xxx was visiting at the time), Amy asked, “when will you be going?”

xxx came up to me. Her eyes met mine as she said in a soft, pleading voice, “Don’t go, Vijay!”

Looking back, I cannot tell if she was concerned about the risk that I would be at working in with COVID patients in an overflowing, taxed system, or if she was concerned for her friend. Amy did not say anything. When I returned a week later from New York, the house was mostly empty. Amy had moved most of her things, furniture, bed, books, kitchen stuff and lamps out of the house.

Ironically, that first week a terrible loneliness set in. I say ironically, because for the better part of 2 years, we did not share much together. We had stopped sleeping in the same bed 3 years before then and when I was at home, I was in my little office in the basement. We cooked our meals separately and barely exchanged any words. Phoebe was a teenage by then, and shut herself in her room, on her computer with friends most of the time.

I walked within what seemed like a large house, picking newspaper off the floor, moving left behind items to the corners to tidy the place up a bit. The house was quiet and dark. Amy had taken the television with her. Before, the television was almost always on in the hall. Now there was silence.

“Vijay, are you going to church on Sunday? Can I go with you?”

I read the text on my phone in between seeing patients in a busy clinic. The message was from xxx.

“Of course, xxx! Do you want to come home and we ride there together, want me to pick you up, or will you meet me there?” I texted back.

xxx had come to church with my family and I when we went, several times. She was not regular, but then, neither were Amy and Phoebe. I tended to go regularly if I was not working.

Over the next 3 weeks, xxx would meet me in the church parking lot and we would go into church together. We attended the 9 am service. xxx preferred to meet me there because she felt she might run late getting to church. She did not ‘dress up’ for church, like Amy used to do. She came in jeans and a shirt with a winter pull-over.

The first time we went, I had to leave her after the service to pick up Phoebe. I promised her that I would buy her breakfast the following week. The next week, after church, we went to the Pancake House for breakfast. It was great to talk with her, going between Spanish and English. I got to learn more about her and loved spending time with her. I remember that first breakfast. When we checked into the restaurant, we were told there would be wait. They offered to text us when our table would be ready. It was a chilly morning, but we both had our jackets. We walked onto Main Street, and strolled down towards the Ellicott Creek. It was beautiful to see the little town of Williamsville with its quaint shops. xxx had been to the Creek before, but I hadn’t. As we strayed off the road into the Island Park, we chatted and saw the little rapids in the river. We smiled and laughed. It was easy to talk to xxx. Unlike my conversations with Amy, where I felt I had to step over landmines that could change the mood in a second, xxx was soft, easy going and seemed interested in what I had to say.

Our little walk was cut short by the restaurant texting us. We went back and had a great breakfast. We had eaten there before, with Amy and Phoebe along, after church. We had great conversation. She told me that in the future she would like to maybe teach math, using questions that were more interesting to girls and minorities, than the kind of questions currently used in classes and texts. I smiled at her enthusiasm and her vision. Here was someone who was a first generation immigrant to go to college, a female and from a Latin American country who was in the process of getting a doctorate… and in math, to boot. I was excited to see the kind of leader and impact she could have on more girls, more minorities getting into science and math because of her.

I ordered an order of gluten-free pancakes for Amy and for Phoebe. xxx mentioned she would pass by there after this, since we were close to their new place. After breakfast, she drove to Amy’s house and I drove home.

After that first week, I began to notice that I was developing romantic feelings towards xxx. It felt a bit odd. I felt in love. I didn’t think I could feel that way still, at my age. To me, she was beautiful, smart, passionate and had wonderful, selfless goals I was excited about. I looked forward to Sunday morning, worshipping with her in church and breakfast after. I had daytime fantasies of a life together with her. I thought of her as my object of affection as I listened to Latin rock music, ballads or merengue driving home from work.

Jose Jose has song that goes like this:

Mentiras son todas mentiras
Cosas que dice la gente
Decir que este amor es prohibido
Que tengo 40 y tu 20

Que yo soy otoño en tu vida
Y tu eres dulce primavera
No saben que guardo un verano
Que cuando te miro te quema

40 y 20
40 y 20
Es el amor lo que importa
Y no lo que diga la gente

I used to laugh at the song. I laughed because I thought that it was a clever way for this 40 year old guy to justify his affection toward a girl literally half his age. But now, I, a 58 year old guy was in love with a 33 year old girl. Why, when I was 40, she was 15. 15! What was I thinking? Amy and I had an age difference too. When we met, I was 50 and she was 37 – a 13 years difference.  Maybe I am attracted to younger women. But then, aren’t all men? Isn’t that more of a sexual attraction? I thought about that. I did find women most beautiful between 30 and 40. I found them mature, more beautiful than pretty, able to be good conversationalists and companions. I loved xxx because she seemed to share so many more of my values and culture than Amy and I had. She loved the Lord like I did. She had spoken of a previous long-term relationship she had and she had supported her boyfriend, took care of him and wanted to see him succeed in everything he did. In this, she spoke as someone who seemed more similar to the women of my culture. Perhaps Latin culture is more like Indian culture in this way than is American (Caucasian) culture. Perhaps all this was racist profiling.

Problem 2: xxx was Amy’s friend. I met xxx through my ex-wife. People might think she was the reason my marriage to Amy fell apart. In all truth, I did not develop romantic feelings for xxx until months after our divorce. Still, what a way to meet your future soulmate.

Problem 3: xxx was my patient! I had NEVER viewed a single patient in my past romantically. I am not blind. I have found my patients attractive, but there is a professional barrier and a clinical line I would never cross. It is unethical to date one’s patient. There is a unequal position of advantage a doctor has over his or her patient, with the intimate knowledge of their past medical history and the patient’s dependence on them for medical care. What would I do with that?

Amore Prohibido.

I remember reading that when Woody Allen was asked about his falling in love with a 27 year old girl that was an adopted daughter of Mia Farrow with whom he had a relationship before.

“The heart wants what it wants. There's no logic to those things. You meet someone and you fall in love and that's that.”

They have been married for over 20 years and still going strong. He was 62 and she 27.

After the second week of church and breakfast, I got a text one Friday.

“Vijay, I am sorry that I cannot come to church with you anymore. Amy is a little uncomfortable with this. She has not asked me not to go to church with you, but I don’t want to do anything to cause any distress to my friend.”

We exchanged a few texts in which I mentioned that I understood and would not to do anything to harm her relationship with Amy. They were friends first and I got to know her only because of that.

Shortly after that, with COVID cases rising in the area, church went ‘virtual’. By mutual agreement, I would text xxx before the services to check that she was up and attending. It was our way of mutually encouraging one another to attend services.

We continued to text each other in relation to medical questions. After one such text, xxx asked me if I would come to her home to pray over her apartment. She felt there was a presence of evil there that woke her up at night. She sounded scared. I had prayed with people in these situations before. I agreed to come over and shared a verse from Scripture with her. The night before I was to go over there, she texted me that she had a headache and would like to postpone the visit. I agreed, although wondered about the whole thing. That was that. I never did go over to her apartment.

That’s the ‘story’. Here it ends. Nothing actually happened. There was no physical contact. There was no sexting. There was not even any mushy talk. There were romantic fantasies (in my mind, anyway).

What if xxx had been older, or I younger? What if we had met in a different way? What if she was not my patient?

What if I threw all this ‘Amor Prohibido’ thing to the wind and did the ‘Woody Allen’ thing?

Well, a few things come out of this:

1.       I realize that I can still fall in love. I thought that with 2 marriages under my belt and being 58 years old, I was done. I guess not.

2.       I am lonely. What to do is not clear. What if love passes me by and I die alone? I feel alone and without a companion. Is this going to be the rest of my life? Will I be this eccentric single, old man with no life – a workaholic with nothing outside of work?

3.       What kind of love and life can a 58 year old man with diabetes and high blood pressure and cholesterol have? Would it be fair to visit this upon a woman? Do I have a right expect a companion who will love me, want to cook for and take care of me? I would give everything to her – love her, take interest in her life and career, provide all her financial needs and aim to settle her even after I am gone. Is this how this works?

4.       They say ‘You only live once!’ Am I being too cautious or over analyzing things? The Christian and Rational person in me sees this as untenable.

For now, it looks like my story with xxx is over. I am still her doctor and have not crossed any borders there.

To be honest, I do not know if she had or could develop romantic feelings for me. In one of her emails she mentioned something about seeing me like a father/brother/mentor. I suspected she was conflicted – torn between (maybe) having a relationship with me but maybe she sensed my attraction to her and was embarrassed and awkwardly trying to discourage me. I know she is lonely. I know she has no present relationship. I know she wished she was in a relationship with someone. She mentions she would love to be in a relationship with someone who has a career, versus an unsettled person.  She is in the PhD program. She is ahead of Amy, but still struggling with her thesis and does not have an end date in sight. This weighs on her.

xxx, I hope you meet someone and that it is magical. I hope he is a little older than you, well established in his career, able to provide for you and provide a house and home for you. I pray you graduate with your doctorate, get married and have children of your own. You have so much love and nurturing to give. I am proud of your plan to support women in STEM and particularly encourage people from ethnic groups not currently represented or under-represented in Science and Math. I know you can be a beacon, a teacher and a leader. I pray you meet a godly man who will support your dreams, be the rock in your life and that you both have many years of a happy, wonderful marriage with children.

 

 

Why (and how) I became a Christian

My name is Vijay Aswani. I am a 55 year old male physician, and an Associate Professor of Internal Medicine and Pediatrics at the University at Buffalo -- a State University of New York. I hold a Ph.D. in biochemistry and have worked as a professor of biochemistry and a research scientist before entering medicine.

Roots and Early Beginnings

I was born into an Indian Hindu family in Lagos, Nigeria. My family is Sindhi – my parents coming from Hyderabad, Sindh before the partition of the Indian sub-continent in 1947. My father had grown up abroad and my parents had been outside India ever since they were married.

During my childhood in Nigeria and Liberia, my mother taught me the Hindu prayers. At home, we worshipped the goddess Laxmi, but also prayed to Guru Nanak. Like many Hindu Sindhi households, we worshipped all the Hindu gods and goddesses, as well as followed the teaching of Guru Nanak and Jhule Lal.

I remember learning “He Paramjot Parameshwar” from my mother when I must have been around 7-8 years old. I remember that I was a very naughty child. I am the younger of two children, both boys. My brother was sent off to boarding school at the age of eight because the schools in Nigeria where we were at the time were not very good. Being two years younger, I was not old enough to go yet. As the only child left at home, with my parents missing my brother, I was very loved and got practically everything I asked for or wanted. I guess I was a little spoilt. I still remember being taken by my mother to visit some holy men who had come to talk in the Gurudwara. My mother asked the speaker to pray that I may improve my behavior. He looked at her and told her that “one day this boy may show you the way of God!” I was about 7 years old.

Boarding school and learning Raja Yoga
When I was 10 years old, my parents sent me off to India, to boarding school, with my brother. It was difficult for them to do, but they sent us so far away that we might have a good education. I remember that my first year in school, I cried a lot. Besides the contrast of a militaristic discipline and corporal punishment, seeing the poverty in India for the first time was overwhelming. In view of all this, I also came to see myself very differently from I had before. I had been the only child at home (since my brother was at boarding school). I was used to having my way. I developed a sense of self-loathing for my lack of self-control, my fiery temper and my preoccupation with materiel things. I had taken my loving parents for granted. I resolved to embark on a path of self-improvement.

While in boarding school, I subscribed to a postal correspondence course on Raja Yoga. I did all the lessons and learned about Hindu philosophy and soul consciousness from the course. When I went to Bombay during my summer vacation, I was pleasantly surprised to learn that the school of yoga that I had done the course from existed in Bombay as well. My grand-aunt was a leading teacher in one of the ashrams of that very school! I was thrilled. We had many conversations about seeking truth, meditation and spirituality. I read more books and attended meditation sessions at the ashram. I read books by Swami Vivekananda and his teacher Swami Ramakrishna Paramhans and other spiritual masters in India.

My family in India was impressed by interest in spiritual matters at a young age. By then, I was about 14 years old. My grand-aunt believed I may have been the incarnation of a great soul – that is why I developed spiritual interests at a young age. I was intoxicated with Hindu philosophy. It sounded profound and I resolved to be a seeker of truth and develop soul consciousness through meditation and spiritual discipline. I became a vegetarian – a very difficult thing for me to do, since I did not like to eat vegetables.

Inner struggles
Outwardly, a lot changed. Others were impressed by my attendance at ashrams, my meditation and ability to quote the writings of the swamis and gurus I read. Inwardly, the battle for control of passions, lusts, anger and jealousy continued. I felt I knew what I should do: -- eliminate the vices and cultivate the virtues, practice self-control, be non-attached and achieve self-realization. These goals sounded right. I wanted them inwardly, but they seemed like the horizon – the harder I tried to reach them, the further they seemed. My grand-aunt – easily in her seventies at that time, and a practitioner of raja yoga for at least 4 decades told me that the more she lived, the more she saw that there was still more work to do on herself in realizing these goals. That discouraged me. If after so many years of discipline and practice of meditation, she was still working at it, what hope was there for me?

I began to be frustrated. I had started out to become a better person. All I had achieve, I felt, was an outward form of godliness. Inwardly, I was ashamed of my desires, secret jealousies, seething anger and resentments. I no longer gave in to outbursts as I had before, but I steamed within. I felt like a hypocrite. I resolved to work harder at it, since it sounded right. It had to work.

Confronting Christianity

That year, in the 6th grade, a student joined our boarding school. He was a Christian. Now, we were all in a Christian school. To me, Christians were people with western names like Robert, or Frank. They went to church, while I went to a temple or Gurudwara. Their holy book was the Bible while mine was the Gita. In terms of actual living, I felt we were all the same. There were good and bad people in all religions. Of course, I felt that us hindus were superior, since we were vegetarian, and strict practitioners did not drink alcohol or smoke tobacco. Our women dressed more modestly. We were not contaminated by the corrupt western lifestyle, as I saw it. This boy was different. He claimed to be able to talk to Jesus and that Jesus talked back! What an audacious claim, I thought, to imagine that a mere sinful, impure mortal could communicate with God that easily without years of penance, spiritual discipline or purifying rituals and meditation.

I was impressed with his life though. He seemed to radiate a joy I did not have. I was working hard to be spiritual. He did not seem plagued by the same struggles as I and yet, I was no more spiritual then he was in living. When I asked him about it, he told me about he believed that Jesus died on the cross to take away the sins of the whole world and that we could have a right relationship with God through Him. I did not understand. How could one man hanging on a piece of wood somewhere in the obscure middle-east take the sins of every person on earth in a few hours? That did not seem proportionate to the burden of sin. No! We had to work ourselves out of the cycle of birth and rebirth until we paid all our karmas and got moksha (deliverance) and nirvana (eternal bliss or state of nothingness). I mocked him. I got better grades in class than he. He was just stupid. Compared to the complex hindu philosophy I had read, which was deep, structured and tried to answer the questions of suffering, this sounded like nonsense. It was not profound enough. No, I thought, the answer cannot be here.

A decision

Later on that year, I got to go to a 3 day camp being held at a center outside our boarding school. It was a camp organized by the missionary organization called Scripture Union. I went because (1) I got to go away from school for a few days, (2) there was hiking, swimming and fun activities. At the camp, young students like me talked about their relationship with Jesus. I remember the campfire on the last night of the camping trip. Several students stood up and talked about the state of their inner lives before they came to Jesus. I blushed as these boys talked about the very struggles I was having, but was too ashamed to admit. How could they bare their souls like this? Everyone’s story seemed to end the same way: once they realized they were miserable and stuck in a quagmire of sin, they came to Jesus. At the end, someone came forward and asked us if anyone wanted to “ask Jesus into their heart”. I was confused. How do you do this? What would happen? Was I going to give up the path of the ancient hindu spiritual masters for this? In the end, I reasoned, what had I to lose? I was not making much progress on the path I was on. I reasoned I would try this. If Jesus could do for me what he done for these students and my friend at school, then I stood to gain the very goal I wanted all along. After all, I wanted to be a better person, to overcome my struggles with sin within my body and mind and spirit.

That night, someone led us in a simple prayer. It went something like this: “Lord Jesus, I thank you for dying on the cross to pay the penalty of my sins. I accept I am a sinner – born in sin and a slave to sin. Please forgive my sin and wash me clean. Come into my heart and life as my Savior and Lord. I ask this in Jesus’ name. Amen.”

We went to bed soon after that. The next morning, we boarded the buses that took us back to our boarding school. I cannot quite explain what happened next. It was as if someone opened the windows of my heart and let sunlight and fresh air in. I had nothing to hide anymore. I understood that the reason I could not overcome my struggles and master my desires was because I was a slave to them in sin. I was not a holy soul who simply needed to realize who he was. I was a slave to sin and needed rescuing. And I had been rescued. My boarding school was located in a hilly village, with lots of open spaces and fields. I went for long walks and talked to Jesus. In the beginning, I thought I had to meditate on him. I asked my friend for a picture of Jesus so that I could picture him, just like I had statues and pictures of my hindu gods before. He explained to me that God was a spirit and was to be worshipped in spirit and truth. It took a while to get that concept, but once I did, it was liberated.

Knowing God
I did not need to be in a special place, or posture to talk to God. I could do it anywhere. I did. I felt God talked back to me, in my heart. I had found a heavenly father and a best friend.

I began to read the Bible. I told other kids at boarding school about what Jesus had done in my life. Looking back, we had kids with some real problems. We had kids who were abused at home, some with chronic sicknesses, some with psychiatric problems. In the next few years, we had a group of 15 children, ranging in age from 12 to 16 that had begun to believe in Jesus. Parents of non-christian children wrote angry letters to the principal when their kids wrote to them that they began to follow Christ. The principal was confused, since neither he nor his staff tried to make anyone follow Christianity. It was eventually traced to my friend and myself and we were warned. Of course, we did not listen. We felt we were not doing anything wrong. We were simply sharing our lives with our friends and fellow students.

Becoming a follower of Christ or a Christian?
Over the course of the next few decades, there were changes in my life. I finished high school and went off to college. I was drawn to science and research and went on to get a bachelors, masters and Ph.D. in microbiology and biochemistry from the University of Bombay, India. During this time, I attended a local church in Bombay that met for most of that time in the hall of a local school.

Through reading the Bible and discussions with others, I realized that Jesus did not come to change our names to ‘christian’ names. He did not come to change our culture – to make us eat with knives and forks or wear pants and shirts, if we wore dhotis and kurtas. He did not come to give us ‘western’ values. In fact, he was middle-eastern and probably had more in common with the culture of India I was used to.

What did my family think of all these changes? At first, my parents reasoned that this was a fad (like my Bruce Lee kung fu phase). Soon however, it was clear that not only was it not fading, but I was making important decisions based on my faith and commitment to Jesus. For example, when my british citizenship was cancelled (connected to the passing of an immigration act in 1971 in the U.K.), my family suggested that I go to India and apply for an Indian passport. Of course, the ‘easier’ thing to do was just fill out an application form for an Indian passport and lie with regards to place of birth and prior citizenship. After all, who would know? And documents like birth certificates could be falsified or obtained by bribery. I refused. My commitment to Jesus meant I could not lie. It took me three years to become a naturalized citizen of India. I was told that I would have to bribe officials to move my file along, that I would never be able to go through the whole process without lying or bribery. I did.

I was offered a seat in a medical college in south India, if I paid a capitation fee. I refused, even though I really did want to do medicine. My parents were appalled that I would make an important career decision on the basis of ‘principles’.

Changing religions?

Other concerns my family had was regarding why I was ‘changing my religion’. As I read the Bible more, I did not call myself ‘christian’ because that word meant the same thing to them that it had meant to me previously. I wanted to establish that my culture, my respect and honor of my elders and my way of life from a cultural standpoint would not change. My heart had changed. I described myself as a follower of Christ. Jesus was my Guru – just like others followed Radhasoami or Sai Baba.

There were conflicts over attending temple worship with them on Hindu holy days such as Diwali and Holi. I refused to participate in the house prayers in front of idols, or to eat the ‘prasad’ – food offered to the Hindu gods. This was viewed as an insult to my elders. It was an affront of their traditions. They were my elders. I was a young boy. How could I disrespect them by not obeying when they called me to the house worship? How dare I insult them in this way on auspicious occasions and holy days? Those were difficult times.

I loved my family and respected my elders. But the Bible clearly taught me that I was not to worship or bow down to idols or partake of food offered to idols. I tried to point out that I was only trying to be a good disciple of Jesus and obey his teachings and that I meant no disrespect or dishonor to my elders. There were times when I was told to choose between following them or following the Bible. Arguments were made that “all religions are the same” and that “the Bible does not teach you to disrespect your elders”. I cried many tears of frustration and pain before the Lord in prayer as I chose to obey the Bible’s instructions in the matter, while trying to reaffirm in every other, that I still loved and cherished my elders. It took years before the cumulative, consistent actions and my life on a daily basis convinced my family that I honored and loved them.

The present

Through the different phases of my life – child, student of science in university, scientist and now physician, I have met different challenges to my life in Christ. There were intellectual challenges to the existence of God, to whether the Bible’s teaching were true, to whether Christ and his teaching can claim exclusivity to God. There were family and society challenges – what is like to be a hindu follower of Christ who rejects Hinduism and yet does not accept the culture of ‘christians’ in an eastern culture. How does one live in the world between Christian culture and hindu culture without compromising one’s integrity of faith while not becoming culturally converted?

In the end, the Bible answered the questions of my heart. Here are some of the passages that have transformed my thinking and life. When the reader looks through them, he or she will see their connection to some of the experiences I have described above.

I am not ashamed of being a follower of Christ. The Lord Jesus is lover of my soul, the captain of my life and my leader. I am a disciple, a love slave and an indebted follower for life, forever. He is the foundation of my life, the fortress from where I fight life’s battles, my secret hiding place in the storms of life. He guards my heart. He fills my spirit with dreams, desires and visions that my life is given to fulfill.

I live in the real world. I hold a job, pay rent, participate in sports, music, watch movies, laugh at comedy shows and struggle with all the challenges of daily life as everyone else. However, just as the strength of a house is dependent on its foundation and the steel girders that hold its structure together, the Lord Jesus is that to me. It may not be evident when you see me in clinic or in the lab or in the supermarket, but scratch below the surface and it will become evident quite soon, where I come from.

The struggle within us:
We know that the law is spiritual; but I am unspiritual, sold as a slave to sin. I do not understand what I do. For what I want to do I do not do, but what I hate I do. And if I do what I do not want to do, I agree that the law is good. As it is, it is no longer I myself who do it, but it is sin living in me. I know that nothing good lives in me, that is, in my sinful nature. For I have the desire to do what is good, but I cannot carry it out. For what I do is not the good I want to do; no, the evil I do not want to do—this I keep on doing. Now if I do what I do not want to do, it is no longer I who do it, but it is sin living in me that does it.

So I find this law at work: When I want to do good, evil is right there with me. For in my inner being I delight in God's law; but I see another law at work in the members of my body, waging war against the law of my mind and making me a prisoner of the law of sin at work within my members. What a wretched man I am! Who will rescue me from this body of death? Thanks be to God—through Jesus Christ our Lord!

So then, I myself in my mind am a slave to God's law, but in the sinful nature a slave to the law of sin. Therefore, there is now no condemnation for those who are in Christ Jesus, because through Christ Jesus the law of the Spirit of life set me free from the law of sin and death. For what the law was powerless to do in that it was weakened by the sinful nature, God did by sending his own Son in the likeness of sinful man to be a sin offering. And so he condemned sin in sinful man, in order that the righteous requirements of the law might be fully met in us, who do not live according to the sinful nature but according to the Spirit.

Romans 7:14 – 8:4
The ‘foolishness’ of the message of Christ:

For the message of the cross is foolishness to those who are perishing, but to us who are being saved it is the power of God. For it is written:

"I will destroy the wisdom of the wise;

the intelligence of the intelligent I will frustrate."

Where is the wise man? Where is the scholar? Where is the philosopher of this age? Has not God made foolish the wisdom of the world? For since in the wisdom of God the world through its wisdom did not know him, God was pleased through the foolishness of what was preached to save those who believe. Jews demand miraculous signs and Greeks look for wisdom, but we preach Christ crucified: a stumbling block to Jews and foolishness to Gentiles, but to those whom God has called, both Jews and Greeks, Christ the power of God and the wisdom of God. For the foolishness of God is wiser than man's wisdom, and the weakness of God is stronger than man's strength.

I Corinthians 1: 18 – 25
The Exclusivity of Jesus as the way to God

Therefore Jesus said again, "I tell you the truth, I am the gate for the sheep. All who ever came before me were thieves and robbers, but the sheep did not listen to them. I am the gate; whoever enters through me will be saved. He will come in and go out, and find pasture. The thief comes only to steal and kill and destroy; I have come that they may have life, and have it to the full.

John 10: 7 – 10
Jesus answered, "I am the way and the truth and the life. No one comes to the Father except through me.

John 14:6

An invitation
I have an invitation and a challenge to set before you, the reader. What response will you make to what you have just read? The Bible suggests, “Taste and see that the Lord is good.” This is my invitation – the same I received: taste. If you are willing to change your life for the better, I invite you to try praying the prayer I did. Here it is once more:

“Lord Jesus, I thank you for dying on the cross to pay the penalty of my sins. I accept I am a sinner – born in sin and a slave to sin. Please forgive my sin and wash me clean. Come into my heart and life as my Savior and Lord. I ask this in Jesus’ name. Amen.”

What do you do next? I believe that God will meet with you – an astounding claim to make. You could seek out someone who you know who follows Christ and tell him or her what you have done. You could email me (vaswani@buffalo.edu or aswaniv@hotmail.com) and I will be glad to help you.

I end with this question: what is your response to this personal testimony to the message of Jesus? Please answer the question in your mind. Enunciate your response to yourself clearly.

What will you do?