Sunday 22 May 2016

U.S. Presidency: Who Does Homer Simpson Endorse?

I know this is probably not happening, but putting together what CNN reported with Homer Simpson's personal behavior, I think we can get a fair indication of whose side he is on.

That look really says it all
And yes, in case you're wondering, I am, indeed, binging on The Simpsons this slow weekend.

Also, interestingly, Homer Simpson has been a "pawn" in this year's race, with Republicans allegedly "using" him to curry favor with certain demographics who are on the fence about Secretary Clinton. Here is an article that is loaded with that irrefutable evidence in today's world: Tweets! In any case, he voted for President Obama (or rather he died trying to!) in the XIXth Treehouse of Horror episode. Just to jog your memory:

Friday 20 May 2016

Just one of those days

I feel ya' Calvin!

Done with work, walking back home through the thronging crowds crooning with joy at this being a Friday afternoon, I realized how disconnected I was from the lives being led by these people, many of whom are co-workers. For them, this is a job that is a settled affair; for them, at the end of work on Friday, it is time to go home to their significant others; for them, it is a time to plan a weekend getaway - a movie, dining outside, hanging out with friends and family; for them, it is another week at a job that is a part of their life's plans.

I feel nothing of the sort. To me, the weekend is just another couple of days to cram as much work in as I can. Get some momentum going with my studies. Snappy, snarky phone calls with my parents. Blurry Facetime or Skype conversations with the only other person who knows how difficult my life is right now, and the person I feel like I am failing miserably. For me, it is about finding out that making the climb towards a career shift is so much harder than I thought it would be.

Have you had that eerie feeling when it seems like the bottom just fell out from under your stomach? Well, that Friday evening for me. My weekend begins with me calculating the razor thin margin of savings for this month, and fretting about how I can barely support my own existence, let alone make life easier for my parents. Then wondering about how to manage the cascade of expenses that stepping up to the USMLE will bring. After that, it is about balancing the work that needs to be done in anticipation for the next week. Studying a bit. Panicking a whole lot...

I have almost stopped frequenting Facebook (yeah, real life me has an account over there too!) these days. Almost everyone seems to be flashing that vibe where things are moving on in their lives. Engagements. Weddings. KIDS! Moving up the stairs in their chosen careers. And while I am genuinely happy for them, and wish them the very best going forward, it just is not the same for me. I get the feeling of being so desolate in the crowd of my friends, almost like the bus ride on my way back home from work on a Friday evening. I feel lonely, and out of sync, with the people around me. I keep up appearances, smile and nod, like and respond in an appropriate manner, but all of it almost always perfunctorily, in a rather hollow manner. For within, I know, this is me hitting the pause button on life. And I worry I shall never be able to hit start and live the life I have imagined is ahead of me...

Posted on 12:38 pm | Categories:

...and a terrible work week closes

As I am on the verge of signing out for this week, I realize that a rather crappy work week is coming to a close. We all have one of these some time or another... just that I haven't had one such terrible week in a while.

Why was this so bad? Well, for starters I realized that the pay hike we were looking forward to is not going to be as good as it was initially thought to be, and since my contract is up for renewal, it seems that given the weak financial situation, I will not have much leeway in getting a better deal either. Given the enhanced expenses, thanks to committing to the USMLE, I really was hoping for a bigger raise... it will be a major challenge to save up for the exams now.

Second, I have been working on a couple of key publications and I just cannot seem to be able to make them come out the way I want. I have been delving and diving through literature and published papers, non-peer reviewed reports and the whole hog, trying to figure out the best way forward. For now, it seems like I am treading water, and the faster I try to move, the quicker I tire out but have no significant gain in forward momentum.

Third, I have been so caught up with work and managing time for studying, that in between, I have not been able to talk to the significant people in my life for a decent skip of time. And given that my significant other lives in a completely different time zone, things that were already difficult are becoming more difficult to manage. (Yes, I am in an insanely long distance relationship, and I have the tendency to worry about it when everything else around me is crashing down like a house of cards.)

And finally, studies. Well. The long and short of it is that it is not happening. I did try to plan the studies and work it into a meaningful schedule that allows me to study around my work hours. Unfortunately, it turns out that catching up on hard topics (I am thinking Autonomic Pharmacology here) after four or five years of a gap is a bit of a toughie. And I have managed to shoot myself in the foot thinking that instead of starting with soft topics, I should have a go at the more difficult ones to begin with, since my motivation is high. So much for the high motivation then...

I need one of the three major aspects of my life to start working out (relationship, work, and studying for the USMLE - which includes financial planning and saving up!) ASAP. That way at least I can draw inspiration from ONE thing that is going right in life.

I am so glad that it is Friday, although I guess I will have to keep working on the manuscripts over the weekend so that I can turn them in on time. I have no idea how to balance that with studying and working in some facetime for the One Across The World.
Posted on 12:23 pm | Categories:

Thursday 19 May 2016

This happened to me today

Being a poor medical researcher sucks on most days, but it is especially worse on the days when you really want to buy something and you have to weight the options: do you want it or do you need it? Can you really afford it? Can you manage the expenses for the next couple of weeks (till the next pay cheque kicks in) if you buy this?

Also, I need to figure out a way to be able to afford the new Harrison's as well. That will cost me a bomb.

Times like these, I really feel worried about the choices I have made in life, and wonder whether frittering away a moderately financially safe life in academic obscurity and mediocrity, for the sake of having a shot at a more rewarding academic career (through a path that wends its way through my life's savings) is really worth it.
Posted on 11:05 am | Categories:

Wednesday 18 May 2016

Pomodoro and Pachelbel

So I spent a fair bit of time studying tonight - my first serious stint at studying for the steps. But more than making an amazing amount of headway into the syllabus, my goal was to start getting the feel of studying. I ended up using some of the study techniques that have stood me in good stead over the past few years - Pomodoro and classical music.

I cranked out the much neglected Pomodoro app, which is basically a ticking timer, that allows me to study in sections of 25 minutes each. I study for 25 minutes, then take a short 5 minute break. Now I have set up to app so that it plays Pachelbel's Canon in D when it is break time. This is one of my more favorite musical pieces, and always helps me to relax.

I went through about an hour's worth of lecture notes and started getting the feel of the First Aid. More on what I did later when I am not half brain dead with sleepiness. Things are going to get tougher in the days to come. I feel that initial tingling of excitement and fear as one is about to embark on a journey of a lifetime. Thankfully tomorrow is not a heavy work day so I can turn up at the lab a little late, so I can sleep in for a bit.

Just to share the Pachelbel love, check this out:

Phase V of Clinical Trials

Excerpted from: Mahan, V.L. (2014) Clinical Trial Phases. International Journal of Clinical Medicine, 5, 1374-1383. Available from: Link

Phase V of Clinical Trials

This translational research is designed to “move from bench to bedside”. Phase V clinical trials refer to comparative effectiveness research and community-based research. Research is done on data collected. All reported uses are evaluated. Patients are not monitored. Its main focus is to determine integration of a new therapy into wide spread clinical practice. Filed under: cornell cooperative extension, evidence-based living, policy, the learning center tagged with: cooperative extension programs, evaluation, evidence-based programs, research methods, research translation.

Phase 0 of Clinical Trials

Excerpted from: Mahan, V.L. (2014) Clinical Trial Phases. International Journal of Clinical Medicine, 5, 1374-1383. Available from: Link

Phase 0 Clinical Trials:

The concern was stagnation and declining innovation with a widening gap between knowledge and clinical use. A drug entering Phase I trials in 2000 was not more likely to come to market than one entering Phase I trials in 1985 [23]. Improvement in prediction of failure during early clinical trials saves in development costs and time to market [24]. The concept of exploratory investigation new drug (IND) studies was a result of this FDA analysis and can help with determining whether a defined mechanism of action can also be observed in humans, provide information on pharmacokinetics, select promising products from a group of candidates, and evaluate biodistribution. The purpose of these studies is to help in the go versus no-go decision making process of a drug’s fate early in the development process using human models rather than relying on animal data.

Exploratory IND studies (also known as Phase 0 studies) are conducted early in clinical phase studies and involve limited human exposure and have no therapeutic or diagnostic intent. Doses are subtherapeutic and patients are monitored by the clinical researcher and involve about 10 study patients. Duration of a patient’s participation is usually less than 1 week. Phamacodynamics and pharmacokinetics are studied. These trials are before the traditional dose escalation, safety, and tolerance studies, do not replace the Phase I clinical trials and do not indicate whether a therapy has a positive impact on the targeted pathology. These studies help in eliminating candidate therapies before they reach Phase I studies [25]-[27]. These trials were developed to shorten the critical path for drug development, to explore pharmacokinetic and pharmacodynamic profiles of IND’s in humans, to help in accelerating identification of promising drugs, and to reduce development time and costs. Limitations of these trials include lack of therapeutic intent, motivation of patients to participate, may delay or exclude patients from other clinical trials that may have therapeutic intent, microdosing pharmacokinetics and relationship to therapeutic dose, and availability of sensitive analytical methods [28]. Attrition rates are high and only about 8% come to market.

Tuesday 17 May 2016

New Custom Email!

I am not going to get a deluge of mails, so this is just another thing to geek over, and nothing else, but I just managed to create a custom email address for this blog's domain name... for FREE! The fancy email is:

Special thanks to Zoho Mail for providing small users like me with such fancy alternatives. I wonder who can email me here knowing that nobody knows me!

In any case, I shall persist with the Gmail because I am more comfortable using the Gmail interface and do not want to spend too much time trying to learn another and get accustomed with using another email interface! For reminders, you can reach me at the following email as well:

USMLE Strategy for an IMG

As an IMG who has been away as a researcher for a while now, it is imperative that I put in more hours in studying for the steps. The subjects are detail-oriented and although one retains the broad concepts and general philosophies, it is almost impossible to recall the nitty gritty that often determines the outcome in the examination.

Image Credits: Fizzie at DocCartoon
I am, therefore, on a bit of a prolonged, IMG track preparation plan. My strategy has several phases to its implementation (the policy researcher in me is at work - you know it!), and I have broken down the next few months into dedicated blocks for preparing from different materials. I intend to write the exam in the last fortnight of the year and as such, my plan is as below:

Phase Number
Phase of…
Duration of Phase
Study Plan
Phase I
Introductory Phase
50 days
May 16 to July 4
Study Lectures + First Aid + Standard Texts + Make notes in FA or notebooks
Phase II
Consolidation Phase
50 days
July 5 to August 23
First Aid + Kaplan Lecture Notes + Standard Texts + Reference Texts + UWORLD + Make notes in FA or notebooks
Phase III
Major Revision Phase
50 days
August 24 to October 12
First Aid + UWORLD + NBME + Make notes in FA or notebooks
Phase IV
Rapid Revision Phase I
25 days
October 13 to November 6
First Aid + UWORLD + NBME + Make notes in FA or notebooks
Phase V
Rapid Revision Phase II
25 days
November 7 to December 1
First Aid + UWORLD + NBME + Make notes in FA or notebooks
Phase VI
Pre-Exam Prep Phase
15 days
December 1 to December 16
First Aid + Notes + UWSA + Diiagnostic NBME

The Week Ahead

Just a couple of work days into the week and it has already turned hostile with work! I was run off my feet at work today, with a number of assignments pouring in, and edits on my articles coming in galore. I am currently working on three articles simultaneously. One of them, thankfully, is a Letter to the Editor sort of piece, and I have a lot of help on it from my co-authors, but it is on a VERY short deadline and I shall have to somehow make the cut. It is directed at a major publication in a major medical journal, and I have the fortune of being the first author on it. Let's see if we can make it to the pages of the big pub!

The two others are major papers from one of the recently concluded projects that our team has worked on. One is in a fairly advanced state and I need to wrap up the comments that have been sent in by the collaborating authors. Version compiling is a very difficult and unpleasant task - one is always likely to step on some toes if the work is not done right! The other one is in a pretty early stage. The numbers have been crunched (they are not too exciting, unfortunately); and the conclusions are being drawn. I had a meeting for discussing the implications of the analyses for this paper with the PI and other lead authors. A LOT of ideas poured in, angles that I had not considered popped up. So, now I have to push it through in double quick time.

This week I need to send out these three articles in addition to start properly studying for the steps. This is going to be an unpleasant set of days up ahead of me. I am not even thinking of the post-peer-review work that shall pile up around this time next month!

Image Credits: PLoS Blogs

Posted on 1:46 pm | Categories:

Pearls Before Swine

I am a webcomic nerd, and I love the anthronpomorphized set of creatures that Stephan Pastis has created in his comic, titled Pearls Before Swine. Today's takes cynicism to another level altogether:

Follow Stephan's work from his website on GoComics. The comic takes its title from the Bible:

"Give not that which is holy unto the dogs, neither cast ye your pearls before swine, lest they trample them under their feet, and turn again and rend you." – KJV, Matthew 7:6
Given the attitudes of the protagonists, I could not congratulate Stephan more on such an appropriate naming. I am a big fan of his work, and hope someday, to meet him in person to let him know of this!

House MD Redux: Wilson's Heart

So people who know me also know what a huge fan of the TV Show House MD I used to be. Though I had vicious disagreements with some of the diagnostic trajectories and story lines, in general, the concept of a pained, misunderstood genius appealed to me. I enjoyed watching this misdirected misanthrope and felt his unreal genius attract me.

However, it has been a while since the show ended and though I never really followed any other TV show with as much of interest and passion (though as I betrayed in my last post, I have shifted my nerd focus on to the Game of Thrones), I always kept longing for something like House MD to come along. So today, in the evening, while randomly flipping through the TV shows rerun on the glut of local cable channels, imagine my shock and surprise when I stumbled across what was ostensibly one of my most favorite House MD episodes of all times: the two-part season finale of season four, the one in which Amber, Wilson's love interest, and a fiercely competitive doctor, almost like a female version of Gregory House in certain ways, dies. House puts his life on the line to get to the bottom of the mystery behind the rapidly declining multiorgan failure that strikes down Amber (popularly known to the show fanatics as Cut Throat Bitch because of her gunner nature).

The medicine in the episode was spotty, at best, and sloppy at worst. For example, I still cannot come to terms with the fact that Wilson suggested cooling Amber further down would help - hypothermia does not work that way! And it is extremely rare, to the point of non-occurrence, that someone is put into protective hypothermia for a very long time. The pharmacology behind Amantadine poisoning - the eventual cause of her death - is solid, and there are documented cases, albeit rare, of similar, unfortunate outcomes.

But this episode always touched a chord in my hear. The manner in which a concussed House agreed to get a deep brain stimulation to revive his memories (it does not work that way - we cannot yet stimulate a particular memory thread. You are more likely to succeed with Dumbledore's Pensieve for that.) and went into a coma, the way in which House's fallibility is exposed, and his human, vulnerable side comes out is a revelation. Somehow, you cannot but empathize with the misanthropic physician.

But at the end of the day, Amber dies, Wilson leaves, questioning his friendship with House, and he resorts to his pill-popping shenanigans. People do not change...

The songs... oh the songs...

Monday 16 May 2016

Treatment Dilemma: Catch Scratch versus Cat Bite

Came across this on one of the USMLE Forums:

No treatment needed for mild or moderate disease except for symptomatic relief through antipyretics or analgesics. In severe or disseminated disease or in patients known to have immune suppression go for Azithromycin for 5 days. The causative agent, Bartonella, is resistant to penicillins, including coamoxiclav. In cat bites, however, the insult is polymicrobial, primarily Pasturella multocida, a host of different Streptococci and Staphylococcus aureus, hence the first line choice is Coamoxiclav with Clindamycin and Ciprofloxacin if known resistance exists or if the patient is allergic to penicillins.

Image Credits: SCIELO

SPOILER ALERT: Game of Thrones: Season 6 Episode 4 - Book of the Dead

Alrighty then, new week, new work list and new work load, but what do I do? I come home and fall asleep like a log, only to wake up SO LATE and then instead of studying have a go at the newest Game of Thrones episode. And naturally, being the giant ASOIAF nerd that I am, I go on to Reddit and trawl through the extended commentary, including the birth of a new meme: Tormund+Brienne, the Hagrid-Maxime couple of the GRRM world.

The way Tormund throws his "come hither" wildling looks and Brienne of Tarth is like, "OK, what do I do with that!" is just hilarious! This season the writers have crammed in several several comedy relief moments in every episode. Bromund seems to be the latest in line.

Talking of things thrown into the story line, there is the token killing by the murderous Ramsay Bolton, who is getting established, in each episode, as the worst human being to have ever existed. In this episode, he shoves a knife into someone's throat quite nonchalantly. That someone happens to be Osha, the wildling who accompanied and protected Rickon Stark in his unknown journey since the fall of Winterfell. In fact, she turns up on the show a couple years later, only to be killed after a four minute presence. That is how cruel the show runners are!

A lot happens in the episode - like a perfectly poised game of chess, the power centers are consolidating, and it looks like something big is brewing, an imminent war, winter is coming after all. And though there has been, in passing, the mention of the white walkers, the undead ones have not made an appearance yet.

Tyrion Lannister and Varys make an appearance; though I am not quite sure what the heck is cooking with their story yet. Of all the plotlines running along, this one seems to be the one that is meandering the most.

A nice brother/sister story line was also projected in the episode; Jon/Sansa, Theon/Asha, Cersei/Jaime, and Margaery/Loras all get some screen time, and these also promise to evolve into major plotlines. I especially like the transformation of Sansa Stark from the demure damsel with a diabolical disposition, to a warm war mongering warrior. The way she jolts Jon, back from dead, and totally in need of some serious SSRIs, is interesting.

Oh, the slimy Petyr Baelish makes an appearance, as does the dolt of House Arryn. As mentioned in the Reddit thread, an interesting theme would be: The conversation that King Tommen and Robin Arryn have when they meet for tea at the Moon Door. Weaklings.

The best scene of the episode (I would have said season, but it is way too early, not even half way through) goes to none other than Daenerys, when she, once again, walks out of a major fire with nothing on her, and has the Dothraki horde kneeling in obeisance.

Daenerys Targaryen, the Unburnt

Alright. Enough with the episode listing. Time to now go get some studying done. Looks like I shall have a long night of work ahead of me...

Sunday 15 May 2016

The Uncertainty of Choices

As I was contemplating the inevitability of the changes that are going to be ushered into my life from next week onward, I realized I was getting into something that is going to make my life a whole lot harder than it already is. From a medical researcher, I shall be taking the plunge to get into the choppy waters of USMLE preparations. Considering the pros and cons, I realized that it is a matter of weighing the options.

The way I see it, it makes sense to take this leap of faith, this risk, and give my passion a chance to work out. If it does, I gain a lifetime of fulfillment; and even if it does not, I can come away saying that I gave it an honest shot - you can't always get what you want!

This whole quandary reminded me Edgar's soliloguy from Shakespeare's classic King Lear:

And worse I may be yet. The worst is not
So long as we can say “This is the worst.”
Edwin Forrest (1806 – 1872) as Lear. Berkeley
In one of the most poignant segments from the play, Edgar, the long lost son of old, blinded Gloucester, is referred to as "poor mad Tom" (for he went under the moniker of Tom O'Bedlam); to this slight, the ever self-effacing Edgar mumbles to himself the lines above. Basically, he says, yes, he was poor; yes, he was crazy; yes, unfairly accused of plotting against his father, he was unjustly deprived of all his fair share of creature comforts - but still, as long as he possessed the mental faculties to understand and verbalize that "This is the worst", this, clearly was not the worst. 

Unlike Edgar, who was, hopefully, trying to put a positive spin on things, I think, this not being the worst is actually a bit of a scary situation. Although now I think I am in a difficult situation, things are about to get a whole lot messier once I do take the plunge. I have to, at some point in the future, quit my cushy job, and try to find clinical observerships in the US (which are getting as difficult to land as a residency slot); I have to save every penny I can manage, in order to continue paying the substantial loans I accrued as a student; I have to scrounge every morsel of time I can find in order to maximize my studying; I have to work that much harder in order to keep up with the rush of work that promises to inundate me at my job... I am not even contemplating the difficulty of getting back into the swing of things, starting with studying for the USMLE, with subjects that I have left ling behind in my past. Things are about to get a whole lot worse for me, and very rapidly so, too!

If I ever needed strength of resolve, it is now.

The Last Lazy Weekend

As I have mentioned, it is getting closer to tee off time for me, and in anticipation of that, I gave myself the treat of a lazy weekend. After a rollicking Saturday, I settled in to have a mellow Sunday, without much to do. Spent an awful lot of time reading old Calvin and Hobbes strips (yeah! I know!). And of course, how can one not be hit right in the feels when reading the last (real and fake) strips:

Bill Watterson's rather optimistic last strip

An anonymous fanfic final strip - depressingly real

Ah. Reliving these moments for the final time before I have to purge them from my system for good!

Saturday 14 May 2016

Gearing up...

Image credits: Science All
Of late, my work days have been thrown off mainly by the insane levels of work I have been bringing home from my office. I have ended up burning the midnight oil just trying to clear out the debris left over from the work hours. This tends to happen in every small, lean research team, especially if you happen to be the type who is motivated to spend more time working on stuff in the hope of landing that big publication you have always dreamed of.

Anyway. I decided to hit the reset button this weekend. Totally switched off from work mode today - something that I NEVER do - and I decided to spend some time lazing around and just slacking off. I was so pleasantly surprised by this alien feeling of having a whole day and doing nothing, that I even wrote a blog post about it! Yeah! I was THAT lazy today.

But, as the evening draws her cloak of darkness around me, I have to figure out a way to streamline work and studying for USMLE and life - all very complex affairs for me at the moment. I am trying to put things in perspective, and lining up my priorities in order to have a more balanced approach to the next few months. It is already the middle of May and if I have to take the steps this year, I need to be able to start studying in all earnest. As an IMG, I need to beat the mean by a fair distance, and as an old IMG, I need to keep working away to justify why people should choose me over young blood.

Massive insecurity, fears and apprehensions plague me as the time comes for me to gear up to slay this USMLE beast. Tomorrow, the work starts. I shall possibly make up a schedule for the upcoming week and see how things can be worked out in the context of the time I have available for studying. This is not going to be easy. At all...
Posted on 12:06 pm | Categories:

That Inertia of Lethargy

Image Credits: Word Mall
Alright so every week I make up my mind to make better use of my weekends, and when the weekends eventually come around, I end up lazing around the whole of it. Today, for example, it seems that all I shall manage to do is spend an hour and a bit at the gym (not that it is helping - I still am the same weight I was when I joined last month! Wonder what is going wrong - can't be all the pizza I am eating!). 

As a classic procrastinator, when I did eventually manage to pull myself out and get to the workbench, I ended up tending to my new blog. Awwww. 

But seriously, it is time to pick up the slack, especially around the weekends. In all probability I shall remain swamped with work over the next month and a half, making it essential that I make the best use of every little second I have at my disposal. 

I think I shall start doing that from tomorrow though. Today, I, umm... come on. It is a new blog!!!!