Krupali K. Tejura, M.D.

A Simple Hug

2012-02-13T19:59:00.001-08:00

I hug patients.
This simple act transforms the patient.

A simple hug.
This act conveys so much.

A simple hug.

---

I recently met a 70 year old woman who looked angry the first time I met her. She didn't want to have cancer, she didn't want to come in daily for 6 weeks for radiation therapy, she was OVER it. I understood.

I read her eyes.

I addressed her anger.
I asked her if she was upset...then I gently asked if she was scared.

She shuddered, and I saw her eyes.
Tears were forming.

Instead of talking to her, I simply asked if I could hug her.
She softly said yes.

We hugged. I didn't let go until she did.

She softened up a bit.
I actually saw a smile.

We talked for a bit and discussed how to fight the disease.

---

She started her treatment the following week.
After her first treatment she wanted to see me.

I saw her, and she said she had a gift for me.
'Oh thank you but I don't need anything,' I told her.

She said, 'No, this is for you.'
Inside a bag was a gorgeous poem inside a beautiful frame.

The poem was about hugs.
A poem for those who like hugs.

My eyes filled with tears after she said these words,
'In my 70 odd years I have never been hugged by a doctor, and I just wanted to say thank you.'

---
Hugs.
They matter.
A lot.

Dying Alone

2011-12-13T18:34:00.000-08:00

Death. We all face it. Nobody is immue. To die alone is one of the saddest things I've ever seen. Watch this beautiful story about the VA promise to never die alone.

How Doctors Die

2011-12-06T19:08:00.000-08:00

I think this is a very important, eloquent, and great article to read. I'd love to know your thoughts.

The Phone Call

2011-11-28T18:26:00.000-08:00

**All names obviously have been changed, as in all blog posts if I do mention a name**

"Dr. Tejura, Brandy's sister is on the phone, she wants to speak to you," my nurse told me.

My heart sunk.
It actually plummeted.

I knew what this phone call was.

"Hi Irma, how are you?", I asked.
"Hi Dr. Tejura, I'm hanging in there. I just wanted to call to say thanks for visiting Brandy last week at home. I wanted to let you know she passed the very next day....."

The rest of the conversation we talked about the rest of the family, how everyone was doing, including the newborn child, the other children, brothers, sisters, and Brandy's mother.

Just last week, a stranger had emailed me asking about her and how she was doing.

Why a stranger was emailing me about Brandy is a beautiful story in itself.

---

I met Brandy a little over 6 months ago. She was in her late 30's. She had just delivered a baby, but while pregnant she was diagnosed with breast cancer.

She wanted to delay treatment after the baby was born. Chemotherapy immediately began. Unfortunately by that time, the cancer had spread to several parts of her body.

Could she have stopped the cancer from spreading if the therapy had started earlier? I do not know. That was Brandy's choice and we must respect it. And honestly, that's not the gist of the story.

I treated her palliative to an area, and she did well for a bit. She returned less than 2 months ago for treatment to other sights.

She was progressing more rapidly. You could feel the fatigue, you could sense the decrease of energy, you could see her eyes which were full of sadness.

She was going through so much physically, emotionally, and personally. So much other things were going on in her life on top of this cancer that honestly, I didn't know where she garnered the internal strength to fight. It was truly admirable.

We both found out we had attended the same high school in different years, we had a kinship. I grew close to her and her family members who brought her for the therapy. We talked, we talked about everything. Life, lifespan, hope, her kids, and what the future held.

The conversations at time were difficult and not very easy.
The conversations at time were things I didn't want to talk about, but knew it would be important for her to hear.

She knew it was difficult for me sometimes to talk about certain things. Her response was always, "I know this is hard for your but I appreciate you being honest and caring for me. I love you Dr. Tejura."

During one of the visits I asked her if she had any crazy dream or wish.
She responded fairly quickly with this response, "I would love to go to a cabin near the mountains for a few days and spend some time just with my family, the kids, brother and sisters, my mom...."

I looked at her and her sister Irma and told her, "I'll figure something out...I don't know what will happen, but we'll make it happen."

I knew the time was short.
This dream would have to happen after her last radiation treatment.

I went online, cabins ranged from 2000 to 3500 dollars for the week.
What could I do?

I asked a few people that I spoke with at INTEL. Many were generous and agreed to raise the funds.

But then, magic happened.

That same afternoon I asked Brandy about her dream, I met a nurse Bob that I work with that afternoon and I asked him if anyone he knew had a cabin in the mountains nearby. I told him I needed it for a patient.

The next morning he handed me a piece of paper with a name and a number.

"This is my friend Cathy. She has a cabin where you are looking for....I told her about your patient and she doesn't mind the patient and her family using it... call her," the nurse said.

I called Cathy.

"Hi Cathy, this is Krupali Tejura, I know Bob and he mentioned you have a cabin that you don't mind a patient of mine using...."

After figuring out logistics, she was generously offering her cabin to my patient the following week, a day after Brandy finished radiation.

I told Brandy and her family. They were ecstatic.

They went to the cabin, and by sheer coincidence, it happened to be Brandy's birthday the Saturday they were there. They got to celebrate it together.

They returned from the cabin, and Brandy was hospitalized. She was then sent to home hospice. She passed away peacefully a few weeks later.

----
I have yet to meet Cathy in person to say thank you. Cathy was the person sending me the email asking me about Brandy last week. I sent Cathy & he family a gift and a note of how generous it was to open her home to a stranger's patient. That her gift and kindness and trust was truly remarkable. It was inspiring. It was magic.

As I was leaving Brandy's house last week, I saw pictures from the birthday celebration that she had in the cabin, I saw the cake, the candles, and the smiles.

The smiles.
I will always remember her smile.

Strength, Courage, Hope

2011-11-17T19:12:00.000-08:00

Yesterday I got a call to see a patient with SVC syndrome. They were in their 60's, a longtime smoker, and no prior diagnosis of cancer.

The CT scan showed the large tumor invading her lungs, encroaching upon the superior vena cava. It was ugly. Pathology was pending, and a brain MRI was too.

Both came back positive.
Cancer.

Lungs and brain, making it a dreaded stage IV.

I met the this patients daughter and sister today.

I gave her the results and wanted to start radiation therapy to possibly relieve some of the pressure of the tumor, shrink it, make it better for her to breathe, and hopefully slow the tumor growth.

When I walked in, I saw fear as I started to talk. Nobody had told her the results. When I started to give her the information, I told her it was cancer and that it had spread to her brain.

"So what does that mean?"

I told her it was stage IV, and as gently as I could tell her it was not at the 'curable' yet we would do the best we could to give her the best and longest quality of life she could have.

I heard some crying, her daughter got up and left the room.

As I finished talking to the patient, I told her I was leaving to find her daughter. My patients words were, "She's going to need help... I just lost my husband to cancer last month."

I had no words.
I had to bite my lip to stop from crying.
Internally I wanted to yell at how unfair this was.

I found her crying in the hallway.
I held her hand and then we hugged.
She did not let go.
She cried and it was so hard not to shed tears with her.

I can't even imagine the pain she is going through.
I can't even imagine.

If you can, please send this family some love.
Some strength.
Some courage.
Some hope.

Hope.
I truly hope and pray that my patient fights to the end and she is here for the longest possible time.

I hope.
I pray.
I wish.

I Need Help

2011-10-17T18:56:00.000-07:00

I saw a patient and his wife recently. The husband had a horrible cancer that was growing through the chemotherapy. He had been sent to me by the medical oncologist to see whether or not I could radiate and palliate some of the pain that the tumor was causing.

We were going though the history and physical examination and then I sat down to go over the treatment plan with them.

As I was speaking I looked over at the wife. Her eyes showed something that unfortunately I have seen too much of.... her eyes were full of fear and sadness.

I asked her, 'Are you okay?'

Tears welled up in her brown eyes, and were running down her cheeks under her glasses.

'I need help. I need support. I don't know what I can do anymore...' as she said these words, I went and grabbed her shoulders.

'Can I give you a hug?' I asked.

She held onto me for minutes. I didn't want to let go until she did.

'Take some deep breaths.... breath deeply' I mumbled.

After she let go, she held my hand, 'I haven't said that in the past 2 years we've been going through this....I'm sorry for crying...'

'No need to apologize, and I'm glad you did. It can be overwhelming, and really difficult. I don't and can't even imagine how you're feeling right now....' I said with tears in my own eyes.

I gave her the number to the American Cancer Society which runs support groups for spouses and patients in the area. I told her if that didn't work to come back and I would give her more options.

I told her husband that he was indeed lucky to have this woman by his side, as his rock and anchor to help him through the treatment. He shrugged, and sadly smiled... not knowing what to say.

I told his wife to come daily to me for a hug and that if she needed anything we'd try to help her though this difficult time.

The tears the worry in the eyes the fear and the sadness.... emotions that cannot be hidden by the eyes. The eyes truly speak the truth.

Gift Cards of Hope

2011-09-22T23:29:00.000-07:00

A few weeks ago I met a woman who was being treated with radiation for cancer. She was suffering from side effects of diarrhea secondary to the fields we were treating her with. I sat down with her talking to her about diet, and to avoid certain food (fibrous) to try to slow the side effects along with some medications to help her.

She got quiet all of a sudden when I asked her what foods she was eating.

"Well we are in the process of losing our home, and right now food is coming from the local food bank...," she said softly.

A lump rose in my throat. She was eating whatever she could receive from the food bank, and here I was making restrictions on what I recommend her eating.

I looked at her and said, "I'll help figure something out.." not knowing exactly what I'd do.

Later that evening I went to the grocery store and got a gift card for her. I placed it in an envelope and gave it to her.

Afterwards I put on my Facebook status:

Just met a patient who is terminal, losing their house & goes to a food bank. They can't afford the proper diet to help the side effects from the radiation I'm giving them, need gift cards to grocery stores if anyone is interested in contributing. Let me know, thanks!

The response from this was overwhelming. A friend put it as her status update and she got several responses as did I. It was very heartwarming to know that people wanted to help.

Every few days I'd either get a check or a giftcard in the mail with messages telling me 'thanks for allowing me to help'. I mailed the cards to this patient. I recently got a letter from her saying she and her husband ate a few meals that they both had been craving. Some of the cards were from people who I didn't know and had never met. For them to give and trust was truly remarkable. Kindness was pouring through.

Little things like this have helped this particular patient throughout this difficult time not only mentally but financially. It was a beautiful way social media yet again has helped someone.

Thanks to all who contributed, and thanks to those who sent their wishes and kind words. Being kind matters, it really does.

-Krupali

Celebrating Life

2011-08-11T18:10:00.000-07:00

I've been getting slammed with new patients, most of them with newly diagnosed with terminal disease. Today was no different.

I received an urgent phone call to see a patient who was admitted last night and having difficulty with memory. A CT of the brain showed lesions that should not be there, tumors which were growing causing pain and swelling. Scans were done of the rest of the body and there were tumors all over the place.

I went upstairs after reviewing the scans, a biopsy of an area to get tissue for a diagnosis was still pending however I wanted to introduce myself.

I went upstairs, met the patient and their lovely family. They stared at me as I explained what was going on, and what we were likely planning on doing for his probable cancer.

'So doctor am I cureable? How long do I have...' asked the patient as the family watched.

It is always so hard to tell someone and their loved ones that no, they are not curable and that we are fighting to keep them comfortable for however long they have.

When I said no, that this was likely not curable, tears started streaming, from the spouse, and then all the children....the patient himself was stoic. They had more strength emerge then I had ever seen in someone.

I took the family outside and to hug them....as I spoke with the spouse and met several of their kids I found out it was their twins 20th birthday they day before when there dad was admitted to the hospital.

I smiled, and internally I was crying because I know that this would be likely the last time they would celebrate a birthday with their father.

I left the floor and headed back to see other patients, but I had a plan already in my mind.

After my last patient, meetings, and finishing charting, I went to the grocery store. An ice cream cake was bought along with forks and other shenanigans to celebrate a birthday.

I went back to the hospital, by that time over 30 family members were waiting in the waiting room, and I smiled as I walked in, asking them all to come in. The twins were surprised, I handed the cake to the patient and told him that he needed to celebrate the birth of his kids with his family.

To see 30 people sing their hearts out in a hospital room, smiling beneath tears was an incredible moment for me... not as a doctor but as a human being. I got to meet every single person and tell them what an honor it is to treat their loved one as well as celebrate a happy occasion (despite the pain).

Caring makes a difference. Caring as a friend, a stranger, a caregiver, and just a neighbor. Remember, people are people.

I hope that this family finds strength in numbers and can fight this battle with grace and love. I know that they can, I hope they know that too.

Needs YOUR Help

2011-07-14T13:24:00.000-07:00

Imagine having a child undergoing therapy for leukemia and then having the mother diagnosed with a brain tumor, unable to afford surgery.

Nightmare?

Unfortunately it's reality for a local family.

Here is their story.

They need YOUR help.
If you can, please send whatever you can, every little bit counts.

Thanks,
Krupali

Frustrating

2011-07-06T09:46:00.000-07:00

I recently saw a patient who had a cancer that needed chemotherapy and radiation for possibly a cure to their tumor. They had just seen the medical oncologist and refused chemotherapy. The patient was then sent to me for possible radiation treatment options.

I was quite blunt with the patient.

"What do you want out of life?," was a question of mine. "What is your end goal?". They had a sibling going through the same cancer and didn't want to "look sick". I urged them to go back to the medical oncologist to once again go hear the chemotherapy options.

The medical oncologist and I did a pow wow session, where we both know that if this patient refuses the chemotherapy that their chances for the cancer to recur were sky high. It was a no brainer. A no brainer.

The patient again refused the chemotherapy and came back to me. I told them the facts, and said I could give the radiation alone but the treatment would not be as effective.

They agreed to the localized radiation.

Treatment started, and five treatments in, they called to say they didn't want anymore radiation because it was causing deformity in their skin (something I refuse to believe as five treatments would not cause this).

I called the patient to talk to them.

"I just want to make sure that you want to stop radiation therapy. What are the reasons?" They said their skin was getting 'deformed' and that they cried all weekend. I again urged them to come in so we could talk about it. They refused.

Some patients get diagnosed when they are incurable, and they have no choice of all doors open to them for potential cure. Some patients don't get this choice to live. When people who do have all the options available but refuse, it makes my heart hurt.

This patient has children. This patient has a family. This patient is a human being that I want to help.

It's extremely frustrating when they refuse, because I, along with everyone else who has tried to help and treat them, know what is likely going to happen sooner then later.

It is their life, their body, their choice.
No doubt.

However, I still don't understand, and I don't know if I ever will.

July 1st

2011-07-01T13:51:00.000-07:00

My first tweet this morning was this:

It's July 1st. Stay away from hospitals. Interns start today :)

This tweet brought back a flood of memories from my first day intern year. It was a memorable, full of ups and full of downs. Learning how to deal with all types of people, from the nurses on the floor you were on that month to the residents you were working under to the auxiliary staff, and of course first and foremost with the patients themselves.

My morning that first day as an official 'doctor' was surreal. It was at the county hospital and we had a meeting early in the morning at 7am. I walked into the little room, it was filled with 30 other faces who looked just as scared as me. "What am I doing, I am supposed to have the answers...yet I KNOW NOTHING!" was running through my own head.

People were sitting around the table waiting for the Chief Resident to give us pearls of wisdom and a pep talk before we headed out to the 'big bad world of medicine.'

I saw a friend who had an empty chair next to them, they motioned for me to sit there. I grabbed the chair and sat down.

THUMP.

The chair was a broken chair, legs collapsed and my ass was on the ground. No simple or kind way to say it.

I couldn't stop laughing.

The thoughts running through my head were, "My ass starts on the ground the first day, this year... can only get better, right?"

People laughed, as someone helped me up.
Seriously. Really? Could it get any worse?

Oh... good times awaited me that day.

On my white coat I had 2 pins on it, one from my undergrad and one from my medical school. I was a proud CALIFORNIAN, and being in a different state was 'foreign' :) (Those from California understand).

I met my resident and the other intern who was going to be my partner in crime for that month. We were the lucky ones who were not only starting that day on the wards, but we were also on long call, and had to admit patients. (See how lucky I am?)

My resident looked at me and my pins and said, 'Oh you already want to go back, eh? From now on you'll be known as California girl.'

I gave him a weak smile. Yeah, I missed the beach, my friends, my family.

I went to go see my first patient. An elderly gentlemen admitted for chest pain a few days prior. I wanted to introduce myself and examine him. "My very first PATIENT!" was what I was thinking.

I told him who I was and timidly began to ask him questions. He was a Rastafarian, dreadlocks, seemed happy, and was just 'hanging out' in the hospital bed at 8am. I began to listen to his heart and lungs, and then I felt for edema on his lower extremities. He was wearing jeans, and while examining him, I felt something along his left leg.

I lifted up his jeans. There, stuck to his leg, was a can of beer. A can of beer.

I said gently, "Um sir, I don't think you're allowed to have beer in the hospital on the floor as a patient."

He glared at me.

I repeated to him that I didn't think he was allowed to have it.

What happened next was surreal.

"F*ck you, who the F*CK do you think you ARE? It's MY BEER and I'M GOING TO DRINK IT RIGHT F*CKING NOW!"

He grabbed the can out of my hand, cracked it open and started chugging it. I ran outside the room looking for my resident.

"Mr. X is chugging a can of beer, is this allowed," (boy was I naive!), he laughed and followed me into this mans room.

"Now Mr. X, it's Dr. Tejura's very first day as a doctor, and you're her very first patient. You know there is no beer allowed on the floors...and stop cursing at her."

I walked out. I felt like a complete failure. I had no idea what had just happened or transpired.

That was just the beginning of the long day which was to follow.

It's July 1st.
July 1st.

Welcome to the 'big bad world of medicine' interns. I wish you all the luck, laughs, development of thick skin, and perseverance in the world. You will get through it. You will look back on the year and the very first day with laughs. It will and can only get better.

Promise.

Questions

2011-05-26T09:29:00.000-07:00

“Life is full of ups and downs. The trick is to enjoy the ups and have courage during the downs.” - Unknown

Many people with many stories have walked through my clinic doors. Every single one impacts me in some way, shape, or form. One of the cases that has recently impacted me is of a young mother of a newborn that was recently diagnosed with stage IV incurable cancer.

How do you tell this mother of a 1 month old that she may only have a few months to live? How do you tell her not to lose hope or faith? How do you give her a timeline of living each day to the fullest and not to leave any stone unturned?

How do you react when she is crying, saying, "I wanted to at least see my baby be 10 years old..." How can your own heart not break?

How do you go over lab and imaging results which give more horrific news? How do you remain realistic yet wanting to give them hope? How do you not break down yourself?

How can you not feel their pain, their fear, their sadness, their anger? How can you not feel their strength, courage, hope, and spirit?

I don't have answers or responses... just questions.
Lots and lots of questions.

Generosity

2011-05-17T15:26:00.000-07:00

A few days ago I tweeted how my heart aches when I see some patients undergoing cancer treatment alone. Some cancers are a bit harder to fight then others, and seeing someone alone during this difficult time makes me sad.

Well I got a response from Kelly (@craftyb on Twitter) who said she would love to have her kids make a card for a patient. I was overwhelmed. Really? I told her the gender and age range of the patient, and that was it.

Today I get the amazing, yes AMAZING card in the mail. Her kids, Wyatt, Chloe, Avery, & Morgan sent one of the most beautiful cards to a stranger. I must be honest, I wanted to keep the card for myself :).

Ironically this patient was admitted to the hospital last night, so when I went to see them today, I took this kindness card with me. Let me tell you, it lit up their face. I placed it nearby so that they always will remember that there are people who care about them and are pulling for them.

The timing could not have been better.

So I say this:

Dear Kelly:

Thank you for reaching out with kindness, and teaching your kids that doing something for a stranger can and will make an impact. What a beautiful thing to teach your kids and what an impact they left on me and a stranger who they will likely never meet. They are little heroes in my book and you as their mother are the most amazing teacher.

With Love,
Krupali

Music Until The End

2011-04-21T16:54:00.000-07:00

These past few days have been hard for me. My 'Music of the Heart' patient was placed in hospice a few weeks ago, and yesterday out of the blue I gave her a call. Her daughter answered saying, 'Mom isn't doing too good.' I told them I would drop by after work.

Before going, I had my staff who knew and loved her sign a card, and I bought some Easter lilies. I went to her home after work. When I walked inside, her loving husband said, "She's so excited that you said you were coming, we told her this morning and she perked right up!"

Tears were shed before I entered her room. There she lay in a hospital bed, oxygen tubes in her nose, but there she was, I entered and she smiled.

I smiled right back.

Immediately I went to her and hugged her and gave her a kiss.

"I love you," she said.
"I love you too Miss," was my reply through a mess of tears.

She asked about my mom who she met at the Andre Rieu concert in December. I immediately called my mom and asked her what she was doing. I then looked at my dear patient and said, "well forget about asking about her, how about I go bring her to see you personally within an hour?"

I immediately left their home and drove the 30 or so miles to pick up my mom. We both entered the house 90 minutes later. We each took a hand, smiled, laughed.

I knew she hadn't been eating much, but I knew how much she loved a particular food. Last October I surprised her and her husband on their 62nd wedding anniversary with a large chocolate cake. She couldn't stop talking about chocolate cake for weeks aftewards.

I held her hand and asked her if she craved anything. She thought a little bit. I said, 'What about chocolate cake?' Immediately she smiled and nodded her head and said okay with a grin.

I asked her husband where the nearest grocery store was. I left my mom holding her hand and went to the bakery of the store and got a gorgeous cake and inscribed it with the words "We love you".

She took a look at the cake when I got back, and smiled. Then we cut her a large slice. My mom and I and her granddaughters and daughter all fed it to her until she finished the entire piece. It will be a moment I cherish forever.

As we left, I promised her that I'd be back tomorrow. I smiled as I told her to stay out of trouble and behave for me until I returned. She laughed as did I.

---

That same evening I emailed a violinist Robert Gupta who plays for the LA Philharmonic. I have never met them, but knew of them via a friend. I explained the situation and asked if they would be so kind as to play for my patient via the phone/skype/etc. He replied with enthusiasm that he would love to. I knew that she was critical so we set up a time the next day in the early evening for him to play for her. It was quite kind, and I was excited to share this with her the following day.

----

The next day I went to her home with my phone in hand, wanting her to enjoy the music. As I entered her granddaughter said to me, "The priest already came...she's taking her final breaths...go in."

We all cried...as I walked in, she wasn't alert...she was taking breathes. Her family invited me to hold her hand, and I held it and prayed.

I got Robert the phone and he played for 5 minutes, 5 beautiful minutes via speaker phone for all of us to hear. Gorgeous notes played from the heart who's sounds touched every single person in the room who surrounded her then. All of us took joy mixed with solace at the music being played for her.

She then, took her final breaths.

---

I cannot put into words how precious this entire journey has been for me personally. It reinforced for me how important love is, how incredible family/friends/people who care (even if they may be people you have never met). So many amazing people came together for my patient--so many people around the world sent their love, thoughts, prayers, kindness, and strength.

Late last night I received a text from Robert, the violinist. It said this: "Krupali, Today changed my life forever. Thank you."

To those words I humbly say this: thank you to everyone who changed so many peoples lives with this story--changed them for the better, changed them for good, and changed them with kindness.

With Love,
Krupali

Happy 5th Birthday Twitter

2011-03-13T21:13:00.000-07:00

It's the 5th birthday for Twitter. Here are some interesting insights into the history of how the entire concept got started by one of the founders, Jack Dorsey.

After reading his tweets, I wanted to share my 5 reasons why I love Twitter. Sure, Twitter wasn't easy for me to understand the first few years. (Twitter isn't intuitive, it took me a few years to finally get a handle on who to follow, what to say, and how, and get a read of what was going on.)

So, here they are. 5 reasons to celebrate the 5th birthday of Twitter:

5. Twitter for me is a platform to the world (If, of course you aren't private). Your voice gets heard all over, from people who you know, to people who you don't know. This is much different then Facebook which for me is purely for people who I know and have met in person.

4. It's an amazing way to receive news feeds and updates from stories that are happening in the 'now' rather then waiting hours to hear updates via TV or even the radio. I first came across the usefulness on this front during the 2008 Mumbai terrorist attacks. My parents were traveling in Mumbai at the time and getting updates via tweets from people on the scene, news agencies was quite helpful. I was reading tweets on one screen, having IBN international news online on another. The tweets were at least an hour, if not more, quicker with the information then any TV station.

3. I use it to share information about life, thoughts, and just randomness. I follow people who are funny (@rainnwilson), people who share insights about their struggles, triumphs, people who inspire (@corybooker), and people who are just simply 'people'. I love to learn, and perusing interesting feeds (@breakingnews) just keeps my neurons in check. I get to share my feelings of the world, ongoings, life, and musings as well. To have the interaction with your followers is quite profound at times.

2. It has been an incredible platform to share my blog posts and make dreams come true for several of my patients, and other people around the world.

1. I have 'met' incredible people on Twitter that have sometimes transpired to amazing in real life friendships. (@padmasree, @caroline, @ed, @om, @ktraphagen, @anandc, @nilofer, @jeffjarvis, @jeffpulver, @jessicagottlieb, @monkeycageuk) I am sure I've unintentionally left a few people out (please forgive me!), but these are just some of the incredible people who have become great friends. These are spheres of people that I don't obviously have a connection to (aka most are in tech, other industries, quite far removed from medicine and what I do, yet we all connected as people, which is beautiful!). It has also helped strengthen friendships with people who I knew off Twitter who I follow as friends (@desinole, @saketvora, @trel, @chhabs, @sree).

The past 3 years for me on Twitter have been in one world: awesome. I hope that I get to share in many more birthdays!

I Will Miss You

2011-03-11T18:17:00.001-08:00

This week was extremely rough in clinic. Many dear patients are slowly losing the fight against cancer.

One couple came to me, she in a wheelchair, and he pushed her in the room.

'How are you doing?,' I asked.
'Not good....I fell today...,' she said. I noticed bruising up and down her arm.

'When can we stop therapy? I'm tired,' she said, with a look of sadness in her eyes.

Her scans were not good. Prognosis was dismal.

'Whenever you want. I want you to be comfortable,' I said while holding both her hands staring into her eyes.

She had tears and she said, 'You are so awesome, you got me this far. I am going to miss you so much when I'm gone.'

I started crying as she said this. I couldn't stop.

She looked over at her husband lovingly and said, 'He cleans the floors and things since I can't do them anymore.'

I smiled and said, 'They don't make them like that anymore.'

As we both wiped away our tears, we chatted some more.

When hugged our goodbyes, her husband said, 'Thank you for being my crutch for this entire year, I don't know if I could have done it without you.'

They left, and I came into my room and just bawled.

This week has been extremely rough....it's never easy to say goodbye. Ever.

It's Hard

2011-03-10T20:11:00.000-08:00

Today I passed one of my favorite colleagues in the hallway of the hospital. We usually catch up on politics, life, and the going ons of the world after a good hug.

Today was different, I read their eyes after my hug and instead of a sparkle, I saw a dull sadness.

"How are you," I asked.

"Sad," they replied.

I found out that their best friend had cancer and was now in the final stages. They were having seizures, from the tumors in the brain. The response was dwindling, and he knew that the end was near.

"We started work at the same time, we're the same age, and it's so hard for me to see them this way," my colleague said. "It's so hard on his wife, his family......." they continued with the story.

All I could do was hug them harder.

I told them to talk to me whenever needed and that I was sending their friend and the family my thoughts and love.

Cancer.

It affects everyone.

Everyone.

Interview

2011-03-07T07:01:00.000-08:00

After my TED You talk this past week, I was invited to do a radio interview. Here is the link to it.

Hugs not Handshakes

2011-03-06T12:09:00.000-08:00

Hugging patients is common for me, hugging people just is a nicer way to interact then a simple handshake.

This past week at the TED conference I hugged several people. My new motto became, Hugs not Handshakes, which led to this new 'idea worth spreading'

TED 2011

2011-02-17T11:10:00.000-08:00

In the next few weeks I'm going to be attending a few special conferences. One is the TED conference, a week long conference with people full of amazing and inspiring ideas, and those who make me think. I attended last year, and it was life changing. It's my brain candy.

This year I'm giving a 3 minute talk to the folks at TED Active in the TED You series. Very excited and nervous to say the least.

----

Update:

I'm currently at TED, and loving every minute. My talk for TED You is done. I've received lots of input, and kindness. Overwhelmed.

You Were Always My Hero

2011-01-28T19:34:00.000-08:00

This afternoon I was in a business meeting with my staff, and the front desk nurse popped her head in and said, "Dr. Tejura, a patient who passed away this week, her husband is here to see you."

I immediately excused myself. I knew who this patient was. She was a kind woman, a woman who was well known to me. A woman who had battled cancer for over a decade. A woman, despite the pain the cancer was causing her, always showed up smiling with her hair done, make-up on, and dressed to the nines.

The last time I treated her was a little over a month ago. I remember talking to her husband as she was getting treated. We talked about how they met, to how many children and grandchildren they had, to what they planned on doing next.

"She was my first and only date," he told me. "We married at 17 years of age, while still in high school, and here we are still strong as ever." I remember hearing these words in awe....what an amazing story of the strength, and their power together.

-----

Today I saw him, I saw a few tears in his eyes. We hugged, and I started to have a few tears coming down my face.

"Dr. Tejura, I wanted to come by today to let you know that your hugs and the last time we talked really meant a lot to me, I wanted to say thank you. Thank you for caring. People and other physicians need to learn from your example."

I was stunned. I muttered "Thank you" under my breath.

We hugged again.

"I have no regrets, we both did everything she wanted to do. Our bucket list is complete. No stone left unturned."

They had traveled, gone on cruises, been fortunate to get a dream home which she had the pleasure of decorating all of last year.

"I truly know what it means 'in sickness and in health' after this experience, and I am so lucky to have chosen her...." he said.

I started tearing up again.

"In the last month when she was in home hospice, I spent every waking our with her, getting only 2 hours of sleep if that...."

I asked if she left peacefully.
She did.

"Her last words to me before she passed, "You were always my hero."

I could not stop crying after that.

----
This man shared a life with an incredible woman, a woman who was taken from him by such a horrific disease. He stood it out with her, took her to every therapy, they tried everything she wanted, and both of them never gave up.

He was her hero....and she his.

Both of them are some of my heroes. They have taught me a lot about life, and will continue to do so.
----

May we all be so fortunate to find our heroes, our backbones, the people who truly understand the words 'in sickness and in health.' May we find people who make us realize what is important. May we find people in life who make us aware of what really matters.

Happy Birthday

2010-12-10T06:40:00.000-08:00

A few months ago, I saw a patient in followup. I asked her, 'What are you doing for the upcoming holidays?'. Her response, 'Nothing, I'll likely bake my birthday cake. I was born on Christmas you know...'

My heart broke when I heard these words. I knew she was a widow and was alone. I learned she didn't have family nearby. So I told her, 'I will bring you a cake and we'll celebrate together.' I learned her favorite flavor of cake and we laughed.

I then asked her what, if any, dream she had.

'Well, I am likely too old for this, but I've always dreamed of having a surprise birthday party. You know where I'm really surprised....'

I laughed with her and said, 'Yeah, you're likely too old for that but that's a great wish....'

My wheels started spinning as I said those words...after she left the appointment I went to my nurse and staff and said, 'We're going to throw this patient a surprise birthday party...'

They all laughed....because they knew it was going to happen...and of course they would also be involved.

That afternoon on Facebook I said these simple words in my status update:

"Next patient dream is throwing a patient a surprise birthday party."

What happened next really made my heart smile. A friend from Atlanta, someone I hadn't seen for a few years sent me a message saying she'd like to donate some money to offset the cost of the party, even though I didn't ask for anything. It was kindness and something she wanted to do.

Then I got a message from an elementary school friend, someone I hadn't seen in over 20 years. She lived nearby and bakes professional cakes as a hobby. Her message to me was, 'I'd love to bake the cupcakes/cake for the party, just let me know what you need...'

I was overwhelmed with the support of friends, some so far away yet wanted to contribute to the joy.

That same week we decided to throw the party, I was asked to speak to a few classes at a local high school. I talked about science, medicine, and emphasized the need to care for people. I then threw it out to the the kids in the audience, I told them, 'I'm throwing a patient a surprise birthday party in a few weeks, if anyone wants to come, be there for cake & pizza, please do...'

The response was overwhelming. I got bombarded with emails from students and teachers about wanting to help.

We finally figured out a date for the event, but how was I going to get the patient there?

I called her up the week prior and told her, 'Remember the cake date? Well thats going to be on December 9th, is that okay with you?'

She was stunned. Stunned that I had remembered and that I was calling... I asked her, 'Whats our favorite flavor of cake....whats your favorite color' (As I needed to tell my baker friend these details). My patient didn't know how to respond. She was too shocked that I had called her.

Earlier this week she dropped off a note for me, saying 'I don't feel too good and don't think I can come December 9th....'

My heart sank and I went into panic mode, I didn't know what to do.

I called her and said, 'I got your lovely note, but you have to come, I'll bring you medicines and we must get you there. One of the therapists is coming too, you can't let them down!'

She agreed....and the next day I went to her house to make sure she was okay. She was okay. Stunned that I now was at her house, but she was OK.

-----

I got her to the location of the party, a local family operated pizza parlor. When she entered and I took her to the location, people yelled surprise. She was a bit frazzled as she didn't know who it was for...then she saw her cake with her name on it, and was completely and utterly overwhelmed.

I had never seen her smile so wide and so bright. It was joy beyond words.

20 high school kids had come, current and former patients were there, friends, family, and friends of friends had come. Doctors, nurses, therapists, all had come to wish her a happy birthday.

'I didn't know I had this much family,' she said.

I told her she was loved, she mattered and we cared. She was important to me and the rest of the people here.

For us to watch her open her gifts, her cards, cut the cake, and mingle and meet her family was such a gift. As she spoke, tears came down her face.... and tears came down our faces as well.

'I will never forget this as long as I live,' she told everyone. As people said goodbye at the conclusion of the party she refused to say 'goodbye' to them, only, 'see you later'.

Words cannot properly express my gratitude for everyone who came, sent their wishes, love, and thoughts to make this persons dream come true.

It was magic.

Pure magic.

Full Circle Moment.

2010-12-03T06:13:00.000-08:00

Last night, my "Music of the Heart" patient Thelma (read the link for the backstory) and the man she's been married to for 62 years, Jim, attended the Andre Rieu concert. She made it and fought for 6 months, despite the terminal disease that is affecting her body. Watching her and her lovely husband at the concert brought joy to my heart like no other. Their eyes were wide, their smiles large, and their excitement palpable.

Andre Rieu read my blog post above, and gave her CD's, DVD's, VIP tickets to the concert, and graciously offered for all of us to come meet him backstage aftewards. It was something that we had arranged 6 months ago when she was diagnosed with the terminal cancer, and a moment we all hoped and dreamed would come to fruition.

Before the show, we all went to dinner, along with the patients daughter and son-in-law. It was nice catching up during a meal, talking about life, making jokes, and just being happy that she was here to attend.

If you recall the patients very first words to me from her when she was deemed terminal from the cancer, over 6 months ago, were, "Doctor, will I live long enough to go to the concert in December?"

She made it.
She did it.

Not only did we get to see the concert from amazing seats, but after the great show (if you are near a city where Andre Rieu is performing, it's a must see, go go go!), we went backstage and hung out with the orchestra and finally we all met Andre!

Andre was very kind to her, helped her walk to get a picture taken and walked her back. He joked that she needs to listen to his CD daily and waltz with her husband, and he said he can't wait to see her again next time he's in town.

She was overwhelmed with joy. Her husband was overcome with happiness. All of us were truly for this moment to have come to fruition.

I cried during the concert when "Amazing Grace" was performed. It was grace that kept her here, it was grace that made her fight.

For those who sent their love, kindness, prayers, well wishes, good thoughts from every corner of this planet, I cannot thank YOU enough. It's your support that helped carry her through.

People matter.
People care.
People will come together.
What happened last night is a true testament of this.

Thank you, thank you, thank you.
Nothing else I can say.

With Love,
Krupali

Steelers!

2010-09-10T11:03:00.000-07:00

This weekend a dream is coming true for a patient.

Earlier this year I overheard that a colleagues terminal cancer patient had a wish to take her husband to see the Pittsburgh Steelers play. They had been longtime fans but had never seen this NFL team play live. When the nurse mentioned this dream to me, I told her we should try to make it happen...we didn't know how, but had an inkling that if we tried, that it could be possible.

As they say, timing is everything, and this May, I spoke about this dream the #140conf in Los Angeles held at The Comedy Store in Hollywood. Magic happened.

Jeff Pulver donated flights, Yahoo donated hotel rooms, others contributed money for transportation, and the attendees of the #140conf that night raised $400 for spending money.

All that was missing for them were tickets to the game.

A colleague who works with us, knew someone, who knew someone in the NFL. The story got to Lynn Swann, a NFL Hall of Fame Football Player, and a former player for the Steelers. He graciously gave 4 tickets to see the Home Opening game for the Steelers this weekend in the Heinz Suite.

Incredible.

You have to understand that this was not my patient, I didn't even know their name when I mentioned this dream at the #140conf. This was a stranger to me, who had a dream, that I wanted to try make happen.

When I first called this patient, after consent, with the news, they were in shock, as they didn't know who I was.

Them: "Who ARE YOU?"
Me: "I'm just someone who heard about your dream from a nurse and wanted to try to make it come true."

We met later on that week so that we could hug and meet face to face. It was truly an amazing moment.

The dream for this patient which seemed so far fetched and almost impossible is coming true this weekend.

Pittsburgh or bust.

Thank you to everyone who contributed, gave, shared, and most importantly made a family believe in the power and kindness of strangers.

Every act makes a difference. Each act is like a ripple. in the pond of life...when these ripples multiply, amazing things happen.

-Krupali

Tony Hawk!

2010-08-22T18:52:00.000-07:00

This morning I saw this tweet from Tony Hawk the world famous skateboarder . Tony is a long time tweeter and every few weeks or so, he leaves autographed skateboards for fans to pick up in random locations around the world. In front of signs, to in bushes--no place is too random for him.

I've followed his tweets with wistful humor. Although I'm not a skateboarder, I have always admired him and what he has done for the sport. I was super excited last year when I was in the audience for a taping of NPR's show 'Wait Wait, Don't Tell Me', and Tony Hawk was the special celebrity guest. He was not only funny, but just plain awesome.

So to my utter SURPRISE I saw the tweet with the skateboard location was IN MY TOWN! I ran out from my house and booked it, yes booked it to the Lexus Dealership trying to look for a man named John. I ran into the dealership asking to speak to John. The lady in the information booth paged him and asked me why I was there... I babbled on and on about Twitter and Tony Hawk.

John came down, and we walked to his desk. He pulled out the skateboard from where he had kept it. I yelped in GLEE :), I could NOT BELIEVE IT!

In my hand was a signed skateboard from TONY HAWK! I had got it via his Twitter game. The odds? I have no idea, but it was such a treat. Seriously I am still smiling.

John and I talked for quite awhile as I shared the magic of Twitter and how it has made dreams come true of my cancer patients to the patients we had just treated last week in the free medical camp in Uganda, East Africa. I told John to tell Tony thank you if he ever spoke to him again.

John was happy. He was glad it went to me. I am glad to have it.
I will cherish it always and smile.

Dear Tony Hawk: You don't know me, heck I don't even skateboard, but I admire you as a person and what you have done for the sport and people in general. You are still having fun, and are taking your fans along for the ride. Many thanks and hugs, Krupali :)

-----

UPDATE :)

Tuesday August 24, 2010, Tony Hawk Tweeted this message:

We are live right now... Call in 1877HEYHAWK but be nice. Or not.

So, I called in and TALKED to him to say thank for the skateboard.

How amazing is that? :)
Still stoked!
YAY!

More Safari Pics :)

2010-08-13T12:35:00.000-07:00

Murchison Falls, UGANDA

A Few Safari Pics--Murchison Falls!

2010-08-13T09:52:00.000-07:00

Some of the AMAZING animals we got to see while at Murchison Falls!

Umbilical Hernia

2010-08-10T12:41:00.001-07:00

Today we got to see an interesting case, a child with an umbilical hernia. We gave her mother money to go to Kampala to Mulago Hospital for proper surgical care.

Elephantitis Update

2010-08-09T06:43:00.001-07:00

Jaffar is doing better. Leg is surgically removed. I visited him today and brought him lunch. I'm leaving tomorrow and so this is my last day to see him. His spirit and smile are much better than when I met him the first day of the camp. We are working on placement and other such things at the moment with another physician who is working at this camp who is from Canada. Let's hope the plan works.

The Pharmacy at the Medical Camp

2010-08-09T06:29:00.000-07:00

So this is the pharmacy for the medical camp. It's a room full of medications. Common ones include cough medications, malaria pills, fever reducers, and ring worm eradication. Oh yeah, least we forget iron tablets/vitamins/and iron syrup for the babies. Some of us take shifts counting tablets and packaging them, some are runners to and from the place outdoors where the people are waiting, and some are bagging. Everyone helps out. No job is too small. No job is too big. Everything needs to get done.

Kid with Cancer

2010-08-07T03:52:00.000-07:00

Our last patient today was a 5 year old kid named Daniel. The cutest thing with a large mass on the right neck. He came with his concerned parents and paperwork.

He's been to Kampala, he's had these lymph nodes biopsied, but they came back negative/non-diagnostic. An abdominal ultrasound showed mesenteric lymph nodes. To top it off, his mouth was full of oral thrush--common with immunocompromised people/cancer patients with poor immune systems.

This kid has cancer. I know it, the biopsy shows nothing.
They need to get to the hospital again to get another biopsy.

They don't have the money.

We're trying to gather the $1000 or so dollars to get them back to Kampala to have it looked at again, get more tissue, get more work up done.

It smells, looks, and breathes lymphoma to me.

-----

His parents are truly concerned. I could see tears in his fathers eyes which make me and made me cry then. Cancer's a bitch, but to have it as a child hits me the hardest. To have it as a child, sans the right diagnosis/treatment, stabs me like a knife.

I really don't have much else to say.

Day #5--107 F Fever

2010-08-06T12:22:00.000-07:00

Day # 5 of the medical camp started off with helping out in the pharmacy, but it then became busy shuttling sick patients to the hospital. We took the pediatric patients to the Childrens, and the adults to Jinja General.

The most remarkable case that I saw today was a 6 year old girl named Caroline. This young thing had a fever of 107 F, (normal body temperature is around 98-99 degrees F). 107 is CRITICAL.

My dad literally took bottles of water and threw them over her head, I ran to find more water, and her mother undressed her and we just kept on pouring cold water over her body, and her head trying to cool her down.

My dad luckily had gone to the local pharmacy the night before to buy some personal supplies including antibiotic injections---for high fevers. He ran to get it, and he injected her with the drug.

Her fever came down to 104 F, and I held her hand, as I tried to also make her drink some water. Her eyes were jaundiced… her body was shuddering….yet she smiled at me.
Her mother Margaret followed along as she came with me to the van to take her to the hospital.

I walked into registration, and told them the case, I was immediately taken to the back where the admission doctor was.

I introduced myself, and told him the story. He immediately wrote a lab slip and told them to come back.

I had to leave them there. Hopefully I’ll get to visit her tomorrow in the hospital.

Oh dear Caroline… I hope you get better… your tender smile despite the horrendous temperature and other things that may be ravaging your body… showed me inner strength and spirit…. Although you are only a 6 year old child… you truly taught me a lot.

Sunset at Bujagali Falls

2010-08-06T11:54:00.000-07:00

The Source of the Nile River

2010-08-06T11:21:00.000-07:00

Baby needs Help--Omphalocele!

2010-08-05T22:29:00.000-07:00

Update from Paul via email on 10/30/10:

Young Solomon is now home with his mother and father here in Jinja and doing quite well under the circumstances. He is eating and gaining some weight. He will need further surgeries next year after he grows a bit, but for now he is keeping strong and free of infection.

For the incredible story, read below:

August 9, 2010

Yesterday evening our guest house phone rang,--a man was waiting to meet us. I had no idea who it could be, as nobody, besides the other international doctors that we’ve been working with, knew we were staying here.

Downstairs was an American man named Paul Gibson & with him were a man and a woman. Apparently they came to thel medical camp but it had closed, and they had begged to know where the doctors were staying.

Paul runs a foundation here in Jinja, Uganda taking care of 700+ kids. One of his employees who has been married a little over 1 year just had a baby 3 weeks ago. A baby boy named Solomon.

Unfortunately Soloman is in desperate need of help. His abdominal wall muscles never developed and now his intestines are coming out of his stomach area--it's known as omphalocele. The hospital in Kampala, Uganda, where he is now, doesn’t have the ability to do the surgery.

They wanted to know if we had contacts in Africa elsewhere to see where this complex surgery can be done. It would require intense pediatric surgery along with plastic surgery to rebuild the skin/grafting/etc—I’m guessing.

I didn’t know of anyone here (as I'm just volunteering in a medical camp for 10 days here in Uganda and am a radiation oncologist) but I told him that I’d blog and Twitter his plight, because as I’ve found out, the world is your platform on Twitter, and you never know who may be reading. I’m sure someone out there knows what/where/what they can do.

Here is the plea:

Does ANYONE out there have contacts anywhere in Africa, whether it be South Africa, or other places that could offer advice/help/input? If so, please contact Paul. His email is: paul(at)childrenofgrace(dot)com. His group’s website is: www.childrenofgrace.com.

Any help/info/input would help.

Thanks,
Krupali

--------
Update: Sunday August 8, 2010 9:15pm Uganda

Just got a tweet from Paul Gibson a few minutes ago, he said they found a doctor in Kenya for Baby Solomon and are leaving Wednesday from Uganda.

Incredible.
Amazing.

Thank you everyone for your help, tweeting, helping, and spreading the word. You have just helped someone save their child. You--together have come through to save a life.

Kudos.
Hugs.
Smiles.

Thanks again,
Krupali

Day #4 of the Uganda Med Camp

2010-08-05T04:12:00.000-07:00

So today started off filling prescriptions...but immediately it went to a sick child dehydrated from malaria... right when we were putting the child and the mother into the van, my dad ran to get me because another child needed admission. A 2 month old child with severe pneumonia...as we placed this child into the van to go to the Children's Hospital, another child was needing admission.

After going to the hospital and buying 60,000 shillings worth of medications we ran to the Adult Hospital to take the amputated man his lunch. While there, the phone rang, we needed to get back to the Children's Hospital as 2 more kids needed admission.

One had severe malnutrition and one had severed dehydration.

I took someone along with me this time to experience the hospital conditions. I had shown them a quick video I had taken yesterday of the wards in the Children's Hospital, but when I took him there in person today he was in utter shock.

Him, "I know you showed me the video, but the video doesn't do this horrific place justice."

I just nodded silently, understanding everything he was trying to say.

The smells, the cries, the sounds, the conditions: HORRIFIC.

Back to work, lunch just ended. Counting pills, running around, seeing the kids, and the people.

Uganda Medical Camp Day #3

2010-08-04T05:43:00.000-07:00

Today started off busy, with one of the first children having a case of hydrocephalus. 2 years old, cute as a button, but not as talkative as a 2 yo kid should be. Treatment includes having a shunt put in the brain by a neurosurgeon. We gave the mother money to take him to Mulago Hospital in Kampala for him to be evaluated by a neurosurgeon.

After that, I was called to take a 18 mos old with pneumonia/malaria to the hospital. The grandmother brought this child as the parents were dead. Right as we were getting into the car to drive to the childrens hospital, another patient was needing admission. This time a 20 yo woman with pulmonary tuberculosis.

Prior to us getting to the hospital, we made a pit stop so I could buy them and the amputation patient lunch. We packed it into plastic containers and then we were off.

After dropping the two patients for admission, I made my way around to see the amputation patient.

He was still lying on the floor, but this time attendants were changing his stump dressing. He smiled when he saw me. I told him I brought food, although he doesn't understand or speak English, he smiled. We both understood---and that was all that mattered.

This afternoon I've been working in the pharmacy counting medications and putting them in little bags. The most used drugs include paracetamol, metronidazole, ibuprofen, amoxicillin, vitamin B, multivitamin, folic acid........

Counting away.... trying to be useful wherever I can.

I think we're going to beat our 1004 patients that we saw yesterday, I think we'll go way above and beyond that.

Exhausted.

Amputation, Malaria--Day #2 Medical Camp

2010-08-03T11:06:00.000-07:00

Uganda Medical Camp Day #2 we saw 1004 patients.

This morning started off a bit hectic as a 18 month old was extremely sick with malaria, dehydration, and high fevers. I accompanied him and his mother to help him get admitted to the Childrens Hospital--which was an adventure. Prior to admitting this child, we had to buy IV fluids, IV instruments, syringes, IV Quinine, and other medications for them. Yes, you BYO medications/supplies and food. Yes, there is no 'check what you'd like to eat for breakfast' here. It's whatever your family/friends provide you.

Afterwards I went to go see the man who we admitted for elephantitis.

He had his right leg amputated this afternoon.

This evening after the camp, my parents and I went to a local pharmacy, bought pain medications, IV fluids, IV instruments, syringes, IV pain meds, alcohol swabs, antibiotics, and other sundries to give to the nurse who would administer the medication.

The next thing on our agenda was food. We went to see him. He was on a dirty matress on the floor covered in a bloody blanket. He was at the entrance of a medicine ward which housed approximately 50 patients and their families. Families sat/slept on the ground, on the 'bed' with the patient or wherever they could find space.

When I saw my amputee 'friend', he was sprawled on the ground, no family or food around him. The only thing next to his bedside was a water bottle I gave to him this morning when I saw him sitting outside.

I asked him if he was hungry. 'Matoki, soda!', 'Matoki, soda!'. Matoki is a local banana cooked in an African style. Soda, well is soda.

We went around town to find this--found food, but no plates/tupperware. Hunted down two food containers, bought them, a large bottle of soda, and then filled the containers with matoki and posho--another African dish. We then bought crackers/cookies so that could be his breakfast tomorrow morning.

I will go everyday with food at noon and hopefully at dinner. If not, this man will eat nothing. He has no family, friends, social support.

Seeing him there, on the ground--broke my heart.
Having to bring your own medications, while admitting the 18 month old child--broke my heart.

I saw things I had never seen. I smelled things I had never smelled. I felt things I had never felt. It was an eye opening experience. I don't have answers. I don't have much else to say....

Rundown of Day 1

2010-08-02T21:35:00.000-07:00

Here is a rundown of what was done during day one:

745 patients seen day 1
79 dental
150+ pediatric
350+ medicine
100 or so in the eye clinic

First day was chaotic, opening ‘ceremonies’ where political figures in the town were speaking (for what seemed like hours). Then the clinic part started.

Hundreds of people were registered where they received a booklet for them to take to the doctor. They were directed either to medical, pediatric, eye, dental, or gynecology clinics. Vitals and other information were taken by nursing or medical students and then the patients were seen by a physician.

If prescriptions were given, a pharmacy was there with donated medications. If the medications were not at that pharmacy, we pooled in money to buy it from the local pharmacy.

If cases were severe enough for hospitalization, they were sent to Jinja Hospital. Normally there is a long wait, but if we or someone from the camp accompanied them, they were given priority. Costs, which are prohibitive for almost everyone who is coming to the camp, was taken care of by the doctors donating their time here and the organizers.

The man who has organized this specific camp is a gentleman by the name of Vasant Lakhani—more will be surprised that he is not a doctor or even medically related. A few years back he began organizing camps for the sake of people.

For those interested in donating—whether it be time here in Uganda during the camp (you don’t have to be medical to help), money, or medications/supplies, please go to his website here: http://www.vasantlakhani.com. He and his wife Sudha have organized several camps in Uganda and in India. They have a big heart and a big undertaking –those interested should definitely contact him.

Elephantitis.

2010-08-02T06:14:00.001-07:00

I met a 25 year old man named Jaffeer today. His right leg is diseased with elephantitis. It is the MOST severe case I have ever seen. My father, a pediatrician who has worked at medical camps in India and around the world agrees.

This man who has had this disease for 3 years has gone through a lot. His parents are both dead. After getting this debiliating right leg, his wife and kids left him.

He begs for everything, as he can't move around because he is in constant pain 24/7.

He needs hospitalization in Kampala. He needs amputation. He needs a prosthetic leg.
This all requires money.

If you have always wanted to help, but didn't know how, now is the chance. I urge you to do so, if you can afford to. Every little bit helps. My eyes are tearing up right now. My heart broke while talking to him. He doesn't look anyone in the eye. His spirit is broken, we need to help mend it.

Please let me know if you can help, pass the word along.
Twitter/blogs helping people.

We CAN do this. I know WE CAN!

Some thoughts of Day #1 Uganda Medical Camp

2010-08-02T05:22:00.000-07:00

Day #1 of the Uganda Medical Camp was overwhelming. Hundreds of patients, trying to figure out what the camp logistics are, and seeing some incredible, painful, and heart wrenching cases. I am going to need YOUR help in trying to figure out the treatment for one case which really just broke my heart.

Uganda Medical Camp Day #1

2010-08-01T23:50:00.000-07:00

The medical camp in Jinja, Uganda is starting today. Internet connection is awful so am trying to update/upload as best as I can. Please bare with me. Seriously it's dial-up modem here...yes, I'm back in 1992! :) Let's hope the video I'm trying to upload makes it. Charging my electronics has been a little issue as well.. oh well, when in Rome.....

Twitter is blocked here, so hopefully will upload this link tonight when I'm back to the guest house (the internet is spotty there, I got on for only 5 minutes this morning before it shut off!)

White coats on, stethescope in hand.
Let's help some people.
200 people are already waiting our arrival.

Send good thoughts this way...I haven't done primary care in ages, but I hopefully will get the hang of it. I've also told them to send me social cases where they need extra TLC, so hopefully I can be of use there.

I'm excited, nervous, anxious, and happy. It's a myriad of emotional all piled into one. The people who have come from around the world to help are great....lots of college kids from England/Canada, and a few medical/dental student prospects. It's a good variety of people, all who are here to help.

Hello From Jinja

2010-08-01T22:37:00.000-07:00

Hi from Uganda, made it here safely. Internet and hot water isn't that great here--but hopefully will have updates! :)

Welcome to Dubai

2010-07-31T08:45:00.000-07:00

A 16 hour flight, an aisle seat, watched 'How to Train a Dragon' (LOVED IT!), and caught up on episodes of '30 Rock' and 'Community'. Oh yeah, I slept loads.

Walked around a lot, drank lots of water, and slept some more.

Dubai. I'm here. At the airport, awaiting my parents arrival flight from India.

Early morning tomorrow we leave on the 7.5 hour long flight after a layover in Ethiopia, and finally ENTEBBE!

Whew.
How's that for some frequent flier miles?

Heroes at Home

2010-07-23T23:01:00.001-07:00

Andrew Rieu, my patient, and the magic of Twitter & Kindness.
This all stems for this blogpost: Music of the Heart

Music of the Heart

2010-06-24T22:05:00.000-07:00

A few months ago I met a lovely 79 old lady and her 82 year old husband. She was diagnosed with a large cancer and bravely underwent chemotherapy and radiation for her diagnosis.

We became extremely close as I got to know them during the daily treatment. I'd give them both a deep hug, and we'd chat.

Her husband told me the very first day I met them, 'Doctor can you please get her to our 62nd wedding anniversary coming up this October?'

62 years.

A lot of people don't even live that long, and this is how long this incredible pair were married for. They were in complete synch. He had undergone several serious cardiac operations, wasn't supposed to make it out alive, yet he carried on. I asked him what made him fight, and his response was, 'Well, I have to take her medications out every night and make sure that she takes them,' as he lovingly looked at her.

She smiled, and I grinned.
They were one of the most loving people I had ever met.

As she was going through the therapy, one of the radiation therapists mentioned that they both loved classical music and that they had mentioned a concert coming to town--a violinist named Andre Rieu. I asked the therapists if my patients had tickets for the show and found out that they couldn't afford them.

One day in passing, I asked my patient and her husband about this musician.

The husbands eyes lit up, 'Oh Andre is amazing we've seen him on PBS and tape it every time he's on.'
I asked if they had seen him perform live. 'Oh no,' she said, 'it's too expensive, we've only watched him on TV.'

I smiled and said, 'Sounds like an incredible musician, I will definitely look him up, thanks for telling me about him.'

That afternoon, I went to the arena where Andre Rieu was scheduled to play and got two amazing seats. The very next day, I saw my favorite couple.

'So, I know your wedding anniversary is coming up in a few months if I remember correctly,' I casually said.

'Yes,' the husband replied.

'Here is an early anniversary present,' as I handed over the tickets in an envelope.

I watched her open the envelope, and pull out the two tickets.

Her expression and here eyes were joyous. It was a moment I'll never forget. The reaction from both of them: priceless.

She started to cry. I told her to please stop as we hugged.
'Doctor, nobody has done this for me before, I don't know what to say.'

I told her to be happy, and to fight the cancer. I wanted her to get to October, and December for when this concert was scheduled.

They both left my office with tears...as I shed a few as well.

----------

Yesterday I got a phone call from another physician. My patient from above, who is only a month out from cancer treatment now has cancer in her brain. The bastard disease has now spread to her brain causing her headaches and vision problems.

I got this phone call at lunch.
I went to the bathroom and bawled my eyes out.

She came to see me today, to get evaluated for brain radiation therapy to slow the growth of the tumors in her brain and decrease the swelling causing her symptoms of headaches and imbalance.

I had to prepare myself all morning to see her. Mentally, emotionally, and physically.

I walked into the patient room. I saw her, her husband, and her daughter who came for the first time.

'You missed me so much you had to come back,' I joked.
She smiled, as I held both her hands and hugged her.

Her first words to me as she looked at me was, 'Do you think I will make it until December to go to the concert.'

She had tears in her eyes, as did her husband.
Then she said, 'I'm so sorry I didn't thank you with a card, or send you something.'

I started to cry as I hugged her harder.
'I get a hug from you in person which is more valuable to me than any card.'

I then said the following, 'Visualize yourself at the concert, see yourself in the seats that you have. We will get you to December. You have to go.'

She then said, 'Visualize the concert...without me.'
I yelled, 'NO! With you.'

Her husband, daughter and I told her to think strong. I held her hands and told her that she must be strong mentally. A quick pep talk made her laugh.

'Game ON,' I told her, 'GAME ON!'
'Ok doctor... I just want to also say that I love you,' she replied.

----------------

This evening as I was shopping for odds and ends, I came across this CD--it was a sign-- I was not looking for it, my eyes saw it as I walked down an aisle of the store.

I bought it. Why? Because it was a sign, I came across an Andre Rieu CD not by accident, but for a purpose. I bought it to give to her. To tell her to listen to it every single day and to focus on being alive for December.

I rarely ask favors from people, but I will ask it today--if you can send this person good energy, vibes, prayers, whatever positive thoughts you may have to share--let's get her to her 62nd anniversary and let's get them to the concert.

Thank you.

** UPDATE ***

Mr. Andre Rieu is on Twitter, and a few Twitter friends and I sent him the blog...he started to follow me a week later and TODAY, July 5, 2010 at 3pm PST I received a Direct Message from Mr. Rieu---he would like to arrange to play for my patient. A DREAM COME TRUE!

"We have noticed your blog, and want to contact you, to see what we can do for your patient."

I am crying in happiness..you do not know what this will mean...a dream come true for a terminal patient...a person who's soul will be uplifted by music.

They contacted me, we did a conference call from Amsterdam...their words were the following:

"Hello, we just wanted to say we read your blog and want to do something for your patient. Let us tell you that we get hundreds of requests from everywhere and normally do not do this, but we were touched, and would like to help...."

By this point, albeit 6am my time, I was crying one the phone as they spoke....

"We know you didn't ask us to do anything for your patient but we want to help, please tell us what your ideas are....."

Andre Rieu and his company have generously offered my patient and her husband floor VIP seating for the concert with the opportunity to meet Andre and the orchestra aftewards. In the meantime they have FedExed her a box of Cd's and DVD's in the mail for her to watch to keep her spirits up until December.

I told my patient what had happened....she was so happy, "Doctor, why do you care so much, what have I done to deserve this...." were some of her words. Her husband, with tears in his eyes... smiled...and said, "Thank you for giving me back my life."

Those words. Those words have had such an impact on me. "Thank you for giving me back my life.". That moment in my life....will never be forgotten.

Thank you for everyone's tweets/retweets/etc, your love & kindness will never be forgotten.
Krupali

p.s. this is a thank you note given to me by the patient...I can't wait to see their face when I tell them this update TOMORROW! :D
*****************************************************************************

Crumble

2010-06-04T16:24:00.000-07:00

I am treating a patient with a young family, dealing with a cancer that is taking his spirit away. Concurrent chemotherapy and radiation is taxing, and because of this he's had to take time off from work. A few weeks ago, he came in looking devastated. I asked him what was the matter.

Him: "I got a flat tire coming here today...and normally, I can change a tire, but I was too tired too..I don't have the energy..."

This ended with him having tears in his eyes looking dejected.

It hurt me inside to no end.
I thought to myself, 'Damn you cancer, you can't take this guys determination away!'

We talked for a bit, his family is struggling for simple things--groceries, where the church is helping out, and some other things--all financial since he was the breadwinner of this family.

His son's 5th birthday was the day before, and they didn't do the usual pizza party. Instead he got a t-ball set and played with him (as much as he could due to fatigue). Ironically the patient who I took to the Ellen show had just dropped off a batch of cupcakes as a thank you to me. Instantly I went to my office and got these cupcakes and handed it to this patient....'Celebrate your kids birthday, I want to be a part of it also.'

I then asked him how I could help.
He gave me a hug with tears in his eyes.

It's hard at time to deal with so much pain of people and their struggle with the disease, the financial situations that they go through, the family impact, mental, spiritual, social--illness encompasses everything.

That is when I start pounding away and type the stories...and try to figure out, 'how can I help ease some of the pain, at least the part that can be under my control...'

I went to Twitter and asked if anyone would like to help with groceries.....two people responded, one person, Patrick is a friend I met while at the TED Conference earlier this year, and another David, who listened to a talk I gave about social media and medicine to the physician staff members at my hospital 2 weeks ago. I thank them both for their generosity.

Gift cards for groceries are coming this patients way.

Hopefully these simple cards for food will possibly ignite his fighting spirit again, and help heal his body and mind. I just want him to know that people, strangers, care and want to help.

Although at times people can crumble, we can help and try to build them up crumb by crumb.

One Last Wish

2010-05-31T22:37:00.001-07:00

A few weeks ago, I had the opportunity to speak at the #140 Conference hosted by Jeff Pulver and Eric Greenspan. That evening held one of the most incredible moments of my life thus far... people coming together to help someone fulfill a last wish of theirs.

So....what happened when I told the recipient?

Well this 'Steeler' patient, wasn't my patient--I didn't even know her name. A nurse had mentioned this patients wish to me 2 weeks prior to the conference--since she had treated her. I looked at my nurse and I told her that I wanted to help make it happen. I didn't know how, who, where, when, but what I did know was WHY...and honestly that was all that mattered.

When I called the nurse with what happened at the #140 Conference, she was stunned--with excitement. She called the patient and got permission to speak to me.

The patient was flabbergasted...she and her husband who were both on the phone were overwhelmed.

They said: 'Who ARE you?'
Me: 'A stranger who cares, and wanted to help.'

I explained to them what had happened that evening--an evening where everyone came together and helped build a dream. They both started crying over the phone with the news...as did I.

A little later on during that day I called them back, making sure they knew it wasn't a dream. :)

We finally met face to face a week later.

This couple that we have helped are incredible people. We hugged tightly like old friends when meeting. After sitting down, they mentioned that they couldn't believe they were having lunch with a 'doctor'. I just said, 'Listen, my name is Krupali, and I'm just your friend.'

That opened the doors to laughter, hugs, a few tears, and heartfelt stories.

It was a phenomenal afternoon, and it's going to be an even more amazing dream for them to go see the Steelers this fall.

Again, thank you to all who contributed, sent kind words, hugs, and paid it forward to them or someone else.

Strangers helping strangers.
Simple concept, incredible impact.

Incredible Twitter, Incredible People

2010-05-11T20:08:00.000-07:00

Last night I was onstage at The Comedy Store to speak at the #140conf in LA which is organized by Jeff Pulver. I wanted to share the power of Twitter and how it helped fulfill a patients dream. I had a kind introduction onstage from the co-organizer and fellow TEDster, Eric Greenspan.

First of all, to share and speak to people at the conference was such an honor. To be honest, I didn't prepare something to say--all I knew was that I had to share the stories of my patients and to let people know that Twitter makes a difference. I knew that I'd talk about the Ruby Red Slipper Group, the shoes, and how a patient got tickets to the Ellen Show.

I ended the talk with one of my favorite quotes:

"Be kind, for everyone you meet is fighting a hard battle"
--Plato

I was debating whether or not to mention a patient who was terminal and had a lifelong dream of seeing the Steelers--but they did not have the financial means to do so.

I finally decided to tell the 300+ people in the audience about the dream of this patient --of going to Pittsburgh-- and what happened next was MAGIC, pure MAGIC!

Jeff Pulver kindly donated his frequent flier miles for plane tickets to Pittsburgh, and what occurred next completely took me, and I think everyone in the room by surprise.

Dr. Krupali, an oncologist, brought most of us to tears when she told the "Make A Wish" type stories and needs of some of her dying cancer patients. I was so moved by one story that I started what became a mass rush to the stage, when I went up to the stage, spontaneously, and said "Here's the first $20 towards buying her plane ticket." It was great to see the whole room follow suit. --Bruce Sallan

The whole room, EVERY SINGLE PERSON, came up to stage or passed $1, $5, $10, $20 bills up to stage, by the end of the night I had a handful of cash to fulfill a terminal patients wish. Eric Greenspan was a great help calling the outpouring of support.

The love in the room, people helping people, and the kindness that I felt was something that I can't really explain properly in words. Mankind helping mankind--I was so overwhelmed, I'm still processing the good that happened.

It didn't stop there.

Today, I received an email from Yahoo:

First, it’s amazing that you’re are doctor helping so many people. But what you do is beyond just making their bodies work - it’s about giving them a reason to live, for however long they have.

We’d love to help you patient realize their dream…so Yahoo! will pay for the hotel – they can use the cash for spending money.

I read this email while I was eating lunch with other physicians, and I just started tearing up right in front of them. Some asked me what was wrong, and I just told them, they were tears of joy. I explained what happened last night, and a few of them started to cry with me. One of them said, 'We need to hear more stories like this...we really need to.'

I cried many times today, from the kind words of the people who attended the #140conf last night, from people who watched the video stream, from strangers who 'heard' about the incredible outpouring of humanity.

Thank you dear #140conf attendees. Thank you for playing an integral role in helping fulfill a terminal cancer patients dream. Thank you for recharging my faith in mankind. Thank you for everything....this night will forever be one of the most incredible moments that I've ever been a part of.

Much Love,
Krupali
Twitter ID: @krupali

A HUGE Favor

2010-05-02T23:27:00.000-07:00

I have a dear friend and they are battling some of the nastiest cancer known to mankind. This weekend I got an email from them and it said this:

I am going to get my MRI results from a scan that I had done last week. It has been a semi nervous week of waiting around. So, in order to help kick this damn cancer in the ass, I wonder if perhaps you could all send over-the-top positive energy towards Toronto on Monday morning? Energy can come in any form: some fitness, hard work on the job, a happy beverage, a sleep in, a peanut butter and jam sandwich, a kind act for someone, a smile or perhaps a strongly worded sentence towards the destructor known as cancer.
Anything.

I am asking each and every single one of you to do them a HUGE favor. Please send them a good thought. A positive vibe. Some good energy.

Yes, you may not know this person, and yes, this is for a stranger--but the kindness of strangers at times is the most powerful.

Twitter for Good

2010-04-22T13:37:00.000-07:00

Yesterday I received an email that blew me out of the water...why? Because a stranger reached out and helped someone that they never have met, and possibly never will. Why? Because people can be and are good. How? Via the power of Twitter.

I have a patient, a young patient with stage IV cancer. I've seen this patient do better...they made me cry tears of joy last wee k. They come to my 'Ruby Red Slippers' group. At the first group meeting, they mentioned that they would love to see the 'Ellen Show'.

I tried getting tickets online to the show, with no luck. I called random people, then I put a call out to my Twitter friends.

A few months ago, I was 'introduced' to a woman, a breast cancer survivor, and a makeup artist in the industry. We've become online friends and have never met in person...yet we have a bond. I put out the word to her.

She contacted a friend, and through a friend of a friend, tickets appeared in my inbox yesterday.

2 tickets to the ELLEN SHOW!

You have made a girls dream come true....

I called my patient this morning to tell her the news..... her words to me, "Krupali, you really do make anything happen!"

I honestly don't do anything but put out a call to the world..and at times the world responds.

Strangers helping stranger helping a friend I know online on Twitter.

It is so powerful, so incredibly powerful.

I really have no words....with the exception of these two: Thank you.

Tears of Joy

2010-04-12T22:25:00.000-07:00

When I see someone with cancer, it breaks my heart. When I see someone with stage IV cancer (the highest stage), it breaks my heart even more. It's hard not to get emotional over it--it's almost next to impossible.

A few months ago, I met someone who was diagnosed with stage IV cancer. They came to my clinic in a wheelchair, unable to walk as the cancer was eating away at their knee. I treated her with radiation...and hoped for the best.

Several months afterwards, they came to the first Ruby Red Slippers meeting, and they walked in with a walker--it was the first time I had ever seen them ambulate. I was overwhelmed with joy, and smiled ear to ear.

Tonight I saw them again, for a Ruby Red Slippers Meeting. She came in walking SANS a walker, SANS a cane, SANS any help.

I cried.

They are walking.

They are fighting.

It may be simple to see someone walk, but the story behind her walk is a battle that most people will never know about, never understand, and hopefully never have to fight.

Ruby Red Slippers Group

2010-04-12T09:35:00.000-07:00

Some patients have asked me about support groups-- at times they have said they feel uncomfortable going to a place where they don't know anyone or see a familiar face. This feeling led to an idea sparked by a special shoe.

The 'Ruby Red Slippers' from the Wizard of Oz have had a significant meaning for me and my patients. The story of these shoes that sparkle have made people smile, dream, and have at times made some pain go away.

Stories from this shoe, led to a patient recommending to me that I start a patient group that was called 'Ruby Red Slippers' for them to come together and be supportive of each other and their personal journeys.

We started the group around 5 months ago, and the response has been phenomenal. It's supportive in a broad sense, people coming together, eating dinner, talking about life, talking about whatever is on their mind. They come and meet others who are facing similar issues, whether it be hair loss, nausea, or just share common anecdotes.

I mention the group to my patients when they start, or ask about a group to go to. A few weeks ago, 2 patients who haven't attended called my office to see when the next group meeting was. It was overwhelming--they remembered, and wanted to come. Both of these patients finished their therapy months ago, but still remembered the story, and wanted to be involved.

The response has been incredible, friends have mailed special lip glosses to share with the ladies, to having people want to come and talk to the group--not all cancer related. I have asked people that I know who have special talents to come by-- next time we hope to have my friend Jan talk about makeup for women with cancer and also have another friend Jason perform his incredible card flourishing skills.

I hope that it continues to be a positive force for those who come, those who visit and share, and most importantly, continues to inspire.

My Mother

2010-04-08T04:45:00.000-07:00

A mother is the truest friend we have, when trials heavy and sudden, fall upon us; when adversity takes the place of prosperity; when friends who rejoice with us in our sunshine desert us; when trouble thickens around us, still will she cling to us, and endeavor by her kind precepts and counsels to dissipate the clouds of darkness, and cause peace to return to our hearts.
-Washington Irving

It's my moms birthday today!

My mother is my best friend. I joke and say she incubated me for 9 months, so how could she not be? I've been blessed to have her as my guide in life. The picture from above is a surprise I gave her a few years ago.

When I was in residency I used to 'live' in libraries until all hours of the night --learning physics equations to memorizing staging manuals, and learning cancer therapies. My study breaks were People Magazine. Yes, I read People. It's my guilty pleasure and I'm proud of it.

The issue that I was reading had a contest sponsored by Dove. They wanted to portray beautiful women over 50, and have them in the 50 Most Beautiful People Magazine Issue. To enter you needed to submit a photo and write something about the person you were nominating.

So, that night, I found a photo (It's a photo I took of her at the beach earlier that same year), and wrote this up in five minutes:

My Mother-the fighter, the fearless, the intellect, the healer, the doer, the listener, the motivator, the daredevil, the shoulder, the caregiver, the instigator, the strength, the fire, the glue, the smile, the laughter--the embodiment of everything that I strive to become.

Well, the entry won, and she was in People Magazine. She was utterly surprised and shocked when contacted by Dove.

It was awesome.
She is beaautiful both inside and out.

Happy Birthday Dearest Mom.
I love you.

A Patient Pact

2010-04-07T19:34:00.000-07:00

I am treating a patient for head & neck cancer--which can be one of the most brutal therapies. To receive chemotherapy and radiation concurrently can be pretty debilitating. Swallowing foods can be next to impossible, and taste changes and saliva changes are brutal. It's one of the harshest areas to treat....and I warn the patients beforehand: they are in for a battle.

This patient was a few weeks into therapy, and on their weekly appointment with me, his wife told me, 'Doctor he tried to drink root beer, and it almost 'killed' him'. I looked at him..as I had specifically told him to stay away from acidity, and anything sans water or possibly milky based substances. Drinking and eating foods could be like pouring acid on an open wound.

His response, 'Doctor, I love root beer, I just wanted to taste it again.' Well root beer to me has a special meaning.

I understand his craving, I mean we each have something or the other that we love to eat--whether it be the taste of root beer or chocolate or french fries, we all have our vice. To him it was root beer.

I looked at him and said, 'OK. I totally understand. Let's make a pact. I love root beer also. What if I give up drinking root beer until you can drink it again, and when you can, you're taking me out for a root beer float so we can celebrate together.'

He chimed in, 'It has to be A&W Rootbeer'

He laughed as did his wife.
We shook hands.
We have a pact and hopefully a date with root beer and some vanilla ice cream later on this summer.

Oh dear root beer, you are our end goal.
It is a simple goal, but one with a greater meaning than you will ever know.

Dark Days

2010-04-05T21:37:00.000-07:00

This morning I entered a patient room to meet the new consult. It was a 50-something woman who was recently diagnosed with lung cancer. On her staging workup the cancer was found to have spread into her brain. When cancer is found outside the primary site, it's considered to be metastatic disease--not curable.

I introduced myself and sat down. The patient started to cry. I handed her a Kleenex and asked if she needed a hug, she refused, and cried some more. I then asked again her if I could give her a hug. She consented and I gave her a long, hard hug. We then began to chat.

In the middle of asking her about her medical history and learning more about her, her husband chimed in with questions. I explained to them the difference between palliative care and cure.

He started tearing up. I gave him a tissue, and leaned in.

"How are you doing, I know this news is difficult to hear," I said softly.

"Doctor, these past few months have been hard." He then began to take his wallet out, it was a ruddy wallet, held together by a rubber band. He then took out 3 photos to show me.

"Doctor, I know you may think of these pictures just of dogs, but these 3 dogs were important to me. This one is Sandy, she passed away 2 months ago at 11 years of age, the other dog is Alex who was 12, and the third dog is a dog that was my childhood pet."

I held these precious photos and looked down. I knew the power of pets, they weren't just animals, they were part of the family. They at times were more comfort than a human touch or voice could ever be. I remembered Joey, the bird my brother and I grew up with--our bird was our world.

The patients husband then went on, "Doctor, I lost 2 of the dogs in the last 2 months, and now you're telling me my wife is going to die? I can't handle this." He started crying some more.

I started tearing up. I couldn't hold it in.

"You know, I met her when I was 19 and she was 17. My life is with her, and when I think of the world without her, it looks like the color of your sweater doctor" (I was wearing a black sweater) "My world looks completely dark and dreary without her," he said softly.

I grabbed a Kleenex, not for him, not for my patient, but for me.
I couldn't hold in my tears any longer.

I comforted them as much as I could, I got them positive about the treatment course of action, but inside I was bawling because I knew the darkness that the husband would one day see.

Gary

2010-03-29T14:18:00.000-07:00

A few weeks ago my dad asked me about my friend Gary and if I had contacted his parents recently. I told him no. He told me that I should try to contact them to see how they were doing and to let them know how much their son had impacted me.

Below is the story of Gary.

I get asked many times by people why I chose to go into the field of oncology. For me it comes down to the people. Specifically, the people that I have encountered in my life.

One of the people was named Gary.

Who was Gary? Gary was a spunky Hispanic guy that I met in a class Junior year of college. He turned out to be from the same high school as me... and through that common connection of being from the small crazy town, we bonded..we laughed, and we shared stories.

His dream was to become a lawyer, my dream was to become a doctor.

For those who have known me for years, know that I used to be a fairly quiet and shy person. (Surprised?) In college I primarily kept to myself, lived in the library, and studied away... I was pretty introverted..but Gary helped me open up a bit... and that really changed me.

After the class in which we met ended, I didn't see him around as much... a few weeks later as the year got started, I got word through friends that Gary was in the hospital...in my hometown where my dad worked.

Why was he hospitalized? He had leukemia and he had relapsed...

Nobody had known he had suffered from leukemia in the past... I didn't think twice about his bald head.. just thought he shaved it for his 'look'... I didn't ever ask him about illness, or sickness, etc....

That weekend I went to the hospital..and there Gary was.. lying in a bed.. looking pale, and distant.. his family was in the room...and as I spoke Spanish, they warmed up to me... I held his hand.. he laughed and we made some small talk... then I started to cry..

I couldn't believe that my friend Gary was dying in front of my eyes... I told him he had to be a lawyer.. I must have sounded like an idiot.. my dad was waiting outside the hospital door nearby... I left his room in tears and immediately hugged my dad...

I knew in my gut that this was the last time I would see my dear friend.. the friend who helped me destress during the MCAT study periods.. the friend who made me laugh when I was glum with worry.... the friend who helped me believe in people again.

My dad drove me home as I silently looked out the window with wet tears streaming down my face.

A few weeks later, I got word that he had passed... it was a solemn moment in my life.. one that I will always remember..

I sit here and remember the smell of the hospital room.. me holding his hand.. and the look in his eyes.. and I will never forget it. Never.

I think of Gary on many occasions.. the laughter, the joy, and the positive vibe he shared with me and the others who were fortunate to know him. I hope his parents and family know that he made a difference in the world around him and that he changed a part of me for good.

Touch of the Hair

2010-03-13T16:43:00.000-08:00

A few months ago, I had a 50-something year old female who came for a consult. She had been diagnosed breast cancer 10 years ago. She had undergone standard therapy...surgery, chemotherapy, and then radiation. She had her normal followup visits, until she lost her health insurance a few years ago.

For the past 3 years she had complained of some hip pain, some difficulty in the right leg.. it had then passed to her left and right shoulder blades... and eventually she got seen by a doctor. From the workup, scans and a biopsy, the news for her wasn't good... the breast cancer cells had spread into her bones, from her ribs, to her skull, from her femur, to her scapula.. it was the cancer causing her pain, making her skeleton fragile... the cancer was everywhere.

I entered the room, introduced myself, and began to talk to her. As I began to examine her, I noticed her eyes.

It's hard to hide fear, pain, angst, happiness, excitement from the eyes. You can tell a lot from looking into a person eyes... truth, trust, lies, and love.

Her eyes filled up with tears...she then tried to say 'sorry, I'm usually not like this..'... I found some Kleenex and told her a story of my ID badge during residency training.

My ID badge in residency had a sticker of a smiley face on it...and whenever patients would cry, I would tell them 'if you cry, i cry, and you can't make the doctor cry'...I'd then show them the sticker and say, 'we're on the smiley team'. It sounds elementary, and to most it may sound a bit asinine, but it worked. They started laughing. They stopped and thought about my words---and eventually we would both smile, just like the sticker on my badge.

Today after I told her that story, she looked at me as she wiped away her tears and said, 'can I please touch your hair?' I had never been asked that by a patient... her daughter started laughing, she started laughing, and I started laughing. 'I really want to touch your hair..it's so pretty.' She was comfortable again, and opening up to me--a special moment in our relationship.

I obliged and let her touch my hair, which for those who know is a massive head of unruly curls, as her daughter looked on. My patient smiled, her daughter smiled, and I smiled. 'Can you wear your hair down everyday? I'd like to touch it when I come everyday for therapy'.

My nurse who was in the room said, 'Well the doctor, she hardly ever wears her hair down.' I looked at the patient and said, 'For you, I'll wear my hair down everyday, and you can touch it everyday, and from now on you will be known as 'touch my hair' patient'.

She could not stop smiling, and seeing that smile-- free from pain for that one second-- made it worth it.

Circle of Life

2010-03-10T10:40:00.000-08:00

A few months ago I had to see a patient who was hospitalized. Their tumor was pretty gnarly and they weren't doing too well. We gave them some radiation and some chemotherapy--a few weeks later they completely turned around. It was like seeing a brand new person.

The family and I became quite close. They would come to get their hugs when they were next door for chemotherapy, they came to ask advice about things, and just came by to say hello occasionally.

I saw them last week during a followup visit. We joked, chatted, laughed, and talked about what was next. Chemotherapy would be continued and I'd just be following along as necessary. We hugged tightly and I told them to drop by the next time they were nearby.

Monday morning of this week, I had a note on my desk that the patient had passed away over the weekend.

I was shocked.
I was saddened.

It was a rough way to start the week.

The day didn't get any easier. I found out several patients had gone metastatic (cancer had spread), and that they needed palliative care.

By the end of the day I needed to see something happy.

I went to see a dear old friend who had given birth to twins 3 weeks ago. I got to hold her bundles of joy and play with them for a few hours. Hanging out with all of them appeased my angst and my sadness. I had heard about death in the morning and in the evening I was celebrating two new dear lives.

The life and death circle is never ending...and seeing these joyous faces made me realize again at how precious and fragile every moment is.

An Great Staircase I Saw

2010-03-07T14:08:00.000-08:00

A Favorite Quote

2010-02-23T19:04:00.000-08:00

"How people treat you is their karma; how you react is yours." - Wayne Dyer

Hugs.

2010-02-23T13:55:00.000-08:00

Hugs have always been a comfort to me. A really good strong hug is something that I cherish.

As I was leaving the hospital cafeteria a few days ago, while not wearing a white coat, or an ID badge, I noticed a woman who was crying, alone in a corner of a long hallway.

My heart went out to her. Hospitals and crying are two things that sometimes go together. I didn't know why she was crying, or what had happened....but I walked up to her...and asked her, 'Do you need a hug?'. She looked a bit shocked but then silently nodded her head, and I hugged her tightly.

I asked her if everything was OK, and she said that her husband was going through some tests, and her mom was diagnosed with stage IV cancer a few days ago. She said while waiting for her husband to finish the news about her mother just 'hit her'. I asked her if I could hug her again.

She cried on my shoulder for a few minutes. She told me her mother was only in her 60's and that she was celebrating her anniversary tomorrow. I asked her how her father was taking the news. 'He's not taking it well, he's in denial and always asks the doctors if she will be okay.' She started crying again.

More hugs.

We chatted for a bit, and she asked me my name. I told her it was Krupali. She told me thank you, you were an angel for me today. I hugged her again. I was just doing what I think anyone would do in the same situation.

I then told her I was going to work, and asked if she wanted to walk down with me to get some water. I didn't want her to be alone in the hallway. She nodded and followed me as we walked downstairs.

She then asked me what I did.
I told her I was a cancer doctor.
She stopped.
'Really?,' she asked.

Yes, really.

We walked to my office and I told her to come down anytime she needed a hug or a friend.

She left a bit calmer, and with fewer tears.
I hope she and her mother and family do okay.

Hugs.
Hugs can give strength, hope, and let another person, even a stranger, know that you care.
The power of a good hug is immeasurable.

At the Olympic Games

2010-02-21T18:51:00.000-08:00

I'm currently attending the Winter Olympics inVancouver, Canada. It's been incredible. My first ever Olympic Games, with family & friends. We had this planned over 6 months ago, and to see the fans, sporting events, and joyous crowds in person is a surreal experience.

My TED Highlight

2010-02-18T07:58:00.000-08:00

For those who were at TED with me, please keep this persons identity confidential as they would like it that way. Please protect their wishes! Thanks, Krupali

I signed up to go to TED a few months ago... on advice from a friend who went last year and told me that, 'KRUPALI YOU NEED TO GO!'.

I didn't really know what to expect except mental stimulation, talks that would potentially be riveting, and people who would be incredible.

As I drove to the conference there were a few things running through my mind... 'was it worth the money? was it really going to be as mind-blowing as it sounds? would I think it was a waste of vacation time?'

My first morning, I registered, got my bag of goodies along with a schedule of the extra sessions I had signed up for... including something called TED You, a space where attendees are selected to speak on a topic of sorts (they are selected months prior). We were bussed to the Noah Purifoy Foundation in Palm Springs where we had a great lunch and then settled in to hear some talks... the talks ranged from comedic to serious... crazy to thought provoking.

The talk that resonated most with my soul was done by a now dear friend of mine. She started off with a French saying which basically translated to, 'Life is sometimes full of shittiness'. She then went on to give her story...of how on Christmas Eve 2008 at the age of 24, she was diagnosed with a Glioblastoma Multiforme (Stage IV) brain tumor. She was in medical school at that time, and while people were listening to tacky Christmas music that night, she and her family were hearing a death sentence for her from a neurosurgeon.

She has since then dropped out from medical school and instead enrolled in Nurse Practioner school. She was given a lifespan of 3 years or less. She has gone onto doing the things she wants to do, which don't include traveling the world or doing crazy things. She is doing what SHE WANTS to do... which is to help people, in whatever way she can. She hasn't let go of this inner desire and goal.

After her talk, I walked over to her and gave her a hug with tears in my eyes. I've seen too many good people suffer and have to deal with the shittiest of cancers, and for her to have to go through this made me quite angry.

The next evening I had a chance to talk to her one-on-one and we bonded over a conversation which was intense, and extremely insightful. I asked her how her parents were handling it, 'they have their ups and downs', to her 4 younger brothers. We talked about the future, and what treatments she has gone through and will potentially go through. I asked her how she liked her doctors, we talked about death, burial, and issues related to the entire notion of dying. I asked her if she slept well at night. I asked her how I could become a better doctor.

I left that conversation with a heavy heart, yet a heart that was still joyous because I met this amazing person. She in 90 minutes taught me a lot about life, how to live, and hopefully to become a better human being. I cried that night, too overwhelmed at what this lovely young girl was dealing with.

Her last words in her talk were, 'Next year at this time I likely won't be here, but I did what I wanted to do in my life, the question is, are you?'.

Powerful, spectacular, and moving words from a sweet soul who touched my life and left a permanent footprint in my heart.

Dear Friend:

I can't imagine or even put myself in the shoes you are in right now at this moment, but what I would like to say is simply thank you. Thank you for sharing with me all that you did, thank you for inspiring me and others around me with your words and actions, and thank you for doing what you want to do.

With Love, Respect, & Friendship,
Krupali

TED

2010-02-17T09:22:00.000-08:00

Last year, my friend Pragnya Alekal, was a fellow at a conference called TED. She updated her Twitter and Facebook account every 3.2 milliseconds about seeing phenomenal speakers and people at this event. I wasn't familiar with TED, but as soon as she returned from the conference she messaged me.

Her: Out of all the people I know, YOU are the one who needs to go to TED.
Me: Why?
Her: You love people, learning, networking, you'd be a natural.
Me: Okay....but what is it all about?
Her: Take a look at the website.

I took a look became enthralled by some of the videos including a talk about genius from author Elizabeth Gilbert.

I took a look at the price tag of the conference and my jaw dropped. The conference she wanted me to go to was pricey.

WHAT?

Really? I mean seriously, I think is a bit much for a CONFERENCE?

After I took a look at the price, I messaged her again, the conversation went something like this:

Me: You want me to fork up that kind of money for a CONFERENCE?
Her: Yes.
Me: WHY!?!?!
Her: You will LOVE it.
Me: Sell it to me in 5 words or less.

Her words to me were priceless, and they went something like this:

Her: You'll have a MENTAL ORGASM.

Me: SOLD

So after this conversation I applied and was accepted to attend TED India which happened in November 2009. Due to work/logistical issues I wasn't able to attend, and hence attended the TED conference this past week.

What are some of my thoughts on the conference? It was PHENOMENAL. My friend was right--the talks were riveting--having Bill Gates to Temple Grandin...Natalie Merchant to Dan Barber...Jamie Oliver to Sir Ken Robinson...it was amazing.

However impressive the speakers, the attendees and the people I met were even more incredible. I had some of the greatest discussions with people I would otherwise would never have come across--the friendships and bonds forged in 5 days were pretty damn amazing.

It was 5 days of little sleep, lots of caffeine, interesting conversations, speakers, a mishmash of ideas, dreams, hopes, and passions.

In the next few weeks, as I'm still recuperating from the mental gymnastics that my neurons took, I will try to recap some of my favorite thoughts and ideas that I was surrounded by. Seriously breathtaking. Seriously awesome. Seriously incredible.

My Friend.

2010-02-07T20:52:00.000-08:00

A few years ago, I was called to see a consult in the hospital. From what I was told this woman was mentally challenged, and had pain in her hip. She lived in a facility--and one day started complaining of pain. Upon examination was found to have an ulcerating breast leasion.

The breast was biopsied and it showed cancer. Upon further workup, the cancer was found in other parts of her body--lungs, liver, and bones.

I was consulted to see the patient and see if she were a candidate for palliative radiation to her hip, since it was causing her immense pain.

I entered her hospital room... she was surrounded by family. One elderly lady was introduced to me as her mother, and two other women were her sisters.

During her evaluation, I told her I was a doctor who was sent to radiate her hip. We talked and she asked me to be her friend instead. I told her, 'Of course, I'm your friend first'.

After chatting with the other family members it was decided that she was indeed a candidate for a palliative course of radiation therapy. She was ambulanced to my clinic for her treatments to get started.

She told me about her boyfriend, her likes and her dislikes. She told me how much she liked ice cream cake.

Two treatments into the therapy, her family and her decided to not have anymore treatment. They wanted her to be at home in hospice care. Her sister mentioned that they were going to throw her a 'celebration of life' party later on in the week.

The patient asked, 'Friend, you're coming, right?'

How could I say no?

I told her that I would and asked her mother for directions. I don't think they took me seriously.

The afternoon of her party, I left work a bit early so that I could make a run for the ice cream store. I bought an ice cream cake, had it iced with the words 'We love you!' on it. I then drove to her home.

When I walked to the house, I saw dozens of cars on the street. There were vans from the home that she used to live to other vehicles which surrounded the driveway. I walked inside the house--it was filled to the brim with people...all there to give her love and celebrate her life.

She saw me and squealed, 'FRIEND! You made it!'
I did indeed.

Her sister took me aside and said, 'We gave you our address, never thinking you'd come, but you did. I am just in shock right now.'

I didn't know what to say.
I had given my word and I wanted to celebrate this life that had come into mine.

Spending some time there showed and taught me a lot. She had a disability, she had a fatal disease, yet this patient was still full of zest, smiles, and joy. She was loved by family, friends, and the community.

She was successful in life.

In the end, what do we strive for?
Changing someones life, helping people, and becoming a better person are some of the things on my list.

In my eyes this patient had done all of this, and more.

Mixer of Dreams

2010-02-04T00:21:00.000-08:00

The Mixer

Radiation Oncology residency started July 2003, a year after I completed an internal medicine preliminary year.

I was scheduled to start a Radiation Oncology rotation with a professor who specialized in gastrointestinal tumors (GI)--pancreas, rectal, anal, gastric cancers were his 'thing'. I was nervous to say the least.

My only true exposure in this field was during a 3 week rotation during medical school at UCLA. My research was in something else entirely. I was quite uneasy and unsure of what to really expect. Some may call it crazy, ridiculous, and downright nutty---but in my 3 weeks rotating, what drew me to this field were the patients. People who are faced with cancer see the world in a completely different light--and their light is what guided me.

One of the patients who was on treatment during my first week being a Radiation Oncology resident was a feisty woman named Mrs. Smith. She was being treated for pancreatic cancer. She came to her appointments with her husband. I had the opportunity of meeting her for the first time during her weekly treatment check--to make sure that her daily radiation treatments were going properly and and to monitor the side effects from the chemotherapy and radiation therapy which were given to her simultaneously.

When I met her for the first time she brought in a large plate of little tarts--around 60 or so. She said, 'these are for the department, I made them last night'.

These tarts weren't your ordinary 'tart'. I can remember being gorgeous, something to be posted on a cover of 'Good Housekeeping' or something that Martha Stewart would make, they were professional treats.

I was floored, this woman who is going through a ridiculously harsh therapy for cancer made 60 tarts for the staff at my hospital. This woman left quite an impression on me.

Our relationship during her weekly treatment checks grew, I learned more about her, and her husband, we laughed, and I told her I admired her for having the strength and the desire to bake for us. Every single week we'd be treated to something sweet and delectable. Something that was made with care and love.

I finally said, "I want to learn how to bake from you. I don't know how to bake."
She said, "You don't know how to bake?'"
I said, "My family is vegetarian and we don't even bring eggs into the house, I don't know how to bake."
She said, "I'm going to write down my address, let's figure out a time that you can come by."

I chuckled, "You know I'll take you up on your offer so don't give me your address if you really don't want me to come."
She and her husband laughed aloud, "Honey I don't give out my address to just anyone."

A few weeks later I made it down to her house to visit her. She had a gorgeous home and had 2 sets of Kitchen Aid mixers side by side with bowls of ingredients ready for us. She had typed out a recipe for an almond raspberry tart we were going to make that afternoon.

We talked while mixing the ingredients. I told her about my insecurities about going into the field of radiation oncology, and of how I didn't know if I was in the right specialty. I mentioned to her that I had no family in the southeast and terribly missed my family and friends back home in California.

I told her a lot about me, and she told me a lot about her.

The words which she spoke I wrote down in my heart. I carry them with me to this day.

She said, "You will make a difference. Do not worry. You will change the world."

I was overwhelmed by her words.. She reassured me that everything would be okay, and that everything would work out.

A short time later I purchased my first home. My very first piece of mail in my new mailbox was from her. It was a congratulations card--a card that I cherish to this day. She remembered me while battling a life threatening disease-- her thoughtfulness made me shed a few tears that day, as I read the kind words.

A few weeks later, I was paged by our department front desk. I hurried to see what the matter was. Standing at that desk was her husband and he had a box that he was carrying. His eyes showed some sadness.

I said, 'Hi Mr. Smith, what brings you here today? Where is Mrs. Smith?'
He said, "Cupcake (his nickname for me), Mrs.Smith isn't doing well, we brought her into the hospital this morning, but before we left the house, she wanted me to put this in the car to give to you."

He handed me the box.
I took a look inside.

In the box was her Kitchen Aid Mixer, and attached to it was a note from her. The note told me to keep on baking and was showered with other gems of advice.

Tears streamed down my face. I couldn't hold it in.
It was one of the kindest, most generous gestures I have ever encountered.

Nurses around me started crying, one came up to me and said, 'in my 20 years working here, I've never seen that'.

After work that day, I went to see her, but before I did that I made a run to an ice cream shop and gave her a call.

Me: "Whats your favorite flavor of ice cream?'
Her: 'Why?"
Me: 'Just asking..."

I got us a pint of her favorite flavor and took it back to her room. That night we chatted, laughed, ate ice cream, watched TV, and at one point, I cried. I did not want to say goodbye.

She was discharged a few days later, and one Saturday morning I got a phone call from her daughter who I had heard about but had never met.

She said, "Hi, you don't know me, but I've heard a lot about you from my mom and I'm in town this weekend and I'd love to meet you. I know you likely already have plans..."
I told her, "I do have plans but those can be changed, I am coming over and leaving right now. I'd love to meet you!"

I drove down to Mrs. Smith's house, and by this time she was in home hospice. I saw her daughter, hugged her, and we sat in the living room, and chatted for hours on end. We talked about life, family, love, and dreams. We talked about the life of Mrs. Smith. At one point her daughter started crying, and she told me, 'I have known my mom my entire life, and you bring out stories that I've never heard from her'.

As I left that day, I knew in my gut that it would be the last time that I'd ever see her alive. I walked away from the house with my heart sinking, and my stomach dropping into the depths of the earths floor. How do you say goodbye to someone you have grown to love and have learned from?

A few days later I left on vacation to India, on my way back I finally checked my messages. I had a voicemail from Mr.Smith, and he told me that Mrs. Smith had passed away. I cried silently on the flight back knowing that one of the most important people to ever enter my life was gone for good.

----

Everyday I meet people who come to my clinic with incredible stories, and amazing strength. Mrs. Smith was one who truly believed in me and made me believe in my abilities at a time when I was uncertain and scared of what I was getting into... I will always be grateful to her...and on this day when I think about my 2 years as an attending physician, I think of her family, and I think of her and thank the heavens above for bringing her into my life when they did. She will always be an integral part of me, what I do, who I am, and hopefully will become.

Funerals.

2010-01-25T10:23:00.000-08:00

Funerals are hard to go to.
They are never easy.
A few people I know avoid them like the plague.
Grief is an emotion that people handle in different ways.

I've been to a handful, mostly for family. This past weekend was rough...I had to attend 'Angel's' funeral... and that was a bit difficult for me...

Her dad's wails still echo in my ears from the phone call on Tuesday telling me her state.... she passed early morning on Wednesday....I called on Thursday and her dad's muffled words to me, "I don't want to live anymore"....What do you say to that?

I woke up early...since the drive was 3 hours long...my ipod, and a warm mug of masala chai to keep me company on the drive to the location....I really didn't know anyone except the parents and a few relatives that I had met while visiting them in the hospital as they vigilantly lived near their daughter's bedside for 3 months....

I got there early and stayed to myself...I entered the building..and was one of the first people to arrive... I entered the room where the services were to be held...and there she was... lying in state with the casket open...I felt like I was in a bad episode of 'Six Feet Under'...and how this could NOT be happening.... I was waiting for someone to yell, "CUT", or some other Hollywood term to make this surreal nightmare go away...however I wasn't that lucky.

It is the 9 day Hindu Festival of Navarathri and this was the last day for it...this was "Angel's" favorite time of the year I learned during the services...you wear Chania Choli's, dance Garba/Raas...it's a joyous time of year...however this time this 21 year old could not participate... she lay there...dressed in her favorite set of Chania Choli...and her dear hands holding a pair of dandias... I saw this..and remembered her struggles in the ICU...having electrodes on her head, searching for seizures, and eventually brain waves... I remember her battling this damn disease which nobody could find out the cause... I remember crying when I first met her a mere 3 months back... a lot of memories came rushing into my mind..holding her hand while saying prayers...sneaking in whenever I had a chance to get off from clinic... making sure that her parents knew that they had to eat and sleep and remain sane during all of this... .it was a whirlpool of thoughts, memories, ideas, and moments....

I sat down quietly...and said prayers...I'm a bit taller than most Indian women...and a gaggle of Indian aunties sat behind me.... they were gossiping about god knows what... I glared at them a few times...trying to keep my mental sanity...did they not understand that this was a place to be silent...and mournful...yet respectful for the person who had passed? A few minutes later... after a few more people arrived..and the pews started filling up...one of the the aunties behind me nudged my shoulder and said:

"Can you move your head, I can't see anything"
I told her very tritely, "This ISN'T a show.."

What was there to see? I really didn't understand..then said to myself maybe this is how they handle grief.. I don't know.. people can do some random things...and who was I to judge...but today wasn't the time to evaluate....

Eventually "Angel's" mother arrived...supported by 2 of her sisters...and she went to the casket and wailed like her entire insides had been removed...the pain in that wail was horrific...and I couldn't put up the face of strength...my eyes and face flooded with tears... after her mom sat down...her aunt from Arizona found me...and cried..and hugged me tightly for 10 minutes... I tried to calm her down... she was asking 'Why did god take her, we prayed..and he was supposed to cure her'....

The Hindu services went on with a few speeches...a few times the speakers couldn't finish, being overwhelmed with sadness and tears.. everyone in the room was sniffling...crying...and had a question of 'why?'...

Angel was a fantastic human being as I learned more from seeing photos which were displayed and heard stories during the speeches...she was born and raised in the UK...moved here around 5 years ago...and moved to her current residence around 2 years ago...she was the eldest... she had one younger brother... intelligent, caring, brilliant..a $20,000 scholarship recipient of helping her reach for her dream of becoming a dental hygienist... she would've finished in this year....

As people were speaking...her one and only younger brother fell apart... he was shattered... utterly shattered... and I couldn't imagine his pain... I don't know what I would do if anything happened to my dear brother...he is part of my heart and soul...and Angel was her brothers keeper as well... I can only imagine the emptiness he feels..and then cried some more when thinking who would tie a 'rakri' for raksha bandan every year... he was just keeled over in pain...

Her dad kept somewhat composed... his eyes looked distant...no fire raged within...a sense of disbelief...a look of desperation...

As the prayers ended...we payed respect to the family...and saw the casket for the last time... as I walked up.. I saw her dad... he got up to hug me..and cried and wailed... other people had to get him to release me...I had no words...I cannot imagine the pain... nor the anguish... they had so much faith in god... they did what most parents would do for their child... yet medicine had failed them...and the prayers had too...

Faith is something that you can question during certain situations in life.. death being the most obvious... why...why...why? I've asked that several times...as i'm sure a lot of people have...

The trite and most comforting reasoning being..that there is always a reason... there has to be... god had higher plans...needed her sooner than we would've liked... and shared with us the beauty of Angel in the 21 years she spent on earth...

As they closed the casket... her mother wailed.. her brother couldn't let go of the casket before they took it to the crematorium...his tired body had to be supported by his cousins.... the cries of a mother losing her baby girl, a father losing the apple of his eye, and a brother losing his older sister was unbearable to listen to..it is one of the most shattering sounds ears can ever hear...

The pain in the eyes...the sounds of grief...and the look of disbelief in the family were a lot for me to take... I cried during the 3 hour drive back... stopping for a snack and to breathe a bit...before hitting the road once again...

I talked to my parents on the drive back ...to tell them I love them.. called my brother and left him a message.... sometimes the world and reality can be very harsh...cruel...and some events will try to break the foundation that you have carefully and lovingly built in your lifetime... it is at these times where the strongest bricks on the walls will be the strength...and for me that is my family...

I hope that this dear family which has lost one of it's strongest bricks will heal with time... no, the foundation will never be the same...and nothing we say..even time, will heal their pain completely... however.. I hope that with faith, love, and other family support..they will get through this most difficult time.. and I pray that they get all the love and tenderness they need...

Death is an expected event for everybody, thing, person-- whether it be insect, plant, human, animal -nobody can escape its clutches...however when a young life is tragically cut short...a bowl of questions can float in your mind and make you wonder... when your own soap bubble will be bursting.

Krupali TeHOORA COME ON DOWN!

2010-01-20T23:28:00.001-08:00

So, today I was on the Price is Right--yes, the longstanding CBS gameshow which was hosted by Bob Barker for decades. It was the show where people bid high, bid low, bid under for prizes galore. From washing machines, to bean bags. From cars to bicycles, it is an entire gamut of randomness.

The episode that I appeared on today was taped on November 10, 2009.

I shared the link on Twitter this afternoon to the episode and got this response from one of my followers:

"How did my favorite cancer-curing vixen end up on Price is Right?! Oprah + CNN make sense but this one must have a backstory."

another response was this:

"Oprah, CNN and now The Price is Right. You are a force to be reckoned with in the tv world. Rock on!!!"

The backstory goes something like this:

I had always wanted to attend a taping for the 'Price is Right', and last November my mother and I went early for tickets, sat and lined up... there are 400 or so spots per episode and we were being taped in the afternoon. We sat, got a number, and sat some more.

Later on, we were given 2 forms, including a card to write something about you, and told to wear a number. An hour or so later, a producer and his side-kick did a group interview with 15-20 people at a time. He'd ask you where you were from, and just normal conversation. It was an 'interview' to see who he wanted to call up for the show.

I was excited, (as you can see on the video), and really happy (as you can also see on the video) to be there. I was there with my mom (my rock and best friend) and it was her dream to see it being taped too.

I didn't know who they would call, but I had an inkling that I would be called. I was crazy, peppy and just excited to be there... it was a dream come true!

The show started, lights came on, and it was GAME ON!

Lo and behold.. I was one of the first four contestants...
'Krupal EYE Tehooora, come on down..'

The experience is surreal, you can't think, I didn't pay attention to the prizes I was bidding on, I didn't know how many inches that damn TV was, or what type of bean bag was being bid on...honestly I was completely lost in my 'zone' of OMG I CAN'T BELIEVE THIS HAPPENED TO ME AND I'M SO DAMN EXCITED TO BE HERE! WOOOOOOT!

So if you want, you can watch the fun here .

Oh and to be quite honest, and yes, I'm truly being sincere, I just was going for the experience, and trust me, I had a great time... it was PHENOMENAL.

There you go... the backstory of me being on the 'Price is Right'... luck, happenstance, and serendipity. Oh and they butchered my name as they called me down.... my name is KRUPALI TEJURA NOT CRUPALAEYE TEHOORA.
(Crew-polly Te-jew-ra) :D

Krupali Tejura COME ON DOWN!

2010-01-20T16:54:00.001-08:00

I'm on the Price is RIGHT! Here is the episode. They mutilate my name when they call me down :), enjoy! Just call me the 2 dollar girl!

My Dad & I

2010-01-15T06:34:00.000-08:00

Breathtaken by the beauty of Patagonia.

Flying.

2010-01-13T02:14:00.000-08:00

Today I will be covering 4 cities, 3 countries, 2 continents.
Jet lag to be followed immediately afterwards.

Argentina

2010-01-11T14:40:00.000-08:00

Good Evening from El Calafate in Patagonia, Argentina.

It´s where i´ve been traveling throughout these past few days..it´s been divine.

Landed in Buenos Aires where we roamed the city, learned how to tango, and imbibed the Argentinian ´way´.

Then we flew to Iguazu where we spent an entire day awe-struck by the magnificent waterfall... breathtaking is an understatement. We took a boat ride and were drenched by some of the water... video and pictures to be coming upon my return.

The last leg of the trip is trekking Patagonian glaciers. We trekked Perito Merino today...it was a journey of sorts. The hues of blue on the ice were simply stunning. I don´t think my camera did it justice, but I hope to capture some of the beauty.

I hope all is well...I don´t really want vacation to end, but work continues on...and hopefully will get a chance to come back again someday!

Vacation.

2010-01-06T10:23:00.001-08:00

I´m on vacation for a few weeks. International travel has resumed in 2010, and I couldn't be happier.

The Impossible IS Possible.

2009-12-31T09:51:00.000-08:00

Photo Sharing - Video Sharing - Photo Printing

2009 started off on a crazy whirlwind for me. Many of you know that back in 2004 I wrote a letter to Oprah Winfrey telling her how inspired I was by Barack Obama after catching a glimpse of him speak at the Democratic National Convention. The following day the Oprah Show called me inviting me to be in the audience of the show.

That show was the first show Barack Obama appeared on Oprah. The show taped on January 12, 2005.

I couldn't wait. I talked my way into getting 4 tickets for my family instead of the usual 2. (That story is priceless in itself :))

I made a mental checklist in my head as to what I wanted to accomplish while at the show. I wanted Barack to know he should run for President, I wanted my cute mom to be on TV, and I wanted to let them know that I would help in the campaign if necessary.

Oh yeah, I made a jingle to sing on air. And no, as after you see the clip--I AM NOT A SINGER!

I sang on the show anyways...Oprah told me to keep my day job, and I told her that I was a doctor and just 'saved lives'.

It was a moment for the ages, a moment in history.

But the story got better.

Fast forward to the year 2008. I had an election party, and after Obama won, I went online and booked a flight to DC to the inauguration. I had to be there. It was a full circle moment for me...

I didn't know where I'd be staying, I didn't have official inauguration tickets, but I had to be there no matter what.

The next day, a friend was over, and was surprised by my moxie.
Them, "I can't believe you're going, going alone, and don't have anything planned yet."
Me, "It will happen, I have a feeling I'll get inauguration tickets!"
Them, "HOW?"
Me, "I don't know, but it will happen."

I honestly just had a gut feeling.
Don't know. Just did.

I emailed my Senators, Representatives, for inauguration tickets. The usual process where you leave your name, phone number, and address. I heard back from my Representative that due to overwhelming demand, I didn't receive tickets.

OK.

The phone then rang on December 16, 2008, 4 years TO THE DAY that the Oprah Winfrey Show called me about being in the audience for their Barack Obama show..

It was Senator Diane Feinsteins office.
I won a lottery and received 2 tickets to the inauguration.

They had received over 85,000 requests, 200 were chosen.

Do the math.
It's less than 0.2% chance of getting at ticket.

I was 'officially' going to the inauguration.
CRAZY!

It was too good of a story to come true.

In January a few days before the inauguration, CNN called me. They wanted to follow me on my road to the inauguration. I met them in Philadelphia as we took the train to DC and all the celebrations. It was phenomenal...we then did a recap interview a week later.

NPR also caught word of the story, and interviewed me for 'Talk of the Nation', it was amazing. They made me sing the jingle (ahhhh!). You can catch that interview here.

It is an incredible story, honestly even for me to comprehend that it actually happened. That something that I believed in so much came to fruition.

No matter what your political beliefs, your ideology, the story in itself is kinda nutty.

It's something that defined the year 2009 for me--the lesson, the impossible IS possible. Just look above.

A Special Holiday Card.

2009-12-27T19:15:00.000-08:00

Right before Christmas last week I received a very special holiday card--from someone I had never met, but yet, she was special to me.

I received a card from Maya Chamberlin and her family....inside was a note written by her mother, on Maya's behalf.

"Dear Aunty Krupali,

We have never met yet, but I wanted to take this opportunity and thank you for helping me find a donor. I can't wait to get well and come back to LA.

Love,
Maya & Jaden"

I can't lie, and tell you that I didn't cry after reading these words. I will be honest and tell you that I bawled.

Maya is the 4 year old little girl who's story I read in the LA Times a few weeks ago. She is the little girl battling cancer and the little girl who I've been tweeting about to no end. She is the little girl who showed me what the true nature and power of Twitter.

The story reached the ears of NPR listeners this weekend, and I urge you all to spread the word, tweet, message.

She hasn't found a donor....yet. I hope and pray that she finds one soon.

Please, if you can, get your marrow registered at marrow.org You can help save a persons life.

And as for the card, it is now kept with my most important keepsakes. I want to show Maya the card when I see her after she reaches home, hopefully after a successful bone marrow transplant.

Please help save this 4 year old child.

Happy Holidays!

2009-12-23T19:35:00.001-08:00

The Power of Wearing Ruby Red Slippers

2009-12-22T10:06:00.000-08:00

The day I wore my ruby red slippers, I had to see a new consult-- a gentleman who had lung cancer, which had riddled his body and bones causing him pain.

As I entered the room, I saw he was accompanied by his wife.

After I introduced myself and sat down talk with them, his wife started crying, and couldn’t stop. Crying is common in my field, whether it be the patient, or a family member or a friend—however, before I even began to talk, she was crying. I had to get her some Kleenex and calm her down before I could begin.

I talked to her about being strong for her partner who was going through a difficult part of life thus far. I had to tell her how her strength would make him stronger and her fortitude will help carry him as well.

Eventually she calmed down, and had some silent tears fall as I started talking to her husband about the radiation therapy, and his fight with the disease.

A few minutes later, she looked down at my shoes…and a small smile emerged from her face.

‘Are those Ruby Red Slippers?’

Me, ‘Yes!’

‘Can you click your heels 3 times for me?’

Me, ‘Yes.’

I attempted to click my heels three times, and her smile grew larger. I found out later that the ‘Wizard of Oz’ was one of her favorite movies.

----------------------------

I saw them again the following week. Her husband had begun his therapy, and when I walked in, she grinned. No tears were streaming down her face this time around.

"Dr. Tejura, can I tell you something?"

"Sure"

"I want to apologize for crying last time we met. When we came to see you last week, we were tired of dealing with doctors. We were tired of poor bedside manners, and simply exhausted with the entire process."

"No need to apologize for your feelings, and I can understand some of your frustrations."

"Dr. Tejura, when I went back to work after we met you last week, my friends asked how the appointment went with you. All I could say was ‘The doctor wears ruby red slippers!’"

She smiled.
"Thank you."

I smiled.

A pair of shoes made her day, and helped her believe in something. Something that helped ease some of her angst and pain. A simple pair of shoes did that much.

----------

I saw this couple again the week after, during a routine treatment check. We hugged and started with some small talk: playing poker, work, and then the patient said:

"Dr. Tejura, we have something for you."

I told her that nothing was needed or necessary.

His wife grabbed something out from her purse & they both smiled.

They handed over the "Wizard of Oz" DVD.

She told me, "He ordered it after we saw you with those shoes, and both of us just wanted to say thank you."

All I could say was "Thank You!"

We hugged, laughed, and enjoyed the moment.

------

Those ruby red slippers which I bought because of my 3 year old friend have caused so much magic in my life.

A simple pair of shoes, raised hope for one person, is a childhood for another, and have become a vehicle for me to dream.

Flowers of Sorrow

2009-12-21T00:00:00.000-08:00

It began as a hellish day at work... I was swarmed with patients: patients who were coming back for news that their tumor had come back, patients who were dealing with brand new tumors, and patients who were just here getting a check up. Everyday is different.. some highs, some lows.. and sometimes moments which make you reflect on your own being.

In the middle of the craziness... a family came in... with flowers...and 5 pairs of eyes that had been crying and looked as though they had not been sleeping for days... I knew them all well...

It was a family sans their mother.

The matriarch of this particular family passed away 3 days prior.. my nurse had received the news....it wasn't surprising news to me or the staff that I work with... it was a time that was coming..... I knew no matter what weapons we threw at the cancer..that her death was inevitable.... nothing... not even the highest hope that her family had for her could save her..

I had seen her almost everyday for her 6 weeks of treatment... through the good days when she could say a few words.. through the bad days when she was almost comatose... yet her family, whether it be one of her children.. or her husband lovingly brought her in for her treatment... not one of them was willing to give up... and almost everyone made it to my office door to get their daily hug...at times one of the children would come into my office and breakdown, crying, and asking, 'why can't my mom be normal again?'..

You could see the pain in their eyes everyday... a glimmer of hope... yet a knowing sense of the loss that was soon to be coming...

Their loss happened just a few days ago...
And they came into my office today...

This has never happened to me... a family coming in just 3 days after losing their most loved possession, their mother. Why they came in... made me cry...with them.

They wanted to say thank you... for caring for her.. for being there and for trying to go above and beyond with her care... and for giving them hugs to get them through.. one by one... they started crying.. and being human.. and feeling their sense of pain, loss, and utter devastation... I started crying too.. as best as I could try to hold it in.. I couldn't. I told them it was a privilege for me to take care of her.. honestly, a gift.

I asked if I could do anything... one of them whispered underneath her breath, 'Bring back mom'.... those words were something I wish I could do... her husband who had met her when she was 16 and had loved her for over 40 years... put his hand on her shoulder for support... another daughter just started crying and saying this sucks... and yes... it sucks. There are no words... that can make her reappear.. nothing that will make the pain magically go away.. nothing that will make you fill that empty void that you have...

Their strength is and will always be their sense of family. Their love and respect for one another was amazing.. their courage and hope for their mother was second to none. This family will always and forever be important to me...

One daughter handed me these gorgeous flowers... and now as I sit at my desk... pondering the ways of the world.. the uncertainties.. the glitches.. the surprises... the complete randomness of what the road holds.. I shed a few more tears.. wondering... about my loved ones...and our own mortality.

It's going to be a rough week and holiday season for this family... but I hope that strength, courage, and faith heals them in due time.

In My Blood?

2009-12-17T10:47:00.000-08:00

I've been asked several times if I always knew that I wanted to be a doctor.

My father is a pediatrician, and my brother and I were in his clinic everyday after school. We had a routine--eat snacks from the hospital cafeteria that my dad would bring over, work on homework, and watch my dad go in and out of exam rooms checking pediatric patients.

In middle school I learned how to do some of the billing, would help file charts, and learned a little bit of the inner workings of a doctor's practice.

My father tells me that I held a stethoscope in my hand when I was a toddler and grinned. Who knows if that story is true, or if he's making up a story--since hey, what dad wouldn't be excited that their kid wants to follow in their footsteps?

The answer is, I didn't know if I've always wanted to be a doctor...until two years ago.

Two years ago, after I finished my training and moved back to California, I was packing up my childhood bedroom, and came across a few old diaries of mine. The entries made me laugh when I read them... telling me what teacher was mean, to who was my best friend for that day.

I was perusing a small little diary, written when I was around 6 years old--I came across one of the pages in it and was stunned.

My jaw dropped.

I had to sit down, catch my breath, and smile.
This is a page from that diary, written by me as a 6 year old child:

"I hope you like this diroy that I wrote whoever reads it I want to be a famous scientist and find a way out of cancer"

I had fulfilled a childhood dream, a childhood thought--a diary that I had written in told me what I had wanted to become. (And yes, I couldn't spell diary :))

It was eerie in a way, yet comforting in another.

I am where I'm supposed to be.

Advice for the Doctors

2009-12-15T09:30:00.000-08:00

A few years ago, I was fortunate to come across a blog on NPR written by Leroy Sievers, the former producer of Nightline. Leroy was battling stage IV colon cancer. He blogged daily about his battle with cancer, his thoughts on life, and just simple musings of the day.

I read it regularly. One day I even left a comment after a post. I never thought about it again. Until the next day.

The very next day, I was seeing a patient during a treatment check. The patient mentioned that he wanted to write about his experience with cancer. I told him that he should check out Leroy's blog for ideas and to start brainstorming--better yet, I wanted to show him the blog right then.

I brought the patient into my resident office, and pulled up the blog and told him to sit down and read it. I hadn't had time that morning to catch up on the post for that day.

He sat down, and started reading, as I was going through some paperwork.

The patient then gasped. I asked him what was wrong.

He said, "OH MY GOSH! DOCTOR! THEY ARE TALKING ABOUT YOU!"

I was stunned. What did he mean? What was he talking about? I was utterly confused.

I looked at the screen and saw this:

The other day, Dr. Krupali Tejura wrote in with this question:

"I am finishing my training in radiation oncology in 3-4 more months time. My question to you is: What advice do you have for me, as an up and coming cancer specialist? More specifically, what did you like/dislike about your physicians, what could we do to be better? I know everyone has differing sets of opinions on the matter, but I would appreciate any input."

I was stunned.

The responses I received were breathtaking. They were amazing. Here is the full posting on NPR. I learned a lot from others, strangers who I had never met.

People teach me things everyday, whether it be via blogging, via Twitter, via chat, or in person.

Which brings me to this: What advice to you have for me and other doctors? Please share your input.

Advice is humbling, advice is something to be heeded to.

Everyone is a teacher.

It's our job to keep an open mind and learn.

Birthday Cake

2009-12-11T01:41:00.000-08:00

A fellow physician called me with a consult this afternoon....he described the case as a 60 year old who had stridor (difficulty breathing) for the past week and was admitted to the hospital recently. A CT scan showed lymph nodes in his neck which was compressing the trachea, and other scans didn't show much better. A biopsy was done but the final results were pending. It was cancer...it smelled like cancer, it looked like cancer per his description, and in my gut I knew it was.

I went upstairs to see the patient. He was sitting in his bed, surrounded by his 2 daughters and his wife. We chatted for a bit, and I told them I didn't know the final pathology and that the treatment would depend on what type of cancer or tumor it was. We went over some of the scan results, the cancer had spread to other parts of his body.

His wife's eyes glistened with tears.

I asked her if I could give her a hug. She crumbled in my arms. As I learned more about him, she told me they had been married 33 years, and she had never spent a day without him. Going home these past few days was hard on her, since it was the first time he wasn't with her. She started crying, as did one of the daughters.

His breathing was getting worse, so he was transferred to the Intensive Care Unit where he could be monitored more frequently and have other procedures done.

As this was being done, I ran down to pathology to take a look at the slides. I wanted to see what kind of bastardly tumor was ravaging the mans body. It looked like an anaplastic tumor.. a horrible tumor, one that just looked like the meanest, most ugly thing growing at a crazy rate. The CT scans weren't much better. There were tumors everywhere in his body. This cancer was spreading like wildfire.

I knew the prognosis, and my heart sank. I looked at the pathologist and told him the patients story...how they were married for 33 years, how he has 2 daughters, and how this news going to devastate them. He looked at me and said, 'I don't know how you do it.'

I don't know either.

I went to go see him upstairs, after he was transferred to the ICU. He asked me if he knew what type of cancer it was, I told him. He then said the words I dread to hear at times, as I still haven't perfected the right way to answer the question. 'Doctor, am I curable?'.

I bit my tongue hard. I said, well the cancer is spreading throughout the body, so that makes you a stage IV the highest stage. Right now we need to put out the main fire and keep you breathing, so let's think about that battle first. We can talk about the other stuff in a little bit.

I don't know what else I said, but as I was talking, I was watching the eyes of the family members upon me. They were grasping at every single word--I had to be careful. Their tears and their eyes affect me. Their pain becomes my pain. It is at times hard to pull yourself away from it all and not cry.

I talked to the daughters, and I asked them how old they were (I thought they were 14 and 16). I found out that one was in her mid 20's and one just turned 30 yesterday. She had turned 30 while taking care of her dad in the hospital. That was not a birthday. No cake was eaten, no food was eaten, but tears were shed, and crying was done.

That hurt me to no end.

I left that room, and by that time I had a lunch break.

I took a few deep breaths and sat outside, needed to get some fresh air, and walk it out. This would be the last birthday that she would share with her father. I started crying.

Then it hit me.

I grabbed my car keys and ran to the grocery store. I aimed for the bakery. I then looked at some cakes...and these exact thoughts ran through my mind:

This patients daughter turned 30, I don't know her name yet, and I don't know what flavor cake she likes or dislikes, what do I DO? What kind of cake do I get, will I look crazy? Better yet, DO I CARE? She needs to celebrate with cake with her dad. It's the last one she will have with him.

I picked a chocolate cake (per the bakery worker--which girl doesn't like chocolate?), and she inscribed Happy 30th Birthday.

The bakery worker asked me if I wanted to put a name down... I said no. (And then felt like hitting my head on the counter top feeling dumb for not knowing this girls name).

I bought some plastic silverware, and some plates, and was out the door.

Next stop: Back to the ICU room.

I walked in, but the birthday girl wasn't there. She had just stepped out. I let her dad and her family in on my plan... they were stunned, her dad just smiled.. he was beaming. I told him, 'I know this is your baby, you want to sing, and celebrate'... he just smiled underneath his mask. I held his hand and he squeezed them tightly. I had my phone prepared to take pictures and video. I wanted them to have a special moment, and something that they could think of on the positive side.

She finally arrived... I could see some tears that had recently been shed from her eyes... as she stepped in, her mom said, Happy Birthday, the doctor bought you a cake! She smiled, 'you didn't have to do this'... I know I didn't have to do anything. I wanted to do something.

We sang happy birthday, she cut the cake, and they each ate a piece. They all smiled. Those smiles made me smile. It lessened some of the pain.

It's not the normal 30th birthday celebration. Not many people have a father in the hospital with a prognosis of cancer which will kill him in 3 months. It's not normal. It's not fair, and it just plain sucks.

There are moments where you do happy dances in my field, and there are moments where you just want to vomit. There are moments where you want to scream with glee, and there are moments where you want to hit your head on a wall.

This was a hit my head on the wall kind of day, however the power of a simple cake helped bring some smiles into a family's life, and hopefully will shed some more strength into them too.

Root Beer

2009-12-09T13:39:00.001-08:00

A few months ago, I received a text around 10pm at night. It was a message from one of my best friends. It said that her father was just diagnosed with cancer and they had a few questions. I immediately called her, and said I was coming over. My friends mom was at the house waiting for me with copious notes in hand. My best friends dad was still in the hospital being monitored.

I was there until 1am planning a strategy.
We were not going to go in blindly.

Her mother I've known for decades... it's her home I used to sit at, sit with a group of high school friends, attempting to learn physics. It's her kitchen table I learned how to build a crane made of toothpicks. It's her house where we planned a ditch day for her daughter and other friends to come with me to 'Little India' so that we could get 'cultured'.

It's her mother who, when she traveled to Russia, brought me back nesting dolls, with a note attached that said, "Krupali, I can't wait to see these displayed in your medical office one day". Mind you, she gave me these dolls when I was 15.

I never forgot these dolls. It was the first things I put in my office when I started my job 2 years ago. They are displayed proudly.

Her mom came to my office the next morning so we could chat about the findings, and if I had information on clinical trial that could be of use, or any other things that could be helpful. She wasn't the strong woman that I had grown up knowing at that particular time. She crumbled, and I had to bite my lip not to crumble too-we had too much work to get done.

The first thing she noticed when she sat in my office were the dolls. That made her smile.. 'I gave you those years ago.' Yes she did, and I saved them for my office just like she told me to.

Unfortunately the prognosis of my friends father wasn't good. Within a week he was discharged home to home hospice. One night my parents and I went to visit. I sat next to him, held his hand, and we chatted.

"Ka-polly (he never said my name right), thanks for explaining everything to us. I knew you went to school for something. Never thought i'd be needing you though.".

"Mr. X, I will always be here for you. I love you guys."

We chatted some more, and what he craved most was root beer. He wanted a particular brand. He wanted that and some ginger ale. I said, heck, let's get you some.

"Ka-polly, the home hospice doctor said I shouldn't drink it"

"Mr. X, this doctor says you can drink whatever the HELL you want."

He smiled. We chatted some more, and we left the house.

The next morning, I decided to make a stop at the grocery store, buy some ginger ale and that particular brand of root beer and head over to say hello to Mr. X. I wanted to drink a root beer with him and chat a bit longer.

As I pulled into his driveway, I came out and got my grocery bags out from the car. My best friend walked out.

"Oh, Krupali, you dont' know..."

"Oh god.. what don't I know?"

"My dad passed away an hour ago."

I hugged her as she cried...and I mumbled, 'I brought him some root beer'. We went inside, and I saw a few other family members in the room.

My friend ushered me into the room where her mom and where her dad passed. He was in bed, looking peaceful. He was gone...and the hospice nurse was cleaning things up for the body to be sent to the morgue.

I hugged Mrs. X, as she remained calm... 'He was peaceful when he passed... he is out of pain.'

I remained there for sometime before I left with a lump in my throat. It took me a few days, if not a few weeks to come to terms with the loss that my friend and her mom had to deal with.

I am dealing with it to this day.

Root beer will never look the same to me again. Here's to you Mr. X, as I cheer to you with a root beer in hand. Farewell dear friend and mentor. You are missed.

The Power of Twitter.

2009-12-08T09:09:00.000-08:00

This weekend I came across a story of a 4 year old girl battling a blood leukemia. Her potential cure is finding a bone marrow match. It's hard enough to find a match of one's own race--it's even harder if you're of mixed race. It's the story of Maya Chamberlin which can be read here.

The problem lies in the fact that many people are not registered in the Bone Marrow Registry. You should go to http://www.marrow.org/ to register. It's simple--a cheek swab. No blood drawn, no needles needed.

YOU have the POWER to SAVE a LIFE.

I don't know how much more I can emphasize this FACT.

I started spreading the word via twitter @krupali and the the battle cry spread like wildfire. I want to thank everyone who is re-tweeting this post, telling people to get registered, and spreading the word. From Gotham Chopra to Melissa Joan Hart--people that I don't even know took to the cry-- I will never ever forget their kindness, and their influence with people.

Twitter is a phenomenal source to use for social advocacy, urgent issues, and I've found out that you will find people who give a damn and actually CARE.

It's beautiful.

Even if 10 people read and act and go to the registry, that's 10 more chances that Maya or another person facing something curable will be able to live.

Thank you.

Ruby Red Slippers

2009-12-05T08:51:00.000-08:00

It was not the usual Monday morning in my office--usually a time which I normally dread--the beginning of a long week was actually being anticipated this particular time.

Today was different.

I've befriended a 3 year old child. She is the daughter of one of my patients. Everyday she comes to me for a hug, I give her a sticker, and we chat about things...her dress, what she likes to play, and what she did that day. We've talked about her sister, her going to a dress up party as Snow White, and me just listening to her babble about anything.

She was your typical 3 year old--rambunctious, funny, sweet, but one thing stood out: she wore ruby red slippers.

I admired her shoes, and asked her about them. Last week she looked at me and said, 'FRIEND you should get them too and we can be TWINS!'

After she left with her mother, I went online and bought a pair of Ruby Red Slippers.

I told my 3 year old 'friends' mother about my slipper purchase. My patient laughed and said she'd bring her daughter with the slippers on this Monday morning.

I eagerly anticipated us being TWINS. I wanted to see her face, and her smile, and couldn't wait for us to be twins and share this common bond!

This Monday, my patient came in for her treatment, and my 'friend' followed with her 5 year sister behind her, both wearing the same ruby red slippers.

They both marched to my office door.

I walked out to them with own set of slippers.

The 3 year old YELPED in glee!

"FRIEND! We are now TRIPLETS!"
Her mother started laughing and said, 'She is my doctor....not your friend'
The 3 year old retorted, "MOM! She is MY friend FIRST!'

I could not stop laughing.
It was simply one of the best moments ever.

As their mother was getting treated, the sisters stayed in my office. We chatted about being triplets, school, candy, and of course chocolate. When they left, they both hugged me at once, causing me to topple over... it was awesome.

This particular Monday was great, seriously one of those Mondays that I'll remember for the rest of my life.

The TRIPLETS!

Written originally October 12, 2009.
-Krupali

Dancing with the Foo Fighters

2009-10-29T16:21:00.000-07:00

Check me out at around 27 seconds, red scarf :)

Last night a dream was fulfilled-all by crazy serendipity.

I have this list in my mind, of musicians/groups I'd like to see play live before I ahem.. croak. The top of the list for the past decade have been the Foo Fighters. For one reason or another, I never got to see them play live.

From their video for 'Big Me', which was a play on the Mentos commercials to their hilarious spoof during their video for 'Learn to Fly' (if you haven't seen these videos, do yourself a favor and YouTube them) they've always had fun with the music.

Just 2 weeks ago, I was having a conversation about music with someone, and I told them, 'I have to see my Dave Grohl and Foo Fighters play!', we talked about their new single 'Wheels' and talked about how it had a very Tom Petty feel to that song....

Then last week, via Twitter, @foofighters announced they were having a contest, and winners received tickets to see them play live for a VH1 taping. The contest? Ask the Foo Fighters a question... I quickly tweeted in something (less than 140 characters which is hard), and never really gave it a second thought.

This past Monday came along, and I got an email that told me that I had won, and had a ticket to attend the taping.

Last night was the night.

Stood in line at Sony Studios with 200 people. 50 people were let in... then 50 more people were let in.. I became anxious--when the heck would I be led in? Via randomness, and persistence, I finally went through the metal detectors, and stood in yet another line... by happenstance, I sorta meandered my way into this random crowd, an we were finally let into the set...and were seated...and I was the next to the last seat in the FRONT ROW.

While we were sitting, casting people were moving people around like you wouldn't believe. 'Pretty people' were placed in front, and die hard fans were 'moved to the back'. It was ridiculous. Random people who were sitting near me and I were anxious--we didn't want to be moved to the back. We were here to see the band, we weren't here for any reason but just that. Yeah it's TV, I guess, but it really ticked me off how the entire 'seating' thing worked. Luckily we were either not in any TV shots, or there were enough 'pretty people' near me, that we were spared the ax of being banished to the back. (And yes, I prayed a little prayer to not have to move too).

Then the band came on....to play 13 songs, talk about their songs, and answer questions from the audience. It was amazing. It was amazing to be 5 feet away from Dave Grohl, the lead singer...it was awesome to just dance, jump, and enjoy some of their greatest hits, as they played with passion.

It was just phenomenal.

After the 2 hours, the magic ended. Lights came on, and I finally sat down in my chair, in awe. I pinched myself..this happened, right? We were finally allowed to take pictures, so I snapped a few before they were like 'ahem, you guys need to go home now' :).

It was a magical night. A dream come true. I know I'll likely never get to see them play from this close ever again. All I know is it was a band I've wanted to see for so many years, and in the weirdest, most off the wall way, it happened.

Still in a happy shock.

And yes, the Foo Fighters were worth the wait...amazing live, and Grohl did not disappoint. Oh yeah, for those interested, the Foo Fighters, VH1 Storyteller Show will air at 11pm on November 27th on VH1. You won't be disappointed...