REFLECTIONS ON MEDICAL SCHOOL

 

It is mind-blowing to realize that over two decades have passed since I first stepped foot into Isfahan University of Medical Sciences.

Back then, entering medical school meant surviving an intensely competitive national entrance exam featuring rigorous multiple-choice questions with negative marking. As part of Iran’s post-revolution "baby boom" generation, I was one of more than 1.5 million students competing for a spot, and I was fortunate to place in the top 400.

Surviving the initial preclinical years meant pushing through anatomy, physiology, and other foundational modules. Things grew much more interesting once we transitioned to clinical rotations—even if the endless ward rounds, particularly in internal medicine, tested our endurance. I spent countless hours training at the large tertiary Alzahra Hospital, where senior residents played an invaluable role in mentoring us through the realities of patient care.

Initially, I found myself drawn to cardiology and neurology, fascinated by the complexity of the textbooks and the science behind them. However, dealing with the wards presented a completely different reality. The patient demographics in Iran offered unique clinical presentations shaped by lifestyle and regional factors. With alcohol largely unavailable, we saw high rates of tobacco and opium consumption, alongside a diet rich in carbohydrates that fueled a strong genetic predisposition for diabetes. This translated into frequent admissions for severe chronic obstructive pulmonary disease (COPD) exacerbations and end-stage heart failure. High rates of intravenous drug use also brought prevalent cases of Hepatitis B and C, often presenting as jaundice, cirrhosis, severe ascites, or bleeding esophageal varices.

Conditions like HIV infection or certain gynaecological malignancies—such as vulvar or cervical carcinomas—were rare; I had barely even seen an abnormal Pap smear during those years. Ultimately, witnessing the heavy burden of chronic, end-stage disease in the medical wards, cath labs, and echo labs steered me away from cardiology. Instead, I fell in love with obstetrics and gynaecology at first sight.

My 18-month internship—treated as an undergraduate module concluding with MCQ exams for each rotation—culminated in intensive care and toxicology. Methanol toxicity was a harrowing reality; patients who consumed unauthorized, homemade alcohol often presented with severe metabolic acidosis requiring haemodialysis, and tragically, some lost their eyesight. I also learned the delicate art of managing opioid dependence in acute settings: diluting a naloxone ampule to administer just enough to help a patient breathe and slightly open their eyes, careful not to trigger violent withdrawal agitation.

Visit to the Nomad tent at home, 2011

Primary care clinic in Chaharmahal and Bakhtiari Province, 2011

Following my tertiary hospital internship, I transitioned to rural primary healthcare, serving in remote areas. Each clinic was run by a dedicated team of around 20 local staff, providing maternity, pharmacy, and dental services. As the youngest member of the team—and suddenly thrust into a management and supervisory role with very little real-world administrative experience—I learned quickly. Fortunately, a relaxed, collaborative approach helped us run things smoothly.

Three times a week, our team traveled to even more remote villages with stacks of medication, visiting traveling nomads from the south in regions with high malaria rates. Working out in nature was incredible. I have fond memories of sitting on the floor of nomad tents, drinking tea, and being treated like royalty with fresh barbecued lamb kebabs.

Evenings in my rural accommodation could be quiet, lonely, and dull, but I survived another 18 months fueled by novels, movies, and a tremendous amount of crochet and oil painting. Looking back, that chapter taught me invaluable patience, resilience, and leadership skills that continue to shape my career today.

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FOUR DECADES OF WISDOM

 I turned 41 today. I am blessed to have made it this far in life. I am hoping to be healthy and alive for another 4 decades! I am not bothered about grey hair or wrinkles. I am probably going to age naturally and gracefully. I am still at the beginning of my career as an OBGYN, and I hope to study further and get into fellowship programs.

There are things I want to say to my younger self that I wish I had done differently in life. 

1. I was very young and emotional, and my feminist ideology was bubbling in my twenties. I moved to South Africa and lived with my parents for two years while the HPCSA registration was finalized. I was fighting with my dad constantly, trying to change his behaviour towards my mom, taking her side in the fights and causing more and more tension. It led to their divorce after 30 years of marriage, and me not talking to my dad for four years. They are back to living together, and we are on good terms now. He has not changed at all, but whenever there is an argument in the house, I keep quiet and do not take sides until it settles, and it helps a lot with keeping the peace.

2. In this age, we really do not care how we look in photos or holiday pics; we care how we look in CT, MRI, and Pap smears. We think about our health way more than when we were in our twenties. We think twice before we decide to party and skip a good night's sleep, because recovery is not easy. Luckily, I don't drink, but life is too short to spend so many Sundays and Mondays recovering from dehydration and hangovers. Gen Z knows the importance of this, and they are already skipping the crazy partying and drinking phase of life; they are all about skin care, sleep, mental health, work-life balance, and, most importantly, their pockets. 

3. I no longer care about my next holiday destination. I am more interested in saving for my pension,  investing, and settling my mortgage. Spending a fortune travelling to an exotic island just to relax by the beach, get bored, sip on a cocktail, and read a book. I can still enjoy little moments of life, and not go bankrupt. 

4. Talk less and listen more. I have learnt this the hard way. Once somebody has made up their mind on something, it is impossible to change their mind. The more we argue, the more defensive they become and the more they disagree with us. While interacting with the patients and family members, I let it go very quickly. I discuss alternate options and let them decide as they wish.

5. I would tell my younger self who grew up watching Disney princess stories, believing some guy will come along and make me the happiest girl in the world. Now I see the value of my girlfriends who stand by me and support me during the difficult times. Good friends are priceless, and they are there for you because they want to be, not because they are your parents or partner. 

6. I have been terrible with setting boundaries, especially with family and co-workers. I have been a people pleaser, playing nice and unable to say no. The co-workers who are firm and have boundaries survive much better. I have overworked myself, and I wish I could have done less and assigned different family members and coworkers to do their jobs. 

Midlife is not easy; some people have to deal with career challenges or retrenchment, some younger parents are dealing with teenagers, and some, like me, with a toddler. We have demanding full-time jobs, kids, and our aging parents. It's not easy watching your parents get older. Here is to the next four decades of health, growth, incredible career milestones, and deeply peaceful Sundays. 

My Bestie surprising me on my birthday

A fabulous trip to Mount Grace with my
dear girlfriend. 

SLOWING DOWN WITH MY 4 YEAR OLD

 My daughter is turning 4 in November. I have been having a brilliant opportunity to spend more time with her recently. We have slow mornings in bed. We do arts and crafts, and we read storybooks. She started creche at the age of two, and I used to drag her out of bed at 5am, get her dressed, and drop her off at her creche. Most days she would be the first baby being dropped off. She would panic and cry, and the ladies would try to take care of her until 8am when the teachers and the rest of the children would arrive. They were given breakfast and lunch at school, and she required a late snack, as most days I would fetch her around 6pm. In her new school, we pack her a pretty lunchbox with a little sandwich, and we drop her off at 9:30 am which makes a huge difference.

She is a very sweet and independent girl. There are weekends when I leave her with her grandparents, and she manages well. She was initially interested in Coco Melon animations, and then she started enjoying Peppa Pig. She became extremely interested in K-pop and its music. She had been watching a lot of dinosaur shows and Jurassic Park with her dad and has been enjoying the Paw-petrol dog shows. I love it when she gives me her opinion on things and asks me what she wants to get. One of her favourite toys is the Marshal dog from the Paw-petrol characters. She enjoys watching Spiderman shows on YouTube. She started watching the Frozen animation on my friend’s Disney channel and became very interested in the story. Now she runs around, opens her hands, makes a big sound, and pretends to freeze everything and everyone. When she gets to me, she says, “Mommy hot!” I get excited and jump up and down with joy.

I am a great lover of public libraries, and recently my little daughter has her own library card, and she can take out her own children’s books. She saw a Frozen storybook in the library and took it immediately. She is getting more and more verbal, at her own pace. She is learning new words every day and becoming more curious about various things. She knows her shapes and colours and knows how to count to ten. She knows the names of most of the animals and fruits. She can now solve little puzzles and enjoys playing with blocks and building things. She is very happy when she is around other children. 

She is close to her father’s mother, whom she calls Ouma, and my dad, whom she calls Daddy. She is OK around my mother and my husband's grandmother. My dad and Ouma spend a lot of time playing with her. Up to the age of 28 months,  she was mostly with my mother while I was at work, but my mom was not very pro-active to play with her or taking her outside; my dad was the one to play with her inside and outdoors. She is a picky eater; she mainly lives on bread and butter, milk, and snacks. She loves KFC chicken or any grilled chicken, fried fish and chips, 2-minute noodles, and all sorts of eggs. She is not interested in vegetables except corn and cucumber and a few fruits like apples, oranges and strawberries. 

She enjoys riding her bicycle, doing arts and crafts, and playing with my husband's granny who makes blocks and has pretend tea parties with her. Our neighbour’s boy comes up to my parents' house and the two of them sometimes play well, or sometimes it ends up with disaster and tears and fighting. Whenever she falls or has a sore, I give her a hug and tell her, “Mommy is gonna kiss it better!” Some days when I am a bit nervous or stressed, she spontaneously comes to me, gives me a hug, kisses me, and tells me, “I kiss it better!” I instantly start to feel better; it is such a good feeling.  We do our best as parents, and we hope to raise a happy and confident girl.

                                                  Fun in the sun with the pink bicycle

The giant airplane

The Bird Garden in Monte Casino

Enjoying doing puzzles in the Bryanston Library

DR. ZHIVAGO BOOK VS MOVIE REVIEW

A little sketch work from the epic movie 

 Dr Zhivago was known to me as a classic  Hollywood movie made in the sixties, and I was aware of the unique Lara’s theme. I had no idea what it was about. Two weeks ago, I was looking through the classic novel section of the public library and came across Dr Zhivago. I realized that it was actually a classic Russian novel. I started reading, and the story demonstrated Yuri's (Dr Zhivago) loyalty to his wife, Tonya, even though he was caught in a romantic relationship with Lara during the war, while she was working as a nurse and searching for her husband. He was a doctor, and during his career endured a lot of hardship dealing with the chaos of the war and the revolution in the Soviet Union. He also enjoyed writing poetry, and the poem collections were at the back of the novel. The harsh reality of the intrusion into the citizens' personal lives and the consequences were clearly mentioned in the story. 

I managed to watch the movie as well, and I enjoyed the various scenes, the acting, and the attention to detail. I was anticipating a long movie, based on the events that needed to be covered from the book. The soundtrack was extremely touching, portraying a sense of love, hope, and chaos at the same time. It was painful to see that Tonya was doing her best to be a dutiful wife to Zhivago, but he had way more chemistry with Lara, and he would use every opportunity to get with her. 

I did some research and realized that Boris Pasternak’s book was banned in the soviet Union at the time, due to the negative portray on the revolution and its devastating effect on individuals. It was secretly printed and distributed internationally in the 1950s. He was later offered a Nobel Prize in Literature, but declined for fear of having to leave his home country. The movie was a big box office success and won several Academy Awards and was an inspiration for the next generation of filmmakers. Knowing that the cast of the movie had to make a little Moscow in Spain and shoot some of the winter shots in the middle of summer with artificial snow was interesting, as Moscow did not approve shooting the movie in Russia. It was fascinating that an Egyptian actor, Omar Sharif, managed to be picked as the lead actor, and Charlie Chaplin’s daughter played the part of Tonya. The director David Lean was a great storyteller and a perfectionist. There might have been a political incentive to spite the Soviet Union and raise awareness about the negative impact of the revolution. This masterpiece has had a huge impact on me, from the story to the soundtrack. I am going to sketch the two lead characters in the movie. It took the author 10 years to write this book, and it was partially related to the author’s life. 

I conclude with one of my favourite poems of Pasternak:

Autumn

I have allowed my family to scatter,

All those who were my dearest to depart,

And once again an age-long loneliness

Comes in to fill all nature and my heart.

Alone this cottage shelters me and you:

The wood is an unpeopled wilderness

And ways and footpaths wear, as in the song.

Weeds almost overgrowing each recess;

And where we sit together by ourselves

The log walls gaze upon us mournfully.

We gave no promise to leap obstacles,

We shall yet face our end with honesty.

At one we'll sit, at three again we'll rise,

My book with me, your sewing in your hand,

Nor with the dawning shall we realize

When all our kissing shall have had an end.

You leaves, more richly and more recklessly

Rustle your dresses, spill yourselves away,

And fill a past day's cup of bitterness

Still higher with the anguish of today!

All this delight, devotion and desire!

We'll fling ourselves into September's riot!

Immure yourself within the autumn's rustle

Entirely: go crazy, or be quiet!

How when you fall into my gentle arms

Enrobed in that silk-tasselled dressing gown

You shake the dress you wear away from you

As only coppices shake their leaves down!-

You are the blessing on my baneful way,

When life has depths worse than disease can reach,

And courage is the only root of beauty,

And it is this that draws us each to each.