It started as a regular cloudy morning in the endearing DMV. Oh, how I miss the three hundred days of sunshine in Denver. This definitely takes me back to my training days in dreary Pittsburgh. I started chopping up spinach and garlic as the boys were having breakfast while video calling family from down under. I realized there was no basil and was feeling too lazy to drive somewhere. I did some googling and it turns out, there is a market just a 12 minute walk away. And even better, they sell a dozen eggs for 99 cents. So we watched the boys frustrate themselves into being ready independently and headed out for a stroll. And of course, it began raining just as we started our walk. I sighed and longingly thought of how much quicker and easier it would have been to get in my car, drive for five minutes, shop, and drive back.

But, we started - so we must endure, otherwise what lesson are we teaching our sponges? We have to suffer through the slow walk of our 20-month-old, combined with his fierce desire for autonomy and the four year old’s constant complaints of no playgrounds and of being tired and starved after just a few steps. All while it is pouring rain and we have one umbrella to share amongst the four of us. However, this adventure that was less than a mile from our house was truly enlightening.

We walked by a small pond and I could see the gears turning in my four year old’s head. He kept gazing out onto the pond, seeing the droplets as they touched the surface of water and was mesmerized. He then asked “Why does it rain?” followed up with “How do the clouds get full?”. My husband thankfully took this one and explained the water cycle and I added some tangible examples. It was so cool, I just had to take a step back and remember how I first learned about it too. It took me back to those walks with my great grandfather and how he would explain water, soil, and plants. Life literally comes back full circle.

As we were discussing evaporation, condensation, precipitation, and runoff - there was an elderly gentleman from the store who passed us by. We walked by the pond again; pointed out some Canadian geese while trying to make sure our 20 month old did not run into the water. My husband then saw the same man on the ground up ahead on our path towards home. There was another stranger with him, holding an umbrella and calling 911. The wet sidewalk was painted with thin streaks of blood. There was more on the man’s corner brow as well as some on his wrist. In my mind, I made a rough assessment of the situation - and surprisingly, when I was with my family - I did the BLS/ACLS first step of making sure the scene was safe. I always thought that was such a meh first step, but it happened. We got the story of the elderly man tripping on an uneven part of the sidewalk and taking a fall to the ground. No loss of consciousness. He was sitting, trying not to move his right shoulder. I didn’t have any of my fancy operating room tools, except for my brain. He wasn’t tachycardic, had normal respiratory effort, maintained his airway, and no signs of significant blood loss. He was alert, oriented, conversant, but in some pain. I was relieved he was not in a critical condition; I have never been in this type of situation before. We stayed until emergency services arrived - which took a while to be honest. The logistics of getting a vehicle as close as possible to get a stretcher into the middle of a park surrounded by at least eight residential buildings was difficult.

After the EMS arrived, we pulled my 4 year old to the side and I loved what my husband did next. This man has never run a code but is a boss at debriefing. He explained to our son what happened and why we stopped to help out this gentleman. If we needed help one day, we would have also wanted someone to stop and help us. It’s true, even if they had a busy day planned where they had to make this pesto before the spinach went bad. I only kid.

I feel like at this point in time in our world, we are all chasing optimal efficiency. The definition of efficiency is: the ratio of the useful work performed by a machine or in a process to the total energy expended or heat taken in. They constantly track it in the operating rooms: first case on time starts (FCOTS), turnover time, and causes for delay. I am sure those of you who work in outpatient settings also get the same BS from management about cranking out patient visits. I think I bring this mindset home as well when it comes to household tasks. There is only so much time and I need to get x, y, and z done. So I have to do it in the most convenient and quickest way so I can move on to the next thing. However, I know when I am at work and there is a patient that needs a little more TLC, tuning up, or extra monitoring in PACU, I’ll stay. Even if I’d much rather go home and be with my family, I know when it is best for the patient, I’ll stay. Well, I am going to start doing that at home as well. I know that I often rebrand my impatience as efficiency. I am going to carve out time, likely not everyday, but at least three times a week where I will not do the convenient and easy thing. I’ll take the extra time to see what life throws at us because that is life. Not running around finishing my never-ending checklist.

Speaking of checklists, let’s circle back to this pesto that I can’t stop talking about or making.

The recipe base I use is Palak’s amazing creamy pesto that you can find here. It is really hard for me to follow cooking recipes because I basically cook like I provide anesthesia: customizing every ingredient depending on the case. A little bit of this, and a little bit of that - we anesthesia providers were the original salt baes. I add some silken tofu to the sauce base to increase protein and creaminess, as well as some of Trader Joe’s chili crunch oil to add that spice kick at the end, so the kids as well as the adults are satisfied. But big props for the breadcrumbs - they are the crunch we have been looking for - the chef’s kiss of an emergence.

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It was New Year’s Eve of 2020, the early start of the COVID-19 pandemic. Paati went to Australia to visit my cousins (man, how we hate sharing her) earlier in the year and was scheduled to come back to the United States, but due to strict travel restrictions, was stuck in Sydney. She is a typical elderly South Asian matriarch: hands riddled with chronic inflammation from arthritis due to sewing, crocheting, and cooking delicious delicacies for many; aching knees and feet from manual labor and household rituals; a functional capacity greater than four* as she chases great grandchildren around; and a hypertrophied left ventricle from underlying Ellavarasi (AKA queen) duties (I mean hypertension). Paati has a history of renal cell carcinoma with subsequent nephrectomy; she later developed a localized liver metastasis that was treated. She then decided at the age of 76 that she would no longer want surveillance imaging. This was, until December 31st, 2020. She did not want to burden anyone at home with the news of her hematemesis (vomiting blood) in the morning, but she then had a witnessed melanotic stool (black stool) which prompted further workup. Luckily, this lady has raised 2 grand daughter physicians - one on each side of the world to take care of her. My cousin had taken her in and our Paati had been walking around with a hemoglobin of 3.8. For reference - normal levels in a woman her age would be 11.4 - 13.8g/dL.

It was some day in February 2026, my last day of clinical work before my hiatus - I mean, well deserved and planned time off to be a human being. I walked into a room with an elderly female patient on the stretcher and multiple younger Spanish speaking family members around her. As she told me her birth year and procedure, I inexplicably had flashbacks of a moment where I was not present, but could visualize as if I was. My cousins, nieces, mother, brother, and aunt would have congregated in Paati’s room. While both patients understood basic English, there were moments of medical jargon likely lost in both. Grandchildren stepped in to intervene, asking questions as they should, and then humbly giving consent after concerns were addressed. Of course, I know any elderly woman from an immigrant family has been forced to put on a brave face even against all odds, time and time again. I could see she was putting on a smile and looking forward to the procedure and being cancer free, but the strength she portrayed was for her family, as is everything she had done before. I remembered the course my grandmother had and feared the worst in a similarly presenting patient. I was prepared for the worst and hoped for the best for this abuela. She, just like Paati, was healthy-ish on paper and in person. However, she had no symptoms and her labs were all normal.

Paati went in for an urgent endoscopy for her likely upper GI bleed given her symptoms. Fellow anesthesiologists and nurse anesthetists know that GI is a notorious place for bad things waiting to happen. Questionable NPO status, plenty of GLP-1 users, sick cirrhotics, and the forever aging population with more and more comorbidities. And we, as anesthesiologists, are not in our comfort place - the operating room. These non-operating room anesthetizing locations are called NORA. We are in a tiny GI suite with a substandard pyxis, limited patient access, lack of anesthesia support staff, and using possibly unfamiliar equipment. But things happen quickly. The incidence of malpractice claims are significantly higher in NORA than those in operating room cases. Common complications include airway management failures, respiratory depression, and inadequate ventilation - with aspiration pneumonitis occurring twice as often in NORA settings. In the next decade, it is anticipated that 50% of all anesthetics will be in a NORA space in the United States.¹ Recent evidence strongly suggests that many NORA-related complications would be prevented through appropriate, vigilant monitoring and maintaining the same standard of care as used in the operating room.²

They could not visualize anything but blood and clots during Paati’s endoscopy; it had to be converted to an emergent sleeve gastrectomy. She had about 1.6 L of blood loss (her total blood volume was probably around 4.5L for reference), was found to have a 5cm vascular gastric lesion that was removed, underwent a massive transfusion protocol, and remained intubated post-operatively. She was extubated soon after, recovered, and was sent home with follow up.

As I put on monitors and began pre-oxygenating the abuela, her rigid face began softening. Tears delved into crevasses on her cheeks as her eyes could no longer feign strength and she broke down in the privacy of the operating room. This intimacy and the tension building up to this moment in a patient’s life bring out the vulnerabilities in people. I haven’t even given her any medication yet - this is the art of verbal anesthesia. She pleaded with me and the circulator nurse to take care of her and bring her back to her great grandchildren. The nurse held her hand tightly and I wiped her tears; told her that we will give her the very best of care and that we will see her soon. Everything went smoothly, as things do when you’ve prepared for the worst. She was hemodynamically stable throughout and woke up at the end of the case comfortably. As I wheeled her out to recovery, I truly felt like I took care of my grandmother at that moment. Even though the two courses were dramatically different, we, as anesthesiologists, are prepared for either circumstance and adapt to the situation to hopefully have a good outcome.

Unfortunately, we are living in a time where we are being told constantly of the “other” and made painfully aware of our differences; I hope that I can show my kids and those around me that we are more similar than we are not. That abuela is also my matriarch.

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*Functional capacity is what anesthesiologists or nurse anesthetists use as a gauge to see if a patient is fit enough to undergo anesthesia for a surgery without any further testing. Four is the baseline you would want someone to achieve and is roughly equivalent to climbing a flight of stairs or doing light housework without getting short of breath or having chest pain.

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Citations:

1. Kaye, Alan D.^a; Rogers, Brianna N.^b; Mashaw, Sydney^b; Mosieri, Chizoba N.^c; Urman, Richard D.^d; Shekoohi, Sahar^c. Safety of nonoperating room anesthesia: a narrative review. Current Opinion in Anesthesiology 38(4):p 425-434, August 2025. | DOI: 10.1097/ACO.0000000000001542

2. Chang B, Kaye AD, Diaz JH, et al. Interventional procedures outside of the operating room: results from the National Anesthesia Clinical Outcomes Registry. J Patient Saf. 2018;14:9–16

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.Just writing all of that made me overwhelmed, but in an all consuming type of love and excitement for what is to come!

Even though I have not been as consistent as I was when I was working, I have noticed some significant changes to my life.

1. As a former pre-med and medical student, I used to be great at something called “analysis paralysis”. As the name suggests, I’d do tons of research to try to get a balanced perspective of all pros and cons and it would be a healthy debate as to why x or z is better. It would be difficult, but when you did come to decide, I’d feel good about all the thought that went into it. Then, came anesthesia residency and attending life. When I became an attending outside of my learning institution, I learned that I am a cowboy (I mean, cowgirl) in the operating room and have ALL of the freedoms. It is literally the Wild Wild West in there. I was reminded of my four year old parading around in his Woody pajamas yelling, “There’s a snake in my boot”. And of course, as Uncle Ben says, “With great power, comes great responsibility.”. Man, my kid sure has great taste in movies. All that said, to say that I had lost a lot of the indecision in my life as I grew up to be an attending. That is great when the stakes are high, like in the operating room. But on a daily basis, I wasn’t super proud of making decisions on a whim after an exhausted day of work and wanting to hit pause on mom-brain. Writing brought back the med student in me to want to read more research and to read things I was interested in to make decisions. For example, I didn’t know much about interior design but given my recent delve into Marie Kondo and Feng Shui - I really wanted to be intentional with our space while trying to repurpose old things. I went into rabbit holes about color schemes and wall space. These are things I have not done in the past and I have lived in plenty of apartments where I’ve made it my own and not given two cents about my security deposit. Spoiler alert - a lot of people on YouTube talk about designing on a budget, rental friendly upgrades, and creating well defined spaces - but hardly any of them consider doing that with two toddlers in mind. I want to enjoy my cozy corner with a robust Moroccan inspired rug and have colorful ottomans to stuff all the toys I don’t want to see.

2. It’s not news that journaling or expressive writing has many benefits to the brain. It is thought that writing improves areas of communication and emotional regulation as it involves using both the right and left hemispheres of the brain. Journaling improves emotional health, mental agility, and long term memory. Writing helps us introspect, improve thought structure, and spark innovation. I can’t pinpoint that writing alone has helped me emotionally, but I do feel lighter than I did prior to writing. However, in all honesty, so is not working clinically right now.

3. Lastly, writing consistently has helped me slow down. Slow down to collect my thoughts, realize why I have them, and what I feel about them. Comparable to the advice given on every social media platform for toddler tantrums - let us have the big feelings so we can process them. The “worry hour” in Finland is a time period before bedtime to let children (or adults) write down or discuss their fears so that they aren’t consumed by it during the day. It’s been shown to help relieve anxiety, promote better sleep, and teaches kids that emotions lose their power when expressed, not when they are kept hidden.

So to summarize briefly - most of daily life stressors have led me to rediscover my love for writing. That writing has helped me spark a bit of curiosity I had before the life of medicine burnt it out. Keeping up the habit despite a busy few weeks have improved my mental health, and I looked into how I can help my kids out as they get older too and would love to implement the Finnish worry hour (or 10 minutes) right before bedtime.

Stay tuned for toddler travel itineraries!

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Now, I will say that I couldn’t part with a lot of things as well. I had to tackle the inevitable: my desi clothes - 90% of which are from my wedding that was almost seven years ago. Most people who know me in real life would say that everytime I describe my big fat Indian wedding, I do it with a distinctive eye roll since it was not really a wedding for my husband or I, but mostly for our families. I give my immediate family a hard time whenever we talk about it and I think because in the American world I grew up in, weddings are for the bridezilla, not the families. Maybe I was immature back then, but the other day as I was going through each piece of clothing I had worn, nostalgia just took over me and I couldn’t help but relive those fond memories of sweating in over 100F weather with at least 20 pounds of jewelry on and a sari I could not drape, let alone pee in to save my life. Oops, I actually meant to say that I was reminiscing about seeing my extended family from all over the world who were kind enough to get together after so many years to celebrate my husband and I.

I couldn’t get over the intricacy of the handiwork of the sari and lehenga blouses. I was immensely sad that I couldn’t fit in them anymore either. As Mindy Kaling said in the past, “It takes a lot of work to be a normal/chubby woman.” It’s not like I am fully blaming my children for this, but I definitely fit in them before and after two and a half years of breastfeeding, they don’t fit. Those sponges.

This got me thinking about the concept of nostalgia. What is it and why does it happen?

I listened to this great podcast by the American Psychological Association where they interviewed Krystine Batcho, a psychologist and professor who researches nostalgia. You can listen to or read it here.

The roots of the word nostalgia, which was coined by a Swiss medical student, come from Greek words nóstos [homecoming] and álgos [pain, ache]. It was initially diagnosed as a medical condition, but maybe when they realized it affected men too, they decided that maybe that it is just all in the realm of normalcy. Batcho’s research says that nostalgia is a stabilizing force that comforts us during times of change and stress. On some deep psychic level, change is something that humans have difficulty grasping. You could be the most adaptable, go with the flow, type of person - like what my husband seems to be on the outside and what I actually am on the inside. But, when there is some loss of control, it is most definitely comforting to reflect back on those “good old days” even if they weren’t, to only remind us that even though we don’t know what the future holds, we do know who we have been and who we really are.

Nostalgia is quite powerful: it floods you with memories stained with fondness, even gives you meaning to your current state in life, and then can even empower you to connect with future generations. When I think about my memories growing up in India, although brief, there are many visceral moments I want my children to experience. I remember going on early morning walks with my great-grandfather to collect jasmine and marigold flowers for his prayers. The feeling of holding his hand, sensing his strong sense of self as I watched his interactions with others, and watching him perform his rituals humbly to respect those that came before him, showed me his character. I was only five years old and when I thought about these moments as I got older, I truly felt like they shaped me quietly. To be completely honest, I am not a religious woman and I don’t envision that changing as I married a staunch atheist who may or may not have converted me to an agnostic. All those flower expeditions were just that for me. Seeing the kindness in his eyes as he spoke with everyone and the sense of pride he had when speaking of where he came from and who he was spoke to me so much more than the religious texts he would read. Those are what resonate with me and they were made from consistent and quality time. I guess I was also a sea sponge taking in 20,000 times its volume to get nutrients. Such impressive creatures - a 1kg sea sponge can filter 24,000 liters of water in one day. I digress.

Nostalgia can be incredibly influential. If I get to take the best parts of my childhood and give some pieces of it to the next generation, then why not. It would be a beautiful way to stay connected and keep weaving the tapestry my ancestors have been making. It likely will definitely yield a separate scene and have a different vibe, but will be woven with the same thread.

Speaking of thread, I couldn’t help but feel so much joy when I was holding these timeless pieces. I am motivated to repurpose these beautiful fabrics and patterns and make them into something I can wear. I wish there was something like “I was a sari” where I can bring my own saris and they can make amazing bomber jackets or two piece skirt and top. Any women know of any places? Or maybe I will just have to wait to go back to Hyderabad and use the same tailor my family has trusted for so many years to take my old things and make them into something brand new.

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As most anesthesiologists, I am used to being shoved into a corner while my proceduralist colleagues waste so much space only to be so particular about the way they do things. I guess they get that privilege when they are working on your insides…I get to at least organize the way I like things with my syringes, airway equipment, and work area.

So what is Feng Shui?

It is an ancient Chinese practice that literally translates to “wind-water” and is based on a principle that focuses on bringing harmony between a person and their surroundings. The arrangement and choices of objects in your surroundings can be manipulated to harness the energy “qi” and establish a good flow, which in turn, can make you feel happier or lighter. I don’t know if I truly believe in this concept, but I can definitely see how my own surroundings affect my mood. Of course, I would love to wake up with a chocolate espresso martini in hand and be in another country on vacation. One key point for me after learning about this is to be mindful of the ‘commanding position’ in each room, which is where you envision spending the most time in each room. From that point, you can visualize how the energy can flow in and out of the space. The other major point is to, of course, discard and simplify my life. As they say in anesthesia, it is a lot harder to take back a hefty dose of something, but always easier to give (or get) more. You can take a closer look at the principles of Feng Shui here.

The decluttering concept vaguely reminded me of Marie Kondo’s Netflix show. It came out in 2019, and I remember we had to relocate for residency, but I clearly didn’t retain much from binging her show. Instead of the old me re-watching a series, I decided to read her book, the life-changing magic of tidying up - the Japanese art of decluttering. I am sad to admit this, but this is the first book I have read besides textbooks and children’s books since freshman year of college. I have listened to audio-books, but this felt very different, and in a wonderful way. I could focus on the pages, really envision what I was reading, and unplug from distractions. I yearn for the Icelandic evenings of my family sitting in a living room, each reading our own book and then talking about wherever our minds were taken to afterwards. Yes, you read that correctly - Icelandic. Iceland is one of the most literary countries in the world; they have the most published authors per capita and over one third of the population reads for at least 30 minutes a day. Christmas is all about exchanging books, oh, how lovely that sounds.

Her book was really easy to read and fascinating. Definitely worth it and she doesn’t just keep repeating the same phrase. Some key points I have made note of and am going to test out in real life:

1. Once you learn to only keep things that spark joy, you learn more about yourself and what is important to you. That then allows you to pour your time and passion into what brings you the most joy, your mission in life.

2. More pragmatic: We don’t need a winter/summer/fall/spring wardrobe - fit everything into one space. Layering is the way to do it and is pretty friendly to that postpartum mama pouch. Traveling with two toddlers has made me a huge fan of the capsule wardrobe concept - why not apply that to everyday life?

3. You can only truly discard when you bring every item in the same category from all of their hidden corners of your house and put it all in one place. This was key for me, especially for clothing.

4. Through the tidying process, you learn what contentment is. She stretches this into her clients losing weight since we finally understand what being “full feels like” - I am eager for the results on this one and will keep you posted.

As we have been packing and purging our home items, I realized I am so much more organized at work than at home. When I walk into what may turn into a shit-show of a case, I don’t panic (outwardly of course, on the inside, sometimes I can get a little sweaty) because at the very least, I know where all the things I need are. That is what I would love to feel at home when there is absolute chaos with two toddler boys bouncing off the walls and furniture. Let’s see if that happens!

Here is a sneak peek of what has been going on so far! I got all of my clothing (except my Indian clothes, I know, I know, I’m sorry) and it all fit on our queen sized guest room mattress and was two feet tall. Ended up with 7.5 garbage bags of donation items (which, thanks to all the documentaries about fast fashion and climate change, I do NOT feel good about, but alas, that is life). Super proud moment of fitting all of my clothing, no matter the seasons, into my side of the closet.

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Instead, I’d rather write about what matters to me and why we should continue to ask ourselves, our partners, and maybe even our kids what matters to them periodically as it changes as we go through different phases (unintended pun!) in life. I’m glad that my husband and I talk about our hopes and dreams periodically, especially when we have our quarterly financial spreadsheet date once the kids are asleep. It helps us get on the same page and if it weren’t for this, I would probably not be moving back to the east coast for a much better job offer. It forces us to reflect on the last three months and relive some fond memories since most of our expenses go to travel as that is my priority after the usual investments and savings. It also makes me think about my overall well being over the last quarter because sometimes work really makes for long days but pretty short weeks. It helps to re-frame and remind ourselves what we are working towards and continuously re-evaluate our goals.

Quick aside here: I think it is really difficult for those of us practicing medicine or anything that has required you to constantly tell yourself, “oh when I get into medical school..when I pass step 1 and 2…when I match into residency..fellowship…get my big girl attending job…pass oral boards…that’s when I’ll be free and happy.” The goal posts are always shifting and I distinctly remember my husband at one point telling me, “Hey, you’re here. You finally got to the point where you told me you’d stop worrying. What now?” And I’m here to tell you I still worry about potential malpractice suits, question my clinical judgement from time to time, and what we are going to eat for dinner 2 weeks from now. But that is to say that we really gotta sometimes be grateful for the work we and our loved ones put in to then realize, there is a bigger picture here that is not just our career we have put our blood, sweat, and tears for.

OK - back to big think. I would love to give a huge shout out to Ramit Sethi and his podcast about couples and money. I definitely listen to most episodes and have learned a lot about envisioning my rich life, while satisfying my need for drama rather than some trashy reality television show. You can listen to it here.

In the book The Danish Secret to Happy Kids, the author shares how in Denmark, similar to other Scandinavian countries, they emphasize children to question, debate, and present ideas from a young age in school. They stress oratory skills as opposed to reading since kids naturally speak first and then start reading at a later age (think 7 or 8). They strive to build confidence, self expression, and help kids find their voice early on. In The Smartest Kids in the World and How they got that Way, the author compares the American education system with other countries and challenges conventional wisdom of what education is and how it can be measured. She talks a lot about the PISA test and how it tests analytical thinking and understanding. She also mentions the importance of having discussions about current events and life with children from a young age and how that sparks questioning, analysis, and critical thinking. These two books resonated a lot with me this past year and opened my eyes to challenge the current system and why it isn’t working. We even went to Finland this past summer and the vibes were amazing - more on that later. And we have a trip planned to the Netherlands, Belgium, and West Germany during my work hiatus in the coming few months!

All this to say, do what matters to you, but challenge yourself and ask why it matters and engage in discussions with your people to continuously re-evaluate and change. If anything, physics has shown me how dynamic different phases of life can be and you don’t always have to keep the same static mindset you had when you first envisioned your future. No wonder physics and philosophy are so closely tied historically. I hope to nurture the natural curiosity in my sons, help them cultivate a thirst for knowledge and continue to ask not just me “Why” but also themselves.

I am only a quarter of the way into listening to an audio documentary entitled Lights On: How Understanding Consciousness Helps us Understand the Universe by Annaka Harris and am already fascinated by her questioning of how consciousness can affect our perception of existence, notions of free will, technology, and the future of scientific discovery. Sounds trippy, but it is insightful to listen to her interviewing physicists and philosophers alike on these topics.

Are there any particular books, podcasts, YouTube channels or resources you use to help reflect and re-examine where you are in life? And no, I’m not talking about comparing yourselves to influencers. And how do you and your partner get on the same page when it comes to big life matters? I would love to hear your thoughts!

*Standard disclaimer: I do not receive commissions from links or recommendations, these are solely based on my personal opinions.

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As an anesthesiologist, I put patients to sleep and they wake up in “a blink of an eye”. For me, that same period of time could seem like hours on end if I’m with a surgeon who has terrible taste in music, or worse, one that thinks EDM is music. There was a study published in 2012 that demonstrated general anesthesia had been shown to affect the circadian clock in both bees and humans. ¹ A six hour inhaled anesthetic was administered in both the daytime and at nighttime to honeybees and humans (don’t worry, they did not release the bees into the operating rooms, because that is exactly what I feared when I read this) and found that the anesthetic if given during the day, lead to a delay in the mRNA oscillations of the central clock genes and caused an effect similar to jet lag that can persist for a few days. However, when the same anesthetic was started at night for six hours, there was no effect. So, make sure you book your elective cases at the end of the day and definitely eat beforehand, so I can cancel it and go home early…just kidding! Please listen to your pre-surgery phone call / guidelines. More interestingly for my anesthesia folks, remimazolam induced anesthesia does not have any significant effect on the circadian rhythm in mice² - you know, if you happen to be doing some lucrative vet locum gigs where you have access to that.

If only I could fix jet lag with a snap of my fingers for my toddlers when flying to India instead of literally wasting seven whole days of my life in Mumbai being zombies. I’m sure I am not the only parent who has fantasized about anesthetizing their children on long flights…

Historically, time has been a quantitative data point; people always sought after longevity. With the younger generation, including myself, it has transitioned to more of a qualitative point which is really valuable. You hear about how previous generations in medicine talk down on the newer generation who values their work-life balance. But you only experience this lifetime once (sorry Paati, I sometimes struggle with my beliefs in reincarnation) - you can only recollect this current conscience once if you’re lucky enough to not get a neurodegenerative disease or cognitive dysfunction down the line.

In medicine, I have witnessed people sacrifice so much to get a mere chance to start families and hear the cry of their miracle baby echoing through the room. I saw a young man who had locked in syndrome communicate to his family that he wanted to donate his organs and benefit those he did not know. It is truly mind numbingly beautiful and haunting. I’ve seen lives cut too short as well as those that have undergone prolonged suffering to only have poor outcomes. Palliative care has always held a special place in my heart since my older brother passed when I was young. I think that rings true with a lot of fellow physicians who come from immigrant backgrounds and maybe physicians in other countries as well who have a better system in place for preventative medicine and elderly care.

I kid when I say that only surgeons and toddlers struggle with the concept of time. We probably can learn from our toddlers about being more in the now and present. Maybe not always think so long term or at least think about the long term of how our kids would want to remember our time with them.

As a busy working mom of two, I definitely want to be more intentional with my time. I want to be more present with them; be in the moment, be more like their dad. When he is rolling around with them and playing their made up games, he is just so good at being right there, in that role, giving it his all. I have the luxury of having the most amazing and supportive stay at home husband - however, ladies, I am still looking for a wife to share that mental mom load. This mental load that keeps us not being in the present with our kids even when we want to be. What I would do to give that away! If you have any tips - please share!

Sources:

1. J.F. Cheeseman, E.C. Winnebeck, C.D. Millar, L.S. Kirkland, J. Sleigh, M. Goodwin, M.D.M. Pawley, G. Bloch, K. Lehmann, R. Menzel, & G.R. Warman, General anesthesia alters time perception by phase shifting the circadian clock, Proc. Natl. Acad. Sci. U.S.A. 109 (18) 7061-7066, https://doi.org/10.1073/pnas.1201734109 (2012).

2. Suzuki, Y., Imai, R., Aoki, Y. et al. Remimazolam-induced anesthesia does not affect circadian rhythms significantly in mice. Sci Rep15, 45433 (2025). https://doi.org/10.1038/s41598-025-29999-9

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Sometimes when I’m sleeping with my four year old son, I think about the hardest arterial or central line I’ve placed under the drapes in the middle of a surgical procedure. Picture this: a woman in scrub bottoms that she will forever be between sizes (because of course, cute scrubs are never sterile) who is so contorted you would think she had hypermobile Ehlers-Danlos Syndrome to help maintain sterility, and the glare hits the ultrasound screen at the exact spot she has to cannulate. In the background is some terrible country song playing so loudly you would think you were at the club. Oh if only 50 cent or Pitbull was on. The surgeon then mumbles their demands to adjust the bed height and angle as she hears the most audible disgruntled sigh as she puts dressings on. If I could do that, I can probably make it through one more night with the teeth grinding torpedo, for the cuddles. After all, there will be a time they say they won’t want to be with me, right? And no, I will never see a chiropractor in my life.

My husband co-sleeps with our now sixteen month old son and I try to on days when I know I won’t be working the next day, just for those itty bitty baby snuggles. The two types of touch are so different, yet give me such a sense of relief and calm after they envelop me, especially after a long or rough day.

So much has changed as our family has grown - I think about the mom that I first was as a resident in training. I was fortunate to be in a supportive program with plenty of co-resident mamas to learn from and vent. Going back to residency after 8 weeks of maternity leave and thrust into pediatric anesthesia was one of the most difficult things I have done. I still remember the feeling of taking back infants who had been NPO (nothing per os, 4 hours to be exact for breast milk) to the operating room in my arms. They could smell my breastmilk and tried to get all snuggly, and oh boy, the joys of physiology just worked remarkably. I would promptly leak from my breasts and tears from my eyes followed almost instantaneously for the first few weeks. Tears I held in my mask because I had to just get them in the room and induce anesthesia to keep the day going.

I remember trying to take up as little space as possible then. I actively tried to not get into anyone’s way. I didn’t spend too much time on pump breaks; I didn’t want to take up too much space in the fridge with my supplies and milk; I didn’t want to feel like I was behind my peers for having a baby in residency and being judged for it despite - like I said earlier - I was lucky to be in a supportive program. Not everyone is. All the neuroscience data shows that a woman’s brain changes after having a baby and I kept fighting that early on. Pregnancy and mom brain.

I then contrast that with the mother I am as an attending in private practice. Even though pump breaks are mandated by law, there is no real guarantee of getting them consistently in this short staffed perioperative industry that continues to prioritize profits over retaining staff. From the beginning, I advocated for myself but could only do so much as the day to day unpredictability and lack of staff just made logistics difficult to get what I needed.

So, I decided to occupy space.

I put on my wearable pumps in the ORs under the drapes and took them off at my convenience. I told the nursing staff when to go and put my milk in the fridge if I couldn’t get a break or if the case was running behind than expected (surprise, surprise). I was not going to let circumstances at work stop me from doing what I wanted for my baby. And I know that fed is best and you have to do whatever works for you and baby. But for me, I needed that oxytocin rush when I got to go home and snuggle and feed my babies. I just didn’t want work to decide for me what I had to choose between.

I am proud of the physician I am today after becoming a mom. Mom brain is what keeps generations going. I am more empathetic, humble in admitting when I don’t know and then look it up, (must be from all those “why” questions my toddler keeps asking me), and a better communicator in the operating room. I had a mentor who used to tell me to talk to surgeons (mostly the male kind) like a toddler. Both have tantrums and unreasonable demands, so the key is to try to make them think they came up with your plan.

My take away from my toddlers is that we should also take up as much space as we want and need. No shame. No judgement. Just ask for what you need and hope for the best. And if the best isn’t what you envisioned, do everything you can to make it work. But keep persisting and advocating for all those women who are bound to follow in your steps.

I would love to hear other mama’s experiences and thoughts on this topic that we should reflect on and be proud of ourselves for getting here! You got this!

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​Once we got home, my astute four-year-old asked to see “my stories.”

That was the final straw. It’s one thing to have a posting habit (or, let’s be honest, an addiction); it’s another to realize your child views their own life through your phone screen. I want to teach my sons what real stories are—the ones that aren’t cropped, filtered, or performative. For those of you who do follow - notice I did not have any Ice Castle stories (big pat on my back!)

​The Existential Crisis of 2025

This shift has been a year in the making. I spent 2025 deep-diving into The Anxious Generation, YouTube “tech-exits,” and reading about challenging the norm especially when so many are questioning what was the American Dream. I went through a full-blown crisis: Should we move to Europe? Should we go full Captain Fantastic and live off the grid? Should I use my US citizenship to become a world-traveling tour guide like I envisioned in 3rd grade while it still means something?

​The Reality Check

The catch? I spent the last 15 years training to be a board-certified anesthesiologist. As it turns out, “Big Girl Attending” skills don’t always translate instantly to other countries. For the first time in my career, I finally have some breathing room—and I don’t want to fill it with doom-scrolling and online shopping in the operating room.

​What This Space Is For

This blog is my outlet. It’s where I’m grappling with the “trenches of toddlerhood,” navigating a career that brings me joy, and trying to find myself again in the midst of the daily routine (and yes, that definitely includes vacation because that is life).

​I’m here to talk about:

​Medicine: The view from the head of the bed (and yes, occasional venting about my surgical colleagues that I have the utmost respect for).

​Mothering: Raising humans in an AI-heavy and data-driven world. Here’s to hoping I can give them dopamine hits from travel and nature.

​Travel: Taking my home (AKA family) around the world to explore other cultures and learn what they are doing best to cultivate our own. It’s not always pretty with two growing toddlers, but it keeps me going.

​Thanks for being here.

​P.S. I give zero medical advice.

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