Exploring creative pursuits during medical training and beyond
Hello! I'm Farokh Jamalyaria, MD. I created this blog to document my creative pursuits during medical training and beyond. Since starting this blog in 2014, my writing has been featured in KevinMD, Salon, The Rheumatologist, and Learning How to Learn. I've also published elsewhere. I hope you enjoy my blog!
I’m a board-certified, full-time rheumatologist passionate about high-quality patient care.
I was born in Iran and moved to the US with my family when I was five years old. I was raised mostly in Texas, graduated summa cum laude from Texas A&M University at College Station with a bachelor of science in computer science and minors in math and chemistry, and subsequently enrolled in Carnegie Mellon's computer science PhD program, which I attended for a year before deciding to go to medical school at Baylor College of Medicine. I was editor-in-chief of Remedy, our medical school's magazine of art and literature. After graduation, I moved to Southern California for internal medicine residency, became board-certified in internal medicine, worked for a year as a hospitalist, and then moved back to Texas for fellowship.
Using instructional books, I began learning how to draw in November/December 2010. I've kept at it off and on since then. I freehand all of my drawings (I don't use any tracing or drafting equipment). I began learning how to paint in September/October of 2012.
With no prior musical background, I started learning guitar in July 2013, bought a playable classical guitar (Cordoba C5, set up as a flamenco guitar) in December 2013 (my previous guitar was unplayable), and then started formal classical guitar lessons in February 2014. I haven't looked back since!
We saw this tarantula at Lost Maples last year. (Did you know that the females can live longer than 30 years?) I took blurry reference photos of the creature during our hike there, figured out a composition that I drew freehand onto 140-lb cold press Fluid Watercolor Paper with a pencil, then painted it entirely in Winsor & Newton transparent watercolor (no mixed media this time). It took me about seven months off and on, spending anywhere from a few minutes to an hour 1-2 days a week most weeks until the “endgame,” during which I spent 1-2 hours a day for a few days (three hours today) to finish it. Can you imagine spending so much time wetting, drying, and rewetting a single piece of paper?! There’s no way I could have painted it all in a day or even a week, but I could have finished it much earlier if I’d worked eight hours daily as many professional painters do when they’re working on a project.
I’ve realized that with classical guitar, it’s not possible to have a large repertoire if I practice for only thirty minutes a day. As I gain skill and learn more pieces, I also need to practice longer if I want to maintain a decent repertoire (which I do not have at this time, since I don’t practice enough). Similarly, it’s not possible to create precise, detailed paintings quickly if one spends only a small amount of time painting each day. (I work full-time; guitar and watercolor are hobbies.)
During the course of a significant watercolor project, one invents one’s own techniques–important techniques not described in any book one has read–such as how to graduate a wet-in-wet over two or more existing washes. (This reminds me of computer programming projects in college: it was often necessary to create one’s own code “libraries.”) Any significantly detailed painting, especially in watercolor, is difficult because one must plan ahead, remain intensely focused whenever touching brush to paper, figure out the color scheme that will be used, patiently layer paint atop paint, figure out how to fix minor mistakes (major watercolor mistakes cannot be corrected), keep thinking about how to express one’s ideas using a fickle medium, and keep improvising and persisting despite doubts that inevitably arise. Painting is truly “manual” labor.
It’s surreal now, in the wake of Hurricane Harvey–though the record-breaking inundation is not yet over–to think that Friday, August 25 was a regular workday for the city of Houston. Days before, I asked my patients if they were ready, if they were staying or evacuating. All were staying upon official advice from the mayor*, weren’t particularly concerned, and seemed ready to ride out the storm.
As you’ve read and heard about on the news, and as you’ve seen in photos of the area, millions of people have been adversely affected by Hurricane/Tropical Storm Harvey, including many friends and colleagues whose homes and vehicles flooded. A few people we know lost everything, were evacuated by the Coast Guard. I worry about my patients. I hope they’re safe. I’m thankful that my parents, my brother, and my parents’ house survived the storm without difficulty.
Late last week, my girlfriend and I scrambled to stock up on food and water. I’m glad that we were sufficiently neurotic to buy enough for a cataclysm, which is precisely what came to pass. At the grocery store last Friday, a young man picking up the only remaining water bottles–Evian brand–in an otherwise empty aisle (the rest of the store was well-stocked, including the soda aisle), said that he’s “going to feel like an idiot buying this expensive water if the storm misses us.”
I stopped at a gas station near home to fill up my car, because that’s what one does during hurricane season here (to be able to evacuate, if needed). Several pumps were closed. “Super” was the only quality available. The pump I chose sputtered erratically for at least five minutes before running out of gas, something I’ve never experienced before.
That night, in an ominous turn, we lost power for several hours even though it was placid outside. Power returned, miraculously not going out again despite more than forty inches of rainfall in our area, recurrent tornado watches, and bursts of high wind since then. We’re grateful to have had running water, too. We don’t have a boat, so we inflated three airbeds in case we need to float out on them. It rained heavily last night, is raining intermittently today. We could lose power or running water at any time. The only reason our location hasn’t flooded, I think, is that rainwater continues to drain down the riparian forest next to us and into a large brackish bayou that empties into the Gulf, an “infinite” reservoir, via large/near connections. We’ve been extremely lucky. Rain might not have affected us directly this time, but if a hurricane hit us at the right spot, and it well could in the future, the storm surge could seriously damage or destroy our home.
When I went for a run two days ago, I saw that the major streets surrounding our neighborhood were partly submerged, with water gurgling up from manhole covers in other areas. A Ford Mustang parked streetside seemed to have caught fire at some point because it was scorched on the outside and completely burned on the inside.
We haven’t attempted to drive anywhere since Friday. We, like most other residents of the county–which has become a large lake–are physically isolated for now, unable to drive out to see or help others. Many important details, such as the numbers of missing/trapped/dead people, are not yet known. There have been calls for medical personnel both locally and downtown. Our clinics are trying hard to reopen. My girlfriend and I–both of us physicians–look forward to helping with relief efforts as soon as the floodwaters recede and we can go to where we’re needed. We’re heartened by the great efforts of ordinary citizens and rescue teams in badly flooded areas.
*Our mayor’s rationale for not evacuating the city is that many people died while stuck in bumper-to-bumper traffic when the city was evacuated before Hurricane Rita hit in 2005. (I had just started medical school at that time. I helped my parents board up their house. We drove for many hours just to get from one side of Houston to the other.) However, since Harvey arrived as a tropical storm, not as a hurricane, we feel that evacuating people in the most flood-prone areas could have saved lives and reduced the need for rescues.
As federal land, it’s also one of the starting points this November for Trump’s ill-advised expansion of the US-Mexico border wall, which will be built on the levee between the parking lot/visitor center and the refuge itself, cutting the refuge off and threatening to destroy it.
The first place I ever wanted to visit, when I got into birding a decade ago, was Santa Ana. I read that South Texas is the best place to bird (and to see butterflies) in the US and Canada, especially during spring and fall migrations. Then the 2009 swine flu outbreak dissuaded me from making the trip. I graduated from medical school, moved to California for residency, and didn’t bird in Texas again for years.
Last weekend, I finally visited for the first time. We drove from Houston to Alamo, one of the most southerly Texas towns, to experience Santa Ana for ourselves, and, along with ~681 like-minded pilgrims from near and far, marched against the planned border wall and for Santa Ana’s continued protection and preservation.
Abstract superlatives about Santa Ana that anyone can read online are relatively meaningless until one actually visits the place. This is an account of our brief experience.
As hot as it is right now where we live, it’s even hotter in three of the four cardinal directions away from Houston. This is definitely not the best time to visit the refuge. Nevertheless, within a few minutes, I encountered multiple “life species”–species I’d never seen before. What’s more, I wouldn’t be able to see several of them anywhere else in the US or Canada.
Unlike most other natural places I’ve visited, Santa Ana is tucked away, with little signage, in an area dominated by development: a paved jungle of gaudy chain stores and congested gas stations yields to old neighborhoods and finally to plowed land, with little trace of the original habitat. Visiting the refuge is like taking a time machine to a lost natural world destroyed by development over many decades.
We visited an hour before dusk on Saturday with two friends who drove separately. (Our friends had arrived earlier, were on a different trail. We discovered the following morning that they became engaged during that hike!) The refuge was bereft of employees or other visitors–it was all ours to explore. >100-degree Fahrenheit daytime temperatures had dipped into the high 90s by this time. It was noticeably more pleasant along the tree-shaded trails.
I began picking up life birds immediately. The first was a plain chachalaca near the levee past the visitor center, just inside the refuge. I’d seen gray-headed chachalacas near Arenal Volcano in Costa Rica in 2013 and speckled chachalacas in the Ecuadorian Amazon earlier this year, but, ironically, the plain chachalaca of my own state was a life bird for me last weekend.
At a branching point for trails, we took the Chachalaca Trail, a lucky choice since it was closed off Sunday during the protest hike. The air was infused lightly with the scent of sage–blue sage? It reminded me of my hikes in Southern California. Mesquite trees and scrub seemed dabbed onto the landscape with a natural watercolor sponge dipped into a dull, light green paint. We walked among live oaks with cascades of hoary Spanish moss billowing in the wind. Sabal mexicana palms peeked out here and there. I heard great kiskadees calling nearby. (We heard their intermittent calls both days in Santa Ana.)
While admiring the Spanish moss, my eye meandered over a statue-like Harris’s hawk staring at me.
Flocks of white-winged doves dominated the trees and sky throughout the entire hike. On our way back to the parking lot, several raucous green jays greeted us. (I last–and first, in the wild–saw one of these beauties along a trail near Hacienda Chichen, in the Yucatán, in 2015.) Groups of three or four groove-billed anis–another life bird–clucked melodiously (like a pleasant ringtone) as they hopped from branch to branch at eye level near the trail. Back at the trailhead, a golden-fronted woodpecker flew onto a nearby tree, staying only long-enough for us to identify it before flying off along the Pintail Lakes Trail–we saw several others of this species Sunday.
Our experience the following morning was very different. Unlike Saturday’s spiritual experience of the refuge in the absence of other people, the refuge was crawling with them Sunday. Friendly refuge employees guided us to parking spots as we arrived. The parking lot filled up well before the scheduled protest.
A white-eyed vireo sang and a white-tipped dove flew overhead as we walked past a naturalist–one of many naturalists, birders, and conservationists there that day–being filmed as he expounded on the importance of the refuge and about the birds he’d already seen that morning.
We met up with our friends, hiked to a large grassy depression that’s a lake in other seasons (there are multiple such seasonal lakes there, with three species of kingfishers and other water-associated birds). They pointed out olive sparrows to us along the way. Great egrets and barn swallows occasionally flew overhead. At one point, I saw at least seven northern rough-winged swallows sitting on a power line. (We saw southern rough-winged swallows in the cloud forests of Ecuador in June.) Along this same power line, I later saw a rare olive-sided flycatcher and then a Couch’s kingbird. Four of these species were life birds for me.
Turkey vultures soared overhead, mourning doves sang unseen, and mockingbirds flew by as we walked to the hawk tower in preparation for the march. On the way, I saw an Altamira oriole nest–the longest nest of any North American bird, by the largest North American oriole, another South Texas specialty. It reminded me of the many oropendola nests I saw hanging from trees in Costa Rica and the Amazon.
Nearly an hour later, many more people had accumulated at the hawk tower. We started our march toward the levee. Along the way, a naturalist tried to help a large butterfly on the ground grasp his finger and flip right side up while another person watched. A few large and innumerable small butterflies flew about the refuge–so many, in fact, that we later almost stepped on a couple of them while hiking one of the trails.
As we stood on the levee in peaceful protest of a wall that could devastate this uniquely beautiful refuge, one of our friends spotted an Altamira oriole looking at us from the forest below. I quickly snapped a photo of this life bird before it flew off. Large flocks of red-winged blackbirds rose and fell in the fields opposite the refuge while golden-fronted woodpeckers threaded between the Washingtonia robusta palms. Beyond them, a stampede of deer escaped an unclear threat.
I appreciate the Santa Ana employees and the organizers of this protest. I am disappointed by the callousness, ignorance, and narrow-mindedness of our national leaders for threatening to destroy this vulnerable wildlife sanctuary. I feel that I need to return to Santa Ana many more times, in different seasons, to explore the depths of its complexity; I’ve barely scratched the surface with last weekend’s visit. However, future visits may not be possible if the border wall goes up at Santa Ana this fall.
It’s been a while since I last posted updates on my performance of “Spanish Romance,” one of the many pieces I’ve learned over my years of casual guitar practice. Although I stopped taking lessons almost a year ago–I really want to start lessons again–I’ve continued to practice several days a week on my own. The following is my performance of “Spanish Romance” today:
I’ve improved quite a bit since my last update. Compare this to my performance of the same piece on March 18 of this year:
In the presence of nature, a wild delight runs through the man, in spite of real sorrows…Not the sun or the summer alone, but every hour and season yields its tribute of delight; for every hour and change corresponds to and authorizes a different state of the mind, from breathless noon to grimmest midnight…Crossing a bare common, in snow puddles, at twilight, under a clouded sky, without having in my thoughts any occurrence of special good fortune, I have enjoyed a perfect exhilaration. — Ralph Waldo Emerson, Nature, 1836
A truly open mind is fascinated with and open to exploration of many fields. Nevertheless, the best and easiest way to refine one’s “wonder mechanism,” I’ve discovered, is to grow as a naturalist. The endless variety and novelty of nature is compelling, not least because of its unparalleled complexity.
The granularity of one’s wonder mechanism is an important determinant of one’s baseline happiness. It’s also important in the formation of memories; a finer granularity of wonder results in a richer, more positive set of memories throughout a lifetime.
A coarse granularity of wonder is possessed by this man: “I went on the Circuit de la Grande Chartreuse hike today…The first stretch of forest was…just an ordinary forest, not much more interesting than woods back home. The only spectacular thing was a mountain with two or three peaks between which nestled a…green valley…”
That hard-to-please man was me, twelve years ago, journaling about a solo hike in the beautiful Chartreuse mountains of France. Not knowing anything about the natural history, geology, or archaeology of that region, I could only appreciate superficial, immediately accessible characteristics: grand vistas, mountains, valleys, forests. I remember some of the people I met, but I don’t remember which tree, bird, or insect species I saw, nor which types of rock I encountered, nor did I appreciate the significance of ruins I came across in a valley during that hike. That leaves me with only a shallow impression of that experience.
A finer granularity of wonder is possessed by this man: “A grass-like mantis was on the floor outside my home today. I chased it with my finger toward a wall so it wouldn’t be crushed by an unaware passerby. It didn’t let me touch it; at each near-touch or rare ephemeral touch, it ran forward, at one point flying smoothly up to the wall as if running along an invisible ramp.”
That was also me, journaling this week about an interesting insect species I’d never seen (or noticed) before 2017. I’ve seen it intermittently all summer long in a space about twenty feet by six feet.
Here’s another recent journal entry: “I also did see and photograph a wood stork soaring–it soared over the exact area (vast marsh with adjacent picnic park) where I saw the last male painted bunting of the day! They showed up at the same time, presenting an observational/photographic dilemma. I’ve never seen a wood stork before, as far as I know; this is a life bird.”
Twelve years ago, I had little interest in that marsh, precisely because I didn’t know much about it. Not only did I have little interest, I actively wanted to keep my distance because it’s surrounded by oil refineries:
Each experience of wonder creates a pleasant memory. No grand vistas required. This humble, likely polluted marsh is now elevated in my mind to a new significance.
“A special power of observing and remembering particulars, a special memory for places, allied to a love, a lyrical feeling for nature, is characteristic of this naturalist’s sort of mind.” – Oliver Sacks, Oaxaca Journal, 2002
For those without a naturalist bent, the lowland tropical jungle–as seen in the photograph I took this summer in Yasuní National Park in the Ecuadorian Amazon, above–is a gloomy, menacing, tediously green place. One does not bask there in breathless views on par with those found in Yosemite, the Canadian Rockies, or similar places with awe-inspiring landscapes. The biodiversity, however, remains unmatched…for those prepared to appreciate it.
It may be obvious that preparation increases appreciation, but this is particularly true of nature travel in the neotropics, where the rare is commonplace, the commonplace is rare, and where each bit of background knowledge yields outsized rewards for the observer.
One of our guides–who has worked as a generalist guide as well as a specialist birding guide in the Amazon, the cloud forests, the Galápagos, and elsewhere in Ecuador–confirmed my suspicion that birders seem to get more out of their Amazon experience than do non-naturalist visitors. We ended up seeing or hearing 325 bird species total in the Chocó region of northwest Ecuador and Yasuní National Park. We also saw a tayra, two black caiman, agoutis, several giant river otters, five monkey species (including five common woolly monkeys, which are not common at all), several puma and tapir tracks, and two electric eels.
Each of these sightings, for me, is pegged to a wondrous memory, in addition to memories of all the people we interacted with during the trip–our hosts, our guides, our drivers, and everyone else–and to memories of a more standardized nature: landmarks, street scenes, cityscapes, historical buildings, food, etc.
“It is similar with Tom Morgan–he remembers, I think, every fern of significance he has ever seen, and not only remembers it, but exactly where it was located.” – Oliver Sacks, Oaxaca Journal, 2002
I still have a long way to go as a naturalist and as a learner in general. I look forward to learning much more botany, entomology, geology, anthropology, archaeology, and other fields.
Summer is an oppressive season in southeast Texas. Long days allow heat to build up–it can be nearly ninety degrees Fahrenheit well after sunset–and the humidity doesn’t letup. If northerners are snowbound in winter, we’re sunbound in summer. We visited the Ecuadorean Amazon recently, where it was cool sometimes (cold, even), days were much shorter, wind pollination was refreshingly absent (or rare), and where one stands much less of a chance of being swarmed by mosquitoes than in summertime wildernesses of the temperate zone.
However, despite the unpleasantness of the season, one can still experience the beauty of nature here, as I found out less than two weeks ago when I saw a male painted bunting for the very first time. Ironically, I’ve lived within its breeding range for most of my life but never birded within its habitat during summer. (Also ironic: I saw it only ten minutes from where I grew up!)
If one rises early enough and travels to its breeding grounds–a shrubby, overgrown prairie with not too few and not too many small- or medium-sized trees–then one might see a male painted bunting in a treetop, head thrown back, singing its lovely song. It might even fly from treetop to treetop, singing at each location, as did the males I observed–a magical experience! Here are a couple photos I took of one of them:
In May, during the tail end of spring migration, I also saw a playful, beautifully green, female painted bunting in a nearby marsh. I was observing a female indigo bunting when the female painted suddenly appeared and landed on the same stalk of grass, making them both drop down. The indigo flew off, but the painted remained nearby. Here’s the quick photo I took of it:
“[For a naturalist,] the concrete significance of living things in their natural setting is at least as precious as any generalization.” — Alexander F. Skutch, A Naturalist in Costa Rica
“For lack of attention, a thousand forms of loveliness elude us every day.” – Evelyn Underhill
Last Sunday, my girlfriend, two friends, and I had a remarkable experience in High Island, TX: a quiet Sunday morning hike in coastal woods slowly transitioned from seeming “birdlessness” to finding ourselves literally surrounded by tens of migrant bird species just-arrived from Central and South America. It felt like a Big Bang of birdlife; it felt as though God had just decreed, let there be birds. We were in the midst of a “fallout” of songbirds precipitated by a storm the night before and by abatement of the south wind that had previously allowed them to skip the island entirely.
At Boy Scout Woods (BSW), the warblers trickled in slowly at first. We saw male birds almost exclusively the entire weekend–in many species, males migrate first–indicating that females may be seen in the next week or two. A hooded warbler started the show by appearing suddenly at Prothonotary Pond, then a magnolia warbler and a northern waterthrush became visible. Soon, the treetops were alive with black-throated green warblers. Occasionally found solo, but usually in mixed flocks, we eventually saw bay-breasted, Tennessee, Canada, Nashville, and chestnut-sided warblers, as well as American redstarts and a common yellow-throat, punctuated by sightings of other species: a peregrine falcon and a broad-winged hawk flying inland, a green heron at Prothonotary Pond, an immature orchard oriole singing far beyond the boardwalk.
Sighting a warbler–a tiny, quiet bird constantly on the move–or any other “new” bird is quite thrilling, even addictive: one raises one’s binocular in eager anticipation of identifying the species before the bird moves out of view.
By noon, in the small parking lot and adjacent street alone, in the span of fifteen minutes, I saw four male indigo buntings, at least four female indigo buntings, male and female summer tanagers, innumerable black-throated green warblers, two male Baltimore orioles, a male rose-breasted grosbeak, and a male scarlet tanager. Soon after my girlfriend and I left for Smith Oaks, our friends saw a male painted bunting in the parking lot. Very few of these birds will stay for the summer; most will radiate to their breeding grounds in the northeastern US and Canada. (In fact, when I returned to High Island today, I only saw two of the above species at BSW: the rest may already be at their summer homes.)
At Smith Oaks, where I hiked for about an hour last weekend, I saw numerous male and female Baltimore orioles, summer and scarlet tanagers, gray catbirds, a black-billed cuckoo (we saw a yellow-billed the day before at BSW), a brief flash identified by others as a vagrant black-whiskered vireo, and, at water drips in the forest, males in breeding plumage of the following warbler species: Blackburnian, Magnolia, Tennessee (unclear if male), chestnut-sided, American redstart. So many species observed in so little time amongst the lovely old oaks and other trees! (The birding was so good this week along the upper Texas coast that even I–a casual birder who doesn’t aim to maximize the number of species seen, unlike more “muscular” birders–ended up seeing sixteen warbler species, including the rare golden-winged warbler.) A short walk away, the famous High Island rookery teemed with nesting wetland species we observed and photographed the day before: roseate spoonbills, purple gallinules, common gallinules feeding with their chicks, neotropic cormorants, great egrets, snowy egrets, and other species. Down the road, Bolivar Flats–we didn’t go there this trip–hosted numerous shorebird species, including (rumor had it) red knots and piping plovers, the latter of which I saw in February on a birding trip with two other friends.
Such irruptions of songbirds and other bird species are a rare occurrence for the occasional visitor to High Island, but do occur with some frequency during spring migration, especially following storms or when there’s a north wind. However, I’ve met serious birders who have visited High Island for years without experiencing such a “fallout” of birds.
We met many other birders while there, including the ever-helpful and enthusiastic Houston Audubon Society volunteers who manage High Island’s nature sanctuaries. It was a joy to help others see the birds we saw and to allow them to help us see what they were seeing. Birders are a diverse bunch: while many were casual, some were very professional, taking high-quality photographs of the birds they encountered. Most birders are warm, engaging, and helpful people; I was surprised to find that a few were rather cold and businesslike and seemed to be there just to lengthen their lists of species seen.
I visited High Island for the first time about nine years ago. Since then, I’ve unintentionally built up a store of happy memories associated with this tiny, unassuming salt dome in the Texas backcountry. One of my first visits was with my friends, Jeff and Noam. On that trip, we serendipitously chanced upon the Texas Birding Classic. We were seen as “rare birds” by Texas Parks & Wildlife for being young men out birding–this was even rarer then than it is today–and were interviewed on the spot, had many photos taken of us, and were given free T-shirts (I still wear it; a songbird is displayed on the front with “Portable Audio Device” written under it).
A year ago, serendipity struck again: I found one of those photos while hiking Lost Maples State Park! At the end of a long hike, my girlfriend rested by a bird blind while I went to get the car. When I returned, she recommended I check it out. I glanced at the sign in front of the blind and immediately saw myself in a photo taken with a Texas Parks & Wildlife staff member that day I birded High Island with Jeff and Noam nine years ago: