Sunday, October 12, 2014

Interviews

It's that time of year again. Medical students from begin the very early steps of their postgraduate professional careers, and begin their residency interviews.
But unbeknownst to them, Dr. Vagus gets to interview them tomorrow.
Bwahahahaha.
 I feel a sense of absolute power.
The ability to affect one's destiny.
To control what happens to one for the next 3 years- possibly the rest of their careers.
The ability to control the sun, the moon, the stars.
Bwahahaha.
 smileys
Sorry. For one who can only control his bowel movements and pretty much nothing else the rest of the time, this gets to my head.
But this does bring back memories. Wayyy back to 2001 when LP and I began our 3-week long and very expensive trek around the US when we interviewed at various hospitals. Cold, homesick, hungry, as we tried to stretch out our Ringgit. I remember us resorting to eating instant noodles for budgetary reasons, but all we had was the coffeepot in the motel and had to take turns eating. It was a pathetic sight. I remember the mistakes too.
"Oh, is that your grandson?" me asks, trying to smalltalk.
"No, that's my son, but thank you..." says the interviewer. Needless to say, I didn't end up in that hospital.
 
Though I'm looking forward to meeting the candidates, it's also a bit frustrating the world of political correctness we live in, here in the US. We're given a list of questions we cannot ask. Obviously, we can't ask things like Do you have a girlfriend, or How long is your kukuciau?
But even things like Do you have children, or to a pregnant person, When are you due? Questions that normal people ask in our usual interactions.
So, I'm going to have to try to behave tomorrow. But it'll be fun nonetheless.
(note to self- avoid eating beans tonight)

Sunday, September 21, 2014

A Celestial Revelation

So we are on vacation at the lake. And so, being far away from larger cities, I decided to pack my tripod, telescope and other optical gear.
This was a 10 min timelapse of Polaris. As you probably know, everything spins along this axis, which makes for interesting pictures. Also a reason why even computerize, autoguiding scopes altazimuth mounts (like mine) will not suffice for timelapse photography and why I'm trying to convince my wife I need an equatorial mount (which not only moves the scope on 2-axes but also rotates it).
 But perhaps the biggest revelation to me, in all my years of being a geek and loving astronomy, is this was the first time EVER I was able to visualize the Milky Way with the naked eye. It's not very striking (still some light pollution) but it was certainly visible quite easily. You see it in this picture, running down the middle of the picture, seemingly as though there are some patchy splotches. There is a also a star cluster at the top; Cassiopeia is also in it, though the 10 second exposure makes all the stars show more brightly so the W shape is not easily seen.
In this picture, you can see the Andromeda galaxy at the left of the picture, as a small whitish blot. This is the closest spiral galaxy to ours. The Milky way is seeing in the right 1/3, with a streak from a lucky shot of a shooting star.
It was pretty damn cool seeing the Milky Way. Sometimes, when one is troubled by our earthly worries, looking up at the celestial bodies does give you a fresh perspective on things. That in reality, as huge as our problems might seem, we are just a tiny planet of the millions (?) out there. That perhaps our troubles are not as big as they seem.
It does also make one wonder. Is there life out there? The scientist in me is 100% sure. With the sheer number of stars out there, the probability of life beyond Earth becomes a certainty. And yet, one has to wonder. Who created all this? Is there a Higher Power out there?
Despite being on vacation I got less sleep than usual last night. I went to bed at midnight, and woke up at 4AM. Was it worth it?
EVERY.DAMN.MINUTE.
(Ask me again in 2 hours when I'm about to pass out!)

Saturday, September 20, 2014

Football Practice

Or soccer, as these Americans would call it (after all, everywhere else in the world it's called football!).
And why do THEY call their version FOOTBALL anyway? They're always HOLDING their "Ball". And it's not even round, for God's sake.
Anyway, I digress.
Alli had her very first football (I'm being stubborn, but though I've been here 12 years I'm going to stick with my roots) practice today.
 It was great fun watching her. Though it was probably more amusing/frustrating seeing how she was so excited the night before that she wore her shinguards to sleep. But when she realized she actually had to work and run during the game, it quickly became "I'm so tired. I'm so hungry!"
Nonetheless, it was a nice Saturday morning for us- at least 50 families converged on the field for practice, with several games going on simultaneously. Though I was never into sports growing up (explains why I'm so short and unfit now), it's something I'd want my kids to enjoy.
Week 1 down. We'll see if the drama queen gets into it better next week!

Thursday, September 11, 2014

(Belated) Birthday Present

I got a drone from Kristin for my birthday. Well, strictly speaking, I returned the one she gave me, and got this instead (because the other one did not have a video function).
It's been a blast so far, though I'm still learning how to fly this sucker, and I've already lost a prop.
This is the Hubsan X4- an entry-level UAV (unmanned aerial vehicle) the size of an open palm. It also takes a microSD card which allows for SD video (no audio). It's RC controlled via a 2.4 Ghz remote, which unlike some of the wifi-controlled ones, in theory gives you a longer range.
In theory. This is so small that if you fly it too far you're not going to be able to see your heading, and would be apt to lose it easily. Also the battery flight time is only about 7 mins.
But, it's a blast, and for only $50, I'd say it's a great bargain and a great toy especially for one's first foray into these things.
Will need to work on my flying before I get to do more. I took out one of the motors today on its 3rd video flight >_<
Luckily these things are modular, and ordering another motor was just $11.
  video
 

Sunday, September 07, 2014

Moon Cake Festival

One thing that I find challenging, being a Malaysian dad with an American wife and daughters is the lack of tradition. Not that there is a paucity of Western cultures and traditions, just that I think it's human nature to want to impart to our kids the things we did growing up. The games we played, foods we ate, the festivities we took part in.
And so, came this Moon Cake festival, I was determined to try share some of my childhood activities with the kids.
I had to resort to Amazon to find the lanterns; my surprise I wasn't able to find them in the Asian stores here. I discovered that while the MidAutumn festival is celebrated in numerous countries, it appears that the part about the lanterns is unique to Malaysia?
I spent some time today telling Alli about what we did; how mom and dad would take us out to pick out our lanterns, and being a Dragon that would usually be my pick. I remember that big-ass lantern I got that one year. How we would light up little colored candles and stick them in, and carried the lanterns on bamboo sticks and walked around the neighborhood at night. Found some pictures on the internet to show her, and reminisced my childhood.
I remember the foods we'd eat. Of course, the infamous moon cake. Something I never really appreciated growing up. But now, now that I'm so far away from my other home, I crave it perhaps in a feeble attempt to relive those experiences (I can't believe I actually paid RM22 for a single mooncake!). I told Alli the stories mom told me, of how the people of the Ming dynasty used to hide messages in the cakes to plan their fight against the Mongolian invaders- don't know if they're historically accurate, but it was still a neat story.
I also remember those things mom used to make- I have no clue what they are, but they were black shells of something that was shaped like a cow's head, with some starchy white filling inside (anyone knows what they are?).
Anyway, the girls had perhaps a few fleeting moments of fun with the lanterns, and that was about it. In a silly sort of way, there is a certain tinge of sadness, knowing your kids will never appreciate the things you did as a child, but then again this is to be expected growing up in a totally different world. And the mooncakes, well, let's just say they didn't fall in love with it! >_<
Maybe next year. Happy Moon cake festival, guys!

Wednesday, September 03, 2014

A Sign

I don't want to suddenly post a very spiritual entry, but I just wanted to share what happened today. Just another sign, methinks, of the Guy upstairs watching over you, and giving you exactly what you need.
It's been a busy call week, with some challenging patients. Perhaps in part some in the hospital happened to be people I have known for years. Some very sick DKAs. Marked hypercalcemia 17.5 mg/dL. And huge pituitary macros. Stuff like that.
With one particularly sick patient, I had been fretting and worrying over her. It's true what they say- doctors do take their work home with them, and I had a very restless night thinking about her, second guessing my treatment plan, and worried she was going to deteriorate.
And so, as I was finishing up rounds in Hospital A, and walked out to the carpark to drive to Hospital B, a random stranger stopped me.
"Are you Dr. Vagus?" she asked.
I nodded, somewhat confused.
She gave me a bearhug and got teary-eyed.
"You saved my husband's life 4 years ago. You saw him and diagnosed him with that pheochromocytoma, and got him stable enough to have surgery. It has been years, but we think about you often, and how grateful we are to have had you...."
I was somewhat flabbergasted- at how she recognized me from 4 years ago, and was humbled by her words. But what I was most shocked with was how, on this day when I felt like I had all the burdens of the world on my shoulder, how breathing literally caused my heart to ache from the worries, how timely it was to have someone come and just with those words, suddenly make those worries and fears evaporate. It was exactly what I needed, and I do believe it was more than coincidence. That this was some divine intervention.
I thanked her for the kind words, and asked about her family. I then walked to my car, shut the door, and for those 10 seconds, just let some tears come down.
And just like that, I felt better.
There is a God. I'm sure of it.

Saturday, August 30, 2014

Happy Merdeka, Malaysia

As they say, you can take the man out of Malaysia, but you can't take the Malaysian out of the man.
Though I left Malaysia for North America for medical school in 1998 (and again in 2002), and have had a US greencard for several years, I do identify myself as Malaysian still. Many have asked if I'd give up my citizenship someday, and my answer still remains "probably not".
And so, from half a world away, I wish Malaysia Happy 57th Merdeka Day.
Though the country has come far since the days of our founding fathers, many like myself can't help but to sadly reflect too on how things are evolving. Though it's been over 5 decades, it's heartbreaking to see how in the last 10 years, things seem to be going backwards.
You'd think that a people of a country that is 57 years old would have matured enough to not see only the colour of others' skins. Or that they would not refer to one another as 'immigrants', never mind that many of us are 3rd to 5th generation Malaysians.
But no, unfortunately, because of a selfish few who choose to divide her people for their own political gains, the diversity that was once her strength seems to be turning into mother Malaysia's Archilles' heel.
However, it is also heartening to see that despite that hot air and garbage that some of our politicians and leaders spew, many Malaysians are still of sound mind and are sensible enough to not fall for that trick.
 
So Malaysia, here's wishing you a happy 57th birthday, all the way from the United States.

Monday, August 18, 2014

Happy Birthday Ava!

video

Friday, August 15, 2014

New toy

Yes, I got a new toy. Didn't think I'd get a pair of binoculars, but there was an Amazon lightning deal and it was going for only $49.
The Celestron Skymaster 15x70 bino.
The beer glass is there for comparison- this sucker is taller than a bottle of beer, with high index multicoated optics. It's nowhere near the power of my Matkusov-Cassegrain telescope, but I was looking for an ultraportable, lower-power device for casual on-your-back stargazing, and the books recommend that all astronomers should have a pair of binoculars.
Someday though I hope to go beyond solar system photography, and catch a nice shot of a nebula, or the Andromeda galaxy.
Hopefully this will help me get my bearings better.
But eventually, if the wife allows, I'm going to need an equitorial mount and a faster scope.

Sunday, August 10, 2014

Sick Day

I took my first sick day in a year on Friday; came down with a bad cold and a fever of 39°C. And I felt guilty doing it, because I knew my patients had waited a while for the appointment. And I knew some would be unhappy doing it.
Which gets me thinking about that phrase I've read before.
Doctors save lives by giving up theirs.
Maybe a bit presumptious one might say, but there are certainly days when it feels to be true.
One expects so much from their doctors; that they are never sick, that they are never wrong, and that they have all the answers and cures to their ails. And should they ever fall sick, there should be a backup doctor who can see them, right? Right.
Seems that there are more and more days when I really feel that every single day at work shortens my life a little bit. Rushing between patients, trying to 'work in' the 200 consultation requests we are getting every week. Trying to see the 'very urgent' ones referring physicians are asking for (urgent is a relative term. I'd consider severe hyperthyroidism, uncontrolled diabetes to qualify. Certainly not hypogonadism or weight gain or fatigue. But, we try to please our docs). Seeing patients over my lunch hour most days of my week, resulting in my having H20 for lunch- what I shall soon patent as a new diet program (haven't seen any weight loss yet though). Having to battle insurors for approvals for medications, glucose test strips, diagnostic imaging or blood tests.
While feeling like we've sacrificed so much- family members we don't get to see much anymore. Lost friends. Missing out on kids' activities. Sleep. Student loans. For me, there are days when I feel like the worst son in the world because I can't physically be there for my parents.
And having read the survey results of US doctors, also nicely put in this kevinmd article, I'm certainly not the only one feeling the stress.
Its safe to assume that this job really is going to kill me someday.
And yet, we persist. Despite the knowledge that our job shouldn't be everything. After all, ALL doctors have cared for dying patients, and we've all heard it: "my biggest regret is working too much and not spending enough time with my family".
We all find our reasons. For some, monetary- after all most new graduates have over $100,000 in loans, or the never ending bills for running a family. For others, the smile or handshake of a grateful patient, or the knowledge that this patient will get better. Or the naive and idealistic thinking that our goal in life is to help others.
Whatever our reasons, for me, my cures for a stressful day are the giggles and hugs of my daughters and wife, and a cold beer. And thankfully, that treatment works everytime and I haven't yet built up a tolerance.

Tuesday, July 29, 2014

A Vent about Supplements

I humbly acknowledge that I'm not very smart and don't have all the answers. And I humbly ask for forgiveness if I step on any toes with this. But I have to get this off my chest.
An acquaintance I know on a social media site has been very vocal about promoting certain supplements for various health reasons. Making claims about disease prevention, and improving certain metabolic parameters.
I'll admit I'm a skeptic when it comes to supplements. Not because I'm paid by big pharma, or that I sell medications in my clinic. As far as I'm concerned I'm just a cheap bastard who believes in cheaper meds, but also strongly believes in picking the best for my patients based on what's been proven.
And so when it comes to many supplements, I'm just not convinced of their benefits- there is simply a paucity of scientific evidence. And yes, I know those of you who will come out to say Evidence-Based Medicine is evil, because everything is funded by pharmaceuticals- if you believe that then you're a bigger idiot that I thought. I daresay most studies in medical journals are NOT funded by pharmaceuticals.
But anyway, after reading one too many posts on this social media site, especially when making claims about improving insulin resistance and hinting that they may be beneficial for diabetes patients, I had to ask him: where are you getting your information from? Care to cite your references?
 
I was somewhat unprepared for the answer that he sent me:

It was a screenshot from Google! Not even Pubmed, or Uptodate.
 
And perhaps this is my biggest beef with advocates of supplements. If you can show me good studies supporting its use, I'm all for it. Because, despite what you think, I don't burn up in flames when I touch a multivitamin. I've on occasion taken St. Johns Wort for mood- based on some clinical studies (will blog about that next maybe- but this job is going to kill me someday). And I've been known to suggest red rice yeast extract for my patients who are deadset against prescription statins. But if you're wanting to convince me, or my patients, that something is beneficial, seriously, the best you can come up with is Google? Makes me tempted to ask: if so, the next time you have a ruptured appendicitis, are you going to Google this and take some supplements for it? Or are you going to seek help from a surgeon who was trained based on the latest in scientific evidence?

Tuesday, July 22, 2014

Insulin Use is NOT a Stigma

I was quite pleased when I read this article. And no- it wasn't because she is eye-candy. All too often, people don't like to talk about insulin. Insulin is often seen as a punitive action, thanks to us docs who threaten patients with "if you don't eat right, you're going to eventually need insulin!". Or, insulin is seen as a sign of failure when it should not be.
After all, the person with type 1 is dependent on insulin- her life depends on it.
 
 
And I've seen one too many patients who went into DKA, or have uncontrolled diabetes, because they were embarassed by the fact that they used insulin, and preferred to skip their shots.
And so, I was proud to read about this young lady who decided not to hide the fact that she was insulin dependent.
She would be an excellent role model for many out there. Bravo!

Saturday, July 19, 2014

Management of Diabetes Patients During the Fasting Month

I have quite a few Muslim patients, mainly those from the Middle East. And it always surprises them when I show a little awareness of what they have to go through during the month of Ramadan. After all, in the USA there is much ignorance about Islam, and being raised in Malaysia we've certainly had our share of exposure.
Obviously, the glycemic management of a person who is fasting for religious or medical reasons will change. And so, these perhaps might be some helpful tips:
  • When fasting, one should not take any oral hypoglycemics. This refers to the sulfonylureas like glyburide, glipizide and glimepiride. These are 'blind' secretagogues- you take the pill, you will make insulin- whether or not you need it
  • It should still be OK to continue metformin and incretimimetics like Sitagliptin, Linagliptin, or the injectables like Exenatide or Liraglutide. After all, one 'defect' in type 2 diabetes is excess hepatic gluconeogenesis even when one is fasting- so it is often helpful keeping patients on these. And recall these medications do not cause hypoglycemia (as even for the incretimimetics, the insulin secretion is glucose-dependent) so it will be safe, even if one is not taking any caloric intake
  • For insulin users, it is often OK to continue the basal insulin like Glargine or Detemir. If the dose was appropriate to begin with, there should be no need to even reduce the basal insulin though the truth is many overdose their basal insulin to partially compensate for meals. And so it might be prudent to advise a 10-20% reduction in the basal insulin dose when one is fasting
  • For rapid-acting insulin (Aspart, Glulisine, Lispro) users, recall there are two parts to this: the nutritional dose, and the 'sliding scale' or correctional dose (though in reality it's all given the same time). And so when one is fasting and not consuming any carbs, then it's logical to skip the nutritional portion- but if the blood glucose is high, then it's still OK to give the correctional dose of this
  • Same goes for insulin pump users: when one is fasting, just leave the pump running on basal insulin. May need to bolus for hyperglycemia; but obviously there should be no carb boluses. Again, in these patients there should be no need for reduction in the basal settings in the fasting state, though if one notices a decrease of >20 mg/dL/hour of glucose on the basal insulin alone, this suggests that the basal rate should be reduced anyway
And so, these are some tips that might be helpful in the management of patients with diabetes. It is also prudent to advise patients to carry glucose tabs even if one plans to fast, in case one experiences hypoglycemia.

Friday, July 18, 2014

MH17

I was in disbelief when my wife texted me to read the news. This time, it was not accident, but a vile act of war.
It makes me boil. It breaks my heart. While we are in the business of saving lives, and how every single one is so precious, how can another human being so callously take 298 souls away?
Enough of this nonsense we are reading in the Malaysian news- let's try to put our petty differences away and remember the big picture. Let us take a moment to remember the lives lost, and try to make this world a better place.
RIP
 

Tuesday, July 15, 2014

2014 US Hospital Ranking

It was with great pride when I read of the news today.
The US News and World Report published their annual hospital ranking.
And this time, for the first time ever, my alma mater was ranked number one.
RankHospitalPoints*High-ranking specialties*
1Mayo Clinic, Rochester, Minnesota2915
2Massachusetts General Hospital, Boston2815
3Johns Hopkins Hospital, Baltimore2615
4Cleveland Clinic2614
5UCLA Medical Center, Los Angeles2315
6New York-Presbyterian University Hospital of Columbia and Cornell, New York 2212
7Hospitals of the University of Pennsylvania-Penn Presbyterian, Philadelphia1911
8UCSF Medical Center, San Francisco1710
9Brigham and Women's Hospital, Boston1510
10Northwestern Memorial Hospital, Chicago1310
 
For many years, she has ranked number two, just behind Johns Hopkins. This was in spite of being number 1 for many subspecialties. But this time, it barely beat out the competition and ended up on the top, with Mass Gen (Harvard) being right behind.
Well done, Mayo!
As one of the thousands of your graduates, today we beam with pride at the news. This was well-earned, and reflects well on the teachings of the Mayo brothers, one of which I hold dear to my heart even today: The needs of the patient comes first


Tuesday, July 08, 2014

Do Healthcare CEOs Deserve More Money Than Doctors?

This was the interesting article I read on Medscape recently.
It's certainly a timely article, when many of us in the frontlines of seeing patients, who really abhor the politics, business and economics of things and really just want to play the role of the healer, is being caught between a system that is cutting down costs and reimbursing doctors less, versus trying to provide quality care without being restricted by policies.
Some excerpts from the article:
 
When politicians and government officials talk about high healthcare costs, physician earnings and salary tend to be at the heart of those discussions. And yet, there are other players in the healthcare arena who earn much more than physicians- in particular, much more than primary care physicians.
At a lot of health insurance companies, hospital systems, and large academic hospitals, many chief executive officers (CEOs) earn millions of dollars per year, far exceeding what any practicing physician makes.
 
This wide gap is troubling to some doctors. They wonder what it says about the importance of clinical work, the stress of patient care, and the training needed to become a physician.
 
Researchers have pinned the average income for a CEO at a nonprofit hospital at almost $600,000, with CEOs at large networks and large teaching hospitals making much more than that. In California, for example, no fewer than 32 CEOs at nonprofit hospitals made more than $1 million per year in 2013. In addition to base pay, healthcare CEOs can make a great deal more in bonuses- and, at for-profit organizations, in stock options.
 
Does the amount of CEO pay have anything to do with raising quality of care, or even improving the hospital's bottom line? Not according to a recent study in JAMA Internal Medicine, which examined pay for CEOs at not-for-profit hospitals. The study found no significant association between CEO compensation and the hospitals' finances or these organizations' quality, mortality, or readmission rates
At the 11 largest for-profit insurers, CEOs earned an average of $11.3 million in compensation in 2013.
 
Hospitals, by contrast, haven't done as well financially as insurers have, owing to stagnant reimbursements and lower volume of inpatient services. But CEOs at the largest hospital systems, especially the for-profits, nevertheless managed to make good money- in some cases up to about $12 million
That kind of compensation raises the ire of many physicians. "An insurance company is only interested in the bottom line," said Richard M. Dupee, MD, a primary care internist in Wellesley, Massachusetts. "When I'm not paid $30 for an electrocardiogram because it's supposedly not indicated, I think of the insurance company CEO who is making millions of dollars a year."

That bitter statement is something I can relate to, when I think about the 5-20 minutes my CMA or I spend on the telephone per patient when we are trying to obtain approval from the insurance company to do a scan, even if it's something as simple and as textbook as a thyroid I123 scan in working up hyperthyroidism- needing to be passed from one person to another over the phone. Or, having some nonmedical person on the phone deny my request for a Thyrogen-stimulated radioiodine whole-body scan in a thyroid cancer patient with an unstimulated thyroglobulin of 30, because the levels were not "increasing compared to the previous". Yes, I'm referring to you, United Healthcare- of all the insurors, you disgust me the most- clearly, patient health is not your priority. But the others are just as stupid. I can't even keep track if I'm allowed to check a lipid panel every 365 days, every 335 days, every 90 days, or whatever (all of the above are different restrictions for the different health insurance companies!). So if I have a pancreatitis patient with serum triglycerides of 1200 mg/dL and I put him on insulin and a fibrate, if this was Company X, I'd have to wait a fucking year to retest him, or have him pay for the test out of pocket???
 
Another doozy- having to contact the thousands of patients of our clinics when the new year comes along and the stupid insurance decides this year to cover Novolog, and not Humalog, or that the preferred Testosterone medication is now Androderm, and not Androgel. And the fun part is the formulary often changes yearly.

All these for what reason? To "save money"- but does it lower premiums for patients? Hell no. Saving money probably gives the CEO or VP-this-or-that a higher year-end bonus.
 
It does make you bitter, feeling like you can't really do your job as a doctor, but yet someone way up there is getting paid millions, with little direct knowledge (and probably concern) of your patient and his welfare.
 
Even at a local level, to have policymakers force clinics to adopt a certain defective EHR (electronic health record), only to make sure the 'Go-live' dates was on track- never mind that the system was flawed. Or to be forced to use a certain lab for tests, even if that lab frequently messes up the test, even as simple as getting the damn gender wrong, and issuing the wrong reference ranges. Just for the sake of 'uniformity'. Not patient care or safety.
 
It's true that we always judge our self-worth to be more than what it really is; and so my personal bias when I read that article was that CEOs of healthcare systems are getting paid too much. But then again, it probably has something do to with that envy that I'm getting paid 2-5% of what the CEO is. And they say envy is a sin, no?
 
So, the option is to 1) Get an MBA and hope on the bandwagon- but I'm not smart enough, or 2) Find a new job.
 
And there are days when I'm REALLY tempted to go to option 2.

Monday, June 23, 2014

My First Ferrari

Finally.
After working over a decade since graduating from medical school, countless sleepless nights, shortening my life trying to to save that of others, after saving for years, I could finally afford one. 
I finally went ahead and bought  it.
Yes, I bought my Ferrari.
It's for real. It's the original from Scuderia Ferrari.
After all, maybe I sound entitled, but I think I deserve this.
I deserve a Ferrari.
Though red would have been classic, I picked black.
Yes. I finally got my Ferrari.
My Ferrari T-shirt.
(What, you thought I was talking about a car??? I'm an endocrinologist, not a plastic surgeon!)

Saturday, June 21, 2014

The Endocrine Society Meeting

It has been a few years since I attended the Endo Society meeting, arguably the largest endo meeting (if you don't include the ADA) in North America. And unlike the AACE meetings, this has a major basic (versus clinical) track, so you get to hear about research from the leading basic/laboratory scientists.
Also, it was nice to meet up with my fellow alumni, and for a change we did not have to fret over presenting our abstracts/posters and could just relax and enjoy the meeting and the camaraderie.
Admittedly, it did make me feel aged when, in reminiscing, we realized that we began our careers in endocrinology in 2005, and graduated 6 years ago.
We were initially planning to make this a family trip, though in the end decided to spare the girls the trip to Chicago (we have another road trip coming up) and so I came alone, which made things a bit simpler. Having said that, this would be my VERY first trip without the wife and the 2 girls- so I'll admit I missed them terribly even as I was leaving home this morning at the ungodly hour of 4AM. Even now in my cosy hotel room, it seems too quiet.
Anyhow I'm not going to complain about my relative freedom, of not having to worry about 2 screaming kids, or a wife telling me to go to bed and not watch TV :P
And it will be a nice change not thinking about patients or work, but just to keep my mind open and learn about the exciting new discoveries in my specialty. The areas I'm particularly keen to find out more about are the new closed-loop continuous subcutaneous insulin infusion systems (aka 'bionic pancreas') for type 1 DM, and the new gene expression classifiers in the evaluation of thyroid nodules.
Needless to say, the food scene is always good here in Chicago!

Wednesday, June 18, 2014

Sometimes, this job gets a bit thankless. After all, we work long hours, deal with crazy bureaucracy (having to deal with prior authorizations, insurance companies, auditors etc), to have little tangible benefit especially when many patients don't want to be there. It's easy to forget why we go into medicine. To heal; if not the body at least the spirit.
And so sometimes it's fun and a bit refreshing to do something different.
This week, Mr. N, one of my patients with metastatic thyroid cancer, ended up in the hospital for complications following a surgery. And though he is diabetic, he was craving a chocolate milkshake from McDonalds. I got blessings from his surgical team, and dropped off a milkshake and some car magazines for him (though it might seem hypocritical when your endocrinologist brings you a dessert!).
Also, Mr. J, whose wife has been struggling through complications of chemo in the last few months, was finally able to organize a trip for the two of them to the beach. He shared at his last office visit with me: "This was going to be our last trip together. I don't think she'll hang on much longer". It's heart-wrenching to see a 68 year old man cry, a reflection of the deep love they have between then. And so I was delighted to hear that they were able to make this trip- that she was feeling well enough. I was able to track down which hotel they were going to be staying at, and organized a dinner for them, on me (my compliments to Snapper Sea Grill at St. Pete's beach, whose team was so accomodating with my many phone calls). I had wanted to organize a limo ride from the airport, but found out they rented a car.
He said he has never had a physician do this for him. I'm not sure if he understood my response when I told him that this job has become too numbing, but that it was these little joys that bring so much pleasure to me, and makes this job feel human again. I thanked him for letting me indulge in this fun activity.
I imagine I'll see him in a month for follow up- I look forward to seeing pictures from his trip.
But truly, once in a while I think we need to do something fun for our patients, to remind us of the joys of being so involved in their lives.

Saturday, June 14, 2014

Happy Father's Day

Being a dad myself now, you see things in a whole new light. Things previously unfathomable to you suddenly become norm.
You're constantly on the lookout for things that could hurt your child.
When you see a cute cartoon character, you think "Ohh my kids would like that..."
You're always keeping tabs on your finances, asking if you're saving enough for their education.
You ask, "If something happens to me tomorrow, have we prepared enough so that their needs are looked after".
You think about wills, life insurance and all that morbid stuff.
You also suddenly realize that it's possible to be so mad at someone so little that you want to jump off the cliff, but yet at the same time love them so much that you can't bear the thought of your little ones one day leaving home.
 
It gives me a new understanding of what a huge role a father plays, and how thankful I am to have such a wonderful father figure. You also humbly realize that your achievements in life thus far, have less to do with what you have done, and more to do with the lessons your parents have given you.
 
So to all the dads out there, especially mine: Happy Father's Day!