Friday, July 03, 2020

Telehealth Thoughts

Life as a doctor in the times of COVID19.
What a strange world we are in right now- but though we've had to make some accomodations and experience some inconveniences, I think about what the previous generations had to endure during humanity's previous worldwide catastrophes, and I remind myself this is a small price to pay, and this too, shall pass.
As an endocrinologist, almost all I do is lab-based. With the exception of thyroid ultrasounds and biopsies, inserting/removing implanted continuous glucose monitoring devices, pretty much everything else I do does not require the patient to be physically present. So, in times of COVID, my specialty seems well-suited for telehealth compared to my comrades in procedure-dependent specialties. Indeed, we were able to pretty rapidly convert the practice to telehealth visits almost overnight, almost to the point of seeing zero patients in clinic. Indeed, in the last 3 months, I saw only 3 physical patients, and have been "seeing" 15-20 remote patients a day. This has kept our patients safe by having them stay away and minimize exposure, and has kept staff healthy for the most part (only 2 clinic staff came down with COVID). So, I thought it might be helpful or of interest to some- here are some random thoughts on this topic.
Patients are given scheduled times for the visit. Before the time of the appointment, my medical assistants are calling them to do the usual "intake"- going over the medication list, answering some questions regarding how the telehealth platform works, reminding them they have an upcoming appointment.
My default is Zoom; this works well for most patients. The video is relatively good quality an it's HIPAA compliant. There is a whiteboard and screen sharing option- helpful for me when I want to draw diagrams of the thyroid or the hypothalamic-pituitary-adrenal relationship, or when I want to show them their glucose tracings online.
If Zoom does not work (if they can't download, or if the audio is not working which seems to happen 10% of the time), my fallback options are Doximity, or, or Facetime or if really nothing else works and if their specific insurance allows for it, a phone call. Phonecalls are poorly reimbursed by the insurance, but medical needs obviously take priority over reimbursements so if a patient needs a visit, the phone will do.
I love what technology has allowed us to do now. For my insulin-dependent patients who are wearing continuous glucose monitors, I am able to view their glucose tracings over the last 2 weeks, seeing their minute to minute trends and how their meals and insulin balance each other out. I am blown away sometimes by the ease of how I can see a person's glucose trends almost in real-time, from 80 miles away. Obviously, the patient needs to be tech-saavy and connected enough- for the Dexcom patients this would be Dexcom Clarity, and for the Libre patients I'd use Libreview. For patients on CGM-augmented insulin pumps, one gets to see not just the CGM tracings but their insulin use. For patients not yet uploading, my MAs would help them set this up prior to my telehealth visit with them.
If labs are needed, and they often are, we can electronically send orders to the lab, or mail them the order, and once the results are received, I tend to call them to update them of the findings. So this is somewhat duplicative since there would be 2 points of contact per patient and adds to the work, but I don't see this being too different from the usual face-to-face.
You read about anecdotes of patients who Zoom in awkward situations. Well, I've had 3 patients Zoom with me wearing only their underwear. All three were middle-aged men for some reason. I've had one woman join the Zoom call while in the car. Driving. Yup. And when I said I'd reschedule the visit, she said it was OK- she could talk and drive. For safety reasons, I obviously declined.

It's been a steep learning curve. But apparently we are doing OK. Obviously, telehealth is not well suited for all, but we did well enough that we were cited by the hospital system as one of the top telehealth clinics in the state- and yours truly gave a presentation on our experiences on this topic last month. COVID has certainly changed our way of life- and I am looking forward to days that are more normal again (someday- not to distant future I hope). In the meantime, looks likes telehealth is here to stay for the time being.

Monday, May 18, 2020

Dear Buddy

Dear Buddy,
I can't believe it's now been 9 years since you left us for a better place. This was the last picture we ever took together, the last moment I saw you alive. It's been 9 years, but I remember that night well- having dinner at a food court in Penang; some words unspoken but it was clear to me (and I'm sure to you too, my oncologist friend) that this was a goodbye for us for this Earthly world and that soon your battle with cancer would end. I remember our last embrace before we left.
Much has changed, evolved since then, and the world has gotten crazier. I wonder if you'd recognize what was going on if you were here. Who would have thought that we'd ever be in a global crisis from an incurable viral pandemic that would take so many lives and affect every facet of society the way it did?
Much has changed- I'm sure you know she has remarried which is something I'm sure you had wanted for her, to a wonderful chap, and we are so happy for them, for her that she ha found love again. We're supposed to be at the prime of our careers, though admittedly there are days I question if this was the right path for me (and then there are days when I don't). The kids are growing fast, and transitioning from "children" to "pre-preteens" and forming their own opinions and gaining the sort of confidence and independence I never knew at their ages when we were in Malaysia. In that picture, Alli was not even a year old, and she has no memory of you now, though Kris and I talk about you to the girls regularly.
Though it's been 9 years, I think of you much, and depend on those memories of simpler, happier days to get me going. In my darker moments, I find myself confiding in you still in thought an prayer, and once in a blue moon we get to meet again in my dreams. Dreams in which we again visit our favorite post-call hangouts or partake in our Halo marathons.
I miss you buddy. I'm sure you know that. You've touched so many lives on this Earth that your mark here will always remain. Till we meet again someday in a different world, take care.

Wednesday, January 01, 2020

Happy 2020!

Happy New Year.
It's surreal, thinking it's 2020. A whole new decade (though the mathematicians and purists amongst use would argue the new decade starts in 2021...). Especially those of my generation, having grown up in Malaysia, there was that neverending talk to Wawasan 2020, a dream that seemed so distance you never thought it would get here.
Much happened in 2019- some hits, some misses, and some near-misses- but still, much to be thankful for.
We almost lost a good friend last month- he essentially coded and required CPR and external defibrillation (thankfully the people he was with were trained) because of an acute myocardial infarction- leading to a 3-vessel CABG. He's OK now, thankfully- and if you know the odds of pulling through an episode like that, you really it's miraculous that he's alive, and his kids still have a dad.
Also recently our friend remarried after having lost her husband Buddy to cancer over 8 years ago. We've known that the love never goes away even long after one has passed on, but we've hoped for some time that she would meet and fall in love anew again, so we were ecstatic hearing the news that she did meet someone and got married. Buddy- bless his soul- would approve I'm sure.
At home, I continue to be amazed by how quickly the kids are growing. I'm sure I'm not the only parent who- deep inside- yearns for the days when he has a small toddler or baby still, and wishes there was a way to slow things down or reverse the clock (then again I'm an endocrinologist....).
Another notable event in the last decade- my amazing wife went on to get her doctorate despite working full time and being a mother to 4 (the kids, the dog and me!). The pride is immeasurable.
Here's to another exciting decade- Happy New Year everyone!

Tuesday, October 15, 2019

A friend of mine, a junior from residency but also from Malaysia, was recently diagnosed with cancer. I have not seen her for years, but I was shocked and saddened to learn of her diagnosis. It did get me thinking about our own mortality.
After all, as doctors we get so preoccupied with our patients; we spend more time collectively with patients than we do with our family. We diagnosis issues, treat them, sometimes cure them- but it's easy to forget we belong to the same group- we are after all human, susceptible to the same ills that befall them.
God knows how many doctor friends I've lost over the years. A couple to motorvehicle accidents. Maybe 4-5 to cancers (esophageal, lung, bone, breast). A gaping hole still exists where Buddy used to fill, and he's left this world for the next 8 years ago and it still feels fresh.
But we are after all just human; who knows what our future holds, and if we'd be facing the same problems we try so feverishly to cure or at least heal, our patients of.
It's a little reminder to myself- to slow down, and take some time to count my blessings. My wife, my kids, my family. The many intangible but priceless gifts with which I have been blessed.
To all those healthcare providers out there struggling with physical and mental health issues- I hope and pray you find your peace and healing.

Sunday, September 15, 2019

The Countdown

The countdown has begun.
Yup, I depart for the good old USA in a few hours. I miss my wife and kids terribly and can't wait to see them, and it's been a really productive trip. In a way, travelling solo is easier as I'm much more flexible with time. No need to worry about bedtimes, or whiny or tired kids, or whether a place is kid-friendly. So this trip, I've been able to cram in much more social events than previously possible. I got to meet up with friends I have not seen for over 26 years, believe it or not. By a stroke of luck and coincidence it was my high school reunion, so it was surreal seeing vaguely familiar faces- people you kinda knew a lifetime ago- but you don't know remember their names.
It'a also great to meet up with your buddies. Yes, we have good friends where we live. But there's something to be said for soulmates, the kind of friend with whom you can truly be yourself, who have known you all your life. For some, the last time I saw them was maybe 8 years ago- yet it's amazing how we just click back into place like I never left. It was great to see my brothers again.

I also did the customary food checklist- and went down it, some foods 3 times even (nasi lemak!). Considering I am signed up for a half marathon in a month, I'm going to have to work this off when I get back.
But it's always a treat coming back for a visit. It's always heartwarming to hear the local accents and dialects, and to see the familiar sights and hear the sounds; though the haze is perhaps dampening that somewhat.
Until our next visit (CNY 2020!), take care of my Malaysia!

Tuesday, September 03, 2019

Leaving for Tanahair

Will be taking off in a few short hours for my next trip back to Malaysia. It has been over 2 years since my last visit, and this time it'll be a solo trip- social mainly to meet up with friends and family, with a lecture at the local medical school too.
Admittedly, this time I'm not as psyched about travelling as I have in the past. For one, it'll feel weird flying without the family- as chaotic as it might be travelling with 2 kids (though the kids are now seasoned fliers and at ages 9 and 7- they travel pretty well). But perhaps the main reason is a bit more sentimental and closer to heart. This will be my last trip back to Malaysia as a Malaysian. In a few weeks, I shall be sworn in and officially become a citizen of the USA. I've dragged my feet for years- after all I could have applied many years ago but somehow liked to retain that red passport and my Malaysian identity. But then reality hits- there is really no reason to keep this and only requires troublesome trips back to renew the passport, and with my wife and kids here in the USA, there is really no reason I would be moving back. And so, earlier this year I began the process of application for naturalization. And I've been surprised (pleasantly) by how quickly things have happened, I'm also a tinge saddened by what I'd lose.
As a parent, I can't even imagine what my parents, and many of their generation, had to go through bringing up kids with the advise "if you can, leave Malaysia and don't come back. The future is brighter elsewhere....". I have trouble even dropping my kids off at camp- and to plan your kids' future away from you is gut wrenching.
Anyhow, yes, this will be my last trip back with the red Malaysian passport. The next trip back I'll likely have to use the 'foreigners' line at KLIA immigration.
However this will be my first trip back to "Malaysia Baru"- one my parents and I never thought I'd see, and one that fills me up with so much more hope for Malaysia's future than I thought possible. 
KLIA, here I come!

Monday, August 12, 2019

8 Months

I'm back.
Wow, 8 months. I didn't realize my last post was that long ago. Then again, life (especially with kids) has a way of keeping you so preoccupied that you lose track of time.
Much has happened in the last few months. The kids are just wrapping up with their summer break, and now comes the usual dreading-to-go-back-to-school fears. Also brings me back to the times when I was in primary (elementary) school, and preparing to start a new grade. The kids do find it fascinating when I share my stories of my youth.
I remember how we would go to Lee Sam road to shop for new school bags, though invariably the trend then was one of those 3M polyester Lego-yellow backpacks. We'd then make a trip to get new school uniforms- the usual white short-sleeved shirts and navy blue shorts, white socks and white shoes. I do miss the concept of school uniforms- so much less work- as you don't have to worry about how to dress the kids. Also, everyone dresses the same, so there would be minimal competition regarding clothes. I wish our kids' school implemented this.
I also shared with the girls how I was a mommy's boy and had major separation anxiety. Come to think of it, ironic that I ended up here in the USA, but I digress. I remember how it was so bad during kindergarten that my Ah Kong ended up actually accompanying me to school for the first month! He'd sit in the corridor outside of the classroom and I was able to see the back of his head through the window. And if he ever moved away momentarily, I would get nervous. And this was before the era of cellphones or ipads, so he would have absolutely nothing to do except sit and wait for me for those few hours of classes.
I remember how bad it was for standard 1- I held on to my dad and cried so bad, not wanting to let go for dear life, that the headmaster actually came up to me with a cane in his hand; something that is not socially acceptable anymore perhaps.
Boy, I was high-maintenance as a kid.
It was fun though that during our last trip back to Malaysia, we were able to make a visit to my primary school. I was able to show the girls where their daddy went to school, where the canteen was (a word that is foreign to them), or where I squatted to brush my teeth whenever we had our dental checkup at school.
How time flies, and the roles revese.

"...and the son becomes the father...."

Sunday, December 16, 2018

Physician Suicide

Someone I know recently took his own life. A physician at my medical center, a father, a son, a brother. Someone who should be at the peak of his life. Those who knew him and worked with him till the very end say that he hid it well. No one knew. Right up to the point when he said he wasn't feeling well and wanted to go home early. To do the deed.
The rational side of the brain can never justify such an act. Why would an organism, a human being at that, while physically health, would willingly and intentionally end its life, serving no purpose, no greater good, at that. After all, isn't life programmed to endure, to find  a way to survive? Isn't self preservation a natural instinct?
The emotional side of the brain though has, well, mixed emotions. For one, in a messed up way, though I'd never agree to this path, you can perhaps relate to what might be going on in his mind before the deed. It's easy to understand how in the hubbub of work, and the burn out and frustrations we go through, how one can lose one can forget the meaning of life. To not see joy or beauty or kindness anymore. To not find a reason to go on, and to conclude that ending it all is the best way out.
Those of us fortunate or blessed enough to have our meanings to life- family, loved ones, friends, some other passion, these keep us grounded and gives us perspective. However, for the few without these lifelines, you can almost understand why it's easy to give in to those temptations.
A little knowledge can be a dangerous thing. Probably another reason why the suicide rate amongst doctors is high. Depending on your specialty, you may have the means, and you certainly have the know-how about the body enough to cease its function.
It's always a tragedy when this happens. And I'm biased of course- but it's a greater pity when it's a member of the fraternity. 
Someone once told me, "Doctors save lives, at the expense of their own..."
It's a difficult topic to discuss, and because there are professional consequences to be known to have psychosocial issues, doctors are much less likely to reach out for help. Yes, there are helplines and counsellors- but I personally know of some people who despite severe depression refused to seek professional help.
Yes, it's a real issue. A stigma that no one wants to talk about or acknowledge- but depression and (physician) suicides are real. As difficult as it might be, we need to be more open about these things an have more discussion. And not judge.😥
And so, if you have problems, reach out. And if you think someone is struggling, it never hurts to ask.

Saturday, June 02, 2018

Happy Anniversary

It's about that time of the year again.
Buddy and his sweetheart got married 9 years ago this week (speaking of anniversaries, we are coming up on our 10th this week too!). Since he passed away, Kristin and I have made it a habit to send his wife flowers every year on their anniversary. After all, painful as it might be to have lost him on this Earth, the day still holds much meaning, and should never be forgotten.
Every year, I have my favorite KL florist send her a bouquet of flowers.
I figured, if someday I die before my wife, I'd like my best friends to send something to her on our day too. That's the least a brother could do for me.

That was a special day. I admired their strength and their resolve; they knew how this story was going to end, being an oncologist with stage 4 esophageal cancer. Long before that day, I remember us having a conversation; he asked if he should propose to her- knowing he had a terminal disease, and not wanting to make her a widow. And then they decided that love knows no boundaries, and that they wanted to be married and make full use of whatever time they had on this Earth. I remember how when the had their first dance, there was much laughter (they had a professionally choreographed dance!) as well as tears, seeing this play out, a story worthy of a Lifetime movie.
Happy Anniversary, guys. Bro, I got your back- you can repay me for the flowers when we next meet.

Saturday, May 12, 2018

A New Era

It's the dawn of a new era. And I'm sure my many other fellow Malaysians feel the same way.
Truth be told, I have not read the Malaysian news for some months. There was a time I read The Star and such daily- as you might recall the days when I was an avid writer to the Letter to the Editor section.
However, as the months and years went by, the news got more and more discouraging. The racism, corruption, abuse of power. So I heeded a mentor's advice- a fellow Malaysian who left our Tanahair many years before me: "You've left- best to not know what's going on and follow the news. It brings only heartache". 
So true. Except there was no running away; the abuse of power got so bad that Malaysia came up even here numerous times. My American friends were in disbelief- the sheer magnitude of the 1MBD scandal, getting even the Justice Department here involved. They asked: why isn't Najis et al in jail? How are they still in power?
Well, last week, you, my fellow Malaysians, in an act of unity never before seen, toppled the corrupt BN and its leaders. Something I did not expect to see in my lifetime- but yet inside, across the oceans, I was bursting with pride and joy, to see what you accomplished (disclaimer: I take no credit for it as I am not a registered voter).
The shockwave resonates even here; some of us got together to have a celebratory dinner- no teh tarik where we live but we celebrated over a chilled margarita on a warm spring afternoon. And it's no exaggeration to say that it felt like it was a new chapter, like the air was fresher, and the future seemed brighter. If you're Malaysian, I'm sure you know what I mean. And that's from someone who left Malaysia 19.9 years ago (yes, it will be 20 in a few months).
For decades, BN played racial politics, fanning the fires and using the divide-and-conquer strategy. For decades, we were known by our kaum/agama rather than our similar bangsa- it was inspiring to see the opposition movement was led by people of all backgrounds- skin color did not matter. And to see that even our Malay compatriots saw through race, to vote away the corrupt UMNO.
The next step, this is undiscovered country. One that is full of hope- though a part of me remain leery- so my hope for the leaders and the country- is to maintain the common vision for a better, more harmonious, economically stronger and more educated Malaysia- and to not fall back into the trap of racism. Or internal squabbling within the party. And, perhaps most of all, recalling the common saying that power corrupts- I pray that our new leaders led wisely, justly and be free of corruption.
It has been a while, but now I can again proudly declare that I am Malaysian.

Tuesday, April 24, 2018

The Libre and Dexcom G6

I'm excited. Optimistic too perhaps.
For the first time in the history of diabetes care, we now have options to offer patients aside from the tried-and-proven age-old pricking the finger with a lancet, then getting a small drop of blood on the glucometer strip. 
True, in the larger scheme of things, this isn't a big deal. However, for patients on basal-bolus insulin programs, testing 4 times a day is a necessity. And for many, it would be a lifelong deal. And while CGMS (continuous glucose monitoring systems) have been around for years, they are by no means perfect; they often are inaccurate enough to replace glucometer testing, and require glucometer readings several times a day for calibration. Years ago, if you asked me if there would be better options, I'd have said no.
However, in the last few months, the FDA has approved several newer devices that is likely going to change how we manage diabetes.

First off, the Freestyle Libre, which is the first no-calibration continuous glucose monitoring system in the USA. A rather simplistic and minimalist device- you insert it on the arm- and once it warms up, it's good to go. You can wear it for 10 days, during which when you wish to check your glucose level, you just take the reader and swipe the sensor on your arm, and it reads the glucose value. So instead of 4 pricks a day, you just swipe the reader 4 times a day. Pretty neat, and definitely cheaper than the existing CGMS systems. Though this will not preemptively warn a user of hypo or hyperglycemia, and does not work with any insulin pumps- so I see this as a great replacement for the glucometer, but might not be the best device for my patients with severe hypoglycemia and hypoglycemia unawareness. This is new, but I have over a dozen patients already on it, and most love it and find this life-changing.

Then more recently, the FDA approved the Dexcom G6 CGMS. This too, is Dexcom's very first device that does not require calibrations with the glucometer, and can be worn for 10 days. This is a more sophisticated system, and hence will likely cost a lot more than the Libre (not in the market yet- probably soon). However, this is expected to work with insulin pumps and can work with smart phones, and one should be able to program in glucose thresholds for alarms, and could be a lifesaver for some people.
Professionally, I'm excited about what the future will hold for my patients suffering from this horrible disease. There was a time many would scoff at the prospect of a closed-loop CGMS-insulin pump system, long considered to be the holy grail in type 1 diabetes. But with how diabetes technology seems to be evolving rapidly in the last 5 days, the future in theory seems bright. Now, if only these things are more affordable to more patients.... but that's a different battle to be fought.

Saturday, January 13, 2018


I'm back.
And freezing. Times like this I ask myself why I don't live in a more tropical place. It's -15C right now.
Anyway, it's been awhile. Updates- I did pass my Boards, thankfully. Surprisingly. After all, when you've been out in practice for 10 years, and see what you see and don't see what you don't see, and never see something like X-linked hypophosphatemia, and have ordered SDH genetic testing only once in the last decade, it's hard to remember the details or even be interested in reading these things up.
Plus, a 10-hour exam was brutal when I was in my 30s. It's just as bad now.
We've had a lot of travelling for the holidays- 6 hour drive to the inlaws for Christmas, and a 10 hour drive to the Rockies for a ski trip. It was a blast seeing the kids learn to ski; and they actually picked it up pretty well.

Having lived here for so long, Malaysia seems to be but a dream away and I sometimes avoid reading local news to minimize the heartaches from knowing about the dirty and racial politics there. That being said, even over here, amongst the few Malaysians, there seems to be a building sense of excitement, that perhaps this GE, the corrupt dictatorship can finally be toppled- though one prays that it will not be simply replaced by another tyrant. But here's to you people back home- here's to finding your foothold and finding the will and momentum during the next general elections- to not vote for skin color or religion or hatred, or money- but to listen to your heart and brain- and to vote for change, for the better.

Friday, October 20, 2017


I'll admit; I've been slacking.
Maybe it's the lack of motivation. Or the lack of energy. Or maybe this isn't the ideal outlet for me anymore- I've done this long enough I feel that I've lost much of the anonymity that comes with blogging. After all, even my parents know about this 😛. And I suspect some of my patients too. So that means I can't whine about home, or work. And probably much in between.
But the truth is probably simpler: I'm lazy.

And so, I'll pop by and update this occasionally. But yes, I'm still alive and kicking. And yes, I'm busy studying too- it's been 10 freakin' years since I took my specialty board exams (how time flies) and so I am due to take the dang 10 hour exam again soon. So wish me luck

Thursday, August 31, 2017

Patient Survey

Sometimes you don't know if you wanna laugh, or cry.

Our clinic received our patient satisfaction survey results today, this was a survey conducted by an independent 3rd party, contracted by the hospital for probably a generous sum of money, to do these surveys. Physician bonuses are tied in to how satisfied a patient is. This seems to be the norm these days in the USA.
One comment an anonymous patient put nicely sums it up:
"Dr. X (one of my highly respected partners) knows nothing about Hashimoto's! Doesn't she know when you are taking Armour Thyroid, the goal is to get the TSH as close to 0 as possible?".

And that is why basing physician performance on patient satisfaction is a flawed metric.

I've read of urgent care or ER doctors sending most patients home with a goody bag to keep them happy: either antibiotics, or opiates, or both. And often topped with a serving of work excuse for a few days, and having put them through unnecessary testing.

Sunday, May 21, 2017

Sharing with a patient

Admittedly, that was a first time for me. A patient telling me he was worried about me.
A patient, a guy I have known for 8 years, having treated him for his diabetes, but more recently noted on exam to have a thyroid nodule- one thing led to another and eventually he was found to have papillary thyroid cancer.
Anyways, I know him well enough to consider him a friend. We share stories of our wives and kids, who are about the same age. But at our last visit, he said something that struck a different chord with me.
He said: "Doc, I'm worried about you. I'm worried about your profession."
He had read some articles recently about burnout and depression and suicide rates amongst doctors. He had heard too about the long waitlist to see a specialist in our state (3 months)- because there is a shortage regionally of endocrinologists. He read about how it is so damn complicated now to be a doctor in the USA, not because of medical reasons, but because of the bureaucracy and the paperwork involved. How a prescription generates a 3 page "prior authorization" form that is faxed to me and I have to fill in, justifying to some non-medical clerk in some office why a test or medication is needed. And he/she probably has to follow a script to approve/disapprove my request.
It was a timely question- for that afternoon I was just fuming as I spent 32 minutes on the phone being transferred to 5 different people (yes, that's you, United Healthcare) regarding a prescription I send in. And at the end of the call, it wasn't even resolved. The last gentleman said I should talk to Department A, which was the first person I spoke to. I ended that call with a very unprofessional "Dude, are you kidding me? That was the person I spoke to 30 minutes ago. You guys have to get your act together!" Right before I slammed down the phone.
So yes, Mr. W's statement was timely, and therapeutic. Apparently he wasn't in a hurry, and he was my last patient for the day. So when he asked me how difficult it was to be be a physician, I offloaded on him. Being his physician, I shouldn't have. But I shared some of the frustrations our fraternity faces.
It did make me feel 100% better though I felt guilty that I shared as much as I did.
The truth is, sometimes all it takes is one or two appreciative patients, who do really believe that you have their best health interests in mind, to make all the work seem worthwhile.

Wednesday, May 17, 2017

Always in our hearts and minds

Dr. Tan Tow Shung
November 6th 1978- May 18th 2011

I can't believe it's been 6 years. The time just flew by, the 6 years since you left us here on Earth to be at a better place. In that 6 years, we've all aged but you remain ageless in our hearts, my friend. In that 6 years, our families have grown, our outlook in life has changed significantly. We have learnt much professionally.
But yet, it doesn't seem like that long ago when we were together, as room-mates and best of friends. I remember fondly the simpler days, days without other responsibilities, days when we would hit the Xbox and play round-the clock Halo on weekends. Our hitting the buffets postcall as our comfort food. All that crazy shit only bored Malaysian boys can think of.
I think about life's unfairness. How, you, at the prime of your life and at the start of a very promising medical career, how a cancer doctor can himself be stricken by esophageal cancer. I think about the long hard battle you fought, the times we visited you in the hospital when you had reactions to chemo, or when you underwent surgery. I remember that time when played cards in the hospital family room.
Truth be told, I miss my confidante. I know you're somewhere up there, watching us. But I miss our talks, and your words of wisdom.
It's been 6 years. But we'll never forget you. And till we meet again some sunny day, memories of our friendship and brotherhood will always hold you near to the heart.

Tuesday, May 09, 2017

A Note

I got this in the mail today, coincidentally.
From the spouse of the patient I wrote about the last time.
I wasn't expecting this- but it was sent to my office. And the shameless softy that I am, I'll admit that it made me shed a few tears.

It's been a frustrating last few weeks; between the stupid bureaucracy of  insurance, having unhappy patients who are upset at me that I can't fix their obesity/fatigue/sex issues, the guilty of putting patients into financial hardship because of the expensive insulin prescriptions I write. And so, sometimes things like this make all the work worthwhile. Sometimes, all we need is just a few patients who really appreciate us, to make all the difference.

Wednesday, March 08, 2017

Losing Patients

I found out the other day that one of my oldtimer patients Mr. G has died. A 71 year old man I had been seeing for his diabetes and hypothyroidism for the last 8 years.
And then 2 weeks ago, I was informed another, tragically lost her battle with a chronic issue. She was only 24.
I guess I've been working here long enough. 6 years in my previous place, and going into my 9th year here. And so, for something like endocrinology, where the bulk of our cases are comprised of diabetes, a chronic condition that often requires quarterly visits, pretty soon you get to know your patients pretty well.
You know their glucose trends. Their downfalls (for the gentleman above, it was nightly creamsicles). Their fears, their hopes, their dreams.
Like how Mrs. A hopes to retire to Florida, if her husband survives his treatment for colon cancer. How Miss H. is training to be a teacher. How Mrs. T misses her grandkids out East, but isn't able to travel because of her severe CHF and oxygen-dependence, and fears greatly she will never see them before she leaves this world.
You get to know your patients pretty damn well. And truth be told, I've begun to see many of them as friends, even (if I could call them that, as they do pay to see the doctor), or even an extended family member.
And so, when I found out that the two patients had died, I was quite upset. More than I expected the news to affect me. So much so that I called their families during my downtime to convey my condolences and perhaps to share the sadness and grief.

It's true this job sometimes feels thankless. With the numerous dissatisfied patients who are mad that you can't cure their depression or fatigue or obesity. With the piles of bureaucratic crap on my desk- refills, prior authorizations, Medicare forms. The hoops we are made to jump through. But perhaps the one thing I enjoy most in my job is the rapport you do form with some patients. Almost to the point where you look forward to their visits to find out how they are doing.

And so, when you do lose some patients, the sadness (though not comparable to what their family is going through) is real.

RIP. It has been a privilege to have been your doctor.

Saturday, February 04, 2017

Our Trip

In the blink of an eye, this trip is coming to an end. We leave in the next 24 hours. As always, this is the time when I'm torn; part of me is looking forward to returning home- after all the USA is my real home now- and getting settled back into the rhythm of things. And to be rid of this dang balmy heat.
But part of me obviously is saddened to be leaving so much behind. The first is obviously family- my parents, who look a bit more frail every time I see them, and it fills me with so much guilt that I am not able to spend more time with them, my siblings, dear friends, schoolmates from 2-3 decades ago, people who know your deepest darkest secrets and love you despite it all. Leaving behind the food and culture that is familiar to you, the local accent and how it in a strange way relaxes me to be able to speak in Manglish, in our politically-incorrect way.
That all being said, this was probably one of the more special trips back to Malaysia for me. For one, I really wanted my kids and wife to experience the Chinese New Year festivities, with all the noise and in-your-face family chaos. And this they did, from eating the CNY cuisine, my girls playing with fireworks (to my wife's chagrin) and learning to say Kong Hey Fatt Choy. Eating the numerous cookies- the little one loves the 'cupcakes' (kuih bahulu- she would wolf down 5 at a sitting), or learning to appreciate Milo ais (despite the high sugar content!). Simply seeing what their daddy experienced when he was a little kid.
A bonus to coming back this time of the year, is the balik kampung phenomenon; I randomly ran into so many schoolmates in town. That, and the planned CNY reunions we had- I saw people I have not seen for 25 years! How we all have aged- I was embarrassed that I did not recognize a few lads.

It was particularly heartwarming just sitting back and watching the kids interact. How, despite a lapse of several years, my girls just started playing with their cousins from here and Australia, as though they just saw each other yesterday. And watching little Ava hold Ah Ma's hand when I told her she had a bad knee and had trouble walking.
We did make some excursions away too. A short trip to PD- a place I frequented a lot in my youth, and my first trip to Langkawi. This was certainly a different experience from the other islands we've been to: Perhentian, Redang, Tioman, Pangkor. In contrast, this was a huge island- never appreciated the size until now, and a lot more commercialized. The cable car ride and the sky bridge were particularly breathtaking, and despite the complaints I've read about the long queue, we went early in the morning and the lines were quick- definitely the highlight of our trip.

We leave on our ANA (All Nippon Airways) flight tomorrow. We enjoyed the flight in, though in retrospect, compared to our previous flights on Korean, Cathay, Malaysian, Qantas, I felt that this wasn't good value for money. The service was impeccable- but we paid for premium economy seats expecting more perks like lounge access, priority checkin- stuff that we didn't get to experience because of some technical issue- so I'd recommend skipping the premium prices and just diong economy, or trying some other airline. Perhaps better luck next time. I imagine our next trip back won't be for another 2 or more years..... so till the next time, Malaysia, Selamat Tinggal. I shall always hold a part of you close to my heart.

Tuesday, January 17, 2017

Chinese New Year

I read somewhere that the exodus during Chinese New Year is the world's largest annual human migration.
Something the rest of the world have trouble understanding. But to us, it's as simple as "balik kampumg".
This year, I'm especially excited to say that we will be joining the madness.
It has been 2 years since my last trip back (solo- part business as I gave a few lectures). It has been 3 years since Kris and the girls went. And they have never been there for Chinese New Year.
This is important to me. After all, being 1/2 angmoh, being raised in midwest USA where it's pretty homogenous and largely Caucasian, one doesn't get the feel for CNY. You don't get the firecrackers, food, and red being plastered everywhere (except perhaps for Valentine's day). Yes, we've attended a few CNY dos in the local colleges, but it's hard to get into it when the lion dance troupe consists of white guys.
And so, it's important for me to have my girls (wife included) experience what was the major holiday for my family when I was growing up. To feel and indulge in the culture and crazy traditions I grew up with.
Things like the CNY eve dinner. The midnight prayers to welcome the various Gods, with the altar facing different directions every year. The early morning routine- getting up and getting changed into our CNY clothes, the greeting mom and dad and getting our angpows, then the temple, and the open house thereafter.
Getting together with my neighborhood pals- cycling from one house to the next. Having our blackjack and cho-tai-tee sessions, feeling like a big shot betting 25 cent wagers. And, who can forget the fireworks- the Moon Travellers in the early days, graduating to Thunderclap later on.
The lion dance. The irritating but yet comforting high-pitched CNY songs by those Chinese opera singers.
Yup, we will be knee-deep in all that madness. We will be making the 21-hour flight back in the coming days, and spending a few weeks there. My siblings, whom I have not seen for years, will be there too.
Year of the Rooster, here we come!
At a CNY party with Alli 4 years ago!