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!

Friday, June 13, 2014

An example of why bigger is not better and only makes life impossibly complicated. Work has been 'growing' (and not necessarily in a good way) with clinics being bought out and merged with the health system. More and more committees, work groups, admins, VP are being added by the week. Things are getting outsourced, even IT (apparently to Indian). And so it's no longer a warm, familiar environment- some days it feels like you're a part of some bureaucratic institution.
And so, it brings me to my frustration at work today; recently work access to a news website was blocked because it apparently violates policy. What policies it doesn't make clear since news websites are allowable, even social media (which I think should be blocked). So it was probably some error on someone's part.
Now, when I log on to the Malaysian news, the page is blocked: "Request for review can be obtained if this occurred in error".
This necessitated 1 phone call (woo hoo, I got to talk to someone in India for free), two emails and now I'm being asked to fill in a form to submit to some committee. 

Somehow, all this trouble just doesn't seem worth it.
 
I'll just read the news on my iPhone, thank you very much. 

Sunday, June 01, 2014

Dr. DIY

I never saw myself as a particularly handy person. After all, unlike my brothers, I never changed my car's oil myself, or knew a lot about electrical systems. Heck, until I left Malaysia, I probably could fry an egg without screwing up. However, being in the USA where labor costs are so high (at least for a kiamsiap person like me. Fixing the bicycle brakes cost more than our cheapo bike itself!), and being a homeowner (if you are in this group, you know that it's a never ending project) tend to change things.
And so, I was thinking the other day about the DIY projects I have undertaken myself over the years:
  • Putting in a storm door (for you Malaysians- it's that glass door immediately outside of your main door)
  • Changing the wall switch for the lights
  • Mounting two LCD TVs on the wall. Thankfully the 47-inch one hasn't yet collapsed. I'm still not sure I mounted it right
  • Putting up 3 ceiling fans. And I'm most proud of the fact that I did this solo with no help as Kris was out of town that week. Now, try climbing a 9-foot ladder while trying to balance a 20-lb fan, and then trying to mount that sucker on the supports! And that was the first time I directly messed around with the electrical systems. I was half fearing I was going to fry myself
  • Painting
  • Painting
  • Staining the damn deck
  • Putting privacy laminates on the windows. This one ended in disaster. For a year, our windows had horrible air bubbles; our neighbors kept asking if a bird had flown into it and cracked it
  • Installing bidets into our three full bathrooms. One of my best pleasures at home, in a world when these ang mohs don't wash their butts- being able to clean myself!
  • Installing a blower into our fireplace
  • Putting in a pet-containment system aka invisible fence. Lasted 2 years until the lawn guy cut the wires by accident
  • Putting in a new toilet. Our old wasn't flushing, and the ceramic on the porcelain bowl was coming off (I guess our pee was too toxic?). And so we both one from Costco, a 90-lbs sucker that almost broke our backs carrying it upstairs. We ended up making 3 trips because the first two were broken. After a lot of Cantonese and Hokkien swear words and 3 hours later, we had a new, working, water-conserving dual-flush toilet. And yes, I refitted the bidet onto it.


Maybe I should think about quitting my dayjob someday if things don't work out. Not that I'm all that much handier, but I think I'd be proud of myself. And in large part thanks to Youtube, and Amazon. You'd be surprised of the videos you find online.

Monday, May 26, 2014

Updates


Aa promised, more pictures from our recent trip to the Keys. It was our first trip without the two girls- thanks to Kris' parents who drove in to town to babysit.
We flew in to Miami, and drove the 3 hours to our hotel (it was not a long drive, just slow traffic).
It was interesting flying without the kids. At our point during our layover, we had to pee. So Kris told me to go ahead while she waited and then she could go when I was done. Only after then did we realize how stupid that sounded, since we have been used to taking turns to use the restroom because of the kids!
 
The Florida Keys are a coral cay archipelago in the southeast United States, consisting of about 1700 islands. They begin at the southeastern tip of the Florida peninsula about 15 miles south of Miami and extend in a gentle arc south-southwest and then westward to Key West, the westernmost of the inhabited islands. The islands divide the Atlantic to the east from the Gulf of Mexico to the west. At the nearest point, the southern tip of Key West is just 90 miles from Cuba.
Though nothing compares to the waters of Malaysia, this was truly the most beatiful sunset I have ever seen. Unlike the skies of Malaysia which tends to be very hazy, cloudy or unclear (humidity?), we had a clear view of the setting sun on the horizon, where it seemed like the sky itself was ablaze.
The best view was probably from the famous 7-mile bridge, close to our hotel in Marathon. This connects the island to Little Duck Key- we actually ran part of the distance on our morning jog.

 
From our location, we made several day trips including a very picturesque drive down to Key West, a very enjoyable 1 hour drive. Very touristy but not too congested.
 
 

Though it was only a short 3 night trip for us, it was a nice change from the pace we were used to; to not having any kids waking us up at unholy hours of the morning, of being able to just relax and having absolutely nothing to do.
So, that's one place checked off my USA to-see list. Next stop... Grand Teton?

Friday, May 23, 2014

3 years

Dear buddy,
I've been sloppy; I'm sorry. I know I'm a week late. But it's surreal realizing that it's been over 3 years since you last left us.
Yes, life goes on for the rest of us. And in the hubbub of work, kids and all that, it's easy to take things for granted, and to forget the ones who've left us like you and Gene. It's easy to live only within our little bubble and forget anything else outside our crazy world.
But the truth is, I think about our good times a lot. Perhaps a part of me yearns for those simpler days. Of no kids, simpler job (and we thought playing doctor gets easier after our training; hah!), just us doing our thing. I miss our conversations- though it was more usually me complaining about some girl and you just quietly listening. Or us bitching about some crazy case at work. Or our pig-out sessions with the other Malaysians, or the 3rd person in our triad Nick.
Life is certainly different now. Not better or worse, but different. We've all grown up a bit. Different responsibilities. Not about call, or getting those damn abstracts or powerpoints done, or getting manuscripts published. We all have our own families. It's been a while since I've seen the others, and I miss them greatly too, though some of still occasionally stay in touch. But certainly not as much as those days.
The other day, Alli saw some of my old pictures. Including the one of us playing Wii, but one of you wearing my oven mitts because of your chemo-induced neuropathy. She innocently asked why you were wearing those gloves, or why you had that JP drain sticking out of your neck in that picture when we visiting you in the Methodist hospital and hung out playing cards.
Those were great memories, though recalling the pain and suffering you had to endure (and yet the strength you showed!), part of me is glad you're in a better place now.
I often wonder where heaven lies. The times when I am out with my telescope, looking out into the vast universe in the relative peace of the night, I do wonder- are you up there somewhere, watching the rest of us? Probably sniggering over what we schmucks have to endure in this physical world.
Anyway- the kids are asleep, and I finally have a moment to myself. I thought I'd reach out and let you know you are missed, my friend, and though you left us 3 years ago, those memories remain vivid, and you remain close to heart.
We miss you.
 

Saturday, May 17, 2014

Key West!

So we are on out very first trip without both girls (the dogs are babysitting them)(kissing. Inlaws drove in for the weekend).
Anyway we took a trip to the Florida keys. It's a place I've always wanted to visit, though it was a bit of a drive (very scenic) from Miami. The Keys are a set of small islands off the Florida coast, connected by numerous crazy long bridges.
More when we return. For now:

Thursday, May 15, 2014

'Rejection'

Dear patient,
It might surprise you to know this, but for many of us doctors, there is a slight tinge of hurt when we are 'rejected'. You know, when you ask to seek a second opinion from someone else. When you choose to not follow our advise and choose to take your case elsewhere.
Certainly, as a consumer and as a person you are entitled to that. I'm sure I'm not the smartest physician out there; perhaps I just did not live up to your expectations. Or perhaps our personalities just didn't match. And though professionally I did what I felt was ethically and scientifically best, there is admittedly still that tinge of disappointment. So, I'm sorry that I could not:
  • Prescribe you a treatment for what the internet says is a hormonal disorder when you have 'too much' scrotal skin at the base of your penis
  • Write a letter to your landlord medically justifying why you needed to have 4 cats in your apartment to 'look after the diabetes' so that you would not pay the penalty
  • Start you on Testosterone replacement despite your total Testosterone levels being 800 ng/dL, because your gym trainer tells you you should be able to lift more weights than what you are doing
  • Give you a miracle pill for dramatically lose some of your 350 lbs, when you tell me you don't want to work out
  • Tell you why your phallus is shorter than that of your son who is 23 years younger than you
It really gives me no pleasure to disappoint a patient, especially one who was probably given misguided expectations of what an endocrinologist does. And the truth is, there really is a tinge of hurt, when as you check out you ask the receptionist to make an appointment to see one of my colleagues for a 2nd opinion for the above.