To Epi, or not to Epi, that is the Question?

*Disclaimer: This reflects my personal (not professional) opinion about peripartum pain control and is not meant to be a means of birth control, nor is it to generalize that all men are wimps like me*

Best friend and his wife expecting. Baby's due date in mid-March. So we were talking about labour, and delivery.

"Go for the epidural!" I say

But they had heard stories about epidural babies needing forceps and vacuum assistance and weren't sure.

Well, I'm not an obstetrician. The last time I delivered a baby was 4 years ago. But I've seen enough pain from labour that I swore years ago that I would never put my wife through that.

Case in mind. Young late-20 plus primigravid. Pain pain pain. Huff huff huff. Cuss cuss cuss. And then the anesthesiologist comes in. Starts the epidural. Several minutes later I asked her how she felt. Her answer?

"I'm fine, doctor. How are you doing?". Smiling. La-dee-da.

Night and day.

Maybe I'm just a wimp when it comes to pain. Women, time immemorial, have delivered with no more anesthesia than punching their husbands' faces while uttering, "Why on EARTH did I let you do this to ME???" But I just can't forget the look of pain those women had. Sweat. Tears. Screams. Even to the extent of being fecally incontinent (okay, okay, I admit, this may have been from sphincter incontinence from the pressure).

Shudder.

Funny thing was, my buddy's comment was, "Oh, CK (another doctor friend in our gang) said the same thing; that she should get an epidural. Is it that bad?"

Buddy, you have no idea. Get some flowers ready, man, for you're gonna owe your wife a big one.

Ran into one of my old patients the other day. I had looked after this lady with a congenital heart defect, with resultant pulmonary hypertension, in my internship cardiology rotation. That would have been August 2002. Her husband was a country singer, and they gave me a copy of his CD when she was discharged.

Then, over 2 years later, on one of my not-so-good days, I had dinner with friends at one of the restaurants in town. It was a tough day, with some sick patients who were not doing well. While waiting for our table, I noticed this familiar looking couple eyeing me.

Turns out, it was them. And they remembered me by name. She's doing relatively well now, back here just for a follow-up.

It's funny, how on days when you're feeling tired and discouraged, how the person upstairs surprises you with little things to keep you going.

That made my day.

And all of a sudden, I remembered why I love this job.

Home Sweet Home

Back at last. Big change in temperature, that's for sure. My poor family is jetlagged, and frozen. But I think they'll warm up nicely.
Uploaded my pictures to my online photo album; feel free to browse. Just no wisecracks.

Becca

Becca

Will be heading back soon.
This is Becca. My car for this month. A Chevy Malibu Maxx 3.5l V6. Pretty nice really, although the V6 was heavier on the gas. But, like her as I might, I miss Veronica (my Honda). Hope she's gonna start after sitting in the garage in the winter for a month.

This month has been interesting. But, I think it's time to head back.

4 Days to go...

Almost done here. Just month just flew by.
Will officially wrap up my month of elective in Arizona, and travel back to Minnesota for my next (cushy) rotation in outpatient medicine.
And the bonus to that, is that my family will be here for the month. My sis will be doing a research elective here, and with that my folks have decided to come long. Nice... seeing that the last time I saw them was in March of last year.
Still have my Christmas tree up, to let my sis experience a late 'white Christmas'. I suspect mom will convert that tree into a Chinese New Year tree (February).
Surprisingly, I'm actually looking forward to going back. This place was fun, but other than that, lacking. Friends. Familiarity. And I realize how pampered one can be having trained in the 2nd ranked hospital in the USA, and then coming to an underfinanced county hospital.
Well, 4 more days to work on my tan, before I return to the icebox.
By the way, am done with Tom Clancy's book. Took me a week, but the Bear and the Dragon was good; they should make this into a movie.

Grand Canyon 

Grand Canyon 

Grand Canyon National Park

Grand Canyon

Drove 4 hours to the Grand Canyon. That was one of the places I wanted to see before I die.
One word.
Amazing.
I was in awe. Speechless, humbled by the beauty and sheer size. Did hours of hiking and took a LOT of pictures. Didn't have the time to hike down to the Colorado river (would take 2 days) so I just walked around the south rim.
Went alone because my buddy LP who was supposed to fly in had his flight from Minnesota cancelled because of the snowstorm there. But the solitude was good for me.

Done the Grand Canyon thing. Next would be Paris.

Rounding.... and rounding.... and rounding

The day was painfully slow today.
Began my prerounds (speaking of which, have not prerounded since CCU in August. One of the perks of being a 'senior') at 645am. I saw all the patients today as my colleague was apparently at clinic.
Anyway, the day just dragged on. Firstly, my colleague turns up at 9am.
"Oh, I found out my clinic is tomorrow instead."
(Which means that I will have to preround on all the patients again, and that he had nothing to do today)
And then, for a manageable census of 7 patients today, rounds took forever. I wasn't too discreet in expressing my impatience.
And it wasn't that we were talking about our cases. My attending just liked to digress.
Spent 30 mins telling us about his research.
15 mins there talking about photography.
20 mins about how he used to bike until he hurt himself.

I don't think he saw my hints.

Attending: "Oh, and for my current research, we're doing a trial on a new antiretroviral... blah blah blah..."

Me: Fidget fidget fidget

Attending: "...where we hope to enrol X patients to try..."

Me: Shift foot. Scratch right butt cheek

Attending: "... and speaking of which, I had this crazy patient this one time who liked to tell me too much information about his sex life..."

Me: Glance at watch. Yawn.

Attending: "... who liked his farm animals a wee bit too much..."

(No, I made the last part up)

The day just dragged on. And on. And on. If I had a gun then, I would have gladly shot my right foot, just so I could interrupt him and say, Ooh, I'd love to hear more, but looky here, I had a freakin' bleedin' foot and need to stop that before I bleed to death.

Naturally, my colleague's at clinic (or so he said) tomorrow. Which means I'll have to wake up at 530am again. At least I get the weekend off.
Planning to go to the Grand Canyon with a buddy. And then, it's back to the icebox (Rochester) next weekend.

12 hours. I was at the hospital for 12 hours today, not bad by Rochester standards, but this being my HIV elective (supposedly a cushy month), I was surprised.

"It's cushy, I was home by 4pm most days."
That's what Tony had said. 4-5 patients, tops.

Yea right. Sh*t hit the fan today. Started with 9 patients and 2 new ones. Complicated. Stuff I had never seen before in Rochester.

Kaposi's Sarcoma. Disseminated histoplasmosis. Cryptococcal meningitis. Way over my head. CD4 counts of 14 in one patient (bad enough). And then I had another in the ICU with a CD4 of 1.

Still, it was a lot of good learning. And there was this *really* cute Caucasian medical student working there. Didn't mind working till 730pm.

About Letting Go...

Was talking to one of my online friends about letting go. Suddenly old memories about a special someone start coming back.
How does love and life work? Is one born with a soulmate that one if destined to spend the rest of his or her life with? One you end up with regardless of what you do and where you go, simply because fate has plans for you?
Or do we have many potential mates out there, and the decisions we make in life bring us to the one we finally end up with? (Gawd, I must have made bad decisions then! :))
Years ago, I made a conscious decision to complete what I had set out to do. Work, training, career. That was 4 years ago (I was in the midst of deciding if I should stay in Malaysia or leave for the United States for further training). And in the process, I had to say goodbye to a young lady with whom I was madly in love. I was told much later that she felt something too.
I finally let go, 3 years later. Realizing that the distance will never let anything happen. I had been sending her flowers on her birthdays, Christmas and Valentine's Days for the last 3 years(easy with the USD:RM conversion). But I suppose my chats with Paul tonight reminded me of her.
That brings a movie to mind.
Serendipity.
One of my favourite soppy movies (something I would never admit to in real life, but the internet gives me some anonymity!)
John Cusack, Kate Beckinsdale.
A movie about love, but more importantly, Fate.
Fate. Is there really such a thing? Do we go around in life led by what was already written?

Will I finally know for sure only on my deathbed? Everyone seems to ask that at the very end.
So, 2 schools of thought.

Oak Creek Canyon, Sedona

Sedona

Cathedral Mountain at Sedona

Made a day trip to Sedona, Arizona. Nice 2 hour drive to the place famous for the red mountains. It's about an hour from the Grand Canyon (planning to hit that place next weekened). Pretty enjoyable day. On the way back, bought a book to keep myself busy for tonight. Tom Clancy's latest.
I'd read Dan Brown's books, except I've gone through all of them.
Which reminds me. Does it occur to you that he's got a pretty stiff style of writing? I mean, it keeps you on the edge, but, you'll notice that his style is the same; he pushes the twist too hard near the end of the book. So, you kinda know near the beginning that the villain is really one of the good guys he meets early on.
I found this to be true in all his books, so much so that I knew at the start of Digital Fortress who the villain was gonna be.
Still, the Da Vinci Code was a great read.

Tsunami Aid

As I write this, the Tsunami Aid: A Concert of Hope telethon is being carried out live. Annie Lennox is now performing her song. Actors, including Brad Pitt, George Clooney, Annette Benning are manning the phone lines accepting donations. I've tried to call for the last 30 mins, but it's still busy.
One guy donated one million dollars USD. And school kids here are raising funds.
Perhaps I'm more emotional today, but seeing the scenes on TV, and the stories, brought tears to my eyes.
170,000 people dead so far.
This is a catastrophe of cataclysmic proportions. And yet, despite the death, despite the aid people locally and from afar are giving, terrorist bombs are killing innocents in Iraq. The Indonesian government is ungratefully telling the American troops providing support there that the sooner they leave the better. The imans there are threatening the Christian relief groups working there.
Does this make sense?
Is there no hope for humanity? Of not being white, black, Asian? Muslim or not? Can't we just exist together?

If you can find it in your heart to donate, please call 1-800-HELP NOW, or visit www.redcross.org

Natural selection

Just came back from a night out. S, one of my colleagues in neurology, took me out to a night out at a club in Phoenix. It was interesting, people watching. The few things I observed:
Like attracts like
Natural selection at work (let's keep it at that). I doubt Darwin had this in mind when he came up with his theories, but it's certainly well and alive today

Mind your manners

So, the Malaysian PM's wanting to instil us with good values, huh? In essence, I agree. For some reason, it's just not in our nature to be nice. We don't say hello and thank you as much. We are atrociously selfish on the roads. This is one of those things that make going home difficult; having to deal with rude, unfriendly people and inefficient service.
The cause? Probably multifactorial. Family? School? The wanting to be first mentality? Obsession with grades. Exam after exam. Wanting to have the tallest this or fastest that.
We need to grow. And not be so selfish.
The thing is, I'm expecting the government to come up with some totally stupid ideas. Some stupid campaign with a corny slogan and song (think of the RTM 'Suka IT' and 'A-E-D-E-S' songs from the recent years). Some simplistic approach, like force Moral studies into the curriculum, or increase our national anthem's tempo to reflect our nation's advance.
The people who run the country can be so shallow.

Saguaro cactus 

Saguaro National Park 

My car here... 

Saguaro National Park

Arizona 

Phew. Drove down to Tucson (2 hours away) and did 4 hours of hiking at the Saguaro National Park. Named after the saguaro cacti. Bloody tall. The landscape made me feel like I was in a roadrunner cartoon. But it was enjoyable.
Totally pooped now.

Can you spell 'BIOHAZARD'?

Had to do an incision & drainage of an abscess at the left armpit of a patient with HIV. That was a bit unnerving, especially after I had incised the abscess and the pus and blood started draining. I remember thinking, Man, do I have any open wounds on my fingers? Are the gloves intact?
Saw another bunch of patients, which got me thinking. I bet I could come up with a scoring system to predict if someone's gonna end up as a lost cause. Yea, the TK Criteria:

Being a parent before age of 20: 1 Point
Single parent: 1 Point
On antidepressants: 1 Point
Taking opioids: 1 Point
Smoker: 1 Point
Current history of fibromyalgia or irritable bowel: 1 Point Each
Family history of fibromyalgia or irritable bowel: 1 Point

Score:
<3>

3-4: High risk

>5 Points: Look for a social worker

I guess the question is, who IS in control on one's destiny? Is it our parents' fault, ours, or our environment when you end up doing drugs?
I felt bad when this one patient of mine (in his late 30's) came in with his parents because they were worried he wouldn't come to the clinic if they didn't force him. Aged, weakened parents, who should be enjoying their lives now. And yet, they have to still look after him.

Have been seeing a totally different side of medicine from what I'm used to.
18 year old girls, HIV positive and pregnant. Homeless elderly men with fullblown AIDS who can't afford housing. 27 year old men (younger than I am) with a CD4 count of 10. People who can't afford even acetaminophen.
It humbles you, and makes you feel blessed.
In the last 3 days I've seen more HIV patients than all of my 3 years in Rochester.

Phoenix!

Wow. This is a nice change. It's pretty warm here, warm enough to go out in shorts. They gave me a nice 2 bedroom apartment and a rental car. Work seems ok too; no calls, 9-5pm everyday, and I get Saturdays AND Sundays off. After cardiology, this will be a sweet month. Plan to drive to the Grand Canyon one of these days.

Happy New Year 2005!

Wow. 2005 already. Seems like just yesterday when we were counting down to the millenium new year. Now it's already half a decade gone.

Had a great day yesterday. After call, had a quick nap and then went to Vincent and Yvonne's. A surgeon couple from Singapore (he's a hand surgeon, she's training to be an opthalmologist). They exchanged their vows in a quiet ceremony at their home yesterday, and they asked me to be one of their witnesses.

Have been anxiously waiting to be someone's witness since one of my best friend's wedding in Malaysia. He has asked me to be a witness for their marriage. However, in our usual Malaysian warmth and logic, this fat Malay woman said that my long-sleeved collared T-shirt wasn't formal enough. I needed to wear a proper dress shirt. Hence one of our other friends had to stand in. What an idiot.

Anyway. Things went well yesterday. And the Juctice of Peace didn't comment anything about what I was wearing (shirt and jeans). And their union is now complete.

We had a nice BKT dinner there with some other people from home, and counted down into 2005.

It was also my last day in cardiology yesterday. Hate to imagine what those crazy transplant patients did last night. They were a merry lot, and were giving out party hats and party poppers to the doctors yesterday. Will be starting my away-rotation in Phoenix, Arizona on Monday.

Well. What did 2004 have in store with me?

• I'd finally learnt to trust myself to look after patients. Somehow, I guess I have become a pretty competent physician
• I learnt that sometimes, you just have to let go. And life does get better when you do
• I learnt that sometimes one shouldn't try too hard

I'm expecting a lot from this year too. This is the year I complete my specialization in internal medicine and move into endocrinology proper. And I'm expecting to say a lot of good byes when my classmates leave for fellowship elsewhere.