Mom/Dad

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Read the Star Education today.

They did some creative editing, but otherwise most of my article came out intact.

Had the itch to contribute something to the Star. Also partially, wanted to smack some sense into kids before they jumped blindly into medicine without knowing what to expect. Have seen too many rich, spoilt kids at the Immediate Moneymaking Uni. who think life is a catwalk and promptly crash and burn when they enter the real world. Which is unfortunate, because in the process they've spent enough of their parents' moo-lah to buy a car, and also take up precious PMS spots from other deserving students. And some become so disillusioned that they never practice medicine even if they graduate.

Anyway, sent an entry from my diary from 2 years ago. Looking back, interesting how much I've grown since then (from my estimate, at least 4 inches at the waist).

Within a day, an email:

"got it, thanks. cld u send some digital photos with yr story? ideally pix of life as medic student."

So I sent some pictures for them to pick. Told them medical school days are years behind me; can't find much. Was hoping they'd pick a nice one, perhaps one of Veronica.

And then:

"yr article will be out this sunday in the education section. thanks for pix. pls give me full name, ic no and address if u wld like to be paid for the article. RM150 to RM200 depending on length. thanks."

I get paid??? Woo hoo! Need to start working on my next article. Life as a student huh?

"How it feels to have your boogers freeze in winter: My life as a Canadian student"

"My days as a mostly drunken but sometimes sober undergraduate"

But seriously. I think it's good that there are now private medical schools in Malaysia that provide an alternative route for people who are, ahem, racially challenged, to get into medicine (although it's NOT good that they have to fork out RM600 for the registration forms and 'processing' fees).

Therein lies a a problem as well. When something becomes more accessible, it somestimes attracts the wrong population of students.

• Wrong motives for wanting that MD/MBBS/MBChB behind their names (Reasons: mom/dad wanted kid to be a doctor. Or someone offers a medical scholarship to a student who isn't really interested in medicine)
• Overly glorified impressions of doctors (hey, I mean, how glorified do you think I feel being awake at 2am, disimpacting a 87-year old man's rectum full of rock-hard stools?? If you have to powder your nose every hour, and are constantly afraid of scratching a manicure, then you're in for some surprise. Dry, hard poopie can do serious nail damage).
• Wrong personalities (controversial one, this one. Some would say certain specialties do not require a personality; path or surgical. My humble opinion: you still need to be human. Personality's important)

I may be way off base here, and I hope I didn't offend anyone here (my sis tells me some of her medic friends visit my blog. And shh, some of them scare me)... but I say this from my year's worth of teaching in Malaysia, and 3 years' of teaching starry-eyed med students here, as well as having been a student myself. The fact is, it doesn't really matter what one does in life as long as that person is content. One doesn't need go into medicine or law just cos someone made the grades. And no, contrary to public belief being a doc doesn't make girls line up at your door. But our Malaysian thinking seems to be flawed: "Aiya, what a waste, your daughter got 5As, decide to go into teaching."

How often have we heard that one. Why is it a waste?

Go do something you like. For the reasons you like. And if you're silly enough to be like me, then know what you're getting yourself into. But for gawd's sake, go TRIM YOUR NAILS. Not pleasant to perf your glove while disimpacting. And that's just from the doctor's standpoint. What about the person at the receiving end?

That's why, I recommend the book, The House of God to would-be medics. My sis tells me her friends from Malaysia have trouble finding this one. It's by Samuel Shem. R. Marek Publishers (08/01/1978) ISBN: 0399900233. Hopefully that helps.

Honeymoon's Over

Honeymoon's over.
Sigh.
2 months of call-free nights. Just wheezed by. That sweet, sweet month in Arizona, and that slow outpatient urgent care month.
Gosh, I get lazy just thinking about it. Back to inpatient medicine. I begin my General Medicine Senior rotation tomorrow. Which means I'll be setting my alarm for 530am.
Oh well, I suppose it's time to get back to real work... I was getting bored of seeing the usual coughs/colds/knee pain etc at clinic.

"Dr, I've been pooping watery brown-green stuff"

"Doc, I have trouble peeing."

"Doc, my throat hurts."

"My toe is swollen"

Peeked at my team's list of patients... COPD exacerbation, CHF, renal failure. More interesting.
My first Gen Med call is Monday. So that means I'll probably come home Tuesday grumpy :)

The Modified Serenity Prayer

Thought this was funny.

God, grant me the serenity to accept the things I cannot change, change things I cannot accept, and the wisdom to hide the bodies.

Also found this site with some good (albeit not entirely PC ) jokes. I take no responsibility for the contents there :)

Had another run-in with my infamous colleague. She told some lies about me to other people, and this came back to me only because a mutual friend thought it was strange that I would indeed say such things, and came back to clarify. Sigh. Why can't some people just cut the drama? The thing is, I've seen her 'stretch the truth' so many times that it just sickens me that she seemingly gets away with it. I suppose at the end of the day we have to face ourselves in the mirror. And our Karma.

On another note, saw a patient earlier today, who was diagnosed with type 2 diabetes mellitus some years ago. He's basically a vasculopath; history of AMI requiring PTCA (percutaneous transluminal coronary angiography) with stenting of his proximal and distal RCA. Hyperlipidemia. Still smokes 2 packs a day. And he's wondering why he had his heart attack in the first place. Dude!

So, to make things simple, I'm coming up with my list to give to patients.

How to tell if you're gonna die from a heart attack before 55

• The amount of money you've spent on cigarettes in the last 10 years could buy you a car
• Your basic food groups are: KFC, McDonald's, Burger King and Marlboro
• Your idea of salad are those two slices of tomato in your Big Mac
• If you get stabbed, you bleed fat
• The last time you saw your feet was 10 years ago. And no, you didn't lose them in the Gulf War
• Your lawyer is preparing to sue KFC on your behalf for getting you fat
• Your childhood superhero is the Michelin Man
• Exercise is walking to the refrigerator for a Coke
• STRENOUS exercise is walking to the refrigerator for a Coke, and THEN reaching into the freezer for that ice-cream
• You think a BMI (Body Mass Index) of 40 is normal

Snow!

Big dump of snow today. Over 10" of nice, wet snow. Those guys don't know what they're missing in NYC.

Migraine

Characterized by an episodic, usually unilateral dull, throbbing headache lasting hours to days. Can be precipitated by chocolates, alcohol, and lack of sleep. Other symptoms include phonophobia, photophobia, nausea.

I know that condition well. Lifelong migraine sufferer, my mom and sis have that too. But last night.... dooooh. Dropped family off at the MSP airport (on their way to a nice weekend getaway to NYC, and dumping their prodigal son/brother in Boringsville). My classmates and buddies Tony and Bryan thought that would work out well as they were planning to go to Minneapolis for dinner. Met them, and Michele, Bryan's wife at this hip fusion restaurant that I like (Chino Latino's) on Hennepin. Modern deco with a Bohemian touch. Beautiful people (hey, it was Friday night after all). Haven't had good experiences with fusion restaurants, but this place does a good job. Had some good sushi, a curry dish. And 2 drinks; Heineken and a Bombay. And this led to the MOM.

The MOM, the Mother of all Migraines, is something I experience perhaps once a year. Much, much worse than the regular migraines I get every 2-3 weeks, this one starts as the regular dull throbbing pain but quickly degenerates to a severe steady retroorbital pain that makes you wanna just scoop your eye out just so you can get to the (perceived) source of the pain. And the loud music wasn't making things any better.

In the end, after a nice meal with good company I had to call it a night. They had gotten a hotel room in the city and were planning to spend the night there. Had to excuse myself and cut the night short. Tony and Bryan were planning to hit a pub or strip club (with his pregnant wife's blessings.... these crazy Americans!) and were trying to get me to go. But I knew what would happen if I did. I would cross the TOP (Threshold of Puking) and it would not be from alcohol.

Started driving down to Rochester, thinking that driving isn't really a strenous activity, therefore it shouldn't worsen the headache. But boy, was I wrong. I failed to realize how much concentration driving took. And I forgot how irritatingly bright the other carlights would be. Wanted to pull over and find some cheesy motel to spend the night, but my migraine pills were at home.

5 mins away from home, I started dry heaving. Finally got home and prayed to the porcelain God. Puke puke puke bleeh. And the worse thing is, with retching, it increases intracranial pressure, worsening the migraine. There went an expensive $56 dinner.

At least now, hours later, it's gone.

Food For Thought

Why do we expect perfection in medicine?

Is it because we realize that every single mistake one makes can potentially impact a patient in a big way?

But are physicians and surgeons not human beings?

Think about it, in another field, mistakes while frowned upon, are forgiven. Think about it. In the last one week, how often have you made a mistake at work, whether you're talking about miscalculating numbers, or remembering details of a meeting wrongly, or just not realizing you had made some typos on a report?

This came to mind when colleagues and I were discussing a recent case at lunch hour where an ER physician and the hospital were being sued for not recognizing that a child's multiple longbone fractures were in fact the result of child abuse. I mean, sure, it should have rang some alarm bells in his/her head, but Hey, the doc didn't abuse the kid. It's not like he was deliberately negligent (an oxymoron, if there ever was one).

This topic came up too on a busy day for me, having had perhaps too few hours of sleep last night working on my paper for that upcoming conference. Went to work sleepy despite that 750ml Starbucks coffee I carry to work everyday. Felt like my head wasn't screwed on right. At the start of the day, did some practice test questions with classmates (we're all taking the internal medicine boards in August) and made some silly mistakes. Which stupidly enough, really irritated me for the rest of the day. And then, had some demanding patients in the morning who rushed me, resulting in my forgetting to write one of them a prescription for a medication besides his other 7 meds (as it turns out, it was for Sildenafil, otherwise known as Viagra). Had to phone him at home and tell him that I'd send the script to him. But that made me feel like a total moron.

So, why does the practice of medicine forbid mistakes? On one hand, it's obvious: lives can be at stake. But on the other hand, we're just human, not some superbeing.

Guess my clinic colleagues had a busy day too so this led to that topic at lunch.

As expected, my brother in Malaysia is telling me that the Ministry of Health will take their time with the papers I'm so urgently needing. Great.

At least on the bright side, something good happened. Got word that a paper of mine has been accepted for a conference in Washington next month. So that'll mean that I get to take a few days off and with free food, lodgings and flight. Will be talking about marantic endocarditis.

That should be a nice breather from the busy General Medicine Senior month I'm expecting for March.

Due to its extreme whininess, my previous entry has been removed. For those who sent me notes of encouragement, thanks.

"The soldier is weary, but his will remains strong. The battle goes on."

Happy Valentine's Day!

Well, okay. Technically it's still Sunday night, so it's not V-day yet. But it's Valentine's day in Malaysia now. Discovered this survey website last week when I was putting together a medical survey for a Quality Improvement Project for work. Pretty cool/cute thing... so, since it's Valentine's day, decided to put on together for this occassion too, if nothing else, for me to learn what one shouldn't do! Check it out.

Happy Valentine's day everyone (Psst, Paul, will be rooting for you...).

Angpow mari... 

Like the chili apron? Got that from Rachel last year. It's gotta be bad when a girl gives a guy an apron huh? Then again, she knows I love cooking.

(Mom's telling me what I was doing wrong, as usual)

Had a proper CNY dinner last night. Had a small group of friends, Asians, most from Sinpapore and Malaysia, over for dinner. Quite a number of no-shows, which is something that perpetually irritates me when my classmates here say one thing but do another. Poor mom, spent hours in the kitchen (we helped too)... made over 60 spring rolls, and at the end of the night, we had a lot left over.

Never mind though... we all had fun. Had a few rounds of Halo 2 (us 4 here, with Quan online in Texas). Got creamed proper.

What more could one ask for, huh? Good food in the company of loved ones and good friends. Nick's getting married this August (he's engaged for me to be his wedding dinner waiter, or so he says) so this will be his last chance to actually receive red packets instead of giving them.

After most had adjourned, my friend LP stayed on and we chatted, till 2am. About life, about work and where our careers are headed. About love. He gave me his two-cents worth on the girl I finally decided to let go. Talked about the year we spent teaching clinical medicine in Malaysia, and about the medical students we thought had crushes on the two of us! Talked about the good old times, life in medical school, people who had come and left their marks, and then went along in their own way.

Bad news

Received some bad news today.

One of my classmates, Mike, and his wife lost their baby yesterday. She was in her late third trimester with their first baby, when she felt the baby stop moving. An ultrasound provided the grave diagnosis. Last I heard, they induced her.

Sigh. Tragic. Beautiful couple. I'm not particularly close to Mike, but they've had a lot of battles. She was involved in a major motor vehicle accident 2 years ago, and had to be flown in to the hospital. She had significant closed-head trauma and recuperating took a long time. I had visited her in the neuro ICU and then the rehab unit, and I teared up when I saw her that day, intubated. I'd seen hundreds of patients intubated, with an ET tube going into their mouths, pumping air and inflating their lungs for them. But when it's a face you recognize... it hits you like a bomb. She fought hard, and with Mike's undying love and devotion, they pulled through and recovered.

Everyone was ecstatic when she got pregnant. But this news must be devastating to them. Being doctors, one would think that we would be able to handle these things well. But sometimes things just hit a bit too close to home. With another 2 classmates expecting, this would affect us all at a very personal level.

And then, I just heard from another friend, that he and his wife of just 3 years are separating. How long, he didn't know. Took each other for granted, that's what he says.

"The separation will do us some good."

I had to nod and give my support. But does a period of separation ever do anyone any good? Maybe I'm just being too idealistic and unrealistic, but heck, if you're having problems and you KNOW you're taking someone for granted (I know the couple well and that's probably true on his part) then dammit, you married her, for better or worse, so you better darn well not give up, but fight. Fight to the end. Because if love is not worth fighting for, then what is? Money? Paper degrees? Material wealth? That's all b*llshit. Love, love is what gives life meaning. You commit to someone, and you never back out. Never.

Not a good way to start the new year. But life goes on. And as I type now, I hear the airlift helicopter landing at the hospital. Someone's very sick and dying. But life goes on.

My prayers will be with Mike and Ana. I hope yours will be too, whoever who's reading this.

Happy Chinese New Year

My first Chinese New Year in years. The last time I celebrated was years ago, when I was still back in Malaysia. Haven't had the chance to celebrate much here; we don't get holidays for CNY, and in a small town like this, one doesn't really feel the CNY mood. Although I did make a feeble attempt at getting some people over to watch a Chinese movie last year (ahem. The type you buy from the pasar malam); but as it turned out, people just wanted to snack and chat. Merlot sounded better than Wong Fei Hung.

Having family here is swell; mom made a great CNY feast. Had some friends over, a Singaporean cardiologist and family, and a cardiac surgeon from Malaysia. Think everyone had fun. They were even able to make an improvised 'Yee Sang' dish. Brought tears to my eyes... sniff sniff... I missed that dish.

Some other things I miss about Chinese New Year. The acrid smell of fireworks. The food. The loud reports of the 'Moon travellers' my brothers and I used to shoot at our neighbours (these days though, this has been replaced by the big guns; Thunderclap, a huge honking rocket probably capable of shooting down the moon). The food. The smell of the Chinese temple I used to go to early in the morning on the first day of CNY. The food. My late grandpa. The food. The anxious anticipation of guests when we had out 'open house' (well, ok, I was always hoping to see my first love, Elaine. See earlier blog).

Time flies when you're having fun huh?

To put things in perspective; I started medical school 9 years ago. Graduated 4 years ago. By the time I'm really done, it would have been 12 years after starting medical school. Scary huh?

Now things have changed. Instead of just elders, I'm starting to get red packets from my own friends (digression for those not familiar with our Chinese traditions: Red packets containing $$ are given at CNY by those who are married to single people, usually kids). And my relatives are beginning to grumble at when they might be able to stop giving me red packets (pretty clear hint. I think people are starting to worry). Hey, it's just one of the perks of being single, I say. And I'll take mine in US dollars, thank you very much!

209 Visitors

That's what my sitemeter reads.
Since Jan 28th.
209?? Who are you people?
Don't think I even know 200 people. I mean, my groups of friends in childhood were mainly imaginary friends. You can imagine, playing on the see-saw wasn't much fun.
Didn't exactly start off expecting company (was more of a venting outlet).
But it gets me wondering though, who might be checking my blog out. Well. Feel free to browse and leave your comments.
Just don't hold me responsible for any habits you might pick up from here. Whining's a bad habit to break.

Just rented the movie 'Shall We Dance?'. The english version. Loved it. Some have told me the Japanese version is better. Well, haven't seen that one yet, but I thought this was a pretty enjoyable feel-good movie. And the dancing was just spectacular. Good enough to make my mom and dad dance in my living room. Really. Maybe it was the codeine in the cough medicine that made them do it (Dad's recovering from a case of viral bronchitis).

Chicago (again)

Made another weekend trip to Chicago. This time, took my family there (their first time).

My tush was close to developing a pressure sore by the time we arrived; 5 1/2 hour journey. Naturally, I drove after having been at work the whole day, while mom, dad and sis slept. Had Helen, one of my neuro friends, company to keep me awake (and driving under the 65 mph speed limit). Didn't help that my sis called me, frantic, at 11am with a crisis, while I was in the midst of seeing a patient (but that's a different story).

Chicago. One of my favourite cities in the USA to visit. 3rd largest in the country, 8 million people in the city itself, or so I was told. The grand Lake Michigan, so large that you can't see the end. I interviewed there for both residency and fellowship, but it's probably a blessing that I will stay here for another 3 years; I don't think I could afford living there.

Anyway. Late now, and I will be presenting at senior morning report tomorrow, so I'll upload the pictures later.

Valentine's Day

February 14th.

Sometimes I wonder if this day was created by the greeting card and flower industries, what with how overly commercialized things have become.

Hallmark AGM, 1200 A.D:

"Business down. We need to do something to boost sales."

"I know, why don't we take advantage of man's perpetual neglect of woman, and create a day that will instill so much guilt in him to make him buy her cards, flowers and mountain-goat droppings wrapped in sweet syrup?" (Dear readers: real chocolates had not yet been invented)

Not that I have anything against presents, flowers and chocolates. After all, I've been known to pamper people who mean something to me with these. But my thinking is, if that someone's special enough, why show her/him only on that particular day?

Also, there's got to be something wrong with the system when one starts expecting presents and flowers (which on that day, can cost RM10 per rose. Something I discovered to my utter horror in Form 5)

My favourite picks? Probably not very creative or original:

A dozen roses. Champagne or peach-coloured

Chocolate-dipped strawberries

A nice dinner, with nice wine (Riesling, probably)

New month

Wow. And I thought last month was cushy. Outpatient clinics throughout; and 2 of my patients were no-shows. So, I was at work from 8am till 1130am. Could have come home then, but I had a lot of paperwork and patient correspondence I had to do from my month away. So hung around doing stuff.

Also trying to complete my manuscript and hopefully get it published soon; have been futzing around with that darn paper on CNS lymphoma for months, with another paper on diabetic mastopathy (539 charts to review) in progress. Hopefully, I'll get this work done.

My sis started her research elective today. Complained about the number of papers to read. Heh heh heh. Wait till she finds out that the reading NEVER stops. So much for a career as a doctor.