To shake or not?

Hmm. Okay, here's a purely hypothetical situation. Just for the heck of it. Any resemblance to living persons is purely coincidental.

So let's assume one's at, say 1 Utama. And you go to the washroom to take a leak. As you go in, you see a highschool lecturer of yours from St. Paul's, who had just done his business at the urinal and was walking out. There's immediate recognition, and so he extends his hand out to shake yours.

Except you had seen that he was just done at the urinal, and he hadn't washed his hands!

So, question is, should one return the gesture and shake his hand?

I read somewhere that up to two thirds of men don't wash up.

Eww.

Anniversary

Mom and dad's 32nd wedding anniversary. Wow. 32. Had wonderful time at dinner, with family and some very close friends, good food, a lot of cabernet and scotch whisky.

Gave them a personalized calendar that I had printed in the US before I came back. 18-months, each with a picture of mom/dad.

What was funny though, was how they sneakily 'invited' friends over, and asked them to bring their single pharmacist daughter over (I think their friends were worried too). I found out only because dad, kinda like me, has trouble keeping secrets, and told me the other day they were organizing a 'surprise' for me at dinner. Sounded ominous, almost like when your wife tells you she has quadruplets. So I dug, and I found out.

Nice lady, but there was no chemistry I suppose.

Chemistry huh? That unpredictable, intangible connection between two people. When, for reasons unclear, you click. You just click, and boy, do you click. Wham. And you talk about anything and everything that you just don't want the day to end. Thing is, I don't think you can ever predict who would and who wouldn't. It's not just personality, and even then, it's not like you can predict if similar personalities get along, or if opposites do.

So while I appreciate mom/dad's efforts (and I'm still very amused), I told them not to worry. Things have their time and place.

Without going into detail (and don't ask) I think some people are really suckers for punishment. Perhaps some enjoy torturing themselves (the masochist), like the attention and to show off (the narcissist), or simply, don't know any better (the idiot).
I think I belong in the 3rd group.

On another note, I got an email from a patient of mine. Not really MY patient, someone I saw for another doctor in acute care. Saw her for something 2 weeks ago. And now she's emailing me with a list of other complaints/symptoms and requesting I respond. She works at the same hospital as I do, and therefore am able to obtain my email easily. This, with my out-of-office note that I would be out of country till early June.

I'm miffed. Mainly by how inconsiderate some people can be. I am after all on vacation. What, do people expect physicians to be at their mercy, 24/7 with no holidays? And she has her own doctor anyway. And I saw her for a totally different complaint, and do not really fancy e-diagnosing someone on the basis of emails.

Wow. Hung out at the local pasar malam (night-market) yesterday. Things have changed. You know your hometown's grown when:

• Besides the usual bootleg CDs, they sell DVDs too (USD 4-6 each)
• Masago rolls and other sushi joined the ranks of the popiahs and karipaps (I swear, there was sushi there)(although I think you need to have a death wish to try one at a pasar malam)
• You see vendors with laptop computers and printers there. I think this guy was selling personalized stickers, or something?
• The mar-kiok is selling at RM0.50 each (I think they were 20 cents each when I was in highschool)

As usual, I had my fill of things. Ahem...

The Hunk!

That's it. I met my match. Someone who easily topped my good looks and charm (ahem... at least lemme fantasize ok? This is my blog, dammit..)

Meet Alex. My 8 month old nephew, whom I met for the very first time this trip. A really happy babe... I don't remember seeing many babies who smiled so much. Then again, in my line of work, I don't see anyone younger than 18 years and the last time I looked after a pediatric patient was pre-2001.

This was a weird experience, so say the least. It was like, suddenly it's clear what's important in life. Things like this. Family.

Man... you know it's bad when this comes from a guy, but seeing him made me wanna have my own kid.

Home (at last)

Home sweet home. That sticky muggy feeling despite having just had a shower. It's nice to be back.
The flight was painful. For some reason, more painful than usual. Departed Rochester Saturday 21st, local time 1250pm central time. Arrived KLIA Monday 23rd 1am central time. That kinda tells you something. What with the 5 hour transits in MSP, LAX. Ugh.
I was hoping that 10mg of zolpidem would help. And it did, but the problem was I had the aisle sit, and this youngish guy at window had a bladder the size of a peanut; he kept going to the lavatory every 30 minutes or so, until I actually asked him if he was ok (diabetic, perhaps? Or maybe just too much to drink?). We finally traded seats.
The 2nd problem was that I had 3 hyperactive kids in the row behind me. They each probably had a gallon of Mountain Dew and 10 sugar cubes each for breakfast. Were just talking, laughing, screaming loudly.
"Mommy, we're flying!" Thought this was cute, until he said it the 1587th time.
The other one, had this uncanny sense of patriotism at 38,000 feet: "I pledge allegiance, to the flag of the United States of America..."
Almost made me want to stand up and salute.
But, long as it was, I got back in one piece. Albeit a 1 1/2 hour delay. Went immediately for food!
My jetlag kicked in early in the evening and I crash. Which explains why I'm wide awake now at 530am.

Home!

All set to go; my first flight departs in a couple of hours.

Anyway. Long long flight, while I'm not looking forward to the journey, the food at the other end will be my reward (and before my family kills me: Oklar, will be great to see family again too).

*Please please please give me a free upgrade to business class....*

Vagus, signing off. My next entry will be from half a world away,,,

Revenge of the Sith

Omigod. Omigod omigod.
That was beautiful. So very beautiful. Sniff sniff

Star Wars III: Revenge of the Sith

George Lucas is a bloody genius. Genius.

Ok, so maybe I went with too low an expectation. And maybe, being a Star Wars freako I'm being too generous with my comments. But overall, it was a great show. Can see why they rated this PG13; the gore surprising though.

CC was right on when she thought I had a big grin on my face throughout. Here are my thoughts in general, without revealing the plot:

• Great Star Wars show... my favourite of the 3 mainly because of the way the story connected. But some may say the action is better in Episode II
• Perhaps they tried a bit too hard with the jokes/corny comments (ie wisecracks from the droids)
• Anakin kinda switched sides a wee bit too easily. Too 'slutty', not really in keeping with his character

Show was great, mainly because it formed the perfect bridge between Episode II and IV (A New Hope). And this is where Lucas' genius comes in. Just look for the subtleties:

• How the battle cruisers here look similar to the Imperial Cruisers in Episode IV
• The clones, obviously, you can tell will evolve into the stormtroopers
• The 'fathers' of the tie fighter, X-wing fighter and even the Imperial shuttle
• You find out why Leia's last name was Organa
• The emperor in Episode III looks like the emperor in Episode VI. Duuh, right? But this blew me away: Lucas used the same guy (Ian McDiarmid) who acted as the Emperor in Episode VI to play the role of Senator Palpatine (now, I don't consider this giving away the plot; if you didn't even know that Palpatine becomes the Emperor, you obviously never watch the movies. So you won't mind) as well as the Emperor now, almost 20 years later! Same guy! Except he looked OLDER in a movie made 15 years ago!
• Look closely at the folks baby Luke Skywalker ends up with in this movie; they look very much like his uncle and aunt on Tatooine in Episode IV! Either Lucas used the same actors now and made them look much younger, or he used someone who looked like them. But they do, you can totally tell! (ok, I admit I'm a geek and that most normal people wouldn't notice these things)

Granted. My expectations are low. And I'm easily satisfied. But, this was a great movie. And the cycle is complete. This would transition very smoothly into Episode IV. Tonight, I will sleep a happy man.

Aww, what the heck. Might as well tell you the plot. Anakin is the not the real father. It was C3PO! And Yoda and Obi-Wan get involved romantically. And Palpatine develops prostatic hyperplasia and had to go for TURP surgery (the poor thing).

Tahan, Tahan...

Mind doesn't seem to be on work today. For some reason.

TK: So, what seems to be the problem today?
Patient: I have a bad cough, and I ache all over.
TK: What? You are Luke Skywalker??
Patient: No, no! I ache all over.
TK: Oh, sorry.
I think you're sick becoz you're looking at the Dark Side of the Force. You need to use the Force. Use the Force, Luke.
Patient: What the $%&*?? Are you alright, doctor?
TK: No, I am your father.
Patient: That's it, you're crazy. I'm getting out of here.

Doctor starts playing with stethoscope.

Sigh. Logic prevailed in the end; was tempted to catch the 1215am show tonight in order to beat the crowd (oklar, my kiasu-ism kicked in too, can gloat to my Malaysian friends that I saw it first). The show would be 2 1/2 hours long. I'd be back home and in bed by 3am. Adrenaline would keep me up till 4.

Problem is, my first patient tomorrow comes in at 8am.

I'll wait. Wait.

I hear the show sucked big time (self-consolation and denial at work). I'll catch it later when the gang's ready.

Hmm, I wonder if they're gonna censor the show in Malaysia (after all, Lucas did say it's PG-13 rated here)

I'm an addict

I'm an addict.

No point pretending now.

I worship the ground caffeine spills on.

It's a rarity to meet someone in medicine who's not a caffeine junkie. Me, I picked this bad habit up (bad for the bladder) in medical school during my surgical rotation. Was waking up at 4am everyday. At that time, I was up to 6 mugs of coffee a day. When I completed my surgical exams, I stopped, and promptly developed a caffeine withdrawal headache.

Now, I've cut down. I have my first mug at home (see my Ikea french press, my little pot of Go-Juice) before I leave for work. 2nd mug (Starbucks) while I'm doing my morning rounds in the hospital. 3rd usually at lunch. And sometimes a milder cup of tea at night (Boh Tea, no less).

Although I drink Starbucks at work like a fish drinks water, everything else being equal, I think I'd much prefer sitting at the kopitiam in a Pagoda T-shirt and shorts, slurping coffee not from the cup but from the saucer. The coffee they serve is so strong that you could float a spoon on it. Would work better than ten milligrams of epinephrine during a code. And let's not forget that inch of condensed milk they add in (that would be job security for an endocrinologist).

And the ambience:

"Oi, loti kaya dan milo-ping"

"Aiyar, gua eh kia nah bi kok cho ee-seng"

Krrr-aaa-akk (sound of Ah Pek clearing throat)-ptooooeey (you know what comes next)

Hah hah hah, sound like a real Ah-Pek don't I? Oh yes, to complete the picture, sitting on the wooden stool with one leg on the seat.

I imagine that was how my late Ah-Kong and his pals used to do it.

Why you shouldn't live with bachelors

Did an inventory of stuff I had in my kitchen closet. Pastes/spices from home.

WTF??!?

Some of them years old. Uh-oh. Which led to this conversation with my housemate:

TK: "Wei, wanna eat 6-month-expired food for dinner or 7-month?" (Ayam kurma or ketupat with satay sauce?)

TS: "Aiyeh anything lar. Hungry lar."

TK: "7-month it is, then."

12 hours later we're still ok. I guess what they say is true; Malaysians have the strongest stomachs and can eat anything.

She is a beautiful lady

This short story was taken from the medical journal Annals of Internal Medicine (Battar SS, Ann Intern Med. 2005;142:304). It's a true story written by Sara Battar, M.D., and happens to be one of the more touching stories I've read in a while.

About a patient with dementia, and how he reacts to his wife's death.

I've never been much of a sucker for medical journals. I suppose I should be more like some of my 'hardcore' colleagues who read these bimonthly journals religiously who are able to regurgitate studies that were published in them. This story stood out from all those case reports, randomized double-blinded case-controlled studies.

Not really sure what my point is, or if I do have one.

Perhaps, in the pursuit of academic advancement and professional growth, we sometimes lose touch with humanity. Forget what makes us human first and healers second.

I vividly recall this semi-argument I had with a physician senior. Brilliant person who will be heading to NYC for a coveted cardiology fellowship, who (in my humble opinion) lacked compassion. He said that it was wrong and unethical to having one's patients become friends. And that it was wrong to even have a meal with them. I suppose I can see how some people find this a hot topic. For me though, it's only natural that after caring for someone for years, you get to know someone more than as a constellation of diseases and medications. You are thrilled when you hear they have a new grandson, or are celebrating their 50th anniversary.

More recently, I had my exit interview with my program director. Something the SMuRfs do before we complete our training. Dr. K asked me, "What do you consider to be your greatest achievement?"

I think my answer surprised and stupefied him. I think he was expecting the WFMC usual: research, this award, that award, blah-blah.

My answer: "Forging good friendships and knowing I made a difference."

The truth is, I don't really consider my degree or publications or certificates symbolic of my achievements. No, I keep my treasures in a shoebox in my bedroom. That's where I keep cards and letters from patients and friends. And that's why I remind myself I love this job.

New Orleans

Interesting. Bordering of being bizarre. That's probably how I'd describe this place. Spent 4 days there with a friend, Karen, from KL.
Very warm and humid, almost like Malaysia. The food is great. But we hung around the famous part of town; the French District and Bourbon St. It was just interesting... a lot of college students or retirees holidaying (I think tourism is a big source of revenue here), all boozed up and dancing, laughing on the streets. The architecture was different, balconies on every restaurant or bar that faces the street. People were up there, just throwing beads out to the people in the streets. People flashing their tops. Strip clubs.
I felt dirty just walking on the streets.
But, coming from Minnesota, it was an eye-opener. This was an interesting place to visit, but I wouldn't want to live here for too long (no offence to any Louisiana readers). Also the seafood is to die for.
Overall this trip has been fun. And the presentation went well too, am thrilled that my paper was published in the Journal of General Internal Medicine, so that was a nice bonus.
Also, got to meet with a highschool friend who's based in New Orleans. Heard he was here, so I emailed him and we were able to meet up.

Street vendors, selling their art or talent (palm reading and tarot cards).

One of the many jazz bands in New Orleans. This was at the Market Cafe during dinner.

Alligator meat! Kinda tasted like chicken (isn't it funny how everything tastes like chicken?) but the consistency of sotong.

French dougnuts, Beignets (Bay-ee-neah). At Cafe du monde in the French Quarter. To die for, really. Notice that thick layer of sugar?

Karen and I at Bourbon Street. Ahem, evening entertainment. (No, we didn't go in. Note the beads)


Jackson Square, New Orleans. Horse-drawn carriage rides were popular.

The infamous Bourbon Street, New Orleans.

$425 for a WHAT??

Without going into too much detail, I'd like to know what people think.
Can one ever justify paying RM 1627 (or US $425) for one handbag?

Leave your comments. I want to know if I'm normal.

Enjoying a lazy weekend. While reading the obituaries (bad habit of mine, I've been told many of my colleagues share this morbid habit, looking out for names of our patients) I came upon a familiar name.

Patient I admitted to the ICU 2 weeks ago. Elderly gentleman from a nursing home, with severe dementia, admitted for COPD exacerbation and a NSTEMI. He was DNR/DNI but his family allowed us to use BiPAP (Bilevel Positive Airway Pressure) ventilation.

Although he was in some trouble, he was pleasantly demented and made no complaints. My daily "How are you feeling?" was always followed by his "Puuuurrtty good."

Pretty low maintenance guy; other than the fact that he needed the BiPAP to breathe.

He passed away a few days ago, why I don't know (I left the ICU a week ago).

Anyway.

Read his obit in the papers. Things you don't find out about a person as his doctor. This guy was a prisoner of war in World War II. And he got a couple of purple hearts. He had 3 kids. Wife still alive. Last living sibling from a family of 4.

From our perspective, we don't see all that. As doctors, it's always about past medical history, medications, allergies etc. And when we see the patients in the ICU it's always about blood pressure, pulses, oxygen saturation.

Well, wherever he is right now, I hope he's found peace. Me, I'm going to remember Mr. R a bit differently; with newfound awe and respect.

"How are you feeling?"

"Puuuuuurrtty good!"

Spring has sprung (finally)

It was such a nice day. Was so motivated that I overdid things this weekend. Washed and waxed my car. Did some gardening; figured it's about time I did something to that plot of earth in my backyard. Pansies and sunflowers. We'll see if they really sprout. Days like this, I love this place.

Things I'm Looking Forward To

Yesterday was great day. Warm, 17C. Washed my car, and was so motivated that I dug up the old flower bed (plant to do some gardening this year) and fired up the barbeque pit (first BBQ of the year. Just some burgers, beer and my housemates).
Looking forward to a few things now:

Warmer days, so that I can go canoeing again
Biking on the Root River Trail near Lanesboro (perhaps next weekend will be warm enough)
Going to New Orleans for a... emm... 'conference'
Flying home to Malaysia in 15 days (woo hoo!). Finally get to see my new nephew. And old friends (including Mr. Satay and Ms. Nasi Lemak). And some new (blogger buddies)
Nick & Helen's wedding in August (however, my internal medicine board exams will be the week before. Ugh)

Revenge of the Sith

Call me a kid. I turn 30 in a couple of years. Yet, when I saw the trailer for Star Wars Episode III my goosebumps just started popping up.

I imagine most guys my generation grew up on Jedi fodder. I mean, yea, we're all grown up now, some married, some with kids, some are doctors, lawyers and accountants. But deep inside, show me someone who didn't once think that the Millenium Falcon or the X-wing fighters were the coolest machines. And ladies, don't laugh; my girlfriends have told me about their childhood yearnings to have the Princess Leia cinnamon-roll-hairdo.

There is a word people use to describe folks like ourselves.

Geeks.

Never mind them. Foolish mortals. The Force will sustain us. Now, where did I leave my lightsaber?

Kelinik Pakar Kencing Manis & Hormon Ah Boon & Ah Kim

Heard from a good friend from med school. Kowsai (I swear, that's what we all call him. Got the nickname when he got pissed drunk at orientation dinner and yelled 'Kowsai!')(which incidentally means canine feces). Sigh. Those were the good old days. When we were still naive and idealistic. Haven't seen him in 5 years.

He's doing well in the UK now (at least professionally. Relationship-wise he's about as bad as I am). Made a career choice to go into diabetes and endocrine. Like me.

So, we joked about opening our own clinic when we're done. Ah Boon and Ah Kim. That'll be a hoot. In fact, with the various subspecialties my pals and I are going into, we could probably open our own mini-hospital. Let's see, there's a nephrologist, a couple of hematologist/oncologists, endocrinologists, a neurologist, cardiologists and some general surgeons. What we're missing are shrinks.