All over

That's it.

It's all over. Finally.

I am no longer a resident. Didn't hit me until I ran into HH, a cardiologist from Singapore.

"Congratulations on completing your residency."

Huh? Oh yea, that's right.

Completed my last call and last day of resident work today. I get tomorrow off, and the new academic year officially begins Saturday.

It was a rough oncall night, but it's all over.

I pick up my diploma tomorrow.

Admittedly, there were days in the last 3 years when I wasn't sure I would graduate. Complete my training. Instead, I was sure I would quit, or get kicked out, or go crazy, or kill someone out of sheer incompetence. Thankfully that never happened.

My worst night ever? By far that fateful night in the ICU as junior in January 2003 when patients were crashing and dying at the same time. When that patient with multiple myeloma developed a tension pneumothorax and died before my very eyes, despite intervention. I still sometimes have nightmares about that day. Or the time when I had to do chest compressions on that osteodystrophic patient; I remember so clearly how it felt pumping his heart but feeling his ribs crack under my hands.

My most memorable. Probably that Christmas eve when a bunch of us were oncall, homesick and miserable. Fortunately, there was a lull at night that enabled us to go to the hospital chapel for midnight mass. The camaraderie we felt, the warmth from the crowd, mostly patients and their family who knew what we were sacrificing working on Christmas eve. That was unforgettable.

We sat down and calculated. Most of us spent about 148 nights in the hospital. 148 overnight calls. Wow.

When I return to work next week, it will be a totally new environment. And I will not be stepping into the clinic as a resident. I will be an endocrinology fellow. PGY-4. Post-grad Year 4. 9 years into my medical training.

I looked at the introductory messages by the incoming interns (PGY-1). Eager, idealistic and naive. I remember a time when I was like that. Now, I think we're all worn out. Jaded. A lot wiser, maybe even smarter, but jaded. Time to close this chapter.

Radio Ads...

Ever notice how many of the radio ads you hear in Malaysia seem similar? Noticed this today when I was listening to Mix FM online. Do that a lot, especially when I'm yearning to hear the local accent, and when I'm just sick of speaking American English (for crying out loud, 'can't' is pronounced 'Kah-nt', not 'Keh-nt'. And it's antibiotics, not an-tie-biotics!).

Anyway, I digress.

Notice how many of local radio ads have the same theme?

Ah Beng talking to Ah Lian, complaining about how pathetic his life is.

Ah Lian tells him about some wonderful miracle tongkat Ali/ginseng drink that would improve his mood.

End with Ah Beng exclaiming, "Oh, I must get some too!"

Variant 1:

Guy with fake Brit accent talking to friend. Friend tells him about some My Wan-lar! homeloan or something to that effect.

Guy goes, "Oh, I must get some too!"

Variant 2:

Girl 1 talking to friend Girl 2 about some miracle facial creme made of Mongolian lamb placenta and wild Antarctic zebra hemorrhoids*, guaranteed to make her Everest-like zits melt away (not unlike hydrochloric acid). Never mind that that leads to deformed, very ugly decendants.

Girl 2: "Oh, I must get some too!"

*Okay, fine. There are no zebras in Antarctica. But if there were zebras there, I'd bet that with the lack of fiber in their diets, they'd get humongous hemorrhoids.

Variant 3:

Woman talking to her friend about some once-in-a-lifetime super-mega-colossal-gigantisaurus sale going on in Gaya Gusto departmental store.

Her friend: "Oh, we must go now!"

(Then again, maybe she had too much to eat at lunch, and meant that she had to go to the toilet to do a number 2?)

Okay, so I took some creative liberties to modify the examples so that people don't sue my pants and polka-dot Gap boxers off. But really, the next time you're caught in the usual 32-hour rush hour traffic in KL, have a post-it handy, and mark down the number of ads you hear in that one trip resembling the above.

Kinda makes you wonder. Are we not capable to trying something different?

Then again, I'm probably being hypocritical; after all when I was home recently, all I kept having for breakfast every day was lor-mai-kai.

HOLY COW!!!
@%#$&!!! WHAT THE SH*T KINDA DAY WAS THIS???
What a day so far!!! GEEZ!
The cuss words I'd like to put on my blog, but can't (apparently, my folks read this blog too).
5 admissions and one death so far, the last one we flew in on helicopter, and spent 3 1/2 hours resuscitating and stabilizing her. Bled like stink, and received over 15 units of blood in the last 24 hrs. Have never seen anyone bleed like that before.
It's 530am now, not worth going to bed anymore for that one hour of sleep.
Right now, I'm thankful for 3 things:

• That I'm not the patient
• That I'm not going into Critical Care medicine
• And Endocrinology has no inhouse call

1 more week...

Addendum:

Despite our efforts and the patient's determination to stay alive, she passed away after my shift. Basically bled to death after the family decided to withdraw care. She was suffering from terminal cancer, and was bleeding from an arterial-enteric fistula. Our vascular surgeons felt that surgery would only be temporizing (she had failed a previous procedure).

It was like a warzone today, in that one single ICU room. Alarms going off every few minutes. Nurses and doctors shouting orders to the respiratory and IV techs. Large volume lower GI bleeding with reflux hematemesis. Basically was vomiting blood onto the bed every 30 minutes, despite our continuous NG suctioning. Good thing she was intubated. She received over 30 units of blood products.

Despite a rectal tube connected to suction, her bedsheet was soaked with blood, clots everywhere. Blood on the floor. Blood splatters on my shoes.

I don't think I can come up with a better definition of chaos.

I'd like to imagine that things were more peaceful for her when she passed on. That, after the family decided to withdraw support, she was comfortable and the room kept as quiet as possible. Our nurses are usually very good with things like that.

Wherever she is right now, I pray she's finally at peace. And I hope I'll be able to sleep tonight without having nightmares.

Back to the frontlines...

Crap. Just when I thought things were coming to an end. End of residency, start of fellowship; no more working like a dog, staying in the crummy St. Marys call-rooms, or running to the next code blue hoping that it's a false alarm.

Yup, I'm back. Have been pulle for the very last week of residency, to cover for a friend who left for Virginia to begin his cardiology fellowship. And, pulled to cover the medical ICU (where I was, 3 months ago), no less.

Oh well. At least now the unit is relatively empty; last I checked, of the 24 beds in the MICU, less than half were taken. So, fewer sick people to look after I suppose. But that could be potentially bad too. That means that I have a lot of empty beds and the folks in the ER, on the general floors or even the airlift helicopters will be pushing patients my way.

Tahan, tahan. Only one more week. One more week before I forever flush that code pager out of my life and into the toilet. One more week before I am forever done with overnight call (ok, not sure what awaits me in Malaysia should I decide to return, but we'll worry about that when we get there).

Wrote this when I was on cardiology. Thought it would be fitting to put it up again.

Ode to my Pager
Oh Code Blue, you hateful Code Blue

I dread the days when I hear from you.

Up the stairs, and down the halls I race,

To find the patient, who's trying to leave for a better place.

I shout to the nurses, "I'm here, I'm the code team leader!"

(But actually, there isn't anyone in the room stupider).

Check his airway, breathing and circulation

Then shock, shock, shock for ventricular fibrillation.

Epinephrine 1mg q 3 minutes

And other crazy chemicals in the code kits

Should I try lidocaine, or should i do amiodarone?

Quick, quick, decide, before the patient's gone.

Do we have pulses, or is he in PEA?

Oh, crap, what's making him this way?

Stat blood gases, and check his electrolytes.

Is this an MI, PE or some other plight?

Thoughts of you, give me sleepless nights,

Coz I don't know, when my pager might bite.

I might be showering when the patient decides to die,

Or will you code, when I go to pang-sai?

So here I am, awake on my callroom bed,

Need to poop, but I think i'll hold it in instead.

Online Doctor Consultation

Got an email from a buddy in Malaysia, questions following my recent blog outburst, wondering which test he should go for. His menu was like this:

Type of checkup :
A) RM380
1) Blood test
2) ECG
3) Chest X-Ray
4) Cancer cells check only for liver and colon (based on family history, unless there are other specific places to test, additional charges apply)
5) Analysis by Medical Officer (like normal GP)

B) RM450
All as above except analysis by Specialist, not MO.

Thought option B was funny, having the choice of a more specialized doctor see you instead of an MO. So, seeing that gave me an idea. Perhaps I could make some extra cash by doing online consultation huh?

Dr. K's consultation options and fees:
Examination by a board-certified, US-trained subspecialist: (Come back in 3 years time)
Examination by a specialist in internal medicine: US$ 250
Examination by a medical intern: US$100 (get one of my interns to do this)
Examination by medical student: We pay you US$50 per student

Package includes 132 of our most popular blood test, even able to test if your great-grandkids will be smart or stupid, and palm-reading by our resident chinese palm-reader/bomoh/bobohizan/exorcist.

Now, buy one, get one free!*
*Applies only to digital rectal exams. Does not include price of a 2nd pair of surgical gloves

I'm pissed. Just got a copy of mom/dad's routine blood test results. Which included a whole bunch of crap tests. This prompted me to check out this company's website which promoted certain tests. Kinda the stuff I was complaining about in my earlier blog.

Total BS man. I'm disgusted. Hence, wrote a nasty email to them (which undoubtedly would be ignored):

My parents recently sent me their lab test results. I must say I'm shocked by the types of tests that were done as part of their general screening tests. You list on your website too the types of tests that are usually done, including the cancer markers. The tests that your perform, including the CEA, CA199, AFP are NOT recommended cancer screening tests and are not sanctioned by the many professional medical bodies internationally. I am certain that you know the limits of the sensitivities and specificities of these tests, and any falsely abnormal result may lead to invasive testing. Invasive testing like transrectal prostate biopsies and other tests which have significant risks. Even the PSA, probably the best test of the lot, is still controversial (American Cancer Society vs the American College of Urology).I am a practising physician at the XXX. I am aware of the medical research and data regarding these tests, and I question your rationale in suggesting these to the general public for screening. Perhaps you can enlighten me by providing me with research papers that I may not have been aware of, advocating its use as a screening tool. I believe in evidence-based medicine, and I will let the numbers speak for itself. But for now, I'm somewhat disappointed that you are putting profits as a priority in your service to unknowing Malaysians.

Screw them. Greedy little people. Sang Chai Mou Si Fatt! Cis cis cis!

Dr. Love?

Okay, I hope no one gets offended or anything. But just felt that I had to say something after the many emails I've been getting from visitors to my blog seeking advice on their love lives and relationship problems. It's not that I'm miffed or upset or anything. Maybe just feeling amused and somewhat awkward.

Just that, come on, you'd think that getting relationship advice from a still single 28-year old physician with no social life who's crashed and burned so many times in his pursuits, wouldn't be the smartest thing right? Especially if we've never met before. Kinda like asking Saddam for advice on how to bake chocolate-chip cookies.

So, while I appreciate the vote of confidence, trust me, I'm way too cynical and scarred to give any useful advice. So perhaps I'm not the Dr. Love you're looking for. Good luck though in your pursuits, and I wish you better luck than me...

One afternoon at the clinic. Patient is a LOL (Little Old Lady)

Dr. K: So, what seems to be the problem today?

LOL: Doctor, my problem is that I have a lot of gas. I fart a lot. But, the gas is silent and is totally odourless. In fact, since I came into your exam room, I've farted 20 times, but you didn't know because it was silent and you couldn't smell it.

Dr. K: I see. Ok, take these pills twice a day, and come back to see me next week.

Next week, patient returns mad as hell...

LOL: Doc! I don't know what the hell kinda pills you gave me, but my gas, although still silent, now stinks like the devil!!

Dr. K: Excellent! Now that we've fixed your sinus problem, let's get working on your hearing...

Heh heh. No, that didn't happen to me. Read it somewhere, thought it was hilarious. One of the funniest nondirty jokes I've read/heard in a while (okay, so farts aren't exactly clean, but you know what I mean)

Go shove a camera up your ass.

Essentially, that's what a colonoscopy is. Simply put. Okay, you're also able to insufflate, deflate, suction, squirt and put a snare wire in too.

I had mine done today.

Which meant I was on a clear-liquid diet for the preceeding 24 hours. And nil by mouth 4 hours before. Had nothing but chicken broth and Jell-o for dinner yesterday.

("Yum yum, are you sure you don't want to have some of this apple pie?" my idiot housemate taunted me)

Also had to consume some of that phospho-soda purgative. I bet that stuff would dissolve even hardened concrete; the type they use for ICBM silos. Cleared out my gut in no time.

Why on earth did I get one done? you may ask.

Colorectal cancer screening. Dad had colon cancer at 52. His mom died of colon cancer at 35. Thankfully, my exam was normal.

Why on earth am I sharing this on my blog? you're probably wondering.

Well. I don't know. I guess I feel that there's still a lot to be said about health screening awareness in Malaysia. Especially in the younger-middle aged crowd. It's hard to accept that one would get a test done while one is healthy (or, perceived to be).

As one of my brothers once put, "What? Get that test done when I'm healthy? Crazy-wan ar??"

But that's precisely the point of screening. Doing a test and catching a disease while it's in its early stages.

Of course, screening has its limits or criteria too; that the test has reasonable sensitivity and specificity, and that something can be done to improve outcome if the disease is caught early.

Also, at least in my family, the concept of 'family doctor' is not quite there. Usually, we see the most convenient doc when we're sick. Hardly have an annual health exam and get our cholesterol or glucose checked.

What surprised me though when I was home last year, was that these labs were now offering all forms of blood tests for cancer markers, most if not all of which have not been shown in studies to be good markers and are not sanctioned by most medical bodies in the world. Package A: CEA, CA19-9, alpha-fetoprotein, Package B: CA125, etc etc.

Consider this, in the USA (sorry, don't have Malaysia's data handy, but it shouldn't be too different) colon cancer is the 3rd most common cancer in men and women. 1 in 9 women will develop breast cancer in their lives. There are some of us, who believe that songstress Anita Mui's death (Bless her soul) was avoidable with routine Pap smears, because cervical pre-cancer and cancer is so slow-growing that in this day and age, should not be allowed to progress to such an advanced stage.

Yet, how often do we screen? I remember talking to my good friends' wives, all women in their mid-late twenties, who thought I was crazy when I said they should be getting annual Paps.

"Won't happen to me" is the favourite mantra.

Having said all that though, much of this depends on the infrastructure of the medical system; I'm not sure what the availability of colonoscopies and mammograms and Paps are in smaller towns.

Over here, the standard recommendations we adopt and suggest are:

• Colon cancer screening beginning at 50 years (or 10 years younger than the age of diagnosis of the first degree relative) by means of colonoscopies every 10 years, or flexible sigmoidoscopies with barium enemas every 5 years
• Pap smears annually starting at 21 years of age, earlier if sexually active before then, which may be decreased to every 3 years with 3 consecutively normal results
• Mammograms every 1-2 years starting at 50

But I guess this is not an ideal world. Ok. That's that. Now I need to go and eat 2 days' worth of meals.

Heavy traffic

Looks like a busy day. The helicopters were just flying in and out. I'm glad I'm not working today. Medical ICU, Surgical ICU, CCU, Neuro ICU, trauma OR and ED; that's the usual destination of these patients. Occasionally they (or rather, the organs) go to the transplant surgery patients. Well, wherever they go, I hope the patients do well.

These are some of the pictures I took today. The ER residents get to work on the medical airlift helicopters, and they get their own navy-blue flight suits to wear. Now, THAT's envy for you. Every male resident I know wishes he could fly in the helicopter. Even those 40 year old ones. At the very least, to have your own flight suit (I'd be sure to get that Top Gun Rayban sunglasses too!).






This one reminded me of Airwolf. You know, that ultracool black super-heli, piloted by Stringfellow Hawke? Come on, I'm sure you remember...





This one's one of our three. M-One.

SUTA Syndrome

Interesting.

Been facing this person with some distinct symptoms. Perhaps I should write this case up and try to get it published in a medical journal. Wouldn't mind having another publication. I shall call it SUTA Syndrome.

Stick stuck Up The Ass Syndrome. When someone just has trouble not being rude and has to expel some offensive words from his/her oral orifice.

For some reason, this one person (I'm assuming it's the same guy/girl but it's hard to tell when someone lacks the balls to leave a name). First it was some comment on my personal blog thoughts. Then it's some comment on someone else's medical blog. The original topic was about the withdrawal of recognition of a Russian medical school by the Malaysian Medical Council. Seems like this person really has it for me. Reasons I postulate:

• I slept with his sister in my past life
• He/she's frustrated by the system where he's at, and wants to take it out on others practising and specializing elsewhere
• He/She thinks I make more money than he/she does
• Atrophy of the frontal lobe
• Atrophy of the gonads
• I 'yong-sui' (likely major culprit too)

Anyway. Ariel taught me that there's a name you give these people. Trolls.

As such, I will not lower myself to his/her level of name-calling and ill-mannerisms, and walk away as gracefully as an elephant on stilts.

Oh well. But back to the original topic of the derecognition of a med school in Russia, on one hand it's good to see that MMC appears to be putting the interests of the patients first (at least from a zillion miles away that's the impression I get), but on the other hand I imagine the med students there must be feeling really crummy. It's a punch in the gut when someone says they doubt the quality of graduates of your medical school, whether or not it's true. And, with the crazy money-making private medical tuition fees in Malaysia, this has been a welcome alternative for struggling families. Until now. I hope the students and families are able to find peace and not let this affect them much. God knows medical school is stressful enough.

SUTA Syndrome.... gotta start working on the abstract...

Boy, was this a fun weekend. Hosted my graduation party on Friday (everyone was keen to get together, but no one volunteered their place). It's sad, some people have begun leaving this place. The ones going to Johns Hopkins left this weekend. We started with 42 people in the class, had a couple of casualties; people who dropped out to go into a different specialty or work in a different hospital. But it's been a memorable 3 years, having made a lot of friends I'll miss. The barbeque was a reminder too though; we were socializing at the party, but in the background St. Mary's Hospital stands. The helicopters were really busy today (see picture), grim reminder that someone's always working. For thankfully, at least for the weekend it wasn't us.

Also went canoeing at Lanesboro with some Malaysian friends. Got thoroughly burnt. We were so smart that we forgot the sunblock:

Wei, where's the sunblock?

What do you mean where's the sunblock? I thought YOU were bringing the sunblock?

Me??

&^#&!!

Tried to prove my point my showing off my bikini lines at dinner. Butt still like pak-cham-kai. It took a strong will for Helen to contain her gastric contents and not puke.

It was a great day; plenty of sun, good friends and a 3 hour canoe ride. Plenty of boating mishaps which we won't mention again (but no one capsized, unfortunately). By the end of the journey, I couldn't feel my arms anymore.

"Pay to suffer. Why??" My mom would say.

Take my Quiz on QuizYourFriends.com!

Pop Quiz

Pop quiz:
Can anyone identify this lesion? Prize to the winner.

High-maintenance?

Disclaimer: This is meant to be an unbiased entry. Not meant to offend anyone who happens to fit into any of the categories below (had to add this addendum after multiple comments appeared seconds after I blogged)

"Do you think I'm 'high-maintenance'?"
An ex-girlfriend asked me that not very long ago. After she had yet another squabble with the new man in her life.

It's one of those questions to which there are no right answers, and the best way to tackle that especially if you're still dating that person, is to not answer the question, but to suddenly stiffen up, roll your eyes back and starting shaking like you're experiencing a generalized tonic-clonic seizure.

Feigning urinary incontinence makes it a bit more convincing. And don't forget to froth at your mouth. Have some alka-seltzer ready in wallet at all times for moments like this (kinda like how some jocks at college kept condoms in their wallets).
If she has even half a heart, she'll forget asking that question and move on. Hopefully that includes calling 911. And if some idiot bystander tries to jam a piece of wood into your mouth, remember to bite off his fingers for believing that stupid myth (Dear readers: If you ever see someone seizing, NEVER try to put anything into his mouth to prevent tongue-biting).

Anyway. In the realm of guy-talk, what exactly IS a high-maintenance woman anyway?
Loaded question. With very subjective and variable answers, most of which are probably very chauvinistic porcine views. And since I'll be mostly quoting others, I should be safe from offending women. Should I?

• Someone who does nothing but spends your money. Like I said, subjective. I have no problem having my significant other spend my money. In fact, I think that I would like to spoil and pamper her on occasion. But what people are referring to are probably women who carry a credit card in your name, who don't work, and yet use only G00-si (Gucci), Louis Vuitton and the like. You could fly to the moon and back every year, with the frequent flyer miles she chalks up on your credit card.
• I remember this girl I had my eyes on some years ago. She had the cutest smile. And so I asked her out and she said yes. But my alarm bells went nuts the minute she said, "And by the way, I eat only Spanish and Italian food." Nothing wrong, except she's Singaporean.
• And then, there's the woman who expects monthly flowers, to be given at their anniversaries. Again, I have nothing against gifts and surprises, but when someone starts expecting, that's when trouble begins. Conversely, some guys can be on the other end of the spectrum, not ever giving their partners even the smallest 'I care' surprise.
• But my personal definition of high-maintenance, is probably someone who isn't sure of herself and demands constant reassurance and company. And I mean constant. I once went out with a girl who constantly asked me to tell her she was beautiful. It wasn't, "Am I beautiful?" but rather, "Tell me I'm beautiful." And she was, but that wasn't the point. Maybe I'm way off base (which would explain my current status), but she didn't seem interested at all with "I don't care how you look, I love you anyway." And so, she was always insecure with other women around, especially if they were perceived to be better looking. And she was always trying on the nicest/sexiest clothes to outdo them. I burnt out in a hurry.

Anyway. That's just my view. Someday, I'll ask one of you ladies out there to educate the rest of us what a high-maintenance man is.

"By the way, do you think my biceps are big?"

My Hero...

This gets personal. Very syrupy. Be forewarned.

Let me tell you about my hero. He grew up in a poor family in Jelebu, son of a poor man who cycled rubber sap to the processing plant for a living. His was an uneducated family, one that discouraged tertiary education. Yet, out of sheer stubbornness he got himself into college, and became an engineer.

He is a hard worker. For all the complaining I do about my work as a doctor, he works even more. He made sure that his 4 kids got everything they needed; a good home, solid education, food on the table. Things went well at work, he spent some years working as a GM in a firm in KL. However, one year the firm went down, and he was retrenched. His kids recall their folks telling them to cut down on the spending and try to save some. But that was it; they told their kids not to worry, that things would be fine. And to the kids, although things did seem tighter, felt secure throughout, sheltered by mom and dad.

They got through some hard times. But things turned around after some time. They were able to send their kids for good education despite the scholastic racial bias we see so often. 2 have accounting degrees, one's a crazy physician, while the youngest (silly girl) is in medical school.

Recently, only very recently, 15 years after dad lost his job, did my sister and I find out the truth. That this gallant man, an engineer by training who lived in a big house and drove a Volvo then, head of a household, in an valiant effort to keep food on the table, went as far as to work as a labourer, spraying weedkiller in fields of lalang and brush, under the sweltering sun of Malaysia. He did this for a year. Sometimes driving as far as Seremban to Rawang, to put on his straw hat, boots, and then to load the heavy spray tank on his back and to work, to earn a few dollars for his family. But, in spite of it all, he sheltered his kids from the truth. Not a squeak.

And told us only a decade later.

I was in awe. I think Caryn (my sis) was too.

While I'm lacking in qualities, I'd like to think that I picked some of my better traits from Dad. His generosity, and kindness. Things he would do for strangers, but also the length to which he would go for friends.

I remember this one event when I was a kid, of Mom scolding him for doing something she considered to be very dangerous, of picking up a stranger/hitchhiker at the Seremban end of the north-south highway, and giving him a ride to KL to see a sick relative, because this pak cik had spent his money on tickets for his wife and kids and couldn't join them on the bus. Dad had wanted to check his IC first and made sure his wallet was empty (so that his story checked out), but otherwise, gave him a ride after hearing him out, and gave him money when he dropped him off. I doubt they'd remember this story now, after all it was over 15 years ago. But I do. So vividly.

Dad tells me now of how proud he is of us, his kids. But the truth is, we are the ones who are proud. Of him, and Mom.

Who I am, what I've accomplished, how far I will go in life, I owe it entirely to them.

Happy Father's Day, Dad!

Roger Roger

These Brits are weird.

Learnt a few new words today. And you know that the words you learn over beer, and from a crazy Brit cardiologist, are things you can't put in a public domain.

Tuesdays are wings nights. BWW has cheap beer (I think they call it Buffalo Piss or something) and cheap wings, in BBQ, teriyaki and some other sauces. Got together with my batch-mates today knowing that we have another 2 weeks left and some of these guys will be leaving.

Hemant is this crazy Brit guy who will be going into cardiology. Done a lot of work and publications on erectile dysfunction. We get along well mainly because he has the same perverted sense of humour as I do, a breath of fresh air in this overglorified, sterile medical center.

I remember one day a year ago, while we were on service for hematology. Dressed in our spiffy suits, nametags and stethoscopes. Consultant walking around like he was God himself. Rounds were putting us to sleep. And then, from the far end of nursing unit 7-4, Hemant shouts out to me in his thick English accent (apparently out of boredom):

"Hey, TK, wanna come touch my bum?"

That cracked me up. The nurses looked at us funny for the rest of the month (never mind he's happily married with a kid)(incidentally his wife is named Veronica. But I had to swear to him I didn't name my car after her), but that is precisely why I love that guy. The sense of humour.

Anyways. The words I learnt (you can look it up yourself):

• Bugger (not in the Manglish context)
• Randy
• Roger

These Brits are weird.

Monday Monday...

830am: At the EKG lab with Dr. JM, reading EKGs:
Yawn. Boling-lar. Hmm, lemme check my patient calendar for this afternoon.
Woo hoo! Onli 2 patients. Will be done by 2.30 pm.

115pm: After lunch, when I casually strolled in to 4B in my Ralph Lauren shades:

TK thinking: Hmm, should be done really early today. What should I do? Nap till 5 pm, then take the bike out for a ride around Silver Lake? Then a nice cold beer at the backyard to cool down. Have time to study in the evening too.
Secretary: Oh, hi Dr. K. There have been some changes in your calendar. Let me print you a new one.
TK: Oh? Okay. (Thinking: Hmm, oklar, at most they add another patient, still have time to nap)
Secretary: Here you go... have fun.
TK: What the sh*t?? Six patients now??? And all new ones, not my patients.
Secretary: Pardon me?
TK: Oh, I meant thanks.
430pm: Still seeing patients
445pm: Still seeing patients
510pm: Done seeing patients, but now dictating notes and signing prescriptions. %&*$#!!!

Had a BBQ. Great time, gang of Minnesota Malaysians/Singaporeans, including a new arrival just today (arrived at 630am, but he was game enough to join us anyway). And we're expecting another whole bunch to Minnesota soon; 4 new residents (internal medicine, psychiatry, pathology) and a pharmacist in the next couple of months. Our numbers are growing.

It was nice seeing these guys again. And it was a beautiful day too. As usual, half the chicken came out burnt, but hey, if it ain't burnt, then it ain't barbeque. I'll worry about the GI cancer later.

If the weather holds, we'll probably go out canoeing next weekend.

Brain-block. Perhaps from the jetlag.

Woke up this morning again at some ridiculous hour. And since I haven't blogged in a a few days, thought I'd update my blog. With something meaningful and of significance. All-inspiring. Funny.

And so I sat here with my coffee while waiting for the inspiration.

And waited.

And waited.

And waited.

Oh well.

Not that nothing's been going on since I got back. Started work a couple of days ago; working the EKGs this month, so I work alongside a cardiologist, reading those darn heart-a-squiggles. Trying do discern fascicular blocks (was that a left anterior, or a bifascicular?) and LV hypertrophy (what was the latest criteria again? They keep changing the damn things). All the while asking myself why I needed to know this since I was gonna be an endocrinologist. Hey, don't get me wrong, EKGs are great. But I'll be happy just being able to pick out those ST elevations and high-degree blocks.

Been so much warmer here. Balmy 26C yesterday. So much greener since I left. Love Rochester at this time of the year. It's actually beautiful. Although I have yet to go out biking since I returned. And I've yet to go canoeing this season. And, recently had the idea to fly a glider (there's a place not too far away); always wanted to do that (shh. Don't tell mom/dad. They'd sooner have me take up smoking). And it's warm enough that I get to have the windows and sunroof down on Veronica.

Ouch. Veronica. Missed her so much; hadn't realize how underpowered our Protons are. Even my brother's V6 Perdana. My heart broke when I found this huge zit on her bonnet. Some chip off her paint, right down to the body of the car. About 1mm. Probably from a pebble from the stupid road works on Highway 52. Was able to pop by Honda yesterday for some Touch-Up. Now that's a brilliant idea. Selling the original paint in a small bottle for touching up small nicks. Kinda like concealer, from what my sister tells me. Do we have that in Malaysia?

Did wake up early yesterday in a bit of a panic attack. ABIM. Less than 2 months away. American Board of Internal Medicine exams. Kinda like the MRCP. My specialty exams. And paid a bomb for it. So much more to cover (been studying on-off for months), but so little time. I will need to put in a lot more effort into this.

Better go study...

(by the way, to would-be medical students: They lied when they said you stop studying the day you become a doc. First it's premed. Then medschool. Then licensing exams. Specialty exams. Subspecialty exams. Then recertication. All the while, studying medical journals for updates. And taking the stupid ACLS every 2 years!)

Back!

Geez! After a butt-busting, hemorrhoid-inducing journey, I'm back in Rochester. It's 11.10am local time, and despite my efforts to keep busy unpacking and staying awake, I suspect I'll need to nap soon (it's midnight back home).

Walked in my front door at about 930pm Tuesday Malaysian time. Can't believe I left KLIA at 315pm Monday. Mom and Dad sent me off, and as usual, Alvin came by the airport. Think he's been sending me off every year since I left for Canada, including that fated year of 2002 when none of my family or other friends were able to see me off. Talk about feeling unimportant (and that was soon after I was rejected by a woman too).

What was surprising was, despite this being my 7th year flying off, it wasn't easier. In fact, as I was leaving home, there was some kinda pepper spray leak at home and as a result, involuntarily my lacrimal glands acted up. Ahem. I blamed it on family, particularly Alex.

Didn't make it easier when I chose to watch a touchy-feely movie on the plane (Hitch, my 3rd time watching it!). Thought there was a lot of truth about the love in that movie. Among the many lines that struck me, was this one Wil Smith's character said about love:

"... coz that's what people do. They leap, and hope to God they'll fly, coz otherwise they drop..."

How true. Love's a big leap of faith I suppose.

Anyway. To answer some of the questions people have been asking me:

• Yes, I'm glad I went home
• Yes, I ate everything I wanted to, and more
• Yes, Veronica started without so much as a grumble
• Yes, my sunflowers and carrot plants are growing okay (although I think the pansies gave up)
• No, I don't start work till Thursday
• No, I'm not sharing any of the Maggi Chili Sauce I sneaked back in
• Yes, I put on weight

Baby food

Why Alex is such a happy baby...

Hiatus Schmiatus

I'm back. Hiatus Schmiatus; after clearing my head for a day, I realized that one shouldn't be bothered by little things, especially by thoughtless people who mean nothing to me. For those encouraging notes from others: Thanks.

That said, I've probably not been myself for the last couple of days. No matter how many times one has left home, it never gets easier (despite what people say), and it's the last few days preceeding my departure that I dread the most. I'm sure those who share a life like mine outside of Malaysia would understand. It never gets easier. When you start counting down. It's like, Oh, this will be the last time I'm seeing you this year. Or eating that this year. Or, for some people, you kinda know you'll probably never see them again.

This is the phase when I'm unusually grumpy.

That said, I can't say that part of me isn't looking forward to going back. Away from the sweltering heat. Back to the system I'm familiar with. And of course, back to Veronica. Sweet Veronica. I hope she starts ok; forgot to tell my friends to start her engine while I'm gone. I must say, despite missing home and family and food; I feel blessed to be there. So, I'm not going to put up with remarks of an insensitive entity.

Although this trip has been short, it was well worth it. I got to spend some precious time with my family. Everyone's a bit older now, but it's nice to see how close we remain. Got to see my nephew for the first time (hmm, perhaps I could fit him in my hand luggage?). Met up with my old friends; Al and I were just talking today, about how it's interesting that our primary school group is still pretty close. Perhaps it was the ties we made in the prefectorial board, or being a La Sallian. But it's almost like I never strayed very far from my buddies here. Even though it's been well over a decade when we left St. Paul, and many are married and some are parents. And our emails are infrequent short notes often peppered with objectionable language (Hmm, guys, wasn't that somewhere in the Prefectorial Board Code of Condult? Thou shalt not use objectionable language?). And, for that I'm thankful, that I'm able to come home, be who I am, and be loved for it. No charades or false accents. Just plain old me. I'll miss you clowns, guys (and gals-lar). Sorry I'll be missing your wedding, Sal. Or Kev (we'll see lar how much time off I get during my fellowship, no promises I'll make it back). Or Sharon (geez, issit me or is everyone getting married this year??). Know that I'll keep you guys close to heart, and wish you the best (and save myself some angpow money since I won't be going to your dinner!).

This has also been special, in that I got to meet some new friends too. People who, despite my being here for such a short time, made me feel comfortable hanging out with them. And I felt like I'd known them for years. And surprisingly, put up with my qwerks and habits, although there was some mention of how I looked! I had a lot of fun, and I think I made some good friends in them. And thinking about it, it's serendipitious how I met some of them.

I have been able to close (I'm trying to convince myself it's been successful) some other chapters in my life which was way past due. Emotional housecleaning which I had neglected for too long.

So, like I said, fruitful trip, if a bit short.

The one thing that I hate though, is how one meets people who touches you at a very deep level, and then, one has to walk (or in this case, fly) away. How is one expected to do that easily?

I suppose upcoming work will keep me busy.

By this time tomorrow, I should be somewhere over the Pacific. Hopefully the flight will be less painful this time. But, I'm recharged, and I know I'll be fine. So, till the next time I return, Godspeed.

A short hiatus

I will be taking a short hiatus, for several reasons. Just to rethink and refresh my jaded self.

For one, this blog was started as an online diary of some sort. Appealed to me for the anonymity the net offered. But I suppose along the way, I made too many friends online, and while I gained in special friendships, I lost some in the anonymity I so need. Thus, some thoughts and emotions that are meant for me, and me alone, not longer belongs. Thoughts that are probably too personal for people who actually know me (kinda makes you wonder, huh, if this is related to YOU? Heh heh).

Secondly, a recent comment(s) hit me at a personal level I didn't expect. It was like, this was meant as a platform for sharing my troubles, but I felt that that was violated in that certain readers didn't respect it for what it was. While I'm a real greenhorn in medicine in Malaysia, having only done 2 1/2 of medical school here and 3 months of electives, I'm not a freakin' fresh graduate. I've been in North America studying medicine and undergoing postgrad training since 1998. And while I may be naive and have biased views about the way medicine is practised there, the reader did not consider the sacrifices one had to make. I'm thinking that the reader did not lose family members while abroad, or having to miss the funeral because he was simply too far away. Or to say goodbye to a certain woman who meant the world to him, because he was simply naive enough to think that training abroad would bring some of the much needed expertise to our country (then again, why on eath would Malaysia need an islet cell transplant program? Our medical system is self-sufficient to treat all type 1 diabetics, right? We don't need to grow, right?). Or with every departure, one worries if he'll see his parents again, or elderly family members. Or about the weddings of best friends he'll be missing. Or the nephew he'll never see grow up. The many goodbyes one has to say, because no matter how long is each trip back, no matter how special the people he meets are, one knows he again has to say goodbye.

I haven't been in his shoes, but I'm willing to bet a million bucks he hasn't walked a bloody half-step in mine.

I expect to be back someday. But for now, I need to rethink. Thanks for the patience.

Rhabdomyolysis

Ugh. My butt aches. And no, it's not what you sick perverted people are thinking.

Had a very vigorous game of squash with a buddy. 2 hours of butt busting, obscene cussing, hand numbing squash. Without air-conditioning. Think I almost died from heat exhaustion. It was fun. And of course, games are always more fun with trash-talking. Just hope I don't start having bloody urine or something. Heh heh, kinda brings to mind this patient I saw and really sympathized last year.

Elderly guy, but nonetheless fit. In his late sixties. Married to the most delightful (but practical) lady. Spent hours in the garden doing some landscaping, which included lifting heavy rocks. After that, he decided to play golf. And he decided to play 36 holes!

Didn't quite make it, he became too tired after 20 or so. Came to the ER after his pee looked reddish. Rhabdomyolysis. Muscle breakdown from overuse/trauma, with the reddish pigments coming out in the pee. Which also drove him into renal failure.

He was otherwise alright. And treating him was simple enough; IV saline. Lots of it. But we couldn't save him from the major complication: His wife of many years. Just nagged and nagged and nagged him about how silly and over-ambitious he was. And nagged and nagged. For the 3 days he was in the hospital. About how he wasn't 20 years old anymore.

Poor guy; he looked so helpless and frightened.

Don't know why, thought about him after my game. If I end up in the Seremban Hospital tomorrow, you'll know why...

Time's a-flying. Can't believe I'll be leaving again in 5 days.

Was just talking to a friend at the mamak last night. An observation I made. It's like, every year I return, it almost feels like there's less and less I'm familiar with with Malaysia. The roads, building etc. But also to an extent, the attitudes. The prices of things. The traffic. The medical system.

I suppose it's only natural, being in the US one tends to compare, which is probably unfair seeing that the US is so ahead. But this leads to frustrations, about how seemingly corrupt this place can be (although I'm thankful the PM's putting his foot down). Inflation (inflasi sifar, yea right. Catchy slogan, a song. Like that's all it would take to decrease this. Prices of everything going up. Some politicians are getting rich at the expense of the people, let me tell you). Why some people can be so selfish (think Malaysian driving habits, using emergency lanes). The misappropriation of resources (tallest this or longest that. UGLY looking light/sculptures. Yet, basic ammenities are lacking; telephones, water. Heck, there was no water supply at home for 12 hours yesterday). The medical system (WFMC's MI door-to-cath time of 20 minutes! Adequate surgical and subspecialty support).

However, in that seemingly perfect world (no, don't kid yourself, the US has its share of problems), the other things that make life complete to me are lacking. Hence my intention to return to Malaysia in 2008.

My fear is that I lose the connection after a while. And decide to stay. I suppose things happen for a reason; so we'll see how the next 3 years pan out.