Playing with Fire

Freakin' good time.
Had bad dim sum in this far-far away restaurant in St. Paul called My Lehoa with my Malaysian gang. Following that, they came down to Rochester for yet another barbeque.
I had my citronella lamp out, hoping to keep away the mosquitoes. Didn't quite work. So, took out the insect repellent.

And then LP starts spraying it onto the lamp...









Setting it on fire...









Until TK comes to the rescue, squirting beer to douse the flames...










Kinda retarded huh? Hard to imagine that we're 28 and 29 year old physicians! Anyway, it was fun, sitting around the BBQ pit and toasting marshmallows and talking about our old camping days. Below is a group shot with CE's brand-spankin'-new Toyota RAV4.

The Hotel St. Mary's

Saw a patient in the famed VIP wing today. Have been there only once before.

This is a wing on the top floor of the hospital. The first time I went up there, I was blown away.

Fully carpeted, large screen tv with surround-sound system. Large queen-sized bed with mahogany bedposts.

Personal nurse. Personal bathroom with separate shower area, and a bidet (no, Nick, it's not for dipping your ass or washing your face).

The windows and doors are bullet-proof; this was partially designed by the secret service for the presidents when they come here. Even the physician ID cards can't get you in; you need to be buzzed in by security.

Rumour has it that our ex-PM and some royalty from home have stayed here (have seen a member of the royal family here before).

Price of a night's stay here? USD $15,000

Batteries and medications not included.

Doctors' fees extra.

What a crazy place.

Syncope

915 am, seeing consults in the cardiac surgical ICU:

40 year old patient with a history of AML, status-post chemotherapy with resultant interstitial lung disease, having undergone bilateral lung transplantation last week. I was being consulted for post-operative hyperglycemia.

As I was about to go in to check the patient out, my beeper goes.

Damn. ER? Why are they calling me??

Me: Hi, this is Dr. K, endocrinology. I was paged.

ER Lady: Yea, Dr. K, I think we have something here that belongs to you...

Me: Huhhh? (Thinking: Oh man, some crazy pregnant woman claiming to be carrying my kid??? Or did they find my stash of junkfood?)

ER: Do you know an Amelia Earhart? (Name changed to protect identity)

Me: Err, yea, that's my medical student. She's supposed to be in unit XYZ seeing a patient (?).

ER: Well, seems that she fainted (twice) while checking the patient out. They brought her down here to be checked out. Perhaps you wanna come down here when we're ready to release her...

Me: !!!

When she was ready to be dismissed, I drove her home. Had to give her the royal treatment as she was a family member of one of my bosses. Although she said she was well enough to return to work, I was afraid he'd fire my ass if I didn't send her home!

Perhaps it was the sight of the multiple lines, or the 2 chest tubes, or the long midline scar running down that guy's chest after having undergone a 2-vessel bypass (LIMA to LAD, saphenous vein graft), or maybe she just skipped breakfast.

Fairly classical; started feeling queasy, some nausea, minutes before she fainted. Then some sweating, and then boom... she was gone.

Popquiz for the med students out there: What kind of syncope do you think this is likely to be?

Since no one took up the challenge:

Answer: Vasovagal syncope. Diagnosis made mainly by history and the negative physical exam. Could consider doing a tilt-table study if in doubt.

"Have a heart..."

Started my rounds at 715am today. Got a call from one of the cardiac surgeons to see a patient of theirs.
Gentleman in his 50's with dilated cardiomyopathy, no history of diabetes, status-post heart transplant last week, now on massive doses of steroids and having post-op hyperglycemia. Looked at the name, and thought it seemed familiar. So I dug around a bit deeper.
I'll be damned!
Mr. X was one of the 3 stooges (or the 3 wise men, depending on which nurse you talk to) I was looking after last December. Of the 3 of them, he was the last to get his new heart! Was thrilled to see him again, and he thought I looked familiar too. Glad he lived long enough to receive his gift of life from some anonymous saint.
Did get me thinking too; a gastroenterologist here was killed in a car crash while driving to a rural hospital to see patients. On the same day. And he was 42, left behind a wife and 2 kids. Tragic, really. One life ends, another 'begins' (again). Is it possible that's who he got his heart from? Who knows?
The evening was pretty interesting too. Bad storm in the midwest, with a tornado warning at 5pm. I heard over the radio a twister actually touched down some miles away (small one, no one was hurt).

Veronica

Spent some quality time with Veronica. Gave her a nice bath, and then 2 layers of wax. Cleaned the inside and out.
I love spending time on my car. My housemate wonders how I can spend hours in the garage, just tweaking, adjusting, wiping, washing or polishing. But on a nice lazy sunny weekend, that, and a cold beer, and I'm done. Happy. (This is pathetic, no?)
Hopefully, it's not gonna rain or anything this weekend.

It was a beautiful day today. Caught this shot of M1 taking off the hospital roof.

People have been asking me why I've been ignoring them on MSN and Yahoo. Well, this is why. My internal medicine boards is in a month's time. ABIM; the American Board of Internal Medicine, similar to the UK's MRCP.
This is my study room. And no, the notes on the walls aren't nurses' phone numbers. Although I haven't the foggiest idea why playboy.com is on my monitor. Err.

Sunflowers

I love sunflowers. And no, before Paul and Ariel start malicious rumours again; I'm as straight as an arrow (okay, okay, I'm referring to my preferences, not my genitalia).

Anyway. A week before I left for Malaysia, in a moment of inspiration and mad ambition, I decided to weed my flower bed (realized it was about time when I needed safari gear and a hunting rifle to safely roam the garden) and put it to good use.

So, I planted some sunflowers (varying colours, the box stated), carrots and tomatoes. While the tomatoes and carrots died, the sunflowers thrived. Guess I now know who the neighbourhood bully was.

Now, 6 weeks later, the plants are 5-6 feet tall. And the flowers began blooming. Really pretty, even if this statement damages my image of male strength and virility (but hey, somewhere out there, there's bound to be a girl who digs muscle-ripped, tattooed guys who are knee deep in manure lovingly tending to his garden right? Right? Anyone?? Er... harlo harlo?).

Brings some cheer into my dreary life. Like this morning, when I left for work insanely early for a Sunday. Walked out and saw the bright colours of the flowers. Almost talking to me:

"Have a good day ok, TK? Never mind that you woke up at 6am on a Sunday. Never mind that you didn't have breakfast. Never mind that everyone else gets to stay at home in bed. Including us. Have a REALLY good day, ok? We're sure being in the hospital would be more fun."

Now, where did I leave my herbicide?

You want me to round at six-freakin' a.m???

I'm a fellow, not a resident, goddamit! I was tempted to say. But, while the spirit was willing, the balls were not. So I kept quiet.

I had asked a colleague when I should plan on coming in on Saturday. My first day in a 2 week inpatient consult service that covers all diabetes consults from the ICUs of the hospital. On nights and weekends, I also cover all endocrinology consults.

Anyway. Day one. Blur case, trying to figure out the damn forms, the damn computer system and the damn paperwork. Good thing I DID go in at 615am, for I wasn't quite done when my boss called me to meet him to discuss the patients at 11am.

While it wasn't too busy, the teams as usual were a wee bit premature in getting us involved. There was a type 2 diabetic in the unit who was intubated, on an insulin drip, and was basically coding every 5 minutes. Runs of V-tac or worse. In fact, when I was looking through his charts outside, the alarms went. Ventricular tachycardia. They had to put the leads on him in case they had to shock him. With that, why the freak were they wanting to hurry him off the insulin drip and start insulin SQ???

The evening was more fun. It was Tony's birthday. One of my buddies from California who turned 32 today. Instead of doing fellowship, he was smart enough to come out and work as a consultant. Earning over RM 350,000 a year now. Not bad, for a new grad. Never this much in Malaysia.

Anyway, it was fun, a bunch of senior docs, all boozed up on hard liquor and food, playing with fireworks (the classics like Moon Travellers, etc. All illegal in Minnesota!). This entourage included a chief resident, 2 fellows, 3 consultants; no longer small-fry docs. All running around with lit fireworks in their hands, trying to throw it before they exploded. The rationale was, if anything happened, there was an ER consultant with us. It was a fun evening. And while we worked fewer hours, you could tell our level of responsibilities were higher; all carried our pagers, and few of us got direct calls from patients during the party. You kinda realized, unlike residency, often you're it, no boss to report to. You decide then and there, what they should do.

While it was fun, and while I enjoyed the company of my American friends, I did catch myself yearning for the company of my pals I grew up with.

Chest 2005!

I got Chest 2005!! One of my final papers in residency was accepted for the big Chest conference in Montreal! I'm thrilled, naturally. This happens to be one of the more prestigious pulmonary and critical care conferences in North America, and automatically includes an abstract publication in the journal.

Problem is, I'm not sure my division would let me have the time off. Nor would they provide funding, as technically I co-authored that paper as a resident, in my medical ICU rotation, and this was a rare case of a urea-cycle enzyme deficiency presenting in late adulthood. So, I'm almost expecting to not be able to go to beautiful Montreal in November, and will likely get my 2nd author to present the slide instead.

We'll see. I'll keep my fingers crossed.

Certainly a welcome piece of news, especially with how messed up my other issues are currently. Am in the midst of transitioning into fellowship, and on top of that, struggling from a major case of stupidity for which I'm trying to knock some sense into myself.

I'll spread my wings

And I'll learn how to fly

Though it's not easy to tell you goodbye

I gotta take a risk

Take chance

Make a change

And breakaway

Out of the darkness and into the sun

But I won't forget the place I come from

I gotta take a risk

Take a chance

Make a change

And breakaway

It's one of those days when a particular song keeps playing in your head. For whatever reason. Breakaway by Kelly Clarkson. Perhaps it was the tune, or perhaps it was when I actually listened to the words, and went, Damn, I can understand!

At least it had a good tune; better that than to have songs like I'm Too Sexy playing over and over in your head.

Had a long day; my first clinic with my own patients in endocrine. Inherited someone else's practice, so I met these patients for the first time. Looks like we're gonna be together for the long haul; I keep them for the next 3 years.

Fated

Isn't it funny how life unfolds? How, when you're lost, or unclear about something, and aren't sure what exactly it is you should do, that something comes along and points you in the right direction? Divine roadsigns. Often unexpectedly.

I was looking forward to an upcoming trip. Partially to meet up with a friend, and partially to get away from this place, even for a weekend. There were things between us yet unsaid. Perhaps things left to be said, or perhaps it was better to let things be.

Anyway. In a twist of fate, that didn't come to be. Disappointing, it is. But probably for the better. Or is it?

I'll be optimistic and tell myself this was a sign.

Oops, we did it again. Although the guys at Hopkins beat us again this year. The endo department did pretty well. Too bad this doesn't translate to a nice, fat pay raise or bonus for us.

Chicago (yet again)

My housemate and I made an impromptu weekend trip to Chicago. 5 1/2 hours drive from here, to hang out with my friends Nick and Helen. It was a beautiful weekend, a lot of sun. We had a great time there. This is my portable GPS navigation system; it got my housemate and I there in one piece (despite our Malaysian driving habits).

Below is an aerial picture of the Millenium Park. One of my favourite haunts in Chicago. A lot of artsy-fartsy things, including the pavillion in the upper part of the picture, the shiny orb-like piece of sculpture on the left (we call it the jelly-bean) and that huge wall-like structure with the person's face, which gushes water every couple of minutes.
Basically, besides catching up on dirty jokes and playing video games, we ate. And ate. And ate. This was one (of 3) helpings of sushi/seafood I took at Todai. Note the sisa-sisa of a large crab.

Now, this was a work of art. Had brunch at this really nice joint called the Bongo Room (which kinda sounds like a strip club, doesn't it?) on Milwaukee Ave. Had Eggs Benedict for my entree, and we all shared this humongous pillar of chcolate and bread they called Chocolate French Toast. Basically french toast dipped in chocolate. When you stabbed it with your fork, it would bleed chocolate syrup. It was so sweet that they had to serve it with syringes filled with insulin.

And this was how I looked after finishing brunch. Had trouble keeping my eyes open for the 5 hour drive back here. But overall, it was a great trip. It was nice meeting up with Nick and Helen again. To be able to be myself. Speak in Manglish. Cuss our favourite swear words. Do our crazy boy-things (poor Helen was cringing and shaking her head most of the time though).

Chicago skyline, and Lake Michigan. My one glamour shot.

Trust me:

"A bidet is not something you soak your ass into"

Pronunciation: bi-'dAFunction: nounEtymology: French, small horse, bidet, from Middle French, from bider to trot: a bathroom fixture used especially for bathing the external genitals and the posterior parts of the body

A friend recently returned from a trip to Barcelona. Stayed at a spiffy hotel with bidets. Unfortunately, he didn't know what to do with it, and was gullible enough to believe his liar of a friend, who told him to use it to soak his fat (oops, I meant firm) ass like a sitz bath.

The Road Not Taken

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth.

Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same.

And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I--
I took the one less traveled by,
And that has made all the difference.

~Robert Frost

I keep this in my collection of favourite poems, along with Invictus (William Henley) and You'll be a Man, my Son (Kipling). A very, very long time ago, I had a discussion with someone dear about it. Perhaps this is not what the author had intended it to be, but I interpreted this as a poem of regret, or at the very least, of doubt. Of having chosen a path, but yet wondering, perhaps even regretting, if the path chosen was the better of the two.

There are times when I catch myself wondering that. Of choices I made in the past. You catch yourself wondering if those choices were for the better. And better for whom? I sometimes ask myself. Me, or the patients who will forget about me 6 months later? Better for the family I never see, especially when they are in need of healthcare, or the patient's family now that they get to have their dear old mom around for another 5 years?

I suppose it's pointless wondering. One would never know. All one can do is be thankful for what he has been blessed with. But it's human nature to wonder, no? And unfortunately, it's human nature as well to never learn from their mistakes.

4th of July

Happy 4th of July! Housemate and I went for the fireworks display held at the nearby lake. Knew that area was gonna be packed with people, so in a brilliant stroke of genius, I suggested we head to the Methodist Hospital elevated carpark and hang out on the top floor. That would give us great views. Except when we got there, there were literally hundreds of people. So much for my stroke of genius.

You gotta give it to these guys though. They love their 4th of July celebrations. From the top we could see this bunch of old foggies sitting on lawnchairs at the nearby carpark watching the fireworks display. Click here for another video.

Hey, I may be Malaysian, but I celebrate any occasion here that gives me a holiday!

Boys with Too Much Time on Their Hands, Part 2

The picture says it all.
Great way to simultaneously get some sun, drink beer and play video games.

Boys with Too Much Time on Their Hands

Question: What do you get when you put a crazy Seremban clown and a retarded Penang nut together on a long 4th of July weekend?

Answer: Boys with too much time on their hands

Kicking football around at backyard

CSC: Hey, look at them fireflies

RPN: Maybe can take photos

CSC: Ya ya. Let me get my tripod, can use long exposure to catch their blinkin' asses

15 minutes later, inside house...

RPN: Oii, quick quick. Have some in my hands. Find me a transparent jar or something?

CSC: Hmm, where got? Aiyah use my beer glass lar.

RPN: Too small lar. Get Helen's sushi seaweed jar (please don't tell her we used that to store bugs!)

RPN: Ok, all 5 bugs in. Now all we do is wait for them to blink and we snap some photos

15 minutes later...

CSC: Eh, still nothing la. You sure you didn't kill them or squish their glow-glands ar?

RPN: Nolar, still moving. I think that one's feeding on the seaweed

CSC: I think I read from somewhere they don't glow in captivity?

RPN: Lemme go check the web...

5 minutes later...

RPN: Hey, this website suggested warming them up to get them to be more active. That'll start their blinking

CSC: Warm? How? Can put the jar into the microwave or not? Ok, got it. Lemme use my portable winter heater and blast the jar with it

5 minutes later...

CSC: Sh*t! The blardi room now like a sauna and they're still not doing anything. Wait wait... that one seems to be moving. Lemme get my camera and tripod ready...

RPN: THERE! THERE! Blinked! Quick, take photo!

CSC: Sh*t, missed it. Ok, camera now ready. Come on my pretty ladies. Show me your booties...

2 minutes later...

RPN: Nothing wor

CSC: WTF??!? This is pathetic.

5 minutes later...

CSC: Aiyar give up lar. Got better things to do. Go let the bugs out lar

RPN: (Lets bugs out of jar) Ok, all done. Eh, they started lighting up again lar. Look at them go...

CSC: @#%$&!!!

Click here for video (couldn't embed the blardi thing)

Men Rules for Women

Got this from a nurse friend. Thought it was hilarious. Perhaps some truth in it too.

Learn to work the toilet seat. You're a big girl. If it's up, put it down. We need it up, you need it down. You don't hear us complaining about you leaving it down.

Shopping is NOT a sport. And no, we are never going to think of it that way.

Crying is blackmail.

Ask for what you want. Let us be clear on this one: Subtle hints do not work! Strong hints do not work! Obvious hints do not work! Just f*cking say it!

Come to us with a problem only if you want help solving it. That's what we do. Sympathy is what your girlfriends are for.

If you won't dress like the Victoria's Secret girls, don't expect us to act like soap opera guys. (my favourite!)

If you think you're fat, you probably are. Don't ask us.

If something we said can be interpreted two ways and one of the ways makes you sad or angry, we meant the other one.

ALL men see in only 16 colors, like Windows default settings. Peach, for example, is a fruit, not a color. Pumpkin is also a fruit. We have no idea what mauve is.

If it itches, it will be scratched. We do that.

If we ask what is wrong and you say nothing," we will act like nothing's wrong. We know you are lying, but it is just not worth the hassle.

If you ask a question you don't want an answer to, expect an answer you don't want to hear.

You have enough clothes.

You have too many shoes.

I am in shape. Round is a shape.

It was a beautiful day today. And since I had the day off, figured I should take advantage of it. So, loaded my bike unto Veronica, and drove an hour south to the small town of Fountain. Planned to bike on the Root Rover Trail, a trail I've biked on before.

It was glorious. Warm, up to 28C. Had all my gear; bike helmet, gloves, water, MP3. The trail was relatively busy too, a lot of cyclists out. Started off at about 345pm for the quaint town of Lanesboro (same place where we canoed 2 weeks ago). The trail was decently paved. The trail, about 20 km each direction, brought me through flat, boring farmland terrain, hilly bluffs, along the scenic Root River. Crossed numerous wooden bridges such as the one below.
Root River Trail. From Fountain to Lanesboro (actually went slightly beyond that) and then back to Fountain. Total distance about 40 km. I guess I overestimated myself. For the last 2-3 kms, I had to stop for walking breaks. My quadriceps were just killing me, from the accumulation of lactic acid. And, thanks to my genius, I had neglected to bring any energy source. All I had was water, and some diet Coke. Which had no much-needed glucose.

(Why oh why did I not bring any chocolates? Ugh, 1 more kilometer to go. Go go go. No, need to stop. No, go. Damn)

But, in the end, perseverance prevailed. My legs were so tired they felt like jelly. Made an immediate pitstop at the nearest Dairy Queen for some milkshake.

Never again. Not without more training first.