And back to work

Holy cow!

Thanks to Hurricane Katrina, gas prices in the US have gone through the roof. Here in little old Rochester, it's 3 bucks a gallon (it was $2 a few months ago). Nick tells me it's $3.50 in Chicago. Veronica takes 17 gallons... so that would be $59.50!!

With the prices of gas these days, soon you'd expect the drug dealers to be out tugging plastic gas tanks and dealing petroleum.

And, like the coke they sell, it's probably diluted down too, with kerosene or whatever it is that they use.

Makes the people who drive big-ass cars like Hummers and Jeep wanna shoot themselves. It's almost like everytime you step on the gas, ka-chink, there goes 50 cents' worth of gas. Then again, they probably could afford it.

If I could invent a car that runs on fart, or dirty laundry, or something else that I have plenty of, I'd be rich enough to retire and buy my own desert island and stock it up with belly-dancers, beer and candy. Yea, I'm daydreaming, I know.

Anyway. At work, I had the most fascinating case. Lady with spells of hypoglycemia, and the work-up is hinting at NIPHS (Noninsulinoma Pancreatogenous Hypoglycemic Syndrome). Even rarer than insulinomas. The thing that had me in awe, was this lady travelled half the continent to see my supervisor, this world expert on the subject. The patient and her doctors found this guy through one of his recent publications in NEJM. Kinda made me wanted to ask him for his autograph.

We'll see how the case goes. I'm still waiting for some CT and ultrasound results. But, this is so rare that I may never see another one of these cases in my career. Then again, this place being what it is, attracts enough of these rarities that I might just get lucky again.

Addendum:

The full impact of Katrina is only becoming clear now. With the devastation they're having down south, the cost of gas hardly seems to be a big issue now. Last I heard, people were rioting, some out of sheer hunger. Hundred dead thus far, likely to go up. I wonder how my friend Gilbert is doing down there; had met up with him when I visited New Orleans earlier this year.

I hope they survivors there get the aid they need soon. Sometimes, I wish the programs here allow us to participate more in crisis aid and humanitarian work.

The Wedding

Man, what a night! What a beautiful wedding. An exhausting weekend, but well worth the time and drive.
My good friends Nick and Helen got married. And mua was the best man. Ahem.
Anyway, the wedding banquet was held on the ship The Odyssey. That was special, what with the Chicago skyline in the background, and the usual summer-weekends fireworks display, which made for a spectacular ending to an unforgettable evening.
This would be my 2nd time being best man. This time, I had to wear a tux. Also, it was different in that it was an American crowd, and people actually listened to the speeches of the fathers of the bride and groom, best man and maid of honour. People weren't rushing to eat or drink. So, we all did what was natural to us; we all shared our special memories and tributes to these two special people. Me, I had to tell them about the time Nick zinged his eyebrows while lighting the barbeque, because that crazy pyromaniac emptied a whole bottle of starter fluid into the charcoal. I felt comfortable talking, and if I may say so, think I gave a pretty good speech (ahem). I actually felt appreciated.
Naturally, after the speech, and not having to stay sober anymore, I got plastered, at the dinner and later at a friend's room where she brought some vodka to share. It was a great night. But no, for those who are wondering about that rumour that the best man gets lucky; no, nothing else happened .

For more pictures of the night, click here.

The newlyweds' first dance:

This was the bouquet toss at the end of the wedding (the bride was trying to aim for a particular person!):

This was my special gift to them; a wedding music video (not to be mistaken for the professionally taken video of the night). Click here for the higher res video (30 Mbs, you'll need broadband).

I survived ABIM, and all I got was this T-shirt...

Phew. All done.
I can't believe it.
While it wasn't too difficult an exam, it was certainly painful. 12 hours was pushing it, really. Although thinking back, the USMLE Step 3 was 16 hours.
The next couple of days will be hectic too; Nick and Helen's wedding this weekend. So, more to come when I get back from Chicago.

Day One

Lived through Day #1. 6 hours down, another 6 tomorrow to go.
Geez, can't believe how anxious I was yesterday. Had trouble sleeping, and woke up at 530am this morning. I suppose the exam went well (touch wood), wasn't as bad as I had thought it to be. Although the questions were at times mind-boggling:

• Was that really tularemia??
• Sarcoid, sarcoid and more sarcoid
• Eaton-Lambert syndrome (I think...)
• Methanol intoxication (thank God I remember the osmolar gap formula)
• AML M3

One more day...

Birthday Wish List

To make things simple for people, I decided to put up my wish list. By coming to my blog today, you've agreed to the conditions of my site, and are now legally obligated to get me a present from the list below (you shoulda read the fine print).

TK's wish list:

• 21-speed aluminium or carbon-fiber road bike
• A new PDA (Palm OS only, please) with wi-fi
• Motorola RAZR (black)
• Answers to my upcoming ABIM exams
• A nice, sweet girl (preferably shorter than I am) who likes biking and my cooking. Send CV and passport sized photo to me
• A Tag Heuer
• Honda S2000
• Sony mini-DV camcorder
• William's Textbook of Endocrinology
• Electric car polisher
• ACME vacuum penis enlarger (damn, did I say that out loud??)
• Apple mini-Ipod
• Meade 5" reflecting telescope
• 40-inch Samsung or Sony plasma TV
• Cash donations exceeding US $ 200 each

Addendum: Just had to include this conversation I had with my family. They had called to wish me Happy Birthday, and I cheekily grumbled about not getting any cards/presents from them this year.

Dad: Oklar, go ahead and buy yourself a nice birthday gift, and send us the bill later. Anything you want.

Me: Err, okay. There IS this nice road bike I've been eyeing. 600 bucks.

Dad: .............. long silence............... Err, is that is Ringgit or Dollars?

So much for sincerity! I was just kidding, dad! Thanks for the birthday greetings, all!

Another Day, Another Year

I turn a year older in a couple of hours. How old? Err. 24 (believable?).

Anyway. It's scary being so close to the big 3-0. I guess at one time, i though being 30 was o-l-d. Now, it's all relative. Case in mind, when we were talking about a cute 24-year old pharmacist the other day, and my reaction was "Aiyar, too young lar!".

And then I did a double take. And realized how stupid that comment was. 24 being too young. What it really meant was the rest of us are older.

Looking back years ago, I guess I hadn't really pictured where I'd be when I became older. There were some things that I had thought I would have achieved by the time I became 30. Among them:

• I thought I would have been married for a couple of years
• Become a parent by 30 (well, still one more year to work on this!)
• Expected to have settled down professionally and started my boring GP clinic practice. But, as life unfolded, my career is still very much dynamic and not yet stabilized. I guess I never thought I'd become a subspecialist, much less being trained at the US's 2nd ranked hospital. My family would tell you that I was the homesick kid in the family. Never in my (or their) wildest dreams would anyone have guessed that I'd spend 10 years overseas.

Sometimes life can spring unexpected surprises huh?

Today, got the most thoughtful birthday gift I'd received in a while from a precious person. A short, funny and very touching birthday message/music video. Thank you. That one's going into my personal record book as one of my all-time favourite presents.

With the friends and loved ones that I have, what more can one ask for?

Farewell

For the last 3 years now I have been stubbornly stupid (or maybe it's stupidly stubborn) about an issue in my life. Someone who stepped into my life for a time, left her unforgettable mark, and went away (okay, I went away, to be exact. I came here). Those were among the most memorable months in my early working life, and she was one of the most mesmerizing women I'd met. Still am.

But then fate put me here. And things, life, unfolded as it has.
For someone who claims he believes things happen for a reason, I certainly wasn't seeing too clearly.
And so I struggled. Held on. Hoped. Waited. Yearned.
Despite the signs.
And then, recently, like a slap on the cheek, things become clear. Perhaps it was divine intervention, a flashing neon signboard from God:
"Enough already, some things are meant to be. Some aren't."

I received the news today. Good news for some. Equivocal for me. My reaction was more of a "Okay, that's that then. I'm finally seeing what You've been trying to show me."
Perhaps a bit saddened, but just a touch. But happy too that something is going well for a friend.

Things have been pretty dynamic in my life the last couple of months. Some things ending. Some new things. New people I've met. People I enjoy, but perhaps felt inhibited by other unresolved issues. Perhaps now, I can move on, and see what happens.

If this is cryptic, it's probably meant to be so. But if this feels like I'm talking to you, because I know you come here occasionally, then I am: I wish you all the best in your move. I'm happy for you, really. Perhaps ours are of those paths that cross and then diverge, to continue in their separate directions. But know that those months will always remain memorable to me. And if we ever do meet up again, remember you owe me a beer (and a platinum Star Wars DVD collection)!

ABIM

1,095 Days of Residency

2,039,092 Drops of Tears, Sweat and Blood

3,820 Ringgit for Fees

8 more Days to Study

7 more Sleepless Nights

4 Modules

360 Questions

12 Hours

1 Chance:

ABIM

Satay Night

In a moment of reckless bravado, we decided to do a satay night. Surprisingly, it came out ok. In fact, I thought it was pretty good for something we made ourselves. CE made the satay sauce, something her granny taught her.

"Family secret." Meaning she'd have to shoot me if she told me the recipe.

Me, got the satay recipe from Kuali, combined with stuff I got from my Thai cook book. Nice small group of friends. Could definitely tell summer is nearing its end; there was a chill in the air as the sun was setting.

Let's hope everyone doesn't end up in the ER for food poisoning tonight. Come to think of it, that WOULD be pretty funny. 4 internal medicine docs, a pharmacist, a PhD student and a cardiac surgeon, all going in at the same time. All from Malaysia/Singapore.

PMS

Those who know me well will tell you I am known for my moodswings. Monthly down-in-the-dumps, Touch-me-and-die sonofab*tch moods. Anyway. I suppose I started like that today.

With that disclaimer out, I swear I'm not really an asshole of a doctor. I'm not usually this judgmental.

Just got a bit irritated by some of the patients today.

People with severe peripheral arterial disease. Foot ulcers. Not surgical candidates. Failed arterial flow-pump therapy. Failed angioplasty and stenting. Transcutaneous oxygen saturation of 12 in the foot. Dropped to 5 on elevation. So much for wound healing potential.

Ulcers look like a meditteranean pizza topping; yellow-red with bits of olives (black from the dry gangrene).

Now almost demanding that we refer them to the vascular surgeons here for consideration of a bypass.

Except, they choose to remain smoking. Knowing all too well that that would impair wound healing.

Perhaps I was a wee bit too judmental. But come on. How can you expect your physicians to work miracles when you refuse to help yourself? Just cos we're a big medical center doesn't mean we can do anything. Quit wasting my time; if you don't wanna help yourself, don't expect others to wanna bend over backwards to help you.

I have other patients to look after.

The Haze

Everyone's talking about the haze these days. Even posting pictures of grey nothingness on their blogs. So I thought I'd hop on the bandwagon.
And put up the picture of our hazy, grey skies here.

I mean, it's so bad I can hardly inhale without going into coughing fits. The skies are just so hazy.

(I probably deserve to be beaten up, don't I?)

But seriously. I wonder what crazy-ass ideas some low-IQ but high-volume politician's gonna suggest next. I remember the last time someone suggested implementing the water curtain idea. Spraying a curtain of water down from tall buildings. In hopes of clearing the smog in KL. Yea, right. Talk about trying to take down a whale with a sewing needle. And this, in the midst of a water crisis in Malaysia.

Don't these guys know to actually read up and do some research before they come up with these ideas? And does anyone (probably way before your time) remember when they hired some foreign rain-making company to help make it rain in Malacca? I think that was in the 80's. Except it wasn't cloud seeding, but using weird looking conical/cuboid/spherical object on the ground, pointing up to the sky. Something to do with the ions/chi/The Force. Worked so well that these foreigners were laughing their way to the bank. Naturally, it didn't rain. (Results may differ, stated the fine print)

Sounds like things are pretty bad right now. So, what can we do about it? Besides the obvious, like banning open burning (which our lazy authorities never enforce until it's too late anyway), if they're serious enough about it, perhaps a short-term solution would be to declare an emergency holiday and to limit vehicles only to public transportation and emergency services. Sounds harsh, but I bet having few cars on the roads for even a day would make some difference. Also, I'm not even sure if we have hybrid vehicles in Malaysia (any readers can enlighten me?). Perhaps it's high time the government promote these vehicles by providing a subsidy or tax return for owners of hybrids.

Oh wait. I forgot, "We have to protect the local carmaking industry..."

Malaysia memang boleh.

Best Man

Nick asked me not too long ago to be his best man. They get married later this month in Chicago. So, I asked him what he needed me to do.
"Oh, nothing much. Just need you to give a speech. And yea, you'll need to get a tux too!" (which I took to mean I look too sloppy in my natural state)
Looked around for something presentable to get. Thought perhaps a black tuxedo with grey vest would look nice. Something traditional.

Then again, the wedding banquet will be on a boat. Romantic cruise around the lake, so perhaps black would be too hot. Maybe something white?

Strangely enough, the rental website didn't say anything about whether the date comes along with the tux.

Or maybe something a bit more traditional, to reflect my heritage?

Or perhaps something more 'modern'? Don't quite like leather pants though; I hear they rub pretty bad. Or maybe that's a good thing.

This would be my 2nd time being best man. The first time was at one of my best friends' wedding in 2001. What took the cake then was when he, at the end of the banquet, inebriated and unable to drive, came up to me to ask me to go out to buy him a box of condoms.

"This is your wedding night! What on Earth did you expect to do tonight???" I exclaimed. To me, it was akin to Neil Armstrong about to get disembark from the Eagle but realizing that he left his helmet behind.

Nonetheless, being the dutiful Best Man, I excused myself from the gang who was meeting up at the local mamak, to make a trip to 7-11 in downtown Seremban. To pick up a box of condoms. Still dressed in my suit. Still had the corsage on my lapel. Still reeked of a mixture of booze, sweat and Escape by Calvin Klein.

They must have thought I was one high-class but butt-ugly gigolo. But still, the adik at the store didn't call the cops on me. Or try to pinch my ass.

I'm actually quite looking forward to this. Except, I have no idea how American weddings go. I know somewhere, somehow there should be a bachelor party (have been to only one thus far. Ahem. At least that's what I'm willing to 'fezz to) . And I'm pretty sure I'm not supposed to shout 'Yammmm Sennnnnngg' at the end of my Best Man's speech.

The week that was...

Glad the weekend's finally here. There was a steep learning curve for me this week. Returned to work on Thursday after my short ill-fated vacation to the west coast that never came to be, spent a couple of days at the thyroid and bone clinics. In that 2 days alone, got to perform 4 ultrasound-guided fine-needle aspiration/biopsy of thyroid nodules. Give me a few more tries, and I think I'll get pretty good at it. The pathologist called us back 3 hours after we sent off the slides; all good bites with adequate tissue.

Been thinking about my career plans; still somewhat keen on type 1 diabetes and islet transplantation, but haven't seen much of a progress in that field. And certainly, Malaysia has no viable islet transplant program, and looking at things, will likely not have one for the next 20 years even if this becomes an accepted procedure. So, been leaning towards thyroid diseases. And the procedure is straightforward enough that should I decide to practice back home, I can set up my clinic to perform FNAs quite easily, unlike something as technically complicated as islet transplant.

Having said all that, it's hard to jump totally into my fellowship and start thinking like an endocrinologist, not with my internal medicine boards in 17 days (gosh. 17, is that it??). So for now, at least until after the Boards, I still consider myself to be an internist.

Boards. Bleh.

Things I've Learnt

I've learnt that sometimes, no matter how hard you try, people just don't give a damn. Nada. Not a rat's ass.
I've learnt that life isn't fair. Never was, never will be. The prize doesn't go to the person who deserves it, but always to the person who kissed the most ass.

I've learnt that walking away is often the best solution to many of our troubles.

I've also learnt that walking away isn't as easy as we think.

I've learnt that everyone likes to have a 'good friend' around to bitch or turn to. But being a 'good friend' is often a lonely place with little rewards.

I've learnt that some people who deserve to live, often die.

And that some people who shouldn't live, sometimes do.

I've learnt that physicians shouldn't be making judgments on who should live and die. But we're only human.

I've learnt that some people (myself included) can be infinitely stupid at times.

I've learnt that things that are often the most precious in life; love, friendship, faith; can cut and hurt you deepest. And sometimes, the damages are intentional.

I've learnt that it's possible to keep going when you've been awake for 32 hours and every single cell in your body is just screaming at you to give up.

I've learnt that sometimes patients die as the direct consequence of your decisions. And sometimes we do make the wrong decisions.

I've learnt that the people who speak the most and loudest, often have the least to say.

I've learn that people you know can sometimes betray you, and when they do, sometimes the best thing to to is to cut your ties and stay away.

I've learnt that flowers can't always melt a woman's heart. No matter how many.

I've learnt that some people like to play on your guilt. And when they do, occasionally the best thing to do is to tell them to f*ck off.

I've learnt that a six-figure salary doesn't guarantee happiness. But it sure buys a lot of toys.

I've learnt that one should always back-up his PDA.

I've learnt that the quality of the stethoscope DOES make a difference, and the lame-ass people who say it doesn't are just too stingy to get anything other than a Fisher-Price stethoscope.

I've learnt that I absolutely hate running cardiac codes.

I've also learnt that sometimes, you pass the point of 'being diligently cute and determined' and become a genuine pain in the ass.

As Andrew Lincoln said in that movie; Enough, now.

Lust

It's been a while since I lusted the way I shamefully did yesterday. That uncontrollable urge. I know, it's wrong for one to do so, especially if one is in a happy relationship. How would I even explain this to Veronica?

Went over to the bike shop to pick up some gear.

A Camelbak hydration pack and Cateye speedometer.

Then, decided to look around the road bikes (we call them racers back home). Before coming here, a long time ago I was a road bike person. Just love the way the pedals respond to the firm downward force of your feet. And you shoot off like a bullet leaving the barrel.

On long-distance biking, the much less wind and ground resistance is glaring (p/s: when I say ground resistance, I meant dynamic friction between the tires and the road. Not me). The road bike tires are much narrower.

Anyway, I kinda missed that feeling. Not exactly what you get with a Mongoose 21-speed mountain bike. Although the MTBs are sturdy and built like a tank. And it's nice to have front and rear suspension. But I decided to check out the racers anyway.

Holy cow!! Works of art. Nothing like the ciplak racers we have back home. Beautiful carbon fiber or alloy or aluminium frames. Shifters located at the brake handles themselves. Nifty.

And then came the bomb. Special offer for a 2005 Specialized Allez model: US $1009.

You won't believe how tempted I was with that. My loins were just aching for the feel of a racer's seat (actually hurts some, the way you sit on them. In fact someone once told me long-distance cycling is associated with a lower sperm count. Couldn't be bothered looking it up though). I could feel my Visa in my back pocket just struggling to get out. That's the bad (or good) thing about being a single doctor; you can spend your money without having someone wiser knock some sense into you. Then again, these 'wiser' entities tend to go insane at handbag and shoe stores, strangely enough. Perhaps leather emits kryptonite rays.

But I had trouble justifying spending RM 3.7k on a bike. Especially when I have another. And Veronica.

So, I left. Took their card and catalogue, and am left drooling over these things in the privacy of my bedroom.