Chick Flick

I saw yet another girlie movie today. And I'm not ashamed to admit it: I liked it.

Okay, out with the bad first. There is no way in hell you can diagnose a tension pneumothorax by just seeing someone fall to the grown, or seeing his chest expanded. And there is NO way a person in a coma for 3 months can look that good, without even a hint of muscle atrophy. There is no way you would leave anyone intubated endotracheally for that long (you'd do a tracheostomy). There is no freakin' way (except in Hollywood) that a person with an ET tube for 3 months can speak that well after an accidental extubation. But, granted, that movie wasn't targeting doctors as viewers.

That aside. It was, simply put, a show about fate, and soulmates, if you believe in such things. About how, if the time for something to happen isn't right yet, somehow someway your paths will converge again.

Hogwash, as some would say. But I'm a dreamer.

The main character is a herpes-positive transvestite who plays croquet profesionally.

Not really. She's a doctor.

The gist of it: workaholic doctor who falls into a coma. Meets the man of her dreams while her spirit's out roaming around. Man-of-dreams saves her.

And though the show was oozing with corny-ness and cliches at parts, the part that hit me at a deeper level, was when she pondered at how she spent so much time working, and neglected to live her life. Said something about how she was busy saving lives, she even saved her own for a tomorrow that never came.

Certainly could relate to the part when she catches 30 min naps after working 22 hours.

Overall, I enjoyed it. Go watch, and let me know what you think. Just don't bring any doctor friends. We'll spoil it for you.

Dogsat for a friend over the weekend. I've always been a dog person. My favourites? Beagles and pugs. So anyway, when Yvonne, a surgeon friend from Singapore, asked if I'd look after her dog while they went fishing, I jumped at the chance.

While it was fun looking after Fly, a mutt (perhaps with some collie blood in her?), it had me thinking twice about buying a dog. It's one thing having a dog outdoors in a kennel. It's another having a hairy dog shedding all over the carpet and furniture. Or having her wake you up at 230am with her barking. Or having her bring her toys to you (a frisbee and a piglet doll) with those puppy-dog eyes pleading for you to play with her. Or having to take the dog out for walks, and then having to grab up whatever crap (literally) she deposits. Yeech.

Granted, dogs are major chick-magnets; taking a cute dog for walks attracts females like bees to honey, but I'm sure there are other ways of attracting attention (Now, maybe if I took a dog for a ride dressed in hospital scrubs and having a stethoscope around my neck, all while driving a convertible. Now THAT's attention for you).

I know I've been having baby fever since I saw my nephew in May, but this makes me appreciate my freedom. Not having any dependents, human or otherwise. Not having a bawling, hungry, smelly baby with poopy skidmarks on his diaper, wanting to feed at some unGodly hour.
I'll just pop by Yvonne's place whenever I want to play with her dog. Kinda like how good grandparents have it; go to their kid's place to play with the grandchild, but you get to hand it back at the end of the day.

The Versatile Pager

The Totolola Advisor Gold™ Word Message Pager (name ahbeng-ified to prevent lawsuit). So versatile. Really. Their functions include:

• Alarm clock
• Patient-related messages
• Emergencies ("Code Blue...")
• Personal messages ("You left your fly open" or "Hot nurse at 6 o'clock")
• Means of Escape. If you get a really long-winded patient: "... and then I told my son that he shouldn't date that skank, but he did anyway, and so they...." you can just pretend you got paged (on silent mode) and just excuse yourself from the room (have done this more than a few times)
• Showing off (ooh, you must be a doctor...)
• Vent frustrations. Can't believe how therapeutic it is to accidentally drop your pager down the stairs. But, they must have anticipated these things... the damn pagers are indestructible. My friend in medschool once claimed she dropped her pager into the toilet by accident. Most of us didn't buy that
• Vibrator (in silent mode) (for massage-lah! What were you thinking???)
• Paper Weight (with built-in holster clip too!)

I remember when I first picked my pager up years ago. Wow, lookie here, I'm a real doctor now. 30 minutes and 20 pages later, I was ready to run it over with my car.

Had some interesting patients.
For one, had this guy with an LVAD. Left ventricular assist device. All you could hear when you auscultated his chest was the whirring of this bionic heart, keeping him alive until he could get something more permanent. He was actually able to go home (albeit with all the support hardware) for a few days before needing to come in again. Not that this would be a cure for cardiomyopathy. But just, sometimes what we're able to do in medicine is just impressive. What next? A bionic pancreas? After all, we already use insulin pumps for type 1 diabetes patients here. Implantable automated cardioverter/defibrillator? Already have that.

The other guy... was someone with cerebral palsy. I made a courtesy call to his primary doctor to let him know we admitted this guy for an infection.
"Ask him what day you were born on." Dr. Y told me, mysteriously.
So I did. He asked me for my birthdate. And I told him.
"Saturday!" He told me. In all of 45 seconds. Mentally.
Turns out, he has this gift with numbers. Amazing mathematical skills. My consultant's age was 43. And in 10 seconds he was able to tell us what the squared of that was (1849, and I had to use a calculator).

Mother Goose said in that poem of hers that 'Saturday's child works hard for a living...'

She's right.

On a personal note: Thanks for the messages in response to my earlier blog. I deleted it because I realized I was sharing more than I was willing to in a public domain. But I appreciate the notes of encouragement anyway.

15 Things You Didn't Know About Mua

Despite having been overseas since 1998, I'm still very much a mommy's/daddy's boy
I have 6 sets of suits (I wear a suit to work unless I'm oncall)
I'm a tie-pin & cuff links kinda guy
My car's name is Veronica
I love biking. Prefer biking alone, usually
The fastest I've ever driven was 110 miles/hour. I got nailed for speeding that day
I like to soak in the tub after a bad day
I love sentimental songs/movies
I hate doing CPR or running a code
Boxers, not briefs
Favourite women's scent: Pleasures by Estee Lauder
My favourite constellation is Orion
I have 28 ties & 1 bowtie
My favourite part of the female body is the collarbone
I like a confident woman. Can't stand the damsel-in-distress types. Neither do I get along with people who think they're beauty queens

The End is Near

The end is near.
You can tell summer's ending. The leaves are changing colour, some trees starting to shed even. The days are still warm, but the nights now have a chill. And the sun's setting earlier. It's still dark when I get up at 6.
Not that I have anything against the changing of the season. I do love the snow. And I think a white Christmas is one of the most magical events of the year.

The few things I had wanted to do before the season ends, but haven't yet:

Learn to fly a glider

Make a trip to the North Shore

Tattoo my right arm

Paint my study and bedroom

Bike 500 kms before winter (have done 270 so far, in the last 4 weeks)

Then again. Doubt I'd really do all of them.

That aside. Back on the inpatient service now. Which explains why I had to get up at 6 am on Saturday and Sunday (don't get a day off this week). Ran into one of my old patients, Mr. G, who was here at about the same time as the 3 stooges. This guy got his new heart a few days ago. We recognized each other when I went into his room for a consult, and traded stories from the last few months. He's still in touch with his old cardiomyopathy buddies, and tells me that their original group had 6 people on the cardiac transplant list. All waiting for hearts. Most with automated implanted defibrillators. Of the 6, the 3 stooges all received their hearts months ago. Another's still waiting, while another had died months ago. His heart just couldn't wait I guess.

Having said that, I'm still awed by how things move here. They do heart-lung transplants by the hundreds every year. Bless those people who pledged their organs. The one thing I find especially cute (cute... hmm... can a Guy use that word? Or is this making me look soft?) is how they give all cardiac surgery patients a special heart-shaped red pillow with a picture of the heart and coronary arteries on it. Patients who get bypass grafts have the coronary arteries on the pillows altered according to where the grafts went. And invariably, all of them get their family, doctors and nurses to autograph their pillows.

I signed Mr. G's pillow yesterday. That made my day, really. I'm glad he's doing so well.

Hot or Not?

There has been some recent comments on my blog about a certain author being hot. Really misplaced comments, if you ask me. Probably froma combination of:

a) Bad eyesight

b) Bad eyeglasses

c) Bad monitor

d) Bad taste

e) Touched-up pictures

After all, the only 'hot' I hear that's used in association with mua is usually when I cook curry for my kwailo or kwaipoh friends. But since this appears to be a popular (though unfounded) subject, I thought I might as use this to find me a mate.

So, like that other website....

Hot or Not?

"Never Again"

I saw my first Katrina victim today. Lady who was displaced from New Orleans as a result of the evacuation. I was consulted to see her by one of the surgeons to recommend evaluation of her primary hyperparathyroidism. But, we spent more time talking about how it was for her to go through that nightmare. The fear. For her safety. Those around her. The desperation, for even the simplest of things we take for granted; food, clean drinking water.

Thankfully, she didn't lose anyone in the tragedy.

Her home, last she saw, was still intact. But without anyone there, and with the looting, who knows now?

Probably doesn't matter anyway.

"I'm never going back to New Orleans. Never again." She told me. A tear running down her cheek.
I'm thankful I was able to visit that city earlier this year, for one wonders if it, its people, will ever be the same again.

Fishing trip

Had a blast fishing. My first trip. My friend Vincent, a hand surgeon from home, took us out to the Mississippi (it was more like a lake, really. > 2km wide) for a fishing expedition. He's kinda hardcore; his philosophy is, he's only here for a couple of years, so might as well do it before he returns. So he bought a truck and a boat. Invited ET and I for a trip, since he knew we had never done it before.

This was his boat's GPS system. Comes in useful especially on longer fishing trips.... like on Lake Michigan, where it kinda looks/feels like the ocean cos you can't see land at the end of the horizon. The cool thing was this had an attached sonar... so you could pick out areas with schools of fish.

Unfortunately, there was no such thing as beginner's luck for us. After 7 hours of fishing and being burnt to a crisp under the sweltering sun, all we caught was a 4 inch fish. Which we used as bait. All the while, the other fishes were taunting us; there were numerous 2 foot fishes that were leaping out of the water. None into our boat, however. Was tempted to pick up a large bass at the local grocery store, just so I could tell people I caught something. Bah!

At least we had fun. And I'm no longer a fishing virgin.

One of those days

Today I was gently reminded of a lesson I should have known better.

"Ultimately, this is your patient," Dr. M told me.

Too true.

This afternoon's events left me feeling so mad at myself. And so totally stupid.

I had seen a patient with hypercalcemia, high-normal PTH and osteoporosis last month. Perhaps primary hyperparathyroidism? I had wanted to obtain some confirmatory tests. But my boss that day said No. We have all we need. Just get a sestamibi.

I didn't quite agree, and had suggested some other tests, but he just brushed me off. After all, this was a 60-year old consultant with decades of experience, and I was a 2-month-old clinical fellow, so who was I to argue?

Well, as it so happens, her parathyroid scan showed a ditzel in her left lower pole of the thyroid.

"Just a hint" the nuclear radiologist told me. He didn't see it on the Iodine-123 or sestamibi subtraction images, but on the SPECT.

And so my boss made me get the surgeons involved. While I had this nagging doubt. After all, she was in her 70's. And her T-score wasn't all that bad.

They came by today. Wasn't impressed at all by her numbers. And as it turns out, I had a different boss today, who felt we did a sloppy job clinching the diagnosis in the first place. And I had to agree. It was as sloppy as sloppy went.

He realized the scenario after reading my other boss' notes. And gently added his words of wisdom:

"It may be your consultants who are in-charge. But ultimately, it's your patient. If believe something isn't being done right, you need to say something. Because ultimately, you will have to defend your stand and your actions or inactions."

And true as it was, I wasn't able to defend myself today, except with lame, "My boss made me do it."

We learn on the job. But really, I hate days like this.

Boy, talk about homesickness.

One thing I told my sis when I left home this year, for the 8th time running, is that it never gets easier. I hope she's stronger than I was when it's time for her to leave home next year.

But anyway. Today went well. Good day at work with some very interesting cases (I'm sending that lady to surgery tomorrow. Partial pancreatectomy). Got to play with some very canggih imaging machines; PET+CT scanners (amazing colour 3D images I never thought possible without cutting into a patient), thyroid and parathyroid nuclear scans.

And then I came home, was listening to the radio when I worked out in my gym. Boom. It hit me.

Micheal Buble's 'Home'. Man, talk about a song that will make you homesick.

If you're abroad right now, I strongly recommend you not listen to it. But if you're a sucker for punishment, check it out. It's actually a wonderful piece of music.

Kinda like that song someone introduced me to. 'When you say nothing at all' by Allison Kraus. That song's hauntingly beautiful; I'd marry the first girl who sings that song to me (Suanie, are you there??). Heh heh.

Addendum:

Just went in to check on my patient. Thankfully things went well. Distal pancreatectomy, uneventful surgery. I'm still awaiting the path report.

Thank God. I was anxious about her all day.

You know

You know you've been spending too much on flowers when:

• Your florist has your credit card information on file
• You know your florist by name
• Your florist recognizes your voice when you call
• The florist has the receipient's details on file
• Your florist emails you a reminder that her birthday is coming up
  AND
• When you mess up and write the wrong age on the greeting card, your florist reminds you that she's turning 27, not 28!

Bloody hilarious (and pathetic).

Miracle Blood Tests

Cancer test by bogus NGO
BY PARVEEN GILL
The modus operandi is sleek. A sweettalking “Datin” calls up the human resource unit of a company and introduces her NGO's cancer awareness programme. She claims it is endorsed and subsidised by the Health Ministry and is compulsory for all companies in the private sector. Once the bait is taken, a talk will be held for all women staff at the company's premises. Horror stories about cancer are presented and participants are asked to sign up for blood tests to detect cancer.

They finally highlighted the issue of blood tumour markers, after this non-existent NGO scammed some companies.

I wonder if this was what happened to BH (yes, YOU!) and S when they told me about their company offering these tests.

I remember my reaction.

"You're only 28! Why on #%$*^ do you need this checked??"

Anyway. This only serves to highlight the rampant, inappropriate use of these nonspecific tests. Wrote a letter to the Star's Letter to the Editor. We'll see if they publish that.

Remembering

You never forget the ones you wrote up.

I was cleaning my study yesterday. Which involved getting rid of a lot of my old notes, research papers, patient notes (I use a shredder), articles. And I found some of my old case report abstracts, stuff I had presented at medical conferences over the last 3 years. But the surprising thing was, I clearly recalled the patients I saw, the details of their case and why it was challenging/rare enough that it warranted a paper.

Like Mr. H with a chordoid glioma and panhypopituitarism (less than 30 reported cases then).
Or Ms. A with pulmonary hypertension and SLE (unlike scleroderma, pulmonary hypertension doesn't occur as often in SLE).
Mr. K with West Nile viral acute flaccid paralysis (poor prognosis for recovery).
Mr. T with severe pulmonary hypertension from chronic pulmonary embolism.
Mr. E with central neurogenic hyperventilation from large cell lymphoma.

Unfortunately, because these were complex cases, usually that means the patients didn't do well (we wouldn't write up the simple, straightforward cases).
But yes; despite these being up to 3 years old, I do remember them clearly.

Show of patriotism

Was surprised at the number of bloggers who blogged in Malay today. And the this was driving me nuts because in my mind, I had to translate things to English before I could follow the stories. It was kinda like 10 year old kid expecting to read Enid Blyton but finding advanced quantum physics instead, in LATIN, no less.

You know it's bad when your Malay's starting to sound like "Gua dali sekolar menengah san pol, Selemban mali punya."

I take full responsibility for this though; has something to do with being away since 1998, so I'm getting rusty.

Me, my show of patriotism will have to be limited to hanging my 6 inch Malaysian flag up in my gym, since I can't speak fluent Bahasa now. But that's gotta look bad too, a 6 inch flag beside a 5 foot American and Canadian flag (but I swear, I had a full sized Jalur Gemilang, until the president of the Malaysian club at my uni stole it 5 years ago. No kidding!)

"Err, makcik. Gua doktor. Mau periksa lu punya tetek."

(I swear to God that line was actually used by someone I know who spent years in Canada)