Leave tomorrow.

Will probably have internet access there, so will keep you posted.

Wish me luck. My presentation's gonna be on Tuesday. No, not gonna say when/where, in case my stalker fans show up and steal my Care Bears™ undies.

Digression: I'm feeling so sick. There was a ton of food leftover from the Halloween party. Some are more perishable. So I spent the weekend pigging out on pizza, cheesecake, brownies and chips. I feel sick. Ugh.

Happy Halloween!

Had an early Halloween party, since some of us would be leaving for Montreal soon for the Chest conference.
This was something we started in medical school. Mainly because we never celebrated this in Malaysia, and you could never find beautiful, big pumpkins there. So this became a tradition for my friends and I. Halloween get-together every year, with a pumpkin carving session.

It was a great night. About 24 people, mostly from home, Singapore, others from Germany, US and Thailand. It was nice to get everyone together again. Though we're so far from home, it's nice to have an extended family here. I'm thankful for the friends I've made here, though some will leave for good in the next year.

After the parties, we usually keep the pumpkins outside for a week or so, and I light up the tealight candles at night. The problem is, those things are damn kid-magnets. We learnt this the hard way last year, when my housemate and I were postcall and tired, just chilling and watching TV, when kids came a-knocking.

"Trick or treat!"

We had conveniently forgotten it was October 31st. TS had ONE Snickers bar and I had some Miller Lite in the fridge. And for the moment, he comtemplated giving 3 kids ONE miserable bar to share. Me, I wondered if they'd appreciate beer.

But no. We sent them away (in retrospect, I know now it's acceptable to give money in place of candy). And watched TV the rest of the night with the lights off and windows shut. And so, this year I havea stash of diabetes-inducing sweets; job security for an endocrinologist, muahahaha.

Halloween 2003

Halloween 2004

Genius?

Dr. V is this nice research endocrinologist in my division. Almost geriatric, semi-hunched over with his thoracic kyphosis, steel-rimmed glasses and kindly eyes. Always remembers people by name. Friendly.

He seems to know something about everything. And then someone spread this rumour about him being one of the smartest guys in the world. Which we thought was just bullsh*t, the kind of rumour people spread like "TK's got genital hippopotamo-elephantiasis from fondling the squirrels' lanciau at the backyard."

(Obviously, I made that up. If I had you doubting for a moment, I think we can deduce your IQ. For the record, it wasn't the squirrels)

Until someone did a Google search. Keywords "Highest IQ Guinness Book of records". Holy shit, his name came up (obviously, I'm not gonna blatantly point out his name, but it's somewhere in there).

IQ 197.

Kinda makes you feel small.

But humble as he is, he never showed it.

I'm afraid to look him up on Medline. He's probably got somewhere in the 200 range or more publications.

I wonder how much ginseng and bird's nest I need to drink before I can get smart. I'd probably need to deprive generations of swallows of their home before I can break a hundred.

Why I hate Fall

No more burgers on barbeque grills
Too cold, with early morning chills.
No more biking on the Douglas trail
Instead, stuck at home, writing emails.
Leaves have turned yellow, then stool-brown
And soon, there won't be any around.

Changing of the seasons, a miracle in the making,

Perhaps, but Gawd, HOW I HATE RAKING!
Trees become bare, skinny like Kate Moss
Makes me wanna tell Mother Nature: Up Yours!

For I know, the misery that is to follow:
5 months of nothing but f*cking snow!
But instead, I tell myself, to grin and bear it.
To be patient, and to tolerate.
Who knows, what may be in store this winter?
Maybe Santa will bring me a spinster.

New Toy

Finally received my new toy today. Bought it a week ago, and have been anxiously waiting for the parcel to arrive for days.

Palm TX. To replace my 4 year old Palm m505. I'm kinda surprised the 505 survived as long as it did, upgraded mainly because I was wanting something with wi-fi, and my wallet has been giving my butt irritant dermatitis or something, and that itch needed to be scratched.

The specs seem impressive enough; 128 mb flash memory, wi-fi, bluetooth, pretty good display, MP3 capability. Spent hours tinkering, tranferring and installing files. So far, I'm somewhat guarded; in the last half day, this thing has crashed/frozen on me half a dozen times.

Granted, it was partially my fault too, I installed some ancient 3rd party software that's no longer compatible with the platform. But still, have yet to be impressed with the wi-fi. Seems to take forever to load a webpage. And it has hung a couple of times too (then again, perhaps it's my Conan-the-barbarian picture from my blog).

This product is too new on the market to assess. We'll see if it lives up to my expectations, for considering the moolah I spent on it, if it doesn't I'm gonna shove this down Palm's throat and ask for a refund.

Matched

My sis matched to her first choice! Dalhousie University medical school. Halifax, Nova Scotia, Canada.

So that means she'll be a couple of hours from me, and I can keep an eye on her. It'll be nice to have her nearby (relatively speaking).

But no, you're still not getting your allowance from me!

Congrats, my little pigling! You deserve it (with a lot of help from your dear old brother)!

Shepherd's pie alá TK.
I'm only putting this up because some people made me; couldn't send the picture for some reason (firewall?).

I read something today that really spoilt my night. Something that seems so uncivilized, so selfish, that it boggles the mind. Me, reading as a physician, a human being, and one with a grandpa who had a stroke.

I don't usually let things I read on blogs piss me off (unless it's something racially discriminating/biased). But this one entry was about how this blogger felt that the disabled shouldn't be entitled to have their own disabled toilets.

As far as I am concerned, you have a physical disability - and that is where you
have a disadvantage. Your bladder is working fine isn't it? So you wait, just like normal people do, when there is a queue for the toilet. The rest of us queue up to use a toilet - I don't see why the disabled should be any different. Don't even go near the issue of handicapped parking lots. That is different, because waiting for a parking lot is not a matter of 2 minutes.

Man, that takes the cake. I used to find her blog entertaining. And then it got shallower and shallower, nothing but pictures of her cute self prancing about under an inch of make-up (which is ok, everyone's entitled to some narcissism, even ugly people like myself).

It's obvious though, this person has no idea what a disabled person might have to go through. And no, often their bladders are not working fine, you moron.

The way karma works though, I hope she doesn't one day pop a cerebral artery and stroke out and become wheelchair-bound or something. Or throw a clot to her brain from smoking or taking oral contraceptives.

Or worse, have someone in her family become handicapped. Because the way things work, what goes around, comes around. Then again, with her out of the equation, it'll probably be different; I doubt the rest of the world is that selfish.

And yes, I'm intentionally leaving out names/web addresses. While I like to bitch, moderation is key. And secondly, in the unlikely event that a disabled person chances upon my blog, I'd prefer to spare that person from actually going to her blog and reading every immature, spoilt word.

Of autumm leaves and lor mai kai...

I LOVE AMY BEH!

Never met that lady, but bless her heart. She's a lifesaver for the people so far away from home. The one thing I've been really itching for (okay, talking about food here, not members of the opposite sex. That's another story...) is lor-mai-kai. Glutinous chicken rice. Yea, you can find it here, but dang it, I don't like the Hong Kong style where it's anemic like its hemoglobin is 5.4, and utterly fat and taste-free.

No, I'm talking about the dark-brown lor-mai-kai, the ones that are dripping in lardy-lardy-lard, with a creamy-sweet taste. The ones that come with a waiver, and that you have to sign away your rights to sue them if you get a massive myocardial infarct taking your 2nd bite. Now, THAT's quality LMK!
And so, on a gorgeous autumm Sunday morning, I start off wanting to make lor mai fan. And then I decided to try doing a search for lor-mai-lai on Kuali. Almost fell off my chair when I found the recipe. Compliments of Amy Beh. And not too difficult to make, too.

And so, ladeez and chanelmen, I present....

P/S: Needs more lard

This is a true story (didn't happen to me, but to someone I know).

A cunning but not-too-smart patient with narcotic dependence steals a prescription pad from his physician.
He thinks he's made it big, able to forge prescriptions for oxycontin, morphine and the likes.

Later that day, his doc gets a call from the pharmacy...

Pharmacist: Doc, I think a patient of yours just tried to fill a forged prescription...

Doc: Really? Who/what/where?

Pharmacist: Mr. X just handed me a prescription for Oxycontin 1 kilogram....

Doc: !!!

I passed!!

Hot off the press. I just found out 2 mins ago!

I PASSED! ABIM, you-be-damned!

I'm now officially an internal medicine specialist! Woo hoo hoo hoo!

And I can now flush my notes down the toilet and concentrate on Endo! (pantang-mar, dare not throw away notes until official confirmation)

How many people have you seen die?
Someone asked me that in a chatroom recently.

In the real world, most will deal with death perhaps just a few times.

Personally, I've lost count. 25? 50? 75? From the ICU septic patients to the CCU pulseless vtac to terminal cancer. Not that anyone's keeping score.
Something we don't think about much being doctors. Which is bad, because we become desensitized. You don't think twice about it anymore. True, we do show compassion, and we feel sad for the family. But when we leave, often we don't give much though of it anymore, other than the prayer we give when we go to bed. We talk about patients passing, sometimes saddened that our efforts didn't yield success. But the world keeps on spinning. And you sometimes feel guilty that you don't feel more.

Perhaps it's a defense mechanism? Or perhaps it's just become work. In IT, computers crash. In medicine, people die. Not a fair comparison by any means, but perhaps it IS because we've learnt to see it as work.

And no, I'm not some heartless SOB doctor. My patients can testify to that. Just that death has become routine. Though I dread the day when it becomes personal.

Case Conference

I'm so needing a weekend. Unfortunately, it's not going to be this weekend.

Have been busy with work the last 2 weeks. In large part due to a presentation I was to give to my division. A 45-minute, 52 slide talk on a case of mine, with a review of 7 articles related to the topic.

Noninsulinoma pancreatogenous hypoglycemic syndrome. Something most endocrinologists will never see in their lifetimes. But because of the referral bias we get here, something that my advisor has seen numerous times. And I was lucky enough to be a part of this.

My intro slide had the KLCC on it. A pet peeve of mine. I tend to stick pictures of Malaysia into every powerpoint presentation I've ever given. The tourism board of Malaysia should pay me.

Now that that's over, I can breathe a bit easier. Just a bit; I'm oncall this weekend, which explains why I woke up at 6am today. Won't get a day off this week, only next weekend.

Perks or qwerks?

A letter of mine was published in the Star a few days ago. The gist of my letter was the apparent random posting of some returning subspecialist. This came up after hearing of yet another case of an outstanding US-trained laparoscopic surgeon who was made to do donkey work in some other department back home instead of laparoscopic surgery. Despite training in world-class institutions. Not that it's his loss. Last I heard he's looking at jobs back in the US with a salary of US$300,000.
Surgeons being made to work in peds. Internists in surgery. Psychiatrists in obstetrics. Scary, if you ask me. The last time I treated a kid was 5 years ago. I think many share my concerns about returning.

"Many Malaysian doctors I know are keen to return. However, we all share the same fear, that after having trained for up to 10 years in our areas of sub-specialty, even in a top US or British hospital, that when we return, we are forced to work as housemen, in whichever department we are assigned to.

I know of a laparoscopic surgeon who was trained in New York and was not given the job he had trained for when he returned. I also know of a Malaysian anaesthesiologist who spent 10 years in the United States, who was made to work in obstetrics when he returned. "

Personally, I think I'm willing to live with the 1200% pay cut many of us will face working in the public health sector back home. But I'm not sure I'm willing to be posted an area I have no interest nor skill in. Which is dumb, considering we have less than 30 endocrinologists in the entire freaking country of 23 million. So my point was, why waste the expertise on random 'mandatory' postings?
Anyway. The President of MMC was kind enough to reply (condensed below):

"I refer to the letter,“Don’t waste these talents,” (The Star, Oct 4).
I would like to thank the writer for expressing his views, all done with good intentions, I am sure (is he being sarcastic or what???). New incentives introduced include:
·Exemption from compulsory service rule for Malaysian practitioners working abroad who are above 45 years old (both specialists and non-specialists), specialists with rare subspecialties (was just talking to Nick about this. Most of us are thinking, this sounds awfully vague and subjective, doesn't it? Which usually means, up to the whims and fancy of the MOH)
·Medical practitioners who have completed their housemanship and are accorded full registration with foreign medical councils;
·Although the Medical Act 1971 mandates that obstetrics and gynaecology posting be a compulsory component of the housemanship training, the Malaysian Medical Council imposes this ruling only on those who have recently completed their housemanship without undergoing this particular posting during the training. Medical practitioners with post-graduate degrees or specialists are exempted from this posting;
·On the issue of placement, the Health Ministry, being a caring ministry, will consider requests by those returning from abroad to work in specific areas or localities as long as their services can be optimised for the benefit of patients in need of their services (please excuse me while I throw up)
I am all for encouraging Malaysians working abroad to return to serve the country in the hope that their valuable services can be utilised fully to further enhance the standards, quality and accessibility of healthcare in this country. I give my firm assurance that the policy of the ministry to place specialists in their relevant specialty areas will be adhered to. "

Actions will have to speak louder than words. For although that letter seems encouraging, I do know of so many who were randomly posted. And perhaps it was just me, but I felt that the statements in the letter were so vague. 'Rare specialties'. Yea, right. Someone tell that to my surgeon senior who's making plans to leave. Or that Sarawakian anesthesiologist I met in Canada. Though he's happy with the life he's leading now.

When my time comes, I really hope they don't give me a reason to leave home permanently. For while medicine's ideal here, I really do want to return, and to help out.

KNN!

Went biking yesterday afternoon, hoping to chalk up another 50 km. But had to stop after 20; felt warm, almost feverish. And it almost felt tight to breath.

Ok, so I thought I was out of shape, or falling sick (maybe my herpes was acting up). And granted, I took my bike out after I rushed home from a 10 hour work-day, so no time to rest.

And then I checked the temperature. WTF?! Bloody 31°C! Not that I'm complaining, just that I didn't expect the temperature to go up that high. And look how it's gonna drop to subzero by Thursday night!

Well, folks. To see how we're gonna be freezing our balls off, feel free to follow our weather forecast into winter (link also on left).

Time to air my fall jackets.

Code 90

Wow. Have never seen all 3 M-1's on the hospital roof at the same time before. Suspected something was up when I saw the choppers just flying in an out, all at about 4pm.

And then I found out from a friend I had dinner with. There was a code 90 today. In my 3 years here, I didn't even know there was a code 90. Never heard one before. It's always been Code Red, Code Pink or Code 45 (blue). Means disaster or multiple trauma victims. As it turns out, motor-vehicle accident. Read it in the news today. 2 fatalities, another 2 critically injured. All flown in.

Just started pondering this after I read the entry in Gina's blog.

I hope things turn out well for the remaining victims, and their families.

Please, sir, may I have more Papadam?

Banana Leaf Rice!
Was missing my old Lotus® (Jln Gasing) and Kanna® (Section 17) days back in KL. So, out of desperation, we decided to make our own. I think we pulled it off quite well. Made papadam (brought in from Malaysia) which was very good, chicken curry, while CE made some spiced potato whatchamacallit.
Was able to buy banana leaves here quite easily.
Top it up with lai-chee water, and good company.... and wa-lá.... you got pretty a decent banana leaf rice meal. Restoran Nasi Kandar Khoo, M.D. (just bring your own imodium)

Turned out better than the roti canai (made-in-Malaysia) that I tried to make last week. Moral of that story: don't cook and internet-chat at the same time.

"I swear, it IS supposed to be black like that..."

Incidentally, the papadam was really good, and easy to fry. For those overseas heading home for a visit; consider buying packs for yourself. And for those at home wishing to contribute to my papadam addiction, feel free to email me here for my mailing address!

Eye of newt and toe of frog, wool of bat and tongue of dog...

In our quest for beauty or health, we're often willing to believe anything. Slimming teas, slimming massages, wraps, vitamins, birds' drool.

And for some reason I'm not able to comprehend, the public has this belief that 'if it's herbal and not a medicine, it's gotta be better...'
Don't quite understand why something's better if it's not properly FDA approved, and hence has never been studied to see if it works, or more importantly, if it harms. After all, that herbal slimming product that actress took did have one small side effect. And that's why she has a new liver now.
But anyway. It started with this. Fad about vitamin C injections and how it improves beauty. Something not sanctioned by the Malaysian Medical Association (and all other medical bodies I'm aware of).
So, a colleague of mine wrote about this in a blog in which I sometimes write. Which led to the stream of messages below.

jessy garcia Says: September 28th, 2005 at 12:28 pm
saya ingin bertanya, ape effect suntikan vitamin C??adakah ia
membawa kepada kesan yang tidak elok di masa akan dtg?saya terasa ingin mencuba
suntikan tersebut kerana ada kawan kawan yang telah mencubanye menceritakan
tentang kesan baik mengenai suntikan vitamin C..contohnye kulit mereka semakin
cantik, halus mulus, dan berseri..parut jerawat juga hilang disebabkan suntikan
vitamin C..adakah semua ini benar hanya kerana pengambilan suntikan vitamin
C?dan adakan doktor mengesyorkan untuk saya mencuba suntikan tersebut?adakah
suntikan vitamin C sudah mendapat kelulusan Kementerian Kesihatan Malaysia?

September 28th, 2005 at 2:05 pm
anyone..plz answer me..

Palmdoc Says: September 28th, 2005 at 3:00 pm
The answers are in the posting and comments above. Pls read.

jessy garcia Says: September 28th, 2005 at 3:22 pm
x fahamlaa…

jessy garcia Says: September 28th, 2005 at 3:24 pm
so, do u recommend me to take the injection???

Palmdoc Says: September 28th, 2005 at 4:25 pm
No.

gabby natasha Says: September 29th, 2005 at 4:15 pm
to me this is all about you and your body…every girl in this world
want to look beautiful..that is why we are willing to pay..but the real fact is
vit c jab is the most easy,effective and affordable choices that we have. i
don’t know about these bad effects and all that i can see is the better
complexion. beaty is pain afterall……

Vagus Says: September 30th, 2005 at 11:54 am
“…but the real fact is vit c jab is the most
easy,effective and affordable choices that we have…”????Omigosh. How gullible
can one be? What is the evidence for this ‘fact’?

fitri Says: September 30th, 2005 at 4:06 pm
i have inject the vit c and i think it’s good..i only
take it for about 15 dose..so..what u wanna say palmdoc?

Besides the obvious (poor quality of English), the thing that saddens me as a Malaysian, is how behind we sometimes still are, willing to believe every hearsay, rumour or chainmail.
Granted, when people are desperate, they'd believe anything. I remember when dad had his cancer; besides his monthly 5-fluorouracil, we also fed him bottles and bottles of 'herbal cancer-fighting' pills. God only knows what was in them. But that also reflects on how gullible, or naive we can be.

Call me an old-fashioned doc. Or new-age, whatever. But if I don't see a good study proving it works, then I don't believe it.

"I rubbed lhama dung onto my and after 3 months, it's so much larger!"