Ah. The wonders of Sitemeter.
A blogger is able to track the number of hits daily, location, referral site. Heck, if you paid a small premium you'd even be able to track the IP address of the visitors, secretly view their webcams and even operate their electric toothbrushes.

With this, I've found numerous interesting blogs that linked me over the last year.
People have also stumbled upon my blog via search engines (Eg. keywords: Hunky Malaysia Doctor). But the one that takes the cake, really, came from this.

"Girls doing sex with 5 doctors"??? WTF? Dude, if you're reading this, you're more desperate than I am. (If you are a dudette: I seriously think you need professional help. Here, call my secretary and I'll be happy to see you)

Obviously, my next question was, what did my blog have to do with doctor-orgies? If there was something, someone else must have been secretly blogging here, coz I certainly had nothing to do with it (not that I wouldn't have wanted to).

On to another topic, have you ever had a song, any song (though you hope it's not something like Lemon Tree, or that theme song by Barney the irritating purple thing) just keep playing in your head? Something you heard, that you can't just shake off like dandruff? Not to be mistaken for that voice in your head telling you to do bad things to people because Mother is unhappy.

I'm currently experiencing that to the extent that I actually went online and 'obtained' the MP3. It came up the night before I left, when Mavis took me out to this cosy, really nice coffee place in Seremban for a drink (Coffee Mug). They were playing songs from the 80's (I've heard of all the wisecracks about my taste of music, thank you very much, so none of that), you know, from groups like Starship, Lionel Richie. And then, WHAM, one song really just sucked me in. So much that I actually asked the owner what song it was (he didn't know) and though it was time to go, made Mavis sit there with me until it was over. Heck, now that I have the song, I've been sitting on the potty in the mornings with my MP3 player.

I'll be there, by Escape Club.

I heard it last sometime last month on that late night cheesy sentimental radioshow. A love song, albeit a sad one. About love that endures, even through death. Something I deeply believe in, and something I share with my patients when they have to say the ultimate goodbyes. I believe loved ones are still close by even after they pass on.

".... I still care; I may have died, but I've gone nowhere..."

That got me thinking about songs I like. There are some songs that we associate with certain events, certain people, certain memories or feelings. Special unforgettable moments or characters. Love gone wrong. Chances missed. Words unsaid. Kisses. Fights. Anything. Everyone's got them. I've got a list too long to include completely, but they include:

• Reflections of Passion- Yanni
• Please Remember- Leann Rimes
• When You Say Nothing at All- Alison Krauss
• I Wanna be with You- Mandy Moore
• Chances Are- Vonda Shepard & Robert Downey Jr.
• Angel- Sarah McLachlan
• Iris- Goo Goo Dolls
• All for Love- this particular one brings back warm memories of my pals. Memories of our form 5 days.

You probably know what I'm talking about. Coz I know some of you visit my blog.

What I learnt at work today

Jetlag makes you look more stupid than you already do.

Had trouble speaking, let alone think, at work. Especially at 2pm.

Me: "Err, re... re... (dang it what's that word I'm looking for?).... (doop-de-doo)... refractory... no...(&^!&!!)..."

Consultant: "Reflex?"

Me: "Ya, ya, YA! Reflex hypertension!!!"

I must have looked really dyslexic. Doesn't inspire a lot of confidence, does it? But hey, at least I didn't have to stick a 6-inch long needle into someone's belly while postcall and half asleep (the medical system's dirty little secret. Every resident has done that).

Read up on my old patients. As predicted, Mr. X passed away (peacefully, blessedly) soon after I left, on Valentine's day. Hard to imagine sometimes, or rather, easy for me to forget, that while I was half a world away, having a good time with friends, he slowly drifted away.

Mr. Y too. He went to a hospice and died while in the company of his beloved wife. I wish we could have done more.

Wherever they are, I'm sure they've found more peace than what they had in the ICU.

Monday morn'

As I sit here on my desk at 545 am sipping on my morning coffee (in part jetlag, in part due to the impending work), I'm having this sick, twisted, empty feeling in my gut. And no, it's not hunger.

It's quiet. Usually I cherish this. The moment to reflect, to think, even to daydream. But not today.

Where are the sounds familiar to me? My dogs barking. The crickets. The mynahs and their song. Dad's snoring. Alex's crying. My buggy sister. The school bus. The newspaper guy's motorcycle engine.

Instead... deafening silence. Slight hum of my PC. And the clock. Nothing else. No heartwarming, familiar sounds.

Could it be?

Am I missing home already?

I look at my list. 5, possibly 7 patients to round on. Pituitary apoplexy. Radiation-induced panhypopituitarism. Pheochromocytoma. Adrenal insufficiency. And hypothyroidism.

Vacation's over. Nothing else to do, but to get dressed and get to work. Pick up the oncall pager for the week. Back to the grind.

Vagus' Laws of Air Travel

1. The bladder size of passengers is inversely proportional to their seating distance from the aisle.

2. The body mass index of aircraft passengers is directly proportional to their distance from the aisle.

3. The screaming capacity of infants (measured in Decibels) on a particular flight is directly proportional to the duration of the flight, and inversely proportional to its distance from the passenger most needing sleep.

Enroute

Ok, so I lied.

I'm not blogging from the USA (yet).

Am at the Incheon International Airport, Korea. Have another 3 hours to kill before my connecting flight. Already did some shopping; bought some weird ginseng-chocolate for my secretaries, so I had nothing else to do.

So, am using the internet kiosk here. Which by the way is driving me nuts. USD3 for an hour, which is fair. But I am having so much trouble typing on this blardi Korean font keyboard that I'm close to quitting. Can't seem to get a backslash even. And half the words on this screen aren't English.

Lookie here. I can do 세ㅏㅜㅠㅊㅍㄳㄷㅁㅇ!!! I don't even know what it means, and for all I know I just cursed twenty generations of kids to a life without backsides (don't ask; old Cantonese curse phrase).

The flight was uneventful this time. All 7 hours of it. There was an infant 2 seats to my left, but no, he was good and slept all the way. Apart from my migraine, there was no medical emergencies.

Thanks everyone, for sending me off at the airport just now. Always bittersweet; in a way you kinda wish no one you cared about would send you off, so that it would make leaving easier. But, when you see your family and friends there, you're overjoyed that you get to say goodbye to them.

As usual, there was a lump in my throat just now. But it's gone now, thankfully.

Will report in when I get in at 6-ish a.m. Sunday Malaysian time.

Leavin' on Jet Plane

All my bags are packed I'm ready to go

I'm standin' here outside your door

I hate to wake you up to say goodbye

But the dawn is breakin' it's early morn

The taxi's waitin' he's blowin' his horn

Already I'm so lonesome I could die

So kiss me and smile for me

Tell me that you'll wait for me

Hold me like you'll never let me go

Cause I'm leavin' on a jet plane

Don't know when I'll be back again

Oh babe, I hate to go

There's so many times I've let you down

So many times I've played around

I tell you now, they don't mean a thing

Every place I go, I'll think of you

Every song I sing, I'll sing for you

When I come back, I'll bring your wedding ring

So kiss me and smile for me

Tell me that you'll wait for me

Hold me like you'll never let me go

Cause I'm leavin' on a jet plane

Don't know when I'll be back again

Oh babe, I hate to go

Now the time has come to leave you

One more time let me kiss you

Close your eyes I'll be on my way

Dream about the days to come

When I won't have to leave alone

About the times, I won't have to say

So kiss me and smile for me

Tell me that you'll wait for me

Hold me like you'll never let me go

Cause I'm leavin' on a jet plane

Don't know when I'll be back again

Oh babe, I hate to go

Cause I'm leavin' on a jet plane

Don't know when I'll be back again

Oh babe, I hate to go

Thanks everyone.

You make it difficult for me to leave. Mom, Dad & everyone else at home. My pals, especially Alvin, BH, Jerry. YT. MN. Till the next time, take care...

Vagus, signing off from Malaysia. Next blog entry will be from the USA.

25 hours to go

One more day.
This trip really just breezed by.
Today, at the pasar malam, as I strolled with dad, I told him I felt like a deathrow prisoner choosing what he wanted for his last meal. Should I take popiah? Or curry puff? Hmm, that looks good too.
Because of that, I overate. Literally. Kinda feel like I'm pregnant at 34 weeks, and that critter is about to burst out of my belly like that dude in The Alien.
Today alone, Ipoh sar hor fun, then hainanese chicken rice for lunch. Then, afternoon tea of 3 goreng pisang and one curry puff. Dinner was 12 sticks of satay and one popiah, and supper was a latte with half a slice of cheesecake. Bleh.

I remember thinking while at the night market of how I'll miss our culture. Then again, hours later when I drove past that area and saw all the rubbish strewn around there, for a moment I wasn't sure (really, we need to learn the simple rights & wrongs. We need to get past that).

Phases of a Trip Back Home

Week before Returning: The Can't Wait to Go Phase
Can't wait to go home. Can't wait to go home. Don't have to bloody put on 3 layers of clothes just to stop my balls from turning blue. I can actually walk out in shorts. And... oooh, lor mai kai, how I lust for thy flesh....

Days 1-2: The Hate-Malaysia, Miss-USA Phase
Jetlag
This is stupid. Why do Malaysians bloody drive like this? Why can't Malaysians be friendlier? Why can't things here be more efficient? Why must the bloody immigration department take so long with my passport renewal? Why must this place be so corrupt? Why is Proton so sucky? I miss Veronica.

Days 3-7: The Lau-Nuah Phase
Wahhhh. The girls. Omigod why did I ever leave Malaysia? So slim. So supple, gentle. So pretty. And the food. Perpetually bloated from the 5 meals a day. I'm getting dehydrated from drooling so much.

Days 8-10: The Adaptation Phase
Hmm. Home isn't so bad. Yea, it's not perfect, but neither is the USA. And yea, we're decades behind in terms of public attitude, and the medical system. But we'll catch up someday. And If I return, maybe I can help contribute and change what's lacking here. And hmm... that girl (Ms X/ Y/ Z) is really sweet. I wish I didn't have to leave. Maybe something beautiful would have come out of our friendship. She'd make a good partner in life.

Maybe I should just tell my program director I quit. To hell with my fellowship.

Days 11-Departure: The Regret Phase
Damn it. So what if I work at that bloody famous hospital. Doesn't matter how many degrees I get at the end of the day. Not if my dear friends are not around to share my life with me. Not if I don't have a family to come home to at the end of the day. Not if I can't have wild, rolling-on-the-floor, animal sex five times a day. Or have so much roti canai that ghee oozes from my ears and I bleed cholesterol. Farkdammit. Maybe I shoulda just stayed in Malaysia instead of getting myself into a residency and fellowship. Maybe I'd be happier being a regular Joe-MO.
I don't wanna go...

Departure-Arrival: The REALLY Homesick Phase
Err, Miss Stewardess, I want my mommy....

Week 1: The Surreal Phase
Huh? Did I really go home? Almost feels like I didn't. Hmm. I don't feel homesick anymore. True, I miss my friends and family... but that was how I felt before returning.
Shit. All the stupid clinical notes I have to sign. And patient phonecalls I have to return. Prescriptions to sign. And shit... I'm oncall for the week. Oh well... back to the grind.

Tongue-in-Cheek to an extent. But true in many aspects. The emotions I go through. I'm at day 11 now, so go figure. The feeling I get at the airport is incredible. Almost like it wouldn't take much for me to just rip my ticket up (oops. I got an e-ticket this year). Takes a herculean effort to hold back the tears. Chee How, the first in our gang to leave, gave this advice once; "At the airport, never look back. It makes it easier."

I wonder if they have teddy bears on that Korean Airlines flight I'll be taking? However, knowing me, the last tinge of nostalgia and sadness I experience is when the plane thrusts forward on the runway, and I look out the window, and silently bid Malaysia farewell, and pray that I'll be back soon. By the time we're at cruising altitude, I'm usually no longer homesick.

Public Service Reminder

Ok. Giving my talk at the IMU Seremban Campus tomorrow 2/23/06. Same talk I gave at Bukit Jalil last week.
1030-1130am.
Admission free.

Hellos & Goodbyes

Today was a day of hellos and goodbyes.

I got to see some dear friends for dinner (and lunch!) today, people I've been wanting to see for a while. Last time we met up was 10 months ago (thanks for taking the time to meet up with me).

Then, rushed off for another meeting with another bunch of friends.

It was fun, just talking and enjoying each other's company. However, this was a farewell of sorts for me too, for I knew I wouldn't be seeing them again for a year.

We talked about why it doesn't become easy. Even after 8 years. How do I even begin to explain this to people who have never been away for so long? For me, perhaps fear of change is a factor. Something always feels or looks different each time I return. The roads. Family. Friends. New baby. New car. Death. Emigration. You never quite know what you're saying goodbye to each time you leave. CC and I were talking about the topic of goodbyes over lunch too. How it can be difficult in life to make good friends, the type you call platonic soulmates, and then have to say farewell. Almost makes it not very worth it, doesn't it? But I suppose one can't go through life hiding, to prevent ourselves from going through the pain of separating.

You also leave behind a familiar culture. I'll have to revert back to speaking proper English. Perhaps even with a Minnesotan touch to it (Uff-Da!). I'll have to make do with Mix Fm online to hear our local accents. Leave behind family and friends who have learnt to read you like a book. Leave behind people who share your skin colour. Who look like you.

You change gears again. When's my next presentation? What about that abstract? Next clinic day. Next oncall. Need to check up on that patient post-radioiodine ablation. Or that postop lady.

Back to the daily grind. Back to my reality. I can't imagine why people would want to watch medical dramas on TV just to be a part of it.

What I miss about Home

We had a barbeque last night. It's become a bit of a tradition in my family (and circle of friends). Every year when I return, dad would organize a barbeque (he's a bit of a pyromaniac) and I'd get my friends to come. Except this year it was distinctly different.

Firstly, one of my bestest buddies couldn't come; his sister was getting married, and he has his own family obligations now.

Was able to get some friends from my past to come... people I haven't seen in years.

Also another couple from my closest circle of friends, just found out they're expecting.

We reminisced. Old camping days. Our days in the prefectorial board. Fun times. And realized, to our (or perhaps just me) that we're turning 30 this year. And while many has a lot to show (family), the rest of us don't. Aside from our careers, that is, which means diddly-squat at the end of the day. Really.

Nonetheless... this brought back old memories. After all, after the BBQ, we adjourned to the local mamak and hung out there until 3am. Like the good old days. Though I see these guys (and girls) only once a year... it's nice to see, to feel that the bond we have hasn't changed. It's nice to feel accepted for who you are, not because of that nametag you wear, or the degrees you have on your wall, or because of your publications (or lack of it), or that farking stethoscope you wear around your neck. Just pure and simple love & friendship.

I'm gonna miss you guys. More than you'll ever know. Because at the end of the day, when I'm down and tired and discouraged, you guys understand me. Perhaps it is true what someone told me, that sometimes what we miss more are the memories.

What I hate about Home

I'm melting.
And no, it's not even because of the gorgeous women here.
It's hot.
The forecast on MSNBC showed 32C at KLIA. While back in MN, it's currently -27C not including windchill. While after windchill, it's -37C.
Holy smokes. So between this week and next, my body will go through the shock of an almost 70-degree celsius change. Brings a whole new meaning to the words 'balls shrink'. A favourite phrase amongst my highschool friends.
The one thing that's really irking me this visit (well, every visit, come to think of it) is how we Malaysians drive. There's just something about us. Maybe it's the schooling. Maybe it's the air. Or diet or something. But we just absolutely farking suck at operating vehicles, whether it's how we drive, or park.
Just that day when I had breakfast with Alvin, I saw this Toyota parallel parked behind some other cars that were parked perpendicularly. The thing was, there were at least 3 empty parking spots there. Instead of spending the additional 30 seconds actually turning in to the parking, she chose to doublepark behind someone.
And then there's this weird phenomenon, when there's a traffic jam, seems that half the drivers develop some emergency. That has to be it, cos they all start driving on the emergency lane. Never mind that it hardly ever saves any time. Perhaps just, oh, 90 seconds. Which would be enough for, what, time to force one extra piece of poop from your rectum?
There are the impatient ones, who flash or honk you if you're in their way because you're overtaking someone and they're driving their little matchbox on wheels at 200 km/h? Perhaps that Cantonese phrase is real; they're all rushing to reincarnate (as Jabba the Hutt's next ass-pimple?).
Let's not forget too the Mat Rocks on their kap-chais. Rushing in and out of traffic, often without their helmets. Ever so generous for wanting to be on the organ donor list. Just remember to not pledge your brains.
Look, I'm not forgetting my roots, I am after all still Malaysian, and I probably drive just as bad myself, but it's true, having been overseas for 8 years.... it's true we absolutely, horribly suck at driving etiquette.

Tomorrow, I'll talk about what I do miss about home though.

Random Thoughts of a Friday Afternoon

It's 6pm over here. Sweltering heat, until the blessed merciful rain came.

I looked at the weather forecast over there in Minnesota. Apparently it was as low as -17 C. A foot of snow, my housemate told me (thank gawd I'm not having to shovel that. Bwahaha)

I catch myself wondering right now, if Mr. X and Mr Y are still alive. Chances are they're both deceased.

Peacefully, I hope. Because having to code Mr. X would be disastrous. Truly disastrous. And perhaps partially for my own selfish reasons too; I'd hate to be the one doing chest compressions, because you know you're going to be squishing out GI secretions from his enterocutaneous fistulae.

For whatever reason, when I was napping just now, I dreamt about my very last code. 8 months ago. Elderly lady with PEA (pulseless electrical activity). I dreamt about how NS and I worked on her for 15 mins. And just as we were gonna quit, her rhythm and pulses return. Except by the time I evaluated her during the MICU admission, I find her pupils dilated and unresponsive. Absent brainstem reflexes. And so, after all that work, we told the family she'd never come back. I had to request her husband's permission to shut off the ventilator.

Very Very Impatient People

Recently one of the issues that came up in the news was how some VVIPs were abusing the medical centers in Putrajaya.

Putrajaya Hospital Being Abused By VIPs, Says Chua

KUALA LUMPUR, Feb 14 (Bernama) -- Health Minister Datuk Dr Chua Soi Lek said today the Putrajaya Hospital is being abused by people claiming to be Very Important Persons (VIPs) and demanding "special treatment" when they seek consultation.He said that based on complaints by the hospital's medical officers, some of the doctors had been receiving four to five VIPs daily, who insisted on being seen by a doctor for outpatient treatment without following the usual procedure."There are people who claim they are VIPs, they cut queue, they don't want to be registered and they want to be seen straightaway. That's the issue. So the issue of VIP should not arise. The issue is that they don't follow the right procedure as a patient," he said.

Though sickening, for some reason I wasn't too surprised to read that. Considering how entitled some so-called VIPs already feel. I was horrified though, to read of Dr. Cheah's story of how specialists were made to leave their patients and drive 30 mins to treat a VIP with a minor rash.

Aside from the sense of entitlement and impatience, another factor, I feel, is their lack of understanding of how the system works, or perhaps they simply don't care. I.e: "I don't care if the healthcare sector is lacking, as long as I get what I want." I think the same applies to traffic... after all, all they need is a police outrider team, so why would they care about congestion in KL?

Anyway. My response, though edited, was printed today in the Letters to the Editor section. So, if I suddenly disappear, will someone please get me a lawyer (piffles... help!) and look me up at ISA detention?

The trip to date...

Slowly getting into the groove of things. At least now I'm not longer waking up at 3am. Time's really flying.... 4 days into my trip... only 8 days to go. Blardi hell. In short, this is how things have been:

Food:
Nasi Lemak

Roti roti roti

Lor Mai Kai

Fried kuey teow

Banana leaf rice

Murtabak

Dim Sum

Wan Tan Mee

Sushi

Satay

Siew Pau

Laksa

Rojak

Char Siew Rice

Girls:

Have been constantly nosebleeding since I came back. I forgot people start off being slim. What with my 400-pound can't-fit-in-CT-scanner type patients there. Omigod... my eyes were just confused having too many gorgeous people to look at in KLCC. Bangsar. 1 Utama. Even IMU, for that matter (I'll need to speak to college admin... we NEVER had anything like that. Unfair). Too many. So very pretty. Even my friend's Canadian wife was practically drooling at them (admit it, CW!).

Friends:

Have been able to meet up with some people, mainly my good friends from my hometown. Haven't yet been able to meet everyone on my hitlist; some bloggers I'm keen on meeting, some old friends. Looking at the way time's running out... I probably won't be able to meet everyone this visit too. So many people, so little time. Might have to cancel my Singapore trip too.

Valentine's Day:

Had a swell time, met up with a classy lady for dinner for Valentine's day. The dinner itself was kinda disastrous, starting the long wait for our table (they eventually forgot they had us waiting), what with the stupid restaurant service (we waited to order, and when I finally grabbed a waiter to place the order, he had the cheek to say the kitchen was closed! With a few choice words, I convinced him to take our order), and the crazy teenybooper Tanner Stage IV highschool Valentine's day couples infesting 1 Utama (but well, we were all like that once). Sheesh. But the night itself was fun. Always great to meet new people, especially people you've come to know online.

Traffic:

I miss Rochester. I was in a f*cking 3.5 hour jam from KLCC to Damansara to Puchong last night. One of these days, I'm gonna have a carton of eggs in my car, and egg every car that tries to shave off 20 milliseconds from their trip time by driving on the emergency lane. KNNCCB. What is wrong with these people? You know, these mentally retarded people shouldn't be given a license to operate machinery (or to reproduce and spread their gene pools, for that matter).

Weather:

Between this and the snow, I'd pick the snow. Really. I've given up trying to feel clean. You shower, and 5 minutes later you're clammy again. At least over there you never sweat. And you could recycle your boxers for a week. Not that I do that.

Ahem.

Well. 8 days to go. Will need to make the most of things.

Home

I'm home. Gawd... this feels so foreign, and yet so familiar.

As the plane was minutes away from KLIA, I had a clear view of the city, even recognized Sunway Pyramid from the air, KLCC. In the distance, I could see Genting.

Naturally, from the airport, we immediately went to a mamak stall. I kid you not. At 1am. Roti goreng. Murtabak.

I'm pooped now... need my rest. The flight... well, you'll think I'm making this up after my recent blog on this subject, but as it so happens, there was a medical issue that came up that I had to respond to enroute to Korea. I think it's protocol that the flight crew gives you something (cos I've always been given a present)... this time they gave me a silk PJ set.

Would have preferred an upgrade to business class, actually.

Good night.

The End

As I did my rounds today, trying to tie up loose ends before I leave on vacation, something struck me. Some of the really sick patients I'm following aren't doing well. In fact, 2 of them probably won't make it through the week.

Mr. X, who in a bout of severe depression, tried to kill himself by shooting himself in the gut. This was last October. Since then he's been in the hospital, fed by central parenteral nutrition through a PICC (peripherally-inserted central catheter) line because he had multiple enterocutaneous fistulae. In other words, his gut spews contents out through openings in the skin. We've supported him all we can, but in the last few days he's gone into multiorgan system failure. Shock liver, anuric renal failure on continuous veno-venous hemodialysis. Sepsis. Intubated. We have all the 'miracles' of modern medicine to keep the body alive for days or weeks, but sometimes 'living' is worse than death. He's already begun what we doctors call the 'spiral', slowly swirling around the vortex, about to get sucked in. I don't expect him to make it through the weekend.

And then there's Mr. Y. Post-MI, ischemic cardiomyopathy with an automated implantable cardioverter-defibrillator. Has been having runs of V-tac daily, triggering his AICD to shock him. Had an ischemic stroke. Now in renal failure. But because of his poor EF, wouldn't tolerate dialysis too well. After meeting with his family, he wished to be comfort care only. So we pulled all the lines. Removed his NG feeding tube. The uremia will take his life in 2-5 days. Hopefully he'll gently drift off into a coma. Yesterday they were still doing the full-cord press. But last evening he had had enough; he wanted to die in peace. So today when I visited him, there was nothing to say, except, "Are you comfortable?"

To which he nodded his head.

I held his hand for a minute, quitely said a prayer for him. And said goodbye. He knew exactly what I meant. The ultimate farewell. The celestial hospital discharge.

All this, and I'll be flying home in 15 hours to see my family and friends. So how does one walk away from all this? How does one pretend that one isn't all drenched with death, and the dying? We do what we can, I suppose. And life goes on for the rest of us.

Peace be with them.

"Is there a doctor onboard?"

T= minus 30 hours.

Will be flying off soon.

Rochester-Minneapolis-Chicago-Seoul-KL.

22 hours of pure clautrophobic bliss.

I read somewhere that within the US alone there is an average of 30 (or was that 300?) inflight medical issues/emergencies daily necessitating a doctor.

Me, I've been unlucky (or lucky?) before. Have had 2 inflight experiences. The first was classic; final year medical student, just completed a long surgical rotation. Was flying back to Canada from KL after an elective, somewhere over the Pacific, when they overhead paged for a doctor. It was a full flight, so I was pretty sure there would be a physician onboard. But there was none. And so I offered my help.

As it turns out, this Japanese girl, all boozed up, fell as she was getting up to use the little girls' room (they drink like fish, don't they? Then again, so do I). Hit the back of her head on the metal seat legs and suffered a 3 inch long deep gash. There was a small puddle of coagulating blood on the carpet, but thankfully the bleeding had slowed to an ooze. And so, because I had my precious new opthalmoscope in my hand-carry, was able to do a quick fundoscopic exam to look for papilledema (never mind that a med student would never see one in an undilated pupil). They had a suture kit onboard; but because the bleeding had stopped, we left it alone. But it would have been something to talk about if I had to stitch someone up in the plane; bragging rights for a year. They did give me a complimentary bottle of champagne to take with me though. I felt like a hero (who did nothing).

My other experience was on MAS, enroute from Narita to KL. Lady who was having her menses became syncopal when she got up. So, we just laid her down and raised her legs; suggested they move her to first class where she could lay down and get some blood to her head. Got a free bag of MAS toiletries on that one. No champagne. But my ego was inflated pretty big that time; what with the stewardess' all being there. But no, no one asked me for my phone number. In fact, they didn't even offer to move ME to first class.

Still, I can't beat what happened to Nick though, when a passenger coded on the plane. Probably has a post-MI arrhythmia (hubby said she was having chest discomfort that afternoon). They had to emergently land the plane. Apparently the AED showed asystole; they couldn't bring her back (you tried your best though, Nick).

The story that takes the cake though, was the one I read in Reader's Digest. Lady with a tension pneumothorax that was collapsing her lung. So happens there was a Scottish surgeon and a new medical graduate on the plane. Using drinking alcohol (I hope it wasn't Chivas), oxygen tubing, bottles and whatnots, they farking placed a CHEST TUBE on the plane and improvised a one-way valve. We're not talking about measly injections here, ladies & gentlemen. A bloody chest tube! And saved her life. Fark. Gutsy. Something you tell your grandkids. And have them tell their grandkids. About how grandpappy sliced someone's chest wall with a butterknife and shoved in a rubber hose to reinflate the lungs. All while in the smaller-than-a-coffin economy class.

So, this time, I'm just gonna load up on my benadryl and red wine, and go right to sleep. And pray someone doesn't pop a hemorrhoid or go into labour while we're somewhere over the ocean.

Valentine's Day

Valentine's day is coming. Good (or bad?) thing I'll be home. Anyway, there was a time I'd be crazy about buying flowers for a special someone. My personal favourite was cream-coloured roses, but obviously after RM2000 over 3 years that didn't work for me. And she had the cheek to tell me not too long ago the flowers from that company weren't too nice. Sheesh. Kanineh CCB!

However, this year, perhaps I should do something different. I discovered this company that ships sinful chocolate-dipped strawberries within the continental US. While I haven't tried them myself, I've heard good things about them. I've bought from them 3 times before in the past, and the service is excellent. Price is reasonable if you ask me, though one might not agree if you convert it to RM. Besides, she's worth it, isn't she?

(Answer: Loaded question. Always say yes, even if you have to lie and spend your eternity in hell. Same applies for "Honey, am I pretty?")

Anyway. If one wishes to be traditional and stick to flowers, I feel obliged to mention my KL florists who have done all kinds of shit for me, right down to having their delivery man send Starbucks coffee and sandwiches to my interest who was doing some consulting work in the Shell HQ; I was impressed by the successful completion of their 'mission' seeing that she was not a Shell employee and wasn't listed in the company directory, yet the deliveryman was resourceful enough to find her.

And then there was the time my credit card was blocked for transactions in Malaysia (a US security measure) but yet the florist said, "Don't worry about it, you can pay us later". Despite not ever having met me in person.

Last year, when I got the age wrong on her birthday card, they even gently reminded me that she was turning 27, not 28! Where else can you find a florist like this?

Lillian/Agnes, you ladies rock!

Sometimes, patients remember you. Sometimes they don't.

I got an email from a patient of mine. How they got my work email address, I don't know.

Someone I saw 3 years ago, when I was on cardiology, and she came in with respiratory distress from pulmonary hypertension. Looked after her for perhaps 5 days at most. Nice lady, her husband's a country singer; up-and-coming. So they emailed me now telling me he's finally making it big. Going to be on TV (can't divulge when/where/who). Visiting town soon, wanting to meet for coffee.

It's nice when they remember you. This was the same couple I ran into at dinner a year ago. They remembered me by name. And, surprisingly, I remembered them by name too, though I didn't quite recognize her because she had gained some weight and didn't look so cachexic anymore. I probably remembered their names because they had given me one of his CDs (autographed) before she was discharged.

Then, there's another patient. Someone I had looked after 2 years ago. Neurotoxicity from antipsychotics. He was in the hospital for 2 weeks. The psychiatrists said it wasn't possible, since he was on 'baby doses' of his medications. But there he was; after we stopped everything he got better. He's back out hunting and fishing now. Ran into him and his daughter last month. He doesn't remember me, he has no recollection of that hospital stay. His family remembers though. They think I don't remember the details of the case, but I do; I still have their card tacked on my wall.

Random thoughts

This is when I usually would start counting down. And maybe I am, but perhaps, just subconsciously.

I leave for Malaysia from this wretched, wretched wintery hell (-10.5C now as we speak)(though I'm exaggerating my sentiments) in 6 days. Due to arrive in 7, if a DVT and pulmonary embolism doesn't take me first.

In the past years I've had a calendar with a countdown, starting from a month before my departure. But somehow this year I don't. It's surreal; I know I leave soon. But yet it doesn't feel to be so.

Maybe it's related to a busy last few weeks. After all, I've had a steady flow of complex clinic consults all month. And clocked a few hours last week preparing for a presentation which I gave last Friday. Maybe too it's because I've been on hospital service the last 2 weeks. And am oncall this weekend, so will have to work a 14-day stretch before I get my day off. After all, why else would I be in St. M's hospital at 730am Sunday?

I also know, from having done this for 7 years, that once you get home, the countdown clock begins again; this time, you're counting down the time remaining before you leave. You look around, trying to commit people, things, places, smells, tastes, feelings, to memory, because God knows when you experience them again. If you do. That's how my grandpa left me.

And you pray you don't meet someone special. It's happened to me twice, coming back to home. Sometimes inevitable. You make a conscious effort to hold your feelings back; to not let anything develop beyond platonic friendship, because you know you'll be half a world away soon. Last thing you need is to have someone make it more difficult for you. Applies too to family; I shed tears for the first time in years last June, all because of a cheeky little toddler nephew.

Having said all that, I AM so looking forward to going home though. Tired. Time to recharge. I was at a party last night. I had fun in a way. Just not the kind of fun I enjoy. While dancing, booze in one hand, looking at the girls on the dance floor grinding their hips into random guys, I was thinking; this is so not me. Not my world.

I wanna go home.

A historic day.
Our institution's very first islet cell transplant. Though I wasn't directly involved in this case, everyone in the division of endocrinology's all hyped up.
Transplantation of pancreatic islets of Langerhans, either cadaveric or auto-transplant. Isolated and purified. The portal vein is then cannulated by the interventional radiologist, who then injects the islets in. Colonizes the liver, and starts producing insulin!
Though there is much to improve still as the technique hasn't yielded good longterm viability, this is an exciting step towards curing type 1 diabetes.
I doubt we'll see this in Malaysia in the next 50 years. In fact, I'm not sure if we even do pancreatic transplants for type 1 DM (can anyone enlighten me?).