The Conference

.... was Awesome!

As usual, I love Chicago. And it's always nice when you're working with a very generous travel budget. We stayed at the Hyatt Regency.

The food here was great. Had shrimp and crabs and fish one night with my old buddies; the other night we had dinner at this interesting sushi fusion place called Sushi Samba. The food and service were excellent. I think it was Japanese/Peruvian (or was it Spanish?). Good music, and even bikini-clad Carnivale dancers! (and no, it wasn't THAT kind of place, in case you wonder).

The meeting was huge. A few thousand people, in several meeting halls and ballrooms. And as is the usual practice, so many pharmaceutical people, setting up these very elaborate huge-screen TV, colourful stalls. This one company had a certified fitness instructor prance around showing off this workout gadget, and once there were enough people, she'd give them out for free. You kinda realize (perhaps with a tinge of guilt) how big an industry this is, for them to spend tens of thousands of dollars just trying to impress physicians and do their thing. It gets murky here, and I don't want to start an ethics discussion, but they do spend a lot (at the patient's expense?) to attract us. Having said that, these companies have provided tons of educational grants too I guess.

The one pharmaceutical stall that takes the cake, must have been this company that dressed models up in body-organ costumes, and took pictures with us doctors, which were then printed onto complimentary mousepads! Hilarious!

"Mom, lookie here, I took a picture with Ms. Adipocyte!"

(I wonder if it sucks to have a job like that though)

The toys. Always an interesting issue. I read this in Atul Gawande's book Complications, and he describes this phenomenon well. Doctors and surgeons going crazy over cheap freebies. At this conference, people were making at least US$150,000 a year. Some in private practice, probably upwards of a quarter of a million (well, we're just endocrinologists you know. None of that $2.5 million per annum pay). But, in a huge exhibit hall with all this bright fluorescent lights not unlike kryptonite, people waiver in their strength. And go crazy over 2 dollar pens or 3 dollar thermo-mugs or lapel pins or measuring tapes or PDA software or theater tickets or laser pointers. Despite our salary. And these drug companies give out a bag for you to carry your toys in. And some people walk around with bags and bags full. Just smile at the drug reps, maybe listen to their schpiel for 30 seconds and walk away with a new laser pointer. I've heard for some surgical conferences they have given away Rayban sunglasses.

Ok, enough of that. Now about the conference proper. The talks and seminars were mostly good. My presentation went well. I an award for my presentation and got a nice prize. I had a feeling that was gonna happen when I had 3 different judges come by my poster and asked me to present to them when everyone else had only one.

The seminars have been good. Educational, good discussions. You realize too where you work and the impact your hospital's name carries. Because you meet all this people who present 'interesting' cases you've seen so many times, and their references include the professors you work with all the time. And you tell them, Oh yea, I know Dr. S. I had lunch with him last week. And how people are fighting to get into the lectures your colleagues are giving.

Disappointingly, again, no Malaysian doctors are here. 5 from Indonesia, some from Singapore. Numerous other countries, but none from home. Oh well. Was hoping to meet some new people.

Ok, this is enough of an update; my bed beckons.

And yes, if you HAVE to know, I shaved before my presentation. I figured I didn't want to be mistaken for a homeless person in a suit.

Gone for AACE. Back Sunday...

B-O-D-O-H

Some guys are proper idiots.

They get burnt. Sometimes stepped on. Taken advantage of. Often, as in my case, it's self-deserved.

Yet, despite it all, despite the nagging feeling that it's sometimes best to walk away and cut your losses, some idiot guys just go back for more punishment. Hypnotized, under a spell, like those bugs flying around one of those electrified bug-zappers. Like masochists who are too blind to see what they're doing to themselves. Because, sometimes no matter how dang-hard you try (or perhaps one tries too hard) there ain't nothing you can do about it. If the girl thinks you don't look good enough, or aren't eloquent enough, or don't make enough money, or whatever else, then there ain't nothing you can do.

My friends and housemate are trying to hold me back from spending more money on someone else. I'm kinda dumb that way. I have trouble spending money on myself if it's not electronic. But, when it comes to spending on someone I really like, be it flowers, chocolates or gift vouchers for massages, I work on a very generous budget. And believe me when I say generous. When you're a single doctor making American Dollars, you can do a lot of damage. And, if allowed to, I've been known to keep blowing dough for up to 3 years. Especially on the girls who are not interested.

Someone told me I'm persistent.

I think the operative word is stupid.

Just a few days. Though I have this overwhelming temptation to go out and blow US$150 on a gift card for a local spa and flowers, I just need to fight this for a few days until I leave for Chicago.

In the meantime, I'm gonna rely on my friends to remind me how stupid I am. And hopefully, I'll refraint from making a bigger fool of myself.

Results of tattoo poll

Results are out. I've been wanting to do something, a change of image. Since things weren't working out for me in the first place.
Ok, so chicks don't really dig tattoos. I won't get a tattoo. Fine. *sulks in the corner*
I'll just make do with the goatee and moustache.

True Story 1:

At my continuity clinic. Knocks on door, steps in.
Mr. X: Huh?? I thought we were here to see Dr. Vagus??
Me: Relax. It IS me. Just a new look.
Mr. X: Blinks eyes and adjusts bifocals. O_o ROTFLOL

True Story 2:

Starting a longdistance videoconference with mom and dad (our first time in 3 weeks)
Me: Hi mom. How are things back home?
Mom: What the??? WHAT DID YOU DO TO YOUR FACE???
Me: >_<

Of the old patients I've seen in the last 2 weeks, only ONE have said the new hairy look looks great on me. Unfortunately, he's a delightful obese truck driver with a faceful of hair not unlike Chewbacca. Hardly a credible source of compliments.

I'll shave sometime I guess...

1st BBQ!

We had our first BBQ of the season!
Glorious spring is here.
Our 2nd attempt at satay came out pretty good, I thought. And some new additions to the gang.
(and yes, you're seeing right. I'm growing a goatee. Just for the heck of it!)

On being a doctor

The bad thing about being in medicine, is everyone treats you like their personal physician.
This started literally 2 months into medical school, back in 1996, when I was this clueless greenhorn 1st year medic still trying to properly spell 'brachioradialis', and was still pronouncing papilloedema 'pap-e-loh-ee-de-mah'.

"Hey, your aunt ABC has this spot on her big toe; why don't you take a look at it?"
Like I was a bloody dermatologist then.
Or, when I was going through customs in KLIA in 1999 during my annual vacation. This idiot Encik asked me what I studied, and I told him, and he started telling me the 2 million symptoms his father was experiencing and wondered what that might be. My family was impatiently waiting outside, and they could see me peering at them. I think dad must have thought that I was caught smuggling Playboy magazines into Malaysia.

I mean, come on, I know we're friends, but what makes you think I really wanted to see if that lumpy goomba sticking out of your ass is a hemorrhoid? Sometimes you really don't want to know your friends THAT well (I still can't look that guy in the eye without seeing his anus. And when he winks, I just burst out laughing thinking about the anal 'wink' reflex!)

These days, I'm getting consults via MSN or phone, about weight loss, pregnancy, ejaculation, babies, coughs, colds, Pap smears, cancers, diabetes, chest pain, you name it.
I still get phonecalls at 5 a.m. asking me if they need to see a doctor for their cough.
And not too long ago, a blog reader was shitting in her skirt because she thought she might be pregnant (next time, use a condom. The withdrawal method doesn't work)
And the other day, someone else asked me if there was a 'quick, safe & effective way to lose weight'? Yea. I told her to stop eating.
Or that midnight call I got a few weeks ago, when a friend's friend called concerned about her chest pain (if you're reading this, my bill's one its way ).

So, if you ever have the desire to call me at weird hours, remember, I charge US$390 for an initial consult. And no, I don't take personal cheques.

Colleagues,
I regret to inform you that ABC received bad news from his CT scan today, indicating progression of his malignancy. He will be stepping down from the practice effective immediately and for the indefinite future. He wanted me to pass along this news to those of you who have been so supportive of him over the last few weeks because he knew you were concerned and would want to know what is happening.

Sometimes these things just hits a bit too close for comfort. A consultant in my division, someone I've worked with extensively in the last few months, just found out his cancer had progressed to the next stage. It was no secret that he had just completed chemo, and went for a head CT. The primary, rumour has it, was malignant melanoma. With this piece of the puzzle, malignant melanoma with brain metastatasis, has poor prognosis.

And while our patients face this every day, often physicians feel like they're above that, forgetting their bodies are mortal too.

Presumably, that memo that came from our section chair meant that Dr. ABC is stepping down, essentially, to live the remaining days of his life at home. Days, to be measured in short months.

Just 2 weeks ago when I gave an afternoon conference on growth hormone use in short pediatric patients, he was just jokingly giving me a hard time about my height. And, he co-authored that book with the rest of us, and I was thrilled to have him authograph his section.

The mood in our section has been gloomy the last week because Dr. ABC, while a controversial character with his blunt ways and crazy sense of humour, was well-liked. And one of the top physicians in his sub-subspecialty.

However things go, I hope he finds strength and peace to faces his days.

Ooommmmm

Holy cow.
What a huge day.
The Dalai Lama was here! Not some corrupt Dato', or crazy celebrity..

Here to our humble place. To give a special talk.
"Compassion in the face of Suffering"
The 14th Dalai Lama Tenzin Gyatso, spiritual and political leader of Tibet. In 1989 he was awarded the Nobel Peace Prize for, among other things, his exemplary commitment to peaceful resistance to Chinese occupation of the Tibetan homeland. In his Nobel Prize acceptance address, he called himself "a simple monk from Tibet," adding that, "I am no one special. But, I believe the prize is a recognition of the true values of altruism, love, compassion and nonviolence which I try to practice, in accordance with the teachings of the Buddha and the great sages of India and Tibet."
The city was a madhouse today. The crowds that came from out of town to see him. Me, I ran into some Secret Service people when I went into the clinic in the morning, and for a moment, thought the President was here. No kidding. 5 huge guys in suits, walkie-talkies, with the earpiece. Black limos with tinted windows were parked outside.
Though I couldn't get into the packed auditorium to see him in person, this was telecast to 20 other sites in the medical center, so I was able to catch most of the talk. Truly inspiring. He spoke from the heart. His own words of wisdom, not something written up by a PR speechwriter. Not something powdered up with poetic grammatical-correct phrases. In his own words. Almost like a father giving advise to his children. Or a grandfather sharing his ideas. What was the root of suffering. What what was important in life. Affection.
For some words of wisdom, you can find a video of the hour-long talk here.

I'm inspired.

(I hate to say this, and I say this with the utmost respect, but watching reminded me so much of the grandpa I miss)

I've been pretty quiet, I know.
It's been a busy week and weekend. I've been oncall for the last 14 consecutive days, and though it's homecall, it gets mentally tiring. Not to mention not having a day off in as many days. I terminate my call next Sunday, so it's another 7 to go.
Anyway. I was tired, so I decided to relax in the tub. Long hot soak, music, and a good book. Tuesdays with Morrie, one of my favourite nonfiction books. And as I read, it reminded me again of man's endless quest for bigger, better things, until it's too late. Perhaps I am guilty of that myself, being in the endless pursuit of medical knowledge, career, letters behind the M.D. that comes after my name; the pursuit that has taken me so far away from those I hold most precious, for the last 8 years.

"Love each other, or perish"

I remembered my patient too. The only ALS (Amyotrophic Lateral Sclerosis, or Lou Gehrig's disease) patient I ever saw, lady in her 60's. That was 2 years ago, when I felt like a hotshot senior resident. Had a constellation of neurological signs and symptoms, and perhaps out of luck, or wisdom, or perhaps for the lack of any other better diagnosis, I thought it was ALS, and sent her to neurology. They confirmed it.
They took over her care after that. Me, I wrote her up, and presented her at a medical conference. And never saw her again. And sometimes, being from the physician's perspective, especially if you never see your patients again, you can be pretty nonchalant. Forgetting that you just gave them a death sentence. Yes, sure, we're usually pretty sympathetic and we listen. But what happen when they leave your office? When they begin the downward spiral, when they begin the process of dying?
I wonder where she is now. I hope she's doing okay.

I like to think about that book as a 'reset button' to make you ponder about your life, to remember what's important and what's not. And it does make one feel blessed, to have all that one does, instead of focusing what one doesn't and is yearning for. I love that book.

Coincidentally, my other favourite nonfiction was written by another who was afflicted by the same illness. A Brief History of Time by Stephen Hawking. Someone who chose a totally opposite destiny with regards to ALS.

Whoops

Time: 2030 hrs Central Time, 0930 hrs Malaysian Time
Location: Home
Activity: Making an international phonecall to a birthday boy

(Ringing tone.....)

Her: Hello?
Me: Woi, leng lui!
Her: What? Who is this?
Me: This is TK lar. Where's your idiot hubby? Want to wish him Happy Birthday lar.
Her: I think you got the wrong number...
Me: Er. This isn't YF ar?
Her: No
Me: That was embarassing . Sorry, I must have dialled the wrong number..
Her: Giggle giggle. It's ok (you crazy weirdo prankcaller you...)

So BH, since I have no way of contacting you, and since I know you come here occasionally, Happy 30th Birthday, bro! Let the rest of us know how it feels to be old. Muahahaha.
(Hard to believe we've been buddies for 24 years!)

On a dark & stormy night...

Time: 2200 hrs

Location: At home

Activitity: Having a pillow fight with 4 blonde bombshells. Ok, fine. Watching TV and drinking Milo

Beep beep beep, beep beep beep, beep beep beep

Damn. My pager.

Me: "Hi. This is Dr. V. I was paged..." (Let this be a wrong number...)

Her: "Oh hi, thanks for calling back. Is this peds endo?"

Me: "Er. Sortakinda...." (read: no, this is the ADULT endocrinology fellow, who's doing a rotation in something that doesn't concern him)

Her: "Pardon?"

Me: "Never mind. Yea, this is endo. Shoot, go ahead." (Endo is endo, right? Kids are just small adults. Maybe I can clinch this one. After all I take pretty good care of my adult patients. And I AM board-certified in internal medicine)

Her: "Ok. Well, we have this 3 day old fullterm baby boy who had a newborn metabolic screen that showed bla-bla-blah-might-as-well-be-talking-in-Greek-cos-I'm-not-a-blardi-pediatrician-bla-bla.... So, what should we do? "

Me: O_o (I fight the overwhelming temptation to pretend I'm losing the cellular connection)

". . . . . . . . . . . . hmmm . . . . . . . . . .ahem, cough cough. . . . . . . . . . (scratches chin). . . . . . . . "

(Apparently, kids are not just small adults)

Her: "Hello, are you still there?"

Me: "Let me talk to my boss and call you back!"

Her: >_<

I hate this rotation.

Though I suppose this is better than when I was oncall for infectious diseases as a resident and got weird phonecalls from ulu-hospitals seeking advice on proper antibiotics for septic patients already on gorillamycin and tyrannosaurofloxacin. Now that was WAY out of my league.

Sick Kids

I remember why I ruled out pediatrics as a career choice 6 years ago.

I can't stand sick kids.

Not that I have anything against them. Just that, in my primitive, simple mind, kids aren't supposed to be sick. They're supposed to be cheeky, playful, noisy, bouncy. Poo poo and pee pee. Not sick.

I have this 5 year old with a humongous sellar tumour. Surgery last week; they were unable to save the pituitary stalk, nor the optic nerve. He's blind now. Having trouble adapting; crying in bed, whining, screaming. I don't blame him. A lifetime of visual stimuli, all gone. At so young an age. He'll never see the colours of a rainbow. His dog's face. People. The gaze of his wife. The sensuous form of a lover. His baby. Trees. The ocean. Instead, total darkness.

I pray he regains his vision. Yet, unless he defies the laws of anatomy and physiology, I know he never will.

Then, I saw a 7 year old girl the other day, with severe mental retardation, wheelchair bound, blind. Has a tracheostomy and on a portable ventilator for recurrent pneumonias. Can't eat, so she has a percutaneous gastronomy feeding tube. Recurrent pressure sore.

Aside from an occasional smile, perhaps random, she doesn't interact with the environment. Or her family. Has been like this since birth.

My emotions and mind were in turmoil. May the heavens forgive me for saying this: If I was her I wouldn't want to live. If I were her parents, I'd pull the plug. Not drag it for decades, bankrupting the family. Because this is existing, not living. Terri Schiavo comes to mind.

I respect her parents for their undying love and dedication, and for their strength, and not taking the cowardly shortcut that I am thinking. Because they're infinitely stronger than I will ever be.

But for me, life is meant to be lived. Not merely to exist.

On a different note: Thanks for the words of encouragement regarding my earlier post. I'm just going through a tough time right now having to deal with some interpersonal issues. Appreciate the words and prayers.

Oh, what I wouldn't give sometimes for total blogging anonymity. Things I'd like to say. Frustrations and disappointments and tears and anger and fear and bitterness and weaknesses and heartbreaks I'd spew out.

I'm a Millionaire

I'm Rich! I received this letter in the mail yesterday. I won US 615,810 Dollars!!! Woo hoo. Never mind that I never enrolled in any lottery, and never mind that this letter came from Spain and I have no relations there. I mean, come on.... the Spanish are known for their hospitality and kindness so maybe their International Promotion Program director gave me a break and decided to pick my name out of a hat and give me money. After all, I can speak Spanish. Ölé (hmm. Or was that Punjabi?)

Wow. That would be a cool RM 2.3 million. A millionaire. I always wanted to be a millionaire. So now I can get that Jag XJ 220 I've always wanted. And I can have promiscuous sex with any girl I want (coz if money can't buy you girlfriends, what can?). Anywhere I want. Even on my boss' desk, or on the International Space Station, because heck, I can pay them off. Heck, I'll even cover Veronica in a layer of 24-carat gold.

What? You scoff at me? Doubt this is real? Oh come on, have some faith in your fellow man. Do you think everyone's out to con people? Why should a total stranger a zillion miles away in a country I've never been to, not give me loads and loads of moolah, for a lottery I didn't enroll in? What is wrong with that? Don't I deserve it? Or maybe, just maybe, a patient I once saved was the governer of some Spanish city, and submitted my name for me. Don't you think this happens in real life? You make it sound like this is a scam.

What's really unnerving is how they got my address and name out of nowhere. I'm not even listed in the directory here. I'm assuming this is someone's half-baked idea to scam some simple-minded redneck of money.

"Congratulations, you've won money. Now give us $5,000 for processing and we'll give you the $1 million you did absolutely nothing to win"

Yea right. Though you see time and time again in the papers the stupidity of people: "Woman loses RM10000 to bomoh". "Man conned of $8000 in get-rich-quick scheme."

Then again, pot calling the kettle black: "Stupid doctor spends RM2000 on flowers for girl" or "Silly man buys RM300 rockclimbing shoes for woman who disses him".

(Having said all that, if this turns out to be a real deal, I'm gonna shoot myself for throwing away $615,810.00)