Heat Wave

Wahlan-eh. If balls could ever melt, they would today. Or at the very least, boil.

33º farking Celsius, with everything else factored it, a whooping 38º C (okay, okay, before you guys back there start giving me a hard time, I admit I've been too aclimatized to the temperature here).
Heat waves here kill, and that's a fact. Most vulnerable are elderly people and younger idiots too stupid to stay out of the sun who go biking without water.
It's true; I couldn't make it beyond 4 km today (usually do more than 20 km) and had to struggle to get back home. Coming in to the house, my fingers were numb and I was seeing black spots. I was also retching. I had to lay down with my feet on the couch for a few minutes because I was presyncopal.

Farking crazy when you consider that it was -23º C last November (drops to well below -30 in February).
Maybe being in north America for 8 years has done things to me. But I almost prefer the cold than the heat. You could always layer your clothes and wear longjohns to keep your eggs nice and incubated, but when it's hot, there is only so much clothes you can remove that is socially acceptable. And even if you're just home, 2 guys living together walking around butt naked gets the neighbours talking. Especially when one of them drives a sporty car with suggestive number plates.

Kinda reminds me of the joke about not picking up the bar of soap you drop... (there might be kids here so I shall not elaborate)

True, summer is barbeque season, and hot weather makes for skimpily clad joggers by the lake and bikini-babes at the pool, but heck, there is only so much pleasure your eyes can derive from these before you start losing your vision from the heatstroke.

On a day like this, if I could pick between wild animal sex with 5 Carmen Electras and a nice bowl of cendol with pulut, I'd pick the cendol. It's a no brainer.

I've been abusing Kristin. My own mother would be ashamed of me. Such shameful behaviour. And, of all people, by a physician. Sometimes I just need to remember that I'm no longer single, and can't do the things I used to do. Having a partner changes things. Can't take certain liberties for granted anymore.

Scenario 1:
Me: Babe, would you like some toast with jam for breakfast?
Kris: Sure.
Me: Hmm. Can't seem to find the expiry date on this jar of jam. How long do these things last anyway? (I believe this has been in my fridge since the days Helen and Nick were here)
Kris: They should last forever, no?
Me: Ok.
5 minutes later...
Kris: That was good, thanks.
5 hours later, I notice (in fine print) :

Expiration April 4 2006

Scenario 2:
Me, about to leave for work: Babe, help yourself to the cereal for breakfast, ok? Milk's in the fridge....

But what I didn't realize- A picture says a thousand words:

I mean, this is unacceptable treatment for a girlfriend. Totally acceptable way to treat a sister, but certainly not my girlfriend (Yen... would you like some milk? ).

No wonder I came home from work 2 days ago and found she had shopped for groceries for me (thanks, babes)

Research Blues

So I'm working on a thyroid project. Working on a research proposal for a grant ($$$) application. Dateline August 1.

Vagus: "Dept X? Yea, I need someone to sign my application form. The IRB (Institutional Review Board) has already approved my protocol."

Dept X: "Oh, you need to submit this for IRB approval again."

Vagus: "But this has already been IRB approved. You mean I have to request another IRB approval just to apply for a grant??"

Dept X: "Yes. And you need to fill in these 6 forms, and get someone from Dept Y to sign it too."

Vagus: KNNCCB!!!

Calls Dept Y.

Dept Y: "No, you need to call Z, not us..."

Z: "Nope, wrong department. Try A..."

A: "Wrong guy. Try B..."

B: "Hi, I'm away for the day, please leave a message with my secretary and I'll get back to you.... beep!"

Vagus: ^&*#!!!daoiquvnsl !!! (Cuss words that would make a prison deathrow inmate blush)

After a couple of days of chasing around, finally able to complete the paperwork, and had my secretary Fedex it away. Gawd.

Research. Worlds apart from clinical medicine. Never been one to be crazy about this; after all I consider myself a clinician, never a researcher. I like my patients too much. And data analysis drives me nuts.

It's fascinating though, sometimes. To do a chart review, for example, to dig into medical records decades old, to get a feel for the patient's past. You almost feel like an uninvited guest in their lives. Especially the ones you pull up that the computer flags PATIENT DECEASED. You know you're really looking into the past. You look through their records and find out how the disease was first diagnosed, and then treated. You almost sense how they struggled before they finally succumbed to their illness.

You almost gasp when you pull up a patient with papillary thyroid carcinoma that was diagnosed at at 12. Or shake your head when you read about the other one with invasive cancer going into the carotids with hepatic mets; though the patient might not have known it then, you know reading those 2 lines what that meant.

Not sure how this project will end up. We'll see.

(don't ask me for details. For obvious reasons my protocol will be kept confidential)

Another venting post

One of the things that irritate me as a doctor is health irresponsibility.

So, I help out at the free clinic here in town. Every fortnight for 2-3 hours, I see diabetes patients for free (usually it's 300 bucks a pop for a new consult). I enjoy it, really. And, considering the bad stuff I've done in my life, thought I needed to do some good to change my karma (probably community service for 100,000 years might do it). Seeing different types of patients, usually more grateful, less pretentious, less sense of entitlement.

And then, on some days you get patients like these:

31 year old type 1 diabetic, who runs out of long-acting insulin 3 freaking days ago. Calls up the clinic after my staff is gone promising to come in 5 mins but shows up 18 minutes later as I'm leaving. Wants more insulin eventhough she's never been seen at the diabetes clinic before. Doesn't check herself eventhough we give her the strips for free. Spends whatever money she has on cigarettes and booze. And has the cheek to demand for her medications to be filled immediately because her ride's waiting for her.

I believe adults are capable of making informed decisions on their own health. If you don't wanna live a long, healthy life, it's your own choice and I will gladly step out of your way.

But when they come to you wanting help but clearly are not wanting to help themselves, and in the process, causes inconvenience to you when you're doing them a free service, I draw the line.

As the Chinese say, if you're in a rush to reincarnate, just go ahead and be my guest.

Superman Returns

So I saw Superman Returns late last night with Andrea. Been itching to see that movie since 1990. The trailers and ads on TV only made me feel more like 8-year old Tommy trying to sleep on Chrismas eve. The show's been out for a some days, but Kris gave me that look when I suggested that as a date movie (almost like wanting to watch Transformers) (which, dear readers, apparently is being made into a movie, release date Summer 2007. I hyperventilated like a schoolgirl at a Backstreet Boys concert when I saw the teaser trailer 2 days ago).
But anyway. Superman. Man of steel. Blue tights and a red outerunderwear. Able to fly. See through anything (now, now...). Christopher Reeve was my hero. The theme music still gives me the goose pimples. Especially that part when it climaxes with the trumpets.
Gawd, I wanted to be Superman. My mom even got my brother and I matching caped T-shirts (I got a red Superman shirt, he got the wuss Batman's).

I enjoyed the movie. I was surprised to see that they meant this as a sequel; I had expected this to be a stand-alone movie (then again, Superman RETURNS, duhh). Same theme song. 5 years after where they left off. Apparently, they at one time considered Nicholas Cage to play the Man of Steel. Ole Nick? That's as bad as DiCaprio playing Anakin Skywalker. But in the end, I was pleased by their choice of actors. I read the late Dana Reeve had to OK the actors. This guy actually looked like Reeve, albeit a lot younger. Lois Lane, on the other hand, didn't look like the old actress (Margot Kidder), thankfully. I thought this new one was one hot mama (that's a hint of how the story goes..). The award, however, goes to Kevin Spacey. Unlike Gene Hackman's comedic, mad-brilliant baddie, this guy played a Lex that you really wanted to hate, or hurt. Like inserting a salt-lined unlubricated Foley catheter.

"Honey, do we have any more Metamucil?"

And what would one do with such superpowers? For example, to be able to see through ANYTHING? Never mind, stupid question (I foresee a market for lead-lined women's clothing).

So, go catch the movie. Just don't hold me responsible if you have the impulse to go leaping off skyscrappers clad in red undies and a cape.

She's Pregnant!

Today, I found out I got a girl pregnant.

Really.

And instead of balls-shrinking, nauseating fear, I was ecstatic. Beyond myself. It just made my day.

She was a 32 year old woman who had trouble conceiving for many years. Had bad acne, overweight and looked like a man. So they thought polycystic ovary syndrome. Her docs did some blood tests which were negative, and then decided to scan her head and found a pituitary adenoma on magnetic resonance imaging, high IGF-1 levels.

Acromegaly. They sent her to me. Pretty classical features, what with the ring size, coarsening features, space between her lower teeth. So classical that I had the medical center photographer take her pictures for teaching slides.

Her prolactin and other pituitary hormones aside from the GH and IGF-1 were normal. So I sent her for a transphenoidal resection of the adenoma, and she was dismissed a day after brain surgery.

Although her prolactin levels when we checked it were normal, the tumor stained for growth hormone and prolactin, so it was likely a co-secretor.

Saw her back for follow up today, 4 months afer I last saw her. I gave her my share of good news; the IGF-1, growth hormone and prolactin were normal. And then she sprung her good news: after 8 years of unsuccessful conceiving, she just found out 3 days ago she's pregnant!

Although the PRL wasn't too high, it likely was high enough to suppress normal reproductive function. So while I can't say for sure that we fixed her, I'm pretty certain we did.

I don't usually show too much emotion with my patients these days, but the 3 of us; patient, her mom and I shared a warm embrace. And I left work with my feet feeling a little bit lighter, my strides bouncier.

I bet I scared the crap out of Kris though, when she asked me how my day was. I replied, "I got a girl pregnant!".

On most days this is something most guys fear more than "Honey, I had a little accident driving your car..." but this I shall make an exception.

Today was the first time I saw Grey's Anatomy. Or rather, part of it. One scene had that Asian chick-doctor coding someone despite the patient being a DNR (Do-Not-Resuscitate). And in the end, she had to call it.

For some reason, that brought back a flood of memories.

Which of us doctors did not have to go through it? Pronouncing the patient. Or specifically, calling the time of death? I must have done that over 20 times in the last 3 years.

You ask the family for a moment of privacy with the patient. Auscultate the heart. Feel the pulse. Test for brainstem reflexes. Stick a piece of Kleenex into the patient's eye for corneal reflex. Flash a light. Turn the head.

And then you look at your watch. You say almost ceremoniously to no one:

"Time of death: 1:12am"

And you mutter a quick prayer for the departed that they may find peace, and go out to comfort distraught family.

Which one of us did not have to go through this?

She belongs to me

She belongs to me now.
I don't care what people say. I don't care that some people think she never 'belongs' to you.

I am her master.

I own her. I tell her what to do. And I can do what I want to her. If I feel like it, I can touch her, caress her. Feel that nice smooth round butt. Even in public. Even in front of family.

I can hurt her if I wanted to. Not that I ever will, intentionally, but I feel oh-so-powerful knowing that.
I can ride her whenever I want.
I decide when I feel like feeding her. Bathing her. Starving her.
She belongs to me now.

Yup.
I got this from the bank today.

(What, you thought I was talking about my girlfriend? She's a nurse. Nurses run the show)

I decided to pay off my 4-year car loan a couple of years early (it's nice not having to pay an arm and a leg for a car like back home, and oweing the banks for a generation). I figured I'd saved enough.
So now, Veronica physically, emotionally AND legally belongs to me.
I should take her out for a college-girls' fundraiser carwash to celebrate.

Then again. Veronica is a woman's name. I can't be selfish; she needs to be pampered too. So perhaps something she'd enjoy?

I'm making myself sick. I'll stop here. (Hey, you. Guy in the spandex undies. Yea, you with the butt hair. I said I wanted two coats of wax, not one)

My first time

So it's the new academic year.

I was in the hospital today, on an unbelievably hot Sunday to work on a grant application. Overheard some new interns talking. Asking some very basic questions about a certain procedure, and how to treat their patients.

Even a blind and deaf person could tell they were greenhorns. Not that all practising doctors didn't go through that stage at some point in their careers. There's always going to be a first time for everything.

Case in mind:

Neurology rotation in my intern year, when I was attached to the LP (lumbar puncture) clinic. For all you non-medical types, an LP involves sticking a needle as long as a pen in the lower back till it hits the sac of fluid that bathes the spinal column.

There was this obese man in his 50's, some bigshot in his company. You could tell he was nervous as hell (I was too, but I had a mask hiding my face). Yet he tried to pretend he was cool and unafraid. Tried to crack some jokes and make light of the situation as I was prepping his back with antiseptic.

Until this statement almost had me choking back a laugh.

"Hah hah, I wonder how you guys find those suckers to practice your first-time on?"

I was tempted to say: "Simple. Just as we found you".

He was my first time. But I didn't have the heart to tell him.

It's okay to cry

"Get your ass back here. Your patient's coding!"

I got that message when I was at clinic, on a sunny autumm afternoon back in 2002. My colleague was covering for my hospital patients. Among them Mr. C, someone who had had a rocky hospital course since he was admitted for compartment syndrome of the right arm 5 weeks ago. He was on anticoagulation for a prosthetic mitral valve. One day, he just bled into the arm spontaneously.

Compartment syndrome, needing a fasciotomy. Complicated by aspiration pneumonia. Rebleeding.

The team who signed him out to me at the start of the month had basically written him off.

Poor prognosis, they said.

Regardless, he stubbornly hung on for weeks. And then, ever so slowly, got better.

First his breathing got better. We corked and removed the tracheostomy tube. And then the percutaneous gastrostomy feeding tube was pulled. And he began talking, then walking. In the 3 weeks I had him, I got to know him better. I'd stop by at the end of my day, to say hello, and to talk to his wife to see how she was holding on. I got to know him, his fears of losing that right arm. His hope that soon he would be dismissed. He got so well that we started getting social services to help find him a temporary nursing home to rehabilitate.

It was a massive myocardial infarction, they later said. And his living will stated Do Not Resuscitate. So the code team did not resuscitate.

Immediately after I got that page, I drove back to the hospital like a maniac, almost running some people over. Left my car out front with the blinkers on, and rushed up to the wards. But he was already gone.

It was such a shock to him, this new medical intern of just 4 months, still idealistic and naive about what he can and can't do. Such a shock, because this morning, he had just told Mr. C he looked so good that he might be leaving soon.

In the privacy of his room, I said a silent prayer while holding his still-warm hand. And, slowly, the tears came down, progressing to small sobs.

I felt like I had lied to him.

And then, I felt a hand on my shoulder. It was Mrs. C. She had snuck in after me and watched quietly.

She embraced me.

She whispered, "It's okay. It's okay to cry..."

And I did. It was one of those very few times that I allowed myself to shed and share tears with patients or their families.

It's okay. It's okay to cry

Balls, or the lack of it

Read this interesting piece of Malaysian news. So, there's this local artiste who was engaged to marry a woman.

But shit happens, so he decides to call off the engagement. Though not ideal, these things happen, can't fault him for that.

What disgusts me though, is how he decided to do it. First of all, he uses the media to relay things to her for him.

And then, he sends his 'delegation' of family members to her place to tell her. Except he isn't there himself. And she happens to be out of her home at that time so he's going, "Ooh, but I tried to tell her. I sent my machas".

He may be a local singing sensation (actually, from what I understand I don't think he is, quite), but this is just pathetic, one that reeks of cowardice and totally lacking in honour and respect.

"Mummy, can you please tell her for me it's all over? Teletubbies is on TV right now."

It makes the rest of us men feel ashamed that there are people capable of doing this.

I don't consider myself a particularly courageous person. You can ask my girlfriend about how I was screaming yesterday when I got my undies wet while canoeing. And lemme see a flying roach while I'm on the can, and I'll run out of the restroom stark naked, body parts flinging around and all. But doing something like that would never even cross my mind.

And makes you sympathize with the girl. Because, unless she had sex with your best friend in the backseat of your newly cleaned car while parked in your garage and accidentally sitting on your pug Max and killing it, no one deserves this.

This is why I think it's ridiculous that some people even wanted to allow divorcing by just text-messaging them on a phone. Despite us wanting to be a civilized and developed nation, I think many aspects of our culture and society are backward and chauvinistic. I think we don't always treat women fairly.

Speaking of which, maybe someone at home could enlighten the rest of us; did they allow this practice in the end?

WILL B BACK LATE 2NITE. PLS PICK UP MY LAUNDRY. P/S WE'RE DIVORCING.

The Day My Girlfriend Tried to Kill Me

"It was a sweltering day on the Amazon. The five gallant travellers knew of the dangers of the waters. Alligators, they were aware, roamed the waters. Suddenly, the 6-foot long starving reptile lashes out at the Gnats' boat, capsizing it. They fall into the water, helpless against the laws of physics. The heroic doctor ripped off his shirt to reveal his rippling muscles, and dove into the cold water to save Mr. and Mrs. Gnat. Despite the piranhas and alligators in the deep. All while his fair maiden watched from his boat."

Actually no. Their canoe hit a submerged log at an angle, capsizing it. I took off my shirt to expose the pale-skinned beer belly, and waded in waist high water to recover the floating oars and to help upright the canoe. The water was cold enough that the family jewels secured themselves deep in the titanium-alloy vault.

Otherwise, it was a fun though uneventful trip. My clothes had almost completely dried by the end of the 2 hour journey. I was thinking just as we were reaching the end point how lucky that my camera was still nice and dry. Since Kris sat in front, when the boat came up to the bank, she stepped off first to disembark. To help secure the canoe, she wanted to drag it further onto the bank. Naturally, I wasn't going to let my girlfriend pull the canoe up while I sat my big fat pimply ass on the backseat, so I got up to help.

And that was when she pulled.

And I promptly flipped over. Into the murky 3-foot deep water.

With my backpack.

And wallet.

And cellphone.

And camera.

And dry clothes.

I knew something was up when she had asked me earlier where I kept my spare car keys.

This was a crazy dog from a nearby campsite that kept jumping in and out of the river, around our canoes. Too much coffee, me thinks.

Not quite sure what this thing is. It swam across the river. A beaver?

So I heard that one of the departments here is trying to cut down on its cost of medical transcription. Here, as in most medical centers in the country, we no longer write our clinical notes. Just pick up the phone and dictate, and in 2 hours my note's all typed up for me to review on the computer and sign.

Apparently, that department spent US$400,000 last year on this alone. Though it is a high amount, considering we had over 1 million outpatient visits in the year of 2005 alone, doesn't seem excessive. Our department head was bugging us about it too, to the extent that he reviews our notes sporadically and does word counts and provide feedback. I suppose this is good practice for those wanting to go into private practice.

So when I started off working years ago, my notes would be long-winded and full of irrelevant information.

This is a delightful 40-year old Caucasian man from Idaho presenting for evaluation of his poorly controlled type 2 diabetes mellitus. This was first diagnosed in 1984 when he developed polyuria and polydipsia. Complications include proliferative retinopathy status post photocoagulation, and nephropathy....

And then, I've learnt to be more concise and to the point.

40-year old man with type 2 diabetes for 22 years, complicated by retinopathy and nephropathy....

And now:

Sick. Need treatment.

Good Shit

Das is goot bier

Ok, that probably wasn't even close to a Belgian accent.

Suanie and FA have been harping about this beer forever. But I was a sceptic, after all, what do chicks know about beer anyways*? And then Gnat, the new couple from S'pore, talks about this too.

So, we were surprised to find it at the local liquor store. US $8.99 for a six-pack.

I gotta say, I stand corrected. This is good shit, especially for a warm summer night.

Suanie, this one's for you.

Cheers.
*Obviously, I was being facetious bastard. I happen to know some women who can outdrink, outburp me at the pub.

My Girl...

Ok, I made you readers wait long enough. Actually, she had okayed putting up her picture here weeks ago. But I thought I'd make you beg and wait a bit longer.

(though I wondered if I should be offended. Never have I received so many comments on one single post than that one mentioning her for the first time. So are you here to read about me, or her?? Hmphh)

Meet Kris. She's about as crazy and silly as I am, and that's why we get along so well. And not only does she swim and rollerblade and play softball and run and rockclimb, but she also bakes a mean pizza and great cookies. And she's just about the most thoughtful and smiley person I know. Unfortunately, she's also too good of a nurse; those dirty old men she looks after keep hitting on her.

And PLUS she actually thinks I'm a bit of a hunk (and for this I thank the Myopia God. I will forever ensure she never gets proper corrective lenses).

And you guys out there, don't even think about it. I know Tae-Kwan-Do. And I have my Beretta beside me.

PGY-5

So this marks the end of yet another year.

The academic year begins in July. So, now I'm officially into my 2nd year of fellowship, 5th year of postgraduate training, PGY5. It's surreal, sometimes, how time flies by you. 5 years.

I begin my research year Monday. A whole year in the lab, learning tissue cultures, PCR and things like that. Will be doing thyroid research with one of the leaders in the field (won't be more specific than that). While it will be nice to have a break from clinic, I'll miss seeing my patients too.

On another note, we did something different today. Went to a farm for raspberry picking (that's Kris in the background). It was a glorious day, and we all had fun.

It works like this: You get a basket and fill it with as much as you want, and you pay by weight. In the meantime, you could eat some too while picking. Couldn't believe how sweet them raspberries were.

Naturally, quite a few of them went into the mouth instead of the basket.

Credit Card Bill

Think Alfred Hitchcock.
T'was a dark and stormy night. The gallant hero slowly steps towards the mail. Slowly, purposefully, he slits the envelope open with his Victorinox.

Hands trembling like that of an elderly man with Parkinson's, he pulls the folded papers out.

He unfolds it.

And promptly lets out a bloodcurling shriek.

Arrrgghhhhhhh!!!

So much for giving my kid sister a Visa Platinum card.