Stories from my Psych rotation

Looking at my sis' blog entry about her psych rotation experience (as a medical student larr, not as a patient), and talking to her about it, made me think about MY psych days as a med student 7 years ago.
I remember how, despite it being a cushy rotation, many of us were mentally fatigued. I think it takes a lot, listening patiently to depressed, manic or troubled patients. And perhaps I'm not made out to be a psychiatrist in the first place, but I remember being impatient. Thinking, "Snap out of it. What's wrong with you? This is nothing. You're lucky that your health is good!". Thinking that what they had was a poor coping mechanism. Of course, I'd never say it to them. And that's why I could never be a psychiatrist. But many of us actually felt depressed that month, just from all that negative energy we got.
Perhaps this echoes the study out of Oxford some years back (J Epidemiol Community Health 2001;55:296-300) of how psychiatrists have the 4th highest suicide rate amongst doctors.
Of the patients I saw as a medical student on psych, this one story stands out from the rest. Be forewarned: This gets graphic.

He was a man in his 40s who apparently was in the Canadian military's corp of engineers, admitted for severe PTSD (Post-traumatic Stress Disorder). He had done a stint in Bosnia (or was it somewhere else?). He displayed the typical symptoms; insomnia, nightmares, flashbacks, exaggerated startle reaction, irritability and panic symptoms, to name a few. He was haunted by things he saw during his tour. Things he couldn't forget.

Because they were engineers, and because of political reasons, they weren't directly involved in the war. They were not authorized to engage, as that was a civil conflict and did not involve their country. One day, he witnessed a horrifying event. Militia from one side held a couple hostage- a man and his pregnant wife. Because of the hatred they had for each other, simple execution wasn't enough, apparently. Restraining the man, they nailed his wife's hands to a wall. While she was alive and screaming, her belly was slit open. The late-term fetus was yanked out and shot. They then shot her in the head, all in full view of her husband. Only then were they satisfied enough that they had emotionally tortured the man to the fullest, and mercifully executed him.

My patient felt helpless to stop this. And this has haunted him since. Makes you glad that the rest of us didn't have to grow up in those conditions, or to witness that. You pray the ethnic disparities and simmering resentment in your home never leads to civil war.

7 years later, I haven't the foggiest idea what his name was, but I remember his face. 7 years later, I catch myself wondering how he is doing.

Oh woe is me...

I've come to a few conclusions about orthodontics.
One, only stupid people wear braces. Really (okay, I'm being facetious here).

After all, why else would you commit to a year or two of having your teeth wired up with metal that would probably set off the metal detectors at the airport? They are the vain and gullible people who believe that lie that teeth should be straight.

I say no.
Maybe, just maybe, we were meant to have crooked teeth. Individualized. Something that makes us unique. You know, like fingerprints. I'm thinking this now as I'm finding out that most of my friends here had braces at one time in their lives. Now doesn't that make you wonder? If more people than not have crooked teeth, perhaps we were meant to be that way?
Maybe God wanted us to have a way of identifying each other, if say, we commit a murder by biting someone to death. By making a match of the bite marks on the victim's ass to our dental records.
But now, thanks to Man's ingenuity and vanity, that's all ruined.

CSI Grissom: "What the hey? Here's ANOTHER suspect with matching teeth! What on God's green Earth is going on??"

Though to have our teethprints on our Malaysian ICs we'd have to carry wallets the size of Reader's Digest. And I imagine the airports would be a prime source of hepatitis A and rabies transmission, if all international passengers were to have their teethprints checked at immigration.

Two, I think I've figured out how braces improve one's looks. By making them look so shit-ugly for so long that people get used to it, that when they're taken off, suddenly they're looking like Pierce Brosnan, only younger. Even though they have the same ugly mug. Akin to how your eyes adjust to a dark room, and when you step out, you're suddenly blinded by glorious light. Even if it's just a view of the local garbage dump. Plus, you lose weight because of that liquid diet you're on for the next 2 years (unless of course liquid diet means Bud and Heineken and JD). After all, who'd wanna spend 3 minutes having a solid meal and 30 minutes cleaning the dang corn off the wires? Thank goodness though for silly Caucasian girlfriends with bad eyes who think you look like Jet Li, and for mothers. Then again, when my mom found out, the first thing she did was laugh. No wait, guffaw is more accurate a description. And the second was to say that I was vain. So much for the 'face only a mother could love'. That bumper sticker I saw comes to mind:

Be nice to your kids. They pick your nursing homes.

Just kidding, mom!

Oh well. Thus is the price of vanity.

Apologies to Coolcat and other Grissom fans...

Double Tragedy

Tragic. Dr. Norbaizura was killed following an accident involving the ambulance she was travelling in, during a patient transfer. And now, the MOH has the cheek to say that because she was 'not confirmed', her family would not be eligible for compensation.
Never mind that she was killed on the job. Never mind that these HOs usually don't have any choice when they are asked to go accompany the patients. Never mind that the inefficiency of the system causes confirmation to take up to 2 years.
In the meantime, docs are cheap labour for the government, with little liability for them.

The Star published my letter today, as well as those of others expressing outrage. Though they did chop a lot out and minced my words. You wonder, if your very own hospital, or employers, won't look out for you on the job, who will?
My friend Mat stuck himself with a dirty needle once, while working in GHKL. He told me that the hospital wouldn't do anything, and he ended paying for the prophylactic AZT out of pocket. In most systems here, should any mishaps happen on the job, the doctors are covered. Be it accidental needlestick injuries or motor-vehicle accidents.

The very least workers expect is for their employers to look out for them. It's too bad that that doesn't seem to be case with the MOH.

After All, It's Still A Business

After all, it's still a business.

These words still ring in my head.

He was a pleasant young man in his thirties. A bit of a worry-wart. But then again, with his medical history, who wouldn't be? He had his first myocardial infarct (heart attack) in his early twenties. Since then, he's had another 2. He's had so many angioplasties that he's lost count. The stack of medical records that came with him told of the 9 coronary stents he has. I didn't even know you could get that many stents.

Yes, he has a reason to worry.

His L_D_L was over 500 mg/dL (in his situation, should be below 70). Despite being on maximal doses of 3 medications to lower this. Familial hypercholesteroloemia*, refractory to the usual. In a last-ditch effort to lower this, we suggested L_D_L-phoresis. Think of it as hemodialysis for the kholesterol*. When I saw him next, his numbers were in the 200's. Still shitty numbers, but the best they've ever been, and very likely will impact his survival.

Until he called me recently, upset. His insurance company is now balking at the cost of the treatment, and will soon stop payments.

I wrote a very strongly worded letter to them. So did her other doctors. Without his treatment, there's a good chance he won't live into his 5th decade. But I'm not sure this will do anything.

When I confided to a mentor, who's seen this one too many times, he just sighed, and said:

After all, it IS still a business. These people make money out of the sick, or those who fear illness.

Healthcare isn't cheap. In the meantime, the physicians are helpless, while the sick die.

*Yes, I do know how to spell. Some words misspelt intentionally to avoid inadvertent Googling.

And it begins...

Like having bicycle parts stuck in your tooth.

That's how it feels, for those who have been asking me/wondering. To think that I'll need to have this in for up to 2 years. And to think that I only have the brackets on today (braces proper to go on next week).

For some reason, I'm imagining that that's how the bicycle brake mechanism would feel if someone inadvertently shoved it into my mouth for oogling his girlfriend at the park. You know, that part where the brake cable meets the part that holds the brakepads.

I had a lunch of rice and beef today. I had to swallow the meat pieces whole. I made sure my lunch companion was well-versed with the Heimlich maneuver before I started, just in case I started choking. Or, at the very least, he had the tools he needed to perform an emergency tracheostomy. After I was done eating, I could feel huge chunks of meat and leaves stuck in my tooth. Kinda reminds me of the joke friends told me last week, about being able to make a meal of the stuff stuck in the braces if one ever got hungry. Not pleasant, believe you me. Peritonitis with a perforated gallbladder would probably be a more appealing sight.

"Oh lookie here. So that's where I left my cheeseburger from last week!"

I guess this would be the start of my gruel-and-porridge diet. For those who know me as a carnivore, you'll know that I'd prefer to have my right (and left, come to think of it) testicle nailed to the wall with a blunt rusty nail than to become a vegetarian. This is gonna be a loooong couple of years.

Stay tuned. This blog will be renamed to Please Kill Me And End My Suffering; Why Did I Do This In The Name Of Vanity, KNNC-C-C-C-C-C-C-C-CB?

Why? Why at your age?
Why so vain?
Now? You crazy ar?

Those were amongst the questions with which I was peppered. Since you'll find out sooner or later, might as well let the cat out of the bag:

I'm getting braces. Yes, the ones for the teeth. Something I've wanted to rectify for years, but never had the guts to. I figured, since I'm working at a decent medical center with an excellent orthodontic department, and since I have good health insurance which would pay for part of this, I might as well get this done now.

Also, this will get the woman off anyone's back regarding issues of marriage, for at least a couple of years. After all, who'd want metal teeth in their wedding photos?
Some interesting factoids. Something I could use to distract people who stare a bit too much at the pieces of steak stuck in the metal wires.

Did you know that the correction of malaligned teeth has been attempted since 1000 B.C.? Or that the first orthodontic text came out in 1850? Wonder what they used back in those days to bind and hold teeth? Mammoth pubic hair? Tree vines? Shudder.

Anyways. They should be coming on in the next few weeks. So be forewarned; don't be drinking any hot drinks when visiting here unprepared, or else you might choke or scald yourself seeing any pictures.

5 Years Later

They say every generation has its moment, a historic event frozen in time so vividly in one's memory that a person takes that to his grave.
My dad once told me he remembers clearly still exactly what he was doing when he got the news of John F. Kennedy's assasination. Mom remembers that moment too.
I imagine for another generation, it might have been Pearl Harbor. Or the atomic bomb.
It's not difficult to imagine what that moment would be for people of my generation.
It was the day I learnt that evil truly exists in this world.
Before that moment, I was naive enough to think that man, inherently, was good. But that taught me that some people deep down truly are full of evil, and hatred. People who would maim, torture and kill for the sake of their own sick, blind and ignorant interpretation of what their God asks of them.
I was in KL then. Staying at a friend's apartment when he came knocking on my door. We watched CNN together. My eyes did not believe what they saw. A building on fire. Replays of the first plane flying into it. And then the 2nd. I remained glued to the TV. In disbelief. Horror. And when the towers fell, half a world away, it felt like someone had stuck a red-hot dagger into my very chest. I had to go into my room. I said a prayer for those who were killed. The tears fell before I was done.
I called my (then) girlfriend to make sure she was ok. Though, being in Canada, she was oblivious to the ongoing nightmare.
The news started trickling in in the next few days. I heard from a friend from medical school who was doing an emergency medicine residency in NYC at that time. She said in her email that it was eerie. They had prepped the hospital for a disaster, ambulances after ambulances, bringing in the wounded. But they never came. We know now, it was because they didn't make it.

I went to work the next day shellshocked. How I can explain it, I don't know; I knew of no one personally in the tragedy. But the pain was real. And so was the anger. The intense anger, and shame to be a human being, when at the medical school where I worked, this lady lecturer said, "Serves them right. They deserve it."
At that moment, I had to resist the impulse to go up to her and slap her across the cheek. Shouting. Doesn't she know masses of people were killed? Masses. Nothing can justify that act. No racial, religious, political differences. This comment, coming from a professional in an institution of learning, of healthcare. The irony. A product of a country's racist system, no doubt.
3 years later, on 9/11, I visited Ground Zero. Though the ruins had been removed, the mangled beams that made out a cross remained. A stubborn symbol of faith in man's darkest moment.

There were hundreds of visitors. Yet, silence. Everyone just looked on. Some prayed. Some held hands. Some cried. Some (family?) took turns reading out short paragraphs of biography of the victims. Perhaps afraid, someday, their loved ones would be forgotten.

That day changed not only families of the victims. That was a day that changed a generation. A day when the human species took a step backwards. And yet, a day when commonfolk and the men and women in uniform, showed us the real meaning of heroism.

No, we shall never forget. The ones who died. The ones who lived. The ones who reminded the rest of us what live, love and strength is about.

(And to the ones who think that your cause is worth killing thousands for, here's a big FUCK YOU. I hope you burn in hell)

Medical Research

Ever notice how the big medical studies all have catchy names?
AWESOME- Angina with Extremely Serious Operative Mortality Evaluation.
CURE- Clopidogrel in Unstable angina to prevent Recurrent Events.
HOPE trial. APLAUD. VITAL. PURSUIT. OASIS. CAPRIE. SOLVD. PROGRESS

No wonder the patients get blown away by medical research. Really. So long as the studies have a great name, the healthcare implications and the results don't really matter. Kinda like how someone with a name like Tom Cruise or Bill Clinton Brad Pitt would be destined for wealth, fame and having nubile young things throw themselves at you (after they throw their clothes off first, of course). Even if you looked like Gérard Depardieu.

Conversely, if your folks were high on sniffing glue and named you Bibimbap-KokKokKai, you're screwed for life even if you look like a Greek God and are hung like a baby's arm. Even driving a Mercedes SLK isn't gonna go anything except bring attention to the fact that you're pathetic and can't get laid by anyone but ugly ah-kuas with big hairy arms.

And, as we all know, doctors aren't too smart when it comes to remembering things, especially elderly doctors over 30 years of age, so it helps to have a study name that stands out.

I mean, why is it that you never see a study like:
Do CUp sizes correlate with back PainS (D-CUPS) study?
Lack Of Sleep and medical ERrors (LOSER) study?

Or the Loperamide Antidiarrheal Utility in Southeast Asian food Intake (LAUSAI ) study to see if these things can take on our mamak-food induced food poisoning.

Or the Porsches Help Lonely Endocrinologists Get Married (PHLEGM) trial? That could be an interesting prospective randomized placebo-controlled trial to study the effects of having a sports car on attracting women (study to be jointly funded by EHarmony and Porsche). We could use the Kenari for the placebo arm.

Simple.

The names ain't catchy enough, and so will never be published. In fact, I doubt the IRB would even approve of these. Doesn't matter if code of ethics are breached or not... if the name doesn't look good, it's on to the chopping board.
Someday, I'd like to see someone use DUMBASS or PANGSAI as their study name. Any takers?

North Shore trip

Two Harbors is a delightful coastal town on the North Shore area of Lake Superior, the largest freshwater lake on Earth. Kris and I made a trip there for the weekend since I'd never been there, and Monday was a holiday. We stayed at this lakeside lodge with an amazing view of the lake.
It was absolutely serene, and I especially liked the smalltown feel of the place. It's amazing when you consider that this 'lake' is over 250 miles long, and its maximal depth is over 1000 feet. You can't even see land at the end of the horizon. For all practical purposes, it's an ocean!

Anyways, I'm pooped from the 4 hour drive, so I'll stop here. Enjoy the photos.

What have I done?

What have I done? I think to myself, laughing and shaking my head.

The patient was a 64 year old farmer, a tough old bird, whom I first saw months ago when he was admitted for atrial fibrillation with rapid ventricular response. He was also found to be thyrotoxic, with impressive levels of free T4 and T3, no doubt a key player in causing his a-fib.

But true to his farmer personality, he didn't think he was symptomatic. He didn't feel the irregular pulse or palpitations (not uncommon). He did proudly report an 80 lb (36 kg) weight loss. I blamed that on his thyroid. He disagreed; he claimed to have intentionally lost this via a strict diet and exercise (as he told me that, his dear old wife looked at me with a half-giggle and shook her head).

A thyroid uptake and bloodwork suggested Grave's disease. I nuked his thyroid with an ablative dose of radioactive 131-I. When I last saw him, his blood tests suggested he was starting to become hypothyroid, and so I initiated thyroid replacement therapy.

Fast forward to this week; I see him again after 4 months. The difference was visible from across the room. He had ballooned up. No other word for it, he was now fat. 25 kgs in 3 months. And he was euthyroid. He feels a ton better; his energy and sleep and general well-being are improved. And he sheepishly admitted, maybe I was right, he didn't lose all that weight himself; maybe it was the overactive thyroid.

He asked me what he could do to keep the weight down. I told him to do it like everyone else; diet and exercise.

But I ask myself in jest, what have I done? I've created a monster. Heh.