The Year That Was

As 2006 draws to an end, I think about what this fateful year brought. I know it's a tacky phrase, but it reminds me yet again, time flies. It really does.

What has this year meant for me? What was special about 2006?

• I completed my specialty training in internal medicine, and moved on to my fellowship. Something that was a bit of a leap, since when I started my medical journey 10 years ago, I thought I'd get my Dr title, come out and work as a GP and start a family. Who would have thought I'd still be in postgrad medical education, up to 7 years after I became a doc?


• I turned 30. Yea yea yea, aside from the jokes and teases about bald spots, erectile dysfunction and dementia, it really unnerved me, realizing I was no longer in 'my 20s'. Not that being 30 felt physically different but it was a huge psychological milestone. Also, it unnnerved me to think I am now older than those beauty queens and models I drool over.


• I met a wonderful woman who brings so much laughter, joy and love into my life. She makes me so happy, it makes my head spin. And you know what? It excites me to imagine what the future has in store for us.


• This was the year that, after having thought otherwise for the last decade, I realize that my future probably lies here on this continent, than the land I call home. Why? Personal reasons. Career reasons. But most of all, looking at how things are going back home, I have sadly come to the realization that Malaysia will never truly be fair to all. That because of retarded politicians and idiots like Khairy, Malaysia will always have a 3rd world mentality. That controlled racism will always thrive. That some will always preach and practice discrimination, corruption, and racial hate. And while they claim to be fighting for their rights, to the extent of waving a weapon and making physical threats to others, they promote double standards, laziness and corruption, and ultimately, downfall of a society. And while that might work for some, that I cannot raise my family in a country in which some of her sons think that others are lesser people than them simply by virtue of race and religion. Simply because their ancestors arrived on a land before mine. And believe me, having missed and yearned for home for so long, this is a hard decision to come by. But for me, it's a necessary decision.

What about the future? Of my resolutions and goals for the new year? Well.

• Complete my current research project and get a paper outta it.


• Be more patient. With others as well as myself.


• Work out in my gym more. I had a pretty good workout schedule. Until I starting dating, and everything exercise related went to hell (now isn't that typical?)


• Learn to fly the space shuttle.


• Maybe, finally, will get a tattoo.

Happy New Year, everyone.

Toronto, Ontario

Dec 29th-31st: Toronto. It was absolutely freezing here, even for a Minnesotanized Malaysian. Still, it was nice to be in a major metropolitan city again. You could feel the energy building up for the new year countdown tomorrow. It's too bad we leave on New Year's eve. We spent most of our time doing things the Malaysian way:
Breakfast in hotel room, then out to Chinatown for 'real' breakfast of Vietnamese pho. Then walked around until lunchtime and had dim sum, then walked around somemore until dinner time, and ate again.
I-feel-bloated.
Still, it's been a swell trip. But most of all, I'm going to miss my kid sister. However, it's nice to see that she's doing so well, that she's grown into an independent young lady and doctor-to-be. I'm proud of her (shh... don't tell her).
Next report will be from Minnesota. Till then, cheerio.

Niagara Falls, Ontario

27th Dec: At Niagara Falls, Ontario now. It's great to be back here (was here 5 years ago), and this time, we didn't have to stinge and get a crummy room. We're staying in the Sheraton this time, with magnificent views of the falls right from our room. As usual, both the American falls and the Canadian horseshoe falls are illuminated by humungous multicolored spotlights at night. And because of the holidays, we get a fireworks display every night.We rented a car from the airport in Toronto, and with the aid of my Garmin GPS, drove the 90 minutes to Niagara falls. So we were able to check out the smaller surrounding towns as well, including Niagara-on-the-lake, famous for it's dozen or so vineyards. One of their specialties, icewine, a (pricey) sweet dessert wine harvested only during the winter.
One feels so small, so insignificant, being in the presence of the Falls. The thunderous roar of the water is audible from even half a kilometer away. And they say on a clear day, you can see the mist all the way from the CN tower in Toronto.
Strangely enough, looking at the falls, all I could think of was going to pee. Maybe the misty air does things to the prostate or bladder?

Halifax, Nova Scotia

23th Dec: Halifax, Nova Scotia. Nice Atlantic city with great seafood. Though we could have come at a better time; things were closed 25th-26th Dec. Still, it's great to be with family again.
It's weird to be back in Canada; I'm now confused seeing roadsign distances and temperatures in metric again, or seeing ads half in French. You remember that it IS after all, a different country.
It's windy like hell here, and with the added Atlantic dampness/sea air, the cold goes right to the bone. Kinda makes me feel like one of the crew on some king crab fishing ship.

P/S: We got 4 of our bags back after a day, and the fifth after 4 days. Dang that Air Canada.

You just know it's gonna be a swell holiday, when:

• The airline charges you US$25 for overweight luggage
• Check-in and airport security takes 2 hours to clear
• And the kanineh airline loses all 5 pieces of your luggage. Thankfully Dr. Vagus was smart enough to instruct his family to pack emergency overnight clothes in the hand-luggage in case of such an event. Except he himself didn't practice what he preached, and had to sleep in day-old undies last night. 16 hours out, and we're still awaiting word...

As I sit in my sister's living room looking at her Christmas tree and listening to O Holy Night on the radio on Christmas eve, I'm reminded of Christmases from long ago. Midnight mass in Seremban with my dear friends, and then mamak after that. Still the memories bring a certain warmth to my heart, though with a tinge of longing and nostalgia as well. God knows if we'll ever do that again. Perhaps the era has come and gone?

Merry Christmas, everyone. And gang, I miss you guys.

Merry Christmas

Will be off to Halifax, then Niagara Falls (ON) and then Toronto, starting tomorrow. Anticipating a swell week with the family, being able to meet up with the pigling again. In many ways, it's hard to believe it's Christmas again, and that 2006 is rolling to an end. It's been a memorable year, professionally and personally. It's enough to make me almost nostalgic. Almost, but not quite. Probably because it's past midnight, I'm not done packing, and we have an early flight tomorrow.
Will blog more after the trip. But for now, To all a Merry Christmas, and Happy New Year. Tell Santa to leave my presents at the front door.

Parents are here

So my parents are visiting from Malaysia.
What that means to you, my dear readers, is probably less updates on the blog, and less swearing, and less talk about sex and violence.
What that means for me, is their wonderful company, home-cooked meals, laundry service and ironed clothes!
Mom sneaked in brought so much stuff that it would have earned her a place on the Food Smugglers' Hall of Fame.
4 packs of curry powder (the ones here suck), 4 cups of kaya (including the ones in the plastic cups!), carton of Indomie Mee Goreng, Maggi, dried mushroons, anchovies, shrimp, coconut candy, Brahim's pastes, Portugese fish curry sauce, sambal sauce, dark soy sauce, ikan bilis paste, chicken stock. Enough booty to last me a year or more. In fact I still have that 2 huge packs of Milo from 2 years ago. Her shining moment was probably when the customs officer suspiciously eyed the kaya container, which had large pictures of chicken eggs on them (poultry products apparently aren't allowed in), and asked her if this contained eggs and what it was. Her answer was a convincing "It's just bread spread". Never argue with a mother.

And that was food alone, not counting my sister's stash of things. Unfortunately, her most precious, a Christmas gift from her boyfriend in Malaysia, was lost in transit. Mom had packed the beautifully wrapped box into her main luggage. But it was gone by the time it got her. Caryn was close to tears when she heard. I spent about 30 mins on the phone, talking to airport info, lost & found, Northwest Airlines info, TSA lost & found. Airlines these days can be so unreliable. But strangely enough though, like the mystery of the Bermuda Triangle, that package reappeared in Mom's bedroom in Malaysia. When we videoconferenced with family in Malaysia and vented about the missing package, my siter-in-law picked up a parcel and showed it on the camera and asked, "You mean this package?"
So much for mom having packed it.

The parents met up for drinks and dinner last night. Kristin's parents and mine, I mean. We all had a wonderful evening. I have to admit, I was initially nervous about mom and dad sharing baby stories, like the time I had a checkerboard seared onto my fat ass when I was 2. Digression: Was in the hospital for a case of gastroenteritis. After cleaning the toilet, they had neglected to wash away the corrosive chemical detergent which then collected in the spaces between the tiles. After pooping, I slipped and fell and suffered severe chemical burns on my tush (in retrospect, this is pretty good lawsuit material against the Seremban Hospital). Because of the pattern of the tiles, the burns I suffered looked like a checkerboard. For years after that, the scars remained and you could use my butt for checkers or chess if you wanted too. My mom would make me show that to their friends whenever they told that story. Thankfully, I didn't have to show my hairy butt to Kristin's parents. And the scars are gone. Though I imagine it'd be a lark to say, Hey Mrs. Olsen, wanna have a game of checkers? Anyway, they got along well, my parents and hers. I suppose that's a great start, for someday we might have to talk about dowries. On that note, I'm not taking anything less than 2 cows, 5 chickens, 4 goats and a dozen eggs. After all, I've been told doctors are high commodities these days. Even ugly ones.

Dear Santa (part II)

I've been a really good boy this year. Aside from feeding the poor, elderly lhamas at the Minnesota zoo, I've also been good to the environment by recycling my underwear at least 6 times before washing them. And, unlike those totally false accusations last year of me groping women's der·ri·ères (as I said last year, I was just brushing off a spider), there has been no such episode on my record (aside from taking photographs of thighs, but for that I blame those women's sexy attire. I am after all, just following the examples of our exalted Malaysian politicians. And we know how they in all their wisdom is never wrong).
Therefore Santa, I feel that I have earned the right to provide you with my Christmas wishlist. I trust you would be delighted in bringing me my goodies.

• Honda S2000 coupe Mercedes-Benz SLK280 hardtop convertible roadster.
• Xbox 360, premium edition. With the 3D human surface anatomy video game, Rumble Roses XX. After all, what better way for a doctor to study anatomy AND his hand-eye coordination? Santa, it's hard to find a doctor as dedicated to studying than I.
• Male enhancer, for err, my friend who shall remain nameless. No no, of course it is not for me. Why on earth would I need such a thing? So quick to jump to conclusions, Santa. You forget my college nickname was tripod.
• The next Powerball winning numbers, so that I may use the $33 million for the good of my fellow mankind.
• Life-sized pin-up of Carmen Electra, and if you can, her personal phone number Some ice for my bruises and some flowers for my girlfriend...
  
  

Your cookie and 'milk' (vodka and lime) will be under the tree. And in return, I, as a physician, would be more than happy to give you that prescription for Viagra. Don't be embarassed, these things are common in the elderly. Just don't take nitroglycerin with these. And don't worry, I won't say anything to Mrs. Claus.
Thank you.

P/S: And Santa, watch out for them 747s.

CYA (Cover Your Ass)

At CME conference today, we had an interesting if not perturbing but totally relevant subject. At least to doctors in north America. Medical malpr@ctice. Something that, on average, most doctors face at least once in their careers. Perturbing because the lawyer speaking made us realize how litiginous society has become, and how really, the only way to avoid someone trying to sue you, is to quit working. And even that doen't always work (think neighbour slipping on ice and falling on your sidewalk).

Kinda brings me back to that time when a patient tried to pull a fast one.

I had suggested the patient undergo a diagnostic procedure. The interventionalist explained to him the risks and potential complications, and he consented and wanted to proceed. And unfortunately a complication occurred, not due to negligence or lack of expertise, but sheer dumb luck (no invasive procedure is 100% risk-free. Never believe a doctor who tells you that), necessitating urgent treatment. After a few days' stay, he was dismissed with no side effects other than perhaps psychological.

I should have known something was up when I visited him late at night in the hospital, and the first thing he said was

"Doc, since I owe your hospital a lot of money for previous treatments and this happens now, what say we call it quits and you have them scratch off my debt?"

I told him it wasn't my call, and suggested he talks to admin. Last I heard, he's been harassing the staff and verbally abusing them, threatening to sue. He's left me alone coz he knew I wasn't the one performing the procedure. I doubt though that this will ever surface, because the complication was not due to negligence or error, and he had consented knowing the risks. But it does leave a bad taste in the mouth. Kinda like you've been taken advantage of, your trust of the patient has been breached. Makes you wonder why you bothered worrying if that was cancer, and suggested the evaluation.

Among the CYA advise the speaker gave at the conference was to document everything (which we all do anyways, even the 30 second phone calls we get) in the charts, and to not let patients tape-record your meetings. True, that would raise red flags and an eyebrow, and I'd probably feel that way if this work environment was more hostile, but really, how can you say 'no' to that sweet little old lady who can't remember your explanations of her diverticulitis and wants to record it for her daughter? I haven't said no yet to a patient who asks to record our meetings.

I suppose you could keep patients at arm's length and not let your guard down, but really I can't see practising medicine in that cold, formal, sterile (not microbiologically speaking) manner. I like the other approach; warmth, kindness, a hug here or there, hand holding, tears and laughter, and even a sense of friendship and trust. I hope I won't regret this someday.

Thankfully, the vast majority of our patients know we mean well and that we try our best. That we aren't Gods, and can't always prevent death or bleeding or infections when patients already come in really sick. So they trust us, and in return, we trust them.

It's just 4 drinks!

He was a tubby kid. Oh, about 22 years old or so. Pudgy, even funny face, in a Drew Carey sort of way. Laying on the cold steel table. My first autopsy. I remember how dark blood seeped out when we rolled him to the side, only it no longer looked like blood. I remember thinking it looked like motor oil. I remember how his half his lower teeth moved independently from the other half; he had broken his jaw right through. Motor-vehicle accident. And the pathologist said alcohol was suspected.

Some facts:

• In 2004 there were over 16,000 alcohol-related deaths in the USA. Equivalent to a fully-laden 747 jet crashing with no survivors, every 9 days.
• Most accidents did not happen to a chronic alcohol abuser, but rather, people who drink occasionally.
• The legal blood alcohol content in most US states is 0.08 %. For a 140 lb person like me, that's about a limit of 2 drinks before I fail a breathalyzer. However this is also dependent on how fast you absorb alcohol (empty stomach versus full) and how slow you metabolize it (and yes, it's a medical fact that some Asians lack the enzyme, alcohol dehydrogenase, to metabolize it).
• Many of us think you need to be drunk silly to cause an accident. In fact many alcohol-related accidents are caused by poor reflexes, impaired judgment, disinhibition and recklessness. Think about why you took a few swigs before you approached that chick at the bar, or popped the question to your girlfriend; it makes you more thick-skinned, disinhibited. Bravado.

In the last one year, two people very close to me have had alcohol-related accidents. In the more recent one, the speed of impact was about 100 km/h. The car, a Proton, had no airbag, flipped over from the impact. Possibly a good thing, for if the car had hit a solid block of concrete at that speed and was not able to decrease its force by flipping over, the accident may have had dire consequences. Going from 100 to zero in the few milliseconds it takes with no airbags would likely have been fatal. And t-boning another car at that speed would likely kill those passengers.

In the second accident, it was lower impact, but shamefully, regrettably, involved another vehicle.

In both of there, people could easily have been killed.

Perhaps for that reason, I at awake now, at 430am, unable to sleep. Feeling so angry. So anxious. Yet so relieved. And so grateful the God was watching over them. Praying that they have learnt their lesson.

It's a fact. Drinking and driving is taken lightly in Malaysia. The police hardly enforce this, and when they do, it takes just a few dollars to gearse their hands enough that they let you go. People don't think twice about taking more than a few drinks and then driving home. I daresay I've seen so many people, men especially, in my social circle back home do this.

I'm ok, I can handle my alcohol. Look, I can still walk and talk alright.
It was only 4 drinks. That doesn't apply to me. I'm not drunk. I'm not an alcoholic!

Haven't we all heard this?

But the truth is, you don't need to be drunk to kill someone on the road. Just intoxicated enough, just disinhibited enough, to drive a little bit too fast, to drive a little bit too recklessly. I know many of you who visit my blog drink. And many have families, or are just starting up. Some still in college. So please, don't drink and drive. You have a good life, don't throw it all away by killing yourself, or killing others and going to jail for it.