TB scare

Now this pisses me off. A patient with TB who was asked to not travel, intentionally flew to Europe on a commercial jet without even a mask, sparking attempts now by the CDC to track down and test the other passengers.

The man flew to Paris on May 12 aboard Air France Flight 385, according to the Centers for Disease Control and Prevention. He and his bride also took four shorter flights while in Europe — Paris to Athens on May 14; Athens to Thira Island May 16; Mykonos Island to Athens May 21; and Athens to Rome May 21 — but CDC officials said there was less risk of infection during the shorter hops compared to the trans-Atlantic flights, which each lasted eight hours or more. It was while the man was in Rome that he learned further U.S. tests had determined his TB was the rare, extensively drug-resistant form, far more dangerous than he knew. They told him turn himself over to Italian health officials and not to fly on any commercial airlines.
Instead, on May 24, the man flew from Rome to Prague on Czech Air Flight 0727, then flew to Montreal aboard Czech Air Flight 0104 and drove into the U.S., according to CDC officials. Officials are trying to contact people who sat within five rows of him on the two longest flights for testing.

After finally finding out that he had an extensively drug-resistant form, he began to fear for his life and got his butt back to the US for treatment.

Maybe I'm being too judgmental, and true, it was his wedding, but in his selfishness he put numerous people at risk. Even if it wasn't the drug-resistant TB strain. Some may argue that the federally-ordered quarantine of the 31-year old is harsh, but under the circumstances he has shown himself to be irresponsible and selfish. What do you think?

Katrina Dreams

When I was in New Orleans earlier this year for medical relief work, the organizers showed us a music video of the disaster entitled 'Katrina Dreams', made to raise awareness of the Katrina aftermath. I'm glad I was able to finally find this online after months of looking.

I saw it again today, and it had the same impact it did months ago. My eyes welled up seeing what people had to go through, especially the baby in a cardboard box. I remember how it felt treating patients there. Far from the politics and complexities of medicine, just pure and simple doctoring and treating. It's why I decided on this career over a decade ago. And believe it or not, one of the patients I treated is on the video (he told me so, and was a prominent community figure).

I'm going to make this a permanent link on my blog.

Darned if you do, Darned if you don't....

She had been struggling with her symptoms for years. Because of the rarity of her disease (intentionally left out, you can guess but don't ask) her small-town doctors were not able to diagnose the illness. Episodes of sweating, dizziness, shakiness over the years progressed to confusion and even loss of consciousness and seizures. Which finally prompted a referral.

She underwent surgery last month which cured her of her debilitating problem. But, even in the best of hands, when you cut open someone and expose a sterile body cavity, the risk of infection increases. Which is what happened in this case.

Wound infection, septicemia, empyema, renal failure.

You catch yourself wondering if you should have left her alone in the first place. Despite her debilitating symptoms.

Then again, you never have a crystal ball to predict the future. And you know the risks of all surgeries are real, and that she really was in the best of hands and that even the best surgeon in the world is not God himself. And in this case, this surgeon probably was one of the best.

I keep my fingers crossed and pray for a quick recovery and discharge to home.

Cheap Thrill

Never been so close to a world leader before. But I ran into one in the corridors this afternoon. I swear, I could have just reached over and touched him (except security or the Secret Serv would probably tackle me or chop off my arm). After all, he walked past me no futher than 2 meters away.
It was cool, though, I have to say.

Phobia

Doctors do ghastly things to patients. That's a fact. Not intentionally, at least not maliciously, of course. But in our evaluation and treatment of patients, we strip off all fabrics of privacy and modesty. We ask them personal, intimate questions. About their sex lives. Drug use. We try to do it nonchalantly to not embarass or guilt them.

And then, there are the procedures. We stick fingers into orifices. Places that have never seen light of day. Needles into body cavities or organs. Catheters, tubes and endoscopes into lumens. We inject, aspirate, incise, excise, ablate, suture.

I thought about this when the patient whose thyroid we biopsied jokingly said that yesterday:

"Doctors do ghastly things."

Who can blame her? We talk in some foreign language, muttering 'nodule' and 'tai-roid'. We then lay them on a cold uncomfortable bed, with the pillow intentionally placed too low that it hurts your neck to extend. Then rub some cold goob that looks like it came from someone's runny nose (ultrasound gel). Then tell you to not talk, push a hard probe on your neck and proceed to stick your neck with a 25 G needle at least six times, while 'rolling' it between your fingers, sometimes even using a 'gun' to aspirate. Geez. The lady was a real trooper though. And even said I was cute (a compliment is a compliment, even from a short-sighted 65 year old; I'm keeping this one!).

Personally, the thing that scares the shit out of me is eye surgery. Be it Lasik, keratoplasty, vitrectomy, blepharoplasty or just foreign body removal. Call me a wimp, but the thought of someone messing around with my eyeball, with my eyes wide open, and being able to see it, unnerves me like a hyperactive kid in an antique china store. And I'm sure the surgeons are skilled, but what if someone slips? I'm not a surgeon and haven't the foggiest idea what would happen; but would the eyeball pop? Gooey liquid streaming down the face? (I'm sure the vitreous humour isn't like so, but that's how it is in my nightmares)
Next up on my list, a spinal tap. Now, I'm sure it doesn't hurt as much as a bone marrow biopsy (have seen patients soil themselves getting that one), but having performed many in my residency, the thought of someone else sticking a needle longer than a pen into my back, working it's way between the bones (and often scraping them) into the sac that contains the cord, while you're lying in a fetal position, helpless and unable to punch out that sucker hurting you, makes this my 2nd greatest fear.

In the scheme of things, I'm sure there are scarier, more invasive and painful procedures doctors do. But really, I think I'd rather have my nuts under a sledgehammer than voluntarily undergo those two procedures (though I hope I never do).

Truisms of emergency care

A friend who's an ER nurse sent this to me some time ago, and in keeping with Nurses' Week last week, thought I'd post this. Think it's hilarious, though I pray I never have to use the ER myself after reading this!

• Don't tell me you have abdominal pain as you eat Doritos in my triage booth.
• If you come to the ER by ambulance, the first thing I will ask you is how you are getting home. No, we don't have people on staff to drive you home, and don't tell me you don't want to "bother" one of your family members at this hour. You had no problem bothering 911 for the back pain you've had for 3 months.
• You don't get to pick your own IV site. This will irritate me and I will probably miss your IV on purpose and start your site in the place I wanted to initially to prove a point.
• Nausea is not a reason to come to the ER. If you are not in severe pain, are not vomiting or pooping your pants in front of me, your butt goes back to the waiting room.
• How can you have the worst migraine of your life, but be able to yell at me about the wait after you just put down a magazine you were reading?
• Don't ever say things like, "I usually get 4 mg of Dilaudid." Requesting a narcotic and dosage will prompt me to squirt out half of the med before I inject, then I lie about the dose.
• If you are allergic to Tylenol, Toradol, and Motrin, I have already assumed you are a drug seeker.
• If you came to the ER having a family doctor appointment that same day, I will make sure you are still in the department well past the time of your original appointment.
• I don't care if you are neighbors with the GI specialist. Unless he drove you to the ER himself, you can't be that friendly.
• Just because, "my doctor sent me here", does not mean you get right back to a treatment room. This tells me you are a pain in the ass, and he's pawning you off.
• The louder you moan/whine, the bigger size IV needle you get.
• Foley catheters cure pseudo-seizures. They also cure intoxicated persons.
• If you are on more than 2 medicines at home, bring a list. Don't say, "You know, the little white pill." I am not a pharmacist.
• RN is not synonymous with waiter/waitress.
• Don't bitch about missing breakfast when I'm on the ninth hour of my shift and haven't peed yet.
• What gives you the right to complain about your sore throat for a week while I have diarrhea from the antibiotics I've been taking for pneumonia?
• Broken toes are not an emergency. We'll make you feel stupid by putting a little piece of tape down there and kicking you out.
• If you tell me you have fibromyalgia or chronic fatigue syndrome, know that I'm rolling my eyes and thinking you're a loser.
• If you list Haldol, geodon, Xanax, and trazadone as allergies, don't tell me you have no psych history.
• Never sign in with chest pain because you were too embarrassed to write "penile sores" or "foul smelling discharge". This will piss me off that I bumped you ahead of other people and I'll make your visit horrific.
• Although you've been in the ER four times this week, you cannot list the ER doc as your family physician.
• Do not talk to me while I'm trying to listen to your lungs.
• Don't tell me you have no money for medicine while you have a carton of cigarettes in your purse (next to your cell phone), and each of your seven children are playing their own PSP's.
• Gravida 7 at age 22 means you are a slut.

Happy (belated) Nurses' Week.

Back to the grind

Ugh. 5 days here and I'm still struggling with jetlag. I for one don't react too well to this. I'm a really light sleeper, and to make things worse, usually function with 5 hours of sleep a day. And so, I'm finding it hard to really sleep in till my usual wake-time. Which explains why I'm fighting to keep my eyelids from closing, at 8.29 pm. Even a jiggling Jessica Simpson wouldn't keep my eyelids open.

Still struggling to catch up with my backlog of paperwork (research and patient correspondence), so I apologize for the lack of emails, phonecalls and blogging. Though the trip was a rush, it was special in more ways than one. A highlight was being able to meet up with so many people, some I haven't seen in, what, 7 years (Kowsai?). Some taking the time to come over after a tough day oncall at 11.30 pm. Some waiting patiently at some gas station in the middle of nowhere.

I'm reminded of some things:

For some friends, time has no meaning. You feel as though you last met up only yesterday despite an absence of years

Life is unfair. Despite biking 50 km and lifting weights 3 times a week, you look like hell and are balding, while your fat medschool friends are now thin and look like Hong Kong movie stars (heh heh)

Thanks, guys, for making this trip special.

In transit

Ugh. Incheon International Airport, Seoul, for a 3 hour transit. Flight was ok I guess, though we slept through it all. Guy behind Kris had long legs and kept bumping into her seat. If looks could kill, he'd been dead and turned to dust probably since somewhere over the east coast of Malaysia, with the glares Kris gave him.

Getting to KLIA was eventful. About 10 minutes away, dad's car got a flat tire. Kris said she was impressed by how fast we got the tire changed. Dumped the luggage on the road, got the jack and spare out, quick bait-and-switch and we were on our way.

Thanks for coming to see me off at the airport, everyone. It wasn't necessary, but it was nice to see everyone again one more time.

More updates when we get in to Minnesota. We'll see if they need a doc on this flight :P

Departure

We leave for KLIA tonight. Though this year, I haven't the luxury to sit down and really feel the depressing, impending countdown to departure. In a stupid way, I'm almost keen on getting back to work on my presentation to the division in 2 weeks, and my oral presention at a meeting in Toronto next month.
Anyways. I know I will miss Malaysia. With all her imperfections (the States has her own share of 'em too). The lush greenery. The food. The loud, rambunctious social interactions (something that unnerved Kristin initially). The language. The traffic. The squatting toilets. You know that though you return every year, something will be different. Something always changes. New highways. New buildings. Even The Star newspapers looked different. Even without your social network.
Friends and I were talking the other day when we met in KL. 4 buddies came to meet us, pushing 2 baby strollers. And the stuff we were talking about was vastly different from our highschool days. That was something new to me. And I know next year, there'll probably be a few more strollers (not mine!). I suppose that's the way life goes. The Stages of Life, reflected in your gang's topic of conversation:

• Which technique of throwing a guli (marble) is best
• How to impress girls
• Cars and cellphones
• Buying homes and getting married
• The best baby food, diapers
• Best school for your kids
• Hypertension/cholesterol-lowering medications
• Adult diapers

Alrighty, Malaysia. Thanks for a wonderful time. Friends, thanks for the well-wishes. Till the next time (July 2008?), take care.

The trip so far

It's been a busy couple of weeks. Probably a bit too busy, but it couldn't be helped given the short time frame we're here and the number of things we wanted to do.
The wedding went well. Was impressed by the planning my brother put into it. Executed with the precision of a general at Desert Storm. That is, until he got pissed drunk.
2 days after the wedding, we took the bus to Singapore, where we spent 3 days. Two things I learnt: 1) 'Executive' and 'VIP' buses usually aren't, and 2) 5 hours in a bus reeking of body odour is a dizzyingly unforgettable experience. Besides doing the usual touristy things, I was thrilled to be able to meet up with some buddies from Rochester, some I haven't seen in 2 years since they left. The last time I was in Singapore was about 10 years ago.
You also realize Singapore is so far more advanced than Malaysia. So terribly efficient. So clean. They even have comics in the public toilets to keep you entertained.Such a 'fine' city. (Heh heh, pun intended)From Singapore, we flew to Tioman for another 3 days. It was great, except that on the first night, my now-Americanized stomach couldn't take the local seaside restaurant/shack food. I woke up at 2am nauseated, with projectile vomiting, and diarrhea that would embarass even the filthiest of pigs. And the biggest problem was, while I'd usually tell my patients with gastroenteritis to take things easy and take only clear liquids until the diarrhea resolved, I was a glutton and kept eating. Even had sushi between my diarrhea explosions in 1 Utama last night. A doctor's worst patient.

But that aside, it's been a great trip. I just wish we had more time. As it is, we leave tomorrow night. And there are still dear friends I have yet to meet. Things I wanted to do. Foods I wanted to molest and savage. Char bohs I wanted to watch (oops. I'm a chained man now, aren't I?).
Well, there's always next year, isn't there? For those who met up with us, it was great seeing you again even for a short meeting. For those who didn't, we'll have to try to do this the next trip.

I've often wondered why I am here. Smalltown kid, somewhat of a mommy's boy, the person who got homesick going camping 1 km away from home when he was 12 years old. A boring, unambitious person, more contend being at home with family than leading an exciting life.

And so, it's a mystery to me why I'm here. Half a world away from home. 10 years of medical and postgraduate medical education. By fluke, by accident, at one of the top hospitals in the USA. So unlike me. Perhaps more suited for someone smarter, someone ambitious.

It was a mystery, until you came along. And then, the questions faded away. Suddenly it seemed clear why I was meant to come here. Why fate had planted me thousands of miles away from home. Why I suddenly belonged here.

Honey, the last year has been amazing. To be with the most considerate, thoughtful and caring person I know. Despite our vastly different backgrounds, it's unbelievable how things simply fell into place. Fit so perfectly. So well that I can't wait to see what the future has in store for us.

Kristin Ann Olsen, you have brought so much joy into my life. And I can only hope that I have done the same for you. Will you marry me?

Kristin: I said 'Yes'! He actually proposed (in person!) in Tioman, on the beach late at night. It was very romantic, and the ring is gorgeous. I'm impressed with his choice (Vagus: Heh, women really can't tell cubic zirconia from a real diamond!). Thanks for the messages, everyone! I had fun reading them.