Trip to Lanesboro

It was a beautiful Saturday. Feeling the need to be adventurous, we drove 30 minutes to the town of Lanesboro for a 2 hour canoeing trip. The Root River was just packed full of people, canoeing, kayaking, or just tubing lazily down the river with iceboxes of beer in tow. We ran into a lot of traffic as there were hordes of skimpily-clad sun-worshipping college/high-school age people, half drunk and just gayly babbling away. Others were trying to commit suicide jumping off ropes onto TS' head.
Being kiasu Malaysians (and one honorary Malaysian) we had a bit of a boat race closer to the finishing line. Strangely enough, despite working out in the gym, rowing till my trapezius and lats muscles were going to pop, my boat was inexplicably sluggish.
I suspected something was amiss. And turned around to check on my aft boatmate. And found out why.

She had blown a gasket. The poor dear. But nothing a little evening BBQ couldn't fix. Another casualty of the day: TS lost his ham/turkey sandwich that Kris packed in a ziploc bag. We found out only when another couple behind us made the horrifying discovery of finding the sandwich floating face down in the river. I did hear them say the sandwich looked dry. I wonder if they ate it?

2 stark contrasting situations from the last week. Of satisfaction versus profound helplessness.

I see a patient for poorly-controlled diabetes. He also tells me of some atypical symptoms, of which I am suspicious for occult coronary artery disease. After all, he is a high-risk patient. Because of bad knees (maybe laziness too?) he tells me he can't exercise, so I send him for a dobutamine stress echo, which is positive for ischemia. I refer him to the cardiologist, and the first cardiology fellow who sees him (who was a bit of a prick) tells it's not his heart, and that it was a false positive test. He suggested the symptoms were caused by 'male menopause' and that I should treat him with topical testosterone. Which needless to say, pisses the hell out of me, when the cardiologist tells me, the endocrinologist, what to do with the freakin' hormones when it's not indicated. Thankfully, with some bugging from my part, his consultant looks over the case and takes the patient to angiography. He sheepishly calls me from the cath lab: "It's severe triple-vessel disease. Dr. P will operate on him tomorrow". My patient undergoes surgery last Monday. He's doing great, and will be discharged today.

"You saved my life, doctor", he tells me (really, it was the cardiac surgeon). He's been introducing me to his clan of family members. It's a great feeling, knowing that you did something right. That your intuition and persistence paid off. The cherry on the icing was hearing that he thought the cardiology fellow was a dick, too.

This, in contrast to what happened to closer to heart, when my mom fell ill so far away from me. They had gone on a trip to Lhasa, Tibet, to take the famous train ride to Chengdu. At that elevation of 3700 m, many in the tour group had some symptoms of acute mountain sickness. Mom, however, developed symptoms to suggest HAPE (high altitude pulmonary edema). When dad called me at work, I felt helpless beyond words, not being able to do anything from so far away, besides giving some directions over the phone, and telling dad to by any means NOT let that stupid hotel doctor treat her with ceftriaxone (idiot was treating as though she had pneumonia. And ceftriaxone, despite us telling him she gets an anaphylactic reaction to penicillin). She got better after getting oxygen, and descending to a lower altitude. They arrived home in Malaysia 3 days ago.

Those who practice away from home know this well. That despite having been put through medical school by your parents, of having the best training or facilities, to not be able to do anything should loved ones fall sick. It's something we fear, something I've talked about with others in the same predicament.

After all, what does it matter anymore even if you make a difference here, when you can't help those closest to you? I catch myself asking that now and then.

It's a dilemma, one I hope not to face again soon. But for now, I'm glad mom and dad are back home in Malaysia and have recovered fully.

Open Day

If there ever was a time I was really envious of someone else's job, then last Wednesday has to be it.

There was a family day/medical transport demo at the airport to display our fleet of emergency transport vehicles. There was an ambulance, one of our 3 choppers, and 3 fixed-wing planes. With free mugs, brats and soda. The turnout was bigger than I expected, mainly moms and dads being lugged around by their kids. Prancing about excitedly, wanting to sit in the ambulance or chopper.

And then I came along. While everyone else was taking pictures of their kids, I had MY camera, and asked people to take pictures of ME.

And I was prancing about. The ambulance was pretty well-equipped. Never had the chance to look inside our Malaysian hospital ambulances, but I've worked in the St. John's ambulances before. Which were essentially just vans with 2 stretchers and a siren. These ones had the whole nine yards. Oxygen, intubation kits, ambu-bags, medications to run a code, computer, suture kits and a defibrillator.

The creme de la creme for me, obviously, was the chopper. Strangely enough, all 3 of our choppers have the same name. M*yo 1. Basically, a flying mini ER. Crew of 3, with GPS navigation, night-vision googles. And their oh-so-cool blue flightsuits. The choppers have two large 45-degree blades on the front of the cockpit to guide cables away into 2 cable-cutting mechanisms. For instances when they inadvertently fly into some cables. The pilot tells me he has not yet done this, nor does he completely trust the mechanism, but he's seen it on the promotional video.

The flight crew was truly the envy of most of the men there, fathers and kids alike. And they friggin' knew it. Standing proudly beside their chopper answering questions, they all had this knowing look.

"Yup, I bet you really want my job. Well, too bad. Nyeh nyeh nyeh nyeh nyeh".

The bastards. And suddenly my job seems stale, boring and normal. It doesn't seem fair that endocrinologists don't get to be on the crew. I mean, who knows, maybe a trauma victim might need an emergency thyroid biopsy? Or cardiac patients with hypothyroidism? After all, they ALL get amiodarone anyways.

Also got to look at our planes. There were 3 total, though I think only one technically belongs to us. Wasn't exactly the cush private jet feel inside the cabin. Instead, I felt a bit claustrophobic. After all, the ventilators and other medical equipment take up space.

4 lucky buggers had their names drawn for a free 20-minute flight around the city. Naturally I was lucky enough to get a place to stay on Mother Earth to take pictures. After all, it's cramped inside. And probably infested with MRSA. So it was good that my name wasn't drawn.

Sigh.

Boys and toys. And I didn't even get a bloody free mug/T-shirt.

Clinics

It's nice having your own clinic. Something not all my colleagues agree with. The ACGME requires all trainees to have their own continuity clinics. For us, one half day a week of my 'Dr. Vagus' Clinic. I see only MY patients (we still see patients the rest of the time, but this is my own time). They know me as their endocrinologist. I have my business cards, and 2 secretaries to help me with the paperwork and scheduling.

I like it because unlike other clinics, these are my very own patients. Some I have known since residency who also had diabetes, and opted to 'follow' me from my internal medicine practice to endocrine. People I know well enough to enjoy their company, or to share even some personal stories.

I saw Ms. HN again yesterday. A high-performing CEO, somewhat of a Southern Belle, who was also overweight and has diabetes. As recalcitrant and stubborn as they get. I remember our first meeting, with her almost seething, arms folded and pouting, when her family doc finally made her see an endocrinologist for her diabetes.

"No injections. Over my dead fat body." A direct quote.

Now, 2 years later, it was a totally different scenario. She gave me a bearhug. I told her about our engagement, and showed her pictures (she was my last patient for the day and I was in no hurry). She told me of some legal/work problems she was having. She wanted even to come for the wedding (I'll take my private jet, she says).

Her diabetes is controlled. Controlled, not great, as she's still stubborn about not wanting insulin. But, she's on twice daily injections of exenatide (Byetta) and her hemoglobin A1c's way lower than they've ever been. And she doesn't mind the shots, "As long as it's not insulin!"

Some of my colleagues hate their clinics. Always a lot of paperwork. And though I'm not too excited about all that stuff myself, I do like my continuity clinic.

It's nice to see how your patients evolve, and grow. And, in a weird way, patients see how you grow as well. They know that you're a fellow; a trainee. At first meeting, they know this field may be new to you, and yet accept that (knowing you're supervised by a consultant). And they see, I'm sure, how one learns from them, and grows into a confident endocrinologist. Yup, I like my Thursday afternoons. Despite usually finishing up late from the chatting we do in clinic, seeing old friends again.

They say that behind every successful man, there is a woman. Now, more than ever, I believe that. I would not be here today without you beside me. Thank you, Kris.

Concert

Kris and I attended a free concert at the park today. Though the rain shut things down early.

So, it was a free concert, at a riverside park by the civic center. And though it wasn't a band in the charts now, it was something I was a fan of a decade ago.

Starship.

Yes, that Starship. Nothing's ever gonna stop us now. Sara. We built this city.

Never mind that they from the 80's (you can tell they're an 80's group from the mullet the lead singer sported, or the leather pants the musician wore). And that the crowd was of the 'older' generation. At least 2000 people turned up.

It was a great day. We had an hour before the rain came and people scurried away. But we had fun.

And there were certainly some fans who got carried away:

Friends gained, friends lost.

One of my sources of bitterness here.

I'm not sure why this came to mind this week. But it's something that's bothered me for the last 2 and half years. And to this day, I wonder what really happened.

When J and K, a couple from home, joined our motley crew here 4 years ago, we were happy. After all, more friends, right? Adapting to a new place was initially tough for K though. I remember hearing about how she spent the first few days crying in their apartment. We brought them some satay from one of our barbeques to welcome them and to cheer her up.

We got along well, well enough for me to consider them good, reliable friends. When my folks came to visit that year and I was at work, K was nice enough to take them shopping. Truly, I felt blessed to have them as friends.

Then suddenly, something changed. Out of the blue, they stopped hanging out with us. Just fell off the radar. When we ran into them in the mall, or at restaurants, J was friendly though K seemed short, even unfriendly. We thought it was the pregnancy, and her being unwell. Being the bigmouth of the group, I felt guilty, thinking that perhaps one of my jokes or teases must have offended them. And sent her a card. Never did hear back from her.

Years later, J confided in a mutual friend, who relayed it back to me. And what I heard was beyond belief.

Somehow, somewhere along the way, K thought we were looking up her medical records, especially details of her pregnancy. And decided to terminate all contact with us.

Needless to say, we were shocked. After all, we knew of the pregnancy only because her tummy was obviously swollen.

Here, looking up medical records of non-patients would be considered a major offence, enough to get someone sacked. And even if I wanted to, I couldn't as we never knew her maiden name. And to be brutally honest, I had better things to do than to look up friends' medical records. And my career wasn't certainly worth that cheap thrill.

When I confronted J to ask him about it, and to hear why this came up, he had nothing to say. After thinking about it, I realized that I was giving him no choice; I was essentially telling him to explain to me why his wife was delusional.

And so, I wrote him a note: "You don't owe me any explanations; just know I harbor no resentment". To which he replied warmly as well.

To this day, we talk like friends when I meet him on the floor. But in the company of his wife, he's less talkative, while she's cold, as cold as rivals could ever be.

What exactly happened I suspect we'll never know. Peripartum delusional disorder? After all, that's a well-known condition. Something we said during one of our childish jokes? Someone told some malicious lie?

But truth be told, my feelings are mixed. I miss my friends, J and K, that's for certain. Yet, I'm saddened, perhaps even bitter, feeling like we've been treated in a most unfair manner, without even having been given the chance to discuss this directly with K.

Thus is life I suppose; you make friends. You lose a few. Life goes on.

Transformers

Warning: Geeky substance ahead.Just watched Transformers.

Hmm. Movie about robots. Predictable. Shallow. Bad acting. What can I say?

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Omifarkinggawd!!! What a rush!!! KNNCCB, I'm still tachycardic, 20 mins after the show. Drove Veronica home like a freakin' maniac, like she was Bumblebee himself.
For those wonderful 2 hours 23 minutes, I was grinning ear to ear, excited beyond words. Like a teen watching his first X-rated movie. And I'm not even talking about the very foxy Megan Fox (yea, lame pun I know).
For the moment I'm going to forget I'm a 30-year old physician at an extremely academic institution.
And admit that I was the classic 80's Transformers fanatic. Till now, I swear to God, I know the words to the Transformers cartoon theme.
"Transformers. More than meets the eye. Autobots reach their travel to destroy the evil forces of, the Decepticons...."
I could go on.
I even teared up when Optimus Prime died in Transformers, the Movie (the cartoon movie, that is). Okay, fine, I didn't tear up; I fucking cried, ok? Happy??
I even had some of the toys.
Triggerhappy, Misfire, Jetfire. Though mom chucked my toys into the trash over a decade over, I remember how to transform the jets into robots. I still remember!! Every single step.

Back to the show.
As a movie, I didn't think it was anything special. Typical action movie. But as a movie adaptation of Transformers, now that was beautifully executed! It was amazing what the CG allowed them to do. Fast cars, planes, turning into robots, now what's not to like? The action and battle scenes were just out of this world.
Purists might condemn how Bumblebee became a Camaro instead of a VW Beetle, or how Starscream was a F-22 Raptor instead of an F-15, or how Megatron wasn't a gun. But hey, one has to move with the times, right? Though I don't remember Optimus Prime having that funky flames tattoo (that was Rodimus Prime).
The acting, though, was predictably crap. The Section 7 goon acted like he was some insane, incompetent moron. Who bore a striking resemblance to Seinfeld's Kramer. Megan Fox's acting, though I worship the ground she walks on, was as plastic as a Macy's window mannequin. Only Megan's prettier. And has bigger boobs. But still, this is probably the only time I'll say I watched a movie with a supermegahot babe not to see her, but to see computer-generated robots.
I thought the storyline was very predictable. And the script lame at times. Almost like they tried to hard to make some parts funny (Jazz talking in hip-hop lingo= not cute). And tried too hard to incorporate some of the classic cartoon quotes. Like 'More than meets the eye'.
There were the usual stereotypes too. Computer hacker is some weird-looking nerd/freak who knows not only how to hack into your blog, but also how to hotwire a 1980's computer into some radio from the Cold War era? I'm not sure if Wikipedia teaches you these things. Or hotbabe whose father was a 'car-person' (without spoiling the story for you readers) is able to start a borrowed car simply by tugging some wires and reconnecting them, in less than 3 seconds.
It was also interesting how every woman in the theater tonight came with a guy. Every single one of them. No females came voluntarily, on their own. Which was a reversal of 3 weeks ago when I watched 'Knocked Up' with Kristin and I noticed the cinema packed with females, and that the only males there came accompanying the females. Needless to say, most guys tonight were about my age, probably grew up on this cartoon too. And there was applause at the end of the movie.
My verdict? If you're a big, dumb guy like me who's girlfriend happens to be out of town, who likes cars, planes, robots and babes, and especially if you're a Transformers fan from my generation, go go go watch this movie. And enjoy every single millisecond of it!