Stress

I'm stressed.
Ask Kristin if you don't believe me. Ask my colleagues. I'm usually known as the clown, but people are starting to complain that I don't smile/laugh/clown around anymore.
Main reason- my specialty board exams in 19 days. October 18th, 3 colleagues and I will be taking the dreaded 'boards' for endocrinology. The final final examination (not counting the 10-yearly recertification exams to keep my license) that will make me a 'board-certified endocrinologist'.
It's also 10.5 hours long.
And cost over US$1600.
Which explains why my wall is full of notes. Why my notes are ruffled and textbooks highlighted and scribbled. And why I'm grumpy, and even more anal than usual. I bet my anus could crack walnuts, what with how tightly it's clenched these days.
This (and the graduation) will mark the completion of my 12-year journey in medical training, from Day 1 of medical school to specialist to subspecialist. And while I had the patience in medical school to sit for 6 hours at a time studying, I now have the attention-span of an ant. 10 minutes of studying is always followed by some distraction, whether it's TV, internet or nail picking, butt scratching, and other bodily unmentionables.
That October is going to be a busy month itself isn't helping. I leave for a conference in New York in 4 days where I will be presenting 2 abstracts, return to Minnesota Sunday, and leave again for another meeting in DC Monday and finally return days before the exam. Hmmph.
On another note (reflecting my procastinating and surfing when studying), I found this Youtube video recently. The Top Gear comparison of the two cars I lust for and am contemplating purchasing within the year- the Mercedes Benz SLK and the Porsche Boxster (though deep in my heart I know the SLK has already won by leaps and bounds). I know, you've seen comparisons before. But not like this. This is the ultimate fightout between two cars.

This guy must have the best man-job in the world. This, and a Playboy photographer.

Happy Birthday, dad!

Happy 60th Birthday, Dad!!! Remember, 60 is the new 30!

Dear readers, please feel free to add your birthday greetings in the comments.

At work now, so this was the only picture I could find. Mom was a babe, wasn't she? And dad had a headful of thick almost curly hair; now it's as shiny as they get. I guess this is where my scalp is headed too in a few years.

Apple Picking!

We had a fun weekend. The weather was perfect, the sun was out. We went to a nearby apple orchard to pick some apples, a popular autumm activity. I'm embarassed to say this was my first time, despite having spent 8 years in North America (thank goodness for girlfriends!). And to think I used to think apples grew in the dirt, like potatoes.
We went with some close friends from Malaysia and Singapore.
You get bags, and just roam around the orchard, picking what you want. You pay $4 for a full bag. Tasting the apples is allowed, even encouraged. Gala apples, chestnut apples, Macintosh, Honey Crisp etc. My head was spinning: I thought apples came only in two choices- red or green. Eitherway, the kids and adults had fun. These orchards usually have activities for kids- we ran around the corn maze, jumped on haystacks, and got to see some farm animals.
We even picked our pumpkins, for the upcoming Halloween gettogether.

Here, piggy piggy piggy...

At the end of the day, Veronica (my car) was really dusty, because we had to drive on a dirt road to get to the orchard. Kristin wasn't too amused by what I wrote on my car.

Of Men and Testosterone

I was seeing this patient Mr. D, a man in his 50's, for hypogonadism, currently treated with testosterone shots weekly.

He has a history of mumps orchitis. Also has a history of partially treated obstructive sleep apnea, bad enough to cause polycythemia.

So, I was explaining to the patient and his wife that this may be primary or secondary hypogonadism (problem in the pituitary, or in the testicle). Had to go into some basic endocrine physiology:

"The pituitary gland which is part of the brain, makes hormones (LH & FSH) which then stimulates the testes to make the male hormone, testosterone. So, when you have low testosterone levels, this can either be a problem in the testicles (primary) or centrally (secondary)...."

At this, the patient's very prim and proper wife of 10 months (second marriage) cracked up. She tried to swallow her giggles to no avail. She guffawed. Mr. D and I looked at her blankly.

I did what I usually do in these situations: I checked to make sure my fly wasn't open (it wasn't). And asked her what was so funny.

And so, the prim and proper Mrs. D, with tears in her eyes, blurted out between laughs:

"I always thought it was the testicles that controlled the brain, and not the other way round!"

One of the funnier situations I've had in a while.

Double Standards?

I read with some relief, like many others, about Dr. M's progress after his bypass surgery in IJN. After all, people of my generation often see him as the father of Malaysia (not having grown up in TAR's era).

However, as happy as I am with his progress, I can't help but feel saddened for the other Malaysians who will never see the kind of care he received. Unbeknownst to many, myself included until some friends from a Singapore sniggered at this, IJN actually flew the chief of cardiac surgery from my hospital here to Malaysia to help perform the surgery. The following was taken verbatim from a bulletin board:

A: Vehement US critic Mahathir gets top US cardiac surgeon to operate on him. Does this mean he trusts his own countrymen less? LOL

B: Sure. When come to personal matter. He trust American!

C: TMM RETIRED as PM of malaysia and is entitled to all the benefits of retirement, allowances, i dont think he has to pay a sen

Not that I don't think the modern father of Malaysia doesn't deserve the best care, but rather, I wish our politicians were proactive enough and had the foresight enough to try to improve the state of healthcare in the country.

We hear about the recent scandals regarding the misappropriation of public funds. Concurrently, doctors in the public sector are underpaid and overworked. Many feel they don't get treated well. Many leave the MOH, even the country, for greener pastures. Hospitals lack the vital equipment and manpower they, or rather, the patients, need. There is a lack of research and training opportunities. But the people who make the decisions- the Menteris and politicians- do not see this to be a problem because when they need healthcare, they either go to private hospitals, or demand VIP treatment, or fly overseas. Or in this case, they fly a surgeon over. They often do not see what the average patient has to go through: the long waiting lists, the unavailability of tests, or subspecialty support.

So, while I'm glad he's doing well, it's disheartening (no pun intended) to see that the politicians are all singing the same tune "No it don't need fixing, let's spend money elsewhere (like a RM5k toolkit)" and yet when they need healthcare, they go for the special treatment.

While the average Ah Beng, Ali or Mutu waits months for a surgery.

Six years.

Still, the memories linger. I can never comprehend how man can perform such acts of evil. Or how one can expect his God to ask that of him.

We owe it to those who perished, to remember.

Geriatrics 101

I learnt this lesson in geriatrics early on in my medical career:

Beware of opioid use in the elderly

That, and Always check your gloves for holes before manual disimpaction.

This reminder came about last week. I had the rare opportunity of sharing a patient with my fiancee, who's a cardiac surgery ICU nurse.

I saw Mrs. M before her surgery. LOL (Little Old Lady) with type 2 diabetes, admitted for aortic valve surgery. She was as sharp as a tack for someone who was 79 years old. Single, independent. After surgery, I followed her progress and worked on getting her off the insulin drip. That was when she spent a few days in the ICU. As I did my rounds, I told Mrs. M that I knew she was in good hands because she had my fiancee as her nurse, winking at Kris as I said so. She asked about our wedding, so we talked a bit. Despite her having a chest tube in place still.

After I left, apparently pain got the better of her. And she decided to use the PCA (patient controlled anesthesia, a nifty pain medication pump the patient herself controls). And boy, did the Fentanyl take care of the pain:

• She thought Kristin was her dog, Scruffy, and kept calling her to fetch.
• She said that my honey's face was scaring her (how can that be possible??)
• She thought the laundry bag in her room (for soiled blankets) was a person riding a horse.
• She told her family members that Kristin and I were going to change our wedding date so that she could attend.
• She was singing Jingle Bells and Here Comes the Bride (to which my Kristin sang along to, to pacify/humor her. That, in the ICU, must been quite a sight).
• And when I came by a few hours later to check on her, she thought I had been drinking. I said I haven't, but if she were to find some beer, to be sure to tell me so that we could share. I got a giggle from another nurse with that.

Anyways. 4 days and a pacemaker placement later, I again saw her in the CV Surgical ICU. I asked her who Scruffy was. She looked at me in puzzlement and asked if I was trying to read her mind. She had no recollection of her antics the other day. And so I told her.

Despite being anemic from 2 surgeries, she blushed a deep hue of violet. And made me promise to relay her apologies to my fiancee.

As I left her room, I turned around and told her new nurse:

"No more Fentanyl for her!"

Win some, lose some.

That's life, I suppose. I got word that one of my manuscripts was rejected by a journal. Not too big a deal- I have a few other journals to submit this to. Nonetheless, it's always a bummer. You almost take it personal, like you've been rejected by a woman. You catch yourself wondering why they (the reviewers) don't see things the way you do, or what they have against you. On a bad day you might even feel stupid.

I was eyeing this journal as I thought my study was very relevant to it. And though this would be my 9th paper to a journal, this one held a special place for me just because I inherited a dead project from a somewhat lazy senior who did nothing, and out of sheer stubborness and diligence (and probably some foolishness as well), managed to salvage the data and improve on it and actually wrote up the entire manuscript myself. I'm probably more proud of this one that my other papers.

I guess I won't complain. That's life, and all in all I've been productive. A mentor and friend once told me, there is a journal for every manuscript that has been written. The question is finding it. You always aim higher, then work downwards if it's rejected. And my friend, being a well-published researcher, gets rejected by about 3 or 4 journals on average before his paper gets accepted.

This for me is just strike two. So, the only thing left to do is to resubmit to another journal. And hope for the best. Though with my 10-hour board exams in 42 days I'm not wanting to deal with any manuscript revisions if they get back to me before then.

Cest La vie.