What I've learnt in this difficult week:

• People express care in different ways...
• ... But sometimes the people who talk loudest, do really seem to do the least
• In the larger scheme of life, I really shouldn't sweat the small stuff
• I need a stiff vodka lime (but I can't as I'm oncall till Friday night)

Halloween Party

Happy Halloween, folks!

We had a party last week, our annual pumpkin carving bash. This has been a yearly tradition for us since buddy and I started it here, 4 years ago. In fact, LP and I did this in medical school in Canada too, and somehow I carried it on here. Stems from the fact that I had never seen pumpkins like this before in Malaysia, let alone carve one. So the suaku (mountain tortoise) decided to carve some and invite his friends. Needless to say, this year's turnout has been the biggest. Amazing to see how our 'family' here has grown in recent years. Though far away from home, it's nice to have a huge group of Malaysians and Singaporeans here who are fairly close.
Buddy decided to keep the news of his illness to ourselves until after the party (he broke the news late at night, after the kids were sleeping). So this was the last party we would have without the burden of that knowledge in our hearts and on our shoulders. As he put it: Things will be different now. Perhaps some may look at him in sadness, sympathy or with a new seriousness? Though I think most would see him with newfound respect and admiration for his strength and clarity of mind.
It's always hilarious, and sometimes dangerous, to see the mischief the boys come up with. And when I say boys, I mean us the adults, and not the kids. Case in mind the dry ice and coke incidents. Here Nick is making keropok in my Optimus Prime helmet.

We would usually have a bunch of people over, plenty of food, and just carve the pumpkins on the living room floor. After it was done, we'd put it outside and light the tealight candles.

And here's the traditional group photo we take at the end of every session.

(One other thing I've learnt: If you're gonna have pumpkins outside your house, you better have candy for the kids on Halloween night. These things are like bloody kid-magnets. I remember the year 3 kids came a-knocking. Buddy and I were postcall and had nothing aside from one snickers bar and beer. He was tempted to ask the 3 kids so share the one bar, while I contemplated the legal consequences of giving the kids Bud lite. Needless to say we watched TV in the dark with the shades closed the rest of that night)

Bump on the road

Poor guy.

Not exactly a good start to things.

Buddy was supposed to have a central catheter placed today by the surgeons, to begin chemotherapy soon. For most, a simple day surgery. I got the call when I was halfway through rounds.

"He's developed a pneumothorax..."

An airleak into the cavity between the lungs and the chest wall. For some, this can be life-threatening (he's stable).

He spent a night in the hospital yesterday, and will probably spend another night tonight before they discharge him.

Feel free to pop by his Caring Bridge site to drop him some words of encouragement. As this really isn't my story to tell, I shall refrain from elaborating more on my blog.

It's easy being the doctor.

But sometimes, the tables get turned and things hit a bit closer to home. In this case, someone close to us, someone we consider family. My Buddy.

In this case, we got the devastating news that one of our own, esophageal cancer. When we heard, it hit us like truck, and left us reeling in shock and disbelief. Even now, it's hard to imagine especially since he looks so well. But, being in medicine, you know the odds. And frankly, it's scary.

When we heard, it seemed like everyone put on their doctor's hats. Even my Buddy. He coolly and methodically outlined the test results, the staging, the prognosis and mean survival. After all, who would know better than him, the oncologist. The patient.

The most bitter irony of all; the cancer doctor has cancer.

He calmly outlines how he wouldn't recommend surgery, or radiation therapy. Because he knows the odds.

And then everyone just started giving medical and nonmedical advice. Perhaps out of habit since this is our work. But as Alan, another friend, put it, "But what were we thinking? This isn't my patient. This is my friend!"

And as always, it seems that the worst things happens to the best people. In this case, a wonderfully considerate and gifted young man, with a bright future.

Though dealt with this blow, it is perhaps heartwarming to see the sudden and overwhelming outpouring of support from friends and colleagues, near and far. Case in mind, when we were going to be late for an appointment because of a test and I called ahead for him to see if they would wait up for him, the front desk said, He's one of us; we'll wait as long as we have to.

On a Friday evening.

I was oncall last weekend, and it was hard for me when I saw a patient on consults, who was just seen by Buddy a week ago, for 'autoimmune hemolytic anemia'. Instead, my astute friend suspected a valvular problem and ordered an echo, which led to his mitral valve surgery on Thursday. He was just full of praise for Dr. Buddy. Little did he know. I had to swallow the lump in my throat.

Nonetheless, it is clear that Buddy is deeply loved and cared for by many. We continue to see acts of kindness and generosity every day, and I continue to see immense strength and faith and clarity of mind in Buddy.

Where we go from here is totally uncharted territory, one that frankly scares most of us. More so because we're medical professionals and know the odds. But Buddy knows he's not alone, and that we make this journey as a family.

I ask for you to pray for Buddy, and his family.

Sometimes, when things happen, life just suddenly seems to come to a standstill. A moment frozen in time.

Today was one of them. No, although I wasn't thrilled by how tough the exam was, that's not what I'm referring to. Someone close to me just shared a piece of bad news. That hit Kris and I like a bolt from the blue.

The last time I felt this utter shock, and numbness and fear, was when Mom told me of Dad's cancer diagnosis 11 years ago.

Tonight, Kris and I spent some time holding each other, shedding some tears. We will allow for this tonight. However, come tomorrow, there's only one thing we can do- to band together, to be strong, to pray and to overcome this.

(if this seems vague, it's meant to be)

13 hours to the Board Exams!

People react to stress differently. Some turn to smoking, some to alcohol, some people bang like jackrabbits on Viagra, while some turn to faith. Me, I just grow facial hair. Something Kristin isn't too pleased at. But, being as supportive and understanding as she is, she's letting me be, just as long as I don't scratch her face. Though I suspect she'll make me shave immediately after the exams.

The last time I did this was in April 2006. Don't ask me why; I just stop shaving my chin. Perhaps it's the comfort of having something to scratch when I'm thinking.

My study room wall's all pasted with notes. From the Fredrickson classification of hyperlipidemia, to the Wolf-Chaikoff effect, to UKPDS and DCCT to thyroid cancer to the differential diagnosis of a hairy pregnant woman (cause of the hairiness, that is. We all know what causes the pregnancy part). I leave for Minneapolis in an hour (the exam's an hour and half away so I'm not taking chances and will be staying in a hotel there tonight). And, being as anal as I am, believe it or not I'm carting all my wall post-it notes along, all conveniently stuck to a large piece of paper that I'll simply roll up.

Well, folks, this is it. $1675 and 630 minutes of pure exam bliss; Wish me luck.

Back again!

I'm back from D.C. It's been a rough week. We were there for the NIH-organized endocrine board review course, held in Bethesda, Maryland (short distance from Washington, D.C). While it was a well-organized course with excellent content (though isn't always concordant with our philosophy of care at MC), the days were just long, with the lectures starting at 8 am and ending past 10 pm on some days. I surprised myself by sitting in for most of the lectures, braindead as I was. Most of the attendees are like me, to sit for our 10-hour exam this Thursday. So, this served as a refresher course.

Bethesda is a nice city/suburb. The hotel was in a happening area, with many restaurants (even a Malaysian restaurant!) and pubs. The subway station was just nearby. So, on a day when lectures didn't end as late, I took the subway to downtown Washington, D.C. to look at some sights. Because time was limited (and it was nighttime) I didn't visit the Smithsonian. Rather, I walked around the monuments.

The Washington monument is a staggering 169-meter obelisk made of granite, marble and sandstone. Was never been able to appreciate its majesty seeing it on TV; this is so tall that you see you from miles away. In this picture, the Capitol building is seen in the background. There is a huge, soccer field-sized reflecting pool between the monument and the Lincoln Memorial, which makes for amazing night-time long-exposure pictures (using a tripod). Really, I came all the way here, ALONE, at night, to take these shots. The night almost ended in tragedy when my camera batteries (even the spares) died on me. I uttered words that would even make Madonna blush. Thankfully, I was able to find a giftstore a block away, and resurrected my dead camera.

This was the Lincoln Memorial, situated at the opposite end of the reflecting pool. The Lincoln statue is huge; you get the idea looking at the ant-sized people standing on the stairs in comparison.

Beside the monument lies the recently dedicated WWII memorial fountain. The effects the lights and water gave was nothing short of spectacular. And although it was late, and even rained for a few minutes, the entire park was crawling around with tourists, all awed by the amazing sights.

I'm glad the pictures turned out ok. That's one nice thing about digital cameras; you can take as many as you want just in case some didn't turn out well. I took about 70 that night!

Anyways. I'm back in Minnesota now. Back to the grind. 5 more days till my exams, so I don't expect to blog much (unless I needed to vent/cuss).

Wish me luck!

Back, and off I go again!

I'm back in Minnesota. However, I about 16 hours before I have to leave again for the airport, this time to Washington, D.C. for a course till Saturday. The meeting was good, at least the parts I attended. There were some controversial and very interesting topics, such as the use of I-131 for low-risk thyroid cancer. It was much smaller than what I expected, only about 2000 attendees, compared to the 8000 or so at the other conferences; however this being such a specialized organization I guess I shouldn't have been surprised.

My presentations went well. The first one, a comparison between FNA and core biopsies, received quite a few questions and generated a lot of interest. My 2nd one, well, while I stand by my data, I was less comfortable presenting this as this was work from the lab, and there were many PhD types here who asked me many basic-science laboratory technical questions which were above me. So, ladies and gentleman, I present to you, my pictures from New York City!

Actually, I lied. As you probably could tell from the 'Producers' poster, these pictures were from my last trip to NYC 2 years ago. Because this was my 2nd trip, and with my exams round the corner, aside from Central Park and Chinatown I didn't really bother doing any of the usual sightseeing.

New York is certainly an interesting city. It's huge, extremely diverse, chaotically congested. Lots and lots of eye candy, in various shapes, forms, colours and stages of undress. And while I constantly complain about being in a smaller city, I realize that at heart I'm still very much a smalltown boy- this was nice to visit, but I wouldn't enjoy living here. The cost of living is crazy- my friends pay 5x of what I pay for studio apartment while I have a 3 bedroom/2 car garage. And one couldn't possibly afford a car there.

I did however get to meet up with several Malaysian doctors all doing their residencies in NYC, people I have not seen in 5 or 6 years (some of them at least). Meeting up in a Malaysian restaurant, eating Hainanese chicken rice, was surreal. It was great to meet up again, and one does feel a bit of pride seeing your friends/juniors doing fairly well in their careers.

Okay, I'm pooped. More when I return from DC.

The Big Apple

Short update; it's darn near impossible to blog using a blackberry.
A few observations:
There are no fat people in NYC. Everyone dresses like they're models.
ATA is a lot smaller a meeting than what I'm used to.
Presentations went well; had quite a few questions.
Ran into a Malaysian and a Singaporean here.

More when I return tomorrow.

And I'm Off!

Got a piece of good news today.

My manuscript was finally accepted for publication. The third time was the charm. I had gotten the email a few days ago, notifying me the reviewers suggested 'minor revisions' (a good sign, they almost never accept it without any revisions). I had thought about leaving this aside until after my board exams in 16 days, but my impatience got the better of me. I couldn't study with this halfway done. It's like trying to sleep the night before Christmas, or Chinese New Year. So, after tweaking and rephrasing some things, I resubmitted. And so, months and months of work, 700 patient charts, 7 co-authors, a study that was started 5 years ago, comes to an end. Publication date: August 2008. (KNNCCB, have to wait so long!)

Going to pack my stuff and get ready. I leave for New York tomorrow to present my two studies (expression of Thy-1, a surface glycoprotein, by the orbital fibroblasts of patients with Graves', and a comparison study of two thyroid biopsy techniques) at a meeting. Also lugging along several textbooks as I'm expecting to spend more time studying and less time actually listening to the seminars there. Also have scouted out several Malaysian restaurants in New York! This will be a no-holds-barred competition between the size of my stomach and the restaurants, since this my expense will be covered.

Will likely not blog until I get back Sunday.

Ciao!