Last Day of 2007, Already?

New Year's Eve.
Can't believe 2007 is almost over (even more so for you folks in Malaysia- 14 hours ahead of us). As with the past years, this year has again breezed by. And now, I catch myself wondering what I did this past year.
This has certainly been a memorable one. Professionally and personally. The highlights that stick out:

• I realized who I'm meant to spend the rest of my life with. And asked her to marry me.
• I took my harrowing board exams, and became a board-certified endocrinologist.
• Being apart of the New Orleans Health Recovery week. Experiences that I will remember all my life.
• My buddy being diagnosed with his cancer. And yet, the love and support everyone has shown in response. He's truly become an inspiration to me.
  My brother's wedding in Malaysia, and being able to be a part of it. And knowing I was going to propose soon thereafter made it more special
• I published some papers with much guidance from my mentors; papers I probably will never again write after I graduate (out of laziness or lack of motivation?).

What about the next year? Well, I've always said I'm not one for resolutions, but I shall list that for tomorrow's entry. But there are some highlights for 2008:

• Our weddings. Yes, plural. In the USA (June) and Malaysia (July). Drawing lots for invitations to the Malaysian wedding so email me fast!
• Leaving the place I've trained and worked for the last 6 years. And going into the 'real' world of medicine. In some ways I'm anxious, perhaps even fearful. After all, practising medicine here is so, easy, so perfect. But it's time I try to fly on my own.
• Leaving my 'home' here for the last 6 years, and moving to my first self-purchased home. Kris and I are already planning how to decorate it, and where to put the swimming pool (kidding!).
• Finally buying my silver Mercedes-Benz SLK. It's just a matter of time.
• Seeing my kid sister graduate from medical school.

Well, we'll see what the year brings. In the meantime, a few hours to the new year. And to you guys on the other side of the world, Happy New Year 2008!!
(And do party safe)

A good day

Today was a good day. Aside from it being New Year's eve. Buddy had a restaging PET today. He shared the good news with me while I was at work. The peri-aortic/celiac nodes had a lot less FDG-uptake than previous. The other previously FDG-avid areas including a supraclavicular node, GE junction, perigastric nodes are no longer FDG-avid. In other words, there appears to be significantly less tumor mass.

We know he's got a long way to go. But at least this was a definite positive step.

As I came home from work, it started snowing. And I caught myself admiring the pretty snowflakes that landed on my windshield. I took these pictures from my car.

How is it that they form these pretty yet each distinctly different star-shaped crystals?

I caught myself smiling. Thinking that these were part of God's miracles. And today, He gave us all another reason to rejoice.
The journey remains long. And with this Buddy will likely start radiation therapy soon. But I can't help but think that The Guy Upstairs was telling us that things will be alright.

Thoughts

Tonight, inexplicably, I was hit with a sudden tinge of loneliness and homesickness.

Perhaps it had something to do with sharing the evening with some close Malaysian friends who are in healthcare, all sharing how Malaysia has in many ways turned us away.

Perhaps it had something to do with me being alone now, on Christmas night.
Or me, being oncall all week.

Or brought on my thoughts of family and friends, moments from Christmases long ago?

Or of that young patient I saw today we all knew was dying, but didn't want to admit it, who made me wonder why I'm so far away from family when it's family that matters?

Perhaps it was just me missing Malaysia? The warmth. The people.

My Malaysian friends often tell me I'm lucky to be here. To be trained at an excellent academic institution. To have these research opportunities. To have a career that is taking off well. To work in a system that, well, works. To be far away from the racial hypocrisy of home. True. I'm thankful to be here. I feel like I've made the right choice. But, dang it, there are days when you just miss home.

Whatever it is, life has its reasons. And with every choice you make, there is something you sacrifice.

Christmas Eve

Merry Christmas, folks.

As I round on my patients on Christmas eve, half missing my family, half missing Kristin (who's on the way back to be with her family), I'm tempted to grumble that I'm on hospital service.

And then I see my patients. I think about Mrs. P, who's been in the hospital for 3 months after post-surgical complications and now ventilator dependent. I think about Mr. V, our guest since June for enterocutaneous fistulae. I think about Mrs. M, who is waiting for a nursing home to take her if she stays stable, or a hospice if she doesn't. I think about Mrs. M, who with her family drove 3 hours to see me, worried to death that I would tell her the thyroid cancer's back (thankfully it isn't).

It's a slap in the face, really. I am reminded of my blessings, and that I have no right to complain, and that I am here to comfort. I am reminded of the significance of this day.

My thoughts will be with my patients this Christmas. My prayers will be for their quick recovery, for their comfort, for peace.

Merry Christmas, folks. And have a Blessed holiday.

This has been all over the news the last week. Sure, the tattoo story itself is amusing, perhaps even funny, and sure, that would have been a great story to tell friends. But this guy crossed a line. Perhaps it was just a moment's lapse in judgment, but it was a really stupid thing to do. And now, he's paying bigtime for it. We found out he was fired a few days ago. A chief surgical resident. 6 months out from becoming a full-fledged surgeon. 4.5 years of training, down the drain. Now, to become a surgeon, he'll have to repeat part of residency elsewhere IF someone else will take him.

And some people told me that he has a family too. What a bummer.

Some people say it wasn't a big deal. Or that the patient's identity was not visible in the picture he took. Others say it's not an issue because as it turns out the patient is the proud owner of a, err, Gentleman's Club in AZ and probably doesn't have issues with modesty. In fact, I've read comments in bulletin boards that go as far as saying this is the best thing that's happened to this patient, because he's going to see a lot more action now.

The truth is plain and simple. This surgeon crossed a line. He betrayed a patient's sacred trust, that his doctor would take good care of him. Holistically, not just medically.

These days, it really IS pretty easy to take someone's picture, and to circulate it. After all, with the ease and portability of cellphone cameras or PDAs, it's easy to 'snap and share'. Perhaps it's my paranoia, but I've always been to fearful of doing something like that. The only patient pictures I've taken was via the hospital's official photographer, with a signed consent from the patient allowing use for presentations, and publication. And I've yet to use a single one for my blog (all I found on Google). Personally, I believe informed consent should also include telling the patients what you plan to do with the pictures. And saying 'oh, and by the way I want to put it on my blog' just doesn't sound right. Eventhough the motive may be to spread knowledge. But then again, this is just my tight-assed interpretation of ethics- I know many would disagree with me as many blogs out there do publish patient-related pictures.

And although I think this surgeon was wrong, I feel bad thinking that he's probably ruined a bright future because of a moment's childishness. That this Christmas his wife and kids will be miserable, perhaps even fighting, about how stupid he was and how he ruined the family.

Food for thought, for us who use cellphone cameras.

I passed!

By some cosmic fluke/mess-up in the marking, I passed!
Yes, my harrowing endocrinology board exams!!
Yessirree. Yours truly is now a board-eligiblecertified endocrinologist. Never mind that I have another 6 months of fellowship (I don't have to complete my remaining months to practice since we have an extra clinical year).
Never have I been so fearful of failing. Of leaving an exam hall with a certainty that I didn't pass. In fact, I still have my rolled up post-it notes stuck in my car trunk, ready to mount on my wall again should I find out I have to retake the exams. Then again, all my life, I've felt like failing the exams I did well in, so in retrospect my feeling of impending doom was probably a good prognosticator.
I got through. So did the rest of my classmates. Historically, this 10.5 hour/US$1650 exam has a passing rate of 89%, though I've been told our graduates have yet to fail (this wasn't a consolation to me: you'd hate to be the first though).
Now, I can sit back and relax, and try to enjoy the remaining months of my fellowship. Phew!

8 days to Christmas. I catch myself reflecting on random things.

It's surreal, how time flies. And I remember just talking about Christmas 2007 only not too long ago. I had an interesting celebration with family in Halifax, while visiting my kid sister. Everything was closed for the holidays, so we spent much of the time cooped up in her tiny space-efficient apartment. Though the turkey turned out good.

Anyways. I am reminded that this will be our last Christmas in Rochester, seeing that we move to Iowa next year. The last year putting up the same artificial tree, the same ornaments, the same Christmas lights, even the same mistletoe I've used for the last 5 years with no success (until last year!).

I miss my family. I miss my buddies back home too. I'll miss our tradition of midnight mass, followed by supper till 2-3 a.m. I'll miss (or maybe not) the sticky, humid Christmases back home, where we won't have to worry about frostbite. I even miss the really fake-looking Santas (come on, an Indian man with a fake white beard and a deformed square-pillow tummy?). You realize though that often when one misses home, it's really the moments that we miss. For now, with everyone having their families, my gang has broken tradition for some years ago. Things are different.

This year, for the first time in a while, I'll be oncall for Christmas week. I'll be rounding in the hospital while others are cozying up to the fireplace. My diet-Coke will take the place of wine and whisky.

Well, whoever you are, wherever you are, here's to a warm and Merry Christmas to you, one surrounded by love and candy!

Dear Santa:

I've been a really good boy this year. I've done the dishes and laundry. I brush my teeth at least twice a day, wash my butt after I'm done pooping. I do (almost) everything Kristin tells me to. So, I hope you'll remember that when you come down my chimney this Christmas. What I'm really wanting this year:

• Mercedes SLK 280, iridium silver exterior, red leather interior, with the heating, lighting packages and the Ipod integration kit
• A new computer- would love an HP desktop with at least 2 Gb RAM and 19" monitor
• Sony digital camcorder- to record those special moments leading to and during our wedding
• Complete set of Victoria's Secret Emma Collection 2007 (to give my fiance mar). I'll take the full-sized posters too, thank you (this one's for me)
• Samsung or Sony Bravia XBR4 46" LCD HDTV
• More hair on my scalp
• Halo 3

Thanks, Santa. Will have a glass of scotch and some pretzels by the tree. None of that pathetic milk & cookies the other kids give you.

Winter!

So, we had a real Minnesota Moment yesterday. There's snow on the ground, and the Christmas trees all look pretty with the lights and snow. And it's cold. So cold that my nuts are retracted up to somewhere in my thorax.

And so, to break the boredom and to warm the heart with some fellowship with good friends, we decided to have dinner in a pub/restaurant (great ribs!). And upon arrival, we were greeted with this sign. KNNCCB. Mamak closing because of the rain is one thing. But this???

I didn't remember it being this cold in December before. Usually I'd expect this in February.

But, winter has its fun too. No prizes for the person who guesses what this is.

(Yes, I do think I'm somewhat dehydrated from working in the gym today. And I AM somewhat impressed at my ahem, 'penmanship').

On another Christmassy/Winter note, we found this hilarious site by Officemax where you can turn people you know into Elves. Check us out! And turn up the volume!

Endocrine Surgery

It was an interesting week at work. I spent a week working with our endocrine surgeons. It was a great experience, and extremely high-yield and educational. Although endocrinologists are not surgeons (duh!) we send so many of our patients to surgery that it helps to actually see what we put our patients through. After all, there is only so much you can learn of a procedure by reading.

The operating room is an interesting setting. This certainly brings back memories of medical school. After all, the last time I scrubbed in for surgery was in 2001, when working with Dr. Preshaw (not counting the bronchoscopy I observed in internship). I've always been fascinated by the sequence of events that happen in there, even before the first incision is made. You scrub in (and unlike Nip/Tuck you put your own mask on and BEFORE you scrub). Then, hands always above your elbows so that the water drips away, you go in. The scrub nurse hands you a towel. Then your gown. You stick both arms in, another nurse ties the ties in the back. Scrub nurse shows you your left glove; you stick your hand in, then your right hand. Next you hand her the ties in the front, make a 360-degree anti-clockwise turn and grab the tie she's holding, and finish by tying that to the other one on your left waist.

It's a dance, really. Everyone goes through the sequence. And finishes with that turn.

And then you make sure you don't screw up and contaminate your sterile field.

As a medical student, I remembered the scrub nurse admonishing me:

You touched your mask! Your hands are below your elbow! Don't touch his back!

I learnt then, if she says you're contaminate, you're contaminated. Just don't argue- regown and reglove. Everything is so clean in there, you probably could eat off the floor.

I got to see several minimally invasive parathyroidectomies, subtotal thyroidectomies, a Roux-en-Y gastric bypass surgery, a distal pancreatectomy for NIPHS, a laparoscopic resection of a pheochromocytoma, and a transphenoidal resection of a pituitary adenoma.

I gotta say, despite the ongoing medical-surgical rivalry and jokes, my hat's off really to these guys. It takes a lot of dedication to train, and then to work as a surgeon. Maybe I'm just getting old, but just standing and holding the retractors was killing my back! It also takes a certain kind of personality, confidence, to go into one's body cavity almost so cavalierly, cut out the diseases part, then suture things back up. Or so actually go into part of the brain, through a small opening you've created via the nasal cavity. I mean, is this like Star Trek stuff or what??

You also see the different personalities. The neurosurgeon who loves Led Zepellin, and makes his OR staff listen to it blaring over the speakers on YouTube, or the soft-spoken kindly surgeon who suddenly lets one out on the radiologist who's slow in performing the intraoperative ultrasound of the pancreas, or that surgeon who's singing Christmas carols in the OR.

I remember as a medical student, I was in awe of the lanky Scottish surgeon I was working under. He had the most vile sense of humor, but we got along great and he tried to talk me into surgery. But, my love for physiology (and probably laziness) got the better of me, and I chose medicine instead (no regrets so far).

I got to see a different perspective this week. And when I saw that patient with acromegaly at clinic yesterday, I was able to better describe what surgery I'll be sending her for on Monday.