Sunday, November 25, 2007

Happy Thanksgiving!

Thursday was Thanksgiving Day, a public holiday in the USA. Something about celebrating the pilgrims discovering turkey stuffing. Anyway, Kris and I took Friday off, and spent a long weekend with her family in Milwaukee.
It's interesting, hanging out with future in-laws. The word in-laws haven't scared me yet, strangely enough. I'm sure it's got something to do with how warm and welcoming they have been. As my dad told me over the phone last week, they're going to be my family in this continent.
But anyways. They graciously invited me to join their family tradition. Seems the Olsens have this tradition of making gingerbread houses, along with one of their neighbours. And they've made it an initiation for anyone wanting to join the family. One of their daughter's then-fiance was one of the victims lucky ones last year. And this year, me. It's pretty interesting for a Malaysian boy to experience, I must say. Something you read about in those Enid Blyton books or hear about in songs, yet something my mind has never been able to fathom totally. You know gingerbread was involved (but what exactly is gingerbread?) and you know you're supposed to make houses (but how?).

So, this was a real learning experience for me. And all the while, my future in-laws and their friends tried to be nice and encouraging.
Oh, that's creative. That's one thing about Americans. They always find something nice to say to you. My Malaysian friends, we'd be like, What the ^%#@ are you making????
Though I would not openly admit this to my buddies at the gym, I actually had a ton of fun. Reminded me of my Lego days, when your creative juices overflowed and you had the power to build anything you wanted.

And so, my end product I proudly display:
Erm, no. Actually my creation is that pitiful looking shack on the lower left corner. Though, ugly as it was, it tasted pretty good; by the time we left for a movie that night the roof, half the fencing, windows and even Santa (on a chimney. Go check it out!) had disappeared. I hear it was a killer tornado.

We also met up with some dear friends from Rochester, and did some window shopping. The malls were already decorated for Christmas. I'll have to start writing my wish-list up for Santa soon.
Then again, I already got what I wished for. What more can a man ask for?
I look blur, don't I? Still not into PDA I guess. (Malu mar...)

Wednesday, November 21, 2007

I was made to break one of my rules yesterday. And I wasn't happy about it.
An out-of-towner, who was referred to me for work-up of his hypercalcemia, labelled 'primary hyperparathyroidism'. Except in this case, his referring physician did a sorry-ass job of working this up.
From a mile away, you could tell this was from lymphoma. Thus, it was no surprise that his PTH was undetectable. That his sestamibi (pre-ordered) was normal. And his 1,25 Dihydroxyvitamin D was sky-high when his 25 levels low. Aside from fluids and some steroids, what is else is an endocrinologist to do? Except to consult a hematologist.
Except the waiting list is a month out. And he's from the other end of the country. And so, my consultant made me admit him to a general medical service. This otherwise well patient, who had the cheek to complain to me about how he had to wait a few hours for a PET scan (also ordered by someone else. Some people wait months for this).
I felt angry, and made it a point that I disagreed with my consultant. That, in my opinion, admitting someone into the hospital to 'facilitate evaluation' is a clear misuse of infrastructure. Having the inpatient hematology team see him, instead of the outpatient team, so because it's Thanksgiving this week, and things move slower in the clinics.
When I called the admitting resident, my first words were "I'm sorry, but I'm being made to do this..."
Because we've all been on the receiving end before. Between sick and unstable patients, you admit someone who's stable, who doesn't need to be in the hospital, purely out of convenience. It's no wonder that many US hospitals are losing money (we make money from the outpatient clinics, apparently). Besides, not properly triaging patients lead to poorer care for those who really need it. Last I heard, this patient was complaining about the TV programming and food in the hospital. I hate to imagine what the other 'real' inpatients have to deal with.
No, I don't blame the patient. I blame the referring physician, who didn't bother doing his work. And in the process a patient flies in to town to see the wrong doctor and has to wait before he sees the right subspecialist.
But, alas, I can only do what my boss tells me do to.

7 more months.

I'll be a consultant in 7 more months....

Saturday, November 17, 2007

Sharing Stories

I saw Mr. D for follow-up earlier this week.
He was found to have a non-functional pituitary macroadenoma causing visual problems, for which he underwent surgery many years ago. I had been his endocrinologist for 2 years now, focusing on the issues relevant to me. In this case, hypogonadotropic hypogonadism.
However, looking back at his records, he was also diagnosed with esophageal cancer 3 years ago. Though not directly relevant to his follow-up with me, my ears perked up, just because of what my Buddy is going through now. He was the last patient of the day for me, and had nowhere to go, so we talked.
From his description, probably Stage 3. Diagnosed when he was 68 years old. He went through chemotherapy, followed by surgery. 3 years out, he's still disease free and followed closely by the oncologists.
He's now an unofficial spokesperson for cancer patients. He tells me he meets, counsels and encourages cancer patients and their families. More than just talking to doctors, most patients also want to hear another patient's perspective, for some strength. Hope.
He tells me he just met with a lady whose husband was diagnosed with pancreatic cancer. He shared with her how he found strength, coped. He listened.
This gentle, bespectacled kindly-looking white-haired man of 71 years of age. I can't imagine a more peaceful face.
And so I shared with him the story of Buddy. He frowns his burrowed brows, he says how it's not fair, because he's in his 70s but Buddy is not yet 30 and is a budding oncologist. But, he shares with me that he's doing well so far, and if he can do it, perhaps so can Buddy. We both agree that these things remind us that life shouldn't be taken for granted, and that cancer is a terrible disease, and we need to keep working to find a cure.
Talking to doctors, sometimes you get an overly logical, evidence-based, methodical perspective (which is alright, after all we have to base our treatments on science, not hearsay). But sometimes, being overly logical probably doesn't allow much for hope, faith or miracles. Sometimes, we need to hear from the patients to remind us of things that are possible.
Mr. D offers to talk to Buddy and tells me to give Buddy his contact number; I tell him I can't for confidentiality purposes. But he takes down Buddy's website address. And promises that he'll say a prayer for his recovery.
I stop short of giving him a hug. But, as an afterthought, I remove the bracelet Buddy and Buddiette are making for friends and family, and give it to Mr. D.
He looks at it, smiles gratefully.
"Cancer Sucks, God Heals. TS & TY"
Until his next visit, we shake hands and say our goodbyes.

The weekend that was (a week later)

Sorry, my posts have been a week late.
Was in Indianapolis last weekend to visit my sister who doing a 2 month elective there. I had some extra days off and way too many frequent-flier miles anyway, so Kristin and I flew down for free.
Indianapolis is a nice city; retains some of the friendly, midwestern feel, though more cultured and vibrant than Rochester.

War Memorial

Stayed at a beautiful downtown hotel. However, as nice as it was, our stay was plagued by some very rude and inconsiderate peri-pubertal (and some post-pubertal) kids, attending what appears to be some church meeting. The Hilton became a huge slumber party, with kids from 10-30 running around the hallways well into the night. They were talking, screaming, laughing everywhere, even right outside our door, slamming doors. Sticking my head out to tell them off only shut them up for a few seconds, for another group would soon come by and do the same thing. Hotel security couldn't keep them quiet too; after a sweep the kids just came right back. And there were hundreds of them spread out on different floors, in different hotels. I'd like to think that a church meeting would promote among other things, kindness. But they were just thoughtlessly inconsiderate, perhaps in a teenage kind of way. We were pissed. I even have a 2-minute recording on my cellphone of the noise they were making late at night, heard from INSIDE my room. Just to show to the hotel manager.

After I went down to speak to the supervisor at 11 pm, I was on the way back up to the 16th floor with yet another bunch of teenyboppers. Don't get me wrong; I think religion and faith are important and powerful tools for life. But when one gets so high on it that he gets inconsiderate, that's never a nice thing to others. One of them kept holding the door open at every floor, telling hordes of people waiting outside melodiously, 'Do you know Jesus loves you?' which sparked an active 60 second exchange, with the door open. While the rest of us waiting for the elevator to go. Eventually, I just said to them sternly, 'Will you please let go of the door???'. The euphoric kids looked at me like I was the devil himself, trying to sabotage their mission. I was like Scrooge, telling kids Santa was dead.

But anyways. Back to Indianapolis. That aside, we had a swell time. We hung out with my sis, and got to do some shopping, visited the War Memorial, the zoo and aquarium. Drove to a large outlet mall about 30 minutes away, where my sister's eyeballs almost left their sockets when she saw the shopping potential of the place. We spent 3 hours there (and that was with my whining about my headache, no doubt in part from the racket the kids made the night before).

Plane, what plane?

There was a nice group of Malaysians there too, most in medicine. So it was a bonus meeting up with others, and knowing that they're doing well in their respective fields. Despite my insistence, they bought us dinner (thanks, guys).

We got back to Rochester Sunday evening, just in time to attend Buddy's fundraiser benefit. This was organized by his classmates and some consultants, one of them kindly donating his tapas restaurant for the event. The turnout was amazing, with everyone showing their support to my friend who's at the start of his uphill journey. But it's clear, he's not going to be alone for the journey.
There were numerous tributes, all wonderful reminders of the character my friend is. I think too that it was therapeutic to others seeing him there as it reminded everyone that Buddy's still the same guy, and that they (in his words) didn't need to use 'kiddy gloves' on him. It was good too that his parents attended; they should be proud of themselves that they raised such a wonderful man.

It was well-attended, by people from various divisions within the department of medicine. Families, friends, colleagues. All there to say we're here to help, and to contribute to his now-expanding expenses.

Sunday, November 11, 2007

It was Kris' best friend's birthday the other day. So, we went to celebrate with them in a town a few hours away.
Hence my first and probably most unforgettable experience of a smalltown bar.
As we pulled up the bar in the middle of nowhere, there were trucks parked outside. Some of them had dead deer strapped to the back (I kid you not). That was a warning of what was to come.
We walk in, and it's like, suddenly the music stops and everyone turns and looks at me, the only Asian in the room (not that anyone was unfriendly or anything, but I did feel like I had a 3 inch zit on my forehead).
Half the people in there were dressed in camouflage gear from their hunting that day. And all the men sported more facial hair than the iceman on steroids.
And to top it up, there was karaoke in the bar, but nothing like I've ever seen before. There were some folks belting out strange songs like 'Will you please play with my ding-a-ling'.
It was like a scene out of some 1980's hicktown B-grade chainsaw horror movie. The only thing missing from the picture was the woman with D-cups in see-thru tanktops who inevitable get eaten by the monster alligators when she goes skinny-dipping.
It was hilarious.

Wednesday, November 07, 2007

Yesterday was a special day.
My Buddy turned 29. And he and his longtime girlfriend (to whom I shall refer as Buddi-ette) got engaged.
Yes, though I almost spoilt the surprise several times, he was able to keep things secret and popped the question without her expecting it. And true to her fierce loyalty and dedication to him, Buddiette said yes. Without any hesitation.
Yes, they have a long road ahead of them. Both oncologists, they know the odds are stacked high. But if there was anyone that were meant to be together, it has to be them. And if one ever needed an example of what true love and loyalty is, look no further. They have been together for 7 years; they will fight this battle together. With us right behind them.

Congratulations, guys!

Tuesday, November 06, 2007

You Know You're Malaysian If:

Being a smalltown boy, dating a Midwestern American girl is quite a cultural exchange. Though I've been away from home for almost 10 years now, I realize at heart I'll always be a Seremban boy. How you know you're Malaysian:

  • You feel like you need to start with the most expensive food groups at a buffet. Salad, drinks are just a waste of precious stomach space.
  • You save and re-used old wrapping paper.
  • You don't feel comfortable if you don't wash your butt after taking a dump.
  • You know of at least 10 ways to cook Maggi mee.
  • Between satay and black Angus sirloin, you'd pick satay anyday.
  • You eat every grain of rice on your plate, for fear that your spouse will suddenly sprout a healthy crop of pimples.
  • You grew up hearing the "Don't you know kids are starving in Somalia/China/Ethiopia/etc" nag when you didn't finish your dinner.
  • You use toilet paper as a cheap Kleenex substitute.
  • You need to shower at least once a day.