Another Kembang moment

Here's my second kembang moment (the first was 2 years ago).

Weeks ago, the folks in my old medical college asked me for some photos, for 'PR purposes'. Ok, so I thought it was for some prospectus, or something. Or perhaps it was to warn students of what not to become. So I sent them a few, and didn't think much of this until some of you readers started talking about seeing my picture in the papers (I thought perhaps someone has mistaken Jet Li for me).

And then my dad sends me the newspaper ad. And yesterday, someone emails this to me. Some might say I'm being taken advantage of, since I'm not getting paid a cent. But when you're as narcissistic as I am, you wouldn't mind seeing your face blown up onto a billboard. And truth be told, despite my bitchin' about how moneyminded my old school was, I do owe them a lot, so I didn't mind helping out.

Except that I'm not sure I'm 100% comfortable having my picture so close to two strange-looking guys dressed in tiger suits, holding a stuffed cow and biting on something (and this was supposed to be an ad for rice??)

P/S: 10 bucks to the person who can spray-paint more hair onto my scalp.

Wedding preparation

So we went looking at tuxedos today for the wedding. So difficult to choose; so many different designs. Our wedding theme colour will be apple red, so the woman tells me. I guess that means I'll have to get something that matches or complements that. Well, whaddaya think? Something contemporary, or something modern? Personally I like the kilts, but seeing that it's going to be near the lake, I think my nether regions will be a bit drafty if I went commando.

Feel free to drop your choices.

Number 10

I received word that my manuscript was accepted for publication. That's 10 journal publications. Well, 7 to be exact, with 3 currently in press. Not including the abstract and textbook publications.
Academia- it's an interesting world. And in many ways I feel torn. I like clinical work. And I'm very put off by the mental demands of research, of writing grants and writing papers. The peer pressure. When I started, even in medical school, the word research would make me sick to my stomach. I hated my medschool research endeavors. In some ways, it still makes my stomach turn.

And yet, it's like a virus. Years ago, I told myself I'd be happy with just one publication. But one quickly turns to two. Two to three. And before you know it, you want more. Whether it's really to add to the knowledge of medicine, or something as simple and greedy as seeing your name pop up when you do a Pubmed seach, I really don't know. Probably just naked ambition.
I thought I'd stop when I got to 10, a nice round number. Now I'm not so sure anymore. I have another 3 papers in the works and a textbook chapter close to publication (look out for the book in late 2008). Though these are small-time affairs that would not raise many eyebrows here, especially when your consultants regularly publish in NEJM and have over 200 publications.

Once I leave this place though, I'm not sure if I'll have the time nor the resources to do research. After all, I'll no longer have 'protected research time', something that many public universities in Malaysia have yet to learn. That if they truly want their lecturers and professors to excel in academia, that they need to be supported in terms of time (you can't be doing research if you have to teach 9-5) and money (you need money to do research, really). Case in mind, when UM almost lost Prof. Edmund Gomez, who was denied a two-year leave of secondment to take up the prestigious research appointment at the United Nations Research Institute for Social Development (UNRISD) in Geneva.

Anyways. We went out to celebrate last night. I have to say, this place really taught me a lot, and I'm thankful that I've been able to be productive.

Viva Las Vegas!

Phew. We're back.

Las Vegas, was all I thought it would be, and more. No offence to people who live there or anything, but I can truly understand why they call it Sin City. Las Vegas just oozes temptation- sex, booze and gambling. And having spent 6 years in the Midwest, it was a jolt to the system (especially the reproductive system!).

We stayed at the magnificent Signature suites at the MGM Grand. A couple of blocks away from the main hotel, away from the smoke and casino and noise but not too far away. The room was easily, one of the best hotel rooms I've ever stayed in. We got a fully equipped kitchen, 42-inch LCD HDTV with an additional TV in the bathroom, which houses a 2-person jacuzzi tub and a separate shower stall.

We did a bunch of touristy things; walked the 'Strip', which is really the 'newer' part of Las Vegas which houses the main hotels and a few miles away from the true downtown, which has the famous Fremont Street experience. There, you find massive roof straddling several city blocks, which turns into a visual display (kinda like the ultimate bigscreen TV) at dusk.

The hotels there were out of this world. From the Egyptian-themed pyramidal Luxor, the pirate ships (and the siren's dance) at Treasure Island, the New York with the recognizable NYC skyline, to the Venetian with its ceilings painted to look like blue skies and indoor gondolas, to the very extravagant Bellagio and its world famous dancing fountains (featured in Ocean's 11). The fountains were probably my favourite thing in Las Vegas- just amazing, watching this coordinated water and light display. The fountains can shoot as high as 200 feet, apparently. End to end, the strip is about 6 miles long, so we had to divvy up the walking.

Besides the sex the city exudes, another sin was gluttony- every hotel had its buffets which is often cheaper than the restaurants of the celebrity chefs like Wolfgang Puck. And so I gained a few pounds and am accused of having a double chin now; but I'll spare you readers the details.
Now, the nice dirty part. Is it really a city of sex? Positively. Firstly, there are quite a few risqué shows. We caught the Crazy Horse, Paris show. It was just overflowing with sensuality, celebrating the sexiness and beauty of the female body. It was done pretty tastefully (if it is ever possible), Kris and I agreed. And then, there were the hundreds and hundreds of flyers and business cards people were blatantly handing out on the streets like they were candy. Pictures of naked women (occasionally men) with their family jewels and mammary glands starred out, with a phone number and price (as low as $37), advertising some unknown 'service'. I'd hate to bring a child to Vegas- I came back feeling like I need to soak in a tub of holy water to cleanse myself.

(picture above taken from Wikipedia)
On our 4th (of 5) day, we rented a car and drove to nearby Hoover Dam. The pictures we took don't do it justice as it still looks small, but believe me, looking down at the downstream side of the dam made the hair on the back of my neck stiffer than a porcupine's quill. And though they say the water level's down in recent years (you can see the water level in the pictures) the dam still holds plenty; with the lake at highest level, 35.2 cubic kilometers. Just being there made me want to pee every 5 minutes. It was simply breathtaking, and awe-inspiring, what man is capable of doing. I was somewhat disappointed though, that we didn't get to see Bumblebee. The guide I asked had no clue what I was talking about when I asked him where they kept him, or Megatron. He must be new. Also spent some time at the Red Rock canyon, 20 mins away from LV. Did some hiking around the breathtaking rock formations there.

Overall, it was a great trip, and it was nice to get away from all the white stuff here we call snow. To look at more pictures, check out my online album.

Sin City!

We'll be heading to Las Vegas for the next 5 days!

This will be my first trip there (almost drove to Vegas when I was in Arizona that month, but I got lazy) and so I'm looking forward to it. Though the guys also want to plan to have my bachelor party there, I doubt we'll all be able to find time off at the same time.

This time, it's only going to be Kris and I. We've been working hard the last few months, and so this will be a welcome vacation. As Andrea, a friend and confidante put it, I'm going through a bout of 'senioritis'. That syndrome of laziness, lack of motivation, and just wanting-to-get-it-over phase. After all, I have been in post-graduate medical training for 6 years (10 years if including medical school) and so you can imagine my classmates and I are keen on moving on.

Anyways. We'll be out of touch and will be staying at the MGM Grand's The Signature. We'll be catching a show or two there too, and maybe the Hoover Dam. Pictures when we get back!

Yin and Yang

I spent yet another week at the Thyroid clinic. And amongst other things, saw and diagnosed several patients with thyroid cancer.

I caught myself thinking this one day. It seems ironic that the thyroid harbors both (one of) the slowest growing cancer (papillary thyroid cancer), and the most aggressive as well known to man (anaplastic thyroid cancer).

It's such a contrast. I knew the man I saw with PTC is very likely going to do well. Yes, it's possible that he may be left with miniscule amounts of remnant disease in the nodes after surgery, but it will likely not impair his longterm survival. I felt pretty good reassuring him of his prognosis, and telling him he'll see his daughter grow up. That his smoking probably has a higher chance of killing him than the cancer and so he should think about quitting.

But later the same morning, when I walked in the door to see the lady with anaplastic cancer, it was different. She already had an inkling this was to come. Her surgeon had already pre-emptively put in a tracheostomy. And just a few weeks out of surgery, she was already noticing a new mass in the neck. We both knew she would not live to see 2009. I suspect she would not be alive by the time I graduate. She knew what was coming, and got to the point:

"What's going to kill me, doctor?"

She wanted to know how she was going to die.

Probably loss of her airway, I told her. Despite the trach.

I reassured her as best I could. That we probably won't be able to change the outcome, but we've advanced far in the field of palliative medicine.

Such a contrast, these cases.

Gong Xi Fa Cai!

As I ran into Carolyn today, she said 'Gong Xi Fa Cai'.

Oh yea, I almost forgot. Thursday's Chinese New Year. Except there is nothing remotely close to that in the air here.

It's one of those things I dearly miss. The biggest festival of the year. This time tomorrow, my family, along with millions of others worldwide, will gather for a reunion dinner.

I bet mom would make her ginger chicken soup. And probably roasted pork.

The house would be decked out in red. The prayer sticks and papers all ready for the midnight prayers. Mandarin oranges all stacked up in bowls. 'Kam' as they called, or 'Gold', given away to guests for luck.

Come midnight, the warm breezy silence will be shattered by the reports of firecrackers, inviting the God of Prosperity, to come and help them welcome the new year.

The year of the Rat.

Friday morning, mom would wake us up during the wee hours of the morning, to get dressed. We had to wear something colourful, preferably red. Nothing black. We'd get our red packets of money from mom and dad, and promise to be good for the year. After breakfast, we'd head to the temple for prayers. And then head home to wait for the crowds of visitors for our open house.

Gawd, I miss all that. I miss the smell of gunpowder from the fireworks. I miss the food. The warm hugs of family. I miss my grandpa. I miss the 'gambling sessions' we kids would organize (20 cent bets; the only time of the year parents would allow kids to gamble).

Wherever you may be, folks, Happy Chinese New Year to you all.

Superbowl XLII!!

Okay, I admit, I still don't get football. After all, I've been in North America only for 10 years. So go easy on me already, ok?

I confess, when people first started talking about Superbowl in my first year here, images of a huge candy bowl full of Skittles® came to mind. Why candy, I don't know, and why there were girls in bikini fighting in that bowl for the sweets, I haven't the foggiest idea.

While I still don't understand football, and why the hype over men in tights running after and pummeling each other over a ball that's not even in the shape of a ball, I guess I'm able to at least vaguely comprehend what's going on.

Enough to know that 99% of every American would be glued to their TV sets watching the game. That the halftime performance will be by Tom Petty, probably most famous for his song, Free Fallin'.

I also know some simple football math.

Football=cheerleaders. Superbowl=funny TV ads and entertaining halftime shows.

And who could possibly forget, when Janet Jackson immortalized the phrase 'wardrobe malfunction'.

Yea, right. Come on. Leaving your fly open, fine. Having your button fall off, ok. But that?? And I'm thinking that women do not normally wear those titanium bullet-proof nipple shields unless you're planning to have JT rip off your bust. Or some hired gun to make an attempt on your life and shoot you, right there on the nips.

Needless to say, I was working on a research paper on thyroid nodules on Sunday evening and got restless. And decided to watch part of the Superbowl, live from Arizona. Some of the TV ads were pretty darn funny. But really, I wanted to see if the performer this year could live up to Janet Jackson's legendary performance.

But no, as entertaining as he was, nothing eventful happened. No one ripped off any parts of his clothes. Not that I was wanting to see that happen, but it would have been pretty darn funny.

The Start of the End

The last few weeks of clinic, I've found myself doing something different.

I've begun saying my goodbyes to my patients.

I see my patients at least once a year. The stable pituitary, adrenal adenomas. The thyroid cancers. I tend to see my diabetes patients more frequently, perhaps every 3 or 6 months. Having been here for 6 years now, I've accumulated quite a patient list. And in fellowship, I must say I've had a greater sense of ownership of my patients.

They're MY patients. I'm THEIR doctor.

I know their history, often I remember their faces and recall their medical history by the mere mention of their names. We've shared life stories- I'd seen them go through weddings, jobs, divorces, deaths, surgery. They knew of my plans to propose, the engagement ring, the upcoming wedding plans. Just last Monday, I saw Mr. C again for follow up of his diabetes. The first thing he says, '6/7/08, right?' (Our wedding date). He asks me if I'm pissing in my pants yet. And reminds me that if I change my mind, he's got a very cute single grand-daughter my age (I don't think he realizes I'm 32 and not 25).

Now that I'm less than 5 months from graduation, I'm likely seeing my patients from now on for the very last time. And so, I've gently been preparing them, telling them I'll make sure the doctor who inherits them 'will be smarter and better looking than me'.

Some have been nonchalant (perhaps even relieved?) that I'll be leaving. Many, though, have told me they'll miss me. As I will miss them. It's funny, but it's true. Many patients have asked if they could continue to see me when I move down to Iowa and begin my new practice. And though I tell them I'd love to see them again, I do often remind them that their patient records do not come with me, and the care they receive here, really, is second to none. After all, it would be inappropriate for me to recruit my patients from here for my new practice.

Though in a way this is a business relationship, I've felt like we've gone a long way with many of them. Like the 40 or so thyroid cancer patients I have who are disease-free. Or the diabetes patients who have been able to keep their hemoglobin A1c below 7%. It's like, we've come so far together, that I'm proud of their achievements.

This year, the program decided to do something different. Instead of new fellows randomly picking up the patients of graduating fellows, they've decided to have one fellow 'inherit' all the patients of a graduating trainee. So, I basically know who will be taking over my practice come July. And so, I reassure my patients that they'll be in the good hands of Dr. MN. And hope that they get the care they so deserve.

I begin every patient interaction with a handshake. I've done so for the last 6 years. Now, I'm ending many visits with a warm hug. I really shall miss my patients.