The Suitcase Sign

The Suitcase Sign.

It's when a patient presents to the ER with, literally, a large suitcase or two. Usually occurs at the start of a weekend, or holiday. Usually negatively predicts the severity of illness. Almost always an ominous sign. Patients coming to the hospital lugging a suitcaseful of clothes either expect this to be a hotel stay, or expect to have an extended hospitalization, or both.

The outpatient version of this that we dread, is when the patient brings a suitcaseful of medical records. Though sometimes they do this to be helpful, sometimes it can also hint at 'doctor-shopping', or obsessive-compulsive traits.The other day, as I started my day, Dani, my clinical assistant half-giggled as she handed me my patient list.

"Your patient brought his medical records with him", she gestured towards what I thought was a box of printing paper.

I kid you not.

A box.

And not just a box. A full box. And the patient actually brought it with his own cart. Yes, you heard me. A cart. The kind grocers use to transport wooden crates of tomatoes.

It was a Monday. These things always seem to happen on Mondays.
800 pages of outside records, 4 days and a half-dozen tests later, I provided him with the diagnosis I had suspected all along: No endocrinologic disease.

(for a nice sum of money for 'health supplements' , some health practitioner had misled this poor guy for the last several years)

Oncall

I know I know. Enough lousy excuses, but I've been terribly busy. One weekend was dedicated to wedding stuff in Milwaukee (and if you feel generous enough to get us something from our wedding registry, who am I to stop you?). And then the weekend before last was househunting in Iowa. And so, I was looking forward to some down time last weekend. To, for the first time in a month, sleep past 7.30 am. I had mentioned to Kris on Thursday, how I was dying for the weekend.

And then on Friday, to my horror, I find out that some lazy, incompetent moron did not check the oncall schedules and failed to inform me that I was oncall for the weekend.

KNNCCB. The French that mouth uttered would have curled even Kid Rock's neck hair.

Naturally, that moron I'm referring to was me.

For whatever reason, I thought I had only one more weekend call for fellowship.

But here I am, halfway through the week, with my pager close by, on 24/7, waiting for calls from the hospital. Before I get my day off this weekend, I'd have worked for 12 days nonstop.

3 more days...

Our first home

With the money we're spending, we could have gotten almost two of these beauties. Instead, the practical side of us spent the money on our home. Behold, what 2 Ferrari F430s can buy you:

10,000 square feet and one big pile of earth. Woo hoo.

Okay, I'm being facetious. Though there is nothing to look at now, our home should be completed by July. We decided to work with a builder to build something to our specifications. We're both terribly excited, being able to pick our colours, partially design the house, tell them where to wire the surround-system cables. Though I'm leaving most of the designing to Kris.

Like most guys, I'm colour-blind, have no sense of style, and if I could have it my way, have a dance-pole in my living room. Heck, I'd have my toilet right there in the middle, in front of the TV and within arm's reach of the oven that will bake the pizzas. I think I'm fairly easy to please- requirements for home:

1) TV room

2) Garage

3) Toilet

So thankfully I have Kris to tell the builders what to do. I've learnt to stay out of the way, and to say 'yes dear'.

And in case you're wondering, no we're not paying for this in cash. We're taking a 30-year mortgage.

Househunting

Sorry, I've been neglecting my blog of late. Kris and I have been sh*t busy with stuff. Last weekend was wedding prep. And then the past, we went house-hunting.
It's intimidating, for a first-time homebuyer like me. Trying to decide: price range, which area, 3 vs 4 bedrooms, 2 vs 3 car garage, location. Our head's spinning, and even after 2 days there we're just as confused. Granite countertops vs.... nah, we want granite.
We saw a few we liked, and many we don't. But, it's hard to find a house that has everything we're looking for.
And so, we're making another trip down tomorrow, 3 hours there to look around, then 3 hours back in the evening. Wish us luck. And until we finalize things, I don't want to jinx things and say where we're looking.

Winds of Change

Though I've been away from home (I still find myself calling Malaysia home) for 10 years now, I still follow her progress avidly. This time, I must say I'm extremely pleased by the recent election results.

Many of the younger Malaysians, I suspect, voted for the opposition. And in one fell swoop, BN (Malaysia's ruling party) loses 5 states to the opposition. Many like me, I'm certain, are just sick and tired of the nonsense going on there. The middle and lower class become poorer, while the rich get richer. The fatcat policitians laughing their ways to the bank.

Irresponsible wastage of public funds (most recently the spending of over a million RM for indelible ink that's now gone to waste. Then again maybe not; I bet this was the final straw for many Malaysians), corrupt practices and double standards (the close one eye incident, etc), cronism, racist and sexist practices, the ever-increasing inflation rates (toll, gas, locally-made cars). And that idiot Samy saying Malaysia has one of the cheapest toll-rates in the world (yea, right!). I'm glad the voters gave him the finger and told him to go to hell. And politicians saying the most retarded, stupidest, moronified statements.

And those many have felt helpless in the past, too afraid to vote for the opposition because of BN's threats of political and racial instability if the opposition ever wins, this time, many have decided to take action.

I've always believed in natural selection; if there is no competition between species, then a species will never better itself. Applies to biology, race and even politics.

Like many Malaysians, I will give the opposition the benefit of doubt, and keep an open mind. We will look forward to the next few years. And let the politicians beware: if you piss people off, they will get rid of you.

Taking things personally

Sometimes when you send a patient for surgery, even if it's necessary, and things go wrong, you just can't help but feel partially responsible for it.
A patient had pretty severe primary hyperparathyroidism. We had put off surgery for some years because she was fearful of the knife. And she has a complicated medical history.
But this year, because things had worsened significantly, we bit the bullet and decided to go ahead with surgery. Which went well, but she suffered some nonpermanent postsurgical complications.
It was one of those things, related more to her underlying health and no fault of anyone's. And every procedure has its risks and benefits, and it's always something we weigh before deciding to proceed. In her case, clearly she needed surgery.
But still, I felt horrid most of yesterday. During a lull in clinic, I went to see her in the hospital where she was recovering. Tried to encourage her as much as I could.
You know it's not your fault, that you acted in the patient's best interest. And that you shouldn't carry burdens such as these. But deep inside you mind, you do catch yourself thinking that this would not have happened if she didn't go for surgery.
Thankfully, she's likely going to be discharged today.

Being Hands Off

Buddy got admitted again last night for intractable nausea and vomiting and pain, from the chemo and radiation-induced esophagitis. He's been a real trooper, but the nausea got the better of him the last few days. Things have been going well enough that they've proceeded with radiation, and he's into his 5th week. And thus the resultant side-effects.

As a doctor, we all get irritated by those overcrowding, breathing-down-your-neck, doctor-type family members who go as far as to almost direct care. It just gets in the way of the medical team. And when emotions are involved, you don't make objective decisions.

Well, I was one of them yesterday. When the intern came in to assess my friend, I was mentally sizing her up to see if she was competent (she was). I found out the supervising oncology fellow oncall is my ex-classmate and friend, so I paged him to talk to him. I was getting ansy at how long it seemed to take to get his IV fluids started. In short, I think I was being a prick. And I came home mad at myself for it.

It's hard to be hands-off, I reckon. Especially when it's someone you care about, especially when you're very much a Type A, and when you've been trained to take care of patients and not sit back and watch passively. It's a total role reversal, to be sitting in the corner of the room, instead of being that person examining the patient. It must have been hard enough for the intern, with 4 doctors in the room watching every one of her moves.

It's also a lesson, on several levels. One, as Kris puts it, to learn to relax and let others take care of the ones I care about. Two, to have more understanding, patience and empathy then I deal with my next over-bearing patient kin.

In the meantime, please pray for Buddy's prompt recovery and hospital discharge. And feel free to leave him messages of encouragement on his Caring Bridge site.