37 More Days

37 more days.

Yes, you can say I'm stressed. 37 more days to the wedding here, and then there's a 2nd wedding in Seremban in July. And then there's our imminent move (and the headaches that come with building a house). And a new job (start date August 4th).

Pepper in 2 national meetings at which I'll be presenting my research data. It's no wonder I'm losing my hair at an alarming rate.

But, back to the wedding. I'm anxious. But in a good/fun way, I guess. We picked out our wedding bands the other day. Had them sized. For Kristin's case, we had her band fused to the engagement ring. Which kinda made me realize we men had the wrong end of the deal.

For example, answer me this:

Why do women get engagement rings, while men don't?

Why do women get diamonds on their rings while ours are usually plain?? Combining the engagement and wedding bands, Kristin gets 21 individual diamonds, while when I asked for some bling-bling (just trying to be funny) my better half and the jeweller looked at me like I was queer.

Is it fair that women's rings are usually gold or platinum, while men's come in either stainless steel, titanium or some other less expensive metals? Mine a tungsten carbide two-toned ring. Strong enough that if an asteroid ever lands on me, you can use that ring for ID.
Ok, I'm being facetious. Outwardly I tell people I'm a wee bit nervous. My secretaries take delight in reminding me of my remaining days as a free man. Secretly though, I'm as excited as a kid on Christmas eve. I mean, this is big deal stuff. We're getting married! Two becomes one! And I get lifetime supply of free laundry and home-cooked meals. Wait, or did I get that the other way around?

Anyways. I'm sure there will be interesting updates in the month to come. Stay tuned.

MOH: No Longer Issuing Letters of Need?

For an international medical graduate (IMG) the process of getting into a US training program is a long, tedious and very pricey one. One usually needs several letters of references, USMLE Steps I and II and a good CV.

After the complicated applications are in, you may get invited for interviews. Following that, you rank your programs while they rank the candidates in the order of preference. Come March, the ‘match’ results are released. With a match, foreign doctors must obtain the necessary J1 visa before they can enter the US for training. A prerequisite for this, is the ‘Letter of Need’ by the health ministry. However, whether or not it is official policy, it appears that the Ministry of Health of Malaysia is no longer giving out these letters of need, effectively eliminating the possibility of postgraduate medical training in the US (unless you obtain the H1B visa, but I won’t go into that). I am finding out from several very distressed juniors who have gone far in the application process and have secured residency positions, only to find out at the end of the journey that their request for that letter was turned down. A very disappointing and pricey roadblock. It seemed that rarely ’special cases’ were allowed (ie. string pulling). Certainly, I can understand if you are bound by scholarship and loan responsibilities, but this applied even to self-funded students.

Presumably this was done to curb the brain drain from Malaysia, and while this may prevent doctors from coming to the US for training, personally I feel this is a short-sighted plan which would result in more doctors in Malaysia in general but not result in the increase in subspecialists. For, although many of us may choose to remain in the USA after training, many too, will return to Malaysia. A letter I wrote appeared in the Star yesterday requesting that the MOH clarifies its official policy on the issuance of these letters.

"... recently many of my juniors have shared with me that the ministry is no longer issuing these letters of need, effectively eliminating the possibility for new Malaysian doctors to obtain specialist training here. Presumably, if this is indeed a policy, it is being done to curb the brain-drain as it is true that many will choose to remain in the US after training.
However, one must remember that although some of us will choose to stay, many still will still return to Malaysia after their residencies and fellowships, bringing back the much-needed skills in various medical and surgical specialties.
Therefore, if it is true that the ministry is now preventing us from obtaining training here, although this may result in more fresh medical graduates working in Malaysia, ultimately, it would be a short-sighted plan that would lead to even fewer sub-specialists.
This is because with the recent changes in Britain, post-graduate medical training there no longer seems feasible for many, while Malaysia itself lacks adequate training positions in numerous fields.
Even if half of the US-trained Malaysian specialists choose to remain in the US, we still have half returning home after their training, bringing vital expertise for a growing country.
Therefore, on behalf of my young colleagues hoping to be trained in top US centres like the Mayo Clinic, Johns Hopkins and Harvard, I like to ask the ministry and the president of the medical council to clarify the official policy regarding the issuing of letters of need. For, given the chance, these Malaysian doctors may very well do the nation proud."

Let's hope they come up with a formal answer; I'm sure everyone else isn't comfortable with see-what-happens and see-who-can-pull-strings scenario. We'd all prefer an official stance. In the meantime, a junior did get in touch with me after reading my letter, sharing her recent painful experience, but offering to help give advice on how to appeal, and who to talk to for a letter. Please contact me for her email address.

Addendum: This must be a record for me; an MOH representative has already replied in The Star today.

We are pleased to inform you that, contrary to the claims made by the writer, letters on ‘statement of needs’ continue to be provided for doctors planning to pursue their specialty training in the US.
The main problem, as noted by the writer, is that the majority of these doctors (including his good self) have opted not to return to serve in Malaysia for various reasons, which is contrary to the ground that the ‘statement of needs’ was issued because there is a dire need for professionals in this area of specialties in the country.
To facilitate the processing of the document requested, the doctors intending to be trained in the US are required to furnish their home address, contact number, information on their qualifications and working experience in Malaysia.
In addition, they are also required to provide a written assurance or a statutory declaration that they will return to Malaysia and report to the ministry on completion of their training programme.

This is at least some good news as 'officially' they still are issuing these letters, though many of you have shared with me your totally opposite experience. Keep at it, and if you had been declined, perhaps this response may provide some encouragement to keep trying and appealing. Good luck!

I read this story in the Sunday papers. Kris was working, and so I was alone, having my morning coffee.

The story hit me like a bolt in the blue. Excerpt from the Star Tribune:

Like many first-time parents, Matt and Liz Logelin were understandably nervous. Two months before her due date, Liz was put on bed rest in early March to keep from going into labor prematurely. Twice, she was wheeled into the delivery room, and twice, the baby changed its mind. So when baby Madeline finally arrived on March 24, small but healthy, the entire family breathed a sigh of relief. Then the unthinkable happened. Liz, 30, passed out the next day on her way to hold her daughter for the first time.
Within minutes, the young mother was dead from a blood clot no one knew she had developed. Suddenly, Matt Logelin was facing life as a new dad and a 30-year-old widower all at once.
As his world fell apart, Logelin turned for solace to the Internet, which has become an unexpected lifeline for many sharing joy or grief. In his case, both. He told their story in a blog, www.mattlogelin.com, which he subtitled:
"Life and death. All in a 27-hour-period."

It's so sad, this story. As someone just about to start a family, Kristin and I have recently started worrying about each other, about our health, about how life can be fragile. We worry more so because things seem to be working out for us so well. Reading this story today only made me worry about us more.

And yet, it's an inspiring story about how love endures. About faith and strength.

Go have a read- but get your Kleenex ready. And do say a prayer for Liz, Matt and Madeline.

Graduation Banquet

The other day, I attended the school of graduate medical education's graduation banquet. A night to honor those of us who will be graduating from training, from the 'mothership' this coming June.

Being in that hall and looking at the crowds of colleagues and consultants, I couldn't help but to reflect. It has been a long journey which is now only coming to an end, with another chapter to begin very soon. After all, I began medical school in early 1996. If someone had told me I'd be training for the next 12 years, I'd probably have told him to go straight to hell and packed up my bags and gone into school for something else.

Even now, when I lecture to the starry-eyed medical students in IMU, I wonder if they have any idea what's in store for them. I know I didn't.

But now, 12 years later, when I'm not so young anymore, when I'm a PGY-6 (in many's opinion, that's considered really senior. A career trainee), knowing what I know now, what would I have told myself, if I could travel back in time? What pearls of wisdom might I impart?

It's going to be a sacrifice

Thinking back, I've worked insane numbers of hours, missed out on so much in life, left behind loved ones, been so far away from my dear family, studied hundreds and hundreds if not thousands of hours. To this day, I feel guilty if I don't spend a few hours reading something medical. Nothing great comes without a price- only that person can decide if it's going to be worth it. But you have to know going in, that you're going to let go of a lot of things, even parts that make you more human.

It's okay to be weak

To have moments when one has to cry. I know I've done it. Numerous times as an overworked, exhausted intern, when my patients die, or when I make a mistake on rounds, or when I get dressed down. To survive, I've used the 'hide in the bathroom/phonebooth and cry' trick. Me, a 25 (then) year old. But, with every tear, one learns to be stronger.

Have faith

That the Lord will provide. I don't consider myself overly religious. But I do believe in a Higher power. And I do believe He took me, a homesick, shy kid from a tiny country in Asia, and put me here, for a reason. When you're on the verge of exhaustion and have been on your feet for 32 hours, have faith that you'll find the strength to go on. One of my favourite quotes:

"When you come to the edge of all you know, you must believe in one of two things. There will be earth upon which to stand, or you will be given wings to fly".

I've leapt off so many edges I've lost count. And yet, somehow I'm still here.

Only you can sell yourself
One handicap I've always faced was, coming from Malaysia I tend to be more reserved than my counterparts here. And often, you meet people who speak a lot, and loudly, without actually saying much in substance. You realize that it's sometimes sadly not what you say or do, but really how you sell it. In a competitive world such as this, there is a fine balance between humility and losing out.

Never forget your roots

Though I've been away for so long, and will likely settle down here, I never forget when I came from. Undoubtedly, neither my grades nor luck put me here; my family did.

It's alright to make mistakes

After all, doctors are human too. And it's hard realizing mistakes often involve people, and can result in harm and lawsuits. But as much as I hate to admit it, we do make mistakes. And we need to forgive ourselves, and learn from it.

Never regret, never ponder

Never look back and wonder about lost loves, family and career opportunities left behind. There was a time I tortured myself with this. But I finally learnt: it's hardly relevant. You picked a path, you stick with it until you complete the journey. No point wondering about 'what ifs'.

Your patients will hate you. Your patients will love you

As with all relationships, some patients you can never please. Some patient will always complain and be dissatisfied, and you can't let that get to you. Instead, remember the gratitude and friendship from those who genuinely appreciate your help and use that energy to sustain you.

Give back

As you learn from patients, give some back. Volunteer; you get back so much more than you give, really. My most memorable and fulfilling experiences have been related to volunteering.

Patients die

No matter what. Whether it's of old age, or of that acute pulmonary embolism that caused a cardiac arrest that made your resuscitation efforts futile. Such is the circle of life. And yet, death isn't always a failure, and even in death, you often can provide comfort and care as a physician.

Officially, I close this chapter June 27th. 2 more months as a fellow. Unofficially, we're all board-certified endocrinologists and have already signed up with our respective employers. The next chapter will be an interesting one.

This week I've been doing a totally new attachment. Makes me feel like a fish out of water, everything being so different. Heck, even the terminology is new.

I'm doing a short stint in reproductive endocrinology. Though this really falls into the realm of the OB/Gyn department (it's an OBGYN fellowship, not a medicine subspecialty) there is some minimal overlap between our specialties, so I thought it would be interesting shadowing these folks.

It's a different world, really. Far from discussing mortality and death and prognosis and cancer, these folks are in the business of creating life. I've seen some pretty amazing stuff this week. Several IVFs, embryo transfers.

You also realize something. A vast majority of the patients I've seen this week are well-educated, highly-trained professionals, mid to late-30's, who've spent their lives chasing their career dreams. People like us. And, perhaps from a reproductive standpoint, spent a bit too long doing that. And with the biological clock ticking against them, are having trouble conceiving. I caught myself thinking about when Kris and I should start our own family. Then again, there's so much we want to do. Travel. Enjoy our new home. Get my 'toy car'. Kris to get her Masters in Nursing Anesthesia.

Oh well. One step at a time.

I'm back.
The bachelor party was swell. I'm sworn to secrecy so don't ask me for the details.
We, err.... hung out at the.... erm... library. And then had 'porridge' for dinner. And just had.. ahem... coffee later. Yes, that's it, coffee.

Why? What did you think we were gonna do?

The Bachelor Party

There are few things that make me swear like a drunken pirate. Snow in mid April, well into spring, is one of them. And I was already planning to get my bike out. In fact 2 weekends ago the temperature was well into the 20's °C.
I guess I shouldn't complain. I heard they got a foot of snow further up north.
So today happens to my bachelor party. My buddies are planning it and we'll be spending the night in Minneapolis. What exactly they have planned for me, I don't really know (and we'll probably be sworn to secrecy).
I do know we'll be having dinner at a Brazilian Steakshouse. It's pretty simple, really. You have what looks like a Stop/Go sign on your table. If you flip it to 'Go', the wandering waiters with different cuts of meat keep piling it up on your plate. When you have enough, flip it back to 'Stop'. Eat, and when ready repeat cycle.
Knowing the gang, there will probably be a lot of alcohol involved. When we get together, it's usually hard to really drink because of the kids around, and because of driving responsibilities. Tonight we got a couple of rooms in the Marriot; I only hope we'll be sober enough to crawl our way back to the rooms.
Hmm, maybe there will be some 'exotic' dancing involved?
(Which seems to be the norm here from the bachelor parties I've attended. And it's a lot less wild then what the movies portray) Probably not, seeing that most of us are 'family men' and are AOTH (Almost Over The Hill). Seems like good friends, good food and alcohol are all it takes to make a man satisfied these days.

Then again, HH was trying to get Kris to attend one of the male strip shows in Vegas. I hope HE doesn't have a surprise planned for me (it's scary what a mild-mannered cardiologist with FIVE kids can unleash when he is away from home).

And if you think we've being unfair to our significant others, have no worries. The ladies are getting together for Kris' bachelorette party next weekend. From the stuff I've already heard, it's already making ME blush. They last time they got together for something like this, they even had a cake made into the shape of a man's salami.

And it's pretty amusing that her sisters and MOTHER are involved in the kinky details of her party too!

I offered to pay for a male stripper to show up, but I was afraid she'd start buying me male-thongs after that.

P/S: Dear readers, if I don't return by Monday, please start a $$ collection amongst yourselves. We'll likely be needing some bail money. And I swear, they made me do it.

A Historic Night

Today was a historic day.

At least for some of us.

I've been helping out at the Salvation Army free clinic in town since early in residency. And then, when I started fellowship in 2005, a friend and I started the diabetes clinic part of the facility. After she left, I took over her position and have been the medical director of the subspecialty clinic since.

We've long been used to the '3rd world medicine' setup of the clinic. So unlike where I usually work- just a big hall with no private rooms, no blood tests aside from a stat A1c kit. Small pharmacy housed by big-hearted volunteers, dispensing free medications donated by organizations. And somehow, our patients there never complained. About the lack of pricavy. About the long waiting periods. Or lack of everything except heart.

Last week saw the launch of a $7.5 million newly-constructed building, housing our medical, dental and eye clinics, and containing even 32 residential units for the homeless.

Tonight was the first time we held our Diabetes & Hypertension clinic in the new facility. For many of us it was a night of pride. To be able to offer our patients the privacy of an exam room. A proper waiting area that was warm and well-lit with comfortable chairs. It's still not a world-class institution. But somehow, perhaps from the warmth of the hearts of the people there, this facility feels first class. And I'm glad that when I step down as medical director in a few short months, the clinic's legacy lives on.

2 Weeks Later

2 weeks ago, this was all there was. A big pile of dirt and a concrete foundation. Our realtor sent us this picture she took when she passed by the place today. In just under 2 weeks, now lies:
It's pretty amazing, how fast things move here. Unlike Malaysia, houses are not made of concrete/bricks, only the foundation. Eventually, we hope it would look something like this:
It's great fun, I must say, getting a house that is still being constructed. You're able to work with the builders and tell them what you want and what you don't. The red marks were my comments for the builder. For the most part, the floorplan is fixed, but we're able to change cosmetic aspects of the house. In fact, our place will have a stone arch around the main door and a large window above the entrance which should put a lot of light on the staircase. That part was our own idea, something Kristin and I had seen on another house.
We also made some minor changes with the master bath, to have glass-block windows against the jacuzzi tub, and to have the shower stall be lined by stone tiles. I had wanted a skylight window for the master bathroom (I thought it would be neat to take a dump on the toilet and to have sunlight shining down on you like you had achieved enlightenment), but Kristin quickly put her foot down on that. That would add precious $$ to our already overbudget home, and would probably affect the insulation of the house. Also, when I asked the builder if they could put in a dance pole Kristin gave me a look that would have killed King Kong. Thank heavens we have our women to keep us on the ground!
The construction is expected to be completed by the end of June. We can't wait, really. It's not going to be a mansion, that's for sure, but for someone used to staying in crappy little places, that's going to be as close to a dreamhome as I'll get for now.
The next question is, which garage stall will house my new Mercedes SLK?
(Answer: Dream on, unless I get lucky with the lottery)

I got my car!!

Woo hoo! After months of sweating and deliberation, and surveying you, my readers, I've finally bitten the bullet and placed an order.

Not the Mercedes SLK 280. Not even the Porsche Boxster (the "poor man's Porsche"). I went for a silver coloured Porsche Cayman S.

The Cayman is a mid-engined, rear wheel drive 2-seater sports car, first launched in 2006. The car was derived from the second generation Boxster, with a 3.4 liter flat-6 engine, driving out 295 HP and hitting 100 km/hr in 5.1 seconds.

I've already selected my car but we're waiting for the paperwork and so I will be picking up the car from the dealership only on Friday. In the meantime, please check out these awesome photos here.