Part 2?

Again?

That was my reaction when I read the news on CNN.com (it wasn't even on the Malaysian newspaper websites yet).

Really, I think many Malaysians are getting sick of how dirty Malaysian politics is. Personally, I think it's a smear campaign. In addition, it is noteworthy that "sodomy, even if consensual, is punishable by imprisonment"; IMHO, a person's sexual orientation speaks nothing about his leadership abilities (not that I believed any of the original accusations anyway). After well, we've had nothing but a bunch of straight but corrupt, racist and inefficient leaders.

We'll see how this saga unfolds.

The end of the End (and the start of a new Beginning)

I woke up an hour before my alarm went off this morning. Tried as I might, I couldn't fall back asleep.

Years ago, if someone had asked me how I'd feel at the end of my training, I'd have said that I'd be ecstatic, euphoric, and leave running and yelling and not look back.

Today, I confided in Kristin that I went to work with a heavy heart. In the midst of all the wedding and presentations at conferences and family visiting, I'd forgotten what this really means.

The end.

My training ends (the CME of course, continues for life).

My educational and legal association with this wonderful medical institution, formally comes to an end.

I came to work seeing everything differently today. This was the last time I'd take the elevator up. The last time I'll walk past the board with the photos of the members of the endo division. The last time I'd say 'Good Morning' to my secretaries. The last time I'd log in to my computer and see the electronic medical record system boot up. The last time the clinical assistants call me 'Sparky' (I happen to be the speediest fellow). The last time I'll see the med-evac helicopter take off from the hospital rooftop.

6 years. I've had 6 wonderful and proud years at this institution. And though I still have much to learn, it's taken the shy, scared fresh medical grad and turned him into a confident (hopefully skilled) endocrinologist.

Though I've had some nightmarish experiences here (mostly in internship), my time here has definitely been a positive one. And I'm probably biased (and being a bit boastful, but this is my blog, after all!) but the patient care this magnificent institution provides, is really second to none. And it's even more amazing working alongside literally, the world experts in their respective fields, who remain ever so humble and approachable and keen to teach. And the numbers are stagerring:

Over 2 million outpatient visits a year. 2209 residents and fellows like me, 3200 staff physicians. Almost 2000 beds, 90 operating rooms, 4 helicopters. 33000 lab tests, 200 MRIs done daily.

We've all been spoiled and working in a new place will definitely take some adjusting.

I'd like to think that I not only survived my training, but to an extent, thrived. Training that started in 1996 and ends in 2008. Years that would not have been possible without the support of my mom, dad, Kristin and friends.

I hand in my employee access card and pager this afternoon. Pager number 8402, something I've used for 6 years. I'm going to feel naked without it.

As I hug my colleagues goodbye, I'll have to bite my lip and hold back tears.

Farewell

2 More Days

It's hard to believe. 2 more days in this institution, and then I'm officially 'terminated'. That's how the memo phrased it. Basically, I'll no longer be a part of this magnificent institution, and will have been given wings to fly on my own.

The last week has been of goodbyes to patients, staff. Or signing my clinical notes and ensuring follow up has been arranged for my patients.

I saw Mrs. R again today. She had presented with a thyroid nodule, the biopsy of which was suspicious for follicular neoplasm. The FNA is not able to differentiate between follicular adenoma or carcinoma, one of the limitations of the test. Hence, we tend to send these patients to surgery because of the significant chance of cancer.

I wasn't expecting to see her again so soon, as she was originally scheduled to return in 2 weeks. She told me she wanted to see someone familiar, and wanted to say goodbye to me.

Sheepishly, she added as well that she heard that July is not a good month to undergo any procedures. Wise thinking.

Though I hate to admit it, having been on the other side of the fence and having been an intern myself, July is when hordes of new interns, fresh out of medical school, begin their residency. The new academic year begins. So, if you happen to be treated by a trainee in July, there's a chance he or she may be very inexperienced.

It's a necessary evil, for we all have to learn, and we have to start somewhere. I recall my first lumbar puncture; the patient on the table half-joked, "How on earth do you find suckers to be the first patient the resident ever does this procedure on?"

He turned a couple of shades paler when I confessed that he was my first.

Anyways. Mrs. R undergoes surgery tomorrow; chances are on her side that this will be a benign follicular adenoma.

Come Friday, I will formally hand over my nametag, ID and access card, pager and parking tag. By the time Saturday comes around, Dr. Vagus will no longer be found on the employee online directory.

I have so many memories of this place, good and bad. I shall leave with a heavy heart, a lot of gratitude, but hopefully enough knowledge and skill to offer to my patients in my new practice.

Newcomer to the family!

We wanted this to happen, but didn't expect it to be so soon. After all, we just got married 2 weeks ago. We've always wanted to start a family, and I suppose sometimes you just can't plan for things 100%.

Despite things happening a bit faster than we had planned, we're ecstatic. After all, I think we're emotionally and financially secure.

Yes. We're going to be a family!

Meet our new baby!

She's a 4 week old Shih Tzu that we're getting from Kristin's colleague. We're still debating on the name.

What do you think?

1) Peanut

2) Chloe

3) Other suggestions?

We'll be formally picking her up when we return from Malaysia mid-July!

San Francisco

Greetings from San Francisco!
I'm here for the Endocrine Society 90th Annual Meeting where I presented my research data in a poster session yesterday.
Anyway, this would be my 2nd trip to SF. It's an interesting city; I liken it to a hilly Vancouver with its waterfronts, large Asian population. I'd describe it better if I could, except I learnt long ago that I suck at descriptive narrations. In fact my writing abilities are limited to foul, politically-incorrect satiricals; not surprising if you know my all-time favourite classical writer was Tim Allen (Don't Stand Too Close to a Naked Man).
We stayed at the W. It was my first time in this hotel chain, and I must say it's interesting. Pricey, clean and modern rooms. Chic, hype, and very, how should I say, zen. It has an Asian theme, with paper lampshades and a weird glowing smiling Buddha in the room!
The meeting itself was as usual, pretty high quality. I met up with a group of Singaporean endocrinologists and we had lunch one day. It's great to meet up with people from home, though there wasn't any research presentations by any Malaysians this year. I did however meet some docs from HUKM.
As an added bonus, my research poster got us an award. It was a retrospective study we performed looking at the frequency of acute pancreatitis in patients with primary hyperparathyroidism. Unlike other previously published studies from surgical cohorts, this is the first population-based study out there and we found much lower numbers compared to the other papers. The manuscript is in its final preparatory stages and hopefully I'll be submitting that for publication within the next month.
Will be leaving for Minnesota tomorrow. And in 14 short days we leave for Malaysia. No rest for the wicked...

Blah

I'm feeling a bit overwhelmed.

After the wedding?? you might ask.

Well, I'm realizing that there's just so much to do, and so little time.

I officially graduate June 27th, 13 days away. But yet before I do, I have a meeting to attend and present at. And have about a dozen patient calls and letters to address. And a presentation at Endocrine Grand Rounds. And Drs. W and B are semi-bugging me to revise the manuscripts we're working on before I graduate. A reason why I'll be bringing a laptop and working on my papers when I'm supposed to be attending the conference in San Francisco.

We leave for Malaysia on July 1st. That's 17 days away. And yet, between now and then we need to move Kristin's stuff to my house proper (she sold her apartment, Hooray!) for the movers. And then, there's the Malaysia wedding, with a whole new program we need to work on. And a new vacation itinerary, only this time we'll be playing tour guide to her family.

We haven't had the chance to even contemplate a honeymoon; I suspect we'll only get to sigh down and breathe a big sigh of relief when we return and have moved in to our new place late July.

On that note, we visited the house yesterday. Aside from some minor hiccups that the builder has promised to address, we're extremely pleased, and are excited to think about the projects we'll undertake in our new home. Thankfully, we haven't had any flooding in that part of town.

Our wedding!

We were worried. After all, that weekend of our wedding saw the worst rain in the midwest in decades. You probably read about it on CNN. Several tornadoes were sighted in the state the Friday and Saturday. Thunderstorms were forecast for the weekend.
We had our rehearsal and dinner Friday evening, a meeting of our closest friends and family who would be involved in the wedding. Miraculously, despite the forecast, we woke up to a sunny, cool day on Saturday. Per tradition, Kristin and I had said our goodnights the night before and I was not to see her until she walked down the aisle with my future father-in-law. And so, on Saturday morning, my mates and I got ready in one section of the church, safely segregated from my bride-to-be. I know I wondered several times how her gown looked (again, another tradition here; I was not allowed to see her wedding gown).

My groomsmen were TS, the best man and my housemate for the last 5 years, who at his last PET scan was in clinical remission, Nick and LP, my pals from IMU who did medical school in Canada. It was through God's grace that TS has responded so well to the treatment and has recovered enough to help with the wedding. Our ushers included ET, the first friend of mine to have met Kristin. We've all shared so much that it feels right to have them as my groomsmen, perhaps as one more saga in our friendship beofre LP returned to practice nephrology in Malaysia, and before I moved to Iowa.
My family, including my sister, brother and sister-in-law, flew in for the wedding. It was nice to have then share this day with me, for it would not have been complete without them.

The mothers and the bride. My Kristin.


"But dad, I wanted tall, dark and handsome"

Both Kristin and I got teary at the wedding. It's inexplicable why; to have my family and dear friends there to witness this, and to see the woman I love walk down the aisle towards me, it was, simply put, the happiest day of my life (well, so far. Who knows how happy I'll be when I get my Mercedes SLK!)

Brendan and Shavon, the ring-bearer and flower girl. Kids of our very good friends here.

Kristin looked positively radiant (well, aside from the red-eyes), walking down the aisle with her dad, David. She wore a white gown with an apple-red sash and a tiara. My friends tell me that when they saw me crying too, many of them sheds tears too. It was a very intimate, emotional event.

Kristin's bridesmaids were her sisters and her buddy from nursing school.

We had our lunch reception at Bartolotta's Lake Park Bistro, a Zagat-rated French restaurant overlooking Lake Michigan, whose chef recently won the James Beard culinary award for the midwest. The restaurant was cozy but big enough to hold the 120 guests with room for a dance floor, and the food was spectacular (then again, it was our wedding so I'm biased!).

Just after we wrapped up our day and checked in to our hotel, the rains started again, to cause havoc in the Midwest. The timing couldn't have been more perfect. It was like some divine power held out an umbrella for us just long enough to enjoy our wedding day.

We're back in MN. Phew, it's done; one wedding down, another to go (July 5th in Malaysia. To the same woman, in case you're wondering!). I'm still off work for another few days, before I have to fly off to San Francisco to present my research at a meeting. So far, it still seems surreal at many levels.

For one, the name 'Mrs. Vagus' conjures up images of my mom, not my new bride. Secondly, I joke about this but really, the ring on my left ring finger really does feel heavy and big. And I still catch myself thinking of Kris as my girlfriend, not wife.

But with all that, this is an exciting new chapter and a whole new beginning. So life, here we come!

20 hours to go.

We're all in Milwaukee, WI. And it's fun to see how, despite the noise and hordes of people (more to come) converging here, our families and friends get along so well.

The weather forecast doesn't look promising right now, so if you believe in a higher power, pray for nice weather tomorrow!

The next blog update from me will be after my shackles, ball and chains have been put on! So, stay tuned for pictures!

In the meantime, I'll end with this joke:

A newlywed couple had just arrived in their honeymoon suite. After unpacking, the husband took off his pants. "Put these on," he said to his wife. She did and they were obviously much too large. "There's no way I can wear these - they're way too big," she said. "Good! Now you know who wears the pants in this family," replied the husband.
Flustered, the wife removed her panties, and handing them to her husband said, "Put these on." The husband looked at the tiny panties and said, "There's no way I can get into these." To which the wife replied, "You're darn right! At least not until you change your attitude!"

Crunchtime

The countdown timer on my wall shows:

4 Days, 12 Hours, 48 Minutes.

Can't believe we're down to crunchtime. I remember the time when the timer showed 350 Days. Where did the time go?

To say we're stressed is an understatement. All throughout today my mind wasn't on work, I'm ashamed to say, but on the wedding. Because, after all, as far as the patient is concerned, he's here to see his doctor, not empathize about upcoming weddings.

But, one patient did give me good advice. Mr. G, whom I've been seeing the past 3 years for hypopituitarism, came with his wife today. I must have mentioned it to them the last time we met (8 months ago!), but the first thing he asks me was, "When's the wedding?"

Turns out, they had been married 40 years.

After we were done with his plan of care, he shares:

It's easy to forget the significance of this day. There are 101 wedding things to do: schedules, family, financial issues. Often, the couple just spends the day rushing from one thing to another, finally enjoying the moment when the day is over, and they both go 'Phew!'.

But really, if you think about it, that's not what the wedding is meant to be. I'm reminded of what Pastor David said to us when we last met for premarital planning.

It's the start of a beautiful, lifelong journey together. One that begins with 'I Do', that leads to decades of laughs, tears, hugs, warmth and love. It's when a person promises to be true, faithful and dedicated. It is when I pledge to Kristin, her family and my family that we shall look after each other, and function as one. It's the day, I thank God yet once again, for sending me this wonderful, caring and thoughful angel. It's a day that we both should enjoy, and never forget.

Yup, it's easy to forget that a wedding is all those things, and more. And it's certainly not about champagne and dancing and looking pretty (though those are bonuses).

And so, through the inevitable headaches we'll face on Saturday, we'll have to try and remember that this is our day, and ours to enjoy.

We leave for Milwaukee tomorrow night, and so I'm not sure how much I'll get to update this blog. If I don't, wish us luck, and pray for a sunny day!

Pictures to follow...