Saturday, February 28, 2009

A Day of Mourning

Today was a sad day for the millions of men worldwide.
I feel like I need to spend the weekend mourning.

Yes, our day was shattered when we read of the events on CNN:

Gisele Bundchen got married. To NFL star Tom Brady, no less.

The millions of men out there, sharing the testosterone-rich XY camaraderie, are screaming out:

What does Tom Brady have that we don't???

Well. For one, multi-million dollar contracts. Heavily-chiselled looks, with a figure sculpted to resemble Thor, God of Thunder, on 'roids. Winning 3 of 4 Superbowls. And now, having supermegabombshell Gisele hanging on his arm.

Sigh... Gisele, we wish you the best...

(my wife puts up with my fantasies. And I think SHE's mourning over the loss of Tom Brady, too)

Thursday, February 26, 2009

Pulling Teeth

I biopsied a patient last week. A youngish guy who hadn't the foggiest clue that he had a visible 5 cm lump on his thyroid until his doctor asked him about it (probably typical for us men. He probably thought he had 2 Adam's apples!). He had a thyroid ultrasound showing a goose egg in his thyroid. Anyway, it looked suspicious to me on the scan, with irregular margins and some microcalcifications. I biopsied him, specifically aiming for the areas of calcification.

The pathologist called me up today to say it was suspicious for papillary thyroid cancer. And so, I reviewed this with him. Even if this was PTC, there is a good chance his survival won't be significantly affected. I assured him that this is very treatable and that with proper care, I expect him to do very well. I set him up to have a formal neck ultrasound done to look at the lymph nodes, and for him to see a surgeon for thyroidectomy +/- lymph node dissection. And this is where the headache begins.

His insurance company calls, complaining about the ultrasound, because he had had a thyroid (I reviewed the notes and spoke to the radiologist myself; they only did the thyroid previously) ultrasound already and that they were not too keen on paying for another ultrasound, never mind that we were looking for something else. After 3 mins of arguing with my nurse, she got flustered and asked if I could talk to them. I had to bite my tongue, and be civil about things.

I asked the customer service rep:

"If I told you you probably have thyroid cancer, and that a surgeon was going to have to go into your neck, wouldn't you want to know beforehand, if he needed to also take out your lymph nodes?

Would your company prefer to pay for a 2nd surgery for this patient, then?"

Especially with PTC. Especially since with the discordance in practice, not all surgeons routinely do a central compartment dissection as is done in my alma mater. Especially since we overabuse post-surgical radioactive iodine ablation to 'clean up' whatever gross nodal disease the surgeon left behind because we didn't look at the nodes in the first place. One thing I'm struggling with, being new out in private practice, is how much time we (the patients and the healthcare team) expend trying to get medications and procedures approved by private health insurance companies. It's almost like pulling teeth; and you begin to wonder if these insurance companies really have the patients' best interest in mind.

(Never mind, stupid question. Obviously their priority is profits).

Sunday, February 22, 2009

A busy weekend

Buddy had surgery on Friday. Thanks to all your prayers out there, things were uneventful and surgery went well. We drove up immediately after work on Friday, and spent the weekend with them. He was discharged today after a 2 night stay, after his JP drain volume trickled down to a minimum.
I have to say, strange as this may sound considering we were visiting someone in the hospital, we had a swell time yesterday. True, we didn't do much of anything besides hanging out in the hospital for almost 12 hours, but you sometimes realize that you really don't have to DO anything special to have fun with your good friends.
You can just be sitting there and not even say anything and still end up having a good time.
In this case, Kristin took buddy's girlfriend out for some girlie stuff like pedicures and massage (after all, the poor dear probably needs a break), I just stayed in his room chatting, reading my book, or just sitting there.
He was feeling well enough by the evening that we actually bought ribs from Applebee's and sneaked them in. We ended up playing cards and chatting until almost 10 pm.

Yes, it was a good weekend. It was swell to see our close friends we miss so much. And it was a bonus to see buddy doing well. We know he's going to restart chemo and radiation again soon, but we'll cross that bridge when we get there. For now, we are thankful and feel blessed for this weekend.
Coming back to Iowa was an adventure on its own. Usually a 3-hour drive, I was driving the CRV on a bright sunny day, and Kristin was talking to her sister on the phone when in the distance (probably quarter mile away) I spotted a huge cloud of snow surrounding a red moving object on the median. Squinting, I soon realized that it was a car from the opposite direction that was flipping over and over again. We pulled over to help; a trucker had already stopped and so we were the 2nd ones on the scene.

A pickup truck laid there, with its windshield gone, it's roof smashed in. Running towards the car, I was shocked to see what I thought was a body, 20 feet away. We could soon see that he was alive, and groaning. His wife remained in the driver's seat, bleeding and groggy, with her chin split so deep that I could swear I saw bone.
A lady and her husband, for reasons unclear, slid onto the median. And against all wisdom, both did not wear their seatbelts. That man who was ejected out was lucky to be alive. There was debris everywhere, including a motorcycle they were carrying. Any one of these could have crushed him.
We didn't do much, aside from making sure they had their ABCs going, and that they weren't moving (for fear of spinal injuries). Another doctor and a paramedic soon joined us on the scene. Though it was a bit irritating to have the off-duty paramedic come into the cabin of the truck where I was, jostling me out of the way, saying loudly, "Stay back, everyone. I'm a paramedic".

I was tempted to say, "And when you get to the part where you need the doctor, I'll be right here."

The ambulance got there after 10 mins, and whisked them away. Wherever they are, Jessica and James, I hope they're okay.

Tuesday, February 17, 2009

A request for prayers

We got the news tonight.
Buddy's PET showed that things have progressed, despite the chemo. Despite having had painful radiation therapy. We had a short, calm conversation just now. But frankly I'm not sure what to think or how to feel. And I'm sure they're going through a hell of a time.
Bud, one of the kindest souls I know. My roomate for 5 years, one of my best friends. The Best Man at our wedding last year. And for whom I shall be standing in as Best Man for HIS wedding this June.
Bud, the unassuming but extremely bright oncologist from Penang, who has dedicated his life to healing others. Engaged to another oncologist, to be married in 108 days. Who, at 29 years of age was diagnosed with Stage 4 esophageal cancer.
I've never considered myself particularly religious though I do believe in a Higher Power who oversees everything. That things in life happen for a reason.
Dear readers, I know I'm only getting ~150 of you daily, but if there is one selfish thing I can ask of you, please pray for TS. If at all you believe in miracles, please pray for one.

Sunday, February 15, 2009

Happy Valentine's Day!

Hope you all had a good one. We certainly did. I for one happen to think it's an overcommercialized, Hallmark Bonanza Day, and I don't think you need a special day a year to tell your significant other what she means to you. I get her flowers at least once a month.
And admittedly, the last week has been horribly busy, with me going off call just a few days ago. So, I wasn't planning to do much of anything but to just catch up on my rest and to spend a quiet weekend with Kristin. Heck, I wasn't even planning to get her a card.
Until the realization hits me on Feb 14th itself.
"Oh, what did the two of you do on your first Valentine's day together as a married couple?"
"Um, nothing. I didn't even get her a card..."
I'd sound like a cheap, unromantic bastard.
And so we got our butts into gear and make some fast plans. Kristin took me to an outdoor skating rink. She knows I love to skate... (after that spectacular fall the OTHER time I went ice-skating 9 years ago I swore I'd sooner get circumcised without any lidocaine, than to skate again).

Thankfully, my wife was firm. Emotionally AND physically- I held onto her hand like I was hanging off a 100-foot cliff. We had an hour of fun and yet terrifying skating. The rink was busy; you could always tell the veterans from the amateurs. The veterans were skating backwards and displaying all kinds of tricks. The newbies had a wide-eyed look and patches of snow on their knees and butt (from all the falls).
We skated until dark. And, to our delight, witnessed a wedding on the rink! Yes, on Valentine's day, a couple and their entourage came here and were married on the ice. After that they spent about 15 mins skating with the rest of us (while family watched and their photographers attempted to take their pictures, but probably got more pictures of the other skaters who inadvertently skated into their view just as they took the shot).
Kris and I figured this couple must have met or gotten engaged at this place previously.
Back home, rather than fighting with the crowds for a table at a restaurant, and then paying for an expensive meal, we thought we might start a tradition of making a new recipe for us each Valentine's day.
And so, ladeez and gentlemen, I present to you our entree, baked lobster tail with sweet ginger sauce. Never cooked lobster before, but I must say this turned out pretty damn good. And the sauce is to die for. Check out the recipe here if you ever want to give it a whirl.
Just be prepared that lobsters ain't cheap, even if bought from the store. It was about RM140 for the lobster tails.
And for dessert, we had chocolate-dipped strawberries and sweet kiwifruit/raspberry wine.
All in all, we had a wonderful, quiet day. Far from those corny Form 3 (15 years old) Valentine's dates (someday I'll blog about that). Hope you folks had a good one too.

Friday, February 13, 2009

Just when you thought it was safe...

.... Wham!
You get hit with a foot of heavy snow. And to think 3 days ago all the snow was gone, it was 16° C and warm enough to go out in shorts.
It was so bad that you could hardly tell what was road and what was snow. My commute home today took 45 mins (usually 15). And naturally, snow tires or not, a rear-wheel drive car isn't going to be the best thing to drive in the snow.
Despite that, Claudia did me proud. True, traction was a bitch, but she went where I wanted her to, and safely too. I counted at least 6 cars that weren't that lucky. Though many people must have found it amusing to see a tiny car covered under 2 inches of snow (I just cleaned the snow off the windshields).
We should have known this was coming; Phil the Groundhog predicted another 6 weeks of winter. Interesting superstition/tradition. February 2nd,
the day that the Groundhog comes out of his hole after a long winter sleep to look for his shadow.
If he sees it, he regards it as an omen of six more weeks of bad weather and returns to his hole. If the day is cloudy and, hence, shadowless, he takes it as a sign of spring and stays above ground.
Apparently he saw his shadow this year. Damn groundhog.

Thursday, February 12, 2009

An Afternoon's Thoughts

Ok, this is my next soppy, sentimental post.
I never quite understood this when I was in high school. I was childish (well, still am) and would get irritated by friends who neglect friendship. Who don't bother keeping in touch.
And then, it's funny how life just happens.
16 years later, I'm here and it's now. And life is just about trying to get work done well, housekeeping issues, bills etc. You tell yourself you'll call 'soon'. And before you know it, you've not called your friends in months.
I realized this when I was looking at my old pictures. Of highschool buddies whom I miss and are still dear to me. Of college friends, people who saw me at my lowest points during the stresses of medical school. Mamak friends, squash friends. Ex-roomates, colleagues. Even ex-girlfriends and ex-flames.
And so, if you know me in person (and we didn't part on bad terms), there's a good chance this post is meant for you too:
I'm sorry I haven't kept in touch as often as I should. I do still cherish the friendship and the memories and do miss the times we hung out.

Sunday, February 08, 2009

And They're Gone

The gang left today. After what seems to be an eternity, too.
Mom, dad, my sister (who were here for 2 months), brother, sister-in-law, and their 2 kids.
(That's Benjamin over there. I think he was confused about something)
It was swell having them here. It took some getting used to, in a way, as Kristin and I have not had so many guests at our new home before. And it has been a while since I was in a house with so many people under one roof.

And as many Malaysians abroad can attest to this, when family visits, they usually stay weeks or months at a time. My family stayed longer this time because my sister was interviewing for a residency spot here and mom came earlier with her. And things are usually pretty chaotic in the house, what with all the noise, activity, food. The law of entropy at its finest.

Despite the noise level at times (unbelievable how much noise a 2- and 4-year old can make; if only there was some way to harnest the energy!), it was nice having family here. For one, it made our large, sterile and quiet house feel much more like a home.
And it was nice to finally show my mom and dad what our new home is like. To reassure them, that I truly am ok being here (and not Malaysia) and that they shouldn't worry about us being able to take care of themselves.
True, at times the screaming kids made me want to hit my head against the wall, these last few weeks our house exuded a certain amount of warmth; walking through the doors after work and hearing those familiar sounds, smell of mom's cooking, felt like I wasn't just coming back to a house we owned, I was coming home.
Truth be told, after having 9 people under one roof in a 5-bedroom house, there is some certain amount of relief to have our personal space back. But the overwhelmin feeling right now is one of emptiness. And strange as it may be, when I got back from the hospital just now (am oncall over the weekend) the silence was just unnerving.
They left only 10 hours ago, but we're already missing them.
And though Kristin's able to study in silence now, really, we're just looking at each other, wondering what do to with ourselves. Even Chloe, our dog, seems depressed that her buddies have left.
They'll be back sometime again, I'm sure. Especially if my sister ends up in the Midwest for her residency next year.
And I sure hope they enjoyed their visit this time, especially my 2 nephews who saw snow for the first time. I was able to arrange for a tour of the hospital helipad for them yesterday, and I think the boys were in awe seeing the chopper up close.

Wednesday, February 04, 2009

Attack of the Crazy Fowls

What do you get when you add one flightless fowl to a 3.2 liter flat-6 Porsche Boxster S cruising at 250 km/hour?

(And no, that's not my car though those pictures did make me cringe. I'm going to have to watch out for them chickens)

Monday, February 02, 2009

One of those days

I hate to say it, but here it is.
If I wasn't bound by locale restrictions by my visa, or by our home mortgage, today probably would have been one of those days I would have handed in my resignation.

Maybe I'm just not cut out for private practice. You're gone for 2 days, and you already have 2 inches of charts and 20 phonecalls to catch up on. The patient traffic in unbelievable; I'm seeing at least 1.5x the number of patients my colleagues at my alma mater sees. It's rush in, rush out. And I don't think we're even the exception amongst nonacademic centers. There's no breathing time, I don't feel like I'm having enough time to properly chart, to explain things to patients. And then, on a day like this, all you need is one pissed-off patient to really, really make you feel horrid about yourself.

I'm trying to remind myself that you win some, you lose some. You help and heal some patients; yo lose some. Kristin told me to look at the numerous cards I've gotten from patients, to remind me that thankfully most patients are grateful. I'm also trying to remind myself that that particular patient has some psychiatric issues and has been verbally abusive to numerous staff. And that she's obviously forgotten, that the very thing she is pissed off about was something we were doing voluntarily, as a charity case, because she couldn't afford things. And there she was, in our office, yelling about how I'm a terrible doctor because she didn't get her free samples on time.

Don't get me wrong, I don't hate my job, but there are days I wish some things were different. I wish I didn't start Mondays (or calls) with that constant deep chest pressure/tighness and anxiety that you know is stress. I wish I didn't feel like I had to rush the patient out the door on time, otherwise the next 6 patients would be left waiting. I wish the clinic wouldn't try to fill every single minute with a patient. Really, I don't care if I have a 30 minute lull here or there. I could catch up on notes, call my patients to review labs rather than punting that to my nurse. I could finally complete my thyroid nodule manuscript that's collecting dust on my table. Heck, I could even be blogging or reading CNN; I don't care.

Work is stressful. And then, wham, on days like this, really, you just come home feeling horrid. Your logical side tells you you're doing a good job, but that emotional side takes to heart what one crazy patient said.