So we went for a tour of the Labor and Delivery Unit today. It was pretty nice, with all the bells and whistles. There's even a jacuzzi tub in the bathroom (I wasn't sure if this was for the mom-to-be, or the dad?). I didn't find a minibar in the room though.
Anyway, things are getting exciting. We find out in a few days if this will be a boy or a girl. In the meantime, will be taking bets.
What do you think?
Click here to take survey

The Joys of Pregnancy

Having an expectant wife is different, to say the least. It does take some getting used to. So, this is for all you men out there planning to have kids someday.

• For one, her appetite is increased. We read somewhere that she needs to be eating an extra 300 calories daily to sustain the baby's growth. Which is all ok. Except if you have a husband with little self control; and so if the wife is eating more, he ends up eating more. Which explains the paradox I suppose- she's the pregnant one but I'm the one gaining all the weight.
• The hormones are raging too. And although I'm an endocrinologist and trained for 12 years and did my fellowship at the number 1 endocrinology program in the country, I have no clue what's going with the hormones. All I know is that it makes for extreme emotional outbursts. I saw her crying the other night, and I asked her why. "That was a beautiful story on Delilah (soppy evening radioshow)". She watches TV, she cries. She hears Christmas songs, she cries. It's pretty comical, actually, and she laughs at herself along with me.
• Obviously there are the physical changes too. I tell my wife she is more beautiful than ever. And I mean it; there is something about the glow, the euphoric cheery mood, smile of a pregnant woman. And truth be told, the little bump on the tummy only makes it more endearing. And it's a pretty surreal feeling, knowing that it is your unborn child, slowly growing. But guys, even if you don't share my sentiments, if your wife asks "Am I still pretty?" there can only be ONE answer. Trust me.
• This one I'm having a lot of fun with. Maybe it's the fatigue that sets in. Or maybe it's the relative cerebral ischemia from the circulatory diversion, who knows? But we've both noted that she's a lot more absent minded. Forgetting things. Like that dinner appointment she had with a friend (she leapt out of bed at 2 am that night, only then having remembered that she stood her friend up). I think this will come in handy on those nights I come home at 2 am: "Honey, remember I told you twice that I was going to the pub with the buddies? You even told me to get a couple of strippers to give me a lap dance!"
• I'd like to say pregnant women are more hamsap. But my wife would kill me. So I'm not going to say it.
• Her senses are heightened too. "Honey, stop chewing so loudly. Do you smell that? Can you not put belacan into your fried rice? Why are you breathing so loudly? Don't you think it's cold in here? Now it's too hot!". Remember that show, the Bionic Man aka the Six Million Dollar Man? Well, if you want to spend less that six million dollars to get a bionic woman, just get your wife pregnant!
• The pregnancy seems to also confer women superpowers. Like the look she gives me when I say something wrong- has the power to fill me with fear and make my legs shake. And the increased muscle strength. Which explains the bruises on my face and the broken humerus.

Ah, the bliss. Yup, we're going into our 17th week. We'll find out the sex of Shim (yes, that's what we're calling the little char-siu pau for now) in a couple of weeks. We're excited, for sure, but in a few weird ways this is almost happening too fast; I think we're both enjoying the phase of pregnancy and the closeness it's brought (or maybe we know how crazy life will become when Shim gets here!).

Things Some Patients Ask For

Today I got the most inappropriate (read: unethical) request from an ex-patient of mine which really pissed me off. I saw her 4 months ago for something, and had dismissed him back to her GP.

Apparently, this girl who's in pre-law school, skipped out on some exams last month. And she's on the verge of getting kicked out. So now, she's wanting me to write her lecturers a letter that she was at my clinic for a medical appointment and that was why she wasn't at her exam. Except she wasn't. The last time I saw her was months ago.
Oh, the words that I so wanted to tell her (but can't). We politely told her no.

If she's already willing to be so dishonest in pre-law, who knows what she'd do as a lawyer.

Reminds me of some other incidents too. Like the guy who wanted to take his side in a lawsuit against another doctor, claiming that a medication caused him to have permanent diabetes. For one, he admitted taking that medication at much higher doses than was prescribed, and secondly, it was his genes and his BMI of 45, not the pills he took for a week, that did it.

Or that one time when I was a senior resident, when a patient threatened to kill himself and make his daughter an orphan if I didn't give him another Oxycontin prescription.

Thankfully 99.9% of our patients are not out there to take advantage of you.

Just when you thought it was safe

Mother nature slaps you in the cheeks with a surprise. We had a winter ice storm yesterday. In some parts, about half inch of freezing rain.

Now freezing rain is an interesting phenomenon, one I still can't quite fathom. Something like this, I guess: It rains. But the ground is still cold, so the water freezes on contact.

Voila, you have a sheet of ice (not snow) covering everything. The roads, sidewalks, branches, cables. Walking is impossible, and driving is darn close to that (they closed all the schools today). Trees snap from the added weight, and utility cables snap.

At least they look pretty, don't they?

Typos

We dictate our hospital consults, which is then transcribed by a medical transcriptionist for us to sign digitally. Though these aren't as funny as the ones you read elsewhere, here are my collection of medical typos in the last year.

• The patient was found to have a surprised TSH- suppressed
• Suggest I131 radioactive ion ablation- iodine
• The city coloring sticks of the mass suggests this to be a benign adenoma- CT characteristics
• Most likely to be postsurgical central diabetes mellitus ancipitious- diabetes insipidus
• Given the context in which the labs were found, I suspect this to be thick euwthyroid syndrome- sick euthyroid syndrome
• He had decreased breast sounds in the right base- breath
• The parathyroid sister's needy- parathyroid sestamibi

But I think the one that takes the cake was the physician whose dictation ended up with the patient being sent home with homo two (home O2).

Vee asks:

Hey Vagus, in your opinion..At age of 27. Workin 2 and a hlaf yrs as medical
officer. Is it too late to apply USMLE?

Well. The short version: it's never too late, go for it.
The longer version though is, well, longer. There are many, many things you have to consider, even before you consider the actual probabilities of getting into a residency in the specialty and location of your choice. The truth is, it's a long, long hard road.
For one, for many from the time of application to the USMLE steps 1 and 2, then the results, getting application formalities in order like CV, letters of references, interviews, etc etc things usually take a long while. We're probably talking about at least 2 years before you actually begin a residency. If you are sure this is what you'll want, then it's important to stick with the plan. I've known many in Malaysia who started off preparing for the USMLE 1, but between exhausting work, family obligations and the such, they run out of steam after a few months and abandon their plans.
The residency program themselves differ in length depending on specialty, but factor in at least 3 years. In the meantime, if you've already worked a few years in MOH, if you're at the point in your life when you're starting to make a stable foundation for yourself professionally and personally, you'll also have to ask yourself how much are you willing to sacrifice to begin training in the US. Unless you've had some certification most US programs will probably have you begin at internship level. Also, it's (in my opinion) easier to leave Malaysia the younger you are. Once you're a bit more established, especially if you're in a stable relationship, then it makes it all harder to leave, because the fact is though you may plan to return, a lot can happen in that 3-6 years of postgrad training and fate may change your mind.
However, (and I am biased of course) the training programs here are excellent for the most part. I liked it for their well-defined durations, curriculums, academic expectations and (unless you screw up and get expelled) a pretty-definite credentials at the end. You know, for example, once you're in you'll be a general or orthopedic surgeon in 5 years. So, obviously I think it's all well worth it, though I've had to sacrifice a lot along the way, especially the proximity and time with family part.
So, to answer your question, it's never too late to apply for a residency if you know what you're getting yourself into, and are willing to face the challenge. Age itself is not an issue- I had a 40 year old in my class in residency who was previously an ENT surgeon in Vietnam, who moved here and decided to do internal medicine instead!

Good luck!

Another scar

I, as I'm sure many of you are too, am extremely disheartened and disappointed by the ongoings in Malaysia now.

(CNN) -- Attackers firebombed three churches in the southeast Asian nation of Malaysia overnight, assaults that come amid widespread Muslim ire over a court ruling that allowed Christians to use the word Allah as a term for God.
The violence comes as Muslims protest a recent court ruling that allowed a Catholic newspaper to use the word "Allah" for God. Muslims believe Allah, an Arabic word, should only be used by Muslims.

While disappointed, I can't say I'm surprised as many of us probably knew deep in our hearts something like this was inevitable. While I think the issue at hand (of the usage of a mere word) is petty, I'll stay clear of this since I'm fairly equivocal myself. What's disturbing is how groups are using violence, and threats of violence (seen on the website hackings) to intimidate others. This, in full defiance of the Malaysian courts; when the people disagree with the court, they take matters into their own hands. What kind of society does that make you? A vigilante, mob society?

In a highly polarized society as Malaysia's, with all her discriminatory practices, it has been so ingrained in some groups that they have certain privileges, while other groups are merely immigrants (never mind that they are 2nd, 3rd or 4th generation Malaysians). You knew it was a matter of time before something happened. After all, just how many times have the rest of us received subtle threats, like "Don't ask for too much, or else..." or "Remember May 13th" or simply "You should be thankful that we let you stay" like we just got off the boat from China.

With the firebombing of the churches, I imagine the court decision will be eventually 'overturned' which should appease the ignorant, unsophisticated mobs out there. However this will not be a good thing on several levels either; for one it serves to show that religious extremism and violence gets priority over the legal system and this will only positively reinforce these zealots. Secondly, the implications of the renewed peace that follows is, you'd better agree with us the next time, otherwise we'll do something harsh again. It's racial intimidation against the minorities.

On the international stage, even people I know here, are starting to compare Malaysian to countries of religious extremism, intolerance and terrorism. Because this was an act of terrorism.

On that level, perhaps I cannot comprehend this because I'm not very religious, but really, if you're trying to convince the world that your religion is one of peace, then resorting to threats, waving kerises, firebombs whenever someone disagrees with you, seems like a retarded way of convincing others.

It seems ironic that as a Malaysian, I've always face more discrimination, and felt more like a 2nd class citizen in my home country, than I have in these 12 years in North America. Thus, it's a good thing that I am making here home now.

This week, Malaysia has taken a giant step backwards. This week, Freedom bleeds.

Somehow, it doesn't seem right to be saying "It's warmer today, it's only -9C..."

Ramblings of a Family Man to be

I have to say the last couple of years have seen me go through some personal changes. And I wouldn't dare use the word 'maturing' lest some of you who know me personally laugh yourselves to death.

It's probably a combination of factors. A role reversal between parents and I in that I'm at that stage when I am worry more about them than they do of me. Of being married and no longer having the 'luxury' of being a selfish bastard. And now, having the proverbial 'bun in the oven' and the impending fatherhood.

I was mentioning this to Kristin the other day. Years ago, I would have thought nothing of something like life insurance. I mean, I was broke and trying to save up. Why would I pay hundreds of dollars for life insurance in case I died? I mean, if I get run over by a truck, why does it matter to me then that the insurance company pays a million bucks to kin?(again, the self-centered bachelor thinking then).

But now though, it's all different. From the financial side of things, we are doing okay, but I do worry about Kristin and our baby should anything happen to me. I am more fearful of flying back to Malaysia alone without at least the security of knowing my family would be OK should the wing fall off. I worry about whether they can handle the mortgage. Her school tuition (she has another year in her MSc program). I worry about the kid's schooling, and even college. And so, we finally took the big step and got ourselves life insurance policies (by the way if they find me dead at home under mysterious circumstances, the wife did it!). It's something that I couldn't see myself do years ago. But now it seems right.

From the developmental standpoint too, I worry (sometimes) about the baby and how he/she is growing. And I was even more fearful after that episode with my two patients. I wonder what kind of parent I will be, what kind of parents we will be. I worry if I will be even half as good a father as my dad is. I wonder if I'll be able to pass on the little pearls of wisdow, the stories, our heritage from mom, dad and grandpa, of our culture and little qwerky Malaysian traditions.

Yup, this seems to be a totally new chapter in my life. And probably the one right before the other chapter called "Mid Life Crisis".

Watching an episode of Scrubs the other day, I was reminded on an incident early on in the academic year when I was an intern.
A classmate of mine was asked to perform a digital rectal exam on a patient with lower GI bleeding. While we were out in the hallway on rounds, and he was doing the deed, we heard an Oww!!! coming loudly from the patient room.

Now rectal exams ain't fun; I've been on the receiving end before. But it shouldn't really hurt, instead causing a weird need-to-poop sensation.

Unless you use the wrong lube.

Yup. Poor guy (the patient, but the intern too, as it was traumatic for the both of them I'm sure). The intern had mistook the alcohol disinfectant for good-ole KY lubricant. To add salt to the injury, quite literally, the source of the hematochezia was apparently a small anal fissure which didn't receive the alcohol too well.