Goodbye Hello

As we begin to countdown to the new year and the new decade (Ok, I won't be nerdy about this, but the mathematicians amongst you know that the new decade really begins in 2011, not 2010), we should take a moment to reflect on the year that was, and be thankful for the blessings we received.

For us, undoubtedly the highlight was the addition to our family, she who has become the center of our universe and has spelt the end of restful, interruption-free nights, our very own crying/smiling/pooping drool-making machine Allison. For Kristin and I, this has changed our lives in so many priceless ways, and despite the fatigue, we are enjoying every single moment of it.

I also can't help but to look back. 15 years ago, when we were 'cool' high school graduates; my pals and I would gather for our mamak sessions. We'd stay up, and counted the hours, minutes and then the seconds down, and when it hit midnight, we'd joyfully celebrate the coming of a new year (yes, guys, I miss you all!).

Now, I'm quite a bit older. And I know exactly how we'll count down. We'll probably watch TV, just the two of us, and do a 'New York Countdown'. That is, count down with NYC, using Eastern Standard Time, be done with the festivities by 10 pm, and be in bed by 10:01 pm. In fact the last couple of years, I've had to struggle to be awake till 10. Sigh, such is getting older.

Though the most ironic thing is, my parents and inlaws are planning their own gatherings where they'll actually stay up till midnight to countdown. Hmm, the retired parents are out playing. While the kids are feeling too old to stay up. You have to admit this sounds pretty damn funny.

Anyways, I wish you readers out there a very Happy New Year 2011. Whatever 2010 held, be it blessings or mishaps, the year is almost done, and may the new year bring you health and happiness.

And please, be safe on the roads!

Sometimes You Can't Do a Dang Thing

Sometimes if someone doesn't want to help herself, there is really nothing you can do.

Case in mind, this 26 year old woman with type 1, who was admitted with yet another case of diabetic ketoacidosis. Her 3rd in December, and her (I kid you not) 18th hospital admission this year.

Now, sometimes these can't be avoided, as many of my patients know. Try as you might, illness, bad infusion sites, idiopathic, these things happen. Sometimes, however, when a patient stops her insulin, and stops her glucose checks, and in the same breath that complains about cost of meds (and mind you her healthcare is funded by yours and my tax dollars!) she remains a 2-pack a day smoker.

This admission I happened to be oncall. And in an attempt to figure out what the problem was, I gently asked her in her ICU room while she was watching CSI and pretending to be oblivious to the world, what insulins and how much she was supposed to be taking. Because, between her family physician's notes, her ER admission record and the nurse who had her that shift, her story kept switching from having been on Glargine, then Detemir with Lispro insulin, then premixed insulin, then Regular insulin.

And so, when she ignored my questioning, I gently said I had to turn off the TV to talk to her, at which she yells at me, "Why do you all ask the same God-damn questions everytime about my medications every time I come to the hospital?"

To which, I'm ashamed to say I lost my cool and almost-yelled back, "Because every God-damn time you come in, you tell us something different!"

I hate to yell at patients. And in my 9 years of being a doctor, this is the 2nd time I recall actually yelling. But sometimes, really, if a patient is determined to kill herself (and at the taxpayer expense, for her $9000-a-day ICU stay) our of sheer ignorance, ambivalence, or stupidity, then there is really nothing you can do. And one of these days, she's going to succeed, too.

Why you shouldn't give patients the middle finger.
(heh, kidding. Some tenosynovitis)

-- Sent from my Palm Pre

Merry Christmas

Merry Christmas, from mine to yours!

I'm oncall for Christmas this week. And as I rounded on my patients just now, some thoughts occured to me. I expected to be grumpy, being made to work this holiday. Instead, I had fun; I wore my antlers and my Santa badge. I laughed with the patients (and the reindeer antlers were a hit with the nurses! Note to self, must do again next year). I suppose I realized that I shouldn't complain for I have much to be grateful for. And, I'm there to help patients, and wasn't there as a patient, so I shouldn't grumble.

It also brought back memories of the last time I was oncall for Christmas. 2003, when I was a 2nd year resident. At that time, it was night call too, in St. Mary's. I was doing my chest/pulmonary rotation. And being a Catholic hospital, there was a midnight mass too; I recall my colleagues and I, about 10 of us residents from the various medicine services, all attending mass, amidst other employees, patients and their families. Though inevitably, during the hour-long mass, one-by-one we got paged out to admit patients so by the time the service ended, only 2 residents were left. I recall too the attendings who dressed up and went to the various wards, singing Christmas carols and how it made me feel homesick.

Boy that was 7 years ago. And now we're here. A husband, a father, and yet still a son. Though I have aged prematurely and quite harshly, and have lost an alarming amount of hair, I AM blessed with a lot- my family and our health.

Merry Christmas, everyone!

An Endo's Guide to Turkey Roasting

Firstly, brine the bird real good. I make a solution of 1 cup salt, 1/2 cup brown sugar, peppercorn and ginger. Let soak in cold brine overnight, either in the fridge, or in the cold garage. Tastes a lot better if you use the same pail you use for washing the car (Shh, don't tell the people I fed) After brining, wash and pat dry the bird. Inject with flavor enhancers to fool your gullible guests. For this, I make a solution of soy-sauce, sesame oil and orange juice. Inject liberally with heavy-duty flavor injector, or with stolen 16G needle/syringe. The breast tends to dry out easily, so use liberally there.
For added flavor, I make slits around the breasts and thighs, and shove in garlic cloves.

Next, prepare the baste. Use salted butter, crushed garlic, thyme and cilantro. For a kick, I've added curry powder too. Baste liberally. After all, it's the holidays and calories don't exist this time of the year.

Pop the bird into the over, covering the breast and wings with foil. Use a meat thermometer, aiming for 180 degrees F. Alternatively, I've actually roasted the bird breast side DOWN before, as counterintuitive as it sounds. This actually gets the juices dripping down and keeping the breast moist. But, you don't get the nice browned ta-tas.

Figure about 5 hours in the oven set at 350 F.

Make a gravy with the fat droppings, garlic, some Chinese mushrooms, oyster & soy sauce and some corn flour. Whisk over a low flame.

And voila. One roasted turkey.

(Just don't hold me responsible for any food poisoning).

Dear Santa,

I've been a really good boy this year. I know Christmas is only 9 days away, so I thought I'd make it easier on you and send you my Christmas wish list. Yes, I know I'm being thoughtful by sharing this with you, but you know such is my nature.

This year, I'd like:

• A 46 inch LCD TV to put in the basement. After all, having a TV to watch while running on the treadmill would tremendously increase my exercise duration. And to really make me work out, throw in a BluRay player
• While we're at it, I'd love a NordicTrack C900 treadmill. After all, a diabetes doctor should practice what he preaches, no?
• An Apple Ipad. Not because I need it, or even understand what the fuss is about. But I figured, if 99% of the world wants it, I should too. After all, I'm Chinese, and kiasuism is in my blood
• An outdoor Jacuzzi tub, the one with the LED lights and waterproof speakers. I'd love nothing more than to soak in a hot tub on a cold winter's day. To have your nuts boiling, while your nose is blue/black from frostbite
• A practical car. Now that I'm a father, I can't be driving the 2-seater all the time, can I? So, nothing flamboyant, but something practical. Something with 4-WD for the winter. Perhaps even something hybrid. Ah, I know, you can get me the Porsche Cayenne S Hybrid. Now isn't that a good compromise? I'll even take the model that comes with the car. We could use a German bombshell nanny for the baby
• A lifetime supply of Rogaine. After all, I'm concerned about cancer of the scalp

See? I wasn't too greedy, was I? I'll even leave you some rum under the Christmas tree. And this month's Maxim magazine. Promise I won't tell Mrs. Santa.

-- Sent from my Palm Pre

Snow!

Yes, this would be Alli's first snow (well, real snow- we had some flurries previously). The pantry's full of supplies, the Christmas lights are up, my snowblower's full of gas, and I have new shoe-spikes.

Bring it one, I say!

The Tree Ornament

And so it was time. We put up our Christmas tree the other day.
And no, unlike last year we didn't get a real one. It was a lot of trouble, and the 'real tree smell' we were promised wasn't noticeable amidst the dog odor!
Anyway as we put up the ornaments, Kristin asked me about their story. And one of them came to mind very clearly.
It was sometime pre-Christmas in 2003. I was a 2d year resident, doing a rotation called 'Medicine Consults' where our primary role as I had seen it was to be the surgeons' slaves (heh, at least that's how I saw it). The patients belonged to them, but we managed everything else while they were in the hospital- blood pressure, infections, etc.
It was a dreary month- early mornings, coupled with the cold dark days. And that's when I met Mr. and Mrs. C. A dearly elderly man who was admitted for a below-knee amputation for complications of a diabetic foot ulcer. Except one thing led to another and by the time I saw him he had been in the hospital for 3 weeks. And somehow, between our daily visits, he led known that he was particularly guilty that they were spending their wedding anniversary in the orthopedics wing of the old hospital, about 3 hours away from home.
And so I decided to get them a cake. Nothing fancy, just a small cheap cake from the local Hyvee, and brought it in on one of those rounding days for him to surprise Mrs. C with. I didn't think much of it; anyone else who heard his story would have done the same.
A few weeks later, they gave a beautiful Christmas ornament. A little angel, with a bell. She said that there were many angels in St. Mary's and I was one of them.
I never saw them again after my rotation that month but I thought about them often.
A few months later, to my surprise, I got a Valentine's day card from them. They were doing well and was home by that time.
I still keep these as one of my prized possessions. Maybe when she's old enough, someday I'll tell Alli the story.

Gasp.

The Endo Clinic is highly estrogenized (yes, pun probably intended) today, with tears flowing and heads fuming.

Have. To. Tread. Carefully.

Don't ask me how, but Alli pooped on her mom's sweatshirt. While Kris was wearing it! Something tells me our daughter's going to Princeton someday...

Spam!

So, of late I've been getting a lot of spam in my mailbox. And no, not talking about the luncheon-meat kind.

I'm not sure if these damn spammers (may they 'sang chai mou see fat'!!!)(Old Confucious saying) profile their victims, but if they do, it does make me wonder what they may have profiled me as?

"Old horny doctor with erectile dysfunction AND a short penis. And oh yea, he's also hooked on opioids. This will be a doozy"

Yea, I bet my email sells for a lot of money in the spamming world.