A Yearning

Ok, this is a juvenile post by a spoilt boy. But hey, it's my blog and I don't feel like talking about work. Take 2.5 weeks of vacation, and you know the shit's waiting for you in the office when you return is inches deep, you know how it is. So, no, this isn't about work.

I'm missing her.

My Claudia, from Stuttgart (Germany). A 2.7L flat-6 with a beautiful wail when you hit 3000 RPM.Replaced instead by Allison, from Iowa. A 18-lb 4-V (mitral, pulmonary, tricuspid and aortic, mar), screaming, poopy-making machine.For obvious reasons, I haven't had much of a chance to drive my car. It's a 2-seater, with passenger airbags; so while I've been almost tempted enough to even call the cops to find out if it's legal to have a carseat up front when you only have 2 seats, I know it would be irresponsible of me to drive her to daycare with this. And so, ah, the very exciting CRV.

I feel like a bad 'husband'. There she sits, in the garage. She was my daily driver the first year I had her (even in the winter!). Now, I've hardly touched her more than twice in the last month, though I've given her yearning glances more than once. The warming weather only makes the temptation worse. I'm missing the feel of the wind in (what's left of) my hair; the smooth-shifting short-throw gears, the acceleration as I drive onto the freeways.

And so, until Kristin starts working soon, I'll likely be doing daycare duty.

(and before you accuse me of being sexist and giving my cars female names, my wife calls her car Lucy).

I was heartbroken by the events I heard about today. I saw Matt for follow up of his diabetes. I had known him for the last 2 years, and we've had a pretty good relationship. He has worked hard all his life, and for the last year he had been planning his retirement. He was excited at the prospect of finally slowing down, and spending time on carpentry, his hobby. I last saw him in January.

Today, his outlook was completely different. He seemed saddened, almost tearful. 2 months ago, his wife of 33 years was diagnosed with metastatic colon cancer. She had undergone surgery, and just yesterday had a portacath placement in anticipation of chemotherapy. Unfortunately, she developed a pneumothorax, and required hospitalization and a chest tube.

He shared how they had dreams to travel. How his wife was so guilty that she actually apologized to him because she ruined his retirement plans. About how this was not a priority for him though he would have to work indefinitely, to keep their employer-subsidized health insurance to pay for her treatment. Knowing how much he was looking forward to retirement, I know this must not have been easy for him.

There wasn't much to do for his diabetes; I just made some adjustments to his insulin pump. But I spent the next 10 mins just listening to him, letting him share his emotions, his fears. I listened as he was telling me in other words how much he loved his wife, and how afraid he was of losing her. I had to keep from tearing up.

After he left, I sent some flowers to his wife's hospital room. And said a little prayer for them.

Sometimes, these things just tear you up inside.

Back at Work

Day 1 of work after having been gone for almost 3 weeks. As it turns out, one of my patients today had a multinodular goiter.

And thus I learnt-

Never a good idea to consume a tall Starbucks White Chocolate Mocha prior to performing a thyroid fine-needle aspiration.

(It was good stuff, actually. And no, there were no complications and I hit the nodule I wanted to. But still, the trembly hands probably did not instill confidence. By the way, did you know that that drink contained 470 calories, 63 g of carbs, and 150 mg of caffeine??? Damnnn...)

A Study

Now that I've completed my data collection, I intend to submit my manuscript soon. This is one of the most spectacular medical studies I've been involved in. So, I plan to submit this to the most prestigious of journals. With such high quality material, I'm 100% sure this will be accepted by Nature or Science. Heck, even NEJM isn't good enough for this. The results are sure to shake the scientific world.

My manuscript shall be entitled:

"The effects of a Malaysian diet on body weight and composition: A 2-week prospective study"


Objective: Malaysian food has typically been thought to be lacking in nutrients and was traditionally thought to be a poor source of energy. We sought to investigate this and to dispel any myths regarding the unhealthiness of the Malaysian diet.
Methodology: This was a prospective study of 2 weeks duration involving a large number of subjects (n=1; however because the study subject was an outstanding male specimen, this was deemed adequatedly powered to show a statistically significant difference). The patient was subjected to no less than 4 meals a day of Malaysian food of his choosing, limited only by stomach capacity and postprandial nausea. Western and non-ethnic foods were omitted from our study. Body weight was measured by a single Weight Watchers digital scale, and data regarding intake/output was captured using a specialized digital-ink-wood fiber papyrus interface (ie pen and paper). Data was analyzed by using the t test or Wilcoxon rank-sum test.
Results: In the 16 days in his native land of Malaysia, the subject consumed 85 meals (mean daily 6 ± 2). He experienced 2 episodes of traveller's diarrhea, both of which were minor and did not require decreasing the frequency of meals. At the end of the study duration, he gained 2.3 kg (p<0.01).
Conclusion: Contrary to public belief, we have shown that the Malaysian diet is rich in nutrients, and should be employed in a malnourished population.

My next project:

"Prevalence of depression in subjects deprived of Malaysian mamak food".

The trip back

Goodbyes are always difficult, but it was nice to have family and a group of friends come and see you off. And as always, mom's tearducts got a bit hyperactive (and after 13 years too!), especially when Alli was waving Bye-bye to her. But, we finally made it. 31 hours total, with the 4 flights and 3 layovers. This time round, though the journey was long, Alli did a lot better. She didn't fuss at all, and seemed to enjoy the ride. She slept most of the way, which allowed us to finally enjoy the facilities, and perhaps a glass or two of champagne.

And though this sounds weird, I swear I'm not making this up: The satay served on the plane is pretty damn good. So good that I'd say it's even better than the stuff from Kajang! (except Kajang satay tends to be fattier- which also adds to the flavor, and the atherosclerosis).

It was so good that I had 3 plates of this. Hey, I figured if this is going to last me for a year or two, why not indulge?

As the plane headed to Taipei, we flew over the city, and I thought I'd share this shot I took:

Hope I get over the jetlag before I start work Monday.

My hope for you, Malaysia

We leave for the US in a few short hours. Am hoping the babe will behave herself on the long flight back (she did pretty OK flying here, only from Taipei onwards did she fuss). Not sure when we'll next travel back since long journeys with an infant is more challenging.

I am reminded again this trip, as previous, though deep in my heart I'll probably always call Malaysia 'home', every visit I make, things seem more and more foreign. That I find more and more issues that only make me more certain that my decision to immigrate was the right one.

At the heart of my concerns, is the evolving and progressing racial issues. 15-20 years ago, perhaps I was blinded or shielded from all this, I never saw race being as big an issue as it seems to be today. The Lat cartoons of Ah Kow, Ali and Raju of yore captured those sentiments well. We played alongside each other, made good friends and never wondered why our names, skin color were different. No one ever question the others' patriotism, or belonging in this country. No one ever accused the other of being an 'immigrant'. No one ever told me to 'Balik China' until college.

These days, the tone seems completely different, in large part methinks is the fault of hot-headed or ambitious politicians who play up the racial card to win support, and the system itself. The major political parties are racially drawn. Schools (and indeed some universities) are racially divided. Certain jobs. Housing areas. Affirmative action policies that clearly have failed (it doesn't take a genius to see that if a program hasn't achieved its targets in 40 years, it's never going to. Also, it's a simple Darwinian concept; providing a crutch simply makes a group depend on the crutch and selects against the stronger).

Time and time again, the Chinese and Indian put up with subtle threats if they question too much. Threats like "Don't test our patience", or "Remember May 13th?" or waving a keris.

This seems ironic, as we have been independent for over 50 years. 50 years that one would think would give a country, its people and its leaders some maturity of how a progressive and modern society works. Instead, we seem to be going backwards, with the younger generations becoming more and more suspicious, entitled and perhaps bitter, of the other races. Younger generations using the term 'pendatang' (immigrant) on the others, when the truth is we all were born in the same country and are citizens (and this particularly stung when I had a KID, no more than 16, direct that statement at my parents a couple of years ago at a nearby park! A kid, who has not been around for even a third of the time my parents have).

People often ask me if I've encountered racism in the United States. The truth is, I've experienced more of that here, in my native country of Malaysia, than being a foreigner there. There, you are respected as a person, based on your contributions to society, not on your skin color or religion.

And right alongside all the policies that clearly remind us that we are different, and are not seen as equals, the politicians are spending taxpayer money promoting the concept of 1Malaysia. That seems contradictory, don't you think? In addition, if you can't see each other as equals in your own country, how do you expect to perform in a global setting?

And so, as we prepare to leave 'home' again, I do leave with this hope for my Malaysia. I do hope that her people will tire of the retarded rhetorics of the politicians with their own agendas. That Malaysians truly will see that we're all really not that different after all, and that what defines us is really our actions, rather than the amount of melanin in your skin, or what term you use to call God. I hope that we will again learn to respect and admire and take advantage of our differences, rather than use them to drive us further apart. I hope that her people will learn to ignore or even punish the leaders who play the race card, rather than flock toward them seeing them as their saviours. I hope that leaders will be chosen based on their abilities, not skin color (and for that matter, get rid of corrupt and greedy leaders in a speedy fashion). I hope that we will strive to better Malaysia for the good of Malaysians, not just for the Chinese, or Indians, or Malays, or whatever else race.

Perhaps you may say these are ambitious dreams that will never happen. But you know, I believe that humans, society, evolve for the better. And so, while I'm not holding my breath that things will change soon, I am cautiously optimistic that Malaysians will eventually succeed in seeing each other as simply that: Malaysians. Nothing more. Certainly nothing less.

Till the next trip, farewell.

So this trip is almost done. 16 days just breezed by, and we leave for the US soon.

We got to meet up with my buddies the other day, good friends from primary school. It's always interesting, how some friendships, despite the distance and time, still holds strong. It feels like I never left these guys, when in fact I last saw them well over a year ago. It's interesting how you just catch up on where you left off previously.

Though this year, it was also somewhat weird that the number of kids were starting to outnumber the adults.

I also took Kristin to my old high school. It's unreal, finally realizing that we left in 1993. That's almost 20 years ago! It was a treat to run into some teachers I recognize, though they seemed a lot scarier back in those days.

We're ready head back. We've done enough travelling. We were able to meet up with the people we wanted to see (well, most of them anyway. Some plans didn't work out, disappointingly). And I've certainly had enough of the heat (that, and the 5 day headache I've put up with).

Snow, here we come.

Textbook Chapter

Finally, it's out.

The book in which I authored one of the chapters. The publisher sent me a copy of the book the other day right before I left. It's always gratifying to see your work come to fruition. Except these things sometimes take too long. Not that I have a ton of publication experience, but journal manuscripts take at most 4-6 months to be published from the time they accept it. Textbooks on the other hand...

This marks my 2nd textbook chapter. My first was some very dry EBM-type garbage that would put an insomniac to sleep (hah). This project was more appealing to me when I was invited to contribute. I wrote this in the 2nd year of my fellowship, back in 2007. And this is only coming out now, 4 years later. I was beginning to wonder if it would ever be published.

If you're ever looking for a book with scary bedtime stories/pictures, go check it out!

(and no, my dears, I don't get a single cent. The work was done out of professional/academic courtesy)

Back!

So, after a long 8-day roadtrip to Ipoh, Pangkor, Penang and Cameron Highlands, we're back in Seremban to unwind before we leave in 5 days. The road to Cameron was windy, so windy that we both got carsick. And so, I showed my wife the traditional Chinese way of treating nausea: Dried sour plums.

She loved it.

Driving back, we saw quite a few of these. I just had to ask Kris to take a picture of this. Why would anyone in their right mind who was driving be checking Twitter for traffic conditions??? Is this where taxpayer money is going to?

To say goodbye

Medical school provides you with the basic scientific knowledge you need to become a doctor. The 6 years of specialty and subspecialty training gives you the experience and the confidence to go out in practice. But despite all the difficult cases you have to face being a doctor, the one thing no medical school or residency ever teaches, is how to say goodbye. Especially to one of your own. To family.

This has been a long, hard battle for Buddy these last 4 years. One that he has fought with much grace and fortitude. However, because things were still progressing, a few months ago he made the decision to cease his chemo. And so, the primary purpose of our trip home this time was to see Buddy and his wife. Where we go from here will be uncharted territory.

These last few days, we were able to meet up with him and his wife, and caught up on things. Shared memories of the good old days, when we were roomates for those 5 crazy years. Did so much together that for the longest time, many thought we were gay and were an item. We reminisced of the time we played with Coke+Mentos . Or the many Malaysian potlucks we hosted, or the Halloween pumpkin carving sessions we did.

Tonight, we had dinner with him before we left for the journey south tomorrow. And though unspoken, it's pretty clear what we were thinking: Is this goodbye?

Where will the road lead us next? No one knows. How would metastatic esophageal cancer behave in a 30+ year old? But it was difficult seeing him suffer from the pain. It seemed almost too much of a coincidence that Boyz II Men's "It's so hard to say goodbye to yesterday" came on the radio in the restaurant as we were wrapping things up. Kris and I could not keep our eyes dry as we got up to hug them and bid them farewell.

I catch myself wondering why life seems so unfair. Why is it that I get to go on with my life, and start a family, while they've had their lives put on hold while they fight this battle? I feel a tinge of guilt, with a dash of anger and bitterness.

What's next? Who knows.

But if there is anything inspiring in all this, it is the overwhelming amount of love and faith surrounding them. Their love for each other. Of their families and friends for this wonderful couple. Their faith. And if there is one thing I'd ask of you, regardless of your beliefs and faith, is to say a little prayer for him and his family.

Stories from the Twilight Zone

HO#1: The bloodbank did not have any blood to send up for this patient.

MO: How can that be? No blood at all?

HO#1: No, they said completely zero. They even confirmed it with a +.

MO looks at the chart to verify. Written on the chart was O+.

MO: Patient is low on Vit B12. Please order this for the patient.

The next day:

HO#2: The pharmacy did not have any Vit B12. But I took care of the problem. I gave the patient 2 doses of Vit B6.

We met up with our buddies in Penang for lunch. I almost died when my friends shared the above real-life stories. It would have been hilarious, had it not been true. These 'doctors' should not be out running around in our public hospitals treating patients.

Here we are, on the island paradise of Pangkor with beautiful white sandy beaches, and here I am, sitting in the kiddy pool.

(not that I'm complaining; had the time of my life with my little one)

An Industry

Day 3. So far so good. Had a case of Mamak Malady (ie diarrhea) already, but it's all worth it for sure. Poor babe though- the heat/jetlag seems to be really affecting Alli and she's having a tough time sleeping and staying asleep. Naturally this means mom and dad too.

As always, it's a great feeling being home. And I sometimes do feel weird calling this home, since technically our home is in the USA now. But, one can always have two homes, no? Plus, introducing Alli to family and friends here has been great. Though we'll have to make another trip when Alli's bigger- she won't remember this trip. I've had many sentimental moments, telling her "This is where I slept as a child" or "This was my Ah Kong's room" or "This is where I used to get haircuts" etc. One of my joys has been sharing stories of my childhood with my daughter. I imagine all parents do that. Because, as importance as our futures are, it's also vital to have a sense of your past. And I'd like Alli to know where her dad's roots stem from.

Anyway, I digress. Something I wanted to blog about. And yes, before you go around condemning me, I'll be the first to admit: I'm a hypocrite.

You see, I was surprised, or perhaps shocked is a better word, to see the sheer number of ads in the newspapers for private medical schools. And it'll seem like I'm a bastard for saying this, as I'm a product of a private medical school too. But I do still (naively?) consider the field and the practice of medicine and healing, to be sacred work. It's not just a profession, but it's a lifestyle, a passion, and an art. And no, not that I think I'm so damn smart that I got into medical school and all, but I do find it concerning that there are so many 'alternative' paths to becoming a doctor. Seeing so many ads promoting medical schools only seem to cheapen things, especially when many of the ads promote how economical the programs cost, with no hint on the academic requirements for entry.

Yes, I'm being awfully judgmental and jumping to conclusions, but seriously of the (at least?) 7 ads I saw in the papers, with many of the schools not even having had any graduates yet, of the many foreign schools of which some where not even WHO-recognized, I do question the quality and reliability of the medical education. Granted, I have not had the pleasure (or displeasure, as some of you have commented in MMR) of working with grads from these schools, so I have little basis for my concerns.

It's clear, this is a multimillion-dollar industry, one that is also driven by the lack of medical school positions in public universities and coupled by the unfairness of affirmative action. So, the motives for the sprouting of these private medschools is pretty clear- everyone's out to make money. And when a country as small as ours boasts of so many medical schools locally (more than Canada!), plus the numerous others in other countries aggressively recruiting Malaysians, you have to wonder what will happen a few years when the hospitals are overflowing with HOs who don't get the training and experience they need, before they are let out into private practice?

Who suffers?

The patients.

Leaving on a jet plane

Woo hoo.

We leave for the airport in 6 hours. And so we're now at that paranoid phase.

Did we pack this? Is our bag overweight? Will we miss our connecting? Is Alli having a fever?

It's been a year since I was last in Malaysia- for Kristin the last time she was there was our wedding, 3 years ago. So, we're both excited about this but truth be told, because of all the craziness in our schedules, the excitement for trip didn't really hit us until yesterday.

We start the first of 4 flights at 2.50 pm local time, Saturday. We arrive in KL at 11 pm Sunday, Central time.

32 hours.

Bring on the wine!

See you guys soon!