My Birthday Present

Yea, I know, this is a way belated post. My birthday was well over a month ago. But, I wanted to check out the results before I blogged about it.

I love my wife!

The wives out there (no offence) would probably have gotten their husbands birthday presents like socks, or sweaters, or ties or something boring like that.

No, not my Kristin. She bought me a beer making kit! (then again, what about those women who got their husbands a BMW??).

And so, like a mad professor tinkering around in his lab, I couldn't wait to try it out.

The kit comes with all kinds of parts. A big plastic barrel, some plastic beer bottles, and the all-important brewing mix, which contains the hops, spices and for all I know, toenail dirt.

It also comes with a manual, thankfully. I guess this prevents dumb people like myself from fermenting something into methanol and going blind. Anyway, I thought it was pretty straightforward.

All I had to do was to dissolve the brewing mix in water and slowly bring it to boil. And for a personal touch, I added in some orange peel zest.

After that was done, let the mix ferment in the barrel in a cool, dark place. They recommended at least 1-2 weeks, so I left it there in my basement. Except, like a boy on the night of Christmas eve, I kept peeking and checking in on the barrel, which probably didn't help. Then again, I was worried it was going to blow up or something.

After the fermentating, put 2 tablespoonfuls of granulated sugar into the bottles. And if you don't have a funnel you can always improvise with the junk mail you have sitting on the kitchen counter. I guess I must have missed this part in my chemistry classes, but apparently this is the thing that carbonates the damn thing.

Fill bottle up with the beer mix concoction, and leave in in a dark place for another 1-2 weeks. I kept my stuff in a brown paper bag in the basement, completing the picture of an alcoholic!

And waa-laa: Home Made Beer.

I must say, it turned out pretty damn good. Then again, I'm probably biased, and the higher-than-expected alcohol content might have played a role. But I was impressed by the outcome.

Cheers!

We brought Alli to the apple orchard today. She had a blast feeding the animals and playing in the corn pool!
I love autumm! Despite knowing that winter comes next.

-- Sent from my Palm Pre

Sustainability

I admit, I'm not very smart when it comes to picking the right approach to my patients with uncontrolled diabetes. I'm still trying to figure things out.

It's a truth; how well a patient does depends in large part to compliance (with some exceptions), with glucometer checking, and proper usage of medications.

And so, from my end, I'm often left totally helpless when a patient comes in for his/her checkups and has an A1c of 14% but NO glucose readings in the past 2 weeks to review. And freely admits to missing 50% of the insulin.

On one hand, I try to tell myself: "They are informed adults- if they choose to not take care of themselves knowing the risks, it is their perogative..."

On the other hand, it makes me, the physician, feel like a failure and a fraud. It makes me feel guilty that they will get billed for this office visit and yet they get nothing out of it, aside from my encouraging them to do better.

And so, I've done things my colleagues have advised me not to. I have my patients email or fax me their logbooks in a couple of weeks so that we have some objective data to guide adjustments of doses. I've even been known to call patients to remind them to send me numbers. So, this inevitably leads to a torrent of emails and faxes weeks later; I sometimes spend hours a day going through these, advising changes. Except this is done in my own personal time; we don't charge for a telephone call.

Sometimes I request for a 2-4 week follow up. Except that my schedule is booked 2 months out, so whenever I ask for an urgent 'work-in' what this usually means is I see them over lunch. Which means the special diet of SpeedLunch+Dyspepsia®, or NoLunch+HungerPangs®.

Sometimes seeing the improved control is gratifying enough. Sometimes, things are no better. But consistently though, I come home exhausted and hungry. And so, I do wonder about the sustainability of this practice. It's not a smart or healthy way for the practitioner, but eventually to keep myself sane I suspect I'm going to have to back off, and accept that some patients just don't want to help themselves and if so, I shouldn't be trying to kill myself helping them.

It's hard sometimes to not take things personally, methinks. Or maybe I just need to develop a thicker face.

But it's true, for me and many of my colleagues. While we supposedly know that it's just work, when something doesn't fall into place we sometimes take them to heart. It's something I have yet to learn well.

Take today; I received a message that a patient I had seen had a miscarriage. I saw this young lady a months ago for "thyroid dysfunction". Her thyroid labs were perfectly normal, but because she was gaining weight, was fatigued and was losing hair she was convinced her thyroid was underactive. Despite a pretty normal TSH and FT4.

Between that visit and now, she got pregnant, and had a miscarriage. And despite the results, is convinced her thyroid is to blame. She called today, asking to see another endocrinologist for treatment of her 'thyroid problem'.

Being a father, I realize it's tragic to have a miscarriage. Being a physician, the logical side of the brain knows this was not anything to do with her thyroid gland, but there's still a side in your heart that feels a tinge of hurt realizing that a patient may blame you for something.

Indeed, over the years my colleagues and I have had numerous patients switching back and forth. Sometimes it may just be a matter of the physician's personality not being compatible with a patient's. After all, we're all different. While I've 'inherited' several patients in the years, I know I've had a few who requested a different physician follow their case instead. Sometimes, it may be because of something as stupid as my not wanting to prescribe pain medications (when it was their diabetes or hypothyroidism I was managing). Other times, they turned out to be unexpected especially after all the time you've invested making sure you explain things and answer their questions.

Life goes on, and we try to help the next patient.

But every time, like a spurned relationship, there remains a tinge of hurt and disappointment, admittedly.

10 Years Later

10 years.

It still seems all too surreal, 9/11/01.

What many consider to be the darkest day for mankind in this generation.

On one horrific day, nearly 3000 lives were lost. Countless others scarred and changed forever.

People of all walks of life. All skin colors, religions, political ideology, ages.

I can never fathom how one can plan such a horrible event; I can never understand how one can ever justify killing, let alone that many people. For what? Their beliefs? Revenge?

In some ways, I try to switch off the TV as it shows the many reminders. The haunting video of that United Airlines 175 and AA flight 11 crashing into the towers. I've seen it so many times over the years that it's seared into my brain forever, and I don't need more TV reminders of it. Yet, part of me feels a sense of duty to remember that day, every horrifying event, to remember and respect those who were lost.

They say there are moments that you will remember for the rest of your life. I remember what I was doing when I first heard. I was at Al's apartment in KL- I was teaching in IMU then and was renting a room from him. It was nightime, and I had just taken a shower. I heard him yell, and then call a friend. "Sell your stocks! Someone just attacked the US (in his typical fashion)". I remember being glued onto the TV, and then calling my (then) girlfriend who was in North America to ensure she was OK. I remember going to work the next day, in a daze and shock, that such an attack had occurred, and thinking that the world is forever changed. That such evil, actually existed. I remember the anger and disgust I felt, when I heard numerous people at IMU actually say, "They deserved it..." (the irony, this was supposed to be a MEDICAL SCHOOL, teaching about health!).

10 years after that fateful day. May the world never forget. May we learn to be stronger from it. To be kinder to each other. To be a better people, never mind our race or religion.

Hey Buddy,

Hope things are going OK. Then again, where you're at, I can only imagine perfection, and that you're at peace.

Though it's been almost 4 months, we miss you terribly. I can't say I go through what your family may struggle with, but you are after all my 'brother'. It's surreal, the realization that you're gone, at least from this physical world. It's difficult realizing that we can't even make a simple phone or Skype call just to chat. Or to confide in my work, or to run a heme-onc case by you. Or just to complain about the wife

I miss those days. I miss the post-call days we went out to stuff ourselves silly. Or when we attempted to play tennis (I'm not sure you could call what we did 'tennis'). The Battlestar Galactica nights.

Funnily enough, one of those things that made me think of you the other week, was Halo. Yup, after a year of sitting in the drawer, I played Halo 3 again. And I couldn't for the life of me figure out why this time round I was having such a tough time getting through the levels. Until I realized, I had a wingman the last time we played. Oh God, how we played. Remember those Sunday 8 AM to 2 PM games? Or when we didn't want to waste a nice spring day playing video games? (and so we brought the damn TV and Xbox outside?).

We had good times, didn't we? I still think of those times, everytime I look at the wall art I have hanging in my study. Yup, the one of two guys playing cards, the one that you claimed "looked gay".
The funniest thing happened the other day. I got a Facebook message from you, wishing me a Happy Birthday. The first thing I thought of was, "Wow, they must have good Wifi in Heaven!". And then I realized your wife had sent me a message but was logged into your account. But still, it was a good laugh. The kind of humor you and I are used to.
It's been 4 months. But know that we miss you dearly still, and will always do. Perhaps the pain and the tears will get better, but we'll never forget you. Till the next time, buddy, be well.

We took Alli kite-flying for the first time over the Labor Day weekend. Surprisingly, she seemed to enjoy herself. Though after a while she would just toss the reel away and enjoyed watching dad and grandad chase after the kite as it was blown away.
It's amazing how fast kids grow.