Part 2

Uh-oh.

Here we go again.

I should have realized something was wrong different from all those clues:

My wife crying because she got so emotional from watching TV ads.

Those 11 p.m. "Hey hun, wanna share a bag of popcorn with me?" cravings.

Hypersensitive smell when I was cooking belacan fried rice "What are you cooking, fermented poop??" (I love how Kris doesn't mince her words)

Yup. Just as we're going into Alli's Terrible Twos, we found out we have Number 2 on the way! And no, it wasn't an 'accident'- heh, admittedly I was 'Cina' enough to want to have a Dragon baby.

So, we will start taking online bids for the baby name.

Bidding, Ladies and Gentlemen, starts at US$100.

In Simpler Times

Sometimes I wished things were simpler: You see a patient. You make an assessment based on clinical suspicion (and not have to order tests to 'rule out' something). You make a diagnosis and prescribe a medication (and not have to worry about the crazy costs, or have the insurance deny it). The patient is charged for your visit but if he cannot afford it you write it off (and not have to worry about getting sued by others for discriminatory charges).

Sad but true, that is the state of affairs now. I thought about this yesterday, from the patients I've seen this week.

I ordered a radioactive whole body scan for a woman. But her assurances of "I am not pregnant" was not enough for the radiologists; we needed to get a pregnancy test first.

I saw a patient with pituitary apoplexy with central hypothyroidism, growth hormone deficiency and hypogonadism with undetectable testosterone levels. I prescribed topical testosterone, only to have the medical director of the insurance deny coverage for the medication, claiming there wasn't enough biochemical evidence of low testosterone. 3 days later I'm still waiting to hear from him.

I think about the guy I saw for type 1 diabetes who lost his insurance and has to pay out of pocket. And how I had once been reprimanded by the legal/admin team to never underbill someone just because they have are not insured, as that will get us a lawsuit.

What a crazy world it's become.

I get asked this a lot.

What's it like living in America?

Well, different, obviously. After all, the cultures, traditions, food, even language, is different. You'd think that English is English; but there are so many nuances that I still get caught up over. So, here's my Malaysian-American English dictionary for you would-be travellers. Granted, these might not apply to everyone- but I thought I'd just list this smalltown Malaysian boy's learning experience over the years.

• Biscuit- A biscuit is not a biscuit. To us, biscuits are those baked cookie-like pastries. You know, those Khong Guan products. Here, a biscuit is a fluffy, flaky bread. In Malaysia, heck, we'd just call it a bun and be done with it. To many of us, a cookie is a chewy version of a biscuit.
• Tissue- To us, we'd be referring to Tissue paper. The kind you'd use to wipe your mouth. In fact, I grew up referring to even toilet paper as tissue. Here, typically refers to the soft paper you'd find in a gift basket. For the stuff to wipe your face, just ask for Kleenex.
• Lipgloss- Air gets helluva dry here, and your lips get cracked. Everytime I ask my wife to borrow her lipgloss, she'd give me a stupid look. Apparently, only women use that here; instead, ask for Chapstick.
• Boot- something you put on your feet to keep the snow out. If instead you're referring to the rear end of a car, it's called a trunk here.
• Bonnet- likewise, if you're trying to show off your muscle car and offer to open the bonnet to show off the 4.5-liter V8, you might catch some laughes. Little girls wear bonnets. It's called a hood here.
• Weed- to this smalltown boy, this means 'lalang'. Apparently this word has many meanings here. Including a plant which is a potent source of ahem, THC.
• Sausage- this one still gets to me. To me a sausage is a hot dog; a hot dog is a sausage. End of story. However, here, hot dogs and sausages may look alike, but a sausage is a spiced length of meat, typically served at breakfast. A hot dog on the other hand, according to my dear wife, is junkfood. And to confuse me further, a sausage can also be a flat circular piece of meat, which to this Malaysian boy, just looks like a piece of burger patty. And to top it up, there are also bratwursts. Why can't they just call all these sausages???
• Ramen- essentially, Maggi mee. Except Maggi's unheard of here.
• Supper- refers to dinner here. To us sophisticated Malaysians, this refers to that special meal that comes after dinner, typically at an open-air roadside stall with plastic furniture and rodents scurrying around the longkangs. Ah, this is making me hungry.
• Football- you probably already know this. Football here hasn't been the same since the Brits were vanquished from America. Someone apparently sat on a football and squished it to an oblong-shaped object. The main spectator sport here; source of multimillion dollar contracts and traumatic brain injury. No, what we know as football is referred to soccer here, often with a little snigger (blame it on American arrogance/ignorance, not knowing that football IS soccer in most of the world).
• Hockey- don't even mention that we know this as a game that is played on a field by people running around in shorts and a stick, after a little hard ball. When people here say hockey, it's safe to assume that it's ICE hockey here. I don't think people here know the other version even exists.
• Porridge- is called congee in Chinatown. Outside of Chinatown, it's an unknown food.
• Panadol- you know, that stuff you take for a fever? Acetaminophen, or paracetamol? Well, better luck asking for Tylenol.
• Singlet- called a wifebeater here. No, don't ask me why; I don't think I want to know.

Yup, I've been in North America since 1998, but truth be told, I sometimes feel like there so much more to know!

I got this from a patient of mine.

I wasn't sure if she liked me, or hated me:

She brought a box of chocolates and a Thank You card a couple of days after her consultation for thyroid nodule at which I performed an ultrasound-guided biopsy.

She was Chinese, and our conversation shifted to the Chinese New Year. And so I casually mentioned,

"Oh yea, I was born in the Year of the Dragon..."

But I almost died at what she next said.

"Oh, were you born in 1952, then?"

Sigh. I know I don't age well. But 1952???