My Sister and I

Just wanted to share this glamor shot we took.

So far so good- Alli's been a great help with the baby. Aside from the occasional jealousy-not-wanting-to-share-her-stuff moments.

Phew, I forgot how much work a baby is! Thankfully my mom is here to help for the month.

When I was 5, I thought being 12 was cool

Then when I was 12, 16 was the age to be

When I was 16, it became 21

And then when I was 21, perhaps 24. Being 30 was unimaginable

Alas, this week, I turned 36.

Perhaps it's just denial, but birthdays don't seem to have the same impact as it did perhaps 20 years ago.

The thought of a party, or even a cake, seems to be a hassle. Getting presents for turning a year older almost seems to be a con job- I feel guilty getting a gift from someone for doing less than farting. But also, the thought that I am now 36 years old, that's 3 x 12, my 3rd Year of the Dragon, makes me feel aged. Indeed, even one of you, my dear readers, mentioned this recently. Perhaps it's the job, or being a father, or the wife(ouch ouch ouch), but I feel like I've aged a lot in the recent years.

Admittedly though, I feel blessed to have so much love in my life. And this year, I got the best birthday present a person can ask for, though she came a few days before my birthday.

And so, I got to spend my birthday with my special ladies...
(can someone say 'estrogen'? This will be fun when they're in their teens!)

Welcome Ava!

Annoucing the arrival of Ava;

She decided it was time to pop out Saturday. And in a rush she was- mom went into labor in the morning, and less than 4 hours later she was here!

Mom and baby are doing well. Dad not so- am sleep deprived, and I wish I had taken some time off (I went to work Monday).

And yes, we decided on Ava. That was the 2nd pick on the poll I posted previously. Sadly for Allison, there weren't too many picks for Chocolate! That was the name we had been leaning towards and so we went with it.

Can't understand those people though we name the baby based on how she looks. "Oh, I think she looks like an Ann" or "Doesn't she look like an Elizabeth; let's call her that?" I love my kids, but really, if I named them based on how they looked as a newborn, I'd have kids called Winston Churchill, or Michelin Man, or Ugly Wrinkly Swollen Kid. Personally I think all newborns are ugly. They only begin to look cute after a week or so, methinks.

Speaking of Allison, she's still not sure what to make of the baby. In the hospital she was more interested in mom's french fries than her. We'll see how well they get along.



We're 5 cm!!! Baby's on her way!

Requesting A Letter of Recommendation

One of my students recently asked me for a letter of recommendation for residency application. While I don't mind writing these, I did suggest she tries to get letters from elsewhere as well- my little hint that I really didn't get to spend enough time with her to give a glowing review. But I thought perhaps some of you out there might these tips find this helpful:

• Try to get letters from the physicians/professors in the specialty for which you are applying. No, you don't need ALL your letters from a surgeon, or a pediatrician, etc, but perhaps a couple.
• Let them know early on in your rotation that you are hoping to get a letter from them. This allows them to perhaps challenge your knowledge more, or give you more opportunities to shine or to do presentations.
• At the finish of the rotation, ask if they'd be comfortable writing you a good letter. If you sense some hesitancy, look elsewhere. Because most letters are confidential you never know what they may say and a good letter from an unknown physician is better than a bad letter from a renowned professor. I'd prefer not to write a student a shitty letter, but if you keep pushing you might just end up getting one.
• If your rotation is early in the academic year, it's probably too early for your referees to be submitting the letter. However you'd want to at last tell them before you are done so that they can start a file on you so that when the time comes to ask for that letter, they remember who you are.
• Best to get some letters from the hospital to which you are applying. Or at least some from US hospitals, because the truth is these carry more weight for many than an overseas letter.
• Plan to spend at least a month in that rotation. I personally have trouble writing letters for people with whom I have worked for less than a couple of weeks.
• Kissing ass helps. No, I'd go as far as to say kissing ass is a necessity. And I don't meant wanting medstudents to wash my car or fetch me coffee. But SHOW SOME ENTHUSIASM! Take the initiative to find articles relevant to what we talked about. Offer to give a small presentation to your peers in our group. IMPRESS ME!
• Don't expect a letter if you're going to be lazy. The one person I subsequently declined had the cheek to tell me she didn't study up the topic we were going to discuss because "It was Mardi Gras yesterday!"
• When you submit to your referee your info and instructions for the letter, also give them a copy of your CV. This may help reinforce their points.
• It's good manners to say thank you, or to write a thank you card after the letter has been sent.
• It's also good manners to update your referees after Match Day to let them know where you matched. Really, we'd like to know.

Many of these are really common sense, but I thought some of you might find it helpful. The academic year is in full swing, and soon many of you will be submitting your applications. Good luck!

 

J writes:

I am now in the process of applying to the match. I have been very sure in the past that I really want to go to the US for residency training, but recently I have been having some mixed feelings. Perhaps it is the fear of leaving people whom I am comfortable with, leaving my family and my Malaysian lifestyle- and venturing into a relatively unfamiliar place.

If you do not mind me asking, what was your motivation to continue training in the US after you completed medical school? Have you ever considered staying back in Malaysia and begin work as a house officer?

Well, there is no one simple answer. Indeed, on occassion I sometimes ponder those questions even now. The objective answers are simple: training in the US provides a clear-cut, probably faster, pathway to becoming a specialist. 3 years after graduation, you can be a pediatrician, or internist. 5 years after medical school you could be a general surgeon, or nephrologist, or a silly endocrinologist (well, 6 for me including that research year). It's a very well organized curriculum; you spent time doing rotations only relevant to your scope. No pediatrics for someone going into adult rheumatology. No OB for a psychiatrist. Specific, one could say almost to a fault. Tunnel vision. But with that, comes efficiency and expertise. By the time I completed training I had treated hundreds of thyroid cancer patients. Countless thyroid biopsies and ultrasounds. You know from the start of a program that you WILL finish in a specified time unless you screw up. And, if one trains in an academic institution, the research and scholarly experience can be priceless, one that may be lacking in many hospitals elsewhere. So, objectively, the reasons are simple. It's fast. From what I understand this is not the same in Malaysia. No guarantees on how long one has to work before you get into a Masters program. If you even get into one. Obviously, I speak as a naive outsider as I have no basis for comparison. But, I do know that many of my classmates who went back have not yet completed their specialty training. One of my juniors who trained in the US subsequently returned to Malaysia and is now an Assistant Professor at one of the teaching hospitals. And she's also the superior to one my IMU classmates who did not pursue training overseas. Understandably, he's frustrated- he is academically 5 years ahead of her, but is lightyears behind in academic standing.

However, as we all know, life is not objective. And so J, your concerns are valid. The truth you will have to face is this: when you pursue this path, there will be sacrifices. In every imaginable way. Things that we often take for granted. But often the most precious: family, friends. Our way of life. The birthdays, social gatherings, the Chinese New Year celebrations I've had to miss. The sickness, and not being there when family and friends are ill. Even the funerals I've had to miss. You will leave familiar territory, a culture and country that may frustrate you with its shortcomings but still one you hold dear to your heart, to join a totally foreign world. One that at times seem so sterile, financially rewarding, efficient and friendly, yet lacking in the warmth, depth and substance to which you have grown accustomed. And needless to say, you will miss the food, terribly.

You will close some doors, never to return. You may say goodbye to a woman with whom you had yearned for a future. To friends whom you have known since you were a toddler, some you may never ever see again in your lifetime (outside of Facebook).

Yes, there will be sacrifices.

But the truth is, with one door that you close, you open others. And it is my strong belief that it is only by stepping into the unfamiliar, the unknown, that we are able to grow and develop. And for most, we are resilient enough to adapt to our new lives, to cherish it and eventually to call this our new home if we so choose.

Have I ever considered returning? Yes, up until my postgrad year 4 I was certain I'd return to my native Malaysia. Have I ever pondered how I'd be had I returned? All the time. I fantasize about the ease of which to find satay at 10 PM. To easily join friends for a meal. To have our children play together. To show Alli where her daddy grew up, the things he used to do.

Do I regret staying? Not even for a fleeting moment. When I look at the loves of my life (and no, I'm not referring to the Porsche) and the family I've gained calling this home, everything makes sense.
J, only you can decide what is right for you. Only you can decide if it is worth it. Good luck.

Names

Ok, we're getting close to our due date. With how things seem to be going, I doubt we'll make August 28th; Kris looks like she's ready to pop. Indeed, you can see Baby X moving sometimes (you know, I bet this is where the creators of Aliens got their idea. Seeing their very preggo wives and wondering if the baby is just gonna pop right out!)

So, maybe we should decide on a name. We have a few we like, plus one Allison suggested. Would love to see what readers think:

Click here to take survey

Well Done LCW!

As they say, you can take the man out of Malaysia, but not Malaysia out of the man.

I cursed when I realized that our satellite provided did not telecast the Men's badminton singles from London live. And then, joy when I found that we could watch this live online.

Dato' Lee Chong Wei found a valiant battle. There should be no shame, only pride, when he stood on the podium to accept the silver.

I was unprepared however for my emotions, how caught up I got watching the game. After all, the last time I watched a badminton match was over 20 years ago?

I got really ansy, and paced up and down. Whenever LCW scored, I shouted. Several times loud enough that our dogs and daughter jumped. I wailed when his shots went out.

And then, at the very end when he lost, my wife (indeed, me too!) was shocked that my eyes welled up with tears, visibly so.

(I suspect I might be less emotional even when tha baby gets here in a few weeks )

Though we're all disappointed that the gold was not ours, we all can proudly say that he played a terrific game, and clearly gave it his best. And thanks to him, we have another medal to take home.

Breakfast

Somehow I suspect I'm not the only Malaysian expatriate like this:

Go out for a 10 km bike ride in the morning, come home to eat a nutritious Special K cereal breakfast, with low-fat milk.

Feel exceptionally proud of myself, feeling fit as my calf muscles are tight.

Feeling good for eating such a healthy breakfast.

For perhaps 2 mins.

And then I fight the urge to sob uncontrollably as I'd rather be eating Chee Cheong Fun, or an oily roti pisang, or murtabak, or Hakka mee.

Sigh.

Treat the person

"Treat the person, not the disease..."

One of my medschool mentors always said that. It's easy to identify a person by his or her illness. After all, when you're seeing 15-20 patients, names are hard to remember. It's so much easier to think of this person as someone with an MI, or DKA, or pneumonia.

However, it's important to remember that ultimately, it is a person we are treating. Not some interesting case from the textbooks.

I had the unpleasant experience recently of being in the doctors' lounge recently just when some of the surgical residents were performing their sign-out.

The sign-out is a vital meeting, a short 5-10 minute event when one team updates the incoming shift of the patients they have on their list. Diagnoses, hospital course, plan of care, pending test results and such.

And yes, we are all aware of the stereotyping of surgeons, and while I disagree with the generalization, well, simply put, this episode made that stereotype seem classic.

The residents, doctors but trainee surgeons in their 1st to 5th year post-medical school, were discussing the cases as I sat in the area, looking up my patients' results. And what I overhead was a callous, cold discussion. They laughed at their patients' misery. About this person's impaction, or what a screwed up colon they had. Talked about them like cuts of meat. Complained about their pain needs, and made accusations that they were opiate-seekers. While using profanity. The men and the women in the group. Almost like they were trying to outdo each other.

It was rude. It was heartless. It was not fitting of doctors. It wasn't even fitting of a caring human being.

I was disgusted, especially at the thought that these were young doctors, training to be surgeons. While I was tempted to make a complaint to their program director, I did not. Perhaps I should have, but I didn't. After all, 'caring' is a subjective term, and one that may not be deemed too important by certain quarters.

But I did recognize one of the residents as a student I had years ago; I pulled her aside and suggested perhaps they should not be talking of patients like that.

Whether it's going to change anything, I highly doubt so.

But I do hope I never talk of my patients that way.