Updates



Aa promised, more pictures from our recent trip to the Keys. It was our first trip without the two girls- thanks to Kris' parents who drove in to town to babysit.

We flew in to Miami, and drove the 3 hours to our hotel (it was not a long drive, just slow traffic).

It was interesting flying without the kids. At our point during our layover, we had to pee. So Kris told me to go ahead while she waited and then she could go when I was done. Only after then did we realize how stupid that sounded, since we have been used to taking turns to use the restroom because of the kids!

 

The Florida Keys are a coral cay archipelago in the southeast United States, consisting of about 1700 islands. They begin at the southeastern tip of the Florida peninsula about 15 miles south of Miami and extend in a gentle arc south-southwest and then westward to Key West, the westernmost of the inhabited islands. The islands divide the Atlantic to the east from the Gulf of Mexico to the west. At the nearest point, the southern tip of Key West is just 90 miles from Cuba.

Though nothing compares to the waters of Malaysia, this was truly the most beatiful sunset I have ever seen. Unlike the skies of Malaysia which tends to be very hazy, cloudy or unclear (humidity?), we had a clear view of the setting sun on the horizon, where it seemed like the sky itself was ablaze.

The best view was probably from the famous 7-mile bridge, close to our hotel in Marathon. This connects the island to Little Duck Key- we actually ran part of the distance on our morning jog.

 

From our location, we made several day trips including a very picturesque drive down to Key West, a very enjoyable 1 hour drive. Very touristy but not too congested.

 

 

Though it was only a short 3 night trip for us, it was a nice change from the pace we were used to; to not having any kids waking us up at unholy hours of the morning, of being able to just relax and having absolutely nothing to do.

So, that's one place checked off my USA to-see list. Next stop... Grand Teton?

3 years

Dear buddy,

I've been sloppy; I'm sorry. I know I'm a week late. But it's surreal realizing that it's been over 3 years since you last left us.

Yes, life goes on for the rest of us. And in the hubbub of work, kids and all that, it's easy to take things for granted, and to forget the ones who've left us like you and Gene. It's easy to live only within our little bubble and forget anything else outside our crazy world.

But the truth is, I think about our good times a lot. Perhaps a part of me yearns for those simpler days. Of no kids, simpler job (and we thought playing doctor gets easier after our training; hah!), just us doing our thing. I miss our conversations- though it was more usually me complaining about some girl and you just quietly listening. Or us bitching about some crazy case at work. Or our pig-out sessions with the other Malaysians, or the 3rd person in our triad Nick.

Life is certainly different now. Not better or worse, but different. We've all grown up a bit. Different responsibilities. Not about call, or getting those damn abstracts or powerpoints done, or getting manuscripts published. We all have our own families. It's been a while since I've seen the others, and I miss them greatly too, though some of still occasionally stay in touch. But certainly not as much as those days.

The other day, Alli saw some of my old pictures. Including the one of us playing Wii, but one of you wearing my oven mitts because of your chemo-induced neuropathy. She innocently asked why you were wearing those gloves, or why you had that JP drain sticking out of your neck in that picture when we visiting you in the Methodist hospital and hung out playing cards.

Those were great memories, though recalling the pain and suffering you had to endure (and yet the strength you showed!), part of me is glad you're in a better place now.

I often wonder where heaven lies. The times when I am out with my telescope, looking out into the vast universe in the relative peace of the night, I do wonder- are you up there somewhere, watching the rest of us? Probably sniggering over what we schmucks have to endure in this physical world.

Anyway- the kids are asleep, and I finally have a moment to myself. I thought I'd reach out and let you know you are missed, my friend, and though you left us 3 years ago, those memories remain vivid, and you remain close to heart.

We miss you.

 

Key West!

So we are on out very first trip without both girls (the dogs are babysitting them)(kissing. Inlaws drove in for the weekend).
Anyway we took a trip to the Florida keys. It's a place I've always wanted to visit, though it was a bit of a drive (very scenic) from Miami. The Keys are a set of small islands off the Florida coast, connected by numerous crazy long bridges.
More when we return. For now:

'Rejection'

Dear patient,

It might surprise you to know this, but for many of us doctors, there is a slight tinge of hurt when we are 'rejected'. You know, when you ask to seek a second opinion from someone else. When you choose to not follow our advise and choose to take your case elsewhere.

Certainly, as a consumer and as a person you are entitled to that. I'm sure I'm not the smartest physician out there; perhaps I just did not live up to your expectations. Or perhaps our personalities just didn't match. And though professionally I did what I felt was ethically and scientifically best, there is admittedly still that tinge of disappointment. So, I'm sorry that I could not:

• Prescribe you a treatment for what the internet says is a hormonal disorder when you have 'too much' scrotal skin at the base of your penis
• Write a letter to your landlord medically justifying why you needed to have 4 cats in your apartment to 'look after the diabetes' so that you would not pay the penalty
• Start you on Testosterone replacement despite your total Testosterone levels being 800 ng/dL, because your gym trainer tells you you should be able to lift more weights than what you are doing
• Give you a miracle pill for dramatically lose some of your 350 lbs, when you tell me you don't want to work out
• Tell you why your phallus is shorter than that of your son who is 23 years younger than you

It really gives me no pleasure to disappoint a patient, especially one who was probably given misguided expectations of what an endocrinologist does. And the truth is, there really is a tinge of hurt, when as you check out you ask the receptionist to make an appointment to see one of my colleagues for a 2nd opinion for the above.

Weekend Misadventures

I just had to share this.

So the wife was in Boston for a few days for a conference, leaving me with the kids to play single dad.

We had a fun weekend; but it came to a head Saturday, in ways you could only shake your head and laugh.

Perhaps because of daddy's excellent choice of restaurants for lunch (McDonalds), Alli got sick. Had nausea all afternoon, and threw up several times. But she seemed to get better by dinner and was complaining of hunger and wanted mac & cheese. And devoured 3 helpings. Shortly after, we go through the evening routine. The girls are in the tub for a bath. During which Alli suddenly said she was feeling sick again, and puked up all the mac & cheese.

Into the tub.

Onto her sister.

All 3 helpings.

And so, I grab Ava and rinse her clean and dry her, and proceeded to do the same for Alli. In the meantime, she goes all crazy like a monkey on crack, and runs around stark naked giggling.

A minute into things when I'm drying Alli, I notice she is being awfully quiet. And if you have kids, you know what I mean when I say silence=trouble.

I step outside the bathroom to see her staring intently at something.

To. My. Horror.

A huge piece of poop. On the bedroom carpet.

While the dogs are sitting by the side looking at me, seemingly saying "Dude, that wasn't me".

And at this point, Alli is outside giggling as well, which then causes Ava to giggle hysterically too.

O.M.G.

Let's just say it was a relief when Kristin got home last night!

Personal Responsibility

I wanted to share these two things that came up today.

First of all, an urgent phone call from a patient my Nurse Practitioner saw- someone I have not seen myself. She was a 54 year old woman with diabetes and BMI 54, who wanted to be started "immediately" on weight loss pills because she was short of breath. Never mind that at her last visit it was revealed that she had a crap diet, and didn't work out because she was busy with work.

Another was an email I got from a local lawyer. She was wanting me to be an expert witness for her case, a woman with poorly controlled diabetes and noncompliance, who was admitted for hyperglycemia of 650 mg/dL, A1c 14%. They were very willing to pay me for my time. Apparently during the hospitalization she fell because she was unsteady on her feet. One thing led to another and she developed an infection which ultimately led to a below-knee amputation. She's now suing the hospital because appparently they didn't prevent her from falling. So it's their fault that she lost her foot. I was fuming when I read the report. And diplomatically told the lawyer: "No thanks" though I was tempted to say that it was not the hospital's fault that your patient was in poor health, and weight 230 kg, and was lazy and had uncontrolled diabetes. She had only herself to blame for losing her foot. And suing the hospital only shows her, and her lawyers' greed. Go to hell, I was tempted to say.

It's easy to blame others. But where are we going to draw the line? When are we going to admit that our health is our responsibility- no one else's. And that if shit happens, take a good look at the mirror before you blame anyone else.

But in the meantime, we blame others. The doctors. The hospitals. McDonalds (remember that case years ago when the stupid mother sued McD for making her kid fat?). And we wonder why the healthcare costs go up. We wonder why hospitals charge so much, if nothing else only to be able to cover the millions they spend on legal costs every year.

It is times like this that I realize there is no hope for the future of healthcare in the USA. That I worry about retiring here and having to incur healthcare costs. And that perhaps it is just a matter of time before a patient sues me because his diabetes was making him blind.