Merry Christmas!

I saw this on the neuro floor of the hospital today.

 

Yes, I had to round on Christmas eve, but at least I get to sign out the pager to my colleague in the afternoon.

I'd say this was pretty creative of the healthcare staff.
And I do like how the hospital is decked out in holiday decor (without racist Isma and Perkasa idiots tearing down they don't accept).

 

And I guess I shouldn't complain. After all, I get to go home and be with family when the day is done. I can't say the same for my patients- they have to stay in a foreign, strange place, with strange food and smells and sounds, with strange people poking, prodding and waking them up.

So I thought it'd be fun to dress the part. I wore a Santa hat and reindeer tie for rounds yesterday and today.

And I thought it'd be a lark for the endocrinologist to be giving out candy canes to patients (see what's poking out from my pocket?).



(Don't sue me: I figured it's only 11 g of carbs and shouldn't mess up anyone's blood glucose too much!).

Merry Christmas, everyone. May this be the season you are filled with love, with family and loved ones near, or at least near to our hearts. In these times of madness in the world, let goodness and kindness prevail.

Signs You're Getting Old

This crossed my mind when I looked in the mirror this morning. And no, I'm not 'fessing to any of these.

• You are finding grey hairs. Grey nose hairs
• You look in the mirror when you first get up, and for a fleeting moment you see your dad
• You refer to those twenty year olds as "those kids"
• Your favorite cars on your Cars.com iPhone app are minivans and electric vehicles
• The damn drug companies start sending you laxative samples (I still have a dozen boxes if anyone wants any!)
• You see a hot 20+ year old nurse, and the first thing that comes to mind is "Hmm, I wonder how her mother looks like?"
• You think getting up to pee 1-2 times at night is normal
• You're afraid of getting a new computer eventhough your current is on the brink of death, because you're secretly afraid of Windows 8
• Your optometrist is giving you 2 years before you'll need bifocals (that sonofabitch)
• You think bow ties and plaid sport jackets look nice
• Your eyebrow hairs are starting to curl
• College student-types call you "Uncle"
• Your bowel habits are as regular as the cesium atomic clock
• Between Playboy magazine and Consumer Reports, you'd pick Consumer Reports any day
• You use 'Jaws' from the original 007 movies to illustrate the phenotypic changes of acromegaly. Only be to met with blank stares and questions of "Who's Jaws?"

Oh well. As a mentor once told me, the only way to avoid getting old is to die young.

Priceless

I admit, I'm one of the millions of Facebook users who are ungrateful, who use the social media site without paying, but complain about its privacy policy, data mining practices and the stupid intrusive advertisements that put up on my wall. Your know, the "related links" ones.

But this one wins a prize.

 

This was priceless; there was no better ad in response to the post above it.

Maybe they're not that stupid anymore.

Farewell, Elaine....

I found out a patient of mine passed away 3 days ago.

I had been seeing her for the last 5 years- and it's something I've really come to enjoy in my field- the longitudinal care we provide and so we really get to know some patients, and even get attached to some of them (This would be in contrast with the role of a hospitalist, or ER doc, who provides on-demand care).

Anyway, she has type 2 diabetes, but was a dear little old lady, with dementia. I also see her son and cousin as their endocrinologist. And at the visit with her cousin, he shared the sad news. She wasn't feeling well that day and wanted to rest. But she never woke up.

She was 89.

She finally got what she wanted. She lost her husband a long time ago. And despite the dementia, remembers him well. And everytime I see her, she would grumpily say that "old people have no business being alive for so long. Why wouldn't He just take me now?".

And I would tell her "Elaine, it's just not your time..."

She lived alone in a trailer home before her son made the difficult but necessary decision to put her in a nursing home 10 months ago; she was the lady Kris and I brought a birthday cake to last year.

I shall miss her, seeing her spunk, her dry sense of humor, and hearing her stories (stories she had told me a dozen times before but doesn't remember).

But at least she's finally at peace, and she'll celebrate Christmas with her husband, finally.

Farewell, my dear... I hope I took good care of you while you were here.



Congratulations!

So our 'foster' son graduated today. We 'adopted' several students from Malaysia who are in the university here, if nothing else to help out in the initial transition from Malaysia to the American way of life. Thinking back to my culture shock leaving Seremban for Canada 16 years ago, I thought it would be nice to have someone from 'home' take you in, and so we have been doing this for several years.

Anyway, today, we attended the graduation ceremony of one of our students. He has been here for several years, and it has been satisfying seeing him bloom from a shy, quiet person into the man he is now.

Yea, I know, that makes me sound aged, but it was really neat to see him walk up to collect his hard-earned degree. And Kris actually even teared up a bit.

In fact, this university is apparently popular amongst Malaysians, and there was some pride on my part, watching the many Malaysians graduate.

His folks flew in for the graduation, coming from a small town in Malaysia and being in the USA for the first time. And so we've been hosting them for the last several nights since we had some extra rooms. That being said, the glitch is they speak little English while my Hokkien and Cantonese is bad enough to make my ancestors turn over in their graves and cringe. But we got along great, and it was amusing seeing Kris communicate with them.

They leave tomorrow for a long awaited vacation before their long trip back to Malaysia.

Congratulations, guys. May this be the first step in a fruitful and fulfilling journey.

I Won Something

Omygod I won I won I won!

Not sure what I won since I didn't submit anything, but this text message must be real right???

Perhaps someone out there, some random philanthropist out there, must recognize my genius.

Anyway, let me know what happens if anyone calls the number above to claim the prize on my behalf. Fully invite all the readers to spam that number.

A starry-eyed premed student shadowed me the other day. And as much as I tried to show her to ropes, I felt guilty showing her the realities of practicing medicine in the USA.

Not only do doctors need to know and treat disease states, our roles have evolved in not-so-ideal ways to include other duties.

Like how the insurance companies expect me to know what is on their formulary drug list (ie what is preferred, or cheapest, for their members). Not only is this confusing enough as every company has a different preferred list, but the same company often changes in the new year. So this year they prefer Insulin A, but next year it's Insulin B, or C. In the meantime, when the new year comes along, we get faxes from the pharmacy or calls from the patients, that their med is no longer preferred.

Like how I spend at least 2 hours every week performing paperwork (not inclusive of charting since this isn't paperwork anymore, being on EMR). Signing prior authorizations, or writing letters explaining why that patient with thyroid cancer and increasing thyroglobulin levels need an iodine scan. Or why a patient needs to be testing his glucose 4 times a day.

And yet we play the unenvious role of defense lawyers. How it's no longer about clinical suspicion. Or simple trust. Like how when the patient tells me she isn't pregnant and I send her for a scan, the radiologist still wants us to do a pregnancy test, "just in case". Because her word isn't good enough, in case they get sued. Or how pretty much everyone who walks into the ER complaining of a tummy ache gets a CT scan. And you wonder why the USA spends more money per patient than anywhere else in the world, with nothing to show for it.

Or how I feel like I'm reduced to a secretary or record keeper. Needing to do stupid items to "meet meaningful use". To have my clinical notes explode into 4 pages, when I have only 2 paragraphs relevant for the referring physician- only to fulfil some quality measures that some bureaucrat with the IQ of a snail has decided to be important.

It's true that medical school and residency only teaches you so much. That in the first year of practice you really do have the steepest learning curve; when you actually come out into practice on your own, no longer shielded by attendings.

And so, after the half day of shadowing, I hope I didn't put the student off medicine. However it is true that being a doctor is getting way too complicated these days...

Apparently I'm constipated. Just received a huge carton of samples in the clinic. Addressed specifically to me.

Well, you can't say I'm anal retentive anymore...