Coincidences

Sometimes, you just have to be at the right time at the right place. It’s funny how Fate puts you in an unlikely situation, And you happen to be the vital piece of the puzzle that makes all the difference.

We were recently in London for our summer vacation trip. It was my first time there (truth be told I didn’t quite like London – thought it was too congested and too crowded with people). on July 24th, after dinner, the girls wanted a little treat and since they had been good throughout, we decided to stop by a nearby grocery store within walking distance to the hotel. It was an M&S Foodhall store, the one on York Rd, and had just what we wanted – treats, snacks, drinks. While I was looking at the selection of chocolates on the aisle, I heard a scream and Kristin exclaims “something is happening there”.  We see a man on the ground and his wife screaming hysterically. It was clear he was not breathing – he was unconscious and his face was blue. We rushed over and found him pulseless and immediately started CPR. Another doctor in the crowd joined us and assisted as well. He and I took turns with the chest compressions; I yelled to someone to get a defibrillator while feeling for pulses to ensure the compressions were adequate. Someone brought an AED and Kristin slapped it on his chest. Shock recommended, it stated. I yelled “clear”, did a quick visual to confirm, and she pushed the button. His body jolted for a moment, I then resumed chest compressions, but it seemed clear something was happening. Color returned to his cheeks, and stopping briefly to check, he had pulses! About that time, EMS arrived, and he was starting to come to. The other doctor started to give report; in the meantime, our girls were standing in the back, one of them in tears because of the sheer shock of things. Kristin and I went to them to comfort them, I quietly thanked other doctor and helpers, and we quietly made our way out of the store.

To be honest, though we brought him back temporarily, I do not know his condition right now. I don’t know if there was any residual neurological damage, which is often the case for patients who code and then are brought back. I recall that elderly lady we resuscitated in the hospital when I was a resident. Despite being in her 70s and having numerous medical issues, her family did not want us to stop, so we went on until she regained pulses. But a subsequent neurological exam showed what we feared- brain death- but at least being able to say goodbye to her in person would give the family closure.

Perhaps out of pride or ego, I’d like to think that because we were at the right place at the right time, the unlikeliness of all- two American healthcare workers who happen to be at a store in London to get snacks when a person had a cardiac event- that someone today still has a husband, father, brother. We shall remain nameless and faceless to him and his family as they'll never know who we were, and aside from this blog and some family we shared the story with- this incident will never be known. But I’d like to think that perhaps we were put there for a good reason, and that we helped save a life. And a lesson I'd like to pass on to my girls is, when someone is in trouble, never be afraid to step in and help.

 😢

13 years

13 years today. It'll be 13 years since you left us. Doesn't seem fair- that for the rest of us life went on, but you had to leave this world for the next. 

There isn't a single week that passes by that I don't think of you, buddy. And miss our conversations. Sometimes, if I'm lucky, we get to meet in dreams, but that's becoming somewhat of a rarity. But, dreams or not, know that you're still in our hearts and on our minds.

 

Fathers and Daughters

 As you probably know, I am surrounded by females. Estrogen and Progesterone.

Having grown up in a household of boys, this was initially a shock to the system, having daughters. Wouldn't change it for the world. Never in a thousand years would I have thought I'd learn to French-braid my girls' hair. Or paint nails. Or learn to put on makeup, or help dress princesses.

That all said, it does get lonely sometimes. Especially when they're in their preteens or teens. And they lean a lot more on mom for girly advice; about their shoes, shirts, makeup, acne concerns. And my wife, she is a supermom, and my mother aside, I know no one else who mothers as well as she does. But it does leave me feeling like I'm standing alone sometimes. Sure, I can solder their broken necklaces, or fix the wifi, or change the engine oil in the mower, etc. But what do I know about finding the right kind of underwear, or what kind of top matches their shoes? And so, it does sometimes feel pretty lonely being the only male in the house. Especially one who grew up half a world away, in a cultural polar opposite, who cannot at all relate to how the social circles in schools here function.

Time moves so quickly. I can relate to that song Butterfly Kisses. We are certainly not at that stage of life yet of me giving my girls away, but it's so true how they go to perfumes and makeup, from ribbons and curls. I miss their younger years, when they were toddlers, and I could pick them up with ease. When they used to think things I did were funny, and their dad was Superman. And just like that, that chapter is gone, and we're moving on to the next.

While I can't wait to find out what the future holds for them, I wish we could slow down time. And in many ways, I wish we could turn back time. And to experience some things again. And perhaps to undo some mistakes.

I'm Back

I'm back. At least for now. I figured people probably aren't following this blog anymore, so I can just pop in sometimes and have some alone time with my thoughts. 

It is funny how life evolves and changes.  Looking back to when I started this blog, indeed when blogging was popular, it is interesting to see the person I was, and the person I have become.  For better or worse?

Priorities change.  Then, it was learning.  Learning about medicine.  Learning how to survive internship, residency and fellowship.  Learning how to cope in a foreign country when all your loved ones are half a world away.  Being lonely and girl–crazy.  Emphasis on academia, publications, patient care.

Now, 2 decades later (how crazy is that) I guess I am officially middle aged.  My world revolves around my family (even though sometimes they may not feel that way). We've gone through some losses and grief. My outlook on life have changed.  Some things do not bother me as much anymore though other things touches me at the very deep level. Sometimes grasping, squeezing, suffocating.  Sometimes the world does not seem like a very promising place anymore and my view of the human species have become somewhat pessimistic, what with politics, environmental disasters, effects of social media on society, and simply the stupidity of man.

You realize that sometimes, as much as I love patient care and see some of them as family, some people just do not want to help themselves and in these situations there is absolutely nothing you can do.  You realize medicine is not as simple–you drown in the bureaucracy of insurance, medical economics, politics. You burn out. You face your own mortality and wonder what Legacy you would believe this will, your daughters, when you are gone.  You realize that life is finite.  Indeed, human civilization itself is finite.

As someone once said:

“I shall pass this way but once; any good that I can do or any kindness I can show to any human being; let me do it now. Let me not defer nor neglect it, for I shall not pass this way again."

Losses

It's been awhile since my last post. To be honest, I wasn't sure if I would blog again, since there are other social media outlets. However, with blogging, there remains a certain amount of anonymity. And I felt that I needed to vent somewhere.

I went to the hospital today to bid farewell to a patient. Someone I've seen for the last 11 years, when I first was asked to consult on him after his CABG. Who fought a valiant battle- but finally, in the last stages of renal failure, and battling a losing battle with wound infection after a below-knee amputation- is being transferred to hospice. 

"I'm ready to meet God. I'm ready to go Home", he tells me.

And so I went in to see him one last time, to tell him how privileged I am to have been involved in his care.

But this feels so familiar.

Truth be told, since this pandemic started, it seems like I've said goodbye to so many patients. So many. Many lost to COVID19. But others to cancer, renal failure, MIs. So many that my heart is just aching. Maybe I'm just sensitized to this. Or maybe I've been in practice long enough that I'm beginning to outlive my patients. But with every loss, it feels like I die a little. My heart cracks a little. My spirits wane a little. 

I'm tired.

So very tired.

10 Years Ago

In a heartbeat, the 10 years just flew by. This was the last time I saw him alive. Allison was not even 1 then, when we flew back to Malaysia to say goodbye. Kris and I were wrecks- as we said good night to him, knowing the implication of this, that this would be the last time we'd see him alive on Earth. He was nonchalant about it (as a cancer doctor, I'm sure he knew what was coming...), maybe even a bit embarrassed to see the tears and the attention he was getting.

I can't believe it's been 10 years today when he passed away after a long battle with cancer. On this special day, we remember my friend, room-mate, the Best Man at our wedding, my comrade-in-arms at Mayo. The person who got me through those harrowing years of residency and fellowship. God, I miss our conversations. 

Perhaps one reason why I spend a few moments on this day to remember him stems from my own fear. That after we leave this world, that we are eventually forgotten. Wiped from existence, forgotten from memory. As though we have never existed. And so, I never want Buddy's memories ever be forgotten.

The doctor and oncologist, who not only practiced what he learnt, but also lived it. Till we meet again, brother, here's a toast to you. Wherever you are.

20 Years Ago

20 years today, my name forever changed. Two simple letters added to the end of my name. M.D. Doctor of Medicine. And I have never been called the same since.

I can't believe it's been 20 years since I took the oath to do no harm, and to try my best to help my patients.

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

I can't help but wonder how many in the last 2 decades I have encountered. How many- dare I say- I might have helped. And- as with all who are learning, who realize that medicine is as much an art as it is a science, with a healthy dose of luck, faith and sometimes miracles- how many I might have harmed. I wonder if the gullible, naive newly molded doctor who walked on to the stage to receive his degree might have known that he would be in this position, practicing the kind of medicine he is today, in a world that seems jaded and complicated by bureaucracy and medical economics. Not only does a doctor have to  stay up-to-date with the advancements of science, but also the newer medications, and which insurance prefers which medications for which years. That somehow, doctoring in the United States have gotten so complicated that there are so many barriers between the patient and the healer.

Truth be told- yes, I was proud to have people call me Dr. Vagus in my first few years- but very quickly I realize that I miss people calling me by my proper name. That the title, like respect, should be earned with time as you get to know the patient- and also sometimes especially when I am dealing with patients many years older than I am, that I feel humbled and a bit embarrassed to have them call me Doctor So-and-so- and that they should just use my name.

Someone told me today- "just think of all the patients you have helped in the last 20 years...". That thought doesn't really come to mind- all I can think of is how much I have learned from those patients in the last 20 years who have shared part of their lives with me.

Primum Non Nocere

I pray that I be granted the wisdom to maintain this part of my oath.

Saying Goodbyes

 I went to say goodbye to a patient the other day.

Not something I usually do; but I was informed by the patient's wife that things were endstage and they were putting him in hospice care. And so, despite the pandemic, I did something unorthodox. I did a housecall.

I called and asked the wife if it would be OK for me to stop by; it so happens it was his birthday that day. She said he would love that, though she cautioned me he might be a bit tired since he was in midstages of organ failure, and the uremia is likely going to affect how he feels. And so I packed up the car with some balloons, flowers and a cake (to hell with his diabetes, I told his wife- he can enjoy cake on his birthday).

It was somewhat of an emotional meeting. I wasn't quite sure if he knew it was a goodbye visit; but his wife, daughter and son, and myself, knew.

I spent 10 mins with him, just talking, and listening. I told him it has been a privilege to have been his doctor for the last 11 years. I told his family to call me if they needed anything. I gave him a firm handshake, and gave his wife a hug as I left.

That was 6 days ago; I'm not sure if Mr. J is still alive today. But I pray that he goes in peace, pain-free, and with the knowledge that his legacy will live on in his kids, and that he fought the good fight.

Fatigued

I'm tired.

I'm sure I'm not the only one. This pandemic has been going on for some time. 490,000 deaths and counting in the USA. Our lives currently unrecognizable- after all, who would have thought 2 years ago that we'd be living in a world where we are all masked; that as social as humans are, that we are asked to socially distance ourselves from friends and loved ones; that many have lost their livelihoods and are in financial ruin. I miss my parents and siblings, and it terrifies me that they are so far away and there is no way for me to reach them if a need arose.

Personally, I've lost at least 10 patients I know of to COVID19; these are only the ones I am aware of, when their family members call to update me and to explain why they are cancelling their next visit. Just yesterday, I wrote another condolence card to the family of another patient who died from COVID complications; on the very same day, I saw another patient- a man I have known for 8 years and have come to enjoy his visits- who tells me COVID is not real, and the numbers are made up. That he wore a mask only because the clinic requires it. My soul feels torn, battered, and lost. There are times when I question the goodness of humanity, and whether we deserve to be saved from this pandemic. I wonder how as a society we have evolved into this ugly community with so much disdain and lacking so much in decency.

COVID fatigue is real. And I'm not even someone on the frontlines treating COVID patients. I'm just on the sidelines- treating patients, and unfortunately higher risk patients since most of my patients have diabetes and many are elderly- but I can only imagine how my critical care, infectious disease and hospitalist colleagues must feel.

Times like this, I can only look to the kindness that sometimes shines through the darkness. Seeing random acts of kindness and selflessness. Being reminded of the unconditional love my kids and wife shower me with. And remembering that humans, fortunately enough, have a habit of being stubborn and not giving up easily, that science and ingenuity will (probably) eventually win.

The numbers are still climbing. But with the vaccination programs being implemented in stages worldwide, let's hope and pray that this nightmare will come to an end soon.

End of the year

What a year it's been. 

2020 started off with so much promise. What with those of us raised with that motto of Wawasan 2020. Alas, it turned out to be a horrible year; one with so much suffering, tears, heartbreaks, losses. Over 300,000 lives lost to COVID19. I've personally had over 30 patients I know of contract the disease, and have her a handful of patients lose their lives. Those who did not get the infection are still left isolated- I think of elderly people, those who are not tech-savvy- who are left alone at home or isolated in their nursing homes from family and loved ones. Those who might have lost their jobs and livelihoods and suddenly face financial insecurity, not knowing how they would feed their families.

I count myself lucky- so far, no one in my family has had (knowingly) COVID. And yesterday, I received my first shot of the vaccine.

It will be some time before the masses get vaccinated. It will be some time before this pandemic comes to an end; however I'm hoping and praying that this is the beginning of the end, and that this marks the first steps humanity takes to wipe this pandemic out.

Here's hoping to a more promising 2021.

Telehealth Thoughts

Life as a doctor in the times of COVID19.

What a strange world we are in right now- but though we've had to make some accomodations and experience some inconveniences, I think about what the previous generations had to endure during humanity's previous worldwide catastrophes, and I remind myself this is a small price to pay, and this too, shall pass.

As an endocrinologist, almost all I do is lab-based. With the exception of thyroid ultrasounds and biopsies, inserting/removing implanted continuous glucose monitoring devices, pretty much everything else I do does not require the patient to be physically present. So, in times of COVID, my specialty seems well-suited for telehealth compared to my comrades in procedure-dependent specialties. Indeed, we were able to pretty rapidly convert the practice to telehealth visits almost overnight, almost to the point of seeing zero patients in clinic. Indeed, in the last 3 months, I saw only 3 physical patients, and have been "seeing" 15-20 remote patients a day. This has kept our patients safe by having them stay away and minimize exposure, and has kept staff healthy for the most part (only 2 clinic staff came down with COVID). So, I thought it might be helpful or of interest to some- here are some random thoughts on this topic.

Patients are given scheduled times for the visit. Before the time of the appointment, my medical assistants are calling them to do the usual "intake"- going over the medication list, answering some questions regarding how the telehealth platform works, reminding them they have an upcoming appointment.

My default is Zoom; this works well for most patients. The video is relatively good quality an it's HIPAA compliant. There is a whiteboard and screen sharing option- helpful for me when I want to draw diagrams of the thyroid or the hypothalamic-pituitary-adrenal relationship, or when I want to show them their glucose tracings online.

If Zoom does not work (if they can't download, or if the audio is not working which seems to happen 10% of the time), my fallback options are Doximity, or doxy.me, or Facetime or if really nothing else works and if their specific insurance allows for it, a phone call. Phonecalls are poorly reimbursed by the insurance, but medical needs obviously take priority over reimbursements so if a patient needs a visit, the phone will do.

I love what technology has allowed us to do now. For my insulin-dependent patients who are wearing continuous glucose monitors, I am able to view their glucose tracings over the last 2 weeks, seeing their minute to minute trends and how their meals and insulin balance each other out. I am blown away sometimes by the ease of how I can see a person's glucose trends almost in real-time, from 80 miles away. Obviously, the patient needs to be tech-saavy and connected enough- for the Dexcom patients this would be Dexcom Clarity, and for the Libre patients I'd use Libreview. For patients on CGM-augmented insulin pumps, one gets to see not just the CGM tracings but their insulin use. For patients not yet uploading, my MAs would help them set this up prior to my telehealth visit with them.

If labs are needed, and they often are, we can electronically send orders to the lab, or mail them the order, and once the results are received, I tend to call them to update them of the findings. So this is somewhat duplicative since there would be 2 points of contact per patient and adds to the work, but I don't see this being too different from the usual face-to-face.

You read about anecdotes of patients who Zoom in awkward situations. Well, I've had 3 patients Zoom with me wearing only their underwear. All three were middle-aged men for some reason. I've had one woman join the Zoom call while in the car. Driving. Yup. And when I said I'd reschedule the visit, she said it was OK- she could talk and drive. For safety reasons, I obviously declined.

It's been a steep learning curve. But apparently we are doing OK. Obviously, telehealth is not well suited for all, but we did well enough that we were cited by the hospital system as one of the top telehealth clinics in the state- and yours truly gave a presentation on our experiences on this topic last month. COVID has certainly changed our way of life- and I am looking forward to days that are more normal again (someday- not to distant future I hope). In the meantime, looks likes telehealth is here to stay for the time being.

Dear Buddy

Dear Buddy,

I can't believe it's now been 9 years since you left us for a better place. This was the last picture we ever took together, the last moment I saw you alive. It's been 9 years, but I remember that night well- having dinner at a food court in Penang; some words unspoken but it was clear to me (and I'm sure to you too, my oncologist friend) that this was a goodbye for us for this Earthly world and that soon your battle with cancer would end. I remember our last embrace before we left.

Much has changed, evolved since then, and the world has gotten crazier. I wonder if you'd recognize what was going on if you were here. Who would have thought that we'd ever be in a global crisis from an incurable viral pandemic that would take so many lives and affect every facet of society the way it did?

Much has changed- I'm sure you know she has remarried which is something I'm sure you had wanted for her, to a wonderful chap, and we are so happy for them, for her that she ha found love again. We're supposed to be at the prime of our careers, though admittedly there are days I question if this was the right path for me (and then there are days when I don't). The kids are growing fast, and transitioning from "children" to "pre-preteens" and forming their own opinions and gaining the sort of confidence and independence I never knew at their ages when we were in Malaysia. In that picture, Alli was not even a year old, and she has no memory of you now, though Kris and I talk about you to the girls regularly.

Though it's been 9 years, I think of you much, and depend on those memories of simpler, happier days to get me going. In my darker moments, I find myself confiding in you still in thought an prayer, and once in a blue moon we get to meet again in my dreams. Dreams in which we again visit our favorite post-call hangouts or partake in our Halo marathons.

I miss you buddy. I'm sure you know that. You've touched so many lives on this Earth that your mark here will always remain. Till we meet again someday in a different world, take care.

Happy 2020!

Happy New Year.

It's surreal, thinking it's 2020. A whole new decade (though the mathematicians and purists amongst use would argue the new decade starts in 2021...). Especially those of my generation, having grown up in Malaysia, there was that neverending talk to Wawasan 2020, a dream that seemed so distance you never thought it would get here.

Much happened in 2019- some hits, some misses, and some near-misses- but still, much to be thankful for.

We almost lost a good friend last month- he essentially coded and required CPR and external defibrillation (thankfully the people he was with were trained) because of an acute myocardial infarction- leading to a 3-vessel CABG. He's OK now, thankfully- and if you know the odds of pulling through an episode like that, you really it's miraculous that he's alive, and his kids still have a dad.

Also recently our friend remarried after having lost her husband Buddy to cancer over 8 years ago. We've known that the love never goes away even long after one has passed on, but we've hoped for some time that she would meet and fall in love anew again, so we were ecstatic hearing the news that she did meet someone and got married. Buddy- bless his soul- would approve I'm sure.

At home, I continue to be amazed by how quickly the kids are growing. I'm sure I'm not the only parent who- deep inside- yearns for the days when he has a small toddler or baby still, and wishes there was a way to slow things down or reverse the clock (then again I'm an endocrinologist....).

Another notable event in the last decade- my amazing wife went on to get her doctorate despite working full time and being a mother to 4 (the kids, the dog and me!). The pride is immeasurable.

Here's to another exciting decade- Happy New Year everyone!

A friend of mine, a junior from residency but also from Malaysia, was recently diagnosed with cancer. I have not seen her for years, but I was shocked and saddened to learn of her diagnosis. It did get me thinking about our own mortality.

After all, as doctors we get so preoccupied with our patients; we spend more time collectively with patients than we do with our family. We diagnosis issues, treat them, sometimes cure them- but it's easy to forget we belong to the same group- we are after all human, susceptible to the same ills that befall them.

God knows how many doctor friends I've lost over the years. A couple to motorvehicle accidents. Maybe 4-5 to cancers (esophageal, lung, bone, breast). A gaping hole still exists where Buddy used to fill, and he's left this world for the next 8 years ago and it still feels fresh.

But we are after all just human; who knows what our future holds, and if we'd be facing the same problems we try so feverishly to cure or at least heal, our patients of.

It's a little reminder to myself- to slow down, and take some time to count my blessings. My wife, my kids, my family. The many intangible but priceless gifts with which I have been blessed.

To all those healthcare providers out there struggling with physical and mental health issues- I hope and pray you find your peace and healing.

The Countdown

The countdown has begun.

Yup, I depart for the good old USA in a few hours. I miss my wife and kids terribly and can't wait to see them, and it's been a really productive trip. In a way, travelling solo is easier as I'm much more flexible with time. No need to worry about bedtimes, or whiny or tired kids, or whether a place is kid-friendly. So this trip, I've been able to cram in much more social events than previously possible. I got to meet up with friends I have not seen for over 26 years, believe it or not. By a stroke of luck and coincidence it was my high school reunion, so it was surreal seeing vaguely familiar faces- people you kinda knew a lifetime ago- but you don't know remember their names.

It'a also great to meet up with your buddies. Yes, we have good friends where we live. But there's something to be said for soulmates, the kind of friend with whom you can truly be yourself, who have known you all your life. For some, the last time I saw them was maybe 8 years ago- yet it's amazing how we just click back into place like I never left. It was great to see my brothers again.

I also did the customary food checklist- and went down it, some foods 3 times even (nasi lemak!). Considering I am signed up for a half marathon in a month, I'm going to have to work this off when I get back.

But it's always a treat coming back for a visit. It's always heartwarming to hear the local accents and dialects, and to see the familiar sights and hear the sounds; though the haze is perhaps dampening that somewhat.

Until our next visit (CNY 2020!), take care of my Malaysia!

Leaving for Tanahair

Will be taking off in a few short hours for my next trip back to Malaysia. It has been over 2 years since my last visit, and this time it'll be a solo trip- social mainly to meet up with friends and family, with a lecture at the local medical school too.

Admittedly, this time I'm not as psyched about travelling as I have in the past. For one, it'll feel weird flying without the family- as chaotic as it might be travelling with 2 kids (though the kids are now seasoned fliers and at ages 9 and 7- they travel pretty well). But perhaps the main reason is a bit more sentimental and closer to heart. This will be my last trip back to Malaysia as a Malaysian. In a few weeks, I shall be sworn in and officially become a citizen of the USA. I've dragged my feet for years- after all I could have applied many years ago but somehow liked to retain that red passport and my Malaysian identity. But then reality hits- there is really no reason to keep this and only requires troublesome trips back to renew the passport, and with my wife and kids here in the USA, there is really no reason I would be moving back. And so, earlier this year I began the process of application for naturalization. And I've been surprised (pleasantly) by how quickly things have happened, I'm also a tinge saddened by what I'd lose.

As a parent, I can't even imagine what my parents, and many of their generation, had to go through bringing up kids with the advise "if you can, leave Malaysia and don't come back. The future is brighter elsewhere....". I have trouble even dropping my kids off at camp- and to plan your kids' future away from you is gut wrenching.

Anyhow, yes, this will be my last trip back with the red Malaysian passport. The next trip back I'll likely have to use the 'foreigners' line at KLIA immigration.

However this will be my first trip back to "Malaysia Baru"- one my parents and I never thought I'd see, and one that fills me up with so much more hope for Malaysia's future than I thought possible. 

KLIA, here I come!

8 Months

I'm back.

Wow, 8 months. I didn't realize my last post was that long ago. Then again, life (especially with kids) has a way of keeping you so preoccupied that you lose track of time.

Much has happened in the last few months. The kids are just wrapping up with their summer break, and now comes the usual dreading-to-go-back-to-school fears. Also brings me back to the times when I was in primary (elementary) school, and preparing to start a new grade. The kids do find it fascinating when I share my stories of my youth.

I remember how we would go to Lee Sam road to shop for new school bags, though invariably the trend then was one of those 3M polyester Lego-yellow backpacks. We'd then make a trip to get new school uniforms- the usual white short-sleeved shirts and navy blue shorts, white socks and white shoes. I do miss the concept of school uniforms- so much less work- as you don't have to worry about how to dress the kids. Also, everyone dresses the same, so there would be minimal competition regarding clothes. I wish our kids' school implemented this.

I also shared with the girls how I was a mommy's boy and had major separation anxiety. Come to think of it, ironic that I ended up here in the USA, but I digress. I remember how it was so bad during kindergarten that my Ah Kong ended up actually accompanying me to school for the first month! He'd sit in the corridor outside of the classroom and I was able to see the back of his head through the window. And if he ever moved away momentarily, I would get nervous. And this was before the era of cellphones or ipads, so he would have absolutely nothing to do except sit and wait for me for those few hours of classes.

I remember how bad it was for standard 1- I held on to my dad and cried so bad, not wanting to let go for dear life, that the headmaster actually came up to me with a cane in his hand; something that is not socially acceptable anymore perhaps.

Boy, I was high-maintenance as a kid.

It was fun though that during our last trip back to Malaysia, we were able to make a visit to my primary school. I was able to show the girls where their daddy went to school, where the canteen was (a word that is foreign to them), or where I squatted to brush my teeth whenever we had our dental checkup at school.

How time flies, and the roles revese.

"...and the son becomes the father...."

Physician Suicide

Someone I know recently took his own life. A physician at my medical center, a father, a son, a brother. Someone who should be at the peak of his life. Those who knew him and worked with him till the very end say that he hid it well. No one knew. Right up to the point when he said he wasn't feeling well and wanted to go home early. To do the deed.

The rational side of the brain can never justify such an act. Why would an organism, a human being at that, while physically health, would willingly and intentionally end its life, serving no purpose, no greater good, at that. After all, isn't life programmed to endure, to find  a way to survive? Isn't self preservation a natural instinct?

The emotional side of the brain though has, well, mixed emotions. For one, in a messed up way, though I'd never agree to this path, you can perhaps relate to what might be going on in his mind before the deed. It's easy to understand how in the hubbub of work, and the burn out and frustrations we go through, how one can lose one can forget the meaning of life. To not see joy or beauty or kindness anymore. To not find a reason to go on, and to conclude that ending it all is the best way out.

Those of us fortunate or blessed enough to have our meanings to life- family, loved ones, friends, some other passion, these keep us grounded and gives us perspective. However, for the few without these lifelines, you can almost understand why it's easy to give in to those temptations.

A little knowledge can be a dangerous thing. Probably another reason why the suicide rate amongst doctors is high. Depending on your specialty, you may have the means, and you certainly have the know-how about the body enough to cease its function.

It's always a tragedy when this happens. And I'm biased of course- but it's a greater pity when it's a member of the fraternity. 

Someone once told me, "Doctors save lives, at the expense of their own..."

It's a difficult topic to discuss, and because there are professional consequences to be known to have psychosocial issues, doctors are much less likely to reach out for help. Yes, there are helplines and counsellors- but I personally know of some people who despite severe depression refused to seek professional help.

Yes, it's a real issue. A stigma that no one wants to talk about or acknowledge- but depression and (physician) suicides are real. As difficult as it might be, we need to be more open about these things an have more discussion. And not judge.😥

And so, if you have problems, reach out. And if you think someone is struggling, it never hurts to ask.

Happy Anniversary

It's about that time of the year again.

Buddy and his sweetheart got married 9 years ago this week (speaking of anniversaries, we are coming up on our 10th this week too!). Since he passed away, Kristin and I have made it a habit to send his wife flowers every year on their anniversary. After all, painful as it might be to have lost him on this Earth, the day still holds much meaning, and should never be forgotten.

Every year, I have my favorite KL florist send her a bouquet of flowers.

I figured, if someday I die before my wife, I'd like my best friends to send something to her on our day too. That's the least a brother could do for me.

That was a special day. I admired their strength and their resolve; they knew how this story was going to end, being an oncologist with stage 4 esophageal cancer. Long before that day, I remember us having a conversation; he asked if he should propose to her- knowing he had a terminal disease, and not wanting to make her a widow. And then they decided that love knows no boundaries, and that they wanted to be married and make full use of whatever time they had on this Earth. I remember how when the had their first dance, there was much laughter (they had a professionally choreographed dance!) as well as tears, seeing this play out, a story worthy of a Lifetime movie.

Happy Anniversary, guys. Bro, I got your back- you can repay me for the flowers when we next meet.