Sunday, October 16, 2016

My first 1/2 marathon!

And so, at the ripe old age of 40, I finally did my first half marathon. If you know me, you know I didn't like running. I did not see this as a natural thing for someone with short, stubby legs. But somehow, being married to Kristin, it's true they say that your spouse changes you. Like how she was almost vegetarian when we first met. And after yet another potluck in my old house, she call home crying to her mom "These Malaysians eat soo much meat!". And now, there are days when she craves for meat more than me.
And so, 2 years ago she talked me into signing up for our first 5k run. Signing up was figurative. More like I was at work and I received an email: "Congratulations, you are now signed up for XXX run....".
After that run, she suggested we train for a half-marathon. She'd done a few of these before. Never I. But today, after having trained for the last 8 months, and actually willingly getting up at 530AM Sunday mornings to go for a 5 mile run before the kids wake up- we finally did it!
It was an interesting experience, to say the least. The way you get palpitations and pumped up for the run. How your gut does some acrobatics the morning of. Certainly gave me a new perspective on things.
Like how the so called runner's trot is real. I called it the runner's rectum. How your gut objects, and causes you to lau sai. Hopefully this happens after the run. But sometimes, shit happens.

Also, never thought much about chafing. I'd heard people joke about it, of using bandaids to cover up your nipples, and using Body Glide to minimize friction and skin irritation. But until you actually experience it, it's hard to understand. By mile 10 my nips were burning like someone stuck cigarette butts into them. And when I stepped into the hot shower just now, my first feeling was agony. However, it could be worse. Just ask this guy.

My wife told me running is 90% mental and 10% physical. She's wrong. I tell her the brain doesn't have much glycogen. It's all physical, dammit. You start the race feeling pumped and excited. With people cheering you on, and you're still full of energy. At Mile 1, you smile and wave at those cheering you on. You see all kinds of hilarious signs, like "Run as though Trump is trying to grab your p*ssy" or "All this running for a free banana doesn't seem worth it". At Mile 6, you're wondering why the mile markers seem to be further and further apart. At Mile 9, those signs you thought funny, don't seem that funny anymore. Mile 10 you're wondering why the hell did you let your wife talk you into this? You're wondering if she's trying to get your life insurance money. Mile 11 your legs feel like dead weights, your nipples are burning and your tummy's cramping. Mile 12 you're thinking where the hell is the Mile 13 marker??? And finally, as you see the Finish Line, you find a last reserve of energy and force yourself to pick up your pace, and force a smile as the photographer snaps your picture.


After we collected our medals and walked to the refreshments tent, I told my wife: I either have to puke, or pass out. Thankfully, I did neither. But what a day it's been; something tells me this won't be our last half marathon.
(ask me again tomorrow when I wake up to find my legs paralyzed).

Saturday, October 15, 2016

The Orion Nebula

After talking about my telescope set up, I took this picture last weekend. I had to wake up at 4AM to get a nice view of Orion, well before dawn.
And so, in the cold and in the dark, after lugging out 50+ pounds of gear to my backyard, spending 20 minutes just to set up, polar align the mount, then to align the scope, and to power up my laptop, I aimed it at Orion's Belt. Target: the Orion Nebula.
This was a 7 minute stacked shot of the nebular, 1300 light years away from Earth. It's surreal to think; that means what I'm seeing is from 1300 years ago- the photons that left this huge cloud of gas began it's race to us that long ago and is only now arriving. Through the eyepiece it was easily visible though the colors were not clear. But with minimal photo editing, I was able to bring the color out.
As a friend told me, this picture alone is worth the cost of the equipment.

Wednesday, September 21, 2016

Patient Satisfaction

As I did inpatient rounds today, I was struck by something new in the hospital.
Came across numerous phone/tablet charging docks near the elevators, family rooms etc.
These appeared new. All in the name of patient satisfaction.
The newer hot topic in USA Medicine.
That somehow, one of our jobs (as a doctor, clinic or medical system) was to satisfy the patient. Not that I would intentionally wish to dissatisfy them- however it's important to realize that patients are not customers or guests.
The doctor-patient relationship isn't one based on PR; this is not a service industry (though we are here to serve in a way).

So when systems or doctors start to get assessed based on patient satisfaction, this is where things may potentially go wrong. For some years now, more and more systems based their remuneration, at least in part, on how satisfied patients are. This is also becoming a metric for how insurors/Medicare reimburse providers. I know for me, part of my performance bonus is based on satisfaction scores.

The problem is, the patient sometimes not in the position to decide what's best for him or her medically. And may rate a doctor as such. Examples we see regularly:
- The patient who sees a GP for a viral upper respiratory infection- who leaves the clinic mad because he did not get antibiotics
- The patient who goes to the ER, wanting to leave with prescriptions for opiate medications
- The patient who does not want to be discharged despite being medically fit- because he "didn't feel like it yet". (While there are 10 patients in the ER waiting for inpatient beds)
- Closer to home- something I face weekly- the patient with normal testosterone or thyroid or growth hormone, wanting to be put on these hormonal agents for symptomatic benefit
- Or the inpatient I see who just got over his diabetic ketoacidosis, who is mad because he is on a diabetic diet, and feels that he should have unlimited amounts of carbs

Indeed, there are studies showing an inverse relationship- patient satisfaction scores are related to poorer outcomes- higher morbidity or mortality, longer hospitalization, higher cost of healthcare.

And if so why is there such a push to emphasize satisfaction scores? As Dr. Mayo once said, the needs of the patients come first. Not the wants of the patient.

Somehow, in the convulated world of politics and bureaucracy, we lost sight of what's more important. And so, the hospitals are spending more money installing iphone docking stations, provider bigger parking ramps, free valet parking, coming up with extravagant menus for patients. While nurses have a high rate of turnover because they are underpaid. Or the hospital tries to cut costs by forcing formulary medications on patients.

Saturday, September 17, 2016

An expensive hobby

You can probably tell by now. I've am astro-geek. I love all Sci-fi, space, Star Trek, Star Wars etc. I've had this fascination since I was a child. Indeed, there was a time when I wanted to be an astronaut- nevermind that Malaysia did not have a space program (do we, now? Or is it more like a space tourism program?).
One day when I was about 10, I was given a simple 40 mm refractor telescope by dad's boss who got tired of this. Then, it might as well have been the Hubble! You could see the craters on the moon! You could use it to project an image of the sun and watch the sunspots. It was great.
Anyway, life and school and budgetary constraints made me neglect that hobby. The one big treat I gave myself was purchasing a hard cover copy of Hawking's A Brief History of Time (now, if you want a book that will drive you made, go read that).
Fast forward a few decades. I still catch myself looking up, yearning, wondering. My wife knew that. My wife also knew I had a loadful of crap in the garage, including some almost new winter tires I bought for the Porsche which I used only 1 season. It was now taking up space. And playing the little devil on the shoulder, she suggested "why don't you sell your tires and use that money to buy that telescope you've been dreaming of?".
That was good encouragement. I sold the wheel/tire package for $500. And bought the Celestron Nexstar 4SE Maksutov Cassegrain computerized telescope.
Problem was, like any hobby, it starts to become a parasite. It asks for more. And so, over the last 2-3 years, my collection has grown; so has the cost.

$499 Nexstar 4SE. But oooh, the batteries don't last very long for long tracking/viewing sessions. And so next came...
$20 AC adaptor. Now that I'm viewing, why not take some pictures? Well, I'll need a T-ring...
$22 T-ring for Nikon SLR. But I'm shaking the camera too much. Maybe I should get a shutter release cable
$10 Shutter release cable. Hmm, pictures are so-so. I've read that you can also use video- take a 30 second video of solar system objects, then stack them into a photo.

$160 Celestron Neximage camera. Great shots! Loving the images of Saturn and Jupiter. But dang it, I need a laptop to be portable and to operate the camera.
$300 HP laptop (basic specs- use only for the webcam). Have been quite happy with this. But I wish I had more zoom. Maybe I should get a Barlow lens.

$75 Celestron Xcel 3x Barlow lens. Triples the zoom of your telescope. Have been very happy with this setup. But am wanting to branch out and take other pictures. Maybe I should try taking pictures of the sun. I'll need a solar filter to not blind myself....
$12 Solar filter. What next. I'd love to take DSO (Deep Sky Objects) but my altazimuth mount, as easy it is to use, simply cannot compensate for Earth's rotation. Do I really want to take the next big step and get a larger scope with a German equatorial mount???
(2 years of contemplating later) $1599 Celestron 8" Schmidt Cassegrain telescope with AVX equatorial mount. This thing is huge! Built like a tank and heavy like one too. But very stable, and allows me to finally attempt exposures up to 90 seconds long. But, I need a polar finderscope to properly polar align the mount.
$42 Celestron CG5 polar finderscope. On a good day, I get great shots. But on most days, I'm still getting field rotation and star streaks with shots over 60 seconds. Not getting good shots of faint galaxies and nebulas. How the pros do it is they use a separate scope with an autoguider, hooked to a computer, to guide the main scope with precision.
$340 Orion Magnificent Mini Guidescope package. It's still in the mail- to arrive in 2 days. Alas, when will this parasite stop sucking money out of me??
(I did catch myself salivating over the Starizona Hyperstar lens, which would let you take a 30 second shot of a nebula, in better quality than spending 30 mins doing long exposures. But this would cost $899, and the corresponding Atik camera would cost $1359. So I mentally told them to go to hell)
(for now :P )

Monday, September 05, 2016

Blog Party

One thing I like about our neighbourhood is how we all get along. Quite a few families at our stage in life- 30-40 year olds with kids about the same age. We have numerous gatherings and social events every so often.
And so, one activities that my wife, the unofficial social chair of the block, organized was the block party. This was something she's wanted to do for years, since her family did these when she was growing up. So we decided to hold the very first one, and boy, was it fun.
To close the street completely, we had to do a few things.
- Get signatures of the residents- at least 90% of homeowners have to agree
- Outline a party plan, and seek the approval of the city and fire department
- Rent barricades to close off both ends of the street

Thankfully, all the residents agreed this would be fun, and with that we were off!
We had the block closed off for 5 hours on a weekend; the kids could roam around, bike and scooter up and down the road to their heart's desire, without any parent yelling for them to get ff the street!
We had several bounce houses and carnival games set up. Had a long table in the middle of the street for food.
And Kris even got a sno-cone guy to come and set up a table- that was a  hit amongst the kids, and the adults! We even had sno-cones of the, err, 'adult' variety. Which contributed to a more merry evening.
As a bonus, she had the fire department send a firetruck for a visit. The kids went bananas when the firemen came, blaring their sirens- they got to climb into the firetruck and check out their equipment. We only recently found out that the fire department does this as a community service, and it's nice to meet your local firemen and show your appreciation for the work they do.

Anyway; it was a swell evening, and the first of an annual neighbourhood event, I'm sure.

Wednesday, August 17, 2016

A New Decade

I'm afraid.
In a few days it'll be my birthday. 
A. Whole. New. Decade.* see footnote
For the sake of sanity, let's not go into details about which decade, but lets just say I'm not a teenager anymore.
It's kinda surreal. After all there was a time in my life I thought being 24 was "old".
And now, I find myself referring to twenty year olds as "those kids".
And you slowly have to acknowledge the signs that you're no longer a spring chicken. Things like how you develop random joint aches. Or how your hair thins and your children always draws their daddy with short spiky hair in their drawings- all 5 spikes. Or how you've gone from finding grays on your scalp, to finding gray nose hairs, to finding gray pubes. How you find plaid jackets and bow ties fashionable. Or how you think 50-something postmenopausal women to be more attractive than a 21 year old. And how your idea of driving too fast is 76 mph.
Yes, folks, it's that time.
And I'm not sure if I'm just going to wake up that morning to find my scalp totally clean ala Jean-Luc Picard (minus the charm).
A long time ago, I had some pipedream goals for this decade of life. Things like being married and having my own children. Owning a Porsche 911. Having more than 20 publications. Having more than one million dollars in my retirement/investment portfolio.
Hah- most of them will remain pipedreams for now. But here's to the next decade* of life....

* though to be mathematically accurate, the next decade actually starts the following year. Just as how the new Millenium began not in 2000, but 2001, or how we begin counting at 1, not zero. But what's the fun in that?

Sunday, August 14, 2016

Of DRGs and BS

I was frustrated recently by the system and how in some situations it fails the patient.
I was asked to see a hospital consult recently. 78 year old man found to have an incidental thyroid nodule.
It was a 3 cm hypoechoic solid nodule with some microcalcifications on sonogram. The team had already ordered an FNA to be done- results came back suspicious for follicular neoplasm.
Traditionally, with this result, the next step is surgery, as you've exhausted the capabilities of the dainty 25G needle of the FNA- cytology alone cannot differentiate between a follicular carcinoma versus an adenoma. Often, our surgeons would do a lobectomy and frozen section; and if there is no cancer they would leave the intact lobe behind.
Now, with the option of using molecular markers, there is potential for second-tier tests to restratify the nodule into a benign versus suspicious nodule- if it comes back the former, then the patient is spared from surgery as it has good negative predictive value. In a case like this- elderly man with comorbidities who is a higher risk surgical candidate, this would be a good test to try to avoid surgery.
And so when I saw the patient and read the pathology results. I was curious as to why they did not run the additional test. I called the pathologist up to enquire. Frankly I was quite put off by his answer.
This was a Medicare patient, admitted for chest pains. His DRG would not cover the 2nd tier test which means they will end up forking out the cost of the test itself. So it was felt to be unjustifiable.
The DRG. Diagnosis Related Grouping. Essentially, it you are admitted for condition XYZ, Medicare pays the hospital a set amount. Anything else on top of this, regardless of length of stay, the reimbursement is the same. A system to incentivize hospitals to not to do too much of keep the patient too long. But in situations like this, backfires on the patient.
My initial thought was- if that was the case WTH did they even biopsy this in the first place? It could have been done as an outpatient. I was a bit miffed that it seemed that the bottom line superseded proper patient care.
And so, I'm left with choices I don't like:
a) Consult a general surgeon for thyroid surgery- something I try to avoid for elderly patients with thyroid nodules as there is a good chance the nodule is no longer clinically relevant. The risk of surgery arguably may be higher than the risk of leaving a small speck of differentiated thyroid cancer in the neck
b) Attempt a 2nd biopsy as an outpatient with the molecular markers- something I do routinely in clinic- but it seems illogical to put him through a 2nd procedure, and it's certainly not the recommended step in a case like this, as the concern is the 2nd FNA might not procure cells from the same location accurately enough to reassure even if the 2nd set of results came back OK
c) Leave things be. Which I'm most tempted to take- given his cardiopulmonary comorbidities. Indeed, when I see clinic consults for nodules, I ask myself if this patient is likely physically fit enough for surgery- if he/she is not in good health I often try to dissuade FNA. After all, if the test isn't going to change my management, why run the test?
And so, I'll be seeing him for follow up in a few weeks. But yet another clear example of why a needlessly complicated system, coupled with money-minded administrators, end up failing the patient.

Saturday, July 30, 2016


So, the question is: Should I or shouldn't I? I know it's 2016, but as someone once said, precious food contraband from home should never be wasted. They never expire. Or maybe I said it.
Anyways, if this ends up being my last post, you'll know what happened.

Saturday, July 23, 2016


About 20% of my diabetes patients have type 1. And as any patient or physician will know, this can be more challenging than type 2 in many ways- for one a person is completely dependent on exogenous insulin to survive. For some, this insulin-glucose-meal-exercise relationship can be very precarious and brittle.
And to make things worse, over time, many lose their protective senses and have hypoglycemia unawareness. Not being able to rely on symptoms to warn you of low glucose- palpitations, tremors, sweating. The first sign of low sugars might very well be loss of consciousness and a seizure.
Many of my patients try their best- they test their glucose all day. They carry glucose tablets, glucagon at home and at work, medic-alert ID. But sometimes, that might not be enough.
Last month, I lost perhaps my 5th patient in the 8 years I've been here to hypoglycemia. Mr F. was a 52 year old man with very brittle diabetes. He was prone to episodes of diabetic ketoacidosis or hypoglycemia, and was a frequent visitor to the emergency department. It was clear that he would benefit from having closer monitoring with a continuous glucose monitoring system (CGMS). However, these things are very pricey, and while it might be partially covered by some insurance, there is still a huge cost to patients. And his insurance unfortunately did not cover this.
One morning his wife came home and found him unconscious in the living room, drooling and having some twitches. She called 911 and have him a glucagon shot. When EMS arrived, his glucose was 23 mg/dL. He was brought to the hospital, but despite treatment, did not regain consciously. The neurologist felt that he suffered irreversible anoxic/metabolic brain injury. He passed away a week later, in hospice care. I felt his family's pain, after having been his doctor for 7 years, and seeing him struggle.

And so, thinking about him, and many other patients like him, yesterday marked a big step for continuous glucose monitoring devices.
The FDA advisory panel recommended allowing Dexcom to change its label- from a device meant to be used to supplement glucometer data, to a a nonadjunctive use.
The concern has always been if measuring glucose continuously from interstitial fluid, is accurate enough to be relied on for insulin dosing, versus blood glucose. And the truth is, when the earlier generations of CGMS came out they were unreliable, and a hassle to use. I remember seeing a few during training and thinking, "Who would pay to use this?".
This has evolved to very sleek, reliable (somewhat) and frankly, life-saving devices. And they are not too uncomfortable- I wore one for a few weeks to get a sense of how it feels.
The major hurdle for many is cost; and though it might be covered by insurance, there is still a significant out of pocket cost. In addition, Medicare does not cover these at all, so for my older patients, this is not a viable option. One reason has been it was felt to be "experimental".
If the FDA grants it full approval, it would mean they acknowledge that though it's not a perfect device, it's good enough to not have to prick your finger 4-6 times a day to get glucose data (you still need to do so twice a day for calibration). And hopefully, this will lead to eventual change- better coverage by insurors and more accessibility for patients.
Sadly, this will not come at least for a year I'd imagine- it takes time for insurance companies to change their policies. And it will come too late for Mr. F. But I hope this will make a difference for many others.

Wednesday, July 13, 2016



Get it? Dumb Bell.
Ok, this is a geek post.
As you probably already know, I like space. No, I'm not claustrophobic- but I like all that is related to astronomy.
I'm a Trekkie. I'm a Star Wars fan. All manner of Sci-fi.
One of my favorite books is Stephen Hawking's A Brief History of Time (now, how's THAT for a bedtime story?).
Anyway, I've had my telescope for several years. It's a 4" Celestron Maksutov Cassegrain scope with computerized goto altazimuth mount. I love it. It's given me hours of viewing pleasure. But the mount has always been limiting me to solar system photography- while it tracks the stars, it does not rotate along Earth's axis.
So this year, with the blessings of the wife, I upgraded to an 8" scope with an equatorial mount. And took a deeper (much more expensive) step into astrophotography.
Meet Big Brother....

I still have much much more to learn about deep space objects. But I was particularly proud of this one. 
This was a picture of the Dumb Bell Nebula, or M27. A planetary nebula 1360 light-years away in the constellation Vulpecula. So the light took over 1000 years to hit the camera's sensors.
It was a 20-minute stacked picture at ISO 800.
Sleeping 4 hours that night and feeding the mosquitoes in the backyard was worth it.
More to come in the future.

Monday, June 27, 2016

Bedtime Stories

So last night, as I was putting the girls to sleep, they asked for a bedtime story. 
"Something about a Princess!", Ava gushed. After all, it's princess everything, these days.

So I told them the story of the princess who lived on a mountain, who ate too much candy and developed diabetes, and how Prince Metformin came to her rescue, and along with diet and exercise,  lowered her blood sugars from 200 to 100 mg/dL and saved her from the clutches of neuropathy, retinopathy and nephropathy, and they lived happily ever after. 
Something tells me someday they're going to take away my Daddy License. I'm gonna need to work on my bedtime stories 😜.

Sunday, June 19, 2016

Happy Father's Day

Happy Father's Day!

Thank you. For all the sacrifices you have made. Things that I never understood as a child- why you'd spend so much time at work (to ensure your family was provided for), why I got spanked (when I was up to no good), why you pushed me when I wanted to give up. For your love, support and quiet strength, and for being the role model you are.

Being a parent changes one's perspective, doesn't it? I see things a bit differently now. Like how noisy babies on a plane don't bother me anymore (if anything else, I give them a look of empathy). You look at not just the beauty of the world, but the hidden dangers that may hurt your child. You avoid taking unnecessary risks, to keep your kids safe. You get excited over not cars, but over cute kiddie dresses, or nail paint colors, or stick-on earrings. Your TV spends most of its time tuned in to NickJr or Disney. 
You're convinced that your greatest achievement in this world, is having those kids in your life. And part of you fears the inevitable day, then your kids leave home and start their own journeys into the real world, and you can only hope that you gave them a good enough of life's roadmap to make the right choices.
To all the dads, granddads, dads-to-be: Happy Father's Day!

Tuesday, June 07, 2016

8th Anniversary

In the blink of an eye, it's been 8 years.
2 kids, 2 dogs, 5 cars, 2 cities and 3 jobs later.
Though I look nothing like that picture anymore. I've aged significantly while my forehead has, ahem, grown upwards (ie am balding), while my wife has only grown more beautiful, wise and graceful over the years.

Happy Anniversary, honey!

To many more to come!

Monday, May 30, 2016

Of Expirations and Best Before Dates...

Question: Is it safe to consume ikan bilis that expired 4 years ago, or sambal paste from 3 years ago, or rendang mix that expired in 2011?
Affirmative. Affirmative. Affirmative.
As with other few (precious) weekends when I get to play the role of bachelor, when my wife is away visiting family, or at some medical conference, I turn to my vices. And in some ways I wish I could say my life was exciting enough to have secret sex orgies, or drunken escapades, or spending the night in the 'lokap' when I'm a free man, no, what I really do is cook.
As in cook Malaysian food that my kids, wife, neighbors and American friends consider to be more pungent than fermented gym socks.
And because I can't usually cook certain aromatic, spicy dishes, I hoard racks and racks of Malaysian spices. If you're a Malaysian expat living in abroad, you know what I mean. That pack of Bak Kut Teh spices or Rendang paste is more precious than my left arm. 
So when you hoard stuff that you don't usually get to use, the inevitable happens. They expire. But who in their right minds would throw away otherwise perfectly 'good' food and spices from the Motherland??
After all, expiration dates are a government conspiracy. I tell my wife that nothing vacuum packed/frozen ever goes bad.
This weekend, with the missus being away at Boston  with one of the girls, I took the opportunity to make Nasi Lemak.
My wife would rather inhale the air in a small sauna with a dozen flatulent sumo wrestlers than to smell ikan bilis. And with my kid having a peanut allergy, this is a no-no in our household. But with me being semi-alone this week, the timing was perfect.
Except I then noted the print on the packets. April 2012 for the ikan bilis. Ogos 2013 for the sambal paste, and Feb 2011 for the rendang spices.
For a moment, I thought about tossing them and not risking it. For all of 2 seconds.
But then I realized I already have my last will and testament and trust all written up. And life insurance policy in place. And my retirement portfolio has done quite well so far. So the family would be OK without me should shit happen. Literally.
And so, voila:
Nasi Lemak with sambal ikan bilis, ayam rendang, satay sauce. 8 hours later, I'm still alive and kicking. No gastronomic catastrophe yet. I haven't gone blind yet.
Except Ava was getting worried for me, seeing how much I was sweating. The beads of sweat was literally dripping off my head.
In retrospect, perhaps making a spicy dish on a warm 30C day wasn't the best time. But man, it was worth it. And perhaps speaking as someone who hasn't tried it, but there is no way some orgy would be more satisfying that a spicy nasi lemak meal.
Or can it?

Sunday, May 29, 2016

On The Mend

Thanks for the well wishes. The trooper she is, she seems to be on the mend steadily. She had her "permanent" cast placed the other day, And being smaller, and below-elbow, it's proving to be more comfortable. And she was actually excited to be given several choices for color- she picked tie-dye.
The pain is completely gone. Gone enough that we have to keep reminding her to not do anything too physical. After all, my greatest nightmare is to need an ORIF.
And yes, that's a hula hoop she's holding- but that's about all we're letting her do. No slides, climbing, trampolines.
She was initially unsure of how her schoolmates would react. I have to remind myself that they grow so fast- and now she's already to the point where she cares about what others think.
But when she learnt that she could customize the cast, this gave her something to look forward too. 
And so, daddy hot-glued some crystals on it. And because she's always wanted to be a superhero, I put a Batman patch on her sling.

Now she's all set to take on the world. Just don't be breaking any more bones!

Sunday, May 22, 2016

Poor Alli

It's one thing being the doctor.
It's a totally different thing being a father.
I learnt this the hard way a few days ago. Allison had learnt how to use the monkey bars at school, and so wanted to show us she could do it.
Inevitably, when you wage a battle with gravity, gravity always wins. And so she fell, and suffered a distal radial fracture.
While it was not life threatening, it breaks the heart, seeing her cry, and knowing even before the X-rays that the radius was fractured. After all, there was an obvious body deformity.
The X-rays and fluoro told us all we needed to know.

I've seen perhaps 20-30 fracture reductions during medical school and residency. Not a whole lot, since my career path was destined for a nonsurgical route. While I've always felt for the patient in pain, I've never experienced anything like this.
Seeing your own daughter, in so much pain, in so much fear, looking at the foreign white lights of the ER. Seeing the strangers in white coats (not something she is used to, since neither mom nor dad wear white coats to work), poking and prodding.
And then, despite the sedation and pain medication, seeing the orthopedic surgeon reducing the displaced fracture. Despite the sedation, she was somewhat whimpering. And it was sickening, nauseating even, to see your child's distal forearm manhandled, and twisted in abnormal ways to reduce and reposition the fractured fragments. I'm glad I sent my wife and other child out- even I could not keep my eyes dry.
Thankfully, that did not last too long. And so, after a 4 hour ER visit, she went home. With a cast that she will wear for the next 2 months, right into summer vacation, right into her birthday.
She's not happy that she has to miss swim class, or skip gymnastics, or riding her bike, or jumping on the trampoline. But she's being a trouper so far. And perhaps even finding things to look forward to, like how she wants to decorate her cast, or her sling.
Hopefully, this will all be over soon.
But it has me thinking wondering if playsets with monkey bars are secretly sold by companies owned by the American Orthopaedic Association?

Tuesday, May 17, 2016

5 Years

I can't believe it has been 5 years since you left us.
How time flies, my friend. In those 5 years, the world continues to revolve but yet, our precious moments and memories of you become frozen forever.
Down here, much has changed. I've become more cynical, jaded, tired and aged. We now have two girls- you met the older one in your last weeks, remember? She's now in kindergarten, while the other is in preschool.
I miss our conversations; truth is with work and life as a parent, it's hard to form bonds like those we had, when we were relatively young and carefree, and it's hard to find a confidante to fill your shoes. I miss those sessions we would have over a meal, or Halo, complaining about work or life (usually it's me, with your patiently listening). Now, I like to imagine that when all is not well, somewhere up there you're still listening...
I sometimes think about the unfairness of life; of why someone like you would be taken away so soon, so young. Truth be told, I've asked myself many times in the past- why a man like you? Why not someone like me? After all, you'd leave a bigger mark in this world than I ever would. Or maybe that was the point- to teach the rest of us who have much to learn, how to life live and make the most of things.
I remember the time when you told us that you decided to not carry on with chemotherapy. Being the oncologist you were, you knew the odds  even before treatment began. And you knew when you had had enough, and you wanted to just make the most of your time. We both knew the implications of your decision, which was why we made that last minute trip back to Malaysia.
And I'm sure you knew, as I did, when we had dinner at that food court that evening in Penang, that that would be the last time we would ever see each other, at least in this world. Yet, in your usual quite demeanor, you seemed a bit embarrassed when Kris and I gave you our goodbye hugs. You were at peace and perhaps more ready to move on- but we certainly weren't.
You carried yourself with more strength and grace than I ever will know. You never once asked, "Why Me?". And did I ever share with you how I actually met the wife of one of your patients here; someone who was bitter and angry and had trouble accepting his diagnosis, until he found out that his oncologist had stage 4 esophageal cancer, and yet carried on in peace? His wife told me that you gave him newfound peace, that when he finally lost his battle, he was no longer angry.

Buddy- my best friend and confidante, my partner in crime during those 6 years at WFMC, my room-mate, my Best Man, my brother, my Halo teammate.

5 years ago, the world lost a wonderful man, brother, son, husband, oncologist. And yet, you remain near to those whose lives you've touched, never to be forgotten.

I miss you, buddy. Till we meet again someday... here's a toast to you. I'm sure you and our pal Gene are living it up there. 

Saturday, April 16, 2016

Ok, I admit it.
I've gotten lazy.
It's been 3 weeks since my last post. 
Therein lies the issue. Maybe life has gotten to be too mundane. Or busy with the kids. Or perhaps I'm just blissfully happy and have no need to vent out on my blog anymore Smiley. After all, I think that was one of the drivers for my posts:
Complaining about work.
Complaining about being homesick.
And perhaps most of all, complaining about being single (hoping that a girl would fall in love with me reading my blogs!)

It's interesting, a bit embarrassing, and maybe envy-inducing, reading my old posts, those going back 10 years ago when I was a trainee, working at the Mothership under the supervision of the Medical Gods, and seeing all those super-rare cases. Then coming home to a small rented house, hanging out with our community of Malaysian/Singaporean friends. I had a lot more free time then at night, and perhaps a lot of brain-juice and flowing creativity (hah).

I admit I've neglected this. For some reason, I just have less to say. I can't help but notice though I'm not the only one. Many of the blogs I used to follow (still sometimes check it out) are kinda like mine. Lapsed, infrequent entries. Or perhaps stopped completely. Are blogs fads that have passed, perhaps superseded by the newer social media platforms? After all, I vent and share so much more easily on Facebook, and at least I know the people there a bit better. I haven't yet caught up with Twitter or some of the other stuff out there, and it makes me feel old saying that.

Anyway, I'll still continue to update this with boring, mundane stuff. And the way life is right now, much of it will probably be of my most priceless possessions- my girls (wife included). I'm not even sure if I have any real readers anymore, beside those spambots- feel free to drop me a line if there are real people out there.

Happy weekend.

Wednesday, March 23, 2016

15 years

The wife and I were talking last night, when our university days came up.
And I started off wanting to say that it wasn't that long ago that I was in university.
Until I actually stopped to count, and realized to my horror:
I have been a doctor for 15 years.

15 years ago, I had those letters M and D added to my professional/academic name. Be it a blessing or a curse, it's been with me since.

Holy cow- did the 15 years just whizzed by. After all, between that day (graduation) and now, I've done clinical teaching at IMU in Bukit Jalil, completed my residency in internal medicine at WFMC, followed by 3 years of fellowship in endocrinology, gotten married (twice- but to the same girl thankfully!)(in the USA and Malaysia, lah!), had 2 kids, and have been in practice for 8 years.

It's true what they say about time flying. But it's also interesting to note how I've changed professionally. Sadly enough. After all, ask any keen medical student, and they'll tell you they're going to change the world and help everyone. But somehow along the way, you get jaded, numbed and burnt out from the harsh realities of medicine in the USA: the complexities of health insurance and the skyrocketing cost of care and medications, the greed you sometimes see from industry, the bureaucracy, the lawyers and administrators. And yes, sometimes the patients too- when they argue and fight or are simply indifferent.

But, life goes on. We do what we can. Perhaps less of a spring in our steps, but we have after all taken that oath, and it's one I intend to keep. And the few guiding principles I try to live by:
  • The needs of the patient come first
  • Primum non nocere
I wonder where I'll be in the next 15 years?

Sunday, March 06, 2016

Disney Cruise, Part 2

Ok, this is a bit of an outdated post, but I've been busy (and lazy).
We got back from our 2nd Disney cruise a couple of weeks ago. Again, we sailed on the magnificent Disney Dream ship. It was no surprise that Cruise Critics awarded the Dream the 2016 Cruisers' Choice award. 
We went on this cruise with family last year. And this year, it was a long-overdue reunion with friends from my medical residency days, including one from Malaysia.
The last time we all met up, there was only 1 child amongst us.
Now, well, the picture speaks for itself.
The last time this group got together, it was 2004!

This time, we took the 5 day/4 night cruise to the Bahamas (we did 3 nights the last time). And like the last time, we had a blast. There is always much to do on the ship- plenty of activities for the children: a huge playroom with free child watch, with enough stuff that I had fun there too (I mean,come on, they had a mock up of the Millenium Falcon!!) and the kids spent hours there. Meals were provided in the playroom if the kids wanted to stay, and adults get a "wave" phone that allowed them to text you if your child wanted to be picked up. But the one thing I was surprised by the first time, was the amount of activities to keep the adults occupied. Sports bars, jazz bars, karaoke, games,gym, adults-only pool. And this time, at last knowing the layout of the better, we were able to explore much more compared to the last time.
The first day was spent sailing from Port Canaveral to Nassau, Bahamas.It was a quick overnight sail, with the ship getting into port in the morning. The kids wanted to stay in the playroom so the wife and I were able to explore the island on our own a bit. We got to sample some pretty good rum cake. And the straw market is an easy 5 minute walk from the port- plenty of nice little souvenirs you can get; and they're always open to haggling (I wish I brought my mom!).
We left port that evening, and sailed towards perhaps what is the most amazing part- Disney's private Bahamian island, Castaway Cay. We arrived at about 8AM the following day. It's a smallish island, only about 4 km2- but large enough to give the cruisers plenty of space to have fun and explore. Pick your activities- the two family beaches including one with water slides, the adults only beach, cabanas for rent, water sports, kids' play areas, snorkelling, biking, character meeting. Of all the activities, my wife had to sign us up for the Castaway Cay 5 km run! I suppose it was a good way to burn calories from the amazing food.

Truth be told, the February waters were a bit too cold for me (though the air temp was comfortable). That didn't stop the hordes of swimmers though. After saying farewell to the island, we sailed off- day 4 was spent a sea- and this was the difference between the 3 and 4 night cruise. This was actually a nice welcome- it turned out to be a relaxing day as you didn't have to rush and get everyone ready to disembark for activities. So we just replenished our Vitamin D, laying on the deck on the bow of the ship, and hung out with the other adults in the group.

We got back to port about 6AM the following day. After an early breakfast, we disembarked early at about 8AM to do some exploring in Orlando. All in all, it was another great cruise, and it was especially nice to see some old friends.
Would I sail Disney again? Hell, yes. Maybe not next year as the budget probably won't allow, but in a couple of years, perhaps.
If you're planning to do Disney, some words of advice:
  • If you want to explore the pool, choose an early boarding time
  • You'll need to pack a daybag, as your luggage will be brought to your room only many hours after you board. Obviously, you'll need swim gear if you intend to use the pool while waiting around- but it's a good idea to actually be wearing your swim suits under your clothes when you board. The last cruise, there was a long line for the ladies' restroom so the girls had to wait to get their suits on
  • You'll have a choice of first or 2nd dining for meals- with younger kids, I'd say the first dining is best- you get to have your dinner and catch the shows after that. And the shows were excellent- don't miss them
  • Consider using travel agency for booking. We used Dreams Unlimited- fares were the same as the Disney website, but very helpful agent, and they give freebies, as well as onboard credit ($100 this time, and $250 the last cruise- so it's really a rebate).
  • Plenty of websites with room suggestions- check it out. Very helpful times. We got a deluxe verandah room with balcony- on the port side of deck 8. I thought this was a great location. Port side is where they dock on Castaway Cay; but if you want a view of the beach from your room, then pick starboard.
  • I think this changes depending on wind conditions- but the two times we sailed with them the fireworks on Pirate Night was towards starboard, so not visible from our room.
  • Alcohol is pricey. Yet, they allow you to hand carry alcohol onboard if you wish- check out the website for limits.
  • If you have young kids, bring their pirate/princess costumes- great photo ops for Christmas cards.
  • Likewise, if you intend to give the girls a treat and send them to the Bibbidy-Bobbity Boutique, dress them up in their princess dress and then take them there- you'll save a huge bundle having them do the hair package only, but yet they'll already be in their dress. They'll feel like real princesses for a few days!