Just Keep Knocking

Sorry folks. Got feedback that the link to my new blog isn't working. Checked it again and again...and it seems to be working fine. Gee, how long does it take for a new domain name to "propagate" through the Internet?

Moved!

It's A Doc's Life has moved.

If I'm on your blogroll, kindly update my link !

Gate Crasher

I will be gate-crashing an intensive care conference in Kuala Lumpur tomorrow.

A physician in the midst of anaesthesiologists and intensivists. I hope I won't be singled out for my ineptitude in all things ventilator-related.

Blogging shall resume in 3 days' time.

Innovative Patient

Spotted in my ward : One lady's fierce determination to ensure that her IV cannula stay firmly in place.

Her request to have her plaster reinforced must have fallen on deaf ears.

Shameful.

Very Irritating Person?

V.I.P.

What it means to me :

• patient with acute myocardial infarction - needs my immediate attention and antifibrinolytic therapy STAT. Time is myocardium
• patient with respiratory failure - needs my immediate attention and early anaesthetic assessment for consideration of assisted ventilation
• patient with upper gastrointestinal bleed - needs my immediate attention and judicious fluid resuscitation while we arrange for means to stop the hemorrhage
• patient with a sudden deterioration in GCS - needs my immediate attention and assessment for need for airway protection while measures are underway to determine its cause
• patient with cardiac arrest - you know what he/she needs

What it doesn't mean to me :

• high-ranking government officer who walked in (or chauffeured in, whatever) with fever for 3 days, but stable
  
• relative of some MP who has mild abdominal discomfort
• some Datin with moderately high BP but asymptomatic
• resident orthopedic surgeon's neighbour who has diarrhoea

Can't we just do our job? Your order of importance is dictated by the nature of your medical condition, not your status. Don't pry me away from a patient who deserves my attention more just because you are an "important" person who happens to have a trivial medical problem.

Did I just commit professional suicide? Maybe. Not that I have any political aspiration anyway.

I took an oath to be fair and just to my patients, and I intend to honour it.

Everyday Hero #2

I cannot possibly do for one and not the other.

This is beginning to appear contrived, but I really do have something to say about the first man in my life.

I have a cool dad. Not cool in the fashionable, hip, tech-savvy sense, but cool in the way he raises his children. He's conservative, yes, but not in a you're-not-wearing-that-out sort of way. I remember a childhood peppered with humour, lots of story-telling, and even more books. He hurt more when I grazed my knees, cooked us horribly bland food when we had acute gastroenteritis, ferried us to various school meets, sports outings and tuition classes, and remained very supportive of our choices in life. He's dependable, reliable and kind.

Some say we came out of the same mould. So dad, I'm proud be your girl. Hope you're proud of me too .

Happy Father's Day!

(This time I'm posting at the right time.)

*Image courtesy of www.donnabellas.com

R.I.P.

Sucky, sucky, sucky.

3 mortalities. Thought by now I should be accustomed to deaths, but yesterday's just felt particularly sucky.

Man in his 60s, single, survived by a brother. COD : Advanced colon carcinoma. Did he even have his chance at a meaningful life?

Man in his 30s, mentally-challenged, welfare home resident. COD : Diabetic ketoacidosis and septicemic shock. Survived by no one. I stared at his I.C. and felt depressed that his demise probably meant nothing to anybody.

Man in his 50s, heavy smoker, survived by one son. COD : Acute myocardial infarction with cardiogenic shock. Another boy has just become newly orphaned.

As for me, I was worn out, physically and emotionally.

And the curtain closes on a chapter in my professional life.

*COD = cause of death

August 2002 And Everything After

14 June 2007.

I am on call today. It's my last call as a medical officer, since I started in August 2002. For many nights in the last 5 years I have had to spend nights alone in the hospital (mostly awake), walked along empty deserted corridors and entered spooky elevators in ungodly hours of the day, had uninspiring (to put it kindly) on-call meals provided by the kitchen, dragged myself out of bed to attend to patients who had a knack of "collapsing" the moment you fell asleep, and braved temperatures of Artic proportion in the very, very cold emergency unit in Sarawak General Hospital.

It's a lonely business, what we do. When the world is sleeping, you are up, thrust into a position to make life and death decisions. There have been s****y calls, when bad outcomes transpire despite all that you do; there have also been rewarding moments, when your action makes a difference (with a little divine intervention).

I shall miss escorting patients in the short journey from casualty to CCU most, where I would surmount all my strength and push open the CCU doors to allow the trolley through - a moment time and time again I would liken to Aragon pushing open the door in Edoras in his return from near-death (Return Of The King). A little fantasy-diversion wouldn't hurt!

And my on-call attire...my trusty black top from Isetan I had worn on most of my calls, is starting to fray. Even the backpack I carry to store my personal effects has a small tear near the strap. It's time they retired, having served me well over the years.

Strange, somehow I don't feel like I'm moving forward to a better phase. Now s**t begins!

Blackout!

What a night!

The lights went out on me last night. It wasn't personal. I heard the whole of Seremban had a power outage too.

And lives were disrupted, plans foiled. Hair left semi-dry, recipe for frizz. Laundry pile gaining critical altitude, deferred yet another trip to the washing machine. Navigation around the house aided by the faint glow from my mobile phone screen, with a high risk of rolling down the stairs and sustaining a head injury (and we wouldn't have been able to find the car keys to take me to the hospital). Blog not updated...at risk of losing its readership?

So what's a man and a woman to do?

I played Quadra Pop - a pathetic underwater theme Tetris rip-off which is strangely addictive - on my mobile phone, while hubby fell promptly asleep beside me.

Yes, many a generation have been conceived in darkness, but it simply had no amorous effect on 2 very tired people!

Unclear On The Concept

Some patients can be so unbelievably clueless. Some examples :

• Man walks in, sits down, says HI and then asks, "Doc, what's my BP today?" Wait, I haven't checked!
• Woman, told that she's just been diagnosed to have diabetes mellitus from her blood test, exclaims incredulously, "You didn't even check my urine! How do you know for sure?" (Can I propose that the misnomer kencing manis be banned?)
• Man, told that he has renal impairment, asks, "Which one? The left or right kidney?"
• Woman, a hypertensive on treatment, pleased that her blood pressure has returned to normal, asks hopefully, "So am I cured? Can I stop my medications?"

A former consultant of mine was of the conviction that no one should ever be admitted for hypoglycemia. If ever, he was adamant that it was the medical practitioner's fault. I remember an exchange during a grand ward round when we were house officers in the medical ward.

Consultant : Why is this lady here?

HO : Hypoglycemia.

Consultant : You are not answering my question. Why is this lady here?

We were dumbstruck, but really, his point was that no patient would develop hypoglycemia if we took the trouble to educate our patients.

HO : We have counselled her on multiple occasions, but she just doesn't understand.

Consultant : You don't need a high IQ to comprehend these instructions, just common sense. And she can't be so stupid.

(Turned to patient) Makcik, apa itu Proton Saga?

Patient : Tak tahu lah!

This has now been immortalised in our memories as the "Proton Saga Story". The point is, patient education is extremely important, but on many occasions, all your advice and instructions fall on deaf ears or get deflected by a thick cranium.

Well, we do try anyway.

Newly Added : Blogroll

Technology is a beautiful thing (yes, the geek in me has spoken!). Over the last few weeks I have reconnected with some people from my past, with a little help from blogging.

YLTan aka DocPerineum (it's obvious what he does, doesn't it?) is a former colleague from the Land of The Hornbill; he also lived in the room across from ours in the HO quarters. He is a budding photographer when not dealing with matters of the nether regions.

Dr Flora maintains a witty blog that tells of funny patients and even funnier medical personnel in Sarawak General Hospital, hence it's no surprise her blog is called Laughter, The Best Medicine. We have never actually worked together in the same department, but have braved heights, leeches, the open sea and endless boring lectures in our induction course.

Medic Fang was a classmate in medical school. Known for spouting the best straight-faced one-liners, he continues this tradition in Medic Diary, with his funny insight into matters both medical and non-medical (like movies!). He was actually part of my husband's group of Heroes Of Might And Magic fanatics fans - they had marathon sessions lasting well into the wee hours of the morning, and called themselves by nicknames.

I have hence added a blogroll - of blogs by people I know and those that I stalk visit often. Now, when do you think a class mate from secondary school will drop by and say HI?

Organised Chaos

This is a copycat act following a rash of posts featuring doctors' worktops/desks in the MMR.




This is where I spend most of my waking hours at home - where I have toiled for my membership exam, spent countless hours in the quest to better my own Bejeweled scores, edited scores of photos, and blogged. Most of the time with my husband next to me playing real-time strategy games.

There's a Pfizer year planner for 2006 (!), stacks of review articles yet to be read, a notebook that's perpetually glued to the table top, some water bottles that have been there for weeks, my MRCP scroll still in its case, a dummy Symbicort turbuhaler and a handy DIY stationery organiser from IKEA (where "miscellaneous" objects go).

It's messy but functional. That's why it's called organised chaos.

LULU II

This is another LULU moment.

We bought tickets to see Shrek 3 and to our surprise the movie projected on the screen was Pirates of The Carribean 3, which we had already seen! The guy at the ticket counter must have been day dreaming - we asked for Shrek, but he sold us tickets for Pirates instead. Our fault too for not checking the tickets before leaving the counter.

Oh well, we didn't mind sitting through another 3 hours of swashbuckling action. When the credits rolled, people streamed out of the cinema while my husband and I stayed behind, knowing that there's extra footage midway through the credits, having missed it the first time. We felt so smug!

Then again, who's the bigger lulu? Probably us!

Painful

What a day.

I sat for a "competency assessment" (otherwise known as the PTK) today, which in spite of what it's called, does little to measure my ability as a physician. It is however a prerequisite to a promotion and pay rise, and so we poor civil servants have little choice but to force-feed our brains with facts that are irrelevant in our practice.

And so for the past 3 nights I had been grudgingly poring through information I know will slip through my brain once it's been regurgitated in the exam hall. It's called cramming, which is disdainful. I must say though it's one of the least stressful exams I have ever had to prepare for, which leads me to the conclusion that life is indeed blissful when one has absolutely no expectation (you might call it ignorance).

I am glad it's over, but I'm left nursing a migraine and an extremely sore right upper limb (from 5 hours and a half of furious writing). I need analgesia.

The hazards of exams...study, anyone?

Little Kathmandu II

I ran the tuberculosis contact screening clinic today. A woman brought in a van-load of Nepalis, all of whom had the misfortune of having shared a hostel room with a co-worker infected with tuberculosis.

Hah! Another outbreak of Nepalis!

There were altogether 11 of them. My job was simple - take a targeted history and perform a quick examination, and review the chest x-ray and sputum results. These smart guys took the opportunity to complain about their headaches, body aches, skin rashes and constipation! Pretty soon I felt like I was running a polyclinic. By the fourth patient, I had to tell them that I was just a "TB doctor"! Health care should not be this compartmentalized, but I had tonnes of other patients to see.

Sigh. I hate to turn patients away, especially these gentle Nepalis.

A Step Forward

After umpteenth months, the powers that be have decided that I am "ready" to assume specialist responsibilities.

It's life as usual, except for a certain awkwardness in doing ward rounds with people who were once your colleagues of same rank (and with whom you sometimes b***h about some specialists over lunch). What is really wonderful though is the fact that my signature carries a great deal more weight now. Imagine, I can now prescribe amlodipine for my mother-in-law without having to beg for a specialist's signature!

Some genius told me, "Membership has its privileges".

I couldn't agree more!

Welcome Back!

Hubby's back in the hospital for his final 2 years of postgraduate surgical training.

It's surreal. Not having to drive myself to work. Constantly feeling for the car key in my pocket and not finding it there, and feeling a few ounces lighter. Having a consistent lunch buddy. Being able to go have lunch outside, then leaving it to him to deal with the stress of finding a car park space later.

Welcome back. You have been missed, by me and the staff alike.

The Transformers

My brothers and I loved Transformers (probably under heavy influence of a cousin whom my second brother worshipped). I think the appeal lies in the humanisation of the bots, and how good versus evil is played out. That good always triumphs, against great odds.

I saw the first animated movie. When Optimus Prime "died", we fought back tears.

Perceptor: I fear the wounds are... fatal.

Daniel: [long pause] Prime, you can't die.

Optimus Prime: Do not grieve. Soon I shall be one with the matrix.

Hot Rod: Prime.

Optimus Prime: Ultra Magnus, it is to you, old friend, I shall pass the matrix of leadership as it was passed to me.

Ultra Magnus: But Prime, I'm - I'm just a soldier. I - I'm not worthy.

Optimus Prime: Nor was I. But one day, an Autobot shall rise from our ranks, and use the power of the matrix to light our darkest hour.
[opens his chest to reveal the matrix. Removes it and begins to hand it over to Ultra Magnus]

Optimus Prime: Until that day, till all are one.
[Matrix starts to fall to the ground. Hot Rod catches it, gives it to Ultra Magnus. Ultra Magnus inserts it inside. Prime dies]

And when the Autobots seemed to be headed for a certain doom, Rodimus Prime saved the day.

Rodimus Prime: This is the end of the road, Galvatron.
[throws Galvatron through Unicron's hull and opens the Matrix]

Rodimus Prime: Now light our darkest hour!

The place blew up. And the soundtrack played. What a moment!

Michael Bay, please don't disappoint us.

Flushed Away

Spotted in one of the cleanest and least known, least frequented (explains the "clean") wash rooms in the hospital.

Well-placed message, but do you see what I see? Is it what I think it is?

*The sign says don't forget to flush

I Wonder

I've had some memorable patients in my days in Kuching. I sometimes wonder if they are still around, whether they won their battles....or had succumbed.

M was a young lady who had never smoked a cigarette in her life. At age 32 years, she was diagnosed to have stage IV lung carcinoma. One of the first chest drain insertions I performed was on her, which she bravely tolerated. Her husband brought me fresh tiger prawns from the village - I think they lived in my freezer for months. She was lost to follow-up subsequently. I wonder if her last weeks or months were good.

J was another young lady diagnosed to have multiple sclerosis. It was heart-wrenching to watch her disability progress. Each time her ward stay became longer; soon it felt like she'd never left the ward at all. My colleague and I chipped in to buy her an AM/FM radio to ease the boredom of being confined to her bed 24-7. It broke my heart when her young son came to visit and took the radio home with him. I wonder if you're in a better place now, J.

Mr B had bronchial asthma, initially cared for by a GP who put him on years of long-term oral corticosteroids. His asthma control was atrocious. He was a regular at the emergency department - on most of my on-call days he was certainly there. I wonder if he is still steroid-dependant?

Finally, an adolescent with Type I diabetes mellitus, who had recurrent episodes of diabetic ketoacidosis. His presentation was classic - he'd walk in, looking a little dehydrated, breathing a little rapidly, and he'd say, "Doc, I think I have DKA"! A blood gas analysis always confirmed his acidotic state. He'd survived each one. I wonder if he'd run out of "luck" some day.

I wonder if I'd still see some of these folks when I return to Kuching.

LULU!

We love this word. We don't know its origin, or how it crept into our vocabulary.

lulu (n.)
one who has been duped / easily duped

Several examples to illustrate its meaning :

Scenario 1
I was at McD trying to get some take away dinner. There were 3 counters, only one of which was operational. I went to an empty one, but no one was manning it, and no one intended to (there were idle staff members milling around, looking busy). As soon as I joined the queue, a staff opened another counter and immediately served a lady who had just walked in. I swear she saw me come first. I felt like a lulu.

Scenario 2
I caught POTC : At World's End last week. Felt rather pleased I could get tickets. Enjoyed the movie, though the ending was less than ideal. Cleverly surmised that a 4th movie was definitely on the cards, as there were loose ends and no closure. Capt Jack Sparrow lost his Black Pearl? Will was separated from Elizabeth? Learned today however that there was a "second" ending, which came up after the credits. Yes, you guessed it. I felt lulu-fied.

Scenario 3
This is a frequent occurrence at Baskin Robbins - being short-changed. For instance, the bill says RM 22.06. If you pay RM 22.10 you won't get any change back. They won't accept RM 22.00 either, because you're 6 cents short. They think we are lulus.

Get it?

You Are In My Way

Two words : Selfish + Inconsiderate


This car belongs to my neighbour, and it's parked outside everyday. Of course, my portion of the driveway is trespassed and sometimes I have difficulty reversing my car out of the porch. That's all right, Mr Neighbour. Your action is perfectly understandable, given that you don't want to block your own driveway so that your family members will find it a breeze to drive in and out everyday.

Motivation note to self : Make tonnes of money so that someday I can afford to be a hermit holed-up in some posh one-elevator-to-one-unit condo.

Round And Round We Go

Life is an endless series of rounds.

This downward spiral (pardon the pun) is detrimental to members of my team. Here's how :

• my FEET hurt - even Clarks and Hush Puppies can't save me


• my THROAT hurts - from repetitive case presentations
  


• my HOUSE OFFICER hurts - from scribbling what is essentially the same information over and over in the patient's notes

• my PATIENT hurts - how many times does an abdomen need to be palpated?

• my NURSE hurts - HO says to turn off the oxygen, MO says to put it back, specialist says to change to oral antibiotic and remove IV cannula, consultant says to continue with IV. Huh?

• the ENVIRONMENT hurts - God knows how many trees we can save by cutting down on paper use, which can be achieved through minimising entries in patient's notes. If it's going to be a seen by aka S/B entry ending with a continue same treatment aka CST entry, why bother duplicating it?

I don't know a better way to do it, but multiple ward rounds are counterproductive.

Everybody Hurts. Maybe REM was really singing about us.

Home Alone

I am home alone.

Hubby's been doing back-to-back calls. He is the one man in a one-man unit - no surgeon, no fellow trainee. And all this in a teaching hospital! The higher authorities want the show to go on. Comply, or risk being kicked out from the programme. Hardly a choice.

And so one man has to pack his clothes and move into the hospital. Watch TV with the nurses, eat out alone, send dirty laundry to his parents' house (nearer) and get bitten by bugs that occupy his call room bed.

And somewhere, about 90 km away, his wife comes home to an empty house everyday, finding no one to listen to her b***h about the horrible things that happened at work. She too has to dine alone, and is running out of meal ideas. Having now to drive herself in search for food, she sticks to familiar places (mainly along the route from home to hospital and back!) - she's been lost in this town on more than 1 occasion. She's fine otherwise. Laptop + Internet connection + DSLR + car that takes me places - man = FINE. Of course, Laptop + Internet connection + DSLR + car that takes me places + man = PERFECT!

A typical homemade dinner

Can't believe 1 month is nearly up. I will soon be home alone...no more.

Bragging Ladies

During a ward round with my consultant, she pointed out an old lady whom she knows personally. This lady speaks proudly of her children to anyone who would listen; both have successful careers in UK and Australia respectively. Yet, she is alone in her twilight years. No one visits her in the ward. I was instantly reminded of a Petronas Chinese New Year TV ad, which I loved.



I look forward to these gems by Yasmin Ahmad every year.

Not A Playground

There's a presence in our hospital corridors or wards I strongly feel we can do without.

It is that of children's laughter, merry-making, play.

I remember the times when my mother was admitted to a government hospital. My dad would leave my brother and I at the hospital playground while he went up to the ward to see my mum. I used to think that cruel and not very child-friendly, but this rule was not made without good reason.

I'm not Scrooge, but I don't like the sight of children in my ward. We see toddlers lying on hospital beds, kids crawling under the beds or chasing after one another while their parents look on with adoration. There's a potential hazard at every corner waiting to befall these little ones - trolleys and drip stands they could knock into or over or dirty slippery floors they could slip on. There's also an unseen danger - nosocomial bugs they could pick up. If we have to allow children into the wards, more supervision is required.

Kids will be kids, but the hospital is not a playground.

Not My Fault

How do you apologise for something that's no fault of yours?

Over the years I have had to put on a brave smile to endure hostility, anger and disappointment hissed at me from disgruntled patients. Drip finished, still not replaced. Drugs administered late. BP not checked but charted. Urine bag on the verge of bursting and not emptied. Bed too high. Bed too low. Ward too hot. My MRCP training dictates that I have to be impartial, objective, calm and empathic. And so I have always been impartial, objective, calm and empathic. I always apologise on my nurses' behalf, on the hospital's behalf, and heck, on the Health Ministry's behalf! All this while the patients, sensing a diplomacy they mistake to be guilt or fear, intensify their tirades against all the wrongs that have been committed against them.

We have nursing sisters who should be overseeing such things. Today a patient of mine complained incessantly about poor nursing practices that had befallen her (she being a former nurse herself). I asked my ward sister to join our "discussion" (mostly one-way sonar traffic with the patient doing all the talking and us listening) hoping that she could come up with some solutions.

She spent the whole morning grumbling about how she always had to apologise for things she didn't do! Hmm.

These days, I take diplomacy a bit further. I take the patient's side. Ever so subtly I nudge them towards making a formal complaint. Let the hospital director hear about our shortcomings. Maybe then things will improve.

We always have to learn the hard way, don't we?

Hair Woes

I'm a low-maintenance woman.

I couldn't sustain a high-maintenance existence even if I wanted to. I hold an unglamorous job, and while I maintain that style AND substance will get you far, I'd look out of place all dolled-up. Not in the hospital anyway. My only indulgence? Trips to the hair salon.

Of late, these trips have become somewhat stressful, and not unlike a visit to the hospital. Here's how :

THE WAIT
Sure, some salons entertain walk-ins; the hot shot ones by appointment only. There's no numbering system, no irritating ding-dongs indicating your number is up. But you wait, nonetheless.

NO CONTINUITY OF CARE
Then, the person you trust with your hair is not always available. He may be on leave, or held up with another patient...I mean customer. Darn, but he knows my hair history. Are you sure the junior MO...I mean stylist, is competent? Which hair design institute did he graduate from anyway?

MORE THAN YOU BARGAIN FOR
I come for a wash-and-cut, but I always end up with a new diagnosis that requires further treatment. Hair too frizzy. Scalp too greasy. Colour fading. Excessive hair loss. Each time there's a new - expensive - product to be purchased to avoid further complications. If my hairstylist conducts a spot-check of my bathroom he'd conclude that I'm a customer who practises polyhairproduct-y but who has compliance problems (bottles and bottles of unfinished hair products).

THE DEFAULTER
My stylist expects to see me more frequently than I can afford (both temporally and financially). He says, see you in 6 weeks for a trim and I don't turn up unless my bad-hair days become more intense, more frequent and occur even when I'm not post-call. I'm a bad customer, but I have no time.

Phew, lucky for me I'm not into facials, manicures or pedicures.

The Wedding

I'm attending the wedding of a long-time friend today.

I'm looking forward to it despite being day 2 post-call - stressed-out skin, less than sensational hair, a pair of tired-looking eyes and some insect bites on distal extremities which I could in no way cover up (Insect bites? Probably from bugs that co-inhabit the bed in my on-call room).

I'm looking forward to it because I'd be meeting up with people I grew up with, way way back in the pre-Blogger, pre-YouTube, pre-Friendster era. It's nice to see what varied lifestyles we have each pursued. It's even nicer to celebrate our similarities, that we can still pick up where we left off and laugh at the same silly things.

Mostly though, I'm looking forward to it because hubby and I could pretend that we are celebrating our other wedding anniversary (which falls on the same day) in a swanky hotel on another person's expense. Mwa ha ha ha!

Now, how do I assimilate a DSLR into my look without looking like an overdressed photographer on the job or a pretencious wanna-be photographer?

*Other wedding anniversary : when we threw a dinner reception to celebrate our marriage which had taken place earlier

What's In A Name?

Took the lead from Jimbo and decided to check out a name-bestowing site. Wow, I can have a monster or sexy or cyborg name!

Get Your Cyborg Name

Get Your Sexy Name

Get Your Monster Name

It's silly but fun. Harmless and surprisingly delightful on a post-call day!

Food For Thought

TODAY'S SPECIAL

hors d'oeu-vre

Bread and butter

soup du jour

Cauliflower soup

entree

Pizza Pie with Swiss Cheese

or

Grilled Salmon with Anchovy Sauce

dessert

Strawberry Ice Cream

Coffee or Tea

What a doctor/pathologist may envision instead :

Anchovy sauce pus of a liver abscess


Pizza pie (?new fusion food) appearance in CMV retinitis

Strawberry cervix of trichomoniasis

Cauliflower-like growth of a laryngeal papillary squamous cell carcinoma

Bread and butter appearance of fibrinous pericarditis (you'd have to drop the bread on the floor to leave that kind of texture!)

Swiss cheese appearance of emphysematous lung

We see food in everything.

Thin...and Loving It!

I have a positive body image. Well, some parts may be entirely delusional, but if I like myself with conviction - false belief or otherwise - that's a good thing. I learnt from a tender age not to take things at face value. Looks-aren't-everything was my mantra because, well, I was more brainy than I was pretty. Smacks of sore loser-ism, I know. I'd just rather call it positive body image. After all, my husband (then boyfriend) saw beyond my pimples and orthodontic contraptions, and he always thinks himself lucky to have me! (All husbands think that of their wives, I reckon.)

So why did it bother me so when more than 3 people I met over the weekend commented, similarly, that I had become thinner? Well, thin is supposedly good. I've been thin all my life. But now I'm thinner! Those remarks did not have a complimentary ring to them; they were more you-poor-thin-thing-what-happened-to-you kind of remarks. Do you know what's disturbing? The fact that I was sufficiently bothered!

I weighed myself that very night. I hadn't done that in a very long time. I just wasn't weight-conscious (remember, I have a positive body image). I discovered that I hadn't gained a single ounce since the fifth form! Boon or bane? I feel healthy. I eat heartily. I am clinically euthyroid. My body mass index is well within the normal range for Asians. Why was I bothered at all?

(Chant) Positive body image...positive body image...

I guess I allowed myself a moment of frivolity there. There are a lot of people out there whose obesity is no choice of their own, or underweight persons who are that way because of medical reasons. Me? I should just be glad that there are labels that carry my size, or a seat that fits my rear, or food that I can eat without ever having to count every calorie. The next time someone calls me thin, I'll thank him for the compliment!

Fashion Tips for MRCPians-to-be

You are what you wear.

Why do you think we're made to wear white coats anyway? A robe doesn't a good doctor maketh, but until one opens his mouth or touches the patient, he can fool anybody into thinking that he is competent. Because he wears the white coat and looks the part. Also, added bonus if he wears the tie too!

So how do you look the part going for exam (specifically MRCP UK)? Admit it, it's relevant and pertinent. And don't judge me because I spent time fretting over what to wear on my exam day. I had worked hard, and I wasn't about to let a less favourable first impression cloud the judgement of my examiners.

Concern #1 : Hair
Bun? Too severe. Ponytail? Too girly. Long and loose? Too unkempt. I ended up pony-tailed. A friend of mine took it a step further - she got her hair done in a salon just hours before the exam. Well, she passed!

Concern #2 : Top
All right, we all agree that the powersuit is the safest bet. Very professional. I was undecided on the shirt. Pink? Again, too girly. Blue? Probably. I finally opted for a white Victorian-style blouse with some lace trimmings. Feminine, but subtle.



Concern #3 : Bottom
This was the tough one. Skirt or the pants? In the end, the skirt for me.

Concern #4 : Shoes
Flatties? Pumps? Heeled-pumps. Needed to look taller lest they think I look too juvenile to become a physician.

Concern #5 : Brain
The most important fashion accessory. I operate on many modes - sharp, confident and pleasant, or slow, sluggish and stammering, or high-strung and fidgety. I think I wore my brain well that day, when it mattered the most.

So there, I was what I wore on my exam day. I was definitely assessed based on my skills as well as my appearance. Don't call me shallow. I am of substance, but I do not think style and substance have to be mutually exclusive.

*Even the Singaporeans put emphasis on appearance. There's a section in Look and Proceed - a useful clinical skills book written by Singaporean doctors - that teaches you how to stand when you face the examiner, where to "hang" your steths when idle etc. Like, seriously.

Old Is Gold

People say I'm good with old people.




I'm more surprised than flattered. Who, me? I'm hopeless with old people. I can't remember the components of a mini mental state examination, and so I can't perform one without reference. I don't deal with age-related complaints very well - the aches and pains, constipation, poor vision, the forgetfulness. To make up for my lack of experience in geriatrics, I inject an extra dose of kindness in my approach.

How do you not feel compelled to be 10x nicer to the pakcik in shabby clothes with a backpack and an umbrella who had travelled in a bus from another district just to see you in the clinic? Or to a polite octogenarian with a walking stick who drove himself to the hospital but had to take a RM2 cab ride from the car park (about 2 hills and a mortuary away) because it was too far for him to walk? I think we owe it to these elderly folks to spend more than the customary 5 minutes to take a BP and ask close-ended questions. Find out how they came, who they live with, what they used to do, what they do now.

Have a heart, people. We'll all be droopy and saggy and wrinkled one day too.

This Is What I Think...

"Good course...compulsory for anyone even thinking of attempting PACES!"
Dr VMA, Tunku X Hospital

"Intensive...it whipped me into shape; so crucial just weeks before the real exam"
Dr FBC, University Hospital

"The best course available locally...book early to avoid disappointment!"
Dr ABG, Oh Pee Dee Clinic

Very cheesy comments, reminiscent of those gosh-it's-so-good kind of remarks you'd find in the inside covers of paperbacks.

You see, I have been asked to submit a comment on last year's PACES preparatory course organised by the country's premier private medical university for use in their promotional flyers for this year's event (since I was a participant...and passed!) I presume they want only good comments, but the first thought that sprang to mind was, it's not cheap! Well, the PASTEST courses in UK cost much more, but I hear they are really good. The price has escalated this year for the prep course in Singapore, but then NUS brings in good tutors from UK. A few years back, they had Dr Praveen Kumar (the Kumar of Kumar and Clark)!

So what of the local course? I can't really compare, this being the one and only prep course I've ever attended, but we have our share of prominent local clinicians who are actual MRCP PACES examiners. Can't say much for the cases though, but then again the patients were mostly from my hospital so it didn't feel like we were seeing fresh cases. What was important to me though was the opportunity to size up the competition - people you would be up against on exam day.

But guess what? I walked out of the exam ward grinning and shaking my head in disbelief. I had for my skin station a gentleman with pachydermaperiostitis, which I took the trouble to read up after coming across this big word in PACES MRCP. And it's free.

Seriously.

Little Kathmandu

There's an outbreak in my ward.

An outbreak of err...Nepalis!

I had a field day on my call last Saturday receiving one Nepali after another. Poor guys. To leave your home country for the promise of wealth and a better life in bolehland is one thing, but to get bitten by the evil Aedes aegypti and end up in a third world health institution where nobody understands a word you say, is surely something else.

Some spoke a smattering of English, and some, remarkably, Malay. Then there were some who spoke neither, but somehow history taking was accomplished with the help of wild gesturing. I say wild because - trust me - there is no genteel way of communicating the meaning of vomiting, bleeding or diarrhoea. The only word I know to utter in Nepali (or Hindi, I think) is namaste, but I usually spare them the agony. I mean, there's only so much nee hao mas or apa khabars you can stomach from gwai lohs who visit our country, so I won't do the same to these poor Nepali souls.

None of them pulled a bleeding, plasma leakage or shock stunt on me that night (despite the fact that my very considerate boss Jimbo turned up in a RED shirt!). I hope they get well and get out of the hospital soon. And that they will return to their beautiful country Nepal when they have made enough money, where there's little chance of falling ill with dengue fever.

*bolehland = Malaysia, where nothing is impossible
Aedes aegypti = the mosquito vector that carries the dengue virus
namaste = ?hello and good day in Hindi
nee hao ma = how are you in Mandarin
apa khabar = how are you in Malay
gwai loh = cantonese slang for "white man"

Shattered Glass

Did you catch this in your Sunday paper?

"KLANG : A couple had the shock of their lives when the windshield of the car they were travelling in shattered into thousands of pieces.

Mr and Mrs K were on their way back to Seremban. The incident took place at 2 pm, just as the car was approaching a flyover several kilometers away from the Kota Kemuning toll plaza. The otherwise pleasant journey was ruined by a loud crashing sound, followed almost instantaneously by cracks that formed radially from the point of impact. They did not know what hit them.

Mrs K was furious. Although there was no eyewitness to attest to her claim, she was certain a stone had been thrown in their direction. "We were not trailing any big trucks carrying debris or rocks so it could not have been a stray pebble that hit us. There must be someone on that fly over intentionally hurling an object at us. What scums! Don't they know that lives could be lost? We could have lost control of the car; the glass shards could have injured us. What kind of sick people are we raising?" Mr K was also visibly upset. He had lost his prized collection of car stickers accumulated from the different places he had worked in.

Car stickers beyond salvage

Traffic was not disrupted. The said flying missile had not been discovered, but police have yet to rule out any foul play. No KESAS official could be reached for comment."


That sort of summed up my weekend. A damaged car, no Spidey ticket, and pathetic broadband service.

An Everyday Hero

*This fine piece of art work is the property of Gustav Klimt

I could submit a heart-warming story of her to the newspapers, for a shot at the attractive prizes at stake. But you know what? It won't win.

She has no superpowers. She is not perfect. She has bad days. She has quite a temper. She doesn't drive. She raised us with a lot of help from her husband. She never walked through fire or parted oceans. See? I have no mother-overcoming-adversaries kind of tales to share.

So mum, you'll have to settle for a blog spot instead.

You are to us in ways that other people will never understand. Simply put, there's only one of you in this whole wide world. And for that, you're our HERO.

Happy Mother's Day!

*This is a tribute from the daughter who never inherited your infectious-laugh gene, and never found out what day in May Mother's Day falls on. Nonetheless, I hope I've made you proud with... ahem...the good job you did with me!

One Day Blog Silence

Top 10 Books

5 out of 10...ain't so bad.

The Malaysia top 10 favourite books (fiction) list was revealed today in The Sunday Star. I am slightly dismayed to learn that I have only read 5 of these shortlisted books, and I consider myself an avid reader.




Actually, I was an avid reader. Call me a geek/nerd/bookworm, but as a child - when the Internet was a concept you heard about in shows like Beyond 2000 - my idea of fun was being left alone with a good book. A book a day, I lapped it all up with glee. I even started my own library - my books were catalogued using serial numbers and all had a "date due slip" pasted onto the last page - except that there was no patron. I enjoyed the trips I took with dad to various book fairs/exhibition/warehouse sales around KL, when we'd take a bus down from our hometown of Klang instead of drive. Those express bus trips (aka direct trip), windows down and wind beating on my face, with me struggling to keep my eyes open, will forever live on in my mind as one of those classic father-daughter moments. We'd return home after a tiring and fruitful day, pleased as Punch, with our individual loot. Mum would roll her eyes (all done with affection) in a way that said, like father like daughter. And of course, I once fantasised that I would meet the guy of my dreams in a bookstore!

Over the years I read less and less fiction. My reading list consisted of medical text and journals, guidelines and papers, all very boring stuff, I must say. The occasional fiction I read, I read during air travels, books I purchased at the airport bookstore and never quite got around to finishing when I got home. My last book? Amy Tan's The Opposite of Fate (which doesn't really count as fiction). Status? Unfinished.

I didn't take part in the poll, but my top choice echoes that of the Malaysian public. The Lord of The Rings rules them all!



Mr JRR Tolkien

The Right To Know

It upsets me to learn that some fellow doctors do not bother revealing the origin of low molecular weight heparin (LMWH) to their patients. It upsets me even more that they think that those who do, shouldn't!

On what grounds? Look, I know most of us have the genuine intention to treat our patients to the best of our abilities. Therefore, my opponents think that withholding a minor detail such as that above is done in the patient's best interest - a so-called therapeutic advantage. They argue that most Muslim patients who were told of LMWH's porcine origin ended up declining its use. They are after all offering the best treatment there is (in the case of acute coronary syndrome - ACS).

But still I ask, on what grounds? If you're a Muslim, don't you want to know if your treatment is halal? If there is no better alternative, the origin or religious legitimacy of a particular therapy does not preclude its use. I usually make it a point to counsel a Muslim patient before I administer LMWH. Yes, it's porcine in origin. Yes, it's the best treatment available (for ACS). Yes, there is an alternative, albeit an inferior one. Yes, in my professional opinion, you should receive this form of heparin. And yes, the final decision is yours.

In the end, if you are mentally competent, able to comprehend and retain this information, the final decision is yours. It's your right, the right to self-determination. In my limited experience, most of my Muslim patients have no objection to using LMWH, since it is undoubtedly the one thing that can save their lives when they present with ACS.



We'd like to think that doctors know best (and want the best for their patients), but let's not also forget that ultimately it is the patient's right to decide what they really want. Autonomy still rules.

My Cup Of Tea

An old love affair has been rekindled.

Ah, the joys of drinking tea...rediscovered.



Growing up in a household virtually devoid of caffeine (bar the occasional root beer, cola or Sarsi during festivities), I didn't begin to drink tea regularly till I was much older. Tea quickly became my new favourite beverage. I love both its taste and after taste; I like it thick and black, slightly bitter, and hot. Of course, I also like what it does to my spirits - one cup and I'm living up to my potential. I could do a million things, I write better, I articulate better. That, as we very well know, is caffeine-driven!

I have tried a variety of tea brands, and so far Tazo has been a sentimental favourite. I remember my first days in Sarawak General Hospital, when my husband and I were housed temporarily in one of the empty rooms in the specialist clinic complex while waiting for the actual quarters to be vacated. Those were such cold days in every sense of the word. The air-conditioning was on 24-7, and I would be reduced to a cyanosed, shivering mess trying to get an express shower at midnight after returning from my "tagging" duty. My only material comfort was my Tazo tea. For that I think I have Wyeth to thank. To promote their antibiotic Tazocin, they gave away Tazo tea bags with their drug papers. What a clever marketing gimmick! My darling hubby had collected an impressive 6-8 sachets from his colleagues because he knew I loved tea. I was wary and slightly confused at first ("you sure this tea doesn't contain any Tazobactam?"), but Tazo had me at first sip.


Over the years I had come into contact with some mediocre tea; you know, those shamelessly watered down, diluted imposters. And the lure of coffee was strong. Even if coffee proved too strong for me initially - giving me palpitations, headaches, and insomnias - I soon crossed over to the dark side. Pretty soon I was downing something like 3 cups a day (which is to be considered massive given my small frame), and I realised I was more dehydrated, edgy, and thoroughly exhausted at the end of the day. One of my resolutions for the year had been to cut down on my coffee intake. First quarter review : partially successful. Will work harder on that.

So how did I rediscover tea? I was at a conference recently and expecting to be fed the usual inferior quality brown beverages passing off as tea/coffee during the multiple tea breaks. But this particular hotel of the many many 5-star hotels I know had this charming little booth where tea bags were displayed and we could have our own pick. Fine tea all, measured in bag per cup, not in parts tea per million. My cup of tea, precisely. So there I was, one tea break after another, trying a different flavour each time, quietly but rapturously sipping my tea in the corner. Ah, the simple pleasures.

For now, I'm sticking with tea. The perfect cuppa? Tazo Awake, an English Breakfast blend, of course.

*Tazo says it best : Before the advent of Tazo Awake, most of humanity lived in a kind of dazed, dreamlike state where nothing much got accomplished on a regular basis. This made organising things like the Internet pretty much unthinkable.
Tazo is available at Starbucks.

Steve Versus Bill

Poser of the century : PPC or Palm? Canon or Nikon? Mac or PC?

While I have sworn allegiance to Canon, and would switch to a Mac in my next upgrade, I still don't own a PDA because I cannot decide which to get.

Anyway, here's a hilarious Steve VS Bill cartoon I found in You Tube. (Note : Bill has the green lightsaber, but why is he the good guy?)

Drug Wars

It's war between the drug cartels (small fry need not apply). Drug pushers are sent out to the streets to ply their trade, and we're caught in the cross-fire. No, I've not migrated to some drug-lord infested South American nation. I simply work in a hospital.

The hospital, or for the matter any health institution is fertile ground for drug-pushing. I don't mean that in a bad way. Pharmaceuticals is a multi-million dollar industry, and understandably it's break-neck competitive. The prescribing policy of a hospital could mean a windfall for a particular company and bust for another. New drugs and old ones given new indications are pushed into our faces all the time. So how does one choose?

Life just keeps getting more and more complicated. Choices, choices, choices! From skin care to hair care to brand of cereal or fresh milk, I am swamped with choices. Consumer products are petty matters. With drugs, my choices can have a huge impact on patients' lives and health economics. So how do I choose?

All drugs being more or less equal in terms of efficacy, tolerability and cost, do I choose based on

• the strength of evidence of drug trials
  
• my consultant's prescribing preference
• the likeability of the pharma rep
• the agreeable appearance of the pharma rep
  
• the support from pharma company (i.e. sponsorship for CMEs, conferences, department, research grants)?

All of the above for me, to a certain extent, with the exception of the physical attributes of the salesperson (there are more comely young lasses than lads in the pharma industry anyway, so not very interested). Our prescribing practice usually mirrors that of our specialists and consultants in the early years, with some fine tuning along the way as we mature into experienced practitioners. Ultimately, most of us prescribe within the confines of consensus guidelines where they exist, and where cost is not prohibitive.

In the meantime, we enjoy the attention. Sales blitz is the latest marketing ploy, where reps sometimes dress and give out lunch packs or snacks according to theme. My favourite so far? Sushi packs, as sushi=fish and fish="mascot" for one 3rd generation cephalosporin. The most desperate? Secret Recipe cakes for energy to last you 24 hours, to remind us of a certain ARB's "24-hour protection".

We are not complaining.

*CME : continuous medical education; ARB : angiotensin receptor blocker

Disclaimer : Opinions expressed are entirely the author's and may not reflect the truth of the situation, and certainly do not represent the views of the doctors practising medicine in Malaysia.

Roma Fan

This is old news, I know. That Manchester United trashed Roma 7-1 like ages ago. Yawn.

Anyway, just thought I'd share this because I find it amusing.

Spotted in my ward the day after the breathtaking match :


The caption should read : Roma fan keeps flag (towel) flying. Poor thing. I bet she didn't even know her team had lost!