Wednesday, December 17, 2014

Priceless

I admit, I'm one of the millions of Facebook users who are ungrateful, who use the social media site without paying, but complain about its privacy policy, data mining practices and the stupid intrusive advertisements that put up on my wall. Your know, the "related links" ones.
But this one wins a prize.
 
This was priceless; there was no better ad in response to the post above it.
Maybe they're not that stupid anymore.

Sunday, December 14, 2014

Farewell, Elaine....

I found out a patient of mine passed away 3 days ago.
I had been seeing her for the last 5 years- and it's something I've really come to enjoy in my field- the longitudinal care we provide and so we really get to know some patients, and even get attached to some of them (This would be in contrast with the role of a hospitalist, or ER doc, who provides on-demand care).
Anyway, she has type 2 diabetes, but was a dear little old lady, with dementia. I also see her son and cousin as their endocrinologist. And at the visit with her cousin, he shared the sad news. She wasn't feeling well that day and wanted to rest. But she never woke up.
She was 89.
She finally got what she wanted. She lost her husband a long time ago. And despite the dementia, remembers him well. And everytime I see her, she would grumpily say that "old people have no business being alive for so long. Why wouldn't He just take me now?".
And I would tell her "Elaine, it's just not your time..."
She lived alone in a trailer home before her son made the difficult but necessary decision to put her in a nursing home 10 months ago; she was the lady Kris and I brought a birthday cake to last year.
I shall miss her, seeing her spunk, her dry sense of humor, and hearing her stories (stories she had told me a dozen times before but doesn't remember).
But at least she's finally at peace, and she'll celebrate Christmas with her husband, finally.
Farewell, my dear... I hope I took good care of you while you were here.


Saturday, December 13, 2014

Congratulations!

So our 'foster' son graduated today. We 'adopted' several students from Malaysia who are in the university here, if nothing else to help out in the initial transition from Malaysia to the American way of life. Thinking back to my culture shock leaving Seremban for Canada 16 years ago, I thought it would be nice to have someone from 'home' take you in, and so we have been doing this for several years.
Anyway, today, we attended the graduation ceremony of one of our students. He has been here for several years, and it has been satisfying seeing him bloom from a shy, quiet person into the man he is now.
Yea, I know, that makes me sound aged, but it was really neat to see him walk up to collect his hard-earned degree. And Kris actually even teared up a bit.
In fact, this university is apparently popular amongst Malaysians, and there was some pride on my part, watching the many Malaysians graduate.
His folks flew in for the graduation, coming from a small town in Malaysia and being in the USA for the first time. And so we've been hosting them for the last several nights since we had some extra rooms. That being said, the glitch is they speak little English while my Hokkien and Cantonese is bad enough to make my ancestors turn over in their graves and cringe. But we got along great, and it was amusing seeing Kris communicate with them.
They leave tomorrow for a long awaited vacation before their long trip back to Malaysia.
Congratulations, guys. May this be the first step in a fruitful and fulfilling journey.

Wednesday, December 10, 2014

I Won Something

Omygod I won I won I won!
Not sure what I won since I didn't submit anything, but this text message must be real right???
Perhaps someone out there, some random philanthropist out there, must recognize my genius.
Anyway, let me know what happens if anyone calls the number above to claim the prize on my behalf. Fully invite all the readers to spam that number.

Sunday, December 07, 2014

A starry-eyed premed student shadowed me the other day. And as much as I tried to show her to ropes, I felt guilty showing her the realities of practicing medicine in the USA.
Not only do doctors need to know and treat disease states, our roles have evolved in not-so-ideal ways to include other duties.
Like how the insurance companies expect me to know what is on their formulary drug list (ie what is preferred, or cheapest, for their members). Not only is this confusing enough as every company has a different preferred list, but the same company often changes in the new year. So this year they prefer Insulin A, but next year it's Insulin B, or C. In the meantime, when the new year comes along, we get faxes from the pharmacy or calls from the patients, that their med is no longer preferred.
Like how I spend at least 2 hours every week performing paperwork (not inclusive of charting since this isn't paperwork anymore, being on EMR). Signing prior authorizations, or writing letters explaining why that patient with thyroid cancer and increasing thyroglobulin levels need an iodine scan. Or why a patient needs to be testing his glucose 4 times a day.
And yet we play the unenvious role of defense lawyers. How it's no longer about clinical suspicion. Or simple trust. Like how when the patient tells me she isn't pregnant and I send her for a scan, the radiologist still wants us to do a pregnancy test, "just in case". Because her word isn't good enough, in case they get sued. Or how pretty much everyone who walks into the ER complaining of a tummy ache gets a CT scan. And you wonder why the USA spends more money per patient than anywhere else in the world, with nothing to show for it.
Or how I feel like I'm reduced to a secretary or record keeper. Needing to do stupid items to "meet meaningful use". To have my clinical notes explode into 4 pages, when I have only 2 paragraphs relevant for the referring physician- only to fulfil some quality measures that some bureaucrat with the IQ of a snail has decided to be important.
It's true that medical school and residency only teaches you so much. That in the first year of practice you really do have the steepest learning curve; when you actually come out into practice on your own, no longer shielded by attendings.
And so, after the half day of shadowing, I hope I didn't put the student off medicine. However it is true that being a doctor is getting way too complicated these days...

Friday, December 05, 2014

Apparently I'm constipated. Just received a huge carton of samples in the clinic. Addressed specifically to me.
Well, you can't say I'm anal retentive anymore...

Wednesday, November 19, 2014

Some Pictures

As promised, here are some pictures of the trip. We flew in from Dallas, TX to Sydney, on what I'm told is the world's longest nonstop flight- on the Qantas Airbus 380. A butt-busting 16 hours 55 minutes! Thankfully the girls did OK.
Spent a few days touring the sights of the beautiful city (though I was struck by the high cost of living, something I wasn't expecting).
From there, we flew the 4 hours to Perth to see family, before flying back to the USA 1.5 weeks later (only to get stuck in the airport, but you already knew about that).
 




What I can't understand is, EWWW. Placenta cream, and for $36??

Tuesday, November 18, 2014

Back!

Phew. The weeks just rushed by.
We got back to the USA 3 days ago. Barely made it home though; the irony was it took us less time to travel from Australia to the USA, than it did to get back from our port of entry to home.
Thanks to the reliable US airlines. In this case, the wonderful United Airlines.
We wait, and wait and wait.
While watching the sign go from Delayed 5 mins, to 15, to 60, and eventually CANCELLED. All because they were "waiting for a part from the warehouse".
Yea, try having a flight get cancelled at 1045PM, with 2 cranky kids, when you're jetlagged after a 20 hour flight.
Thanks, United Airlines.
 
And it didn't help that when we did get back, they misplaced our bags, which needed to be delivered the following day.
 
KNNCCB.
 
Anyway, I'm glad we are done with travelling for now. It was wonderful to be able to see mom and dad and my brother's family. To watch the kids interact. Australia and her beaches were also breathtakingly beautiful (and I'm not even referring to the bikini-clad women).
 
Anyhoo- it was back to work yesterday. And start oncall tomorrow. What fun. Hope you're staying warm, people. For us, it was 20C last week, and -12C today.

Thursday, November 06, 2014

The Trip Thus Far

We're having a blast so far. Five days in Sydney and now in Western Australia to see family.
More when we return but here's some pictures from the trip so far.

Thursday, October 30, 2014

Leaving on a Jet Plane

So, a year from our last trip, we are now headed for our big trip of the year.
This time, Down Under.
Yes, Australia, mate!
I've never travelled there. And with my brother living there now, we figured it would be an interesting change. Mom and dad will be joining us on part of the trip.
And seeing it's been a year since they last met the girls, I'm excited to see them interact again.
And so, when I glanced up to the sky in the garden today and saw a plane flying overhead in the blue skies, contrasted by the color of the autumn leaves which seem ablaze, I took this picture with my iPhone.
This will be the longest nonstop flight I've ever taken.
15 hours 30 mins.
This will mark my first flight on the Airbus 380. As excited as I am about the trip, I hope the girls will not drive Kris and I crazy.
Wish us luck!

Sunday, October 26, 2014

Of Sharks and Ladybugs

Happy Halloween!
Almost.
It will be fun this year, with both girls being old enough to understand Halloween= candy.
Especially since last year Alli didn't really get to use her shark costume because we spent Halloween night in Urgent Care because of her bronchitis. And it was the eve of our trip to Malaysia, too.
Anyway, the girls are excited, and have had use of their costumes for some of the preHalloween events in the area.
Alli gets a choice of a shark, or Princess Sophia, or Elsa (probably THE most popular girl costume this year).
And Ava gets to be a Ladybug!
Beggar's Night is on Thursday. Wish us luck!

Sunday, October 12, 2014

Interviews

It's that time of year again. Medical students from begin the very early steps of their postgraduate professional careers, and begin their residency interviews.
But unbeknownst to them, Dr. Vagus gets to interview them tomorrow.
Bwahahahaha.
 I feel a sense of absolute power.
The ability to affect one's destiny.
To control what happens to one for the next 3 years- possibly the rest of their careers.
The ability to control the sun, the moon, the stars.
Bwahahaha.
 smileys
Sorry. For one who can only control his bowel movements and pretty much nothing else the rest of the time, this gets to my head.
But this does bring back memories. Wayyy back to 2001 when LP and I began our 3-week long and very expensive trek around the US when we interviewed at various hospitals. Cold, homesick, hungry, as we tried to stretch out our Ringgit. I remember us resorting to eating instant noodles for budgetary reasons, but all we had was the coffeepot in the motel and had to take turns eating. It was a pathetic sight. I remember the mistakes too.
"Oh, is that your grandson?" me asks, trying to smalltalk.
"No, that's my son, but thank you..." says the interviewer. Needless to say, I didn't end up in that hospital.
 
Though I'm looking forward to meeting the candidates, it's also a bit frustrating the world of political correctness we live in, here in the US. We're given a list of questions we cannot ask. Obviously, we can't ask things like Do you have a girlfriend, or How long is your kukuciau?
But even things like Do you have children, or to a pregnant person, When are you due? Questions that normal people ask in our usual interactions.
So, I'm going to have to try to behave tomorrow. But it'll be fun nonetheless.
(note to self- avoid eating beans tonight)

Sunday, September 21, 2014

A Celestial Revelation

So we are on vacation at the lake. And so, being far away from larger cities, I decided to pack my tripod, telescope and other optical gear.
This was a 10 min timelapse of Polaris. As you probably know, everything spins along this axis, which makes for interesting pictures. Also a reason why even computerize, autoguiding scopes altazimuth mounts (like mine) will not suffice for timelapse photography and why I'm trying to convince my wife I need an equatorial mount (which not only moves the scope on 2-axes but also rotates it).
 But perhaps the biggest revelation to me, in all my years of being a geek and loving astronomy, is this was the first time EVER I was able to visualize the Milky Way with the naked eye. It's not very striking (still some light pollution) but it was certainly visible quite easily. You see it in this picture, running down the middle of the picture, seemingly as though there are some patchy splotches. There is a also a star cluster at the top; Cassiopeia is also in it, though the 10 second exposure makes all the stars show more brightly so the W shape is not easily seen.
In this picture, you can see the Andromeda galaxy at the left of the picture, as a small whitish blot. This is the closest spiral galaxy to ours. The Milky way is seeing in the right 1/3, with a streak from a lucky shot of a shooting star.
It was pretty damn cool seeing the Milky Way. Sometimes, when one is troubled by our earthly worries, looking up at the celestial bodies does give you a fresh perspective on things. That in reality, as huge as our problems might seem, we are just a tiny planet of the millions (?) out there. That perhaps our troubles are not as big as they seem.
It does also make one wonder. Is there life out there? The scientist in me is 100% sure. With the sheer number of stars out there, the probability of life beyond Earth becomes a certainty. And yet, one has to wonder. Who created all this? Is there a Higher Power out there?
Despite being on vacation I got less sleep than usual last night. I went to bed at midnight, and woke up at 4AM. Was it worth it?
EVERY.DAMN.MINUTE.
(Ask me again in 2 hours when I'm about to pass out!)

Saturday, September 20, 2014

Football Practice

Or soccer, as these Americans would call it (after all, everywhere else in the world it's called football!).
And why do THEY call their version FOOTBALL anyway? They're always HOLDING their "Ball". And it's not even round, for God's sake.
Anyway, I digress.
Alli had her very first football (I'm being stubborn, but though I've been here 12 years I'm going to stick with my roots) practice today.
 It was great fun watching her. Though it was probably more amusing/frustrating seeing how she was so excited the night before that she wore her shinguards to sleep. But when she realized she actually had to work and run during the game, it quickly became "I'm so tired. I'm so hungry!"
Nonetheless, it was a nice Saturday morning for us- at least 50 families converged on the field for practice, with several games going on simultaneously. Though I was never into sports growing up (explains why I'm so short and unfit now), it's something I'd want my kids to enjoy.
Week 1 down. We'll see if the drama queen gets into it better next week!

Thursday, September 11, 2014

(Belated) Birthday Present

I got a drone from Kristin for my birthday. Well, strictly speaking, I returned the one she gave me, and got this instead (because the other one did not have a video function).
It's been a blast so far, though I'm still learning how to fly this sucker, and I've already lost a prop.
This is the Hubsan X4- an entry-level UAV (unmanned aerial vehicle) the size of an open palm. It also takes a microSD card which allows for SD video (no audio). It's RC controlled via a 2.4 Ghz remote, which unlike some of the wifi-controlled ones, in theory gives you a longer range.
In theory. This is so small that if you fly it too far you're not going to be able to see your heading, and would be apt to lose it easily. Also the battery flight time is only about 7 mins.
But, it's a blast, and for only $50, I'd say it's a great bargain and a great toy especially for one's first foray into these things.
Will need to work on my flying before I get to do more. I took out one of the motors today on its 3rd video flight >_<
Luckily these things are modular, and ordering another motor was just $11.
  video
 

Sunday, September 07, 2014

Moon Cake Festival

One thing that I find challenging, being a Malaysian dad with an American wife and daughters is the lack of tradition. Not that there is a paucity of Western cultures and traditions, just that I think it's human nature to want to impart to our kids the things we did growing up. The games we played, foods we ate, the festivities we took part in.
And so, came this Moon Cake festival, I was determined to try share some of my childhood activities with the kids.
I had to resort to Amazon to find the lanterns; my surprise I wasn't able to find them in the Asian stores here. I discovered that while the MidAutumn festival is celebrated in numerous countries, it appears that the part about the lanterns is unique to Malaysia?
I spent some time today telling Alli about what we did; how mom and dad would take us out to pick out our lanterns, and being a Dragon that would usually be my pick. I remember that big-ass lantern I got that one year. How we would light up little colored candles and stick them in, and carried the lanterns on bamboo sticks and walked around the neighborhood at night. Found some pictures on the internet to show her, and reminisced my childhood.
I remember the foods we'd eat. Of course, the infamous moon cake. Something I never really appreciated growing up. But now, now that I'm so far away from my other home, I crave it perhaps in a feeble attempt to relive those experiences (I can't believe I actually paid RM22 for a single mooncake!). I told Alli the stories mom told me, of how the people of the Ming dynasty used to hide messages in the cakes to plan their fight against the Mongolian invaders- don't know if they're historically accurate, but it was still a neat story.
I also remember those things mom used to make- I have no clue what they are, but they were black shells of something that was shaped like a cow's head, with some starchy white filling inside (anyone knows what they are?).
Anyway, the girls had perhaps a few fleeting moments of fun with the lanterns, and that was about it. In a silly sort of way, there is a certain tinge of sadness, knowing your kids will never appreciate the things you did as a child, but then again this is to be expected growing up in a totally different world. And the mooncakes, well, let's just say they didn't fall in love with it! >_<
Maybe next year. Happy Moon cake festival, guys!

Wednesday, September 03, 2014

A Sign

I don't want to suddenly post a very spiritual entry, but I just wanted to share what happened today. Just another sign, methinks, of the Guy upstairs watching over you, and giving you exactly what you need.
It's been a busy call week, with some challenging patients. Perhaps in part some in the hospital happened to be people I have known for years. Some very sick DKAs. Marked hypercalcemia 17.5 mg/dL. And huge pituitary macros. Stuff like that.
With one particularly sick patient, I had been fretting and worrying over her. It's true what they say- doctors do take their work home with them, and I had a very restless night thinking about her, second guessing my treatment plan, and worried she was going to deteriorate.
And so, as I was finishing up rounds in Hospital A, and walked out to the carpark to drive to Hospital B, a random stranger stopped me.
"Are you Dr. Vagus?" she asked.
I nodded, somewhat confused.
She gave me a bearhug and got teary-eyed.
"You saved my husband's life 4 years ago. You saw him and diagnosed him with that pheochromocytoma, and got him stable enough to have surgery. It has been years, but we think about you often, and how grateful we are to have had you...."
I was somewhat flabbergasted- at how she recognized me from 4 years ago, and was humbled by her words. But what I was most shocked with was how, on this day when I felt like I had all the burdens of the world on my shoulder, how breathing literally caused my heart to ache from the worries, how timely it was to have someone come and just with those words, suddenly make those worries and fears evaporate. It was exactly what I needed, and I do believe it was more than coincidence. That this was some divine intervention.
I thanked her for the kind words, and asked about her family. I then walked to my car, shut the door, and for those 10 seconds, just let some tears come down.
And just like that, I felt better.
There is a God. I'm sure of it.

Saturday, August 30, 2014

Happy Merdeka, Malaysia

As they say, you can take the man out of Malaysia, but you can't take the Malaysian out of the man.
Though I left Malaysia for North America for medical school in 1998 (and again in 2002), and have had a US greencard for several years, I do identify myself as Malaysian still. Many have asked if I'd give up my citizenship someday, and my answer still remains "probably not".
And so, from half a world away, I wish Malaysia Happy 57th Merdeka Day.
Though the country has come far since the days of our founding fathers, many like myself can't help but to sadly reflect too on how things are evolving. Though it's been over 5 decades, it's heartbreaking to see how in the last 10 years, things seem to be going backwards.
You'd think that a people of a country that is 57 years old would have matured enough to not see only the colour of others' skins. Or that they would not refer to one another as 'immigrants', never mind that many of us are 3rd to 5th generation Malaysians.
But no, unfortunately, because of a selfish few who choose to divide her people for their own political gains, the diversity that was once her strength seems to be turning into mother Malaysia's Archilles' heel.
However, it is also heartening to see that despite that hot air and garbage that some of our politicians and leaders spew, many Malaysians are still of sound mind and are sensible enough to not fall for that trick.
 
So Malaysia, here's wishing you a happy 57th birthday, all the way from the United States.

Monday, August 18, 2014

Happy Birthday Ava!

video

Friday, August 15, 2014

New toy

Yes, I got a new toy. Didn't think I'd get a pair of binoculars, but there was an Amazon lightning deal and it was going for only $49.
The Celestron Skymaster 15x70 bino.
The beer glass is there for comparison- this sucker is taller than a bottle of beer, with high index multicoated optics. It's nowhere near the power of my Matkusov-Cassegrain telescope, but I was looking for an ultraportable, lower-power device for casual on-your-back stargazing, and the books recommend that all astronomers should have a pair of binoculars.
Someday though I hope to go beyond solar system photography, and catch a nice shot of a nebula, or the Andromeda galaxy.
Hopefully this will help me get my bearings better.
But eventually, if the wife allows, I'm going to need an equitorial mount and a faster scope.