Saturday, July 26, 2008

Random Act of Kindness

in March and April this year, i worked with 16 young boys and girls from St George's and Convent Taiping, as they prepared for a national-level debate tournament. they did well, and i'm very happy, and i didn't expect to get this today:

today is St George's Awards Day, and they decided to have a new category to say thanks to the people whom they felt had helped the school in one way or another. so, for my Random Act of Kindness, i got a tie, a tiepin, a school mug and a certificate - none of which i wanted or needed, and certainly not in response to my coaching of the debate team.

and my Act of Kindness wasn't Random, it was PreMeditated and Planned. down to the last detail, even about what they were going to wear, and how they were going to walk from their seat to the podium. haha! quite a laugh. but it's always very nice to be appreciated, so thank you, St George's!


afterwards, i also had lunch with very pleasant people, all of whom between the ages of 45-65, and all with children or grandchildren. it's an interesting diversion from people close to my own age, but the topics weren't very different from ours, except that the way they think is markedly different.

case in point: once a few of us had this conversation: if you had to pick, will you choose USD10million, or a lifetime of small pieces of good luck, like always getting a parking spot and having a queue-less supermarket checkout counter?

we chose, and we gave reasons why we chose what we did. and it was a spirited and good conversation, with laughter and ribbing.

but these older folk? they refused to choose, saying that money isn't everything for them, but also saying that always having good luck makes you unable to appreciate it.

they chose neither - and isn't that a more mature way of looking at things? :-) i'm very impressed, and i can't wait to grow older and have grandchildren and see things in a very different way.

curiously though, between USD10million or a lifetime of small pieces of good luck, which will you choose? and if you chose the money, how little are you willing to settle for? USD2million in lieu of all the good luck in the world? how about USD50,000? how low will you go?

Tuesday, July 15, 2008

bad bosses

i guess i've been lucky all this while - i've had good superiors to work under, and i've always been lucky enough to not get bullied or victimised.

but that's no good, when you get a new boss who's not only a difficult person to work with (and i'm not the only person thinking that way), but i suspect dislikes (or even possibly hates) me and (i suspect) goes out of his way to make life difficult for me.

i suppose i must have contributed something to such vexation, it DOES take two to tango - but sheesh, surely such anger and negavitity is best reserved for Hitler and Pol Pot?

what does one do, but grin and bear it, and hope that the whole experience will toughen me up, and keep doing my usual stuff and try not to get in his way.

no one's working environment is perfect, for sure, but with a generalised low-level rebellion simmering under the surface everywhere he goes, surely it's just a matter of time before a small spark lights a huge explosion?

Saturday, July 12, 2008

gambling with lives

as a doctor, we deal with so much philosophy on a day to day basis. for ill patients who are refractory to treatment, we have to counsel family members that there isn't much we can do. for poor patients, we refer to the Social Welfare and then stop ourselves from thinking about poverty, because we're finding it hard to cope with our workload itself. for patients who need long-term care, especially those needing dialysis - we tell them the cold hard truth in 2 minutes; you have kidney failure, you need dialysis, 4 hours 3 times a week, forever.

we take consent to invade privacy, bodily integrity and lives - on an hourly basis. we ask for permission to inspect, touch, listen and manipulate body parts all the time. we ask for permission to take blood, set lines, insert catheters and all manner of tubes. we ask for consent to perform surgery - essentially you're signing a piece of paper that allows total strangers you just met two hours ago, to gas you unconscious, and then cut you, literally cut you. with a sharp blade. in another setting, that's tantamount to murder.

there are many aspects of philosophy that i think impacts medicine in so many ways, that junior doctors often do not see. but there is one that today, i'm suddenly very aware of, that i want to tell.

doctors are actually gamblers. and the best ones are the best gamblers.

assume that a 37 year old man presents with cough for a week. there are a lot of possibilities: simple infection, potentially overwhelming infection, bronchiectasis, lung cancer, Wegener's, HHT, ACE-inhibition, even a brain tumour can cause cough (cerebral edema leads to uncoordinated swallowing and subsequently a hyperactive cough reflex).

the optimist will think of infection, the pessimist lung cancer. but the gambling doctor will depend on his experience, and a series of questions and a targeted physical examination to decide that this 37 year old man has a simple community-acquired pneumonia, amenable to 5 days of oral antibiotics.

or the gambling doctor may see the nicotine-stained nails and the thin anxious patient, and diagnose lung cancer. or the heavily pregnant lady who may actually have listeriosis. or the frail old lady just discharged from the Orthopaedics Ward after a hip replacement may actually have a particularly nasty Pseudomonas.

the optimist can (and frequently does) dismiss the cough as a simple one. but the pessimist will lie awake at night thinking he missed out that brain tumour in that young boy presenting with vomiting. both approaches will not benefit the patient - the optimist frequently misses the dangerous illnesses, and the pessimists overinvestigates the young boy with vomiting with a CT brain.

nope. medicine is for gamblers. and if you work at it, you can actually get pretty good at the gambling business. that's why we always go see a doctor who "cures" his patients - not because he's an optimist or a pessimist, but because he's a lucky gambler.


i'm reminded suddenly of something a paediatrician of mine once said. it's very profound, and has got so much karma and philosophy in a pithy line, that i was staggered for a full minute.

he said that he "believes that people will always get the doctor that they need". if they have a serious illness, they will get a good doctor. and if they have a trivial complaint, they'll get lucky even if they get an incompetent doctor, because no one can mismanage a trivial complaint bad enough to kill them.

i like the compelling logic of this belief - God always means well for us, and he always gives us what we need. why shouldn't the doctors we get be any different?

Tuesday, July 08, 2008

The Epic Match - Federer v Nadal

i don't play tennis at all, but i know a sporting spectacle when i see one.

and i think i'm out of words to describe that match, the Wimbledon Men's Singles Final of 2008, between that elegant Swiss who was aiming for his 6th Wimbledon crown, and his bete noire, the indefatigable Spaniard who is unbeatable on clay, but still waiting for his breakthrough on grass.

oh what a game for the ages! sports is the essence of humanity - we take our bodies and train it, tweak it, hone it, and we stop believing that there are limits, and we give it all we have (and then some more), we demonstrate courage and spirit, we show the world that there is more than just flesh and bones that make us a human person.

and how magnificently has these two men shown us, that we are more than just the sum total of our flesh and bones.

other men more eloquent than me say it better -

James Lawton of The Independent
Splendour on the Grass

Sunday, July 06, 2008

Federer v Nadal

i guess i've always been a fan of the elegant, instead of the brute-force-ish. okay, maybe it's a little prejudicial - especially when you put it that way - i mean, who would choose animal force over elegance anyway?

but with Roger Federer v Rafael Nadal, the world finds it hard to choose. it's such a compelling match-up - the force of nature, with his all-action i'll-run-till-i-die-then-run-some-more game, the very height of athleticism VS the stream of elegant strokes and balletic movement (and that white trousers and monogrammed blazer) of the very history of the All-England Lawn Tennis Club.

it's the first modern rivalry where there is no disrespect or hate between the two protagonists, or their fans. Barcelona hates Real Madrid, Tiger doesn't speak to Els, basketballers trash-talk everyone, Alonso resents Hamilton and even Thorpe and Hackett had a thing going on, and they didn't even swim the same events!

such a great rivalry, one of the ages - such a clear distinction between styles and contrast between personalities. no one knows who will win, and no fan of one will resent it if the other won.

isn't this sports, at its best? a match to see who is the best, by two of the classiest practitioners of the art? The Match starts now, and i'm off!

Thursday, July 03, 2008

accidental proverbs

my first two Medical MO calls came and went without much fuss - only a total of 5 admissions during the two calls, combined. it's good i guess, i got to sleep 6 hours straight two calls in a row - and i'm not going to complain at all.

so i go to the clinic today, and i saw this gentleman with diabetes which was poorly controlled. he was injections of Actrapid (a fast-acting insulin) 3X daily, and Insulatard (a long-acting insulin) at night. they have to take a bit of insulin out from the bottle, so the manufacturers kindly made the Actrapid a clear fluid, and the Insulatard a "muddy" one.

i decided to change the Insulatard to Glargine (another type of insulin, this time administered via a pen syringe, not a traditional syringe), but had trouble explaining the change of medication...

...until i suddenly said "buang yang keruh, ambil yang jernih" (translated as "discard the muddy, embrace the clear"), a traditional Malay proverb.

and the nurse and he broke out in laughter, to my puzzlement for a few seconds.

buang yang keruh, ambil yang jernih - indeed!

*okay, these small things amuse and cheer me*