Doing a Britney

Last Saturday I was having lunch with my wife and kids at a rather crowded restaurant. My wife went to order some chicken rice while I was getting my kids seated at a vacant table.

Suddenly my son exclaimed:

OH MY GOD! SHE IS NOT WEARING UNDERWEAR!!! OH MY GOD! OH… MY…… GOD!

To say I was stunned would be the understatement of the year!

At that moment, time stood still.
I bet every woman in that crowded restaurant heard it.
And every woman there must be thinking of one (or all) of the following:

1. Some one was doing a Britney/Paris Hilton in that restaurant!

2. Others, like Madonna, would find the above ‘dreadful’.

3. Still others would think that this little 4+ year old boy is a little too precocious to be preoccupied with woman’s underwear (or the lack of it).

4. And some would think that this premature ‘hum sup-ness’ must be the lack of parental guidance. “Tsk tsk tsk..”, they would be thinking, “What kind of a father is that bloke there, look what he did to that poor kid!!”

5. Some must be wondering if they were the ones who FORGOT to wear their inner wear that day.

The mystery was eventually solved when my daughter explained that her kid brother picked up that phrase from the last week’s episode of HOUSE, where Dr. Gregory House, that awfully sour and sarcastic physician challenged his proteges to secure his boss’ (Dr. Cuddy) red panty! Ugh!

Ryan is henceforth banned from watching HOUSE unsupervised.

Wed, 310708 @ 0700

Paranoia

Contrast yesterday’s story with this one:

I received a phone call last week.
It was from a fellow specialist who was visited by a Health Officer who came to her with a problem.

Apparently the head master of a local school got to know that the father of a 12-year-old boy, who is a student in the head master’s school, was diagnosed with HIV+ (how he knew, God only knows ~ obviously some one couldn’t keep his trap shut).

Now this head master insists that the poor student undergo a HIV test! The Health Officer is now in a bind as to what to do next and hence, the visit to my fellow colleague!

My opinion, when asked, was this:

1. The head master has no right to insist on the test.
2. A 12-year-old boy would not survive that long if he has been born with HIV without treatment.
3. Even if he does survive, what business is that to the head master?
4. And if he tested positive, what action will this paranoic head master do? Expel him? Quarantine him?
5. A test (if needs to be done) cannot be forced upon the boy. Consent must be obtained from his parents.

What is your opinion on this matter? Speak it here!

Wed, 300708 @ 0700

Will to live

Twelve years ago, as a woman reached the last few weeks of her pregnancy with her first (and only) child, her husband lay dying in a hospital in another state. He eventually passed away and the woman was told he died of ‘pneumonia’.

She was widowed and she grieved.

The time came for her to deliver her first born. She delivered a baby born naturally. Her joy was short lived because she was then informed that she has HIV+. Subsequently the baby was diagnosed with HIV as well.

She went to stay with her mother, took on a few jobs, and single handedly raised her son. She went for her follow-up religiously. Her son was also followed-up by a Pediatrician.

The son grew up, strong and ‘healthy’, never forgetting to take his medications. The time came for him to be schooled and his guardian angel must be watching over him for he was enrolled in a school where the headmaster knew about his condition and was sympathetic. The boy studied along with all his other HIV- class mates. The only condition was that he refrain from participating in any sports activity, a limitation which the boy did not like, for he yearned to run and play all the games that his school mates play.

Still, he obeyed the rule and only plays at home, by himself.

“He is a good boy”, his mother told me when I saw her in my clinic a while ago.
“He is good in his studies and is healthy”, she added.
“I’m okay”, she replied when enquired about her well being.

The first of many tear drops welled in her eyes as she related her story to me.
I was silent as I listened to the tragic story being told.

Tear drops became little rivulets running down her cheeks.

“You know, doctor, there were many times I wanted to end it all. I thought of taking my own life. You know what held me back? You know what gives me the will to live?”

“It’s my son. I have to live and survive for him.”
“Because he has no one else…”

Tues, 290708 @ 0700

Case #46: Lumps on Face

This 44-year-old man is an ex-IVDU, hepatitis C positive and was diagnosed with HIV. His CD4 count is 40. He presented with tuberculosis and was commenced on anti-TB medications. Unfortunately he tolerated the medications poorly and was on 3 drugs instead of 4 drugs regimen most of the time. After a year, his anti-TB medication was stopped and he was started on HAART.

Two months after commencing HAART, he presented to the clinic with this:

Questions:

1. Describe the lesions seen.
2. What are the differential diagnoses?

Mon, 280708 @ 0700

Restless Legs

Jimbo is having restless legs.
He is itching to climb another mountain!
Maybe after August, when the rain (hopefully) stops pouring on a daily basis and the stress of exam is over.

Jimbo’s wish list:
To climb all the mountains in Negeri Sembilan.

Sun, 270708 @ 0700

Toilet Security

A while ago, a friend brought to this chic restaurant some where in KL when I was last there to attend a conference. We went there for coffee and a bit of chit-chatting. The music was loud and the decor was a bit confusing, the tables and chairs were of different shapes, sizes and colors! I forgot the name of the place but what really caught my eyes was this:

I was amazed at the number of locks they installed in their toilet doors! I suppose it must be some really insecure people!

Which reminds me to show this picture of a toilet door I took while I was in Shanghai early this year.

Now, picture this in your mind with me. I took the picture above while I was INSIDE the toilet, aiming the camera at the glass door and looking out!

The glass door was transparent!!! Actually I didn’t realise this until I was outside and noticed a guy was doing his big business in the next cubicle, oblivious to the fact that everyone outside his cubicle could see what exactly he was doing!

These toilets are meant for either flashers or those with supreme self confidence!

Sat, 260708 @ 0700

Sound of Silence

I’ve had the most unusual time in the clinic a couple of weeks ago. A man who was newly diagnosed with HIV was referred to me. When he walked in, he gave me a tentative smile (most first timers are like that ~ having a mixture of anxiety, fear and relief, in descending proportions).

I greeted him, shook his hand and smiled back, to put him at ease.

But he was silent.

That’s when I realised that the man is a deaf-mute! Not knowing any sign languages (besides those that are vulgar and one that says I’m a doctor ~ I learned the latter from another deaf mute), I was wondering how will I communicate with him! Apparently he was quite ignorant of sign languages too!

He gestured to me, indicating that we could write to each other! What a good idea.

And so began what would turn out to be a 2 hour consult as we wrote to each other on sheet after sheet of paper as I explored his history, his knowledge of the disease, his fears and anxieties etc etc.

I’m not sure, at the end of the consult, if I have managed to communicate effectively what I could probably do better using words. I just hope that he understood what I was trying to get across to him, things about his condition and more importantly, that the disease can be controlled.

Fri, 250708 @ 0700

Dr. Aaron Kwok

I had a ‘kembang’ moment while doing round in my semi-comatose state (I am post call) today. The call last night was particularly bad with 2 people having cerebral hemorrhage and another transfered from another hospital with Dengue Shock Syndrome.

I dreaded the round this morning as well as the task of taking 4 students for clinical bedside exam after that.

But this patient made my day.

After checking in on him (with a student whom I assigned to him), he said to me:

“Doktor, muka doktor macam Aaron Kwok la, especially the chin”!!

For the ignorant, Aaron Kwok looks like this and is a megacelebrity in Hong Kong, one of the ‘heavenly kings’.

Give me a second….

KKKEEEEEEEEEEEEEEEEMMMMMMMMMMMBBBAAAAAAAAAAAAAAAANG*!!!! (plus plus plus!)

Hmm, maybe I should change my name to Aaron.
Dr. Aaron Jimbo (or just call me AJ). Who cares if it’s just the chin that I resemble.

Thurs, 240708 @ 1153

*kembang: a Malay word meaning to ‘expand’, and in this context, it’s the immensely intense emotion of being praised!

HIV/AIDS in a few mouse clicks

In the latest issue of the NEJM, there is an interactive graphic program where one can download and with a few clicks of the mouse, one can learn (almost) everything about HIV. I tried it and found it to be cool and fun! This is how medicine should be taught!

Here is the link: NEJM AIDS Interactive Graphics

Organs for sale

I woke up on Tuesday having a bad feeling in my heart. Just a week before, my car stalled on the fast lane and it took a full (unproductive) day before my car would run again. I thought to myself, “it can’t possibly happen again, right?”

But you know how life is, and what Murphy’s law dictates.

Let’s just say, if the engine is to a car what the heart is to a human, then, my car had a massive heart attack on Tuesday.

I was driving happily to KL on that fateful day when I smelled something funny coming out of the air con vents. A few moments later, I heard a knocking sound. Sensing something was very wrong, I quickly pulled the car to the side. Just as I rolled onto the emergency lane on the super-busy highway, my car stalled and smoke started billowing from under the hood.

I went like, “Oh God, this is not happening again!!!”

This time, I kept a cool head since I wasn’t obstructing traffic. I made a number of calls, mainly to my foreman in Seremban and he made a telediagnosis ~ the engine overheated. He said to wait till he arranged for a tow truck to come pick up my car AND warned me not to allow any other people offer to repair my car.

Sure enough, like vultures to carrion, mechanics, pseudo-mechanics, and tow truck operators suddenly appeared out of nowhere! One got close enough to my car to open the engine cap and promptly asked me to smell it. He then declared that the “gaskets are all gone”. He offered to repair the whole thing including tow charges for RM 160!

I was sceptical as it’s like being offered a cardiac bypass for RM 50. Hardly plausible. I politely declined his offer and mentioned that my mechanic is on his way.

I also called the PLUS highway patrol. Two very under-exercised personnel came in a truck belonging to the highway company and also made a diagnosis of “gaskets all gone”. They then offered to call in a tow truck operator. I declined as well because by then my tow truck was already on its way.

With nothing to do, I sat down by the road side to wait.

It’s amazing what one sees on the highway when one is stranded.

Like traffic speeding past you at break neck speed. I was glad my car didn’t stall on the fast lane.

Scenery I took for granted because most times I was speeding as well.

Such a contrast to the busy highway just next to it.

You notice things like trees and metal poles of highway lights.

And even small white sign boards denoting the distance of the highway. I noticed this sign after the receptionist at PLUS asked me to look for it and tell him what was written on it! This one says ’298.6′. I guess it means I was somewhere at the 298.6th km on the long highway. Funny I never noticed such signs before when I was driving.

Heck, one even notice the grass and dead leaves.

After what seemed like an eternity (50 minutes actually), the tow truck came. It was a pretty fanciful one (read: sure to cost a bomb). The tow truck operator was friendly (as any vampire would be before biting its victims) and we chatted (or shouted) over the din of his truck engine all the way back to Seremban.

At the workshop, the mechanic did a once-over my car. The diagnosis?

“Gaskets all gone” (hmmm, this must be the car equivalent to an Acute Myocardial Infarction”)

It’s in the car ICU now. He said the radiator must either have sprung a leak or the internal pipings must have blocked up, thus preventing water from cooling the engine, resulting in an overheated engine resulting in a complete meltdown and “gaskets all gone”.

He explained what he would do over the next few days (minimum 2 days). He warned that despite the best repair effort, the engine would be “fragile and will not be the same anymore”.

I guess it’s true, a bypassed heart will never be as good as new.

We didn’t discuss the cost. (I heard it will probably cost more than 1K)

That would be quite painful on my heart.

And so, to finance the payment of the car repair, I am now auctioning the following to the highest bidder:
1. My left kidney
2. My left family jewel (apparently one is enough and I have completed my family, I just need it for the male hormone production bit)
3. The left lobe of my liver
4. Stem cells from my marrow
5. My left parotid gland (one should be enough to produce all the saliva I need)
6. Both tonsils (I don’t really need them)
7. My entire DNA sequence (in case any one wants an ID physician clone for a kid ~ I was pretty well behaved when I was a kid, barring a few near-catastrophe).

Any takers?

Fri, 240708 @ 0700

Updated: The cost of repair will be RM 6 K and the ICU stay will be a week! I am offering the right kidney as well. Charitable donations are welcome.