Being tall

I remember praying to be tall when I was a scrawny pre-pubertal boy. I specifically asked for a height of “6 feet”. God has a wonderful sense of humor because lo and behold, when the hormones kicked in, I shot up to be 183 cm tall (that’s exactly 6 feet!) in one year but because I neglected to be specific in my prayer (for instance, I forgot to state “proportionate growth horizontally), I remained pathetically scrawny for another few decades! Being tall and scrawny sucked!

Anyway, being tall in a country where the average make height is 165 cm (5 feet 5 inches!) wasn’t much fun. I could go on and on about the disadvantages of being taller than the average Malaysian dude – like hitting the roof of a Kancil car with my head whenever I get in, developing a sprained neck while standing in a mini-bus, relative hypoxia, getting the first drops of rain, higher exposure to UV rays, smelling the scalps of fellow travelers in a packed train, etc.

But every once in a while, being tall has its advantage. Like what happened the other day when I was disembarking from the plane after a 5 hour flight from Delhi to Kuala Lumpur. I was one of the last few passengers to get off the plane and as I was walking through the narrow aside towards the exit, I spotted something in one of the overhead cabins 10 or 12 seats ahead of mine. When I got closer I realized that it was a book, which was probably left behind by a fellow passenger or maybe even a passenger in any of the plane’s earlier flights. Instinctively I reached out and picked it up as I passed the seat.

I quickly flipped through the book but found no name of the owner or any sort of ID within so there was no way to return the book to its rightful owner. My travel mate walking behind me urged me to just keep the book.

I glanced at the title and was delighted to discover it was this book:

It’s the book I wanted to buy while I was in Melbourne but did not because it was too pricey! Maybe it’s a sign that I should read this book! I can’t wait to start on it and discover the secret to a “ridiculously good life” – just as soon as I finish the last 150 pages of the last book in the Harry Potter series!

Ominous sign

It doesn’t bode well for the medical profession when we have health care providers who doe snot even know how to apply the plaster to secure the i.v. cannula properly – in the patient I saw this morning, the plaster was applied the wrong way which occlude access to the cannula (except via the pink cap) and the error was not noticed for 3 days!

Doing rounds these days is a major stress factor for me. This morning my house officer stared at me blankly when I walked them if they know what a ‘venesection’ is!

These are ominous signs indeed!!

Frisky Indians

Indians are really frisky – no, not in the amorous sense. I think it’s the constant threat of terrorism or ethnic violence that made most establishments like airports, hotels, touristy places and even some retail shops install walk through metal detectors at their entrances.

While I was in India last week, I lost count of the number of times I had to walk through the detectors, which will invariably make a noise regardless of how meticulously I took off anything that was remotely metallic on my person; and then be subjected to a full body fondling search which was never pleasurable (they kinda like to squeeze here and there while rummaging through my surface anatomy which was terribly discomforting).

The worst experience had to be at the departure gate of the Indira Gandhi International Airport in Delhi where I underwent no less than 3 frisking moments before being allowed to depart.

Sigh.

I felt a little violated.

Indian History Retold

History, when retold by a person with less than proficient English, can be quite hilarious as I discovered whilst on my recent trip to India.

We were on a bus crawling towards Agra from Delhi (crawling because the speed limit for large vehicles on the highway was 40 km/hour!) and the tour guide decided to tell us bits of history regarding Mahatma Gandhi, India’s patriarch and founding father.

Here were some of the hilarious bits I heard:

“Mahatma Gandhi did a lot of movements during his life time. The most famous three movements he did were the Non-cooperation Movement, The Salt Movement and the Quit India Movement.”

“Mahatma Gandhi first started his fight for the discriminated people in South Africa. He f**ked the British there and then later came to India to f**k the British again.” (The tour guide pronounced “fought” as “f**k” !!) LOL!

But for commentaries like these, the long dreary bus rides in India would have been quite intolerable.

Harsh Medicine

Spotted this while I was in Jaipur, India; a few days ago. Apparently medicine there is harsh! Lol!

Back to India

Ordinarily, if given a choice, India as a destination to visit would be quite low on my list. I’d rather visit the Grand Canyon or the Great Pyramids of Egypt, for instance. Having lived close to 6 years in India when I was a medical undergraduate was enough experience to last a life time. TQVM.

Sure, I’ve become a changed person from living all those years in India – I complain less and I’m grateful for every small blessings I receive. Compared to the what I have seen and experienced while in India, what we have here in Malaysia can only be described as opulent abundance! I also learned to appreciate Hindi, its songs and movies, the very British habit of having afternoon tea and shake my head sideways to say ‘yes’!

I’ve only been back to India once since I graduated and it was to Bombay a couple of years ago to present my thesis at an international conference. The trip was uneventful save for a harrowing 2 hour ride in an auto-rickshaw at 2 am in the morning through the streets of Bombay simply because the auto-rickshaw driver lost his way to our hotel!

I didn’t think I will ever want to go back to India again.

But then again, I think very few can resist the opportunity for an all expenses paid holiday to Agra, to see the famed ‘monument of love’, the Taj Mahal!

And so, this Friday I will be joining a number of work mates on a trip to the famous site next to the Yamuna River!

I’ve started my Doxycycline for malaria prophylaxis and I’ve got my supply of activated carbon, Lomotil, ORS, Maxolon and Cipofloxacin. And if the words by Emperor Shah Jahan is true, some inner cleansing wouldn’t hurt too!

Should guilty seek asylum here,
Like one pardoned, he becomes free from sin.
Should a sinner make his way to this mansion,
All his past sins are to be washed away.
The sight of this mansion creates sorrowing sighs;
And the sun and the moon shed tears from their eyes.
In this world this edifice has been made;
To display thereby the Creator’s glory.

Unwilling Pseudo-celebrity

intr.v. pro·gress (pr-grs) pro·gressed, pro·gress·ing, pro·gress·es: To advance toward a higher or better stage; improve steadily (The Free Dictionary)

One would think that in the name of progress, work processes would get easier. I would expect a work process that used to involve 5 steps would  be reduced to say, 2 steps, in the name of progress. Simple work would get simpler.

Not so apparently.

Before I left for Melbourne in October last year, to request for a CD4 cell count from the lab would involve the following steps:

1. Blood must be taken in EDTA bottles.
2. Blood can only be sent on Wednesday mornings.
3. A single sheet laboratory request form must be filled with the clinical details of the patient, specifically the words ‘HIV’ (or RVD which means retroviral disease) and HAART should appear on the form.
4. The form should be signed and stamped by the requesting doctor.

And to order a HIV viral load test, this must be done:

1. Blood must be sent in a plain bottle.
2. The laboratory request should be in duplicate sheets with the clinical history of the patient filled in. The sample is then sent to the a centre in Kuala Lumpur for processing.
3. The forms should be signed and stamped by the requesting doctor.

While I did have some issues with filling up clinical details of the patients, especially for the CD4 count request (I really wonder who actually reads the details and whether merely writing the words ‘HIV’ and ‘HAART’ regardless of whether the patient is actually on HAART or not would influence the results in any way), and tedious as it may be, I did them anyway because I needed the results in order to manage the patients appropriately.

Fast forward 10 months and I came back from Melbourne and to my horror I discovered the following changes have taken effect!

For the CD4 cell count request:

1. Blood must be taken in EDTA bottles and sent on Wednesday mornings (no change).
2. The request form must now be filled in DUPLICATES with clinical data of the patient filled in (as usual the magical words ‘HIV’ and ‘HAART’ must be written or the request will be rejected).
3. The form can ONLY BE SIGNED BY A SPECIALIST!!!

And for requesting the HIV viral load:

1. Blood must be sent in a plain bottle (no change).
2. The request form must now be filled in TRIPLICATES with the clinical data of the patient filled in (or risk rejection on the grounds of ‘data not filled in’).
3. The form can ONLY BE SIGNED BY THE ID SPECIALIST!!

And so, in the first ID clinic I was in since coming back, I spent a large proportion of my time filling up and signing laboratory forms instead of seeing patients! The other doctors in the clinic could not sign the forms as they were not specialists! In the end I got so exasperated I passed my rubber stamp to the nurse and taught her how to fake my signature just so I can see patients!

I do not know who made up these new rules. Perhaps the underlying reason for it is noble – it’s probably to stop wanton abuse of ordering all sorts of investigations by doctors and prevent wastage but surely these rules are counter-productive! As far as I know, nobody in the right mind would order a CD4 count or a HIV viral load unless they are really indicated and often at the order of an experienced senior doctor.

A better measure would be to EDUCATE the young doctors in judicious ordering of relevant investigations instead of making stupid rules that turn people like me into UNWILLING PSEUDO-CELEBRITIES who have better things to do than to sit around and sign laboratory forms!

Whatever this is, it is NOT PROGRESS! So, to whoever it is who wakes up in the morning feeling lousy and vengeful and then proceed to make rules that make other people’s work tougher, stop and think! And most of all, have a heart!

PS: Thankfully after a rather heated ‘discussion’ (which I was not involved), the rule that every form must be signed by a specialist was revoked but unfortunately the requirement for duplicate and triplicate forms remained.

SIRIously?

I breathed a sigh of relief now that the iPhone 4S has been revealed (and unleashed to the world in a week’s time). Perhaps now I can whip out my phone in public without having to worry that some one would sneak up and snatch it away (yes it happens in Malaysia) and I could perhaps loosen my grip on the phone whenever I use it and finally give my white ischemic knuckles a breather.

Compared to its predecessor, the iPhone 4S looks exactly the same – externally that is. Apple tells us that it’s the stuff within that has been revamped and souped up. Oh dear, it just occurred to me that I will still need to be on the alert when using my phone because the blardy would-be-thief would have no inkling I’m not holding the new iPhone 4S!!!

So what has changed? Plenty it seems, as Apple tells us. The ‘S’ version has twice the processing speed with a souped up camera (with 5 lenses, no less!) that can capture HD video with image stabilizing effect and smile detection. *yawn*

I guess the ‘coolest’ thing about the new phone, if it works that is, is SIRI, touted as your very own ‘very personal digital assistant’ – it’s kinda like a secretary in your pocket. All you have to do is ask your phone a question and SIRI will apparently understand your question and find the appropriate answers.

SIRI could come in pretty handy, I reckon, especially in ward rounds. I could ask questions like”

“SIRI dear, here’s the patient’s symptoms and signs, now tell me the diagnosis and its management”; or

“SIRI darling, tell me where has my Houdini-House-Officer disappeared to?‘; or

“SIRI sweet heart, this patient has terminal cancer. I’m gonna just leave you on his bed a while and you can tell him the diagnosis, prognosis and counsel him. Thanks!”

Of course it remains to be seen (and it will be soon enough) whether SIRI actually works as well as Apple claims it would. I also wonder if SIRI would actually understand the kind of ‘Engrish’ spoken here in Malaysia! I bet the Chinese are already developing a bootlegged version (called ‘SILLY’?) which can understand any Asian sounds!

Apparently the name ‘SIRI’ means ‘Smile’ in Tamil, which is pretty sweet. Unfortunately, according to this article it also means ‘ASS’ in Japanese and in Georgia, it can also mean that…ugh..male appendage..!

LOL!

While reading the first article, I also came across the word ‘OSRAM‘ (which according to the light bulb maker, means “let there be light’) which in Polish means “I will defecate all over you/it” !!

Personally, as a medical person,  I think ‘OSRAM’ means “to pound incessantly at an orifice”.

Have a great weekend!

Thanks Steve Jobs (1955 – 2011). RIP

Thanks Steve, for having led a company that changed the way many of us work and play and for enhancing our lives. May you rest in peace.

Teasting Teasting

Anyone wanna get teasted?