Courting death online

Last Friday, in my clinic, I discovered something new, something horrifying!

A patient came an unscheduled visit. He wanted to be transferred to another hospital because he will be moving to a new place which is nearer to that hospital. I have never seen this patient although he has been under the follow-up for almost a year. All those times, he was seen by other doctors.

I listened to his request and then had a look at his notes.

I was puzzled because he has been diagnosed with HIV infection for almost 10 years. There was an entry from an earlier referral (for he was transferred from yet another hospital when he moved) that his CD4 count was low and yet over the last one year, I noted his CD4 count was hovering between 900-1100 (the normal being above 500) and that he was gaining weight.

And yet, the patient was never started on Highly Active Antiretroviral Therapy (HAART) which is currently the best bet in treating HIV-infected persons.

That aroused my suspicion and I asked him a number of probing questions. Finally he revealed his secret.

“I have been buying Stocrin and 3TC online whenever I have some money”, he confessed.

“Why do you do that?”, I asked, suppressing the horror that I felt.

“Because I do not trust the medications given by Malaysian government, or the Thai government for that matter! I have seen my friends waste away while taking these medications. When I order online, I get the real deal. They are from the USA and they are the best!“, he replied.

“How long has this been going on?”, I asked, while resisting the urge to try to knock some sense into him.

“Oh, for a while now, maybe a few months, I can’t remember”, he replied tentatively.

“And what happens when you run out of money?”, I asked.

“I stop taking the medications and wait till I have some money, then I order some more”, he replied innocently.

“Do you know you are only on dual therapy instead of three medications? That is very dangerous and it could lead to viral resistance? Furthermore you are not on any close monitoring by a trained doctor.”, I said.

“Yes I do. I hated the taste of AZT and so decided to just take two types of medications. So far I am alright! See I am gaining weight! I am not falling sick!”, he declared.

I can’t argue with that! His CD4 is normal, he was gaining weight and he wasn’t ‘sick’ in anyway!

It took me a while for to recompose myself and then I proceeded to write a carefully worded letter to his future caregiver in the hospital which I was referring him to, explaining what I discovered and apologising for not reassessing the patient further because he insisted to be transferred immediately.

What I discovered is worrisome. If this person could order anti-HIV drugs easily online, so can others and without proper monitoring, these people might just be courting death online.

Houston, we have a problem….

Gunung Datuk Statistics

The peak of Gunung Datuk – note the dilapidated state of the UMNO flag on the tree ~ probably a reflection of the current state of the party.

Last Saturday I climbed Gunung Datuk (in Rembau) again – 1.5 years from the last time I ascended the mountain. There were 14 of us this time and only 4 have climbed Datuk before. It’s always a joy taking ‘newbies’ up a mountain!

Here are my statistics from the climb:

1. Ascend: 1 hour 40 minutes
2. Descend: 1 hour 20 minutes
3. Water consumed: 1.5 litre (excluding 325 ml of Isoplus)
4. Food consumed: 1 sweet and half a loaf of walnut bread.

Age must be catching up because I took longer to ascend and descend although it may also be because I had to stop many times in order for other to catch up while going up and I had to stop repeatedly for a young boy who decided to leave his buddies behind and descend with me only to tell me he has a heart problem and needed to stop every 100 steps or so to catch his breath!

There were many new things this time round:

The ‘Keris’ is gone!!!

1. The giant ‘Keris’ at the entrance to the park has mysteriously disappeared. (Maybe a politician took it for his party’s annual general assembly).
2. The road to the park has changed so much that we got lost driving there.
3. The park is now under new management and is a wee bit cleaner.
4. There is a new shower area built right above the old one (but unfortunately, there wasn’t any water supply! Some things just don’t change for the better).

Smurfberries?

And we discovered what appeared to be ‘Smurfberries’ along the way. It’s definitely inedible as one of my fellow climbers wisely said, “If it were edible, the monkeys would have eaten it a long time ago!”

Next year I want to climb Gunung Ledang (again)!!!

Cubicle Etiquette

Now that I have been downgraded (yes, you read it correctly, I consider being forced to move from a room to a cubicle a downgrade) to working in a 6′ x 6′ cubicle, some one recently emailed a document about ‘cubicle etiquette’ to everyone.

I didn’t get the email.

That’s because a long time ago I have set a rule in my inbox to automatically thrash all emails from aforementioned person.

Still, I was curious and so I looked it up on the net and here was what I found on a website:

Here is the “Cubicle Etiquette”:

PRIVACY

1. Never enter someone’s cubicle without permission. Behave as though cubicles have doors. Do not enter before you have eye contact “permission” from the occupant.
2. Try not to sneak up behind someone in a cube. Announce yourself at their doorway or lightly knock on the wall.
3. Post a sign or flag at your cube entrance to signal when you can be interrupted. Avoid making eye contact with people if you don’t want to be interrupted.
4. Don’t “prairie-dog” over the tops of cubes or peek in as you walk past each one.
5. Don’t loiter outside someone’s cube while you wait for him or her to finish a phone call. Come back at another time.
6. Never read someone’s computer screen or comment on conversations you’ve overheard. Resist answering a question you overheard asked in the cube next to you!
7. Keep your hands off a cube dweller’s desk. Just because there’s no door doesn’t mean you can help yourself to their paper clips.

PHONES

1. Try to pick up your phone after one or two rings. Set the ringer volume at a low level.
Limit the use of speakerphones. If you must use one, keep the volume as low as possible. Use a meeting room for conference calls.
2. Watch your volume when talking on the phone. A headset can help keep your voice low.
3. When you leave your cubicle, turn your phone ringer off and let it go to voicemail or forward your phone number to your new location.
4. Never leave your cell phone behind in your cube without first turning it off or to vibrate.
5. With personal or sensitive calls, be aware that your neighbors can hear your end of the conversation.

TALKING

1. Use your “library voice”.
2. Don’t talk through cube walls or congregate outside someone’s cube. For impromptu meetings, go to a conference room or break room.
3. Don’t bring clients to your cube to meet with them. Go to an office or conference room.
4. Don’t yell across the “cube farm”. Get up and move to the other person’s location.

GENERAL NOISE

1. Use email or instant messaging to communicate silently with your coworkers.
2. Play radios at low volumes or use a headset.
3. Set your PC volume to a low level and turn off screensaver sound effects.
4. Set pagers to vibrate.
5. Work out an arrangement with your neighbors to take lunch breaks at different times. This will give each of you some quiet time in your cube.
6. Eat quietly. Avoid gum-popping, humming, slurping and pen tapping.

SMELLS

1. A good rule of thumb is to never eat hot food at your desk. Food odors can bother your hungry or nauseous neighbors.
2. Perfume and cologne should be avoided in a cubicle arrangement. Your neighbors may have allergies.
3. Keep an air freshener handy.
4. Keep your shoes on!

I think I can keep to almost all the suggestions above, except maybe keeping my shoes on!

Immediately after the email from that person, a senior staff shot back an email with the following sentences:

“You can also add: Do not attempt to break into other people’s desktops esp. during weekend to fish for information, or being plain “penyibuk!” Everybody should mind their own business.”

What I like about the article from the website where I got these cubicle etiquette suggestions were some of statements the author made such as:

“However, why even choose to submit yourself to so much misery in the first place? That is beyond my comprehension. A $40,000 salary is definitely not worth the pain or even a 6 figure income for that matter. There are much more fun, creative, more exciting and fulfilling ways to make a heck of a lot more money.”

And this one:

“There were some great suggestions in there for those of you who work in a cubicle. I wouldn’t be such a critic if I hadn’t worked in one myself. Whatever reason it is that landed you in a cubicle job, make it completely temporary. Certain people are meant for cubicle jobs and certain people have so much more potential. If you feel like you are the latter, kick the cubicle to the curb. I know for Amy and myself, it has been the most profitable decision we have ever made…and also the most liberating!”

I’m gonna give this cubicle-working thingy a short tryout – and if it doesn’t work out, don’t be surprised if I say an early ‘Sayonara’.

Kama Sutra for Geeks

While researching (by research, I mean googling for a suitable picture) for my blog post yesterday, I came across this picture on the net that I just have to share here:

It’s awesomely hilarious! LOL!

Now, can any of you translate the goobledegook for the rest of us?

Facebook Photo Tagging FAIL

The other day, while waiting for the next dish to arrive at a wedding dinner (Chinese wedding dinners are notorious for serving their 8 dishes on the menu at irregular intervals), I had a bit of fun with a new game I downloaded onto the iPad. The game was ‘Snoopy‘s Street Fair’ wherein the objective was to help Charlie Brown organize a street fair to raise fund for his baseball team. Within the app, there is a button wherein one could snap a photo of a person kissing the adorable beagle.

I snapped a photo of my rarely-willing-to-be-photographed wife and that night, just before retiring, I decided to upload the photo onto my Facebook page and tagged it to my wife with the caption:

“I CAUGHT MY WIFE KISSING SOME ONE ELSE!!!”

I thought nothing of it and went off to sleep only to wake up the next morning to find a larger than normal number of comments related to the photo!

It wasn’t too long before I discovered that some how Facebook has messed up my tag – instead of tagging my wife to the photo I intended, it was tagged to this photo below taken during my trip to India (a land famous for the ancient-acrobatic-sex-manual known as the Kama Sutra!):

Thankfully my rarely-willing-to-be-photgraphed wife also has a great sense of humour and was quite willing to forgive me (and Facebook) for the minor foul-up!

Phew!

Bad Email Etiquettes!

Maybe I’m getting old and out of touch with the ways things are done these days or maybe I’m just hypersensitive. Lately I’ve been pretty angsty over many things. One of my major pet peeve is the lack of decorum and etiquettes of some of my friends, students and colleagues when sending emails.

Some people have an annoying habit of sending out multiple emails to everyone on a daily basis assuming that I will be interested in the subject. Unfortunately, much of the time, I am not. For these people, I have assigned a rule in my inbox which will automatically consign all their emails directly into the thrash bin. There is a risk in doing this of course because perhaps one day, they may actually be sending out a most interesting or beneficial email (like, for instance, the news I have won a 2 weeks all-expenses-paid to Europe – although given the current scenario, is most unlikely) which I would miss.

Others have an annoying habit of what I could call the “Syiok-Sendiri Syndrome” wherein they would like to publicize all the ‘work’ they have done so that everyone knows they are doing something. For these people, I read the subject heading and hit the ‘delete’ button instantly.

The “Syiok-Sendiri Syndrome” always leads to an interminable round of “Slap-on-the-back-and-Well-done! Syndrome” emails by people who want to be seen to be very “supportive and affirmative”. Unfortunately, they also send their congratulatory notes to everyone in the address book whether they are remotely connected to the subject matter or not. As a result the inbox gets filled with all these ‘legal spam’ and one would have to wade through the mountain of thrash/trashy emails to read something meaningful and legitimate. For these emails, I hit the ‘delete’ button faster than you can say ‘Syiok’!

And then there are some who would love to air their arguments and disagreements in public, making sure that the arguments and counter arguments in emails are CC-ed to everyone else in the address book! These disagreements can turn really nasty from my experience. I read these emails – it’s a little like watching ‘Dallas’ or ‘Dynasty’ on the server! One of the Professors I have great respect for would reply to these emails with these few words: “Do I have to know this?”. LOL!!!

And then there are those who will send a ‘Parting Shot’ email just as they are leaving the place of employment. For them it’s the relish of telling things as it is (for instance, “I hate the way you dress!!!” or “You suck!”  or “Your hair is positively toxic!” without the fear of being reprimanded. For these people, I’d like to say this: “never offend any of your previous employers because they influence your future, one way or another” – unless, of course, if you decide to sell everything, embrace an ascetic religion, and go live on a deserted island.

And finally, the emails that annoy me most are those that are sent without so much as a word of “Dear Sir”, “Hello”, or “Thank you”. My medical students are particularly good at doing this. They attach their written report onto the email and shoot it off – no subject matter, no written word, no nothing! Just the attachment and nothing else!

For these students I have this to say:

“Your lack of email etiquette reflects poorly on your character. Not writing a word when sending an attachment is considered extremely rude. Imagine if I throw you a dirty piece of clothing without explaining, you would also consider it extremely rude. My humble suggestion is that we all learn a little courtesy even when communicating using the digital media.”

Cheers!

Indecent proposals

Some one started an interested thread on the ‘Doctor’s Life’ group on Facebook and the subject matter was on ‘what have your patients offered/given you?’.

My immediate response was this: a daughter’s hand in marriage!!!

I kid you not.

I was a medical officer then and apparently an elderly couple I see often in the clinic took a great liking to me. Initially they brought me innocent gifts like some fruits or biscuits during their follow-up visits. And then one day, he brought a photograph of his daughter and showed it to me after I had examined him and settled his prescriptions.

“She is a final year pharmacy student”, said the father unabashedly. “She is clever, capable, pretty and SINGLE“, he hinted broadly while looking imploringly into my eyes, probably hoping I would ask for her hand in marriage there and then and he would immediately consent to it!

He was sorely disappointed when I informed him that I was happily married with a kid.

“All the good ones are so quickly taken!!”, he sighed regrettably.

There were other instances of indecent proposals too, like the time when I was a junior house officer and a few nurses were trying to get to know me beyond what is expected professionally. A quick white lie comment from me indicating I was married (I wasn’t) quickly put an end to these amorous enterprises.

And there’s the time when a psychotic woman tried to get my contact number because she thought I was a “kind-hearted handsome doctor”!! I managed to divert her attention to a better looking colleague of mine!!

And the one that takes the cake has to be the attempt by a male medical assistant to get my attention in the dead of the night while I was on duty in the ED by lifting his uniform to reveal his 6-pack abs!! Now that was really disconcerting!

But these incidences were thankfully, few and far in between. Nowadays I am offered benign stuff like key rings or souvenirs from patients who went overseas, biscuits and homemade cakes.

A lot less exciting but definitely safer. Actually a simple ‘thank you‘ would more than make my day.

 

GALS in 4.5 min or 1 min?

I’m supposed to take a class on ‘GALS’ in a short while. Like any self-respecting lecturer, I looked up the video to refresh my geriatric memory.

For the ignorant, GALS stands for ‘Gait, Arms, Legs and Spine’- which is a rather quick way to check for any abnormalities in the aforementioned parts of the body. It does not stand for ‘Gaze At Ladies Suggestively’ although any hot-blooded young man would also gaze upon the gait, arms, legs and spine of any ladies worth gazing!

What I discovered on youtube was this video:

It’s a 4.23 minutes video of a person speaking as if he has hypothyroid describing the steps of GALS. (read: excruciatingly boring).

Personally, I’d rather prefer a video on GALS like this one:

A word of caution though. Don’t do the last 20 seconds bit of the second video.

Doors and Knobs

I took about 700+ pictures when I visited the Golden Triangle (Delhi, Agra, Jaipur) in India last month. It will be a while before I could sift through the lot and maybe share some of the photos here but for now, I’d like to share some photos that I reckon would not be of much interest to most people but which I find interesting.

I like to take photos of doors and knobs – especially the ancient ones, like the ones I saw when I was in Forbidden City in Beijing and recently in India. For me, doors and knobs are ‘touch-able’ and when I lay my hands upon these ancient door ways, I could almost palpate the history behind it – I am sure Kings, Queens, Prince and Princes or even the humble slave or door-keeper must have, at one time or another, laid their hands upon the same door panel or knob that I touched. It’s like touching history!

Door panel and knobs at the entrance to the Jamma Mosque in Old Delhi.


Door frame to the entrance of the tomb within the Taj Mahal, Agra.


Door latch and knob seen at the Agra Fort.


Door panel and knobs at the Fatehpur Sikri, Agra.






Door knobs seen at the City Palace in Jaipur.

Hold one of them knobs, close your eyes, give it a hard knock and you are transported back in history! Awesome! (My travel mates probably thought I was nuts knocking around all the doors that I found!).

Invitation FAIL

Er…It should be ‘to share a special moment with us’ and I think it should either be ‘Festival of Lights’ or ‘Festivities of Lights’. Correct me if I am wrong.