Wednesday, October 26, 2005

Music & Magic

I brought my younger son, an aspiring percussionist in his school band, to watch & listen to the Cincinatti Pops Orchestra at the Esplanade Concert Hall, in the hope that seeing them perform will inspire him to greater heights with his music. I did not expect to be moved myself, but indeed, moved I was by the magic of movie music brought to life by an amazing orchestra.

The resounding percussion introduction of the theme from "Lawrence of Arabia" actually gave me goosebumps, while the theme from Star Trek: The Next Generation stirred up memories of this TV series - I think I watched every single episode of this sci-fi saga (sigh...I miss Capt Jean-Luc Picard & his crew...).

The versatility of this talented group of performers showed in their interpretation of music from Broadway (Cats, West Side Story), to Disney (Mary Poppins, Beauty & the Beast, the Mickey Mouse Club, to name a few) to epic movies (Star Wars, Harry Potter, 2010: Space Odyssey, Jaws, E.T., Lord of the Rings etc). Their encore finale of a Benny Goodman tune from the Big Band era almost had me Lindy-hopping in the aisles!

What a night it was.

Wednesday, October 19, 2005

Things that go Bump in the Night

I watched a pseudo-documentary yesterday about movie director M. Night Shyamalan, who has given us great thrillers like "The Sixth Sense" (my favourite of all his movies), "Signs", "Unbreakable" & "The Village". All these movies have the common theme of 'things are not what they seem to be'. The documentary, done in a very tongue-in-cheek manner, implied that Night himself 'sees dead people', much like the character, Cole, did in The Sixth Sense. Although I loved the movie, especially the twist at the end, it scared me to bits! Boy, was I glad then, that my night call days were over & I did not have to wander the hospital from ward to ward in the still of the night...

I have heard stories of certain hospitals here being haunted by spirits; unsurprising, as many of them were pre-war buildings, & were used during the Japanese Occupation for God knows what. One of these hospitals, apparently had hidden tunnels under its grounds, in which the Japanese invaders imprisoned patients & left them there to die.

Fortunately, I do not possess a sixth sense (thank God!) & would be totally oblivious even if an unsettled spirit waved its appendages in front of my face & did the mamba - a blessing, as once upon a time, I did have to wander through the dark corridors of an old maternity hospital to patients located in different certainly had the right atmosphere for a horror movie.

Colleagues have told me that certain areas in certain hospitals are notorious for being "inhabited" by restless spirits, but I have yet to hear a first-hand account of such an encounter. So far, it has all been just hearsay. Maybe someone should compile a "True Hospital Ghost Stories" book.

Sunday, October 16, 2005

We ARE Human After All

Recently, I attended a lecture by an eminent professor who spoke about medical errors and its impact on not only the patients but also the doctors & healthcare professionals who treat them.

The topic of Medical Errors is an important & interesting one, which was brought to the forefront after the report ”To Err Is Human” from the Institute of Medicine in the USA in 1999, which highlighted the alarmingly high mortality rate & cost of adverse events.

Doctors, nurses & other healthcare professional do not go to work everyday with the intent to kill/maim/injure their patients. We are not God (although some may believe & behave like they are), and human error is inevitable. It is a fact of life. Misdiagnoses, missed diagnoses, mis-treatment, omissions of treatment all happen. Is it avoidable? Absolutely.

A huge first step needs to be taken in changing the climate of fear that surrounds every medical error that happens now. The first reaction (after correcting or attempting to correct it) is usually one of how to cover up the fact that the error had ever occurred in the first place. There is usually a blame fest that surrounds such an error, with fingers pointing every which way. This culture of blame needs to change within the medical community, first, before systems & processes can be put in place to address the problem. Without the fear of punitive action, people would be more willing to identify errors or near misses. After all, if you don’t know where the problem lies, how will you correct it? Currently, who would dare to report the problem for fear of being blamed for the problem in the first place. A vicious cycle, eh? And how would the person who made the error feel? Pretty damned awful.

Now, what systems am I referring to, you may wonder. An excellent example that was given by an expert on patient safety is that of the ATM machine. Previously, people would often leave their ATM cards in the machine after withdrawing their money. So a system was put place whereby the machine would alert the user (with an incessant beeping) to retrieve his card from the slot before issuing the cash withdrawal & receipt. It is almost impossible for the user to leave his card there now, as the machine WOULD NOT proceed with the transaction until the card had been retrieved.

The aviation industry has improved by leaps and bounds as far as safety is concerned, and is often used as the gold standard. So why can’t similar systems be put in place in the healthcare world to minimize risk of errors? In fact, many healthcare facilities in the USA, the UK and Australia have done so with encouraging results.

Here’s a little factoid for you to mull over: the chance of you dying from a medical error in a hospital is higher than you dying in a plane crash or from a nuclear accident. That is to say, being a patient in a hospital is more dangerous than flying in an airplane or working in a nuclear plant – think about it…

It’s time to start making changes, and accept/admit the fact that mistakes do happen in the practice of medicine. We are, human, after all.

Friday, October 14, 2005

Racism & Medicine

Racism reared its ugly head recently in the news, when two bloggers were charged with putting up racist remarks on the Internet. I wonder how many doctors have encountered racism in the line of duty. Don’t get me wrong, I don’t believe that racism is a huge problem here, but I think that racial intolerance does exist even in this so-called multicultural, multiracial country. Usually this is subtle but I have come across overt racism against physicians.

I know of instances in which patients request NOT to consult with a certain doctor because of his/her race (and it was NOT even a language problem because the patients spoke English). This happened in a GP setting in a multi-doctor clinic, and I am pretty sure that this has happened in the hospitals & specialist clinics as well. I am not sure how other clinics or hospitals would handle something like this, but at this place, the clinic acceded to the patient’s request. And this was not an isolated incident. Unfortunately, many local organizations are not progressive enough to face up to such behavior, for fear of losing the business of the clients. Basically, they have sold their soul.

From another angle, I was once accused of racism by a patient and that the medical staff was treating him differently because he belonged to a minority race. Now, being accused of racism by a rather inebriated patient in the wee hours of the morning at the Emergency Department wasn’t something I was going to take lying down. I replied civilly but indignantly to this gentleman that it didn’t matter whether he was black, purple, green, yellow, brown or white, he would be treated just the same. He clammed up after that.

What would you do if you encountered either of the situations above? What would your employer or the institution that you work for do? Would you treat your patient any differently because of his racist attitude? As for me, in the first situation of knowing that the patient is racist, I treated the patient’s medical problem, as I would any other. However, I admit that my behaviour towards this person was colder than normal although I did not go as far as giving a lecture to the patient about racial prejudice. I felt that if I had done so, it might have compromised the doctor-patient relationship.

What would you do?

Wednesday, October 12, 2005

Ethical Aesthetics & Lifestyle Medicine

I'm sure many have heard of the term "Lifestyle Diseases" - conditions like Diabetes, Hypertension & even Obesity which can be contributed by factors like sedentary lifestyles, bad dietary habits etc.

The term "Lifestyle Medicine" came to mind when I noticed the increasing number of physicians catering to people looking for medical means to "correct" imperfections, be it wrinkles, freckles, love handles, cellulite, flabby thighs (you get the picture). Don't get me wrong, I am not trashing Aesthetic physicians or plastic surgeons; I believe that it is their prerogative to assess and treat these patients if they feel that there are benefits, and I believe that most are ethical & make the right decisions.

However, when I read about things like 'Mesotherapy', 'Carboxytherapy, 'Laser Lipolysis' (not cheap procedures, by the way!), I start to wonder at the true efficacy of using these methods to "treat" patients. The thought of fat being dissolved by lasers/chemicals delivered to the subdermal layers to be subsequently removed by one's own body sounds too good to be true (unless one was living in the Star Trek Universe. I have always wished that we had one of those tricorder devices used by Dr Beverly Crusher in the Star Trek:The Next Generation TV series whereby she could diagnose an illness just by waving one of these thingeys over the affected body part -cool!- but then I digress...).

I hope that these physicians also advise their patients that if they continue with their previous lifestyle habits (not applying sunscreen, not eating right, not exercising regularly), these "conditions" would, more than likely, recur & require more treatments, which means more moolah spent (and correspondingly received) for thought, eh?

Monday, October 10, 2005

Michael Buble's concert was a Blast!

Talented, charismatic, good-looking and personable, this dulcet-voiced cutie-pie gave his all & more at his concert tonight! He charmed us all, male & female, with not only songs from his albums but treated us with a touch of opera and a little bit of rock 'n' roll.

Thanks, spacefan, for going above and beyond and getting me a program autographed by Mr B. himself! It was great to meet you finally. I am sure you will be giving us a brilliant review of the concert & a detailed blow-by-blow account of your pre-concert meeting with him (you lucky devil, you!).

Weighty Matters

Have you noticed how many ads there are in the newspaper/TV/magazines for weight loss centers lately? Most of the models used for these ads look underweight - BMIs of probably less than 17! The use of popular TV celebrities for such ads is also very common, despite the fact that these personalities were probably not in need of weight loss in the first place.

Growing up in the 70's & 80's, the obsession with weight (or the lack of it) was already rampant, and I've always had to deal with the "overweight" issue, no thanks to thoughtless comments made by well-meaning relatives & friends. I look at photographs of myself in my mid-teens & to my present self, I looked skinny!!! Fortunately I did not become bulemic or anorexic, but I do believe that I had suffered from a mild form of body dysmorphism, thinking that I was something that I actually wasn't. I only became comfortable with my self after moving out of this country & living in the USA for several years. It was somehow "more acceptable" to be heavier than the so-called beauties that one saw in ads & on TV.

Moving back here again, not only was I inundated with all these images of skinniness that one is supposed to strive for, but shopping in the stores for clothes which actually fit was a nightmare & absolutely depressing. The only clothes which could fit a size 14 (considered "normal" sized in the USA) could only be found in the Womens Plus section. And these clothes were not exactly the epitome of fashion either.

A few years ago, a local celebrity almost lost her life when her liver failed due to her taking a weight loss supplement that was hepatotoxic. She did not appear to be overweight in the first place, but probably under pressure from her peers or from her job requirements, she started taking these supplements. Fortunately, she survived after a liver transplant.

At that time, I thought that it would be a wonderful platform for someone like her to promote being healthy (having learnt her lesson which almost cost her her life) instead of chasing that never ending goal of looking like the models in a fashion magazine & being obsessed with reaching a BMI of less than 17.

Unfortunately, that did not happen & the next thing you know, she appears in ads as a spokesperson for a weight-loss center.

Adolescents these days are faced with so many societal pressures, especially the girls - I wonder what it will take for that all-important wake-up call that health and a good self-image is more important than being skinny. I wish that the media & celebrities would take a lesson from Dove's Campaign for Real Beauty, and start sending the message that self-worth does not depend on what you look like, how large or small you are, what colour your skin is, and how old you are; I know it's cliched, but it's what's inside that counts.

Friday, October 07, 2005


Yeehah! Just booked excellent seats to this award-winning Broadway musical that will be performed here. During our many visits to the Big Apple, hubby & I would often say "Hmm, maybe we should catch 'Rent' this time." but we never did. With 2 kids in tow, and given the exorbitant cost of Broadway tickets so that we had to think of the most "cost-effective" way of the whole family enjoying the theatre experience, we always ended up watching more age appropriate performances like "Grease" or "Stomp" (which are both excellent performances as well, by the way). And when we do try to get tickets, it's perpetually fully booked.

But now it's coming to our neck of the woods, & I HAVE TICKETS {jumping for joy!}!!!

One other great thing about this performance is that it is supposed to be direct from New York (although it is also featuring an Asian actress/singer) so I don't have to struggle with understanding Australian accents - historically, "Broadway" plays which come here seem to be mainly produced and performed by Australian casts (nothing against Australia - beautiful country, warm & hospitable people; just darned difficult to understand their speech:)).

A Doc's Life - Memorable Moments 10

This is my final installment in my mini-series of Memorable Moments. Note that these moments occurred over a span of over one & a half decades, and I hope that I haven't given the impression that a doctor's life is full of these "unusual" happenings :). In most cases, a doctor's life is usually routine, oftentimes mundane, and not as glamourous & "happening" as portrayed in most TV series & movies...

Scenario: GP clinic

I am sure that a lot of doctors out there have had the experience of meeting with rather ignorant patients not being terribly clear about their medical conditions & treatment. Eg, when asked about what kind of medication they are taking for diabetes/hypertension/arthritis/gout/heart problem, they reply "One round white tablet, half a blue oval one, & a small red one" like we are supposed to know what kind of medicine they are referring to just because we are doctors).

Patient was an elderly gentleman who was there for a medical examination for insurance purposes. He was accompanied by his wife & son. I took the usual medical history (nothing significant, according to the patient & his family).

When I exposed his abdomen, lo & behold, there was a mid-line abdominal laparotomy scar, at least 8 inches long! The following exchange ensued (note: patient's dialogue has been translated from a local dialect into English, so pardon the glaring grammatical mistakes):

Me: "I thought you said that you had no surgery done before? What was this scar for?"

Patient (grinning):" Oh, small thing only lah. 16 years already - not important!"

Me: "This is a very big scar. Didn't the doctor tell you what was wrong with you before you had the operation?"

Patient (gleefully): "No lah, doctor say cut so I go and cut lor!!!"

I was speechless.

Thursday, October 06, 2005

A Doc's Life - Memorable Moments 9

Scenario: GP clinic in the heart of town.

Patient was a lady in her mid-40's complaining of a vague vaginal discomfort of 2 weeks duration. No significant medical history of note; menstrual history was also normal, with LMP 2 weeks prior to consultation.

After taking her history, I proceeded with an abdominal examination and then a PV during which I was surprised to feel a firm irregular mass in the posterior fornix of the vaginal vault. Thoughts of "tumor", fungating mass" etc ran through my mind, but I didn't want to say anything until I could visualise it. I proceeded with a speculum exam & saw a brownish colored FOUL SMELLING mass with a tail - it was a retained tampon (her LMP was 2 weeks prior, which allowed for Lord knows what kind of micro-organisms to proliferate in that very fertile medium...).

The patient was shocked when I told her what it was, & I could tell that until I actually showed her the offending object, she could not believe that she had forgotten to remove it.

My consultation room smelt like something had died and was decomposing, even after the patient had left; and we had to allow it to air out for several minutes, spray plenty of air freshener before it was fit for occupation again. The last time I had experienced something so malodourous was as a medical student doing the forensic path posting and had to undergo the "traditional" exposure to a decomposing body - that smell just sticks to your clothes for the rest of the day...

Wednesday, October 05, 2005

A Doc's Life - Memorable Moments 8

Scenario - Labour ward of a teaching hospital

I had just helped bring into the world a healthy baby, and had delivered the placenta. I was repairing the episiotomy when suddenly, I hear a "PLONK" of something dropping on the floor behind me.

"Did you drop the baby???!!!" I yelled at the nurse in panic, in the middle of a stitch.

"No," the nurse replied calmly. "Daddy just fainted" she continued matter of factly (I guess it was a fairly common occurence for the men NOT be able to take the bloodshed, gore & trauma of childbirth).

I had to check Dad for head injuries (fortunately, he was fine) after finishing the repair.

I have always known that men are not as macho as they'd like you to think. Somehow, the sight of the episiotomy & the placenta being delivered are the things that tip them over...

Tuesday, October 04, 2005

A Doc's Life - Memorable Moments 7

Scenario: Local teaching hospital - Internal Medicine ward

My first encounter with death. I was an intern, and medical school definitely did not prepare me for dealing with death, the dying & their loved ones.

The patient was a 40+ year old lady with advanced CA Breast that had metastasised to her lungs. Despite the oxygen mask, she was gasping desparately for air. Her pre-teen daughter was at the foot of the bed, crying; her husband was at her bedside, crying & pleading with his wife to "hang on, fight it, fight it..." Before our very eyes, she was being asphyxiated by the cancer cells that had taken over her lungs.

I wanted to yell at her husband to stop, to comfort his wife instead of asking her to struggle on, I wanted to cry with the daughter, but it was not my place to do so...I had to leave the room to compose myself before I broke down. I did not re-renter it until the patient had passed on. Fortunately, I had an understanding MO.

A Doc's Life - Memorable Moments 6

Scenario: Largest maternity hospital in the local scene; I did a 6 month rotation through the Neonatal ICU.

I saw and did things which I would never have imagined if I hadn't gone through this posting. Among the unforgettable are congenital abnormalities some of which I would be unlikely to see again in this lifetime.

SIRENOMELIA: Or the Mermaid Syndrome. This baby was a BBA (our acronym for Born Before Arrival), still birth, born to a Malay family. It (unclear of it's gender) had just one fused limb with a single toe. The upper half of the baby looked absolutely normal.

CUTIS APLASIA: The baby was literally born without any skin. According to literature, this rare condition usually affects part of the body, most commonly the scalp. However, in the case that was admitted, the ENTIRE baby had no skin. He was covered by a thin transparent glistening membrane. You could see his muscles, superficial blood vessels etc. We kept him as comfortable as possible; setting an I/V on him was a nightmare. He survived for 3 days before passing away.

ANENCEPHALY: This was an undiagnosed case, because of lack of antenatal follow-up. The baby was a stillbirth.

ACHONDROPLASIA: This was also undiagnosed antenatally, despite adequate follow-up. Understandably, the mother was depressed. We kept the otherwise healthy baby boy in the ward longer than normal to prevent the parents from doing anything "drastic" in the immediate post-partum period, and arranged for them to see a counsellor.

One of the most heart-wrenching, gratifying, stressful, tedious tasks we had to perform was the resuscitation and intensive monitoring of premature babies, some as small as 700 grams. Blood gases, electrolytes, parenteral nutrition all had to be closely watched to keep them alive. It became a bit of a moral dilemna for me after watching the effects of surviving prematurity: CP, BPD, developmental delays, mental retardation (some more severe than others). Was it worth saving their lives? I had to accept that the moral decision was not mine to make; as doctors, we were there solely to save lives when called to do so. There was even one instance of a mid-trimester TOP who called for the NICU MO-on-duty (moi) to go to the gynae ward to resuscitate the 23 week old fetus who had been expelled & was actually crying! This little life clung on for 3 days before letting go...It was hard not to weep with the mother, who, for whatever reason, had to go through this ordeal and live with her decision.

This posting was the most stressful and at the same time the most enriching one I had gone through. Not only did I learn so much about the resilience of babies (they are not as fragile as one might think), but it would later serve me well for my adventures as a new mom (I did not become one of those panicky moms who would call the pediatricians when Baby refused to stop crying/refused to suck/poo-ed too much/poo-ed too little). And in the rare free moments, the nurses taught me how to feed/burp/bathe the babies - this definitely was good practice!

Monday, October 03, 2005

A Doc's Life - Memorable Moments 5

Scenario - Orthopedic Dept of a teaching hospital. Patient is a young gentleman involved in a RTA.

This happened midway through my Orthopedic rotation as an intern. It was early in the morning when this patient was admitted through the A & E department. He was a motorcyclist who had skidded and ran into a roadside barrier.

His right knee had been almost totally amputated, and was literally hanging by a skin tag posteriorly. The tibia/fibula had been avulsed from the femur - we could see the glistening white femoral cartilage of the knee joints. It had been so "cleanly" (for lack of a better word) torn off that not even the meniscii nor the cruciates had been left behind.

The team tried to reattach the limb but unfortunately, by the 3rd POD, it was obvious that the distal limb was not going to survive, and had to be amputated. Understandably, this young man at the prime of his life developed clinical depression and had to be transferred to the psych ward later.

During my Ortho postings as an intern as well as an MO, I saw countless injuries, some mild, some fatal, due to motorcycle accidents. I decided then that no child of mine, nor family members, nor friends would get on a motorbike, if I could help it.

Terror Strikes Again

Bali, once a haven & paradise destination for thousands of tourists, has again become a victim of religious fanatics. What makes someone become a willing participant of such an awful act? And I am not talking about just Muslims. Other religious extremists like Christian white supremacists are just as guilty.

If a psychiatrist interviewed a group of such people, would he find that they have some kind of neurosis/psychosis? I just cannot believe that a sane person would do something so vile. I NEED to believe that mankind is not that cruel.