Abstract-ion

Abstract art is tough to do! That was the theme for today's Art lesson. We were supposed to clear our minds of images, & draw from our emotions & translate them on to our canvases.

How many of us have, while wandering through an Art museum or exhibit, exclaimed, "Even I can do that." over a seemingly simple piece of abstract art? I plead guilty to having done so before. It's not that easy, I realise now.

First of all, it was difficult for me to "visualise" my feelings & translate them into a painting. I am too used looking at things "just as they are". Everything looks like Still Life to me. My right brain hasn't been exercised enough.

I ended up taking home an incomplete piece of Art (I hesitate to use this word to describe it :)). I am hoping that I will feel inspired to finish it at home - not sure how long that will take...keeping fingers crossed...

Coloring Outside the Lines

My foray into the art world, taking painting lessons, has really taught me a lot about myself. It's strange how art reflects the artist's personality, background, & even upbringing.

In my first class, I tried to paint "within the lines"; I kept my brush strokes as even as possible; it was hard for me to let go of what I had previously been taught since toddlerhood. Remember the coloring books we used to have as kids, & how our teachers & parents would tell us to color within the lines? I realise now that that has how I have been living my life. Always coloring within the lines. Not making a "wrong move". Doing what is conventional & expected. Not upsetting the balance of the universe.

My art teacher told us to forget all that we have been told about what art should look like. It's OK to have uneven brush strokes. You don't have to color within the lines. The sky doesn't have to be blue or the grass green.

It's still an uphill battle for me to use my right brain, and to try to perceive of the world around me in a totally different way than I am used to. I have been so used to seeing the world in black & white & gray, that I had forgotten about the other colors in the spectrum.

With Art, I am starting to open my eyes, & to stimulate previously slumbering neurons in that area of my brain that has been left idle too long. I see a long journey ahead, but one which I look forward to with relish.

Random Thoughts on...

AI - ...and he's finally out! Never quite enjoyed Bucky as much as the other finalists. He always seemed uncomfortable performing on stage. Katie McPhee needs to go next...she likes to shout her songs.

Rumsfeldt - ...read about the comments & opinions made by retired Generals from the US military who say that Rumfeldt needs to go...makes sense to me...if you don't have experience in the field, how can you, with good conscience, make decisions that will affect thousands of troops?

LKY - ...our esteemed Minister Mentor is getting old...I saw him speak at my kids' school during a special ceremony celebrating the diamond anniversary of the school. He seemed more frail & his voice was softer & less forceful than I expected, & his speech seemed rather rambling, like he was trying real hard to stay on track but not terribly successfully.

Good Grief

"I am amazed that men of higher education can commit such stupid crimes."
Lt. Mac Taylor to a doctor who conspired with his medical colleague to commit insurance fraud in last night's episode of CSI:NY

I ask myself the same question after the recent weeks' very public revelation of cheating, perverted, drug trafficking doctors. WHY???

Oy vey.

Weirdos

Today's letter in the newspaper from a patient requesting a waiver for the need of a chaperone for her acupuncturist during treatment, triggered memories of certain kinds of patients which left me (& my female colleagues) rather uncomfortable.

The need for a chaperone when a male doctor does an examination on a female patient is pretty much standard practice, not only to protect the patient, but also to protect the doctor from allegations of inappropriate behaviour. However, when it comes to chaperoning a female doctor examining a male patient (specifically if said patient has a complaint related to his genitals), there hasn't been much discussion over this issue.

Usually a male patient who has a complaint like urethral discharge, or penile rash or testicular swelling would request to see a male doctor, especially in the local context where Asian sensibilities tend to be more conservative. Hence, when I get a male patient who specifically asks for a FEMALE doctor to examine him for such complaints, alarm bells start to go off! Fortunately, such encounters are rare. But my female colleagues & I have compared notes & each of us had our own "Penis Guy" (different patients but similar complaints, each time requesting to see us specifically)who would come in complaining of a rash or some other malady that has affected his organ. And when you examine the affected area, there really is nothing obviously wrong with it. When the same guy comes in repeatedly for the same problem, we would try to redirect them to our male colleague to handle. This usually would put a stop to further unneccessary consultations for non-existent problems.

We have been fortunate that these patients did not exhibit any drastically inappropriate behavior during our non-chaperoned consults (although there was a case that was publicised fairly recently about a male patient who masturbated in the presence of the female doctor while consulting her for a supposed traumatic injury to his groin). Worst that ever happened to me was my Penis Guy trying to invite me out to dinner DESPITE the fact that I was wearing my wedding ring, & did not give him any indication whatsoever that I would even remotely be interested! The gall of some people...

Talent

JAMES BLUNT

James Blunt was on Oprah yesterday. This young man impressed me with his talent (he performed 'You're Beautiful' & 'Goodbye My Love' on the show) & his self-deprecating humor. Before his current gig, he was a soldier in the British army & brought his guitar with him (strapped to the side of his tank) on his rotation through Kosovo. He has also served as one of the Queen's guards, & include "prancing on a horse for Japanese tourists to take pictures of him" on his resume.

When he sings, look into his eyes & you can see that the music & words truly comes from his soul. My husband bought his CD a few months ago, & I never really listened to all the tracks. I will now...

AMERICAN IDOL

Country music was the theme yesterday. I can't say that I am a huge country music fan. Apart from Shania Twain & Faith Hill, I can't think of any other country performers that I would listen to on a regular basis.

The final 9 gave a rather lacklustre performance; even my favorite, Taylor Hicks, singing Take Me Home Country Road, sounded like he was (to use a Simon Cowell-ish analogy) at a campfire trying to get people to join him in the song. The two idols who are supposedly the most comfortable in this genre, Kelly Pickler & Bucky Covington (question: what reason on this good earth would a parent have to name their twins Bucky & Rocky???!!!) failed to impress me - they just didn't seem very comfortable on stage.

And Kenny Rogers - gosh, I didn't recognise him without the full beard that he used to have....he should have kept it...

Hats Off

I salute this bunch of doctors for what they are doing.

I can honestly say that I don't think I could do what they do, mojo or no mojo...

Room with a View

This is the view from the balcony of our cabin on a cruise to nowhere last weekend, a much appreciated birthday gift from my mom (thanks, mom!).

Why go nowhere, some may ask. For the uninitiated, these cruises cater to the casino goers. Singapore has no casino (I should use the politically correct term coined by the government: Integrated Resort, or IR) yet. For some reason, Chinese people like to gamble (not being racist, but based on observation). So the cruise ship is a convenient & comfortable way of doing so without the hassle of having to go all the way up to Genting Highlands in Malaysia or flying to casinos in Australia/Europe/USA.

I am curious to see how the IR wil turn out. I hope it won't be seedy like Reno, or tacky like Atlantic City. I'm actually hoping that it can capture some of the glitz & glamour of Las Vegas, with top-class entertainers (in the calibre of Elton John, Cirque Du Soleil, David Copperfield)& family-friendly venues (think MGM's theme park, or Venetian's indoor water canals & gondolas, or New York New York's roller coaster that goes through & on top of the hotel!). It'll be tough bringing in those stretch- & super-stretch-limos though, seeing the limited space available for parking here.

Did I win any money on the cruise? No, because I don't enjoy gambling. I enjoyed the cruise, though, because the sea calms me - the sound of the waves & the soothing breeze makes me forget all my troubles & stressors. I love sitting by the ocean with a good book & can spend hours doing just that. Forget about the casino, & the multitude of activities planned by the cruise director. I am happy with just my book, thank you very much.

Pride & Prejudice (again)

OK. I am officially a Jane Austen(more specifically, Pride & Prejudice) groupie.

I bought the Pride & Prejudice DVD, watched the movie again (which makes it a total of 3 times within a span of 4 months), watched all the bonus bits (even the tour of the homes used in the movie shoot), swooned over Mr Darcy (again), now wish that the men of today still stand up & bow when ladies walk into the room and that a man dressed in a cravat, coat, breeches & riding boots can be sexy (especially if he is Matthew Macfadyen).

Sometimes You Just Have To Listen To Your Gut

You wake up & have this bad feeling in your stomach (& you know it’s not the curry you ate last night). Things just go downhill from there. The car has a flat. Or the traffic is horrendous. You’re late for work. The F-O-N patient you usually try to avoid turns up & ends up in your consultation room. The waiter gets your dinner order messed up.

You also read about people with close calls who didn’t get on a plane because of a “bad feeling” & the plane ends up crashing with everyone on board losing their lives.

This sixth sense (no, not the I-see-dead-people variety) that you get sometimes is inexplicable, and unexplainable. I don’t know if it’s a gender-biased characteristic (the so-called “women’s intuition”); maybe the guys have a different name for it.

Whatever you may want to call it, this gut feel that you get can sometimes be a life-saver for your patients. I remember a few cases I encountered…

Patient A was a Malay gentleman in his early 40’s, who presented to me with mild gastric pain. Medical history & physical examination were unremarkable & he had only had the symptoms for a few weeks. Usually, I would prescribe an antacid and/or a H2 blocker with some lifestyle advice & review the patient again after a week or two, depending on the severity of symptoms.
However, in this case, something made me feel the need to refer him to a tertiary center for further investigations. 2 months later, I received a reply letter from the specialist who saw him at the specialist clinic giving me an update on his condition. Turns out that endoscopic examination revealed a gastric ulcer with very early malignant change. Fortunately, it was early enough that the patient did not need a total gastrectomy & just needed the affected area to be resected. I can’t begin to describe the feeling of relief (& some incredulity) I felt that we had caught this in time, thanks to my gut feel.

Patient B was a Chinese gentleman in his early 30’s who complained of a persistent cough of 2-3 weeks’ duration. He was not a smoker, & had no significant family or medical history of note. He had previously been prescribed cough mixture & lozenges by another doctor in the practice, without any relief. When I saw him, there were no physical signs to suggest any infection or malignancy. But again, gut feel made me order a chest x-ray…and to my horror, I saw a suspicious looking mass in the right lung. The radiologist report had daunting words like “suggestive of malignant change” & “infiltration”.

I referred him to a tertiary center. He returned to see me two months later to let me know that after undergoing a bronchoscopy & biopsy, the mass was not malignant, neither was it tuberculous (tested negative for acid-fast bacilli); even the specialists were puzzled by the diagnosis & thought that is was some unusual mycobacteria strain that had caused the infection. They ended up treating him empirically with what I believe to be a combo of Rifampicin & Streptomycin (patient was unclear as to the name of the drugs used). Happy ending – the treatment worked, & the patient was eternally grateful that number 1, the illness had been picked up, & number 2, it was NOT cancer.

Patient C was a Chinese lady in her early 20’s whom I saw as a health screening patient. During history taking, she revealed that she had a history of colonic cancer (!!!)& had a partial colectomy done. Apparently, she had seen her personal GP for (get this) epigastric pain (!!!), & the GP became suspicious & immediately referred her to a specialist for further investigations. Colonoscopy revealed early Ca Colon. I suspect that this GP had a gut feel too, that something was not quite right in this patient.

So the moral of the story is: don’t ignore that niggling voice that comes from that gray area between your conscious & subconscious, which sometimes makes you do things which you otherwise would not do. That strange feeling in your gut may not be indigestion, but your intuition telling you that things may not be what they seem to be.

Brrrrrrr

I think the older one gets, the lower one's tolerance level is towards the cold.

Cases in point:

We spent the 2004 Christmas holiday visiting my MIL in New York City. The night we arrived, the city received its first snowfall of the season. Needless to say, the kids were ecstatic - they were jumping for joy, sticking their tongues out trying to catch the snowflakes. As for me, I was chilled to the bone...the windchill factor was something like -20 Farenheit...at least it felt like it to me. As I desparately clutched the neck & hood of my parka close to my body to prevent the cold from creeping in, I thought: I don't think I will want to retire in any place that is not tropical or at least, sub-tropical!

Today I went swimming in our pool with my 2 boys. Now, we live in the tropics right on the equator (alright, maybe we are one degree north of the equator, not that it makes much of a difference) & the ambient temp today was something like 33 degrees C, humidity felt like it was in the high 90's if not 100. And yet, when one of my feet went into the pool, the water felt D**N cold (to me, anyway)....cold enough to curl your toes & make other unmentionable parts of the body shrink/pucker/retract.

But my boys? They went right in, initially went "Ooo it's cold" and within seconds (literally) were doing laps & somersaults in the water.

As for me, I stayed seated on the side of the pool with just my legs dipped into the water (up to the knees), to 'allow' my body to gradually accept the sudden change in temperature. Took me at least 10 minutes before I was able to totally submerge myself in the "icy" waters.

42

Today.

Me.

Winken Blinken and Nod

Insomnia hits me occasionally. Often, it is due to unresolved issues, running through my brain although the body is exhausted, preventing Sleep from taking over.

Tonight, there is no reason why I should not be fast asleep in bed right now. I can't think of anything that is bothering me, which may be keeping me up. My eyes are falling shut even as I type this. And yet, when my head touches the pillow, sleep eludes me. The harder I try, the further Mr Sandman seems to run from me...

Maybe I should try counting sheep...

Hugs & Kisses

As I read an article written by Linda Baker for the New York Times titled "When a mother must muzzle the nuzzle", about her attempts at weaning off the physical bonding she has with her children, it struck a chord with my own childrearing experiences.

I have always been a touchy-feely type of parent to my two boys. Hugs & kisses have always come freely from me to them & vice versa. Maybe it's a rebound phenomenon of my own childhood in which, as is typical of Asian upbringing, physical expression of love was not exactly a norm.

They still give me hugs & goodnight kisses. But I miss those "cling-to-your-neck-&-nuzzle-their-face-against-my-shoulder-&-neck" type of hugs which they used to give me. Something happens between the ages of 10 & 12. They develop a reserve that prevents them from giving you that all-out expression of affection. I guess it is a first step towards growing up. Perhaps this gradual weaning off process is a natural way to prepare for the day when they eventually leave the nest to make their own way in the world. I don't think it would make it any less painful, though.

Ahchoo!

Been sneezing up a storm. My allergic rhinitis has been acting up the last few weeks. Must be something in the air - mould, or the haze from Indonesia. Let me tell you, sneezing is very strenuous activity. It really drains your energy. I wonder how many extra calories I burnt up because of my allergy attack.

Those who suffer from VMR can empathise with me. Before the days of steroidal nasal sprays, one would wake up every morning with runny noses, sneezing fits, & oftentimes, clogged up sinuses. I think I spent most of the first half of my life breathing through just one nostril. Those of you who are not cursed with this affliction, don't take for granted this luxury of being able to use both nostrils at the same time.


Signed up for an ENT CME symposium this weekend. One of the topics being discussed: Allergic Rhinitis - A new Look at Immunotherapy.

Whoopee. Very timely indeed.

Blown Away

Wow.

What a concert it was last night. Mr A-Z (Jason Mraz), performing with percussion & vocal support from Toca Rivera gave a mesmerizing performance showcasing his vocal & guitar-playing talents.

I was amazed by the versatility of sounds & melodies displayed by a simple acoustic guitar with the accompanying percussion instruments (a small standing cymbal and a drum - not sure of the exact type, but it had a very Caribbean sound!). Even my boys, who are usually fans of heavy metal music a la AC/DC/Deep Purple/GunsNRoses, were suitably impressed (& hopefully inspired to add Mom's type of music to their repertoire of songs!)

I was blown away by how effortless he made it seem, with his improvisations, and his vocal acrobatics. The casual bantering with the audience was the icing on the cake.

This is what I call Talent.

Arty-Farty

Circles of Life- Angst

The Person

In the latest episode of Grey's Anatomy, Dr Christina Yang reveals to Dr Meredith Grey that the clinic she has gone to to "take care" of her unplanned pregnancy needed an emergency contact in case of unforeseen circumstances. And Christina has appointed Meredith as "The Person".

Scene

Meredith puts her arm around Christina's shoulders & leans her head against her in a show of support of what she is about to go through.

Christina (in her usual acrid tones): "You do know that this constitutes a hug?"

Meredith:" That's OK...I'm your Person."

This poignant & wonderfully written scene, which was brilliantly acted out by the two actress (Sandra Oh & Ellen Pompeo respectively)showed the friendship, trust & loyalty between the two friends.

I am lucky that I have a Person in my life. Someone who may not neccessarily be from within your family, or even your spouse, but whose relationship with you is such that he/she accepts, respects & supports you & your decisions at face value, no questions asked.

I hope everyone has their own Person too.

So Many Places, So Little Time...

Planning our summer vacation now. We have to make the obligatory trip to visit my M-I-L in New York City; this will make it our gazillionth time in NYC (no offense to NYC but I really would like to see other places in the USA as well :)). We'll probably have to limit ourselves to road trips on the Eastern coast of the USA within reasonable driving distance from Manhattan. Anyhoo, am looking at Martha's Vineyard (seems pretty enough on the websites that I've seen but don't want to end up going to a tourist trap), Providence (am attracted by the town from what I saw in the short-lived but excellent series a few years ago), Newport (hubby trained there while in the US Navy, & says it's a pretty town). Maybe I should also look south & see what's there.

Kids & husband don't really care as long as they get to make their pilgrimage to Matt Umanov (a guitar store that has been in the Village area forever). Of course, Woodbury Commons (factory outlet stores!!) is a must. Maybe a Broadway musical (been trying to get Lion King tickets for the longest time....seems to be perpetually sold-out...I guess I should start trying to get tickets NOW).

There are soooo many places in the world that I'd love to visit - horseback riding in the Canadian Rockies; cruising down the Nile; riding a camel to the pyramids; a safari in Kenya...these are some of my dream vacations. Oh well, one of these days...

It's Not About the Money

There has been some discussion lately about the economics and business of Medicine and some of the ethical & moral issues surrounding this. Oftentimes, these issues get lost in all the rhetoric.

In my POV, I don't think the debate is over whether doctors should make a lot of money from their profession. I don't begrudge highly skilled surgeons and well-respected, knowledgeable physicians earning large amounts of money for services rendered in practising good solid Medicine. Many have & still do make a lot of money for much needed services mostly in the private sector, to cater to people who can afford it (hopefully!).

I think most of us in the medical community have no qualms about denouncing the doctors who prescribe addictive drugs like benzodiazapines or Subutex or codeine-containing cough mixtures inappropriately. This is clear-cut inethical behaviour.

However, when doctors start to perform aesthetic procedures on teenagers, prescribe weight loss medicine to non-obese patients, or order a gamut of largely unneccessary tests under the auspices of Health Screening, I start to wonder at the motives of these "healers". I don't feel comfortable with doctors pandering to the vanity of the masses, the way they do now, with the numerous ads one sees in various publications expounding the availability of aesthetic services. They have become glorified beauticians. The LASIK procedure is also being aggressively promoted (not as bad as in the US but still...), and now that the competition is heating up, I wonder about the decision making process both for the doctors (in patient selection) and for the patients (same day service - eye assessment + procedure done on the same day...does that leave time for the patient to actually go home and think through this???).

It is all these gray areas which we should question ourselves about.