Introducing the Red Sloth

I have not updated this blog for a while now.

Working as a doctor, I do have many stories to share, on happiness and sadness, of life and of death, of suffering and joy. However, the privilege of being privy to some of the most personal and real faces of patients and other humans alike, that is bestowed upon me in my capacity as a doctor, does come with a cost of protecting the secrecy and privacy of my daily work.

I think I shall focus on things outside work for a little bit.

I have failed the physician exam for the fourth time. I am done mourning over it. I have one last try next year. I will make it.

I have recently traded in my old Toyota Corolla and bought myself a Subaru WRX

My WRX

So far, I have been pretty happy with this purchase. I was looking for a sedan, that is a bit more powerful, preferably with a sunroof. I always wanted a sunroof!

I was initially tossing between a BMW 3 series and Audi A4. For the options I wanted, it would cost me upward of 70K. No doubt they are of more luxurious brand and with much more comfortable ride.

Then I came across the new WRX by Subaru. It is a sedan. It runs on a turbo-charged 2.0L FA20DIT engine which puts out about 197kW , approx 260+ bhp. It has a moonroof. And it is automatic. I was looking for an automatic, or those fancy semi automatic dual clutch transmission since I am driving mostly city and street. Manual transmission used to be more efficient, but now in some cases, automatic is more fuel efficient than manual.

I kinda like its look since it resembles the Evo car I used to dream of driving. However, I come to realise the Evo is quite impractical for daily driving, not to mention for the price you are paying, you can get a European luxury car like a BMW 3 series.

2 months down, I have clocked up nearing 1500km. The power scared me at first, but now I am getting used to it. That said, I have yet to floor the accelerator since I got it. An official 0-100 time of under 6 second does make the heart race. I have learned to lightly feather the accelerator(since it has so much power) It needed just 10% of accelerator at 1900rpm to do a 100km/hr on highway.

Engines

I have read a lot about the new FA20DIT engine before committing. It felt like I would be buying a car with a tech I really like. Subaru introduced the FA20DIT only a few years ago. What I do like about it is its not too bad fuel efficiency. Owners on the internet had been getting under 10.0L/100 km and the official number is approximately 9.2L/100km. For some reasons, BMW can build a 330i to have more power with a fuel efficiency better than my old  Toyota Corolla. I suspect on highway, the car can be a surprising fuel sipper in the region of 7.0L/100km. Of course it’s no match to my brother’s Prius C returning just above 4.0L/100km.  All in all, it’s not too bad. And Evo? The official number was about 13L/100km. In real world, you will probably do 20L/100km in city.

The second thing I have learned recently, about engines is the power at a specific RPM. Internal combustion engine, the torque produced is not linear nor it is constant. Engines produce different torque and different speed. For daily driving, a high torque and max power at low end RPM is more useful than a higher power at a much higher RPM e.g. 4000 rpm, which you will rarely reach on a daily driving. My old Toyota does 100km/hr at 2600 RPM at its final 4th gear. Thus, for me, the FA20DIT, is better than the old EJ 2.5L in its STI which produces more power but at a higher RPM band. In my day to day, the engines rarely revs above 2200rpm even in moderate acceleration. I thought this is fantastic.

Noise

I have just done some driving on the highway. Noise was an issue raised in a lot of forums by some owners. Now that I pay attention to it, the sound proofing is definitely not as good as the BMW or Audi. My Corolla probably was a bit quieter, by a very small margin. I find my Corolla is already very quiet so it’s not so much an issue for me. I suspect it’s because of the hood scoop where the air enters to cool the turbo intercooler that generates a lot of wind noise. That said, my is a 2016 model which apparently had improved soundproofing compared to the debut 2015 model. I can hardly hear the exhausts as reported by some owners where they can not even make a phone call in the call due to the sound. Definitely not the case for me.

Handling

I thought of the word “raw” when thinking about the car’s handling. It feels very raw. Not sure how to best describe it. The car is very responsive, possibly unforgiving if you are too careless on the road. A tap on the accelerator will bring you up pretty quickly to the next car. This applies to braking as well. It feels as if the car would drive the exactly you drive whether intentionally or not. I had the sense of really feeling in control while on the highway.

For the price I am paying for this beast, I am happy with it thus far

Till next update, arrivederci.

 

Student Examination Prayer

Someone sent this to me, thought it’s a good poem/prayer

Lord, grant to me a quiet heart,
Before examination start,
Teach me to use my leisure hours,
To re-invigorate my powers,
My mind from daydreams liberate,
Give me the will to concentrate,
From all distractions set me free,
That in my studies I may be
A student with the sole intent,
To make my work my sacrament.

From my faint heart in love expel,
All failure fears that therein dwell.
And from my pillow drive away,
All dark foreboding of that day.
Help me in faith to rest so deep,
That I may have untroubled sleep.
While notes and summaries I prepare,
May I not lose my zest for prayer.
And may I not forget to look
for daily guidance in Thy book.

In quietness, confidence and peace,
May I find sure swift release
From needless fears and apprehension
From outward strain and inner tension
And my I ever grateful be
To all who offer prayer for me.
While for myself I intercede,
For other students I would plead.
So may examinations find
Each one alert in heart and mind.
Thus inward joy and peace processing
Exams will prove a source of blessing.

R.I.P. Ah Por

The last few weeks have not just been physically trying, but also mentally trying. The original plan to travel back home to Malaysia to attend a friend’s wedding cum mini IMU reunion, did not materialise as planned.

Within days of touching down in Malaysia, my beloved Grandma, of 88 years of age, had fallen gravely ill. After a couple of sleepless nights for everyone in the house, and a second visit to the Emergency Department, the true picture of her condition surfaced. She had suffered a heart attack, further complicated by a dense stroke and the finding of an aortic dissection. All of the diagnoses which, I have considered and explained to my parents, even before the diagnoses were revealed with further investigations. In a way, that could be considered as one of the best testament to my clinical acumen. After a few years in medicine, I have come to learn I have an astute sense of diagnoses, whether by luck or experience, my “sixth sense” had rarely been wrong. I had a feeling that she would not have long to live, despite some degree of improvement allowing her to be discharged home, that I had my younger brother flown back from UK to visit her. Sadly, I could not have been proven more right this time. She lasted a little under a week after she was discharged home.

She was 88 years old, although her IC had her at 85 due to under-reporting of age when she first came to Malaysia. She died peacefully in her sleep at home. There was no heroic yet often futile CPR or artificial life support. This might not have happened so smoothly if I have not been trained as a doctor or physician, for that, I am thankful.

I am sad. I miss her. I will miss her greatly for some times to come.

I have tried to distract my thoughts and rest my swollen eyes with more positive and academical stuff. Here are two of which really stroked my interests today.

A rather interesting thought, for I do not think I would be very comfortable with such transparency, not so much the commercial interests but more of my person.

Which got me thinking, what type of doctor I would describe myself as. Am I a good doctor? Do my patients like me?

All I can say, I think I am a rather competent doctor. I am a hospitalist, in the midst of being trained a physician i.e. the non-cutting types. I have broad knowledge and experience in multiple specialties, though I would not rank Neurology, Rheumatology and dermatology as my strong points. I like doing procedures and thus procedures  do not scare or faze me.

I am a rather strict doctor, with my practice of medicine more of a paternalistic type rather than the emphasis on patient’s autonomy in modern medicine. This is because, I think my job is more to treat patients to make them better, and if not, to relieve their suffering to the best of my abilities, not being a customer service relation officer. Throwing treatment options A,B,C or D at patients, with no recommendations or a personally justified stance as a doctor, or pandering to the certain insistence of some patients or family despite good and rational reasons not to, is not a proper use of our training and knowledge as doctors, in my opinion. I believe this is even more the case if the patient is in a grave condition or has an incurable disease. I relieve suffering but I do not treat people’s guilt.

Compared to my peers, I believed I have sat down a lot more often with many patients and family to discuss about diagnoses, treatments and even difficult decisions like end of life care. After striving initially in my career to try to “cure” as many patients as possible, I am now more amenable and definitely comfortable with the idea of palliative care and emphasis on comfort and quality of life than length. I am not a believer in alternative medicine, and would not actively recommend my patients to seek them.

I would normally use the older, proven and cheaper drugs on my patients rather than the newer and more expensive ones with marginal improvement in benefits. I believe this is essential for sustainable practice of medicine in a resources challenged era. If anyone wants a free advice, drink more water and exercise more. Definitely would work much better than those pills and I am saying this as a doctor. LOL.

I think that’s all for now. I need to rest my battered soul.

Arrivederci.

“The first step to happiness is an attitude of gratitude”

This is something I have always said and told myself and others.

When you are feeling down or sad, always remember first to say thank you. To no one particular. To God if you are of strong faith. For? Living in a world of sounds, where you can make one or hear one.

There is this video that had been circulating over the past month about a young boy, apparently from South America, who had received a chopping board for his birthday present. He still thanked and hugged his mum and dad, for giving him a chopping board. Then he was given he real present – a tablet. He literally broke down with happiness and gratefulness. And it was just an ordinary tablet, not an iPad or Samsung tablets. Lemme rephrase that, it was an extraordinary tablet, bought with sweats and love of his parents, something that might cost less but worth a lot more to the kid than other iPads or tablets.

The reason I brought this up because it reminded me of my early childhood. I remembered being relatively poor compared to many of my peers yet content with many things in life. Alright, not exactly all content, I loved going to the Toys R Us at one point because of the abundance of toys there. More often than not, I would leave the store either in tears or broken heart with no toys because Mum and Dad just couldn’t afford them. The new RM50 ( back in 90s) Lego set I wanted would have been a third of my yearly textbook costs. Or two months of my bus fare.

One more thing I realised as well, our house did not celebrate much of birthdays. As I grew older , looking back, those birthday cakes would have cost the us probably a month worth of meat for us. As we skimped and saved, at one point I have totally forgotten the notion of celebrating birthdays until later in secondary school. I have never received a birthday present from my parents and funnily I didn’t complain much about it.

As I got older and went to college and then university, somehow, I got myself more and more obsessed with the notion of celebrating birthdays. I guess it is all good if a bunch of us could sit down, sing some silly song and have some fun on birthdays. However, do I even need a reason for those to happen?

Anyhow, recently, I have found comfort in solitude. I cook and eat alone. I watch movies by myself in the cinema. I talk to no one outside of work. I gone to gym all by myself. I am working in a no-mans land where Internet was even an issue, though not a persistent one. I met more people. More wonderful people. Maybe some of them will turn out to be life long friends perhaps, as skeptical as I am now. Who knows?

I do however have a lot to thank for. I would not starve to save money. I have a roof over my head. I still have some forms of income. My family is still intact. I have the latest iPhone when someone around the world had to sell a kidney for one. I am able bodied. I can walk. I can run. Etc. plenty of things I should be grateful or remind myself to be grateful for.

Arrivederci.

Happy birthday to me

I have just turned 30 yesterday. I have noted, without the power of social network like the Facebook, nobody would care to remember birthdays anymore except for a select few friends who might have bothered to pen in a reminder on their calendar. And of course, my own family.

Priorities change as we grow older, especially those who have started a family. Or those in the relationships, on the way to forming a family. Anyhow, that would be something to talk about on another day.

There is a lot of things in my life today that leave a lot to be desired.

I am single and alone, nowhere close to finding my lifetime partner or forming a family.

I am jobless, I have no full time job at the moment nor for next year. I am bouncing from hospitals to hospitals on short term contracts.

I have failed my physician exams three times, with no certainties where I would go if I do fail it again.

I am untrusting and hateful. After a recent debacle in dealing with some of the closest and dearest people in my life, I do not have the capacity to trust anyone anymore. And I also absolutely hate this one person who was a catalyst. I know I would totally smash him up if I ever see him, that’s why I would minimise contact with this scum as much as possible.

I haven’t been happy since the turn of the year…..on contrary, quite miserable. Even contemplating of taking the easy way out. That would be very easy for me to do, being someone trained in relieving ills, pain and suffering.

I am overweight and unfit.

Yet, the eternal optimist in me just wouldn’t give up.

I am single. Thus I have no commitment at the moment. I can travel the world or do something absolutely crazy or risky without having to think much about leaving a widow or a child behind. Okay, if something does happen, my brothers and parents might have been sad but it wouldn’t be near as bad leaving behind my own growing kid and a single mother.

I don’t have a full time job but I do have a rather lucrative locum stints, bringing to the various rural and regional areas of Australia. In addition, the medicine had been really fun. Let’s not forget in current economic climates, any wages earned is better than having no job at all.

Failing exams. I do not fear failures, for failures occur at a higher rate than success, but I must make sure I do not embrace it. I am going to pass my FRACP in 2015. That would be the promise to myself.

Sometimes, some of us gotta learn things the real hard way. Especially relationships. Particularly relationships. I think I am learning it at the insanely hard level. There is no one sure way to get it right in dealing with people. What should really matter is the consistency of one’s actions and thoughts. If I am to be honest to myself, I have always thought that I have always been giving more to others than I have received. It’s not a good thought, but from my experience, that is exactly what happens. No, there won’t and can’t be a better version of me. I am already on my best and worst behavior.

“Time heals, if it doesn’t, it will always bury.” My own words. I have chanted it for years, like a mantra. Maybe I have done things wrong all these while. I can’t not have hated anyone after so long but it is what it is. Maybe the reason I don’t hate as often is because I would have left a trail of bloods and broken bones. Anyhow, slowly but surely, everybody gotta move on.

Rather than sitting down and crying alone over things, on my birthday, the rare one day where I haven’t been working or studying all these years, I went out to buy myself a small birthday cake.

There was no song sung. No gift to open. No wishes apart from my immediate family and three other friends. No candle lit or blown either. However, I am a stubborn person. I refused to feel sad. Not on this day. I ate my birthday cake, which actually tasted quite good, and made a wish for things to be better for me and the few people that had been down in the dumps lately, over the coming year. I was rather superstitious, by doing those, it shall be a new start for me and of me, for better times ahead.

Rather than buying the PS4 I have been thinking off, I actually went to the sports shop and got myself a couple of sweat shirts, glove, resistance band and shorts. I did actually head to the gym too yesterday for some exercises. Finally after 2 years after my knee surgery, I actually think and feel my legs are getting stronger. It is never too late to get my priorities in life right.

Friendships are overrated. All human are selfish by nature. My thoughts along those lines had never been clearer. The day that was before, could not have personified those words, any better. The funny thing is why had it been taking me so long to realise that?

Alright. Enough banter. Time to go back to my immunology studies.

In no particular order,

I wish for my beloved Granma to live her probably limited days on earth, happily.
I wish for Rachel and Aiesha to keep winning their battles against the big C.
I wish for my brothers to be successful in their careers and happy in their lives.
And the same wish I made every year, may my birthdays to come be spent with someone who means a lot to me and whom I love.

Salute, mi familia.

Arrivederci.