Aug 12, 2014

The Fragrant Harbour

Back in June in the midst of community rotation, I was having difficulty occupying my extremely long weekends in a new and relatively small town and very few acquaintances. It was like going into retirement suddenly - a typical workweek is less than 4 days and all of my friends, whom are mostly physicians, too, are busy slaving in the hospital. One weekend I find myself stranded with about 4.5 days off. My brain screaming from boredom and the summer heat, I found myself planning random trips to nearby countries. Thank God SoonKhen is just next door in Hong Kong and Cathay Pacific has last minute tickets for slightly more than USD 200, a call to reservations and I'm scheduled to leave in 2 days.

On Cathay Pacific flight 565 bound for Hong Kong on a cloudless summer afternoon

 Rolls-Royce engines

 Hong Kong airport!

 Central MRT station in red tiles

Overlooking Hong Kong island on the ferry crossing to Kowloon

Every city should have a promenade and a skyline. Sadly Taipei doesn't.

I love MRT station names in Hong Kong and their coloured tiles. Now I understand why Cathay Pacific has a tile wallpaper in their lavatories.

Took the (very crowded) tram up to Victoria peak the next day

Traveling solo means having to depend on fellow travellers to take your picture.

We can easily spot British influence on the Commonwealth - wide, orderly streets, lots of windows, and easy pedestrian walkways

The promenade again in daylight

A fellow Mainlander took this picture for me.

Jun 28, 2014

Community Rotation a.k.a. Summer Vacation

For our one-year post-graduate training (PGY) mandated by health authorities, 2 months are dedicated to community rotation which serves to familiarise us with community health resources and health disparities on a community to regional level. Translated to laymen language, it's essentially 2 months of vacation local clinic visits, emergency medical transport, home and institutional care facilities, local health policies, and a community health report. Simplified further: it's spending 2 months away from the wards!
I scheduled my vacation community rotation for the final 2 months of PGY-1 to make full use of summer as well as to settle the complicated mission of re-applying for a work visa upon switching jobs in August. Also moving into the hustle and bustle of Taipei and procuring furniture for the new house, it's less of a vacation compared to my fellow colleagues - one of whom plans to conquer all the mountains in Taiwan and the other renovating and renting out his newly bought apartment.
Anyway, summer is too tempting to be wasted and each of us have our own plans making full use of the 2 months.
For a start, my parents were here earlier this month for my sister's commencement. As I'm on, ahem, community rotation, I picked up my parents from the airport with my free airport transfer gratuitous of Citibank. My parents' flight was delayed for an hour thanks to Hong Kong air traffic control. Just as I was about to file a complaint to Cathay Pacific, my sister's classmate told me her parents' flight was delayed for 6 hours, arriving Taipei at 2 am with their bags completely soaked. I hope they have travel insurance.

My family and my sister's classmate

President Ma's best wishes to all graduates. Strange I did not receive any congrats during my graduation. English translation as follows: I was informed of your school's commencement for MinGuo Year 103 (2014) will fall on June 7th and would like to extend my best wishes and blessing to all graduates. I look forward to seeing you persisting the school's excellent motto into our workforce along with (a chain of politically-sophisticated, hope-instilling but empty words). President Ying-jeou Ma.

Summer is not so nice in Taiwan due to the heat and humidity. But it's good to be spending time outdoors before I start my imprisonment residency in September.

Apr 19, 2014

The Kinship of Sorrow

I was on surgical floor duty on March 8, 2014. It was an ordinary morning with everyone anxious to go home early when a random swipe on Twitter starts an infinite roller coaster of emotions.
It was learned that MH370 from Kuala Lumpur (KUL) to Beijing (PEK) has "lost contact" shortly after departure with 227 passengers and 12 crew onboard.
As a fellow Malaysian and frequent flyer of Malaysia Airlines, one's heart missed a beat. While preparing for the worst, we repeatedly prayed to God Almighty that it be a minor error, that no souls were lost, that the incident would end safely. Worldwide, #MH370 and #PrayforMH370 were trending on all social media as netizens wake up not expecting a sophisticated Boeing 777 would simply vanish into thin air.
I can only imagine the agony and frustration of family members later that day as irresponsible social media users spread false information about the missing aircraft. Stuck on Al Jazeera English (our hospital router blocks all other news sources, AJE is the one our IT department apparently missed) for the next 20 hours, helplessness developed into fear and anger as numerous questions were raised about appropriate actions - why was the authorities informed so late? Why are there false travel documents? Why was the transponders turned off? Possibly even deliberately? We were haunted with newsflash of agonised family members at both PEK and KUL as journalists rush to the story and endless theories like sharks smelling blood.

The days that followed were as heartbreaking as it was confusing for all. Amidst the shorthanded and inexperienced Malaysian authorities fumbling with the initiation of search and rescue operations, our ASEAN neighbours, Australia, UK, and many more nations joined in the search in what is possibly the worst (and most clueless) air disaster in decades. As days went into weeks, family members of multiple nations began demanding answers from our authorities, which we scarcely have. Chinese families staged protests, pressured diplomats, went on the media, and even started a nationwide boycott fuelled by the void of information about their loved ones on board. Others, such as Maira Nari, daughter of chief steward Andrew Nari channels her loss with great composure and integrity on Twitter.

Across a nation divided over a recent high court sentence and political stance, Malaysians unite in praying for missing MH370 in an unprecedented scale and momentum. People of all color and creed were one in their daily prayers - that the aircraft be found soon and its passengers and crew safe and sound.

Over the weeks we gradually started to accept the fact that the aircraft and all its passengers are "lost", it united aviation photographers from around the world to pay a tribute to something forgotten all the while - the aircraft herself. Unsurprisingly 9M-MRO on her last flight as MH370 had a fruitful 12 years in service, bearing the flag of Malaysia across exotic nations during Malaysia Airlines' better times. I particularly loved a black-and-white 9M-MRO landing in KUL on January 30, 2014 - one of her last landings back home, which the photographer aptly titled "Oscar, you're 'home'."
As search operations continue against an uphill battle in the Southern Indian Ocean after the aircraft has gone missing for more than a month, we continue our prayers for the quick salvage of wreckage and revelation of truth for all involved. As a Malaysian this tragedy has struck me as deeply as it has struck families and staff of Malaysia Airlines. My family has flown Malaysian for innumerable years for better or worse and has always trusted her on safety, reliability, and the professionalism of her crew. It is a harrowing tragedy that struck close to home and has reminded us of loving each other more. Through flowing rivers of sorrow, it has doubtlessly united people of different races and ideals, taught us more about tolerance, and befriended people that would otherwise never cross paths.
Wherever you are, we hope you're in a better place, MH370.

Jan 31, 2014

The Decision to Come Home for Chinese New Year

Some of the disadvantages working overseas, aside from earning a foreign currency and able to stand as a bystander when our comedian government does something stupid, is having to play the "home / no home" game during Chinese New Year. Being in Taiwan, Chinese New Year is the pinnacle of peak travel season which means air tickets are sold almost twice their original price. As students with a fixed semester schedule, you purchase your flight tickets well in advance while avoiding the hot dates. However, after starting work, applying a day off during Chinese New Year is like trying to give birth to an elephant with a human pelvis - a stand-in must be found to relief your duties, lots of negotiation on the on call schedules, and train tickets typically sold out within seconds must be acquired by whatever means. Any lapse of this chain of events would mean spending Chinese New Year alone overseas.
The on call schedule of our hospital is fixed only a month in advance. So by December I was calling my January and February departments for details which were still sketchy. I literally had to hold them at gunpoint for them to give me leave. We had mutually respectful discussions and I was rather disappointed to find our Chinese New Year leave would only be 4 days in total. Anyhow, anticipating the short break due to lack of residents, I deliberated on whether or not to come home for Chinese New Year.
As my travel agent gleefully typed into her computer unleashing a record high price tag of NT$ 22000 round trip from Taipei to Penang (with a transit), my senior at the ED repeatedly reminded me he gets paid NT$ 20000 per 12-hour session of emergency duty at a rural community hospital. I had numerous sleepless nights and asked around on what will my first Chinese New Year abroad be like.
Gradually the department of obstetrics and gynaecology, where I will be rotating in January, completed our duty schedule. They did a good job avoiding all my blackout dates but I learned I will be on call the night before my intended flight. This means I will be working until 8 am while my flight departs at 12 noon at Taoyuan International Airport, if I am flying Cathay Pacific, the cheaper option.
Worried that I might not make the flight (Hualien to Taipei is 2 hours by train; Taipei to Taoyuan International Airport is another 50 mins by bus), I even tried Malaysia Airlines which happily sold out its economy class a month in advance. I decided to treat myself to business to be told the entire price would be NT$ 26000, enough to feed my family of 4 for a month.

My travel agent, the always aggressive Ms. Tsai must've checked the empty slots until even the computer hates her. Over the course of 3 weeks we managed to downgrade our fare class to around NT$ 20000. She must also hate me because I often Line her in the middle of the night to ask her to check if there's any cheaper seats. One fine day she finally broke and screamed at me to pay up before she goes to psychiatry. The final price is NT$19900 with a PEN-HKG sector in premium economy. I can't remember it was because economy was sold out (more likely), or there was only a slight price difference for a wider seat and more privacy.
Next comes applying for leave during a period when the hospital is most stretched out of human resource. For this I decided to employ a tactic from Sun Tzu's Art of War - distraction and dissemination of attention. I would talk about something happy like our year-end bonus while maliciously slipping in my leave application and needing a stand in. After 4 to 5 trials and employing some hypnotic skills along the way, my partner finally agreed to stand in for 3 days while I'm off making my leave up to 6.5 days in total including traveling.
If I leave Hualien after call duty at 8, I will be in peril of not boarding my flight home given the short margin of error. Arriving in Taipei at 10 and taking the bus will probably see me at the airport at around 11:20 for a 12:05 flight which is cutting it very close for an international flight. I finally decided to take the earliest train out of Hualien which is 6 am. The 2 hours of call duty I owe my friends to cover up for me as evidenced here.

On call personnel: Intern Dr. Huang with PGY Dr. Sim. Please call PGY Dr. Wang or Dr. Guo after 5:30

After a monthlong battle for tickets, leave, and stand ins with an array of seditious acts, lies, and drama worthy of an Academy award, I finally board the very chaotic flight home to Penang as one-third of the world's population scramble to be home for reunion dinner. I must say it is worth it to be home for the festive season, no matter the price.
Happy Chinese New Year to all!

Jan 7, 2014

Vulnerable when Unpowered

My MacBook Pro will be with me for 3 years come April. It is an extremely well-travelled laptop during its short lifespan - completing my lengthy journal report while transiting in Narita, sending happy pictures of me and Dr. Drazen, editor-in-chief of the New England Journal of Medicine from Boston to my family, checking my residency application status while vacationing in Bali, and blogging from New York.
It is easy to forget how convenient life has become when so much could be done by pressing the on button and navigating billion dollar investments with a stable internet connection. However, we usually take the power / battery for granted as life gets too easy for us.
For Macbook users, you'll be familiar with the MagSafe adapter which Apple fanatics love to call the "tofu":

My "tofu" is as old as my MacBook Pro now and I must confess I did not take good care of it, especially so when I travel. As the laptop gets up to 8 hours battery life on a single charge, I usually chuck the tofu into a checked luggage and only see it after we're settled at our destination. During the period, the luggage usually went up and down 14576 steps, into 34 puddles, and got smashed along with 287 other luggages in a temperature of -97^C under your comfy cabin on the airplane.
After 3 years my tofu has finally decided to quit me last Saturday. The usual assuring green or yellow LED did not light up when I happily plug it in at my duty room. Convinced that things designed by Steve Jobs would not fail, I plug it into another outlet. I must imagine the green dot so hard I think my retinal cone cells almost revolted against my grey matter for the hallucination. No green. No yellow. Just plain blackout.
With the remaining battery, I troubleshot my problem from the Apple Support website. First, make sure your power supply is working - blimey, I always thought Apple users were smarter than that. As I was plugging into a hospital-grade uninterruptible power supply I'm positive there is sufficient electrons to kickstart a laptop. Or else the 50 ICU patients wouldn't still be breathing.
Second, unplug your adapter and let it rest for 60 seconds. Replug.
I must have tried no. 2 at least 60 times. During the final frantic moments I almost wished electricity would pass through me while I hold on to the computer. I don't mind being electrocuted as long as I can get onto Facebook!
Then comes some key combinations which would reset your whatnot - something similar to Clt-Alt-Del on Windows - still not working. Finally, I booked an appointment for an Apple genius to call me. Apple tried to charge me NT1,790 for the call but thank God there was a "I just bought OS X Mountain Lion" option allowing me a free call. I managed to save 2 weeks' living expenses for a family of 5 in the Philippines.
5 minutes later an Apple genius with a fake Mainland Chinese accent called. I explained to him the steps I had done. After a series of questions like what temperature is the room now and did you drop your adapter into hot soup, the genius told me the problem probably lies in my tofu and advised me to go to the nearest Apple store, which is 119 km away from my current location.
With 4% of power remaining, I checked the Apple Store for a new adapter. Apparently if you think a call costing 2 weeks living expenses for a family of 5 is exorbitant, an adapter would likely feed an entire zoo.
Like Sandra Bullock in Gravity (2013), with the computer screen blurring every 3 seconds and apocalyptic warning signals flashing away, I went to Ruten, the Taiwanese version of Ebay, and found the same product for half the price, including delivery. With 1% power to spare, I clicked "purchase" before the laptop went into a deep coma.
The following day, I forced politely asked my junior for his adapter to infuse some much needed electrons into my baby which is barely breathing (sleep indicator of MacBooks resembles breathing patterns).

I must admit hearing the "puck" sound when the cable attaches magnetically to the laptop is like God speaking himself that morning. When I plug on, the familiar yellow bulb flashes on - even utopian Shangri-La seems slum-like when compared to the warm glow of electrons flowing through. My MacBook is saved!
After 2 days, my own adapter arrived. As I lay the old tofu to rest, it seems almost a joke to me that while our computers may produce medicines that cure cancer or save the planet, they are still just a metal casing made from recycled Cola cans when unpowered.

Oct 29, 2013

Still Hanging There

Just to remind all of you I'm still alive, kicking, and will be back with posts very soon.

Sep 15, 2013

Foreign Family Caregiver

Like most middle class Malaysian families, I grew up with a family maid. We used to call them kakak, or sister in Malay. Like the African American ladies in "The Help" they cooked, cleaned, took care of the children, the elderly, and even buy groceries and manage the pantry. Throughout my childhood we had at least 5 kakaks from Indonesia. All of them worked for at least 2 years and returned home for good after their lease was done. Our last kakak was with us for the past 5 years from 2008 to February 2013. She subsequently returned to Bali, bought a store, and sold ice to hotels and tourists.
Growing up, we were extremely grateful to all our kakaks for shouldering all the housework and upkeep of our family - our sweat stained school uniforms, all the windowpanes in our airy home, breakfast, lunch, dinner, and endless guests and relatives frequenting our house. We spoke Malay but they eventually knew Mandarin from our daily family conversation.
After I started working in Taiwan, I had endless opportunities to work alongside lots of foreign caregivers of our patients. Unlike Malaysia, Taiwan has very strict regulations regarding foreign caregivers - they could only care for the elderly or severely disabled evaluated by specialist physicians approved by the Ministry of Health. As a result of a regulated cap, foreign caregivers in Taiwan usually have experience taking care of bedridden patients as well as the ability to speak and understand Mandarin.
At the end of one's life in bedridden state, these kakaks are their full time companions. Most other family members just pop in once in a while or may not even show up during the patient's hospitalization.
Taking care of a bedridden patient can be extremely depressing. Unlike babies which are tender and sweet, these patients might have nasty bedsores, pus-oozing wounds, foul-smelling phlegm to suction every 4 hours, and an endless list of medications to give at different times of the day. Imprisoned by their foreignness and round the clock demands, they maintain a minimal social life through text messaging or unlimited call plans. One could easily spot them chatting away on the phone or texting during their free time. Sometimes they got so engrossed they would ignore us during rounds. Their mastery of Mandarin varies and hence communication could get fiery when they aren't up to standards, especially in matters of hygiene.
On two occasions during the past month, however, their genuinity touched a cord in me. Our first kakak was caring for this bedridden old lady who was admitted for massive pleural effusion. On the night of her chest tube insertion, she accidentally removed the tube during one of her nightly delirious episodes. I went in to check if the patient is okay and found this angry kakak scolding the old lady for being impulsive and trying to slowly kill her by disrupting her sleep every 30 minutes.

3 days later, the old lady's consciousness took a turn for the worse. She was barely breathing and bloodwork finds severe hypercapnia partially corrected by positive pressure ventilation. Afraid of the inevitable, I called the family members for advanced directives and DNR. After the entire proceeding was over, I found the kakak quietly sobbing away along the corridor while firing away text messages.
"Are you okay?"
"It's my fault...I shouldn't have been so harsh on her."
"You took care of her for so long and did a very good job. It's hardly your fault. It's the natural way of life."
She went back into the old lady's room even more emotional than any of her family members.
The second kakak was a bubbly Indonesian girl who speaks very good Chinese. She had been taking care of Mr. Lin for 2 years and provided me with a detailed account of his present illness on admission (family members busy elsewhere, again). On his fourth hospitalization night, Mr. Lin accidentally choked while drinking some milk and was struggling for breath when I was called. After doing all the necessary workup and prescribing antibiotics while praying everything works out, I found the bubbly kakak in the same state as the previous kakak, as if all of them were programmed to tear up, cry, and text their friends about the conditions of their patients.
"Two years and he was doing very well..."
She was right. Mr. Lin had hardly any wounds, no bedsores, was clean every day I see him, and looks well-nourished.
"It's not your fault. It was an accident. You were great in taking care of him so well," I tried to comfort her.
While their emotionless family members went home to sleep in their snug beds, these kakaks are the ones who changed their granddad's diapers, patiently feeds 5 meals to their grandmother every day, cleans and bathes their parents in vegetative state, freeing up valuable time and energy for us to do the things we think are important. When they are hospitalized, they are the ones who slept on the minuscule sofa (convertible into a chair during the day), and had to tolerate the noisy and claustrophobic wards. When their patient is in critical condition, they joined in to pray, possibly to a different God, but for the same patient. At the end of the day, their daily keep is not just about money anymore. The bedridden granddad has became kakak's own parents.