Heard from Hugh Palmer @ Prom Praise:

When Greg Louganis, world's greatest diver, was once asked how he stood the pressure before every dive (he had once hit his head on the diving platform during the dive in the qualifying round, but went on to place in the finals), he said, 'I know that no matter what happens, my mother will still love me.'

Happy Mothers' Day!

Chocolate Is Associated with Lower Mortality Following First MI

Amount of chocolate consumption was related inversely to cardiac-related mortality during an 8-year follow-up

Several studies have suggested that chocolate, perhaps in a process mediated by its antioxidant content, protects the heart (JW Gen Med Jul 10 2007 and JW Gen Med Sep 23 2003). A Swedish team identified 1169 nondiabetic patients who were hospitalized with initial nonfatal myocardial infarctions. Detailed food histories for the preceding 12 months were completed by 86% of patients; participants were followed for an additional 8 years.

Compared with patients who never ate chocolate, those who ate chocolate less than once monthly suffered 27% less cardiac-related mortality (after multivariate adjustments); risk was 44% lower for weekly chocolate eaters and 66% lower for those who ate chocolate two or more times weekly. Nonfatal adverse cardiac events, strokes, and total mortality, however, were not related clearly to chocolate consumption. Consuming other sweets (e.g., cookies, cakes, ice cream) had no relation to cardiac mortality.

Comment: The strengths of this study are its size and long-term follow-up. The main weakness is that chocolate consumption was assessed only once, during hospitalization for initial MIs, and not during follow-up. To me, the most interesting result of the study is that chocolate strongly protected against cardiac mortality but not against adverse cardiac events. The same finding has been reported for ω-3 fatty acid supplements, which suggests that the primary beneficial effect of both chocolate and ω-3 fatty acid supplements is in suppressing arrhythmias.

— Anthony L. Komaroff, MD

Published in Journal Watch General Medicine September 3, 2009

Citation:
Janszky I et al. Chocolate consumption and mortality following a first acute myocardial infarction: The Stockholm Heart Epidemiology Program. J Intern Med 2009 Sep; 266:248.

Birthday ruminations

Thank you everyone for your thoughts on this "special" day of mine! In true Malaysian style, I spent the days running up to it EATING - laksa (the smell lingers around my flat), a Malaysian mix-and-match of cuisine, and lots and lots of cake. Perhaps too much eating, for over the weekend I just felt like sleeping, which isn't what I was supposed to do! It was just as well as the flow of patients was just about a trickle.

I've settled into the rhythm of the job I think, 3 months in (and changing jobs in a month's time!), and although I still get bullied sometimes by the nurses and allied health professionals, I'm learning how to assess situations by asking relevant questions so I don't rush around like a headless chicken trying to please everyone. I know my own agenda better, and try to meet that while accomodating the requests of others. I still feel very junior, but a more capable one than that green girl who stepped onto the "Green Mile" 3 months back!

And amazingly, I'm finding time to indulge in other pursuits as well - reading, blogging (as evidenced), music, movies, food, exercise, friends, holidays. If all goes well, I'll have a week in NYC to look forward to, a regular prayer support group in the hospital (setup still pending), a new camera whose resolution is higher than my camera phone, my audit set up and running, and less hiccups in the daily living out of my duties as a doctor. And maybe more time in theatre...

When Facebook has to send you a reminder that you haven't visited the site for some time, you know you've been away from "civilisation" for a while.

Thank you for all the comments and emails in response to the last blog - I feel loved. And vindicated, since many people are on the same boat, kind of. LoL consolation in numbers. Anyway, I will update more when I have more energy and time to reflect and type things out. As of now, after a weekend on call followed by a long day on call on Monday, I'm flat tired out. And I look forward to this weekend!

It's 8.24 pm and I'm sitting in the doctor's office, and I'm not on call. It's the first day we've had pretty much no senior cover, and I had the dubious honour of finishing the post take ward round by myself (thank goodness there weren't any serious problems!). I feel alright, not really tired, but I think that's because I had loads of sleep over the weekend, and I need to go back soon to build up on that.

My world has really shrunk down to this - work, often more than the 40 slotted hours per week (more like double that, and then some), some fleeting interactions with fellow sufferers, then weekends with closer friends (always the same ones in the past few weeks - the joy of rituals never cease, and they are such comfort to me ;>). But I've missed so many important occasions in other people's lives - birthdays mostly, but also new babies, new couples, new marriages, passing exams, etc. I hope you've had great days on those special occasions, all of you.

And if you do spare a thought for me, drop me an email to console me re. my lack of life. I'd like to live vivaciously through knowing about your lives.

1st full week

The weekend - a precious time to stock up on food, water and oxygen, or to make up the deficits run up during the week.

And for now, a great time to enjoy the sun! :)

Work has been a scramble to get on top of things. Everytime I think I have, something new pops up to remind me otherwise. The learning curve is steep indeed, but we're slowly working our way over it. I am liking it (and I grin to myself when this thought flits through my mind as I race to do another random job)- the busyness, the activity etc. I don't think I could do a proper sit-down job, so this suits me for now.

I've been marking survival success as the number of death-free days working in the hospital, but since Friday I have to find another way. I did my first death certification that day, feeling solemn and sad and slightly ludicrous as I went through the motions of finding life on this woman, whose skin had already taken on the blue sheen of death. It only served to drive home the reality of the job - we walk on the line between life and death, and we need to sharpen those skills that help us navigate between the two. This lady was on her way over the line, yet she had clung to the hope that she would improve. On another ward, a man with an encouraging prognosis but slow recovery was giving up hope, and it was hard to find the words to boost his fighting spirit.

Med school, even with its communication skills teaching and increased ward exposure, can only do so much to prepare us for the job. It's only with hands-on experience do we really learn what's needed, and learn to like or hate what we do.

Standing at the precipice

It's that familiar feeling. The immensity of the event and the knowledge that everything is changing, rearranging (in the words of a long-gone boyband :P) into a new kind of existence that could last as little as one year or as long as, who knows, is enchanting and exciting - a new frontier I haven't walked on before. In my relatively sheltered life I haven't had many life-defining events but this can definitely qualify as one of them, augmented by the fact that it's being accented with a big move, and rudely punctuated with visa issues and other adult-ish stuff.

And yet, unfamiliar. As I grow older these few moments I have grow increasingly tinged with the worrying knowledge that I may not like it, that I may not know what to do, that I may find it very difficult to cope, that I may fail. It may be acceptable to think so, even encouraged (so we don't go all cocky and over-confident into the job, however prepared/unprepared we may be), but it's hard to come to terms with. Also the coziness of dwelling in the known present and past makes me loathe to move out of my comfort zone into the future that I know is coming and face the uncertainties awaiting me.

So I'm thankful I'm familiar with Chertsey, and that my fellow foundation year doctors seem like a good bunch. I'm thankful for the tiny revision session on acute management of sick patients that tried to stop the drain of information out of my brain's backdoor. I'm thankful for a great landlord and landlady whose willingness for my departure date to be fuzzy helps my gradual move out of my current place, as with the friends in the said house who aren't shooing me out (inviting me back for next time, rather! :) ). I'm thankful that I had a month to indulge in the coziness of my current student-y life (helped by the unpredictable British weather) and random leisurely pursuits, while making tiny forays into the thought processes and activities of the grown-up working world. I'm thankful for the insistence of my mom's investment plans so I'm not clueless when I discuss my income management with financial advisors etc. and when I survey the minefield that is money management (sigh...).

And most of all, I'm thankful that no matter how some things change, Someone doesn't. And all is alright.