My new boyfriend

I am so in love with my iPhone 4.

I really really do.

And I can't stop Grindr-ing. The guys on Grindr are so different than those on Axcest. At least, there're no kids. You tend to meet more mature and financially sound guys. And the interesting thing is, they're mostly hot.

I'm still waiting for one those with six-packs to buzz me. Which will always be a fantasy because I guess they only approach guys with similarly perfect bodies. Perhaps one you can take the initiative to?

It's kinda exciting sometimes when you realize there's a hot gay guy less then 500 metres away from you. However, as conservative as I've always been, I don't think I'll go beyond the 'boundary'. Not yet.

Today, something pretty embarrassing happened.

I actually missed the diagnosis of tricuspid regurgitation in a chap with decompensated congestive cardiac failure secondary to chronic rheumatic heart disease complicated with atrial fibrillation and prosthetic valve dysfunction. I should have referred to the echocardiogram before I presented the case to the cardiologist. 

Well, he impressed us with his ability to come out with the provisional diagnosis of tricuspid regurgitation just by placing his stethoscope on the patient's praecordium. Awesome.

Hmm. Why didn't I think of that when all my physical examination findings actually pointed towards that diagnosis? The pansystolic murmur at the left lower sternal edge? the tender enlarged liver (though it wasn't pulsatile) ? the elevated jugular venous pressure? the gross ascites and bilateral pitting edema? 

But then, I guess I'm excusable because that wasn't a very direct case. He'd had his aortic and mitral valves replaced. I could hear a cacophony of ejection systolic murmur and clicks here and there produced by the mechanical valves.

In medicine, you may know something theoretically. You may know all the manoeuvres to accentuate certain types of cardiac murmurs. But, when you actually see the patient, it's really not that simple. A lot of practice is needed. You may know everything in the textbook ( which I don't). Yet, if the patient is uncooperative or if you fail to present your findings confidently to the examiner, that's the end of the story. You've got to make an impression. That's why I feel so stressed, you see.

I learnt my lesson today. 

I will improve. =)

Exam's on Monday. No more Grindr-ing.

Medicine posting in 500 words

I grinned when that laborer told me that the precipitants of his migraine included ejaculation. And I was wondering if that's coital cephalgia. He must really hate sex then.

I chatted with the stubborn lorry driver with Crohn's disease complicated with perianal fistulae who refused to quit smoking. I sorta sympathized with him when he talked about her wife's infidelity and his recent unemployment. I saw hopelessness in his eyes. Could these have caused his flare up?

I examined the cute, hunky farmer who suffered from pleural effusion secondary to pulmonary tuberculosis.

I examined that pitiful woman with bulbar palsy with very beautiful tongue fasciculations who had dysarthria and a very clear carotid bruit. Carotid stenosis. She had the look of an elderly ill woman who'd been abandoned by her children. For some reason, my heart ached.

I examined the girl with Down's syndrome who had missed the boat for a surgical correction of her ventricular septal defect. I wondered why she had digital clubbing and cyanosis. And I later found out she had developed Eisenmenger's complex. Poor girl.

I talked to the hot fisherman with decompensated Child's C liver cirrhosis secondary to chronic Hepatitis B infection who could recall every single detail of his variceal bleeding. And I couldn't stop ogling at his son who was so damn hunky and muscular.

It's nice to meet the medical lab technologist with cholangiocarcinoma who was admitted due to liver abscess. She was able to give me a detailed history with medical jargons. She's the sort of patient you hope you can get in exam. You'll know how frustrating it is when you meet someone who can't even tell you the medications he'd been taking for the past 10 years. 

I realized how devastating the complications of haemophilia A can be when the hematologist brought us to see the guy who'd suffered from a subdural haematoma.

I like the friendly girl with myasthenia gravis who talked to me about her bilateral ptosis, double vision and how she progressed to the stage where her respiratory muscles were involved and required intubation. 

The gastroenterologist mentioned something about gay bowel syndrome during a discussion on inflammatory bowel diseases the other day. And I found that very relevant. Never knew such a syndrome existed. Gay bowel syndrome. Interesting. Speaking of this, did you know that AIDS was actually known as Gay-related Immunodefiency Disease (GRID) in the early 1980s?

I saw a diabetic with all the macrovascular and microvascular complications. Diabetic retinopathy, nephropathy, neuropathy, peripheral vascular disease and coronary artery disease. You name it, he has it. That was the day I decided to reduce my sugar intake. 

I saw a young father with systemic lupus erythematosus (SLE) in the rheumatology clinic. SLE rarely affects guys. But, when it does, the prognosis is bad. Does he know that SLE patients have a lifespan 10 - 20 years shorter in comparison to the general population?

I felt bad when I talked to patients who didn't know they were actually dying.

It's fun to appreciate the pansystolic murmur of that chap with severe mitral regurgitation. And to see the spider naevi of that chap with alcoholic liver disease and electrocardiogram of that man with sick sinus syndrome.

But, when exam comes, it's not that fun anymore.

I have to be prepared. For the battle next week. 

Tuls, thank you

I'm really really tense.

My last class today ended at 8pm. My mind could barely absorb anything when someone was going through some of the inconsequential details of the management of hepatic encephalopathy based on the American Association for the Study of Liver Diseases.

I feel so tired. I feel like crying. I feel like collapsing.

I've got so many things to do. So many things to read up on.

I have to present a case of Crohn's disease to the head of the medical department tomorrow. I've got a case report which I've completed due to procrastination. I've just rejected a girl very politely by coming out to her. It was a spur-of-moment decision which I hope I won't regret. Apart from that, my beloved car is still being hospitalized. And I'm still waiting indefinitely for it to be discharged.

I texted Tuls out of desperation and frustration, compelling him to say something nice that would soothe my soul.

To my surprise, he did, very obediently.

I smiled.

I really did.

I wish I had my own boyfriend (instead of someone else's) whom I can exploit when I'm in such a predicament.

But, for a moment, I could forget the saddening fact that there'd been nothing really significant in my sexual history and grinned as I read his SMS-es for the second time.

Thank you, Tuls.

No way

I think I'm on the verge of falling for a straight guy again.

The same guy Alicia used to fall for.

Damn it. I need to rationalize.

The worst thing is, he's homophobic.

I don't know how I managed to conceal my sexual preference so perfectly. Sometimes, I feel guilty having to make a few white lies to avert suspicion.

I cannot afford to let this happen. No way!