Devils in the Emergency Room

"Men never do evil so completely and cheerfully as when they do it from a religious conviction."

Blaise Pascal

Mr Pascal's Wager himself.

Yesterday night, at the beginning of my graveyard shift in Emergency & Trauma, a trio of police officers frogmarched an 18-year-old Malay young lady into the Yellow Zone. She was clearly in a state of extreme agitation, struggling, kicking and screeching glass-shattering notes at the top of her lungs. Getting the savage screaming girl down onto a bed and restraining her consumed my attention for five whole minutes and by the time I looked around, the policemen were nowhere to be seen. So there I was, left with a very disturbed young woman tied down to a bed who continued to yell abuses at me and I had no idea what transpired, where she came from or who I could contact to find out. Our tax money well-spent right there. Thanks a lot, our boys in blue.

After taking a deep anger-purging breath, I had the medical assistant take her vital signs, shoved an IV cannula into a vein (she tried to bite me in the bid) and took some blood. I turned my back for a minute to run some initial tests on her blood but when I returned, I found two strange portly men wearing songkoks and ankle length robes standing by the patient’s side. 

Must be her family members, I thought. They recited Arabic prayers at her while she barked curses back at them. I rolled my eyes at that and left them to it, thinking I could interview them when they were done – because Muslims in our country can be real explosive when you interfere in anything pertaining to their Religion of Peace™. I didn’t want to make the news. I could already see the headline in my head: ATHEIST DOCTOR FORBIDS MUSLIM FAMILY FROM PRAYING FOR THEIR LOVED ONES IN EMERGENCY ROOM. 

I returned shortly after and found that the men had drawn the curtains all around her bed. A whole lot of commotion and noise were coming from within so I took a peek. One of them was hunched over her at the head of the bed. His hands were clasped around her face and he was shouting angrish at her while she shouted back. He was trying to get her to recite something Arabic but that was to no avail. At one point, he even threatened to murder her (or what he believed was inside her). As he became increasingly more flustered, I saw his fingers pressing harder and harder onto her mastoid processes - those are the bony bumps behind your ears - till his knuckles were white and trembling. The girl started whimpering in pain and cried out, begging him to stop hurting her.

"What is your name?" the man asked again. Eyes screwed up in agony, she said it. He appeared satisfied at her response and lifted his fingers off her mastoids. Then, looking at me and smiling a winning smile, he informed me that everything was under control. He casually gestured at the IV canulla I inserted earlier and said: 

"You can pull that out now. You won’t be needing that anymore."

It takes a lot to surprise me but for I confess that I was stunned for a second by what he was telling me to do.

"Who are you?" I finally asked, my hackles rising. Who the fuck are you?

"I am Ustaz Aladdin and my companion here is Ustaz Ali Baba," the spectating partner of the pair explained in Malay. The names had been changed to minimize my own risk of getting sued. "This young lady here was possessed by an evil spirit. It was a difficult battle but we finally cast it out."

"Oh really?" I remarked acidly as my eyebrows climbed my forehead. "Are you related to her?"

"No, we just wanted to help."

At this point, the girl hulked out again and renewed her commitment to contact space aliens using only the strength of her voice alone. She struggled so violently against her bonds that I was afraid that she was going to dislocate something or worse, damage our expensive bed. Ustaz Ali Baba clamped down on her face again in a hurry with his fingers positioned behind her ears, ready to unleash torture anew. He began murmuring something Quranic.

From right to left: the patient, Ustaz Ali Baba, Ustaz Aladdin, and
the beer gut of the security guard I brought with me to confront them.

"Please unhand my patient," I told him. "You failed. Whatever you did to her is obviously not working."

Also you shamans are not part of hospital personnel and are of no relations to her – how dare you curtained yourselves off alone with her without any chaperones and manhandled her without her or her family’s consent? What you motherfakirs were doing is called assault and battery, and that shit is highly illegal. And who died and made you King of the ER that you deem yourselves to be in any position of authority to order me to remove my acutely psychotic patient's IV cannula? Also, if you claim to represent and speak for Allah, you better have papers bearing his almighty signature to prove it, you goat-bearded wizard-robed balderdashers.

Besides, isn't it haram to touch a non-mahram stranger of the opposite sex based on what the Prophet Muhammad said? These two ustaz (ustazes?) clearly didn't think so.

While I was addressing them, my patient started retching. Ustaz Aladdin cried excitedly, declaring that the young lady was about to cough up the demon possessing her. I ignored him and quickly turned her on her side to prevent her from aspirating her vomitus. When she stopped dry heaving, she - surprise, surprise! - remained aggressive and unruly. I stared daggers at the pair of defeated exorcists and said, "Please leave now."

To calm her down and to prevent her from injuring herself and her caregivers, I gave her 5 milligrams of midazolam. In just a moment, she winked out like a light (something I couldn't have done without an IV cannula).

It must had been a strange sort of ghost, demon, or djinn that can be subdued by a sedative which only affects her brain and not her body. It's almost like her psychotic actions were, gosh, all dictated by her own brain! I wanted to point this out to our Saracenic Tweedledee and Tweedledum but they had already evaporated from the Yellow Zone. Got it under control, they said. Pull out the IV cannula, they said.

When the sedative wore off and she came to an hour later, she was acting normally again.

More than even the belief in superstitions and the insistence on blaming mental illness on demonic possession, I was shocked by the gall and presumptions of the two Muslim clerics - civilians all - who thought that it was okay for them to walk into a restricted area of the Accident and Emergency department without authorisation, impose themselves onto an ill patient whom they do not know, commit assault and battery on her, and then somehow have enough nerve left in them to tell the patient's doctor what to do in regards to her medical treatment. No one, not the security guards, not my colleagues, not even my senior officers dared to reproach them for their highly unethical and unlawful actions towards a patient that was entrusted to our care. It is because they are afraid of offending the religious over-sensitivities which certain people professing to certain faiths wear around themselves like some sort of criticism-proof Kevlar jacket. It is because they afford certain people far more respect that they rightfully deserve, as their deplorable conduct showed.

It is this same misplaced respect and cowardice of standing up for what's right that led to this brutal attack orchestrated by an imam on a poor innocent Muslim woman in the UK, and this fatal exorcism in Belgium conducted by a "sheikh" and his acolytes in Belgium which ended in the death of another Muslimah.

It is high time we point out the painfully obvious fact that these self-professed spokespersons of their respective gods have no fucking clue what they are doing. Two such lowlifes attacked my patient, and I had a responsibility to protect her so I did what's right. Also, mistaking mental illness for demonic possession was something medieval yokels would do, back when trepanation and having holes in the head was still in vogue. Now that we are living in the age of smartphones, the internet and self-flushing toilets, I can't believe that people can still be this stupid.



P.S. When I related this incident to one of my colleagues who witnessed the whole thing, she told me she thinks that my patient might be possessed for real - but she disapproved of what the two ustaz was doing and probably thought that a Christian exorcist would had been more effective given her own beliefs. I just laughed loudly at her face and walked away.



Buster of ghostbusters,
k0k s3n w4i

The Dangerous Breastfeeding Advocates Network

"A little learning is a dangerous thing;
drink deep, or taste not the Pierian spring:
there shallow draughts intoxicate the brain,
and drinking largely sobers us again."

Alexander Pope

I first found out about The Breastfeeding Advocates Network (TBAN) when I saw their poster, a collage of happy baby faces, hanging in one of the maternity wards in the hospital I work in. "Neat," I thought. Trying to get parents to breastfeed can be quite a challenge sometimes but if the general public wants to take up the cause, crusade away, I say! One of the cornerstones of modern Paediatrics and Obstetrics is that infants should be fed exclusively on breastmilk for the first six months of their lives and the benefits are numerous - I would tell you what they are but this is not a post about the manifold wonderfulness of breastmilk.

When my pregnant wife told me that she had just joined the group, I joined as well and for weeks, I was contented with just observing the buzz of activity within the group. A lot of new mothers are posting what are termed in-house as "SOS'es" - mothers seeking advice from other more experienced mothers to troubleshoot breastfeeding issues. One of the more common cries for help there is are mothers not producing enough breastmilk after giving birth. The mothers there rightly advice that often, the supply of milk will appear low in the first few days after a child's birth and that mothers should keep allowing their babies to latch on and suckle regardless. I mean, that is the same advice I give to encourage new mothers! Damn, this is a great place for new moms!

However, after spending some time there, I noticed that there are also mothers who post there asking for medical advice when their babies fall ill and often, they receive large volumes of opinions that are anecdotal and sometimes contradictory. This is where I started taking notice of the more questionable side of TBAN that operates beyond the boundaries of breastfeeding. What is worse, there are mothers who post about advice given by doctors that they aren't sure about, and the response these posts generate were generally abusive, like "That doctor's an idiot!" or incredibly cocksure, like "That doctor is obviously wrong!"

As an insider in the medical field, I know better than most people about the number of nincompoops that managed to escape through the graduation end of med schools, but on the web, I will never dream of making such statements on any specific case when I myself have not acquainted myself with all the details of a patient, including giving said patient a proper physical exam and getting an eyeball of some investigations. One thing that any medico would quickly learn right out of med school is that all patients are different and they sometimes warrant different advice for the same condition. However, these highly-empowered mothers are not limited by that same prudence. They think that if something applies to their few offspring, it should apply for all mothers and all babies. I suppose that this is what they mean when they say that a little knowledge is a dangerous thing.

Here's an example of a thread that demonstrates the ignorance and arrogance that is endemic and encouraged in TBAN:

It's someone asking "What is your favourite colour" right AFTER someone said that their favourite colour is purple.

The first commenter above, Ong Chiew Ping, immediately disputed and disparaged a doctor's diagnosis of iron deficiency anemia, betting that that doctor didn't do the required test and merely guessed it by looking at another blood test (she was referring to the complete or full blood count). See what I mean about an immediate knee-jerk distrust towards licensed, respectable medical professionals even when they know nothing about the patient discussed?

The second mother, Hui Hoon who started the thread, clarified that the test also included iron level and the total iron binding capacity (TIBC), which was what she meant by the protein that binds iron being low. The rub is that she also proved the doubtful mother above her wrong.

The really funny bit is the third mother, Xe Hui, who advised that the second mother seek a second opinion to ensure that a proper iron study is done, right after the second mother told everyone that the proper iron study was indeed done. This may seem innocuous to anyone else but to anyone in the medical line, it is obvious that the mothers offering advice only know about the medical stuff they talk about superficially, but any real depth eludes them (I mean, they didn't even recognise an iron study when it flew right into their faces flapping its wings). These are mothers who call doctors stupid, by the way. Would you take medical advice from them?

You have seen nothing yet. Here is another mother whose immediate automatic reaction is to assume incompetence on the part of the doctor,

I wonder if these people really think replacing "fuck" with "fish" makes it okay.

The thread-starting mother, Hui Hoon, clearly stated that her child is 15 months old but in her righteous anger to threaten ballistic harm on the doctor and her eagerness to show how much smarter Mandy thinks she was compared to him, she missed the fact that the child in question was older than her stipulated age below which infants shouldn't be fed eggs. These mothers even fail to take account of a patient's details that are available on the page, let alone spend any time to consider the details that aren't available to them like physical examination findings and blood works. Would you take medical advice from them?

Here is how that exchange continued. Notice how reserved and polite I was trying to be in contrast to my usual belligerent online persona,

Doubling down.

As you can see above, the mother trying to justify her position have obvious trouble telling the difference between early exposure of allergens to prevent the development of allergies versus exposing a child with egg allergies to eggs to treat said allergies. You might want to read that last sentence again. Medicine is rife with subtleties demonstrated above and this further underlines the importance of knowing one's patients thoroughly before advising anything. Would you take medical advice from mothers who don't understand those subtleties?

Anyway, the mother was basing her advice (directly or indirectly) on the old 2000 feeding guideline by the American Academy of Pediatrics (AAP), which the AAP retracted in 2008 due to lack of evidence for its efficacy. Would you take medical advice from mothers who do not bother themselves with the latest evidence? In fact, based on the latest news in the world of allergies, Mandy Chee's advice may actually cause more children to develop allergies. Thanks Mandy, for making other people's babies sick!

But after I was banned from TBAN (more on that later), the same mother who doesn't understand those subtleties was seen bragging about how she knew better than I do,

Incorrigible.

See the fire-breathing pomposity of someone who still cannot tell the difference between preventing the development of allergies and treating children who are already allergic? How the fuck does someone prevent allergies in an already allergic child anyway? She can type an entire sentence of complete nonsense and not even realise it.

Of course, this kind of behaviour is fostered and nurtured by the admins who run the group - admins who claims to be certified Breastfeeding Peer Counselors but nevertheless, does not shy away from giving advice unrelated to breastfeeding. They have many quacky beliefs, but one of the worst of them is this,

Okay, I may or may not have baited them into saying those things, but I was gathering evidence.

Now, for a bit of background. Sudden Infant Death Syndrome (SIDS) is a nebulous entity and a boogie man of all new parents everywhere. According to the AAP, there are many things that reduce its risk and many that increase it based on countless studies over the years. Now, one of the latest, largest study and analysis into the phonomenon turned up a startling find: co-sleeping, when it takes the form of bed-sharing, increases the risk of SIDS in infants below 3 months old by 5 times. It was estimated that 81% of SIDS cases with no other risk factors could have been prevented if parents choose to sleep on different surfaces than their babies.

Yes, these Breastfeeding Peer Counselors are dispensing medical advice that increases the risk of babies dying suddenly. I wonder if their certification can be stripped away for doing that.

Their justification? "Other studies" which they have not exerted themselves to provide and that it helps them sleep better. Gina, the founder of the group, even wondered if the researchers are parents - as if that somehow changes the numbers and stats those researchers found. By her logic, shouldn't you avoid all male obstetricians because they have never given birth themselves? Most practicing oncologists are not suffering from cancer, so does that mean that they don't know how to treat cancer?

While doctors have yet to determine the exact cause of SIDS, the medical community have observed it for decades, learning what we could about it. In 1994, there was a huge campaign called Back to Sleep which exhort parents to place their babies on their backs to sleep, and it resulted in more than 50% decrease in SIDS. That recommendation too was based on pesky "research" and "studies".

Some of them cited Dr Sears who advised co-sleeping but he did not make the important distinction between bed-sharing and room-sharing - which was irresponsible. Just to be clear, bed-sharing is bad while room-sharing is good. You'd notice that in his article, he recommends sleeping with babies on different surfaces. He also talked about his two books as evidence of his expertise, but they were written in 1996 and 2005. The latest and largest study on bed-sharing was published in 2012, evidence not available to Dr Sears when he wrote those books.

An admin of TBAN, however, does make that distinction and proudly announced that she bed-shared and endorses the practice,

If there are identifiable underlying issues, it wouldn't be called SIDS, lady.

The admin Daphne Lee-Yang is also the admin of another group which is part of of the anti-vaccination movement,

That's because your unvaccinated babies are being protected by the herd immunity created by other parents who decided to vaccinate, you bloody parasites.

Talking about how the anti-vaccination movement have made ill and even killed countless babies, children and vulnerable adults would require a ten-hour long lecture and a 200 slides presentation on its own, but needless to say, this woman is using her positions of influence to give dangerous advice to other parents. I feel that as someone who witnessed such harmful unscientific ideologies being sold to so many trusting parents, I have a responsibility to say something against this breastfeeding advocacy group that clearly oversteps their boundaries of expertise.

Now on my banning, I have always stayed completely polite when I was in TBAN. I never said anything I couldn't back up with evidence and I have never used my qualifications to bully others into agreeing with me, preferring instead to refer to respectable medical organisations and medical studies. My profession is irrelevant. I could have been a plumber or a rubbish collector but if what I said came from reputable sources, they can stand on their own. This stood in stark contrast to how I had been treated there in turn. The mothers who disagree with me prefer instead to attack me, pointing out that my profile picture is boo-hoo-hoo scary and that I, as a medical doctor, should be out saving lives instead of posting in a Facebook group. Their abusive behaviour had not gone unnoticed,

Finally, a voice of reason!

I had also received private messages from lurking members who wanted to know more about the information I was sharing in TBAN, but they did it quietly because they didn't want to appear to be supporting me for fear of drawing the ire of other moms and the admins, which is yet another indication that TBAN is intolerant of anything that deviates from their orthodoxy.

I was banned because too many mothers disagreed with me. And what is even more baffling is that my wife too was banned from the group as well, even though she wasn't "guilty" of the crimes they executed me on. When my wife asked an admin regarding the reason for her banning, that admin couldn't give her one. Maybe they just didn't like the fact that she's married to me.

A couple of those messages sums up the environment in TBAN quite well,

Uno.

Dos.

Last I checked, they were calling me a "quack" after I had been banned. That is libel, of course, and I can sue them for it. I was also accused of being a House Officer in Sabah when I am actually living in Sarawak. According to them, I was also guilty of the heinous crimes of taking time off from saving lives, reading from a Kindle and blogging about my cats. Ho boy.

Actually, I do have an answer for one of those accusations. I didn't take time off from saving lives. I used my free time to try and save the lives that they were inadvertently harming.

And if they kicked me out for calmly explaining my case (and my wife for being married to me), why then do the admins allow such vitriolic, abusive speech in the group? They talked about me giving off negative vibes and undermining the supportive atmosphere in the group but seriously, what the others were saying were far more mean spirited than anything I would dream of saying - yet they get to stay on. Why?

Because they agree with the admins. They are the echo chambers that insulate them from ever learning anything that doesn't sit well with their personal biases.

In summary, The Breastfeeding Advocates Network is a good peer resource for breastfeeding. Full stop. Take everything there with a sackful of salt. Aside from that, it is nesting site for arrogant mothers who would bully people with views that are different from theirs and while dispensing often misguided medical advice themselves of their own to trusting parents in need. The admins there encourage such imprudence while recommending dangerous medical practices of their own. They also remove anyone who share opinions that upset their monopoly on the minds of their members there.

Needless to say, I'll be directing my patients to safer, more civil and ethical breastfeeding groups in the future.



P.S. Don't take my word (and screen caps) for it, go visit them and see for yourself!



Milking it,
k0k s3n w4i

Attempted Prison Break by the Inner Child

"Lay my body down down

Down upon the water

Wrapped up in the clothes of my mother and my father

O this is longing

I want to be complete

I was waiting round in a little jump seat"

Becomes The Colour (2012) by Emily Wells

Last Tuesday, the wife was admitted to the Labour Room for observation because her Inner Child™ tried to make a break for it from his tiny solitary-confinement cell before he completes his 40 weeks sentence. I like to think he gave up halfway to take a nap. He did, however, manage to have his first cardiotocogram recorded while the wife had a sort of rehearsal in prep for his actual birthday - so all-in-all, it was quite an experience.

The Obstetrics team wanted to keep her under observation for a couple of days, but by Wednesday evening, the wife had quite enough of "being observed" doing nothing the entire day so I went and talked to the Registrar in-charge to ask for an early discharge, which she reluctantly granted. The baby is still inside my wife at the mo, so all is good.

Because of how gravid Cheryl is, moving around have turned into a laborious and, in light of the recent episode of threatened preterm labour, a potentially hazardous proposition. I now buy her her meals ahead of time so she doesn't have to venture out on her own to get food while I am at work. Once in awhile, I would try making dinner.

This was what we had today,

None too shabby, I thought.

It was spaghetti with white creamy mushroom sauce mixed with Genovese pesto and reconstituted dried cranberries. I also tossed in a bit of fried ham strips and sausage slices which I had lying around. The garlic-and-pesto toasties were a teensy bit burned but I kinda like them that way. The wife was really sceptical about the cranberries when I proposed them but she ended up liking them after all.

I made a promise to myself in med school that no matter how busy I get, I must make time to read at least one book a month. While I managed to keep that promise till I graduate, I am sad to report that I had been less than committed to that self-imposed duty once I started working. This month, I managed to finish Tad William's The Dirty Streets of Heaven, a noir-ish supernatural thriller in the veins of The Dresden Files by Jim Butcher (which are guilty pleasures of mine). It was a fun if forgettable read.

On my Kindle, I have gotten started on The Baby in the Mirror, which is an engrossing read by developmental psychologist Charles Fernyhough who detailed his daughter's psychological growth from birth to three. I'm only about a quarter of the way through, but I really enjoy the neurological explanations behind all the little things that babies do and I foresee going back to it over and over again like a sort of guidebook as I watch my own kid grow up. There are a few experiments that I would like to perform on my baby boy, but Cheryl would have none of it. Maybe she'll come around, like she did with the cranberries in the pasta sauce.

Meanwhile, here are some obligatory cat pictures,

Catnapping in the afternoon with Sophie.

Mikey with his crazy blue "WANT" eyes trained on Cheryl's bowl of super not-halal pork porridge.

Mikey, a minute later.

A close-up of Sophie.

We are just three more weeks to term. Wow. I can't believe that this is going to be happening so soon.



Prison warden,
k0k s3n w4i

Why Kindle?

"There are worse crimes than burning books.  One of them is not reading them."

Joseph Brodsky

In 2004, I told the Ex-Grrrfriend™ that in the future, people will read from paperback-sized devices, each capable of storing thousands of books. She laughed and scoffed at that, telling me that it was one of the most ridiculous thing she ever heard and that the idea would never take off. She told me that reading from an electronic display strains eyes and that such devices cannot provide the same tactile pleasure of thumbing a real paper-and-ink novel. Then, we broke up. Probably unrelated.

Later that year, Sony released the LIBRIe, allegedly the first E-Ink e-book reader in the world. A few days ago (or 9 years later depending on how you want to look at it), I decided to buy myself an Amazon Kindle Paperwhite as an early birthday present to myself which, at the time of writing, is the absolute slicing edge of e-book readers.

Now, living on the island of Borneo - the proverbial hairy bottom of the world - I am not privileged with access to Amazon.com's services so I was forced to employ a third party to do my purchasing for me. The wife told me she can get one of her legions of Singaporean friends to help me get one and then mail it to me, but once I start fancying something, waiting any substantial length of time for it will invariably cause me a disproportionate amount of stress. Can't help it. I have been completely spoiled by the culture of instant gratification that the internet engenders. So, I found Kindle Malaysia by way of Google (Praise the Motherboard!) and ordered one from them. I also e-mailed them twice within minutes of purchasing to essentially ask "Is it here yet?"

Kindle Malaysia advertises themselves as a "Painless way for Malaysians to buy Kindle" and boy, they kept their words. They even salved my vexations by answering my e-mails (twice). I made payment on Sunday and my parcel arrived at my doorstep on Wednesday, so I guess that they must have some floor stock ready to ship at a moment's notice.

Damn straight it was urgent, bitches.

I bought the Wi-Fi version of Kindle Paperwhite and a leather wallet plus screen protector for it for a grand total of RM 690. I figured that having constant internet access wouldn't be a necessary feature for a device that can literally store years of entertainment in it. It is also the version with "special offers" that would display unobtrusive ads for deals in the Kindle Store. I opted for it because I might actually be interested in these deals and because it shaved the price of the Kindle down further.

It came in this cool minimalistic chisel-shaped hexahedral black cardboard box,

And I must squee.

After peeling off the seal (which sadly defaced the box a little), I find my newest toy. On it was a screensaver instructing me on how to turn it on,

Technically, the term "screensaver" is a misnomer in this case.

Two of the most irritating things that people say when I told them I bought a Kindle are "Why not get an iPad?" and "Why don't you stick to real books?" So, why indeed? Now, let me take you through my decision making process,



So, Why a Kindle?

I like bright-coloured stuff. Helps me look for them at a glance.

Compared to a smartphone or a tablet PC like Apple's iPad,

• Longer Battery Life: As a heavy smartphone user, I find that one of the biggest handicaps to such devices (with AMOLED or LCD displays) is how long I can use them on a single charge. An iPad, for example, would be drained of juice in just a third of the day. The Kindle Paperwhite boasts that its battery can keep going for 8 weeks at half an hour of reading a day with the wireless turned off and the light setting at 10 (or 28 hours of continuous reading, if you are allergic to hype-speak) because it only needs power to refresh the display.
• Better-Suited Display: The biggest disadvantage of an E-Ink display is that it is only still available only in grayscale (where Kindle is concerned) and users who habitually use smart devices might find the stuttering manner by which E-Ink refreshes a page to be a tad distracting, at least at first. However, its strengths more than made up for its weaknesses. For starters, you can read it just fine under direct sunlight making it much more suitable for outdoor use (and I read out-of-doors a lot when I travel) while the glassy display of other smart devices would be nigh unreadable in the same conditions. And because E-Ink does not glare - a complaint I frequently hear from people trying to read on a tablet PC or smartphone - it reduces eye-fatigue too. Having used it heavily in the past few days, I can attest that it actually looks like there's an actual piece of paper behind the screen.
• Cheaper: Much, much cheaper. More than 2 to 3 times cheaper. Enough said.

An unedited photograph of my Kindle taken with flash at close quarters.

Compared to real ink-and-paper books,

• Lightweight: I compared it to a few paperbacks I have lying around - while it is undeniably weightier than a thinnish novel like China Miéville's The City & the City, it weighs about the same as Neal Stephenson's Cryptonomicon (or Neal Stephenson's anything really). But if I weigh it against my medical textbooks, it is practically feather-light so I can study in bed if I so wish. Also the last time I went on a backpacking trip, my books took up nearly a third of the total weight of of my backpack. Now, I can theoretically carry up to a thousand books with me wherever I go.
• More Ergonomic: I am one of those finicky readers who wouldn't open any book I read more than a 45° angle because I hate creasing the spines (people who have borrowed books from me would know my ground rules). Also when I read a heavy book in bed, I was obliged to rest it on the mattress and turn in bed with every page turn to have the right page facing me. Turning pages is necessarily a two-handed task or I might accidentally dog-ear or fold them. With my new Kindle, I no longer have to worry about all that!
• Read in the Dark: No night-lights or reading lights required. With the illuminated screen, I can read in pitch darkness while my wife snoozes beside me. It's great for when if I go camping as well. With the Paperwhite, I can even finely tweak the luminosity and the gradations run from 0 to 24.
• Special Features: The Kindle Paperwhite comes with a few cool features that real books can never have. For example, I can look up any word using the built-in Oxford Dictionary by just pressing on said word for a second and the definition would pop-up on screen. I can also look at some books with the X-Ray feature that gives notes on who the characters or what objects/places on the page are, and where within the book the same names occur (which would be useful when you are reading a series with a bajillion characters like George R. R. Martin's A Song of ice and Fire). The size of the letters are adjustable, and you can even change the font, the distance between lines and the size of the marginal spaces. There is also a Time to Read feature that tells me how long it would take me to finish the book or current chapter calculated based on my real-time reading speed. Connected to Wi-Fi, I can instantly translate any word or passage using Bing Translator with just a few taps on the screen, or download and read any book I own that I have stored in the Kindle Cloud (which I can access using my PC or my smartphone as well). There are also highlighting, note-making and book-marking features as well, and whenever I open a book, the device and Cloud remembers exactly where I left off.
• Ease of Purchase: One of the most important differences between real books and e-books is that I can have any book I want within seconds. In the past, I had to order them via Kinokuniya or Borders and wait for weeks for them to arrive before making a 2-hour journey from Malacca to KL to pick them up.
• Cheaper: So far, every book I have bought from the Kindle Store cost less than what I would have to pay had I bought them from a conventional bookstore.
• Access to Free Books (Legally): I just downloaded Charles Darwin's On the Origin of Species from the Kindle Store's free e-book collection and there are thousands of books there with expired copyrights that you now technically own by just buying a Kindle. Aside from Amazon.com, you can also download free e-books from Project Gutenberg, Open Library, and countless of other websites on the internet. Seriously, you can get a Kindle and read non-stop for the rest of your life without ever buying a single book.
• Greener: No trees ever need to die to support my reading habit.

And unedited closeup of the display in semi-darkness.

The correct question is, why are you not reading from a Kindle?



P.S. I'll admit that the idea of my own physical library still holds a sort of magical sway over me (and I already own several hundred real books). I guess I just need to get over my irrationality about it.



Embracer of futures,
k0k s3n w4i

Ugly Rumours Regarding Our Marriage and Pregnancy

"What you don't see with your eyes, don't witness with your mouth."

Jewish Proverb

When met with questions regarding the legitimacy of his citizenship, the 44th President of the United States answered those allegations with first releasing the short form of his birth certificate followed by the long form version. There are some who criticised Obama's move because they saw the "birther" movement as a bunch of racist cranks which should not be dignified with any response whatsoever. They think that by responding, the president only managed to smear himself with the shit that had been flung at him. That's how I had been taught to deal with false gossips - just ignore them and people will stop talking about it.

And that sounds exactly like what a defeatist who is too cowardly to deal with the ugliness would say. The thing about gossips is that they are undead. They shamble all over town, festering and growing stinkier as time passes. You may not see or hear them very often, but you can always smell that general atmosphere unaddressed lies hovering about your person. In this aspect, I agree with what Mr Obama did. Rumours and zombies should be put down with a shotgun blast right in their fucking faces ASAP.

I wasn't even aware of the zombie the haunts the circumstances surrounding my marriage and my wife's pregnancy until fairly recently when Cheryl told me a mutual friend of ours mentioned it - he thought that our kid was conceived before we married. In other far unkinder words, he thought that our unborn son is a bastard. Now, I don't have anything against bastards or illegitimacy or any other weird cultural taboos that society gets pathologically hung up about. Cheryl thought it was funny, but I began wondering if the stench of rot was worse than the whiff we got.

Apparently, the suddenness and speed of our knot-tying and our surprise joint-venture into baby-making collided squarely with my known personal views on commitment and procreation. I told all my med school colleagues that I would never marry. I told my father once to forget about any grandchildren from me because I don't like the idea of having kids. Then, I went ahead and did the exact opposite of everything I said. Of course, instead of assuming that I just happened to have met someone so amazing that she turned my whole world around and changed my mind about love, family and everything, people (being the base schadenfreudian scandalmongers that they are) prefer to think that I was snared in a shotgun marriage. This offends me not because people think that I am marrying the love of my life because I wanted to save her the embarrassment of an unplanned pregnancy, but because it insinuates that I actually care if our kid is born out of wedlock or not (hint: I don't). I am deeply offended to be mistaken for someone who observes outdated superstitions of purity and honour that, for some stupid reason or other, our conservative and backward Asian culture prizes so highly. I also do not appreciate the implication that I, a medical doctor by profession, am incapable of using contraception effectively.

Now, I am not going to simply deny that here. I am going to do one better than that - I will provide irrefutable scientific proof to forcibly lay that motherfucking zombie in its grave so hard that it will stay there till kingdom comes and goes away again.

Here is my first piece of evidence, my marriage certificate,

I got two colleagues who happened to be free on that day to come witness.

Here are the points of interest: It records that (a) I am married to Cheryl, and (b) we signed it on the 5th of November, 2012 in the presence of the Registrar and two witnesses. Bear in mind that according to Malaysian marriage regulations, a notice of our marriage must be posted on their notice board for 21 days before we can marry so the latest possible date that we could decide to get hitched is on October 15, 2012. Hold that thought.

Here is evidence number two: my wife's antenatal card,

I call it her "report card".

The crucial piece of information here is my wife's LMP or Last Menstrual Period which had been documented as 23 November 2012. It means that up till the 23rd of November, Cheryl was still having her period so our kid couldn't possibly be conceived earlier than this date.

Here's a bit of medical trivia: the EDD or Expected Date of Delivery is calculated using Naegele's Rule, and it's done by,

1. Adding 1 year to the first day of the last menstrual period.
2. Subtracting 3 months.
3. Adding 7 days.

In other words, a baby's expected birth date is around 9 months and 7 days after the LMP.

Now, in case anyone still wants to quibble or accuse us of putting a fake LMP on the antenatal card (and I can already hear some conspiracy theorists pointing out that the date in the picture above had been crossed out and rewritten once, suggesting that it might had been an arbitrary cooked up date), I have here a third piece of evidence: my wife's early dating scan report,

In a way, it was his first ever baby picture.

In Obstetrics, one of the most reliable tools in ascertaining the gestational age of a baby in its mother's womb is the early dating scan, usually done between the 8th and 14th week after the LMP. The CRL or Crown-Rump Length, if measured in the first trimester, is accurate in determining a baby's gestational age within a ± 5 days error bar. In the picture above, you'd notice that at the time of scanning on the 23rd of January, 2013, the gestational age was 8 weeks and 6 days. So if you work it out backwards, the scanned gestational age was only ONE DAY different from the LMP. Now according to the guidelines, if the difference is less than one week, the calculation of the EDD is then based on the LMP - hence the statement "follow date" which Cheryl's doctor scrawled beside the result.

So, there you have it: scientific and medical proof that all you naysaying fishwives are terrible, negative human beings. Our Unborn Foetal Object™ couldn't possibly be conceived before our marriage. If you perpetuated the gossip or even suspected it in your mind that we got married so quickly because I accidentally impregnated Cheryl, you owe us an apology.

When two persons met and married each other in such a short span of time, it is very easy to look at it with cynical eyes and read ulterior pressures behind the decision. The fact that we decided to forgo any wedding ceremony certainly gave a rushed and disreputable sheen to our union - but that's because we both think weddings are merely pageantry for pretentious patsies (no offence).

But guess what? It's all true. I met someone so sweet, caring and wonderful that she made me abandon everything I thought I knew about relationships and love. She left her job and her life in Singapore in an incredible act of lovestruck spontaneity, not because she was with child (she wasn't) and had to but because she believed in us - and her faith changed me. Together, we decided that we can't live without each other just weeks after our first date. And isn't the truth a lovelier story to tell?




P.S. And if you read this post published on the 30th of July, 2012, you'll see that we have already decided to get married then, almost half a year before Cheryl got pregnant. It seems that rumourmongers are not only spiteful, but are too damn stupid to do basic sums as well. According to them, our baby is still baking in the oven 11 months after he was conceived.




Straightener of records,
k0k s3n w4i