Storm

Read up about heart attack in medical textbooks and, chances are, you will learn about the plaque that clogs the arteries, the lipid-rich core of vulnerable plaque covered by a thin fibrous cap - as thin as half of our hair diameter. Think of it as a trash bin secured barely with a foil instead of a sturdy lid: when things has gone haywire (as they always did), that fibrous cap or foil breaks suddenly and erupts like the deadliest volcano, with all the junk suddenly bursting like lava to cause blockade of the artery.

Heart attack or acute coronary syndrome is serious, that much is clear. Remarkably little is known about the lung attack by the new coronavirus. If the devastating attack of this virus sounds completely mind-blowing, I'm with you. The blitz or ambush by this ever-changing-from-delta-to-omicron virus can be worse than a volcano eruption - ask anyone who has looked after an infected patient. It's practically called a storm. The virus simply kicks off a lid and spews out powerful drivers of inflammation, setting up a cascade of bushfire spreading everywhere, faster than you can imagine.

Every time I came across such a patient, I had that same precarious feeling I'd met him or her too late, like there would have been a better and earlier time window to find a trash can lid lock. Every time I thought I should have control, the bushfire bounced back like a boomerang. So it lingered. On and on. And on.

I seemed to tame the fire in one of the worst patients more than one month ago. Initially, she struggled to breathe when the hyperarousal state of immune system shut down her lungs. With time, she was getting rid of the coronavirus but still needed high flow moistened oxygen delivered through tubes into the nose. I told her I would go back to see her every day. I did. Day after day.

I told myself, as with anything, if you don't try then you will never know. I was carried on a wave of enthusiasm through that nasty wild bushfire fighting, here and there, week after week.

She didn't make it at the end.

Looking back, what do I remember?

If it doesn't set your soul on fire, it's not worth the burn.

Schadenfreude

Let me be the first to confess that I've been having unbridled antipathy towards patients coming to hospital, sick with the virus but without vaccination. I'd describe myself as having difficulty with being neutral to antivaccination folks, even I know pretty well a doctor shouldn't be.

The terrifyng rage moment of seeing the unvaccinated status, every time I admitted such patients, would set off a curse inside my head. God forbid, I know how a doctor should have behaved otherwise. But still.

Enter Brené Brown, American professor, long-time researcher on shame and vulnerability, who recently published her book Altas of the Heart. In this book, Brené Brown has devoted thirteen chapters to a kaleidoscopic medley of emotions. Here, too, she raised the topic of schadenfreude. How true: the undeniable-yet-so-guilty emotion during our struggle with schadenfreude toward unvaccinated people who get infected. That's a topic we don't talk about openly. At least not for a doctor like me.

Descale

Of all my rituals after waking up, making coffee appears to be the most highly consistent. I crave coffee every morning. We all do. It is little wonder, then, that it's disconcerting for me when my coffee machine didn't work two days ago.

People used to think that it can be dangerous for heavy drinkers to suddenly stop alcohol. Alcohol withdrawal actually kills. Not infrequently, I think this applies to coffee, too. I was, of course, trying hard to troubleshoot by googling. I started calling the service hotline after several unsuccessful attempts.

It was then I realised that my coffee machine was getting stuck because of the need for descaling. I have never bothered to do so since my purchase of coffee machine nearly four years ago. As I checked from the machine website, I learned that, with time, minerals in water will accumulate on the machine's heating element. Hard deposits like calcium have to be removed or else the limescale build-up will disrupt the coffee-making. Worse still, the machine heating elements can't be seen. Months of mineral build-up could have existed without our knowing it. The terrifying calcium burden inside the coffee machine is no different from the silent killer of calcium-rich cholesterol plaques growing inside our artery wall. First, nothing, I mean nothing, can be felt. Not until the build-up of plaque is heavy enough to rupture and completely clog our heart artery to trigger a heart attack.

As I stood next to the machine watching the rinsing cycles, one after another, I felt a gush of relief. It turned out that I descaled my coffee machine shortly after a weary overnight shift at the hospital. Think about it; those of us working for years without descaling should do so too.