I do not have New Year resolution to make. It's not that such resolution doesn't work – it does. However, why should we make resolutions simply to make ourselves feel better? Why should anyone? Does anyone? I don't, and I never did.
I turn forty next year. Come to think about it. It didn't take long for me to realize that I haven't had my baby until somewhere near the "half time" of my life. What I do at this point, as the panic mounts and I think about my age by the time my daughter graduates, is to stop. I stop just short of actually dropping dead from worrying. Then I think about something I really treasure. A beautiful Christmas gift, say, arriving long way after the festival is still much better than a run-of-the-mill box that arrived on time.
Thurgood Marshall, an eminent jurist who helped bring about the desegregation of America's schools, said it best when someone asked him what he wanted written on his tombstone: "He did the best he could with what he had."
It reminds me of a clinical trial I'd recently completed. The study design is almost impressive – except that it's not. I first launched the study around three years ago. Since then, the recommended treatment has really changed, leaving my treatment design obsolete. I sighed. Yet I know I did my best I could with what I had three years ago. I then tiptoed into writing up the study.
Let's move on. That's all any of us can do – try our best with what we have. Forget about the New Year resolution.
Thursday, December 31, 2009
Tuesday, December 22, 2009
Pi
Recent reading the novel Life of Pi brings back my overseas training memories that are engraved in a way I know will never fade.
Yann Martel's Life of Pi chronicles the tale of a 16-year-old Indian boy moving to Canada. One time, during my training in Montreal eight years ago, I started reading this novel, and never got the chance to finish it before coming back. I know I won't remember the story and will have to go back to page one again.
Wait. I talked earlier the memory that has stayed with me for years. There is another story I like to tell.
Those books I read in Montreal, over twenty of them, made clear ripples and then less and less so. Obviously, I can never remember every detail. One thing I know for sure is that lovely memory of the Chapters bookstores in Montreal, where I buried my nose at all kinds of books every evening and weekend.
Over the course of one-year laboratory training in Montreal, I didn't have to look after patients. When the day's work was done, it would be hard for me not to hang out at the Chapters. I found plenty of chairs and couches inside the store. They were not the most comfy couches on earth, but they were mostly very kind with hospitality. I loved them and stretched out on the couches to read. By the time I closed a book with a sense of triumph and satisfaction, I would have almost sunk to the bottom of the couch. There was just one problem: most of the blood would have settled in my legs after sitting in a locked position during my avid reading. Next I tried to stand up, and every so often would pass out. But the point is that, like shooting heroin, the experience of near-fainting feels so good.
Yann Martel's Life of Pi chronicles the tale of a 16-year-old Indian boy moving to Canada. One time, during my training in Montreal eight years ago, I started reading this novel, and never got the chance to finish it before coming back. I know I won't remember the story and will have to go back to page one again.
Wait. I talked earlier the memory that has stayed with me for years. There is another story I like to tell.
Those books I read in Montreal, over twenty of them, made clear ripples and then less and less so. Obviously, I can never remember every detail. One thing I know for sure is that lovely memory of the Chapters bookstores in Montreal, where I buried my nose at all kinds of books every evening and weekend.
Over the course of one-year laboratory training in Montreal, I didn't have to look after patients. When the day's work was done, it would be hard for me not to hang out at the Chapters. I found plenty of chairs and couches inside the store. They were not the most comfy couches on earth, but they were mostly very kind with hospitality. I loved them and stretched out on the couches to read. By the time I closed a book with a sense of triumph and satisfaction, I would have almost sunk to the bottom of the couch. There was just one problem: most of the blood would have settled in my legs after sitting in a locked position during my avid reading. Next I tried to stand up, and every so often would pass out. But the point is that, like shooting heroin, the experience of near-fainting feels so good.
Saturday, December 19, 2009
Colic
Preparedness is no laughing matter. It's real. Just when I think I've read up and prepped myself on a subject, the real thing will happen exactly.
To give you a little bit of the idea, I would say it's just like looking into a crystal ball. I believed that I should take a good look at Dr. Spook's Baby and Child Care yesterday; I then read the advice how to nurse and breast-feed a baby when the mother is ill. This made me feel like I was already in control of it. I was less scared after being told, to be sure, there is a chance of the baby's catching the ailment, but this would be true even if the infant weren't being nursed. I can rest assured that babies on average have milder colds than other members of the family because they received many antibodies from their mothers before birth.
I told my wife all about this. Then the real story unveiled itself last night; my wife caught some bad virus and began to throw herself up. She moaned. No, she grimaced as she continued to feed our baby. Ugh! Colic is much less a problem for our baby. It's her mother who got into nasty colic. Her stomach was in knots. Oh, my. That's exactly what I had been told. I know.
To give you a little bit of the idea, I would say it's just like looking into a crystal ball. I believed that I should take a good look at Dr. Spook's Baby and Child Care yesterday; I then read the advice how to nurse and breast-feed a baby when the mother is ill. This made me feel like I was already in control of it. I was less scared after being told, to be sure, there is a chance of the baby's catching the ailment, but this would be true even if the infant weren't being nursed. I can rest assured that babies on average have milder colds than other members of the family because they received many antibodies from their mothers before birth.
I told my wife all about this. Then the real story unveiled itself last night; my wife caught some bad virus and began to throw herself up. She moaned. No, she grimaced as she continued to feed our baby. Ugh! Colic is much less a problem for our baby. It's her mother who got into nasty colic. Her stomach was in knots. Oh, my. That's exactly what I had been told. I know.
Sunday, December 13, 2009
The Little Prince
I remember reading the queer experience of the little prince seeing a lamplighter putting out the street lamp, followed by lighting it again. And then another morning, with the lamp extinguished again. Over a hundred thousand times. I remember it as a back-and-forth between the lamplighter and the little prince's fondness for his own rose. Antoine de Saint Exupéry's story helps me understand what the little prince describes as "the rose that belongs to me."
"Because she is my rose," said the little prince. "In herself alone she is more important than all the hundreds of you other roses."
This passage moves me every time I read it. This is even more so after having a new baby. Now she has my full attention; it is she that I have changed nappies; it is she that I have bought truckloads of outfits and nightclothes. Just as the little prince cherishes his own rose, I'm simply enthusiastic with mine although an ordinary passerby would think that my baby looks like the hundreds of other babies.
It's an idea that cries out for individual experience. It appeals not to the gardeners' teaching of how to water roses, but to your own way of watering. We learned the bell curve and growth chart, but I have to look after my baby in her own manner. Never mind that mine hasn't gained much weight after birth. Nobody is to classify my baby as "failure to thrive." And let's face it, we don't want to classify ourselves as a failure. Who does? Countless times my wife and I have to decide if our baby gets enough breast milk. Sh-h-h, we fix our eyes on the clock and keep track of how many minutes (if not seconds) our baby suckles. From the moment we brought our baby home from the hospital, everything changed. Taking care of our own baby is, after all, a learn-by-doing, seat-of-the-pants, unique and individual project. To make life simple, we need our own way of doing it. Right now, for example, we've thrown away the notepad for scoring the start and end times of each feeding. Every time our baby girl starts her meal, I play a new CD. Instead of counting as the clock ticks, we learn to count the number of songs. It works – and definitely for our little princess.
"Because she is my rose," said the little prince. "In herself alone she is more important than all the hundreds of you other roses."
This passage moves me every time I read it. This is even more so after having a new baby. Now she has my full attention; it is she that I have changed nappies; it is she that I have bought truckloads of outfits and nightclothes. Just as the little prince cherishes his own rose, I'm simply enthusiastic with mine although an ordinary passerby would think that my baby looks like the hundreds of other babies.
It's an idea that cries out for individual experience. It appeals not to the gardeners' teaching of how to water roses, but to your own way of watering. We learned the bell curve and growth chart, but I have to look after my baby in her own manner. Never mind that mine hasn't gained much weight after birth. Nobody is to classify my baby as "failure to thrive." And let's face it, we don't want to classify ourselves as a failure. Who does? Countless times my wife and I have to decide if our baby gets enough breast milk. Sh-h-h, we fix our eyes on the clock and keep track of how many minutes (if not seconds) our baby suckles. From the moment we brought our baby home from the hospital, everything changed. Taking care of our own baby is, after all, a learn-by-doing, seat-of-the-pants, unique and individual project. To make life simple, we need our own way of doing it. Right now, for example, we've thrown away the notepad for scoring the start and end times of each feeding. Every time our baby girl starts her meal, I play a new CD. Instead of counting as the clock ticks, we learn to count the number of songs. It works – and definitely for our little princess.
Wednesday, December 9, 2009
Buying
Many a time while going shopping, I would ask my wife what's the purpose of buying a new thing. Without a doubt, finding the reason to spend money on anything new is the most challenging test a man will ever face.
After nine months of witnessing my wife's ever-growing belly to be a full-fledged baby, it began to dawn on me that I might not be as good as my wife in buying the right stuff.
Oh, sure, I hadn't thought of any good reasons when my wife previously bought all kinds of pillows and cushions – not until the pregnancy Olympics kick-started. I then saw her juggling the pillows and cushions to sleep through the night during her last trimester, to accommodate the gymnastics routine of our new baby during breastfeeding. I must confess the shame I feel when I had the eye-opening demonstration of versatile cushions.
In much the same vein, I could never understand why my wife bought me that many T-shirts. T-shirts are downright durable. Why should I have so many of them when one T-shirt seems to last forever? It isn't easy to find out why until I looked at her bigger and bigger tummy. Each and every day I would see her wearing my comfy T-shirts – lots to pick from my wardrobe.
After nine months of witnessing my wife's ever-growing belly to be a full-fledged baby, it began to dawn on me that I might not be as good as my wife in buying the right stuff.
Oh, sure, I hadn't thought of any good reasons when my wife previously bought all kinds of pillows and cushions – not until the pregnancy Olympics kick-started. I then saw her juggling the pillows and cushions to sleep through the night during her last trimester, to accommodate the gymnastics routine of our new baby during breastfeeding. I must confess the shame I feel when I had the eye-opening demonstration of versatile cushions.
In much the same vein, I could never understand why my wife bought me that many T-shirts. T-shirts are downright durable. Why should I have so many of them when one T-shirt seems to last forever? It isn't easy to find out why until I looked at her bigger and bigger tummy. Each and every day I would see her wearing my comfy T-shirts – lots to pick from my wardrobe.
Sunday, December 6, 2009
Red Letter Day
Red letter days never cease to fill our hearts with joy and real fun. So much so that, hooray, the arrival of my baby brings with her miraculous words of admiration.
But there's a catch. The right thing to say – as it is when it comes to so many aspects of red letter days – is what's appropriate for everyone.
If there's anything more embarrassing than a question "So, when are you going to tie the knot?" in a wedding party, it's the question "When are you two going to have kids?"
The reality is that such questions often pop up while we're supposed to be celebrating. This happened when the friends came to celebrate the birth of my angel. Beads of perspiration glistered over my forehead when my mum, brimming with surprising enthusiasm, asked the second "funny" question. Hmmm. Is this really anyone else's business? That never is.
But there's a catch. The right thing to say – as it is when it comes to so many aspects of red letter days – is what's appropriate for everyone.
If there's anything more embarrassing than a question "So, when are you going to tie the knot?" in a wedding party, it's the question "When are you two going to have kids?"
The reality is that such questions often pop up while we're supposed to be celebrating. This happened when the friends came to celebrate the birth of my angel. Beads of perspiration glistered over my forehead when my mum, brimming with surprising enthusiasm, asked the second "funny" question. Hmmm. Is this really anyone else's business? That never is.
Saturday, November 28, 2009
Fish
It's one week before the birth of my baby and I have many ultrasound photos capturing her adventure from the earliest embryo inside the womb. It is hard not to feel awestruck watching her growth from a humble-looking yolk sac to a lovely one with brain, heart, nose and legs.
Having a wife as an obstetrician means abundant opportunity for me to watch and adore my yet-to-be-born baby's face. Sure, the photos of her face invite lots of oohs and aahs from our enthusiastic friends and families. "Amazing! The nose looks like mum's and her mouth resembles dad's…"
In no ways is her face to be confused with others. No one will be surprised that we're obsessed with the question how different and unique our baby is to be. I really believe it's so.
After my recent bedtime reading of Neil Shubin's Your Inner Fish, however, I start to look at our body in another way.
It turns out that we all look incredibly alike, instead of being unique in oneself. In his entertaining book, the distinguished paleontologist showed me all the exciting similarity between our anatomy and that of mammals, reptiles, and even fish. The chapter on the twelve pair of cranial nerves is the funniest. Most medical students, writes Shubin, should have had lost their ways amidst the maze of these twelve nerves, branching to take bizarre twists and turns inside the skull. Complicated as they are – believe it or not – cranial nerves inside our head shared a remarkable and elegant blueprint with every skull on earth. This applies, alas, to that of a shark, a bony fish, a salamander, or a human. Quite contrary to my imagination, virtually all of our cranial nerves are present in sharks, for instance. The parallels go deeper than having the equivalent trigeminial nerves, facial nerves, glossopharyngeal nerves, vagus nerves: these equivalent nerves in humans and our aquatic cousins supply similar structures, and they even exit the brain in the same order.
The message from Neil Shubin is clear: we're profoundly similar to each other. We are.
Having a wife as an obstetrician means abundant opportunity for me to watch and adore my yet-to-be-born baby's face. Sure, the photos of her face invite lots of oohs and aahs from our enthusiastic friends and families. "Amazing! The nose looks like mum's and her mouth resembles dad's…"
In no ways is her face to be confused with others. No one will be surprised that we're obsessed with the question how different and unique our baby is to be. I really believe it's so.
After my recent bedtime reading of Neil Shubin's Your Inner Fish, however, I start to look at our body in another way.
It turns out that we all look incredibly alike, instead of being unique in oneself. In his entertaining book, the distinguished paleontologist showed me all the exciting similarity between our anatomy and that of mammals, reptiles, and even fish. The chapter on the twelve pair of cranial nerves is the funniest. Most medical students, writes Shubin, should have had lost their ways amidst the maze of these twelve nerves, branching to take bizarre twists and turns inside the skull. Complicated as they are – believe it or not – cranial nerves inside our head shared a remarkable and elegant blueprint with every skull on earth. This applies, alas, to that of a shark, a bony fish, a salamander, or a human. Quite contrary to my imagination, virtually all of our cranial nerves are present in sharks, for instance. The parallels go deeper than having the equivalent trigeminial nerves, facial nerves, glossopharyngeal nerves, vagus nerves: these equivalent nerves in humans and our aquatic cousins supply similar structures, and they even exit the brain in the same order.
The message from Neil Shubin is clear: we're profoundly similar to each other. We are.
Saturday, November 14, 2009
Team
When Stephen M.R. Covey told the story of a business student sitting her final examination, the punch line was the last question of that business degree exam: "What is the name of the person who cleans your dorm?"
What a question! This sort of question made the student want to pull her hair out. Crestfallen, she asked the professor if the question really counted on their final grade. "Indeed it does!" he replied. "A good leader takes nothing for granted and recognizes the contributions made by everyone on the team."
Obviously I am not a leader. Yet, I'm lucky to have someone clean my house. With my baby on the way to landing, we hire a domestic maid. The hardest rite of passage to go through before our maid's arrival is how to live with a newcomer. Well, adults and kids have a common affliction: stranger anxiety. I worried and moaned.
I used the past tense in the last sentence because my maid has arrived and we're having a good time living under the same roof. Several friends of mine sent me their recipes. No, they aren't talking about the recipes for cooking, but the rules to lay down for the domestic maids. An example of the rules is "to pay more attention to taking care of the baby rather than preparing the meal." That sounds reasonable to me. Next the rule states that "No kissing baby." Is there not something amiss when a maid must love our baby but not kiss her? We can only say, "It doesn't work for us."
Our baby hasn't arrived. We don't make particular rules in black and white, but seem to be doing well. She cooks dinner for us, and we treated her to a good seafood dinner at Sai Kung. My friends are stupefied to learn that we're even sharing the laptop (and broadband access) with the maid. But surely the time has come to ask: Why not?
What a question! This sort of question made the student want to pull her hair out. Crestfallen, she asked the professor if the question really counted on their final grade. "Indeed it does!" he replied. "A good leader takes nothing for granted and recognizes the contributions made by everyone on the team."
Obviously I am not a leader. Yet, I'm lucky to have someone clean my house. With my baby on the way to landing, we hire a domestic maid. The hardest rite of passage to go through before our maid's arrival is how to live with a newcomer. Well, adults and kids have a common affliction: stranger anxiety. I worried and moaned.
I used the past tense in the last sentence because my maid has arrived and we're having a good time living under the same roof. Several friends of mine sent me their recipes. No, they aren't talking about the recipes for cooking, but the rules to lay down for the domestic maids. An example of the rules is "to pay more attention to taking care of the baby rather than preparing the meal." That sounds reasonable to me. Next the rule states that "No kissing baby." Is there not something amiss when a maid must love our baby but not kiss her? We can only say, "It doesn't work for us."
Our baby hasn't arrived. We don't make particular rules in black and white, but seem to be doing well. She cooks dinner for us, and we treated her to a good seafood dinner at Sai Kung. My friends are stupefied to learn that we're even sharing the laptop (and broadband access) with the maid. But surely the time has come to ask: Why not?
Wednesday, November 4, 2009
Truth
When doctors speak casually to their patients, little do we realize our words mean an awful lot. Sometimes the truth hurts, and it pains me to say this, but there will be situations that challenge a prima facie duty for honesty. "A good speech isn't one where we can prove that we're telling the truth," Sir Humphrey Appleby once reminded James Hacker, "it's one where nobody else can prove we're lying."
Few, if any, moral philosophers would admonish us to always "tell the truth, the whole truth, and nothing but the truth." Telling a white lie might not do anybody harm. More often than not, it can do your patient a world of good.
Doctors are by no means having the monopoly to please their patients; the reverse also holds true.
Lately, I have been sharing a story about telling truth to doctor. It's a tale I wish didn't need telling. It all started when most of our team went to the States for a conference last week. I screened the referral letters to our specialist clinic for kidney problems. One of the patients had been seen in our clinic decade ago for the finding of heavy protein in her urine. She remained well after treatment but seemed to have the same problem coming back this month. I jotted down a note to expedite her care.
That patient was called back to see me yesterday. As she came into my room, she made a quick remark that she recognized me. "Indeed," I continued the conversation, rather superbly I thought, "I just realized that, after going through your case notes, I was the doctor who first saw you ten years ago." I was pleased to see her again, with pride written all over my face, because my patient remembers me after all these ten years.
"Yeah, yeah, you were young at that time," she replied.
I nodded reluctantly, as if my head was hanging over a guillotine. She is absolutely qualified, I know, to remind me I look older than ten years ago.
Few, if any, moral philosophers would admonish us to always "tell the truth, the whole truth, and nothing but the truth." Telling a white lie might not do anybody harm. More often than not, it can do your patient a world of good.
Doctors are by no means having the monopoly to please their patients; the reverse also holds true.
Lately, I have been sharing a story about telling truth to doctor. It's a tale I wish didn't need telling. It all started when most of our team went to the States for a conference last week. I screened the referral letters to our specialist clinic for kidney problems. One of the patients had been seen in our clinic decade ago for the finding of heavy protein in her urine. She remained well after treatment but seemed to have the same problem coming back this month. I jotted down a note to expedite her care.
That patient was called back to see me yesterday. As she came into my room, she made a quick remark that she recognized me. "Indeed," I continued the conversation, rather superbly I thought, "I just realized that, after going through your case notes, I was the doctor who first saw you ten years ago." I was pleased to see her again, with pride written all over my face, because my patient remembers me after all these ten years.
"Yeah, yeah, you were young at that time," she replied.
I nodded reluctantly, as if my head was hanging over a guillotine. She is absolutely qualified, I know, to remind me I look older than ten years ago.
Saturday, October 31, 2009
Nesting
Expectant cats, rodents, birds, and dogs develop a marvelous burst of manic energy to ready their "nests" just prior to childbirth. This may mean nothing to you, but means a lot to me.
By a quirk of evolutionary fate, human beings are often proud of being different from even our closest cousins in that chimps don't have the ability to reason. Hard as it is for us to imagine, nevertheless, the nesting instinct encoded in the nucleotides of our feathered or four-legged friends of the animal kingdom has been sealed in our DNA, too. There is simply no reasoning when the compelling nesting urge catches us.
I came to accept this shared nesting flurry among all members of the animal kingdom when we're expecting the arrival of our baby. My wife and I – oops, to be honest, the former – clean every crevice of the home, put together cribs without assistance, climb the ladder, go through all our cabinets, set up the baby's room, and do everything at an astoundingly effective tempo. Yeah, yeah. I know you might rightly scratch your heads, but I'm talking about Olympic gold level. Incredible.
Pregnancy folk lore and old wives tales have it that hammer and nails are strictly forbidden at home throughout the pregnancy. I couldn't see why that matters. In fact, I nearly lost my temper when the worker suggested not to carry out decoration last month. Call it superstition if you wish. Not that there will be anything wrong with your baby, I should emphasize, if you break the taboo. After I had shrugged off the spasm of temper tantrums, I started to think about the wisdom of the folklore. Well, it could have been meant to give us a brake to the nesting instinct.
By a quirk of evolutionary fate, human beings are often proud of being different from even our closest cousins in that chimps don't have the ability to reason. Hard as it is for us to imagine, nevertheless, the nesting instinct encoded in the nucleotides of our feathered or four-legged friends of the animal kingdom has been sealed in our DNA, too. There is simply no reasoning when the compelling nesting urge catches us.
I came to accept this shared nesting flurry among all members of the animal kingdom when we're expecting the arrival of our baby. My wife and I – oops, to be honest, the former – clean every crevice of the home, put together cribs without assistance, climb the ladder, go through all our cabinets, set up the baby's room, and do everything at an astoundingly effective tempo. Yeah, yeah. I know you might rightly scratch your heads, but I'm talking about Olympic gold level. Incredible.
Pregnancy folk lore and old wives tales have it that hammer and nails are strictly forbidden at home throughout the pregnancy. I couldn't see why that matters. In fact, I nearly lost my temper when the worker suggested not to carry out decoration last month. Call it superstition if you wish. Not that there will be anything wrong with your baby, I should emphasize, if you break the taboo. After I had shrugged off the spasm of temper tantrums, I started to think about the wisdom of the folklore. Well, it could have been meant to give us a brake to the nesting instinct.
Friday, October 23, 2009
Lecture
I have been giving a number of lectures recently. This is not to say that lecture is effective teaching. It almost never is. Some people like me, I have to say, don't do well during lectures and quickly doze off.
As far as education is concerned, nonetheless, lectures are forever the default mode and practicum little more than a footnote. Indeed, nearly 80 percent of college courses are simply lectures by professors, in a way that you may have been sleeping through most of the time. Only a saint wouldn't sleep during a lecture. Correction: only a dead saint wouldn't sleep in front of a bloody boring lecturer (and it's hard to see how I can be anything else).
Did I mention the guilty lecturer (who has no excuse not to)? To please myself and make the students feel less miserable, I decided to put up my first PowerPoint slide quoting Derek Bok, a former president of Harvard. By the end of a lecture, according to his book Our Underachieving Colleges, a student remembers just less than half of what was taught. Only a week later, that number is down to a stunning rate of 20%.
As far as education is concerned, nonetheless, lectures are forever the default mode and practicum little more than a footnote. Indeed, nearly 80 percent of college courses are simply lectures by professors, in a way that you may have been sleeping through most of the time. Only a saint wouldn't sleep during a lecture. Correction: only a dead saint wouldn't sleep in front of a bloody boring lecturer (and it's hard to see how I can be anything else).
Did I mention the guilty lecturer (who has no excuse not to)? To please myself and make the students feel less miserable, I decided to put up my first PowerPoint slide quoting Derek Bok, a former president of Harvard. By the end of a lecture, according to his book Our Underachieving Colleges, a student remembers just less than half of what was taught. Only a week later, that number is down to a stunning rate of 20%.
Monday, October 19, 2009
Taxi
Of all teachings given by the emotion intelligence guru Daniel Goleman, none is more important than that of the almond-shaped amygdala in an area of the human brain called the limbic system. Disgust, fear and anger, it is said time and again, come from the amygdala which acts like a central alarm system calling for a full-fledged "fight or flight" response.
My recent lectures in Beijing brought back the nineteen-year-old memory of my first (this is my second) visit of Beijing. As so often happened to tourists in mainland China, I found my amygdala sending messages of apprehension, making me edgy and easily startled, say, on a bus or at the train station. I am not sure if you've heard those stories of tourists being mugged and robbed of their kidneys, but I was stupefied to imagine myself coming back with single kidney.
The extent to which our neural circuitry overwhelms us with fear is no news to us. Fear and anger, on the other hand, can be reshaped or relearned. After attending the dialysis conference in Beijing, I traveled around on my last day there. When I went aboard a bus yesterday, I found out there wasn't conductor. That means I had to tender the exact fare – which I didn't have. It seemed clear to me that I should get changes with the passengers on the bus. I tried it sheepishly with my ten-yuan renminbi banknote. You can imagine how nervous I must have been as my Mandarin skill won't allow me to utter more than a few simple sentences. In hindsight, I realized that I had undoubtedly made myself look stupid enough, and I was thrilled when the passenger volunteered to pay for me!
When I headed for the airport in the evening, I took a taxi. I ended up paying 70 yuan while the taxi meter stated 60 yuan. Only a foolhardy gambler would bet that I didn't protest when I had been shortchanged. But no, I didn't. Just why I didn't fly into a fury and quarrel with the taxi driver, to be sure, had nothing to do with my poor Mandarin. Good mood, which lasted after the pleasant experience on the bus in the morning, had probably got my amygdala rewired, short-circuiting the path to irritability and hostility.
A postscript to my story of taxi ride: It is not the case that I was shortchanged, I reckoned afterwards, because the extra ten yuan went to the toll fee.
My recent lectures in Beijing brought back the nineteen-year-old memory of my first (this is my second) visit of Beijing. As so often happened to tourists in mainland China, I found my amygdala sending messages of apprehension, making me edgy and easily startled, say, on a bus or at the train station. I am not sure if you've heard those stories of tourists being mugged and robbed of their kidneys, but I was stupefied to imagine myself coming back with single kidney.
The extent to which our neural circuitry overwhelms us with fear is no news to us. Fear and anger, on the other hand, can be reshaped or relearned. After attending the dialysis conference in Beijing, I traveled around on my last day there. When I went aboard a bus yesterday, I found out there wasn't conductor. That means I had to tender the exact fare – which I didn't have. It seemed clear to me that I should get changes with the passengers on the bus. I tried it sheepishly with my ten-yuan renminbi banknote. You can imagine how nervous I must have been as my Mandarin skill won't allow me to utter more than a few simple sentences. In hindsight, I realized that I had undoubtedly made myself look stupid enough, and I was thrilled when the passenger volunteered to pay for me!
When I headed for the airport in the evening, I took a taxi. I ended up paying 70 yuan while the taxi meter stated 60 yuan. Only a foolhardy gambler would bet that I didn't protest when I had been shortchanged. But no, I didn't. Just why I didn't fly into a fury and quarrel with the taxi driver, to be sure, had nothing to do with my poor Mandarin. Good mood, which lasted after the pleasant experience on the bus in the morning, had probably got my amygdala rewired, short-circuiting the path to irritability and hostility.
A postscript to my story of taxi ride: It is not the case that I was shortchanged, I reckoned afterwards, because the extra ten yuan went to the toll fee.
Emotion
This month, a special issue of Science magazine published over 10 papers, written by a total of 47 authors from 10 countries, covering the discovery of an extraordinary 4.4 million-year-old hominid fossil skeleton known as Ardipithecus ramidus.
Of course, I don't have a whiff of paleoanthropology knowledge to discuss how our ancestors ended up walking on two legs. Still, I must admit, evolution is always a fascinating subject. I've been reading recently about the evolutionary root of our emotional life. I am impressed by the way Daniel Goleman chronicles how our primitive brain evolved to have new layers of brain cells endowed with intellect and emotion. It is not that we have improved a lot in terms of emotional intelligence when compared with our ancestors – trust me, we haven't – but many of us are doing not enough.
An account by a subject in one of the very first scientific studies of anger done in 1899 captures the heart of it:
Once when I was about 13, in an angry fit, I walked out of the house vowing I would never return. It was a beautiful summer day, and I walked far along lovely lanes, till gradually the stillness and beauty calmed and soothed me, and after some hours I returned repentant and almost melted. Since then when I am angry, I do this if I can, and find it the best cure.
The same had certainly happened to me. Once, during my teen years, my mother broke my table tennis racket. That made my hair stand like porcupine quills. Alas, I behaved exactly like what that child did – and, remember, back in 1899. My eyes watered. My heart took flight. I exploded. I grabbed my bag and stepped out of the door: I wasn't coming back. The cooling-down walk left me feeling less angry, not more. The memory of this maiden runaway from home has stayed with me for close to thirty years. Seeing how the history repeats itself – so much so that the narrative looks exactly the same with my own – speaks to a sense of déjà vu. And let's face it, we are no better than our ancestors a century ago.
Of course, I don't have a whiff of paleoanthropology knowledge to discuss how our ancestors ended up walking on two legs. Still, I must admit, evolution is always a fascinating subject. I've been reading recently about the evolutionary root of our emotional life. I am impressed by the way Daniel Goleman chronicles how our primitive brain evolved to have new layers of brain cells endowed with intellect and emotion. It is not that we have improved a lot in terms of emotional intelligence when compared with our ancestors – trust me, we haven't – but many of us are doing not enough.
An account by a subject in one of the very first scientific studies of anger done in 1899 captures the heart of it:
Once when I was about 13, in an angry fit, I walked out of the house vowing I would never return. It was a beautiful summer day, and I walked far along lovely lanes, till gradually the stillness and beauty calmed and soothed me, and after some hours I returned repentant and almost melted. Since then when I am angry, I do this if I can, and find it the best cure.
The same had certainly happened to me. Once, during my teen years, my mother broke my table tennis racket. That made my hair stand like porcupine quills. Alas, I behaved exactly like what that child did – and, remember, back in 1899. My eyes watered. My heart took flight. I exploded. I grabbed my bag and stepped out of the door: I wasn't coming back. The cooling-down walk left me feeling less angry, not more. The memory of this maiden runaway from home has stayed with me for close to thirty years. Seeing how the history repeats itself – so much so that the narrative looks exactly the same with my own – speaks to a sense of déjà vu. And let's face it, we are no better than our ancestors a century ago.
Saturday, October 10, 2009
Grief
Of all the diseases doctors need to be afraid of, spontaneous fracture of an aging Littmann Cardiology II stethoscope is near the bottom of the list. Unless, that is, the stethoscope belongs to you who are seeing patients.
It was a busy Friday afternoon, with packed schedules including unit meeting and clinic, and many patients were coming in from the emergency room. This time, I thought I could feel my stomach tighten when I heard a painful yell of my stethoscope tubing, which was broken into two pieces. When I put my finger on the tubing, it felt as if I were examining a shoulder dislocation with a palpable gap.
Bleakness massed around me quickly, much faster than it had when a senior soccer player found out he had to hang up his boots. I paused and tried to count to ten but only got to two. I breathed in. And I breathed out. Then I breathed a huge sigh of relief. "A retired stethoscope shouldn't ruin my day," I told myself. A broken stethoscope is the psychological equivalent of milk teeth which are beginning to fall out. They simply signify, so to speak, a developmental milestone. My stethoscope is to step down after serving me (and my patients) for more than a decade.
With that in mind, I learned to make peace with the grief reaction while moving on to see my next patient.
It was a busy Friday afternoon, with packed schedules including unit meeting and clinic, and many patients were coming in from the emergency room. This time, I thought I could feel my stomach tighten when I heard a painful yell of my stethoscope tubing, which was broken into two pieces. When I put my finger on the tubing, it felt as if I were examining a shoulder dislocation with a palpable gap.
Bleakness massed around me quickly, much faster than it had when a senior soccer player found out he had to hang up his boots. I paused and tried to count to ten but only got to two. I breathed in. And I breathed out. Then I breathed a huge sigh of relief. "A retired stethoscope shouldn't ruin my day," I told myself. A broken stethoscope is the psychological equivalent of milk teeth which are beginning to fall out. They simply signify, so to speak, a developmental milestone. My stethoscope is to step down after serving me (and my patients) for more than a decade.
With that in mind, I learned to make peace with the grief reaction while moving on to see my next patient.
Sunday, September 27, 2009
Linus
"It's reassuring to believe that circumstances are against you and that you would write a lot if only your schedule had a few more big chunks of time to devote to writing," says Paul J. Silvia, one of the psychologists who received the Berlyne Award. In How to Write a Lot: A Practical Guide to Productive Academic Writing, Silvia helps me see that this barrier, like most false beliefs, persists because it's comforting. I opened this book at random during my recent visit to City Hall Public Library, and could not stop myself turning page after page.
Why do I find this book nifty? A good question. Not that I aspire to be prolific in publication, but that I am writing less productively.
That admitted, I must further confess the shame I feel when caught napping (and with the dream of a big block of time such as spring break). Admit it – we've all indulged in the dream of waiting for the spring break, waiting for inspiration, and on and on and on. Put simply, there is a good chance that my manuscripts, study proposals, book chapters, manuscript reviews, and even reference letters for my interns, will never be finished because of the time wasted in the cozy dreams. The way we bask in such oddly soothing dreams is difficult to quit, much in the way that Peanuts character Linus clings to his security blanket.
Why do I find this book nifty? A good question. Not that I aspire to be prolific in publication, but that I am writing less productively.
That admitted, I must further confess the shame I feel when caught napping (and with the dream of a big block of time such as spring break). Admit it – we've all indulged in the dream of waiting for the spring break, waiting for inspiration, and on and on and on. Put simply, there is a good chance that my manuscripts, study proposals, book chapters, manuscript reviews, and even reference letters for my interns, will never be finished because of the time wasted in the cozy dreams. The way we bask in such oddly soothing dreams is difficult to quit, much in the way that Peanuts character Linus clings to his security blanket.
Friday, September 18, 2009
Teaching
Ever had a bad luck that dooms your day? And as if that's not enough, your friends or classmates are highflying, and that can demoralize you indeed. After recent discussion among our colleagues and students, I'm convinced that taking a look at these bad luck theories can help.
The bad luck theory is one all-important law of human destiny. If we obey the bad luck theory, we shall almost be sure to get into endless trouble. The bad luck theory goes like this: "If I am assigned to a superb teacher like KL, I'll have the advantages that I didn't have." Or: "If I don't get the chance to listen to the heart sound of that patient with atrial septal defect, I won't be able to pick it up at the final examination..." I can hear the sigh already.
When we perceive ourselves at a disadvantage in our school or workplace (that is, most of the time) we tend to get anxious and picture the worst thing that could keep us struck. We sat there and imagined the worst lives that would be without the luck, playing out the consequences or self-fulfilling prophecy.
I'm sure the bad luck theory is too devastating and should be got rid of. There's going to be a completely different story if we remember the modern Pygmalion story of the musical My Fair Lady – I know this makes me sound optimistic, but I am – and accept ourselves who we are and what we have. To draw upon my student experience, I still remember the autodidact days when we didn't have a whiff of teaching on blood diseases. I ended up reading a textbook of Essential Haematology from cover to cover (but not other subjects within the area of medicine) by the time I graduated from medical school. Of course, I have better knowledge on this topic than other subjects for which I received tons of lectures.
The bad luck theory is one all-important law of human destiny. If we obey the bad luck theory, we shall almost be sure to get into endless trouble. The bad luck theory goes like this: "If I am assigned to a superb teacher like KL, I'll have the advantages that I didn't have." Or: "If I don't get the chance to listen to the heart sound of that patient with atrial septal defect, I won't be able to pick it up at the final examination..." I can hear the sigh already.
When we perceive ourselves at a disadvantage in our school or workplace (that is, most of the time) we tend to get anxious and picture the worst thing that could keep us struck. We sat there and imagined the worst lives that would be without the luck, playing out the consequences or self-fulfilling prophecy.
I'm sure the bad luck theory is too devastating and should be got rid of. There's going to be a completely different story if we remember the modern Pygmalion story of the musical My Fair Lady – I know this makes me sound optimistic, but I am – and accept ourselves who we are and what we have. To draw upon my student experience, I still remember the autodidact days when we didn't have a whiff of teaching on blood diseases. I ended up reading a textbook of Essential Haematology from cover to cover (but not other subjects within the area of medicine) by the time I graduated from medical school. Of course, I have better knowledge on this topic than other subjects for which I received tons of lectures.
Tuesday, September 15, 2009
Insane or In Synch
A man was about to stand up from his chair near the end of clinic consultation, when he asked me about his kidney problem. It's around lunch time on a rainy Monday, and after seeing 16 patients, I was wondering if I missed to make abundantly clear that his diabetes mellitus hasn't caused any complications.
"No, not at all. Not even a trace of protein in your urine. Let me repeat: your kidney function is perfectly fine," I explained in a professional manner after looking back at his blood test and urine results. I had a hunch (and it later proved to be pretty accurate) that this patient didn't believe in what his doctor – hell, a doctor with special interest in kidney disease – had said.
Yet, I saw no reason for the worry as to the odds of having kidney problems. He didn't even recall a single family member who had developed kidney disease. So our discussion went on and on and on. I told him it isn't possible. He told me it is. I told him it isn't. He told me it is. I was beginning to conclude that this guy must be insane until he told me about his weak kidneys taking a toll on his sex life. Bank on it. My patient was talking from the perspective of traditional Chinese medicine, wherein our kidneys take care of the sexual function.
There's a lot of this going around. The two of us were simply not in synch when we spoke to each other. There is a story about a five-year-old girl who was chatting with Daniel Gottlieb when they went for a trip in his van. Just as they pulled up to a traffic light, the girl asked this famous psychologist from the back of the van, "Uncle Danny, what does having sex mean?" Needless to say, this is not a question you and I want to answer. Finally Gottlieb took a deep breath, and whispered, "Having sex is what grown-ups do when they want to have a baby."
The older sister of that five-year-old girl wasn't impressed, though. "Uncle Danny, what are you talking about? My sister just asked you, 'What does heaven's sakes mean?'"
"No, not at all. Not even a trace of protein in your urine. Let me repeat: your kidney function is perfectly fine," I explained in a professional manner after looking back at his blood test and urine results. I had a hunch (and it later proved to be pretty accurate) that this patient didn't believe in what his doctor – hell, a doctor with special interest in kidney disease – had said.
Yet, I saw no reason for the worry as to the odds of having kidney problems. He didn't even recall a single family member who had developed kidney disease. So our discussion went on and on and on. I told him it isn't possible. He told me it is. I told him it isn't. He told me it is. I was beginning to conclude that this guy must be insane until he told me about his weak kidneys taking a toll on his sex life. Bank on it. My patient was talking from the perspective of traditional Chinese medicine, wherein our kidneys take care of the sexual function.
There's a lot of this going around. The two of us were simply not in synch when we spoke to each other. There is a story about a five-year-old girl who was chatting with Daniel Gottlieb when they went for a trip in his van. Just as they pulled up to a traffic light, the girl asked this famous psychologist from the back of the van, "Uncle Danny, what does having sex mean?" Needless to say, this is not a question you and I want to answer. Finally Gottlieb took a deep breath, and whispered, "Having sex is what grown-ups do when they want to have a baby."
The older sister of that five-year-old girl wasn't impressed, though. "Uncle Danny, what are you talking about? My sister just asked you, 'What does heaven's sakes mean?'"
Thursday, September 3, 2009
It has been two years since I joined Facebook. I still remembered my reluctance to accept my friend's invitation to join this social-networking site at the very beginning. Why? One reason – one of the big ones – is the anxiety of my space being invaded.
It's a thorny question. We're looking for ways to link with our distant friends. And yet, we might not want certain people (oh, say, our parents) to access our profile page. No matter how many times we hear the stories of Facebook users being caught as a result of their online pictures (for possession of alcohol, defacing a national monument, or any monkey business you can imagine), most of us keep on publishing our personal lives and tastes without a second thought.
Which brings me to a recent New England Journal of Medicine Perspective article about practicing medicine in the age of Facebook. That, in itself, is a remarkable essay of Facebook etiquette, reminding us the possibility of posting items on networking sites that might reflect poorly on us and the medical profession. In practice, doctors and medical students have been taught to be discreet in disclosing information. Matters aren't so straightforward when we surf the social-networking sites. We might simply assume that we're wearing Harry Potter's Invisibility Cloak in front of a computer screen. The next thing we know - God forbid - we're naked.
It's a thorny question. We're looking for ways to link with our distant friends. And yet, we might not want certain people (oh, say, our parents) to access our profile page. No matter how many times we hear the stories of Facebook users being caught as a result of their online pictures (for possession of alcohol, defacing a national monument, or any monkey business you can imagine), most of us keep on publishing our personal lives and tastes without a second thought.
Which brings me to a recent New England Journal of Medicine Perspective article about practicing medicine in the age of Facebook. That, in itself, is a remarkable essay of Facebook etiquette, reminding us the possibility of posting items on networking sites that might reflect poorly on us and the medical profession. In practice, doctors and medical students have been taught to be discreet in disclosing information. Matters aren't so straightforward when we surf the social-networking sites. We might simply assume that we're wearing Harry Potter's Invisibility Cloak in front of a computer screen. The next thing we know - God forbid - we're naked.
Sunday, August 30, 2009
Forgetful
I was reading a short medical review about memory problems in older people. There are, I suppose, good tips for doctors who often come across patients with memory loss.
The article teaches us to ask if the forgetful patient is paying his bills. Does he forget his way and get lost? A quick assessment of the severity of cognitive impairment, I was told, should include orientation to place, recall of three items and general knowledge such as news headlines. And something like that.
"Oops, are they talking about me?" I read with trepidation as I went over the list of questions. "It certainly has happened to me recently." A week ago, I found an insurance payment notice in my bag and simply couldn't remember if I had settled the bill. And then, I lost my way when I traveled on the train to Tsim Sha Tsui. Alas, I forgot the news of opening new rail line. By the time I realized my failing to change train at the new interchange station, I had been sent back on the same train – all the way to my place of departure.
I was in for yet another surprise when I quickly finished that wonderful checklist. If the doctor has the chance to see his patient in his own house, they said, it’s worth looking at the state of his fridge – is it empty or full of decaying food? "Good gracious! How on earth do they know everything about my fridge?" I was dumbfounded. Before the arrival of my baby I took efforts to clean up my home last weekend. And, ah - I found, inside my fridge, zillions of foodstuff already expired.
The article teaches us to ask if the forgetful patient is paying his bills. Does he forget his way and get lost? A quick assessment of the severity of cognitive impairment, I was told, should include orientation to place, recall of three items and general knowledge such as news headlines. And something like that.
"Oops, are they talking about me?" I read with trepidation as I went over the list of questions. "It certainly has happened to me recently." A week ago, I found an insurance payment notice in my bag and simply couldn't remember if I had settled the bill. And then, I lost my way when I traveled on the train to Tsim Sha Tsui. Alas, I forgot the news of opening new rail line. By the time I realized my failing to change train at the new interchange station, I had been sent back on the same train – all the way to my place of departure.
I was in for yet another surprise when I quickly finished that wonderful checklist. If the doctor has the chance to see his patient in his own house, they said, it’s worth looking at the state of his fridge – is it empty or full of decaying food? "Good gracious! How on earth do they know everything about my fridge?" I was dumbfounded. Before the arrival of my baby I took efforts to clean up my home last weekend. And, ah - I found, inside my fridge, zillions of foodstuff already expired.
Tuesday, August 25, 2009
Wasabi
There are only two kinds of people in this world: those who believe that the earth revolves around the sun and those who act as if their babies are the centre of the universe.
Having said that, I find myself morphing inevitably from the former into someone who will monopolize conversations with boring baby topics. Simply put, "baby talk" is similar to wasabi: a little at the right time feels good, but we often overdo it. Oh, yeah, isn't this a normal reaction of becoming a father-to-be? My friends start to say that I have changed, and they're right. I have become more interested in childcare, nursery necessities, parenting, and so on.
Again, the point here is not to discourage us from seeing the world differently. There's plenty to learn how to share our joy and yet without boring the friends, in particular those without kids. It would be hard for a new parent not to talk about his or her newcomer. Still, it would be even harder for us to look from another angle before we're in other people's shoes. That's why I had never thought of freeing our mom-to-be doctors from the action-packed duty of admitting patients from the emergency department in the middle of the night. Nope – not until my wife's becoming pregnant.
Having said that, I find myself morphing inevitably from the former into someone who will monopolize conversations with boring baby topics. Simply put, "baby talk" is similar to wasabi: a little at the right time feels good, but we often overdo it. Oh, yeah, isn't this a normal reaction of becoming a father-to-be? My friends start to say that I have changed, and they're right. I have become more interested in childcare, nursery necessities, parenting, and so on.
Again, the point here is not to discourage us from seeing the world differently. There's plenty to learn how to share our joy and yet without boring the friends, in particular those without kids. It would be hard for a new parent not to talk about his or her newcomer. Still, it would be even harder for us to look from another angle before we're in other people's shoes. That's why I had never thought of freeing our mom-to-be doctors from the action-packed duty of admitting patients from the emergency department in the middle of the night. Nope – not until my wife's becoming pregnant.
Tuesday, August 18, 2009
Conformist
Not long ago, my wife and I had a dinner in a Chinese restaurant. It wasn't a particularly big one, but it served great dishes. But when I caught my wife's eye, I could see she was feeling tired. Then I started to notice that we were sitting beneath a noisy television, and right next to a busy corridor. You can't think of better way to make people throw a fit. Plus an epileptic fit - if you happen to be sensitive to the flicker of the television.
I wondered what prevented me from protesting when I was led to the table. Was it courtesy? An absent-minded faux pas?
I don't think either answer quite fits.
Looking back, it seems now that I have been shaped by my childhood history of making peace. If everyone has a narrative, mine is a tale to conform. Ever since my childhood, I've found it more disturbing to say "no" than to face the real threats to my well-being. Or as Robert Fulghum puts it, "All I really need to know I learned in kindergarten." And I have learned to say yes since I was a little boy. Which means being an easy-going buddy, an amicable student, a peacemaking brother, and on and on and on.
Being a profound believer in the I-do-so-because-I-had-been-taught-so myth, I have occasionally ruminated on whether I am clinging to a romanticized version of the past.
I wondered what prevented me from protesting when I was led to the table. Was it courtesy? An absent-minded faux pas?
I don't think either answer quite fits.
Looking back, it seems now that I have been shaped by my childhood history of making peace. If everyone has a narrative, mine is a tale to conform. Ever since my childhood, I've found it more disturbing to say "no" than to face the real threats to my well-being. Or as Robert Fulghum puts it, "All I really need to know I learned in kindergarten." And I have learned to say yes since I was a little boy. Which means being an easy-going buddy, an amicable student, a peacemaking brother, and on and on and on.
Being a profound believer in the I-do-so-because-I-had-been-taught-so myth, I have occasionally ruminated on whether I am clinging to a romanticized version of the past.
Saturday, August 15, 2009
Summer
Thank God for the air-conditioning. Summer nearly does me in every year. You can feel it. Chocolate melts in your bag before reaching your mouth. The shirt simply sticks to your skin with sweat, and the temperature is unforgiving.
It's no accident that schools break at the summer time. This idea of summer break is not new, but certainly not to be taken for granted. For those of you interested in the history of education, children in the old days attended school year-round, with as many as 48 weeks of study a year. It wasn't until the 1840s (when educational reformers decided that overstimulating young minds could lead to nervous breakdown or insanity) did summer vacation come into existence.
This is just the beginning of the story, not the end. Everything changes. These days, we want our kids to rest less, not more. If you don't believe me, read those bitter laments about short school calendar in the United States (with an average of 180 days) when compared with 243 days a year in Japan. Go and ask the kids here how packed their summer class timetables are. Mind you, it's hot, and don't faint when you hear their answers.
It's no accident that schools break at the summer time. This idea of summer break is not new, but certainly not to be taken for granted. For those of you interested in the history of education, children in the old days attended school year-round, with as many as 48 weeks of study a year. It wasn't until the 1840s (when educational reformers decided that overstimulating young minds could lead to nervous breakdown or insanity) did summer vacation come into existence.
This is just the beginning of the story, not the end. Everything changes. These days, we want our kids to rest less, not more. If you don't believe me, read those bitter laments about short school calendar in the United States (with an average of 180 days) when compared with 243 days a year in Japan. Go and ask the kids here how packed their summer class timetables are. Mind you, it's hot, and don't faint when you hear their answers.
Wednesday, August 12, 2009
Silver Spoon Kid
Being born into not-so-wealthy family, as I mentioned before, doesn't mean a nightmare. How many times have you heard, "Shirtsleeves to shirtsleeves"? This curse is often heard, and its origins are probably buried in those rich-kids-gone-bad tales. Nobody would deny that growing up amid affluence can easily backfire.
Before I tell you what I mean by backfire, let me explain what I don't mean. I would not go so far as to say that the son of a less privileged family learns a good deal about finance management. No. I don't remember any financial education. As a kid or teenager, I was [insert the word am here] woefully ignorant about finance. I had no idea of a paycheck, and I didn't have my personal piggy bank. My knowledge about money can be summed up in a single word. Zilch. "Something that's hard earned," I thought.
So let me go further. From my vantage point, one of the most important lessons from my upbringing is the down-to-earth spending habit. Here's how. I wasn't born to be a spender. My parents never gave me regular pocket money or set up an allowance for me. Although I knew nothing about investing, my dad and mum didn't impose strict rules on how each and every penny was spent. Every time I needed money (often, I didn't) when I was a kid, I simply took whatever I wanted from their purse or wallet. They seldom asked where the money was going and why, and I am glad to this day. My chest swelled with pride, as would my mother's, to know that how much my parents trust me.
Before I tell you what I mean by backfire, let me explain what I don't mean. I would not go so far as to say that the son of a less privileged family learns a good deal about finance management. No. I don't remember any financial education. As a kid or teenager, I was [insert the word am here] woefully ignorant about finance. I had no idea of a paycheck, and I didn't have my personal piggy bank. My knowledge about money can be summed up in a single word. Zilch. "Something that's hard earned," I thought.
So let me go further. From my vantage point, one of the most important lessons from my upbringing is the down-to-earth spending habit. Here's how. I wasn't born to be a spender. My parents never gave me regular pocket money or set up an allowance for me. Although I knew nothing about investing, my dad and mum didn't impose strict rules on how each and every penny was spent. Every time I needed money (often, I didn't) when I was a kid, I simply took whatever I wanted from their purse or wallet. They seldom asked where the money was going and why, and I am glad to this day. My chest swelled with pride, as would my mother's, to know that how much my parents trust me.
Sunday, August 2, 2009
Toys
My wife and I seldom pay attention to the roving exhibitions in shopping arcades. This said, I admit there are good ones around. The other day, for example, we were walking home when we saw an exhibition about local toys from the days of yore. It's hard to walk away without staying behind to go over the sweet memories of long-ago toys.
Years passed. Five. Ten. And decades. Some childhood memories – in particular, with our toys – are engraved in a way we know will never fade. Absurd as the image is, it's often a small toy that lasts the longest in our closet of memory. It might take the form of a used chess set (as what we hear from Amy Tan's Rules of the Game) with dog-eared instruction book, and missing pieces of black pawn and white knight. The weird truth is that most children have their own way of having joy.
I didn't come from a rich family, but I never complain about being brought up in a public housing estate. One of my toys was the door key of my dad. By the end of the day, my father came home and couldn't wait to see us; he held out his bunch of keys a long way down the corridor. Clang, clang, clang. Wait! My brother, sister and I would then listen carefully to the sounds of footsteps and the clanging of keys, trying our best to be the first one in the family to call out loud "Papa." Bingo!
Years passed. Five. Ten. And decades. Some childhood memories – in particular, with our toys – are engraved in a way we know will never fade. Absurd as the image is, it's often a small toy that lasts the longest in our closet of memory. It might take the form of a used chess set (as what we hear from Amy Tan's Rules of the Game) with dog-eared instruction book, and missing pieces of black pawn and white knight. The weird truth is that most children have their own way of having joy.
I didn't come from a rich family, but I never complain about being brought up in a public housing estate. One of my toys was the door key of my dad. By the end of the day, my father came home and couldn't wait to see us; he held out his bunch of keys a long way down the corridor. Clang, clang, clang. Wait! My brother, sister and I would then listen carefully to the sounds of footsteps and the clanging of keys, trying our best to be the first one in the family to call out loud "Papa." Bingo!
Thursday, July 30, 2009
A "Rash" Decision
According to strict local and religious customs in certain Asian countries, male doctors are only allowed to "see" his lady patients covered by full-length veil. Being a doctor myself, I have more than once ruminated on how it can be done. I think for the thousandth time how lucky I am here and don't have to see my patients behind the curtain.
What we seem not to recognize is that, much to our chagrin, we're carrying out such behind-the-curtain consultation every now and then. Many a time while running into another doctor on the corridor, we have a quick conversation about a patient's condition and then offer our expert opinion. We also give order after hearing few words from our nurses at the other end of the telephone. Truth be told, some of us had trouble with this – me, too.
Once upon a time – just one week ago really – my nurse consulted me because his mum got painful tummy. He didn't bring his mum to see me but described the whereabouts of her pain, "Pain at the right side of her tummy, lasting for two days. She went to see a doc at the government clinic, and then was given a referral letter asking for surgical opinion."
I tried to collect my thoughts. "Did she ever mention problem with taking fatty meals?" We agreed that it could have been coming from gallstones, those little pebbles of cholesterol that plague the gallbladder. Behind the story, nevertheless, lurks one of her mum's uterus cancer, which was operated five years ago. That means her mum's belly had a surgical cut made before. When the muscles become weak over that area, the internal organs can bulge through the scar. The nurse thought that this was a very good suggestion. He actually believed that his mum (and the doctor at the government clinic) felt a lump over the belly. I nodded. "Let's get an ultrasound for your mum and see."
A lot of times I get it right and pride myself on my know-it-all diagnosis. Not always, though. Two days later, the nurse brought the ultrasound images and her mum to see me. His mum's ultrasound did show a few innocent gallstones. I couldn't see why that mattered. In fact, when I took a look – finally – at her belly, there was the telltale angry-looking rash of painful shingles on the right side. Ha, ha, ha.
What we seem not to recognize is that, much to our chagrin, we're carrying out such behind-the-curtain consultation every now and then. Many a time while running into another doctor on the corridor, we have a quick conversation about a patient's condition and then offer our expert opinion. We also give order after hearing few words from our nurses at the other end of the telephone. Truth be told, some of us had trouble with this – me, too.
Once upon a time – just one week ago really – my nurse consulted me because his mum got painful tummy. He didn't bring his mum to see me but described the whereabouts of her pain, "Pain at the right side of her tummy, lasting for two days. She went to see a doc at the government clinic, and then was given a referral letter asking for surgical opinion."
I tried to collect my thoughts. "Did she ever mention problem with taking fatty meals?" We agreed that it could have been coming from gallstones, those little pebbles of cholesterol that plague the gallbladder. Behind the story, nevertheless, lurks one of her mum's uterus cancer, which was operated five years ago. That means her mum's belly had a surgical cut made before. When the muscles become weak over that area, the internal organs can bulge through the scar. The nurse thought that this was a very good suggestion. He actually believed that his mum (and the doctor at the government clinic) felt a lump over the belly. I nodded. "Let's get an ultrasound for your mum and see."
A lot of times I get it right and pride myself on my know-it-all diagnosis. Not always, though. Two days later, the nurse brought the ultrasound images and her mum to see me. His mum's ultrasound did show a few innocent gallstones. I couldn't see why that mattered. In fact, when I took a look – finally – at her belly, there was the telltale angry-looking rash of painful shingles on the right side. Ha, ha, ha.
Saturday, July 25, 2009
Parents
"I made quite a few mistakes last night," one of our new doctors confided to her friends in the Facebook, "but I'll learn. By heart."
I was silent for a moment, nodded to myself, and wrote a few words of encouragement.
How could one begin a new job without making mistakes? I couldn't fathom it. The credo of learning from mistakes is never new, not the least for someone, myself included, who is reading a lot about parenthood. New parents, as I was told, can be very much like new doctors; they all make mistakes in order to learn and survive their first few months.
"You know the only people who are always sure about the proper way to raise children?" Bill Cosby had reminded us. "Those who've never had any."
I was silent for a moment, nodded to myself, and wrote a few words of encouragement.
How could one begin a new job without making mistakes? I couldn't fathom it. The credo of learning from mistakes is never new, not the least for someone, myself included, who is reading a lot about parenthood. New parents, as I was told, can be very much like new doctors; they all make mistakes in order to learn and survive their first few months.
"You know the only people who are always sure about the proper way to raise children?" Bill Cosby had reminded us. "Those who've never had any."
Thursday, July 16, 2009
Novice
If there is any similarity between novice medical interns and new parents, chances are that they all make lots of mistakes.
There is so much we don't know about when we become new parents. The same is true for new interns. Of course, they must learn their trade on the job.
As a father-to-be, I haven't the foggiest idea what a parent's life would be. Then I sit back and pat myself, trying to learn the dos and don’ts from the parents' bible, What to Expect: The First Year.
Which brings me to one of the lessons I learned as a medical intern: the way to become a doctor could never have been learned during my medical student's days of reading.
There is so much we don't know about when we become new parents. The same is true for new interns. Of course, they must learn their trade on the job.
As a father-to-be, I haven't the foggiest idea what a parent's life would be. Then I sit back and pat myself, trying to learn the dos and don’ts from the parents' bible, What to Expect: The First Year.
Which brings me to one of the lessons I learned as a medical intern: the way to become a doctor could never have been learned during my medical student's days of reading.
Wednesday, July 15, 2009
Cookie Cutter
With computer being a must for patient care nowadays, our new medical interns scurried off to learn all the electronic survival skills before they started their job this month. Many times, senior and junior doctors alike aren't immune from the trend of electronic medicine. My consultant, to take but one example, asked us about the computer keyboard shortcut keys yesterday. These shortcut keys, in a nutshell, help us to navigate the computer keyboard efficiently. To cut and paste a paragraph, you can do so by simply hitting two keystrokes such as "Ctrl + C." Yeah!
I see no reason for objecting such ways to increase our productivity. I'm simply uncomfortable. Don't ask me why. In a rush to finish the task of writing discharge summary for patients, many of us champion the good news of going electronic. Presto! A few keystrokes would miraculously cut and paste from the old notes, filling the new medical notes with large blocks of texts verbatim. Same size, same order, same sentence, line after line.
Perfect? Yes and no. Simple, perhaps, but much more than that.
Whining about all these paragraph-clones (with copying and pasting identical number of sentences paragraph after paragraph) makes me sound like a stubborn Luddite who bemoans the stem cell cloning technology. Am I? The truth is… new technology is exciting, but not always. Once we doctors let this computerized cookie-cutter do the "cut and paste" job, we've seen the identical (and sometimes meaningless) repetition of patient notes during our rounds and in our clinics. A patient who has had his diabetes mellitus first diagnosed years ago will then persist, in this era of "cut and paste" cloning, to be called "fifty-year-old, newly diagnosed diabetes on dietary control" for each and every of his subsequent clinic visits.
That really bothered me. Still does.
I see no reason for objecting such ways to increase our productivity. I'm simply uncomfortable. Don't ask me why. In a rush to finish the task of writing discharge summary for patients, many of us champion the good news of going electronic. Presto! A few keystrokes would miraculously cut and paste from the old notes, filling the new medical notes with large blocks of texts verbatim. Same size, same order, same sentence, line after line.
Perfect? Yes and no. Simple, perhaps, but much more than that.
Whining about all these paragraph-clones (with copying and pasting identical number of sentences paragraph after paragraph) makes me sound like a stubborn Luddite who bemoans the stem cell cloning technology. Am I? The truth is… new technology is exciting, but not always. Once we doctors let this computerized cookie-cutter do the "cut and paste" job, we've seen the identical (and sometimes meaningless) repetition of patient notes during our rounds and in our clinics. A patient who has had his diabetes mellitus first diagnosed years ago will then persist, in this era of "cut and paste" cloning, to be called "fifty-year-old, newly diagnosed diabetes on dietary control" for each and every of his subsequent clinic visits.
That really bothered me. Still does.
Sunday, July 5, 2009
Verify
We live in an age of mistrust, and perhaps one of the greatest mistrust is felt by those of us with busy lives at work.
This idea began to dawn on me during recent conversation among our medical colleagues who complained bitterly about urgent consultation to see patients outside our department. It can be somewhat frightening to think about the mushrooming consultations within a hospital nowadays. Never in the past were doctors confronted with endless consultation to see patients from other departments (which, mind you, keep increasing in number and variety). The consultations come in many guises. Some of them are darn real urgent, some less so, the others being trivial and almost meaningless.
One of the most difficult tasks is to find out which is which.
Last week, my nephrology trainee brought me to see a patient who had just undergone a surgery of cancer at his neck; he has kidney disease and is on dialysis. "It should be a straightforward case," I thought.
Not until I met the patient did I realize that he had a metallic heart valve. Which means he needs to take anti-clotting medication to stop his metal valve from getting blood clots and hence damaged. Alas! His usual oral anticoagulant (or blood-thinner) medication was simply discontinued without any bridging anti-clotting medication like heparin for almost one week. In case you're wondering whether the surgeons had consulted the cardiologist for opinion, here is the answer: Yes, they did. The consultation letter asked for opinion about the medication before and after the surgery, but never mentioned that the patient has a metallic heart valve. The medical doctor then turned down the request to see the patient and wrote back to the surgeons, asking them to refer this patient for opinion at the outpatient clinic.
In no sense do I mean to say who's right and who's wrong. Difficult to grasp as it might seem, I have always had difficulty in turning down a consultation without either seeing the patient or talking directly to the doctor who makes the consultation request.
My colleagues are no doubt tired of my favorite quotations, including that signature phrase from Ronald Reagan. To which may I add here, "Mistrust, but verify."
This idea began to dawn on me during recent conversation among our medical colleagues who complained bitterly about urgent consultation to see patients outside our department. It can be somewhat frightening to think about the mushrooming consultations within a hospital nowadays. Never in the past were doctors confronted with endless consultation to see patients from other departments (which, mind you, keep increasing in number and variety). The consultations come in many guises. Some of them are darn real urgent, some less so, the others being trivial and almost meaningless.
One of the most difficult tasks is to find out which is which.
Last week, my nephrology trainee brought me to see a patient who had just undergone a surgery of cancer at his neck; he has kidney disease and is on dialysis. "It should be a straightforward case," I thought.
Not until I met the patient did I realize that he had a metallic heart valve. Which means he needs to take anti-clotting medication to stop his metal valve from getting blood clots and hence damaged. Alas! His usual oral anticoagulant (or blood-thinner) medication was simply discontinued without any bridging anti-clotting medication like heparin for almost one week. In case you're wondering whether the surgeons had consulted the cardiologist for opinion, here is the answer: Yes, they did. The consultation letter asked for opinion about the medication before and after the surgery, but never mentioned that the patient has a metallic heart valve. The medical doctor then turned down the request to see the patient and wrote back to the surgeons, asking them to refer this patient for opinion at the outpatient clinic.
In no sense do I mean to say who's right and who's wrong. Difficult to grasp as it might seem, I have always had difficulty in turning down a consultation without either seeing the patient or talking directly to the doctor who makes the consultation request.
My colleagues are no doubt tired of my favorite quotations, including that signature phrase from Ronald Reagan. To which may I add here, "Mistrust, but verify."
Wednesday, June 24, 2009
Loudness
Do you often find yourself giving the thumbs-up to those who finish the job with a big voice? We do. To be honest, we should quit doing so. Here's why.
We've been lately getting unhappy with the performance of my wife's beeper, which makes a less loud voice than before. Two days ago, we decided to buy a new beeper. We can't – and, in fact, we're not supposed to – have a lot of choices because the commercial market of beepers is shrinking with all the cellular telephones and iPhone models around. At the end of the day, the shopkeeper handed us a beeper, the same model of our original one; she told us that it was the one and only one beeper available in stock.
Good, fine, we thought. So it goes. We made the payment at the drop of a hat and got a new beeper. The voice of that new beeper was much louder, I swear. But, it soon came to our attention that the new beeper makes a loud bleep only when it receives the signal – and it rarely does so. Whew! What's the point of a loud beeper but with weak coverage? Well, that was foolish and we lived to regret it.
It goes without saying that we immediately returned the beeper and redeemed our adorable old beeper.
All right, that original beeper doesn't make a big noise, but it sounds much more adorable to both of us now.
We've been lately getting unhappy with the performance of my wife's beeper, which makes a less loud voice than before. Two days ago, we decided to buy a new beeper. We can't – and, in fact, we're not supposed to – have a lot of choices because the commercial market of beepers is shrinking with all the cellular telephones and iPhone models around. At the end of the day, the shopkeeper handed us a beeper, the same model of our original one; she told us that it was the one and only one beeper available in stock.
Good, fine, we thought. So it goes. We made the payment at the drop of a hat and got a new beeper. The voice of that new beeper was much louder, I swear. But, it soon came to our attention that the new beeper makes a loud bleep only when it receives the signal – and it rarely does so. Whew! What's the point of a loud beeper but with weak coverage? Well, that was foolish and we lived to regret it.
It goes without saying that we immediately returned the beeper and redeemed our adorable old beeper.
All right, that original beeper doesn't make a big noise, but it sounds much more adorable to both of us now.
Sunday, June 14, 2009
Sneakers
As we live, we begin to discover what was perfectly sound in the old days would no longer work out in the present day.
Not that I am claiming to be a stubborn old chap who keeps reminiscing about his youth. I'm not sure if you will remember the days when we were left at home taking care of the young siblings. Picture yourself alone with your younger sister, two toddlers not even old enough for kindergarten, playing with a washing-up basin of water. You would have to make sure your younger sister won't drink the water. Fast-forward to the present. This is absolutely illegal. Period.
Then you start to notice that we are simply being disqualified to repeat what we were able to do previously. Over ten years ago (okay, almost two decades) I was having fun hiking and mountaineering with a pair of white canvas sneakers. Okay. The light shoes with flat rubber bottom are primitive, but are affordable to students living on grants and loans. It's no surprise that those slippery sneakers are not waterproof. What may strike you, though, is that I was then doing perfectly well with them, off the beaten tracks like Tai Shing Stream and Double Deer Creek. Not now. Shortly after having a badminton game with my friends this weekend, alas, the primitive white sneakers gave my feet plenty of jolly sore blisters.
I'm not sure of the moral of this story, except that we're often reminded that life can only be understood backwards; but it must be lived forwards.
Not that I am claiming to be a stubborn old chap who keeps reminiscing about his youth. I'm not sure if you will remember the days when we were left at home taking care of the young siblings. Picture yourself alone with your younger sister, two toddlers not even old enough for kindergarten, playing with a washing-up basin of water. You would have to make sure your younger sister won't drink the water. Fast-forward to the present. This is absolutely illegal. Period.
Then you start to notice that we are simply being disqualified to repeat what we were able to do previously. Over ten years ago (okay, almost two decades) I was having fun hiking and mountaineering with a pair of white canvas sneakers. Okay. The light shoes with flat rubber bottom are primitive, but are affordable to students living on grants and loans. It's no surprise that those slippery sneakers are not waterproof. What may strike you, though, is that I was then doing perfectly well with them, off the beaten tracks like Tai Shing Stream and Double Deer Creek. Not now. Shortly after having a badminton game with my friends this weekend, alas, the primitive white sneakers gave my feet plenty of jolly sore blisters.
I'm not sure of the moral of this story, except that we're often reminded that life can only be understood backwards; but it must be lived forwards.
Friday, June 5, 2009
Communication
One of the great boons of working with administrators in a big organization is the chance to learn from them. The fact is, administrators always seem to be miraculous eye-openers. Just asking for something that requires money is usually crime enough under their draconian policy. They don't always turn you down – that depends on how you define it.
I have found numerous such eye-opening examples in the Yes Minister series, and – believe me – they are undeniably fascinating and entertaining. One of the stories goes that Health Service Administration replied to the hospital like this: "Because of the current supply situation it is not possible to issue you with the extra stethoscopes you have applied for. We are, however, in a position to supply you with longer tubes for your existing stethoscopes." The administrators then went so far as to suggest that it could save a lot of wear and tear on the doctors – with sufficiently long tubes for their stethoscopes, they suggested, they could stand in one place and listen to all the chests on the ward.
This is curious, but there is much more curious thing going on around us. I recall with pristine clarity my experience of applying for four cordless phones from our hospital administrators in order to help our medical interns. I talked about the busy extended night shift when our poor interns keep running to and fro, drenched with sweat, their weary lives impoverished by the beepers shouting in bursts. I then suggested that the cordless phones will make the situation less chaotic for our interns in the middle of the night, when the hospital telephone operators are half asleep.
Two days later we received a note from the administrators, who saw no objection to the utmost importance for interns to return beeper calls with telephones. They told us, nevertheless, that the proper way should be to provide the intern rooms with landline phones, instead of cordless phones. As for me, and my sort of brain, I can't figure out the logic. Good gracious! Our interns are schlepping throughout the hospital during the night shift, instead of drinking coffee and answering phone calls at their rooms. The only way their counterproposal can help is to let us live with the illusion that our interns are staying in their rooms for nap. (Often, they can't.)
Finding your request unreasonable in every way imaginable, they come up with astonishing decision, to which you would have difficulty in understanding, not to mention rebuttal. The administrators are, in my mentor's parlance, creatures who have emigrated to Pluto. In short, for reasons too difficult to explain, or impossible to explain, they do not understand a whit what we speak on this planet. And vice versa.
I have not the slightest notion what goes on in the mind of administrators, beyond the conviction that it represents a mind totally beyond my capacity. Just as the administrators are able to make suggestion that I cannot imagine, and smell important things of which I'm unaware, I have a hunch that I can never become an administrator.
I have found numerous such eye-opening examples in the Yes Minister series, and – believe me – they are undeniably fascinating and entertaining. One of the stories goes that Health Service Administration replied to the hospital like this: "Because of the current supply situation it is not possible to issue you with the extra stethoscopes you have applied for. We are, however, in a position to supply you with longer tubes for your existing stethoscopes." The administrators then went so far as to suggest that it could save a lot of wear and tear on the doctors – with sufficiently long tubes for their stethoscopes, they suggested, they could stand in one place and listen to all the chests on the ward.
This is curious, but there is much more curious thing going on around us. I recall with pristine clarity my experience of applying for four cordless phones from our hospital administrators in order to help our medical interns. I talked about the busy extended night shift when our poor interns keep running to and fro, drenched with sweat, their weary lives impoverished by the beepers shouting in bursts. I then suggested that the cordless phones will make the situation less chaotic for our interns in the middle of the night, when the hospital telephone operators are half asleep.
Two days later we received a note from the administrators, who saw no objection to the utmost importance for interns to return beeper calls with telephones. They told us, nevertheless, that the proper way should be to provide the intern rooms with landline phones, instead of cordless phones. As for me, and my sort of brain, I can't figure out the logic. Good gracious! Our interns are schlepping throughout the hospital during the night shift, instead of drinking coffee and answering phone calls at their rooms. The only way their counterproposal can help is to let us live with the illusion that our interns are staying in their rooms for nap. (Often, they can't.)
Finding your request unreasonable in every way imaginable, they come up with astonishing decision, to which you would have difficulty in understanding, not to mention rebuttal. The administrators are, in my mentor's parlance, creatures who have emigrated to Pluto. In short, for reasons too difficult to explain, or impossible to explain, they do not understand a whit what we speak on this planet. And vice versa.
I have not the slightest notion what goes on in the mind of administrators, beyond the conviction that it represents a mind totally beyond my capacity. Just as the administrators are able to make suggestion that I cannot imagine, and smell important things of which I'm unaware, I have a hunch that I can never become an administrator.
Monday, June 1, 2009
Italian lakeland
Sometimes it's the smallest one that gives us the most. Difficult to grasp as it might seem, my recent experience of Italy is a case in point.
When I attended the World Nephrology Congress in Milan, I stayed in a big hotel that comes with the name "Executive." As its name indicates, this hotel must be a grand one, being occupied by over thousands of executives, if not hundreds of thousands. Ah, that's the point, and I ended up paying 10 euros just for the sake of using the wireless net service for 60 minutes.
After the congress, I traveled with my wife and stayed at a two-star hotel above a family-run restaurant in Stresa (a location in Hemingway's A Farewell to Arms, in case you're interested). This small hotel is not a grand one. Obviously not, I know. Yet, the friendly family shared with me their password of the Wi-Fi, without charging me a buck. And, in a way, it didn't matter very much that this small hotel doesn't have rooms at the top end. When I next moved to Menaggio's youth hostel, the room was even smaller – and cheaper. Lest I begin to sound like mean old Scrooge, however, let me say that it is this youth hostel that offered me the most pleasant lakeside view throughout my trip.
Size rarely matters. Content does.
When I attended the World Nephrology Congress in Milan, I stayed in a big hotel that comes with the name "Executive." As its name indicates, this hotel must be a grand one, being occupied by over thousands of executives, if not hundreds of thousands. Ah, that's the point, and I ended up paying 10 euros just for the sake of using the wireless net service for 60 minutes.
After the congress, I traveled with my wife and stayed at a two-star hotel above a family-run restaurant in Stresa (a location in Hemingway's A Farewell to Arms, in case you're interested). This small hotel is not a grand one. Obviously not, I know. Yet, the friendly family shared with me their password of the Wi-Fi, without charging me a buck. And, in a way, it didn't matter very much that this small hotel doesn't have rooms at the top end. When I next moved to Menaggio's youth hostel, the room was even smaller – and cheaper. Lest I begin to sound like mean old Scrooge, however, let me say that it is this youth hostel that offered me the most pleasant lakeside view throughout my trip.
Size rarely matters. Content does.
Monday, May 25, 2009
Neat
Confession time again. When I don't have time (that is, most of the time), I tend to turn my desk into a haven of messy work space. One desk, no filing cabinet, and countless documents, letters, and manuscripts bumping together, frantic as atoms. On many days, I simply pull books out of a jumble of messy documents. Well, my reputation of being a messy guy grows in proportion to the height of the piles on and around my desk. Usually, three days is about all it takes for the piles to grow big enough to block my view of the computer screen, at which point another pile will sprout elsewhere.
Dealing with the mess on my desk is as much fun as visiting the dentist; no one will ever want to share this private bit with others. Conjure up an image of taking showers in the seventh- or eighth-grade gym. It's really about opening the insides in front of everyone, who could see your everything or your lack of everything.
As is often true with embarrassing story in our life, we will grow out of it eventually. For heaven's sake, I'm getting less and less guilt-ridden about the way I tolerate mess. Albert Einstein put it this way: "If a cluttered desk is a sign of a cluttered mind, of what then, is an empty desk?"
Truth be told, I have been lately reading A Perfect Mess, a book that inspires me to learn that our bedroom is a pretty good place to maintain a mess. For those of you who think otherwise and struggle to keep a perfectly neat bedroom, I see no reason why you should miss this book. As the book captures the heart of it, making a bed when you get up in the morning is like tying a shoe after you've taken it off.
Dealing with the mess on my desk is as much fun as visiting the dentist; no one will ever want to share this private bit with others. Conjure up an image of taking showers in the seventh- or eighth-grade gym. It's really about opening the insides in front of everyone, who could see your everything or your lack of everything.
As is often true with embarrassing story in our life, we will grow out of it eventually. For heaven's sake, I'm getting less and less guilt-ridden about the way I tolerate mess. Albert Einstein put it this way: "If a cluttered desk is a sign of a cluttered mind, of what then, is an empty desk?"
Truth be told, I have been lately reading A Perfect Mess, a book that inspires me to learn that our bedroom is a pretty good place to maintain a mess. For those of you who think otherwise and struggle to keep a perfectly neat bedroom, I see no reason why you should miss this book. As the book captures the heart of it, making a bed when you get up in the morning is like tying a shoe after you've taken it off.
Saturday, May 16, 2009
Scary
"I want to go to Hong Kong," my nephew Ethan says firmly. "There is so much fun."
Why the high praise? In the eyes of a seven-year-old second grader brought up in the United States, everything here unleashes his creative process. New things sparkle. Synapses sizzle. That alone is enough to let his creative juices run like spilled ink; Ethan wrote a funny article for his school newspaper after visiting Hong Kong. (https://netfiles.uiuc.edu/echow/www/newspaper2009.pdf)
No matter how many times I read it, I always chuckle when I read the wonderful piece about how eerie our elementary school sounds.
"They have no play structure and grass on their playground, imagine… isn’t it scary?! They don't have snack time and "show and tell", imagine… Isn't it scary?! We can wear anything to school but they have to wear uniforms, too bad."
Among the details Ethan chose to capture was this gem describing the stifling education bureaucracy here. Which is a pretty exact description of the educational system among Asian countries in general.
We dare not tell Ethan, for instance, that the Japanese education ministry had strict requirement to stipulate the exact height of school desks, which has been adjusted upward four times since World War II as students' average height has increased. The detail is specific – it's amazing, actually.
Ahem, sure enough, the way we teach our students matter-of-factly is even more amazing. Our first lesson in strict format came the hard way. Think about the arithmetic lesson at elementary school. The very first thing we learned was the sacred rite to draw a vertical line at seven spaces from the right side. This area, seven spaces in width, is meant to be the box for students to think and work out the arithmetic answer. Boys and girls have been taught to toe the line. Seven spaces, no more and no less. Period.
When it dawns on me that this rule of seven burned indelibly into my mind after so many years, I can't help but shudder.
Why the high praise? In the eyes of a seven-year-old second grader brought up in the United States, everything here unleashes his creative process. New things sparkle. Synapses sizzle. That alone is enough to let his creative juices run like spilled ink; Ethan wrote a funny article for his school newspaper after visiting Hong Kong. (https://netfiles.uiuc.edu/echow/www/newspaper2009.pdf)
No matter how many times I read it, I always chuckle when I read the wonderful piece about how eerie our elementary school sounds.
"They have no play structure and grass on their playground, imagine… isn’t it scary?! They don't have snack time and "show and tell", imagine… Isn't it scary?! We can wear anything to school but they have to wear uniforms, too bad."
Among the details Ethan chose to capture was this gem describing the stifling education bureaucracy here. Which is a pretty exact description of the educational system among Asian countries in general.
We dare not tell Ethan, for instance, that the Japanese education ministry had strict requirement to stipulate the exact height of school desks, which has been adjusted upward four times since World War II as students' average height has increased. The detail is specific – it's amazing, actually.
Ahem, sure enough, the way we teach our students matter-of-factly is even more amazing. Our first lesson in strict format came the hard way. Think about the arithmetic lesson at elementary school. The very first thing we learned was the sacred rite to draw a vertical line at seven spaces from the right side. This area, seven spaces in width, is meant to be the box for students to think and work out the arithmetic answer. Boys and girls have been taught to toe the line. Seven spaces, no more and no less. Period.
When it dawns on me that this rule of seven burned indelibly into my mind after so many years, I can't help but shudder.
Sunday, May 10, 2009
Contagion
How often, when you visited the hospital over the past two weeks, were you asked to take temperature and wear mask? The answer, of course, is often, when everyone seems to be on high alert for human swine flu. If you still aren't convinced about the panic, go and read the posters put up in the hospital elevators: they are now teaching us the recipe - if there is one - which is called cough etiquette.
Regardless of the controversy over the need to quarantine people, most of us are afraid of anything that can spread like a bat out of hell. Swine flu, mad cow disease, severe acute respiratory syndrome, Hansen's disease... Omigod! The list of contagious possibilities is lengthy and, yes, horrifying.
Well, our tendency always is to get overly serious and paranoid, I must say. You're probably thinking that everything that spreads is bad, but it isn't. In fact, I have come across quite a number of good examples recently.
Investigators at Harvard Medical School, for instance, had documented in a part of the Framingham Health Study just how the smoking cessation by a friend or coworker spreads through close and distant social ties. Published in the New England Journal of Medicine, the study highlighted the network phenomena whereby groups of interconnected people stop smoking in concert.
This study dovetails with another "offspring cohort" of the Framingham Health Study, this time published in the British Medical Journal, reporting that happiness is contagious. When the scientists analysed the data looking for happiness trends, they found that happy people passed on their cheer to connected people they didn't personally know - and this transferred happiness lasted for up to a year.
To look for clusters of happy people in the social network, the same group of researchers are now studying happiness contagion in Facebook. Believe it or not, they noticed that people who smiled in their Facebook profile pictures tended to have other friends who smiled.
If you don't believe me, think about the old adage, "Laugh and the world laughs with you. Cry and you cry alone."
Regardless of the controversy over the need to quarantine people, most of us are afraid of anything that can spread like a bat out of hell. Swine flu, mad cow disease, severe acute respiratory syndrome, Hansen's disease... Omigod! The list of contagious possibilities is lengthy and, yes, horrifying.
Well, our tendency always is to get overly serious and paranoid, I must say. You're probably thinking that everything that spreads is bad, but it isn't. In fact, I have come across quite a number of good examples recently.
Investigators at Harvard Medical School, for instance, had documented in a part of the Framingham Health Study just how the smoking cessation by a friend or coworker spreads through close and distant social ties. Published in the New England Journal of Medicine, the study highlighted the network phenomena whereby groups of interconnected people stop smoking in concert.
This study dovetails with another "offspring cohort" of the Framingham Health Study, this time published in the British Medical Journal, reporting that happiness is contagious. When the scientists analysed the data looking for happiness trends, they found that happy people passed on their cheer to connected people they didn't personally know - and this transferred happiness lasted for up to a year.
To look for clusters of happy people in the social network, the same group of researchers are now studying happiness contagion in Facebook. Believe it or not, they noticed that people who smiled in their Facebook profile pictures tended to have other friends who smiled.
If you don't believe me, think about the old adage, "Laugh and the world laughs with you. Cry and you cry alone."
Saturday, April 25, 2009
Final Examination
It is no accident that my friends talked about the medical school examination in their blogs recently. The fourth week of April had passed, and the year-end examination is looming large on the horizon.
Mention final examination, and most of us envisage a medical ward flooded with medical students at every corner, making every effort to see – and touch, if lucky enough – their patients. Like it or not, a grizzled man with artificial heart valves becomes a popular Hollywood movie star, and the hospital is virtually awash with his fans.
This is a race final year medical students have wrestled with for years. And it is symptomatic of all the pressures put together, after five years of medical education.
It would seem to be a truism that a medical student must do well in the final examination in order to be a great doctor. However, I believe that reality is not quite clear. The ability to feel a skin-deep spleen in the examination can earn you good marks or even get on the dean's list. So what? The sense of professionalism is never palpable in the examination setting. As it turns out, there is really not much we can correlate with a student's task of being a professional.
Which brings me to the numerous studies performed at Harvard Business School: those studies were designed to figure out which factors are correlated with a student's future achievement. They've looked at courses taken, marks earned, and all manner of other variables, including height. Unfortunately, there seems to be no relationship at all between the grades a student receives, and his or her later degree of accomplishment. Short-term correlations, yes; long-term, none at all.
Mention final examination, and most of us envisage a medical ward flooded with medical students at every corner, making every effort to see – and touch, if lucky enough – their patients. Like it or not, a grizzled man with artificial heart valves becomes a popular Hollywood movie star, and the hospital is virtually awash with his fans.
This is a race final year medical students have wrestled with for years. And it is symptomatic of all the pressures put together, after five years of medical education.
It would seem to be a truism that a medical student must do well in the final examination in order to be a great doctor. However, I believe that reality is not quite clear. The ability to feel a skin-deep spleen in the examination can earn you good marks or even get on the dean's list. So what? The sense of professionalism is never palpable in the examination setting. As it turns out, there is really not much we can correlate with a student's task of being a professional.
Which brings me to the numerous studies performed at Harvard Business School: those studies were designed to figure out which factors are correlated with a student's future achievement. They've looked at courses taken, marks earned, and all manner of other variables, including height. Unfortunately, there seems to be no relationship at all between the grades a student receives, and his or her later degree of accomplishment. Short-term correlations, yes; long-term, none at all.
Friday, April 17, 2009
Taste
My elder brother came to visit us recently, after working in the United States for more than ten years.
One afternoon I took his family to a food kiosk selling the local street snack "eggettes." That's real Hong Kong style mini-pancake made from special frying pan and served hot. I didn't realize that it is my brother's son, but not his father, who loves these eggettes the most.
Thinking about the changing taste with age, I am often reminded of my experience with cotton candy. As a boy I had not much chance to have cotton candy. I grew up with the belief that cotton candy is one of the most amazing foods in this planet. You'll never know how big a loss that was for me to get a chance to try, and then disappointed by, cotton candy in a carnival many years later at Edmonton. That doesn't mean the cotton candy wasn't sweet. It was. The candy went down sweet, but once done, little substance remained, and even that vanished quickly.
The message is: You can't – and, in fact, you're not supposed to – know exactly what your taste looks like when you get older.
In Bird by Bird, Anne Lamott offers a great lesson about olive: "It's an acquired taste. It is not easy to pop that round odd thing into your mouth. But as you grow up, some things you didn't like, because they're strong, become absolutely delicious."
One afternoon I took his family to a food kiosk selling the local street snack "eggettes." That's real Hong Kong style mini-pancake made from special frying pan and served hot. I didn't realize that it is my brother's son, but not his father, who loves these eggettes the most.
Thinking about the changing taste with age, I am often reminded of my experience with cotton candy. As a boy I had not much chance to have cotton candy. I grew up with the belief that cotton candy is one of the most amazing foods in this planet. You'll never know how big a loss that was for me to get a chance to try, and then disappointed by, cotton candy in a carnival many years later at Edmonton. That doesn't mean the cotton candy wasn't sweet. It was. The candy went down sweet, but once done, little substance remained, and even that vanished quickly.
The message is: You can't – and, in fact, you're not supposed to – know exactly what your taste looks like when you get older.
In Bird by Bird, Anne Lamott offers a great lesson about olive: "It's an acquired taste. It is not easy to pop that round odd thing into your mouth. But as you grow up, some things you didn't like, because they're strong, become absolutely delicious."
Monday, April 6, 2009
Grandpa
My father asked me to go with him paying respect to our grandpa this Ching Ming Festival. His eyes were hopeful, his face eager. His son was ambivalent.
I'm sentimental about many things concerning my grandpa: the memory of going out with him when I was young, the time when I went to his home every day to have wound dressing for his foot ulcer, the night I accompanied him to have foot amputation at the operation theatre, the scene of buying him beer (alas, by the doctor of a patient with diabetes mellitus) in the hospital. But grave-sweeping eight years after his death leaves me cold. It's a festival that has not an iota of idea of what it’s really about. Or at least whom it is dedicated for.
In the interests of domestic harmony, I visited my grandpa's grave with my dad, and observed thousands of people climbing the slope to burn the paper offerings. There's nothing wrong, of course, with spending money on the gold and silver offering paper. Love or passion, apparently, can sometimes be measured in physical quantities. A grandson might measure it in gallons of beer he brought his grandpa; and the grave-sweepers in terms of the height of the stack of paper offerings awaiting to be burnt. For many of us, though, there is confusion between genuine belief of this folk ritual and pretended dialogue with our ancestors – or worse still, with the peers.
I'm sentimental about many things concerning my grandpa: the memory of going out with him when I was young, the time when I went to his home every day to have wound dressing for his foot ulcer, the night I accompanied him to have foot amputation at the operation theatre, the scene of buying him beer (alas, by the doctor of a patient with diabetes mellitus) in the hospital. But grave-sweeping eight years after his death leaves me cold. It's a festival that has not an iota of idea of what it’s really about. Or at least whom it is dedicated for.
In the interests of domestic harmony, I visited my grandpa's grave with my dad, and observed thousands of people climbing the slope to burn the paper offerings. There's nothing wrong, of course, with spending money on the gold and silver offering paper. Love or passion, apparently, can sometimes be measured in physical quantities. A grandson might measure it in gallons of beer he brought his grandpa; and the grave-sweepers in terms of the height of the stack of paper offerings awaiting to be burnt. For many of us, though, there is confusion between genuine belief of this folk ritual and pretended dialogue with our ancestors – or worse still, with the peers.
Sunday, March 22, 2009
Light Bulb
I bragged about my carefree way of living in my last blog. This is a guilty pleasure, I admit.
Confession time. For years, I have not the foggiest idea of what my shirt size or shoe size is. I wrote my birthday wrongly throughout my teens. After all these years, I have been mixing up the hot water tap and cold water tap until I ended up burning my hands with boiling water - each time.
Not that I love Mr. Perfect less, but that I like Mr. Bump more.
So let me go further. I had not bothered to change the light bulbs in my bathroom until the last bulb was gone two weeks ago. When my wife asked me to change the light bulb in the dark (and being a little disappointed, I confess), I kept forgetting until another week later.
Then, the light went on, beaming like a halo around my slobbish head.
Confession time. For years, I have not the foggiest idea of what my shirt size or shoe size is. I wrote my birthday wrongly throughout my teens. After all these years, I have been mixing up the hot water tap and cold water tap until I ended up burning my hands with boiling water - each time.
Not that I love Mr. Perfect less, but that I like Mr. Bump more.
So let me go further. I had not bothered to change the light bulbs in my bathroom until the last bulb was gone two weeks ago. When my wife asked me to change the light bulb in the dark (and being a little disappointed, I confess), I kept forgetting until another week later.
Then, the light went on, beaming like a halo around my slobbish head.
Thursday, March 19, 2009
Who Cares
It takes years before we became aware of what we did have, instead of obsessing about what we didn't. Better still, we'd have better life by not caring at all.
Our team was introduced a cutting-edge machine that is supposed to measure our body composition yesterday.
It goes like this: A current passes through your body and, within a matter of two minutes, the device will tell you much more information than the number of inches around the waist. Enter the details like your age, body weight and body height. Voilà! Amount of fat, lean tissue and water content inside your body will be quickly displayed on the screen, based upon the technique bioimpedance, whatever that meant. Don't feel bad. The worst is coming; the next screen will tell you how many extra pounds of body fat you're carrying.
Not surprisingly, I was being asked to be the guinea pig in order to test the accuracy of that device. "Is there a problem, KM, for you to try the measurement?"
"Not at all," I assured my boss. And, of course, I am not the type of guy who would care. I don't care a whit what I have, to say nothing of what I don't have. The trouble is, I said to myself, I don't even know my body weight and body height, which are supposed to be entered into the device for computation purpose.
I ended up making up the numbers of my body weight and body height. Who cares? And then, who knows?
Our team was introduced a cutting-edge machine that is supposed to measure our body composition yesterday.
It goes like this: A current passes through your body and, within a matter of two minutes, the device will tell you much more information than the number of inches around the waist. Enter the details like your age, body weight and body height. Voilà! Amount of fat, lean tissue and water content inside your body will be quickly displayed on the screen, based upon the technique bioimpedance, whatever that meant. Don't feel bad. The worst is coming; the next screen will tell you how many extra pounds of body fat you're carrying.
Not surprisingly, I was being asked to be the guinea pig in order to test the accuracy of that device. "Is there a problem, KM, for you to try the measurement?"
"Not at all," I assured my boss. And, of course, I am not the type of guy who would care. I don't care a whit what I have, to say nothing of what I don't have. The trouble is, I said to myself, I don't even know my body weight and body height, which are supposed to be entered into the device for computation purpose.
I ended up making up the numbers of my body weight and body height. Who cares? And then, who knows?
Monday, March 9, 2009
Slumdog
Who would have thought that the Oscar goes to the Indian film Slumdog Millionaire this year? And yet Slumdog shines.
As most audience realized, the film is based on a novel written by Indian diplomat Vikas Swarup. I'm not making a judgment about the writing of a diplomat – far from it – but rather noting the undiplomatic manner Jamal Malik answered the interrogation. Picture Jamal at the police station answering the accusation of cheating in order to win two million rupees - by a former street child with little education.
After watching the Slumdog, I went home and had a dream. To help you set the scene in my dream, I should tell you that I didn't take part in "Who Wants to Be a Millionaire." That wasn't a dream of millionaire. I simply found myself dumbfounded in a meeting, with beads of perspiration glistering over my forehead - similar to the street child Jamal.
I was asked to give thoughts on the courageous move proposed by the Prime Minister. I waited. Should I heave a pail of cold water on the suggestion, I surmised, I will get myself into trouble. Call it a stupid move, and I'll get as sure as hell a two-ton chunk of marble dropped on my head.
"I'm not sure that our team will be totally comfortable with the change," I replied at the end of my dream.
The meaning of I'm not sure, obviously, is the opposite of what is to be taken literally. I am quite sure that we're not totally comfortable. This is akin to the situation when we're being challenged on a proposed cut in medical expenditure. "We're not cutting a thing," we should answer. "We're reducing the rate of increase." As taught by William Safire, this should be followed by a laboured explanation how the net amount being spent is more, but less than it would have been if the current rate of increase were allowed to run amok.
You gotta ask, Isn't this a lie?
This isn't, I should make plain, a lie. Come to think of it, we're simply economical with the truth.
As most audience realized, the film is based on a novel written by Indian diplomat Vikas Swarup. I'm not making a judgment about the writing of a diplomat – far from it – but rather noting the undiplomatic manner Jamal Malik answered the interrogation. Picture Jamal at the police station answering the accusation of cheating in order to win two million rupees - by a former street child with little education.
After watching the Slumdog, I went home and had a dream. To help you set the scene in my dream, I should tell you that I didn't take part in "Who Wants to Be a Millionaire." That wasn't a dream of millionaire. I simply found myself dumbfounded in a meeting, with beads of perspiration glistering over my forehead - similar to the street child Jamal.
I was asked to give thoughts on the courageous move proposed by the Prime Minister. I waited. Should I heave a pail of cold water on the suggestion, I surmised, I will get myself into trouble. Call it a stupid move, and I'll get as sure as hell a two-ton chunk of marble dropped on my head.
"I'm not sure that our team will be totally comfortable with the change," I replied at the end of my dream.
The meaning of I'm not sure, obviously, is the opposite of what is to be taken literally. I am quite sure that we're not totally comfortable. This is akin to the situation when we're being challenged on a proposed cut in medical expenditure. "We're not cutting a thing," we should answer. "We're reducing the rate of increase." As taught by William Safire, this should be followed by a laboured explanation how the net amount being spent is more, but less than it would have been if the current rate of increase were allowed to run amok.
You gotta ask, Isn't this a lie?
This isn't, I should make plain, a lie. Come to think of it, we're simply economical with the truth.
Sunday, February 22, 2009
Remember
Yesterday morning, my students asked me reasons for the way certain diseases behave. "This is the way it is," I answered. "All that is ever asked of you is that you have to remember it."
This is my mantra – one I seldom follow.
Despite my teaching others to memorize this and that, I have to admit that my own memory is in decline. There is no question that creativity declines throughout all those years in the medical school. Hey, decline in creativity after rote learning is natural; what else do you expect? Most of us take it for granted, akin to the way a man thinks about the growth of the belly circumference – it simply grows with our age.
But - and this is the point - when it comes to the decline in our memory, we feel like an old man regretting and bemoaning his receding hairline. My brow furrowed and the crow’s feet deepened as I struggled to keep myself from forgetting things. Alas, I went to the post office yesterday and picked up my registered mail, and simply forgot to collect the stamps. Uh-oh. Whenever I quoted something like "a recent study published last month in the New England Journal of Medicine" during the rounds, it would turn out that the paper appeared in the Journal few years ago. As the months and years went by, I realized that I am the victim of dementia. And what makes it worse – it's the sort of disease for which there's no cure! Out loud I say, "I can't even remember when was the last time I remembered correctly."
This is my mantra – one I seldom follow.
Despite my teaching others to memorize this and that, I have to admit that my own memory is in decline. There is no question that creativity declines throughout all those years in the medical school. Hey, decline in creativity after rote learning is natural; what else do you expect? Most of us take it for granted, akin to the way a man thinks about the growth of the belly circumference – it simply grows with our age.
But - and this is the point - when it comes to the decline in our memory, we feel like an old man regretting and bemoaning his receding hairline. My brow furrowed and the crow’s feet deepened as I struggled to keep myself from forgetting things. Alas, I went to the post office yesterday and picked up my registered mail, and simply forgot to collect the stamps. Uh-oh. Whenever I quoted something like "a recent study published last month in the New England Journal of Medicine" during the rounds, it would turn out that the paper appeared in the Journal few years ago. As the months and years went by, I realized that I am the victim of dementia. And what makes it worse – it's the sort of disease for which there's no cure! Out loud I say, "I can't even remember when was the last time I remembered correctly."
Monday, February 16, 2009
Jerome Groopman
In many ways a doctor keeps stories behind their back – stories he's a part of, stories that happen to patients he take care of, stories that he has to live with after sleepless nights, stories nagging at him in the dark places of his mind. So I was not surprised to learn that Jerome Groopman, one of my favourite medical doctor writers for The New Yorker, has been haunted by his own tale.
Having finished his book How Doctors Think, I've learned his story of looking after a middle-aged woman with a litany of complaints. After listening to a new complaint of discomfort in her upper chest, Dr. Groopman made a diagnosis of acid regurgitation from the stomach, and couldn't think in a different way. Several weeks later, his patient died of aortic dissection, a life-threatening condition when a tear happens to the giant artery that carries oxygenated blood from the heart to the smaller blood vessels throughout the body.
Simple as the case may seem to us in hindsight, many of us – certainly I include myself – could have been fooled and regret afterward. I do not wish to compete for a trophy in making wrong diagnosis. I'm simply trying to understand the corrosive mixture of shame and guilt that I learned to feel after hearing the story of Dr. Groopman.
Not long ago, I met an extremely fit man who attended the emergency room after a growing weakness in his legs. He didn't recall injury but he mentioned numbness. The admission team arranged an x-ray and an MRI scan of his spine. That's the way to find out if the large bundle of nerves (that run from the brain to the bottom of the back) is being compressed. I'd already had the MRI reports in the patient file when I first met him. I asked myself what was wrong with this patient. "Ugh. I really don't know, if they can't see evidence of acute spinal cord compression." I then pondered the possibility of a neurological condition in which spinal cord inflammation leads to the disruption of its communication to the legs, and thus problem with moving and feeling his legs. After putting a needle into his lower back to get a sample of fluid surrounding the spinal cord, I found nothing abnormal.
Two days later, a young doctor, who had bothered to take a good look at the MRI films instead of the radiologist's report, discovered an all-too-obvious tear at the large blood vessel, alas, shutting off the blood supply to the patient’s spinal cord.
I kicked myself for missing another case of aortic dissection, but it's too late.
Having finished his book How Doctors Think, I've learned his story of looking after a middle-aged woman with a litany of complaints. After listening to a new complaint of discomfort in her upper chest, Dr. Groopman made a diagnosis of acid regurgitation from the stomach, and couldn't think in a different way. Several weeks later, his patient died of aortic dissection, a life-threatening condition when a tear happens to the giant artery that carries oxygenated blood from the heart to the smaller blood vessels throughout the body.
Simple as the case may seem to us in hindsight, many of us – certainly I include myself – could have been fooled and regret afterward. I do not wish to compete for a trophy in making wrong diagnosis. I'm simply trying to understand the corrosive mixture of shame and guilt that I learned to feel after hearing the story of Dr. Groopman.
Not long ago, I met an extremely fit man who attended the emergency room after a growing weakness in his legs. He didn't recall injury but he mentioned numbness. The admission team arranged an x-ray and an MRI scan of his spine. That's the way to find out if the large bundle of nerves (that run from the brain to the bottom of the back) is being compressed. I'd already had the MRI reports in the patient file when I first met him. I asked myself what was wrong with this patient. "Ugh. I really don't know, if they can't see evidence of acute spinal cord compression." I then pondered the possibility of a neurological condition in which spinal cord inflammation leads to the disruption of its communication to the legs, and thus problem with moving and feeling his legs. After putting a needle into his lower back to get a sample of fluid surrounding the spinal cord, I found nothing abnormal.
Two days later, a young doctor, who had bothered to take a good look at the MRI films instead of the radiologist's report, discovered an all-too-obvious tear at the large blood vessel, alas, shutting off the blood supply to the patient’s spinal cord.
I kicked myself for missing another case of aortic dissection, but it's too late.
Saturday, February 14, 2009
Habit
Almost everyone follows his or her own routine meticulously, so there's a good chance that you do too. And why not? Admit it. We have our own rituals of daydreaming, doing grocery, writing blogs, and even visiting the john.
Trust me, I am no expert on following the routine doggedly. But I've been keeping a habit weekly; I read the New England Journal of Medicine every Thursday for years. In particular, I never miss the case records of Massachusetts General Hospital or Clinical Problem-Solving feature published in the Journal. This weekly clinicopathological exercise is a mind boggling game climaxed by thorough discussion from renowned clinicians, showing us how doctors sleuth for the footprints to a mysterious diagnosis.
Which brings me to a tongue-in-cheek comment by a discussant in the recent case record, "As rheumatologists, we become comfortable with our inability to render precise diagnoses in all patients." This opens my eyes to the truth that we should frankly admit our ignorance. If you take a deep breath and a step back, I think you'll agree with me that, in a way, this sentence should be remembered by every doctor.
Trust me, I am no expert on following the routine doggedly. But I've been keeping a habit weekly; I read the New England Journal of Medicine every Thursday for years. In particular, I never miss the case records of Massachusetts General Hospital or Clinical Problem-Solving feature published in the Journal. This weekly clinicopathological exercise is a mind boggling game climaxed by thorough discussion from renowned clinicians, showing us how doctors sleuth for the footprints to a mysterious diagnosis.
Which brings me to a tongue-in-cheek comment by a discussant in the recent case record, "As rheumatologists, we become comfortable with our inability to render precise diagnoses in all patients." This opens my eyes to the truth that we should frankly admit our ignorance. If you take a deep breath and a step back, I think you'll agree with me that, in a way, this sentence should be remembered by every doctor.
Saturday, February 7, 2009
Basic
As mentioned, I took a recent trip to New Zealand’s national park. On the coastal trail in the park, I carried with me the sleeping bag and stayed in the basic hut.
I said that the hut is basic, and it is. In a nutshell, bunk bed and mattress. We didn't have to share shower facility or electricity because there is simply none. Not much to share with each other really, except the sound of someone snoring.
You're probably thinking that I was having trouble to stay there, but I wasn't. For most of my memorable years after graduation from medical school, I used to sleep like a primitive man at the Stone Age. I simply slept around a humble corner at my hospital – be it the sofa at the office or the patient's bed at day care centre. For goodness' sake, I didn't have to hide from predators as in ancient time, but had to wake up before six thirty, when the hospital amah comes back in the morning.
After all these years, I cherish the gypsy memories of sleeping at any place I can find. Not that sleeping in a basic hut or a corner in the hospital is cozy in itself. The idea is that we might be happier not to bother too much, or, in Henry Thoreau's words, "Man is rich in proportion to the number of things he can do without." I have come to believe it's so.
I said that the hut is basic, and it is. In a nutshell, bunk bed and mattress. We didn't have to share shower facility or electricity because there is simply none. Not much to share with each other really, except the sound of someone snoring.
You're probably thinking that I was having trouble to stay there, but I wasn't. For most of my memorable years after graduation from medical school, I used to sleep like a primitive man at the Stone Age. I simply slept around a humble corner at my hospital – be it the sofa at the office or the patient's bed at day care centre. For goodness' sake, I didn't have to hide from predators as in ancient time, but had to wake up before six thirty, when the hospital amah comes back in the morning.
After all these years, I cherish the gypsy memories of sleeping at any place I can find. Not that sleeping in a basic hut or a corner in the hospital is cozy in itself. The idea is that we might be happier not to bother too much, or, in Henry Thoreau's words, "Man is rich in proportion to the number of things he can do without." I have come to believe it's so.
Tuesday, February 3, 2009
Abel Tasman
I had just returned from the Abel Tasman National Park Coast Track at New Zealand. Situated on South Island's northern shores, it was a long walk over 36 km, with primitive huts for stay overnight.
There is a wealth of awesome tramping tracks in New Zealand but this one is indeed classic. Throughout the track along the coastline, there are quite a number of tidal crossings which can only be passed within a few hours either side of low tide. That means we have to consult a tide timetable when planning the trip across those estuaries, lest the high tides block the track.
To stop myself treading water and wasting time at high tide, I ended up waking before sunrise to leave the hut and start my walk on the second day. Oh, that wasn't a big deal as the sleeping quality at those huts isn't what one would savour. And the tidal crossing turned out to be a revelation.
As I headed across the estuary at low tide in the wee hours of the morning, amidst the songs by bellbirds, fantails and tui, it was with some relief I read from the signpost that the detour route, in case of high tide, would have taken me extra three hours of walk.
Does that sound similar to what we did in mundane world?
I think there's a good deal of similarity between tidal crossing and the day-to-day challenges we face – big ones and small ones alike. The mortgage of our properties, the level of difficulty in any examination and, obviously, the Hang Seng Index, all come with high tide and low tide. Do not mistake my point here. In no sense do I advocate taking short cuts. All of us, no matter how hardworking and diligent, must be ever aware of the possibility of hitting at the high tide. And, for that matter, the time of tide in this universe varies from day to day, and we can't make the low tide comes earlier (not least because the tide timetable doesn't exist at all in most circumstances).
And therein lies a lesson, for which I keep reminding myself and others. A doctor who takes longer to get his or her membership qualification doesn't necessarily perform worse than anyone else; he or she might have simply hit the high tide during the professional examination.
There is a wealth of awesome tramping tracks in New Zealand but this one is indeed classic. Throughout the track along the coastline, there are quite a number of tidal crossings which can only be passed within a few hours either side of low tide. That means we have to consult a tide timetable when planning the trip across those estuaries, lest the high tides block the track.
To stop myself treading water and wasting time at high tide, I ended up waking before sunrise to leave the hut and start my walk on the second day. Oh, that wasn't a big deal as the sleeping quality at those huts isn't what one would savour. And the tidal crossing turned out to be a revelation.
As I headed across the estuary at low tide in the wee hours of the morning, amidst the songs by bellbirds, fantails and tui, it was with some relief I read from the signpost that the detour route, in case of high tide, would have taken me extra three hours of walk.
Does that sound similar to what we did in mundane world?
I think there's a good deal of similarity between tidal crossing and the day-to-day challenges we face – big ones and small ones alike. The mortgage of our properties, the level of difficulty in any examination and, obviously, the Hang Seng Index, all come with high tide and low tide. Do not mistake my point here. In no sense do I advocate taking short cuts. All of us, no matter how hardworking and diligent, must be ever aware of the possibility of hitting at the high tide. And, for that matter, the time of tide in this universe varies from day to day, and we can't make the low tide comes earlier (not least because the tide timetable doesn't exist at all in most circumstances).
And therein lies a lesson, for which I keep reminding myself and others. A doctor who takes longer to get his or her membership qualification doesn't necessarily perform worse than anyone else; he or she might have simply hit the high tide during the professional examination.
Tuesday, January 20, 2009
Walk the Talk
When we fall in love with arguing with people, it is a good feeling that will lead to a darn bad effect. Dale Carnegie claimed that we can't win an argument. We can't because if we lose it, we lose it; and if we win it, we lose it. Why? As often happens, the moment we triumph over the other man and shoot his argument full of holes in an apparently landslide victory, we feel good. But that particular person gets hurt and resents our triumph. And, according to Carnegie, a man convinced against his will is of the same opinion still.
Let me tell you my story. My friend phoned me up yesterday about her mum, who has been seeing me for high blood pressure. She is worried about the "water pill" that I gave her mum, and asked for a "better one." Not every doctor would like the idea – and I bet that many do not – to be challenged. I wasn't sure I'd heard her correctly. "Problem?"
"No, not really, but in case that medication gets rid of too much salt from my mum."
I sighed. I knew there seemed to be nothing I can do, although I have checked her mother's salt level after starting the humble medication. She'd won and I knew it. That medication, indeed, is far cheaper – at least ten times less expensive than those you see in the advertisement. "Fine," I said humbly, "I'm glad that you raised the concern, and yes, I couldn't see the problem with switching to another class of drug. Let me know when she is ready to come to see me."
One final reference was necessary, I thought to myself, after hanging up the phone. So I sent my friend a short message, "Forget to tell you I give the same drug to my mum for her blood pressure. It is not a second class drug, really."
Do I have to tell you the rest of the story, when she replied me about her final decision last night?
Let me tell you my story. My friend phoned me up yesterday about her mum, who has been seeing me for high blood pressure. She is worried about the "water pill" that I gave her mum, and asked for a "better one." Not every doctor would like the idea – and I bet that many do not – to be challenged. I wasn't sure I'd heard her correctly. "Problem?"
"No, not really, but in case that medication gets rid of too much salt from my mum."
I sighed. I knew there seemed to be nothing I can do, although I have checked her mother's salt level after starting the humble medication. She'd won and I knew it. That medication, indeed, is far cheaper – at least ten times less expensive than those you see in the advertisement. "Fine," I said humbly, "I'm glad that you raised the concern, and yes, I couldn't see the problem with switching to another class of drug. Let me know when she is ready to come to see me."
One final reference was necessary, I thought to myself, after hanging up the phone. So I sent my friend a short message, "Forget to tell you I give the same drug to my mum for her blood pressure. It is not a second class drug, really."
Do I have to tell you the rest of the story, when she replied me about her final decision last night?
Tuesday, January 13, 2009
Counts
I would be lying if I told you that I never pay attention to the whims and words of others. It is not that the external opinion is the gold standard of judging ourselves. We are simply human beings who tend to fall prey to the others' view. When the story of our hospital or unit appears in the press, I simply can't ignore it and then answer like Socrates who was once asked if he would worry about being called names, "Why? Do you think I should resent it if an ass had kicked me?"
You might argue that we should convince ourselves that we may be lovable even outside the halo of the praise of others. What's wrong with ignoring the comments from others? Aren't we all comfortable without the worry?
Not as long as you have gone through a whole life of education with emphasis on the grades assigned to you, and with your transcripts studded with those shameful Bs, instead of As.
Without a doubt, the thing that sticks in our mind about our student days has to be that moment we received the report cards. Everyone simply loves a number, a particular number assigned to you by others and reckoned as a good measure by most, if not all, people. Such scoring system haunts us ever since the day we entered the school, and continue to do so for the rest of our life. The popularity of citation index as a means to rank the scientists is just an example of our obsession with the numbers. After an academic researcher has published his works, the number of times that his publications have been cited would then be meticulously counted. Mind you, they only count those citations made by other scientists, but not by the researcher himself or herself. The message is clear and that makes tactical sense: you can't boost up your citation index by yourself and have to rely upon the external voices. Under the big name of bibliometrics, such counting exercise simply drives the university staff busy in their jostle for a better citation index.
Lest you think that I am immune from the obsession with all these numbers, I must confess here that I do time and again look at the number of visitors at my blog. Yes, you count.
You might argue that we should convince ourselves that we may be lovable even outside the halo of the praise of others. What's wrong with ignoring the comments from others? Aren't we all comfortable without the worry?
Not as long as you have gone through a whole life of education with emphasis on the grades assigned to you, and with your transcripts studded with those shameful Bs, instead of As.
Without a doubt, the thing that sticks in our mind about our student days has to be that moment we received the report cards. Everyone simply loves a number, a particular number assigned to you by others and reckoned as a good measure by most, if not all, people. Such scoring system haunts us ever since the day we entered the school, and continue to do so for the rest of our life. The popularity of citation index as a means to rank the scientists is just an example of our obsession with the numbers. After an academic researcher has published his works, the number of times that his publications have been cited would then be meticulously counted. Mind you, they only count those citations made by other scientists, but not by the researcher himself or herself. The message is clear and that makes tactical sense: you can't boost up your citation index by yourself and have to rely upon the external voices. Under the big name of bibliometrics, such counting exercise simply drives the university staff busy in their jostle for a better citation index.
Lest you think that I am immune from the obsession with all these numbers, I must confess here that I do time and again look at the number of visitors at my blog. Yes, you count.
Wednesday, January 7, 2009
Doc 2.0
My boss showed me his recent discussion with one of the chair professors concerning our patient last weekend. It was not very long – or, I should say, deceptively simple.
"Thank you for asking me to see Mr. X. We did review him on daily basis. As a matter of fact, the blood test requested today was not yet received and hence the parameters are all as yesterday."
"Thanks for your information. I am sure he is in good hands but the patient is very concerned. Next time when you drop by, he will be very appreciative if you pad his shoulder."
The last sentence unnerved me and for a moment I floundered.
Sure enough, from the perspective of electronic culture, it's tempting to treat our patients as an icon on the computer screen. Such phenomenon of spending time in front of a computer tracking the patients' blood count like a Dow Jones Index has been pointed out by Dr. Verghese in the New England Journal of Medicine last week. He put up the quote of Alfred Korzybski – that the map is not the territory – to laugh at this cockamamie chart-as-surrogate-for-the-patient approach.
Electronic system is glorious and helpful in a thousand all too obvious ways, but it's always perilous to use computer science to solve every human problem. If you don't believe me, think about the last time you made an enquiry phone call anxiously and ended up being directed to a digital answering machine. Mind you, this is quite similar to an answer like this: "Thank you for calling. Your doctor is currently busy. He or she is behind the screen, making every effort to monitor your health. Please press one for questions related to your white blood count and press two if…"
"Thank you for asking me to see Mr. X. We did review him on daily basis. As a matter of fact, the blood test requested today was not yet received and hence the parameters are all as yesterday."
"Thanks for your information. I am sure he is in good hands but the patient is very concerned. Next time when you drop by, he will be very appreciative if you pad his shoulder."
The last sentence unnerved me and for a moment I floundered.
Sure enough, from the perspective of electronic culture, it's tempting to treat our patients as an icon on the computer screen. Such phenomenon of spending time in front of a computer tracking the patients' blood count like a Dow Jones Index has been pointed out by Dr. Verghese in the New England Journal of Medicine last week. He put up the quote of Alfred Korzybski – that the map is not the territory – to laugh at this cockamamie chart-as-surrogate-for-the-patient approach.
Electronic system is glorious and helpful in a thousand all too obvious ways, but it's always perilous to use computer science to solve every human problem. If you don't believe me, think about the last time you made an enquiry phone call anxiously and ended up being directed to a digital answering machine. Mind you, this is quite similar to an answer like this: "Thank you for calling. Your doctor is currently busy. He or she is behind the screen, making every effort to monitor your health. Please press one for questions related to your white blood count and press two if…"
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