We

I was asked to speak in a hospital forum about nonpunitive response to medical incidents. An apt illustration of the current climate comes from those stories in which honest doctors who make full confession find themselves viewed unfavourably. Should we then keep our mouths shut?

Hardly. There comes a time in the career of most doctors when things go badly awry. It comes earlier for those who work the hardest. No matter when it comes, however, the struggle is best overcome with support from the others. That's why I shared in the forum my way of handling my downright crestfallen colleague after a medical blunder. My usual response is a conscious effort to make use of the term we instead of the insulating pronoun you. "Did we forget to remove the tourniquet after blood taking?" is much preferred to "Did you leave the tourniquet on the patient’s arm?"

Wait. The human psychology of association behaviour is usually the other way round. Instead of linking ourselves to negative stigma, we tend to keep ourselves separate from the failure by the pronoun they. This is best shown by Robert Cialdini who did an experiment in which students at Arizona State University were phoned and asked to describe the outcome of a football game their school team had played a few weeks earlier. Some students were asked the result of a certain game their team had lost; the other students were asked the result of a different game that their school team had won.

How did the students describe the school team victory? "We beat Houston 17 to 14," or "We won."

How about the lost game? "They lost to Missouri, 30 to 20," or "I don't know the score, but Arizona State got beat." And, do you know what the most remarkable answer was like?

"They threw away our chance for a national championship!"

Farewell

"Will you still go to our departmental Xmas party?" It was the shaky voice of my colleague after attending the funeral service of my respectable patient last night.

I said yes. It wasn't that I did not shiver after temperature plunged from 20 degrees Celsius to five degrees. I did. No, the uneasy feeling of transit from a memorial service to a social event with party theme is difficult to shake off. And, I didn't miss the party that much. Going to say goodbye to my patient is even more meaningful. After looking after my patient for few months, I had never realized how awe-inspiring he was – not until I heard the obituary read by his daughter. It's really hard to say that I looked after him when I found out I knew so little about my patient before.

Actually, I'm going to say that I started to love my patient since last night.

Review

A recent British Medical Journal commentary argued about the fairest peer review system in biomedical publication.

Peer review system has been a time-honoured process of evaluating scientific manuscripts; qualified individuals within a relevant field are often invited to critique and comment upon a submitted manuscript (without monetary reward or academic recognition, in case you're interested to know) before the editors make a final decision to publish it or not.

Is it fair? Not even close. No, it's not fair; but it is a fact. Peer review is done by and large anonymously. It is never easy to be objective. The first sense to judge a manuscript is, if I'm being honest, the stomach. I'm serious. It occurs right in the pit of my stomach when I first judge a manuscript. I listen more to my stomach, far ahead of my heart of hearts, and definitely above my brain, if at all. Unsettling as it is, psychological evidence indicates that we experience our feelings toward something a split second before we can intellectualise about it.

I remember quite well my stomach feeling early this week, after accepting an invitation to review a manuscript submitted to the journal Peritoneal Dialysis International. I didn't know the authors, but my stomach tightened as soon as I read their cover letter. "On behalf of all the authors, I would like to ask you to consider our manuscript entitled XXX for publication in Clinical Journal of the American Society of Nephrology as a case report." All at once, things began to make sense. These were people (or lazy slug, dare I say) who submitted their manuscript to a far more prestigious journal, got rejected, and submitted the whole stuff unchanged (including the cover letter) to a second medical journal.

A decision was made before I read further.

Happy Birthday Jasmine

On the same afternoon in 2009, I was reading What to Expect the First Year, eager to set the stage for Jasmine's arrival. One year later, I brought Jasmine to her first preschool playing class today, carrying with me the special TimeFrames issue. That's an issue devoted to looking back at the stories of the past decade (and what it might presage about the future).

After taking a quick look at the Time magazine's content, I began to realize that quite a lot of changes have occurred since the start of the millennium. Understandable? Definitely, when I consider how many things have changed within just one year of Jasmine's birth. Never before have so many delightful moments of parenting been known to me. And never before have I witnessed so many new skills acquired by a human being within a matter of twelve months.

A year brimming with big surprises, I must say. Though it seems like just yesterday (okay, maybe the day before yesterday) when Jasmine mastered the skill of rolling over, my daughter has run around our living room umpteen times before I finished the first paragraph of this blog.

I can admit it freely now. I didn't think too much about having a baby. I couldn't have been more wrong.

Reciprocity

The psychology professor Robert Cialdini keeps saying that reciprocity is the most powerful of all the forces that influence behaviour - give what you want to receive. The Max Planck Institute for Evolutionary Anthropology in Germany just reported a study that makes this very point.

After observing 3-year-olds' behaviour in a between-subjects design, researchers concluded that children are much less likely to help a person who has been seen to harm someone else – in this case adult actors tearing up or breaking another adult's drawing or clay bird. But it was the judgment of intention that characterizes the linchpin. Indeed, the odds are low for a toddler to help one person even if that person tried to harm someone else but didn't succeed. And as if that's not enough, when the toddler observed a person accidentally cause harm to another, the youngster was more willing to help that person.

Hooray for the toddlers' ability to understand another's intent.

In fact, such ability has been demonstrated to be universally present even in preverbal infants. Few years back, Yale professor Paul Bloom conducted similar experiments and published their findings in Nature. At the age of six months and 10 months, babies were shown one figure (made of wood and with large eyes glued onto it) initially at rest at the bottom of a hill. The babies witnessed events in which the figure struggled to climb the hill, and on the third attempt was either aided up by a helper who pushed it from behind, or was pushed down by a hinderer. In the test phrase, the babies showed a robust preference for the helper over the hinderer. And then, the hindering figure was either punished or rewarded. In this case, the babies preferred a character who was punishing the hinderer over ones being nice to it.

The moral of these two studies is enormous, particularly to parents like me. I remember reading once that experience may be the sculptor of the baby's mind but it is we adults who provide the chisel.

I'd better behave myself.

William Osler

A glance at my dialysis patient's blood count reminds me the Recession – everything went down except the level of anxiety. It's the third month like this. I told my patient, "Well, we don't really know what's happening. Your white cell and platelet counts are both coming down, almost as quickly as you're going anaemic." I suggested him to have a bone marrow test to figure out the problem.

Of course, my patient didn't believe me. He was nervous about the bone marrow biopsy examination. "Yeah, I bet you must have come to this decision after several round of blood tests," he hesitated. "But I'd rather wait and see. I'm feeling well."

I shook my head, but I gave in. All I knew was that I couldn't be sure I would miss something treatable. After all, the patient has already a problem list long enough to bother about, including his diabetes, kidney failure, blocked blood flow to the legs.

My patient returned to my clinic last week. "C'mon, let's be brave," I asked him again. "Have you decided on the bone marrow study?"

"No, I guess not," my patient answered. "Not at the moment. I wish you don't mind. Can I say something? The problem seems to start ever since my leg problem three months ago. Right? The vascular surgeon saw me when my toes turned dark. And then I was told to take the medication cilostazol, which is supposed to open up my blocked blood vessels. I have a hunch that it's this drug that causes the plummeting blood counts that you kept mentioning to me over the last few months. I never have problem with my blood counts before taking cilostazol."

I paused, nodded, and was wordless. There was nothing to say. I looked at my patient for as long as I could without embarrassment, and then took a quick look at the desk reference of drug information. Bingo! The problem with blood counts after taking cilostazol has been well documented before. My patient has a point. Who in his right mind would want to go for a gruesome and painful bone marrow biopsy procedure if the problem might be solved by stopping a medication? I had never thought about it.

Well, we all know the moral of this story, don't we? William Osler taught us almost a century ago to listen to the patients because they are trying to tell us the diagnosis.

Dictionary

When I walked into my office of the new hospital building, I saw an uncluttered desk. The only thing I wish to do to my room is to keep it tidy. I make the wish like we make New Year's resolution.

To celebrate the new office, I bought a gift for myself last night. It's the seventh edition of the Oxford Advanced Learner's English-Chinese Dictionary. The last dictionary I bought has been with me for over twenty years, like a loyal golden retriever with dog-eared pages.

"Gee, why do you need to buy a dictionary in printed hard copy when we can search any word on the net?" you might ask.

My first answer is, "I don't know." I mean that. I can't say why. I simply like to go back to the printed dictionary. That's how looking up words has been for me ever since I got my first elementary learner's dictionary at the age of six. This is how it works: each time I home in on the word when I leaf through the pages, I meet other words in the neighbourhood. It's just the same for drinking coffee: you've always wanted to get your coffee at the café, but instead you meet your friends sitting around. I guess old habits like addiction to dictionary or coffee die hard.

Keeping the habit of having a good cup of coffee has always been easy, but a decent printed dictionary? That's another story – Oxford University Press, the publisher of the Oxford English Dictionary, said that they're considering not printing their next edition. Such move is, obviously, related to the free, instant online dictionary. The printed copy currently sitting on the desk of my new office was published in 2008, and it seems to be the last edition that I can buy.

Calpurnia

The stories of au pair taking care of kids have formed a genre of their own in Hong Kong.

Too often, the working parents – me included – are hiring domestic maids to look after children at a very young age. As is often the case, the children spend more time with the maid than the parents, whether we admit it or not. While much has been written about the proper way to wean a child from the breast or bottles, neither Dr. Spock nor the parenting guidebook What to Expect the Toddler Years covered what to do when we try to "wean" the children from the maid. Admit it: we don't know, and we don't want to.

Growing up with a maid is simply a new whole way of life, a way of seeing, learning, being. Here's a case in point. My friend's maid is going to leave after living together for six years. Her eight-year-old son wrote a touching piece that leaves everybody in tears. I can see that it's a deep, deep attachment much harder to cut than the umbilical cord.

Lest I be misunderstood: I do not want to suggest we parents are to "outsource" the job of childcare. Nor do I think it always proper to feel guilty about hiring a maid. Remember the father of Jem and Scout in the novel To Kill a Mockingbird? Atticus Finch is doing a good job, and so is the black housekeeper Calpurnia. There's no better lesson for parents to remember.

Mockingbird

In the Pulitzer Prize winning novel To Kill a Mockingbird, the middle-aged lawyer Atticus Finch taught his daughter a simple trick to get along better with all kinds of folks.

"You never understand a person until you consider things from his point of view," he inspired, "or, until you climb into his skin and walk around in it."

But the real problem is that we have to make sure we've completely shaken off our feelings and dogma before we can really climb into someone's skin. Try as we might, we just can't, most of the time.

And is that all? Not really. We can try Atticus' trick for same-sex marriage and – well, yes – many of us, I suspect, simply find it hard to feel connected.

To the teaching of Atticus we must now add a "fly on the wall" position, a position where we are a neutral observer. From there, we can look at both ourselves and others, and find out what's going on between us. That would then give us a new perspective, somewhat like Gregor's metamorphosis in the story by Franz Kafka.

I think.

Round

My favorite essay from the recent Annals of Internal Medicine is "Attending Round," named after the doctors' job description.

The narrated events took place one morning in 1963, when the doctors seized the moment of looking after their patients themselves, with little assistance from others, drawing blood, preparing the slides of the urine sediment, the peripheral blood smear, and the sputum Gram stain. After conducting rounds with the nurse, the doctors rushed to look at the bone marrow biopsy. It was followed by tidying the laboratory result folders and shepherding the patients back to the ward, before the attending physician started the senior medical round.

I began to see parallels when I told my intern to poke a needle into a swollen knee and rushed to examine the joint fluid under the microscope. My intern's eye grew wide and stared at me as if I'd forgot that we could simply send out the knee joint fluid for our pathologist to trace the suspects.

"There is so much to learn by looking after our patients on our own," I reminded my intern. I mean that. The nub of the problem is we're spending less and less time in really looking after the patients. It should be obvious from all these years (but I'll say it anyway) that doctors are often destined to sit in front of the computer screen, with the dollar sign hanging sternly atop. We need to enter the diagnostic coding meticulously, prepare one protocol after another protocol, and document everything to secure the hospital accreditation. I won't argue whether these exercises would benefit the patients, but I'm pretty sure that they steal time away from hands-on personalized care of our patients.

My intern took off his glasses and squinted at the eyepiece when I rotated the polarizer. "Glittering crystals," he exclaimed. "That's gout."

Cockroach

Few years back, I learned from Time magazine that a KitKat bar isn't the same all over the planet; a Russian KitKat is smaller than a Bulgarian one, and the chocolate isn't as sweet as in a German one. The Nescafé instant coffee won't taste the same everywhere, too. There are around 200 different types of Nescafé, including the "three-in-one" sachets that we buy locally.

If the ice cream, tomato soup, chocolate – and what not – require modification to find the balance of local taste, it shouldn't be surprising that the most successful foodstuff for the cockroaches need to be prepared for the indigenous population. That's a simple truth that I learned recently. Before that, I'd been buying Japanese product to attract the cockroaches in my house – to no avail.

Just before giving up the ambition to clear the cockroaches, I thought of buying the genuinely local cockroach food that caters for the culture of our own cockroaches. The level of food consumption – or food poisoning if truth be told – by the cockroaches in my house is much higher than the days when I supplied them the imported Japanese meals. A colossal success, I must say.

In any event, this is probably the best personal experience from the products linked with the three words MADE IN CHINA, despite all those stories of tainted baby milk, recalled pet foods, oversulfated chondroitin sulfate contaminated heparin.

I'm not sure of the moral of my personal story, except that if you trust none of Chinese products it would be erroneous not to pay tribute to the Chinese cockroach bait.

Don't

In my mentor's blog, he discussed why we should not lay down written rule "Do Not Do Thing X," such as "do not kill your patient," "do not chop off your patient's head," "do not use four-letter words in front of your patient - and being heard!"

And so on. Imagine a manual for doctors or adults with an endless, often ghoulish, list of "don'ts."

With a creature as complex as grown-ups, it's easy to forget that sometimes the most effective rule can be learnt from the kids. I've been reading about applying neuro-linguistic programming in bringing up our children. Among the rules I learn, perhaps the most useful one is never say "Don't" in front of the kids. It seems that it is hardwired in human DNA to shout "don't do so and so." We will scream with outrage at the kids, for instance, when they're fighting, "Don't hit your brother!"

Every second spent shouting "Don't" is, in fact, a second taken off your life. Not that kids don't listen. But they simply pay attention to the phrase followed by the word "don't." That's how our brain works out what words mean. As every parent can attest to, the kid would then follow religiously the hypnotic suggestion "to hit the brother." Our tendency always is to hear the action but not the instruction "Don't," and positive instruction puts a helpful brake on this. In other words, we can rephrase the negative command "Don't hit your brother" by "Help your brother to finish the Lego."

Every second spent being positive is a second added on. Always the truth, from the alpha to the omega.

Birthday

It's almost instinctive – you count the number of candles on the birthday cake, and you start to gauge the age of its owner.

Which makes perfect sense. I should have forty on mine yesterday. With time, I learn to tell my friends that chronological age has nothing to do with one's real age. During the lunch conversation yesterday, my friend didn't believe that I remain young, and then looked me straight at a scar on my face.

Before she asked, I knew she wanted an explanation or the story behind it. I smiled cheerfully. "Oh good," I said. "My daughter is getting more energetic and charges ahead boldly. She waved her hand and scratched my face few weeks ago. You know, a nine-month-old has literally great leaps of faith, causing wounds here and there. Five minutes after the tenth topple, she's ready for number eleven."

"True. A kid's wound heals and vanishes quickly, unlike yours," my friend reminded me. "And perhaps that is the difference between Jasmine's wound and her father's scar. When you're no longer young, the wound lasts."

Reaction

If outsiders had to describe mistakes in medicine, they might use words like reckless, thinking of the seemingly endless stories of poor patients who suffered. Or, if they read the local newspaper, they could call it unacceptable, with a nod to the call for disciplinary action. Who could possibly object?

Actually, lots of people. After a recent headline story highlighting our loss of a patient's life in the hospital, there are some, of course, who seriously blame a doctor who prescribed too low a dose of anticoagulant drug supposed to prevent the dangerous blood clots that can travel to the brain, causing stroke. That is, broadly, the usual reaction from the mass media. But one important fact is left out of the scene – and that is the image of doctors. When people are being asked to say which professionals deserve the most respect, they usually put doctors at the very top of the list, way above clergymen and lawyers.

We agree that doctors are no longer free to practice away from the cruel scrutiny of the news media, not to mention the constant erosion of the trust in doctors. Admittedly, their biased emphasis can make it look like a nefarious crime scene, accusing doctors of having "committed the worst blunders, if not murder." I know, I know, that's disheartening. But let's think about how our patients – not the mass media – react. They are forgiving, if you ask me. In a way, we're fortunate to work with the growing realization that doctors are fallible. And that's why doctors are more open to our own mistakes. I'm one of them.

I will never forget the forgiving look on the face of my kidney transplant patient who nearly died because of my mistake. It all started with my prescribing him allopurinol, a pill supposed to work for his repeated attacks of gout. But I forgot the precarious drug interaction between allopurinol and another medication that he had been taking after the transplant. Because of that, the work of his bone marrow came to a halt and the number of his white blood cells dwindled to a dangerous level. This was only picked up by my colleague few months later. My patient was simply told that he wasn't tolerating the medication; there was no mention of medical mishap. My first instinct, after hearing what had happened, was not to sweep the mistake under the rug. I called back my poor patient and told him everything, I mean, my careless mistake. This may seem impossibility, but it is true, and he accepted my apology. He reminds us how far we've come and how lucky we are.

What's Wrong

One day, while discussing the mystery of our patient at the hospital corridor, my colleague who has a passion for automobile mechanic cautioned, "Oh man. If we want to be honest, let me ask you how many times are we doctors certain with what's wrong with our patients?"

Slushy nonsense? Not a bit of it! For some reason I'm amazed at his cruel and frustrating (though certainly true) statement. Consider an eightysomething man who came to the hospital with a bit of cough and not in his usual shape. Each numerical figure in his laboratory results was not very normal, but not too bad. At the end, for the hundredth time, for the thousandth time, the diagnosis, often loopy, would be a chest infection. It's hard to imagine any better diagnosis to be typed in the discharge summary.

Which brings me to the analogy of an auto mechanic, this time attributed to David H. Newman. Consider going to an auto mechanic about an unsettling sound coming from the car. The mechanic also suspected something (but not sure which) wrong. He then shrugged and produced a pair of earplugs - alas, quite similar to what we prescribe - and said, "Wear these while you drive."

Mechanic

"An auto mechanic's job is no different from a doctor's." That's a fair comment from a colleague of mine during dinner.

To pursue the mechanic analogy, he enthused, "Think about it. We were told the symptoms such as acute diarrhea or cramps, which are presumably external signals of a diseased or malfunctioning organ. A doctor examined the faulty organ whereas a mechanic rummaged around under the hood, figuring out a list of hypotheses to be tested one by one. Sooner or later, we're zeroing in on the ultimate problem. Case closed."

Tempting it is to think that such analogy is a true statement. That's not the right way; really, if you ask me, wrong. To say that a doctor can solve a problem under the hood, as what a mechanic does, would conjure up the image of physicians or surgeons who never talk. For goodness' sake, have you heard a mechanic talking to the automobile engine, "Good morning, how is the day?"

The problem isn't that the auto mechanic needs to talk, it's that a patient is simply different from Mercedes-Benz. A sick engine never responds to soothing voice or empathetic nod; our patients will. And the effect is riveting.

Faux pas

As unseemly as it might appear, a patient's thank you card can be very encouraging to a doctor. Not all doctors derive comfort from such a small token of appreciation - but many do.

On a lovely August day, I received a card from my patient's family. This reminded me of that patient's recent bleeding complication after colonoscopy at another hospital. His wife requested me to speak to his surgeon. I did. His surgeon told me what happened, cautiously remarking that bleeding was under control after the second colonoscopy procedure and tranexamic acid, a medication that has been touted as a brake to the domino effect of catastrophic bleeding. When I learned more about the medication dose that my dialysis patient had received, I told the surgeon to stop it and send the patient to see me. With my patient's poor kidney function in mind, I worried that the drug would accumulate pretty quickly in his body.

My patient didn't manage to walk into my clinic the next day - he was shaky and stuttering in a wheelchair, after being intoxicated by the magic drug. He wasn't back on his feet for at least three days.

Few weeks later, I met my patient's wife who sent me the card. In passing, she told me that she owed me her life, too, when she happened to be under my care ten years ago. "Did I?" I responded, pride written all over my face. "I didn't recall seeing you."

"Believe it or not, I collapsed after being given a shot for my abdominal colic, and was then sent to the emergency room. Too much of the injection dose, I guess. You were the one who saved me at that time."

I listened, nodded and blushed. "Mm-hmm," I thought. "We're praised for making remedies for medical errors. That's embarrassing."

Don't Know

I have been learning to make use of the skill to acknowledge what I don't know that I don't know. Knowledge is different from all other kinds of resources, as we have been told, because it constantly makes itself obsolete.

Last week, one of our talented fellows asked me what's the reason of stopping salbutamol, a short-acting "reliever" medication for chest tightness, in case our patients are coughing up blood from the lungs. I took a deep breath and then told her I don't really know. Although I quoted the evidence from an article that appeared in the British Medical Journal 28 years ago, the honest answer should be kind of old wives' tale. That's what I had been taught soon after my becoming a doctor.

Looking back, I reflected on what I had learned about the need to suspend any dogma, however hard earned it may be. Be flexible and admit I don’t have all the answers. To borrow an idea from Nance Guilmartin, the more we think we know, the less we truly know.

Murmur

Medical students don't want to miss out on examining patients with abnormal heart sounds or heart murmurs, because these patients often appear in the final examination. The students are expected to feel the pulse, listen with the stethoscope, and then come up with an answer to the question of which heart valves are leaking or narrowing.

The examination is not for the faint-hearted. I saw beads of perspiration over my student's forehead when I led her to examine a lady with narrowing of the aortic valve. I had a hunch (and it later proved to be pretty accurate) that my student’s heart was doing pirouettes in tandem with the noises of the patient’s heart.

When I debriefed the medical students about the lessons learned, I told them an important tactic. "Pause," I said. "What’s the most important thing to a patient when a doctor or student comes into the room – before you stick that needle in or take out the stethoscope? Stop, and see him as a person first and a patient second. A gentle greeting with a smile would do. As simple as that. Make your patient (and yourself) comfortable."

That's what I learned from my patients and recent reading of Nance Guilmartin's book.

Luddite

Computer technology is incredibly wonderful but never meant to replace humanity, just as knowing about the human genome doesn't give the whole picture of who a person is.

Well, well, well, I seem like an old chap who moans and groans after getting lost in the world of computer. Of course. I am. Maybe I should explain a bit. I was talking about the good old days when I graduated from medical school and did what doctors do – dutifully reviewed the patient's history from scratch and uncovered the hidden story. I learned the ropes of asking questions because there was no computer record for me to scroll up and down frantically. Wait, how did I know my patient's previous abdominal ultrasound study results without computer? Hmm… I couldn't, unless I went down to the radiology department and combed though the cabinet of hand-written reports.

After going through the patient's story, there would be a flurry of questions about what medications were being taken before my patient's coming to the hospital. Once again, I couldn't get the answer without asking questions like, "What's the colour of your blood-thinning medication tablet? And how many brown tablets did you take every day? And, how about that small blue round tablet for slowing down your heart rate? Did you take it every morning?"

While I certainly would have mixed up one medication with another during such primitive way of deciphering, I was convinced that the current computer drug record is equally superficial.

True, the electronic medication record gives us a sense of thoroughness, but this is perhaps the most worrying effect of the technology. As the electronic medical records have been increasingly used in the hospital, we are now tempted to rush to the computer and retrieve all the answers from the screen – but not from the patient's words. Believe me, the meaningless long list of medication on the computer screen never reflects what our patients are actually taking at home. Asking questions is far more powerful than we had ever realized, when it comes to finding out the patient's real medication.

Toy Story

"One of the most obvious facts about grown-ups to a child," Randall Jarrell wrote a century ago, "is that they have forgotten what it is like to be a child."

Yes, that's right. Before I completely forget what it's like to be a child, I went to see Pixar's Toy Story 3 last week. I witnessed how Andy (like every one of us) grows up and forgets how to see the world from the child's perspective.

Hey, guys, come to think about the age at which we still believed that inanimate objects, like Woody and Buzz, can feel envious and be genuinely upset. At that time, we might recognize that someone is feeling sad and then offer comfort in the way children find comforting. The comfort blanket a child offers, be it a teddy, Sheriff Woody, or a hand-painted Roly Poly Clown, is truly a sincere offer. Call it "egocentric" if you wish, but this should never be confused with the term "selfish."

Fast-forward to adulthood. We learn a great deal as we grow up. Ten or twenty years of hard work it had taken us. That was then. This is now. And we lose the capacity to see a children's world. We can no longer understand a preschool child when we lose the vision from their perspective, after transition to a much sophisticated standpoint.

Buffalo

Most of us (I'm guessing here) have read the stories written by Scottish physician Sir Arthur Conan Dolye. Most of us (still guessing) think that medical doctors must have learned from Sherlock Holmes.

And that is where we go wrong (I'm not guessing any more). Great stories like A Study in Scarlet or The Sign of the Four have never appeared in our curriculum of medical students. Of course they should. A doctor's job is more or less a detective work, piecing together the evidence, poring over observation of every system and the eventual "whodunit" revelation.

In suggesting this, I am making no claim for the prowess of the London-based consulting detective. I couldn't profess to know what Sherlock Holmes have mastered. Yet I firmly believe that this is essential if we are to be good clinicians.

This reminds me of recent encountering a lady with hypertension in my clinic last week, together with medical students. They were supposed to listen and afterward, to respond with wisdom and perspective. After talking about the treatment plan for a while, I observed a rash over my patient's sun-exposed area. "Why don't we have a quick look at the rash and see if it's related to the medication?" I continued as I examined her.

"Doctor, I observed a buffalo hump at her neck," one of my students reminded me when my patient dressed up. "We're taught that such weird fat deposition at the base of the neck indicates Cushing's syndrome, aren't we?"

"Yes," I acknowledged with reluctance, "she did have a buffalo hump. Good observation. But be not beguiled." With this, I went on to tell my students why I didn’t think our patient has the syndrome with prolonged elevation of corticosteroid levels. "Well, there is absolutely no excessive fat over the trunk and face. She stands up from squatting position without difficulty."

Instead of continuing a lecture upon Cushing's syndrome, I paused and asked my patient, with the aplomb of Sherlock Holmes, "May I ask if you used to carry loads of heavy objects over your neck or above your shoulder blades?"

"Oh my, how do you know? I was a farmer."

Good Old Days

There is an unwritten rule that if you want to learn medicine you have to learn by words of mouth. I have come to believe more with every passing year that despite new gadgets like UpToDate, it is still apprenticeship that works for new doctors.

So what can I teach the new interns? They looked helpless indeed. I rose from my chair, and straightened my white coat. "Honestly, I once made a bad mistake during my internship." I tried to correct myself. "Well, I've probably made lots. Yep, but I learned a lot. A clever man learns from his own mistakes, but a wise man learns from others' mistakes."

I couldn't deny it. I get very excited when I think about my intern days. Even now. The memory stays. You could put me back at the hospital where I once worked as a surgical intern fifty years from now, in pitch dark, and I'd still know where I am.

"But off the record," I was asked, "what would you have done in a different manner during your internship if you happened to have a second chance?"

"Very droll," I replied immediately. "I would have kept a diary. I'm pretty sure I'd got lots to write down."

I know very well that memory is not, as many of us think, an accurate transcription of past experience. That's what they say. Memory, I was once told, is a story we tell ourselves about the past, full of distortion, wishful thinking, and unfulfilled dreams.

Vitamin

"Should I give my baby a few supplemental drops of vitamin D?" my sister asked me about the vitamins missing from breast milk. "The American Academy of Pediatrics said so."

"Though it may seem right for you to follow their recommendation," I murmured, not that enthusiastic, "it's optional in my personal opinion." There's really no scientific basis why I came to such conclusion. I have to admit it.

The simplest explanation would be that we're often bombarded with dozens of parenting dogmas - most of them conflicting - and each claiming to work. So it goes. What works for one may not necessarily work in another hemisphere. Foods that work in one culture, for example, will not be adequate in another. Well, so is vitamin B12, in a way. Vitamin B12 deficiency or megaloblastic anaemia, as every medical student learns in the first haematology class, is a risk for vegans who consume no meat because vitamin B12 is only found in foods of animal origin. Oddly enough, it was found that orthodox Hindus who had been quite healthy on a vegan diet in their native India began to suffer from a high incidence of megaloblastic anaemia after migrating to England for quite a while, consuming the same diet. This condition can be serious with nervous damage, and hey, even neuropsychiatric abnormalities. If it is obvious there is no real vitamin B12 in plant sources, the really interesting question is why so many Hindus are not affected in the first place. Not until the mid-1970s was the cause traced to vitamin B12 deficiency, which in India was prevented by insect contamination of grains. The same foodstuffs purchased in England were uncontaminated and therefore contained no animal source of vitamin B12.

In fact, neither plants nor animals are able to manufacture B12, so all animals obtain their (and our) supply of this essential vitamin either directly or indirectly from bacteria, which are the only organisms capable of making it.

All Fours

As my energetic little baby starts showing her kinetic energy, we know it's high time we do some childproofing around the house. Without the slightest idea of what to do, I ended up reading my favorite manual What to Expect the First Year.

I was taught that the best way is to take a baby's-eye view of our home. How so? Simply get down on my hands and knees, and crawl around the house. From there, alas, I will see the world in a different light and find a multitude of dangers I may not even have realized existed. I could have found hidden choking hazards such as the lost game piece under the couch and jettisoned food under the kitchen table. A carcass of cockroach, maybe.

Which brings me, somewhat uncomfortably, to the question of health care safety. It is not without irony now that the one who oversees patient safety in the hospital is often working at his consultant office without ever getting a look at the real world from down on all fours – but that is never, of course, the best way.

Smile

"Well, Jasmine didn't sleep well last night," my maid observed.

My wife touched the forehead and the nape of our daughter's neck, wondering. "Jasmine looks fine," I took a deep breath and asked my wife. "Do you think so?" Jasmine was sitting on the rug in our living room, her soft arms waving with enthusiasm, absolutely concentrating on her dad's making a tower of blocks.

At six months, she has been wearing an attractive smile on her dimpled cheek. So warm, her smiles and laughter, so catching and alive. While scientists have shown that simply reading happy words - verbs like "to smile" and "to laugh" - can bring a smile to someone's face, I don't need a scientist to prove that watching my daughter alone can serve the same purpose.

"I'm not sure," my maid said. "Jasmine doesn't eat very well."

Now we paused to listen to her. My maid nodded. "Like me," she said. "Can you believe it?" She was referring to her recent quarrel with boyfriend. Muddled and heartbreaking, the two of them talked as if their relationship was covered with ice. She didn't sleep or eat well.

My maid's voice was weary, but then a smile flickered across her face. "Oh, contagious - even my mood and appetite to a kid like Jasmine. Nothing's simpler."

Mindset

We all commiserate as our colleague told us how we doctors preach with daily exercise while we are culpable of the unhealthy lifestyle. But wait: do we exercise and walk the talk at all?

Inevitably, the priority of daily exercise tends to get eclipsed by the stressful job, examination, family and many other obligations. Be that as it may, our well-being depends on how we process our lives on the inside – on our thinking or mindset. I remember reading once an interesting psychology experiment by the researchers at Harvard University. They randomly assigned each of seven hotels to one of the two conditions: informed or control. Female hotel attendants in the informed condition were told about the benefits of exercise. Specifically, they were informed that how their daily housekeeping work satisfied the Centers for Disease Control and Prevention (CDC) recommendations for an active lifestyle. For example, a 140-pound woman burns 40 calories after changing linens for 15 minutes, and another 50 calories after vacuuming for 15 minutes. Hotel attendants in the control group were also told about the benefits of exercise but they did not receive information about how their work is, in fact, good exercise.

Can you guess what happened when these hotel attendants were tracked down one month later? By virtue of learning that work might serve as exercise, the hotel attendants in the informed condition lost an average of 2 pounds, lowered their blood pressure by an average of 10 mmHg, and trimmed their body fit even though they didn't change their diet or add any exercise to their routine. I don't have to tell you the only change was a shift in the mindset. Yeah, yeah. I know it sounds unlikely, but consider the evidence.

In no way am I suggesting that you indulge in the Pollyanna comfort blankets. And I doubt that I have much in common with a hotel attendant – except that my work of scurrying around the hospital helps to burns loads of calories too. With that in mind, I go to bed at ease.

Pass

The memory of failing examination didn't come to me out of the blue. Have I mentioned I failed the driving test two months ago? And I will never forget the frustration of failing the clinical examination for the Membership of the Royal College of Physicians (MRCP).

Students, of course, are unhappy about failing to pass an examination, though it is nothing new. Over the years, we have been going through the ordeal of worrying "Did I pass?" or "Will I pass?" Obviously there are few occasions in which I didn't pass. At such moments I asked myself one very helpful question: "What are the examination results or those tick boxes on the score sheet really about?" (Not just "What are the examination results about?") Love the word "Pass" though I do, I've learned to live with the word "Fail" at times. Who says that a good doctor has to get the membership qualification in the first attempt? One consolation for those of you who have failed in the MRCP is that quite a number of distinguished physicians had shared the same experience with you.

Fast-forward to my second attempt of driving test this morning (drumroll please). I passed. Yet I dare not call myself a competent driver.

So don't be deluded that our self-esteem depends solely on the two words "Pass" or "Fail." In one way or another.

Examination

The first thing I ever failed was high school music written paper twenty-odd years ago.

Until then I'd scored well in my school examination. Summoning my knowledge (which I barely had) about musical notation and scales, I managed to score two marks – out of 50 full marks.

Hell, yeah! Two marks out of 50. A world record; everyone in my class said so. Absolutely. It's amazing for those of you who know the subject – and many do – how I can totally get lost within the five-line staff.

I then code-switched the difficult-to-comprehend musical notation into numerical figures. The way I designed my own eccentric navigation of the five-line maze reminds me the remark by Alfred Korzybski – that the map is not the territory. Yes, that was loathsome rote-learning without seeking to understand the subject. But strangely – and here was the bombshell – I passed the written paper next school term with full marks. It just isn't a good way to learn music, I know.

I received my report card with no illusions about any future with music.

Wording

I was recently drafting a letter to our medical interns. This is a letter about the common professional, medical, and ethical challenges they will face in daily practice – and more so at the end of their internship. It took a long time to write.

"If you don't mind," my friends told me, "you sound like Sir Humphrey Appleby, always beating around the bush. They will understand not an iota of what you mean. These days you should put away the toolkit of etiquette." Everyone says so.

It's rather sad, don't you think, to be downright explicit in our communication? It wasn't always so. I kept remembering that masterpiece toilet sign. It was something that Ruth Wajnryb wrote about in one of her books on language, of having linguistic politeness. In a ladies room, she read a sign above the cistern. It said: "There's a toilet brush next to the bowl in case it is needed." Not a single word of "you". Absolute anonymity. This is the most unblemished and unblaming communication I've ever known. Some of you might probably scoff at this example and say, "That's so goddamn beating around the bush." In that case, you will no doubt teach me to rewrite the sign like this: "If you dirty the bowl, you should/could/must use the brush."

If I could have one wish, just one crummy little wish, it would be that I don't have to rewrite. There was part of me that admired sitting on the fence, and part that loved the characteristic role of middle-born as a peacemaker.

Listening

Big day for my daughter Jasmine. She has been rolling over from her back to tummy, and is now wiggling and shuffling. Watching her attempts to crawl with the butt high up is an absolute wonder. It's the answer to anyone who wonders if they'd go straight home after work. My wife and I celebrated by giving her a big hug.

My wife was talking about the fascinating baby shuffles and wiggles when I was reading Mitch Albom's Having a Little Faith. I nodded but, oh, she knew my eyes remained fixed on the book. Oops, I made a funny face sheepishly, as what a naught kid did when he was caught red-handed.

Although trivial by any measure, this is a lesson for us who want to do anything more than listening to our wives.

This led me to a story from Mitch Albom's book. A little girl endeavored to show her mom the drawing she'd made in class. Her mother was too busy in the kitchen when the girl waved her drawing repeatedly.
"Mom, guess what?"
"What?" the mother said, tending to the pots.
"Guess what?"
"What?" the mother answered, tending to the plates.
"Mom, you're not listening."
"Sweetie, yes I am."
"Mom," the child said, "you're not listening with your eyes."

I tried to remember the last time I'd listened with my eyes. Or if I'd ever done that.

Salary

At a recent coffee time, with my colleagues, the conversation turned to the salary within our department.

Any time the word salary is part of a dialogue, it's a taboo. After all, asking our friends about their salary is virtually the same as (and probably more impolite than) asking their age. That being said, we all want to know others' age and salary, as what Tom Sawyer's great law of human action had predicted, "In order to make a man covet a thing, it is only necessary to make the thing difficult to attain."

But guess what the link between the amount of our salary and happiness is like. Uh-oh, rather weak. Studies had shown that countries with the "happiest" people are not among those with the highest personal income. One of the true human obsessions is with our friends' salary, but not our own personal income. H. L. Mencken put it so well when he noted a man's satisfaction with his salary depends on whether he makes more than his wife's sister's husband. Why the wife's sister's husband? Because (I was told by Dan Ariely) this is a comparison that is salient and readily available.

Colour

Just as a writer plays with words, a painter works with colours. Good painters dance back and forth across an infinite splendour of hues. For novice like me, it may require a hell of a lot of lessons to learn the know-how.

Yes, though it shames me to say it now, I wasn't sure what to answer when my wife quizzed me about the three primary colours. Truth be told, I've been having a hard time figuring out the colours of the clothes in my wardrobe. Wearing a black suit and charcoal grey trousers is the closest I will ever come to colour matching.

It's one thing for my wife to understand my difficulty with colours, but quite another for the genetic logic to explain the evolution of colour vision in primates and other vertebrates. Colour (like beauty), I was taught, is in the brain of the beholder. In other words, the colours are not "out there," but are constructed in our brain from sensory inputs. Quiz a dog, for example, the primary colour and he will answer you blue and red. Dogs have only two types of specialized receptor cells called cones, with peaks of sensitivity in blue and red. And yes, the majority of mammals have two-colour vision while most birds, reptiles, and even goldfish have four cone types, giving them four-colour vision.

Having less colour vision among mammals, obviously, is at odds with our intuition (and ego). To help us understand the difference, we have to take a time machine and travel to Mesozoic, the age of the reptiles, when mammals were still small, insectivorous shrew-like nocturnal creatures. In the wee hours, early mammals would have depended upon rods (light-receptors in very dim light) rather than cones. Two-colour vision suffices and, in fact, could have been a great plus. Subjects with two-colour vision have been shown to be better in spotting patterns that were camouflaged by colour.

However, diurnal mammals evolved after the demise of the dinosaurs. And these diurnal primates switched to fruit-eating. The mammalian two-colour vision system was never good enough for seeing red fruits against a background of green leaves. This adaptation to diurnal foraging for fruits is probably the secret for evolution to our current three-colour vision.

Ah, you may ask, how on earth would red-green colour blindness be that common in men? That has something to do with the location of the gene coding for the protein that detects visible light in the red spectrum. It so happens that this gene is situated on the X chromosome. In primates and other mammals, X is a sex chromosome that is present as two copies in females, but only as one copy in males. With two copies of the X chromosome, females could have the upper hand in discriminating colours in the red-orange spectrum. Thanks to the enhanced red vision in females, it allowed them to better distinguish berries and foliage when they were gathering food. Of course, we have to suppose that it's the females who did the gathering in prehistoric times. I won't argue.

Sickness

When it comes to sickness, nothing comes close to the severity of a sick baby.

Mention that to parents, everyone invariably remembers the first time one's child got sick. I wasn't that impressed with the chapter on "When Baby is Sick" when I first read What to Expect the First Year. I managed to read that chapter again today; I fetched the book whilst packing the bag in a hurry to bring my febrile princess to the hospital last night. (What else could I smuggle when there was a full truckload of worries?) Though I had never called sick when I fell into pieces, I stayed with my baby this time and requested an urgent leave today.

I learned a lot from this reading. Perhaps I wasn't paying attention because I didn't need the book to teach me the ropes to manage a daughter running a temperature of 39.4 degrees. That bit, yes, I know. Believe it or not, the most difficult bit is how to be parents of a sick baby. How strange! Now I understand what the authors meant by "An infant's illness, even a mild one, usually hits mummy and daddy harder than it does baby."

Grasshopper

There is no such thing as universal truth in the world. There never was.

Anne Lamott wrote that it took years for her to discover that the first step in finding out the truth is to begin unlearning almost everything adults had taught her. I tried thinking of words that I told my little sister when she was young. And I did discover Anne Lamott is right.

One green spring afternoon, I'd been enjoying myself in the garden while my little sister waited for the surprise his brother brought home. I didn't disappoint her. I caught quite a number of grasshoppers. "Grasshoppers?" she asked. She opened her eyes, and then her mouth joyfully. And for the first time in her life, she got fascinated by the little creatures that hopped around inside a plastic bag. She could not even remember if she had taken time to breathe while she enthused over the grasshoppers. It took her a minute to catch her breath after being overwhelmed with joy. She then phoned up our dad and told him the great news. "Yeah," she said, in her childish but enthusiastic voice. "They look funny, jumping here and there! Can you see them?" With that, she held the grasshoppers close to the telephone mouthpiece.

We all laughed – what a witty thing to show our dad over the phone!

Seriously, we were wrong. That was then. This is now. Should I foresee the subsequent development of 3G cell phone decades later, I dared not laugh at my sister.

Sibling

My younger sister is delighted and said it is the happiest day of her life. She gave birth to a boy this morning.

And as the nurse pushed the gurney carrying her baby out from the operating theatre, I rushed in my eagerness to take a peek. I was so overjoyed to meet my baby's cousin. The truth of the matter was, I was reading Only-Child Experience and Adulthood when I waited outside the operating theatre.

I was a middle-child of three children, and have been struggling to imagine my baby being an only child. I would not go so far as to say that the only-child must be spoilt. In no way am I suggesting a bad connotation of the phrase "only-child." Only-children are a a growing phenomenon. None of this is good or bad; it just is. Still, I have always loved the chance to become a brother who understands his sister from head to toe. After all these years, I still find myself calling up my kindergarten memory of saving all the pleasant tea time snacks to bring home for my younger sister.

Nearly nine months ago, I made a phone call to my sister and had a casual talk. In a minute or so, there came a signal, like a jerk on the string, that she's expecting a baby. Though it seems like just a wild guess (okay, maybe my secret wish) when my sister herself had not seen the two lines on the pregnancy test, it's actually true when I proved it by asking my wife to show it by ultrasound the next evening.

Everybody in my family thought that I am prescient and awfully good about crystal ball. "It's simply a brother who knows his sister well," I replied.

Desensitization

Bumps on the road make a rough ride. Such bumps plague many of us, but they shouldn't - once you get used to the bumps.

One of my patients reported a history of itchy bumps 30 years earlier associated with taking penicillin. When I saw him I found a strain of bacteria in his blood. The bacteria lurked in his bone marrow, nodding with a grin, knocking off my patient's kidneys. Shaken, his defenses down, my patient had fallen over like a drunkard. The best way to tackle that bacteria is ampicillin, an antibiotic belonging to the penicillin group.

Ahhh.

For reasons that I will never fully understand, giving an antibiotic to a patient who recalls allergy has now come to the top of the seven deadly sins in our hospital.

"I know," I murmured, meaning both things: yes, it's no good to commit a sin, and yes, I will go ahead anyway. I gave my patient ampicillin after a trick called desensitization. Desensitization means breaking the drug prescription into manageable pieces, starting with a spoonful of very, very tiny dose, usually in terms of micrograms. The whole process involves doubling the dose every 15 to 30 minutes. We work on one at a time, bit by bit, until the desired dose is achieved. At the end of the day, the patient develops tolerance to the antibiotic. Hurray.

The lesson of antibiotic desensitization, in fact, applies to many subjects in our life. Oh, apply the same strategy of desensitization, and you'll find yourself developing tolerance to a long list of disagreeable evils, such as your mother-in-law. Or, to paraphrase Mark Twain, education consists mainly in what we have unlearned.

Rule

The most important sentence in any article is the first one, we are taught by William Zinsser. The most important rule, again, is the first rule of any kind. Consider the book 50 Rules Kids Won't Learn in School. My favorite among the fifty life lessons given by Charles J. Sykes is the Rule 1: Life is not fair.

The average teenager, I was told, uses the phrase "It's not fair" 8.6 times a day. Somewhere behind these complaints about unfairness is an implicit wish that life would be much happier if it is fair. Is it?

Sure, life seems unfair. But so do lots of things. Unsightly mole and acne on our face, or receding hairline, for instance, seems very unfair. A quick fix, you might have thought, is to ask for a better control of the unfairness of the world. The obsession with our request to make this world a bit more fair simply ends up with a burgeoning number of rules, say, in the design of doctor duty roster, the compensation rules from the High Court and Court of Appeal judgments – you name it.

If we could calculate an unfair awareness index, it would be marching toward an all-time high. The mere thought of the spectacular increase in the rules for generating doctor duty roster provoked a shot of pain behind my jaws.

My brow furrowed and the crow's feet deepened as I struggled to remind myself that what we can control is the way we react – but not making this world any fairer.

Tea Box

Everyone trusts old wives' tales. Our grandparents trust them. Mothers trust them. Most of all, doctors trust them. Even I trust them.

There are rules for doctors, I know, under the big name evidence-based medicine. What a splendid name to practice medicine, you must have thought. And who won't? The way to treat my recent febrile illness, of course, turns out to be a far cry from the evidence-based medicine. I was sick upon my way to work two days ago. I felt like a roast potato sold by the street tradesman, running a temperature on the pushcart but shivering in the depths of winter. My bones ached for aspirin, and so did my head. Without second thought, I went to buy the herbal tea that comes in a tiny paper box. The truth is that I have no idea what that box of tea is. I don't even reckon that another name for it is Kam Wo Tea.

One thing I haven't told you about my old-wives' obsession with that tiny box is that I first drank the herbal tea fourteen years ago. I was working in a surgery department as an intern at that time. Well. I was no better than a small shivering potato that morning when I went to my ward with a high temperature - and backbreaking load of work. Even so, I dared not to be off sick. There can be no more absurd invention of having a fever-stricken guy taking care of thirty-odd patients. Exhausting as it was to work it out, I tried not to appear sick. Later that afternoon, the night sister was off duty and bought me a tiny box of herbal tea. And then the miracle happened. I got my energy back after drinking that herbal tea. That's the gift I remember till today.

I didn't bother to find out how - or whether - the herbal tea cures my ailments. Whenever I get sick, I simply think about and drink that same box of herbal tea. It's a good old wives' tale for me to keep. It has kept me from getting any sick leave over the last fourteen years.

Report Card

I talked earlier about resetting my thermostat during university days. But it was before my primary school graduation when I realized for the first time in my life that I was capable of pressing the amazing reset button.

Looking back on my primary school days, I don't recall much except my mediocre academic performance; I just know I always ranked more than ten in my class. At any rate, I remembered the soccer league tables far better than what the teachers said during the class.

Then one afternoon in my final year, out of nowhere it crossed my mind to feel that the odds of getting a perfect report card were almost zero. I could only take that last chance before leaving my primary school. I am not quite sure how I did it, except that I fell sick before the final year examination. Still, I managed to reset and rise to the top among all the eight classes in that year.

If I were to give a slide show of the next six years in my secondary school, it would begin with my report card. I brought home a report card ranking me the first in the class nearly every time through secondary school.

I felt changed and reset, and a little weird. I know.

Reset

Needless to say, nephrologists talk a lot about the blood's salt or sodium content. We teach our medical students that kidneys help to keep our body's solute (composed primarily of sodium) concentration or so-called osmolality within a narrow range. No more, no less. It would be hard to imagine how nature works it out to keep everything in such a fine balance.

Now. Maybe you think our body is too unwieldy or rigid to operate only within a narrow range of osmolality. "Why," you might ask, "isn't life constructed to get along okay with a wider range of osmolality?" Ten points and a gold star if you ask this question. And it makes sense. It turns out that some people are doing perfectly fine after resetting their osmostat, and live happily ever after with a lower blood sodium concentration.

Speaking of reset osmostat, this concept is a gem of wisdom on the way to live our life. Which brings me to the story of resetting my thermostat. I remember how I shivered during each winter when I was a child. My mother used to say that I was the most "utterly lazy cold-blooded animal." I simply looked like a stationary lizard when the temperature plummeted. A lizard flicks the tongue out of its mouth only if necessary. And me too. I sat in front of my textbook with my hands buried in my pocket, and then turned the page using my lips.

My hibernating life cycle continued until my travel to Beijing during the university winter break. I was twenty, enthusiastic with my first ever trip on my own. It was that winter I first saw snow. That helped. More than anything else, resetting my thermostat after return from the snowy trip gave me the energy to wear less and less at winter. I soon went to spend one of the subsequent winters learning ski and dogsled across snow-covered lakes in a Outward Bound wilderness course in northern Minnesota.

Decibel

One of the best-kept secrets about communication is that we always turn a deaf ear to the loudest, outrageous, unceasing, honking, banging, screaming voice. Few things are easier than making a big noise, and few things are harder than keeping our volume low when we're making requests.

Uh-oh, you thought I'm referring to our Chief Executive's deaf ear to the protest about express rail fight. That's undeniably true – up to a point. But it's also true that similar stories can be found anywhere. I woke up at four this morning to feed my six-week old daughter, and then heard the low battery ring tone of my mobile phone. Well, the signal is simply as soft as a cat meowing. They needed help. That's what came to my mind when I heard the meow. I fed the mobile phone as well as my daughter, no questions asked. In two hours, my alarm clock shouted at the top of his lungs. And no prizes for guessing how efficient I was to give a good hit at the snooze button and go back to sleep.

How much that has to do with the noisy alarm clock and how much with my falling into bed weary to my bones after feeding in the wee hours, I cannot say. But surely there is good reason to feel and react differently to the varying loudness of requests. Given my beeper's noisy way of indicating the low battery status, for example, it should come as no surprise that I seldom replace my beeper's battery right after hearing that uproar.

Eggs on My Face

There's a good chance that you agree with me that hard-boiled egg doesn't taste good. Of all ways created by human beings to prepare an egg, none is more humdrum than a hard-boiled egg. But I'm pretty sure not too many of you would have difficulty with the know-how to boil an egg. I have.

When it comes to making an egg, I have no problem with cooking a fried egg, scrambled egg or omelette. Now that my baby has arrived, I have to prepare hard-boiled eggs for the celebration pot with sweetened black vinegar and pork trotter. I ended up plunging my eggs that came straight from the refrigerator into boiling water. I can almost hear you scream. No, before your scream, I heard the crack of my eggs first.

Go slow, at least in certain situation. That's the lesson I learned from my eggs.