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.
Saturday, February 27, 2010
Saturday, February 20, 2010
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.
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.
Monday, February 15, 2010
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.
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.
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