Close your eyes. Picture a bumble bee foraging inside a room.
That happened with my daughter visiting the indoor play centre within a stone's throw from my home. We had bought the ticket for that place with an iconic logo of bumble bee some months ago, and yet didn't bring her there until the admission ticket was going to expire. I suspect that my procrastination may have been a hunch that my daughter won't be too excited to be an indoor bee.
After the indoor game, my wife decided to bring little Jasmine headlong to the beach. "Excuuuuuuse me?" I can hear the query already. "Do you really mean going to the beach in the winter?"
"Why not?" My wife's voice was calm as a summer pond.
My two-year-old did feel stuck indoors and, after taking few snacks, metamorphosed from a bored bee into a caterpillar. Yes, she did. She could not stop laughing whilst having pretend play with mum, who also crawled on the sand like a caterpillar. Yeah, yeah. Within a minutes, the two caterpillars turned into two butterflies running around on the beach.
Pure joy.
Friday, December 30, 2011
Thursday, December 15, 2011
Behave
A little one near the end of her toddler months is about learning to pick up new skills in her rapidly expanding world. Now, if you ask me, what's about growing up with a little child is that we learn to enjoy the world of freedom, making way for more relaxed interaction. But you can't do that if you're not looking through the kaleidoscope of children.
Take a minute - and maybe a deep breath too - and imagine a kid stomping on sand castle, wearing nappy and her smile. Of course, it's my little Jasmine. Soon after I posted her photo online, I was reminded that she wasn't wearing trousers. Oh please! Shouldn't I dress up my two-year-old in her Sunday best at the beach? I say to myself, "Okay, hmmm, let's remove that picture."
I found out more about how two-year-old should behave when I brought Jasmine to a church wedding ceremony. Even if she kept using an "inside" voice, others around me could hear a toddler babbling to herself. Is this a taboo to interrupt the sermon by toddler words like "happy" and "Simba"? No. It's a sin. Without much ado, I was scolded and taught a lesson by someone behind me. Finally, I left with Jasmine, puzzled by the question if it's the two-year-old or the guy behind who was talking with words inappropriate to the age.
Take a minute - and maybe a deep breath too - and imagine a kid stomping on sand castle, wearing nappy and her smile. Of course, it's my little Jasmine. Soon after I posted her photo online, I was reminded that she wasn't wearing trousers. Oh please! Shouldn't I dress up my two-year-old in her Sunday best at the beach? I say to myself, "Okay, hmmm, let's remove that picture."
I found out more about how two-year-old should behave when I brought Jasmine to a church wedding ceremony. Even if she kept using an "inside" voice, others around me could hear a toddler babbling to herself. Is this a taboo to interrupt the sermon by toddler words like "happy" and "Simba"? No. It's a sin. Without much ado, I was scolded and taught a lesson by someone behind me. Finally, I left with Jasmine, puzzled by the question if it's the two-year-old or the guy behind who was talking with words inappropriate to the age.
Wednesday, December 14, 2011
Deadline
It's hard to believe the magic of deadline.
Deadly as the name may sound, it is quite impossible to live without deadlines. To me, this is an absurd state of affairs. How could I have finished so many things like reviewing two journal manuscripts and writing reference letter for my intern before I took my week off? How could there have been so many applications just before the grant submission closes? Did I have to mention the deadline for tax return?
There is now little doubt that, in evolutionay terms, we mastered the skill of procrastination (from the Latin pro, meaning for; and cras, meaning tomorrow) first, before the natural selection of a tool that has become known as deadline.
Although discipline is a linchpin of growing, it remains for most of us to rely on the patrolling of deadline.
Deadly as the name may sound, it is quite impossible to live without deadlines. To me, this is an absurd state of affairs. How could I have finished so many things like reviewing two journal manuscripts and writing reference letter for my intern before I took my week off? How could there have been so many applications just before the grant submission closes? Did I have to mention the deadline for tax return?
There is now little doubt that, in evolutionay terms, we mastered the skill of procrastination (from the Latin pro, meaning for; and cras, meaning tomorrow) first, before the natural selection of a tool that has become known as deadline.
Although discipline is a linchpin of growing, it remains for most of us to rely on the patrolling of deadline.
Saturday, December 3, 2011
Copy
My patient leaned over and stared, her eyes wide open but not at me. She was paying attention to her laboratory test results on the clinic computer screen.
Natural though it seems, the patients' laboratory results in public sector hospital aren't supposed to be released to them. You'd better bring a notebook and a pen if you want a copy of the results. For that matter, the laboratory results sound like PowerPoint slides of a lecturer, who felt that keeping the lecture materials from the students is the way to make students pay attention to his authoritative lecture.
Won't you hate it when you can't concentrate on the lecture while you're busy with copying the slide materials? That happens with the patient who can't get access to the laboratory test reports. It's hard to argue who owns the laboratory results. Harder to fathom are the reasons of denying their free access to a copy of their health information.
I can't think of any.
Natural though it seems, the patients' laboratory results in public sector hospital aren't supposed to be released to them. You'd better bring a notebook and a pen if you want a copy of the results. For that matter, the laboratory results sound like PowerPoint slides of a lecturer, who felt that keeping the lecture materials from the students is the way to make students pay attention to his authoritative lecture.
Won't you hate it when you can't concentrate on the lecture while you're busy with copying the slide materials? That happens with the patient who can't get access to the laboratory test reports. It's hard to argue who owns the laboratory results. Harder to fathom are the reasons of denying their free access to a copy of their health information.
I can't think of any.
Monday, November 21, 2011
Heights
What could be more dogtired than to sit through eight hours of lecture straight? What I have done, under the circumstances, is to either sleep or read other materials.
When I decided to attend an eight-hour parent educational class last weekend, I knew I have to bring with me quite a number of medical journals, just in case. And when I sat down in the classroom, I knew I should not have carried those journals.
The class isn't a ho-hum parroting of theories; it's a story about real people bringing up kids. I never realised the secret of slides on the playground until the teacher reminded me that children learn to walk upstairs before mastering the skill of going down. The design of a slide for those kids to slide down is great - it's amazing, actually.
And how about the traditional jungle gyms or climbing frames? They're disappearing from most playgrounds. Classical as the seesaws had been, popular as the smart-phone game Angry Birds now seems, jungle gyms have turned into dinosaurs. If the story of jungle gym strikes you as a nostalgic memory, you're not alone. I remember climbing heights - and the laughter - on the metal monkey bars that were arranged like Cartesian coordinates in a three-dimensional jungle. It's fun. I'd like to see my little Tarzan learn the thrills of exploring heights but those jungle gyms don't exist on the planet anymore.
Yeah, yeah. I know playground safety is the main concern. But the point is this: children have to gradually expose themselves to more and more dangers on the playground to conquer phobias. A child who's hurt in a fall before the age of 9 is less likely as a teenager to have a fear of heights, I have been told.
When I decided to attend an eight-hour parent educational class last weekend, I knew I have to bring with me quite a number of medical journals, just in case. And when I sat down in the classroom, I knew I should not have carried those journals.
The class isn't a ho-hum parroting of theories; it's a story about real people bringing up kids. I never realised the secret of slides on the playground until the teacher reminded me that children learn to walk upstairs before mastering the skill of going down. The design of a slide for those kids to slide down is great - it's amazing, actually.
And how about the traditional jungle gyms or climbing frames? They're disappearing from most playgrounds. Classical as the seesaws had been, popular as the smart-phone game Angry Birds now seems, jungle gyms have turned into dinosaurs. If the story of jungle gym strikes you as a nostalgic memory, you're not alone. I remember climbing heights - and the laughter - on the metal monkey bars that were arranged like Cartesian coordinates in a three-dimensional jungle. It's fun. I'd like to see my little Tarzan learn the thrills of exploring heights but those jungle gyms don't exist on the planet anymore.
Yeah, yeah. I know playground safety is the main concern. But the point is this: children have to gradually expose themselves to more and more dangers on the playground to conquer phobias. A child who's hurt in a fall before the age of 9 is less likely as a teenager to have a fear of heights, I have been told.
Sunday, November 13, 2011
Safe, Or Save
Think of telephone keypad, and for both push-button and touch screen cell phone users, what come to mind is the standardized grid layout.
Imagine a scene when the telephone factory is running out of certain numerical keys, leaving the manufacturers no choice but putting whatever numerical keys available to fill up the keypad. With such undecipherable keypads, someone could still make use of memory (not many of us) to dial the right number. And I will not say I hate and smash such messy telephones but I will not say I won't.
Yes, dialing the wrong number isn't that bad to be howled about. What if the mix-ups aren't about the telephone keypads but the medicine?
That happened within the government hospitals. Those drugs we gave out to the patients look exactly like the random number telephone keypads. I think no one really knows what a drug looks like because, these days, its appearance keep changing with every new generic drug introduced by the public hospitals. That's why my kidney disease patient (that is, having drug treatment for many many years) could still be confused by the new appearance of pills and took double the amount of blood pressure pills.
Never mind what your hospital managers told you about the top issue of medication safety. They have a higher priority - if money is an issue, they will put anything else behind. There is not a hospital manager who isn't constrained by drug expenditure. The hard truth is, all hospitals go on at length cutting the drug budget, say, by comparing the price of generic drugs. Although brand-name drugs and generic drugs are supposingly interchangeable (another worst-kept tooth-fairy myth), they can differ substantially in their appearance. I'm not saying that generic drugs aren't cost-effective substitutes for brand-name medications. No, the question is not to judge if generic drug and brand-name drug are identical and, of course they never are, we have to accept taking generic drugs. But it seems that we're changing the generic drugs too frequently and totally out of our control.
Of course, we should not complain about things totally out of our control, such as the weather. As for the generic drug change, we seem to change them even more often than the weather change.
Imagine a scene when the telephone factory is running out of certain numerical keys, leaving the manufacturers no choice but putting whatever numerical keys available to fill up the keypad. With such undecipherable keypads, someone could still make use of memory (not many of us) to dial the right number. And I will not say I hate and smash such messy telephones but I will not say I won't.
Yes, dialing the wrong number isn't that bad to be howled about. What if the mix-ups aren't about the telephone keypads but the medicine?
That happened within the government hospitals. Those drugs we gave out to the patients look exactly like the random number telephone keypads. I think no one really knows what a drug looks like because, these days, its appearance keep changing with every new generic drug introduced by the public hospitals. That's why my kidney disease patient (that is, having drug treatment for many many years) could still be confused by the new appearance of pills and took double the amount of blood pressure pills.
Never mind what your hospital managers told you about the top issue of medication safety. They have a higher priority - if money is an issue, they will put anything else behind. There is not a hospital manager who isn't constrained by drug expenditure. The hard truth is, all hospitals go on at length cutting the drug budget, say, by comparing the price of generic drugs. Although brand-name drugs and generic drugs are supposingly interchangeable (another worst-kept tooth-fairy myth), they can differ substantially in their appearance. I'm not saying that generic drugs aren't cost-effective substitutes for brand-name medications. No, the question is not to judge if generic drug and brand-name drug are identical and, of course they never are, we have to accept taking generic drugs. But it seems that we're changing the generic drugs too frequently and totally out of our control.
Of course, we should not complain about things totally out of our control, such as the weather. As for the generic drug change, we seem to change them even more often than the weather change.
Tuesday, November 1, 2011
Wavelength
Remember the long queue in front of the telephone booth at the university dormitory? Not many - even though, as the common scene before the mobile phones have revolutionised the way we talk to our girlfriends and boyfriends.
If it's not because of the recent movie You're the Apple of My Eye, the picture could have faded in the society's collective memory. This movie has made itself a household name after its debut. There's no medium like the movies to give us the flashback pleasure of going young and fooling around. You're the Apple of My Eye is rife with incurably innocent and naive ideas that make us laugh.
I went to see the movie last week and almost laughed my head off. I'm not saying that we should follow the kids and appear stupid. As adults, it's easy to forget how boys and girls feel. Amazing as it may seem, getting on their wavelength is the only way to draw ourselves closer to the young generation. One of the important lessons from the book Raising an Emotionally Intelligent Child is to imagine how we would feel if we were young. Instead of emphasizing that a kid should not whine when his brother received a birthday gift, we are taught to respond in a way to demonstrate our understanding - something like, "I used to feel jealous when I was a little boy and Aunt Mary got a gift."
If it's not because of the recent movie You're the Apple of My Eye, the picture could have faded in the society's collective memory. This movie has made itself a household name after its debut. There's no medium like the movies to give us the flashback pleasure of going young and fooling around. You're the Apple of My Eye is rife with incurably innocent and naive ideas that make us laugh.
I went to see the movie last week and almost laughed my head off. I'm not saying that we should follow the kids and appear stupid. As adults, it's easy to forget how boys and girls feel. Amazing as it may seem, getting on their wavelength is the only way to draw ourselves closer to the young generation. One of the important lessons from the book Raising an Emotionally Intelligent Child is to imagine how we would feel if we were young. Instead of emphasizing that a kid should not whine when his brother received a birthday gift, we are taught to respond in a way to demonstrate our understanding - something like, "I used to feel jealous when I was a little boy and Aunt Mary got a gift."
Tuesday, October 25, 2011
Weber
Like many doctors, I dread the moment I give my own child the vaccine jab. It's not hard to see why: we are supposed to safeguard our kids but there won't be pain-free needles.
The task of giving Jasmine a quick stab wasn't that difficult. When my daughter learned about the seasonal flu jab, she didn't run away. My wife held Jasmine and I picked the right spot - and voilà - a peaceful indentation of her thigh. After that my wife asked me if I wished to give her the hepatitis A vaccine as well. We purchased the vaccine few months ago and waited. And waited. And waited. And it has remained in our fridge. I hemmed and hawed for a while, before I decided to postpone the second injection. Of course I didn't have a whiff of evidence to support my claim to separate the two injections.
If the idea of separating two injections seems humane at first, it doesn't once you know the psychological principle known as "Weber's law," named after the nineteenth-century German physiologist Ernst Heinrich Weber. Although most medical students should be familiar with his Weber test (a screening test for hearing), we might have overlooked the Weber's law. Weber's law states that the impact of a change in the intensity of a stimulus is proportional to the absolute level of the original stimulus. Loosely speaking, you must shout to be heard in a noisy environment whereas a whisper works in a courtroom.
It also means that the change in any stimulus matters less and less with every increase in the absolute level of that stimulus. The idea behind Weber's law is that if you have a number of dental cavities to be filled, get them all taken care of in one trip to the dentist. Unsettling as it is, the pain of two moderately bad experiences will typically exceed the pain of experiencing both at one time.
Which means, come to think of it, that I should have given my daughter two shots at one go.
The task of giving Jasmine a quick stab wasn't that difficult. When my daughter learned about the seasonal flu jab, she didn't run away. My wife held Jasmine and I picked the right spot - and voilà - a peaceful indentation of her thigh. After that my wife asked me if I wished to give her the hepatitis A vaccine as well. We purchased the vaccine few months ago and waited. And waited. And waited. And it has remained in our fridge. I hemmed and hawed for a while, before I decided to postpone the second injection. Of course I didn't have a whiff of evidence to support my claim to separate the two injections.
If the idea of separating two injections seems humane at first, it doesn't once you know the psychological principle known as "Weber's law," named after the nineteenth-century German physiologist Ernst Heinrich Weber. Although most medical students should be familiar with his Weber test (a screening test for hearing), we might have overlooked the Weber's law. Weber's law states that the impact of a change in the intensity of a stimulus is proportional to the absolute level of the original stimulus. Loosely speaking, you must shout to be heard in a noisy environment whereas a whisper works in a courtroom.
It also means that the change in any stimulus matters less and less with every increase in the absolute level of that stimulus. The idea behind Weber's law is that if you have a number of dental cavities to be filled, get them all taken care of in one trip to the dentist. Unsettling as it is, the pain of two moderately bad experiences will typically exceed the pain of experiencing both at one time.
Which means, come to think of it, that I should have given my daughter two shots at one go.
Saturday, October 15, 2011
Count to 10 Before You Yell
I was looking at the school photos with my daughter in front of our laptop computer. When Jasmine was so excited, she pushed the computer screen and hit the vase next to it. "WATCH OUT!" I screamed before calming my nerves to catch the vase.
When Jasmine found her father turning into shrieking grand mal, she stopped. Before she could find her words, she put her hand above the eyebrow, whispering the word sooooorry.
Immediately I realised I'd made a mountain out of a molehill. This was a a terrible situation, thoroughly embarrassing, and it really was my fault. I ground to a halt, mortified and abashed. I smiled. No one joined me. My eyes met hers. I saw tears welling up.
"No, baby. Not your mistake. Write this across your heart: daddy isn't angry with you." I gave her a big kiss on the forehead. Jasmine tried to pull herself together but seemed poleaxed. "Flower broken?"
And her mother came to my rescue. "Flowers," we chorused. Within two minutes we were dancing with the flowers in hand, with smiles as effervescent as root beer.
Researchers coined the term attachment to describe the reciprocating relationship between a baby and the parent. Babies come into this world preloaded with lots of emotional abilities. My response (such as shouting) acts like Post-it notes to tag different things, telling my baby's brain, "Pay attention to this." When I sat down and talked to my wife, she tried to reassure me that nothing was wrong, that I was tagging the wrong Post-it note to the vase, and that I could count to ten before yelling. "Come to think about it, you just screamed at the vase out of the blue, but the two-year-old would look at you with a tag that you're screaming at her. You did the same to me quite often, too."
Ugh. Jasmine gave me another lesson after my going wrong for at least 10 years.
When Jasmine found her father turning into shrieking grand mal, she stopped. Before she could find her words, she put her hand above the eyebrow, whispering the word sooooorry.
Immediately I realised I'd made a mountain out of a molehill. This was a a terrible situation, thoroughly embarrassing, and it really was my fault. I ground to a halt, mortified and abashed. I smiled. No one joined me. My eyes met hers. I saw tears welling up.
"No, baby. Not your mistake. Write this across your heart: daddy isn't angry with you." I gave her a big kiss on the forehead. Jasmine tried to pull herself together but seemed poleaxed. "Flower broken?"
And her mother came to my rescue. "Flowers," we chorused. Within two minutes we were dancing with the flowers in hand, with smiles as effervescent as root beer.
Researchers coined the term attachment to describe the reciprocating relationship between a baby and the parent. Babies come into this world preloaded with lots of emotional abilities. My response (such as shouting) acts like Post-it notes to tag different things, telling my baby's brain, "Pay attention to this." When I sat down and talked to my wife, she tried to reassure me that nothing was wrong, that I was tagging the wrong Post-it note to the vase, and that I could count to ten before yelling. "Come to think about it, you just screamed at the vase out of the blue, but the two-year-old would look at you with a tag that you're screaming at her. You did the same to me quite often, too."
Ugh. Jasmine gave me another lesson after my going wrong for at least 10 years.
Monday, October 10, 2011
Reflection
Don't you find that you learn more about yourself when you learn to weather the changes with your baby? That happened with my recent reading of What to Expect: the Toddler Years.
Heidi Murkoff tells the story of a toddler who gets upset whenever the cracker has a piece broken off. Even a crack in the cracker can set off tirades. By listening to the quizzical compulsiveness about an intact cracker or biscuit, I thought I'm lucky to have my easygoing daughter. But wait a minute: isn't that desire for perfection (or at least, the perception of it) the same as mine? Though I have tried not to delete any less-than-perfect photograph from my digital camera after pressing the shutter, I cannot.
The next story is about a toddler who resists to any change - a new car seat, a new order in the bedtime routine, a new glasses on the mother. Whilst some toddlers just can't tolerate any changes, most kids as I know it, my daughter included, are at least less rigid. Before I congratulated myself for having a daughter who doesn't insist on the status quo, I felt an uneasy idea welling up inside me. No, that story isn't about my daughter; it's talking about me. I'm the one who craves ritual. While having ritualistic behaviour is age-appropriate for a toddler, I wonder if having precisely the same kind of muffin for lunch, during my whole year of overseas training, for instance, is a bit too inflexible. Just a bit.
Heidi Murkoff tells the story of a toddler who gets upset whenever the cracker has a piece broken off. Even a crack in the cracker can set off tirades. By listening to the quizzical compulsiveness about an intact cracker or biscuit, I thought I'm lucky to have my easygoing daughter. But wait a minute: isn't that desire for perfection (or at least, the perception of it) the same as mine? Though I have tried not to delete any less-than-perfect photograph from my digital camera after pressing the shutter, I cannot.
The next story is about a toddler who resists to any change - a new car seat, a new order in the bedtime routine, a new glasses on the mother. Whilst some toddlers just can't tolerate any changes, most kids as I know it, my daughter included, are at least less rigid. Before I congratulated myself for having a daughter who doesn't insist on the status quo, I felt an uneasy idea welling up inside me. No, that story isn't about my daughter; it's talking about me. I'm the one who craves ritual. While having ritualistic behaviour is age-appropriate for a toddler, I wonder if having precisely the same kind of muffin for lunch, during my whole year of overseas training, for instance, is a bit too inflexible. Just a bit.
Thursday, September 29, 2011
Birthday
How, my wife asked me, should we celebrate my birthday with Jasmine?
Spending two days at the small Pak Lap village, nestling at the bottom of a valley with a hillside behind it, seems to be the idea of an eccentric - and quite possibly crazy - person. Well, that idea is mine.
Lodging in a less-than-trendy hut equipped with colder-than-what-you-want-for-shower water, it's easy to make you feel like travelling through time. No wi-fi. No mobile network coverage. No ice-cream.
Still, the village offers much more than any theme park does. With the beach well-protected by its long sheltering headlands, the fine sand gives rise to an unspoilt paradise for my daughter. And the flat marshy land around the hut smells nothing but the cattle. En route to greet the cattle, we taught Jasmine to say hi to the buff-backed herons. Ah yeah, crickets were too busy to stop and say hello. The next lesson, after listening to the chirruping of birds, was to follow the chorus of cicadas. Trust me, that's the best lullaby sung to young children before they go to sleep.
Envious? You should be.
Spending two days at the small Pak Lap village, nestling at the bottom of a valley with a hillside behind it, seems to be the idea of an eccentric - and quite possibly crazy - person. Well, that idea is mine.
Lodging in a less-than-trendy hut equipped with colder-than-what-you-want-for-shower water, it's easy to make you feel like travelling through time. No wi-fi. No mobile network coverage. No ice-cream.
Still, the village offers much more than any theme park does. With the beach well-protected by its long sheltering headlands, the fine sand gives rise to an unspoilt paradise for my daughter. And the flat marshy land around the hut smells nothing but the cattle. En route to greet the cattle, we taught Jasmine to say hi to the buff-backed herons. Ah yeah, crickets were too busy to stop and say hello. The next lesson, after listening to the chirruping of birds, was to follow the chorus of cicadas. Trust me, that's the best lullaby sung to young children before they go to sleep.
Envious? You should be.
Tuesday, September 20, 2011
Rash Answer
One of my students asked me a question about an infection that classically strikes a limited area on one side of the body. "I thought that zoster (also called shingles) usually is confined to a single dermatome or overlapping dermatomes. What would be the significance if a supposedly immunocompetent (healthy) person has an outbreak over multiple dermatomes that cross midline and are not overlapping?"
"Find out if he or she is immunocompetent or not," I replied. "Screen for diabetes, HIV, et cetera. Simultaneous involvement of noncontiguous dermatomes virtually never occurs in the immunocompetent host." I sounded like Charleton Heston handing down the Ten Commandments, or so I believed.
I didn't think much about the question of shingles until I went home and opened my e-mail. My student answered, "That's what I thought too. Actually this happened to me just last week."
I was speechless. I soon found out that some healthy persons can have a few scattered blisters located at some distance away from the involved dermatome.
I kicked myself and tried to explain. In any case, that's the worst demonstration of communication skill.
"Find out if he or she is immunocompetent or not," I replied. "Screen for diabetes, HIV, et cetera. Simultaneous involvement of noncontiguous dermatomes virtually never occurs in the immunocompetent host." I sounded like Charleton Heston handing down the Ten Commandments, or so I believed.
I didn't think much about the question of shingles until I went home and opened my e-mail. My student answered, "That's what I thought too. Actually this happened to me just last week."
I was speechless. I soon found out that some healthy persons can have a few scattered blisters located at some distance away from the involved dermatome.
I kicked myself and tried to explain. In any case, that's the worst demonstration of communication skill.
Wednesday, September 14, 2011
A Piece of Cake
I brought my parents handmade fist-sized snowy mooncakes this Mid-Autumn Festival.
For those of you, my mum included, who have no inkling of how to make mooncakes, you must swallow hard and believe that I learn the ropes of making mooncakes.
But - and I'm sure you expected a "but" - the true story is that we can't judge how difficult it is to create a product simply from how intricate it looks. Think about the diapers my daughter wears. It's hard to get excited about the diapers. Hard, that is, when I've thrown away several thousands of them since the birth of Jasmine.
After having the mooncakes at my mum's home, I caught sight of an old Fortune magazine article about diapers. Illustration of the article showed three awfully amicable babies wearing the same brand of diaper as Jasmine. One of them is dark-haired with dark skin; the other wearing a big smile; the third with an attractive face and short curly blond hair. Picture three naked creatures walking and crawling around. You won't be surprised to know that their diapers could be filling up faster than a Tokyo train in the rush hour.
As I went on reading the story, I was amazed at the exemplary efforts of the diaper research team. They started off hand making diapers of varying dimensions to try out on real babies. There are now baby manikins to check for leaking at their laboratories; their legs and tummies vary in size, just like real babies. With time, the researchers generated enormous databases after bringing babies in and literally scanning them head to toe. The computer models then simulate virtual diapers to fit silhouette of babies from different parts of the world. They even measure the amount of pressure the virtual diaper is applying to the skin at every spot, with red (Ouch! Too tight and discomfort), blue (No-no, too loose, and possible leaking), yellow, and green splotches distributed like a Doppler weather map. They can literally see the pressure points. I can feel it.
For those of you, my mum included, who have no inkling of how to make mooncakes, you must swallow hard and believe that I learn the ropes of making mooncakes.
But - and I'm sure you expected a "but" - the true story is that we can't judge how difficult it is to create a product simply from how intricate it looks. Think about the diapers my daughter wears. It's hard to get excited about the diapers. Hard, that is, when I've thrown away several thousands of them since the birth of Jasmine.
After having the mooncakes at my mum's home, I caught sight of an old Fortune magazine article about diapers. Illustration of the article showed three awfully amicable babies wearing the same brand of diaper as Jasmine. One of them is dark-haired with dark skin; the other wearing a big smile; the third with an attractive face and short curly blond hair. Picture three naked creatures walking and crawling around. You won't be surprised to know that their diapers could be filling up faster than a Tokyo train in the rush hour.
As I went on reading the story, I was amazed at the exemplary efforts of the diaper research team. They started off hand making diapers of varying dimensions to try out on real babies. There are now baby manikins to check for leaking at their laboratories; their legs and tummies vary in size, just like real babies. With time, the researchers generated enormous databases after bringing babies in and literally scanning them head to toe. The computer models then simulate virtual diapers to fit silhouette of babies from different parts of the world. They even measure the amount of pressure the virtual diaper is applying to the skin at every spot, with red (Ouch! Too tight and discomfort), blue (No-no, too loose, and possible leaking), yellow, and green splotches distributed like a Doppler weather map. They can literally see the pressure points. I can feel it.
Monday, September 5, 2011
Feedback
The idea that human decision and performance can be improved by feedback is never new, but has probably been forgotten.
The word feedback has hardly found a place in the field of corporate finance. When someone decides to buy a stock - or even an entire company - it may not be obvious for years that the move turned out to be a mistake. By then, those responsible for the mistake have often moved on to other places.
"True," you say. "But unless I move from being a doctor to the field of finance, what does this have to do with me?" Lots, I hope.
Doctors are no different. We need to be told when we're wrong, and not only when we're right. Depressing as it is to utter the word wrong, I do believe that we have to be told how many times we made mistakes in cleansing the skin before jabbing a needle into the patient for blood culture. Or, how many times we made the wrong decision to (or not to) admit a patient to the medical ward.
For now, I don't have to rush pitter-patter through each and every new case at the emergency room, the way the police would be doing at the road block. To a busy doctor, the job can be a downright classic example of acting on instinct. It ought to fail and it usually does. All too often we send away patients with serious ailments unbeknownst to ourselves. In the binary shorthand doctors use to conceptualize patients, we either admit the patients to the hospital or send them home - a tidy distinction that, unfortunately, crumbles in real life. If an emergency room doctor was to learn anything it was the feedback of his decision.
The word feedback has hardly found a place in the field of corporate finance. When someone decides to buy a stock - or even an entire company - it may not be obvious for years that the move turned out to be a mistake. By then, those responsible for the mistake have often moved on to other places.
"True," you say. "But unless I move from being a doctor to the field of finance, what does this have to do with me?" Lots, I hope.
Doctors are no different. We need to be told when we're wrong, and not only when we're right. Depressing as it is to utter the word wrong, I do believe that we have to be told how many times we made mistakes in cleansing the skin before jabbing a needle into the patient for blood culture. Or, how many times we made the wrong decision to (or not to) admit a patient to the medical ward.
For now, I don't have to rush pitter-patter through each and every new case at the emergency room, the way the police would be doing at the road block. To a busy doctor, the job can be a downright classic example of acting on instinct. It ought to fail and it usually does. All too often we send away patients with serious ailments unbeknownst to ourselves. In the binary shorthand doctors use to conceptualize patients, we either admit the patients to the hospital or send them home - a tidy distinction that, unfortunately, crumbles in real life. If an emergency room doctor was to learn anything it was the feedback of his decision.
Wednesday, August 31, 2011
Fibs
How much distortion can we make in retelling a narrative? By a long way.
On most days, we tell stories from memories and in our own style. In other words, we create stories. To remember something verbatim is a difficult task, made more so when exaggeration and minimization aren't considered lies.
My recent conversation with representative from drug company provides a nifty example. A pharmaceutical sales representative came to solicit my opinion about the recent treatment guideline for prescribing an expensive anaemia drug. To help you set the scene in your mind's eye, I should tell you that he approached me after my whole day of clinic sessions. My face and eyes looked tired, perhaps the result of seeing too many patients. Though I had tried to listen to his question to make sense of it, I could not.
"But wait," the sales representative told me, "I will keep the question brief. What do you think about the latest U.S. Food and Drug Administration recommendation to start treatment of anaemia in patients with kidney disease when haemoglobin level drops below 10?"
"I hear you," I replied after blinking a few times and swallowing what felt like a large goldfish, "but did you omit the second part of the new FDA recommendation? The gist of their new advice is not to make it a must to achieve a haemoglobin level of 10; they didn't define how far below 10 is appropriate to initiate drug treatment."
"Yes, good points," he answered, permitting himself the slightest trace of a smile.
On most days, we tell stories from memories and in our own style. In other words, we create stories. To remember something verbatim is a difficult task, made more so when exaggeration and minimization aren't considered lies.
My recent conversation with representative from drug company provides a nifty example. A pharmaceutical sales representative came to solicit my opinion about the recent treatment guideline for prescribing an expensive anaemia drug. To help you set the scene in your mind's eye, I should tell you that he approached me after my whole day of clinic sessions. My face and eyes looked tired, perhaps the result of seeing too many patients. Though I had tried to listen to his question to make sense of it, I could not.
"But wait," the sales representative told me, "I will keep the question brief. What do you think about the latest U.S. Food and Drug Administration recommendation to start treatment of anaemia in patients with kidney disease when haemoglobin level drops below 10?"
"I hear you," I replied after blinking a few times and swallowing what felt like a large goldfish, "but did you omit the second part of the new FDA recommendation? The gist of their new advice is not to make it a must to achieve a haemoglobin level of 10; they didn't define how far below 10 is appropriate to initiate drug treatment."
"Yes, good points," he answered, permitting himself the slightest trace of a smile.
Friday, August 26, 2011
Face Value
I went home by minibus after giving a talk to the interns last evening. I opened my book shortly after taking the seat, but I confess I was paying more attention to the people around than my book. And conversation of the passengers, in many ways, is about their stories in the hospital.
A couple sitting behind me started their conversation about a young doctor. That young doctor found profoundly offensive the idea that she was being addressed as a nurse - as most people did, I must say. "You know, it's difficult to tell without a closer look," the man said and began to tell his wife how the young doctor quickly corrected his mistake.
"After she returned a stern stare," the man continued, "I froze, sucked in my breath, and quickly called her a doctor. My fault, certainly, but hers too. She looked like a college freshman. Even now. I remember her baby face."
"Absolutely, this teaching hospital is full of green trainees," the wife rhapsodized.
Their story is almost funny - except that it's not. It is symptomatic of all human impressions. There always seems to be something to the snap impressions we form about people's faces. One study at Princeton University, for instance, showed that human inferences of competence based solely on facial appearance predicted the outcomes of congressional elections better than chance. Indeed, the inferences about the competence of politicians occurred within one second of being exposed to their black-and-white photographs. It won't make a centimeter's worth of difference even when people were given more time to think about it; their first impression stuck.
A couple sitting behind me started their conversation about a young doctor. That young doctor found profoundly offensive the idea that she was being addressed as a nurse - as most people did, I must say. "You know, it's difficult to tell without a closer look," the man said and began to tell his wife how the young doctor quickly corrected his mistake.
"After she returned a stern stare," the man continued, "I froze, sucked in my breath, and quickly called her a doctor. My fault, certainly, but hers too. She looked like a college freshman. Even now. I remember her baby face."
"Absolutely, this teaching hospital is full of green trainees," the wife rhapsodized.
Their story is almost funny - except that it's not. It is symptomatic of all human impressions. There always seems to be something to the snap impressions we form about people's faces. One study at Princeton University, for instance, showed that human inferences of competence based solely on facial appearance predicted the outcomes of congressional elections better than chance. Indeed, the inferences about the competence of politicians occurred within one second of being exposed to their black-and-white photographs. It won't make a centimeter's worth of difference even when people were given more time to think about it; their first impression stuck.
Thursday, August 11, 2011
Mood
Hospital can be an intimidating and stressful place, one in which doctors can sometimes feel blue - and not just for the patients.
After returning from my Singapore trip, I started my first working day with an overnight call. The long work hours, as usual, were interrupted by the beeper calls from everywhere. Anyone who works in the hospital quickly learns that it's a race to see whether your beeper battery goes dead before you do so.
Did the work drive me nuts? Not really. I keep telling myself to be in good mood rather than working like Eeyore. A number of behavioural studies, in fact, have already shown that emotions can influence our mental activities. A good example of this proved that the mood affects the way we see things by modulating the activity of the visual cortex. When the study subjects in that Canadian study were shown photographs of faces expressing positive emotion (and with a higher self-reported mood after that), they have better better peripheral vision (confirmed by functional magnetic resonance imaging that monitored the visual cortical activity).
In case you're wondering whether doctors are immune to the unconscious influence from the mood, here's the answer: No, they're worse. In another experiment, a group of doctors were given a small bag of wrapped candy containing Hershey's chocolate and another group received nothing. They were then told to look at a patient's history and make a diagnosis. The doctors who got the candy were quicker to detect the liver problem than those who didn't.
After returning from my Singapore trip, I started my first working day with an overnight call. The long work hours, as usual, were interrupted by the beeper calls from everywhere. Anyone who works in the hospital quickly learns that it's a race to see whether your beeper battery goes dead before you do so.
Did the work drive me nuts? Not really. I keep telling myself to be in good mood rather than working like Eeyore. A number of behavioural studies, in fact, have already shown that emotions can influence our mental activities. A good example of this proved that the mood affects the way we see things by modulating the activity of the visual cortex. When the study subjects in that Canadian study were shown photographs of faces expressing positive emotion (and with a higher self-reported mood after that), they have better better peripheral vision (confirmed by functional magnetic resonance imaging that monitored the visual cortical activity).
In case you're wondering whether doctors are immune to the unconscious influence from the mood, here's the answer: No, they're worse. In another experiment, a group of doctors were given a small bag of wrapped candy containing Hershey's chocolate and another group received nothing. They were then told to look at a patient's history and make a diagnosis. The doctors who got the candy were quicker to detect the liver problem than those who didn't.
Monday, August 8, 2011
Zoo
When it comes to visiting Singapore, it turns out that the zoo is the most unforgettable destination.
It was the middle of summer, and the overcast day made it an ideal one to walk around. To my little girl, that was her first time to come face to face with giraffes and zebras. It's hard to describe the feeling of ecstasy that swept across her that moment. The children's song came closest: "Oh, we're riding on a train called the Allee-Allee O - All through the zoo today!"
A few steps away, four nearsighted rhinoceros strolled in a leisurely fashion, with birds perched atop their thick skin. Just as I was reading the Time magazine featured story of (skyrocketed) rhino poaching recently, I found myself, by chance, in the midst of this endangered species. I surveyed the innocent look of these pachyderm mammals. They must be disappointed to learn that their friends got killed because of their horns, which consists of nothing but keratin. No kidding. That's the same stuff that makes up hair and fingernails.
And then, in the labyrinthine Night Safari, we were joining the nocturnal animals - hyenas, otters, elephants and leopards - in darkness. A strong wind blew through the trees. It took me a minute to recognize that it was a flying squirrel, as big as a pizza, gliding between trees. We were stunned.
Yet the climax memory of the Singapore Zoo trip came for me at the very end: When I returned to the hotel I realized my wallet was gone. That would be a nightmare. Money is just part of the equation. Lost identity cards and credit cards made my heart beat faster. I phoned up the maxi cab driver (who took us to and from the zoo) sheepishly, and waited for his search.
"No problem, I found it in the backseat. I'll hand you the wallet tomorrow. Good night."
I could not believe my ears. My wallet is definitely much more worthy than the rhino horns, and I was able to keep it.
How lucky, I thought.
It was the middle of summer, and the overcast day made it an ideal one to walk around. To my little girl, that was her first time to come face to face with giraffes and zebras. It's hard to describe the feeling of ecstasy that swept across her that moment. The children's song came closest: "Oh, we're riding on a train called the Allee-Allee O - All through the zoo today!"
A few steps away, four nearsighted rhinoceros strolled in a leisurely fashion, with birds perched atop their thick skin. Just as I was reading the Time magazine featured story of (skyrocketed) rhino poaching recently, I found myself, by chance, in the midst of this endangered species. I surveyed the innocent look of these pachyderm mammals. They must be disappointed to learn that their friends got killed because of their horns, which consists of nothing but keratin. No kidding. That's the same stuff that makes up hair and fingernails.
And then, in the labyrinthine Night Safari, we were joining the nocturnal animals - hyenas, otters, elephants and leopards - in darkness. A strong wind blew through the trees. It took me a minute to recognize that it was a flying squirrel, as big as a pizza, gliding between trees. We were stunned.
Yet the climax memory of the Singapore Zoo trip came for me at the very end: When I returned to the hotel I realized my wallet was gone. That would be a nightmare. Money is just part of the equation. Lost identity cards and credit cards made my heart beat faster. I phoned up the maxi cab driver (who took us to and from the zoo) sheepishly, and waited for his search.
"No problem, I found it in the backseat. I'll hand you the wallet tomorrow. Good night."
I could not believe my ears. My wallet is definitely much more worthy than the rhino horns, and I was able to keep it.
How lucky, I thought.
Friday, August 5, 2011
Universal Studios
I was riding a roller coaster. I wasn't flying like a piece of paper in a tornado, but the speed was fast enough for me to lose my mind.
True, it's a must-do experience for most Universal Studios theme park visitors to get flung around on cutting-edge roller coasters. Nobody wants to miss the game. Not even the faint-hearted. Nor do the harried people, although there are exceptions. Those ups and downs, stunning as they are, didn’t get me addicted. As the roller coaster sped on, I kept wondering which turn it was going to make, and which direction I should keep my head. A minute's inattention, and one loses track blankly of one's whereabouts.
"Is it that easy for others to get carried away by roller coaster?" I asked myself after the ride. Maybe, just maybe, I'm too old or too slow for roller coaster.
True, it's a must-do experience for most Universal Studios theme park visitors to get flung around on cutting-edge roller coasters. Nobody wants to miss the game. Not even the faint-hearted. Nor do the harried people, although there are exceptions. Those ups and downs, stunning as they are, didn’t get me addicted. As the roller coaster sped on, I kept wondering which turn it was going to make, and which direction I should keep my head. A minute's inattention, and one loses track blankly of one's whereabouts.
"Is it that easy for others to get carried away by roller coaster?" I asked myself after the ride. Maybe, just maybe, I'm too old or too slow for roller coaster.
Tuesday, July 26, 2011
Marshmallow
Mention the words "skipping class" and you're likely to conjure images of Holden Caulfield, whining rants about "phony" lectures. As a matter of fact, all students have skipped class - some teachers, too.
One of the best-kept secrets about skipping class is that we don't always tell people we skip class. You know, teachers don't take attendance most of the time. When a medical student was recently caught skipping class for one whole week, little did he realize his classmates told the teacher he skipped classes because of preparatory work for the freshman orientation camp. We could not help laughing when we heard the excuse of camping - yes, camping, a pretty lame one - and skipping class. I was to find out later that this student explained to his lecturer that he skipped class simply because he rated the camping more important than the class.
But wait: can we stop laughing and make sense of it? The answer: I can. This remarkable student illustrates very well the fundamental steps of human decisions. The three steps of deciding to skip classes is worth recounting. First, he perceived a situation. Second, he used his power of reason to calculate whether skipping classes is in his best interest. Third, he used the power of will to execute his decision. A test of willpower indeed! The implicit importance of the second and third steps - reason and will - is so pervasive. Such were the kinds of issues taught by moralists for much of the twentieth century. Students have been reminded that candies and soda decay the teeth, smoking chokes the lungs, unsafe sex heralds unwanted pregnancy and bad disease. The list goes on and on. When things went wrong, we gave longer lectures and sermons.
Admit it. We failed. We failed because we forgot the crucial step. What does that mean? The first step is actually the most important one. Self-discipline and self-control can't replace the hidden process of perceiving. The emphasis should really be on how the student perceives the camping. Which brings me to the famous marshmallow psychology experiment. A group of four-year-olds were sitting in a room, with a marshmallow in front of them. They were instructed that they could eat the marshmallow right away, but that the psychologist was going to leave the room and if they waited until he returned he would give them two marshmallows. Try imagining it. How can we, as parents, teach our kids to resist the temptation to pop the marshmallow in the mouth? Should we ask them to calculate the marginal cost (second step)? And how about biting the lip to control their impulse (step three)? Nope. In the experiment, children could wait three times longer when they were able to perceive the marshmallow in a new mental frame. Say, children who were told to imagine the marshmallow was a fluffy cloud could do much better. With just a shift in the frame of reference, the change in human decisions has never been bigger.
One of the best-kept secrets about skipping class is that we don't always tell people we skip class. You know, teachers don't take attendance most of the time. When a medical student was recently caught skipping class for one whole week, little did he realize his classmates told the teacher he skipped classes because of preparatory work for the freshman orientation camp. We could not help laughing when we heard the excuse of camping - yes, camping, a pretty lame one - and skipping class. I was to find out later that this student explained to his lecturer that he skipped class simply because he rated the camping more important than the class.
But wait: can we stop laughing and make sense of it? The answer: I can. This remarkable student illustrates very well the fundamental steps of human decisions. The three steps of deciding to skip classes is worth recounting. First, he perceived a situation. Second, he used his power of reason to calculate whether skipping classes is in his best interest. Third, he used the power of will to execute his decision. A test of willpower indeed! The implicit importance of the second and third steps - reason and will - is so pervasive. Such were the kinds of issues taught by moralists for much of the twentieth century. Students have been reminded that candies and soda decay the teeth, smoking chokes the lungs, unsafe sex heralds unwanted pregnancy and bad disease. The list goes on and on. When things went wrong, we gave longer lectures and sermons.
Admit it. We failed. We failed because we forgot the crucial step. What does that mean? The first step is actually the most important one. Self-discipline and self-control can't replace the hidden process of perceiving. The emphasis should really be on how the student perceives the camping. Which brings me to the famous marshmallow psychology experiment. A group of four-year-olds were sitting in a room, with a marshmallow in front of them. They were instructed that they could eat the marshmallow right away, but that the psychologist was going to leave the room and if they waited until he returned he would give them two marshmallows. Try imagining it. How can we, as parents, teach our kids to resist the temptation to pop the marshmallow in the mouth? Should we ask them to calculate the marginal cost (second step)? And how about biting the lip to control their impulse (step three)? Nope. In the experiment, children could wait three times longer when they were able to perceive the marshmallow in a new mental frame. Say, children who were told to imagine the marshmallow was a fluffy cloud could do much better. With just a shift in the frame of reference, the change in human decisions has never been bigger.
Thursday, July 14, 2011
Evidence
Not a day passes in medical school without someone teaching us the highest level evidence from the randomized controlled trials, which lie at the heart of modern clinical medicine. Everyone touts it as an elixir to make you a top-notch doctor.
Years ago, when I showed up as a young intern prepared to learn about patients with plaque-clogged heart arteries in the coronary care unit, my senior smiled and asked me the details of big names like ISIS-2 trial. I tried to think of answers to his question how many patients we need to treat with aspirin and clot-busting drug in order to save one life. Following his lead, I was convinced with the power – at least in front of an examiner – of reciting the level I evidence. Doctors love the exact number of absolute risk reduction, perhaps more than they love patients.
With time, I started seeing the need to look beyond the level I evidence. And I wonder how on earth one could ever quantify the treatment benefit of paying attention to bedside manner, asking patients about their concerns (of not quitting his smoking after a heart attack, say), making an effort to remember the name (and not the bed number) of our patients. To truly optimize outcomes for our patients, as Anand K. Parekh wrote in the New England Journal of Medicine last month, we first have to win their trust.
Years ago, when I showed up as a young intern prepared to learn about patients with plaque-clogged heart arteries in the coronary care unit, my senior smiled and asked me the details of big names like ISIS-2 trial. I tried to think of answers to his question how many patients we need to treat with aspirin and clot-busting drug in order to save one life. Following his lead, I was convinced with the power – at least in front of an examiner – of reciting the level I evidence. Doctors love the exact number of absolute risk reduction, perhaps more than they love patients.
With time, I started seeing the need to look beyond the level I evidence. And I wonder how on earth one could ever quantify the treatment benefit of paying attention to bedside manner, asking patients about their concerns (of not quitting his smoking after a heart attack, say), making an effort to remember the name (and not the bed number) of our patients. To truly optimize outcomes for our patients, as Anand K. Parekh wrote in the New England Journal of Medicine last month, we first have to win their trust.
Monday, July 11, 2011
Humor
Now that my nineteen-month-old knows more words and goes through her growth spurt in the sense of humor, Jasmine often gives us a riotous chorus of impromptu laughter.
My wife pretended to prepare meal for Jasmine. "My baby, do you want eggplant? Let me cut it into pieces." Jasmine shook her head and said no.
"I bet you want to wash you hands and try this yummy fish, right?"
She said no again.
"Fine, let's then pick tomato."
Jasmine agreed with this jolly good idea, and leaned forward intently to wait for her mum to prepare the plastic toy tomato.
Of course, my wife was proud with her pretend play when she handed Jasmine "prepared tomato."
"Too hot," answered Jasmine, with a fit of giggles.
My wife pretended to prepare meal for Jasmine. "My baby, do you want eggplant? Let me cut it into pieces." Jasmine shook her head and said no.
"I bet you want to wash you hands and try this yummy fish, right?"
She said no again.
"Fine, let's then pick tomato."
Jasmine agreed with this jolly good idea, and leaned forward intently to wait for her mum to prepare the plastic toy tomato.
Of course, my wife was proud with her pretend play when she handed Jasmine "prepared tomato."
"Too hot," answered Jasmine, with a fit of giggles.
Thursday, July 7, 2011
Granuloma
Uncertainty is a key word in science and medicine. Classical description of a disease as we learn from the textbooks, and as we admire it in straightforward presentation, is never happening in real life.
"How true," I whispered as I taught my students yesterday on a chest radiograph from a lady with cough and fluid in her lung. As soon as I showed them the picture, most students pointed to the fluid without hesitation.
"So is there anything abnormal you can spot out?" I smiled. They just stared at the film without blinking, their hearts running fast. No one answered. "Look at this cluster of innocent-looking players at the top," I finally spoke aloud, my fingers pointing at the area what we call granulomas – which are nothing but a large aggregate of host cells and tuberculosis bacteria.
"Take one more look at the chest film of your patients," I explained. "And you'll see these footprints left behind after an attack by the tuberculosis." Although this is for student learning, it's not just for them to learn. I'm learning too. When I went back to my office and read up the topic from the recent issue of the medical journal Lancet, I began to know more about the microbial mystery of granuloma. This is an eerie thought when I found out new theory about granuloma. In the old days, granuloma seems like a cocoon keeping the tuberculosis in quarantine. Now, we're taught that the granuloma also provides the primary growth niche for this organism. Another way of looking at this granuloma is to view its wall as shielding itself from immune-based killing mechanisms and making it very difficult for antituberculosis drugs to penetrate. Granulomas, alas, are no longer considered an innocent guy.
Classifying anyone as distinct binary categories - either good guy or bad guy - is overly simplistic, I know.
"How true," I whispered as I taught my students yesterday on a chest radiograph from a lady with cough and fluid in her lung. As soon as I showed them the picture, most students pointed to the fluid without hesitation.
"So is there anything abnormal you can spot out?" I smiled. They just stared at the film without blinking, their hearts running fast. No one answered. "Look at this cluster of innocent-looking players at the top," I finally spoke aloud, my fingers pointing at the area what we call granulomas – which are nothing but a large aggregate of host cells and tuberculosis bacteria.
"Take one more look at the chest film of your patients," I explained. "And you'll see these footprints left behind after an attack by the tuberculosis." Although this is for student learning, it's not just for them to learn. I'm learning too. When I went back to my office and read up the topic from the recent issue of the medical journal Lancet, I began to know more about the microbial mystery of granuloma. This is an eerie thought when I found out new theory about granuloma. In the old days, granuloma seems like a cocoon keeping the tuberculosis in quarantine. Now, we're taught that the granuloma also provides the primary growth niche for this organism. Another way of looking at this granuloma is to view its wall as shielding itself from immune-based killing mechanisms and making it very difficult for antituberculosis drugs to penetrate. Granulomas, alas, are no longer considered an innocent guy.
Classifying anyone as distinct binary categories - either good guy or bad guy - is overly simplistic, I know.
Monday, June 27, 2011
Adaptation
Think that buying Porsche would actually make you happier than driving Subaru? Or, as my mentor recently asked in his blog post, can dining at Gaddis create a higher overall happiness level than at the fast food restaurant Café de Coral? Think again.
It looks like it's satisfying to buy another new car - and it is. But not for long. Believe me, we thought it was great at first. But it has made a heck of a difference when we step back and think about the overall happiness level. This has something to do with the human psychology of hedonic adaptation - the natural process for humans to quickly get used to things and return to a set point. In essence, the happiness - however high we achieve - will soon wear off. In the end, we sigh and moan and wish we had more money. From an economist viewpoint, the best strategy should be to space purchases to an intermittent approach, instead of the shopping spree.
The same goes for buying coffee. Should I yearn to visit Starbucks? Their coffee is great; everyone say so. If I started buying coffee from Starbucks, I would get used to that level of coffee quality and would no longer be able to derive any pleasure from cheaper coffee.
Man is a pliant animal, as Fyodor Dostoyevsky reminds us, a being who gets accustomed to anything.
It looks like it's satisfying to buy another new car - and it is. But not for long. Believe me, we thought it was great at first. But it has made a heck of a difference when we step back and think about the overall happiness level. This has something to do with the human psychology of hedonic adaptation - the natural process for humans to quickly get used to things and return to a set point. In essence, the happiness - however high we achieve - will soon wear off. In the end, we sigh and moan and wish we had more money. From an economist viewpoint, the best strategy should be to space purchases to an intermittent approach, instead of the shopping spree.
The same goes for buying coffee. Should I yearn to visit Starbucks? Their coffee is great; everyone say so. If I started buying coffee from Starbucks, I would get used to that level of coffee quality and would no longer be able to derive any pleasure from cheaper coffee.
Man is a pliant animal, as Fyodor Dostoyevsky reminds us, a being who gets accustomed to anything.
Friday, June 24, 2011
Gut Feeling
For a species wired for survival, it should learn to make use of instinct to quickly identify the feeding source and spot out the hostile enemy. And no wonder: a recent study from Paris has provided the first experimental evidence in urban pigeons for their ability to distinguish between friendly feeders and hostile foes.
The research team carried out the test with two feeders - one neutral and one hostile. To put it simply, the hostile feeder would chase the birds away. And what was so special about the urban pigeons? The birds learned quickly to discriminate between the feeders. Is this happenstance, do you think? Of course not, the pigeons avoided the hostile feeder even after the two feeders exchanged their coats.
While I subscribe to the theory that most animals are brilliant in terms of their gut feeling, I have trouble with telling this story. Before I heard the pigeon experiment, my wife and I had just found out that our used car was stolen by our auto mechanic - a guy we had counted on for over ten years. It isn't easy or even possible to rely on our gut feeling. But it is something we want. And need.
The research team carried out the test with two feeders - one neutral and one hostile. To put it simply, the hostile feeder would chase the birds away. And what was so special about the urban pigeons? The birds learned quickly to discriminate between the feeders. Is this happenstance, do you think? Of course not, the pigeons avoided the hostile feeder even after the two feeders exchanged their coats.
While I subscribe to the theory that most animals are brilliant in terms of their gut feeling, I have trouble with telling this story. Before I heard the pigeon experiment, my wife and I had just found out that our used car was stolen by our auto mechanic - a guy we had counted on for over ten years. It isn't easy or even possible to rely on our gut feeling. But it is something we want. And need.
Sunday, June 19, 2011
Empathy
Following a hospital forum on doctor-patient relationship, I spent another whole day teaching the medical school graduates to practice empathy in communication. I taught them a good deal to recognize (and verbalize) the patient's emotion.
For those of you who believes that emotion is as obvious as an instant Twitter broadcast (or Facebook status update), you would have laughed out loud. If so, think twice after hearing behaviorist John Gottman's forecast of divorce probabilities. In piecing together years of research on marriage, John concludes that if the wife felt she was being heard by her husband the marriage was essentially divorce-proof. If that empathy was absent, the marriage foundered like a two-legged stool.
Ahem. Did I listen to my wife? Not always. Which is why, after the teaching, I went straight home and tried to hear what she said. She was away for work when I got home but I found three new gift books. My wife had just bought them for our daughter: When I'm Feeling Angry, When I'm Feeling Scared, and When I'm Feeling Happy.
I couldn't have been more flabbergasted; we get to learn our emotion since toddler age but can't seem to master it after a life time.
For those of you who believes that emotion is as obvious as an instant Twitter broadcast (or Facebook status update), you would have laughed out loud. If so, think twice after hearing behaviorist John Gottman's forecast of divorce probabilities. In piecing together years of research on marriage, John concludes that if the wife felt she was being heard by her husband the marriage was essentially divorce-proof. If that empathy was absent, the marriage foundered like a two-legged stool.
Ahem. Did I listen to my wife? Not always. Which is why, after the teaching, I went straight home and tried to hear what she said. She was away for work when I got home but I found three new gift books. My wife had just bought them for our daughter: When I'm Feeling Angry, When I'm Feeling Scared, and When I'm Feeling Happy.
I couldn't have been more flabbergasted; we get to learn our emotion since toddler age but can't seem to master it after a life time.
Friday, June 10, 2011
Help
Every time a doctor breaks bad news to the patient's family members, they go to pieces. From breast cancer to heart attack to motor vehicle crash, and each time, one can feel the family member’s heart almost palpably turning to flutter.
Faced with this common scene in hospital, what should a doctor do? Instead of telling them to let go and accept the diagnosis, I feel a need to give the family members something to do. It's not that they aren't in bad mood themselves – trust me, they are – but it doesn't mean that the family members aren't in a position to offer help to the patient.
On one such occasion, I received a crash call after my patient’s heart and breathing stopped. The diagnosis wasn't particularly difficult. The prognosis was. He didn't improve much and I realized that I was losing that patient. I was tempted to conclude, when his wife and children rushed to the hospital, that they arrived too late. I paused. I quickly gazed at the monitors. My patient's heart tracing wasn't flat yet. "Let's see what we can help your dad before saying bye to him," I changed my mind. I then handed over the Ambu bag to the sons and asked them to give their dad extra breaths. (Ambu bag, by the way, is a hand-held bag valve mask to provide breathing assistance.) In less than a blink of an eye, my patient's wife boomeranged back home to fetch the best attire for her beloved husband. All these, I know, did not save the life of our patient. But wait: the healing power for the family is enormous. They came and joined me to do the best they could to help their family member.
Some doctors have trouble with this. Actually, you shouldn't have been. The primary duty of a doctor is supposed to help the patient. If you ask me, helping the family to help the patient is a close runner-up. As my nurse friend asked me this morning if she could assist me to perform a bone marrow examination for her own dad, I nodded my head and let her join me to unravel the disease of a blood disorder.
Faced with this common scene in hospital, what should a doctor do? Instead of telling them to let go and accept the diagnosis, I feel a need to give the family members something to do. It's not that they aren't in bad mood themselves – trust me, they are – but it doesn't mean that the family members aren't in a position to offer help to the patient.
On one such occasion, I received a crash call after my patient’s heart and breathing stopped. The diagnosis wasn't particularly difficult. The prognosis was. He didn't improve much and I realized that I was losing that patient. I was tempted to conclude, when his wife and children rushed to the hospital, that they arrived too late. I paused. I quickly gazed at the monitors. My patient's heart tracing wasn't flat yet. "Let's see what we can help your dad before saying bye to him," I changed my mind. I then handed over the Ambu bag to the sons and asked them to give their dad extra breaths. (Ambu bag, by the way, is a hand-held bag valve mask to provide breathing assistance.) In less than a blink of an eye, my patient's wife boomeranged back home to fetch the best attire for her beloved husband. All these, I know, did not save the life of our patient. But wait: the healing power for the family is enormous. They came and joined me to do the best they could to help their family member.
Some doctors have trouble with this. Actually, you shouldn't have been. The primary duty of a doctor is supposed to help the patient. If you ask me, helping the family to help the patient is a close runner-up. As my nurse friend asked me this morning if she could assist me to perform a bone marrow examination for her own dad, I nodded my head and let her join me to unravel the disease of a blood disorder.
Monday, May 30, 2011
Pavlov
After reading the social scientist Dan Ariely's book, I've learned that I'm no better than Pavlov's dog. Ditto for Dan Ariely.
Dan experienced a devastating chemical burns accident and got a liver virus from an infected blood transfusion after three weeks in the hospital. For that, he had gone through an eighteen-month ordeal of interferon injection to kick the virus. While interferon treatment has clear health benefits and survival advantages, the medication came to effect at a big price - each shot is followed by shivering, nausea and headache, plus the fact that the drug can cause depression. Dan carried out a ritual every injection day: He would stop at the video store on the way to school and picked up a few films that he wanted to see. He then think about how much he would enjoyed watching them later. Once he got home, he would give himself the interferon injection and immediately jump into his hammock and start his mini film festival.
That way, Dan learned to associate the act of the injection with the rewarding experience of his favorite pastime. The trick allowed him to spend less time mulling over negative feelings of injection. Somewhat like the philosopher's stone that turns lead into gold. Sounds silly, but it isn't. In case you're wondering whether it works, here's the answer: He never skipped an injection.
Pavlov's dog started to salivate in response to bell after repeatedly hearing the bell together with the presentation of meat powder. Much the same could be said about mundane tasks that we would rather procrastinate. I did similar tricks by buying myself can coffee on the way to morning ward round and a can of Coke before the afternoon clinic. I also buy myself teddy bear gum sweets every month, before the otherwise miserable task of duty roster preparation. I could go on and on.
Dan experienced a devastating chemical burns accident and got a liver virus from an infected blood transfusion after three weeks in the hospital. For that, he had gone through an eighteen-month ordeal of interferon injection to kick the virus. While interferon treatment has clear health benefits and survival advantages, the medication came to effect at a big price - each shot is followed by shivering, nausea and headache, plus the fact that the drug can cause depression. Dan carried out a ritual every injection day: He would stop at the video store on the way to school and picked up a few films that he wanted to see. He then think about how much he would enjoyed watching them later. Once he got home, he would give himself the interferon injection and immediately jump into his hammock and start his mini film festival.
That way, Dan learned to associate the act of the injection with the rewarding experience of his favorite pastime. The trick allowed him to spend less time mulling over negative feelings of injection. Somewhat like the philosopher's stone that turns lead into gold. Sounds silly, but it isn't. In case you're wondering whether it works, here's the answer: He never skipped an injection.
Pavlov's dog started to salivate in response to bell after repeatedly hearing the bell together with the presentation of meat powder. Much the same could be said about mundane tasks that we would rather procrastinate. I did similar tricks by buying myself can coffee on the way to morning ward round and a can of Coke before the afternoon clinic. I also buy myself teddy bear gum sweets every month, before the otherwise miserable task of duty roster preparation. I could go on and on.
Sunday, May 22, 2011
Lottery
Have you heard of the HK$100 million Mark Six dream? Of course you have. Everyone has.
I'll confess it; I'm kind of tired of lottery winner frenzy. Maybe it has something to do with the earliest adaptation level theory study on overall life happiness among lottery winners.
This might not be news to you, but in case it is you should hear the experiment in which psychologists compared a sample of major lottery winners with normal controls, and also with paraplegic accident victims. At issue in this case wasn't the level of happiness immediately following the event (of the miserable accident or the lottery win). At issue was simply their effect one year after the event. In the end, the differences in happiness levels among the three groups were not as pronounced as we might expect. Both paraplegics and lottery winners were surprisingly close to normal levels of life satisfaction. What strikes me most about the study was that lottery winners took significantly less pleasure from a series of mundane events.
These ideas dovetail with my recent reading. In his book The Upside of Irrationality: The Unexpected Benefits of Defying Logic at Work and at Home, Dan Ariely talked about how we get used to (with time) the euphoric feeling or painful experience. The point is that, in his words, even if you feel strongly about something in the short term, in the long term things will probably not leave you as ecstatic or as miserable as you expect.
I'll confess it; I'm kind of tired of lottery winner frenzy. Maybe it has something to do with the earliest adaptation level theory study on overall life happiness among lottery winners.
This might not be news to you, but in case it is you should hear the experiment in which psychologists compared a sample of major lottery winners with normal controls, and also with paraplegic accident victims. At issue in this case wasn't the level of happiness immediately following the event (of the miserable accident or the lottery win). At issue was simply their effect one year after the event. In the end, the differences in happiness levels among the three groups were not as pronounced as we might expect. Both paraplegics and lottery winners were surprisingly close to normal levels of life satisfaction. What strikes me most about the study was that lottery winners took significantly less pleasure from a series of mundane events.
These ideas dovetail with my recent reading. In his book The Upside of Irrationality: The Unexpected Benefits of Defying Logic at Work and at Home, Dan Ariely talked about how we get used to (with time) the euphoric feeling or painful experience. The point is that, in his words, even if you feel strongly about something in the short term, in the long term things will probably not leave you as ecstatic or as miserable as you expect.
Saturday, May 14, 2011
Spider
My wife's sling bag always reminds me of the vulnerability of adults, and how easily we can be lured into the shortsightedness.
The bag looked fine until I made a careless splash of ink on it (when I hand-painted a T-shirt). So, what can be done to the blemished bag? The answer: not much - at least not immediately. A small voice inside me said, “Let's forget about the ink.” But the wounded part was less comfortable. It said, “Excuuuuuse me? What's the matter about the two black dots?”
My wife didn't throw away the bag but I still feel bad and guilty, and, if the truth be told, rather uneasy about the stain. I was worried, but not for long. It has made a heck of difference when my daughter Jasmine looked at her mum's tote bag. She smiled and pointed to the two dots of black ink. And, oh yes, she uttered a few words "dah dah." I didn't know what she meant until my wife nodded her head and sang the children song "Itsy Bitsy Spider."
Bingo. The two dots look really like two little spiders. Amazing spiders. I almost laughed my head off as Jasmine pointed to the two "dah dah."
The bag looked fine until I made a careless splash of ink on it (when I hand-painted a T-shirt). So, what can be done to the blemished bag? The answer: not much - at least not immediately. A small voice inside me said, “Let's forget about the ink.” But the wounded part was less comfortable. It said, “Excuuuuuse me? What's the matter about the two black dots?”
My wife didn't throw away the bag but I still feel bad and guilty, and, if the truth be told, rather uneasy about the stain. I was worried, but not for long. It has made a heck of difference when my daughter Jasmine looked at her mum's tote bag. She smiled and pointed to the two dots of black ink. And, oh yes, she uttered a few words "dah dah." I didn't know what she meant until my wife nodded her head and sang the children song "Itsy Bitsy Spider."
Bingo. The two dots look really like two little spiders. Amazing spiders. I almost laughed my head off as Jasmine pointed to the two "dah dah."
Thursday, May 5, 2011
Barber
Not long ago, I read the blog post of my mentor who had to say goodbye to his barber. I found a great example of loyal customer who visited the same barber for over thirty years. Then came the moment for me to have haircut for my Jasmine. This turned out to be a haphazard zigzag style.
Which brings me to the memory of my barber.
The experience of being a child to visit the barber for the first time has a common affliction with visiting the dentist: fear of the knife and the chair. Both are frightening. Dentist and barber are alike when it's the first time you visit them. I started seeing the difference between a dentist and barber after the second visit, of course. My barber's razor never hurts, his smile always shines.
The place was essentially a tenement building where I climbed the terrazzo staircase to find my barber, who was much older than the decrepit building. And it was the comic magazine I liked most about visiting that barber. To me, those magazines were dog-eared but amiable. And by the time my mother allowed me to visit the barber on my own, I had finished all his comic magazines. At the age of 10, I'd still looked forward to visiting my barber. Next I heard about my barber's plan to retire. After that he welcomed me to visit him for haircut for another one year or two – before he really retired.
Sayonara to the barber is hard to say, and it is.
Which brings me to the memory of my barber.
The experience of being a child to visit the barber for the first time has a common affliction with visiting the dentist: fear of the knife and the chair. Both are frightening. Dentist and barber are alike when it's the first time you visit them. I started seeing the difference between a dentist and barber after the second visit, of course. My barber's razor never hurts, his smile always shines.
The place was essentially a tenement building where I climbed the terrazzo staircase to find my barber, who was much older than the decrepit building. And it was the comic magazine I liked most about visiting that barber. To me, those magazines were dog-eared but amiable. And by the time my mother allowed me to visit the barber on my own, I had finished all his comic magazines. At the age of 10, I'd still looked forward to visiting my barber. Next I heard about my barber's plan to retire. After that he welcomed me to visit him for haircut for another one year or two – before he really retired.
Sayonara to the barber is hard to say, and it is.
Sunday, May 1, 2011
Diffusion
I always recommend mentorship to young medical student or doctor who wants to learn medicine.
That is what I'd been doing over the last few weeks when the summer students joined me. Did they learn from me - as a nephrologist - how dialysis works? Not really. For that bit, the students can figure out themselves from the textbooks. It's a good start, of course, to teach them that haemodialysis works under the principle of diffusion.
And that is exactly how mentorship works its magic: by diffusion.
That is what I'd been doing over the last few weeks when the summer students joined me. Did they learn from me - as a nephrologist - how dialysis works? Not really. For that bit, the students can figure out themselves from the textbooks. It's a good start, of course, to teach them that haemodialysis works under the principle of diffusion.
And that is exactly how mentorship works its magic: by diffusion.
Sunday, April 24, 2011
Story
We adults often have memories of the children books from when we were children ourselves. While it may not be too soon for us to give up reading the Harry Potter series, they're just not as good as those books that were read during our childhood.
On the positive side, we are still drawn to books that have a nostalgic theme. The negative side, of course, may be that we're far behind the latest trend of children's storybooks. I simply worry if I am still as great at reading to my daughter as what I used to.
Gone are the good old days when I had regular story time with my younger sister. I'm sure I need to learn to tell Jasmine stories at bedtime. To brush up, I am reading You Can Write Children's Books. If there was one lesson learned from this book by Tracey Dils, it was this: crafting children's stories is never easier than writing for the adults.
On the positive side, we are still drawn to books that have a nostalgic theme. The negative side, of course, may be that we're far behind the latest trend of children's storybooks. I simply worry if I am still as great at reading to my daughter as what I used to.
Gone are the good old days when I had regular story time with my younger sister. I'm sure I need to learn to tell Jasmine stories at bedtime. To brush up, I am reading You Can Write Children's Books. If there was one lesson learned from this book by Tracey Dils, it was this: crafting children's stories is never easier than writing for the adults.
Thursday, April 21, 2011
Langkawi trip
One day after my confirming flight tickets and accommodation of our first venture with Jasmine to Japan, the country was smashed by nature's temper tantrum on 11 March.
We didn't cancel the holiday; we changed the destination. Our heads are round, as Francis Picabia reminds us, so that our thinking can change directions.
This is the first time we cleaned the cobwebs out of our suitcase since the arrival of Jasmine. Venturing out with Jasmine isn't the same as our erstwhile hiking trip at New Zealand's national park. The tote bag and suitcase were more packed this time. What did we bring? Paper towels, diapers, books, crayons and a pad, Barney sticker, and Thomas trains. Enough? Nope, not until we packed a backpack full of outrageous humour. When we learn to travel with a toddler, we learn to laugh when things go wrong - and they will. After going to our car to enjoy our Coca-Cola, we found ourselves all wet with the carbonated soft drink - splashing out from the can shaken by Jasmine.
"Oh," we laughed before we could telegraph our embarrassment to the world (or at least the backseat). "Many thanks to Jasmine, for preparing the surprise champagne celebration; this is mum and dad's wedding anniversary."
We didn't cancel the holiday; we changed the destination. Our heads are round, as Francis Picabia reminds us, so that our thinking can change directions.
This is the first time we cleaned the cobwebs out of our suitcase since the arrival of Jasmine. Venturing out with Jasmine isn't the same as our erstwhile hiking trip at New Zealand's national park. The tote bag and suitcase were more packed this time. What did we bring? Paper towels, diapers, books, crayons and a pad, Barney sticker, and Thomas trains. Enough? Nope, not until we packed a backpack full of outrageous humour. When we learn to travel with a toddler, we learn to laugh when things go wrong - and they will. After going to our car to enjoy our Coca-Cola, we found ourselves all wet with the carbonated soft drink - splashing out from the can shaken by Jasmine.
"Oh," we laughed before we could telegraph our embarrassment to the world (or at least the backseat). "Many thanks to Jasmine, for preparing the surprise champagne celebration; this is mum and dad's wedding anniversary."
Sunday, April 10, 2011
Adjective
If you think adjectives help to decorate a sentence, don't.
Most adjectives are unnecessary, as I learn from Roy Peter Clark and William Zinsser. Thanks to their teaching, I have pruned out the unnecessary words like passionate or enthusiastic or responsible to describe my interns when they ask me to write a referee letter.
Don't just tell people that Jonathan, for instance, is passionate. Show them. And, with that in mind, I wrote, "As every intern attests, it takes good patience to finish an electrocardiogram with our barely functioning machines. As is so often the case in our medical wards, interns frown whenever an electrocardiogram is ordered. Jonathan didn't. He solved the problem by purchasing ECG electrode adhesives out of his own pocket."
Now you see. That intern Jonathan really is passionate.
Most adjectives are unnecessary, as I learn from Roy Peter Clark and William Zinsser. Thanks to their teaching, I have pruned out the unnecessary words like passionate or enthusiastic or responsible to describe my interns when they ask me to write a referee letter.
Don't just tell people that Jonathan, for instance, is passionate. Show them. And, with that in mind, I wrote, "As every intern attests, it takes good patience to finish an electrocardiogram with our barely functioning machines. As is so often the case in our medical wards, interns frown whenever an electrocardiogram is ordered. Jonathan didn't. He solved the problem by purchasing ECG electrode adhesives out of his own pocket."
Now you see. That intern Jonathan really is passionate.
Friday, April 1, 2011
Periodic Table
When was the last time you studied the Periodic Table after the secondary school chemistry lesson? Or, frankly, any at all?
Hardly, if not because of the recent chaos about iodine and plutonium.
Once hailed as the "Law of Octaves," the elements were arranged by their atomic weight to repeat their patterns at every eighth place along a scale, like the octaves on a piano keyboard. The idea turned out to be widely mocked, and withered. It was not until 1869 when Dimitri Ivanovich Mendeleyev, a Russian chemist born in the far west of Siberia, came up with a novel way of organizing every atom in the universe. He nodded off while playing the card game solitaire (wherein cards are arranged by suit horizontally and by number vertically) one evening, and then woke up with a similar concept of organizing the atoms. The atoms simply line up in repeating groups of seven. In this sense, the Periodic Table shows one set of relationship when read up and down, and another when read side to side. Simple, and yet elegant.
Like most of the brilliant ideas, this one dawned on Mendeleyev after waking from his sleep. This type of sleep-enhanced inspiration is not new, and certainly not mine. My mentor also talked about his feelings of inspiration after sleep in his blog yesterday. And, yes, I should now take a nap.
Hardly, if not because of the recent chaos about iodine and plutonium.
Once hailed as the "Law of Octaves," the elements were arranged by their atomic weight to repeat their patterns at every eighth place along a scale, like the octaves on a piano keyboard. The idea turned out to be widely mocked, and withered. It was not until 1869 when Dimitri Ivanovich Mendeleyev, a Russian chemist born in the far west of Siberia, came up with a novel way of organizing every atom in the universe. He nodded off while playing the card game solitaire (wherein cards are arranged by suit horizontally and by number vertically) one evening, and then woke up with a similar concept of organizing the atoms. The atoms simply line up in repeating groups of seven. In this sense, the Periodic Table shows one set of relationship when read up and down, and another when read side to side. Simple, and yet elegant.
Like most of the brilliant ideas, this one dawned on Mendeleyev after waking from his sleep. This type of sleep-enhanced inspiration is not new, and certainly not mine. My mentor also talked about his feelings of inspiration after sleep in his blog yesterday. And, yes, I should now take a nap.
Saturday, March 19, 2011
Train of Thoughts
Commuting to work by public transport can disappoint at first glance. The added time and distance might not be worth the hassle, I know. If that's not enough, the trip can be ruined by greedy seat searchers – to say nothing of someone who blocks the middle seat with a school bag.
Yet I'm unflinching: the best-kept secret of enjoying my train ride is the reading time. This week I traveled to Guangzhou for a conference. Getting there by train takes close to two hours, and that doesn't seem to bother me. The only question for me is what books or magazines to pack.
I was glad to have picked Daniel Gottlieb's Letters to Sam this time. I'd read this book few years back, but I still enjoyed reading it again. As I read the story of this man who has been paralyzed from the neck down (after an automobile accident), I learned great lesson from his struggle with bedsore on his buttocks. The quadriplegic psychologist went to see the doctor, who then examined the skin and said, "It's broken."
"I know," Daniel answered. The doctor had no idea that Daniel was referring to his heart, but not his skin.
"Too much pressure," the doctor explained, meaning his buttocks on a wheelchair all day. "I know," Daniel said, meaning his life.
When the doctor found out the moist wound, he commented on the unhealthy sign, in medical parlance, "It's weeping."
"I know," Daniel gave the same answer. But he wasn't still talking about his wound.
Yet I'm unflinching: the best-kept secret of enjoying my train ride is the reading time. This week I traveled to Guangzhou for a conference. Getting there by train takes close to two hours, and that doesn't seem to bother me. The only question for me is what books or magazines to pack.
I was glad to have picked Daniel Gottlieb's Letters to Sam this time. I'd read this book few years back, but I still enjoyed reading it again. As I read the story of this man who has been paralyzed from the neck down (after an automobile accident), I learned great lesson from his struggle with bedsore on his buttocks. The quadriplegic psychologist went to see the doctor, who then examined the skin and said, "It's broken."
"I know," Daniel answered. The doctor had no idea that Daniel was referring to his heart, but not his skin.
"Too much pressure," the doctor explained, meaning his buttocks on a wheelchair all day. "I know," Daniel said, meaning his life.
When the doctor found out the moist wound, he commented on the unhealthy sign, in medical parlance, "It's weeping."
"I know," Daniel gave the same answer. But he wasn't still talking about his wound.
Wednesday, March 16, 2011
Peppermint
"Guess what," Peppermint Patty told her classmate Marcie one day, "I'm going for the "Most Improved Student" award."
"School just started today, sir."
But Peppermint didn't lose her hope, quite the opposite really, because she went on, "And I'm already better this afternoon than I was in the morning."
The story of Peppermint is the story for all of us to learn. It's not that we should learn to console ourselves when we just receive a D minus - as what Peppermint gets most of the time - but we're to remember the lesson not to envy our neighbours more than we need to. The question is not whether we should compare with others, because we all do. We compare the job title, the size of our house, the examination scores of our children, and the inches around the waist (or the breast, if you like).
The big question is, When should we compare with ourselves rather than our neighbours? Just think about the hypothetical question posed by the economist Robert H. Frank. In World A, you earn $110,000 per year; others earn $200,000. Compare that with World B, in which you earn $100,000 per year; others earn $85,000. So which would you pick?
The truth is, even though the absolute income figures represent the real purchasing power, the majority of people choose World B.
"School just started today, sir."
But Peppermint didn't lose her hope, quite the opposite really, because she went on, "And I'm already better this afternoon than I was in the morning."
The story of Peppermint is the story for all of us to learn. It's not that we should learn to console ourselves when we just receive a D minus - as what Peppermint gets most of the time - but we're to remember the lesson not to envy our neighbours more than we need to. The question is not whether we should compare with others, because we all do. We compare the job title, the size of our house, the examination scores of our children, and the inches around the waist (or the breast, if you like).
The big question is, When should we compare with ourselves rather than our neighbours? Just think about the hypothetical question posed by the economist Robert H. Frank. In World A, you earn $110,000 per year; others earn $200,000. Compare that with World B, in which you earn $100,000 per year; others earn $85,000. So which would you pick?
The truth is, even though the absolute income figures represent the real purchasing power, the majority of people choose World B.
Thursday, March 10, 2011
Fountain Pen
Off all effects created by fountain pen, none is more eye-catching than that created by ink spillage on a white shirt.
Since I started using fountain pen over ten years ago, I came across time and again the creepy experience of wearing a white coat stained with black ink. Never shall I forget the embarrassing story which reminds me of - oh, say - say the Persian Gulf War oil spillage. I was trying to examine my patient yesterday morning, with medical students around. Before I put my hand on the patient's tummy, I noticed my dirty looking fingers stained with Waterman black ink. Just when I thought things couldn't get worse, a cursory glance at my white coat pocket showed another messy ink stain. I shrugged; probably I blushed. Uh-oh.
The stubborn ink stain is not pleasant - how could it be? - but it never deters me from being a fan of fountain pens. And, oh, yes, you thought it was nuts at first, and even more so for nurses who found a drop of water falling upon my handwriting in ink. But it has made a heck of difference in how I found my footprints in the patient record. It takes more than a standard template on the computer screen (in this age of electronic medical record) to keep track of the patient story. Patient story on a computer screen is emotionally dead, that's the crux of it. If you put the story in ink, you will be surprised at how much you will remember when you look back at the handwritten record. By surprised, I mean amazed; and by amazed, I mean stunned and impressed.
Since I started using fountain pen over ten years ago, I came across time and again the creepy experience of wearing a white coat stained with black ink. Never shall I forget the embarrassing story which reminds me of - oh, say - say the Persian Gulf War oil spillage. I was trying to examine my patient yesterday morning, with medical students around. Before I put my hand on the patient's tummy, I noticed my dirty looking fingers stained with Waterman black ink. Just when I thought things couldn't get worse, a cursory glance at my white coat pocket showed another messy ink stain. I shrugged; probably I blushed. Uh-oh.
The stubborn ink stain is not pleasant - how could it be? - but it never deters me from being a fan of fountain pens. And, oh, yes, you thought it was nuts at first, and even more so for nurses who found a drop of water falling upon my handwriting in ink. But it has made a heck of difference in how I found my footprints in the patient record. It takes more than a standard template on the computer screen (in this age of electronic medical record) to keep track of the patient story. Patient story on a computer screen is emotionally dead, that's the crux of it. If you put the story in ink, you will be surprised at how much you will remember when you look back at the handwritten record. By surprised, I mean amazed; and by amazed, I mean stunned and impressed.
Thursday, March 3, 2011
Closet
"I've never known anybody who didn't have a skeleton or two in their closet," writes Robert Fulghum, noting that there are always those things we don't want to talk to anybody about.
It is true that all of us have a few demons being locked somewhere in a closet or drawer. Fulghum, the American author who wrote All I Really Need to Know I Learned in Kindergarten, explains that shame, guilt, and embarrassment are the locks on the closet door. I have long been wishing for a secret recipe to erase the demons, and I have always felt it to be just as well for me to clean up the lockers other than mine - I'm responsible for at least dozens of demons hiding in others' closets.
It's not hard to understand my excitement when I read about a memory molecule that appears in a recent edition of the scientific journal Nature. Researchers have discovered ways to manipulate a protein in the rats' hippocampus to enhance or diminish memory. This means that the scientists are able to deliver electric shocks to rats on entering a particular entrance to a box, but then erase their bitter memories of the shock.
Another way of making sense of the science is to develop a novel target for cognitive enhancement therapy. If you want people to keep remembering a story, you can. The question remains: Do we?
It is true that all of us have a few demons being locked somewhere in a closet or drawer. Fulghum, the American author who wrote All I Really Need to Know I Learned in Kindergarten, explains that shame, guilt, and embarrassment are the locks on the closet door. I have long been wishing for a secret recipe to erase the demons, and I have always felt it to be just as well for me to clean up the lockers other than mine - I'm responsible for at least dozens of demons hiding in others' closets.
It's not hard to understand my excitement when I read about a memory molecule that appears in a recent edition of the scientific journal Nature. Researchers have discovered ways to manipulate a protein in the rats' hippocampus to enhance or diminish memory. This means that the scientists are able to deliver electric shocks to rats on entering a particular entrance to a box, but then erase their bitter memories of the shock.
Another way of making sense of the science is to develop a novel target for cognitive enhancement therapy. If you want people to keep remembering a story, you can. The question remains: Do we?
Friday, February 25, 2011
Good Morning
I used to work in the hospital till late hours. But not now. To a new father, eager to see his daughter, being at home is the only way to make the day count.
If you thought I'm getting lazy, I would have answered, "Quite the opposite." And I would have added, "If that surprises you, it surprises me, as well."
Lest I be misunderstood, let me make it clear that the longer we stay at workplace doesn't necessarily mean the more we would have accomplished. This is often the case when we keep taking breaks to play Farmville.
The truth is that I'm making better use of the morning hours. Often I need my alarm clock to wake me up. Hey! But then the miracle happens when I get up and start my morning rituals, and one thing leads to another, and eventually, before eight forty-five, I find myself calm and satisfied. By then, I should have had my morning coffee, thumbed through a few pages of medical journals, read my mentor's blog, entered quite a few ticks in my diary's to-do-list.
Now, see, I got time to write a blog this morning.
If you thought I'm getting lazy, I would have answered, "Quite the opposite." And I would have added, "If that surprises you, it surprises me, as well."
Lest I be misunderstood, let me make it clear that the longer we stay at workplace doesn't necessarily mean the more we would have accomplished. This is often the case when we keep taking breaks to play Farmville.
The truth is that I'm making better use of the morning hours. Often I need my alarm clock to wake me up. Hey! But then the miracle happens when I get up and start my morning rituals, and one thing leads to another, and eventually, before eight forty-five, I find myself calm and satisfied. By then, I should have had my morning coffee, thumbed through a few pages of medical journals, read my mentor's blog, entered quite a few ticks in my diary's to-do-list.
Now, see, I got time to write a blog this morning.
Friday, February 18, 2011
Silver lining
Teaching our children has always been more by trial and error than science, but that has been pursued for some time, at least in experiment.
Think about a beautiful example done at Temple University in Philadelphia some years ago. The parents of a 4-year-old girl invited a research team to their home. The two professors explained to the little girl that she will get a prize at the end of their visit. This is just what they did, handing out 10 potential "prizes" and asking the girl to rank them from the best prize to the worst prize. Right before the girl, she found a truck, a doll, a broken pair of sunglasses, a pair of socks, and so forth. She was deliriously joyful at this game because she was told further that she will get the prize she liked the best.
The girl zeroed in on Barbie, and happily waited for the moment to receive the best prize. Yeah (drum roll please), and wait - oops. Something wrong. The researchers explained that they had made a mistake and they had to give the girl that she ranked as dead last - a pair of brown socks.
"Sorry for this big mistake."
Now, how does the parent help the child cope with this disappointing news? And this is the real research question.
What will you do? Before I tell you the answer, take a few minutes to think about the possible ways out.
Do you shift your girl's attention away from the socks toward the nice wrapping the prize came in? Do you comfort your girl by holding her or verbally soothing her? Do you "reframe" the situation, putting the socks on your hands and making them into a puppet or suggesting you give the socks to another kid who might really like them? Do you encourage your girl to change the situation, say, by talking to the researchers and telling them that she got the wrong prize?
Of all the options above, none are more positive than shifting the girl's attention and cognitive reframing. The effect of looking more closely at every cloud, to see the silver lining, is riveting. This is, in fact, associated with the lowest level of sadness and anger. If you think you are helping the child who was encouraged to change the situation by talking to the researchers, nothing could be further from the truth. That would lead to more anger and sadness than those in other conditions. The child would simply lose the ability to regulate her emotion in a positive way, directing herself to vent and lash out, instead.
Taking another perspective to look at adversity can always be a new opportunity. Whining never is.
Think about a beautiful example done at Temple University in Philadelphia some years ago. The parents of a 4-year-old girl invited a research team to their home. The two professors explained to the little girl that she will get a prize at the end of their visit. This is just what they did, handing out 10 potential "prizes" and asking the girl to rank them from the best prize to the worst prize. Right before the girl, she found a truck, a doll, a broken pair of sunglasses, a pair of socks, and so forth. She was deliriously joyful at this game because she was told further that she will get the prize she liked the best.
The girl zeroed in on Barbie, and happily waited for the moment to receive the best prize. Yeah (drum roll please), and wait - oops. Something wrong. The researchers explained that they had made a mistake and they had to give the girl that she ranked as dead last - a pair of brown socks.
"Sorry for this big mistake."
Now, how does the parent help the child cope with this disappointing news? And this is the real research question.
What will you do? Before I tell you the answer, take a few minutes to think about the possible ways out.
Do you shift your girl's attention away from the socks toward the nice wrapping the prize came in? Do you comfort your girl by holding her or verbally soothing her? Do you "reframe" the situation, putting the socks on your hands and making them into a puppet or suggesting you give the socks to another kid who might really like them? Do you encourage your girl to change the situation, say, by talking to the researchers and telling them that she got the wrong prize?
Of all the options above, none are more positive than shifting the girl's attention and cognitive reframing. The effect of looking more closely at every cloud, to see the silver lining, is riveting. This is, in fact, associated with the lowest level of sadness and anger. If you think you are helping the child who was encouraged to change the situation by talking to the researchers, nothing could be further from the truth. That would lead to more anger and sadness than those in other conditions. The child would simply lose the ability to regulate her emotion in a positive way, directing herself to vent and lash out, instead.
Taking another perspective to look at adversity can always be a new opportunity. Whining never is.
Saturday, February 12, 2011
Emotional Intelligence
By any reasonable standard, no doctor would like to be called back to the hospital in the middle of the night. But some of them can't be judged by any reasonable standard.
Last night I went to see a 92-year-old woman who has been bleeding from the ulcer in her digestive tract. My guess was that I might have to ask someone to perform an upper endoscopy procedure to help that anaemic patient. Probably it's the most helpful means to control bleeding through a flexible tube going all the way from the mouth to the first part of the small intestine. But that's quite impossible – her doctors have tried this way for three times within one week but to no avail. Strictly, however, she wasn't fit enough for us to take her to the operating room.
I hesitated for a moment, and then phoned up the radiologist team. They had already attempted more than once to put a tube into her blood vessel in the leg and thread it up to block the bleeding artery near the stomach. My classmate radiologist barely flinched when I told him the story. "Prepare her for the third angiography," my classmate told me, "and I'll be back within an hour."
To give you a sense of what it's like for a radiologist to perform the angiography, imagine yourself wearing a sturdy apron made of lead (instead of cloth) and standing for an hour in front of a monitor. But wait: the monitor isn't as colourful as the Wii video games; it is a maze of black-and-white pictures where the radiologist navigates with the wires. So how can the radiologist go without getting lost in the maze? Hardly. They get lost as often as a puppeteer gets his strings entangled. Skill isn't enough. A radiologist can lose his way during the angiography but cannot lose his temper. That's the easiest to lose and the hardest to survive without. When my classmate found his way to the target artery, I was amazed to find that he couldn't go further because of the machine breakdown. More amazing still: he was perfectly composed to finish the task with his bare hands instead of the machine.
I was amazed. Even now.
Last night I went to see a 92-year-old woman who has been bleeding from the ulcer in her digestive tract. My guess was that I might have to ask someone to perform an upper endoscopy procedure to help that anaemic patient. Probably it's the most helpful means to control bleeding through a flexible tube going all the way from the mouth to the first part of the small intestine. But that's quite impossible – her doctors have tried this way for three times within one week but to no avail. Strictly, however, she wasn't fit enough for us to take her to the operating room.
I hesitated for a moment, and then phoned up the radiologist team. They had already attempted more than once to put a tube into her blood vessel in the leg and thread it up to block the bleeding artery near the stomach. My classmate radiologist barely flinched when I told him the story. "Prepare her for the third angiography," my classmate told me, "and I'll be back within an hour."
To give you a sense of what it's like for a radiologist to perform the angiography, imagine yourself wearing a sturdy apron made of lead (instead of cloth) and standing for an hour in front of a monitor. But wait: the monitor isn't as colourful as the Wii video games; it is a maze of black-and-white pictures where the radiologist navigates with the wires. So how can the radiologist go without getting lost in the maze? Hardly. They get lost as often as a puppeteer gets his strings entangled. Skill isn't enough. A radiologist can lose his way during the angiography but cannot lose his temper. That's the easiest to lose and the hardest to survive without. When my classmate found his way to the target artery, I was amazed to find that he couldn't go further because of the machine breakdown. More amazing still: he was perfectly composed to finish the task with his bare hands instead of the machine.
I was amazed. Even now.
Monday, January 24, 2011
Toddler
When it comes to the gene pool, there must be a chromosome that makes us read while we're walking. This is exactly what my daughter gets from me.
And, yeah, that's what I had been told: Baby walking, both in the time and the style, is as unique as personality. Sure-footedness, of course, isn't characteristic of my daughter, age 1 (which is why she is called a toddler). Being a fledgling toddler, Jasmine is eager to move around the room. That's pretty much every other new walkers does. But when it comes to her cruise control and reading mode, I can't help laughing.
"Oh, no, be careful," I told Jasmine when I saw her pick up a book or an instructional manual to "read" whilst she was making her way across the living room. Mind you, I didn't stop her from doing her style of walking-cum-reading trip. After all, her father does similar feat all the time.
And, yeah, that's what I had been told: Baby walking, both in the time and the style, is as unique as personality. Sure-footedness, of course, isn't characteristic of my daughter, age 1 (which is why she is called a toddler). Being a fledgling toddler, Jasmine is eager to move around the room. That's pretty much every other new walkers does. But when it comes to her cruise control and reading mode, I can't help laughing.
"Oh, no, be careful," I told Jasmine when I saw her pick up a book or an instructional manual to "read" whilst she was making her way across the living room. Mind you, I didn't stop her from doing her style of walking-cum-reading trip. After all, her father does similar feat all the time.
Tuesday, January 18, 2011
Yes
I couldn't believe it when my brother brought me the book Difficult Conversations, before he knew that I'm going to take a mediation training course this month. This book might not be new to you, but in case it is I should say that it comes from the same group who wrote Getting to Yes.
Think about the last time you felt the urge to get your boss, your spouse, your friends or colleagues to say yes. It's no secret that today many of us feel that it's harder to negotiate and to foster a supportive environment when we need it most. It hurts.
Yeah, yeah. I know what you're thinking (after reading my last blog). And you're wrong. No, I am not learning to negotiate with my daughter. The truth is, believe me, a toddler is the most simple friend to go along with. What could be easier than to ask a toddler to say yes? Take a moment to teach a toddler to say yes or nod her head. Well, she might not follow - or she might just shake her head. Now, forget the teaching and simply play with a creative mind. Any imaginative game works; it really does. We showed Jasmine a little fairy Unazukin, a Japanese doll who reacts to voice by nodding and shaking her head. She loves that game. After talking to Unazukin and, hey presto, Jasmine learned to nod.
Think about the last time you felt the urge to get your boss, your spouse, your friends or colleagues to say yes. It's no secret that today many of us feel that it's harder to negotiate and to foster a supportive environment when we need it most. It hurts.
Yeah, yeah. I know what you're thinking (after reading my last blog). And you're wrong. No, I am not learning to negotiate with my daughter. The truth is, believe me, a toddler is the most simple friend to go along with. What could be easier than to ask a toddler to say yes? Take a moment to teach a toddler to say yes or nod her head. Well, she might not follow - or she might just shake her head. Now, forget the teaching and simply play with a creative mind. Any imaginative game works; it really does. We showed Jasmine a little fairy Unazukin, a Japanese doll who reacts to voice by nodding and shaking her head. She loves that game. After talking to Unazukin and, hey presto, Jasmine learned to nod.
Wednesday, January 5, 2011
Yes or No
Toddlers love to give "no" for an answer, and my daughter is no exception.
My nephew Ethan learned this fact when he came from the States to visit Jasmine. "Why does Jasmine shake her head every time I ask if she loves me?" Ethan wondered.
Yeah, when it comes to a one-year-old's way of communication, shaking head is much easier than nodding. I was trying to explain a toddler's difficulty with saying yes. Before I could convince Ethan, I found it difficult to convince myself, too. Many of us think that toddler is the only creature to keep saying no, but nothing could be further from truth.
As we grow up, we get glued to the answer "no." Saying yes has become an act of extreme courage, even for adults. Long before we could remember it, the all-purpose "No!" has ruled this world. If you don't believe me, ask your spouse (or your child) to keep a diary for one week and count the times you agree with her ideas. And, would you like to share with me your scores? "No!"
My nephew Ethan learned this fact when he came from the States to visit Jasmine. "Why does Jasmine shake her head every time I ask if she loves me?" Ethan wondered.
Yeah, when it comes to a one-year-old's way of communication, shaking head is much easier than nodding. I was trying to explain a toddler's difficulty with saying yes. Before I could convince Ethan, I found it difficult to convince myself, too. Many of us think that toddler is the only creature to keep saying no, but nothing could be further from truth.
As we grow up, we get glued to the answer "no." Saying yes has become an act of extreme courage, even for adults. Long before we could remember it, the all-purpose "No!" has ruled this world. If you don't believe me, ask your spouse (or your child) to keep a diary for one week and count the times you agree with her ideas. And, would you like to share with me your scores? "No!"
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