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.
Thursday, September 29, 2011
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.
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