Paint-by-Number

After Ian McEwan's novel, I picked up a new book, NurtureShock.

To see how this book gets me hooked, consider the opening pages of its introduction. Po Bronson has a knack for writing stories to illustrate parenting. He talked about his nagging wish to dump the acrylic painting in his guest bedroom. What made him hate the painting was a sense of lacklustre copycat robot art that arises from a paint-by-numbers kit. He simply doesn't like how his wife's great-grandmother bought the paint-by-numbers kit and duplicated the painting.

Is it too much to think of paint-by-number kit as a kind of cautionary note for parents?

At stake is the very idea of conformist's don't-ask-me-why-and-simply-follow-the-number dictum. I sense it when my daughter happened to receive one paint-by-number watercolour and one sticker-by-number mosaics craft this month. Both gifts are set in such a way to literally fill in the blank after matching colour with the number. What we have in our heads are rules like one equals red and two equals blue, and nothing else. You just follow. The better you memorise the rules, the quicker you'll finish the work. You need to trust the pattern. You want to avoid at all costs mixing up the numbers and colours. Your product should confirm and look exactly the same as what appears on the package.

So I teamed up with my daughter to do the job. Red, yellow, and blue. One by one. We kept decorating the mosaics by fitting together small pieces of coloured stickers. The stickers looked nice, petite and sparkling. And those pieces finally made a mermaid. And at this point my daughter told me, as excited as a pirate who found a treasure box, that there were many pieces of extra stickers. I didn't know what to do with them, but my daughter stared at them like real jewels.

She said, "Oh, wow! I think it's now the time for fun. Dad, the blue sticker is just perfect for making a bubble, a bubble that our mermaid blows under the water. Now, what about this red one? Let's imagine and create our own picture."

List

It's customary, at the end of the year, to rate the top stories in the news. It's the time of the year when everyone looks back.

Time whizzes by really quick, and I didn't write too many blog entries this year. Now I count awash in shame. I didn't say it was logical, I said it happens. It's easier to invent reason not to write than come up with a topic to write - that I know.

But.

But there are good things about this year. I read as many as before, and perhaps more. Looking back, I can think of brilliant books that I'd read this year. Here are 10 great choices that I happened to pick this year.

Thinking, Fast and Slow by Daniel Kahneman

The Power of Habit: Why We Do What We Do in Life and Business by Charles Duhigg

Justice: What's the Right Thing to Do? by Michael J. Sandel

 The Glamour of Grammar: A Guide to the Magic and Mystery of Practical English by Roy Peter Clark

Could Do Better!: Help Your Kid Shine At School by Phil Beadle

Making to Stick: Why Some Ideas Survive and Others Die by Chip Heath and Dan Heath

The (Honest) Truth About Dishonesty by Dan Ariely

The Book of Dads: Essays on the Joys, Perils, and Humiliations of Fatherhood by Ben George

Case Histories: a Novel by Kate Atkinson

Sweet Tooth by Ian McEwan

Wait. Not all books are new and the last one that keeps me turning the pages at the end of this year is Ian McEwan's The Child in Time.

Hands-on

"Close your eyes, daddy," my daughter exclaimed once I went home last evening. "Close your eyes."

I did so, and when I opened my eyes it was a new house. Vast terra incognita of wit. There had been a lot going on when I went to work. That's the first Monday of Jasmine's term break. My wife took a day off, and I didn't. My child simply created a dream house. You have to try to guess what it is made of. Cut and stick, draw and paste, think and pretend. The new house is all about firing up her imagination.

Shoe boxes, empty toilet paper rolls, handkerchief, and tonnes of creativity. They were good enough to make chairs, kitchen, fridge, potty, bathtub, bedroom and whatever-you-can-dream-of. Make a grid on the cardboard box, draw few circles and they are stoves, draw a square and it's an oven.

When my daughter was cleaning up the craft materials, she found a crumpled sticky tape balled into a small piece. Jasmine was shaking her head. "Sticky and yucky."

"Not really," my wife replied, "That sounds like a bulb."

Within a minute, the idea lighted up like a cartoon's bulb. Jasmine glued the "sticky and yucky" ball on the ceiling of her new house, and told everyone her house is now brightened. She flashed me a megawatt smile that could have powered the whole town for an hour.

Face

For reasons I accept but will never fully understand, all the characters in the Thomas and Friends series won't look the same to toddlers. Ask a preschooler to get aboard the train Thomas, and he will never mistaken that for Bertie or Gordon. Of course, not everyone can do that. I can't.

It seems that there are both genetic and acquired elements in our ability to recognize faces. Oliver Sacks, the author of Awakenings and The Man Who Mistook His Wife for a Hat, was born with an inability to parse the visual aspects of a face. Dr. Sacks could not even recognize his own face. On one occassion he turned to the restaurant window and began grooming his beard. In fact - and here's the greatest shock - he wasn't looking at his reflection but another gray-bearded man on the other side of the window.

At the other end of face-blindness spectrum, some guys have incredible and indelible memories of almost every face they have ever seen. I happened to meet one such expert few weeks ago at my hospital. I had my usual morning round with my teammates, going through the story and laboratory results of one new patient. He listened carefully, gazed at me, and let me examine him. Then he leaned back and seemed to take a deep breath. "Doctor, were you working in this hospital fifteen years ago?" This was followed by everyone's curious look on me. "It's my photographic memory," he confirmed, and went on to tell us he was a police. There was little chance of anyone being seen by him and forgotten. I was completely floored.

"We have met before," he answered, and reminded me that his wife had been one of my patients too, back in 1997. By late afternoon, I asked him quietly the name of his wife. The name didn't ring a bell.

She died in the same year, I was told, but the family appreciated my taking care of her. I went to the computer and run through the list of patients bearing the same name. It didn't take me long to find the record of my patient's wife.

Over the next fifteen seconds or so I kept my eyes closed, and tried to retrieve the face of his wife. I couldn't. Her face had been erased. I went on to recall details of her illness. Then I started to notice that I had professional memory of her condition in forsenic detail. I have no idea what my patient looked like after fifteen years, but I remember most of her medical problems, as detailed as the finding of purple Howell-Jolly bodies in her blood.

U-Bend

I am writing these words one day after a meeting at my daughter's school. That's a meeting with the principal and school board to discuss the future structure of the kindergarten and primary school.

There have been efforts to expand the school. As parents, many of us say we want a secondary school for our children.

Reality check: There will be financial implication in building a new school, and it might not be easy to find a school which is closing down. Now that a secondary school is not guaranteed, the number of classes will dwindle. That means having one class in the first grade instead of two. The principal said that if we don't want to turn down students after kindergarten we would have to fill more students within one class in the primary school. How many of us want our children to have a place in the same primary school? Nearly all hands go up. How many of us want a bigger class?

Few hands.

But there is not much we can do about the size of the class. Which brings us, somewhat uncomfortably, to the question of whether a bigger class size translates into worse result.

This is not the way it is. As Malcolm Gladwell put it (in his recent book David and Goliath), we are operating in a U-shaped world. That means we should not expect a straight line when we plot the academic achievement against the class size. Why should there be a U-curve relationship between the number of children in a classroom and academic performance? As is too often the case in education, quality is more important than quantity. Yup, smaller class implies fewer children to follow, more time to know the children, and fewer papers to grade. But the trade-off for a smaller and smaller class is less interactions between students. Well, it's chaos when the classroom is too crowded, but it's not a good choice when the classroom is too silent. Small class size makes teaching easier until a certain point - the point when "diminishing marginal returns" sets in. Human nature simply dictates the critical point. Here's an example. You give me two minutes to write this blog, and I will end up with mistakes and rubbish. Let me have another half hour, and I'll write better. What about giving me another week? Would you expect me to spend the whole week writing this paragraph?

Camping

We tried something new this weekend with Jasmine. We decided to have a camping trip, a feat we had not accomplished since our daughter had been born.

It was great to be back in the wild and enjoy the addictive feeling of freedom that comes with camping. We were proud to see how quickly we put up the tent. The first day of camping experience had kept Jasmine occupied. With few toys and limited access to the mobile phone, my daughter learned to find fun in everything around. Sand, sea shells, sticks were good enough to create an ice-cream. She even picked leaves to cover the cow dung, and a swell of laughter - hers - followed. Having spent a day of imaginative games, she got tired.

The clock's hour hand had long crossed eight, and my daughter felt her eyelids grow heavy. Everything turned dark in the countryside after the sun went down. I imagined that Jasmine would be snoring soon after snuggling down happily inside the tent. What I hadn't realised was that she might not be ready for the darkness in the wild.

"I want to go home," she whispered first and then repeated the sentence aloud. Tears followed. So we were telling her it's too late to catch the boat home, and I was starting to wonder if it was all worth it.

I'd tried to calm her down a couple times, but she was not having it, not one bit, not with the darkness outside her comfort zone, the cold outdoor camp, and her longing for sweet bedroom at home. We walked around and watched hundreds of stars lighting up the sky. She became fascinated, got quiet, listened, and forgot about the darkness. Then, half an hour later, when it was dinner time, she asked to count the stars with us. So we went ahead, amazed at the starry night.

"Good enough, and let's go home," Jasmine told me after we'd said good night to the stars.

"Go home? Now?"

"I mean the tent," she quipped with a smile.

Habit

Sure, people always fall prey to everyday habits and routines. Most of us (and I must confess I count myself among them) keep doing the same thing - like looking too much at the mobile phone. It's the first object I reach for in the morning and the last thing I look at before bed.

It all seems so natural. Thing is, if you've read Charles DuHigg's The Power of Habit, there's a good chance you'll understand how a habit - like a parasite, only much worse - enters our brain and lives there.

The basic rule of habit is straightforward. It's a habit loop with three stages: the cue, which is a trigger in the first place; the routine, which is the behaviour itself; the reward, at the end, to satisfy the brain and guarantee that the loop is worth replicating. Straightforward idea, really.

To show you how a habit kicks in, let's think about the urinal in public toilets. For more than a century, the urinal has been one of the dirtiest areas. What would you do if you happened to be given the task of latrine cleaning? I learned the trick from a story at Schiphol, Amsterdam's international airport. Imagine, for a moment, holding your breath in front of the urinals and getting mad about the spillage (which is a tactful term to describe the amount of urine that hits the walls and floors). Can we shape the behaviour and habit of those visitors of the toilet? Remember the habit loop? Not many do, except a smart guy Jos Van Bedoff. Van Bedoff managed to change the habit of thousands of men at Schiphol, because he exploited the habit loop. Guess what is the cue that he invented?

A fake but life-sized fly etched into the white porcelain wall of each urinal.

The rest is easy to understand. Et voilà! Spillage was cut by a whopping 80 percent.

Volcano

Everyone can get angry. Eight till eighty. Get along with anyone long enough and you will come across a volcanic moment. 

One of my exemplary colleagues never loses patience with his patients, and for heaven's sake, exploded few days ago at a wedding banquet. That's after the waitress poured the salad dish on his girlfriend's dress. You could cook a six-pack of eggs next to his burning face. Quite right so? 

However, many of his friends find it unbelievable as if that's the sight of a volcano in Hong Kong instead of Indonesia. This, I fear, is as unusual as a saint using obscene language in their minds. That raises a point worth clarifying: that showing anger is not a sin.

As I learn to teach my daughter to feel okay with anger, I get to appreciate that anger is indeed one toolkit of emotion - and an essential energy source. And just to stretch the mystery of anger a little bit further, it's a birthright. 

There's a line from Aristotle that's an old favourite of mine: "to be angry with the right person, to the right degree, at the right time, for the right purpose, and in the right way."

Echoed

No argument: growing up in impoverished Afghanistan town is never easy.

Ten minutes in the desert and already the feet felt raw. How do the kids walk all day without shoes, I wondered as I read the novel And the Mountains Echoed by the acclaimed author Khaled Hosseini (whose novels The Kite Runner and A Thousand Splendid Suns have sold a combined 38 million copies worldwide). The first few chapters of his latest novel drew me to the touching tale of a brother and sister.

The brother heard about another boy whose family owned a peacock. It would be hard to think of a better gift than a peacock feather with a beautiful large eye at the tip. The ten-year-old brother wished he could bring the gift to his sister. He negotiated. In a last-ditch effort, he traded his shoes for the iridescent green peacock feather.

By the time he made his way home shoeless, his heels had split open and left bloody smudges on the ground. If you'll let me, I'd like to tell you a little bit about his soles: thorns and splinters had burrowed into every cell of his skin. You could hear the brother's groan with every step, and possibly feel the barbs of pain shooting through his feet.

Imagine going to work or school barefoot and finding no path other than the bumpy road. You just keep looking at each step. Because if you don't learn to do this, you'll learn a painful lesson. Keep going. About an hour passes, and you're still only half way through. I had such chance to find out how it goes yesterday. Let me explain.

That's a charity walk to raise money for poor children in countries like Bangladesh and Zimbabwe. That's meaningful, right? And probably the most important thing is that we have to walk without socks or shoes. I brought my daughter to walk with us. She might laugh at the somewhat funny way of walking. And then it turns out that it isn't that funny. Of course, there will always be a flickering moment of insight, like learning to feel sorry for the poor children without shoes - which is, needless to say, how I wish my daughter could learn.

 

Itineraries

My Indonesian domestic maid really wants us to visit South Korea. Well, Korea is not a bad choice, but we kept thinking until recently.

The downside with Korea is that my maid's boyfriend works there as an illegal citizen. She'd love to go there and meet her sweetheart - but she can't get the visa without our company.

We finally agreed to go. That made my maid happy. This isn't to say that going to Korea doesn't take any kind of courage. I'd be lying if I swear my maid won't hide in Korea and elope.

I told my daughter we won't travel together with our maid in Seoul. She nodded. This time we bought a travel guidebook (that tells us a great deal about the parks there) and borrowed a Lonely Planet guide. We didn't speak Korean and yet we found ourselves bouncing around in the enormous Children's Grand Park. One of the best things that we found in the park is that she'd never run out of ideas (or energy) in the playground. She ran up and down and made new songs - she really loved the castle with two decks.

It was much more than that. At the zoo in the park, she learned how to distinguish boy mandarin ducks from girl ones by their plumage. She became fixated by the way how cormorants catch and swallow fish.

Two days later, my daughter thought of going to the park again. We did.

We combined the activity with a visit to the Seoul Children's Museum just next to the park, and that turned out to be right decision. As we wandered and wondered through the museum, discovering grasshoppers and tadpoles with magnifying glass, learning to create handmade motion pictures, we almost missed the chance to visit the royal palace - one of the "has to see" items listed in travel books. That's perfectly fine. Trust me, you should consider yourself really lucky to make up and tick your own to-do list within a journey.

We left Seoul (together with our maid, by the way) feeling enlivened and proud that we'd stumbled on an itinerary that celebrated the triumph of the travel with children.

Metric

I'm not a great fan of performance indicator, particularly those key performance index in our hospital setting. It's really about a quality metric that is worse than useless.

It is often the case that hospitals struggle to get a better score to prove their quality. But the score might tell otherwise. The performance score runs lower and lower, unlike the hospital team's anxiety that swelled and swelled with each passing day. So eager we're to fulfill the quest of performance index that we strive for the top score by hook or by crook.

The obsession with scoring system is understandable. The scoreboard has been in place for all of us in school, from clan to clan, culture to culture, and it is embraced earnestly and repeatedly. The hard truth is, most parents believe in the score. Some students, and many teachers, do. An important and oft-quoted metric on the scoreboard is the "intelligence quotient." But there's an old parable in which two cavemen were frightened when the earth shook with each footfall of a grumpy sabre-toothed tiger. The first caveman named Ug, with his mathematical and logical intelligence, tapped his chin and calculated the angle from which the tiger is approaching to the nearest degree. His mate, Thug, with the bodily or kinetic intelligence, ran away. "Who's the clever one now? Ug or Thug?"

I will say that, whether you're a parent or a hospital manager, should not miss the article "Performance Anxiety - What Can Health Care Learn from K-12 Education?" published recently in the New England Journal of Medicine. So, then. You will see how similar the health care and education system have been misled by the shortsighted performance measures. Examples of the top-down performance measures at school: students' achievement in standardized mathematics or reading tests, teacher's certification status. Just as how physicians lose performance points when patients cannot meet certain performance targets because they were dealt bad genetic and environmental hands, teachers are hold accountable for students' varied developmental timeline and many other uncontrollable factors in their lives. In turn, the author proposed a new bottom-up performance measuring system that, for instance, looks at the discussion and questioning skills, ability to engage students in learning, the expectation that students will correct their mistakes. The proposed measures to be assessed in hospital are similar: measures of patient experience such as effectiveness of physician communication about diagnosis and treatment.

Still, in the presence of pay-for-performance programs, many of us will pay more attention to the top-down performance measures. One good example of such outcome measures is the complication of venous thromboembolism after surgery. That's referring to a blood clot that forms in a vein deep in the body. It's a neat trick to blame and punish the "bad apples," referring here to those hospitals with more event rates of venous thromboembolism. Is it that simple? A new study, using data for nearly 1 million surgical discharges from 2800 hospitals, makes a solid argument against this measure. To cut the story short, the venous thromboembolism rates simply reflect how aggressively doctors look for them, but probably are not directly related to quality of care.

In other words, because some doctors more aggressively look for complications, they find more and appear to have worse outcomes. Good lesson to learn.

Praise

I received a phone call from my daughter's kindergarten yesterday morning. That's her school picnic day. If you're worried that the call was to announce the cancellation of picnic, don't worry - the weather was perfect. The call was all about my daughter's lunch box.

"Hi Jasmine's daddy. Auntie Elsa didn't give Jasmine back the lunch box yesterday when the school bus came. The lunch box is with us, and Miss Rebecca will bring you the lunch box today. Remember to ask Rebecca in case she forgets; Jasmine will need the box to bring her lunch tomorrow."

I didn't say much, except the two big words "Thank you." It's beautiful to have such a sunny day and a fabulous school team.

We received the lunch box, and then told Jasmine the story.

"Well, not really," my daughter answered in a soft tone. "Auntie Elsa didn't forget. It's me. I forgot to take the lunch box."

I didn't know what to say, except two words "Good girl."

Confession time. I had not the foggiest idea where her laudable honesty comes from.

Alphabet

If I had to choose one teacher my daughter couldn't do without, it would be my wife. None of that is to say that her kindergarten teachers aren't terrific. They are.

What I don't say, what I should say, is that I'm far below my wife's teaching skill.

Let me tell you the story of my debut into teaching my daughter's writing. Anyone familiar with teaching kids to write English alphabets will know what I mean. Permit me to correct you, there are more than 26 ways to write the alphabets if you mix up the direction each alphabet faces. For the kids, words - like practically everything else - can either be written in the right way or in its mirror image. Even my daughter can write her name with the first letter J facing the wrong way. Yes: it is different. The difference for these two ways to write the letter J is so trivial that a 3-year-old won't bother.

Writing the alphabet J in itself is a piece of cake for me, of course. I never answer wrongly when my daughter asks me which direction the letter faces. I just know the fundamental truth how a letter J should face. "Curve this way. Got that?"

And then my wife had her turn to teach Jasmine, and she made an intriguing discovery: the alphabet J lines up in front of other letters, and of course, this lovely letter J behaves in such a nice manner she won't turn around and step on the foot of others standing behind. Ah yes - here it is. No book has taught me this, nor have I heard it from my teacher. Real good fun to learn alphabets in this way.

Sure, I admit my daughter can still get her J in the wrong way. But then she will smile, "Oops, this J is naughty today; she turns around and chitchats with her classmates again."

Preconditioning

It was the first Saturday morning after my return from an overseas conference. There's no denying that it takes a bit of time to adjust ourselves to the working mode after a holiday. But I did it. I went back to the hospital and my routines.

Saturday routines have been many things to many people: a morning to sleep in and have brunch, a holiday to recover after long working hours, and tutorial time for students. According to my Saturday routines, I first pick up a topic to read, followed by an one-hour teaching of remedial class students, and then morning round at 9.

Here's what I read this morning: remote ischaemic preconditioning and kidneys, and it's a promising way to save our patients' kidneys from being knocked out by contrast dye (as used in a lot of imaging in hospitals). Such cases are common. In order to show the blood vessels in the heart, for example, doctors need to inject dye. Just as remarkable as the dye's power to outline the blood vessels, is how powerful the dye can damage the kidneys. So how do doctors get around the problem? The idea for such a protective drug to safeguard the kidneys has been around for close to 20 years, but none had pulled off a miracle. Easy to say, hard to do.

Last year, news broke that a trick called remote ischaemic preconditioning could cut the odds of kidney damage by 80 percent after dye injection in the heart.

An unusual trick.

What they did was to inflate a blood pressure cuff on the arm for four cycles, five minutes on and then five minutes off. The action of the inflated cuff, of course, is to apply brakes on the blood flow, and if short-lived, won't suffocate anybody. It's hard to think of any tool, any drug, any machine in history with which so many can afford so easily. It's a form of rehearsal or disaster drill, to the point that our patients' kidneys get better prepared before the real attack.

Which makes me wonder: Just how similar can I apply the concept of preconditioning to prepare my medical students for their examination?

School

My annual leave keeps accumulating. So it came as little surprise that almost two months after my daughter's new school year, I haven't had chance to pick her up after school. A year ago, she wasn't ready to attend school on her own and I've lost count of the number of times she cried at the kindergarten's door. But that was then. Now that Jasmine, more than three years old, is carrying the backpack and lunch box all by herself.

I took half day off yesterday to pick up my little girl, and that means she didn't have to jump on the school bus immediately after class.

It's easy to spend an hour weaving through the kindergarten campus, and around each corner of the playground you're rewarded - with laughter or smile of the kids. Is there any happier sound in the world than your child's giggling with her navigation of a rope course? Or the silly guffaw after a quick slide, landing with the butt? 

Soon after my half day leave, I knew I'm going to take another one soon to join my daughter after school.

Vernacular

Never heard of "TL;DR"? Then you're obviously older than 30. If you've learned English since young and you're having problem with new words, it just might be because of your age.

The list of new entries in the Oxford Dictionaries Online has been expanding faster than the waist size at your belly. Look at those slangs and shorthands that come with digital communication. See how they make communication easier - or not.

I've just read from the Washington Post that a "selfie" refers to a photograph of oneself, typically "with a smartphone or webcam and uploaded to a social media website." It's not as if we don't have the term "self-portrait" in English. But "selfie" is another matter. It's hard to replace "selfie" by "self-portrait" without losing the meaning. Hard as putting panty hose on a porcupine.

That said, it would be important to set a quota for admitting new words. Evolution of lexicon is a series of flukes, some good, many bad. I admit it: words or acronyms like FOMO (meaning "fear of missing out," in case you aren't updated) always give me agita. I'm rock-solid certain that I have absolutely no fear missing out the word FOMO. That's also why I don't think we need "TL;DR" to indicate "too long; didn't read."

Secret

You'd think that clinic consultation is private matter, because we assume that no one is overhearing the conversation between doctor and patient in a consultation room. Think again.

Not long ago, I read an inspirational article about privacy in Time magazine. Though the article mentions how children of a certain age think closing their eyes will make them invisible, it remains uncertain whether grown-ups are any smarter. Or perhaps there's not much difference. We've been all fooled by the illusion of privacy.

The illusion of privacy, I was told, dates back to the Hebrew Bible. Unbeknownst to Bathsheda, King David was pacing on rooftop when she stripped for a bath. Fast forward to the era of WikiLeaks (think Edward Snowden) and Internet service provider like Google (think pop-up ad that matches exactly your recent searches in the blink of an eye), and we don't have to be reminded that it's getting more and more difficult to keep our secrets. Nearly everything is being watched in this new age of data. Everyone is not immune to being watched - everyone, that is, including doctor. It's stubborn to get too furious about being audio taped by a patient. Stubborn, that is, unless you are as naive as a child who thinks that you can keep everything under the cloak.

Promotion

Promotion, in general, gives a lot of good feelings. Everyone seems to be talking about job promotion in my workplace. It is fine to look for promotion - it's just that by mistake, some of them thought that I'm keen to get a consultant post in another hospital.

 

I couldn't help laughing the first time I heard the rumour. And I think I'm going to smile and even chuckle the next time I was asked the same question.

A while back, by chance, I was reading an enlightening story about promotion. That's about someone who gets promotion in your office. That one isn't a personal friend, but you do know her. What do you think you'll say to her the first thing when you see her?

"Congratulations."

Yeah, nobody will disagree. And what next? Some of you will say, "You deserved it."

That makes sense, too. But I was told that this answer isn't the right way to get connected with people. "You deserved it" won't engage people simply because it isn't a statement from the perspective of the person being promoted. It's from your own perspective and literally means "I think that you deserved it."

Too often we are saying the same words from our perspective when we hear the news our friends get promoted. Instead of saying "I think that...," I was taught, we should have responded in a better way, "What does it mean for you?" In short, the response should be about her - not about you. And it would make us more aware of what our friend thinks and feels.

I don't really know who will get promoted, but will watch out for the amazing opportunity to practice the way to get connected with others.

Tapper

Like many internal medicine doctors, I often see eighty-something-year-old men and women coming to hospital with a diagnosis of frailty. The word frailty is more or less the same as fragile. Being fragile, a senior gets easily bulged with ailments, and then bursts.

As one of my fragile patients went downhill, one family member after another asked for escalation of treatment to save his life, understandably so. That patient had weak muscles, scanty comprehensible words and quite some bruises (after doctors' attempts at taking blood), and was making each breath with difficulty. That's why he had a tube inserted into his chest (which appeared to have burst), and ended up breathing (through a tight mask) from a pressure machine. And yet, as we read the advance care plan that accompanied the elderly man, we recognized the clearly written statements not to carry out cardiopulmonary resuscitation, not to have ventilator support, not to give artificial nutrition. At the end of that statement, his daughter dated and signed it. It isn't right to be aggressive in terms of treatment, I thought. I thought the family should have thought so.

But, no. The daughter knew she'd signed a document. "It's about my dad's ill health and a fast channel to get him into hospital without having to go thru the emergency room." She knew next to nothing about palliative care of his dad, leaving me awestruck by her convoluted concept. The patient further deteriorated two days ago, when I happened to be on call at night. He was dying. And that's what I told my intern and the patient's family. Easier to understand than the word frailty.

After a hectic night, I taught a large group of medical students. It's about communication. Not communication to sign a advance care plan. Still, the theme is similar. Doctors who want effective communication with patient or family, in a nutshell, have to "unknow" what we know and get the listeners' perspective. Medical students, like doctors, know so much about a topic, and it's rather difficult for them to imagine a listener who can't understand their knowledge and language. Elizabeth Newton, a Stanford University graduate student in psychology, explained this concept nicely in 1990 by performing a now-famous experiment of tappers and listeners. That experiment simply divided a group of people into "tappers" and listeners." For those who are assigned tappers, they picked from a list of well-known songs such as "Happy Birthday to You" and tapped the rhythm of the song on a table. For the listeners, the job was to guess the song.

Easy job? If you answered "yes" to this question then you - like the tappers in the experiment - may be suffering from the curse of knowledge. The tappers predicted that listeners would get the correct answer 50 percent of the time. In reality, the listeners correctly identified 2.5 percent of the songs. Why? The tappers heard the song in their heads at the same time of tapping. While the tappers had the knowledge, the listeners were simply perceiving a bunch of disconnected taps, like a kind of bizarre Morse code.

And so, I told the students, when we give a lecture on a medical condition like atrial fibrillation, the listeners are more often not following what we say. We are giving them a bunch of Morse code.

Winner

Philip Pullman once said, "All we need is the word 'Once...' and we're off." He is referring to the appeal of classics such as "Snow White", "Cinderella" and many Grimm tales.

All right. Everyone take a seat. Now I'm going to tell a story, not from the Brother Grimm. That's my daughter's favorite recently, and it comes from an amusing author in Japan.

Once there was a family of sweet potatoes, and for years this family had lived with routines underneath the ground. My daughter noticed this, and smiled when she found out the sweet potatoes brushed the teeth every morning, went to potty, got hungry now and then, just like her. They hid everything underground, and no one would dare to steal anything from there.

But it wasn't long before the sweet potato family felt a thump. Or earthquake?

"Oh, no," the daddy sweet potato said, "is it a giant there?" Frightened, he slammed the door shut at once and ran back to gather everyone at the living room.

"Oh, papa, that's not a giant. I saw many children above there. Wait, wait! They're knocking at the door."

The children kept on knocking and called, "Come, we found sweet potatoes. Let's pull and get them out."

The sweet potatoes heard a loud crack from above. "Oh, for goodness' sake! Let's line up and prepare for the tug-of-war." Not long afterwards the sweet potatoes felt the pulling force from boys and girls above.

"Heave-ho, heave-ho!"

When the sweet potatoes nearly gave way to the children, I heard my daughter chanting heave-ho together. My daughter watched anxiously for a minute or two, and really wanted to lend a helping hand. But it's too late. The sweet potatoes were losing the game. And on they rolled as though drawn by a giant, along the rope, up the stairs, until suddenly - hop! All the sweet potatoes were pulled out.

Well, what else did you expect? The sweet potatoes ended up being eaten. "Nothing tastes as good as baked sweet potatoes," the children were busy licking out and guzzling every bit of their harvest.

"Someone's been eating my leg."
"There's a bite out of my back - look!"
"And mine."
"And mine."

Everyone could see that the children were enjoying the sweet potato feast. My daughter wasn't, though; she felt sad about the sweet potatoes.

All gone, every one of them. Not really. Surely it couldn't be that simple? Can you hear the sound? Funny sound really.

Boooom. Booooooooooooom. Booooooooooooooooooooom. My daughter pinched her nose. She almost laughed her head off when the boys and girls could not stop farting. They were farting as often as dogs are panting after running for miles.

Now, who is the winner? Round one to the sweet potatoes, I thought.

Physics

In the middle of the summer holidays, a number of high school students came to my hospital. They sat on either side of the doctor in the clinic, going around with the doctor who saw patients everywhere in the hospital. This could have been the first time they stayed in a public hospital.

I haven't thought much about the high school education before the students joined us. We talked about everything, and then I realized that high-school days are pretty far away in my life. For a moment I was puzzled how much high-school teaching I could still remember.

Not much. Let me think. How about Newton's three laws of motion? The first law states that every body perseveres in its state of rest, or of uniform motion in a right line, unless it is compelled to change that state by forces impress'd thereon. Yes, of course, it's all about the kid's resistance to change. No, not changes. They don't like changes. They really don't. Kids react to changes with vehement opposition. My daughter - and many other children, I'm sure - doesn't want to go out after she has started drawing at home, and once in the playground, doesn't want to leave, and by night time, doesn't want to sleep.

Now think about Newton's second law. We're taught that motion doesn't require the action of a force, but a change in momentum does. That is proportional to the force causing it. That's easy to understand. To speed things up we need to push it. Beautiful, I know, but does it mean I have to push my three-year-old daughter? Wait. The third law states that we can't push something (or someone) without it pushing back.

Let me summarise. A force can cause change, and a harder one gives more drastic change, which can backfire because of another force - you guessed it: action and reaction (or rebellion). What an important rule that would be.

Reactions

How can you get the golden-brown colour and fabulous aroma by cooking food?

Temperature is the trick.

And by temperature I really do mean high temperature. Chemically it's something called caramelisation reaction, which occurs when we heat food in an oven, grill or oiled frying pan up to around 160^oC. That doesn't mean we get nothing below 160^oC. By the time the temperature rises to 140^oC, it will kick start another set of Maillard reaction. These reactions between proteins and sugars explain the secret of many cooks. Brushing a little egg white on the surface of flour, I was told, provides extra protein to react with carbohydrates, helping it brown and adding taste. Notice how much we love the freshly baked bread after these reactions in the oven. 

So now I know why cooking food in a microwave oven doesn't work wonder. In the case of the microwaves, they are tuned to the vibration frequency of water molecules. The heat comes directly from the water in the food, whereas caramelisation and Maillard reactions only happen with dry heat. Alas, without these miraculous reactions, the tasty aroma molecules won't appear.

Take one more look at these reactions in the kitchen, and then outside. You'll see a similar thread of theory around us. There are similar reactions around, whatever your subject. Take final year medical students; once sitting in the library and reading lecture notes only, they now are mandated to go to the medical wards and work as part of a team - in the form of apprenticeship. One tried and tested method is to give them a quota. That means the students have to see a minimum number of new patients, and take blood from, say, no less than six patients. We'd like to aim high and let the students work hard, more or less like achieving the temperature of 140^oC. That is really tough when you compare to spoonfeeding in the classroom (the microwave-equivalent in the kitchen). But, at the end, we hope it will give them a glimmer of golden-brown splendour.

How high should we raise the bar? I don't have the right answer but I remember another important rule in cooking: less desirable molecules can appear after too high a temperature. Go beyond 200^oC, and be prepared to get the bitter-tasting carcinogenic stuff.

Shoe Box

Some time in the summer, at the end of an academic year when Obama was 17 years old, a party was thrown in Hawaii. The old picture of Obama and his date in that party was recently taken out of his schoolmate's shoe box, and shown to the readers of Time magazine.

The years have gone by in the blink of an eye, and oh, photographs are no longer developed. Gone is the day of putting old photographs in an album or shoe box. For about as long as the Internet has existed, the photos of teenagers are more often stored on Facebook than in a shoe box. A few mouse clicks give them the digital footprints. Long lasting one, and easily retrievable. It's almost like a diary online for a myriad of stories, starting from the dish at a restaurant to the ceremony of tying the knot. Letters are giving way to electronic mails, and shoe boxes are giving way to Inbox.

When shoe boxes packed with old memories were as big a part of many old guys' treasure chests, we had to make sure the shoe box wasn't thrown away when we moved. Part of the challenge of maintaining the shoe box is the need to keep buying sachets of dehumidifier. Back in my home and office, I have been making use of boxes to keep track of history. Everything. Clinical photographs captured in slides (something you can't see without a slide projector), a handwritten letter written by my mentor (after I failed in a postgraduate professional examination), and hundreds of letters from my wife during my year of overseas training. Boxes are small, I know, when you think about the size of Dropbox nowadays. My boxes, however, capture far more things than Dropbox can hold.

Masked

When telephone hoax or telemarketing are everywhere, any incoming call without the caller's number displayed can be enough to push us over the edge. It's no different even if the caller is a doctor (who won't sell low credit card interest or mortgage plan).

That's a big problem when a hospital masks all the outgoing telephone call numbers. Hospitals aren't supposed to appear like a terrorist wearing mask, of course, unless that hospital turns out to behave like Osama bin Laden - and mine has. In the broad sense, this means all the telephone calls from my hospital are masked without call number displayed. Believe me, that is annoying when a patient didn't answer the phone call from a doctor who needed to talk about a dangerously high potassium blood level.

Slushy nonsense? Not a bit of it! Masking the outgoing phone call numbers is said to protect the privacy of the hospital. Privacy. It's a big word that seems grand. I could hardly believe it, yet I knew I had to.

If you'll let me, I'd like to mask myself and say it secretly, the brain behind that concept of masked outgoing call number is clogged and sclerotic with hierarchy.  

Flight

I was reading Jonah Lehrer's How We Decide when one of our medical students asked me for help. That student has to take another half year remedial class before graduation. Dare to call remedial school term a "final sentence," and you're likely to hear exasperated moans and groans from the students.

I couldn't help thinking of Lehrer's near-death experience as a pilot. On a rainy fall day, beneath clouds so grey that dawn bled into evening, he was at seven thousand feet and his plane's left engine was on fire. He didn't know what to do.

He knew he could increase the speed but wasn't sure if the only remaining engine can handle the climb. What's the alternative? Well, he could steepen the descent and let the downward momentum steer the plane. Or so he thought. But, alas, he might not be able to regain control and fall into what pilots call a graveyard spiral. His knees buckled and his shoulders slumped, like a marionette's with the string released.

About thirty seconds passed, and Lehrer was still thinking. The clock was ticking. It was such a life-or-death scene that you would think you could not go back. But then it wasn't. It was only a flight stimulator that pushed Lehrer's vein awash with adrenaline.

We may not always know exactly what a pilot feels, why a pilot does what he does, or feels what he feels. But that's exactly what a medical student would face in a disastrous final examination. Gosh, it's about either safe landing or crashing. Everything goes faster and faster until the mayhem takes over, pushing a desperate student into a horrifying nosedive, or what we call a downward spiral.

Yes, yes, that's terrifying.

And then, if you think more about it, that's merely a flight stimulator exercise. That won't kill a single passenger sitting in the cabin, and not even the pilot.

Manual

There's no medium like the books to give us the pleasure of growing up (ah, yes, and growing down) as parents. While Anne Lamott's Operating Instructions gives mothers the solace they seek, Ben George's The Book of Dads lends gravity. After I borrowed the book last week, I've been reading this wonderful collection of essays bit by bit, some of them good, many of them precious.

Recognising that we aren't alone won't make bad days disappear, but it can help us weather the storms. I read Neal Pollack's essay about his son who made a big mess in the store, breaking a toy with horrible liquid leaking everywhere. A bad day. "We're going to pay for it anyway," he bent down to his son. "If you break something that's not your property, you have to buy it."

I won't lie. I am not an honest man who might have done exactly what Neal Pollack did. I might have looked around to see if anyone had noticed.

That admitted, I must further confess the shame I felt in a similar story. On that day almost one year ago, my daughter was reading in a bookstore in Taiwan. My daughter hadn't even noticed that her mouth was hanging open when she tore a page. Just as she started to wonder if she should cry after committing the faux pas, my wife came to her rescue. "I understand that you didn't mean to break it," she said. "But we have to buy it if it's broken. We will bring this book home and mend it together."

But could I really trust myself to do that? I don't know what I could have done (or not done) if I were the one next to my daughter at that moment.

Storm

Eager to be doctors and learn how doctors work, six medical students stayed with me when I was on call this Thursday. In fact, once upon a time, I was just as excited to follow the doctors when I was at their age, maybe even more so. And slowly the idea or know-how of doctoring percolated into my mind.

Young minds tend to be the most sensitive. I wished I could give them a better sense of how to be a doctor. At the same time, I was furiously trying to keep my patients alive. We saw patients together. One of my patients got chest pain. An old lady. Her heart beat in a mad, higgledy-piggledy rhythm. I saw great chance to teach my students every inch of complete heart block.

After taking out my stethoscope, I was amazed to find a loud heart sound like a thunderstorm. Thump, thump, thump. In the same way a rusty and broken door makes a squeaky sound, the patient's heart valve was leaking to make that loudest, scariest, queasiest possible noise. "This murmur wasn't mentioned at all when the two doctors examined our patient this morning," I cautioned. That's something new.

I faked equanimity, which is my strong suit, and pointed out the story of sudden breakdown of heart valve's scaffold support. Implicit in this condition is the no-fun-at-all standstill of heart's horsepower. The thing is, I wasn't sure the elderly lady could survive without surgery, which she can't tolerate either.

I didn't, and couldn't, teach my students to repair the ruptured heart valve. "We as doctors have the illusion that we can fix everything, but we can't." I ended up teaching them how and when to tell our patients (or their family) it's a thunderstorm beyond our capability to fix.

Judge

Over the course of many years of final year medical student examination, I've noticed that students' scores seem to be pretty consistent between examiners.

To explain how, allow me to run you through a typical examination. Each medical student goes through five examination stations, and is assessed by a pair of examiners in each station. Simply put, each student is examined by ten examiners. The basic idea behind meeting five pairs of examiners is using independent assessment as a bulwark against bias.

At the end of the (tiresome) day, most examiners will sit down and have a bird's eye view of the scoreboard. When it comes to proving the coherence between two examiners, the common understanding is seeing how close the marks are within each pair of examiners.

Now let's stop and consider if a coherent marking between two examiners can prove a fair system.

Looking back on the scoreboard, I'd been tempted to believe the close-enough pairs of marks. But I know that's not the whole picture. I can't say exactly why until I read an article published in Proceedings of the National Academy of Sciences of the United States of America.

That's a study investigating 1,112 judicial rulings in which experienced judges granted parole. Being the first case of the day or just after the judges' lunch break, in fact, the prisoners were far more likely to be granted parole. Alas, that's exactly the moment when the judges felt invigorated. As defined by these two daily food breaks of the judges, each day was split into three distinct "decision sessions." The percentage of favourable rulings dropped gradually from around 65 percent to nearly zero within each decision session and returned abruptly to around 65 percent after a break. There is no better example than this to tell us how we can colour the way human make decision. But that is not what the noble judges are supposed to do, you may have wondered. Why did the judges gravitate toward the prisoners' advantage immediately after a break? As it turned out, when judges make repeated rulings, they show an increased tendency to rule in favour of the status quo, default decision of not granting parole. Such natural tendency can then be overcome (call it bribe, if you wish) by taking a break to eat a meal.

As if that's not convincing enough, the researchers considered another explanation: the judges might have in their mind a reasonable proportion of favourable decisions, and once this "quota" is filled, then unfavourable decisions follow. When the researchers included a new variable that computed the proportion of favourable decisions up to that point in the day, they didn't have a whiff of statistical evidence to support such a claim.

Ahem. Sure enough, these results contradict the conventional wisdom that human can be expected to make fair and unbiased judgment. Not even the judges. Absurd as it might seem to us, I wasn't sure if the scores from the medical student examination will show the same cyclical pattern when plotted against the the time of the examiners' tea break and lunch break. Maybe, but only if such analysis doesn't offend either party too much.

Eclipse

I went back to the hospital on Sunday night.

It happened after the news that my wife's erhu teacher had a clot that shut down blood flow to his brain, almost like a fast-acting half eclipse of the brain. The clot couldn't be cleared. My wife and I were secretly hoping that we could talk briefly with her teacher. Of course, she couldn't, because he wouldn't, and he didn't. Her teacher didn't wake up.

My wife was feeling emptied out after hearing the sad story. I suppose this is more so when she had just had an erhu lesson the night before the eclipse. I commiserated, and she talked for a while of how she met her teacher nigh on a decade ago, of how her teacher had showed her the passion, of what she'd learned.

I can feel the heart-wrenching emptiness. Like air hissing out of a tyre in the blink of an eye, without rehearsal. Before she knew it, hers turned out to be the last lesson. This one isn't easy. Mitch Albom could foresee his last Tuesday with Morrie, and Randy Pausch knew very well when he was going to give his last lecture.

It seems, but only seems, that the way to shake off the bad feeling is to make a not-so-serious remark, "Don't think you played erhu so badly to give your teacher a stroke."

Billy

Are you so sure that children's picture books are childish?

If you don't, be assured that Anthony Browne's books will be both entertaining and enlightening to readers of all ages. But don't just take it from me. See for yourself. Thumb through his books.

As for the latest story reading with my three-year-old daughter, I was fascinated by Anthony Browne's book Silly Billy. I won't waste much time on telling you how silly this little boy can be. He was a worrier. Billy worried about his shoes walking out of the window when he goes asleep. He soon started to worry about his bedroom flooded after heavy rain. Omigod! One misfortune (which isn't really real) after another (again, purely imaginative) haunted Billy. He became so worried that the world appeared to be smashed to smithereens.

Then at his grandma's home, for the hundredth time, for the thousandth time, Billy came up with one loathsomely picture after another, and he could not sleep at all. But - and this was the interesting part - his grandma made a creative change. She had a hunch that this little Billy needed someone to share his worry, and handed Billy six brightly coloured Guatemalan worry dolls. Yeah, Billy simply had to tell one worry to each doll, and place the dolls under his pillows. By next morning, the dolls will have taken Billy's worries away, as surely as dawn will follow dusk.

Billy's worry dolls helped him a lot. After he shrugged off the spasm of worry, he went back to sleep. So much so, in fact, he slept like a log with the six dolls. But when Billy let loose for a moment, a torrential outpouring of fear returned, worrying the hell out of him. What did Billy worry? He worried that the dolls will be overwhelmed by his worries.

He was worried, but not for long. How did Billy overcome his new worries? Go read Anthony Browne's Silly Billy.

Fog

It's extraordinary how kids learn themselves the rightness or wrongness of language.

No dictionary or grammar textbook there, and no blind rote learning. Yet children catch the essence of how languages should work. Obviously they make up new words like mouses, but not mice.

No sentence is too trivial or too boring if we spend time to expand the words with kids. I took a day off yesterday to join my daughter's school outing to Kadoorie Farm. The weather was so-so. "Look. Daddy, the mountain is moldy," Jasmine concluded.

I followed her finger and looked out of the car window. I couldn't see the top of the mountain. I knew what she meant. "Yes. Doesn't it look like the scraps of our bug box where the mealworm and beetle live? The scraps turn moldy. You might call the weather foggy, though."

To those of us who speak Chinese, it is no less an example of homophone. Moldy and foggy sounds alike in Chinese. Both words fall under the umbrella of "rain" in Chinese characters, too. Common sense would have told me to give a lecture on the Chinese characters. But common sense has no place in children's curiosity and never has.

My daughter dropped the word for the foggy weather, and then told me, "In fact, dad, the more I look at the mountain, the more it looks like someone behind the bridal veil."

Cell phone

It's late in the afternoon. On my way home, I was reading a book about wordplay on a minibus. But I couldn't concentrate.

I wasn't tired. And yet it took me quite some time to finish a page. I felt an explosion inside my head, as if my brain lost the way underneath a mushroom cloud from the atomic bombing of Hiroshima. Ahhhh, there was too much noise around. That, it hardly needs saying, was the noise of passenger's use of cell phone.

Now that smoking is banned on most public areas, verbal pollution by cell phones has dominated the public nuisance. This new brand of pollution, as Faith Popcorn and Adam Hanft remind us, is secondhand speech, the verbal equivalent of secondhand smoke - "not as dangerous but more annoying, and definitely hazardous to your peace of mind."

Alas, do we have a word to describe those people who talk loudly on the cell phones and broadcast their one-sided conversations?

Cellfish.

Mistake

It's late morning at the guesthouse in Chiang Mai, where we were having breakfast. That's when I'd stopped in the middle of the mealtime and gone for a few photographs.

"Daddy, you'd be away without telling us." My daughter looked at me like a teacher.

"I - I didn't know," I stuttered.

"You should have told us, and we didn't realize you'd been away so long."

"I didn't know it matter," I said, contrite an instant later at my defensive tone. "Daddy sometimes makes mistake."

I reckoned, pretty soon, that it's high time to teach my daughter that adults are entitled to be wrong and make mistakes. Why not? Everyone should have the license to make mistakes. During the recent Thailand trip, my daughter has been taking it oh-so-seriously whenever her drawing got outside the border (or when her cutting got awry). I can't teach her to make every drawing perfect, but I know I can tell her making mistakes is in many ways a birthright.

Chiang Mai

One of the liveliest things about travel is how unpredictably each day unfolds itself. And I suppose my daughter has somehow learnt the random happenstance of every overseas trip.

This time, we went to Thailand and stayed in a large, quiet house in Chiang Mai, a perfect respite from the noise and hustle of Bangkok. I slept in the luxury of air-conditioned room, and woke up to the singsong of birds. As a guesthouse, it's an alluring experience for us: there's a leafy courtyard where we can pick pebbles and play, a bar where we can open the fridge and help ourselves with the apple juice, a canteen we don't have to order meals (the owner chose for us).

The trip to this guesthouse would not be more complete without visiting its affiliated children's aid project. That's a big family to make education possible for children from the mountain villages of Northern Thailand and neighbouring Burma. Turns out, I found, that's the first time in their lives the children have experienced love and stability. After finishing the high school, many of them came to the guesthouse and completed the internship of tourism and home economics.

We weren't planning to have volunteer work at the children's shelter foundation. We were there playing with the kids, hearing from them how the farm was run, seeing how they made a swing like Tarzan. As for Jasmine, she found her friend by herself - the youngest among the children. Even my daughter could not speak Thai (and the other girl knows little English), the two of them were playing the slide together, sharing every morsel of snacks, chasing the cats and talking in meows.

At that, I couldn't help but smile.

Pakistan

I didn't have time to read the Time's 2012 Person of the Year until I brought the issue on my Thailand trip.

It's hard to imagine that the shortlisted one is even more admirable than the champion. Yet, that might be the reason the editor made President Obama on the silver border cover, and at the same time added another cover depicting Malala Yousafzai inside the magazine. The fact that a 15-year-old Pakistani girl can stay just behind Obama means quite something. If you ask me, Malala is just as influential as Obama, maybe even more so.

I was moved by Malala's courage to stand up and speak for an estimated 27 million of the nearly 54 million school-age Pakistan children who are not in the class, the majority of them being girls. She'd been writing blogs for girls' right to education, and then the Taliban tried to silence her with a bullet to her head. She didn't listen to them, and was glad to this day. The bullet had pierced the skin just behind her left eye, traveled along the exterior of her skull, gone through her jawbone, all the way through her neck. It did nothing to stop her voice from being heard. The latest Time issue ran a story describing Malala back in a school uniform.

If Obama made the history, Malala created a miracle.

Control

I recounted the story of rainbow in my blog two days ago, after attending Louise Porter's conference on children's learning style.

That was the first time I heard about the term internal locus of control. The concept, in some ways, isn't difficult to understand. If we believe that outside forces such as the rainbow (or luck) determine our mood or destiny, we are said to have an external locus of control. Stated otherwise, we can possess an internal locus of control by staying in command of our thinking and emotions.

Almost forgotten in all these concepts of self-efficacy and locus of control, though, is the fact that we should apply the same line of thinking in teaching children. That's what I learned from the child psychologist. Her advice to parents is simple: Forget punishments and rewards systems.

It won't be easy. I don't have to tell you why. From clan to clan, culture to culture, the oft seen practice of punishments and rewards has been so hardwired into all of us that they don't even need advocates. Grandmas simply believe that it's impossible to teach without "teaching children a lesson." Moms and dads - and certainly many teachers - say earnestly that star charts are the ways to go.

Benign as it may look, a reward system can teach children that other people's approval counts more than their own judgment. Having heard my daughter's crying when she first attended the kindergarten on her own, we were also enthusiastic about putting up star charts to praise her if she didn't break into tears. Soon, we found that withholding a star or sticker when she cried at the door of the kindergarten is like punishing her for being a child. Within a very short time, we gave up the star charts. Soon Jasmine learned by herself that she can be in control, and things are much more relaxed now.

Rain

A problem I share with with my daughter is a tendency to get obsessed with the weather. That's an unintended effect of being a huge fan of photography, and it can be hard to get rid of.

There are days when I feel like I'm drowning in a whole week of rainy weather. Very well, before we take out the rain coats, the weather can change quickly, and in what seems like minutes, the sky can be clear with new colours, leaving many oohs and aahs for the rainbow. What a cool way to kick-start a new day. But can you find the trap? (I'll give you a minute.) Here it is:

"It had been raining this afternoon, daddy," my daughter whined. "It's gone but where is the rainbow?"

I began to see a logic in this trap when I tried to give Jasmine a good answer. In most cases, we anticipate the light at the end of a bumpy journey. That's why we teach ourselves to keep our eyes on the rainbow. It's okay to get happy as a clam at high tide once in a while, but soon our mood will depend on the tide - to get high or low.

"I don't know why the rainbow didn't show up," I told Jasmine. "We can't control when the rain stops, much less if the rainbow comes out, ever. What can we decide? We decide whether we want to be happy."

She nodded.

Worm

When most people think of school, they think of homework. But that word homework means different things for my daughter's kindergarten than it does for many of us.

It's hard to imagine that my daughter's homework is to raise a darkling beetle.

Last week, I borrowed a book How Not to Be Eaten written by an entomologist, but haven't had time to read. When I went home tonight, my daughter could not wait to tell me the great news, "Dad, come and have a gander. A mealworm. A worm that won't eat you and me." Jasmine was holding a box in which I found a wormlike larva. That's a baby creature that doesn't look like its parents at all. Her teacher isn't teaching her complete metamorphosis, of course, but the theme of her class is "Change" this month. Yup, the reason of asking my kid to raise a darkling beetle from the larva rings clear as a bell.

Wait. I got puzzled when I thought more about it. The teacher gave Jasmine the box to bring home this morning. And my maid picked up Jasmine after school. Oh no, my maid has never really come to terms with her visceral distaste for any crawling creature. The mere thought of a caterpillar could have provoked a squirt of stomach acid into the back of her mouth. How could my maid bring that box of ugly worm home? That's on par with giving her a heart attack. I could hear her heart thumping around her chest like a tennis shoe in the washing machine.

If I had to summarize the second part of this mealworm's story in a sentence, I could say that it's a story of observing how Jasmine changes to a mature girl. I was expecting a tale of my panicky maid covering her eyes, but all my daughter said was, "I know; it's too scary for Wati, and I told her the worm won't eat her. I didn't ask her to hold the box. I bring the box home all by myself."

Proud

Of all the words a proud, jovial daddy might use to describe her daughter after a holiday trip, perhaps only I would choose quiet.

It's no secret that as a toddler continues to grow, so too will the list of parents' surprise items. The very last thing that a toddler needs is our suggestion to make up a thousand ways of playing. The toddler learns the trick by herself.

Hear that thumping sound? That's my daughter's game of flying pillow (when we stayed in a two-storeyed resort at Taiwan). Oops! Did you hear hundreds of bombs dropping on the city? No worry, that's my daughter jumping on the bed. The list goes on and on. Dad and mum are supposed to listen and stay calm, leaving room for imagination. If you're worried that you might really get a big surprise, don't worry - you will.

The biggest surprise for me happened when we visited the Taipei Fine Arts Museum at the end of our holiday. It suddenly seemed absurd for a three-year-old to whisper to her dad to lower down the voice. Things got a lot easier than I could have imagined. She had figured out herself to use indoor voice in a museum gallery. Well, even lower volume than her dad's.

Vacuum

I never delight much in the Chinese New Year.

The feeling of emptiness occurs when you know that even the daily newspaper will come to a break. Newspaper stops, shops are closed, and a lot of hospital services come to a halt. Everything stands still, the way a city stays behind after all the clocks vanish and the minutes quit their orderly tick. Pause.

I can also remember all those legendary words of greeting one has to say in front of the elderly. It isn't that I hate to say kind words. But a lot of them are coming out of courtesy, not from the heart. Add a few more those pretentious sentences, and you end up in a hollow vacuum.

In trying to get out of the vacuum, I have developed my own rituals. Every year, I use up all my library card quota before this long holiday, as if the library won't open again. I made good picks this year, and now end up reading four books at the same time: Michael Sandel's Justice, The Glamour of Grammar by Roy Peter Clark, Made to Stick: Why Some Ideas Survive and Others Die, Fiction 100: an anthology of short fiction. 

Now there's a man living fully.

Feel

One of my colleagues got a bout of serious gastroenteritis last week.

When we went through the patients together during the morning round, he could hardly walk. His stomach hurled heavenward, bile and acid scratching his throat as he told me the discharge plan for our patients one by one. He talked as if his tongue turned into flypaper; he walked as if he trousers would fall. My poor friend stopped after each patient (which he seldom has to) before he could go on, insides cramping.

But, and it's a very big but, what he learns from his own experience of being sick to the pit of his stomach turns into something that really sticks in the heart. He was rather surprised at himself after the illness, feeling what a patient feels. "As doctors, we should never be satisfied simply with how quick we send our patients home. Learning to talk to them and listen to them is the license we need to get," he told us.

Absurd as the moral of this story is, being sick himself is as important as a flu shot when it comes to what a doctor needs. Knowing how a patient feels is like an itch. Every day we reach for it and can't quite scratch it. Every day, it itches a little worse.

Some 50 years before, Herrman Blumgart, a Harvard Medical School professor, said it best: "The patient knows how he feels but doesn't know what he's got — while the doctor knows what he's got but doesn't know how he feels."

Telephone

Telephone manner cannot be found within the undergraduate medical curriculum, but it's something that doctors have to learn throughout the years of medical training.

Doctors are regularly called upon to answer pager. Some are summoned to resuscitate patients whose hearts stop beating, while others are called because their patients have difficulty with counting sheep. Several of them are paged in the middle of a concert. The question could sometimes be about the doctor's indecipherable handwriting, or else, an unnecessary intrusion into the doctor's sleep. More often, the doctors are called when their juniors feel uncomfortable.

Just as a doctor needs to choose his words carefully in front of patients, he must tailor the answer to his junior doctor's query. I know that it's not easy and I'm not here to tell you that we're hard-wired to answer the phone call patiently. Actually, we aren't, most of the time.

This brings me to a remarkable story from a surgeon friend of mine last night. We had dinner and talked about an eminent chief surgeon in the field of liver transplant. The true story is not a tale of hero on one side and villain on the other. Few true stories are. "He is really mean on giving out good marks." lamented my friend. "Not even his own team members." Yet those poor grades in the annual assessment, harsh as they are, don't tell the whole story of that chief surgeon. "When it comes to calling him in the middle of a difficult surgery," she told me, "he never says no over the phone. He will come back and sort things out. Guaranteed."

That chief surgeon's passion reminds me to behave myself over the phone, when I am on call tonight.    

Mary Poppins

I began to get a pretty good sense of kids' stories. Mary Poppins is a case in point. That's one of Jasmine's most favorite stories recently.

In particular, she loves the character of jovial Uncle Albert who floats up in the air whenever he laughs. All visitors of Uncle Albert can join him in a tea party in mid-air, as long as they chuckle together. One word of caution: thinking of something sad will take away your flying magic.

That says everything about the magic of laughter. "It's laughing that does it, you know." This may sound easy - and it is - but it requires our own thinking. There are no licensed laughterologists. For many bedtime story times, I'd reminded my daughter to learn from Uncle Albert, "So. We can decide ourselves whether we fly or fall."

You are probably thinking that it's too early to teach her the lesson, but it isn't. I just knew somehow, after learning a painful lesson ourselves, that she understood. Alas, my wife actually ruined her car's rear bumper while backing out of a parking space tonight. We decided to buy a box of chocolate and then Jasmine helped her mom through the let-go steps.

For the next half hour, we played all sorts of games together. When Jasmine heard her mom talking about the insurance coverage, she told her mom matter-of-factly, "Hey - haven't you got the chocolate? Why are you still sad?"

Kid's Diary

I can easily go on my errands after picking up a book at random. That includes kid's story books, like Jeff Kinney's Diary of a Wimpy Kid.

Don't laugh - unless you're laughing at the story's character Greg Heffley instead of me.

Well, I learned a lot from Grey Heffley, too. His school playground started off the year with all sorts of things, like monkey bars and swings and stuff. But that was a year ago. Then the playground became an empty sawdust pit. It's hard to say how long it takes but Greg was rock-solid certain that the school was having trouble paying the insurance for the playground. Every time there was some kind of accident or injury on a piece of equipment, and imagine, the easiest thing to do was just remove it.

When I read Greg's comment that "people are getting too carried away with all this safety stuff," my "uh-oh" bell rings. The same is true in hospitals that have come up with all those mighty safety measures.