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.