Courage

I have had difficulty in telling the difference between pronouncing "my pleasure"" and "my pressure" for as long as I can remember.

Yes, you read me right. And yes, they sound similar to my ears. I admit that my phonic skill is not as good as my six-year-old daughter.

And yet.

And yet.

I taught my daughter how similar the two words "pleasure" and "pressure" turn out to be.

Yesterday, before my Christmas holiday ended, we met our friends and decided to have bike ride. My daughter has learned riding bikes without training wheels for more than six months. But now we were talking about going to the cycling trails on a public holiday. Few things turn her stomach more than trying something new. Many, and I am among them, will demur to going beyond our comfort zone.

No one, least of all a six-year-old, can discount the intimidating effect of riding bike parallel to somewhat-like-Tour-de-France-team at arm's length. Or even in opposite direction. My daughter wanted to say no. She was afraid and didn't dare join our bike ride.

"No. I really don't want to," I heard her declare.

I simply smiled and said brightly, "I know you can try, and I'm here. I will stay behind." My daughter then put on her helmet, reluctantly at first, learning her way to transform pressure into pleasure. And she did.

Cliffhanger

I've been reading A Manual for Cleaning Women, a collection of short stories by Lucia Berlin. Her tales of pink-collar workers are pretty cool. Some are good. Some are otherworldly (and somewhat drunk). Some are truly touching.

But, to be honest, I love another story book more: Once Upon an Alphabet. This is Oliver Jeffers' collection of short stories, each of them dedicated to an alphabet, from A to Z. I read this book with Jasmine recently. We both love the twenty-six crazy stories. Always entertaining, from the alpha to the omega.

The story plot is simple but always a spark of joyful game. Turn to the page H, we were introduced a lazy Helen, who lived in half a house. Where is the other half? It had fallen into the sea during a hurricane a year and a half ago. Think about it. A half-sized house on the edge of sea cliff. Literally a cliffhanger plot.

"Oh, what shall we do?" Nothing. Being lazy, and not owning a hammer, Helen hadn't quite got around to fixing it yet. Which was fine.

Until the horrible day she rolled out the wrong side of bed.

Ugh.

The story ends with a bit of drama, with Helen plunging all the way into the sea.

The first time we read this story, we were almost laughing our heads off. We read the story the second time this morning, before my daughter took the school bus. Jasmine turned out to build a new ending.

"Dad. Let me finish. What if Helen is able to swim and dive? She must. She must go to the bottom of the sea and find the other half of her house, and live there happily ever after. The End."

Six

Few days ago, my daughter picked up a book at my study: Father to Daughter: Life Lessons on Raising a Girl. So we read together. We became absorbed in the lessons right away. After all, one of the precepts in this book is to be involved in the daughters' lives.

Now my daughter is six this week. I know that's a big milestone for a little girl, and I'm glad that she put on her roller skates for the first time on her birthday. I have always had faith that my wife will pick the best gift, such as new roller skates, for our daughter.

What about me? I couldn't think of a better poem than that written by A. A. Milne (who also wrote Winnie the Pooh and Friends), to celebrate Jasmine's sixth birthday: Now We Are Six.

When I was one,
 I had just begun.
When I was two,
 I was nearly new.
When I was three,
 I was hardly me.
When I was four,
 I was not much more.
When I was five,
 I was just alive.
But now I am six,
 I'm as clever as clever.
So I think I'll be six now and forever.

Coding

The easiest way to distinguish between efficiency and effectiveness is applying the rule of the American management guru Peter Drucker: efficiency is doing the job right, effectiveness is doing the right job.

The only thing you need to know about ineffectiveness, on the other hand, is looking at the canonical example of demanding complete diagnostic coding in hospital patient discharge summary.

The truth is that doctors are supposed to code the diagnosis, besides writing a summary of what happened after a patient was discharged from hospital. Writing a summary deserves significant attention - even if it isn't easy - to let subsequent doctors carry on with the care. No one questions why we need to write good summary, but it is intriguing to conceive how diagnosis coding is linked with patient care. If writing patient discharge summary is like painting a picture, coding means naming each and every colour that has been used.

So let me repeat, once more: diagnosis coding has nothing to do with patient care.

There's an expectation now among our hospital administrators that the diagnostic coding should be as meticulous as forensic examination. Their rules are pretty strict. Writing the code 487.8 indicative of influenza is okay; it isn't when the auditor finds out the patient suffered from influenza A. I just received a letter telling me to change the code to 487.1, supposed to be more specific for influenza A (and not the influenza B virus). Disagreement about my original coding can take on the feel of a Supreme Court decision that will discipline me. I sheepishly ticked the box literally meaning "Pleaded Guilty" on the audit form, amended the coding and returned two copies of the summary acknowledging my mistakes. I felt how woefully the auditors had wasted their time parsing voluminous charts and combing through the laboratory results in this exercise, and wondered what purposes they serve. There is no evidence of real patient risk being infinitesimally reduced by such meticulous diagnostic coding. Obsession with such paperwork can override actual patient care - impersonal at best, distraction at worst.

In fact, I could offer dozens, indeed hundreds, of examples in which doctors are pushed to come up with as many codes as we can.

I really don't have much of a temper, but audits like these put me over the top.

Farewell

I didn't work today.

I went to my daughter's school because it's the parent-teacher interview. The school principal advised us to list any questions that we want to raise. And, keep questions short. I felt that perhaps I should make use of this chance to tell my daughter's teacher one single life event that matters. A lot.

Our domestic helper will leave us after living with us for six years.

Two days later, we will bid her goodbye and I don't think our eyes will be dry at the airport. She has been taking good care of my daughter since her birth. It's been wonderful, until we have to say goodbye.

We have always dreaded the time of eventual separation. This is, quite simply, because we realize how lucky we've been having a trustworthy domestic helper who loves our daughter. This is a gift for which I was - and still am - grateful.

Satisfaction

I proudly carry a hospital pager - known colloquially as a bleep - with me seven days a week. I view my pager the way soldiers view their honour badges - they're insignia not to be taken away. That sounds good for a workaholic like me.

The only mistake I made was not realizing the importance of pauses.

I learned about the beauty of the pauses and silences when I watched Circle Mirror Transformation by the Pulitzer Prize-winning playwright Annie Baker last night. There were quite a number of pauses between drama scenes, and every one of them was as important as the dialogue. This is, of course, correct. We need pauses.

I daresay this is important after taking a break today. It's not that I don't want to go back to hospital and see patients - believe me, I do. Luckily, I did something as meaningful as going to work. I learned the richest of lessons from a medical ethicist (such as the moral dilemma of doctor's deceiving patients) after attending a daylong workshop. Then I finished my reading Your Medical Mind by Jerome Groopman who discussed how to navigate a medical decision, all the way from doctor's rubber-stamping to dictating patient's decision. If you ask me, this book is a must-read for the medical students and doctors.

But perhaps the most satisfying way to finish my day is that I have a chance to teach a group of elite medical students this evening, and for that, I am grateful.

Game

Imagine someone asking her son, "How was school today?"

"Good."

Not so uncommon to find such economy of words, huh?

"What did you do?"

"Stuff."

Is this always the case when we ask our children about their experiences? It might not be, though - not by a long chalk.

Heck, it's sometimes harder to get a school-age child to open up than that of Ebenezer Scrooge's wallet. Try as you might, you just can't make a child talk to you. The more you ask, the more you get stuck. If you've ever poked a snail to coax it out of the shell, you know what I mean.

Recently, I learned a new trick to encourage my daughter to recollect and share her stories after school.

This is how it works for me: "Tell me two things that really happened today - the best part of your day and one not-so-best part. And one thing that are fake. Then I'll guess which two are true."

A good mix of memory integration, humour and imagination. This sidesplittingly funny game has now become the ritual of our dinner.

Working Hours

We doctors have a long history of working long hours. We're trained to do so. Shortly after graduating from medical school, accomplishing the task of internship requires that we define forty-eight hours - not twenty-four - in a day.

With time, we unknowingly enter an addiction loop of long-hour working, which means staying on task until it's done instead of breaking the whole thing into manageable chunks. That explains why I won't be home until eight on most of my working days. I started to worry when I read an meta-analysis published in the medical journal Lancet last week.

The downside of working 55 or more hours per week, they report, is that there is an increased risk for stroke. Bile and dread inched up my throat. I thought to myself: Scary.

Well, that's what the researchers found after pooling data from nearly 530,000 adults who were free of stroke at baseline. During roughly 7–8 years' follow-up, the longer working hours one is engaged in, the higher the stroke risk. That is, the dose-response relationship between working hours and the risk of stroke speaks volumes to the threat - and for good reasons. For one thing, our brain weighs three pounds (only 2% of an adult's body weight) but consumes 20% of all the energy the body uses. The wear and tear of long working hours could have explained the energy crash or sudden exhaustion of the brain. For another, those who overwork tend to ignore their health. That doesn't mean the increase in stroke risk simply comes from smoking and drinking after long working hours; those risks have been factored in when the researchers calculated the odds.

Ahem. Sure enough, I'm not calling for a cut in doctors' working hours based on an observational study. All those conclusions drawn without a more experimental way - such as random allocation of individuals working long hours to reduced working hours - should be taken with at least that much of a grain of salt. To that matter, what am I to think? I am not sure what to say, but I didn't go back to my hospital after giving a lecture in another hospital yesterday. I went to meet my daughter in the playground instead of heading back to work.

Playground. Yes, it's unusual.

Even if the Lancet paper isn't rocket science, it makes me less guilty of leaving work early this Friday. Hooray.

River

There's almost too much to do and see around Melbourne. Covering everything is impossible. We didn't include Phillip Island in our original itinerary. We changed the plan at the end - sorry, after the cut-off time for cancellation of hotel book with refund.

Such flexibility on my part is uncommon: my survival framework has been built on the harmony of clearly written plans. For that sort of impromptu schedule change on the fly, I can't. Or won't.

It speaks to the nature of my stubborn head. But then I read the book by Daniel Siegel and Tina Payne Bryson - The Whole-Brain Child - and learned about the metaphoric river of well-being. Children are thought to float along in their canoe, with one bank representing chaos, the other being bank of rigidity. Near the bank of rigidity, the water smells stagnant and stinky. Another extreme, on the other bank, is a total lack of control. We're zigzagging back and forth between the two.

The easiest way is to integrate the two.

There's more buried treasure hidden in Phillip Island. I consoled myself with this thought: we cancelled the hotel booking at the last minute to make our trip there to see the little penguins (Eudyptula minor), the smallest ones and probably the cutest on the planet, waddling ashore at dusk. From their chaos in the rough sea and back to the comfy home.

Tranquility

After the hotel stay next to the Royal Children's Hospital in Melbourne, we moved to an isolated and virtually traffic-free area, French Island.

The main attraction of this island is its serenity. Being two-thirds national park, French Island has a population of around 100, far outnumbered by their resident koalas.

We didn't camp this time. We stayed in an eco-friendly cabin which provided cosy dinner and basic facilities - minus hair dryer and wifi network.

So that's the bad news: you have to wait for your hair to dry. That's right. Waiting without net surfing.

Well, there are some pretty good alternatives.

Yikes.

The good news is that you can go outdoor stargazing before bedtime. Chances are you won't come back after your hair has been dry. Or even, in the blink of an eye, when it's frozen.

Heart

Living right next to a hospital always ranks low when it comes to holiday. That's what we did in Melbourne during my daughter's term break. Our hotel is right next to the Royal Children's Hospital.

When I say "next to", I mean we shared the same elevator and car park. And I mean the hospital cafeteria is an integral part of our daily life. My daughter really appreciates this special place.

The Royal Children's Hospital, I must say, is a fabulous place for kids and visitors, especially those with a kid like our family. The hospital is surrounded by the 181-hectare Royal Park, the largest of Melbourne's inner city park. With the hospital's child-centric decoration (including a more-than-real size tiger behind the story The Tiger Who Came to Tea) and innovative design (with the ward location named after animals like kookaburra instead of those boring number and alphabets), this place is a showpiece for their love for children. Everything that happens to patients - the picture they see on the corridor, the playground they visit, the books they find at the convenience store - profoundly changes the way a hospital journey is perceived. And more so for children hospital journey.

The location of our hotel didn't really get off the beaten track, but it gets us to the heart of a place.

Lego

Consider for a moment staying home with a child when it's all wet outside - what makes it more miserable is the strong wind and then typhoon signal.

If this sounds humdrum, that's because it is: "Borinnnnnnnnng." Any time this word boring is part of a child's whine, it's as scary as fingernails on a chalkboard.

Nothing in the parenting almanac says we have to put up with boredom like that, so we decided to unwrap a box of Lego when we were hit with heavy squally weather last weekend. That's not a small set of interlocking plastic blocks. A set of more than 800 pieces, big enough to build Christmas village with elves, reindeers, sleigh and Santa's workshop.

I didn't know I would have opened the set that early when I bought it online: the set is supposed for kids aged 12 or above. I was even more surprised at the way Jasmine was absorbed in the project. The length of her attention span amazed us by the time we looked at the watch after finishing the Lego set. Six hours.

Unbelievable.

Literacy

Yesterday I went to my daughter’s school to find out how it looks like during the Literacy Week.

Her teachers are serious about the event. Kids are encouraged to "Stop-Drop-Read" during the lunch recess, when they can visit the library and enjoy a story. My daughter was also eager to attend the Book Fair and learn to purchase books she wished. And it felt so good, you know.

To those who care about literacy, the scene of their kids ploughing through dozens of books rouses feelings not only of gratification but of ecstasy. It's a pity that I can't go to her school today when I am on call. Students will dress up as their favourite characters in a book, and bring that book along to school.

There are no firm rules for how to inspire children to take up reading as an enriching pastime, but I trust her school's way to make it happen. I don't know the way to assess my daughter's reading level, either. Difficult as it is, I prefer the reading proficiency test designed by Rafe Esquith's fifth-graders. The test consists of three questions and goes something like this:

Have you ever secretly read under your desk in school because the teacher was boring and you were dying to finish the book you were reading?

Have you ever been scolded for reading at the dinner table?

Have you ever read secretly under the covers after being told to go to bed?

My secret wish is that my daughter will pass this test, like her dad. Maybe, just maybe. One day.

Balance

I wrote at least one blog post each time I was on conference leave. And why not? Conference leave invariably means more personal time at night.

The schedule of my conference leave is always much the same. I would arrive one day before the event starts, and fly out the day after the conference finishes. In other words, it isn't easy to set aside more than one day to travel. Okay, at least not the off-the-beaten track experience within the tight schedule.

To balance my own travelling needs with those of formal attire in the conference, I find it a good idea to wear a pair of not-too-casual black running shoes. (Yeah, I guess that's the time I saw the envious faces of those ladies who wear high-heel shoes.) For my conference in Korea this week, I used the same strategy. I can hardly add one World Heritage site in my itinerary. It's impossible when I spent the bulk of my time inside the convention centre.

Still, I enjoyed the few short trips the way Koreans relish the banchan (side dishes). A bit from one dish, then a bite from another. A tiny morsel a time but enough to create balance in the meal. This is certain.

Title

The topic of addressing people is always complicated. This is even more complicated when you have more choices than first name and family name. The third choice, in my case, is the title called "Doctor."

Being addressed by my doctor colleagues as "Dr. Chow" has become unbearably heavy. And yes, they sometimes call me like this even in casual conversation or e-mail. If you think this is more appropriate than calling me "KM," I will not argue otherwise. In theory, courtesy is good, right? Well, you can't blame a person for being polite. But I find this way of calling me too polite, and sometimes awkward. As it turns out, the title makes me squirm more often than not.

The way I want to wriggle away from being called "Dr. Chow" is somewhat personal, I know. This could be contrary to what most people think. Today, I know I'm not alone after reading Emily Transue's Patient by Patient. I brought this book by the inspiring professor of clinical medicine for my conference trip to Korea. As Transue wrote in her book, she hadn't always been comfortable being called "Doctor."

Thinking back, she realised that her experience with the title "Doctor" was titillating, and even more so when she was a medical student. Consider it a dream title for someone who is still on the bumpy road to becoming doctor. The title "Doctor" seems distant and precious for young students. Medical students view the title "Doctor" the way children view their parents' clothes - they can try on them and it's okay to play in them, but unimaginable that they would fit someday.

With time - and years of working experience under her belt - Transue was no longer bothered by the question of identity. She knows very well she is a real doctor, even without being referred to as "Dr. Transue." And me too. So yes, if at all possible, call me "KM."

Crayons

Hugh MacLeod believed that everyone is born creative and everyone is given a box of crayons in kindergarten. For him as for most people, puberty means taking the crayons away and replacing them with dry, uninspiring books on algebra, history, etc. Being suddenly hit years later with the "creative bug" is just a wee voice telling you, "I'd like my crayons back, please."

When did that voice come back to me?

After my daughter has arrived, of course. Well, I enjoy the crayons.

Now I know that having a kid is a supple springboard for the right to reclaim my old box of crayons. And in turn, getting the crayons helps keep our children busy with many creative projects. Crayons simply means a "useful box" of tools. That could refer to left-over egg boxes, bottle tops, straws, bits and pieces turning into new designs.

Truth be told, most of the credits go to my wife. After all, she has been at the helm of many projects at our home. My daughter is incredibly fortunate to grow up with her creative mum. When our sister-in-law moved house the other day, we were given many of her left-over carton boxes. Treasure boxes, yes. Alas, we improvised an automobile from those boxes. This project lasted for two months. We cut out windows, assembled the car, decorated the vehicle with fog light, steering wheel, rear mirrors and name plate. We added the finishing touches today after buying a skateboard.

Big enough for the kids to drive. Whirrrrrrrrr. Off we go.

Impartial

For the past two weeks, I have been reading Rafe Esquith's book Teach Like Your Hair's on Fire. I learned about the six levels of moral development, as first proposed by the Jean Piaget and then simplified by Rafe. These six levels seem simple. Yet implementing them is anything but simple.

You might be less eager to learn the basic levels, but I have to briefly mention all these six levels - one by one. Level I thinkers simply act out of fear. Most children do. They do homework to stay out of trouble. To move up the ladder, we can use Level II thinking and do homework for reward such as the homework chart gold stars. Can we do better? Yes, Level III refers to the stage kids learn to do things to please people: "Look, Mommy, is this good?" And on the path to moral reasoning, children should be taught to reach Level IV: follow the rule. And it works. That's why we have classroom rules or the Ten Commandments.

According to Rafe, we should aim higher like Atticus Finch in To Kill a Mockingbird: become a Level V thinker and achieve a state of empathy for the people around. To paraphrase Atticus, You never really understand a person until you consider things from his point of view ... until you climb inside his skin and walk around in it. The most desirable level, however, is the Level VI (the Atticus Finch Level) where a thinker has a personal code of behavior. He does not base his action on fear, or a desire to please someone, or even on rules. He has his own rules. There will be times when the Level VI thinkers become heroes by not following rules. Think Martin Luther King Jr. Or Mahatma Gandhi.

A few weeks ago a friend of mine who is a passionate doctor confessed that he would go the extra mile delivering "better" attention to certain special patients or families. It's one of the worst kept secrets of doctors who are supposed to treat all patients equal. As a clinician serving the public sector, understandably, I should be impartial and avoid favouritism.

The hard truth is, most doctors do have favoritism. Many a time when our patient and family are nice. Remember Level III? Nice patients deserve better care, don't they? Sometimes, out of fear (think Level I). Many doctors learn the hard way that it's rarely a good idea to finish a clinic consultation too quickly when the patient enters the clinic with the whole family. You can call this a veiled threat of complaint. Or call it "squeaky wheel gets the grease" phenomenon, as what Dr. Detsky wrote in the Journal of the American Medical Association some years ago. Pretending that this phenomenon is not so is probably not helpful, in Dr. Detsky's word, and raises the next question - is it wrong?

Emperor

There is more than one way to run a successful classroom. I learn this after reading the teaching guru Rafe Esquith's Teach Like Your Hair's on Fire.

But there is only one way to face a mistake in front of students: Admit it. I know this because I've made one today.

It's harder to do than it might seem. To begin, frank discussion with genuine expectation of divergent views is an exception rather than the norm between teacher and students. If anything, many students avoid disagreeing with their teacher for fear of being ridiculed or because they don't want to present an unpopular view. I've played the dictator enough as a teacher to understand why students prefer to shut up.

This morning, I brought my intern to the operating theatre and showed her the way we inserted a catheter into a patient's tummy for dialysis. Layer by layer. One stitch after another. Everything seemed smooth and clean. And my intern appeared impressed. At the end, we pulled out the catheter from the skin wound. And then out of nowhere, we saw a tiny piece of what-appears-to-be-skin near the wound. No more than the size of a hole created by ticket punch. I didn't really want to be distracted by that small piece of skin.

"Hmm," my intern said, eyeing that stuff with suspicion. "What's that?"

"I don't know. Perhaps a small piece of skin being peeled off."

My intern leaned. She leaned further. There was a curious silence.

She then picked up the skin and brought it closer to me. It took me a while to even bother taking a close look, only to learn that it's a torn piece of glove. My surgical glove.

I felt (and looked) like an idiot.

An idiot emperor who was pointed out by someone he is naked.

Consent

I was looking at a chest radiograph of my patient whose right lung was drowned in a bag of fluid. He had been taking a new blood thinner and had difficulty with breathing for two weeks. The figure of oxygen saturation was swaying up and down like a sail on a ship, as if it might capsize any time in the rough sea. Rising panic.

I washed my hands and put on my gloves. The idea is to put in a catheter and drain out the fluid, before my patient was "drowned." His daughter was standing next to me, and I promised her I'll do my best.

I didn't use a check-in-the-box list that forewarns my patient and his daughter every possible complications. All the worries with wait-and-see (when the right lung was squished and left one squashed). All those concerns with blood thinner (Oh sorry, but there isn't antidote). All the structures that I could bump into accidentally, from artery to nerve to lung to liver.

I managed that patient not long after hearing the story of Montgomery v Lanarkshire Health Board, a British court case in which a Scottish mother was awarded £5.25 million compensation in claiming her doctor who "failed" to alert a risk of traditional birth. The diabetic mother had a small build and her larger-than-average baby's shoulder was stuck at the birth canal.

One of the key implications is that patients should have been told every single risk and information. Otherwise, a doctor can be found guilty in not providing an informed consent.

Clearly, I failed in my case.

I admit that it's not easy to set a standard in the way we disclose the risk of every single medical procedure. There is always a complicating factor: our patient. To answer this question, Lisa Rosenbaum does a fantastic job of admiring paternalism in this week's New England Journal of Medicine.

To paraphrase Lisa Rosenbaum, "The spirit of informed decision making reflects the recognition that only patients are experts on their own values. But our approach assumes a value framework not all patients possess. What if the patient's preference is to know less?"

Inside Out

The list of animated movies is long this summer.

Those yellow creatures wearing goggles and blue overalls, if you ask me, pale in comparison with the story of Riley. This eleven-year-old only child had to move with her parents from Minnesota to San Francisco. Poor little girl. Her apprehension rose with the new school, the new hockey team, and the new way a pizza tastes. Riley struggled with the five emotion characters coming from her prefrontal cortex; she simply didn't know how to put them in the right order.

I can't tell you how many times my daughter cried throughout the movie. Okay, the truth is she cried a lot, so much so that I'm convinced that it's a touching story.

On the way back from the cinema, we talked and went over her feelings carefully, the way you feel for a hurting aphthous ulcer with your tongue. She began to tell me her worry about new school year. One after another. And soon we discussed how much she feels unprepared for our domestic maid's leaving this year (after working for us for five years). That is one of the worst feelings we can think of, to have had a wonderful maid, to know you had the luck, and then to lose it.

It's time, I know, to teach my girl the nuts and bots of finding an island to keep track of wonderful memory. The way five paper dolls (Ticky and Tacky, Jackie the Backie, Jim with two noses and Jo with the bow) are stored in Julia Donaldson's The Paper Dolls.

Dive Hard

Anyone who has tried scuba diving or snorkel will attest to how gorgeous the underwater world can be. I tried that in Mexico more than ten years ago.

We snorkeled with our five-year-old daughter this time in Okinawa. To be totally honest, it scares me. My wife bought her fins and snorkel before departing. We learned the know-how by watching the YouTube and rehearsed at our bathtub.

Turns out, we didn't have to say much. She did well except some problem with fitting the diving mask to seal off seawater. It was so heartwarming to find my daughter singing when she was under the water. I felt the way she lighted up when she discovered a school of fish swimming by.

A whole new world.

Parent

Travel with friends and one's kid can be minefields for parents, in case the kid gets whinny or moody.

I call myself lucky during my Okinawa trip, not because my kid didn't act out. She did. On the very best days - though those were very, very rare - my daughter would smile for the whole day. The real luck is that we travelled with the most placid classmate of my daughter. An easygoing boy who is the second happiest kid in the world, next to Mr. Happy in Roger Hargreaves's stories.

Another stroke of luck comes from my pick of book for this trip. I happened to finish the novel Everything I Never Told You before leaving for Okinawa, and it's hard to find a better one. Fortunately I managed to borrow the inspiring book by Robin Berman: Permission to Parent.

"When my kid goes down the rabbit hole, I try so hard not to go down with him. But it's so tough not to go tumbling down after him," says Robin Berman - a quote I keep coming back to. To make myself clear: it's really hard not to get stirred by our child's pain. Picture your child breaking down in tears, telling you her friend doesn't want to play with her anymore. You might not have to imagine too far. Admit it: not so long ago, your kid told you exactly the same piece of news. Of course, I did. Robin Berman told us a similar story that goes like a textbook answer to stay out of the rabbit hole.

The daddy in the story did a great job by giving his tearful daughter a long cuddle. "I bet that does not feel good." Cool as a cucumber, he wiped away her tears. "What are you going to do now?" he asked.

"Well, I guess I can play with a girl I know with brown eyes and brown hair."

"You mean you?" the dad blurted out the obvious answer.

"Yes."

"Great idea," the dad replied, and off his daughter skipped.

How did the daddy feel? He was just as upset as his daughter, but he didn't let his true emotion complicate the rabbit hole issue. A very clever approach.

Tempus fugit

If you're planning a trip the first thing to do is find your travel companion. We went with my old friend's family to Thailand this summer.

One of the highlights of our Thailand trip is the visit of Kaeng Krachan National Park. Eleven of us, as young as four years and up to ten times the youngest one’s age, trekked to Pala-U, one of the highest waterfalls in Thailand. Step by step, we plodded next to a stream, surrounded by forest over 1000 years old and stunning number of butterflies. The route is tough but the destination is great for families. The stream itself, teeming with carps, makes for the perfect site for feeding fish and swimming.

Trekking with my good old friend brought to mind our school days. By the time we are in Thailand, we've known each other for more than thirty years. You read that right. We were in the same primary school, secondary school and university. Then we became roommates in the student hostel.

One of our favorite activities was stream trekking. That means a narrow, and sometimes slippery, path parallel to a stream. We didn’t have smartphones at that time, and would not bother if there is signal coverage along the trail. We used compass. Instead of photo sharing by Instagram, we had to wait till the films were developed. We didn’t have waterproof backpacks but still went ahead during rainy days. That’s silly, I know. An even dopier mistake was bringing along a medicine textbook when it was raining cats and dogs. Who did it? Not me. Not my old friend. My future wife.

Do you know what happened to the physiology textbook?

It turned cat-eared and dog-eared, I'd say.

Luggage

One way of writing travel memoir is to recollect what's inside the luggage of that trip.

An enormously clear-eyed and quite personal look at how we travel. And a chronicle of how my daughter grows. Absolutely. Do you know we still packed a can of milk powder and a milk bottle for my five-year-old? We did so for our recent trip to Hua Hin in Thailand, as has always been the case. I meant it. The truth is, my girl hasn't weaned from her bedtime bottle.

What else did we take with us?

More story books than I have teeth. We allowed our daughter to pick whatever books she loves. Whatever - no hardcover, if possible. Biff, Chip and Kipper. Charlie and Lola. (By the way, D.W. has also recently been added to her favorite list.) If her milk bottle is a must for her bedtime routine, bedtime story reading is compulsory. And if my wife had a dollar for every time they read a bedtime story together, she wouldn't have enough room in her pocket.

Of course, each of our itineraries come with a chock-full of colour pencils and sketch books. There is a lot more. We took a book of paper-and-pencil games this time. That opens up oodles of fun possibilities. Hangman. Tic-tac-toe (Os and Xs). And many long-lost gems.

Oh, wait - we can't forget a big eraser. I mean, my daughter's mercurial mood is as volatile as the weather in Thailand. As combustible as the Queen of Hearts from Alice in Wonderland, in the event of a mistake in her drawing. It really is.

Separation

There must have been a page that somehow goes missing in our children's school book. It's the page or lesson about separation. That very page has been either torne by a nursery-age kid or got eaten by a dog before any teacher noticed it.

What if we can't teach our kids how to deal with separation? (Often we can't.) What if your kid (like mine) attends a school where turnover of classmates is as high as the staff attrition rate in a public hospital (and mine, too)?

Somehow our children learn their way of facing separation. And pretty well. Sometimes they cry, sometimes they don't. My daughter's story of separation started with her best girl friend who moved away from their kindergarten to a new primary school. I felt freakish and worried. My wife did, too. It was not until my daughter showed me her picture, showing those two lovely girls living next to each other in heaven, that I stopped praying.

Last week, my daughter said goodbye to another two girl friends on the last day of this school term. Those aren't the kinds of goodbye for the sake of summer holidays; they won't come back next school year. I didn't ask if they cried, and I was afraid to do so. Then I learned that one of her classmates went to meet his buddy who had gone back to Japan. The two of them, I remember well, summon up everything good about childhood friendship: silly songs in the class, after-school soccer games, sharing bath tubs in lazy summers. They haven't seen each other for months and really treasured this reunion. They laughed. A lot. Here is the one tiny problem: the two kids cried by the time they had to say goodbye again. They cried so loud that I seemed to have heard them here.

This brings us to the matter of how children, as they grow up, learn their own way of facing separation. We don't quite know how to teach them. They just know. One of my favorite writers, Anne Lamott, tells us when her six-year-old son realised that he and his mum weren't going to die at the exact same moment, he cried for a while, and then said that if he'd known this, he wouldn't have agreed to be born.

Not Dead

Most of our day-to-day tasks - buying birthday gifts, getting an annual check, writing thank-you cards to teachers before the end of the school term, filling of tax return, applying ethical approval for clinical trials, redeeming rebate - are set with deadlines. Such deadline always looms large when it's around the corner. We begin to become a little edgy. Okay, we panic. We sigh and moan and wish we had more time.

Deadlines, by definition, are deadly. As deadly as the MERS-coronavirus. There is no vaccine to prevent it, and there are no drugs to treat it.

Yesterday, my colleague posted his update on Facebook after fighting with time to admit patients to hospitals, barely beating his deadline to submit research grant proposal. "Had a hectic day running between PCR and CPR." That's what he says. Which is basically medical doctor gobbledygook for "mission impossible." Within half day, there were a dozen replies. Condolence. Praise. Encouragement. Long enough to fill a page, I swear. We all know it's tough.

What is it that makes deadlines so dreadful? And why can't we go without deadlines? How much better would our world be if deadlines are scrapped?

Actually, no. Merits of deadline are backed up by behaviour science. For evidence that supports the use of deadlines, consider the British example of the Economic and Social Research Council, which means funding opportunity for university researchers interested in areas of global economics, security and education. At one time, the council decided to remove research grant submission deadlines and accept proposals on a rolling basis. And that, in essence, means more freedom for researchers who won't need to submit proposals on a fixed day (like my poor friend); they can simply submit a proposal whenever they want. No more deadly deadlines. It looks as if that's a big improvement, at least in terms of flexibility.

But wait: do we really know what happened after this new policy?

Proposal submissions plummeted by 15 to 20 percent.

Outside the Box

Psychologists coined the phrase word leap to describe how we solve a puzzle by a shift of mind, such as the experience of seeing two faces instead of that picture of a vase.

When I observed two big carton boxes of milk powder in my wife's car, I was thinking of my sister-in-law who has recently moved in with her twin babies (when her helper is on leave). Clearly this is just common sense; I'd been enjoying the babysitting those two little boys.

But hang on. The carton boxes were empty.

The carton boxes didn't have milk powder. Not any more. Instead of throwing away the used boxes at her clinic, my wife brought them home. They were meant for our daughter, not Gabriel and Joshua. The idea is for Jasmine to build whatever she likes. This appears counterintuitive to me just because I have to stop seeing the milk powder boxes as a thing other than its original purpose. This is exactly what daddies were challenged to do at my daughter's school last Friday; we were to create a slide tunnel (or whatsoever treadmill for a marble to run) out of paper, straws, dried spaghetti, scissors and tapes. Some dads had trouble with this - some kids, too.

Which reminds me a similar scenario known as the Box Problem. Imagine being supplied a candle, a book of matches and a box of tacks, and you're alone in a room with a wooden door. How can you attach the candle to the door so that you can light it, have it burn normally, and create light to read by?

You've got a lot of choices when you're facing this difficult puzzle. Melt part of the candle and use the melted wax to fix the candle to the door. Or else, tack the candle to the door. But does it work? Yes and no. They won't work too well.

It would have been better solved by emptying out the tack box, tack that to the wall, and use it to hold the candle. And then the penny dropped. Like many good ideas, it's so simple you wonder why nobody had thought of it before. Not every psychology expert agrees that it is simply a shift, or a leap, of mind to solve the problem. And, in a way, it doesn't matter very much how we arrive at the solution as long as we can think outside the (tack) box.

A postscript to the story: my daughter and her buddy constructed a hotel, train station and her primary school out of the carton boxes yesterday, and for that, I am proud of the two innovative kids.

Challenge

It's one thing to look darn cool to solve a intellectually challenging case like Sherlock Holmes, and quite another to meet a mysterious patient when you have only half day to sort out the riddle.

When my registrar told me the story of a young chap who had dizzy spell and blackout after climbing four flights, I knew this is tricky. I quickly brought my students to see him, only to find my patient having a seizure in front of us.

This is a good example to tell my students tests don't make a diagnosis - thinking does. After an hour or so, we were pretty sure where the problem is: blood vessels in his lungs got stuck with blood clots. Let me put it this way: If you saw this condition in a 19-year-old, it'd be as rare as having traffic jam in countryside. Oh, my goodness. I knew I didn't have time to figure out why; I'd promised to take half day off to meet my daughter at her school. I looked at my watch.

Still. The urgent and important issue was sizing up the option of open surgery or delivering medicine to dissolve the clots (thrombolysis). After that had been ironed out, I headed for my daughter's school where they are celebrating the important role that fathers play in raising children. I know, because I have a daughter. As the school principal felicitously put it, "While the traditional father's role is different to that of a mother, it is no less important in the growth and development of a child."

Few things are more rewarding than healing as a doctor and teaching as a father. Fortunately, I can be both.

London

I'm sure there are times when we do something for the very first time, and that something seems familiar to most people around.

Well, I'm not sure how many times you have set foot in London. This is my first time.

After going to Edinburgh for my postgraduate examination almost twenty years ago, I still kept some of those United Kingdom bank notes and now found out they're outdated when I arrived in London to attend a medical conference this week. Although I had no time to shop at Harrods or see those not-to-be-missed highlights like the Tower of London or St Paul's Cathedral, I considered myself lucky to get mostly (and let me emphasize the word mostly) good weather and long daylight during London's summer.

It's hard to overstate the basic rule of travel, and the rule is: Be happy no matter what. It's that simple. The easiest way to truly enjoy a trip is get plenty of psychological sunshine. Now, what is psychological sunshine? Ponder on that. This is the last day of the conference when its program ends earlier than usual. Being able to spend time around the capital without hurrying is good news. I headed to Trafalgar Square. Somehow the National Gallery was not open today (for reason I don't really know), whereas London's biggest Waterstone's bookshop nearby closes at six (because it's Sunday). And the weather, it turned out, was the cloudiest in the week. Those are the kind of moments when you look up at the sky, or just down at your shoes, and say, jeez, I've gotta look for my DIY sunshine and move on.

I changed my plan and visited the National Portrait Galley. In a few minutes, surprising as it might seem considering the overcast day, the sun came out briefly. The sunlight was short-lived, but that's good enough for me to capture the fascinating lighting that outlines the iconic National Gallery. I must say I'm most pleased with that photograph today.

Big

Read the opening page of David Schwartz's The Magic of Thinking Big and the story of his six-year-old son's ambition to become a Professor of Happiness will leave you energetic.

Now that I've brought with me this self-help classic on my conference leave, I'm halfway through the book. If there was one lesson learned from this book, it was this: think big, smile big, and grow big.

Let's see an example put up by the author and see what you think: How many times have you been summoned by your boss to accomplish a special task when your timetable has already been darn full?

Think for a minute about the best reply.

Yes, we can give our boss three reasons we should take the task but hundred more justifications why we're simply too busy to handle. But please, I'm told, find ways to believe you can.

The following advice by David Schwartz is important enough to quote at length: Where there's a will, there is a way. And I am growing more and more convinced that I should stick to my habit of never turning down the boss.

Right

Never in the history of our country has any illegal immigrant made the headlines more than a 12-year-old boy who has lived in Hong Kong with his grandma since the age of three.

When I picked up a copy of South China Morning Post on my flight to London, I noticed that his story appeared at least twice in the news today.

But the distance between this mainland boy and me, ultimately, can be measured in light-years. I'd be more interested in the education of our local children. I skipped that boy's story, but found much more interesting feature articles. One of them is about local children's writers who named their favourite picture books for youngsters. I know some of the recommendations (like The Gruffalo); some others I had to jot down in my bucket list.

Another opinion article on the second page of the newspaper drew my attention. It's about the twisted education race, the tutoring centres that rob our toddlers of their childhood by training them how to handle interviews for kindergartens and primary schools. Remember the tagline in the education centre's poster, "You don't like competition? But competition will find you?"

Say those last two sentences out loud and wonder at them. There's never a shortage of places to keep the local kids busy, dizzy or, at best, crazy. Who knows how far that cutthroat game could go?

Terrible, yes.

But it's not one-tenth as thrilling as watching a local documentary of kids' after-school work. I watched a replay of it on the plane. Be grateful you (or your primary school kid) never had to keep track with the incredibly packed timetable of ten homework assignments, as what the poor kid did in the documentary. Yes, ten assignments. By his mum's account the boy is talented enough to finish each item within ten, maybe fifteen, minutes, setting time aside, around 2 minutes between each, for play. That doesn't make sense to me.

There is, of course, an escape hatch. Its name is Plan B. The boy asked his mum, "May I be excused, just for a short while, to go poo-poo?"

Yes, that's allowed. But I tell you, the Plan B is to swap the play time with poo-poo time. All his mum can do is, quite literally, hold her breath and wait for the poo-poo time to finish as quickly as possible.

I have no interest in defending a child's poo-poo time. That's as basic as a human right, and definitely much less controversial than the right of abode for an illegal immigrant. As a parent, I just want to remind myself the 10-minute rule: We should expect all homework assignments together to last as long as 10 minutes multiplied by the student's grade level (or perhaps 15 minutes if required reading time is included). If you don't believe in this rule, go and ask the National Parent-Teacher Association in the United States.

Loss

Everyone fears the ideas of losing. Students fear it. Gamblers fear it. Investors fear it. As long as we own something, we fear the chance of losing it.

The psychologists Daniel Kahneman and Amos Tversky coined the phrase loss aversion to describe how we feel the pain of loss more intensely than we feel the pleasure of gain.

What are the differences between losing a deposit of $150 and not getting a reward of $150? What are the differences between a 5-cent levy on the use of a plastic shopping bag and a 5-cent bonus for bringing your own grocery bag? Simple: we dislike the former (losses) more than we like the corresponding gains.

Have we proven this loss aversion in a scientific way? Not by a long shot, I must say, until I read a research paper on smoking cessation program in the New England Journal of Medicine this week.

Pretend for a moment (if necessary) that you're a chain-smoking guy who can't give up cigarettes, and then receive an invitation to enroll in a randomized, controlled trial for smoking cessation. The idea is simple: you'll be assigned (as randomly as tossing a coin) either to a deposit program or a reward program. In the deposit program, you deposit $150 at the beginning and will get back the money if you kick the habit of puffing, along with $650 extra. In the reward program, on the other hand, there is no deposit to make; you'll be eligible to receive $800 if you stop smoking.

Anyone with an ounce of loss aversion psychology would immediately tell you the deposit program is the least attractive. In the end, it is a simple truth: the least attractive program gives the most impetus to quit smoking. That sounds nuts. And it is! The researchers reported that 52.3 percent of those recruited in the deposit program had sustained smoking abstinence for 6 months, as compared with just 17.1 percent of those in the reward program.

The power of loss aversion is overwhelming.

Showstoppers

Child's growth, like weather, can be hard to predict. But you know it when you see it.

All I need is seeing how Jasmine is determined to prepare gifts for her mum's birthday and Mother's Day this week. Never mind her grammar mistake. Not that she writes perfect sentences. Far from it. But she rehearsed before writing the birthday card. And yes, for the tote bag she designed and painted, my wife loves it with every inch of her soul.

But perhaps the best example of my daughter's readiness is how we celebrated my wife's birthday together. My wife had suggested to buy tickets of Showstopper! The Improvised Musical. The first time we talked about this idea, it took me a while to realise she means three tickets - including that for our daughter. That's a work of surreal genius, I know. And yet. Can a five-year-old appreciate a bunch of professional performers who create musical impromptu based on audience suggestions?

We bought three tickets, anyway. And, of course, our daughter turned out to be the youngest in the audience. The single hardest thing for us is we couldn't check the subject of the show beforehand. We had to wait for whatever crazy ideas that came up on the spot. A fantastical reverie of what-ifs and why-nots. It was our first view of such unique off-the-cuff show; nothing was the same as the previous show. What did we get in the end? A story of rewriting Shakespeare's works, Romeo and Juliet, space station, superpower of ultra-sensitive toes, radioactive kitten, and many many funny ideas.

Incredibly crazy and magical, yes. My daughter loves it a lot. Unbelievable.

Connected

I picked a Japanese restaurant to celebrate the fifteenth wedding anniversary this year. That's a restaurant with open kitchen, by itself a good place to keep my daughter amused. Jasmine spent more time watching the chefs than having her dinner. Within five minutes, or ten minutes, no more than that, the chef made a new dish from the teppan, the way a magician pulls a rabbit out of a hat. I stayed with her in front of the kitchen, delighted. That may seem hard to believe, but I forgot to pay the bill - my wife did that.

The beauty of an open kitchen, of course, is more than children's entertainment. Recently, an opinion piece in the Harvard Business Review caught my attention, and it was titled "Cooks Make Tastier Food When They Can See Their Customers." It was about a research carried out by Harvard Business School's assistant professor. The experiment is about diners and cooks in a real cafeteria. There are four scenarios. In the first, diners and cooks could not see one another; in the second, the diners could see the cooks; and reverse in the third; and in the fourth, both the diners and the cooks were visible to one another.

So what does the customer satisfaction survey tell us?

The food quality was rated better when the cooks could see their patrons. Peculiar indeed. And even higher rating when they saw one another. As it turns out, cooks appreciate the chance to see the diners - a human connection that seems to speak to the power of being appreciated. So much so, in fact, that transparency matters not only to the chefs, but many others. Not too long ago, we've heard about similar research on radiologists' earnest wish to connect with humans. The idea of the experiment is pretty similar to that of Harvard Business School. The story begins with 318 patients referred to a hospital for CT, or computed tomography, imaging examinations. The researchers took pictures of the patients and added their photographs to the medical images. In other words, the photograph appeared automatically when the radiologists opened a patient's CT file.

You should have guessed the study result by now.

Yes, the radiologists reported more empathy, read the medical images more meticulously, and ferreted out many incidental findings beyond the scope of the original examinations. The researchers then picked 81 CT scans with incidental findings and showed them to the same radiologists in a blinded fashion three months later, this time without the photographs. In the end, almost 80 percent of the incidental CT findings were not reported, simply because of omitting the patients' photographs.

Blush

The upsides of the blush or guilt have long been observed. Imagine the following question chosen by Dacher Keltner, a psychologist with special interest in positive emotions, when he had to choose his mate by asking a single question at a speed-dating event.

"What was your last embarrassing experience?"

It turned out that Keltner chose this question to watch for blushing, lip-presses, and averted eyes - all of them being surrogates of his mate's respect of others. Embarrassment reveals how much the individual cares about the rules that bind us to one another, he writes.

In case I'm being asked Keltner's question, my answer will definitely be my recent experience in Nara.

Would you be surprised if I told you that feeding deer around Nara-kōen isn't that much fun? Maybe not, when you consider the pushy table manners of those hungry animals. If you'd like to buy some deer crackers, please be forewarned that deer in Nara are second only to Jerry Mouse as a champion for pushing your buttons. They roam the park, and literally ambush anyone carrying deer crackers. But then it's often the poor little kid who is carrying crackers, and the kid could hardly compete with deer in terms of running.

This hungry deer had yummy cracker. That little deer had none. And this little boy cried wee, wee, all the way home.

Things got a lot more topsy-turvy once the number of deer exceeded that of the crackers. The very thought of deer kidnapping Jasmine's cousin set my heart aflutter. So when the poor boy cried louder, I began to get a little edgy. Okay, I panicked and followed my instincts, shouting and kicking at the deer.

Within minutes, my daughter froze, sucked in her breath, and broke into tears.

Shrieking with pain, guilt written all over her face, Jasmine exclaimed, "Dad, stop it. Stop it. That would hurt the little animals. You should be kind to everyone."

I looked at my daughter as long as I can without blush, and then hugged her, as if I'd made the silliest mistake. And it was.

Kansai trip

Mention Osaka and most people think of Osaka Castle. For most of us, Kyoto means the UNESCO World Heritage Sites. Oh, and gracious geisha. But that's another story when we travel with kids.

This isn't to say I don't fancy those feudal castles and colourful shrines. Soon after my first few trips with my daughter (before the age of three), I simply discovered that there is no all-purpose definition of must-sees with children. It's worth taking a look at the Lonely Planet chapter, but a big part of getting the planning right is to keep the itinerary flexible.

When we travelled with Jasmine and her cousin to Osaka and Kyoto last week, we just made up our own version of holiday. The hotel in Osaka didn't take extra charge for kids sharing bed with us, and we're glad to know that. But then my daughter told us, upon arrival at the hotel, she wanted to create her own tatami (and there is another name for such arrangement: sleeping on the floor).

For most children (and, to be honest, for many adults), it's tempting to break the rules during holidays. The first rule, I'd say, is to withhold our judgements as long as we can - and then a little longer. For instance, when we went to the onsen in Kyoto, Jasmine asked to go to the men's baths (to make for a happier experience with her cousin).

If you love to travel with kids you can probably recall a time - plenty of times - when they come up with crazy new ideas. That's fine. One of the nicest things about travel is a break of the routine and letting the rules go out the window.

New Age

One of the thorniest questions that intrigued my daughter, when I borrowed the picture book Die neue Omi by Elisabeth Steinkellner, is the book's title.

My daughter didn't expect the title, which is translated as "my new grandma." That's a bit tricky - that grandma in her 80s is getting dementia. She forgets the way to take bath, not to mention the know-how of cooking. The theme is among a growing number of children books trying to guide the kids living with their forgetful grandparents.

My daughter will face an even greater grandparent gap, I was reminded by the Time magazine columnist Susanna Schrobsdorff. She was almost 39 when she had her child. Me too. If Schrobsdorff's daughter has a child at the same age, she'll be over 80 when that grandchild enters pre-kindergarten.

My unease doubled after I'd read the special health double issue of Time magazine. The baby in the recent magazine front cover was predicted to live to be 142 years old. That means our lives are getting longer. With that trend of longevity, alas, I'm going to live till 100.

Try as you might, it's very hard to take the news with aplomb. Even as we look forward to more years ahead, the idea of becoming a centenarian is not as funny as we might wish. At least three things dwindle as our body ages: our wallet, hard disc memory space, and muscle mass.

Think of the pectoral muscles that are going to sink with age. Gosh. I was also told that men tend to be less flexible and carry more abdominal weight (which can strain the lower back). The new age is worth preparation. And prepare I did, doing push-up and superman exercise every night since this week.

Cinderella

What do we mean when we call something a "Cinderella story"?

The short answer is a metaphorical expression of rags-to-riches, especially if there is an against-the-odds miracle - but there are plenty variants (as I recently learned from a blog). Origins of Cinderella go all the way back to 1967 (French version) and as early as the 9th century (Chinese version). For now, a Cinderella story refers to a good thing happening to someone nice, concludes the blogger.

Here, then, is my definition of the fairy Cinderella story: Have courage, and be kind.

For those of you who have watched (and go if you haven't) Disney's new live-action Cinderella movie (I went with Jasmine two weeks ago), you should remember this great secret. A secret taught by the mom of Ella, the main character in the movie: "Have courage and be kind, that will see you through all trials life has to offer."

And thanks to this movie directed by Kenneth Branagh, Ella jump-starts my daughter's cinema experience. That's her first time in the cinema. She had enjoyed the pumpkin carriage journey with Ella. Obviously I'm happy that my daughter remembers the lesson to have courage and be kind.

We watched the second movie two days ago. Not a Disney movie this time. No fairy or godmother there, and no magic spell to turn a pumpkin into a magnificent carriage. A local movie titled Little Big Master, based on a true story of an inspirational teacher (think Robin Williams in Dead Poets Society) who takes up the job of a village school principal-cum-janitor. Alas, with merely five students and on a salary of HK$4,500 a month. Dicey though it may be, the village school principal didn't cut back on how much she loves the kids; she cut their school fee instead.

There's no medium like this movie to let us know the pleasure of teaching, and the exemplary way to have courage and be kind.

Pharmacy

When I was asked to teach pharmacy students in the medical ward this weekend, I took them to see patients and talked about the way we used drugs. So we started looking at the drug chart of one patient after another. It wasn't surprising that the vast majority of us teach in this way.

A medley of case examples, in essence.

The method notwithstanding, seeing a few cases can be misleading. The plural of anecdote, as many scientists can tell us, is not data. An anecdote is something that happened to my current patient, or any patient I could remember. Alas, it's more often an outlier than not.

That's where statistics comes in.

After talking for more than an hour, I moved to stories with more patients. Those are the stories of many many patients, instead of an anecdote. I digressed and talked about how we discovered new drugs or devices that often fall short of the oh-so-wonderful promise: the oral direct renin inhibitor aliskiren and renal denervation (that had once been thought to be a breakthrough for treating people with stubbornly high blood pressure) are two "good" examples that didn't work out.

Now, move on to name those old-fashioned drugs that were dug out of the cobweb closet, but with new purpose. Think spironolactone, thalidomide, colchicine and pentoxifyline. The ideas range from a new indication of treating blood cancer by a banned pill for morning sickness to, as if by magic, using colchicine (an ancient drug known to curb joint inflammation) to damp down inflammation of a sac surrounding a sick heart. And the list goes on. They all work wonder for new indication!

It's a testament to the mantra why we need old friends.

Rock or Scissors

Not every child is interested in the game of Simon Says or Duck Duck Goose, headstand or cartwheel, hopscotch or thumb war. But nearly every child is born with a preference to play rock-paper-scissors.

A typical kindergarten kid should be able to follow the simple rules of "rock crutches scissors, scissors cut paper, paper covers rock." Of course, when your kid is small, be sure she has enough chances to win. Wait until she's mastered the game (and you have congratulated her) before giving her the chance to be a loser. Chances are your toddler will throw a tantrum when you beat her for more than three consecutive games. Hey, let's face it, that's an important lesson for the children to learn. Put on a happy face, but don't laugh at her.

And there is so much to observe how your kids play the game rock-paper-scissors. Now, if you have little kids, you already know that there are times they'd rather win the rock-paper-scissor game than a lottery. Even if we don't teach them the tricks to win - and generally, we don't - they made up their own strategies to beat you. I still remember Jasmine giving me "hint" to choose scissors (so that she can play rock on the next throw) when she was four-year-old.

Playing the game fairly isn't always easy. But understanding the reasoning to outsmart the opponent is what I keep to myself. I learn a few tricks to gain the upper hand. First of all, the throws are not equally common; scissors is the least popular choice, and men favor rock. Another pattern is the stereotype of loser; a player who loses is more likely to switch to a different throw the next time. Many of them even unconciously "copy" the sign that just beat them. The third trick is trash talk; announce what sign you're going to throw, and then do exactly what you said. Most players would have thought otherwise.

But I just keep my mouth shut. Teaching my five-year-old daughter these tricks simply makes me feel bad. The little voice in the back of my head reminds me how it sounds like passing on the hacking software to crack passwords.

Load

Carrying a heavy backpack is very much like yoga. It can - and, in fact, it is supposed to - give you shoulder ache unless you have the know-how to gain control of your mind and body.

My backpack was pretty overloaded today. That's my daughter's school field trip, and I went too. I brought with me the camera, a box of puzzle game, a picture book about all of our 206 bones (and about 450 bones for babies, in case you don't know), four story books from Biff, Chip and Kipper series. My daughter carried her own camera, lunch box (for my lunch, too) and water bottle. Okay. That's not all. We had colour pencils, sketch book and so forth.

We just knew that the backpack is for fun, and we felt okay with each of our backpacks. None of us thought too much about the weight of our backpacks.

I'm a firm believer in Lena Horne's dictum "It's not the load that breaks you down, it's the way you carry it."

On the way back from the field trip, one of the boys in my group told me his backpack was way too heavy. As a parent volunteer, I should help him.

"I can see that your backpack is huge. Let's see - okay, do you want me to help you?" I asked.

The boy nodded.

I thought I should carry his backpack. But this is not exactly what happened. Or at any rate, this is not what I expected. My daughter came up and volunteered to carry the backpack for her classmate. We both smiled, put on the backpacks, and off we went. It was hard to say who was prouder, daughter or father.

Bully

Bullying is common.

I knew bully guys existed. I had heard about their dirty tricks from my school peers, I had to run away from them in the playground when I was young - if only I could know how to kill them when they bullied my younger sister.

It just happen. Everywhere. School peers, siblings, athletic coaches, doctors and even consultants. I've met them all. And yes, that's terrible.

Will bullying shape our health? Yes, even in monozygotic identical twins, according to a large study of these pairs who have, by definition, the same DNA.

To prove that upbringing and victim experience by bullying make a difference, the researchers identified 28 pairs of twins from the age of five. These twins were not easy to find. Some of them were separated into different classrooms, and the recruited twin pairs had to have one of them being bullied whereas the co-twin never experienced bullying victimization. In other words, they shared the same DNA but the bullying experience diverged.

The researchers invited these twins into the laboratory at the age of 12, and tested each child's buccal cells' DNA for methylation. They also collected each twin’s saliva to measure the cortisol level when subjected to situational testing. The test included public speaking and mental arithmetic competition; they were told they were in competition against their co-twin in order to get a prize.

How did the twins’ results compare?

It turned out that these genetically identical twins had surprisingly different results. Those who had a history of being bullied had a much higher DNA methylation and much lower cortisol response. Presumably, the bullied kids were surviving through an adaptive epigenetic mechanism. That means the kids tune down a serotonin transporter gene called SERT by more DNA methylation, and thus less protein that can be made to move the neurotransmitter serotonin into neurons. The more SERT gene is turned off, the more blunted the cortisol response.

Cortisol is a stress hormone that will surge during crisis. High levels of cortisol, in turn, can throw our immune system - something that keep us from bacteria and virus - out of whack.

Doesn't it make sense? The twin being bullied day after day would then cope better by avoiding the stress hormone storm.

If you take a deep breath and a step back, I think you'll agree with me that, in a way, the bullied twins learned their survival skill in a hard way but successfully. The rest of us have learned likewise.

Now, you might think that adding bullying to the equation would result in a tough and resilient kid. If only life were so simple. Before you pray for similar bullying exposure for your children to turn off the cortisol response, just a quick reminder that blunted cortisol response in long run can cause serious problems such as depression, and this can pass from one generation to the next.

Avoidance

Have a meal with families with infants these days, and you might get the impression that the planet is full of dietary allergens.

Dads and mums have been taught to winnow away culprits like egg whites, citrus, peanuts, berries and beef from the babies' menu. But be not beguiled. If such conventional wisdom or long-held dogma is a reliable guide - which, of course, it often is not - the food allergy rate should have been declining.

So it goes. There's no perfectly neat rule to keep allergy at bay.

Which brings us, somewhat uncomfortably, to the question of whether there is a genuine need to avoid the potential allergen like water leak from the Fukushima Daiichi nuclear plant. No one is more qualified to stir the cauldron of food allergen controversy than the United Kingdom scientists who published their landmark peanut allergy study in the New England Journal of Medicine this week.

Peanut allergy is no joke; you can get vomiting, itchy hives, a swollen tongue - or worse, die when the swelling occurs in the windpipe impeding your breathing - after one small scoop of peanut butter. Overwhelmed by the threat of peanut allergy, the scientists designed an elegant study and randomly assigned some 640 infants 4 to 11 months old with serious atopic dermatitis or egg allergy either to eating peanut regularly (three or more meals per week) or absolutely-no-peanut diet until age 5.

Contrary to those who expect infants with early introduction of peanut (as early as four months old) to be at high risk of developing peanut allergy, the scientists find that early peanut consumption leads to a far lower odds of peanut allergy at age 5.

That is a surprise to everyone. An accompanying editorial called the results "so compelling" and the rise of peanut allergies "so alarming" that guidelines for how to feed infants at risk of peanut allergies should be revised soon. None of this is to suggest that we should feed our babies whatever we want. But right now, we learn that avoidance isn't the answer.

Page-turner

"Gee, what's that sound?" An elephant turns his head and finds his best friend Piggie doing cartwheel. Who wouldn't read on to find out what will catapult Piggie into the elephant's life?

Piggie says, "What do you want to do today?"

"I want - aaa."

"Yes?"

"aaaaaa"

"A what?" Piggie is flummoxed. And we too.

"aaaaaaaa!!"

By then, our brain is wired to sniff out what elephant is talking about. A ball? A swim? A hat? And so, to keep us from putting down the story book, the author anchors readers in this very simple guesswork. In case you are curious, you can find the answer from the picture book Pigs Make Me Sneeze! by Mo Willems.

I learned more about the secret of grabbing readers' attention fast - from the very first sentence - after reading Lisa Cron's Wired for Story. Picture a breadcrumb trail leading kids to go deeper and deeper into the thicket before reaching the candy house: not everyone knows the ropes of putting the breadcrumbs strategically. Some of the crumbs are too small to be seen. Some are eaten by birds. And you know who is the expert in putting the breadcrumbs?

My 5-year-old daughter will tell you the answer: Mo Willems. As any Mo Willems aficionado knows, he places gold coins, and not just breadcrumbs.

Reports

R.A. Fisher's null hypothesis significance test transformed his field as few statisticians ever do. It goes like this. We run an experiment and assign half of subjects (like flipping a coin) to a wonder drug and another half to get a placebo. If we somehow show good results with our proposed drug, we have to prove that there's only one chance in twenty of getting results this good.

One out of twenty. Enter those numbers into calculator and we see that equals 0.05.

The probability threshold, or the p-value in statistician's lingo, of 0.05 is a magic number we are all obsessed with. Everybody I know, including myself, makes an anxious pilgrimage to this p-value whenever we run a statistics test on computer. To get a sense of what really happens when we execute the so-called signficance test, think about Cinderella's stepsister waiting for her shoe test. Hair on our arms stand straight up. Our hearts drop to somewhere in the bowels, waiting for the almighty p-value to pop up in the statistical package result page.

Those are the kind of moments when you wait and stare, and say, jeez, I've gotta go to the rooftops and shout hurray when the p is less than 0.05 (and you can still go there and jump if it's way more than 0.05).

Another classical example of such anxious moment comes from opening the envelope (or electronic version) of your kid's school report. I received mine this afternoon. That should have been an easy experience. But it wasn't.

I know there won't be p-value or ranking in my daughter's school report. Why, then did it take me pretty darn efforts to take a deep breath before opening the report? Admit it. It's because we are careworn parents.

One thing we know for sure: parents are anxious by definition.

As I read along the letter, the principal's disclaimer in the first few paragraphs made the report less stressful - and to good effect. To paraphrase the parenting expert Michael Grose, before you rip open the report do a little self-check to see if you are in the right frame of mind: Are your expectations for your son or daughter realistic and in line with their ability?

It doesn't take much of an imaginative leap to understand what the principal means by the tricky nature of expectation. His insight isn't new. Too much expectation can turn kids off learning. Too low and there is nothing to strive for. The curved, but not linear, relationship has played a central role in many things for centuries. It's called the Laffer curve. When we plot the child's effort on a vertical axis and the parental expectation on a horizontal axis, the curve turns out to look like a camel's hump. Definitely not a straight diagonal line.

The point is just this: the highest point on this curve is never to be on one end or the other. Usually somewhere in the middle. It's where we are aiming for.

Mathematics

Imagine taking a class in integral calculus, frustrated and puzzled. A long exhale. "What the heck is the point of studying mathematics?"

That's what Jordan Ellenberg is showing in his book How Not to Be Wrong.

Right now, I'm learning from this professor of mathematics why mathematics is the extension of common sense by other means. Soon after borrowing his book from the public library, I found mathematics everywhere.

It happened to be the numeracy week in my daughter's school; there were number games here and there.

And then our family had a weekend holiday at the Discovery Bay. My daughter pointed to the seashell spirals on the hotel elevator door, and said something I haven't heard before. A foreign and recondite name, somewhat resembling Leonardo da Vinci. A big word that left me in a quandary: Did she refer to the name of the nautilus? But is it?

Ah I think hard, trying to google a word or two, here and there, and soon the word "Fibonacci" pops up. That's what my daughter was talking about. Fibonacci Sequence, as what her teacher taught her.

Another mathematics stuff, again. Everywhere.

Snail

I was told stage version of any book won't be as attractive as the original book. That's the rule, everyone says so.

It would be natural for me to read Gillian Flynn's Gone Girl, without bothering to watch the film version.

True wit, however, exists onstage, and Toby Mitchell's drama version of the picture book The Snail and the Whale changes the way I look at adaptations. For those of you who haven't read the book version, that's a tall tale of a tiny snail. And a great big, grey-blue humpback whale. That isn't just a snail, and it is a snail with the itchy foot to sail, to hitch a lift, to see the shooting stars and enormous waves. The story book chronicles the voyage of this tiny snail sitting on the tail of the humpback whale. All the way from the coral caves to the golden sand.

I've been reading this picture book with my daughter for a while. We watched the drama version last week.

But it's hard to transform this story into a drama. A dizzyingly complicated challenge to depict two creatures with extreme ranges in body size. Remember, a tiny snail and a great big humpback whale. Imagine your difficulty in telling the story of Gulliver's Travels in drama format, for that matter.

How should the drama get around? Obviously I'm not supposed to give away too much of the plot. I would only go so far as to let you know the production team borrowed the theme of Storybook Soldiers. That's an organisation which helps British military personnel record bedtime stories for their children to listen to while daddies are away.

So instead of casting as the tiny snail and the great big whale, the two characters become a girl who stays home and her dad in the navy.

What could be easier for a drama actor to be a little girl with itchy foot than to be a tiny snail longing to go around the world? Then the bedtime story (of the tiny snail and the great big whale) recorded by the navy daddy enters the picture.

The transition - from an adventurous snail to the curious little girl and from the brave whale to the strong dad who serves on a military ship abroad - deftly connects two stories. My worries are over. The original picture book and the adapted drama mingle like Velcro. And I understand what is meant by the dad when he says in the drama, "A good story can take you all round the world, without even leaving your room."

Graffiti

Ask parents how their children act (or react) in different situations, and chances are good that mums and dads make wrong guess half of the time. Just don't pretend you know more about your kids than you do, because you don't.

During the festive lunch last Sunday, I entertained my friend's daughter by making a few drawings. It turned out that I had chosen an unfinished page of my daughter's sketch book. By the time I realised my mistake, I had nearly used up the whole page. My daughter cried. It's a matter of unauthorised graffiti, I know, but also perhaps a wee bit of jealousy.

So I vowed never to "invade" my daughter's drawing without asking. But some vows are made to be broken, right?

I went to a wedding party with my daughter this Sunday. With an eye for subject to draw and a deft style, Jasmine quickly pulled up chair and settled down with her own picture of wedding cake. After a moment I noticed my friend's two-year-old girl and thought that it would be a good idea to invite her to share my daughter's colour pencils. And she did. My daughter actually gave her a new paper to scribble all over.

Wow. Good girl.

I let the two girls sit side by side. Everything seemed fine.

But this was not exactly what happened. Or at any rate, this wasn't what I was told on my way home. "Dad, I want to tell you something good,"my daughter said. "Olivia scribbled on my paper, just next to my wedding cake."

A long exhale. (Unauthorised graffiti again - oh my!) "How did you feel?"

"It's okay," my daughter answered. "I mean, Olivia used the black colour pencil, and I took that as the shadow of my wedding cake. I added some more black colour. It works."

Amazing.

Resolution

I worked overnight in hospital this New Year's Eve, and didn't have time to make any resolution.

That's supposed to be the ideal time of setting goals. After 365 days, it's time to take stock of any gain (in terms of waist circumference) and loss (think the time with Facebook). Let me be honest. I am not used to make new year's resolution. I don't think there is science with this tradition.

Except now I do: I read about new research telling us to make plan and avoid keeping a backup plan (translation: lame excuse), to chop up a massive goal into parts (translation: to let yourself feel good with each small step).

Near the end of last year, I purchased an app that allows me to create to-do-lists in my smartphone. The reason? A key factor is its design for users to put a tick next to a completed item, followed by hitting a gratifying button "to delete all completed tasks."

The same way infants celebrate potty training by the sound of toilet flush, ticking off an item from my to-do tasks makes me feel good.

Yes. And it's called instant gratification.