At just 7:30 this morning, my daughter's alarm clock rang and she woke up, missing mummy a lot.
"Hey, I told you, mom has an operation this morning. Dear, let me help you." "Mommmmmmmmmmm, I want mummy."
I glanced at the clock on the wall, the steady sweep of the second hand ticking off precious time, getting closer and closer to the school bus time. My goal was to get my daughter ready before the school bus departed. I knew I couldn't. I was harried; my daughter was weeping; we were overwhelmed. I felt time slipping away.
Before all the tension boiled over, I decided to read a story book together with Jasmine while she had her cereal breakfast. My pick was Should I Share My Ice Cream? by the Caldecott Honor winner Mo Willems. That's a story about Elephant Gerald who bought an ice cream and then had a big decision to make: Should he share his ice cream with his best friend Piggie? An agonizingly difficult choice. Gerald wanted to gobble up his ice cream, but then wondered: Is it right not to share with his best friend?
"Hmmm ... Maybe Piggie does not like this flavour! Piggie is not here. She does not know I have ice cream." The answer, we believed, is difficult.
"Hurry up, Gerald, make up you mind," Jasmine said instinctively as she turned the pages, with a palpable sense of suspense. The ice cream was melting in Gerald's hand. So absorbed was Jasmine in reading the ice cream story that, by the time we reached the last page of the storybook, she hadn't had time to finish her cereals.
Of course, I shouldn't tell you the story ending here. Not so lightly. Which reminds me of another real ice cream story few days ago. We were buying ice cream for dessert after dinner last Sunday. At first Jasmine wanted to pick vanilla flavour. Then, she hesitated and ran to my wife, "Mum, do you want to share my ice cream? And if so, I will choose chocolate flavour, your favourite." Isn't it even sweeter than having ice cream itself? My wife counts it among her most-treasured moments as a mom. As it turns out, this is the closest to the ending of our storybook Should I Share My Ice Cream?
Thursday, January 28, 2016
Thursday, January 21, 2016
Daisy
After finishing a book on empathy by the psychologist Simon Baron-Cohen tonight, I switched topic and read Double Daisy with my daughter. That's a hilarious chapter book for intermediate readers.
Now that Jasmine has turned six, I don't really have to read the book for her. Not because I'm less willing to read but because she's more willing to read. In other words, I simply sit next to her when she reads aloud. What an amazing habit to bestow on our children.
To be extra clear, I didn't simply sit next to my daughter when she read the Daisy book by Kes Gray. I listened. The more I've learned about Daisy and her best friend Gabby, the deeper I was drawn to the story. Their conversation reminds me to view the world from another angle - through the eyes of children. Once, Daisy had trouble with getting cheese out of the triangle and then squeezed it all over her fingers. Her mum said, "Cheese triangles are really easy to open when you know how." (I admit I would have said the same thing.)
"That's the trouble with grown-ups," Daisy said. "They know everything. At least they think they do."
Now I know I don't.
Now that Jasmine has turned six, I don't really have to read the book for her. Not because I'm less willing to read but because she's more willing to read. In other words, I simply sit next to her when she reads aloud. What an amazing habit to bestow on our children.
To be extra clear, I didn't simply sit next to my daughter when she read the Daisy book by Kes Gray. I listened. The more I've learned about Daisy and her best friend Gabby, the deeper I was drawn to the story. Their conversation reminds me to view the world from another angle - through the eyes of children. Once, Daisy had trouble with getting cheese out of the triangle and then squeezed it all over her fingers. Her mum said, "Cheese triangles are really easy to open when you know how." (I admit I would have said the same thing.)
"That's the trouble with grown-ups," Daisy said. "They know everything. At least they think they do."
Now I know I don't.
Comfort
My dialysis patient was dying. The fluid drained from his abdomen was red, and his lips blue. We were discussing the ways to keep him comfortable during the morning round. "Should we stop escalating the antibiotics?" I asked.
Absolutely.
Every team member agreed and I leaned forward to write down the decision. I glanced at the consultant next to me and didn't have to wait long to find out he frowned at my handwriting. So, did I write too much? Probably yes, a small voice inside me told me, but it's impossible to know for sure.
To test the water, I quoted the recent New England Journal of Medicine review article on comfort care for patients dying in the hospital, "I recalled a recent piece of article supporting explicit orders to promote comfort and prevent unnecessary intervention, rather than simply writing an order "comfort care." It isn't easy for our interns to second-guess what we have in mind, say, in case our patient's blood pressure plummets tonight. What do you think?"
My consultant replied, "Not really, because they have to learn. Not just to follow." "But surely," I had to politely disagree, "the very fact that interns need the chance to learn doesn't mean we should write a vague term. Learning is a matter for the interns and ultimately the residents. Unnecessary suffering is a matter for the patients, in this case a dying patient. The two things should be kept rigorously separate."
We didn't have the right answer to the question, but I dared not to argue too much. To my mind, there is no right or wrong answer. I'm not arguing that once the team decision has been made and stated, there is no need to think and rethink, as if this is a gospel. But my argument is that at the very least a decision should be clearly spelled out for others to follow and, if necessarily, revised.
Absolutely.
Every team member agreed and I leaned forward to write down the decision. I glanced at the consultant next to me and didn't have to wait long to find out he frowned at my handwriting. So, did I write too much? Probably yes, a small voice inside me told me, but it's impossible to know for sure.
To test the water, I quoted the recent New England Journal of Medicine review article on comfort care for patients dying in the hospital, "I recalled a recent piece of article supporting explicit orders to promote comfort and prevent unnecessary intervention, rather than simply writing an order "comfort care." It isn't easy for our interns to second-guess what we have in mind, say, in case our patient's blood pressure plummets tonight. What do you think?"
My consultant replied, "Not really, because they have to learn. Not just to follow." "But surely," I had to politely disagree, "the very fact that interns need the chance to learn doesn't mean we should write a vague term. Learning is a matter for the interns and ultimately the residents. Unnecessary suffering is a matter for the patients, in this case a dying patient. The two things should be kept rigorously separate."
We didn't have the right answer to the question, but I dared not to argue too much. To my mind, there is no right or wrong answer. I'm not arguing that once the team decision has been made and stated, there is no need to think and rethink, as if this is a gospel. But my argument is that at the very least a decision should be clearly spelled out for others to follow and, if necessarily, revised.
Thursday, January 7, 2016
Boast
We've all been in a situation like that - growing old and looking back with some pride in how worse we've had been.
It is, without question, one of my favorite ways to talk to my juniors: "When I was your age ..." In so many ways, life is better now than it was then.
To tell others how we drew blood from each and every patient in a medical ward without phlebotomists' assistance can feel like we've been hundred times tougher than the newer generation of doctors. Think of the ooh and aah - it says way more about our accomplishment than any feather in our caps.
And once in a while, it's okay - even helpful - to let people admire our toughness. But if we brag endlessly about our past experience and suffering, that only ups our chances of eliciting hatred, but not admiration. This is an important lesson I recently learned from reading Marshall Goldsmith's book Mojo.
So please remind me next time I flaunt my brilliance in the face of adversity: how poor we were, how tough we were, and blah blah blah.
It is, without question, one of my favorite ways to talk to my juniors: "When I was your age ..." In so many ways, life is better now than it was then.
To tell others how we drew blood from each and every patient in a medical ward without phlebotomists' assistance can feel like we've been hundred times tougher than the newer generation of doctors. Think of the ooh and aah - it says way more about our accomplishment than any feather in our caps.
And once in a while, it's okay - even helpful - to let people admire our toughness. But if we brag endlessly about our past experience and suffering, that only ups our chances of eliciting hatred, but not admiration. This is an important lesson I recently learned from reading Marshall Goldsmith's book Mojo.
So please remind me next time I flaunt my brilliance in the face of adversity: how poor we were, how tough we were, and blah blah blah.
Tuesday, January 5, 2016
Mantra
Medicine is not only about science, it's sometimes about dogmas handed down from generation to generation. Sometimes, these universally accepted dogmas are more often wrong than right.
That's what I taught the two medical students joining me last week for apprenticeship program. The greater the ignorance, to paraphrase Sir William Osler, the greater the dogmatism.
Our conversation started when a senior consultant taught us the rules and dogmas of using diuretic in patients who have weakening of the heart's pumping capabilities. Seemingly, we're inculcated to use continuous infusion of diuretic in case of acute heart failure. I listened and was tempted to say that it doesn't really matter with either intermittent boluses of diuretic (one dose at a time) or continuous infusion. But, of course, I didn't say it openly. Instead I passed my phone sheepishly to my students after opening a page of the New England Journal of Medicine to prove my point. They nodded.
Few days later, we brought a patient to have emergency endoscopy at night because he was bleeding from an ulcer in the stomach. Our conversation, again, was about how to give the stomach remedy called proton pump inhibitor. I pointed to studies that said giving the drug as intermittent bolus is as good as continuous infusion. Hold on, I reminded my students, to take a look at what the doctors did in reality.
The truth is, our patient was receiving continuous infusion of proton pump inhibitor, a practice that is more expensive and inconvenient - but simply in accordance to the dogma.
That's what I taught the two medical students joining me last week for apprenticeship program. The greater the ignorance, to paraphrase Sir William Osler, the greater the dogmatism.
Our conversation started when a senior consultant taught us the rules and dogmas of using diuretic in patients who have weakening of the heart's pumping capabilities. Seemingly, we're inculcated to use continuous infusion of diuretic in case of acute heart failure. I listened and was tempted to say that it doesn't really matter with either intermittent boluses of diuretic (one dose at a time) or continuous infusion. But, of course, I didn't say it openly. Instead I passed my phone sheepishly to my students after opening a page of the New England Journal of Medicine to prove my point. They nodded.
Few days later, we brought a patient to have emergency endoscopy at night because he was bleeding from an ulcer in the stomach. Our conversation, again, was about how to give the stomach remedy called proton pump inhibitor. I pointed to studies that said giving the drug as intermittent bolus is as good as continuous infusion. Hold on, I reminded my students, to take a look at what the doctors did in reality.
The truth is, our patient was receiving continuous infusion of proton pump inhibitor, a practice that is more expensive and inconvenient - but simply in accordance to the dogma.
Sunday, January 3, 2016
Campers
We went camping with three other families at the beginning of this year. It's hard to imagine anything more exciting than bringing kids to sleep in the open air, under nothing more than a tent.
Real phobias aside (say, in case my daughter says no to the smelly loo, yuck), family camping will just give us the right mix of fun and imagination. No matter whether it's the first time or the third time, everyone feels nervous and excited at the same time.
As I learned from the parent guide, there are few essentials for the successful camp-out: friends (the more the better), a tent (the bigger the better), sleeping bags and, of course, the permit for children to build the tent together (like banging the tent stake into the ground).
While we were out, we could think of 101 ideas for a fun day without screen time. There are plenty of other things we can do without iPhone. Musical chairs, frisbee, racing, studying shy Mimosa pudica, digging sand - the list is endless. Things don't have to work out the way classic camping definition suggests, such as building a campfire to roast marshmallows. The truth is, boiling water to make hot chocolate and adding marshmallows were impressive enough for our kids. And if these activities don't make it worth sleeping rough, nothing will.
Real phobias aside (say, in case my daughter says no to the smelly loo, yuck), family camping will just give us the right mix of fun and imagination. No matter whether it's the first time or the third time, everyone feels nervous and excited at the same time.
As I learned from the parent guide, there are few essentials for the successful camp-out: friends (the more the better), a tent (the bigger the better), sleeping bags and, of course, the permit for children to build the tent together (like banging the tent stake into the ground).
While we were out, we could think of 101 ideas for a fun day without screen time. There are plenty of other things we can do without iPhone. Musical chairs, frisbee, racing, studying shy Mimosa pudica, digging sand - the list is endless. Things don't have to work out the way classic camping definition suggests, such as building a campfire to roast marshmallows. The truth is, boiling water to make hot chocolate and adding marshmallows were impressive enough for our kids. And if these activities don't make it worth sleeping rough, nothing will.
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