Cousin

Mention number two to the second-born, and they're quick to grumble.

Oh, look how enthusiastic the parents are with the first child - and then the second. When I polled some parents about the number of snapshots for their first and second children, the most common answer I got was "huge." Huge difference, they said, between the first (volumes) and the second (a few).

I don't have to bother with shortchanging mine, because my daughter is a single child.

That's not to say that a single child is the happiest one on this planet. Happiness also stems from satisfying relationship, from sharing with others, from looking after each other. In fact, to this day I remember the way my daughter answered other children who asked her how many siblings she has. "I don't have brother or sister. But I have a cousin." For that, she says with pride. My daugher and her cousin make good companions. I brought my daughter and her cousin to stay in the hotel at Discovery Bay this week. I've lost count of the number of times we've been there. That in itself isn't important. What counts to me is that every visit brings a lot of pleasure to us. The more they grow up and the more their friendship blossoms, the better I appreciate the words of the writer Marion Garretty: A cousin is a little bit of childhood that can never be lost.

Cousin togetherness is something close, but probably less close than sibling to pose the problem of rivalry. For better or worse - better, I suspect - that's the encouragement that single-child parents need.

Pacemaker

Electrocardiogram is the most common, but not the only, way for doctors and medical students to study the human heart. Those squiggly lines are the graphical display of each heartbeat's electrical activity. Instead of listening to the heart, we can tell its tempo and rhythm by taking a look at those waves, like what most musicians respond to musical notes without listening to the songs.

Not all musical notes are pleasant to recount. And electrocardiogram tracing can sometimes narrate a sad story. Many a time we declare patients dead after examining them, followed by the ritual of printing a flat line of their electrocardiograms. Signed and dated. More or less a picture proof that their hearts stop beating. But then it does not always have to be the case. We can't really come up with a completely flat line when a patient has a pacemaker. I mean, the battery of the pacemaker outlives its owner, firing discharge even after the heart isn't beating. The other day an intern of mine told me he dared not certify a patient dead without a line as flat as a pancake. I stared for a moment in shock. "So, what did you do in the end?" I finally said.

"I cut open the skin and pulled out the pacemaker," he answered. "Then I confirmed my patient's death by a flat electrocardiogram printout."

He really meant it.

I believe that I have heard, for the first time in my years in practice, how a doctor took away a life-sustaining device in order to declare the end of his patient's life.

A week later, I read the book Knocking on Heaven's Door by the American journalist Katy Bulter. That's an achingly beautiful story giving me a new perspective on that life-saving electric device hidden below the collarbone of a patient (when the natural electrical conduction system of the heart has worn out with age). Katy Bulter's dad had one. After his heart had worked for eighty years, the electrical fibres had thinned out and slowed down. The new pacemaker was supposed to save his life. The problem is the law of diminishing returns. With each year over the age of eighty and each downhill step from repeated stroke, Katy's father was never able to complete a full sentence, to put on a shirt without help, or to control his poos.

One day Katy's mother made a bold statement, "Please help me get your father's pacemaker turned off." The family's difficult conversations with the modern medicine never made way to a compromise. Doctors refused to disable the pacemaker, and Katy's dad lived in agony with that life-saving electronic device. For five years. Katy's father died with his lungs slowly filling with fluid, when his pacemaker was still quietly pulsing inside his chest.

Meaning

It's a rainy Saturday morning, and I finished seeing my patients before 10 a.m. After locating the bus route on Google Map, I checked the documents and headed to the bank. I told myself I had to get there within office hours. In many ways, the efforts to squeeze time settling bank account signature issues is even more daunting than the fight to see my patients. I can see patients as long as the wards do not having official opening hours, adding whatever number of hours I wish in an already jam-packed day.

After standing at the bus stop for another 30 minutes, I decided to give up waiting and took a taxi.

No sooner did I get off the taxi than my phone rang. That's a call from my colleague who'd arrived at the bank. "The bank service for our business won't be available on weekend." Which, if you think about it - and I did - could have been sort of frustrating.

Were things really so bad? Not really. I didn't use any curse words. That's bad luck - or, at best, a hiccup. It isn't considered the best use of time. But it isn't the worst, either. I headed back to the hospital, and made good use of the travel time to finish Dr. Paul Kalanithi's memoir When Breath Becomes Air. My somewhat bad luck paled against that of the young neurosurgeon who flipped through the CT scan images of lung cancer, spreading to liver, spine, everywhere - and that was his own film.

A meaningful lesson on a Saturday morning.