Before I'd mastered the skill of mediation, I tried my luck with meditation during my summer family trip to New Zealand. Wow. I wished to learn mindfulness after bringing the book Search Inside Yourself by Google engineer Chade-Meng Tan.
Meng didn't ask for practicing Zen with butt on cushion for one hour a day, legs crossed and chin tucked. Just one breath a day. Breathe in, with focus, and breathe out, mindfully. His analogy is a baby learning to walk. Mine is a beginner learning to ski, as what we did in Queenstown and Arrowtown this time.
One step was all we could manage before falling. Being able to put on a ski and waddle like a penguin is a cool experience. The big secret is to get ourselves to a state where our mind is relaxed and alert at the same time. One step at a time. In focus. Then another, and voilà, we were on our way down the slope.
Meditation is like skiing at the slope, minus the sweating, and the ski boots.
Sunday, July 31, 2016
Saturday, July 23, 2016
Myth
I went to university campus for a meeting the other day, and happened to find a book Because I Said So!
It's hard to find a better mythbuster of old wives' tales than this book written by Ken Jennings. He quotes us countless old-timey examples of parental wisdom confidently passed down generations - and only found to be lies ("The car won't run unless your seat belts are on!") or dead wrong ("Don't sit on cold surfaces, or they'll freeze your gonads and wind up sterile," as kids are being told in Russia).
That's trivia reading, but serious enough with reality check and meticulous search of scientific evidence (or the lack thereof) behind the century-old lectures ("You need eight glasses of water every day!").
Do we have similar dogmas in medicine, similar to those because-I-said-so bluffs quoted by Ken Jennings? I have a sneaking suspicion that we do.
One of my recent duties is to go over the protocol in our dialysis unit. Yes. A very detailed mandate to guide doctors and nurses how frequent we should order this test and that test, how meticulous we should request annual chest x-ray for our patients. We have been following that piece of advice for twenty years, as precisely as kids are told not to swim within one hour of the last bite of lunch (Sixty minutes and one second: you'll be fine). But why? Why do the patients need chest x-ray when there is no complaint at all? But screen we must. Huh? Even after we'd been convinced to do something, the choice of chest x-ray leaves us befuddled. If CT scan sounds like full-frame digital camera, chest x-ray is a pinhole camera. In plain terms, chest x-ray is a primitive tool that tends to pick up noise rather than signal.
So a simple answer to the question is: Because I said so. The advice seems to simplify things and give our patients a safer window. Except, of course, when it complicates the matter.
It's hard to find a better mythbuster of old wives' tales than this book written by Ken Jennings. He quotes us countless old-timey examples of parental wisdom confidently passed down generations - and only found to be lies ("The car won't run unless your seat belts are on!") or dead wrong ("Don't sit on cold surfaces, or they'll freeze your gonads and wind up sterile," as kids are being told in Russia).
That's trivia reading, but serious enough with reality check and meticulous search of scientific evidence (or the lack thereof) behind the century-old lectures ("You need eight glasses of water every day!").
Do we have similar dogmas in medicine, similar to those because-I-said-so bluffs quoted by Ken Jennings? I have a sneaking suspicion that we do.
One of my recent duties is to go over the protocol in our dialysis unit. Yes. A very detailed mandate to guide doctors and nurses how frequent we should order this test and that test, how meticulous we should request annual chest x-ray for our patients. We have been following that piece of advice for twenty years, as precisely as kids are told not to swim within one hour of the last bite of lunch (Sixty minutes and one second: you'll be fine). But why? Why do the patients need chest x-ray when there is no complaint at all? But screen we must. Huh? Even after we'd been convinced to do something, the choice of chest x-ray leaves us befuddled. If CT scan sounds like full-frame digital camera, chest x-ray is a pinhole camera. In plain terms, chest x-ray is a primitive tool that tends to pick up noise rather than signal.
So a simple answer to the question is: Because I said so. The advice seems to simplify things and give our patients a safer window. Except, of course, when it complicates the matter.
Sunday, July 10, 2016
Odds
It isn't that common to find someone studying English literature at Harvard and medicine at John Hopkins.
I came to learn about Dr. Kevin B. Jones who did so. His book, entitled What Doctors Cannot Tell You, gives me good chance to think about uncertainties in medicine.
I feel more like a gambler than a physician after hearing his stories about the prognosis estimation made by doctors. I don't mean to criticize our prognostic skill. Doctors make a lot of attempts at defining good and bad prognosis. That's what we learn from population studies and statistics. We don't call that gambling; we have a better term "prognosis." The word prognosis comes from the Greek and means knowing ahead of time.
Consider the example of breathing machine in intensive care unit. When a sick patient is being put on a breathing machine that inflates the lungs through a tube placed into the windpipe, he is depending on the machine for life about as much as a human can. Doctors often judge the chance for such patient to recover and wean from mechanical ventilation. In case of poor prognosis, we will decide on terminal extubation. That means removing the tube from the windpipe in anticipation of death. Many of these exceedingly poor prognostic cases will not survive. Most will not, honestly. We can't be hundred percent sure, though. A large study, published in The New England Journal of Medicine, noted 6 out of 166 similar patients surviving to hospital discharge.
Oh no. But that's medicine. We learn medicine from populations of tens and hundreds of thousands (read "epidemiology"). We predict well on populations as large as possible, but we face one patient at a time in real life. We will never be right every single time when we talk about the prognosis of an individual. That's a different story.
I came to learn about Dr. Kevin B. Jones who did so. His book, entitled What Doctors Cannot Tell You, gives me good chance to think about uncertainties in medicine.
I feel more like a gambler than a physician after hearing his stories about the prognosis estimation made by doctors. I don't mean to criticize our prognostic skill. Doctors make a lot of attempts at defining good and bad prognosis. That's what we learn from population studies and statistics. We don't call that gambling; we have a better term "prognosis." The word prognosis comes from the Greek and means knowing ahead of time.
Consider the example of breathing machine in intensive care unit. When a sick patient is being put on a breathing machine that inflates the lungs through a tube placed into the windpipe, he is depending on the machine for life about as much as a human can. Doctors often judge the chance for such patient to recover and wean from mechanical ventilation. In case of poor prognosis, we will decide on terminal extubation. That means removing the tube from the windpipe in anticipation of death. Many of these exceedingly poor prognostic cases will not survive. Most will not, honestly. We can't be hundred percent sure, though. A large study, published in The New England Journal of Medicine, noted 6 out of 166 similar patients surviving to hospital discharge.
Oh no. But that's medicine. We learn medicine from populations of tens and hundreds of thousands (read "epidemiology"). We predict well on populations as large as possible, but we face one patient at a time in real life. We will never be right every single time when we talk about the prognosis of an individual. That's a different story.
Saturday, July 9, 2016
Connectedness
When I first read Strong Fathers, Strong Daughters, the daughter I had in mind is a toddler and myself a dad with strong biceps to carry daughter around. I picked up the book again this week. My daughter has grown up a lot since the last read. The fact is, I haven't been any stronger as a dad – and chances are I am simply older.
In part, I believe, this is because men spend most of our time working for someone else, and don't carve out time slots for our kids when we come home. This is what I did this week: I worked overnight in the hospital on Monday and returned home late evening on Tuesday, half asleep after dinner.
The author of Strong Fathers, Strong Daughters, a paediatrician and mother of four children, told a story of her husband who brought their kids to watch the northern lights at 1:30 in the morning. They shivered as brilliant and red corrugated sheets of northern lights streaked through the night. She can't remember what grades their children were in that year, let alone what they faced during the next school day after four-hour sleep, maybe five.
She doesn't remember because it didn't matter. What matters is that all four of their kids remember their father's enthusiasm and connectedness. So what did I learn?
A lot. There's no better ways of being a father than spending time with the child. The key isn't going to extraordinary places. Parent connectedness is as simple as connecting with my daughter - tune in to her, listen to her, and play with her. Oh yes, one-on-one time without looking at my smartphone or answering emails. That dream came true this Thursday when I returned home after work and assembled a big box of Lego bricks with my daughter. We were occupied with our project till midnight.
In part, I believe, this is because men spend most of our time working for someone else, and don't carve out time slots for our kids when we come home. This is what I did this week: I worked overnight in the hospital on Monday and returned home late evening on Tuesday, half asleep after dinner.
The author of Strong Fathers, Strong Daughters, a paediatrician and mother of four children, told a story of her husband who brought their kids to watch the northern lights at 1:30 in the morning. They shivered as brilliant and red corrugated sheets of northern lights streaked through the night. She can't remember what grades their children were in that year, let alone what they faced during the next school day after four-hour sleep, maybe five.
She doesn't remember because it didn't matter. What matters is that all four of their kids remember their father's enthusiasm and connectedness. So what did I learn?
A lot. There's no better ways of being a father than spending time with the child. The key isn't going to extraordinary places. Parent connectedness is as simple as connecting with my daughter - tune in to her, listen to her, and play with her. Oh yes, one-on-one time without looking at my smartphone or answering emails. That dream came true this Thursday when I returned home after work and assembled a big box of Lego bricks with my daughter. We were occupied with our project till midnight.
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