Nostalgia

If you find the new normal hard to live with, you aren't the only one.

Over three hundred years ago, a medical doctor came up with a new disease's name "nostalgia." In his dissertation, the term described the sickness of Swiss soldiers when they were in the lowlands of Italy, yearning for the alpine vistas of home. Oh, how they had oodles and oodles of symptoms like indigestion, high fever, melancholy, fainting, seeing ghosts and hearing voices. And even death.

Things soon start to look like another "nostalgia" pandemic this year. The cause of symptoms turns out to be homebound sickness rather than home sickness. Otherwise, the two are similar. Very similar.

People want to start the day the way we have been having. Not any more. Every morning, we wake up, discover the world has been changed, and can no longer go back to the old habits.

No more trips to Louvre Museum (and hey, even the Hong Kong Museum of Art is temporarily closed). No more Japan autumn foliage tours. Nope. We have no control over the travel restriction. What we can do is to keep our mind (and eyes) open. So that's why I and my wife take a half day off this afternoon to find the red leaves of sweet gum (Liquidambar formosana), a striking example of native deciduous species.

NOEA

It's not always easy to eat alone, but it's always what we're advised to do. I just felt uneasy after reading the "do's and don'ts" for dining at workplace, as if we're entering a whole new season of cold isolation. The dining table around us grow quieter and emptier each passing day.

This reminds me of Lili Rachel Smith, a young woman born with Apert syndrome leading to her horribly deformed face after premature fusion of the skull bones. She grew up in San Francisco where she attended middle school. Although she wasn't bullied, she felt invisible within ever-shrinking walls. Lunchtime means oblivion. Uncertain what to do after eating alone, she'd retreat to a toilet and call her mom. The more she stayed isolated, the more terrible sense it made.

After her tragic death at age fifteen, her mom founded a nonprofit organization to combat social isolation in schools. One of their best known student-led initiatives was No One Eats Alone (NOEA) Day. Ooooh ... can't you just see the inspiring message? It's that simple: Make sure no one sits alone at lunch.

That's not to say that I object to the latest decision to ban dine-in service at 6pm. There is of course a great deal of scientific evidence, including one model using mobile-phone data to map people's movement on the spread of severe acute respiratory syndrome coronavirus 2, proving that restaurants are hotspots for the disease. As published in Nature, the model demonstrated that capping restaurant venue occupancy at 30% would reduce new infection by more than 80%. Much as I love science, to the point of worship, I must confess that I also cringe at the idea of an al desko lunch. 

No. No. NOEA.

Eleven

The decision to have a child is momentous, according to educator Elizabeth Stone. "It is to decide forever to have your heart go walking around outside your body," she says.

That's the best decision we have had more than ten years ago. My daughter turns eleven tomorrow.

If, like me, you have taken on the lifetime responsibility of loving children, you will agree wholeheartedly with the beautiful quote about parenthood.

There's plenty of smiling moments with bringing up a child. I’m still amazed - and grateful - to find the sweet memory's time capsule: how a kid grows up, what a kid has changed, and when we find ourselves changed as well. And really, the journey is far more fun than I could have imagined. Those were the days when I bought stickers to keep my toddler occupied and fascinated. Fast-forward to now, when, interestingly, she returns me bunches of stickers - creative ones via WhatsApp!

Slow

"I would slow down with inner peace," a friend of mine reflected after receiving his first speeding ticket. As he carried on the conversation I found myself feeling more connected with his story.

On my way to hospital this morning, I was reading the news about a possible coronavirus outbreak after healthcare workers carried out resuscitation of a patient. After what seemed like a run-of-the-mill lifesaving treatment, the staff found out that the patient tested positive for the coronavirus and they were not fully donned with personal protective equipment - something we knew was a true no-no. On the other hand, it was not the first time we take safety shortcuts when we're in a hurry for something.

When I related the news to other doctors by text messaging, I was entering the isolation ward. That's an area with negative pressure system. Thus I had to enter an additional door at the ward entrance, installed to create a buffer zone to stabilize the negative pressure inside the ward. As usual, I took my staff card to activate the access control. This should have taken me only a fraction of a second to open the automatic swing door. But not this time. Before I'd even thought about a defective door, I gritted my teeth to wait, and wait. Standstill.

The truth was that the hospital administrators had recently adjusted the automatic door hold-up time. In the end I had to wait longer and slow down. My face reddened. "Having a time-out is harder than I'd ever imagined."

I wish I could say that, after all the stories, I was fine with a slower pace, but that would be lying.

Library

One reason I've been borrowing books the way a hoarder does is that I decide to keep a good trove of reading materials. Tough anti-pandemic measures loom for the city. Who know? The public libraries can be shut down anytime.

With more than a dozen library books - fiction and non-fiction - on hand, I don't feel all that needy. And it's pretty much guaranteed I can pick the one that fits my day. I dived into the novel The Midnight Library by Matt Haig today. That's about a depressed 35-year-old Nora who is on the point of taking her own life. And my daughter told me a Hong Kong student jumped from height yesterday. Alas, that wasn't her school but her teachers decided to have a morning meeting to help students go through the saddening news.

As I read about Nora's story, I got carried away with the plot that there is a library between life and death. Nora was fascinated, too. She found herself in the Midnight Library before she decided to die. There were aisles and aisles of shelves, with books everywhere - definitely more than my trove. The bookshelves go on for ever in that library, as it turns out.

"Every book provides a chance to try another life you could have lived," the librarian told Nora. "To see how things would be different if you had made other choices."

The way Matt Haig narrates the infinite number of ways to pick our book, our life, and our decision, turns out to be the best antidote to the shocking news story.

Animal

For reasons that have more to do with curiosity than industrious style, I often strive to attend every lecture during international conferences. I acknowledge that the excuse of skipping lecture is even lamer now that video replay is mostly allowed in virtual conference.

To my delight, I found a few lessons on comparative kidney physiology in the American Society of Nephrology conference this year. They take me to arena of kidney knowledge in animals other than humans. Yes, it's even more interesting after visiting the Ocean Park with my daughter last week. My late-night listening to scientific explanation for a giraffe to develop a thicker straitjacket-like layer covering its kidneys - at least three times thicker than that of a cow's kidney outside lining - is as entertaining as reading books of Bill Bryson. Answer - to shield kidneys from a high blood pressure because this tall animal needs a phenomenally high blood pressure to drive blood up to the brain.

In another lecture, I learned about the way dolphins develop tricks to conserve body water: how they have lengthier intestine to absorb water (twenty times of body length - no exaggeration - and that's five times more than ours), how they reduce their breathing rate (two to five times per minute) to minimize respiratory water loss, and how they strive to have a much thicker kidney medulla, the inner-most region of the kidney to concentrate their urine.

What a wonderful animal kingdom.

Crowd

Try to catch a ferry to Hong Kong UNESCO Global Tung Ping Chau while domestic travel is a new reality here - a raucous experience to say the least.

Our family planned the trip during this weekend. It was only when I was heading to the ferry pier this morning, and I saw that the queue was ten times longer than that of fans outside Apple stores for the newest iPhone, that I had realized even an overloaded Titanic won't be able to accommodate the crowd.

It's far easier to change route and turn inland, finding a circuit for the pleasure of countryside hiking. At first, we aimed to get out of the city, but as time went on, it was obvious that it's even trickier to get away from the crowd. And more so for the noise-making crowd, those incessantly peevish people who talk more than walk.

It’s very hard not to go up to one of them and say, sotto voce out of the side of the mouth, “I think it is a huge pity to have that many noisy eruption in the wild." 

Virtual

Like it or not, international medical conference is now going virtual everywhere.

That includes the American Society of Nephrology meeting. If you had asked me one year ago how I felt about visiting the United States again (almost a decade since I last attended the conference), I would have had an answer ready: I look forward to that.

Overseas conference is like an airplane mode, allowing us to unplug for few days without access to hospital pager, devoid of many other distractions. We spent three to four days in a conference venue, exploring one lecture hall after another, meeting people, getting the most out of a tight conference schedule.

Virtual conference is different, I know. You don't need me to tell you that. A positive note to this new format, it must be said, is getting rid of the travel time, hotel accommodation, jet lag, not to mention those morass of guilt in leaving family behind.

I don't know how to work out live streams of the lectures, but I do know one interesting fact that my conference falls on my daughter's term break. With a lag of twelve hours between ours and Eastern Daylight Time zone, it would be a perfect split between family time and study time.

Let me try.

Nature

Nature is a perfect playground.

Now that travel is considered unsafe, our family holiday is mostly built on the raw beauty of countryside. That might not necessarily be an once-in-a-lifetime adventure, but the terrains of the New Territories boasts surprisingly diverse array of natural scenery.

We picked a rugged and treacherous mountain trail hidden among the foliage near Pak Tam Chung this Sunday. The hike was challenging, with both figuratively and literally hands-on moments for our family. As we wound our way down the trail, I was grateful.

Of course, I am blessed with a sublime view. And it is. But I am most thankful for raising a daughter who has learned to be fascinated by hiking in the nature.

Steps

In his book Last Child in the Woods, Richard Louv created the shorthand description "nature-deficit disorder" to highlight the human alienation from nature. The term reminds me of a research paper published in the medical journal Lancet. Seventy-eight 3-year-olds were monitored by small electronic accelerometers clipped to their waistbands for a week. The finding of only twenty minutes of moderate physical activity a day is clearly demonstrating our divorce from the wildness.

Put simply, we are spending more and more time in couch, car seats, and even baby seats.

I happened to be promoting an exercise program The Billion Steps Challenge when I was reading the book of Richard Louv. The target of the program is to align organ transplant recipients and the extended community to stay active and collectively walk one billion steps in ten weeks.

Think about what it feels like to have a billion steps by all participants around the world. Pretty ambitious, right? The key is to remember every step counts. Everyone counts.

Forest

For this school year, nothing is more challenging than the socially distanced class.

With the new set of ground rules in classrooms, school is no longer what it used to be. The good news is that we have found an extraordinary secondary school for my daughter. When I received the notice of out-of-class learning from her school early this week, I didn't think twice before clicking the reply link. 

That's a canyoning experience (yes, into the canyon!), with challenges provided by abseils and supervision by outdoor education teachers. When I heard about how the students got wet (totally wet at times, including their masks), I realized the way it's called a forest school. That also reminded me how the school teacher recommends us Richard Louv's Last Child In The Woods in the welcome letter for parents.  

Nothing beats a school bringing kids into the woods. A zoom classroom, without question, can't.

Ball

There are few tricks as strategic as "learned incompetence", by which a husband (mostly) is trying to escape sharing the work or chores.

I suppose that a small confession is in order before I go on. That’s me. I'm among one of those husbands.

School is back. If you want to know my contribution to preparing my daughter's new school term, I shall talk to you privately. If you're still curious about how much I help my daughter's studies, please be reminded of another term for my incompetence: strategic ball-dropping. If you drop the balls and your wife keeps picking them up, you'll learn to keep dropping them.

There's no reason why it has always to be the husband dropping the ball, or ducking. Inasmuch as I'm telling the truth, the answer should be my lack of shame.

Oh dear. 

Bookshelf

A coronavirus-laden world has changes far greater than any event in living memory. Everything is shuffled. Many become uncertain. Quite a lot have turned topsy-turvy. Simple as it should be, breathing becomes uneasy.

What matters to surviving the pandemic, whether as grow-ups or as children, is best explained by Dostoevsky who believes that human is a creature who can get used to anything.

One trick lies in the fact that we can look at more than one side, and at least at the positive side now and then. My daughter has been captivated by page-turning Harry Potter and the Chamber of Secrets this week. "If not because of the outbreak," said Jasmine, "I wouldn't have picked up this entertaining book series."

That's the flip side of closing public libraries. Nowhere is the need for book hunting more evident than in a city with libraries shut down for more than three months. To prepare for the third wave, I had already checked out more than ten books in June, before public library service was axed. Those book companions didn't last long; we had finished them pretty soon. Then it's time to dig into the old books on our bookshelf. 

That's how Jasmine found an old favorite of her mum's books and received a Hogwarts acceptance letter.

Hogwarts

Few things are more rewarding than preparing and seeing our daughter enter the secondary school.

There was so much excitement when Jasmine received her own student Chromebook laptop. The first time she opened the personal laptop, she was riveted by the idea that it has a touch screen. She is feeling like Harry Potter after receiving his first broomstick.

Oh yes, we’ve been reading Harry Potter and the Philosopher’s Stone. This had to be why, when my wife was tidying up the study for Jasmine, I felt guilty for creating a messy and Dursleyish cupboard corner. Yes, yes, it was all very disorganized, and much worse than a cobwebbed cupboard.

Now that school is held in a virtual platform, many of us would have been as puzzled as Harry Potter to locate the Platform Nine and Three-Quarters. I don't have an easy answer for attending school remotely on video. Whether or not people agree with socially distanced learning - and many do not - we are nonetheless having no choice but to accept the government ban on face-to-face teaching at schools. Luckily, my daughter seems to enjoy every minute (well, almost) of new school year.

Not that we're getting on Hogwarts Express with ease. Of course we aren't. Please tell me I'm not the only one who finds it somewhat challenging. Especially on the days that you find a lower bar in the Wi-Fi signal strength symbol. It has taken me three days - not until I asked for technician service - to figure out the best way to reconfigure and relocate our Google Wifi.

Yes, it does require patience, but what good solution doesn't? Just keep trying.

Gratitude

It is the first day of running after my foot injury.

Stifling as running with mask always is, the joy of being on the track again is hard to beat. I couldn't believe my ears when my Runkeeper app audio chronicled and tracked my pace - almost back to my previous one.

Instead of catching my breath as I sped, I sucked in my mask with each breath, huffing. It wasn't long before I came up with an excuse of not wearing mask: I could run much faster without mask to maintain social distancing than being dragged by a mask that sucks. Runners hate the mask and, I have to admit, I do, too.

I mentally didn't want to wear the mask. Yet something about my recovery helped get me up and running with a smile on my face behind the mask. I had decided to increase my pace and press on. The gift of being able to run again is simply too precious to risk losing. I know I shouldn't whine.

Zoom

Over the last few months, most of us have learned to make Zoom video call.

The old-timers FaceTimed mostly. Now, we're zooming, everywhere, and many times. It's unbelievable how quickly everything has changed.

One unique reason of relying on Zoom during the pandemic is when we go to great lengths to give family members a chance to say goodbyes to their loved ones who are dying from the virus. For obvious reason, visitors are not allowed to go to the bedside of an infected patient. To get around the dilemma, we bring an iPad to the room facing the patient, connecting with family via Zoom.

We knew this isn't the best but at least we don't let the patient die alone.

One of my patients left after listening to the farewell messages from the Zoom meeting this afternoon. He died at the age of eighty-six. I entered his room, gloved and gowned, to certify his death. That means checking his movement and his eyes, feeling his pulses, listening to his chest and heart. After going through the steps, one by one, I was to check the time but realized that I didn't have wristwatch. As I looked around and found the iPad on the table, little did I know that the Zoom meeting wasn't discontinued, yet.

Okay, this means a live broadcast of my certifying an old man's death in front of his granddaughter and sons. I froze, and wasn't at all sure how the family feel. I turned and said goodbye to my patient, and was glad that I had followed the steps of checking him with due respect. I should not worry as I had also buttoned up his shirt after putting back the stethoscope.

A dignified death at eighty-six, I certified.

Sky

Right now, the coronavirus has reached the planet's most far-flung corners. It's everywhere.

The stars at the night sky, luckily, remain out of reach. "Why don't we have a night walk to sky gaze?" my wife suggested, and how could I resist?

I always marvel at my wife's creative ideas. And within minutes we packed our bags before twilight and headed to the highest peak in Hong Kong. Offering sweeping cityscape views at an elevation of 957 metres, Tai Mo Shan is one of those special local places where my daughter feels like she has stepped onto a foreign place ... or in this case, Laputa.

Though it's not easy to travel during the pandemic, a celestial journey skywards on such a clear day is the best trip we can reinvent.

"I am grateful, mum and dad, for bringing me to such a special place," Jasmine smiled.

Touch

I had learned many lessons these past six months; some of them are so dense that could have hidden from our narrowed eyes, so deep that I didn't realize until I sat down and looked back.

For many of us, the novel coronavirus outbreak is the first time to experience the specter of a highly infectious virus jumping continents, across the community, and changing life for everyone around the globe.

Back in early months of this outbreak, the rituals of "seeing" patients are by and large through the CCTV cameras and their chest x-ray films. During that period, it was as if the virus will get starved and die on its own after being isolated. The patients were young students from overseas, healthy pilots, businessmen coming back to town; they simply got better with time and gave us chance to get a grip on the dynamics of the disease. Most of our morning rounds were carried out though telephone conversation. Even if we're meticulous in infection control measures, we can't prevent the little tug in our gut that gives us jitters about entering patient's room.

And so it went, one after another, for several months. After taking care of so many suspected and confirmed cases, I had gone through the umpteenth times of donning and doffing personal protective equipment, visors, masks. I had seen so many patients. I had learned so much about the virus. The set of unknowns was shrinking, and the fact that we could step out of the comfort zone actually energized me. Going to greet patients face to face no longer generated armpit-drenching anxiety. And I discovered to my surprise that I am now getting used to take history from my patients during the blood taking - and not on the phone.

And then we are now seeing older and older patients from the local outbreak. Most things we don't get from history taking alone; much of our knowledge on the patients is incomplete without putting our hands or stethoscope on them. I was caring for a veteran in his eighties - let's call him James - who came to my hospital last night with cough and lethargy; James turned out to have been infected by coronavirus. Although the answer of his diagnosis came before I met him, I believed that I should not just make a phone call to "see" him. A thorough examination and inescapably human touch are necessary, I figured. "A bit of being drained out from not eating well this week," James told me. "And a bit of allergy or eczema after taking herbal medicine."

"Okay," I said, nonchalant but still cautious. I pressed on to find out what James meant by eczema, and discovered that he had shingles at his groin - only after taking off his pants.

For a moment I felt content with the choice I had made.

Recover

Mention outdoor and all things positive comes to mind. I am to this day in gratitude to my wife who brings me to relax in countryside whenever I have a much-needed weekend break.

There's no better place to relax and recharge our mind than Mother Nature. Today, I came across a South China Morning Post article in which a certified forest therapy guide rhapsodized about being in nature as "incredibly healing," which indeed it is.

I have been stretching my capacity to work longer and be awake longer in the recent few months. At no time during my life had I wanted a weekend break so badly. I consoled myself with the idea that at least I didn't have to go back to hospital today.

"Why don't we enjoy the sun to the fullest while we can?" I asked my wife.

She stared at me, mouth agape. She paused for a few minutes and nodded. And that is the nature of my wife. Ask her for any favor, and she will make my dream come true. Even summer isn't the best time to go hiking, we brought sunscreen and big bottles of water to hike through a forested ravine with a series of wonderful waterfalls.

The healing power of the walk washed over me as soon as we hit the road. Recovery was instantaneous; the landscape just knocked me off my feet.

The effect was riveting.

Hare

Library is closed. Dining out isn't allowed after six. Swimming pools and sports facilities have been suspended. The coronavirus outbreak has more or less put everything on pause, except the work in a hospital. Taking a break has been the wish of many doctors, much as it did for me last month after I had broken my leg.

I was finding solace in the slower pace of myself, when things are supposed to move slowly. I didn't want to admit that working and walking with one leg had tired me, but it had. It was while waiting for my bones to heal, with the sound of thump for every step I made last month, that I found the lowest figure of local infection.

Now that I'd checked my injured foot's x-ray, it seems like high time to get my life back on track. And yet, our community spread of the coronavirus has hit the record high this week. The only positive note is that, from now on, I am able to work harder with two legs.

Outworn

Now that my daughter is halfway from child to teenager, Jasmine starts to post WhatsApp Status update. Unsurprisingly, I'm beyond grateful and privileged to be allowed access to her interesting ideas and thoughts. It turns out to be a window into the new generation of lexicon.

I'll give you an example, which happened this week.

Soon after my daughter posted a picture with the caption "This Lego store is sick", I texted her and asked why it's sick. Obviously I was nonplussed. I dare say you'd be sharing the same query as mine when you peer through the upscale display of brick-by-brick design.

I blushed when my daughter texted me the answer. As it turned out, I knew too little about the word sick.

"Sick means cool, dude."

"Mmm," Jasmine explained, bemused by her parents' outdated lexicon. "Or else, we can type That's sick. NGL."

If, like me, you graduated in the last century (read "dinosaur"), you might need a bit of explanation.

After we'd found out the meaning of NGL (read "not gonna lie"), my wife summed up what she understood. "I see, that's more or less like saying Honestly speaking, it looks great."

"Okay, that's it," my daughter rolled her eyes. "That's ancient English, though." 

Heads Up

Let me introduce you to a social party game that will test your generation gap from your kids within minutes: Heads Up. 

It's a classic word game popularized by Ellen DeGeneres. I learned to play this game today when my daughter had a play day with her classmates at the end of school term. In short, you're supposed to hold a phone to your forehead that displays a term. You can't see the term but the game requires you to guess the term from your teammates' witty hints. The more terms you correctly name, the more points for your team.  

We chose the terms from categories like celebrities, brand names, characters, and trendy items. Intuitively, parents should outwit the kids. Or not. My daughter laughed when we lined up a team of grown-ups. And with good reason.  

My daughter and her classmates kept laughing. Many times. Out loud. The truth, as I now know, is that adults like me are strangers to many terms: Oscar the Grouch, Power Rangers, Teyana Taylor, iCarly, Millie Bobby Brown, and on and on.

Shut

From the emotional anguish caused by social distancing to the ache of public libraries closing their doors, the coronavirus outbreak runs the gamut in ways we can't imagine. 

I could never have predicted that our public libraries remained shut for four months. At times, I feel like Robinson Crusoe who forgets to bring enough books from the wrecked ship since being marooned. And bereft it was.

As we are all adjusting to new way of living, we are supposed to reinvent ourselves. An obvious option, after library closure, is to have free online access to digital books. In the blink of an eye, we're supposed to have a wealth of reading materials, say, after the National Emergency Library in the United States offered free universal open library collection. 

Sounds perfect? The answer is yes. And no.

Alas, that's not entirely easy for someone like me who is not used to download e-books or audiobooks. I simply can't. The brick-and-mortar library and the printed books, ultimately, are choices as personal as the boxer shorts versus tight-fitting briefs. It takes every ounce of effort to switch from one to another. Every atom of you, still, wants to go back to the original choice. 

One hundred forty two days. That's how long it took for me to subsist on paperback books borrowed from my friends. Excitement didn't even come close to describing how I felt yesterday, when the public library next to my hospital reopened. 

Hallelujah.  

Withdrawal

There are times in life when we encounter a setback that puts the kibosh on our habits. For me, a broken leg is one such hiccup to stop my running.

If my interruption in running is a crossword clue, the answer would be "cranky".

Withdrawal symptom isn't uncommon when we have to give up or quit something important. On the other hand - or other leg, I should say - running is a positive addiction which should never be mixed up with tobacco, cocaine or gambling.

But this is a life skill every bit as important as learning how to quit smoking, since directing my attention to other passion is the best way to heal my leg that was crushed. Let me also say that I am beyond grateful and privileged to have good chance that my bones will eventually heal. Sooner or later, I shall be ready to hit the road again.

Wait for me.

Sunim

Not too long ago I was checking stats on my Fitbit: number of steps and my pace dashboard. Before my foot injury, it was hard to imagine my life reclaimed from slowing down.

The elbow crutches or leg crutch made me profoundly mindful of how to slow down.

Every single step is about being slow, the way we should take coffee in small sips to get the most of the aroma. And the speed of Earth's rotation seems to be no exception. Everything is slow. And, I’d add, I can enjoy longer-lasting stock of socks now that I wear only one sock instead of two.

Does it mean I enjoy the sloth's way of living? Hardly. In fact, I'm reluctantly giving up my pace, because I have to. In a sense, it's tough training for survival in an event of paralysis or injury. I shrugged my shoulders and sat down. Then I saw a message from a friend of mine, reminding me to pick up the book written by the Zen Buddhist guru Haemin Sunim, The Things You Can See Only When You Slow Down.

Now, more than ever, I find the powerful voices from Sunim. That's what he writes:

Don't struggle to heal your wounds.

Just pour time into your heart and wait.

When your wounds are ready,

they will heal on their own.

Dog

Life is unfair, as we all know, and a good thing too.

This is how the novel A Dog's Life opens with. And that statement, nine times out of ten, is true. Always. Heaven knows why, but we can't always ask for fairness.

To this day, after a traumatic evening, I still believe we should find the silver lining even when life has dealt us a bad hand. If you had asked me one month ago how I felt about running home after darkness, I would have had an answer ready: That's relaxing exercise to offload the stress.

Then an accident happened last night. I was attacked by a pug while running home after work.

As much as I love running - and man's best friend too, for that matters - I don't really have up-close-and-spine-chilling experience of being chased by a dog. One of the lessons is that once I spotted a dog off leash in the distance, I should have changed my route instead of passing from behind. The way and pace I ran somehow sounded like dropping a bomb at the pug. I was shocked that my running behaviour led the dog to lunge at me. My first instinct was to run even faster, lest being bitten. But as things turned out, I can't outpace a four-legged animal.

I certainly didn't expect the pug to give me injury, least of all breaking two long bones and two wedge-shaped bones of my right midfoot. I made my way wobbly back to the hospital. There were then magical moments when my beloved colleague rushed to greet me, when the emergency room staff wheeled me to have x-ray, when my nurses brought me two crutches. Call me pollyannaish if you like, but I find the positive spin on the warmth I'd received. And to be absolutely truthful, after a brief pang of anger, I felt better to recall that the dog wasn't suffering from our high-speed bombing. It's better to have one than two being hurt, isn't it?

LED

Unplugging before bedtime, as I have learned from Matthew Walker, has hefty benefit on the release of melatonin, a powerful messenger to signal "time to sleep". How much can reading on an iPad  suppress melatonin release compared to reading on a printed book? A lot, it turns out. By over 50 percent. It's a good idea, obviously, to unplug before hitting the pillow.

That is easier said than done.

Knowingly or not, we might stare at blue LED lights from laptop screens, smartphones, or iPad at night. I've tried to be one of the responsible parents nudging my daughter stay away from electronic devices before sleep. In fact, a family ritual of our own is to pick a book, mostly a graphic novel, to go with bedtime snack before catching some z's. Try as we might, we won't - can't, in fact - strictly stick to the no-screen-time-before-bed rule. Let me say, with all the moderation I can summon: at best, we try not to let the electronic devices rule the roost. But hey, I just say "try not to." So, yes, I failed now and then.

My daughter's snack tonight was string cheese, something new to us. After peeling open the string cheese, I and my daughter looked at each other, musing on the proper way to eat string cheese. We both scratched our head, and ended up taking a detour to YouTube for the answer.

You get the point. Staying from the screen isn't easy.

Classroom

While the classroom will resume for many local students soon, their life won't return to normalcy. Even the simple act of meeting classmates or hanging out with friends seems a pipe dream for them.

Before my daughter could return to campus, she has been "attending" interactive class via Google Classroom or Google Meet. What does it mean, specifically, to go to Google Meet? As my daughter told me, the key is to meet the teacher and learn. One hour or so in the morning. Work after class is often such a pleasure to have. One of her favorite tasks is answering "question of the day" put up by her teacher. What age would you like to be and why? Then the students would keep laughing at the replies posted on the online platform. Use three words to describe yourself. If you want to know the best answer to this question, that would be "minecrafty."

We're grateful for her school's approach to prioritize children's emotional and social health. For others, the virtual classroom can be much more inflexible and even at times boring.

Imagine sitting in front of the didactic computer screen for half day, and you can see why.

Instead of the hard-and-fast classroom schedule, my daughter can sign up at her own wish to have small group meet session, one time slot for each week, four students with teacher at one time. That's the best way to have social interaction in a virtual classroom. I can tell my daughter loves this. The way she picks different classmates each week is even more serious than choosing outfits from the closet.

One night after work, the first story my daughter shared with me is how much fun she'd had with the small group when they played the online Scribbl guessing game. A testament to the central role of social interaction when school is closed.

Sleep

Working the night shift is no good, I know. You don't need me to tell you that. Unfortunately, all-nighters are part of life for many of us.

The struggle with sleep-anaemic mode of work is constantly playing havoc with our internal clock. Worse, should you read the neuroscientist Mathew Walker's book Why We Sleep, you will hear the bad news: the shorter your sleep, the shorter your life span.

One inside story of the book is how birds' sleep pattern can work out better than humans. So this is how birds get around sleep deprivation no matter how busy they are: they're able to sleep with just one side of the brain. One half of the brain rests; the other half stays awake. Then switch.

"Oh, it's fabulous," I heard myself in awe, casting my eyes heavenward. To me it sounds like a genius way of sleep. But wait. Sleeping with half brain off and half brain on isn't a perfect solution, however, and that would still have myriad risks. Split-brain attention can be susceptible to the threats of predators, say. As an analogy, imagine your tummy being cut open and operated by a surgeon with one side of the brain sleeping. It is anything but safe.

How, then, could birds get nighttime benefits and yet maintain safe sleep?

As Matthew Walker tells in his book, many species of birds have an even more ingenious answer when they group together. The flock simply line up in a row. Except the birds at each end of the line, the rest of the group will allow both halves of the brain to indulge in sleep. Charged with the core duty of sentinel birds, those at the far left and right ends of the row are supposed to give alarm-call in case of predators - it's no wonder they can't fall asleep completely. They will enter deep sleep with just one half of the brain (opposing in each), leaving the corresponding left and right eye of each bird wide open. In doing so, the "anchorbirds" provide full panoramic threat detection for the entire group, maximizing the total number of brain halves that can sleep within the flock. At some point, the two anchorbirds will stand up, rotate 180 degrees, and sit back down, allowing the other side of their respective brains to enjoy periods of slumber.

The more I think about the eye-opening lesson from the birds, the more I am convinced of the tried-and-true strategy of survival: teamwork.

Anniversary

"Here's a question," my wife quizzed me last weekend. "Do you know what day is it next Sunday?"

"Yes, I think it must be an important day," I nodded.

When I realized I was caught red-handed without much idea, I averted my eyes from my wife, the way a medical student stares down at his feet like he can find the answer to a professor's question written on his shoes.

I waited. I waited. I didn't really remember the exact day of our wedding anniversary, but I felt I shouldn't say so. "Very nice," I murmured, and "Mmhmm. I see." Then, bit by bit, I began to crack the code, finding out it's our twentieth anniversary since we tied the knot.

I felt ashamed of myself for taking so long to remember the important date. What had happened to my brain? And besides, I have been working for long hours lately, so much so that I didn't seem like to have remembered my home. I actually blushed.

At the end of the day - in case you're interested in my fate - I didn't get guillotined. This is the best gift for me: a safe haven offered by the person I love most in the world.

Safety

At a recent final year medical student examination I was glad to have the chance sitting next to Professor Sung, our truly legendary physician. Like a student myself, I'm always hungry to hear his stories, which are at the very heart of Dickensian or Sherlockian flavor.

A lesson I learned was how we could have behaved like an asshole or bosshole without knowing it. The unfriendly and rude bullying behaviour of senior doctors was much more common in the old days, as I was told, when superiors treated young followers like dirt. What about now? Somewhat better in many fields, I guess. But not as good as what we might have wanted.

What does it mean? That's called bosshole gap. In short, bosses are notoriously poor at evaluating our own performance. We could have bragged about being a great boss, without knowing how much we're getting close to be a full-blown certified asshole.

How is it possible to assess the culture of psychological safety? One good metric is, perhaps, checking the willingness of young doctors or students to take interpersonal risks at work, to admit error or simply say "I don't know" in front of a senior.

To answer the last question, I must say "I don't know."

Sparkle

The world has become so small so quickly. A virus surfaced four months ago, and swiftly sweeps across the globe. This seems so sudden.

One of the social upheavals arises from city lock down, closing school, and isolating one from each other. Here's a heartbreaking reality: people can't visit their parents, even on their deathbeds, for fear of spreading the virus.

In these crazy times, we all need some encouragement to keep ourselves calm. To choose joy for the family, my wife signed up for Netflix and introduced Hayao Miyazaki's movies to Jasmine. I wasn't able to watch Laputa with them, but I was thrilled to be invited by Jasmine to join her arts craft activity this afternoon. That's making use of sandpaper to polish seashells we'd collected from Oki Islands two years ago.

"Good idea." I said. "I like to work out." I joined her and starting scrubbing, really, really hard. Making a seashell smooth and sparkling can be a cathartic and exciting exercise for both kids and adults. We'd been occupied for an uber-entertaining stretch of time.

If you ask me, I would say that children's ideas are what we need to get through these difficult days. A gold mine.

Routine

If you find yourself being addicted to the screen and social networking, be warned that the screen activity is now measurable and easily tracked in real time. Your device simply tracks your average time spent daily on WhatsApp, Instagram, Facebook and answering mails. There's no best way, but remember that statistics aren't too useful to stop us from dawdling in front of the screen.

Let's be candid with ourselves. Instead of bemoaning the lack of high-tech productivity tools, we should begin with simple routine. To get myself to write, I need nothing other than a desk and a computer. I usually do my writing in my office, and less often at home. And no matter where I start my writing, I have always kept my ritual of preparing myself a cup of good coffee. The repetition itself has become an important signal to write, and almost a form of mesmerism.

I didn't go back to office this morning. So I mesmerized myself with a cup of coffee in front of the laptop at home, which is like the Pavlovian response to gear myself into writing mode. In no way did I intend to write an academic paper on Good Friday. Of course not. I simply finished a peer review of a journal submission, and crafted a reply to the rebuttal from another author furious about my rejecting his paper submission.

Not bad.

Connection

Humans are profoundly social animals, and our relational connections shape our inner neural connections. Much of the time, we need more than reasoning to maintain social distancing even if an infectious disease outbreak mandates it.

And that's no small thing. Social distancing is never easy. And it's even more difficult for kids. Dr. Ainsworth's groundbreaking "Infant Strange Situation" study discovered attachment science, and changed how we understand the importance of secure attachment or intimate human relationships for kids.

Here it is in a nutshell: Ainsworth assessed mother-infant interactions throughout the first year of a child’s life. At the end of the year, each mother-infant pair was brought into a room for an experiment that lasted about twenty minutes, followed by separation of baby from the mother. Securely attached babies show clear signs of missing their mom when she leaves the room, actively greets her when she returns, then quickly settle down and return to their toys and activities once the mother is back in the room.

Ainsworth, in short, showed that sensitive mothers are more likely to have securely attached children. That’s an important concept. Although there’s no formula that’ll fix every problem our child faces, there’s one thing we can always do: just show up. Showing up means what it sounds like. It means being there. We all need to. Remember, we all are born with a drive for connection. To give you an example, the wisdom of showing up helped me to break the cycle of insecure attachment - and break the regulation of my hospital, too. Two nights ago, a mother was sent to my infectious disease ward when she developed fever under quarantine order; her husband had been diagnosed with the nasty novel coronavirus infection ten days ago. Then, guess who else was sent to the children's ward? That's right, another close household contact: her twenty-month-old daughter.

I kept waiting for the mother to appear. Wait, wait, and wait.

She wasn't escorted up because her daughter was in a body-shaking crying mode. A nervous breakdown. It's hard enough to send an infant to hospital, but it's even harder to separate her from the mother who's supposed to be locked up in another double-door isolation ward. Plus, it's impossible for the daddy to come because he was too sick in another hospital. As we struggled with putting on emotional brakes, the child continued crying. The mother cuddled the infant when our colleagues kept saying, in the most polite tone, "Just can't wait. Go."

I tried not to show how impatient I found myself to be. I've seen the need to hide our bad feeling time and again over the years in my work with patients. We doctors simply had to be patient with patients (pun intended). It makes sense, doesn't it? I sized up the situation and then remembered Ainsworth's story. And instead of putting two patients in two different isolation wards, we ended up with a new option: admit the child to an airborne infection isolation ward, and her mother into the same room. Paediatric team looked after the child, and I took care of the mother. Under the same roof.

Perfect.

Percuss

Recently, weighed down by the ever-present concern about epidemic of coronavirus infection, doctors are often separated from patients by double doors. Even when doctors muster the energy to go through the doors, the patients should still be examined with gloved hands.

That's what I have been - and supposed to be - doing in the medical wards catered for patients returning from Wuhan province or Korea.

Eager to get an accurate diagnosis, we are instead relying on advanced imaging techniques or laboratory tests like real-time polymerase-chain-reaction assay. Too often, we skip the step of touching the patients.

I'll preface this by saying that I lament the loss of basic physical examination. Skipping physical examination of patients is not my thing. Not remotely. The way I see it, once you've decided to make good use of stethoscope, and if you can bring a proper one instead of improvising the primitive-as-a-toy stethoscope at bedside, there's little reason why you should have a cursory examination. You either listen properly or do not listen. Don't pretend to listen.

The same goes for percussion, another time-honoured bedside skill we have been teaching medical students. Imagine cocking your right wrist and let the right fingertips fall like piano hammers on the left fingers placed on a surface. Then pay attention to finger tapping on patient's body parts - the pitch and tactile sensation - to get the feel. The sound will be resonant on percussing a hyperexpanded chest, but appear stony dull if there is fluid pushing the lungs away.

Over the years, I have learned to appreciate the musical notes crafted by finger-tapping. It works, especially when you don't have easy access to handheld ultrasound machine wherever you go. But then, having worn latex gloves in most hospital designated areas, I am stuck. The typical features of resonant or dull percussion note simply blurred. Try as I might, I could no longer tell the difference between a hollow structure and a fluid-filled body part.

What's the quick fix? My tip: remove the gloves (and make sure the infection control officer isn't behind your back, of course).

Or so I thought.

Decompression

The problem with long working hours in hospital is not that we get overloaded. The problem is that we have had almost no idea how to call it a day.

We've decided that there should not be long shift for doctors looking after quarantined or suspected coronavirus patients in our hospital. If safety and protection are what we sought in such high-risk areas, we should limit the hours of physical and mental stress from putting on and off the full personal protective equipment, as well as mindful hand washing.

I settled in and handled the shift work with reasonably aplomb. I never complained. But while I managed to adjust, I knew there was something amiss. The eureka moment came when I viewed the TED talk by the psychologist Guy Winch. To steal a remark from Guy Winch, we need clear guardrails. We have to define when we switch off every night, when we stop working.

Here's my way of rebooting: I start running home after work, a habit I had recently forgotten.

The very simple and yet empowering action of changing shoes to running footwear defines a boundary from working mode.

A signal for an upcoming break.

There's nothing I like better than a physical springboard to decompress. It works like the step of decompression before surfacing of a scuba diver who has been breathing compressed air (somewhat like a suffocating N95 mask) in deep water.

It's hard to say exactly how important that decompression is, until you find out what it's like without it.

Just before yesterday, at the end of my shift, my mind was so clouded that it allowed dumping my fountain pen with working clothes into the collection bin. In case you skipped over the last sentence, I'll repeat it. I threw away my favorite fountain pen. Seldom have I been so wrong.

Little did I know my faux pas until I was experiencing flow on the running route back home. My body and mind was wide awake by then, and in a matter of nanoseconds, I registered the plan to go to the collection bin first thing the next morning.

It sounds like a magic moment, and it is. I didn't lose my fountain pen. And neither my marbles.

Birthday

I remember the story of "9-enders" (aged twenty-nine, thirty-nine, fifty-nine) who are much more enthusiastic to run their first marathon. In many ways, the left-digit bias reinforces our tendency to categorize continuous variables on the basis of the left-most numeric digit.

The susceptibility of our brains to fall into the trap of heuristics or hard-wired mental shortcuts is common. It can affect many of us. And we (and by we I mean runners, customers, parents, and doctors) tend to be affected without being aware of the cognitive biases.

Hey, I just found out doctors are also making clinical decisions with left-digit bias. For those of you who think high-tech physicians are awesome in calculating the risk-benefit trade-off to manage patients with acute heart attack, go and read the recent issue of the New England Journal of Medicine. Based on data of patients who were admitted to hospital with acute myocardial infarction over six years, those admitted in the 2 weeks after their 80th birthday were significantly less likely to undergo bypass surgery than those who were admitted in the 2 weeks before their 80th birthday.

The creepy reason of your being turned down for a life-saving heart surgery, in short, could have simply been the way you're categorized as being "in your 80s" rather than "in your 70s", and that, in turn, is a matter of few weeks' difference in your birthday.

Amen.

Marathon

First, a disclaimer. After reading this blog, you don't have to follow my type of "workouts."

Entertaining the thought of prescribing the same training intensity for runners, as I have recently learned from reading Hansons First Marathon, is the surefire way to let old injury rear its ugly head. Overzealous goal means taking two steps back for every step forward.

Yes. I asked myself question to get a clearer handle on my natural abilities. That's going to differ for individual. Let me say, with all the moderation I can summon: I am destined to work with minimal requirement of calories and drinks.

That is a crucial reason for my natural proclivity to work in the hospital high-risk areas where patients with suspected or confirmed coronavirus infection are staying. To handle the outbreak, doctors working with these patients are advised to wear the protective N95 masks. They're designed to protect both healthcare workers and patients, but are now in short supply. When I wear the N95 mask, I don't have to discard it after seeing each patient as long as it isn't contaminated or soiled. With little personal need to eat or drink during working hours myself, I have not much need to replace the mask. The truth is, I worked for almost ten hours yesterday with one single N95 mask.

This is not to say, of course, that we should be frivolous about infection control. Nor is my story meant to suggest that we permit hazardous working environment. Rather, this reminds us that each and everyone of us can check how to contribute in his or her own manner.

Know yourself. At your own pace. Don't force others to follow.

Ventilation

Has the thought ever crossed your mind that you might have been ruled by a government getting every opportunity to fracture the relationship with the citizens? Me neither. Not until now.

The city I grew up in had been smashed.

I do not remember since when we'd been having a dreary and oppressive sense of being suffocated by tear gas. Nothing ever had been tried to restore the order and trust - except you count closing things. The government closed train and traffic service. Next, they closed their eyes. And then ears.

That's smart, and you'd be fine … if you're kept in the dark. Unfortunately, the government have closed almost everything except the border checkpoints. When a deadly coronavirus is circulating in Wuhan, our government closes everything - ears and eyes included - except complete closing of traffic from China to minimize the risk of spreading coronavirus. 

One might think that a government should work endlessly to safeguard the citizens' rights, rights that belong to them, rights to live, rights to live without fear. But not here. Not even when the number of confirmed coronavirus cases has gone up more then tenfold in a week. Not even when thousands of medical workers went on strike in an attempt to force the border closing. 

To this day I have no idea how all these could have happened to us.

Trust in one's government, after all, is the worst to lose, is it not?

Marsh

“What comes after twenty-nine?”

That’s a question raised by Kya, a thirteen-year-old girl who knew more about tides, snow geese and eagles than counting to thirty.

I was reading Where the Crawdads Sing on my Portugal trip, during which we had birdwatching activity at the Tagus estuary, a wetland area similar to where Kya grew up. She learned layers of life - squiggly sand crabs, mud-waddling crayfish, waterfowl - but not a single word because she didn’t attend school.

Kya was abandoned by her mum, siblings one by one and then her dad, shouldering all chores - this little piggy went to market.

No one would take care of Kya. Except herself.

The only way she could make ends meet was to slip out with a bucket and claw knife in the wee hours, squatting in mud to collect mussels. To stay ahead of the other mussel pickers, Kya headed to the marsh by candle or moon, and even added oysters to her catch.

That’s real tough mussel money to earn. I can't imagine how I could have survived in her shoes. Oh, by the way, she walked barefoot and could not afford shoes.

Which is why most of us have a love-hate with helicopter parenting style. A matter of independence versus hyper-sheltering. Honestly, most parents never really want to be too harsh. And who wishes to raise a Kya? I don't either. And fair enough. But it's be irrevocably satisfying, perhaps even gratifying, to see my daughter waking up around seven every morning cooking breakfast during our Portugal stay.

Saga

The unpredictable and arbitrary rages of a novel coronavirus make any society, no matter how peaceful, into a potential minefield. Ours has been in bedlam even before the landing of this virus. This sounds like an extra blow of tornado during a heavy snowstorm.

The city shook.

I started my family trip two days after the news of two patients diagnosed with the China coronavirus in Hong Kong. It felt frustrating and spoke to some truth I couldn’t express: survivor’s guilt. It reminded me the most recent social upheavals coinciding with my summer Croatia vacation. And then my overseas training in Montreal when SARS struck the city more than a decade ago.
That memory of paralysing SARS could have repeatedly retuned to my colleagues over the years. I wasn’t in the battlefield and that makes the misery burn less intensely in my memory.

But our homeland is close to the heart of mine. I’m away and will be back one week later.

It will be, I knew, my turn.

Werewolf

Everyone has to talk to strangers and deal with uncertainty, and I am no different. Even if you don't frequent pubs or parties, you might have been invited to play a game Werewolf recently.

That's a popular social deduction game in which you're being assigned different identities. Everyone else becomes a stranger. Then, little by little, night by night, you will have to figure out who is who. It's when, and only when, the villagers find out the werewolves without being killed, the game ends.

The tricky part of the game is, more often than not, you won't be able to decipher the identity of strangers. And that's no small thing. Werewolf kills. Ultimately, each player is killed by the werewolf. The villagers all die, and nobody is left alive.

Nobody, that is, but werewolves. Uh-oh.

Which brings me, somewhat uncomfortably, to Malcolm Gladwell's new book Talking to Strangers.

In no way am I suggesting that I made a mistake in choosing his book. I don't, and you won't. Gladwell is razor sharp. What made me uncomfortable is Gladwell's narrative of Sandra Bland, a young African American who drove from Chicago to start a new job, but was then pulled over by a police officer Brian Encinia. The white police officer first told her that she had failed to signal a lane change, and then challenged her to put out her cigarette. It's only a cigarette. But Encinia got angry and forced her to step out of the car, without good reason. He yanked her out, slapped her, and then arrested her.

I know: that's ridiculous to arrest someone who failed to signal a lane change and was smoking inside her own car. Seriously, what kind of bully is this? But hear me out. The truth is, Sandra Bland was taken into custody on felony assault charges. Three days later she was found dead in her cell, hanging from a noose fashioned from a plastic bag.

That is what happened to one of the tragic citizens who died because the police was making no sense of a stranger.

Lifespan

Many friends of mine blew out the candles on their fiftieth birthday cakes this year. It'll be my turn soon.

Now that I've lived for nearly half a century, one of my birthday wishes would be having one less candle on the cake each year. I am not the only one who dreams about longevity, of course. There are lots of us aiming to stop the ticking clock.

For heaven’s sake, how?

One grows old, but never grows tired of looking up elixir or recipes of youth.

For David Sinclair, an acclaimed Harvard Medical School geneticist, we don't have to think of aging as an inevitable part of life. He remained young like Peter Pan when he wrote the masterpiece Lifespan at the age of 50.

After years of researching aging, Dr. Sinclair was named by Time magazine as one of the 100 most influential people. If there is one piece of advice he can offer, one surefire way to stay healthy longer and get younger is this: eat less.

Oh, this reminds me of a big fan of fasting. That's me. I love the recent New England Journal of Medicine review article on the link between periodic fasting (or eating in a 6-hour period daily) and extended lifespan. I thought, Wow, it's good news. Now there's a strong reason why I skip lunch proudly.

Busy

The other day, my wife and I were discussing if it's good to get days off work during our daughter's term break. Without guilt, I mean.

For a moment, we hesitated. All around were many hardworking colleagues, patients to be seen, plus tasks to be ticked off. We felt as if we'd been caught trying to loaf about.

All right. I should say we won't starve if we put out feet up for a couple of days. And taking a break is something forgivable, and more so when we have been working our butts off.

On top of that, carving out time for the family should have been the priority. Something we all deserve and shouldn't sacrifice. Something we can't wait for retirement to do. What better way to spend time with my daughter at the recently reopened Hong Kong Museum of Art? Or, hiking the waterfront trails near Cape D'Aguilar or Luk Keng? There should not be any excuse except the one we all use: I was "busy" - in the way bestselling author Mitch Albom had previously used. And, as it turns out when I read his memoir Finding Chika, this is the excuse Mitch Albom regrets the most. At one time, work was his focus. He was busy, chasing success, taking every assignment he could get, and delayed starting a family.

And soon, all that was left for Mitch Albom and his wife was to rush, to meet doctors and try extra things to have babies. In vain. Yes, years passed when we told ourselves we were busy.