Tuesday, December 26, 2023

Ownership

Ten years ago, the idea of ownership meant purchasing and owning a physical item. Today, we are moving to temporary ownership. That means ownership-on-demand to minimise overloading our storage lockers.

It's not just the wish to spark joy and free our space; we are rethinking what we mean to own something. 

Our family are perfectly fine with Airbnb holidaymaking at a lower cost. We didn't go as far as joining the market of Turo car-sharing, but I keep enjoying the cutthroat price of bike-sharing monthly subscription fee. In fact, I witnessed similar examples of riding-on-demand elsewhere recently: Meituan bike sharing in China, grab-and-unlock E-Scooter Share Scheme in Perth. Their service - 24 hours a day 7 days per week and scooter location by downloading an app - is even better than ours because each electric scooter comes with a helmet, which you should put back on the lock after finishing the ride.

Suddenly, we stop buying things, and begin subscribing to services. When we think more about it, it's the service that matters, not the thing. 
 

Thursday, December 21, 2023

TripIt

We've got limited time only for the Western Australia trip this season. We based ourselves on Rottnest Island, and then headed south to Busselton and Nannup. 

A short trip.

But that doesn't mean we missed the fun. A shorter trip, in fact, can be even happier than we would have thought. 

I learned this from a psychology professor Jeroen Nawijn, who published in the journal Applied Research in Quality of Life, after his tracking the happiness of over 1500 Dutch participants. As expected, those with upcoming holidays are happier than non-vacationers. What most of us do not know is that the days before the start of the trip registered the peak level of happiness - higher than when the participants were actually on holiday.

Perhaps nowhere is the joy greater than that of anticipation, which is even more powerful than the experience itself.

A deeper look at this study might lead us to think twice before striving for a long holiday. That means we should have more short trips and more frequent breaks. The more trips planned, the more there is to look forward to. 

Wednesday, December 20, 2023

Thrombolites

After our Rottnest Island adventure, we headed south to Busselton. During our way, we came across Yalgorup National Park and met the earliest living organisms on earth. No, I don’t mean Jurassic Park. That’s not distant or early enough. We’re talking here about thrombolites of Lake Clifton.

At first glance, the muddy or rocklike humps look a bit lackadaisical. If you dig out their history, they are the only known form of life on this planet somewhere 650 million years ago. At that time, there was no oxygen in the atmosphere. Next came colonies of prokaryotic cyanobacteria which were able to carry out photosynthesis. That was the key to jack up the oxygen content in the primeval earth’s atmosphere. Thrombolites, as it turns out, are fossil record of these earliest living organisms on earth.

Now that our oceanic oxygen levels had fallen by 2% in 50 years, thrombolites remind us what we badly need.

Quokka

My wife and I first heard about an Australian island populated by a beaver-like cousin of kangaroo called quokkas more than six years ago. Quokka's fur coat is the colour of hazelnut, ears as cute as Mickey but smaller, smile much happier than Cheshire Cat's.

At that time, we only knew Rottnest Island is a Class A reserve dedicated for renewable energy: the best way to navigate is by foot or bikes because vehicles aren't permitted except for work purposes.

This island has been on our bucket list since then.

Blue waters and white sands. Wildlife and bird sightings. Hiking choices, or adventure on two wheels. This island has all the hallmarks of our family's top picks.

For one reason or another, we didn't have chance to visit Rottnest Island until the lifting of tight restriction governing Western Australians inside a "hard border".

We made it to Rottnest Island this week. To thoroughly experience this holiday haven with oodles of natural beauty, our family chose to stay for three days instead of a day trip. 

It's a real pleasure.

Monday, December 11, 2023

Climate

I don't have to read the reccent TIMECO2 series of Time magazine to realise the climate change.

Look around and I know it's everywhere. Consider, for a moment, how many of you would have thought about going to the beach during winter previously? Now that we have global warming, I can easily arrange a birthday beach party this year even it's December.

The record-breaking heatwaves give us less pleasant temperature round the year. During our family hike today, I reminded myself to bring ice pack to keep our beverages cool. We met far more blue tiger butterflies than we could count at Tai Po Kau. Sounds unusual? Not really: blue tigers often gather here at the end of autumn. Butterfly population, still, is one of the indicators of climate change. Environmental groups have apparently recorded a sharp increase in the local butterflies since 2019, in tandem with the rise in our city's temperature.

No wonder this has been a hot topic in Time magazine.

Saturday, December 9, 2023

Sometime

We've been told for decades now, by the geniuses at Seasame Street during their Season 36, that foods should not be labeled as good or bad. They describe food as being "anytime foods" or "sometime foods."

In this way, we steer clear of value judgments when it comes to food. Specifically, we don't want to focus overzealously on dieting and calories counting.

Such is the way of buying snacks for our daughter's birthday party. We let our daughter celebrate with her best friends close to fine sands and waters; we went to Clear Water Bay Second Beach this year. Our family didn't shy away from "sometime foods" like Pringles and chocolates. They are the best choice for sometime like birthday, aren't they?

Sunday, December 3, 2023

Tom Lake

During my conference trip to Guangzhou, I was reading the novel Tom Lake by Ann Patchett, who wrote the entire book on a treadmill desk during the pandemic. She literally walked the whole book: a novel set partly in a lake in New Hampshire, and about a family stuck on an cherry orchard with no idea how much longer they would have to stay amid the virus. My conference hotel at Huangpu District happens to be right next to a pleasant water reservoir. That’s an idyllic location to read Tom Lake.

For some reason, I found something similar to the plot in another novel I had just finished. That’s Station Eleven, a novel recommended in my daughter’s school weekly bulletin. In both novels, I read about actors’ tragic death onstage. One had heart attack during performance, and another died after vomiting blood from drinking too much vodka and whiskey. 

The more I thought about the two novels, the more similarity I could find. Ann Patchett told a story of lockdown, during which a going-to-be-couple were happy to get perfect excuse not to invite anyone for their wedding. The story of Station Eleven, written before the coronavirus pandemic, happened to be about an unprecedented flu outbreak. You might have wondered how an author could write a story so close to how we encountered the coronavirus. 

“Listen. Even if I could book you on a flight out of Malaysia, are you seriously telling me you’d want to spend twelve hours breathing recirculated air with two hundred other people in an airplane cabin at this point?” How familiar such extract from Station Eleven seems now, almost like a prophecy that comes true.

Guangzhou

Nearly four years ago I attended the International Congress of Chinese Nephrologists in Nanjing. Within one month of that conference, international travel has come to a standstill because of the global pandemic. 

When I returned to the same conference in Guangzhou this week, there have certainly been swift changes. High speed train. Digital currency. Artificial intelligence. 

As happens with any new changes, my initial reaction is uncertainty. Little did I know how I could get my digital wallet. And yes, I can’t think of the way to navigate my digital world without Google Search. It is no surprise, then, my WhatsApp works as rarely as we win the lottery. I know for myself that websites from New Yorker and The New York Times are blocked by the firewall, too. 

Maybe I’m not supposed to talk about it. I shouldn’t have complained.

Tuesday, November 28, 2023

Compassion

It is one thing to have empathy but another thing entirely to move to compassion.

I learned the difference from my personal encounter in handling complaints in hospital and from the book co-authored by Jenn Granneman and Andre Sólo, Sensitive. The book is by and large written for readers who already know they are sensitive. I know I am.

As the story goes, a sensitive person can often get too much empathy. So much so that there is a risk of so-called giver burnout. On one hand, empathy is a gift of sensitive people who can truly take in what another person is feeling. On the other hand, internalizing too much emotions of others like a sponge is stressful.

Two weeks ago, I made a phone call to a family member of our former patient who had suffered a great deal. It took the patient's daughter almost two hours to narrate the painful journey. When she asked if I can feel her feeling, I took a deep breath and tried my best not to get overwhelmed by negative emotions. I told myself not to have too much empathy which is inward focus; I should have compassion which means outward focus. Instead of mirroring the emotional state of hers, I switched my brain activity to compassion - a response of concern, caring, or warmth. I knew I was there to help, to give care, and not to experience her emotion.

In other words, I learned to make a magic switch from passive (like a sponge soaking up pain) to active role (like a cleaning cloth to remove upholstery stain).

Sunday, November 26, 2023

Record

I believe with every cell of my body that running with my daughter is one of the best activities. I am a keen runner; my daughter isn't. That means I have to wait for the month before her school sports day.

To eke out the most happiness from such once-a-year chance, we go to the sports ground for running drills. Not once. Not twice. Many times.

From my perspective, this is a perfect daddy-daughter date idea. We ran until we couldn't breathe. We laughed at the absurdity of jokes until our bellies ached.

My recent reading of parenting book on guiding teenage girls let me know how lucky I am, and how trusthworthy my daughter is. We got our seats at the spectator stand because the sports ground wasn't open for practice when we arrived today. We played a few Word Cookies online games, shared our phone message activities with each other. In moments like these, our thinking narrows, sharpens, connects. I heard about her story on digital technology use such as her strategies to keep the personal Instagram account from out-of-bounds followers.

Getting to know daughter's track record of responsible online behaviour, on looking back, is even more valuable than beating her personal record of a track event in the sports ground.

Saturday, November 25, 2023

Reunion

Thousands of Trailwalkers took to MacLehose Trail in the annual Oxfam event today. I didn't.

Instead of completing the 100 kilometre trek, four of us - high school friends - hiked from Cape D'Aguilar to Dragon's Back on the other side of the city. We did our leg work while trading stories. It was a hangout that allows spending time as friends while exercising. 

As always, I needed to reschedule many things to make this holiday happen, shortly after I knew my classmate has returned from abroad. But this is definitely a wise decision to have reunion with good old friends. 

Each time we meet, we grow younger. 

Saturday, November 11, 2023

Haiku

Once the frigid breezes of late autumn sweep in from the north, Japan's countless momiji (maple trees) are painted a spectrum of vibrant colours. That's the best time to go hiking.

Tōkoho region offers one of the best viewing spots during momiji season. Among them, Oirase Gorge is an attractive site, which we'd visited twenty years ago. We chose Naruko Gorge this time. We didn't aim for too many different places in our itinerary, mainly because days are getting shorter in the autumn. Better to be flexible and sensible than pledge to visit too many places before sunset - we're talking about somewhere before five.

One of our favourite places at Naruko Gorge is a quiet country path near the gorge. We were so flexible with our schedule to be walking the same path twice within the same afternoon. That's a path walked by the 17th-century "father" of haiku poetry, Matsuo Bashō. Many great haiku poets, like Bashō, were hikers with keen traveller's keen eye. A hallmark of Bashō's haiku is capturing the "just-so-ness" of each object. To retrace his footsteps, we walked once. 

And twice.

Tuesday, November 7, 2023

Parting

During my recent reading of Untangled by Lisa Damour, I learned about the stages of teenage girls pulling away from parents. The American Psychological Association-recognised thought leader and author gives a step-by-step analysis of teenagers’ departure from childhood.

For reasons a teenage girl can’t explain, there could have been an urge to hold us at a distance. As a father with a wry sense of humour, I know because my same old jokes suddenly turn corny and embarrassing, especially if I crack them in front of my daughter’s friends.

And not all parting with childhood is easy for parents to easily accept. Watching an adolescent daughter liberating herself is not for the fragile. I’m grateful that our going-to-be-fourteen daughter remains flexible and amicable to family get-togethers and one-on-one time with parents.

My daughter’s connection with family makes me feel as if we’ve won the lottery. That said, we don’t assume that our daughter will be enjoying the comfort of our home all the time. This week, she is travelling to Berlin on her school trip. We appreciate that she’d enjoy spending time with her classmates, and secretly wish for an occasional Locket photo or text message from abroad. While we could have hummed Paul Simon’s “Mother and Child Reunion” all week long, my wife and I chose to book a flight to Japan. That’s a pleasantly nostalgic trip for two of us, and not three.

Monday, October 30, 2023

Dragon

I previously marked my diary to be examiner for the medical professional examination today. When I realised I’m not called upon this time, I decided to make good use of time carved out from my schedule. After two days of conference in Macau, I opted not to stay abroad. A day off in Hong Kong can also be a gift for myself.

You might have thought I’m using hyperbole to make my point. No, I’m serious. Think Hong Kong and I can name so many scenic hiking trails. I ended up hiking the famous Dragon’s Back today. As Asia’s best urban hike named by Time magazine, this trail is also highly rated by Lonely Planet and CNN Travel. That’s a guarantee for vantage views of sun-drenched beaches and close-up concert front row “seat” for an orchestra of big waves upon descent.

It's obviously one of the best hikes for those who have an unquenchable love for photography. It's also obviously offering respite, for me, from the deluge of email at workplace.

Saturday, October 28, 2023

Nomenclature

I want to be very, very blunt with the word renal here: there is very little role for "renal" when our patients can comprehend the word "kidney" much better. Forget the false sense of professionalism endowed by speaking the jargon.

This is a tall order, but it's not impossible. "Renal" is a Latin word which has permeated our medical language usage. We've all been getting used to terms like "hepatorenal syndrome". As mentioned in a recent letter to editor of The Lancet, we aren't enforcing Orwellian-style medical vocabulary control of scientific communication. We are asking ourselves to change "renal patients" to "patients with kidney disease" or "renal failure" to "kidney failure" in our Instagram, Twitter, or daily communication with lay people.

In other words, say kidney when its meaning is equal to renal. What matters is what our patient can comprehend.

Drop the word "renal" please.

Ladies and gentlemen, if not now, when? If not us, who?

Monday, October 23, 2023

Offline

As a person who loves hiking, I've witnessed big changes in our navigation: long before the availability of sat nav and all the way to the current offline map apps.

I don't know about you, but I have navigation skill no better than that of Hansel and Gretel - which means it's often a must for me to have a map if there aren't bread crumbs. But if, like many of us, you have been using Google Maps, you don't need to bring a physical map. My antique collections of 1:10,000 country side maps are now hidden in the corner of my bookshelf.

That may sound too good to be true for most road trips, but a number of hiking trails are remote and without mobile phone coverage. My family have just bushwhacked a trail without signposts in the northeastern New Territories today. Most of the time, we were hidden in the bushes. We didn't (okay, nearly) get lost because of the offline map apps. Such apps have made off-the-beaten-track travel a lot easier. The offline map apps allow us to download maps ahead of the adventure, and will work even without a data connection during the actual hike.

Offline map apps, it seems, is a must-have tool for travel nowadays - even if we might prefer occasional bread crumbs (or red ribbon marking, for that matter) along the path.

Wednesday, October 11, 2023

Tomorrow

"Life is very long, unless it is not."

Is there better tautology than this one? 

That's what I came across reading Gabrielle Zevin's novel Tomorrow, and Tomorrow, and Tomorrow.

Sadly, I started the first chapter of this book after paying last respects to a much-loved nephrologist. Everyone was in tears during the funeral ceremony, and I was no different.

We listened to the eulogy for this stoic doctor, and appreciated that the lived experience of illness can be short but meaningful. The greatest obstacle to living - I think the Roman philosopher Seneca sums this up perfectly - is expectation which hangs upon tomorrow and wastes today. My teacher didn't lose the battle with cancer. He beat cancer by how he lived, why he lived, and in the manner in which he lived.



Thursday, September 28, 2023

Birthday

A day away to escape the city during birthday is fun.

This year I have been blessed with good weather to enjoy my birthday hike in Section 2 of the MacLehose Trail. That's a coastal hike renowned for beach view from the slope with zigzag paths, majestic view of conical Sharp Peak, rickety-rackety footbridge at Ham Tin, and abandoned village of Chek Keng.

During the hike, I didn't set aside too much time for taking pictures, but it can always be relaxing to match photography with travel. At first glance, you might think photographing while traveling is not the same as traveling to photograph. The joy of bringing a camera has, however, been a second nature of mine. Many photo shooting opportunities emerged spontaneously as I walked on the east coast of the Sai Kung Peninsula.

In the end, I was rewarded with the joy of photographing and the joy of hiking, and that of celebrating my birthday in nature.

Sunday, September 24, 2023

AIDS

Long before the coronavirus struck us, a mysterious case of pneumonia appeared in Los Angeles.

On a summer day in 1981, an unusual pneumonia, called Pneumocystis carinii, affected four persons, each of them had been in excellent health. Shortly after, the new kind of illness characterized by new acquired cellular immunodeficiency made its début in the New England Journal of Medicine. It’s a kind of “a distinct and unusual clinical syndrome. All were exclusively homosexual and had been in excellent health before late 1980.”

That story, as it turned out, signaled the beginning of the age of acquired immune deficiency syndrome known as AIDS. During my recent reading of three interns’ diary, I learned more about how the disease were soon recognized in five children with identical symptoms. The story of full-fledged explosion of paediatric AIDS was told by the interns when they worked in a major New York medical centre in 1985. They didn’t encounter that many deaths in paediatric wards (because children tended to recover from illnesses) until the AIDS brought in more and more sick children.

Before AIDS, those interns drew blood, inserted intravenous cannula, and did mouth-to-mouth resuscitation without giving it a second thought. Not any more with the concern over the rampant spread of AIDS. All house officers wear gloves. The increased use of latex gloves has caused a worldwide shortage of rubber around 1986.

Looking back, we saw many similarities between our fight against AIDS and Covid-19. The more I think about them, the more similar they look. At the beginning, we were all taken aback by a new kind of illness. Before scientific breakthrough, the only way to prevent HIV infection has focused on behavioural interventions. This was somewhat working but not a panacea. With time, we saw treatment options other than primary prevention. Availability of more than 30 antiretroviral drugs has given better quality of life for more than 38 million people who are now living with HIV, not to mention markedly lower mortality.

The rest is history.

Thursday, September 14, 2023

Reframe

For most peole, a shitty situation is a shitty situation, but when your mindset is what affects how you feel about it, what you do about it and, in some cases, the outcome.

To feel more in control of our destiny, we can change the way we look at things, and then the things we look at change.

According to Deborah James, this is the best way to handle the shit. She was diagnosed to have bowel cancer at the age of 35. Not usual cancer. A nasty one with notorious BRAF mutation, driving very rapid cancer cell growth and giving rise to a resistance to standard chemotherapy. Relentless. Cannibalistic. Rampaging.

Even if her destiny seems bleak, she reframes it and sees the positives. In her book How to Live When You Could be Dead, she never uses the word "terminal" in relation to her cancer - she consciously refers to hers being an "incurable cancer."

The way she finds her hope and reframes her thinking would help all of us to become a happier optimist who sees the rose and not its thorns. 

Setbacks are part of any journey, as I come to realise from Deborah's, but not the destination.

Thursday, August 31, 2023

Technoference

Many of us have heard someone, perhaps ourselves, say something like "Oh that's smart", when that turns out to be dumb.

It's even more interesting when we parents refer to our cell phone as a "smartphone", but then tell our child "Get off of your dumb phone!"

I have a rather dumb habit when it comes to parent-child or household relationships intermingled with my phone. I've lost count of the number of times I've been caught checking my phone during family dinner time. Parental distraction by smartphone is a sin, I admit. A sin I am famous for. In fact, I have been told off repeatedly for stealing look at the phone's message at the dinner table. Not once. Not twice. But distraction ad infinitum.

There's such a strong case to be made for sentencing my behaviour. So much so that it deserves a name: technoference. That's a name I recently learned from reading a book about our digital landscape and technology.

Thursday, August 24, 2023

Parenthesis

Everyone wants attention, and I am no different. Is this unusual? No. Does this mean we desire and crave for validation? Yup. Does it mean a teacher can get the attention all the time? You betcha.

I can't imagine the awkward way I was entering the lecture theatre this morning, with a big crowd facing me but walking in opposite direction.

A bitter welcome it would be.

I pretended to be oblivious to my students skipping my class. I kept walking - it didn't take long - and I overheard a few medical students teasing the title of my lecture: Communication skills. But hold on, I want to be clear, from the start, that I agree it's never a good idea to use didactic leacture to teach communication. I don't know how to make the lecture useful, much less how to make it interesting.

To eke out the most fundamental virtue of empathy, we can't simply teach the students "how" without the "why". So what, you might ask, can bring out the empathy? Simple: be a patient. If not, read more stories about illness. There are so many good novels or memoirs about illness. To give but one example: I finished a graphic memoir of a French artist who learned to accept her repeated seizures from a brain tumor. For a long time, she had been pretty messed-up with memory and lucidity, suffering from what people described as "spells of shaking". This story of an inoperable tumor would have been far better than my lecture to remind students to be empathetic.

Saturday, August 12, 2023

Weekend

You think when people talk about vacation that they must be referring to the paid annual leave, but they don't neccesarily have to be so. Listen to Cassie Mogilner Holmes, a professor at UCLA's Anderson School of Management, and you will see how.

I came across her thinking on how to get more people take their vacations - and I think her answer sums up perfectly: "But then we realized, we actually have breaks in our lives already." Presenting: the weekend.

Holmes' team ran a series of experiments and found surprisingly impressive effect of having the mindset to treat the weekend like a vacation. Nothing special. Simply being randomly assigned to instruction "to treat the weekend like a vacation." That was it. This may seem impossibility, but it is true that a vacation mindset is enough to get the participants happier, less stressed and worried, and more satisfied on Monday than those control subjects who were instructed to treat the weekend like a regular weekend.

The good news, if you could call it that, is that we can still reap the benefit from an hour of protected time (say, on Saturday afternoon) even we can't have two consecutive days of Saturday and Sunday off work.

What better way to celebrate my weekend?

Sunday, August 6, 2023

Balance

Who among us haven't relieved ourselves in the traditional Japanese style squat toilet and thought "Oh, it is slightly less embarrassing than behind the bushes."

Don't laugh. It's not as easy as you would have believed. During our family trip in Hokkaido, we happened to find a poster teaching the know-how of proper squatting above that ceramic squat toilet. A step-by-step manual. A detailed one. So much so that we are taught to face the correct direction, to take down pants to ankle, to focus and aim correctly. We laughed until we couldn't breathe.

Laughing aside, I didn't realize the wisdom behind that poster until our family talked about the dreams we had on the road. Well, my daughter's dreams were funny, and so were my wife's. "I don't know," I said. "I didn't have much interesting stories in my dream last night. Not much, really. I dreamed about rehearsing with my colleague who is going to appear in the coroner's court."

My wife could hardly believe in what I dreamed during the family vacation. She tried to hide her disappointment, and appeared to pity me for being such a workaholic.

My daughter nodded, hearing me. "Balance, you know, daddy. Remember the teaching we'd had yesterday: if you lose balance, you are gonna fall down on shit."


Wednesday, August 2, 2023

Fishing

My travel buddies used to bring us to go fishing during summer trip. A simple yet difficult-to-master pastime that gives us a more jolly experience.

Imagine drawing a line using the softest pencil you could find - I guess that would be a 6B or 10B. Now imagine the nearly invisible line to be cast into the sea or river. Lighter than you're thinking - all fishing lines are invisible but palpable. Stay still and feel for the thrill. You can't see it but you can feel it: the thrill of a fish bite.

I don't get hooked on the hobby of fishing but often enjoy the way I can connect with nature on a boat or canoe.

Calm water. Calm mind. Calm space watching wildlife. That much is the reason good enough for me to go fishing.

Saturday, July 29, 2023

Wildlife

To say Hokkaido has some wildlife is like saying Antarctica is a bit chilly.

Animals are everywhere in this northenmost island of Japan. In truth the only regret was that of not bringing my telephoto lens.

We ventured to find firefly and met one. Raft trip rewarded us with chance to meet all kinds of birds: white-tailed eagles and red-crowned crane. A ferry ride on Lake Akan ended up with meeting a yezo sika deer and a kingfisher.

What else can I complain about?

Friday, July 28, 2023

Garden

Before my current trip, I didn’t realise the route aptly named “Hokkaido Garden Path”, spanning 200 kilometres all the way to Tokachi and Rokka no Mori at the southern end. 

Taking Hokkaido Garden Path is many things: a way to feel the summer flavour of Hokkaido, to stop every few feet to press my camera’s shutter, the excuse we all need to slow down and touch the nature. 

But most of all, it’s just beautiful.

Glamping

For a long time I have wished to have camping in Japan. Now we know it’s more comfy and is named glamping. 

That’s glamourous. Less hassles and more civilised with car park within a stone’s throw. Simple as that.  

Turns out it’s like observing a digital Sabbath. We didn’t even have power socket within the camp. 

It’s literally like keeping our phones away or turning off notifications. We could hardly survived without two portable power banks. 

Next time I should have got a solar energy digital device. 

That’s how bad our addiction to electronics can go, I know.

Tuesday, July 25, 2023

Hokkaido

Hokkaido often reminds us of winter visit and festivals, none more famous than the Sapporo Snow Festival.

That being said, summer vacation at Hokkaido can be equally, if not more, thrilling than winter time.

Teens, parents, and those who aren’t afraid to get their hands a little dirty should have agreed with our pick on the first day of our Hokkaido summer trip. We first experienced forest adventure by pulleys and carabiners. Zigzagging our way on the rope ladder near treetop, we made turn after turn until the best part, when we flew like a flying squirrel on zipline.

Another real start to our adventure is sitting crisscross applesauce in an animal cafe where teacup pigs learn to socialise with humans. We touched them, cuddled them, and took selfies with them. These pigs, also known as MiPig, are cleaner, smaller, more friendly and beautiful all at once, unlike those we found in filthy sty. The MiPigs are smart. So much so that they can be toilet trained to pee in designated spot. Looking back, it should have been we who are learning to socialise with pigs, and not the other way round.

Saturday, July 22, 2023

Email

It's hard to say whether technology has made our lives easier or harder.

Email is one of the conundrums. Why does such communication technology make Yuval Noah Harari, author of his megahit Sapiens, lament over the illusion of progress in humanity?

Hasn't email make our lives more relaxed?

"Sadly not," Yuval wrote.

Now that I'm packing before my departure for my summer vacation, I don't struggle with what to bring but whether I should set up an "out-of-office" message. Yet such auto-reply is useless to resist hundreds of coomunications flooding my inbox. 

"We thought we were saving time; instead we revved up the treadmill of life to ten times its former speed and made our days more anixous and agitated."

I couldn't have agreed more with Yuval.  

Sunday, July 16, 2023

Goodreads

There is no right or wrong way to catalogue the books we have read, or to keep a running list of books we'd like to read.

It's sort of like personal habit of organizing clothes in the closet. Some keep the book list in their heads. My daughter used to draw a bookshelf in her notebook, and add one book after another. That's her hieroglyph system of pictorial writing book spines - not the book covers.

Keeping future reading list of books, as I have learned from educational consultant Phillip Done and reading expert Nancie Atwell, is authentic catalyst for strong readers. After I shared my habit of logging books digitally with my daughter this week, she became a big fan of Goodreads within seconds. She downloaded Goodreads and declared, "Impressive."

And it is. An impressive Facebook with books. And a social network which my daughter won't mind her dad to be follower.

Thursday, June 22, 2023

Kidnapped

We can't recall bringing our daughter to watch dragon boat races in Sai Kung. Other than walking along Sai Kung's waterfront promenade, one of our family's favorite activities in Sai Kung is visiting the bookshop with a funny name Kidnapped. We did both today.

Bookstores, especially an English-language one, are hard to come by in Hong Kong. Not too long ago, one of Hong Kong's oldest bookshops, Swindon, shut its outlet in Tsim Sha Tsui towards the second year of the coronavirus pandemic.

What makes Kidnapped a jewel in Sai Kung for our family is the way their books come without plastic seal on the shelf. As a book lover, I can testify that we can never judge a book by its cover, or blurb for that matter. I don’t have any data to back this up, but I bet customers are far more likely to purchase books without plastic seal. Maybe it's because the freedom to browse that drives our desire to read more. And if you are wondering, let me tell you we bought four books today.

Tuesday, June 20, 2023

Spiral

"Show them the league table."

I cringe recalling how many times I heard such advice intended to improve the grades or job performance. Am I supposed to advocate for creating pressure to conform? My brow furrowed and the crow's feet deepened as I struggled to understand any real good impact of such league table.

Curious if this might really do good, the award-winning behavioral scientist Katy Milkman analyzed reams of research, only to find the results otherwise. The league tables backfire more often than not.

Contrary to those who expect peer pressure to boost the results, she finds that league tables have been harmful. The pressure can sometimes be too overwhelming.

Imagine a social universe in which your colleagues or classmates are constantly oustripping you. Oh crap! You discover that you earned less, ran slower, tested worse, and your patients' length of stay in hospital paled in comparison to your peers. All these comparisons, and so many more like them, can be bundled up into one package called hopelessness. And hopelessness can be summed up in one word - deflation.

Sunday, June 18, 2023

Distancing

If you pick up a book on writing good plain English, you are going to be reminded the problem of starting a new paragraph using the word I.

It may not be particularly surprising to use words like I and me. But it's an accidental egocentric showing-off by using too much I. Too much I ends up looking like the Carmen Miranda song, I-I-I-I like you very much!

Here comes the example: I was going to get my flu shot when I bumped into an old friend.

We can re-write it as: On my way to get the flu shot, I bumped into an old friend.

Putting that I mid-sentence sounds far less intrusive. On another note, shifting from the I and disclaiming the me me me are serving a more important psychological purpose. Ask Elmo. When Elmo explains his commitment to the life of the mind, he favors constructions like "Elmo loves to learn!" Talking about ourselves in the third person, as I've learned from Daniel Pink's book The Power of Regret, is known as "illeism." An easier term for this strategy, as what social psychologists call it, is "self-distancing."

That's what I did after my laptop was stolen during my overseas training. It’s been twenty years and I still think about this nightmare. My slumped shoulders and devastated expression were heavier than two atomic bombs. To find a better way than rumination, I wrote email to my wife and friends, telling the story of KM instead of me. The fly-on-the-wall in me decided to zoom out and write in the third person. The distancing helped me to spend the next forty-eight hours doing everything I could to salvage the loss.

The secret of converting negative thoughts into third-person sentences, it turns out, is supported by scientific evidence. Third-person self-talk reduces worry and increases rational thinking, research shows. Randomly assigning people to use their own name, instead of "I", was shown to generate better fact-based reasons during the 2014 Ebola outbreak. Try it.


Sunday, June 11, 2023

Access

Three years ago, a dear secondary school teacher of mine was struggling with his worn-out heart valve. A normal heart valve is a smooth, glistening, pliable surface that seals off and then opens to the chambers of the heart with every beat. Blood glides over the normal valve. My teacher's heart valve roughened with age, and became a kind of stiff squeaky door stuck with faulty handle. Over time, blood could hardly go through the door. Every time his blood squeezed through the narrow thoroughfare, I could hear the unpleasant screeching sound.

After a while I began to realize that he could hardly survive without getting the squeaky valve fixed. Yet, to state the obvious, it's not as simple as fixing a door handle when we're referring to a door inside an eighty-something-year-old heart. It was a truly challenging operation, coinciding with our cutting non-emergency services to meet the demand from patients infected with the coronavirus. Improbable as it would have seemed to almost anyone else, we tackled his faulty heart valve by inserting an artificial one to widen the opening. All because of our talented cardiologists with state-of-the-art everything.

In effect, the artificial valve acts like a slip coupling for a leaking pipe. The more congruent, the stronger and more secure the case.

It was a big temptation to brag about the success, and sometimes I did. But after less than a year my teacher had a fall at home during a fever spell. Little did I know at the time how sinister that fever was. He didn't text me, as what he usually did in the event of serious medical problem. By the time he found me - after his getting delirious at another hospital - I knew it was something serious. So I took him back to my hospital without second thought, drawing blood myself on the way. Within two days, the blood came back to show sticky bacteria attacking his heart valve; he passed away three days later. "Why didn't he call me earlier?" I kept asking myself.

The situation with my courteous teacher isn't unique in that many patients of us don't want to bother the doctor too much. It's easier for our patients to get hold of our telephone number or email address - and maybe that of our secretary's, for that matter. I know what you're thinking. Who is this doctor kidding? Hear me out. I am not advocating doctors to dole out personal contact number like business card in a party. But sometimes it is worth the effort. Anyway, what's wrong with being accessible when most of our patients are reasonable? One of my patients could not come back from Liverpool in time, and had emailed to reschedule the appointment. After coming back to Hong Kong, he had bad cough and chest pain, but didn't find me again until his rescheduled appointment this Saturday morning. By the time I saw him, he was in such a bad shape I had to quickly get him into hospital, put a tube down into his windpipe and sent him to the intensive care unit for his pneumonia. "Why didn't he call me earlier?" I asked myself.

Saturday, June 3, 2023

Example

The coronavirus disease pandemic has demonstrated the unpredictability of medicine - and the extremely important chance to improvise teaching. The virus itself is a monster serial killer of elderly, many of them healthy and holding a test kit with two red lines one moment, crashing with breathlessness the next. Many vulnerable patients, mostly unvaccinated, oscillated between "okay" and downright critical, sometimes within an hour.

Throughout this crisis, I have witnessed a multitude of opportunities to "learn how to learn."

Blessed are those of us who have gone through such once-in-a-lifetime public health crisis. After watching this mysterious virus in awe, we have plenty of stories to tell our our young doctors. As I looked back at our efforts to overcome the pandemic, I realized that we have turned many services into teachable moments. In the early days while we were still working out the behaviour of that coronavirus, many senior doctors like us set up isolation wards to admit all new cases, taking careful steps to triage out who were infected, and who weren't. Then we let new and young doctors follow our example, including interns to admit cases.

Which, it turned out, was the far more satisfying teaching opportunity.

Tuesday, May 30, 2023

Mirroring

Every now and then, conversations between doctors and patients boomerang between questions and medicalese. Not many of us nod, and even more of them struggle to make sense of doctors' words.

There is a cultural difference in play, too. Not for the first time, I encountered Chinese patients speaking in Chiuchow dialect or accent. "It seems like you're coming from Chiuchow," I enthused. It wouldn't take long for my patient to figure out I'm also from the same heritage.

But why the digression during clinic consultation? What I hope to do is improving trust by concordance. I have learned recently how doctors can make patients feel at ease when we share aspects of culture and identity, including race. Emma Goldberg, the author of Life on the Lines, taught me the emotional bonds from sharing identity between doctors and patients.

In a nutshell, like attracts like.

On the other hand, Black men visiting non-Black doctors turned down flu shot offers more than those visiting Black doctors, even when offered money incentives. Similarly, when Spanish-speaking patients see doctors who speak their language, they're more likely to adhere to their prescribed medications. 

Doctors are, obviously enough, not just the sum of our technical skills. Our gender, our cultural backgrounds, our ages, our race, our personal history matter too.

Friday, May 19, 2023

Endoscopy

The guru of good habits Stephen Covey once wrote, "Between what happens to us in life and our reaction is a space. In that space lies our power and freedom to choose our responses. In our responses lie our growth and happiness."

He had a point. It's often far more difficult to choose the weather of our mind than it is to wait for perfect weather. With that concept in mind, I've been learning not to control everything, but to control how I feel and react. Regardless of what the weather is like, I choose not to feel under the weather.

Recently, stomach pain woke me up twice. I realized that it's better to get an upper endoscopy examination. That means inserting a tube with camera through my mouth and into my stomach. That isn't a terrible medical procedure but most of us can think of a dozen reasons why we should have sedation medication: to help us rest and relax, to avoid discomfort, to go asleep without remembering the tube scratching the throat.

But then, I wish to go back to work immediately after the endoscopy examination. I did that today and sailed through the procedure smoothly without any need of sleep medication. Fifteen minutes and - ta-da! - I was back to clinic seeing patients.

Saturday, May 6, 2023

Break a Leg

I was discussing with my daughter the meaning of the English idiom "break a leg' the other day.

She thought about the context of wishing luck before an audition. That way the "breaking leg" grants you the chance to be "in the cast."

Maybe she's right. Maybe I should not entertain such a question. And man, the story of "in the cast" turns out to be true. Within two months, my daughter broke her leg. Not in an audition, though. After sports injury from ankle inversion, it looked like a golf ball had been seen into her ankle. She ended up in a cast this week.

I went back to get the crutches, which have been passed from one colleague of mine to another in my department. It makes me think of the children's game known as "musical chairs." That's how it works: everyone gets the chance. My daughter's turn this time. Uh-oh.

Saturday, April 22, 2023

Filter

I'm nerdy enough that I had to learn from my junior about Facebook some years after Mark Zuckerberg launched the social media. I have never installed this social networking app in my smartphone, with the hope that it can minimise addiction. I knew nothing about Tumblr or Snapchat. And until recently, I didn't quite understand the knack of using hashtag.

After my daughter asked for our permission to open an Instagram account last week, I decided to read about the story of Kevin Systrom and Mike Krieger.

By the end of the first few chapters of the book No Filter, I have already got more idea how and why I made use of Instagram, Facebook and Twitter.

For Instagram, I somehow craft it like a coffee table with magazines. Instead of inviting Instagram followers, I exclusively browsed photos of Lonely Planet, National Geographic, Runner's World and birds. That much is good. And this is the easiest way to enjoy photos of wildlife, kingfishers and leisure activities.

For Facebook, I use that as a gallery or diary with pictures of mine. Although posting photo on Facebook is more a hassle than using Instagram, the upside of this social media is the way it chronicles our memory like a diary.

For Twitter, I build my account to become a medical "knowledge tank". Following academic accounts such as that of the New England Journal of Medicine and the Infectious Diseases Society of America automatically helps me stay abreast of the most updated journal publication and conference materials.

I don't know if this system of categorising apps works for you, but this is perfect for a nerd like me.

Wednesday, April 19, 2023

Anniversary

The reason to take a day off on my 23rd wedding anniversary today, I would have thought, is self-evident. I'm sure there are hundreds and thousands of reasons.

So: because of the fundamental importance of we-time. That is the reason. And more important than me-time.

Also because, in this particular case, of being grateful for my wife's willingness to tolerate a difficult guy: a guy who doesn't drive and have enjoyed his passenger status for more than two decades; a guy who works for longer hours than Meredith Grey; a guy with a cluttered desk and messy home.

A more immediate explanation is to say that I'm thankful for about my wife.

Monday, April 10, 2023

Wallet

I lost my wallet yesterday evening.

When I found about the missing wallet and thought about the credit cards and the Octopus card, I felt the flutter of trepidation in my gut. I paced around to search, and wished that my wallet was hiding somewhere at home. Except it wasn't.

Stomach in knots, I was seized by the urge to call the bank to cancel my credit cards. Deactivating all cards would make sense, that much is clear.

A small voice inside me than said, "Excuuuuusee me, can I have a reason to feel hopeful about retrieving my wallet?" No sooner did I make up my mind to report lost cards than I thought of something better: a global study on the likelihood of returning lost wallet. I learned about this study from the book Collective Illusions.

The behavioral scientist researchers conducted a series of experiments to calculate the return rates of lost wallets and published their results in Science. The researchers "lost" over 17,000 wallets in 40 countries. Each wallet contained three business cards with a clear ID and an email address, a key and a grocery list in the local language. Some contained no cash; others held about $13; and others contained $100. 

And what did they find? In almost all countries, people tried to return the wallets. In all but two countries, people tried even harder to reach the owner if there was money inside. The more cash, the better return rate.

The little-known moral and altruistic nature of human is best reflected by another survey conducted by the same group of reseachers asking people to estimate the return rate based on whether the wallets contained no money, $13 or $100. Both laypersons and professional economists projected a lower return rate for wallets with money, and the lowest when there were more money. The opposite is true, as it turns out.

Putting these findings together, I decided to temporarily block my credit card and wait with a jolt of optimism. So when twelve hours passed and I hadn't received news of my lost wallet, I began to get a little edgy. Okay, I worried.

I got a phone call more than half day after I lost my wallet, and was told that a stranger wanted to return my wallet. I hadn't even noticed that my mouth was hanging open.

Sunday, April 9, 2023

School

My daughter has graduated from a primary school many of us wished to have graduated from.

Her school is great; everyone says so.

In case you're wondering whether the kids' parents have chance to graduate from this school, here's the answer: Yes. Some of us. Luckily or unluckily.

You won't believe this, I tell you. We have arranged a "graduation ceremony" in the school hall for a parent of my daughter's classmate. That is, sadly, a ceremony or memorial after she died of stomach cancer last year.

Which means, of course, that the school serves like a close-knit family for the students. So much so that, when my wife has committed to get baptised, the church has borrowed the school venue for this important moment.

A moment, and a school for that matter, we won't forget.

Friday, April 7, 2023

Easter

This Easter weekend is unquestionably one of the longest holidays for us since the lifting of pandemic curbs on travel. That means thousands of Hong Kong travellers heading to airport this week. Our family don't.

Make no mistake. Our family remains happy in our own way at our hometown. We didn't let an overcast sky ruin our holiday. Heading to the cinema offered us and our daughter a chance to watch the Japanese animated film Suzume directed by Makoto Shinkai.

Once the rainy day got less rainy, we quickly took advantage of the not-too-wet weather to have a constellation of outdoor activities: hiking, beachgoing, kite flying and cable car ride. 

I learned this richest of lessons that it's never a mistake to take days off when my daughter has school break, and for that, I am grateful.

Saturday, March 25, 2023

Club

I have been raised in a family at the grassroots level. 

That means a guy who doesn't care much about extravaganza. So much so that I didn't realise my shoes are nearly coming apart until today afternoon. 

Luckily, our family and my wife have never been jealous of those premier or elite club membership. Last night my wife joked that we are proud members of the Boys’ and Girls’ Clubs Association, and that of YMCA. 

We wear that kind of membership as a badge of honour.

Saturday, March 18, 2023

Advertising

The last thing a doctor wants to admit is his or her being heavily influenced by advertisements of the pharma business. After all, medical doctors' prescribing behaviour is supposed to be pretty neutral and scientific.

But the awkward reality is that when it comes to pharmaceutical marketing strategy or advertising, doctors' neutrality aren't difficult to undermine. Not everyone believes in this. In no corner of doctors' mind, too, is there even a vague notion that they can fall trap to marketing of gangbusters business.

This is perhaps the good reason I have to read Patrick Radden Keefe's book, Empire of Pain. You should, too. The New Yorker staff writer will tell you how doctors are being influenced by the marketing to keep prescribing Valium, and then a far more dangerous drug OxyContin.

The book brings my memory back to a short article I published twenty years ago. That's the year when I could afford more time in the library during my once-in-a-lifetime overseas training in Montreal. As it happened, I had a chance to dig out four major medical journals targeted for family practitioners (American Family Physicians, Canadian Family Physicians, Journal of Family Practice, and Postgraduate Medicine). Meticulously, I counted the number of pages and frequency of pharmaceutical advertisement to anti-bacterial drugs between calendar years 1984 and 2002.

To the casual observer, rising frequency of advertisement for an antibiotics class called fluoroquinolone, from zero to 37.5 percent, might have appeared to be nothing remarkable. But the interesting finding of mine is that there was strong correlation between such advertisement frequency and the contemporary national fluoroquinolone drug resistance rate to the bacteria, Streptococcus pneumoniae, that commonly invade our lungs and cause middle-ear infection. The two nearly identical curves go in tandem, one following another. The more advertisements in the pages of prestigious journals, the more use (or over-use) of fluoroquinolone antibiotics, and the more antibiotic resistance.

Truly a fact more than chance.


Wednesday, March 8, 2023

Oddball

Photography is a minefield of oddball and obsession, and I'm no exception. 

These will mean nothing to you, I know - they would mean nothing to most people unless they happen to have a family member who is obsessed with taking photos - but my family will tell you the story.

Similar story is told in the book Running Home, authored by Katie Arnold whose father wore his camera everywhere he went, like an extra appendage. Slung around his neck, the Nikon was part of his dress code, just like mine.

A wave of embarrassment washed over me, when I read how Katie made fun of her dad for taking too many pictures. According to Katie, he never took just one - never. "One more shot," he'd murmur as the shutter went click, click and the daughters held their positions, eyeballs rolling back in their heads with exasperation, faint smirks twitching at the mouth corners. "Okay, just one more, one more."

The scenario and conversations aren't verbatim, but they're pretty darn close to what I did (and do).

Sunday, February 26, 2023

Parents

I have been busy with infotainment video shooting this weekend. Many colleagues of mine helped. As parents, we found the best subjects of our conversation being our children.

We don't know when we first discovered that childhood goes in the blink of an eye. So much so that we all start to miss the opportunity, one way or another, when our kids grow out of something now and then.

I know exactly how it feels when Fredrik Backman writes about a father driving to his daughter's new college dorm room in the novel The Winners. The father went to help her drill holes in the wall for bookshelves. He was the one who was there, and he was so pleased with himself when his daugher whispered: "Thanks Dad, what would I do without you?" The holes ended up a bit wonky, though.

The next time the father visited, the shelves were straight. The daughter had bought a drill and fixed them herself. She never told her father because she didn't want to hurt his feelings, and he coughed to clear the lump in his throat and pretended he hadn't noticed.

Well, maybe I will be like that father with a lump in the throat one day.

Saturday, February 18, 2023

Downtime

I'd spent almost one whole day at a public housing estate shopping mall as volunteer to talk to the public. By the time I returned home at evening, I felt guilty for leaving my daughter alone. 

In no way did I think we should talk about her homework. We all need unstressed periods of downtime every day. "I love you too much to fight with you about your homework." This is the title of a chapter in the book The Self-Driven Child: The Science and Sense of Giving Your Kids More Control Over Their Lives.

I have learned about the importance of downtime. Think of downtime as anything relaxing or rejuvenating, nothing purposeful, all of which are powerful for maintaining a healthy brain. We sat and shared caramel pudding, followed by a board game Battleshhp. 

As simple as that. 

Wednesday, February 8, 2023

Transformation

Clad in his sports T-shirt, emblazoned with gym logo, Anders is a white character in Mohsin Hamid's short novel, The Last White Man.

One day, he was horrified to find his skin turned dark on waking up. As much as Anders wished it's a nightmare and waited for an undoing, the answer from his mirror image and selfie picture unfailingly suggested there is no turning back. White became black.

Lest you think it's a Kafkaesque fictional scene, I have to tell you my recent experience in real life. I grappled with transformation on waking up, the way Anders did. I found my near vision lost on walking up this Sunday. The book starts to move further and further away, more or less like how the hairline moves away with age.

I came to the inescapable conclusion that it's time for me to buy bifocal glasses. Which continued to bother me. Nobody wishes to find a decline in near vision, least of all by a voracious reader. I was chagrined at calling myself a presbyope. Kübler-Ross was hovering over the room as I looked up state-of-mind analysis publication on how people felt about presbyopia. The best part of verbtaim analysis is that we can listen to the way each individual frames his or her life event. The sad part is that I have to agree with one of the social media posts "I feel that my arms are now too short."

Sunday, January 29, 2023

Repose

Much as thought-leaders had described, travelling opens our mind. We slow down when we travel. We open up when we slow down.

That’s what I did after I’d taken a week off. Of course, a family vacation during Chinese New Year means opportunity to relax with far fewer unread work-related emails.

The first thing I notice is the number of blog posts written. Next, I watch myself shaking things off like Taylor Swift’s hit song “Shake it Off.”

I leaned back, gazed out the window, and watched the snowflakes. That’s the time when everything - except my hair - has turned white.

Saturday, January 28, 2023

Swing

With lesser and lesser pandemic restrictions, borders have reopened in many places around the world. Our family have longed to travel since three years ago. 

The silver lining of all the hiatus in luggage packing is that I have found my daughter grow up a great deal when we are on the road again. So, when we were taking Shinkansen bullet train from Narita Airport to our town, she did most of the luggage carrying and moving. I saw her preparing own luggage, bringing her diary and picking the snow gears. 

Without realising it at the time, I’d come to travel with an independent daughter, in large measure. It would take some time for a daddy to accept this. Before we headed back home this morning, I took my daughter to a playground near where we had been staying. Without anyone telling us to do so, we made a beeline to the swing. She quickly wiped clear the snow and enjoyed her swing. There’s something magical about swing in playground - jumping on the seat and riding high, for anyone with any age and of any race. As she stood up and asked me to push her, I felt like being on cloud nine. I’ve discovered that I still treasure the way a daddy can be serving the way one does for a toddler.

Friday, January 27, 2023

Snowboard

Who doesn't hesitate to try something new?

No one is born a skier. We are all, at one time or another, going to stumble before getting used to the ski. Now that my daughter is pretty comfortable on ski slopes, her next activity would be snowboarding. It isn't easy. Landing on the butts again and again can be achingly frustrating. That requires patience. And perhaps a mindset to stay low.

In our quest to encourage her to learn snowboarding, we have bolstered learning by watching YouTube video last night. Learning snowboarding by YouTube might not be as easy as learning a language by Duolingo, or learning algebra from Khan Academy for that matter. But that's the most popular experience of learning nowadays. As an intro tutorial before the on-the-ground practice, at least, for my daughter.

We rented the snowboard gear and let her try. She fell. She tried. Along the way, she had toppled over - a lot. One after another, step by step, she found her way on chair lift, and maneuvered her way down the slope. And another. And another. Many times.


Tuesday, January 24, 2023

Ski Pole

I don't think I am a good skier, and even more so after our family encountered heavy snowfall in Japan this week. 

Skiing in a cold snap has cost me heavy lactic acid load today after repeated falls and pushing up from snow.

For a novice like me, learning to ski is tough. The older you grow, the tougher it is. I struggle to remember ski technique 101: learning which leg I have to put my weight to make parallel turn, to lean forward but not back to avoid falling, and how to position my skis and poles to get back up after falls. Getting off-kilter on ski track, believe me, is as scary as accidentally pressing the WhatsApp group call and fumbling to find the cancel button.

Thankfully, my family ski trip started after my recent reading Tom Vanderbilt's Beginners, an inspiring book for a lifelong quest of learning, at any age, and on any subject. As I took the chairlift with my daughter, I was brimming with pride. Not a proud and professional skier. More as a proud dad who can share the precious moment of learning together with my child. I knew that I would struggle. That I would fall. But the joy on the ski track with my daughter has made my life feel richer.  


Friday, January 20, 2023

Taylorism

I love the New England Journal of Medicine story told by Jerome Groopman seven years ago. The title of that article, Medical Taylorism, rhymes with "medical terrorism."

Misleading as it may seem, Taylorism in the context of medical care can be threatening. And make no mistake, we know that Frederick Winslow Taylor wrote the most influential book on management: Principles of Scientific Management. Since his book came out more than a century ago, business owners around the world, Toyota included, have embraced Taylor's approach. He believed in devising a system as machinelike as possible, a factory assembly line as standardized as possible, a conveyor belt as precisely timed as possible.

Does this sound familiar to the clinical pathway, also known as integrated care pathway, in the healthcare system? Believe me when I say they are.

Keep that image of Toyota manufacture factory in your mind. Each of the factory employees work repetitively, precisely and strategically. To do this in the clinic, we can have a standardized electronic health record like Toyota. Press a button when a diabetic patient enters the consultation room, and presto, the computer will have a template consultation page prepared automatically. The doctor won't even have to type extra keystroke to have all the laboratory results filled in the boxes.

I can't tell you how many times I have deliberately deleted all those templates and came up with my own paragraphs in the clinic notes. Ask Jerome Groopman, and he will tell you Taylorism doesn't work in human patients. "If patients were cars, we would all be used cars of different years and models, with different and often multiple problems, many of which had previously been repaired by various mechanics."

In other words, none of our patients want to be treated like a Toyota car. None. Zip. Never.

Sunday, January 8, 2023

Goat Cheese

We are the proud record holders for the most teen sleepover parties during this pandemic. Mentally healthy as it may seem, gathering activities like sleepover are often skipped when Omicron strikes us. Our family, and that of my daughter's classmates, are heartily convinced by what Priya Parker has written in the book The Art of Gathering: How We Meet and Why it Matters.

We didn't want to deprive our children of chance to meet friends. And then, wonder of wonders, we had invited one, two and even three buddies of my daughter to come for sleepover. You can imagine the way we experimented with breakfast choices. Once we prepared Cantonese sponge cake and dim sum. It turned out that my daughter's friends from Greece and France didn't find our choice match their taste buds. And that's fine. Teenagers are mature enough to be grateful and yet honest enough to tell their preference. Telling the truth seems reasonable enough but then it is far from the truth for grown-ups.

I'm reading a psychology book about collective illusions. I learned about the author's joining a summer wine and cheese taste party in his postgraduate days. That was a story when he met the Ivy League stereotype, a guy called Ambrose whose last name was followed by the Roman numeral III. Ambrose wore a navy-blue tailored suit with a crisp white pocker handkerchief, topped off with his usual bow tie. A wealthy and cultured guy, that is. Smart, yes, outstanding, maybe, but never aesthetically wrong. As Ambrose entered the party, he quickly pinged his wine glass with a cocktail fork to call for attention. "Hi, everyone!" he announed with an air of superiority. "Just wait until you taste this! It's a rare vintage from a family friend's vineyard in Sonoma. I recommend getting a fresh glass." Everyone in the party dutifully followed and received a few ounces of the ruby-red wine. They took a sip and looked at the others, all of whom nodding their approval. The wine actually tasted like weird rancid vinegar. Ambrose was satisfied, that’s for certain. He remained so until a statistics professor, a true wine afficionado, arrived and took a taste. The professor immediately spewed it out onto the glass. "This is corked wine," the professor stated matter-of-factly.

"Corked" wine is tainted with a molecule known as 2,3,6-trichloroanisole, which makes it smell like anything from a wet dog to a dirty restroom.

That brings me to another story when it's my daughter's turn to have pajama party at her friend's house two weeks ago. They made their own salad breakfast. The host family served goat cheese with salad, and many of them talked about how delicious goat cheese can be. In fact, everyone liked goat cheese that morning. Everyone, that is, except my daughter and her close friend. My daughter averted their eyes, took the smallest possible nibble of goat cheese with a sheepish smile. After a few swift kicks under the table, two of them confessed how somebody can think less of goat cheese, and then laughed out loud.

Sunday, January 1, 2023

Journey

Few things in the animal world fascinate us quite like bird migration. 

The feathered globetrotters' journeys are packed with energy and stamina. My recent reading about bird migration includes classic annual outward and return "flyways", "loop migration" with a different return journey, or even "migratory divide" meaning more than one route for some species.

One of the evolutionary eurekas that go with migratory journey is the advantage of moving. At a glance it might seem that the exhausting migration is hazardous. It's hard work, mentally and physically, with long, chaotic hours. The truth is, however, that survival rates among sedentary species - those that stay put over winter - are often lower than among related species that migrate. It's not just birds which have to migrate to survive. We too have our own need. As I keep working for the last two weeks - fourteen days in a row without break - I know very well that pattern doesn't confer any survival advantage.

Similar to birds that migrate to find resources to keep them alive, I have tried to depart even I'm obliged to return to hospital daily. Instead of undertaking the long haul African-Eurasian or Asian-Australasian flyway routes, I strike a balance between moving and staying put, and made short hike to a mountain nearby. Not once but twice, in different direction.

Believe it or not, moving around is the best way to fill our tank with fuel to strike for survival.