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.

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?

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.

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.

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.

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.

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.