Signs of Life

Hospital is a messy place, where trivial symptoms can turn nasty within minutes. And even messier in July.

It's hard to get too excited about July. Hard, that is, unless you've never met new doctors. They were medical students who have completed rigorous training for six years.

But do we actually grasp the know-how of being a doctor after graduation? Hardly.

I have been reading the story of an intensive care doctor, Aoife Abbey, who reminded me the first time we experienced fear as a doctor at work. My first job as an intern was on paediatric care ward, and for obvious reasons, it took me quite a while until the issue of a dead patient presented itself during my internal medicine rotation. Both Aoife and I were confused and frightened by the steps we had to go through to verify death for the very first time.

What did Aoife do? She stared. The more she stared at her patient, the more she became convinced that her patient was going to open her eyes. Aoife pictured them snapping open, her hand lurching towards where she had her hands on her neck, and her grip closing itself around her wrist. She stood frozen, waiting for the requisite two minutes to make sure there was neither respiratory effort nor heart beat. After the ordeal of two minutes, she raced out of the room, heart pounding.

I wasn't any better than Aoife. After my first announcing death of a patient, I had to convince myself that I did everything properly until I was taking a short nap in the hospital call room. My patient woke up and went straight from mortuary to find me in my dream. My heart was thumping like a cat in a clothes dryer, when my patient stared at me, face crimson with rage, "Doc, why did you certify me when I wasn't dead?" After the nightmare, I never went back to sleep that night.

Alaska

Bears killing you faster than pistol, daylight shorter than the runtime of the movie The Lord of the Rings, and winters darker than shit.

That's Alaska.

I haven't been there but experienced the harrowing story of a teenage girl Leni moving to Alaska during my recent reading of Kristin Hannah's novel The Great Alone.

Alas, the life of Leni is even spine-tingling than the hardship of Alaska. Leni didn't have much difficulty in mastering the skill of shooting to keep herself safe and stay at the top of the food chain. Her biggest challenge is to live with a troubled dad back from the Vietnam War. A six-feet-tall broad-shoulder man volatile with smell of alcohol and impulsive from POW and PTSD.

My heart ached with the Leni's family tragedy. The way Leni's mum getting her face purple and her eye blackened, her lip torn and nose broken, showed me how human brutality can be a lot colder than the temperature of Alaska.

Injury

Good writers bring us up and down a repertoire of life events. At the very bottom are bloody stories of injury, such as the Good Friday when Melanie Reid fell from her horse.

The moment Melanie, the journalist with The Times, was pinned to the ground with a broken neck and fractured lower back, she knew it was catastrophic, fully aware that her life as she knew it had ended. She chronicled her nine years of daily life following her chestnut mare accident in The World I Fell Out Of.

Her legs froze. Her body numbed. Her arms felt stiff, and her feet were swollen. 

My, what could have been worse? Tiny drops of sweat during her challenge to use a pair of tweezers to lift coloured beads to place on pegs (after loss of motor function). Rivulets of tears after struggles to go through crash of blood pressure and heartbeat (after loss of autonomic nervous system). Pools of pee from leaking bags.

Melanie's description of her spinal injury and tetraplegic life moves every reader. So terrifying and haunting is her irrevocably damaged life that I felt nothing out of my injury. My previous knee injury from ski, my midfoot fracture last year, and that of my recent problem with posterior tibial tendon supporting the arch of my foot. Those are trivial. No story is sadder than the one told by Melanie Reid.

Grebe

If it looks like a duck, swims like a duck, and quacks like a duck, then it probably is a duck.

Or is it?

The vibrant spectrum of plumage in the bird world often fascinates us with surprises. That's how I had the duck test during a recent trip to birdwatching site near Sheung Shui. Beneath the shade of giant lotus heave pad, a small water bird with deep chestnut cheek was swimming like a duck.

Before the what-I-thought-to-be-duckling disappeared with a dive, I just managed to take a picture. That turns out to be a little grebe but not a duck. Despite the similarity to loons and other water birds, recent DNA research shows that the grebes' closest relatives are flamingos.

That's a big surprise.

Actually, I shouldn't have been.

As biologist E. O. Wilson once said, when you have seen one bird, you have not seen them all.

Debate

Adam Grant once described the mantra of karate this way: "never start a flight unless you are prepared to be the only one standing at the end."

When I met the secondary school students coming to medical school admission interview yesterday, quite a number of the interviewees highlighted their hobbies, most often debating, less so for karate.

When details of debate championship appeal to the interviewees, I would let them go on to expound on the impressive number of debate tournaments they won. To make sure they understand the downsides, of course, I would then debrief the students. I acknowledged their skill but went on to walk them through the collaborating doctor-patient relationship, as opposed to the way a doctor who marshals his or her best arguments to win a debate.

It's one thing to convince patients to do what a doctor thinks should be done. It's another to approach in an adversarial die-hard debate argument. 

A good doctor, in other words, shouldn't be too strong-willed to perpetuate a defend-attack debate spiral. He or she should be the one prepared to listen and rethink.

Instinct

Seldom do I get home from work before eight in the evening. I did so today.

After spending an afternoon examining doctors, I left the examination venue without heading back to hospital. On my way home, I visited the public library to pick up a reserved book. That's a must-read: Think Again by Adam Grant.

Cognitive skills from the book reminded me of our examination in which candidates are being asked to give their medical diagnosis, and then second-guess when the first answer doesn't fit the scenario. In other words, rethinking is central to the game of finding out the answer. Unfortunately, the first instinct of many doctors is to stick to the first answer, and prefer not to change.

Which brings me to the Eraser Study at the University of Illinois at Urbana-Champaign, where psychologists counted eraser marks on the multiple-choice midterm examination taken by more than 1500 students. If you think revising multiple-choice test answers will hurt the score, think again. Many a time, revising the answers makes sense. Only a quarter of the changes were from right to wrong, while half were from wrong to right.

This is a lesson that runs so contrary to human nature, or at least to many examination candidates, that we need to be mindful of: the ability to rethink and unlearn.