Desensitization

Bumps on the road make a rough ride. Such bumps plague many of us, but they shouldn't - once you get used to the bumps.

One of my patients reported a history of itchy bumps 30 years earlier associated with taking penicillin. When I saw him I found a strain of bacteria in his blood. The bacteria lurked in his bone marrow, nodding with a grin, knocking off my patient's kidneys. Shaken, his defenses down, my patient had fallen over like a drunkard. The best way to tackle that bacteria is ampicillin, an antibiotic belonging to the penicillin group.

Ahhh.

For reasons that I will never fully understand, giving an antibiotic to a patient who recalls allergy has now come to the top of the seven deadly sins in our hospital.

"I know," I murmured, meaning both things: yes, it's no good to commit a sin, and yes, I will go ahead anyway. I gave my patient ampicillin after a trick called desensitization. Desensitization means breaking the drug prescription into manageable pieces, starting with a spoonful of very, very tiny dose, usually in terms of micrograms. The whole process involves doubling the dose every 15 to 30 minutes. We work on one at a time, bit by bit, until the desired dose is achieved. At the end of the day, the patient develops tolerance to the antibiotic. Hurray.

The lesson of antibiotic desensitization, in fact, applies to many subjects in our life. Oh, apply the same strategy of desensitization, and you'll find yourself developing tolerance to a long list of disagreeable evils, such as your mother-in-law. Or, to paraphrase Mark Twain, education consists mainly in what we have unlearned.

Rule

The most important sentence in any article is the first one, we are taught by William Zinsser. The most important rule, again, is the first rule of any kind. Consider the book 50 Rules Kids Won't Learn in School. My favorite among the fifty life lessons given by Charles J. Sykes is the Rule 1: Life is not fair.

The average teenager, I was told, uses the phrase "It's not fair" 8.6 times a day. Somewhere behind these complaints about unfairness is an implicit wish that life would be much happier if it is fair. Is it?

Sure, life seems unfair. But so do lots of things. Unsightly mole and acne on our face, or receding hairline, for instance, seems very unfair. A quick fix, you might have thought, is to ask for a better control of the unfairness of the world. The obsession with our request to make this world a bit more fair simply ends up with a burgeoning number of rules, say, in the design of doctor duty roster, the compensation rules from the High Court and Court of Appeal judgments – you name it.

If we could calculate an unfair awareness index, it would be marching toward an all-time high. The mere thought of the spectacular increase in the rules for generating doctor duty roster provoked a shot of pain behind my jaws.

My brow furrowed and the crow's feet deepened as I struggled to remind myself that what we can control is the way we react – but not making this world any fairer.

Tea Box

Everyone trusts old wives' tales. Our grandparents trust them. Mothers trust them. Most of all, doctors trust them. Even I trust them.

There are rules for doctors, I know, under the big name evidence-based medicine. What a splendid name to practice medicine, you must have thought. And who won't? The way to treat my recent febrile illness, of course, turns out to be a far cry from the evidence-based medicine. I was sick upon my way to work two days ago. I felt like a roast potato sold by the street tradesman, running a temperature on the pushcart but shivering in the depths of winter. My bones ached for aspirin, and so did my head. Without second thought, I went to buy the herbal tea that comes in a tiny paper box. The truth is that I have no idea what that box of tea is. I don't even reckon that another name for it is Kam Wo Tea.

One thing I haven't told you about my old-wives' obsession with that tiny box is that I first drank the herbal tea fourteen years ago. I was working in a surgery department as an intern at that time. Well. I was no better than a small shivering potato that morning when I went to my ward with a high temperature - and backbreaking load of work. Even so, I dared not to be off sick. There can be no more absurd invention of having a fever-stricken guy taking care of thirty-odd patients. Exhausting as it was to work it out, I tried not to appear sick. Later that afternoon, the night sister was off duty and bought me a tiny box of herbal tea. And then the miracle happened. I got my energy back after drinking that herbal tea. That's the gift I remember till today.

I didn't bother to find out how - or whether - the herbal tea cures my ailments. Whenever I get sick, I simply think about and drink that same box of herbal tea. It's a good old wives' tale for me to keep. It has kept me from getting any sick leave over the last fourteen years.

Report Card

I talked earlier about resetting my thermostat during university days. But it was before my primary school graduation when I realized for the first time in my life that I was capable of pressing the amazing reset button.

Looking back on my primary school days, I don't recall much except my mediocre academic performance; I just know I always ranked more than ten in my class. At any rate, I remembered the soccer league tables far better than what the teachers said during the class.

Then one afternoon in my final year, out of nowhere it crossed my mind to feel that the odds of getting a perfect report card were almost zero. I could only take that last chance before leaving my primary school. I am not quite sure how I did it, except that I fell sick before the final year examination. Still, I managed to reset and rise to the top among all the eight classes in that year.

If I were to give a slide show of the next six years in my secondary school, it would begin with my report card. I brought home a report card ranking me the first in the class nearly every time through secondary school.

I felt changed and reset, and a little weird. I know.

Reset

Needless to say, nephrologists talk a lot about the blood's salt or sodium content. We teach our medical students that kidneys help to keep our body's solute (composed primarily of sodium) concentration or so-called osmolality within a narrow range. No more, no less. It would be hard to imagine how nature works it out to keep everything in such a fine balance.

Now. Maybe you think our body is too unwieldy or rigid to operate only within a narrow range of osmolality. "Why," you might ask, "isn't life constructed to get along okay with a wider range of osmolality?" Ten points and a gold star if you ask this question. And it makes sense. It turns out that some people are doing perfectly fine after resetting their osmostat, and live happily ever after with a lower blood sodium concentration.

Speaking of reset osmostat, this concept is a gem of wisdom on the way to live our life. Which brings me to the story of resetting my thermostat. I remember how I shivered during each winter when I was a child. My mother used to say that I was the most "utterly lazy cold-blooded animal." I simply looked like a stationary lizard when the temperature plummeted. A lizard flicks the tongue out of its mouth only if necessary. And me too. I sat in front of my textbook with my hands buried in my pocket, and then turned the page using my lips.

My hibernating life cycle continued until my travel to Beijing during the university winter break. I was twenty, enthusiastic with my first ever trip on my own. It was that winter I first saw snow. That helped. More than anything else, resetting my thermostat after return from the snowy trip gave me the energy to wear less and less at winter. I soon went to spend one of the subsequent winters learning ski and dogsled across snow-covered lakes in a Outward Bound wilderness course in northern Minnesota.

Decibel

One of the best-kept secrets about communication is that we always turn a deaf ear to the loudest, outrageous, unceasing, honking, banging, screaming voice. Few things are easier than making a big noise, and few things are harder than keeping our volume low when we're making requests.

Uh-oh, you thought I'm referring to our Chief Executive's deaf ear to the protest about express rail fight. That's undeniably true – up to a point. But it's also true that similar stories can be found anywhere. I woke up at four this morning to feed my six-week old daughter, and then heard the low battery ring tone of my mobile phone. Well, the signal is simply as soft as a cat meowing. They needed help. That's what came to my mind when I heard the meow. I fed the mobile phone as well as my daughter, no questions asked. In two hours, my alarm clock shouted at the top of his lungs. And no prizes for guessing how efficient I was to give a good hit at the snooze button and go back to sleep.

How much that has to do with the noisy alarm clock and how much with my falling into bed weary to my bones after feeding in the wee hours, I cannot say. But surely there is good reason to feel and react differently to the varying loudness of requests. Given my beeper's noisy way of indicating the low battery status, for example, it should come as no surprise that I seldom replace my beeper's battery right after hearing that uproar.

Eggs on My Face

There's a good chance that you agree with me that hard-boiled egg doesn't taste good. Of all ways created by human beings to prepare an egg, none is more humdrum than a hard-boiled egg. But I'm pretty sure not too many of you would have difficulty with the know-how to boil an egg. I have.

When it comes to making an egg, I have no problem with cooking a fried egg, scrambled egg or omelette. Now that my baby has arrived, I have to prepare hard-boiled eggs for the celebration pot with sweetened black vinegar and pork trotter. I ended up plunging my eggs that came straight from the refrigerator into boiling water. I can almost hear you scream. No, before your scream, I heard the crack of my eggs first.

Go slow, at least in certain situation. That's the lesson I learned from my eggs.