Take a few minutes to recall the photograph of the three-year-old Syrian refugee boy, Alan Kurdi, lying dead on the shore with his face turned to one side, and that image immediately pulls at our heartstrings. The image stuck with me and still haunted me three years after it made global headlines. That's a disheartening picture I'd never imagine sharing with my daughter. I might have fallen prey to unhealthy overprotective parental style - but who won't?
At the same time, I know I should not hide all news stories from my school-age kid. For example, I am not terrified of talking about twelve Thai boys and their soccer coach who were trapped inside a flooded cave. What makes this story even less scary is that they have now been rescued. Phew.
When it comes to teaching kids to face fears, the best way is explore the subject with a picture book written in a simple, child-friendly way. If you want to explore the subject of refugees with children - and there are good reasons to do so even if you aren't asylum seekers - the award-winning book My Name is Not Refugee is a must. After reading this book with my daughter last night, I've come to realize how a much-needed storyteller can create a comfortable read and yet with a just-right level of tension.
Thursday, July 12, 2018
Wednesday, July 4, 2018
Parable
Parables have a way of creeping into our learning - they're going to stick deeper and longer than any lecture.
Most of the time, without our even realizing it, we've learnt profound lessons after listening to the story of two mice who lost their cheese in a maze. Or that of a Samaritan who happened to bump into a traveler who had been beaten up.
Storytelling holds the key to a good teacher, and works wonder with children and adults alike. Consider the parable from The Napkin, the Melon & the Monkey, a book I've read this week. Here you'll meet Olivia, a new hire at a customer service call centre. Open any page of her diary and you'll find a stressed-out working mom who is messed up with her sons' fight at home and the barrage of angry calls from frustrated customers at workplace.
"Hopeless," Olivia cried, and shook her head. She said the word as if it were a synonym for life. "Are we doomed to just stumble through life unhappy and confused?"
Then she learned an important "aha" from her call centre colleague. "For the ten problems of life - family troubles, work problems and money worries, finding your way in the world - I have no solution. But you have an eleventh problem. For that one I have help."
What's that eleventh problem? "The eleventh problem is your view that you should not have the ten problems. You can never get away from life's problems. Thinking that you can will always make you want to run from your life."
All of which is to say that we will be fooling ourselves when we think that we can have a life without problems. I could almost see a lightbulb appearing above Olivia's head when she nodded, "I get it: the key to a happy life is accepting that problems are simply a part of it."
Most of the time, without our even realizing it, we've learnt profound lessons after listening to the story of two mice who lost their cheese in a maze. Or that of a Samaritan who happened to bump into a traveler who had been beaten up.
Storytelling holds the key to a good teacher, and works wonder with children and adults alike. Consider the parable from The Napkin, the Melon & the Monkey, a book I've read this week. Here you'll meet Olivia, a new hire at a customer service call centre. Open any page of her diary and you'll find a stressed-out working mom who is messed up with her sons' fight at home and the barrage of angry calls from frustrated customers at workplace.
"Hopeless," Olivia cried, and shook her head. She said the word as if it were a synonym for life. "Are we doomed to just stumble through life unhappy and confused?"
Then she learned an important "aha" from her call centre colleague. "For the ten problems of life - family troubles, work problems and money worries, finding your way in the world - I have no solution. But you have an eleventh problem. For that one I have help."
What's that eleventh problem? "The eleventh problem is your view that you should not have the ten problems. You can never get away from life's problems. Thinking that you can will always make you want to run from your life."
All of which is to say that we will be fooling ourselves when we think that we can have a life without problems. I could almost see a lightbulb appearing above Olivia's head when she nodded, "I get it: the key to a happy life is accepting that problems are simply a part of it."
Saturday, June 30, 2018
Henry Marsh
One of my most favorite writers is Henry Marsh, longtime brain surgeon of the NHS before his retirement in 2015.
Little did I realize the double entendre of the book title when I first picked up his memoir Admissions. Once you have read the book yourself, you will know it isn't just narrative of patient admission under his care; Henry Marsh is making confessions or admissions of himself. And he had even been admitted to a psychiatric ward as a patient.
He didn't pretend to be perfect. He has his flaws as doctor and as human. Like most doctors, he has made his share of mistakes, hurt more people than we should have, and, at times, behaved not so properly. He was probably considered to be one of the worst offenders by the hospital managers. One good example is the sin of his wearing suits and ties to work, for which Henry Marsh considered a sign of courtesy to his patients, but then condemned as a breach of infection control in the NHS.
The next error picked up by the managers is his disinterest in diagnostic coding when patients were discharged. The penalty doubled when Henry Marsh didn't make sure that his juniors completed the computerized work. I don't have to tell you how the increasingly depersonalized health care system frustrated Henry Marsh.
If there is one lesson I learn well from his story, it is the way sick patients were handled in Nepal. One sixty-something man was brought to hospital with fixed and dilated pupils, after a catastrophic bleeding inside his brain. The scan showed an undoubtedly fatal bleed. Henry Marsh agreed. When the family was told there was no treatment, they took the brain-dead patient home, squeezing a respiratory bag connected to his lungs. The unusual hand-bagging story struck Henry Marsh as a very humane solution: "He could die with some dignity within the family home, with their loved ones around him, rather than in the cruel impersonality of the hospital."
I can't agree more.
Little did I realize the double entendre of the book title when I first picked up his memoir Admissions. Once you have read the book yourself, you will know it isn't just narrative of patient admission under his care; Henry Marsh is making confessions or admissions of himself. And he had even been admitted to a psychiatric ward as a patient.
He didn't pretend to be perfect. He has his flaws as doctor and as human. Like most doctors, he has made his share of mistakes, hurt more people than we should have, and, at times, behaved not so properly. He was probably considered to be one of the worst offenders by the hospital managers. One good example is the sin of his wearing suits and ties to work, for which Henry Marsh considered a sign of courtesy to his patients, but then condemned as a breach of infection control in the NHS.
The next error picked up by the managers is his disinterest in diagnostic coding when patients were discharged. The penalty doubled when Henry Marsh didn't make sure that his juniors completed the computerized work. I don't have to tell you how the increasingly depersonalized health care system frustrated Henry Marsh.
If there is one lesson I learn well from his story, it is the way sick patients were handled in Nepal. One sixty-something man was brought to hospital with fixed and dilated pupils, after a catastrophic bleeding inside his brain. The scan showed an undoubtedly fatal bleed. Henry Marsh agreed. When the family was told there was no treatment, they took the brain-dead patient home, squeezing a respiratory bag connected to his lungs. The unusual hand-bagging story struck Henry Marsh as a very humane solution: "He could die with some dignity within the family home, with their loved ones around him, rather than in the cruel impersonality of the hospital."
I can't agree more.
Sunday, June 17, 2018
Uncertainty
Medicine is a science of uncertainty, and an art of probability.
Each time I met a patient with not-so-straightforward diagnosis I would remind myself and my junior this teaching by Sir William Osler at the turn of the last century.
Lub dub, lub dub, lub dub. Lub dub, lub dub, lub dub. That's what I heard with my stethoscope yesterday when I examined a gentleman coming to emergency room after feeling breathlessness for two days. Out of pride I refused to rush through the case as that will inflate my chance of failing to crack the puzzle. It wasn't pleasant to miss the additional sound after the usual "lub dub" heart sound, not least after my reading of a medical journal article The Art of Constructive Worrying yesterday morning. I made sure I'd heard that "lub dub whirr, lub dub whirr, lub dub whirr" melody.
Diagnosis resembles a jigsaw puzzle. We are supposed to find the pieces first, then fit them together. One by one. Before the full picture.
My patient clearly had a problem with his heart. What puzzled me is which piece I should focus at the emergency room. Was it because his heart turned oversized after wear and tear from clogged coronary arteries? I didn't have long to reflect on the counterargument that the gentleman neither smokes nor complains of crushing pain of heart attack. A glance at his ECG showed more jigsaw pieces than that of a leaking heart valve; I spotted abundant premature heart beats. Those frequent extra beats, if too frequent, could have caused what we call arrhythmia-induced cardiomyopathy.
Simply put, I was nowhere. There was one possibility after another. Two or three at a time, the possibilities were weighed, and discarded. Other possibilities then cropped up. A good talk with my patient revealed his story of multiple surgery procedures for removing lumps in his neck, torso and legs. I could also palpate some, one of them lurking behind his right calf, not yet operated. By the time I checked his computer record I was pretty sure that he was suffering from a plethora of nerve tumours with a funny name schwannoma. To be honest I don't recall seeing a case of Carney complex, but that could have been the first case in front of my eyes. In short, that's an exceptionally rare inherited anomaly in the human anatomy, with numerous spongy schwannoma and even a tumour inside the heart. Rare, but it can happen.
I don't think I have yet solved the puzzle, but I learned the essence of constructive worrying. Thinking and worrying about the jigsaw pieces that matter most and making plans based on this worrying.
Friday, June 8, 2018
Multitasking
Think about the last time you were multitasking. Are you proud of your versatility and efficiency?
I used to be so. This is even more so when I was attending a true tour-de-force outpatient clinic, in which I had to see twenty to thirty patients within a half day. Everyone is in a rush, and I am no different. After recent installation of dual monitor computer in my clinic, I could scan and call the second patient's name before I finished seeing the first patient. I've lost track of how many patients had entered my consultation room when it was still occupied by the previous patient.
"I've never been in your embarrassing situation, because I never multitask," my mentor shrugged, apropos of my dual monitor story.
I was thrown by this.
But it didn't take me long to figure out why I should not multitask.
An article published in Teaching and Teacher Education titled "The myths of the digital native and the multitasker" highlights that cognitive multitasking simply doesn't exist. What happens in reality is "task switching," indicative of a break in concentration. It strikes me that the human brain is single core; such architecture of cognitive system only allows for switching between different tasks. Switching between tasks, in turn, is not more efficient than carrying out one single task or a series of single tasks consecutively.
Psychological refractory period (bottleneck in switching tasks) is the key, interference the result, and shrinking productivity the ROI.
I used to be so. This is even more so when I was attending a true tour-de-force outpatient clinic, in which I had to see twenty to thirty patients within a half day. Everyone is in a rush, and I am no different. After recent installation of dual monitor computer in my clinic, I could scan and call the second patient's name before I finished seeing the first patient. I've lost track of how many patients had entered my consultation room when it was still occupied by the previous patient.
"I've never been in your embarrassing situation, because I never multitask," my mentor shrugged, apropos of my dual monitor story.
I was thrown by this.
But it didn't take me long to figure out why I should not multitask.
An article published in Teaching and Teacher Education titled "The myths of the digital native and the multitasker" highlights that cognitive multitasking simply doesn't exist. What happens in reality is "task switching," indicative of a break in concentration. It strikes me that the human brain is single core; such architecture of cognitive system only allows for switching between different tasks. Switching between tasks, in turn, is not more efficient than carrying out one single task or a series of single tasks consecutively.
Psychological refractory period (bottleneck in switching tasks) is the key, interference the result, and shrinking productivity the ROI.
Monday, May 28, 2018
God rejse
Danish hygge has become a genre unto itself, as The Little Book of Hygge: The Danish Way to Live Well turns into a bestseller.
While there is hardly an English equivalent for the Danish word hygge, we can simply feel it, and forget about its translation. An oft-quoted idea of hygge is a bike ride in the pouring rain with a candle on the heads. Or eating cakes.
To coin my own way of hygge from scratch, I grabbed my running shoes right after waking up at six today. More hobby than workout, and more pleasure than chore, running in Copenhagen is simply something I heartily recommend myself for hygginess. As I weaved through the scenic trails in the park, I didn't keep track of my pace, learning to make peace with the natural environment instead of the stats.
The park is lively, picturesque, and makes me feel hygge. I saw many birds, and funnily enough, quite a lot of snails. To make sure we're feeling hygge, I didn't broach the subject who's running faster. I ran past a snail, reminding myself not to step on the creature, and sped up.
It wasn't long before I met another animal. A deer. I rubbed my eyes. A wild deer. And then it struck me like a revelation. Running together with a wild deer, obviously, is an instant hygge.
While there is hardly an English equivalent for the Danish word hygge, we can simply feel it, and forget about its translation. An oft-quoted idea of hygge is a bike ride in the pouring rain with a candle on the heads. Or eating cakes.
To coin my own way of hygge from scratch, I grabbed my running shoes right after waking up at six today. More hobby than workout, and more pleasure than chore, running in Copenhagen is simply something I heartily recommend myself for hygginess. As I weaved through the scenic trails in the park, I didn't keep track of my pace, learning to make peace with the natural environment instead of the stats.
The park is lively, picturesque, and makes me feel hygge. I saw many birds, and funnily enough, quite a lot of snails. To make sure we're feeling hygge, I didn't broach the subject who's running faster. I ran past a snail, reminding myself not to step on the creature, and sped up.
It wasn't long before I met another animal. A deer. I rubbed my eyes. A wild deer. And then it struck me like a revelation. Running together with a wild deer, obviously, is an instant hygge.
Sunday, May 27, 2018
Meal
If I were to choose a meal to skip it would be the lunch.
If anything, breakfast should be the last one out.
To understand how breakfast gets in the way of keeping us healthy, we should take a look at the scholarly medical literature. A growing body of evidence shows that breakfast has important effect on the expression of "clock genes" that regulate our body's post-meal glucose and insulin responses. The field of body's inner clock, including molecular mechanisms controlling our circadian rhythm, is in fact the subject of this year's Nobel Prize for Medicine.
The case for a breakfast has been elegantly demonstrated by a Tel Aviv University study, in which 18 healthy volunteers and 18 obese diabetes volunteers took part in a test day featuring breakfast and lunch, and then a separate day featuring only lunch. In both healthy and diabetic subjects, having breakfast jump-starts specific "clock genes" that lead to better glucose control and more efficient weight loss. Breakfast skipping, on the other hand, has dire consequences on the clock-controlled gene expression.
In short, breakfast is indeed the most important meal of the day.
For many, it's often well-nigh necessary to have three meals to keep the brains well-stoked all day. I'm not so sure. From time to time, lunch slows me down, rather than speeding me up. I had raw carrots for lunch before my running yesterday, for example, and ended up cursing it for the stomachache during the race. I tried sandwich today but could not beat the post-lunch slump during the medical conference. In the end, I should probably skip lunch to get away from the dip, I told myself.
If anything, breakfast should be the last one out.
To understand how breakfast gets in the way of keeping us healthy, we should take a look at the scholarly medical literature. A growing body of evidence shows that breakfast has important effect on the expression of "clock genes" that regulate our body's post-meal glucose and insulin responses. The field of body's inner clock, including molecular mechanisms controlling our circadian rhythm, is in fact the subject of this year's Nobel Prize for Medicine.
The case for a breakfast has been elegantly demonstrated by a Tel Aviv University study, in which 18 healthy volunteers and 18 obese diabetes volunteers took part in a test day featuring breakfast and lunch, and then a separate day featuring only lunch. In both healthy and diabetic subjects, having breakfast jump-starts specific "clock genes" that lead to better glucose control and more efficient weight loss. Breakfast skipping, on the other hand, has dire consequences on the clock-controlled gene expression.
In short, breakfast is indeed the most important meal of the day.
For many, it's often well-nigh necessary to have three meals to keep the brains well-stoked all day. I'm not so sure. From time to time, lunch slows me down, rather than speeding me up. I had raw carrots for lunch before my running yesterday, for example, and ended up cursing it for the stomachache during the race. I tried sandwich today but could not beat the post-lunch slump during the medical conference. In the end, I should probably skip lunch to get away from the dip, I told myself.
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