Nightingale

Can a book be too long? That certainly can be. Chances are, we can still handle a long one but not necessarily a heavy one. Sometimes, a book can be too heavy. So much so that I can hardly finish since I picked up the book four months ago.

Kristin Hannah is a lawyer-turned-writer who writes truly moving novels. She gives weight to the story that can't be forgotten. The Nightingale is one of her best historical novels. A captivating novel for a lifetime, narrating two women in war-torn France during World War II. The saddest story of a heroine saving over one hundred and seventeen men as she hiked across escape routes of the Pyrenees mountains. And that of her sister risking her life to save Jewish children from the invading Nazis.

I don't know how many of you can sleep well after reading chapters of women in concentration camp. I can't.

Kristin Hannah asked in an interview about her book, "When would I, as a wife and mother, risk my life - and most important, my child's life - to save a stranger?"

Most of us wouldn't. But it can be even worst: What good is safety if she - your child - has to grow up in a world where people disappear without a trace because they pray to a different God?

Deep Learning

When we talk about the world's famed adventure itineraries, I am sure that New Zealand, Costa Rica or Iceland will spring to mind. These destinations describe the very essence of what photographers or hikers dream about.

I'd say so, but then as anyone can tell that's more a dream than reality at present. With the travel restriction and quarantine policy in mind, I consider my daughter very fortunate to have chance to spend a special week outside the classroom, camping in glorious weather, kayaking, working out her perserverance in ropes courses and scenic ridge-line hiking at Pak Sin Leng. 

This week is furnished with all sorts of new and old friendship in the countryside, where she and her classmates laugh and joke like crazy buddies. That isn't as cozy as five-star hotels - when you count the way of washing dishes after meals - but the students love how they make their own hotdogs. That isn't as classical as holidaymakers snapping selfies - when smartphones aren't allowed - but they have their own journals to create their time capsules of memories.

It's heartening to imagine the fun she has had even without an air ticket or passport.

Hikers

I remember, with exquisite clarity, the time my daughter away from home, joining the overnight school camp. Next come the five-day camp in the week ahead. 

That means we're busy preparing her backpack this weekend, handing her sleeping bag, camping lantern, inflatable mattress and all gadgets she will need. The fun of kayaking, challenging Pak Sin Leng hike, stand up paddle, as I muse, justify the physical separation with our daughter for five days.

The way nature has been woven into the fabric of her school and family lives means we don't stay home the day before the exciting camp. We took a ferry trip to Lantau today and hiked on a sunny afternoon. If I am honest with myself - actually honest, in the sort of way all parents can understand - I need to stay close to my daughter for one good outing before she stays away from home.

We've been fortunate to have an outdoorsy family. You may think my daughter might whine about hiking (again) before her school camp, but she doesn't. We enjoy life in as much harmony as we can find. Flowers and trees, butterflies and dragonflies, the sights, the sounds, the smell all so rich in wonder.

The Four Winds

If you could step into a time machine to travel with Kristin Hannah to The Four Winds in the 1930s, you'd better make sure you have your return trip ticket. 

There's more dust than you would expect, when you finally know the meaning of the word "breathtaking."

That's when the protagonist of Kristin's fiction, Elsa Martinelli, was seized by the natural disaster of dust storm in Texas. Plagued by nightmares of dust raining down like a screaming monster, Elsa kept coughing despite pulling her bandanna up around her mouth and nose, squinting to protect her eyes. That reminds me of wearing the mask for our pandemic.

Dust was engulfing the land deep in the Great Depression. Even cow's milk turned into a dirt-brown stream, smelling fecund. Elsa's son ended up running fever, red eyes rolling back in seizure, wheezing, breathless. Her son ended up staying in a Red Cross makeshift hospital for more than two weeks. When the doctor told Elsa that it may take as long as a year to really heal from the dust pneumonia, I was thinking of the long Covid.

Elsa stopped sleeping well, or at all, really. Their family eventually moved to California with twenty-seven dollars. To make ends meet, Elsa started the low-paying job of cotton picking, her finger bleeding from the thorns, dawn to dusk. What hurt Elsa the most wasn't the thorns. It's the fight to stand up for the rights, for the minimum wages. She was paid a meagre ninety cents for a hundred pounds of picked cotton. Eighty cents if you counted the cut taken by the crooks.

What could Elsa do in the middle of seemingly never-ending wage cutting? One option is to reach and unionise as many of the migrant labourers as possible to organise a strike. To fight for fair pay. To stop the inequity between the haves and have-nots.

The scene of strikers would have scared many of us. When the strikers gathered to chant "Fair pay," they met rampant discrimination and resistance: the cops stepped out of the cruisers, guns drawn, shortly followed by a group of masked vigilantes and landing of metal tear-gas canisters. Now, the image still makes me flinch. You wouldn't wish to be there, and please make sure you have your return trip ticket. Trust me.

Birthday

Smack-dab in the middle of Hong Kong Island, Aberdeen Reservoirs offer me walking paths and a taste of nature near downtown, where I met the auditors this afternoon. 

An open green space is, of course, much more attractive than financial statement. After all, I deserve a more laid-back vacation on my birthday, I told myself. 

Just that - the fact that I could not afford to take a whole day off because of different engagements - was a good excuse for me to carve off time for my own. If I take a break - which I did, just for two hours - I could find a whole different world.

Tuesday

Long haul work has been part of my life so long it has become embedded in my DNA. Sometimes it is the full day clinic during which I experience the flow according to Mihaly Csikszentmihalyi and sometimes it is the every-now-and-then deadline I can hardly beat. But it is always there.

Lately, I realize that I should be more flexible.

Do I have to head back to hospital right after seeing our daughter off on the early morning bus at seven? On reflection: no. At least not on Tuesday. That's the only weekday I don't have clinic until nine.

Shortly after coming up with this idea, I have been spending that one "sabbatical" hour with my wife before starting work for several Tuesday mornings. That's how we can plunge into our favorite place of wilderness. A stroll at our alma mater university. A short walk at Sai Kung. Plus a perfect cup of coffee each time, before my work in full swing. Perfect indeed. A minibreak could fill a day to overflowing, apparently.

Diagnosis

As a medical doctor, what do you do to reassure your patients before telling them to leave hospital? You make sure that your patients understand their diagnosis. Easier said than done. I want to tell my patients what I suspect, and wish that I get it right.

In our clinical practice, we sometimes dare to say that we jump right into the correct answer like what Dr. Gregory House used to do, but not often. On bad days, like today, I knew that I made a mistake.

I'm going to tell you a true story about a young chap I met two weeks ago in hospital. That morning, I was shown his neck with swollen lymph nodes. In the past few days, he'd noticed sore throat, rising temperature and pain in the neck. What I knew was that my colleague had already excluded most infection.

"Now, if that doesn't sound like Kikuchi disease," I told my junior doctor. "I don't know what does." I went on to teach how the disease comes from an immune system going haywire and overactive. I didn't hesitate in the least to suggest my patient go home and wait for the weird disease to die down on its own.

Call it the naïveté of wishful thinking if you will, but it is what I believed and how the self-limiting Kikuchi disease usually behaves.

Two days later, my young patient returned with his parents, looking for me to recount his unremitting fever and neck swelling. I handed them one more prescription and reminded them the appointment to have a needle biopsy of his neck swelling. His mum appeared worried, and told me how another doctor suggested antibiotics for a possible diagnosis of infection.

I nodded. "Indeed. It can be difficult but your son will be better with time." I took a good look at the antibiotics she showed me, and politely said that I won't object to finishing the drug. I was not saying that my patient should get antibiotics. But I was not saying he shouldn't, either.

The overarching message: "I'm open. If you really worry, I can take you back to the hospital. If not, go home and find me whenever you get worse." As I said so, I wrote my mobile phone number on a piece of paper for him to take away. A piece of paper and a sense of you-can-reach-me freedom.

One week passed. The needle biopsy result of his neck lymph node wasn't telling me much. By the time he called me back, his lymph node swelling got more far-flung, spreading to the tummy and groins.

I sighed. "It isn't Kikuchi. I'd better get you back to hospital and will find a way out. Listen, this is more serious than what I'd thought." After few more tests and cutting out one of his lymph nodes, I crossed out the remaining possibilities one by one: from relatively benign Castleman disease to more difficult one like Hodgkin lymphoma. 

By the time I got the final rare diagnosis of anaplastic large cell lymphoma today, I shook my head. It didn't take a genius to notice that I got most thing wrong - except the piece of paper I gave my patient.