Live Concert

We've all been programmed - at all levels including school, work and socal - to think, act, and live in a virtual world under various restrictions. We have Google Classroom; we attend virtual scientific conferences; we watch Netflix movies.

With time, the good news is that we are now gravitating toward out-of-home activities after relaxed social distancing. Who in their right mind would choose not to go out?

Going to live concert by the Hong Kong Philharmonic Orchestra last night has been one of our best family activities after the fifth wave of Omicron. In my opinion, none is greater than their idea of blending music with the Blue Planet II nature documentary.

As I sat staring at charming puffins rattling their beaks together after fish hunting expedition, mouth hanging wide open (mine wider than puffin holding a mouthful of sand eels), I was in awe and blown away by the matching music on stage. Live music by an 80-piece symphonic orchestra in a concert hall. Giant screen of the BBC marine life series, side by side. Ebb and flow. Mind-blowing. I was elated.

Grip

To be honest, I'm not good at remembering characters. But that's what most novels ask us to do. 

So, the gods and goddesses, mythical beings, as what my daughter's reading of Rick Riordan's book series entails, would be almost impossible for me to comprehend. I don't even know how to figure out "who's who" when I read the not-so-divine novel Beautiful World, Where Are You by Sally Rooney.

But there is a catch: It's not every novel that has a large cast of characters for us to keep track of. If you're easy to get lost in the cast, you may decide to pick up the novel by Jeanine Cummins, American Dirt, as what I recently did after my brother's recommendation. There aren't too many characters: a Mexican mother and her son, and sixteen other family members. If you worry about the number of characters, I will be the first to reassure you. The sixteen of them, for that matter, were dead bodies in the backyard by the end of the first chapter. All killed by the end of the first few pages.

Seriously, though, story of the mother and son after the massacre is riveting enough to grip our attention.

Terminology

Language is a rich tapestry of what we feel, what we see and what we record. Think of language as our lens to perceive the world. Chances are, as what exactly Sapir-Whorf hypothesis states, you will be led to believe that the language we speak influences how we think.

Odd as the counterargument would sound to you, the relationship between language and culture can be the opposite way round. That means our language we speak doesn't shape the way we percieve the world. Quite the opposite - one might argue that it's language that reflects our view.

I'll bet the debate can go on forever. The only thing we can agree is that we should mind our words. A recent British Medical Journal article about medical language will show you why.

A real-life scenario that exemplifies how doctors' language belittles patients: "Patient denies fever, chills or night sweats." To deny, according to the authors, is to refuse to admit the truth. Isn't that connotation of untrustworthiness?

Another not-too-uncommon language usage that emphasises the patient as passive of childlike: doctors "take" a history, or "send" patients home.

Now, there's no question that we can use language to blame patients after treatment failure: "the patient failed chemotherapy" rather than "chemotherapy failed the patient."

Noise

I genuinely believe that credibility of recruiting interviews is overblown. To put it more starkly, as explained by the authors of Noise, they are often useless.

Job interveiw sounds robust and effective, but turns out to be as predictive - or unpredictive, for that matter - as any information source from marketing.

What's missing is the awareness of cognitive bias: an illusion of interviewers who think they can make sense of information collected from an interview. The same is true in our imaging a shape in the contours of a cloud. That's literally having our heads in the clouds: spend enough time looking at the sky and we will start seeing pattern out of the clouds. We use the term pareidolia to describe our natural tendency to perceive a specific image in a random or ambiguous visual pattern. You read that right: the interviewers are often imagining a pattern out of answers given by the candidates.

To figure out how likely interviewer is to have excessive tendency to seek and find coherence, researchers had designed experiments by asking some of the interviewees to answer questions randomly. Can you imagine giving a random answer "yes" or taking the "this" option as determined by the first letter of the questions? But you know what? Not a single interviewer realised that the candidates were giving random answers. This might sound counterintuitive, but the interviewers in this "random" condition were as likely as those who had met truthful candidates to agree that they were "able to infer a lot about this person given the amount of time we spent together."

Such is our accuracy of recruiting interview. As good as throwing a dice.

Storm

Read up about heart attack in medical textbooks and, chances are, you will learn about the plaque that clogs the arteries, the lipid-rich core of vulnerable plaque covered by a thin fibrous cap - as thin as half of our hair diameter. Think of it as a trash bin secured barely with a foil instead of a sturdy lid: when things has gone haywire (as they always did), that fibrous cap or foil breaks suddenly and erupts like the deadliest volcano, with all the junk suddenly bursting like lava to cause blockade of the artery.

Heart attack or acute coronary syndrome is serious, that much is clear. Remarkably little is known about the lung attack by the new coronavirus. If the devastating attack of this virus sounds completely mind-blowing, I'm with you. The blitz or ambush by this ever-changing-from-delta-to-omicron virus can be worse than a volcano eruption - ask anyone who has looked after an infected patient. It's practically called a storm. The virus simply kicks off a lid and spews out powerful drivers of inflammation, setting up a cascade of bushfire spreading everywhere, faster than you can imagine.

Every time I came across such a patient, I had that same precarious feeling I'd met him or her too late, like there would have been a better and earlier time window to find a trash can lid lock. Every time I thought I should have control, the bushfire bounced back like a boomerang. So it lingered. On and on. And on.

I seemed to tame the fire in one of the worst patients more than one month ago. Initially, she struggled to breathe when the hyperarousal state of immune system shut down her lungs. With time, she was getting rid of the coronavirus but still needed high flow moistened oxygen delivered through tubes into the nose. I told her I would go back to see her every day. I did. Day after day.

I told myself, as with anything, if you don't try then you will never know. I was carried on a wave of enthusiasm through that nasty wild bushfire fighting, here and there, week after week.

She didn't make it at the end.

Looking back, what do I remember?

If it doesn't set your soul on fire, it's not worth the burn.

Schadenfreude

Let me be the first to confess that I've been having unbridled antipathy towards patients coming to hospital, sick with the virus but without vaccination. I'd describe myself as having difficulty with being neutral to antivaccination folks, even I know pretty well a doctor shouldn't be.

The terrifyng rage moment of seeing the unvaccinated status, every time I admitted such patients, would set off a curse inside my head. God forbid, I know how a doctor should have behaved otherwise. But still.

Enter Brené Brown, American professor, long-time researcher on shame and vulnerability, who recently published her book Altas of the Heart. In this book, Brené Brown has devoted thirteen chapters to a kaleidoscopic medley of emotions. Here, too, she raised the topic of schadenfreude. How true: the undeniable-yet-so-guilty emotion during our struggle with schadenfreude toward unvaccinated people who get infected. That's a topic we don't talk about openly. At least not for a doctor like me.

Descale

Of all my rituals after waking up, making coffee appears to be the most highly consistent. I crave coffee every morning. We all do. It is little wonder, then, that it's disconcerting for me when my coffee machine didn't work two days ago.

People used to think that it can be dangerous for heavy drinkers to suddenly stop alcohol. Alcohol withdrawal actually kills. Not infrequently, I think this applies to coffee, too. I was, of course, trying hard to troubleshoot by googling. I started calling the service hotline after several unsuccessful attempts.

It was then I realised that my coffee machine was getting stuck because of the need for descaling. I have never bothered to do so since my purchase of coffee machine nearly four years ago. As I checked from the machine website, I learned that, with time, minerals in water will accumulate on the machine's heating element. Hard deposits like calcium have to be removed or else the limescale build-up will disrupt the coffee-making. Worse still, the machine heating elements can't be seen. Months of mineral build-up could have existed without our knowing it. The terrifying calcium burden inside the coffee machine is no different from the silent killer of calcium-rich cholesterol plaques growing inside our artery wall. First, nothing, I mean nothing, can be felt. Not until the build-up of plaque is heavy enough to rupture and completely clog our heart artery to trigger a heart attack.

As I stood next to the machine watching the rinsing cycles, one after another, I felt a gush of relief. It turned out that I descaled my coffee machine shortly after a weary overnight shift at the hospital. Think about it; those of us working for years without descaling should do so too.