Like many doctors, I dread the moment I give my own child the vaccine jab. It's not hard to see why: we are supposed to safeguard our kids but there won't be pain-free needles.
The task of giving Jasmine a quick stab wasn't that difficult. When my daughter learned about the seasonal flu jab, she didn't run away. My wife held Jasmine and I picked the right spot - and voilà - a peaceful indentation of her thigh. After that my wife asked me if I wished to give her the hepatitis A vaccine as well. We purchased the vaccine few months ago and waited. And waited. And waited. And it has remained in our fridge. I hemmed and hawed for a while, before I decided to postpone the second injection. Of course I didn't have a whiff of evidence to support my claim to separate the two injections.
If the idea of separating two injections seems humane at first, it doesn't once you know the psychological principle known as "Weber's law," named after the nineteenth-century German physiologist Ernst Heinrich Weber. Although most medical students should be familiar with his Weber test (a screening test for hearing), we might have overlooked the Weber's law. Weber's law states that the impact of a change in the intensity of a stimulus is proportional to the absolute level of the original stimulus. Loosely speaking, you must shout to be heard in a noisy environment whereas a whisper works in a courtroom.
It also means that the change in any stimulus matters less and less with every increase in the absolute level of that stimulus. The idea behind Weber's law is that if you have a number of dental cavities to be filled, get them all taken care of in one trip to the dentist. Unsettling as it is, the pain of two moderately bad experiences will typically exceed the pain of experiencing both at one time.
Which means, come to think of it, that I should have given my daughter two shots at one go.
Tuesday, October 25, 2011
Saturday, October 15, 2011
Count to 10 Before You Yell
I was looking at the school photos with my daughter in front of our laptop computer. When Jasmine was so excited, she pushed the computer screen and hit the vase next to it. "WATCH OUT!" I screamed before calming my nerves to catch the vase.
When Jasmine found her father turning into shrieking grand mal, she stopped. Before she could find her words, she put her hand above the eyebrow, whispering the word sooooorry.
Immediately I realised I'd made a mountain out of a molehill. This was a a terrible situation, thoroughly embarrassing, and it really was my fault. I ground to a halt, mortified and abashed. I smiled. No one joined me. My eyes met hers. I saw tears welling up.
"No, baby. Not your mistake. Write this across your heart: daddy isn't angry with you." I gave her a big kiss on the forehead. Jasmine tried to pull herself together but seemed poleaxed. "Flower broken?"
And her mother came to my rescue. "Flowers," we chorused. Within two minutes we were dancing with the flowers in hand, with smiles as effervescent as root beer.
Researchers coined the term attachment to describe the reciprocating relationship between a baby and the parent. Babies come into this world preloaded with lots of emotional abilities. My response (such as shouting) acts like Post-it notes to tag different things, telling my baby's brain, "Pay attention to this." When I sat down and talked to my wife, she tried to reassure me that nothing was wrong, that I was tagging the wrong Post-it note to the vase, and that I could count to ten before yelling. "Come to think about it, you just screamed at the vase out of the blue, but the two-year-old would look at you with a tag that you're screaming at her. You did the same to me quite often, too."
Ugh. Jasmine gave me another lesson after my going wrong for at least 10 years.
When Jasmine found her father turning into shrieking grand mal, she stopped. Before she could find her words, she put her hand above the eyebrow, whispering the word sooooorry.
Immediately I realised I'd made a mountain out of a molehill. This was a a terrible situation, thoroughly embarrassing, and it really was my fault. I ground to a halt, mortified and abashed. I smiled. No one joined me. My eyes met hers. I saw tears welling up.
"No, baby. Not your mistake. Write this across your heart: daddy isn't angry with you." I gave her a big kiss on the forehead. Jasmine tried to pull herself together but seemed poleaxed. "Flower broken?"
And her mother came to my rescue. "Flowers," we chorused. Within two minutes we were dancing with the flowers in hand, with smiles as effervescent as root beer.
Researchers coined the term attachment to describe the reciprocating relationship between a baby and the parent. Babies come into this world preloaded with lots of emotional abilities. My response (such as shouting) acts like Post-it notes to tag different things, telling my baby's brain, "Pay attention to this." When I sat down and talked to my wife, she tried to reassure me that nothing was wrong, that I was tagging the wrong Post-it note to the vase, and that I could count to ten before yelling. "Come to think about it, you just screamed at the vase out of the blue, but the two-year-old would look at you with a tag that you're screaming at her. You did the same to me quite often, too."
Ugh. Jasmine gave me another lesson after my going wrong for at least 10 years.
Monday, October 10, 2011
Reflection
Don't you find that you learn more about yourself when you learn to weather the changes with your baby? That happened with my recent reading of What to Expect: the Toddler Years.
Heidi Murkoff tells the story of a toddler who gets upset whenever the cracker has a piece broken off. Even a crack in the cracker can set off tirades. By listening to the quizzical compulsiveness about an intact cracker or biscuit, I thought I'm lucky to have my easygoing daughter. But wait a minute: isn't that desire for perfection (or at least, the perception of it) the same as mine? Though I have tried not to delete any less-than-perfect photograph from my digital camera after pressing the shutter, I cannot.
The next story is about a toddler who resists to any change - a new car seat, a new order in the bedtime routine, a new glasses on the mother. Whilst some toddlers just can't tolerate any changes, most kids as I know it, my daughter included, are at least less rigid. Before I congratulated myself for having a daughter who doesn't insist on the status quo, I felt an uneasy idea welling up inside me. No, that story isn't about my daughter; it's talking about me. I'm the one who craves ritual. While having ritualistic behaviour is age-appropriate for a toddler, I wonder if having precisely the same kind of muffin for lunch, during my whole year of overseas training, for instance, is a bit too inflexible. Just a bit.
Heidi Murkoff tells the story of a toddler who gets upset whenever the cracker has a piece broken off. Even a crack in the cracker can set off tirades. By listening to the quizzical compulsiveness about an intact cracker or biscuit, I thought I'm lucky to have my easygoing daughter. But wait a minute: isn't that desire for perfection (or at least, the perception of it) the same as mine? Though I have tried not to delete any less-than-perfect photograph from my digital camera after pressing the shutter, I cannot.
The next story is about a toddler who resists to any change - a new car seat, a new order in the bedtime routine, a new glasses on the mother. Whilst some toddlers just can't tolerate any changes, most kids as I know it, my daughter included, are at least less rigid. Before I congratulated myself for having a daughter who doesn't insist on the status quo, I felt an uneasy idea welling up inside me. No, that story isn't about my daughter; it's talking about me. I'm the one who craves ritual. While having ritualistic behaviour is age-appropriate for a toddler, I wonder if having precisely the same kind of muffin for lunch, during my whole year of overseas training, for instance, is a bit too inflexible. Just a bit.
Thursday, September 29, 2011
Birthday
How, my wife asked me, should we celebrate my birthday with Jasmine?
Spending two days at the small Pak Lap village, nestling at the bottom of a valley with a hillside behind it, seems to be the idea of an eccentric - and quite possibly crazy - person. Well, that idea is mine.
Lodging in a less-than-trendy hut equipped with colder-than-what-you-want-for-shower water, it's easy to make you feel like travelling through time. No wi-fi. No mobile network coverage. No ice-cream.
Still, the village offers much more than any theme park does. With the beach well-protected by its long sheltering headlands, the fine sand gives rise to an unspoilt paradise for my daughter. And the flat marshy land around the hut smells nothing but the cattle. En route to greet the cattle, we taught Jasmine to say hi to the buff-backed herons. Ah yeah, crickets were too busy to stop and say hello. The next lesson, after listening to the chirruping of birds, was to follow the chorus of cicadas. Trust me, that's the best lullaby sung to young children before they go to sleep.
Envious? You should be.
Spending two days at the small Pak Lap village, nestling at the bottom of a valley with a hillside behind it, seems to be the idea of an eccentric - and quite possibly crazy - person. Well, that idea is mine.
Lodging in a less-than-trendy hut equipped with colder-than-what-you-want-for-shower water, it's easy to make you feel like travelling through time. No wi-fi. No mobile network coverage. No ice-cream.
Still, the village offers much more than any theme park does. With the beach well-protected by its long sheltering headlands, the fine sand gives rise to an unspoilt paradise for my daughter. And the flat marshy land around the hut smells nothing but the cattle. En route to greet the cattle, we taught Jasmine to say hi to the buff-backed herons. Ah yeah, crickets were too busy to stop and say hello. The next lesson, after listening to the chirruping of birds, was to follow the chorus of cicadas. Trust me, that's the best lullaby sung to young children before they go to sleep.
Envious? You should be.
Tuesday, September 20, 2011
Rash Answer
One of my students asked me a question about an infection that classically strikes a limited area on one side of the body. "I thought that zoster (also called shingles) usually is confined to a single dermatome or overlapping dermatomes. What would be the significance if a supposedly immunocompetent (healthy) person has an outbreak over multiple dermatomes that cross midline and are not overlapping?"
"Find out if he or she is immunocompetent or not," I replied. "Screen for diabetes, HIV, et cetera. Simultaneous involvement of noncontiguous dermatomes virtually never occurs in the immunocompetent host." I sounded like Charleton Heston handing down the Ten Commandments, or so I believed.
I didn't think much about the question of shingles until I went home and opened my e-mail. My student answered, "That's what I thought too. Actually this happened to me just last week."
I was speechless. I soon found out that some healthy persons can have a few scattered blisters located at some distance away from the involved dermatome.
I kicked myself and tried to explain. In any case, that's the worst demonstration of communication skill.
"Find out if he or she is immunocompetent or not," I replied. "Screen for diabetes, HIV, et cetera. Simultaneous involvement of noncontiguous dermatomes virtually never occurs in the immunocompetent host." I sounded like Charleton Heston handing down the Ten Commandments, or so I believed.
I didn't think much about the question of shingles until I went home and opened my e-mail. My student answered, "That's what I thought too. Actually this happened to me just last week."
I was speechless. I soon found out that some healthy persons can have a few scattered blisters located at some distance away from the involved dermatome.
I kicked myself and tried to explain. In any case, that's the worst demonstration of communication skill.
Wednesday, September 14, 2011
A Piece of Cake
I brought my parents handmade fist-sized snowy mooncakes this Mid-Autumn Festival.
For those of you, my mum included, who have no inkling of how to make mooncakes, you must swallow hard and believe that I learn the ropes of making mooncakes.
But - and I'm sure you expected a "but" - the true story is that we can't judge how difficult it is to create a product simply from how intricate it looks. Think about the diapers my daughter wears. It's hard to get excited about the diapers. Hard, that is, when I've thrown away several thousands of them since the birth of Jasmine.
After having the mooncakes at my mum's home, I caught sight of an old Fortune magazine article about diapers. Illustration of the article showed three awfully amicable babies wearing the same brand of diaper as Jasmine. One of them is dark-haired with dark skin; the other wearing a big smile; the third with an attractive face and short curly blond hair. Picture three naked creatures walking and crawling around. You won't be surprised to know that their diapers could be filling up faster than a Tokyo train in the rush hour.
As I went on reading the story, I was amazed at the exemplary efforts of the diaper research team. They started off hand making diapers of varying dimensions to try out on real babies. There are now baby manikins to check for leaking at their laboratories; their legs and tummies vary in size, just like real babies. With time, the researchers generated enormous databases after bringing babies in and literally scanning them head to toe. The computer models then simulate virtual diapers to fit silhouette of babies from different parts of the world. They even measure the amount of pressure the virtual diaper is applying to the skin at every spot, with red (Ouch! Too tight and discomfort), blue (No-no, too loose, and possible leaking), yellow, and green splotches distributed like a Doppler weather map. They can literally see the pressure points. I can feel it.
For those of you, my mum included, who have no inkling of how to make mooncakes, you must swallow hard and believe that I learn the ropes of making mooncakes.
But - and I'm sure you expected a "but" - the true story is that we can't judge how difficult it is to create a product simply from how intricate it looks. Think about the diapers my daughter wears. It's hard to get excited about the diapers. Hard, that is, when I've thrown away several thousands of them since the birth of Jasmine.
After having the mooncakes at my mum's home, I caught sight of an old Fortune magazine article about diapers. Illustration of the article showed three awfully amicable babies wearing the same brand of diaper as Jasmine. One of them is dark-haired with dark skin; the other wearing a big smile; the third with an attractive face and short curly blond hair. Picture three naked creatures walking and crawling around. You won't be surprised to know that their diapers could be filling up faster than a Tokyo train in the rush hour.
As I went on reading the story, I was amazed at the exemplary efforts of the diaper research team. They started off hand making diapers of varying dimensions to try out on real babies. There are now baby manikins to check for leaking at their laboratories; their legs and tummies vary in size, just like real babies. With time, the researchers generated enormous databases after bringing babies in and literally scanning them head to toe. The computer models then simulate virtual diapers to fit silhouette of babies from different parts of the world. They even measure the amount of pressure the virtual diaper is applying to the skin at every spot, with red (Ouch! Too tight and discomfort), blue (No-no, too loose, and possible leaking), yellow, and green splotches distributed like a Doppler weather map. They can literally see the pressure points. I can feel it.
Monday, September 5, 2011
Feedback
The idea that human decision and performance can be improved by feedback is never new, but has probably been forgotten.
The word feedback has hardly found a place in the field of corporate finance. When someone decides to buy a stock - or even an entire company - it may not be obvious for years that the move turned out to be a mistake. By then, those responsible for the mistake have often moved on to other places.
"True," you say. "But unless I move from being a doctor to the field of finance, what does this have to do with me?" Lots, I hope.
Doctors are no different. We need to be told when we're wrong, and not only when we're right. Depressing as it is to utter the word wrong, I do believe that we have to be told how many times we made mistakes in cleansing the skin before jabbing a needle into the patient for blood culture. Or, how many times we made the wrong decision to (or not to) admit a patient to the medical ward.
For now, I don't have to rush pitter-patter through each and every new case at the emergency room, the way the police would be doing at the road block. To a busy doctor, the job can be a downright classic example of acting on instinct. It ought to fail and it usually does. All too often we send away patients with serious ailments unbeknownst to ourselves. In the binary shorthand doctors use to conceptualize patients, we either admit the patients to the hospital or send them home - a tidy distinction that, unfortunately, crumbles in real life. If an emergency room doctor was to learn anything it was the feedback of his decision.
The word feedback has hardly found a place in the field of corporate finance. When someone decides to buy a stock - or even an entire company - it may not be obvious for years that the move turned out to be a mistake. By then, those responsible for the mistake have often moved on to other places.
"True," you say. "But unless I move from being a doctor to the field of finance, what does this have to do with me?" Lots, I hope.
Doctors are no different. We need to be told when we're wrong, and not only when we're right. Depressing as it is to utter the word wrong, I do believe that we have to be told how many times we made mistakes in cleansing the skin before jabbing a needle into the patient for blood culture. Or, how many times we made the wrong decision to (or not to) admit a patient to the medical ward.
For now, I don't have to rush pitter-patter through each and every new case at the emergency room, the way the police would be doing at the road block. To a busy doctor, the job can be a downright classic example of acting on instinct. It ought to fail and it usually does. All too often we send away patients with serious ailments unbeknownst to ourselves. In the binary shorthand doctors use to conceptualize patients, we either admit the patients to the hospital or send them home - a tidy distinction that, unfortunately, crumbles in real life. If an emergency room doctor was to learn anything it was the feedback of his decision.
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