Alphabet

If I had to choose one teacher my daughter couldn't do without, it would be my wife. None of that is to say that her kindergarten teachers aren't terrific. They are.

What I don't say, what I should say, is that I'm far below my wife's teaching skill.

Let me tell you the story of my debut into teaching my daughter's writing. Anyone familiar with teaching kids to write English alphabets will know what I mean. Permit me to correct you, there are more than 26 ways to write the alphabets if you mix up the direction each alphabet faces. For the kids, words - like practically everything else - can either be written in the right way or in its mirror image. Even my daughter can write her name with the first letter J facing the wrong way. Yes: it is different. The difference for these two ways to write the letter J is so trivial that a 3-year-old won't bother.

Writing the alphabet J in itself is a piece of cake for me, of course. I never answer wrongly when my daughter asks me which direction the letter faces. I just know the fundamental truth how a letter J should face. "Curve this way. Got that?"

And then my wife had her turn to teach Jasmine, and she made an intriguing discovery: the alphabet J lines up in front of other letters, and of course, this lovely letter J behaves in such a nice manner she won't turn around and step on the foot of others standing behind. Ah yes - here it is. No book has taught me this, nor have I heard it from my teacher. Real good fun to learn alphabets in this way.

Sure, I admit my daughter can still get her J in the wrong way. But then she will smile, "Oops, this J is naughty today; she turns around and chitchats with her classmates again."

Preconditioning

It was the first Saturday morning after my return from an overseas conference. There's no denying that it takes a bit of time to adjust ourselves to the working mode after a holiday. But I did it. I went back to the hospital and my routines.

Saturday routines have been many things to many people: a morning to sleep in and have brunch, a holiday to recover after long working hours, and tutorial time for students. According to my Saturday routines, I first pick up a topic to read, followed by an one-hour teaching of remedial class students, and then morning round at 9.

Here's what I read this morning: remote ischaemic preconditioning and kidneys, and it's a promising way to save our patients' kidneys from being knocked out by contrast dye (as used in a lot of imaging in hospitals). Such cases are common. In order to show the blood vessels in the heart, for example, doctors need to inject dye. Just as remarkable as the dye's power to outline the blood vessels, is how powerful the dye can damage the kidneys. So how do doctors get around the problem? The idea for such a protective drug to safeguard the kidneys has been around for close to 20 years, but none had pulled off a miracle. Easy to say, hard to do.

Last year, news broke that a trick called remote ischaemic preconditioning could cut the odds of kidney damage by 80 percent after dye injection in the heart.

An unusual trick.

What they did was to inflate a blood pressure cuff on the arm for four cycles, five minutes on and then five minutes off. The action of the inflated cuff, of course, is to apply brakes on the blood flow, and if short-lived, won't suffocate anybody. It's hard to think of any tool, any drug, any machine in history with which so many can afford so easily. It's a form of rehearsal or disaster drill, to the point that our patients' kidneys get better prepared before the real attack.

Which makes me wonder: Just how similar can I apply the concept of preconditioning to prepare my medical students for their examination?

School

My annual leave keeps accumulating. So it came as little surprise that almost two months after my daughter's new school year, I haven't had chance to pick her up after school. A year ago, she wasn't ready to attend school on her own and I've lost count of the number of times she cried at the kindergarten's door. But that was then. Now that Jasmine, more than three years old, is carrying the backpack and lunch box all by herself.

I took half day off yesterday to pick up my little girl, and that means she didn't have to jump on the school bus immediately after class.

It's easy to spend an hour weaving through the kindergarten campus, and around each corner of the playground you're rewarded - with laughter or smile of the kids. Is there any happier sound in the world than your child's giggling with her navigation of a rope course? Or the silly guffaw after a quick slide, landing with the butt? 

Soon after my half day leave, I knew I'm going to take another one soon to join my daughter after school.

Vernacular

Never heard of "TL;DR"? Then you're obviously older than 30. If you've learned English since young and you're having problem with new words, it just might be because of your age.

The list of new entries in the Oxford Dictionaries Online has been expanding faster than the waist size at your belly. Look at those slangs and shorthands that come with digital communication. See how they make communication easier - or not.

I've just read from the Washington Post that a "selfie" refers to a photograph of oneself, typically "with a smartphone or webcam and uploaded to a social media website." It's not as if we don't have the term "self-portrait" in English. But "selfie" is another matter. It's hard to replace "selfie" by "self-portrait" without losing the meaning. Hard as putting panty hose on a porcupine.

That said, it would be important to set a quota for admitting new words. Evolution of lexicon is a series of flukes, some good, many bad. I admit it: words or acronyms like FOMO (meaning "fear of missing out," in case you aren't updated) always give me agita. I'm rock-solid certain that I have absolutely no fear missing out the word FOMO. That's also why I don't think we need "TL;DR" to indicate "too long; didn't read."

Secret

You'd think that clinic consultation is private matter, because we assume that no one is overhearing the conversation between doctor and patient in a consultation room. Think again.

Not long ago, I read an inspirational article about privacy in Time magazine. Though the article mentions how children of a certain age think closing their eyes will make them invisible, it remains uncertain whether grown-ups are any smarter. Or perhaps there's not much difference. We've been all fooled by the illusion of privacy.

The illusion of privacy, I was told, dates back to the Hebrew Bible. Unbeknownst to Bathsheda, King David was pacing on rooftop when she stripped for a bath. Fast forward to the era of WikiLeaks (think Edward Snowden) and Internet service provider like Google (think pop-up ad that matches exactly your recent searches in the blink of an eye), and we don't have to be reminded that it's getting more and more difficult to keep our secrets. Nearly everything is being watched in this new age of data. Everyone is not immune to being watched - everyone, that is, including doctor. It's stubborn to get too furious about being audio taped by a patient. Stubborn, that is, unless you are as naive as a child who thinks that you can keep everything under the cloak.

Promotion

Promotion, in general, gives a lot of good feelings. Everyone seems to be talking about job promotion in my workplace. It is fine to look for promotion - it's just that by mistake, some of them thought that I'm keen to get a consultant post in another hospital.

 

I couldn't help laughing the first time I heard the rumour. And I think I'm going to smile and even chuckle the next time I was asked the same question.

A while back, by chance, I was reading an enlightening story about promotion. That's about someone who gets promotion in your office. That one isn't a personal friend, but you do know her. What do you think you'll say to her the first thing when you see her?

"Congratulations."

Yeah, nobody will disagree. And what next? Some of you will say, "You deserved it."

That makes sense, too. But I was told that this answer isn't the right way to get connected with people. "You deserved it" won't engage people simply because it isn't a statement from the perspective of the person being promoted. It's from your own perspective and literally means "I think that you deserved it."

Too often we are saying the same words from our perspective when we hear the news our friends get promoted. Instead of saying "I think that...," I was taught, we should have responded in a better way, "What does it mean for you?" In short, the response should be about her - not about you. And it would make us more aware of what our friend thinks and feels.

I don't really know who will get promoted, but will watch out for the amazing opportunity to practice the way to get connected with others.

Tapper

Like many internal medicine doctors, I often see eighty-something-year-old men and women coming to hospital with a diagnosis of frailty. The word frailty is more or less the same as fragile. Being fragile, a senior gets easily bulged with ailments, and then bursts.

As one of my fragile patients went downhill, one family member after another asked for escalation of treatment to save his life, understandably so. That patient had weak muscles, scanty comprehensible words and quite some bruises (after doctors' attempts at taking blood), and was making each breath with difficulty. That's why he had a tube inserted into his chest (which appeared to have burst), and ended up breathing (through a tight mask) from a pressure machine. And yet, as we read the advance care plan that accompanied the elderly man, we recognized the clearly written statements not to carry out cardiopulmonary resuscitation, not to have ventilator support, not to give artificial nutrition. At the end of that statement, his daughter dated and signed it. It isn't right to be aggressive in terms of treatment, I thought. I thought the family should have thought so.

But, no. The daughter knew she'd signed a document. "It's about my dad's ill health and a fast channel to get him into hospital without having to go thru the emergency room." She knew next to nothing about palliative care of his dad, leaving me awestruck by her convoluted concept. The patient further deteriorated two days ago, when I happened to be on call at night. He was dying. And that's what I told my intern and the patient's family. Easier to understand than the word frailty.

After a hectic night, I taught a large group of medical students. It's about communication. Not communication to sign a advance care plan. Still, the theme is similar. Doctors who want effective communication with patient or family, in a nutshell, have to "unknow" what we know and get the listeners' perspective. Medical students, like doctors, know so much about a topic, and it's rather difficult for them to imagine a listener who can't understand their knowledge and language. Elizabeth Newton, a Stanford University graduate student in psychology, explained this concept nicely in 1990 by performing a now-famous experiment of tappers and listeners. That experiment simply divided a group of people into "tappers" and listeners." For those who are assigned tappers, they picked from a list of well-known songs such as "Happy Birthday to You" and tapped the rhythm of the song on a table. For the listeners, the job was to guess the song.

Easy job? If you answered "yes" to this question then you - like the tappers in the experiment - may be suffering from the curse of knowledge. The tappers predicted that listeners would get the correct answer 50 percent of the time. In reality, the listeners correctly identified 2.5 percent of the songs. Why? The tappers heard the song in their heads at the same time of tapping. While the tappers had the knowledge, the listeners were simply perceiving a bunch of disconnected taps, like a kind of bizarre Morse code.

And so, I told the students, when we give a lecture on a medical condition like atrial fibrillation, the listeners are more often not following what we say. We are giving them a bunch of Morse code.