Tuesday, November 26, 2019

Font

Kids, by nature, resemble their parents.

"See, she gets my nose."

"But hey, her eyes look more like mine."

So yes, we parents are somewhat keen to see the similarities with the offspring. And I bet every dad and mum are just going to compete for their babies to look more like them. I sure do.

And yet it also dawned on me that we should not pray for a child being an exact clone of ourselves. Too much and I'd worry about her inheriting bad trait from me, too little and I'd feel distant.

I suppose the magic behind the game of fatherhood is watching his daughter grow up - a new character but with occasional dash of father's style. Even if we're not two peas in a pod, every so often we find ourselves sharing the same blood. We came close to bursting into laughter, say, when we recently realized that the favorite typeface for both of us is Century Gothic font.

Tuesday, November 19, 2019

Scoreboard

Not long ago, our hospital outpatient clinic has been equipped with electronic queue management system. That means we don’t have to use a microphone to call patients at the waiting hall; the automated audio system will do.

It didn’t take long for me to find out the perks of this tracking system. Patient tracking can become its own form of reward. And for good reason.

Let me explain. If you haven’t yet heard about the Canadian stockbroker named Trent Dyrsmid, go read James Clear’s hands-on book Atomic Habits. Dyrsmid began each morning with two jars on his desk. One was filled with 120 paper clips. Soon after making a sales call, he would move one paper clip from the full jar to the empty jar. One by one. Day by day. He kept dialing until he’d moved them all to the second jar. Thanks to the visual cues of moving paper clips, Dyrsmid made brisk progress and good fortune.

In fact, we had been also relying on the paper clip counts to keep a tally of patients we had seen at the end of each clinic session. It works, I know. On the other hand, I'd much prefer an automated system with the real-time computer screen display of the names of patients seen. I fall in love with chasing my scores with rapt attention. The thing is, it is way more satisfying to watch your results grow - the size of your investment portfolio, the number of pages you have read, the number of patients attended - and if it feels good, then you're more likely to endure. Visual proof is immediately gratifying. Gratification of watching the computer screen reminds me of the scoreboard for sportsmen in a stadium. With time, I stick with the habit of recording or tracking the "score" during and after each clinic session. Even if you aren't the type of person who enjoys recording your data, you'll find the measurements insightful. This is why I feel satisfying to track my progress.

The more rewarding it feels to track our progress, in other words, the more our brains’ reward system will spur us toward getting things done.

What if everyone turns out to be too obsessed with the numbers in our data-driven world? In Atomic Habits, James Clear reminds us the measurement is not the only thing that matters. In other words, if we focus solely on that number, our motivation will sag. High scores or not, no measurable data will stay interesting forever. At some point, we are advised to shift our focus to something different and not that measurable. The smiling faces of doctor colleagues who can finish clinic early after my extra hand, for example, are ephemeral but much more meaningful. Ditto for a grateful patient whose name might not appear on my scoreboard.

Saturday, November 16, 2019

Burns

There is more in a vigil around a deathbed than prayer. Tears are shed when cancer cells are scattered around a patient's abdominal cavity like pearls from a broken string. Conversations are intermingled with beeping alarm from the infusion pump for pain medication. Then there are muttered mumbles from neighboring beds.

I have been aware of how heart-wrenching it can be when I reserved a book written by a palliative care doctor Kathryn Mannix: With the End in Mind.

By the time I picked up the book about dying this week, it has become clear to me that conversation about death isn't too challenging. After all, most diseases follow a predictable pattern of trajectory towards the very end of life. But this is not the case for calamities from human clashes.

Now that Hong Kong is sick, stories of dying patients under palliative care specialists are much easier to swallow. The day after our alma mater campus turned into a smoking battlefield with teargas fired, I had experienced much more difficulty in reading news story than Kathryn's chronicle of a woman dying from widespread bowel cancer.

If I had the choice, I'd rather read Mannix's lessons on how to live and die well, instead of the news feed about how our campus burns.

Friday, November 1, 2019

Curiosity

Smartphones are not allowed for candidates in our professional examination. The same rule applies for the examiners, who are supposed to switch off or silence the device, in case of being distracted like Pavlov's dog to that ping! in the middle of examination.

It was already three thirty in the afternoon; I had examined more than ten candidates sitting for the membership examination, and my energy - that of the sweaty candidates, too - was nearly burned out, when I took a sheepish glance at my smartphone. There was an interesting email from a medical student. A curious student asked me why I had cast doubt on giving morphine to patient suffering from heart attack.

"Largely an old wives' tale in the era of dogmatic medicine," I'd previously taught him. Conforming doctors have used the word classical teaching with romantic promiscuity. We have been handed a long list of we-must-believe dogmas, to be strictly followed without asking why. Watch what happens when we exercise our curiosity, investigate and seek after new evidence, and think again. The myth of morphine in myocardial infarction, for example, will be debunked.

 If we are to follow the time-honoured advice, it will be that of Sir William Osler who cautioned that "the greatest enemy to the scientific practice of medicine is the practice of the routine."

Wednesday, October 23, 2019

Hero

It is not the sort of thing most people would lose sleep over. But for the last few months, many Hong Kong people - including me - have been stunned by the city's chaos amid tear gas, bullets, pepper spray and batons.

Seeking a break with the violence, I've told myself stop reading news before bedtime. They're too disheartening, too harsh, too mean, too terrifying. Gazing at electronic devices in our bedrooms isn't recommended anyway; their blue-spectrum screen light is going to inhibit the production of melatonin and throw off circadian rhythm. That's why I choose to read before sleep.

What do you think I have been reading lately? Another heartbreaking topic, ironically. A book written by David Nott, a Welsh vascular surgeon who has worked voluntarily for twenty-five years in disaster and war zone. He ended up with deafness after a bomb blast near the hospital in Aleppo and post-traumatic stress disorder from the humanitarian work intermingled with inhumane scenes. His book War Doctor: Surgery on the Front Line is basically a story of love which, to quote from David Nott, "isn't always tidy, and isn't always easy."

But first, a story.

One day, David Nott volunteered in Gaza where blast injuries were as common as pneumonia in our emergency room. He came across a girl who looked about seven years old, lying in the corner with extreme pallor and thread radial pulse. David Nott removed the blanket circumspectly and found a fragmentation wound to the girl's left arm without radial pulse. If you thought it was the worst scene you should think again. Alas, it wasn't simply arterial injury from the blast injury; her small bowel was hanging outside her body.

It's almost every doctor's definition of major trauma. David Nott knew very well the girl couldn't wait; her chance of survival dwindled with each passing second. He stared at the girl, mouth agape, and made a quick decision to scrub up. No sooner had the girl been put to sleep by anaesthetist than the door of the operating theatre flew open. It was the hospital security manager. "We've got intel that says the hospital's going to be attacked by shelling in five minutes. Everyone out."

The scrub nurse panicked. The security manager began shouting. "You have to go! Now! Right now!"

David Nott looked at the girl's blood pressure monitor, which read around 60 systolic. He knew he himself might die if he stayed. At the same time, he knew the girl would definitely die (in minutes, not hours) if he left. Leaving the girl alone on the operation table meant that she would die. He turned to the anaesthetist and said, "You can go, you don't need to stay."

"Are you staying?"

"I'm staying."

"Then I'll stay with you."

The story went that only two of them stayed behind to continue the abdomen surgery and radial artery repair, when all other medical and nursing staff were evacuated. The scrub nurse had left a lot of unopened swabs for David Nott. That wasn't a very logical decision, but David Nott could not bear to see another injured child die. The girl did survive miraculously, and so did the altruistic doctor.

David Nott didn't simply save the victims of the war. He saved the life of anyone in need. Once he had to operate on a Taliban fighter who'd been injured making improvised explosive devices. David Nott is often being asked how he can square his humanitarian work with saving the life of someone who might go on to making something that kills British soldiers or innocent civilians.

"I don't get to choose who I work on," David Nott says. "I can only try to intervene to save the life of the person in front of me who is in desperate need of help."

It's difficult to conceive of a doctor who teaches better than Hippocrates. But David Nott does.

Monday, October 7, 2019

Cave

A bit off the beaten track, Waipu Caves get fewer visitors than Waitomo Caves in New Zealand. Both are large caves with glowworms and limestone formations, but we don't expect guided boat tours past the stalactites and stalagmites in Waipu.

We found the hard way to Waipu Caves with our daughter today, as the path got darker and darker. We felt something slippery underneath our feet, a flash of fear that quickly turned to tension. My daughter hesitated when we suggested taking off shoes to delve the depths, panicking.

Like a reflex, my daughter shut her mouth and stopped moving. The creepy walk scared the crap out of her, the way one feels trying to smuggle hard currency across the border. She had good reason to be afraid. "Can we go back?" my daughter murmured. Cave walk was pretty darn wonky: black and wet. We paused regularly. 

"The destination is over there," said my wife, by way of encouragement, gesturing at a distant horizon. 

Ten minutes passed, and our eyes were adjusting more and more to the darkness, our feet to the skiddy mud and icy water. Bit by bit, we tiptoed down and were in complete darkness. It was then those luminescent tails of glowworms showed up like a Milky Way.

Seldom had we been so satisfied with every ounce of our efforts.

Sunday, October 6, 2019

iNaturalist

We've been taught: a person's name is to that person the sweetest and most important sound in any language. Everyone. That means any bird, butterfly, or even fern.

I have over the years loved to name the birds I saw on the road. To get a feel for what I might chance upon during my recent New Zealand trip, I brought Andrew Crowe's bird guide to get acquainted with species like tūī, takahe, pūkeko, and fantail.

Now, instead of looking up their names in a pocket-size guide, I was introduced to my new guide, iNaturalist.

The moment I heard from a like-minded travel buddy of mine about this free smartphone app supported by the National Geographic Society, I felt a connection to this digital crowd-sourced naturalist guide. iNaturalist, it turned out, to be the perfect companion to vacation hikes. All we need is a snapshot and a button click to submit the wildlife photo. And within minutes we will hear from the entire community, suggesting names followed by short descriptions of the wildlife.

It is that simple - and that powerful.