Home

It is always a pleasure for paediatricians to write "Home" in the case notes of the patients. There are two meanings. With this definite sign of discharge, the first one is of course the in-patient workload will decrease and everyone, including the nurses and the doctors, will be happy if they have less to do.

The second one is of course the kids can go home without hospitalizations, and they can enjoy lives with their families. The kids can sleep one their own bed in the end. It is hoped by doctors that the kids are not often seen, because they are healthy.

However, the luck is not meant to have for everyone. Some of them are really so sick that they cannot live without hospital care. Like Xara, she had been here since I attached to the department. Her epilepsy was so problematic that if we loose our care she might have severe seizure somehow in the streets.

I know she is still optimistic. Though she could not go outside to enjoy the holiday, many friends of her have come to the ward to visit her. She was never alone.

Also does Ho jai. He still needed to stay for a long time because he needed to grow better to be operated for his throat problem. However, we knew that he will one day complete his surgery and go home. Also, his mother provided all she could to take care of Ho jai. We know he will be cured someday.

When the ward was filled with joy. I just noticed there was nothing absent. Something I never expect to see happen.

Our happy princess cried tonight.

Cosmetics

It was quite rare that you can find patients that are older than you in the Paediatrics module. Nevertheless, I have met a few patients who still need to attend to paediatricians despite being adults.

The difference is immense. You can't easily talk to kids to pick up their history. However, as an adult, they are more descriptive when they mention their symptoms and their long long medical history (that's why they STILL need to be seen by paediatricians!)

She is a thalassemic patient who has been transfused with blood regularly since she was born. Our medical system is good in that we try to provide useful therapy to patients. Sometimes, however, she still suffered from anemic symptoms that she was not able to work normally.

"What would you do if you felt that you don't have enough blood?" I asked her. I was never able to ask this kind of question throughout this module until that time.

"I would put on more make-ups so my face would appear red!" She answered me directly. In my mind, there was only those anemic symptoms like "SOB, palpitation...." and I just wanted to know how she would do when she was working.

That time I realized that she was on cosmetics when we talked.

Medicine is about life, isn't it? She is already a grown-up and she needed to appear attractive. Being pale surely  was not what she wanted. Sigh! It is such a simple thing that I do not understand.

Gift

Christmas is near. What do you want? Let's ask Mr. Santa Claus.

We all like him. We all like the red-clothing old man with a big brown bag who would climb into our house and put the presents into the big sock. If he comes to our town, he will bring us hopes and gifts and he never let us down, even though he never comes to this town.

I never expect he will come, but this year, I really look forward to his gifts for our kids in paediatric wards. Mr. Claus will bring them many good medicines to heal our pretty children. He will play some music for our Down's syndrome patients, for he knows they love music very much. He will get some new cloths for them so they have something new to wear. He will stay with them so that they won't be alone in the night, no matter he just stay for a while.

I beg our Mr. Santa Claus to visit the abandoned children. Will he come to UCH to visit Ocean? He never see his parents since he was born. It was not because Ocean was blind that he could not see, but because his parents were cruel enough to leave him just after the delivery. Ocean could not move probably because he had cerebral palsy, but I know that if he could move, he would go to find his parents.

Will he come to PWH to visit our happy princess Yi-man? She might be a bit irritable during feeding because of her illness, but everyone in this world should love to see her smiling face. How come her parents give up their precious Yi-man? What wrong had she done to deserve just a fate?

Ocean and Yi-man, you better watch out, you better not cry, you better not pout, I'm telling you why: Santa Claus is coming to town, carrying your parents for you in the day where He was born.

Wham!

When this name came out, you probably know what I will talk about.

It is Last Christmas.

This song has been known since 1984. Almost 30 years later, it is still THE song that you can hear in every corner in the city. It makes sense, because there are still many souls waiting for healing. And Pop songs are the best palliative treatments.

Although I know this song for a long time, it has never been so striking to me until this year. Do you know what this song is talking about? It is all in the chorus.

Last Christmas
I gave you my heart
But the very next day you gave it away
This year To save me from tears
I'll give it to someone special

It is a mixture of bitterness and happiness. The past was bitter that the heart was thrown away, not being taken a bit of care. However, the singer is still optimistic that in the future, he will find someone to give his heart to. There is a dependence to the future, which is all we need. If we don't ever have this, we will not just be able to have someone to write this song for us, we have nothing to rely on, for the present is so harsh and intolerable.

We still need to dream of something good in the future.

Voice

Last night I was supposed to sing in the Christmas Party, but eventually I decided to withdraw myself from the list of performance.

The cause was very obvious: I lost my voice this week. The weather was changing and it became drier and drier these days. My throat could not handle the change and became very sensitive to cold air. I was forced to make some dry cough these days.

My throat, as a result, was inflamed. My voice was damaged. In that morning, I realized that my voice was cracked. Without a good voice, how possibly I can sing?

But to me, it is not the cause.

It was because I had no one to sing to. The person I waited for did not come. Probably the one was having fun somewhere in this planet. But hardly the one will think of me. I already knew it. It was not I that was without a voice to sing, it was the one who was without a heart to hear.

If I appeared to be optimistic, I could still think of singing it again. But probably, there was no such chance. I will not have a wonderful tonight.

Throughout the night, all in my mind was a line which was full of wit:

閉起雙眼你最掛念誰 眼睛張開身邊竟是誰

Clone II

The aim of attending public exams are surely score high. What you need to score high in these exams are usually not depend on how work hard you study, but how many tutorial classes you attended. These tutorial classes will have model answers for you a month before the exams. They said these were tips.

Anyhow, many students attended the same star tutors in those famous tutorial school. And they will choose similar programmes (like Business, Medicine, Law...etc). Many be they are really interested in these subjects. May be. Our educational systems train people to specialize in certain aspects in high school. Interestingly, nobody will choose programmes without prospect.

And then the story goes on. When they graduate, they pick up those stereotypical jobs for a ten few thousands. They work so hard for they have to save up money to buy flats from our tycoons in Hong Kong. They work so hard so they may have a chance to have baby in mid-30s.

Their kids will go to the same cycle again.

I am now considering making up these images for one music video. I am sure that New Born by Muse will be very useful.

Clone I

The city is dying, you know?


Perhaps this statement struck the chord of many people in Hong Kong recently. It was no doubt. Rarely, we can see something this stunning that appeared in that broadcast company. We just wanted feeling good when we watched television. We did not want any critics and truth.

Our population is diverse in that there are families which can only earn a few thousands to live every month, and there are families which can earn a few thousand millions every month for lives. Their living styles are completely different.

However, they demand for just the same goal. As our richest person pointed out again and again, he loved  to earn money. Everyone love to earn money. But what for? We don't know.

In a bid to get the money, there is a formula for everyone in Hong Kong once they were born. When we left the hospital, we started to have the best formula milk which claimed themselves to promote the intelligence. Later, we will partake in thousands of tutorial classes for Languages, Mathematics, Drawing, Music. These such of classes were called interest classes which served for the interested parents, but the unhappy kids.

Later we were forced to go to some kindergartens with good name. The cause of having a good name was not necessarily because the kids were happy there, but because they could train the kids to interview better for primary schools with good names.

Of course, the cause of having a good name was again, not necessarily the kids were happy and built up some good moments. (to be continued)

Geneticist

It is so unsettling to think that I, though pretend to be a believer of man-can-overcome-the-fate, am also a geneticist.

I used to think that I have nothing, and it is only the tremendous motivation that drives me to this stage.

But I was wrong definitely. my healthy body and logical body has been enabling me to solve problems these years. It is largely contributed by my family and also a great deal from the health care system which keep me from grave illnesses. Going back to basic, if I (which comes from a sperm and egg) was not a healthy fertilized egg in the first stage, I would already have screened by the antenatal check-up and my mother would then selected for termination of pregnancy. I would then never been born.

I would feel scared if my son or daughter was not screened in the antenatal check-up. What if they had Down's syndrome or Patau syndrome? I could not endure the torture of having a baby that was unable to compete in this world. Therefore, I would also choose to have a termination of pregnancy, should that happen.

It is so shaking to discuss this topic.

Abandon

Sometimes life is cruel. In O&G I've learnt that most of us are of in fact unintended pregnancy. Seriously, we need to be thankful on the failure of male condom. Do you know that there are a great deal of fertilization because of that?It is by chance that our mothers think that it is better to keep us alive and we become what we are now. Otherwise, we are just the residue from the process called Termination of Pregnancy. The mother is really a killer (but it is legal).

Fortunately we become normal people thanks to the advanced natal cares and also the health care system. However, there are still some poor people who are not having the same fates like us. They were born to be defective. (I have no intention to write a political correct entry by naming them reality-challenging)

But being defective doesn't mean that they were useless. The best athlete of Hong Kong is a man with cerebral palsy. And you should know that, the next CE of our locality, may be mentally retarded. They can still achieve.

I also think of Gattaca.

But it seemed contradicting that our antenatal diagnosis is making us a geneticist?

Cult

I never watch an episode of the latest drama When Heaven Burns (天與地) because I spent all the nights in the hostel. However, it appeared to be very interesting and very unorthodox.

The most stunning idea in the drama was known to be cannibalism. There are a lot to discuss about this practice when you are the critical moment of life because you will make a choice on whether Utilitarianism will outright anything to justify the act. But sadly, I can see no commentary in the web talking about the issue. The director and the writer will surely be disappointed.

Of course, there are still a lot of funny things that sculpture the drama to be a cult one. Politics. Corruption. And Rock n' Roll. Something we seldom see in these 10 or even 20 years of TVB drama. People just love the drama.

The director has something to say to us. But whether we are intelligent enough to understand, we are not quite sure. As we can see, we are a commercial city and we all are the slaves of consumerism. The C Lais will dominate the public opinions and mark a drama or a movie.

I cannot stop thinking about the famous line. "Hong Kong is dying, you know?" I knew that the drama was shot 2 years ago.

Target

Despite that the I was not able to register for the HK marathon next year, I still managed to have a running along the Shing Mun river.

This was a shame to tell: I had made a plan of doing it twice a week at the start of year four. However, it turned out that I only did it one or two weeks during Psychiatry module. After that, I just rarely did it. The motivation was further depressed by the failure of the registration. Why bother having a intensive running schedule if I was not going to have any match in the future?

But I was wrong. After all, running is in itself a fun activity to do it. When I did it I could feel the wind blowing against my face. I could recall how I did the same thing in the CU campus in the midnight, when the temperature was just eight degree Celsius and there was no one on the road. It was the fun. There was just nothing but myself in the little world of running. It was so private. It was so fun.

After the exercise, my ankles hurt and my muscles ached. People said you can only feel the existence by suffering. It makes some sense.

Eternality

Christmas is coming, Titus has made a new advertisement for the watches.

The advertisement is artistic. The content is about a woman who appeared broke up with her boy friend for three years. And in these three years, she sold almost all the stuff which belonged to the man. It was, of course, not for the minimal money they she could get. It was because she wanted to forget the man. This was the way she tried to do it.

My boy, how can you forget someone if you still have him in your heart? "Why do you still wear the watch?" The main actor in the advertisement asked her. You should have known that a watch had a special meaning. Because it is about time. Because it is about the time that you spent with the lover. Because it is about memory. Because it is about the memory that made you feel you are not alone in this world. Since you have known so well, why should you ask this?

The advertisment creates a brilliant slogan: Time is love. No doubt.

Question constitutes the romance of love, for love is full of wonders and it has no answer.

But one thing we can be very sure is that love has changed. In the past, the back of the watch was written with 4 words 天長地久. Now people do not like it. Eternality is too long for human being. We just want a bolus of excitement and we don't want more. No wonder we have loved one night stand more than ever before. No wonder we have so many sex partners but we have no lovers. It is so natural.

Treatment

Last night, one of my friend who wanted to work in Paediatrics later asked me how the module was.

It was difficult to tell. While some Paediatrics worked so happily because the children would be curable and have a happy ending, some would work with a mask face. I was not mocking, when I thought of the senior medical officer in the Center who needed to take care of those miserable kids.

However, after all, it really depended on how you worked as a pediatrician, or generally, a doctor. The nature of the job of course makes a big deal, but the attitude towards the patients and the community also matters. We  should always try to remember how happy it is to build up our scientific and logical mind to help our patients.

Most importantly, we have to do it like a human being. Today, I went to CMC for the outvisit, which inspired me a lot. As suggested by a few classmates, the cases given to us were rare and basically they served for "eye-openers" rather than "examination oriented".

Nevertheless, as you know, a lot of rare diseases had a dim prognosis. Our cases were not immune of it. I was given a chance to examine a 15-month-old girl who had a cleft lips and cleft plate. The nurse directly gave the girl to me that I had to hold her in my arm. It was a special experience because it was the first time I was allowed to hold a baby in my arm, and the baby was significantly having some congenital problem. I tried very hard to find out other abnormalities to reach a diagnosis but I failed.

"This is a patient with Patau Syndrome." The doctor stated the diagnosis.

I was stunned. It was not just because the diagnosis was rare but also it was extremely unusual to have a Patau Syndrome patient to live more than one year.

"What is the treatment?" I asked the doctor.

"Tender, Love and Care." The doctor answered with a smile.

Liberal

My mother and I had a liberal discussion during the dinner. Today, she wanted to share with me her experience today in church, when there was a woman speaking for her witnessing of God. She said:

"I was a believer but was not firm enough a few years before. I got pregnant five years ago but my faith was not strong enough. It turned out to be a miscarriage. I saw my weakness to God. It must be I was far away from God that my kid got aborted. Because of that, I turned to my God more firmly.

And then I got pregnant again last year. My doctor told me that I need to have some screening test done since I was a advanced aged mother. I thought of God and I knew that if strong faith, I did not need to care about the health of the kid. Whether or not he will have serious genetic disease, I know the God will be with me. I did not do any antenatal screening and follow-up at all with strong faith. Finally, the baby was born and he was healthy. Hallelujah!"

I told my mother. "This is the extreme of religion."

My mother was so shocked. "Why do you think like that? This was a miracle!"

"Yes, having a healthy baby born was a miracle." I thought those babies in the Paediatric wards and the teaching from Prof. Yuen. " And yet, she was such a irresponsible mother. She should know that it is not just the burden of mother to take care of a sick child. But whenever you use the facilities and medications from hospitals, the whole society needs to pay. Of course, there is nothing that human being can completely control and God will eventually play his role. But then, Why do we still need to promote our health care and prenatal diagnosis of genetic diseases? Can she think of other people in our community (especially doctors and nurses) who work so hard?"

I could not stop thinking of those fundamentalists in the world.

Perfection

I realize that usually every Friday night a RTHK programme will talk about philosophy. Of course I was not able to listen to it when I was still work hard for the revision, but I took time to get the audio clips and listen to it during transit time.

One time I had a chance to listen to Dr. Tao, an associate professor of philosophy from our university. By chance I happened to attend a summer course of which he was the lecturer. The old days were always memorable. I love his teaching. I seldom see the wit and the wisdom from the professors from the science stream.

The topic was the limitation of human being. He said, when we were born we were not able to be something, i.e. we could be born in different places at the same time. And diseases and ageing would limit our life, which was quite easy to understand.

And then it went on talking about the ideas of lovers (this topic had been covered last week by Prof. Cheung, however, they just loved to talk about it. May be it really manifests the romance of love). Who is the ideal? Who is THE one?

In fact we realize that the perfection has nowhere to find in this world. Everyone is limited, the idea of lover is just somewhere in our imagination. No wonder, Albert said imagination is more important than knowledge.

Generation

I went back to my secondary school to give some advices for the juniors since the class this morning by our dean was cancelled.

I intended to tell some of my juniors, who wanted to study Medicine, what our professor of hepatology would say (http://vwswong.blogspot.com/2011/10/orientation.html).

There was only but one guy who appeared to be interested in Medicine. I still told him that being a doctor does no longer mean you can be rich. It is very harsh, if you don't really enjoy it.

It s very important to know the subjects before you are really into it. It is preparation. But when I asked if these people really know what jobs they will have and the characters, they can simply tell me something I can have known via TV dramas. It is, after all, too superficial to convince other people.

The potential medic said he was interested in it, and he thought he would not be able to do it considering his past academic performance. Other people who wanted to their subjects also stated their worry.

Yes, being admitted to medicine, you have to be very competent in terms of academics, but at the same time, they still have time to prepare the A-level. I encourage to be more confident and score more As in the A-level examinations. With that he will have a larger chance to be admitted. It is confidence.

Unfortunately, these 18-year-old people are lacking of both characters. It will later on prove to be critical to their careers.

Publicity

Come on, please be a bit more matured. You do not need people to recognize that you are married by making a show in front of eight thousands people. I cannot see any romance in it. But it is the trend.

I used to think that there are something that you can do only if the other one. For example, a candle lit dinner. However, you see more and more people uploading their beloved photos onto the Facebook to express their affection. May be they think that if they upload the photos (the food should be also well captured), the meal will be more meaningful. An it might as well be as if without a mobile upload, they did not have a dinner.

Of course, I shall not elaborate one other famous example from a local philosopher Dayo Wong about how couples loved to make films on their own sexual intercourse.

It was until recent I heard a term called PAD from my classmate BC. PAD stands for Public Affection Display.

Our society is full of love, if you see the walls of your Facebook and also news during public holidays. Couples holding their hands together feeling so blessed. However, if it is really true, how comes there are so many people decided to divorce a few years later?

Come on, please be a bit more matured and thoughtful. Kids can't make good marriage.

Showbiz

People in the web were talking about Swing. More precisely, they were talking about the marriage of the member Eric Kwok with his long-term girl friend Yip during their concert in Hong Kong Coliseum.

It was a show. More than eight thousands audience witnessed their game. Both were dressed erratically. Some well-known artists including Eason Chan and Nicolas Tse were also on the stage. Mr. Kwok even made the Tse dressed like a wizard being a witness of the marriage. The atmosphere was anything but grand. When the lawyer who was supposed to regulate the marriage said the marriage had to be grand and honourable, I thought he was joking. He might think the same when he said that.

But the fans liked it very much. The crowds were in manic phase. Everyone was so exciting that they could not stop shouting and laughing when the stars on the stage did the show. The Mr. Kwok even interrupted the lawyer when he spoke about the regulation of the marriage by saying something non-sense. That time he invited Tse to be THE witness. You should know that Tse just divorced.

Of course, any event would end with a photograph. They did not mind if they dressed nicely. They were happy, and that was enough. They made a big show and their fans were elated.

What is a marriage? What does it mean?

Experience

In the paediatric rotation, the most fruitful thing was the teaching from our very experienced clinician Prof. PY.

Two week ago, when I first met him, he was a grey-hair-and-walking-so-slowly man in the child cancer centre. I was completely impressed. He was a true physician. I knew it! (I paid no disrespect to some experienced physicians. I was just stunned by the impression.)

His speech was clear and logical. He got in to the point in every sentence. This was Kung Fu. I knew it! No wonder he said that "It was lucky of you to have me as your teacher. I have been in Paediatrics for more than 40 years and I am a retired man. I come back to give the essence of my knowledge to you and hope you can benefit from it." Sure. I reckon these two bedside teachings as the highlight of my year four. And compared with year three, I think these 2 bedsides were superior. Sigh, I am not sure if my med three was spent without direction or these 2 bedsides were so good.

I reckon the other old doctor who taught us with heart. You must know him too.

Comparison

Today I had two stunning findings in QEH where I had my paediatrics rotation.

The first thing was undoubtedly, the dextrocardia from a very active kid. What a shame that I did not get the touch of his apex beat at the right side. What a shame! It could be the only time to get it at the right. And despite that I felt good auscultating the heart sound at the right sound. Brilliant.

The second thing was I had a bedside teaching with the students from our sister school. The students were year five and had a bedside with a paediatrician in the neonatal ward. It was a valuable experience. You know what, the bedside was different entirely with ours. It was not spoon-feeding, which I dislike. It was 100% the Socrates method: the doctor asked, and the students replied, followed by the challenges by the doctor again.

The students were much more knowledge than I was. Also, they were so much capable in answering the questions systematically. I was too dumb when I stood with them. One case I was the one to perform a physical examination, everyone noticed the abnormality but I was the one who stood knowing nothing.

It was not that I didn't learn anything. It was that I didn't really be observant.

This was really alarming because I felt that in year four the learning curve was not promising. I think I will not improve a lot finishing the year four. If I looked like what I was today in year five, I would not be able to compete with the students across the harbour.

The out-visit really benefited me.

Wave

I was told that there was a year three junior being praised by our star medical officer that she could go straight to the PACES with her bedside skills.

I was alerted.

Yes, being so brilliant in year three was good. In fact, you stay longer in the general medicine and surgery during the junior clerkship in our medical school. As a result, you will see more patients, noticing more symptoms and signs, which are the roof of our reasoning towards formulating the list of differential diagnoses and subsequent managements. I wish I was half as bright as that junior student so to learn more in year three.

But then I was puzzled if the junior should be praised so early. As you know PACES is a membership examination, which is 4 years after her junior clerkship. Optimistically, she will keep it up and become a bright gold medalist. Later on choose to become a medicine MO for the PACES. (And hope she will not go to Family Medicine to enjoy QoL!) If our star medical officer was right, she can pass without any difficulty.

But at the same time, I am afraid of witnessing a death of another burning bird. Do you still remember the story of her? scoring an excellent marks in HKCEE in young ages, and then had a famous admission to our medical school. And do you still remember the ending of her?

Let's hope that our junior classmate can bear the pressure. She will be the future of our school.

Philosopher

Last Friday the wise man Lau has made a great radio programme inviting two Professors of Philosophy to talk about Love.

The two professors were Prof. Man and Prof. Cheung from my university. I used to attend a talk of Prof. Cheung on Symposium when in the end of the my first year of university life. He was a humble man. Perhaps he was more humble than Socrates, since he refused to call himself a philosopher despite his knowledge on philosophy, while Socrates declared himself a philosopher though he said he knew nothing! It is sensible. The more you live with knowledge and philosophy, the more you know the limitlessness of the wisdom is.

Professor started the conversation with the material from Symposium again. It again showed the importance of it. How can you talk about love without talking about Symposium? And yet, as he mentioned, Symposium was only one of three philosophies of Love in this world. While the love of Socrates means the pursuit of Good (which follows that we must take away all the bad in our life), other philosophers like Aristotle commented Love is composed of a single soul inhabiting two bodies. Because of the other body, you will try to become virtue and wise. Of course, the last philosophy of Love in this world would be from Jesus Christ. "I love you, therefore, you are beautiful." It is about Sacrifice.

The philosophy of love should be spread out so everyone knows it, and people will make fewer mistakes.

Sickness

This entry was about something trivial: recently I developed a fever, for the first time since Year four.

I knew it was a common cold: I had a bit alcohol last Friday with friends and I did not wear a jacket walking in the streets. I realized that I was the only one who only wore polo shirt only in Yuen Long. Backing home, I knew that the temperature was only 20 degree Celsius. The alcohol desensitized me.

I started to developed fever when on Monday, which was associated with runny nose and lethargy. I knew it had to be a common cold. I tried to rest more so I could get well as soon as possible. I did not want to stop in Paediatrics. This is a module that a small pause could be lethal.

At the same time, I could not stop thinking about the suspected TB patient in the ward. The AFS was negative, but what? Did it mean something? I did a Respiratory exam on him. There were hot signs! Should I ask him more about her recent weight loss - was it because of TB infection? Should I ask him more about the illnesses of his father and his sister? Was it TB? These thinkings cannot leave my mind.

(Later it seemed to me that my worrying was not necessary: the patient has discharged home a few days later. Retrospectively, it showed that the empirical antibiotics worked for his pneumonia and there was no contact tracing for me.)

The psychological burden has been lifted up. And I got much better when I took long-hour sleeps and had a football game.

Unlimited

Today I tried to find what 放題 means in Google translation. The answer I had was: Unlimited.

The fun in having Japanese Buffet was that the unlimited desire would possibly be fulfilled within that one or two hours, but the sin of fulfilling the desire was so grave.

When we were accustomed to this form of eating, we could easily lost the sense of adequacy. How much was too much? How much was too little? You should know that people will be satisfied only if they have meat rather than vegetables. Furthermore, most of the time we had more than enough, therefore, the burden will be transferred to our body. In foreseeable future, metabolic syndrome is bound to happen if people cannot control their diet. I wondered why some middle-aged people would go to Japanese Buffet. They were having long term suicides by having the bulimic eating.

The more I stayed in the restaurant, the more I thought of the little kids in the paediatric wards. When they were just a neonate, hand waving of us would be a great performance in their eyes. They would be laughing so happily. When they were a 2-3 year old kids, they no longer got the enjoyment from that, they needed many toys to fulfill their wishes. In extreme case, I saw a kid lying on the bed watching videos and playing games using a iPad2.

Perhaps, when they became adults and stay in hospitals, they will need 10 maids to take care of them since they were not satisfied with our already-hardworking nursery staff.

Our desire is engulfing our lives.

Buffet

As my friend Abel suggested a few days, having a Buffet was a dilemma. It went on like this:
If you had little than enough or just had enough, when you left the restaurant, you would be struggled with an idea that "I could have some more" and this idea would bother you.
If you had more than enough and got a big stomach back home, you would feel bad because of your hyperphagic action.
Combined the two conditions: No matter how much you eat, you won't feel good.


*Our scientist even made a logical statement like this:


（Ｐ → Ｑ） ∩ （～Ｐ → Ｑ））→ Ｑ


His opinion was interesting and alarming. You know that people in this locality love Japan very much out of many reasons. As the Japanese Buffet provided a great deal of Japanese food, provided that you afford the expensive entrance fee, you could have unlimited food in the restaurant.


Since the demand for the Japanese Buffet was so big, many restaurants emerged in this city these few years. However, still it could not satisfy our stomach and the restaurants had to force customers to eat within two hours. They had to go even though they might not finish the dishes on the table, and shut down their appetites. (Today I went to one Buffet restaurant with LC and NH, and we encountered a tighter time limit: 1.5 hour.)


This time, I proved the logic of my friend to be partially correct. Since I just had enough, and I didn't want more after I had left the restaurant, I didn't feel bad. As a result, despite the validity of the statement "（Ｐ → Ｑ） ∩ （～Ｐ → Ｑ））→ Ｑ", when I had just enough, I did not fell into the category of P or ~P. Finally, I felt good.




Perhaps It was saint in these days to be just enough. I shall not elaborate more.

Rabbit

After the weekly football match, I had a chance to talk to one of my senior JY. The content was of course something about football.

"What is going on with Manchester United?" I wondered. "They used to be so strong at the beginning of the league. Now as we could see, they were lacking of the dominating power to get the 3 points in any match!" In EPL, you can only get 3 points with a victory.

"The root of the problem has planted for a long time. The problem was the midfield! They didn't have a world class central midfielder at all. Now they have to rely on Wayne Rooney, who is a striker, to play that position. It just signaled that there were no reliable midfielder at all in the squad!." He explained.

"Well, they used to win the Gunners with a 8:2. But after that, the gunners bought a few good players to enrich the squad. And you could see how quickly the rebounded! Everyone in the world was so stunned by their achievements!" I said.

"And you see our beloved Manchester United." I went on. "They missed the chance to buy midfielder in the transaction period after the victory over Arsenal. Now the problem emerged and their performance was disappointing. Who is the winner in the end, after the 8:2 game?" I questioned.

It was just a match between the Rabbit and Turtle. 

Pillow

At the weekend before the new module, I took the whole sunday for reading a internal medicine textbook, from which I inherited from Dr. TC.

You should know that a huge textbook has an alternative name, which is called Pillow. It is mainly because of the huge size. People in our medical school seldom read big textbook in junior clerkship, fearing that we would have inadequate time for the panel examinations and the 2nd MB, the examination content mostly come from the lecture materials.

As a result, we would spend our time for memorizing all the notes, instead of reading the three classics: Harrison, Davidson and Kumar and Clark. Interestingly, this approach was exceptionally good. The people who scored A all just read the notes.

I took the opportunity to revisit the topics which I was not familiar with. They had never been so clear before. Perhaps I really have the sense of clinical medicine. Now they were just like some friends of me: when I visit them, we could tell a lot of stories in the old days. When I didn't visit them, I would sometimes think of them.

I found the joy in studying. My professor of Psychiatry said studying medicine is joyful. Yes. It is true.

Predicament

Today is the district election day. As a citizen of responsibility I should go to vote.

But there is a selection predicament in my district.

One is from DAB, the other is from People Power, the so called DAB team B. Interestingly, if PP is team B, it should not have been becoming one of the candidate to versus the team A. But it is what the situation is. I have to choose among the two. And I don't like their parties.

Nevertheless, I still took a look at their election platform, comparing and contrasting it. After that I should decide who to vote.

The platform from the Team A was specific and showed that he really knew what was going on in our district. The crime. The prostitution. The transportation. They were something that annoy us for a long time.

The one from his competitor was broad and general. Democracy. Education. Health Care. His platform was supposed for someone to go to the Legislation Council. Anyhow, it was not really tailor-made for us.

I finally chose the Team B. Interesting, huh? It was based on the OSCE principle. For DAB Team A candidate, he was good in saying specific platform, but at the same time, he said something really irritated me. He emphasized that he would eradicate the unlicensed hawkers in our district, which I 100% disagreed with. Our town is a small town. Our people are not rich enough to go to the supermarkets for daily needs. In many occasions, we rely on the hawkers to provide us the necessities. If he is to clear up the streets, where shall we buy the stuff we need in a reasonable price?

It is as if a candidate who says will discharge a symptomatic psychotic patient for out-patient management. Wrong to society. Wrong to the patient.

Principle

After the MRI experiment I rushed to TKO for the Health Exhibition. I was assigned to be one of the senior medical student, whose responsibility was to give health advice to citizens who finished their health check.

You might think that, this sort of consultations were simple and easy since you just need to explain to them the results of the simplified health check-up. It was in reality not the case. They came to the check-up with their own concern, which was far beyond the general medicine.

(The following was just a imaginary story. It was not the truth.)

A elderly woman came to me for her weight gain problem. She showed me a small of box containing pregabalin, which was an anti-convulsant. She told me that she used to have chronic bowel symptoms and many medications from many GPs had failed her. It was until someone told her the diagnosis would be psychological that she suffered from numerous bowel openings everyday.

"I could not accept that I need to see a psychiatrist for my GI problem. I just had diarrhea and I am not mad!" She told me with tears. Yes. In our world, being a psychiatric patient was a grave stigma.

"No, you are not mad. How to you find the medications given to you? Does it help your bowel problems?" I asked.

"Yes it is good but it also increases my weight continuously. Moreover, it was so expensive that I am thinking of ceasing the follow up and medications."

"In this case, let me give some of my words to you. First, you need to understand that the contributing factors of having a illness are not only physical but also psychological. People often attribute illnessess to be only physically-related and neglect our emotions. So far, we are having more and more evidences showing that emotions play a role in many medical disorders.

The other thing was that Western medicine sometimes could only offer symptomatic treatments and uncomfortable side effects are not avoidable. Even worse, the drugs produced by the drug films were often very experience in the first stage, which barred many people take it.

However, I reassure you the better day will come. The better day will come. One day we will make better drugs with less side effects. One day the drug film will lose their patent and the drugs will be sold much cheaper. One day, you don't need to take any medications and enjoy a beautiful life."

She smiled and thanked me.

喜樂的心、乃是良藥，憂傷的靈、使骨枯乾. The Bible has already told us how inseparable our body and our mind is.

MRI

As promised I went to PWH for the neuroimaging study held by the Professor of Neurology.

It was quite a new experience. First I had to dress the purple gown with my clothes removed. When I took the gown up, I looked as if a terminally ill patient to receive radiotherapy.

One thing is the machine was exceptionally noisy. It was much worse than before the drum set. The beats were regular, and the quality of them made me feel that I was as if in a studio having some acoustic drum beats converting into electronic one. They were distorted. Very nice indeed.

However, the noise barred me from the hearing experiment. The Professor of Neurology had wanted to see the effect of calling on the rewarding system of the brain. However, I hardly hear the exact names. What were the names? The instructions said it would be my name, a name of one of my friend and a name which I did not know.

Well, it would be better not to hear the name of my friend. I am not sure if that name will still activate my rewarding system. The joy of hearing the name has become painful since her birthday.

After the experiment, the staff commanded on my reaction time during the game. "You were exceptional that your slowest reaction time was already the fastest one of others! And your fastest one was outstanding as well!" I thought to myself that if I were not to be a doctor in the future, I could join the real FoxHound and become Solid Snake.

Sky III

I spent the last weekend alone in New Asia College for revision.

Huh? I have already had a dormitory in Prince of Wales Hospital. Why should I stay in the male hall in the peak of the campus, where I can have no friends to entertain (or to be entertained)? Both of my friends went back home in that weekend, leaving me alone in the room.

Did I feel bad? Not at all. Having friend nearby is a bonus. Living alone is the norm. C'est la vie.

On top of that, what drove me back to the campus was not just because of the friends but also the serenity and beauty of the campus. You should also know that the male hall was on the peak of the campus, that when you looked outside from the window, you were as if in the sky.

I remembered one day in year one, when I legally lived in this male hall. I looked out and found that the clouds were all descended and wrapped up all the scene below the window. All I could see was the sea of white and the top of distant buildings. It was as if I lived in a Castle of sky.

Why would I remembered that day recently? Oh. It just reminds me how inseparable I am with the nature. I am not a man for vanity fair.

Sky II

Therefore, today was the first time I voluntarily watch the movie. I don't know why. Perhaps the melody flashed into my mind when I was in pain studying the O&G protocol!

It was a new experience. Not telling you a lie, I still found the falling of Sheeta to Pazu a very romantic scene today. But I won't dare to imagine one day I would become Pazu and have my Sheeta. May be time has changed. Romance only lives in the works of artists.

At the same time, I started to appreciate the thoughts of Hayao. Why was there a castle in the sky? Why was there so many treasures in the castle? Why is the castle heavily enclosed with root of a gigantic tree? Why is there a apocalyptic weapon implanted at the base of the castle? It all had a story to tell.

It can be summarized by the folk song in the movie, as described by Sheeta:

The roots have to be inside the soil 
and live with the wind. 
They have to stay with the seeds in the winter
and sing with the birds.


When we look at the world. You should see how people chase the money and power in the expense of the nature and peace. They fight for vanity fair and neglect our simple needs.

It is just like building a Castle of Sky, where the roots never reach the ground.

Sky I

After the funny OSCE, I decided to relax myself re-watching a anime: Castle in the sky by Hayao Miyazaki(宮崎 駿).

No, I should clarify that I did not re-watch this classic. Every time I watch it, it is a new experience.

When I was just around 6 or 7 years. The ATV showed the film for the first time in my life. What attracted me the most was of course, the background music. I did not realize that time this piece had already won uncountable applause and awards. All in my mind was the nice melody and the female voice. I did not know the Japanese lyrics.*

And when I was a secondary school student, I had the luck to watch it in TVB. In the beginning, you know that Sheeta fell from above into the arms of Pazu. It was a romantic scene in my naive eyes. I wish to have someone in my arms coming from the sky one day. (Even Pazu in the film said: you were just a like an angel descending from the sky to me. Hayao Miyazaki was wit to make this line for entertaining teenagers!)

And now I had another experience.

* This is the English lyrics from an internet source. The song is called Carrying You in English. It was a good one that it retained a lot of ideas from the original one (http://www.justsomelyrics.com/1550285/Laputa-Carrying-You-Lyrics) by Hayao Miyazaki, and it can by sung perfectly.


1.
in the stillness of the night
in the distance there's a light
the horizon is a glow
And it's you that's there I know
why the lights appear so bright
it's because with all their might
they're trying to hide you from me
But I'll soon be there set you free

※
Yes, the time for me has come
To set out on my way
loaf of bread,knife and lamp in my bag
I'm standing up today

I'm taking along with me dad's determined mind
while watching over me
is mom's sweet eyes, so kind

2.
and the earth goes round and round
to the rythm of your sights
in search of you i'm bound
just the sparkle of your eyes
so the earth goes round and round
while sailing throught the skies
in no time at all you shall be found
I'll bring you out of your disguise

Leauge

Perhaps it was because the landslide defeat of Manchester United to the noisy neighborhood Manchester City that I didn't have the right mood to make entry recently. (Of course, the true cause was I would have examinations soon and one other thing)

And I was relieve to saw Manchester changed themselves and had a one-nil victory over the Everton. It doesn't matter how many goals to win. However, it does matter that the team had a clear sheet tonight. The harder we were hit, the harder we bounced. Let's go over it again. It was what define Manchester United.

And one more that astonished me the most was, of course, the 3 - 5 win of Arsenal at Stanford Bridges. Do you still remember how bad the gunners was few months ago at Old Trafford? They had the worst defeat ever in the history just before. And how they were back with a convincing victory. The Flying Dutchman Robin Van Persie, though I was never a fan of Arsenal, had a game that moved everyone who watched the match. This was the man who would bear the losing team, instead of moving to a winning team, and get the team back the right track. The three goals were great. You could not imagine how elated the gunner Captain was when he finished the hat trick a few minutes before the end of the match. Chelsea was a great team, but they lost to the best team of the day.

So stand up! Manchester United. Three point was not equal to the League Championship. It is a long race that will only finish by the time the 20 teams finished all the 38 matches this year. Never forget what the City had done one week ago. We shall get back and want for the revenge!

Orphan

If the new information is correct, then my Nexus One would become the Orphan, despite being the first Google Phone. It will be left behind by the android system that the phone would not receive the Android 4.0 update.

This was a stunning news to me, since after the repairing, I had hoped that the phone would be have a new life: not only having a physical repair, but also a systematic improvement. Now the dream shall not be realized. I was a bit disappointed. You know what, Nexus one only appeared in the market for 2 years and it was abandoned.

One thought came to my head: shall I purchase one new phone to keep the breast with the trend? The new system was very attractive. It was much quicker and beautiful. Also consider my phone: it had been repaired for two times. The third time will surely come.

But for a while I knew I won't do it. I will keep the phone until the very last moment of its life. Because I thought of E, who told me her story with her phone:

My phone had been with me for 4 years. It was of course very out-dated. But I loved it. I love to make text and the phone is able to do it. Therefore, there was no reason to change. It shall be with me until it was no longer usable.

It is the attitude that I am looking for.

舉重

八星期的婦產科實習後，我相當肯定，日後不會做婦產科醫生，可謂有違年少時的戲言！不過，邊個可以預見未來？或者我真係有一日會如我所「願」。

這兩個月內，可圈可點之處不多，惟有一人必須詳講，誰人如此重要？我的導師，L醫生是也。

實習開始不久，我跟同組的伍同學拜會L醫生。因知道他是首領之一，我倆坐在會議室內，都恭恭敬敬，唯恐一個不小心，得罪老師。然後，他進來，講了一些對我們的要求，包括要事先通知他下次會面時間，講病例時要用良好、簡單的英語，例如：要以時間順序講，不要用short-form，除LMP同EDC講實際日期 (例如2011年10月23日)外，其他一律講相對時間（例如3日前），要分清男女，要分清單雙數……原來這些就是首領的要求，實在有點無聊，「一早知啦，洗你講」之言不禁由我心裏發出，自己亦不放這些要求在心內。

點知自己英語實在奇差。第一次在首領面前講婦科病例，我有口難言，發現自己講的內容亳無內涵，邏輯不順之餘，語法亦狗屁不通，首領花了極多時間，才能理清重點。我講完，午飯時間一早過。做得醫科生，捱肚餓固然少不免，唯L醫生堂堂大頭領，為了我差勁的英文竟然不惜花費自己的時間，細心教導，回想自己「一早知啦，洗你講」的心態，實在無地自容。

之後一次會面，他為了使我們的簡報能盡善盡美，反覆思量簡報當中的邏輯，力求使當日的聽眾明白，將簡報一執再執。完成時，我們看看會議室的鐘面刻度，已經是七時多，部門的其他員工都一早回家。L醫生送我們離去時，我又再慚愧多一次。

我那時才發現，他的要求不只是良好、簡單的英語，而係對工作的態度。首領入行多年，大多一眼便知我為人甚為粗魯，不是做婦產科的材料。他為人心水清，知道粗魯者必定粗心大意，為此，他特意訓練，由最簡單的病例匯報入手，改善我多年惡習；以身作則，不惜加班，使我日後不敢偷懶。

或者工作態度決定日後發展：認真的如首領，做事一絲不苟，便有舉重若輕，事半功倍之妙處。

War

I have attention deficit hyperactivity disorder. I know. That's why I can't stay at home just reading the O&G terminology only. I need to entertain myself.

This time I chose to watch a TV drama which aired 10 years ago. It was Wars of the Genders. (男親女愛)

It seemingly the war never ends. Do you know Miss Mo is the drama? She was a middle-aged lawyer, unmarried (until the end). And Yu Lok Tin, was a mere paralegal advisor in the Law firm. He was never comparable to Miss Mo. But they collided anyway.

If not living in drama, the reality should never make them a couple.

Bhutan

There was a story from everything, including my broken phone.

It was the second time that my Nexus One went wrong. The power button stopped working again. I took the phone for the repair in February this year, and it failed me again. Recognizing the same pattern of problem, I searched a web called androidguy.com and found this statement.


"Google’s Nexus One has been, or still is for some users, one of the best Android handset available. However it is far from being the perfect device we would all want to own."


Therefore, I was forced to make the repair again. I contacted the HTC (who was the producer for this Google's son). They told me that this time they could not do it for free, because the phone had no warranty. "How much was that, then?" I asked. "$150, plus the price of the item that the phone needs." They said. (later I confirmed to cost to be $400)

"They are gonna make a higher price when you have the phone repaired. You can just go to some small shops around the streets and get it done! It would be much cheaper!" My intelligent mother said. I did so.

The shop I found said I just have to pay $250 for everything and could get it back on Saturday. Well, it seemed good and I made the deal.

But the deal just proved a cliche from Midnight in Paris. "Cheap is Cheap." On Friday, I got a phone call from that small company. They told me that the repairing needed a higher charge, which was $480. They allowed me to choose if I still need to fix it by them. Of course, my answer was of course a NO.

Today, I got the unrepaired phone and found it was further broken by the company. Before I gave it to them, it was still intact grossly and I could close the case. When I got the phone, the phone appeared to be more irregular and the case was only to be closed with a powerful grip. I forced the company to make it look better at least, so I could get it to HTC for the fix, an official fix.

But what then? Does the repairing mean to be good?
-----------------------------------------------------------------------------------------------------

You see, what happened today would be written in History.

People (who called themselves 99 percent, aka the majority) in many cities were having demonstrations against the greedy Trillionaires. They called it the Occupy Wall Street event. They asked for the reform to bring the rich down. 

They knew that the capitalism system was having problem: when the economy was in prosper, the rich earn a much larger portion of money than the 99 percent, while the economy was in the down side, the rich earn more money from the 99 percent. So no matter how Mr. Sze made his extremely conservative comment (http://hk-property.blogspot.com/2011/10/c_07.html), It was still defective, right?

However, as The Wall Street: Money Never Sleeps suggests, no matter how we decapitate the capitalists (or the vamps, if you like), there will be just another bunch of capitalists moving up and get all the benefits from our world. Don't you agree with me? The greed inside our soul will drive us to do that. In Universities, we train students to support the system. People will still love to have quick capital gains in the stock markets. The world would not change if the system is still this system.

But what will be the system we need to have? We may not like capitalism now, and we hate communism. Where to go?
----------------------------------------------------------------------------------------
Why don't we go to Bhutan to have a look? While most of the countries in this world take money as the most important thing to fight for and use Gross National Product as the index, this very small country took happiness, and the former king of this country create a Gross National Happiness as the index.

Whether GNH was really a good index for happiness, I am not really sure. But at least, the marriage of the handsome King appear to be a good marriage. People were so beautifully dressed. They could forget their jobs for a few days to have fun. Despite that they were really "underdeveloped", for example, they just have had Television for ten few years, still, they can sing and they can dance. They said, happiness is not only from the material, but (largely) from the spirit.

Now I used the old Nokia phone from my father. I lost all the apps. I could not watch News and Youtube using this phone. Making SMS would be more difficult since I am not familiar with the physical buttons. And I could not take photographs. But then? My father gave me a phone, which is a genuine phone that was without any additional use. And still I could talk to people I want to talk. Who cares if I can finally have a healthy Nexus One back? Happiness is not only from the material, but from the spirit. The Kings of the Bhutan were the tutors of the world.

Transmission

Have you heard a news recently, that a man from California who made two thousands bottled-letters and threw them all into the Pacific Ocean to make friends?

It was a news, and it was surprising: after all, in this 21st century, we still used the most fundamental ways to communicate. While it was still lovely of the man to practise this old method. We should praise our nature, the power of which never let us down.

He said he got more than two thousands bottles back. Apart from the people from the other side of the Ocean just as Japan. What astonished him the most was that he got a response from Spain at the other side of the Atlantic Ocean.

Also, he got a letter from a old man from Canada who had a terminal illness. However, the date of the letter was 10 years before, and the old man probably died. What a loss it was. It was the destiny that brought them to know each other. However, the time was the funniest playwright: he loved the jokes of separating people apart.

Today we have the satellite above us and the wifi all around us. Most importantly, we have the Facebook before us. You may wonder, through these systems, if we can deliver our messages to the people we want them to get? I always wonder, if it is a better way than the bottled-letter?

I shall try to do it. If it is not proved a better way, I shall prove it. If it is not better, then I shall go back to the square one: making bottled-letters. The one somewhere in this very city can receive it. I shall also make paper planes. Like the bird which carried the messages in the past, it shall fly into your home and open itself. On the paper it shall write:

You 're Beautiful

You 're Beautiful

You 're Beautiful

It's true.

Anesthetist

What is a surprise? It is something you never expect to happen.

But it does. Today was the first day we three medical students attached to PMH gynaecology team. We were arranged to visit the operation theater in the morning. The feeling of it was as great as the first time I went to OT, though this time there were no really surgical cases at all.

There were 2 rooms for the gynaecology cases which need surgery, so we shuffled the rooms to see if there were something special that catched our eyes. We found it, it was the an Anesthetist to make us stay.

He was a retired veteran who came to OT as a part time worker. In fact I did hear this legend from my friend KW. "When I was there, I stayed in the Gynae OT learing anesthesia! There was a really good doctor who would love to talk to you. It was great when you were a bit bored watching the screen showing the procedure." So as he told me yesterday.

"You know what, now public hospitals are lacking of anesthetists, so I come back to help." The old gun said. He asked where we come from. Knowing the answer, he exclaimed. "You must know Sydney Chung! I worked with him when he was a MO." Oh, he used to work with my hero. It is wonderful.

Why he wanted to be an anesthetist? It was perhaps not really related to the ROAD of happiness (or QoL in a post-modern terminology). "Some people would love staying in out-patient clinics and help patients. Yes they can help a lot, only in quantity wise. How long would they take for a patient? Perhaps 5 minutes. And then they were forced to prescribed some meds for them and send them out."

"But as an anesthetist, you need to take care of the patient who would not respond to you. It could last for so many hours. Monitoring the vital signs of the patient is easy, but rescuing the patient when the signs go wrong in few minutes were very challenging. The responsibility is heavy but it is something that make me feel like I am a doctor."

As we talked the bell rang outside. What is going on? Oh. It was something went wrong in one other OT. "Luckily there was not a fire. But in case there was a fire, you students need to help us to take the patient away!" He said. "And we can never leave the patient behind especially she was now under anesthesia. It was the moral conduct (醫德) that we must have."

I heard this term from my hero when I was in my pre-clinical year too. They really used to work together.

Letter

Tomorrow Hong Kong Post will host an event called "One Person, One Letter". It is to promote making letter and mailing--not e-mailing, please bear with me.

It is indeed an interesting idea that we should all go and join. Writing, not messaging can reveal the character of one. The passages and the handwriting counts. In this day and age, however, we are all too used to making texts on the touch screen and forget how to write something that really come from our heart. Don't you agree with me? We type texts only nowadays. Writing, especially writing a letter, has been an ancient activity.

However, despite that we are still able to hold a pen and write on a blank page, we may not be able to express it properly. Instead of writing to express our emotion, we are all accustomed to putting smileys in our messages nowadays. It is funny but it is also naive, if you put a smiley in a write paper using a black pen. Everything in the letter will be destroyed with a smile.

In this world, I don't have so many things to say. But to her, I have something to tell. Of a thousands houses long, I can write a letter to her. The blank sheet perhaps is not able to contain my heart and soul. But let it be. Let it be! She will see it and she can know everything from me.

Sigh! What I don't have is her address.

Decision II

When you come to a decision to remove one organ, you probably lose it forever.

God is good and wonderful to make some of our organs in pair: the kidneys, the testes and the lungs, for example. If not making it a pair, he makes it a big one (like the liver) or a long one (like the gut). Therefore, surgery will be a success that at least part of the function, after the removal, of the system would be preserved and the patient would be healed.

But what if you want to remove the whole organ which is unique in your body, say, your uterus? Is it good?

Yes you are definitely cured, in a sense that you don't want any menstruation so you won't need to buy pads, you won't be troubled by the embarrassing bleed that makes you dizzy, you are stress-free from the urinary incontinence syndrome. Most importantly, if you consider pregnancy but an infection, you are forever immune because no fertilization or implantation would be take place inside your body.

"What if you change your mind when you meet a guy who loves you and want to have a family with you?" The doctor would ask. The doctor never wants to remove this precious organ of human beings

"Then he has to accept that I don't have it. Go and find someone else." So she replied.

What she didn't want is not just the uterus. May be, our greatest prophet Charles Darwin would be right again that this woman shall not have next generation. May be.

Decision I

In modern medicine, we respect the autonomy of the patients if they are conscious. That means, unless the patient is psychotic or disorientated or behaving abnormally or having significant brain damage that was unable to make decision, they should make the decision.

It is based on medical ethics, really. I am not a specialist of ethics and dare not to speak too much. So in short, if there is an indication, we have the expertise and resources and the patient can decide, something can be done.

It is good in a sense that we change our role from a father to a health partner to the client (which is a more politically-correct term). Don't make any change unless I agree. I am the owner of myself and I can decide.

However, life is not so simple. Everyday our medicine change, do they know really know their favored treatment and the doctor-proposed treatment? Do they really have deep thought on the consequences of the treatment?

Sometimes, especially in surgery, when you have opted for something, it is not reversible.

Right

Foreseeing I will not have enough time to study, I decided to flip though some pages of the Bible of O&G.

Speaking of which, I just saw an interesting case.

"A 33-year-old lady was diagnosed brain death at 8 weeks gestation, and she was put on ventilation through 34 weeks, EFW 1.8kg. Now she has unable blood pressure, however, her husband refused Caesarian section. Which of the following is correct?"

It was just something that would perhaps only appeared in movies or soap dramas: The mother lying on a bed in a cold room was intubated. Near her, a beeping ECG machine with a green line signaling the electrocardiac response and a crying husband holding her hand. It was 34 weeks that the new life could leave the uterus which was dying and enter his life.

And when the doctor asked the husband to operate on her wife, he refused strictly. Nothing is going to change. Even there is a baby inside the uterus of her.

What is the solution?

Here I gave you 5 options:

1)It is illegal to operate on her without her consent
2)Husband is the decision maker
3)Parents have the right
4)Doctor has the right
5)Court has the right

P.S. Of course, when the wife is living and can make decision, she is the one to choose.

Storm

It was the first time in clinical year that our HKO issued the storm warning that we didn't need to go to school.

But who would know if HKO did anything right after waking up. I was the one who didn't know. When I woke up, it was 8:10am. Damn. I told myself. I would miss the senior round in the gynaecology ward. Originally I decided to sleep more but my drive told me to get up and dress up and rush to the ward.

As I walked from the hostel to the ward, there was no rain or wind. I was even more guilty.

Of course, there was no senior round today, nor was there any classmate before I got there. The doctors there did notice my presence, but they preferred finishing their job as soon as possible so they can go.

After a while, VT came as well. He didn't know about the storm until he watched the television in the ward. "The HKO has issued the storm signal 8......"

The nurse wondered. "Why on earth were there some medical students today?"

"We didn't have television in our dormitory and thus we didn't know the message. Also, the weather seemed quite good now!" We finally gave our logical explanation.

Clock

This weekend was a tiring one that I kicked off with a 3-hour driving tutorial in the Saturday morning. After that I had the inter-year match with my medicine classmates. And today I had football in the rain with my friends. Finally, I ended the weekend with big shopping.

It was not really a big shopping after all, I just bought a watch from the Hang Send Clock & Watch Co. at Yu King Fong. What interested me to buy a watch after a exhausting game? It was because the company was going to close down and they decided to make a big discount on the watches.

I asked the owners while I was trying the watches. Why close down? Indeed I had an answer in my mind and I just wanted to confirmed it.

"It was because of the ever-interesting rent. We were a small shop and could not bear up with it. So we have to leave here and stay in the shopping mall there." I know they were talking about the Hop Yick Plaza. They could probably stay there for a while, but just a brief while. "It was not so remote so we can still make our business with the neighborhoods around here." Indeed, this was a old shop which was already established for 28 years. Much older than I am.

The old craftsman amended the length of the watch band for me while I talked to her wife. Well, it was a business of family. It was a small size business of course, nothing to compared with the Li Ka Shing stuff. But I loved the small size business much more.

The clocks on the wall were ticking while we talked. I started to understand why The Clock (鐘) had the same pronunciation of The End (終).

Pleasurable

In this morning, I had my driving tutorial with "German". Time is the thief to steal the happy moment since the beginning of the July. I really learnt a lot from this funny teacher and my driving skills improved a lot.

Today he looked a bit troubled and stressed. I guessed it was not because of my driving technique, for I did quite well today, not making a lot of fatal mistakes. (But whether it will still be enough for the examiners to fail me, we were not sure.)

"I missed the texts of my fiance!" His hand was holding his Samsung Galaxy I. He will marry his fiance 2 months later and she was pregnant. "She woke up so late that I leave home before that. Do you know why?" He knew that I was attaching to O&G, thus relied on me getting the information needed.

"She was fierce when she didn't hear my voice everyday. Sorry Mr. Poon but I need to dial her first......(He phoned) Hello Lo Por, I am teaching so I can't text you back...Are you all right now?......"

"It was a disaster." He told me when he finished the phone call. "If not I loved her so much, I will not able to endure her temper and requests. I need to make phone calls to her every time. I need to talked to her whenever she wanted to." I just recalled The Fortress.

"German. It was a pleasurable annoy, after all. Do you know how many people in this world long for a person to think about themselves?" I told him. "You are a lucky person."

P.S. It was of course a cliche. For me, it will be good whatever you are. The theory of the fortress doesn't apply on me. 

Elation

I woke up so early today. I was so conscious when I watched the clock. Oh, it was just 6 a.m.

Don't get me wrong. I am not having early morning waking like those depression patients. On the contrary, I was so elated by my dream.

Compared with the dream, I wondered, the real life was so boring. Yes Psychiatry is good. Yes O&G is good. But there is nothing compared with the dream. In my dream, I had everything that I wanted to and I could do everything I wanted to. There was no resistance and nothing can stop me.

It was as if I took a high dose of stimulant in the dream. It felt so good. Life is after all beautiful.

But after a while I realized it was but a dream. And more philosophical idea came to my mind. Do you still remember the scenes in Inception?

There was a place where people will get IV infusion of the powerful hypnotics so they could stay in sleep forever. And with the long term sleep, dreams happen. With the physiological support, they could stay in the dream forever.

"They come here every day to sleep?" Said Eames
"No. They come to be woken up. The dream has become their reality. Who are you to say otherwise, son?"

Rigid

"From my own experience, knowledgeable students were too rigid and were not able to make change."

This was not what I said. The words of wisdom came from my driving tutor, "German".

Despite that I was not knowledgeable, I do feel that I was one of those rigid students in his eye. "For example, they would not know how to coordinate in a different way when they got mistakes on the roads. Why always speed up during a turn? They should be able to to split the steps and do it one by one. Slow down, turn around and speed up. It is simple!"

However, I was pushy and often accelerate the vehicle during the turn. Thus my hands were busy to modify the path so the car wouldn't crash. It did anger German.

Sometimes, however, I was cheerful when I was not scolded by him because I had some beautiful turns.

"Don' expect I will say Yeah YOU WERE SO GOOD when you finished it nicely. You should be able to do it!" German said.

It looked to you that German was a harsh teacher? Not really. He was a nice person most of the time when I didn't make big mistakes.

"Mistakes can be classified into tolerable and intolerable." German said. "If you make intolerable mistakes, you will really kill some people in real situation so the examiner will not hesitate to fail you. On the contrary, you always made tolerable mistakes, and yet the examiners might not fail you."

He was telling me how to tackle the driving exam as well as our OSCE.

Sharing

When I felt the terminology unbearable tonight, I decided to take a short break, going down to the common room to enjoy a can of coke and read some "newspaper", if it deserved its name in the night.

Coincidentally I met MT, who was exhausted with Anesthesia.

Both of us were not so enjoying what we were attaching. This was concluded at the first second.

"Anaes is not a good job. Every time they need to get orders from the surgeons." MT diagnosed. "Despite having seas of knowledge, they need to do what the surgeons want. Only women were able to endure it, perhaps." Not necessary. There were many successful Anesthesiologists who are men. "They need to get jobs from the surgeons. So surgeons were as though their bosses." I commented.

And then, I told him about my disappointing attachment in the labour ward. "I felt I was so bad when I could not set the stage for the midwives. I was incapable to set up the things requested by them. Also, I felt that my knowledge was fading after the attachment." I was as if a demented patient with an excellent insight.

"Don't worry." MT said. "You won't use the CTG ever." He was mentioning the Cardiotocogram. "It was the jobs of the midwives. Ah? They said that fever is defined as 37.5 degree Celsius? Let it be. It was written in the protocol." And protocol is bible in labour ward. Midwives were the believers.

"Yes. So the terminology is not so interesting. It is full of protocol!" I complained to my senior.

Then, what is the value of doctors if we only know the protocol?

Gynaecology

The heart of woman is like the needle in the sea. You can only understand one thing from them, is that you can't really understand them at all.

I started to attach to the gynaecology team in our hospital. Do you know the meaning of gynaecology in its Greek? It is the study of woman. Oh, it is the study of woman. They are so special that we need to develop a -logy for them. (In fact, there is a andrology in this world. You might just never hear this word.)

We had our ward activity in the morning and we took a few histories from the patients. The symptoms were mostly about bleeding. It looked like boring. However, the bleeding meant a lot to them. Will guys really understand how patients suffer when they had their pants and trousers soaked with blood for a few times in a day? Will guys really understand how they will suffer when they have to change pads 10 times a day for the sake of the bleeding? It was something serious undoubtedly.

In the afternoon we stayed in the out-patient clinic. It was something different from the clinic during Psychiatry module. The doctor was different. The patients were different. However, one thing that stayed the same was the approach of the doctor towards the patients. She must take the psychological aspect into the account when formulating the management. She must put herself into the shoes of the patients so she could understand how it will affect the patient. After all, we were sons and daughters from our mothers.

How I miss my mother when I made this entry.