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