30 Apr 2012

Winter


Singapore was located in the tropical region. The people enjoy (or suffer from) a summer which lasts for 12 months in a year. Every day here is a sunny day with some rains, or a rainy day with sunshine. Singaporean all adapt to it, because they have nearly no choice.

The only choice that they have is to go travelling. I've met a few local students here. They have been to a lot of places. From the Facebook, I see that most of them go to the snowy places. Yes. Surely they want to experience a white winter. We all want it.

Of course, going to the countries to get some snow in your hand are not affordable to all the people in Singapore. There are not really a lot of people in Hong Kong who can do it. But still, In Hong Kong, you have to wear jackets in December and enjoy (or suffer from) the cold days. There are differences in the four seasons: the humid Spring, the hot summer, and the breezy autumn.

Therefore, whenever I was asked which place (Singapore and Hong Kong) is better, the answer would be Hong Kong definitely. At least, it would be impossible for them to find someone to sing 春夏秋冬 like Leslie Cheung did, because they never experience climate change in Singapore.

And they also never have someone like Leslie Cheung or Anita Mui, and so many in Hong Kong. I shall not elaborate further.

29 Apr 2012

Feast

At the Thursday night of my last week of the attachment, my supervisor invited me and my classmates to have dinner in a Penang restaurant near the hospital. We had a good night, chatting and chewing.

As my supervisor was a graduate from my medical school, we had many discussions about our own school. He talked about his old days: the life as a medical student, the doing of the professor-to-be, the teachings......This was the genuine story of MB.ChB.

Of course, he talked about the life in Singapore. "Living here, I did not have to prepare for the winter because we have the same climate in 12 months." He said. "As you can wear the same clothes thorough out the year, there was not really a need to buy new clothes. Therefore, I realized that when I compared the photos I took recently with that from the past, I still wore the same shirt!"

But still, he stored a case of jackets, for he had to go to meetings outside Singapore, such as Japan.

Prof. K the Japanese surgeon was also in the dinner. He also talked about his old days. Our classmates, Obsessed with mangas and animes, asked if he did the same when was a mere student. "Yes, we all do. My favourites were Doraemon and Gundams that time. The comics were really good to me when I was young. My daughters also loved it!" Something were just timeless.

The dinner was a good finale for my elective here.

26 Apr 2012

Pepsi

Every morning after the round with the doctors, we will go to the canteen for some drinks. As usual, the head of the team will treat all the members of the team. That's why I am so honor to be a part of it.

A doctor in the upper GI team always ordered Coke light (or Pepsi light). Someone asked him why. So he said: because it sounds similar to "light call"--that I don't have to work so hard for a day. It is just a superstitious thinking, and yet because of him, I ordered the same every morning. (Perhaps it is associated with that these 4 weeks have been so leisure-able)

How about the Black coke zero? I saw no one drinking this here. It is perhaps other superstitious thinking.

I realized that I have been drinking sugar-free coke for quite a long time. I forget when I drank the last red Coke. The taste of the original taste of the red Coke was replaced. The more you think about it, the less you can remember it. All in your mind was the sugar-free one. The substituted one. The fake one.

Free association: The more you listen to the love songs, the more you watch the romantic movies, the more you think about the erotic love, the definition of love will be replaced. As a result, you can't get it anymore.

24 Apr 2012

Liquid

But then, I realized that I still have to depend on the morning tea to wake me up in the future. Perhaps it was the only stimulant in the world that could just fit my time schedule, and really makes a day a day, and a night a night.

Just hope that I will not get any kidney problems in the future, and gouty attack as well.

Let's talk about another liquid that we drink commonly. It is alcohol. For your information, a study has shown that minimal amount of alcohol will decrease the chance of getting cardiovascular problems in postmenopausal women and mid-aged men. Sounds good. However, the problem is we could never know how much is minimal, especially when you feel good drinking.

And what it comes after you have binge drinking, is a big box of complications that troubles medical students (because we need to recite), physicians (because they have to take care of the alcoholics) and yourself (because you have to pay for it).

What is the most dangerous drinks in the world? It is called Dihydrogen monoxide. It can choke a person when it gets to the lung. Drinking too much will kill. Seriously, it killed the most in the world as a liquid. However, no one can live without it. It is water.

子貢問:師與商也孰賢? 子曰:師也過,商也不及。曰:然則師愈與?子曰:過猶不及。《論語·先進》

Drinks

All drunken we are. You can see it in every shopping mall there must be some coffee shops. You cannot just see it but you can also smell it with its distinctive odor. Some classmates of mine said they are coffee-dependent. Very true. They can't live without coffee, saying that it is their eye-opener--if you do not drink one in the morning, they can't open up their eyes.

I am not obsessed with coffee because I am too sensitive to it, meaning that I can't fall asleep whenever I took coffee in the daytime, let alone in the night. As a result, my eyes will get opened, my mind apparently awaken in the midnight.

It looked to be advantageous to the health, in a surgical sense. Why? Coffee drinking has been linked into the occurrence of pancreatic cancer, which is one of the most difficult cancer to be cured. All of you should know, Steve Jobs died of this cancer as well (He was already the lucky one to have a mild form of cancer, and received the best treatment in the world, according to the news.)

I like tea. Having it, I can managed to sleep when I want and have to in the night, and my performance in the daytime is much better. In the very last few weeks of the previous academic year, I was almost addicted to it to survive the examination!

However, some doctors said it was associated with renal stone problems. I was shivered when I heard that and I has become more cautious.

18 Apr 2012

Train


As I have said previously, I need to take a long ride to get to the hospital from my hostel. During the transit, I took out A Lover's Discourse: Fragments to revisit it.

I still found it very unusual in that I could not possibly find some terms to describe it. The writings did not come with a system to tell you the philosophy of love. In contrast, it was something that every lover will think of, when they thought they were in love with someone. There was nothing new seriously, but there was no Roland Barthes who manage to write something like this.

Because the book was so melancholic to me, though I finished the book already, whenever I get into the train, I have a fleeting depression from the young Werther, whose name was frequently mentioned in the book. "Oh, we were just passer-by in life". I told the passengers sitting opposite to me in my mind. "Our passion will never get response, our love forever futile. In that case, why should me meet? Is not our encountering making us suffering?" It was the classic Werther-ish writing in his letters.

The passengers of course did not know what I was thinking about.

Therefore, the train has produced a conditioning to me. I hate taking the trains now.

Sick

In the past, the Sadhu would create pain and suffering for themselves. They said it would put them closer to the truth and virtue.

Perhaps I am now closer to it as well. I was sick these days. It was a common cold. Perhaps I stayed in the OT for too long that I did not realize it was so cold inside. I was very lethargic in the weekend that I just could hardly carry my body to the Universal Studios and anywhere in Singapore. After that, the fever subsided and the cough came.

I could not imagine how weak I has become. I was very healthy in year four in Hong Kong. The medications in my room was never used.

Outside the sky went dark and a heavy rainfall was inevitable. I thought to myself, if I were the emotional young Werther, I could have gone suicide now to end the misery. He was bravery to make that decision, but to live up with the adversity was equally bravery.

Ah. Why do I talk about Werther now.

I just realize why I felt sick now. I finished reading the A Lover's Discourse: Fragments.

Statesmen IV


This was the time where British politics came into play. The government decided to upgrade all the colleges into universities. Thus Hong Kong have eight universities that are supported by the Government, and one private university.

The number of undergraduate bloomed. 10% of the students who completed their secondary school education would finally enter the universities as a result. The proportion keeps increasing as the number of undergraduate programmes are also in surge. In the past (when there were only the Big Three), there were around 3% students who could finally reach the universities.

The apex of the pyramid had been blunted. This produced two effects: first, we thought we had more educated people and elites in the community (which was wrong); second, it destroyed the stairway of society that next generations from low socioeconomic class could hardly climb up, since becoming a university student was much easier. It was until they graduate did they realize that they was not able to find a job that was superior to a job for the people who did not finish secondary school education.

Going back to the Singapore medical training system, since everyone can almost get the training they desire and the hospitals are responsible for the 5-year training. They will become happy during the programmes, until the examination which would definitely eliminate a large proportion of people. Even worse, the people who survive the examination are not necessarily better than before.

The doctor concluded: I wish there were some people in the authority who can foresee the problems in the next 5 to 10 years, and stop the change.

In my opinion, they don't need to foresee the problem there. They just have to study how Hong Kong became after the upgrading. As Winston Churchill said. "Study history, study history. In history lie all the secrets of statecraft." Our consultant was undoubtedly a better historian and statesman than the people in the authority in Singapore, and in Hong Kong.

P.S. Don't get me wrong, my friend. I never think that a university undergraduate was a better person than those who were not. Please see the cases of Steve Jobs and Bill Gates.

16 Apr 2012

Statesmen III

I've found an extraordinary similarities of the Singapore medical training systems with Hong Kong tertiary education systems. That made me sweat, and at the same time, shiver.

100 years ago, we had only one university located at the Hong Kong island, whose purpose were to establish the influence of the British Colony in South-east Asia and allow the local Chinese to be educated in a Western manner. Surely, this University cultivated many talents and generated knowledge that had served Hong Kong so well in the next 100 years.

And then, after the PRC dominance in the mainland, some Chinese philosophers and educationists escaped to Hong Kong. In a bid to spread the Chinese culture, they set up colleges, which formed the backbone of alma mater. (This was a much simplified version. In fact, it was the British government which grouped these colleges to build the Chinese University, which angered the Chinese philosophers in the end. But in the end, who wanted to know these facts?)

Towards the end of the last century, one technological university was launched at the other end of our city. It was, as its name implied, a very practical institution whose aim was to make researches and developments. These three universities, were generally called The Big Three (三大), among all the tertiary institutions including the City College, Polytechnic College, Baptist College, so on and so forth.

It actually was a hierarchic pyramid. For those who wanted to govern, study medicine or engineering, they will go to HKU or CUHK or UST. For those wanted to specialize in technology, or learn Arts, they will go to the colleges. Our society needed everything from these institutions, as long as they produced at the right amount (and the right quality).

The system had run so well, until we were told that there would be a handover of the sovereignty.

15 Apr 2012

Statesmen II

He went on. "Because of the change, I found it very difficult to arrange duties for the trainees. Who should be responsible for the most simple tasks? The difference between the junior trainees and the senior trainees have become unclear, thanks to the blanket term (residents). The authority put guidelines for our educations towards them. For example, they said the juniors should know how to do hemostasis (simply: stop the hemorrhage). But what kinds of hemostasis should they know? Stop the bleeding from portal vein? (which cannot be stopped without experienced hand)"

"We as teachers were not told precisely how to teach in a new way for the registrar. In the past, we know who should do the basics and who should do the difficult tasks, because we were taught in that way. Now, the system change, but we did not. I tried to learn how to teach, but the guidelines were not clear and practical that I spent many times to learn. How can I ensure my teaching quality? How can I promise that the juniors and seniors can learn what they should learn in a timely way?"

"Most importantly, I was not sure how the examination would run. In British system, we learned how to solve clinical problems. However, in American system, we needed to know a lot about the origin of the problem (also known as pathogenesis). I agreed that the pathogenesis was important. But I have forgotten the cellular mechanisms when I dissect the stomach!" He was not satisfied. "British system was practical in a way that the examination runs to test on flow of thinking clinically. That's why it worked so well for so many years in many countries in the world, including this city." He said. "I see no point that we should change our system. I was pessimistic about the doctors and even the medical students whom we trained for the next five or ten years. They would not receive good training like what we did in the past. If they do not know how to solve problems. The final suffering would go to our patients."

13 Apr 2012

Statesman I

After the morning round today, I had the last breakfast with the upper GI team. We were not in a hurry, therefore, the team had some deep talks on the change of medical training system in Singapore, which puzzled our consultant AS very much.

To give you some background information first. Singapore training used to be a British system, in which registered doctors could receive basic training and advanced training for around 3 years respectively after they completed the housemanship in public hospitals. The trainee would firstly be screened to enter the basic training programme, and then examined before they enter the advanced training programme. In this case, incompetent doctors would be advised to quit the programme, leaving the able trainees in the stream. After the advanced training, the doctors could become associate consultants or consultants in 2 to 3 years time

As a result, the pyramidal hierarchy is made: only the cream of the cream could receive adequate training and climb to the top of it.

Since few years before, however, the story did not remain the same. The authority decided to change the British system into a American one: After the graduation, all doctors are allowed to choose the specialty they want as a resident (or registrar) provided that the hospitals provided training posts. The hospitals are supposed to provide a 5-year training to the residents for an examination, so they are enabled to specialized in their field. Should they pass the examination, they will become associate consultants or consultants in 2 or 3 years.

In short, the pyramid no longer exists since the intermediate exams for the basic trainee to the advanced training programme disappeared. All the residents would receive the training necessary for the specialist examinations.

I could not help sweating as I listened to our consultant. (To be continued)


12 Apr 2012

Operation II


The next patient who received surgery was a kind aunt. She was quite old but looked quite energetic. She spoke good English and I could talk to her easily. She said she felt uncomfortable when eating for quite a while. The food was stuck at the stomach region: she was telling you the diagnosis.

Since the diagnosis had become quite obvious, I tried to ask about her social history. What is the importance of social history in Surgery? It mattered! According to the Professor of Psychiatry, the surgery patients are your patients. Everything about them can change the management. Also, why do I have to stop knowing about my patients?

I asked her what kind of food she loved the most. She said: every food in Hong Kong! It just touched my deepest part of my soul: I miss Hong Kong so much after staying in this country for around two weeks. I really missed there.

Go back to the surgery. I had to say: it was a complicated one. There were no seedings outside the stomach, however, the local invasion was seen and there were many fibrosis around the stomach. The surgeons took a long time to dissect the lesions. Since the operation was prolonged, we were all tired. Even the main surgeon was so stressed because of the difficulty. Sometimes the field was so messy and blood kept coming out. We were all scared that we could not protect the patient.

Luckily, with the technique of the surgeons, the lesions were taken out. The GI tract was reconnected. It gave the new life of the patient immediately. We were all excited.

I guess it was the love of surgeons. I feel the resonance. I know it.

Operation I

There was a poster on the changing room towards the operation rooms in NUH, saying: Choose the job you love, and you don't need to work everyday.

I think I understand it now, after a long day observing two surgeries which started from eight thirty in the morning to six thirty. To tell you the truth, I was forced to leave the operation room to leave me friend when the surgery was not finished that time!

The first one was to close up the abdomen of the patient who had Abdominal compartment syndrome. To cut a long story short, the patient came to the hospital with constipation. But as the investigation showed signs of obstruction, surgeons opened up him and found that his guts were so swollen, and his kidneys did not work. The diagnosis was made and the patient subsequently had five more operations performed, in order to close up his abdomen. Luckily, the surgery today was the last one. Solving this extremely complicated cases, everyone in the room was so pleased.

Of course, the patient would become the happiest person in the world after the surgery: the long mid-line incision over his abdomen was closed up by two plastic surgeons with continuous stitch!

(to be continued)

9 Apr 2012

Trade

I had a strange dream again. In my dream I became a doctor and was suggested to go training in UK with S.

S was a sweet girl that most of my classmates love, because of her personality. (I have to specify that is not never restricted to erotic love.) She was of course, a good companion to go travelling and a good listener to chat to. My dream is always good, in contrast to the reality (I have to say).

It is also philosophic. Before the day we depart to UK for training, S said the training centre was notorious and the title we would get means nothing after the 6-month training. Therefore, she decided to quit and stay in Hong Kong. I was on the cross road: to go to UK for a training which is supposed to bore no fruit, or stay in Hong Kong to have a easier life?

My response in that virtual world is exactly what I will do in reality. The answer is to go. The reason is extraordinarily simple: the chance only comes once. The source of information of S would possibly be correct. But at the same time it would possibly be false. No matter how unlikely I will benefit, it is still worthy of doing something special in life.

At the same time, I could just think of how the old surgeon told me: be proactive.

8 Apr 2012

Quality

One of the target that I want to achieve in this 4-week medical elective is not just having more experiences about Surgery, but also to eat something more spicy than the food in Wing Lin Store in Yuen Long.

Today I had a chance to taste some real Indian foods in the Little India district in this city. Little India, as the name implied, was a little region where many Hindu in this country lived. When I arrived, it was already six o'clock and the people started going back to their homes and attending the temples. Therefore, there were songs from the temples that you could hear in every corner of the district.

I intended to choose a restaurant where local people would have their dinner. You know, whenever a restaurant opt to do business with tourists, they will adjust the taste for these eaters. I went there, asking for the most spicy food. The waiter smiled and grabbed some chicken and rice, altogether with the sauces   over a paper on the dish. "What about sitting here and have the food?" He was always polite.

And then I started to dine. "Nothing so spicy at all." I initially thought to myself. Seeing there was some more spices on the table, I intended to add some more over my dish. One other waiter came, trying to convince me: The spices at your dish is already enough. It would not be better if you add more."

I was puzzled. This time, I put the sauce slowly into my mouth. I realized the magic of it. There were so many ingredients in the sauce and it would be only possible if you tried hard to identify: the onion, the garlic and the other materials. They were integrated to make one amazing taste that it would be impossible to notice if you only classify a sauce to be either spicy or not. It was a symphony of taste that many instruments played together differently, but under significant co-ordinations by a conductor.

Now I thought I understand more about the method that the professor of Philosopher Tao in our university applied when he listened to symphony and movie: You need to decompose the music or movie, knowing how each of them work, and then recombine them again to enjoy it.

If you just think something either spicy or not spicy, you miss a lot of tastes. Not to mention the more complex thing: life.

5 Apr 2012

幻想

序:近日來往宿舍醫院之間,甚閑,故重讀羅蘭巴特之戀人絮語。現摹擬一文。


一日,他收到了她的一個短信,那是關於一齣沒有人看的電影。她說:女主角演得極好,但造型欠佳,特別是咀角的墨,有點礙眼。女角未獲大眾好評,她深感難過。

這是個意外。他從未看到這齣戲,更沒有和她一起看戲。電影和她和他的關係,大概只有他曾向友人評論過某某電影,而她又聽見了。她誤送信息?或是她覺得他是一個戲迷?他完全不知道。

但自此之後,他思潮泉湧。夢裏中世界都屬於她的。在街上遇到的人,有著類似的打扮的女子,他都以為那就是她。戀人從未戀愛,但又喜歡情歌。 我記起跟你一起花裏遊戲/那笑聲多愉快多美/我記起跟你爭先吸一口氣/走過多芳香氣 奇妙世紀 這些事通通在夢裏出現,就算他已經沒有跟她見過一段日子。

他發現自己近來左眼眼眉調。老一輩的人不是說左吉右凶嗎?他變得迷信,覺得自己左眼調的同一時間,她也在胡思亂想,想念他自己。他只求一個假設,只要理論可能,便不作求證。他但求自己好過一點。

他每天努力一工作,令自己夜間疲憊不堪,為的就是發一場夢。要夢見她,要夢見一切美好的事。現實只是一個短暫的休息,生命於他的眼中,只有在夢中才有價值--他和她在現實不可能相戀,也不能相戀。但在夢裏,一切都可以發生。

戀人都相信來生。他相信來生定能和情人一起,就如梁祝化雙碟一樣。又是那一首歌:到這天恐怕一切將要忘記/那記憶荒謬更淒美/到這天跟你一起不再頑皮/約定下世紀再嬉戲。

4 Apr 2012

Holiday

Today I did not need my phone to wake me up from sleep even at 5:30am. The storm did the job for me.

The sky outside was so bright. Oh my goodness. It was having thunderstorm. When I walked out from the room, there were flooding and the wind blew so heavily that everything would be lifted up, let alone going to the hospital.

I questioned whether I should go to the school under this circumstance. I surfed the web and searched for instructions or guidelines from the Singapore observatory department. I was shocked that there was no "Black rain" issued, which should have been done in Hong Kong in the same situation.

Swiftly I asked for my buddy in the hospital, he texted me: well it would be fine if you missed the early lecture. Professor would understand the situation. Our morning round started at 8.

In this case I had no choice but change my suits and rushed to the hospital. The rain subsided but it was still quite heavy, so as the strong wind.

After the morning round, I discussed this situation with the doctors in the team. They was amused by the Hong Kong system: It would be a holiday! They smiled.

But then they told me it was never happen in Singapore.

I understood something that time: the leader here had a surname with 李 too.

1 Apr 2012

Accident

There were few accidents that stopped me from smoothly going to Singapore.

The flight was severely delayed right from the start. Originally it was to take off at eleven in the morning. However, thanks to some unknown reason, the airways decided to postpone the flight to one o'clock in the afternoon. Fine.

And then the aeroplane decided to land on Vietnam airport at seven o'clock, thanks to the insufficient energy and the limited place for the landing in the Changi airport. We were running out of water and food, since supposedly we would be in Signapore in two o'clock. The kids were wetting and crying.

People were almost having an uprising when the airways just put us in the terminal of the Vietnam airport. Some just demanded the airways to provide drinking water, but the airways refused.

At that time I was just too tired to do anything. There was a football match playing on the TV. I did not feel like watching it. Something is just meant to be. Que Sara Sara.

Last, but the least, soon after the aeroplane went back to the air, we experienced some strong air turbulent. No matter how you had fasten your seat beat, you would experience a few seconds of weightlessness. This time, adults screaming and crying. Babies did not know what had happened.

I felt that my life could have ended that time. Yet I felt peaceful, since I have done something good when I was alive to the people I love, at least.