Supply

The inevitable conclusion from my previous discussion is, a dictator does not have to set up plots against his political adversary; all he needs to do is to shoot down the one who supplies the money behind the scene.

For example, the Qing Empire did not have to arrange an elaborated plan for the assassination of that nondescript Sun Yat-Sen, as you find in the movie Bodyguards and Assassins; the real target of interest should be Li Yutang (played by Wang Xueqi).

Similarly, Vladimir Putin does not have to lock up leaders of the opposition party - as long as Mikhail Khodorkovsky is in prison, there is no money for anyone who wishes to challenge the Prime Minister (or King, if you like) of Russia.

Or, if you prefer football than politics, Arsène Wenger doesn't need to find the world's best defender to guard against Didier Drogba - just a few more players in the midfield to cut off the supply for the Chelsea striker would be sufficient.

By the way, the manager of Arsenal did comprehend this strategy lately.

Thank goodness.

Beggar

You may argue not all changes are from within.

True. Unfortunately, another romantic idea that many of us hold, again as a result of reading too much Jin Yong (金庸), is that the Beggar Party (丐幫) represents a major political force, and people could change the history by loudspeakers.

For example, did Sun Yat-Sen lead the revolution by making public speeches and demonstrations? Of course not. To the contrary, he made alliance with many rich Chinese millionaires and organized a series of unsuccessful attacks. (One of his major supporters was Charlie Soong - the father of Soong Ching-ling.)

In fact, many would believe Sun just boasted and did not do very much in material. The Wuchang Uprising (武昌起義) was actually led by Li Yuanhong (黎元洪) - when Sun was staying in Denver of America.

It was a change from within after all.

PS. The simplest way to change the history is to be the historian yourself. That's another story.

Method

While I was still thinking of that star and our man from Pluto, the more catching local news recently is, of course, from that of a so-called local political star.

I shall not discuss how much is true in the colourful description of our local sensational literature. Nonetheless, in terms of fighting for democracy, his method is - similar to the remark of Hercule Poirot on Cyrus Hardman (in Murder on the Orient Express) - nothing more or less than absurd.

You do not comprehend? Let me give you a slightly tortuous explanation.

***************************

Ever since I first read Demigods and Semi Devils (天龍八部) of Jin Yong (金庸), I was amazed by the character Murong Bo (慕容博).

The plot was simple: Murong came from the royal family of Xianbei (鮮卑); the purpose of his life was to re-establish the long vanished Yan (燕) Empire.

But, what did he actually do? He made friend with the head monk of the Shaolin Temple (少林寺), tried creating conflicts between the Sung (宋) and Liao (遼) Empires, and assassinated a few adversaries. In traditional English jargon, he was a rolling stone and gathered no moss.

***************************

What good is yelling at the Victoria Park? It is miles away from the government headquarters, and thousands of miles away from Beijing.

Real changes could usually only be made from within.

Do you think the Berlin Wall was torn down by Ronald Reagan?

No, it was Mikhail Gorbachev!

Macross

Talking about imaginative heroes, although the most popular series amongst my generation is Gundam, my person pick is Macross (超時空要塞), created by Shōji Kawamori (河森正治).

I shall not elaborate on the details of the story (which I must confess I was quite fond of when I first watched it as a teenager). The most revealing happening was, as always, behind to scene.

To put it simply, the original TV series has 36 episodes.

The main part of the story actually finished at the 27th episode, which described the end of final battle with Boddole Zer. The other 9 episodes were obviously produced because the TV series was so well received that its sponsors and advertisers did not want it to finish too early. In fact, two additional series, The Super Dimension Century Orguss (超時空世紀) and The Super Dimension Cavalry Southern Cross (超時空騎團) were produced for the same purpose - both proved to be hopeless successors of their famous ancestor.

One has to know when the game is up.

PS. Macross was actually a nice demonstration of how people with money has the say: The name of the series - and therefore the spaceship in the story - was decided by Big West Advertising, the major sponsor of the cartoon. The rumour was the owner of this advertising company was a fan of Shakespeare, and the pronunciation of Macross, in Japanese, was similar to Macbeth.

Science

My recent bedtime reading is Kūsō Kagaku Dokuhon (空想科學讀本) by Yanagita Rikao (柳田理科雄). It discusses the problems and flaws (in physical science) of those robots and superman that we find in common Japanese comics and TV series.

Although the book is translated and published in Taiwan, and many of the names and terms are different from those in Hong Kong (so that the text is slightly difficult to follow), it is exceptionally enjoyable.

*************************

On a second thought, we should not be to critical to the creators of Mazinger Z (鐵甲萬能俠) or Kamen Rider (幪面超人). To say the least, their authors never intend to use their imaginative heroes for the replacement of real ones in our life.

In contrast, I am horrified to know some authorities are proposing to evaluate alternative medicine by different standards than those of conventional science.

For example, placebo or non-specific effect should be considered as part of the treatment, and researchers should design studies which do not control for these effects; if the results of a controlled clinical trial turn out to be positive because of placebo effects, Hawthorn effects, or patient-therapist relationship, while the specific effects of the intervention are nil or negligible, this intervention would nevertheless be deemed effective.

Or, as Albert Einstein advised: If the facts don't fit the theory, change the facts.

Go read Ernst E. From alternative medicine to alternative science, in the October 2010 issue of Clinical Medicine.

Naming

Maybe I should not blame our man from Pluto that much. After all, the star was named after him because a fan of him made the nomination. I wonder if our VC actually has the right to refuse.

To say the least, it is better than donating a huge sum of money and ask for a building named after himself.

(Well, I am all happy to have the billionaire donating a gigantic sum and have a building named after his father. That's old fashioned, I know.)

Alas, and it is obviously a thousand times better than donating a tiny amount of money (for example, just to cover the desks and chairs) and ask for the same right of naming - not to say to have a contract signed in order to ensure his name is put outside the building in a font big enough to allow people a mile away to see it, and to have spot lights shinning on it so that the name could still be seen in the dark or in a foggy weather.

All these sophisticated calculation would only be mastered by someone who, as pointed out by our white-hair surgeon in the clinical skill laboratory, professes in doing summation and multiplication.

PS. If I were to have the money, maybe I should donate a sum and have another building next to that named after that billionaire.

I shall name it after, say, my Indonesian maid - to thank her for taking care of my princess.

Star

While thinking about the meaning of the Winter Festival, my friend CB told me that a star was recently named after our man from Pluto.

I was horrified.

Of course I am old fashioned and continue to believe one should not be too bright and outshine the people around (not to say if you have a boss). The traditional Chinese custom is to shoot any high flyer (槍打出頭鳥) - unfortunately often in its literal sense.

And, a living man who agrees to have a star named after him must be remarkable if not extraordinary (as defined by Humphrey Appleby). He would have the personality to agree having our right arm raised and say Heil Pluto, Heil, mein Führer when we meet our friend, or agree to have a little red book to summarize all his sayings so that the next generation could wave to greet him.

As the old Chinese saying: You can infer from little things (見小曰明).

(See http://ccszeto.blogspot.com/2009/10/blog-post_31.html)

I shouldn't think too much, I know.

Winter

For those who are familiar with the history - or, simply, have read De Vinci Code of Dan Brown - you may know that Christmas was not the original birthday of Jesus. The catholic church adopt the date of Winter Festival of the Roman Empire to celebrate the birth of their god.

And, it is commonly quoted that on this very date, the length of the day was shortest in the northern hemisphere.

But, hold on, doesn't the Chinese say that it is the date of Winter Solstice (冬至) - which is almost always 22nd December - that has the longest night ?

Em ... they are both right, to a certain degree.

You know what, there is a whole week in December each year that has an almost equally short days in the northern hemisphere. They are, generally, from 19th to 25th December.

In other words, the Chinese Winter Solstice is in the middle of this very period, and exactly the time when the Earth's axial tilt is farthest away from the sun.

How about Christmas? It is the end of this period of short day; ancient Romans took it as the day that the Sun reversed its southward retreat and proved itself to be "unconquered".

And, by the way, neither of these dates has the latest sunrise or earliest sunset. The former took place in mid-January, while the latter late November - each around three weeks from the Chinese Winter Solstice.

Merry Christmas.

Payback

I could understand the embarrassed feeling of LS - there seems hardly a possibility of payback.

Of course the King would not mind giving his students a treat and never expect something in return. Nonetheless, we were brought up by the old school and, in our concept, we should be the ones to invite our teacher for lunch.

Well, maybe a little story could make me less uneasy:

**************************

A long-graduated student visited his famous teacher, who was about to die. The student was all tears and said, "Sir, you were so kind and taught us that much. How could I ever payback ?"

"You do not have to," the teacher smiled, "At least, not to me. Just remember this: When you become a teacher, treat your students like how I treated you, and ask them to do the same for their students."

And that's the original meaning of passing on the torch (薪火相傳).

PS. On my way back, I could not resist thinking of the elder brother of the King, and a famous sayings of Xun Zi (荀子): 口能言之，身能行之，國寶也。

That's quite irrelevant, I know.

Lunch

It was the university graduation ceremony the day after the Quiz. After that, my friend LS invited all of us (I mean the usual group of people from the good old days: JW, TW, LY, PS, WY, FK, and so forth) to lunch - in reality to celebrate her recent promotion.

LS booked the table in advance. We arrived slightly early, and found a familiar face at the table next to us.

He was the King of the Round Table (who was obviously just back from the ceremony).

A few of us nodded or waved at him. By this time, we realized the women sitting next to him was equally remarkable.

She was RY - the previous professor of endocrinology from the other side of the harbour. In no time she recognized PS and WY, the two endocrinologists of our table, and she actually came around to say hello. (RY was the external examiner when I sat for final MB.)

Some time later, the King left. He waved goodbye to us in the most heartiest manner.

We were slightly embarrassed.

******************************

The lunch was brilliant. It has been ages since the lot of us lunch together. (Alas, the earth is a sphere. By the law of physics, any two objects would be separating from each other as they grow.)

An hour or so later, when we were done, LS asked for the check.

An apologetic captain came and whispered to her ears, "Madam, that's the bill for the dessert. The old Vice Chancellor had signed the rest for your table - he said that you are all his students."

We could not believe our ears. LS's face turned slightly red.

PS. I still remember when I first met the King; he did my interview when I applied for the medical school.

It was shortly before Christmas, 1984.

1984

On the next day, I delivered the medical grand round.

It used to be a tradition of the department to put up some quiz in the grand round just before Christmas. Early this year, my friend JW, who is responsible for organizing the problem, asked me to take this up.

**********************

The talk was smooth. My only disappointment was not being able to give out the prize. Well, to begin with, I could not think of a workable way to see who from the audience score the highest. I must say that's probably a subconscious plan of mine.

You know what. As usual, I bought a book as the prize. This year, my pick was Nineteen Eighty-Four. (It was Bill Bryson's A Short History of Nearly Everything last year.) Unlike my previous choices, I have never read this masterpiece of George Orwell, and I have all the intention to keep this book for myself.

Maybe I shall be more generous next time.

H

(Our dinner discussion continued.)

"I suppose F would have died with more dignity should he be treated in Hong Kong," Vivian sighed.

"Like his friend H ?" I chuckled. H is another billionaire who had a stroke recently.

"Yes ... no," my wife saw my catch, "Well, to say the least, he survived the stroke. But I could hardly say his treatment was satisfactory !"

"No," I agreed, "That's the typical problem of having too much money. For any trivial problem of any part of his body, his family would call for a - sometimes more than one - super-specialist of that area to offer and opinion. When there are nine or ten doctors seeing a patient, everyone just focus on their own field, and no one would make a decision !"

"Who would ?" Vivian continued, "If you make a wrong decision, everyone would blame you because they all share the responsibility. If you make a correct one, everyone would envy you - and you would probably loss all your friends and source of case referral !"

I nodded. The sobering truth is, except the last sentence, her comment also applies to many cases we see in a public hospital.

F

During a casual dinner conversation with Vivian, she commented, "It's not always impossible to bring up a child properly in a rich family - look at MF !"

I know MF - a famous private surgeon with excellent reputation. Everyone who knows him becomes fond of him.

And he comes from that renown billionaire's family. Well, he doesn't have to. As a doctor, he is as good as any.

I decided to change the topic, "Unfortunately he could not alter the tragic death of his father, F."

"That always puzzles me," my wife agreed, "MF should have kept his father around and gave F some good days before he finally died."

"I believe MF did want to," I said, "You know, F was such an important person north to the Shenzhen River. When that blood cancer was diagnosed, he just wished to went for a second opinion - or some symptom relief by acupuncture or massage, whatever that was. But, once he was in the hospital, people up there thought that he was such a figure that he should have the most aggressive treatment, and, therefore he was not allowed to get out of the hospital, not to say going back Hong Kong."

"Alas, that's followed by vigorous treatment by cancer drugs, parenteral nutrition, antibiotics, intubation, resuscitation, and every imaginable or unimaginable agony!" Vivian finished the story for me.

"Quite right," I smiled, "I used to believe they would only detain and torture political prisoners. From this story of F, it seems that they do the same for their country leaders. We couldn't really say our fighters of democracy are being ill-treated !"

Enjoy

(... cont'd)

I decided to bring Euterpe to my site of work - which happened to be her own classroom.

There were no fewer than two dozens of parents and children lining up outside to join the game. I was greeted by Ms Yu, the teacher-in-charge whom I met a few times previously. When she realized that only a half-exhausted father was coming with a suspicious-looking girl, she was a bit worried.

"Too bad Euterpe's mother could not come," the teacher tapped on the shoulder of my daughter, "We'd got to start. Who is going to look after her in the coming hour ?"

"Em ... maybe we can find a chair and let her sit at a corner of the classroom," I suggested, with some hesitancy, "I've brought a few story books with me. She may well just read them."

"Would that do ?" Ms Yu asked.

"Well, let's try." I was, subconsciously, equally incredulous.

************************

To my surprise, it worked out well. In that hour, my daughter just sat there, sometimes thumbing through her story books; more often she played with the balloons that I that I bought for her that morning, or looked at how others played. She didn't even walk around.

After the hour, we left. Ms Yu thanked us eagerly. When we walked out the classroom, I asked my daughter, "Are you bored ?"

"I'm OK," my princess replied, "But, are we having something more exciting next ?"

I laughed. Thank goodness.

Carnival

Went to the Christmas party of Euterpe's kindergarten.

Some of you may remember Vivian and I went to the party of a similar kind when my daughter was in pre-nursery. (See http://ccszeto.blogspot.com/2009/12/party.html) It was a stage performance last year, but, this year, my little princess is in a new school, and the party becomes a carnival.

More so, my wife had a flu this time, and I had to go alone with my daughter.

*********************

The place was full of kids and parents. To my amazement, Euterpe could recognize almost all of her classmates, and was just too eager to say hello to everyone. Nonetheless, my daughter has the same autistic personality disorder as her father, and she preferred observing rather than joining the games.

But it was just the beginning of my problem. A few weeks ago, when the kindergarten announced the Christmas carnival, I signed up as a voluntary helper, and was assigned to help in the classroom later that morning. After Euterpe and I wandered around for an hour or so, it was almost time for my duty.

But, how could I leave her alone ?

(To be continued.)

Purpose

I must say I was slightly disappointed with the evening.

The serious discussion took no more than 3 minutes; the only conclusion was to contact each and every of our classmate to see if they are interested to have a gathering.

For the rest of the time, we had nothing but casual conversation - exchanging information of each other.

And, you could guess that much, I just sat there, turning my head from one side to another, and listened. The life of a boring university academic is nothing compared to the exciting happenings in the private. I must say I am more eager to update the contact list of my class, which I compiled when we had the 10-year gathering, and fix up who is responsible for contacting who else.

In fact, I sent the preliminary list to DL the next morning.

*************************

But, on a second thought, I should be at ease.

The whole purpose of having a 20-year gathering is to assemble the class so that we know what the others are up to after two decades - which was exactly what we were doing in this evening. There are people who enjoyed expressing themselves, some love to listen, a few others just want to hide themselves up and play autistic games.

I should be more receptive.

Gathering

Dined with a group of my university classmate. It is almost 20 years after our graduation and we are planning a gathering.

DL, probably the most out-going one in my class, called a meeting to discuss the things, and he booked a table for 10 at a famous restaurant in Kowloon.

I arrived slightly early, only to find HM, a classmate of mine who is doing orthopedics, was there alone.

We two had some casual chat (his daughters are going to the same school as Euterpe), and, the rest of the people gradually arrived in the next 40 or 50 minutes.

DL was the last.

And it is entirely understandable - he is a private surgeon and had to finish with the evening round in two hospitals.

Alas, many of us are still as hard-working as a house officer.

PS. The restaurant is so high class that I've never been to. It is Michelin 2-star. The place is decent, but, seriously, the dishes were so-so but not quite impressive.

No, I would not downgrade the restaurant.

I downgraded Michelin.

Encephalitis

Recently, a house officer of another hospital collapsed during on-call. That briefly catch the attention of the media and created much hotter a discussion within the medical circle.

To many of us, the focus is simple: It is not humane to be on-call every other day for four or five times consecutively, and it is this cruel system created by some inconsiderate extra-terrestrials that ends up with the tragedy.

I beg to disagree - or to stand back and examine the evidence a bit more carefully before jumping to the conclusion.

There are two levels of considerations:

1. Is it viral encephalitis or seizure provoked by sleep deprivation? If it is the former, there is no point to blame the on call system.
   (For visitors of this site that have some medical background, encephalitis would be more likely if the collapse was preceded by fever, headache, and vomiting for a few hours.)
2. If we conclude that it was sleep deprivation, why was that the case?
   (Do not jump to the conclusion that it must be a creature outside the solar system who put up the cold-blooded call list - did the house officer swap her call with others ?)

Yes, I have a personal dislike of extra-terrestrials. But, similar to what Voltaire said, I do not agree with what they do, but I'll defend to the death their right to be fairly judged.

Ball

Met my friend L again. I could not refrain from asking him about his landlady.

"I hear that she's mad with the ball ?"

"Quite right," my friend sighed, "She is upset because they invite her son - whom she keeps beating up."

"Although I do not agree with her, I must say I could understand her feeling." I said.

"But not her behaviour !" L became slightly excited, "She thinks that she is not invited because she's rude and hideous. And, look, her responses are, in short, making a big fuss - just to prove beyond doubt to any onlooker that she deserves being ill-treated because she is just that monstrous."

I nodded. There's much truth in his comment.

"Well, in that case, what should she have done ?" I asked after a moment of silence - knowing that the ceremony is already over.

"The simple answer is to do nothing except putting up a polite smile," my friend made a grin, "But, I think the best strategy is to go to the place with her son. That would create a delusion that she is also being invited - and, years later, may well be recorded as such in history textbooks !"

Thank goodness his landlady has not thought of this.

History

Believe it or not, my recent bedtime reading is The New Penguin History of the World by JM Roberts.

Frequent visitors of this blog would know that I have a personal interest in history. Nonetheless, I actually had no formal education in this aspect. (The few years of the so-called history class in secondary school certain do not count. Not only was the material superficial - I did not really pay attention to study any particular subject in those days.) As a result, my knowledge is history is similar to what Sherlock Holmes knew about botany or geology, as commented by Dr. Watson, variable, practical, but limited. (See A Study in Scarlet.)

And it is always advisable to have a bird's eye view of a huge subject.

********************

The book is a 1200-page volume, and I have to move on to another book after finishing with the history of ancient cultures. To my surprise, very little detail was given on the history in a traditional sense, and Roberts actually put much emphasis on the evolution of culture and the relevance of technology in the development of civilization. (For example, the impact of using iron tools rather than bronze ones, and why Egyptians built pyramids as pyramids.)

Alas, history could be very interesting in that case.

Competition

(My discussion with the young professor of hepatology continued.)

"But, when I think over the issue again, it remains incredulous," VW said, "I suppose you agree, we put down the apathetic attitude to the excessive supply of opportunity, as well as the culture of spoon-feeding and private tutorial."

"Quite right," I nodded.

"In that case, the situation should be even worse in Taiwan and Japan; both places are well known of their inhumane system of public examination. However, children from these places are as active as you think - they would never miss an opportunity to learn." My friend pointed out.

For a moment I wished to say youngsters in Japan and Taiwan have their own problems - if you ever watch the movie Confession (告白) of Takako Matsu (松隆子).

But I remained silent; there was certainly much truth in my friend's observation.

And, all of a sudden, an idea went across my mind, "Maybe what is emphasized is different. Although students in Taiwan and Japan have much private tutorial, children have a lot of stress because they know very well the competition is fierce - and their culture is rather explicit about that. In contrast, our society does not only promote spoon feeding, we try very hard to reduce the stress and competition. Who would work hard in that situation?"

Bias

Shortly after I dined with Vivian to celebrate my birthday, we held the licentiate examination in my department.

I shall not elaborate on what happened. To me, examination is quite boring if not there is often a good opportunity to have some meaningful discussion with my friends.

This time, during the coffee break, I met VW, and he remained interested in those disappeared medical students.

"I tend to agree with what you said in the blog," my friend began. He was referring to a recent one of mine (see http://ccszeto.blogspot.com/2010/12/apathetic.html and some related entries).

"Yes ...?" I saw that he had not finished.

"But, our observation may be biased," the young professor is certainly a scientist, "Not only are we overwhelmed by a hopefully small group of delinquent local students, the impressive mainland students that we see are no doubt a highly selected group. The very fact that they come to Hong Kong and turn up in the High Table Dinner say that much - and there are probably millions of spoiled children that we would never meet."

I was forced to agree.

Dinner

On the day after lunching with our university college head, I dined with Vivian to celebrate my birthday.

Well, yes, it should be in September. Nonetheless, we were so busy after the Adler was born that we had to defer this yearly appointment again and again.

The tradition is I select a restaurant – usually not a very expensive one – that has a good reputation and Vivian and I have not tried. As you expect, I chose the place long ago. (In fact, I fixed up the selection by Easter this year.) My pick this year was a tiny one in Hung Hum that specialized in serving fried fish in Sichuan style. By mid September, I had already scanned through the menu and fixed up the dishes.

But, when I tried to double-check its address in the afternoon, it was shocking to learn that the place had closed down two weeks ago.

The poem Golden clothing (金縷衣) came through my mind again.

PS. As a surgeon, Vivian is more familiar with handling emergency. She found a seafood restaurant close to the hospital that she works – I must say I was slightly unhappy with the idea because of a personal bias against traditional Canton cuisine.

Nonetheless, I was happily wrong again. The place was superb, with conventional dishes masterly executed (and, surprisingly, not too much a trace of MSG), a gorgeous service, and an amazingly conservative price.

塞翁失馬,焉知非福.

Funding

Towards the end of the lunch, our college head mentioned the difficulty of soliciting donations and our college endowment fund is abysmal. Like all other colleges, we have a dedicated College Development Committee, which does nothing but look for donations.

Alas, development means money.

(My college is well known for this very problem: We are not poor – just needy, deprived, under-privileged, disadvantaged, or whatever flowery word you could think of to cover up our empty purse.)

*******************************

On that very same day, it appeared on the news that a handful of famous secondary schools under the Direct Subsidy Scheme were accused by the Commission of Audit for not using the reserve (or endowment in reality) fund properly.

To say it in a modest term, I believe our thick head government officials are barking at the wrong tree.

After all, do you expect the schools to put their money for fix-term deposit and let the money vanish with inflation ? As long as the headmaster or other managers do not put the money in their own pocket, and avoid margins or warrants or options or other high-risk gadgets (or, in Benjamin Graham's term, speculation), the school should have a free hand to invest.

Or, as my friend TW vividly pointed out: 你不理財,財不理你.

Tradition

A few days after dinning with our past college president, I was (together with a few colleagues from other departments) invited to lunch with our new university college head.

For those who are not familiar with the structure of my university, it runs in terms of both faculties and colleges, the former govern teaching and research, while the latter focus on student affair.

Although there are now nearly a dozen of colleges in my university, there were three to start with. One with a religious background, another supported by business people, and the third has a strong tradition of Chinese culture.

I belong to the last – both as a medical student and, by coincidence, when I joined as an academic staff.

*******************************

In the middle of the lunch, the head sighed, “You know, many of our students and alumni comment that our college motto has died. No one seems to be interested in upholding the traditional Chinese culture, and I find it impossible to promote the idea.”

“I don’t think it’s dead – but it’s certainly much diluted,” I could not refrain from coming out, “When there were just a few colleges, each could have it’s own personality – if I could use the description. When there are some many new colleges, the face and character of each become blur, and it becomes more and more difficult to tell which college is which. And, to get along with a sea of other colleges, we are forced to give away piece by piece of our own character.”

In other words, the paradoxical happening is, although the university tries to promote heterogeneity of culture by having more colleges, we end up having less individualism because all colleges are very much similar.

Blind

Dine with a group of senior physicians.

This is the first time I dine with the man from Pluto since he moves outside the solar system.

There weren't many serious discussion, just some little old funny stories to share, and the table enjoyed an excellent evening of nostalgia.

Here is an interesting one recollected by a previous president of our college, encountered when he was a medical student:

*******************

(In the out-patient ophthalmology clinic.)

Doctor (after examining the patient, who was an aged woman): You come too late. Now you are totally blind and we can do nothing. You should really consult a doctor earlier.

Patient: I did. In fact I was seen in the TW hospital. It was that unutterable little jackanapes of a foreigner doctor who ill-treated my eye and made me blind ... (a burst of three-word Chinese).

Doctor: Why! Can't you recognize me? I am that foreign doctor! What the hell ... (and he returned a series of four-letter words).

And our president-to-be had a good dose of education on spicy colourful explicit vocabulary.

Multitasking

On a second thought, the problem of having too much thoughts going through our mind is not only the difficulty of physicians - every mature adult faces the same difficulty.

For example, in addition to the entirely legitimate and scientific considerations that Danielle Ofri alluded to, I find myself having some additional synaptic activity on slightly unrelated areas:

• That diagnosis code in the computer is not quite right. Shall I spare a minute to amend it (so that my department could get probably a few more cents in the next round of resource allocation exercise) ?
• The discharge summary of his last hospital admission is a rubbish. Shall I spare a moment and call that house officer to give her some education (in whatever sense you prefer to believe) ?
• This chap sounds a suitable candidate of a clinical trial that my colleague just started recruiting. Shall I explore further ?
• Oh, he has a good murmur. Shall I ask him to come for our MRCP examination ?

If you think that's not enough, I've omitted the other epileptic foci from personal, financial, family problems.

And, by then, you would come to appreciate the traditional Chinese wisdom:

竹前坐消無事福，

花間補讀未完書。

What a good fortune.

Problem

You may consider I think too much on those absent students and the response to VW. Well, I agree I had a surge of neuronal activity - an inevitable habit of a physician.

In fact, just now my friend KM quote in his Facebook a recent Lancet article by Danielle Ofri (Neuron overload and the juggling physician, on 27 November 2010, p 1820-1821), which express the difficulty of being a doctor - one has to consider too many (inter-related) problems that no time could be spared to listen to the patient.

This little essay actually brings my memory back to a conversion I had many years ago with the man who used to have a moustache - at the time when I just joined the nephrologist training.

***************************

"Many of the patients are very complicated," I sighed after the round.

"You think so?" My mentor said.

"Of course. I am coming to the conclusion that anyone who could speak out - without taking a second breathe - the list of medical problems that this patient has, or the list of medications that he is taking, has a lung function good enough for general anesthesia!" I smiled, pointing at one particularly complicated patient.

"Yes, his problem is complicated," the professor smiled back, "But that's where the challenge comes along: you've got to make it simple."

"Well, yes ... but how?" For a moment I though the man who still had a moustache was saying nothing but a Sunday school truth.

"A good start is, each time when you see a patient, you identify the single most important problem - maybe out of a thousand of them - and focus your effort to tackle that one." He said calmly.

I nodded, reflecting this insightful advise for the rest of the day - or the rest of my career.

Responsibility

If we believe our students are not apathetic, we are forced to the conclusion that they see the whole issue quite different from us (alas, aged old-fashioned chaps), and they consider seeing patients a responsibility.

Is that a correct view?

I don't think we need to tell - we have just to act accordingly.

In other words, if they see it a responsibility, we should enforce the idea and set up an environment and regulations so that they have to fulfill the requirement. For example, we ask for seeing, presenting, examining, and writing up a certain number of cases. If it turns out that the old world is right, the students would get the benefit - even though they may not be aware of it.

As Franz Kafka said, Die Lüge ist für die Ordnung der Welt. (The lie is made for the world order.)

In contrast, if we are at the wrong, there's nothing to lose. Those tasks are responsibilities of the students; they shouldn't expect getting any benefit.

And, the doctrine is: People who see opportunities in their responsibility would prosper.

Apathetic

You may ask: Which suggestion is more likely (or, more common) for our students?

I have no idea. To begin with, I believe most of our students are intelligent. (After all, they rise to the top.) It seems reasonable to assume they could see the benefit of learning from real patients.

In that case, they are apathetic.

And this is exactly the worrying phenomenon as pointed out in Kong Kid (港孩) by Wong Ming Kit, which I briefly discussed previously (see http://ccszeto.blogspot.com/2010/08/child.html).

****************************

Around the same time, I had the rare opportunity to lunch with my friend JW.

"I am more involved in the college activity of the university recently, and it is really eye-opening," my friend said, "You know what, the university has now some 20% of students coming from the mainland, and they're just different from the local ones. When we hold gathering between students and teachers, or have a talk from outside speakers, most of the delegates are mainland students - and they are eager to ask questions. In contrast, local students hardly turn up - they are just not interested."

That's worrying, I agree.

Privilege

Further to my experience (or missing the chance of having some experience) with our third year students, my friend VW met them, and the encounter proved disappointing - to both side, I suspect. (See http://vwswong.blogspot.com/2010/11/extra.html)

The root of the discrepancy is obvious: To the students, seeing patients and observing what (say) our professor of hepatology does - without a didactic teaching - is their responsibility. To the young professor, he calls it a privilege to learn.

I shall not elaborate what I think is right. (Frequent visitors of this blog know just too well I am always suspicious of the existence of absolute right and wrong.) Nonetheless, the underlying mental process seems worth exploring.

Don't you see the point? There are two possibilities for the students' explanation to VW:

1. They understand, maybe subconsciously, that learning from patient is a privilege, but they are too apathetic to seize the opportunity.
2. They sincerely believe the whole business is their responsibility; the privilege that VW talks about is merely the romantic idea of a naive academic.

You may say neither is true - the students did not turn up because they were focusing on their panel examination. Factually, that's correct - but that's quite beyond the point. It is the choice of wording that the students put up as the explanation that intrigued us.

PS. This method of psychoanalysis is not my invention. For example, as pointed out by Humphrey Appleby, any statement in a politician's memoirs can represent one of six different levels of reality:

1. What happened.
2. What he believed happened.
3. What he would have liked to have happened.
4. What he wants to believe happened.
5. What he wants other people to believe happened.
6. What he wants other people to believe he believed happened.

Go read Yes Minister.

Psychology

You may argue although frequent ward round does not affect the biological process of a disease, doing round twice a day would hasten discharge and reduce unnecessary hospital stay if a substantial proportion of the patients are around for various social or administrative reasons.

Well, yes, I agree many of our patients are in the ward for non-medical reasons. (In fact, I always say that the majority of the problems that we have to solve during ward round and routine patient care are administrative problems and require merely a tiny dose of common sense rather than any medical knowledge.) Nonetheless, it remains a naive idea to believe that doing the round more frequently would facilitate the resolution of non-medical problems - unless you also hold the belief that holding meetings more frequently does help the business.

And we all know it won't. Doctrine of basic human psychology states that if one has more frequent opportunities to make a decision, he would be more tempted to procrastinate. The standard excuse is Let's wait until the time is ripe. For the same logic, we usually treasure the time we spend with someone whom we seldom have a chance to meet, but would turn a blind eye to the one whom we dine with every night.

PS. You may wonder if we have someone with the extraordinary character of not to procrastinate, would doing round more frequently help ?

Of course not. He would merely find more problems in his patients.

Round

You may think my concern about the trading hour of HKSE rather irrelevant to practising doctors.

On that, you are wrong.

*****************************

Around the same time when HKSE announced the news, it has been proposed that all of us should do ward round twice daily - in order to hasten the discharge of our patients and shorten their hospital stay.

I consider that an ingenuous (oh, sounds like ingenious, but in reality not) idea. To say the least, I don't think doing ward round more frequently would enhance diuresis for patients with heart failure, or hasten resolution of bronchospasm for those with asthma, or shorten the course of antibiotics or heparin.

Well, maybe our extraterrestrial friends wish to manage the hospital as a poultry farm. You know what. If you keep hens for laying eggs and bring them up under ordinary sunlight, they will give you an egg each day. However, if you try altering their biological clock and keep them under artificial light of gradually shortening diurnal cycle, they would eventually lay an egg every 12 hours - although the products would be somewhat smaller and with a thinner shell.

No wonder our doctors of the younger generation keep running around like chickens with no head.

Length

For those who are familiar with the local financial market, it is no news to learn that the Hong Kong Stock Exchange (HKSE) is going to shorten the lunch break in order to extend the trading hours.

A similar proposal was put up in 2003 but failed as a result of opposition from brokers. Nonetheless, the argument for extension is simple: The two-hour lunch break between the morning and afternoon sessions in Hong Kong is the longest among the world's 20 major stock exchanges. Extending the trading hours is generally believed to enhance the competitiveness of the local financial market.

But, I beg to disagree.

A simple and earthly reason is a long trading hour would attract speculators and aggravate market fluctuation. (Yes, true, a high volume of speculating trade increase the profit of HKSE - that's why the Venetian and Sands and others are opened 24 hours a day, 7 days a week.)

On the other hand, serious investors do not need frequent trading. As pointed out by Warren Buffett, a good investor needs to trade once a year (for updating his portfolio) and enjoy his life the rest of the time.

PS. A side-track but inevitable consequence of this very suggestion of our giant in investment is related to how we choose a trust fund - another important topic that we can discuss later.

Or I should ask my friend Warren to discuss later.

Risk

(My dream continues.)

Although Company Z really does nothing to promote their Zyximab for the off-label use on nephrologist's dementia, some practising clinicians do spot the opportunity and dilute the drug themselves. A few with an academic mind actually proposed randomized control trials to compare the two medicines.

The sales manager of Company X is horrified. In fact, the sales of their Xyzimab is not as good as they expect - obviously because many suitable cases use that cheap cheap diluted version from Company Z.

An urgent meeting is hold.

"Look. We've got to stop all this." The CEO roared.

"But how ? Zyximab is obviously as effective as our product - and way less expensive." The scientific officer said, rather naively.

"Let me see. Oh, yes. Let's focus on the other side of the coin and talk about the potential risk."

"Risk of what ?"

"Risk of - let me see - causing memory loss." The CEO concluded.

"But, nephrologist's dementia causes memory loss !" The scientist could not believe his ears.

"Exactly. We can put up a few cases who are treated with Zyximab and the memory gets worse - we then blame it to the drug. Since there's no control trial as yet, no one could prove a similar risk of deterioration when treated with our product."

"Jove, that sounds courageous. Who is going to believe us ?" The marketing manager asks.

"No, the public need not to believe in us," the CEO smiled, "We shall pass the cases to those patient support groups and possibly some of our alliance in private practice - they will voice out to the media."

*************************

My dream broke off. I was dumbfounded and soaked with sweat. All of a sudden I realized Zhuangzi (莊子) was wrong - both him and the butterfly may represent reality.

Market

(The meeting in the drug company continues.)

"Why doesn't Company Z advocate to use Zyximab to treat nephrologist's dementia? From a pharmacological point of view, it is essentially the same as our Xyzimab, and they could just dilute the drug by 100 times and give it to the patient - I'm quite sure it works." The scientific officer asks.

"Yes, in theory they could. In reality they wouldn't - and never," the CEO said with confidence, "They are making a good profit of selling their product for Szeto's syndrome already."

"But, they can fund clinical trials to see the effect. It seems doing no harm to explore a new indication ?" The marketing manager added.

"On that, you are wrong," the CEO put up a wicked smile, "Our friends in Company Z know just too well they shouldn't step in our market - otherwise we shall fund projects to see the benefit of using our Xyzimab to treat their Szeto's syndrome - and I'm sure that will show the same benefit. At the end of the day, we set up a vicious cycle of cutting the price for both products in both diseases - not desirable for either of us."

"But ... isn't it Market Division - which is outlawed under the anti-trust regulations?" The scientific officer hesitates to point out.

"I would not comment on this question," the CEO gives the others a cold stare, "Who would know the two diseases belong to the same market ?"

Everyone around the table are forced to agree.

Dream

I must be not sleeping very well recently and keep having funny dreams.

Here is another one I had just last night.

***************************

(During a senior official meeting in the headquarters of a famous drug company X.)

"How much should we sell our new medicine Xyzimab ?" The marketing manager begins.

"What's the cost of making it ?" The scientific officer asks.

"The manufacturing cost is trivial - but that's quite irrelevant," the man sitting at the end of the long table said, "We need to cover the money we poured in for its development, and we need a good profit. Since the standard dose for the treatment of nephrologist's dementia - our licenced indication - is 0.1 mg, let's make it the vial size and sell it at $10000 per vial. After all, we are the only one to make this drug."

"Not exactly," the naive scientist interjects again, "I know company Z is making Zyximab, a similar product; they are selling it for the treatment of Szeto's syndrome - an entirely different disease."

"Really ...?" the rest of the table all gasped.

"Yes. In fact, the dosage to treat Szeto's syndrome is actually 10 mg, and therefore that drug comes in vials of that amount. Company Z will soon know that Xyzimab and Zyximab are almost identical, and they would advocate to give a tiny dose of their product to treat nephrologist's dementia!"

"Don't worry. That won't happen." The chairman said with confidence.

(To be continued.)

Document

(The story of our young medical officer continues.)

It must be a miracle; Dr. C could start his round an hour later.

His first patient is an old man with chronic bronchitis. The young doctor flips through the temperature chart, greets the patients, asks how's everything getting on, listens to the chest of the patient, and, then, he is forced to stop. He notices the problem.

"Em... Sister, excuse me," he finds himself a trouble maker, "Where're the X-rays of my patient?"

"Jove, we're running the film-less system. Go and look at the X-rays from the computer." The nursing officer said.

"Quite right. But, how about the blood test results?" The doctor goes on.

"Same. We no longer keep the print-out of laboratory result. Go check from the computer." There seems a tinge of proudness in the answer.

"And progress sheets ?" Dr. C pursues.

"Yes, and progress sheets." The senior nurse is not moved.

"In that case, may I ask why's this patient still having such a thick pile of paper in the hospital record?" The young doctor is incredulous.

"Jove, we don't need to keep the patient's clinical notes and result, but we need to keep the documents that all the things are done properly. Look, for each blood taking and X-ray, we have a check list on the procedures; we've got to fill in and file. Similarly, we don't need to put down the patient's temperature - they're in the computer. The temperature you found in the case notes is actually yours - as I said, we need to document that you are not febrile when seeing the patient !"

The young doctor collapses and has a seizure.

Fit

Date: 2 July 201x

Time: 9 AM

Place: Medical ward of a public hospital

*****************************

A formally dressed young man enters the ward. He looks around and soon he find his target.

He heads to the middle-age woman in a white uniform standing in the middle of the ward.

He murmurs politely, "Good morning, Sister. I am Dr. C, the new medical officer here. Would you be kind enough to tell me where my patients are so that I can start the morning round ?"

The woman replies in a monotonous manner, "Good day to you. Have you reported the duty and done with the morning routine?"

"Yes, I've reported my duty to the department office and get my pager. In fact, the secretary there sent me to this ward," the young doctor paused for a moment to choose his words, "What's the morning routine?"

The senior nurse seems startled, "Jove, don't tell me you haven't heard of that - we are in the N-th round of this accreditation exercise. To ensure patient safety and free of any legal consequence, each day, every doctor has to prove that they and their instrument are fit for doing the round before they are allowed to see the patient."

"Which means ...?" The medical graduate suddenly suspects he has receptive aphasia, or the other side is speaking the dialect of an alien.

"In short, you have to go to the personnel department and have your ID card checked - so as to prove you are the doctor who you claim to be. Then you have to go to the staff clinic and get a body check to prove that you do not have an infectious disease to spread around. You also need to visit the EMSD (author's note: Electrical and Mechanical Services Department) and get the certificate stating that your stethoscope and other instruments are functioning properly ..."

"Is that all?" Dr. C finds that he is really having a vertigo and may not be fit for the work.

"Ah, just that you remind me. You've also got to see a psychiatrist to get the proof that you are not having pre-senile dementia or paranoid disorder against the others." The ward manager finished triumphantly.

"I suppose there's no need for the last bit," the young doctor sighed, "I'm sure I have."

Leader

When I come to think of Rafael Benítez, the story of Xiang Yu (項羽) keeps flashing across my mind.

Well, I don't think I need to elaborate the campaign between Xiang and Liu Bang (劉邦). The very point is, not only was Xiang's side much stronger at the beginning, many of the Liu's crucial helper came from Xiang. Notably,

• Han Xin (韓信) was originally a junior soldier of Xiang's side. (The classical record was Han used to hold the halberd for Xiang Yu; so called "執戟郎".) He turned out to be, in my opinion, the best military leader in the history of China.
• Chen Ping (陳平) began as the political advisor of Xiang; his excellent planning saved Liu's life no fewer than five times.
• Ing Bu (英布), Zhou Yin (周殷), Lu Ma Tung (呂馬童), and Shusun Tong (叔孫通) all started as subordinates of Xiang, but they left for Liu's side one after another.

And, worst of all, being loyal was to little avail. Fan Zang (范增) was a life-long friend of Xiang's family, and, in modern terms, the chief military advisor of the King of Western Chu (西楚霸王). Suspected of bribery (based on a rumor ingeniously spread by Chen Ping), Fan was fired and sent home with no pension - he died soon afterwards at his home town because of, in modern medical terms, carbuncle.

Alas, Chinese has a long history of voting by their legs.

Milan

While my friend VW was having some special feeling with what happened recently in (the football club) Manchester United (see http://vwswong.blogspot.com/2010/11/manchester.html), I could not help to think of F.C. Internazionale Milano.

Or, more specifically, its head coach, Rafael Benítez, when he took over from José Mourinho, who led the team to win incredibly The Treble earlier this year.

It is always difficult to follow the footsteps of a giant.

And, it really depends on your point of view. To the supporters of Benítez, the team that he inherited was defective in many ways. (Just a bit of technical details, for example, Eto'o always insists to play forward; the midfield depends too much on Sneijder, Samuel and captain Zenetti are getting old, and, as defenders, Lucio and Maicon do not stay in their responsible position as often as they should.)

But, the problems were already there when the team won The Treble ! It was Mourinho who kept Eto'o as a supporting player quietly, maintained an excellent physique of Sneijder and Zenetti, and got the best use of Maicon's ambition to score. In the right hands, crisis becomes opportunities.

PS. The very motto of Mourinho, which I entirely agree, is there exists no undefeatable team - not even FC Bacelona. The job of a coach is to conceal the problem of your side and find out those of your adversary.

We should all hold the same view in the game of our life.

遷葬記

余父仙遊倏已廿載，骨灰素供奉於某道觀內。其始，家母以年事漸長，唯恐百年後杯土之地難求，便於別處覓得靈位兩個，禆作長久之計。後立約刻碑，歷時數月。而今點撥停當，便擇於季秋吉日，舉家赴會，遷舊龕至新處，以償慈願。

此地也，佛道兼容。百殿千廈，依山而建，頗有巍峨勝貌。而背倚峯巒之勢，譬如承先，前佔城門之濶，當澤後人。危欄遠眺，儼仗夸父之肩而能極目，追嚴顏之教而思今日。及念至此，能不悚然乎？

或曰，觀者三九之地，豈不落俗？噫，其事也必。然潌滯之處，不外紅紙一張，自足疏濬。此身外之物，常可通神。其祀也，無非鮮花水果，素雞芋魚，方士一通，誦經數遍。木魚嫋嫋，徙滌心神，檀香裊裊，彌足垂涕。可稱虛應故事，以慰慈顏，亦是浮生半日，自求心安。俄而禮成，便皆歡喜讚歎而去。從此春秋二節，當有所歸。鶼鰈百世，復相廝守。此後嗣報劬勞之義，愧不稱德也。

《庚寅亥月太宰此誌》

Admirer

Maybe I shouldn't blame that naive student too much.

As the old Chinese saying, Since there are people up there like it, for sure the subordinates would overdo the thing. (上有好者，下必有甚焉。)

But, the problem remains: How do we tell a genuine admirer from another who tries to kiss your ass?

I don't know. In fact I am not sure if there exist a qualitative difference. For example, a small pinch of sugar would light up your palate, but a large dose of saccharin inevitably brings you bitterness. Nonetheless, it is not because of a difference in the chemical structure of the two - too much sucrose could give the same unpleasant taste (although you could argue one really needs an industrial dose for such an effect).

And, if there is a qualitative difference, human nature would always favour the malevolent version. The more candies you have, the less sensitive your taste buds become. With time, one would do away with all sugar because he could only sense the sweetness of saccharin.

Maybe that's how many great people die.

Mistake

Received a remarkable email - obviously mistaking me as the man from Pluto.

Here you go:

*************************

尊敬的沈教授：

您好！

首先衷心感谢您前两次对我的慷慨帮助（我曾向您求助过三篇宝贵的文献），其次，我刚刚从网上得知您是香港中文大学的校长,更佩服您的人格魅力，您是医学方面的专家，对肾病方面的研究也独树一帜，不知道以后还能否聆听您的教诲？我是XXX医院的一名学生，目前正从事肾病方面的研究！

最后祝您身体健康！家庭幸福！

学生XX

*************************

I seriously believe we need very much a course to teach our students the proper method to polish others' shoes.

Names

(Our dinner discussion continued.)

"I am also disappointed with that two-and-a-half year of sentence." Vivian said.

"Quite true." I was forced to agree.

"Sometimes I just hope I could have a volume of Death Note and do the justice myself." My wife went on.

"That's silly. Don't try that even if you really have a notebook of that kind!" I smiled.

"Why !? You think I would overuse the power and become a dictator?"

"That may be true, but there is a more simple reason."

"Eh ...?"

"Whose name do you want to put down ?" I asked.

"Well ..." my wife became hesitated.

"Were you a naughty child in primary school?" I went on.

"What do you mean ?" Vivian was at a lost.

"I presume you do not have the experience of writing tens of thousands of names?"

We both laughed - albeit in an atmosphere of sorrow.

PS. For those who are not familiar with Japanese comics, Death Note is the masterpiece written by Tsugumi Ohba (大場鶇). In short, the Death Note grants its user the ability to kill anyone whose name they know. It lends an opportunity to its owner to create a perfect world by removing everything (that he considers) evil.

Rooster

During a casual dinner discussion, my mother wondered who should go to Norway and accept the prize.

"There are two, I think, representatives from Hong Kong, and I'm sure a few key persons who took part in the 35th May matter would go," Vivian said.

"That's exactly the problem. Who should go up to the stage and take the medal from the king of Norway? There must be a hot debate - you know what Chinese people are!" I smiled.

"What would you suggest?" My wife asked - knowing perfectly well that I always have an opinion.

"They could all go to the ceremony, but none should march up to the stage. Since the recipient is not available, they should follow the traditional Chinese culture." I said.

"Which means ...?"

"Which means they should send a rooster to the stage and get the medal - just like what Chinese do for a wedding ceremony when the bridegroom is found absent. It's definitely dramatic enough to catch the attention of all media, and it saves everyone from the undeserved honour of delivering the thank-you speech, as well as stirring up any internal conflict." I explained with a wicked twist on my lips.

PS. There is yet another reason of sending a rooster that I did not tell Vivian - the bird could later be used for another purpose.

Do you know the traditional procedure of getting entrance to the Triad Society?

Options

My friend TW mentioned to me recently that we can do trading of stocks listed on the New York Stock Exchange by a local bank.

It sounds a good idea. To say the least it provides an alternative option of investment (which is very much needed when the interest rate is hell low). I have an account there for a long time. Naturally I visited their web site and downloaded some of the details.

But, on a second thought, I decided not to sign up.

Maybe I could explain by citing a scene in the Demi-Gods and Semi-Devils (天龍八部), when Jiu Mozhi (鳩摩智) offered an exchange in the archives of martial arts with monks in the Tenryu Temple (天龍寺):

**************************

本因道：“師叔，明王遠來，其意甚誠。咱們該當如何應接，請師叔見示。”

枯榮大師道：“本因，咱們練功習藝，所為何來？”本因沒料到師叔竟會如此詢問，微微一愕，答道：“為的是弘法護國。”枯榮大師道：“外魔來時，若是吾等道淺，難用佛法點化，非得出手降魔不可，該用何種功夫？ ”本因道：“若不得已而出手，當用一陽指。 ”枯榮大師部道：“你在一陽指上的修為，已到了第幾品境界？ ”本因額頭出汗，答道：“弟子根鈍，又兼未能精進，只修得到第四品。 ”枯榮大師再問：“以你所見，大理段氏的一陽指與少林拈花指、多羅葉指、無相劫指三項指法相較，孰優孰劣？ ”本因道：“指法無優劣，功力有高下。 ”枯榮大師道：“不錯。咱們的一陽指若能練到第一品，那便如何？”本因道：“淵深難測，弟子不敢妄說。”枯榮道：“倘若你再活一百歲，能練到第幾品？”本因額上汗水涔涔而下，顫聲道：“弟子不知。”枯榮道：“能修到第一品麼？”本因道：“決計不能。”

Capability

After you come to realize the evolution of human brain, there remains an important question that may skip your eyes:

If the human brain was evolved long before a written language, what's the point of having such a large capacity of semantic memory (for those ancient Homo sapiens) ?

I must say I don't know - at least it appears quite useless to me.

The remotely possible reason is that the memory capacity was not meant for semantic information; modern men merely squeeze some of our hard disk for episodic memory and use it for a different purpose. One supporting evidence is that the two memory systems share the same site in the brain. It also explains why we remember stories better than textbooks.

*************************

I'm not the only one to note all these. As pointed out by Jared Diamond (in Collapse), human beings living in an entirely primitive environment and have no opportunity of education are as smart as modernized men like us (if not more smart; otherwise they should have succumbed to the adverse condition).

But, they do not use their intelligence to read textbook or memorize Powerpoint slides; the hard disk is used for observing, reflecting, reasoning, and trying.

Skills that we have long forgotten.

Or, as pointed out by Bertrand Russell, men are born ignorant, not stupid; they are made stupid by education.

Capacity

Although I believe our students could have make a better use of their memory, the problem is not entirely theirs.

They have too much to be remembered.

And that's not a problem for medical students only; all modern man face the same difficulty. (Yes, I agree the problem is exaggerated in our circle because of the breadth and depth of the subject.)

The very fact is, the structure of human brain remains essentially the same as the one we found 200,000 years ago when Homo sapiens sapiens first appeared. (The speed of natural evolution by random mutation is very slow.) However, the amount of knowledge that a modern man needs to master is probably 100 times than that of his ancestor. Notably, with the invention of writing (and paper and printing), human knowledge could accumulate - meaning that more material are there to be learned by a student.

With computer and Internet, the accumulation of knowledge became exponential.

And that amount of information is not supposed to be handle by our good old brain.

Just imagine you are using a computer with Intel 8086 processor to play an on-line game.

PS. A minor feature may skip your eyes: human brain completed its evolution before the invention of words and writing, and is therefore not meant for semantic memory. That's why we are so much more comfortable in remembering a story.

Story

(Continue from yesterday.)

The more important and practical implication of the classification of our memory system is: Although the total capacity of our memory is huge, we have a very different capacity of each category.

And, to most of us, we are somewhat like an iPhone.

Do you see the point? Semantic memory is the files and documents and e-books that we put in that tiny piece of gadget from Steve Jobs, while episodic memory is the songs. Yes, in theory, you can squeeze a whole lot of books and files into an iPhone, but that's not what Apple designed it for, and, when you use the software, there's always a sense of inconvenience.

iPhone is best for storing and playing songs.

Therefore, the system works better when we convert documents to songs, and facts to stories.

As for the latter, there are two ways in general:

1. clinical exposure and experience
2. understanding the theory

(Many commercial classes that boast about a super-memory actually use the technique of converting a chain of unrelated objects into a story.)

PS. You may wonder why I put so much effort to study the physiology of memory. (In fact, I began my interest soon after I entered the university.)

Jove, you read the instruction of your lap-top computer or iPhone before using it, don't you ?

Memory

After my blog on that characteristic adverse effect of a certain drug (see http://ccszeto.blogspot.com/2010/11/placebo.html), some students point out - quite rightly I must say - that our current system of examination tests too much on memorizing factual knowledge.

(That's why I always support open-book examination. See http://ccszeto.blogspot.com/2010/01/open.html)

But, I am still convinced that our students are not making the best use of their memory.

Why? Let's start with a bit of basic neuroscience.

Rather than classifying into short- and long-term, there are four basic types of memory:

1. semantic memory, i.e. remembering a fact (e.g. What is the adverse effect of this drug?)
2. episodic memory, i.e. remembering a short story (e.g. What happened to that patient I saw yesterday who took this drug?)
3. procedural memory, e.g. remember how to drive a car
4. working memory, e.g. keeping a phone number “in your head” or following a route in your mind

That sounds simple, eh? Several interesting facts of these four categories of memory may skip your eyes.

First, working memory is only meant for short term use. In other words, you cannot keep rehearsing a book paragraph in your mind for several months - probably not even a few days, and burning the midnight oil before examination does not improve your knowledge in the long run.

More to come tomorrow.

Meaning

The question that remains for the triplet is, therefore, what would they feel when they grow up and come to be aware of the fact that they were "created" for a somewhat pragmatic reason.

(I shall not discuss the problem of having no mother - orphans do not.)

But, before laughing at them, maybe we should ask ourselves: Why were we "created" ?

Yes, a good many of us were here because our parents were in love and we were very much wanted. (I won't go that far and ask the meaning of wanted - be it an imprinted desire from evolution or, simply, a wish to get a bigger piece of pork in the village.)

Nonetheless, another substantial proportion of the ordinary population are around because of accident or other nondescript reasons. Should they have anything to be ashamed of? (In fact, if you believe in Steven Levitt, getting rid of unwanted baby by legalizing abortion played a major role in reducing crime. See Freakonomics.)

Of course not. We look for the meaning of ourselves from ourselves, not the couple (or the one) who created us, nor any external factor.

Otherwise we wound end up like K in The Castle, who found out that Count Westwest, who summoned K to measure the land around the castle, was actually long dead.

Ethical

What's there for us to have evil?

I believe many of you may answer to provide contrast and demonstrate the love and greatness of the god.

I beg to disagree.

If someone need to set up an evil enemy in order to show off his greatness, he is not that great after all. (There are countless examples in our history. I don't think it needs any elaboration.)

The problem is: Does evil exist?

Yes, we're back to square one.

********************************

But, let's think of it. To a mouse, cats are evil - but not to the farmer who keeps cats at home. In fact, mouse is probably the evil to the farmer. (How about eliminating all mice? Jove, that would put an end to the cat as a domestic animal, and is the last thing that a cat wants. In fact, all human cats must remember this principle.)

Similarly, to the 19-year-old university student who wished to buy an apartment for his girlfriend, the superman is evil. However, a 70-year-old widow whose living depends on the dividend of stock #0001 would think otherwise.

The very question in philosophy and theology is, in fact, Is there anything that is absolutely good or evil, right or wrong, ethical or not?

I don't know, and I shall not pretend to be able to distinguish.

PS. The same topic is, in fact, rather hot amongst biologist: Is there any species on earth that we could eliminate without any inadvertent adverse effect?

Go read the article by Fern Wickson, and other related ones, in Nature on 25 August 2010.

Evil

Little Einstein's story sounds great, eh?

The problem is, why doesn't heat, light, and god be present everywhere, so that there is no cold, darkness, and evil.

In other words, winter is winter because the sun is not working to its full capability. (I discussed this consideration some time ago in this blog under a slightly different context. See http://ccszeto.blogspot.com/2009/11/blog-post.html)

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No, I'm not blaming anything.

We need cold to, for example, store our food, and we need darkness to get a good sleep and refresh ourselves.

How about evil ?

PS. This little story of little Albert Einstein is nothing more or less than fictitious. There is no evidence that it did happen. In fact, by all we know, the Nobel laureate in physics was rather autistic as a child and was unlikely to challenge his teacher.

Triplet

Many of us are amazed with that billionaire who had a triplet of grandchildren. Some said that it is not ethical to use an artificial means to create new life; other are more concerned with the psychological problems to be encountered by the three brothers who do not have a mother.

I have a simple opinion, but I shall give it in a slightly convoluted and very indirect manner.

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To begin with, many of you may have seen a clip on YouTube that described how the young Albert Einstein challenged his teacher on the existence of cold and darkness. (See http://www.youtube.com/watch?v=2JgpARGvBnc)

If you prefer the written version, here it goes:

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The teacher challenged his students with this question: Does God create everything that exists?

A student bravely replied, "Yes, he did!"

The teacher answered, "If God created everything, then God created evil since evil exists, and according to the principle that our works define who we are, then God is evil."

The student became quiet.

Another student raised his hand and said, "Can I ask you a question?"

"Of course", replied the teacher.

The student stood up and asked, "Sir, does cold exist?"

"What kind of question is this? Of course it exists. Have you never been cold?"

The child replied, "In fact, sir, cold does not exist. According to the laws of physics, what we consider cold is in reality the absence of heat. Cold does not exist. We have created this word to describe how we feel if we have too little heat." The student continued. "Sir, does darkness exist?"

The teacher responded, "Of course it does."

The student replied, "Once again you are wrong, sir. Darkness does not exist either. Darkness is in reality the absence of light. Darkness is a term used by man to describe what happens when there is no light present." Finally the child asked the teacher, "Sir, does evil exist?"

Now uncertain, the teacher responded, "Of course, as I have already said. We see it every day. It is in the daily example of man's inhumanity to man. It is in the multitude of crime and violence everywhere in the world. These manifestations are nothing else but evil."

To this the student replied, "Evil does not exist sir, or at least it does not exist on its own. Evil is simply the absence of God. It is just like darkness and cold, a word that man has created to describe the absence of God. God did not create evil. Evil is not like faith, or love, that exist just as does light and heat. Evil is the result of what happens when man does not have God's love present in his heart. It's like the cold that comes when there is no heat or the darkness that comes when there is no light."

The professor was speechless.

And the child was later known as Albert Einstein.

Approval

(Communication between a university professor and the secretary of a grant administration office.)

Dear Professor X,

Thanks for the application on the above grant ... Please prepare a letter addressing to the Fund Secretariat advising them that ethics approval / proof of exemption are being sought from the relative ethics committees and will sent them a copy once they are available.

Regards, et cetera.

****************************

Madam,

Thanks for your mail ... As to the "letter addressing to the Fund Secretariat advising them that ethics approval", since clinical research ethics approval is available and enclosed in the grant application, do I still need a separate letter as such ? (And, if yes, what am I expected to put down in the letter ?)

Professor X

****************************

Dear Professor X,

For the ethics issue, it is referring to those you declare not required in the form. As stated in the requirement, proof of exemption is required to be obtained from the relative ethics committees. At this stage, you can just prepare a letter advising them that these are being sought and will let them have a copy once available.

Regards, et cetera.

****************************

Madam,

Since my application is related to patients' clinical record and does not involve any laboratory work or animal, do I still have to seek exemption from laboratory safety office and animal research ethics ?

Professor X

****************************

Dear Professor X,

Yes ...

Regards, et cetera.

****************************

(The final mail that this humble university academic decided to keep to himself.)

Dear Madam,

For sure I shall apply for exemption of animal research ethics - I shall not study your clinical record in this project.

X

Clinic

Many of my colleagues are still trying to adapt their life in the new hospital block. There are, no doubt, many problems - some are silly, some more serious. I shall not join and point finger to our extra-terrestrial friends. Nonetheless, a casual chat with my friend C was illuminating.

****************************

"I shall move later when I have a new chair. You know, many of us do not even have a chair in our new office," my friend sighed.

"Why don't we buy some ?" I was curious.

"Jove, who's going to pay for them ?"

"Of course the department ! Many of us are seeing private cases, and part of the income goes to the department central fund. The money is meant to be used for the welfare of our colleagues," I said.

"Oh, don't you know that we have used the fund to cover up our budget deficit last year?" C was slightly excited.

"But that's not the original purpose of having such a fund!" I was surprised, "and, if that's the case, who would have the incentive to see private case?"

"None and never," my friend continued, "That's why we find it unbelievable to set up - in the near future - a semi-private clinic for government servant."

"Alas, I suppose the clinic is named after Pandora," I said to myself.

Right

I must say when I wrote the blog that described my discussion with TW (see http://ccszeto.blogspot.com/2010/10/property.html), I was not aware of the fact that JW - the Warren Buffett of my friends - appeared in the morning paper and talked about the same subject.

And the two had rather different an opinion.

More so, they are the two, and only two, distinction students from the same class. I suddenly find it difficult to work out which one to follow.

******************************

This little incident brings my memory back to the days as a first year medical student.

On one occasion, our class undertook a particularly difficult histology slide test (during which each of us had to see 40 slides and answer some questions). In the evening after the test, two of the smartest students of my class met in the canteen and checked the answers with each other.

To their horror, in only one out of that 40 questions, they gave the same answer.

Neither of them slept very well in the following days.

But, their panic attack did not last long. A few days later, the result was announced. The annoying bit was, the two of them scored the highest within our class. (And, as to that question of which the answer they agreed with each other, they were both wrong.)

Alas, when every one keeps making the wrong decision, a few correct ones would bring you to the top already.

PS. Seriously the opinion of TW and JW are not all that different - they were referring to slightly different contexts. Go read http://hk.myblog.yahoo.com/cal-culator/article?mid=468

Guess

You may wonder why I was so sure the students had mistaken the slide and there was no specific syndrome called placebo-like effect.

In fact I was not.

But, to begin with, I merely applied a rule that I used since my days as medical student.

It says: If I have not heard of it, it does not exist.

I could hear you gasp, as well as your unspoken comment: How arrogant and histrionic!

Yes, I am - but not that far.

The fact is, this rule was designed for MCQ examination. You don't need to be encyclopedic and be absolutely certain that something does not exist if you have not heard of it - you only have to be knowledgeable to the extend that if you have not heard of a particular thing, the probability that this subject at hand does not exist is higher than that you are being ignorant on this particular matter.

In other words, if I put my money on the former and keep betting, I would expect a positive return.

I call it a calculated arrogance.

PS. Of course, I was not answering MCQ this time, and I had to go back to the reference and looked up the subject before I could be certain.

Placebo

That day proved to be exceptionally busy. After meeting two friends of mine, I received a whole pile of written paper from the panel examination of our third-year students.

I was responsible for scoring one of the essays.

It was a question on lipid-lowering medicine, their clinical use, and adverse effects.

The task was tedious. To my surprise, when I went through the answer for the adverse effect of a particular drug, nearly half of the class wrote the following:

Placebo-like effect.

I must say I have never heard of a distinct syndrome with such a name, nor did I encountered problems remotely related to this seemingly characteristic phenomenon.

And then I had a hunch.

I went back to the Powerpoint file of that lecture, which was made by another professor. On the slide that described the adverse effect of that drug, there was just one line: placebo-like.

It means the drug has no specific side effect and the profile of adverse reaction was similar to the placebo group in randomized trials.

For sure many of our students have intact visual cortex, temporal lobe (for semantic memory), and motor area - they could recite exactly what's written on the teaching slide without knowing what it means.

A icy cold feeling sudden went through my back.

PS. The most dramatic answer sheet, however, belongs to a remarkable candidate who wrote an entire page in an attempt to answer the question last year (which was pretty much the same as the present one, except that we were asking a different class of drug).

Articles

In that afternoon I met WG - my previous PhD student who happened to be in Hong Kong. (For our relation, see http://ccszeto.blogspot.com/2008/06/wg.html)

"How are you recently ?" I feel really warm to see my student becoming my trusted friend and collaborator.

"So so," he was cautious, "Well, have you read the recent paper in Nature ?"

"You mean the one by Daniel Chitwood and Marja Timmermans on microRNA ? Yes, that's interesting." I said, referring to the review article Small RNAs are on the move, which discussed a topic that WG and I had long for doing some research together. (See Nature 23 September 2010, p 415.)

"No. I mean the story of Fang Shimin." WG said.

"Oh, I see what you mean ..." I was sympathetic, reflecting the problem now faced by my friend, "The title is Brawl in Beijing, written by David Cyranoski." (See Nature 30 September 2010, p 511.)

"You know, it is often difficult for people like me to do serious scientific work." He sighed.

"And, even if you did, it is unlikely to convince other people. In fact, you should also read Strong medicine for China’s journals by the same author." I said grimly. (See Nature 16 September 2010, p 261.)

Fire

Another topic that TW and I discussed in length was cookery. After knowing her for some 18 years, I was absolutely surprised to know she began to prepare dinner for her husband.

And, I must admit I laughed up my sleeve when she asked questions like "How could I fry a piece of pork chop ?"

*************************

The next morning, I met AL. This is the first time after our man from Pluto moved his office.

My friend looked content as ever.

"You know, I just realize Queen Marie Antoinette may not be that malicious - he is just innocent."

"Oh, I think he's quite ambitious?" I knew what she meant.

"He may be," AL smiled, "but he's quite incapable of playing the game."

"How do you know?"

"From how he fired that piece of pork chop."

For a moment I had a déjà vu feeling of my conversion with TW yesterday.

"Oh, the problem is, he did not want to fire it from the very beginning - all he wanted to do was removing it from the top shelf of the freezer. But, he decided to turn on the gas and put the target on a pan for ages. By the time it was handed to me, the whole business was a piece of charcoal !"

I made a wicked smile, "Doesn't he know we could simply talk to a piece of meat, or, more simply, give it some hot potato in order to defrost it?"

My salute to Donald.

Property

On the next day after my mother's birthday gathering, I attended the annual meeting of the society of my specialty.

Met TW there. It has been quite some time since I last saw her, and we decided to excuse ourselves for a while in the middle of the meeting and lunch together.

****************************

We settled ourselves comfortably in a café nearby, and chatted on almost everything. Contrary to her usual never-care-less attitude, my friend was rather hot when she talked about R, a surgeon and (from what I gather) a distant acquaintance of her.

"I can't really understand why he doesn't buy a shop for his own office, or his own apartment to live." My friend sighed.

"Eh ...?"

"You know, R is paying some $30,000 each month to rent his office," TW continued, "and another $30,000 for his house - and he has been doing it for 5 or 6 years. That's quite enough to buy one!"

"Quite right." I agreed.

"And, one needs to retire sooner or later. When you have no income, how could you afford the rent? In fact, life could be very simple and you don't need a lot of money for the retired days - as long as you have a place to live."

I nodded; could not agree more.

PS. Frequent visitors of this site may recognize TW is one of the few who often gives comment to my blog. (And I love her blog very much, particularly her recent story on stress. See http://hk.myblog.yahoo.com/cal-culator/article?mid=413)

Duck

Had a small family gathering over the weekend; it was the 70th birthday of my mother.

The menu was specifically selected to suite her palate:

前菜: 叉燒，鵝肝腸

堂剪茶豬

杏汁白肺湯

一品煲

琵琶鴨

炆班翅

海鮮蒸乳酪

黑松露醬炒野菌

啫啫唐生菜

腊味煲仔飯

杏汁包

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For the part-time gourmets, pipa duck (琵琶鴨) is the Nanjing version of Peking roast duck and a variant of the Canton fried duck, although the seasoning is slightly more complicated and the meat is much less greasy when served. Twenty or thirty years ago, it used to be a regular item available in many roasted meat stores. It is a pity this tasty treat has vanished in the market because it takes much preparation but you can't really make it more expensive than its competitor from Canton.

Alas, Darwin's law is followed even after the death of a duck.

Ponzi

My friend L was not very happy after reading my blog on our discussion about the medical insurance business. (See http://ccszeto.blogspot.com/2010/10/name.html and related ones.)

"You missed my point," he pointed out.

"Did I ?"

"Now, let's consider the problem again," my friend explained, "When the insurance scheme gets going for a while and many of the trustees are elderly, the claim rate would be very high. You agreed on this point. Didn't you ?"

"Yes ...?" I though we discussed that last time.

"Then, how could the business run? In other words, where comes the money to pay for the claim each year?" my friend was slightly excited.''

"You mean ...?"

"I mean, in a stable state, the yearly pay-off would be covered by the insurance premium collected that year." L went on, "When reputation builds up, more people would agree to join the scheme, and the business could prosper."

"Stop there. The story sounds familiar. Where did I hear of it?" I thought I was seeing light.

"Have you heard of the Ponzi scheme?" my friend suddenly put up a wicked smile.

"Yes ... no. What's it?" I vaguely remember the term but could not recollect what's that all about.

"That's the old term. After the financial tsunami, people called it the Madoff investment."

Absent

Met VW in the medical grand round.

Seeing that I did not appear to be interested in the topic, the hepatologist asked, rather lightheartedly, "Have you heard of the story between GY and our third-year students?"

"Nop. What's up ?"

"The whole group of students, who were supposed to attach to the teaching clinic of GY last week, did not turn up, and the cardiology professor almost had a seizure," my friend said, "And this is not the first time. Just another day all the students did not turn up for the teaching clinic of GW, who had already selected suitable cases and arranged everything."

"Why's that?" I considered for a while, and added, "Oh, yes. They shall have their panel examination very soon."

My friend nodded.

"So, what's our cardiologist going to do?" I asked.

"He has asked all that group of students to come to see him next week..." VW said.

Knowing the usual GY, I chuckled for an inevitably long-dwelling meeting, and I said to myself, "That, in itself, is a penalty."

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You may think I was not behaving properly and laughed at my colleague. In that case you are right, and I had retribution the next day.

I mean, when I lead the bedside teaching for my group of third year students, only half of them turned up.