Allow

(My discussion with BK continued.)

"Why not ?" she asked.

"That's against the principle of writing instructions," I explained, "You see, if we accept putting in the rule Do Not Do Thing X, there would be millions to follow. For example, we have to add do not kill your patient, do you chop off your patient's head, do not chop off half of your patient's head, do not use four-letter words in front of your patient - and being heard !"

My friend was speechless - she obviously found me intolerable.

But I was serious. Guidelines and instructions for professionals should, in general, be positive statements. (The same applies to medical textbooks.) They tell you what to do in a particular situation, but will not tell you what you should not do - because there are countless of them, imaginable or not. (For example, you should take off the appendix when it is inflamed. No textbook would tell you not to spit on the appendix and close the abdomen - but would any surgeon with a sound mind do so ?)

The real problem is, of course, many extra-terrestrial creatures could not comprehend this basic principle, and, whenever someone does something wrong, they keep asking for yet another written guideline to prohibit that particular wrongdoing.

I shall not elaborate further.

PS. The principle of professional guide is, in a sense, exactly opposite to that of legislation in democratic countries. In the latter case, law-makers tries to put down everything that is prohibited - and citizens are allowed do anything not overtly banned by the law.

Prohibit

While we were gowning up to do some surgical procedure, my colleague BK asked, "Are you still distributing houseman instructions and protocols for interns rotating to our team?"

I said, "Yes, I suppose. It's just a few sheets of paper that explain what to do for common clinical admissions. K is responsible for it whenever we have a new house officer. What's up?"

"I just want to make sure we add a line to the instruction and forbid new interns from doing the same thing that I saw a moment ago," she sighed, "You know, I'm just back from the ward and had some good words with two gold medalists."

"Eh ?" after knowing BK for nearly ten years, I was slightly incredulous how good the words she could have used.

"Well, I just happened to find our gold medalist house officer doing XXX," she said. (The exact doing is irrelevant. Suffice to say it was something unconventional, and, using the description of Humphrey Appleby, may not always have entirely insignificant consequence.) "The procedure was ordered by a gold medalist medical officer, who happens to be the on-call today, and blindly followed by our distinguished intern." BK went on.

"I agree the order was courageous and innovative, and, despite what's going on in the financial market, the university may be suffering from very bad depreciation of expensive metals," I tried to sooth my friend, "Nonetheless I do not agree to amend our instruction."

Why ?

Island

After reading my recent blog on tolerance, my friend L caught me on my way home and asked, "Are you talking about that little island? You are completely mistaken!"

"Oh, don't be silly. I was referring to something else. But what do you think I have mistaken?" I smiled.

"I mean, our leader is not tolerating. In fact, I would say he behaves rather properly - or wisely." My friend said - after a moment of silence, he added, "And also in the matter related to the exchange rate."

"But he is doing nothing !" I said, "Rather plainly he turns a blind eye to both issues. In the most modest term I call it procrastination."

"You may be right," L chuckled, "But this is the time when procrastination is the best strategy."

"Is it?" I could not believe my ears.

"Alas, do not allow anger or the urge to do something blind your eyes. That straight man is facing a terrible problem inside - his party is about to split. All he wants is stirring up matters and creating an enemy outside, so that he could unite his people." He pointed out.

I was forced to agree.

"And, as to that black president, his party is facing the mid-term election. It is obvious that he achieved nothing in improving the economy. What could be better than blaming everything to a stawman?" L continued.

"I see. Oh, the tactic really appears familiar." I said.

"There's nothing new under the sun," my friend suddenly sounds like Sherlock Holmes, "Stalin, Hitler, Hideki Tojo, and many others tried it."

Plot

(The story of Zheng and Duan continues.)

A few months later, Zheng's mother urged Duan to build walls, stockpile arms and recruit mercenaries to the rebel cause. Soon news of all this reached the capital, and it was clear to everybody what was going to happen. Zheng's ministers urged him to retake the city from his brother before it was too late. However, Zheng dismissed these proposals, stating that he found no fault in Duan, and it could not be proved that he was plotting a coup. Besides, Duan was his brother, and he could not take up arms against him.

Soon Zheng had left the dukedom to Luoyang for some diplomatic matters; his mother (who was staying in the capital) wrote a letter to Duan, ordering him to revolt at that moment and she would open the gates of the capital for him. So Duan revolted against Duke Zheng, and not long after he was under the capital walls.

However, Zheng was well prepared, and it was all his trap. Duan's army melt away quickly, and he had nowhere to run. At last, Duan cut his throat. Zheng rushed to see his brother's corpse; weeping greatly, and he said to him, "My brother, you knew that I would always forgive you; why has it come to this?"

PS. Of course, in real life Zheng was nowhere near as compassionate - he only did it for show.

After all, if Zheng did not appear to be tolerant from the beginning, he would have no chance (or excuse) to eliminate his brother.

Tolerate

While I was thinking about tolerance of evil, another story from ancient China came to my mind:

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

武公十年，娶申侯女為夫人，曰武薑。生太子寤生，生之難，及生，夫人弗愛。後生少子叔段，段生易，夫人愛之。二十七年，武公疾。夫人請公，欲立段為太子，公弗聽。是歲，武公卒，寤生立，是為莊公。

莊西元年，封弟段於京，號太叔。祭仲曰：「京大於國，非所以封庶也。」莊公曰：「武薑欲之，我弗敢奪也。」段至京，繕治甲兵，與其母武姜謀襲鄭。二十二年，段果襲鄭，武薑為內應。莊公發兵伐段，段走。伐京，京人畔段，段出走鄢。鄢潰，段出奔共。

《史記· 鄭世家第十二》

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

For those who had difficulty in reading Chinese, here is the English version of the story I found in Wikipedia (which I modified slightly):

Born as the first of two sons and groomed for the throne, Zheng's mother nevertheless preferred her second son. The reason being that she suffered through an extraordinarily painful time when giving birth to Zheng. (Szeto's note: It was a breech presentation.) When Duke Zheng ascended to the dukedom over the violent objections of his mother, she began plotting to get the younger brother, Gongshu Duan (叔段), into power.

First she asked Zheng to give Duan the second largest city in the country (and was a very important fortress) as a fiefdom. Zheng's courtiers begged him to reject the proposal, but out of courtesy for his mother he agreed.

(To be continued.)

Tolerance

Recently, a friend of mine told me, by what he did, that tolerance is a virtue.

I beg to disagree.

In the name of tolerance every evil is exalted and proudly defended. A tolerance that allows sin to prosper - because it refuses to condemn and punish evil - is merely the accomplice of Satan.

The story of Eli in the Bible told us that much:

Eli was the high priest of Shiloh, and the last Israelite judge before the rule of the kings. His sons, Hophni and Phinehas, were specimens that were not cream but rose to the top - they took all the prime cuts of meat from sacrifices, and they made love with women at the sanctuary entrance. Eli knew all these, but he just told his sons not to do so - without any punishment.

But, by doing nothing to restrain his sons, Eli sent them to hell. The god prophesied to Eli that he will be punished for his tolerance (and his sons for their wrongdoings), with all of them dying in a brutal manner at a young age.

Go read the Books of Samuel.

Moon

One evening, Euterpe looked out the window and cried, "Hey, the moon is there. It looks gorgeous!"

It was 7th or 8th of August by the Lunar calendar. I followed my daughter's finger and, as expected, found a half moon. Yes, the sky was clear and the moonlight was surprisingly bright. But, expecting a much better one in a week's time, I told the little girl, "It would be even better next week, when we have the mid-Autumn festival. Let's go to the garden by then and appreciate the moon together."

My little princess nodded. But, as it turned out, we never met a bright and beautiful full moon a week later - there was a typhoon, followed by several consecutive rainy and cloudy days. I must say I missed the chance to appreciate that fantastic half moon with my daughter.

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

勸君莫惜金縷衣，勸君惜取少年時。

花開堪折直須折，莫待無花空折枝。

《金縷衣》杜秋娘

Fall

During a lunch time meeting, Vivian rang me up, "Euterpe slipped and fell in the school this morning, and her teacher is now calling me."

After confirming my daughter had some lacerations over knees and nothing else, I assured my wife, "Maybe they're just trying to tell you what happened."

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

That evening, when I was back home, my wife looked at me in a funny manner, "Guess what the school was calling us for ?"

"Eh ...?" I was at a lost.

"Well, she told me what happened of course, but that's not the main point," Vivian said, "The teacher was curious that our daughter didn't cry when she was obviously hurt - she just looked upset."

"Didn't she cry at all ?" I was equally incredulous.

"No, of course," my wife went on, "Her tears came like fountain as soon as she saw me - she was just saving her emotion for a better target !"

Frog

You may think although it is difficult to rectify, professors do not commonly teach something wrong to his students.

Yes, that's true.

The real problem is usually not right or wrong, but that each teacher has a different degree of flexibility to the detail. For example, one insists to use a key for the plantar response while another allows the tip of tendon hammer (the latter instrument was strictly prohibited for such a purpose in the old days, but many people are more lenient now), or one asks for the serum potassium level two hours after the first dose of intramuscular vitamin B12 (for the risk of fatal hypokalemia), while the other considers the chance too low and does not even mention in the tutorial.

And I have no answer, although when faced with a situation like this, I always remind myself a frog placed in a pan of cold water that is gradually brought to a boil would eventually be cooked to death.

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

At this moment, a little story of DY, my professor of neuroanatomy, comes to my mind:

"This book is no good," he told our class.

"Why? It's quite sufficient for practice and examination." One of us asked.

"Yes, it contains 70% of all the material," the professor explained, "The problem is, an ordinary student would only remember 70% of what he is taught, and 70% of 70% makes 49%, which is not enough to pass."

PS. His original saying in Cantonese was more vivid:

七七四十九, 啱啱要supple.

("Supple" of course stands for supplementary examination.)

Gauge

While I was slightly disappointed with that examination-oriented student, a little friend of mine wrote the experience with his professor in Facebook. (See http://www.facebook.com/home.php?#!/notes/rutherford-sin/gauge/433926647189)

In short, the professor had mistaken the unit for the size of angio-catheter, and, during the tutorial, no student pointed it out.

I must say we all have a similar experience when we were medical students.

Well, but, let's fast-forward the time. Now, I am on the other side of the consideration. Although I appear fierce and malicious, more than once my students pointed out my mistake during the tutorial. It doesn't feel good. (But, of course, I have seen many things much worse, and am not that easily be put off.)

And, therefore, next time, when you find that I am at the fault, do speak out - but, please do it in the most delicate manner. I consider myself a piece of fine China and is very fragile.

PS. The real difficulty is many a time a student states that something is taught in a different way by another professor - and I recognize that that piece of teaching is wrong.

Question

(To the student who, after my lecture on Friday, asked me for the answers of previous MCQs.)

Dear student,

I appreciate your effort in collecting previous examination questions and trying to study them so early in the academic year - not to say putting up courage to ask a malicious nephrologist like me for the answers. However, your approach is entirely wrong. Medicine is learnt by seeing patients and reading textbooks. Lecture handouts have very little value, and past paper is a drug - it should only be taken under prescription, and is distinctly prone to be abused.

If you think drug is too mean an analogy of past paper, I consider it as a supplement, like all those milk and powder formula we give for our malnourished patients. Yes, it does help to improve the body built, but, because it is so concentrated, you may end up having diarrhea and absorb nothing. More importantly, these supplemental formula should not be consumed as the only source of nutrition - unless you are those bed-bound elderly subjects who require tube feeding.

And they won't live long with such a diet.

Sincerely

Collateral

(Excerpt from the diary of a certain Mr. Greenspan.)

The media is so hot with the accident. Can't understand why.

No, my question should be: Who let the reporters know of all these?

Was it the victim - or, really, her friends and family?

No, it shouldn't be. Otherwise their opinion would fill up the morning paper. Now, it's all facts and cut-and-dry information - with a whole lot of details indeed. It must be from our own man.

Alas, of course it was him. The initial report certainly went to him; he considered the whole thing important, and the media need to be notified.

But, why this time? There were many other incidents previously that he did not make public. Does he have a hidden agenda ?

I couldn't think of any.

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

(Supplementary notes a few days later.)

I was blind.

He did it not for any benefit; he merely wanted to protect himself.

He is running for that highest position, and could not afford being accused by his adversary (or members of the selecting board) to cover things up.

I call it a collateral damage.

PS. As always, if you believe you understand what Mr. Greenspan says, you are definitely mistaken.

Load

You may argue the increase in time and effort on checking the medication and seeing patients should not be limited to one or two senior consultants; every doctor should do it.

Quite right, and it is entirely practical - in utopia.

Alas, if everyone works harder and close the clinic later, it won't take long for many of the doctors to come out for private practice.

And, let's face it, the more competent ones are more likely to leave the public hospital.

Doing good to the public, eh ?

PS. Although I used clinic time as an example, do not be too narrow minded. The implication of trying to do best for some of our patients have more extensive and profound meanings. Imagine the ones who call themselves super-physicians and try to achieve an ideal care within their kingdom (I mean that several beds), while at the same time turning a blind eye to the sea of other patients who are equally in need.

Shift

You may argue it is a necessary evil to spend more time with each of our patient and ensure an excellent standard of care.

I beg to disagree.

(I could hear you gasp.)

The consideration could be very simple: Time of a doctor is the limiting resource.

Imagine if a consultant from Utopia wants to offer the best level of care to his patients by spending one hour with each of them - taking a detailed history, doing a thorough examination, going through every bit of the past record, and double-checking every prescription before the patient leave the consultation room - he would only be able to see three patients in an afternoon (assuming he is punctual for the clinic - which we all know is exceedingly unlikely).

But, the total number of patients attending that clinic, as well as the number of doctor, does not change. Let's say he is supposed to see ten patients in the clinic (a generous assumption), how about the remaining seven ? Alas, they will be seen by other doctors in a cursory manner. More so, the quality of care of the patients under other doctors would actually get worse, because part of the time would be spared for those additional patients diverted from that perfectionistic consultant.

If you need something quantitative, just consider this: An ordinary doctor would be expected to spend three hours for ten patients, 18 minutes each. If he has to see two additional patients, it becomes 15 minutes for each case, or a 16% reduction. The potential adverse consequence (and reduction in the level of patient satisfaction, as our extra-terrestrial friends are so fond of the term) would be much greater than the benefit for that lucky three patients who are now seeing that consultant.

Time

Met TM, a young energetic colleague of mine, during lunch.

"You're a bit late. Are there many cases in the clinic?" I asked.

"Not really," my friend sighed, "But, you know, every one of us were using thrice as much of the time to see each patient."

I could not believe my ears, "How could that happen?"

"That's because of all these recent happenings of prescription error!" He was slightly hot, "Now, we check every single prescription - and there could easily be a dozen items - in front of the patient."

"Could that really improve patient care and safety?" I was slightly incredulous.

"Of course not," LS interjected from the other side of the table, "It improves our safety."

"I think it is also for our patients' well being," I smiled, "That's why we have to pay all our attention to check the drug. Next time, when I see my patient in the clinic, I will ask them to shut up so that my attention would not be diverted to their nitty-gritty complaint."

Misconception

(LY continued to share his wisdom with us.)

"You know, there are two common misconceptions about teaching," he said, "The first one is: We want to improve our teaching evaluation score and earn the Best Teacher Award."

"That's difficult, I know." LS said.

"It is not difficult, but impossible," LY remarked, "How could you ever compare to an energetic and yet highly skillful teacher like JW ? But, the misconception lies here: What good is there to score better in the teaching evaluation ? An improvement from 75- to 95-percentile gives you no benefit - although you have to do a lot more. Yes, an evaluation score of 25-percentile may give you problem when you try to substantiate or ask for a promotion, but, since there are so many horrible teachers - I won't say who - it is equally difficult to score very low!"

We all laughed.

"How about the second misconception?" One of us asked.

"That one is: Doing more teaching would give you a higher evaluation score. Many a time that's quite opposite." LY pointed out.

"Why's that?"

"Because the evaluation is based on students' impression rather than an objective measurement of the amount of time spent or material learnt. The longer you spend with the students, the higher the chance you would offend them - or the higher the chance they would irritate you," my friend continued, "The way to score high in the teaching evaluation is to create an impression that you are an excellent teacher but you are too busy to spend much time with the students. They would just admire you and give you the best score - based on their romantic idea!"

"This tactic sounds familiar. Someone amongst us is making good use of it." One of us said.

"That's XX." My friend concluded triumphantly.

Change

(Our luncheon discussion continued.)

"So, is there anyone who could make a change?" LS asked.

"No," LY was quick on that, "except HN."

We were silent; HN was the one (amongst a few others) who started the whole business.

"I don't think HN is going to retire in the coming few years." I remarked.

"Even if he does," LY smiled, "Who would be interested in taking up the task and be in charge of student education? It is a post that you would get no credit but all the blame!"

LY was right. According to the teaching of Humphrey Appleby, that's the ideal post for your political adversary - so as to make sure he would not move higher up in the bureaucratic hierarchy.

"You know, we do not need someone to change anything," LY continued with his speech of wisdom, "All we need is someone who has no interest in taking up the post and intents to do nothing - then we could all lead a better life."

We all nodded and agreed.

Torture

Lunch with a few of my colleagues.

FK was slightly late, and was obviously in a hurry when she arrived, "Just finished with morning stuff - and there will be another three hours of that reinforcement course for me this afternoon."

"Poor, poor," we tried to calm her down. As a matter of fact, we all have some similar experience. Yes, it sounds brilliant to have a patient or two being examined in a peaceful environment. But, it would be a dreadful afternoon for that one or two patients. After all, what good is there when, for each student, most of the time was just sit there and observe and wait for their turn?

"We all know it's a waste of our time - and a torture to our patients. Can we do anything to change it?" One of us asked.

We all looked at LY, who happened to be the coordinator of third-year teaching in our department.

"Oh, don't look at me. I could do nothing," he explained, "You know, that bit is what they called faculty owned teaching. No department could change the arrangement."

萬三

While our country leader was having a private meeting with the billionaire, I could not help thinking of Shen Manzo (沈萬三).

For those who are not familiar with the history, Shen was supposed to be the richest man in China at the turn of Yuan and Ming dynasty.

During the campaign against Mongolians, he was a supporter of Zhang Shicheng (張士誠). As a result, when Zhu Yuanzhang (朱元璋) seized the reign and forced him - together with tens of thousands of other rich families - to move to Nanjing, he was more than willing to support all government activities in order to win the heart of the new emperor.

Shen and Zhu enjoyed an excellent honeymoon period, until Shen volunteered to paid for the building of one-third of the city wall around Nanjing, and reward the Ming army - one silver coin for each soldier, and there were over a million of them.

Zhu was not amused, and planned to find an excuse to kill Shen. The queen, who was well known for her kind heart and wisdom, said to Zhu, "You do not have to kill him; a man who owns the fortune of a country is ominous to himself."

原文: 民富俟國，民自不祥焉。《明史: 高皇后馬氏傳》

PS. Shen was soon exiled to Yunnan (雲南); half of his property was confiscated.

三鯬

"Guess what we have for dinner tonight ?" My mother made a curious remark when she was back from the wet market on the Sunday morning.

Of course I had no idea. "Let me have a look," and I went into the kitchen.

In there lay a suspicious-looking fish.

"Why, it's shan-li (三鯬) !" I cried.

And, in that evening, we were enjoying its tasty flesh - steamed and well seasoned with douchi (豆豉).

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

I suspect most of you have not heard of shan-li (三鯬), which used to be very common in the Pearl River (珠江) estuary and is still occasionally found in our local wet market.

But, shan-li is the name coined by Cantonese only. The very same fish, when found in the estuary of Yangtze River (長江), has a different name - which you would probably be familiar.

It is Tenualosa reevesii (鰣魚).

PS. With a different name, the same fish is ten times more expensive in Shanghai restaurants. I must confess although I had tried both of them for many times, I never notice they are all but the same - not until I read Shi-Jing (食經) by Chen Mengyin (陳夢因) recently.

Kundera

Many of you may not know, The Joke has a special meaning to me.

The story goes like this:

In the summer twenty years ago, shortly before I began my final year in the medical school, I did a week of locum job as the assistant intern in the surgical ward (nominally under the King of the Round Table).

After an entire week of endless work and intense stress (with not-all-too-bad a payment), I passed a large book store on my way home, and I decided to buy myself a small gift before the term started.

In there, I found two attractive books selling in bargain price: The Joke, and The Murder of Roger Ackroyd by Agatha Christie.

After a moment of consideration, I ended up buying the latter - and, since I was so impressed with the story, I read one detective fiction every weekend for the rest of my final year.

I am quite sure the course of event would be very much different if I chose the other one.

Joke

The briefing session lasted two-and-a-half hours. Nonetheless I could be back to the hospital on time to attend the lunch time meeting.

It was our "team meeting". For those who have joined our department for long enough, you may recognize it used to be called the audit meeting, where we reviewed the cases that died recently, did a random check on the quality of hospital notes and discharge summary, and had a few other activities related to quality improvement. Nowadays, the audit component is fading out, and our team (which used to be firm) had advanced to a stage we talked on more metaphysical topics.

For example, this time, a few house officers were asked to come to the stage and share their feelings.

I had a focal seizure at my angle of mouth.

"You looked funny," LS said, "What's wrong?"

"Nothing, just that I have a déjà vu feeling." I hesitated.

"Eh ?" my friend looked puzzled.

"You know, I'm reading The Joke of Milan Kundera lately. There are several scenes of communist school and party meetings, where juniors are asked to come out - mostly unwillingly - and demanded to say what they feel or what they find good or bad in the system. That's where my déjà vu feeling comes along!"

Notes

Euterpe was about to start her first year of kindergarten. On the day before the term actually began, I took a few hours off and attended the briefing session in her school.

I was there a few times since my daughter applied for it. Arrived slightly early, I took a short talk and tried to have a glimpse of the whereabouts.

The briefing started exactly on time. According to the agenda, it should be a two-hour presentation. I must confess before I arrived, I could hardly imagine what topic could take that long. (Of course my friend LS warned me that much; just a few days ago, she attended the briefing session for her son - and it took four hours!)

But, yes, there was more than enough material. I actually got a few handouts, but there were much more material that was covered - plan of the year, preparation of the school bag, how to apply a leave, a tour to the classroom, and countless of others. With my basic instinct as a student, in no time I took out my Moleskine and began to take notes.

After a few minutes, half of the parents in the hall wrote furiously on whatever paper they could get hold of. Some moment later, one of the teacher realized what's going on, and she said, "These are all important and you really should take notes. Who does not have pen and paper ? Just raise your hand; I shall give you some."

Without a second word, the other half of the parents all put their hands at once, as high up as possible.

PS. Although I said instinct as a student, in fact I hardly take any lecture notes ever since I entered the medical school. (Yes, I often make notes from textbooks, but not lectures.) In a sense kindergarten study is more trying than university - at least for the parents.

1000

I suddenly realize this is the one-thousandth blog entry.

How do I feel? Well, I still remember what I wrote when this little place came to its first anniversary (see http://ccszeto.blogspot.com/2008/12/anniversary.html). My feeling is quite the same.

But, a thousand does have a little different meaning. In the classic of Hayao Miyazaki (宮崎駿) - Spirited Away (千與千尋) - Chihiro (千尋) had to trim down her name to Sen (千) in order to survive in the crooked world of monsters and ghosts. No, she remained her true self and did not pretend to be someone else - she just hid part of her inconvenient trait so that she could get along with other creatures.

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

Perhaps I should also cite a little paragraph from the Thousand Character Classic (千字文) here:

殆辱近恥，林皋幸即。

兩疏見機，解組誰逼。

索居閒處，沈默寂寥。

求古尋論，散慮逍遙。

欣奏累遣，慼謝歡招。

I shall not elaborate the meaning.

六壬

Believe it or not, the bedtime reading that I just finished was Encyclopedia of Liu Ren (六壬大全), extracted from the Imperial Collection of Four (四庫全書).

Yes, I also bought it when I was in Chengdu a few months ago.

For those who are not accustomed with the field, Liu Ren (六壬) is a form of Chinese calendrical astrology. Unlike Zi Wei Dou Shu (紫微斗数) or the Four Pillars (子平術), which are man-oriented (in other words, they are used for the prediction of someone's fate), Liu Ren is an event-oriented system, used for estimating the outcome of something. In the traditional Chinese classification of the Five Methods (五術), Liu Ren belongs to "卜", while the others are "命".

"So, now, can you predict what's going to happen ?" You may ask.

Well, a layman may have much medical knowledge but could never become a physician by simply reading medical textbooks. Similarly, I don't think I could practice this branch of Chinese astrology at this moment - and neither do I intend to do so in the future.

And, for god's sake, if you know what would happen in the future, please don't tell me.

PS. The Five Methods are 山、醫、卜、命、相. Yes, in ancient China, doctors were no better than fortune-tellers.

Retire

(My conversation with L continued.)

"Don't be upset. By the way, I note that you read that last page for several minutes. What's that?" L tried to change the topic.

"I was lost in my own thoughts," I explained, "It's the obituary of GC - Oh, no. Sorry. It's the notice of his retirement."

"I call that Freudian slip of tongue," my friend smiled.

"Don't go that far," I tried to silence him, "But, I agree, he doesn't want the story to end like this."

"Who does! The old sayings is old teachers never die, they just lose their class. Nowadays, old professors are often quite immortal and keep hanging around; when the time has come for them to give up their chair, they become directors of an institute or adjuncts of a centre or what not." L pointed out.

"That's why a simple notice of retirement is such a rare happening in our staff newsletter." I was forced to agree.

"Nevertheless it happens this time. You know, from a grammatical point of view, retire is a verb," my friend went on to explain, "It could be used in both active and passive voice."

Inflation

While I was appreciating our university's staff newsletter, my friend L caught me by surprise.

"Hey! What are you reading there?" cried he.

"Oh, nothing," I tried to be evasive, "Just some record of our staff movement."

"That could hardly be interesting," my friend nodded, "But why do you seem unable to move your eyes away from it? Ah, by the way, the newsletter is getting thicker recently."

"Indeed," I agreed, "That's because our university is really prospering and continues to recruit excellent academic staff. In fact, there are countless distinguished people becoming honorary professors and centre directors and institution presidents and what not. It feels great for a humble man like me to work in the same place with so many remarkable people !"

"Is that really what you feel ?" L was really my friend.

"Well, yes," I had to confess, "Nonetheless, at the same time, I also feel like an ordinary citizen in Seychelles, Mongolia, or Venezuela, where the inflation rates are astronomical. The currency on the market grows by an increasing number of zeros, while the amount of money in my purse remains stagnant."

Mask

Lunch with AC and others.

She asked, "How do you find that pink card on our patients' folder ?"

"You mean the one I met in the out-patient clinic ? It's plain enough another recent invention of our friends living outside the solar system." I could not help smiling.

"Yes," my friend continued, "The nurses put one on the folder of every patient who is about to be seen. It says Patient Privacy and Do Not Read Unless You Are Authorized To Do So and so forth, but all it does is slowly down the clinic. Jove, the case notes are sitting right next to me. Who else could get hold of it and read ? They told me they need to hide up the name and ID number of the cover of the case notes. But, for god's sake, I've tried it from the patient's seat; no one could see anything - it's miles away from the file !"

"That's part of the requirement of that accreditation exercise ..." someone at the table interjected.

"Very true, in fact they have not done enough. There's yet another important aspect of privacy that our extraterrestrial friends have not thought of - and I'm going to make a proposal of quality improvement." I said, with a wicked twist of my lips.

"Eh ...?" AC looked puzzled.

"Our patients' face !" I said, "Facial appearance is a personal information. Alas, you know how embarrassing it is to be seen coming to the clinic or the ward by the others - no matter someone you know or not. We should actually provide paper bags to cover up the face of all patients who are attending the clinic - so that they could not be recognized !"

Letter

Soon after back for work, a paraplegic friend of mine (whose story you could find in http://ccszeto.blogspot.com/2010/03/fire.html) showed me a letter.

It was from the blind man.

Here it goes:

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

To my dear colleague with weak legs,

I am sick of holding you on my back and being told to go here and there all the time. You know, I am not blind - just badly short-sighted. Since I am the one who move around by feet, I should take part in the decision on where to go, or whether we should go or not.

Sincerely, et cetera.

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

"What do you make out of that ?" I asked after reading that piece of paper.

"Nothing. Just that I shall soon meet the fate of that third man on the fire scene, who had good vision and no weak leg."

Training

In real life, Hassan-i Sabbah was, of course, not a master of martial art, but a scholar and brilliant teacher.

He taught his students how to kill his adversaries. (That's the origin of the English word assassin!)

And his method was remarkable. The traditional account is like this: Potential students were sent to Alamut and were brought up in a paradise (in fact, a fantastic garden with wine and beautiful girls and what not). In there, they were kept drugged, and Hassan occupied this garden as a divine emissary. As the old English idiom says, when the time is ripe, the drug was withdrawn, and they were sent out from the gardens and flung into a dungeon. There they were told that, if they wished to return to the paradise they had so recently enjoyed, it would be at Hassan's discretion, and that they must therefore follow his directions exactly, up to and including whipping off whoever they were told, and sacrificing their life if needed.

It seems a common trick of religious leaders.

PS. The story of Hassan and his group sounds great, but I'm not sure how reliable that is as compared to the fictional account by Jin Yong. Most of what we know derives from Marco Polo, who visited Alamut just after it fell to the Mongols in the thirteenth century.

And, you know what, after reincarnation, Marco Polo became Baron Munchausen.