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.

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"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).

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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.