Picasso

It was Vivian’s birthday. I took a half-day off, and the two of us paid a short visit to the Heritage Museum for the Picasso exhibition.

The place was surprisingly crowded in a weekday afternoon - full of schoolchildren going there for a session of general education. I must say I am not particularly fond of the Spanish giant of modern painting. Nonetheless, it was an impressive experience to see many of his famous paintings and craftworks flesh and blood, in their actual size.

My personal favorite is Minotaur with a Javelin and Woman Hostage - a simple monochrome sketch of four characters. Alas, if it were painted last year, I would believe the Minotaur monster represents the Americans and the room Iraq or Afghanistan.

Somehow it reminds me of his Guernica.

沐浴

Although it might have been somewhat impulsive to plan the assassination of the Qin Emperor, we should not be too critical with Zhang Liang (張良).

For those who have little idea about Chinese philosophy or astrology, the life cycle of everything – from each individual living organism to an organization as a whole – consists of twelve stages, which form a circle of reincarnation. The first few stages are: growth (長生), bath (沐浴), mature (冠帶), honor (臨官), and climax (帝旺).

And, what is bath (沐浴)? It is a stage between growth and becoming mature – a period full of uncertainty and rebellion.  For bath is not bath; in ancient Chinese, it means the steam and vapor that just come out of the water and has not yet become the cloud. It has the potential of rising to a high level, but it is also fragile and unstable. A little hiccough may bring it back to where it originates from.

A necessary stage before one could go far.

PS. The subsequent stages are decline (衰), sickness (病), death (死), tomb (墓), extinction (絕), embryo (胎), and culture (養). Ironically, the extinction of a matter is, by definition, the growth of its mother (or, actually, the predecessor). This is the original meaning of seeing life at extinction (絕處逢生).

留侯論

Just to share with you a classic essay of Su Shi (蘇軾):

古之所謂豪傑之士者，必有過人之節。人情有所不能忍者，匹夫見辱，拔劍而起，挺身而鬥，此不足為勇也。天下有大勇者，卒然臨之而不驚，無故加之而不怒。此其所挾持者甚大，而其志甚遠也。

夫子房受書於圯上之老人也，其事甚怪；然亦安知其非秦之世，有隱君子者，出而試之。觀其所以微見其意者，皆聖賢相與警戒之義；而世不察，以為鬼物，亦已過矣。且其意不在書。

當韓之亡，秦之方盛也，以刀鋸鼎鑊待天下之士。其平居無罪夷滅者，不可勝數。雖有賁育，無所復施。夫持法太急者，其鋒不可犯；而其勢未可乘。子房不忍忿忿之心，以匹夫之力，而逞於一擊之間；當此之時，子房之不死者，其間不能容髮，蓋亦已危矣。千金之子，不死於盜賊。何者？其身之可愛，而盜賊之不足以死也。子房以蓋世之材，不為伊尹、太公之謀，而特出於荊軻、聶政之計，以僥倖於不死，此圯上老人之所為深惜者也。是故倨傲鮮腆而深折之。彼其能有所忍也，然後可以就大事，故曰「孺子可教」也。

PS. Although written in traditional Chinese, I suppose this little essay is simple enough to be understood. A translation to modern Chinese could be found at http://xs3.tcsh.tcc.edu.tw/~fish/chinese/tang_song/su%20shi_liu%20hou%20lun.htm

But, on the other hand, if you think you know what I’m saying, you’ve definitely misunderstood me.

Order

Shortly after the final MB examination, I had another chance to visit Euterpe's kindergarten and do some voluntary work.

It was a rainy day and I arrived slightly early. The school had not yet started. A few dozens of kindergarten girls and their parents were gathering outside the entrance and waiting. I naturally stood aside and pretended to be a piece of wallpaper.

It took probably no more than 10 minutes before we could get in, but we seemed to be waiting forever. The sky was as gloomy as it was apocalypse. There was a small eaves outside the school and, to my amazement, most of the girls were gathering without much noise. A few late comers were grouping themselves in four or five  and shared their umbrellas. When there were more and more people and some began to grumble, a few obviously more senior girls decided to keep the order of the crowd and led the others to sing hymns.

Somehow, a scene in Casablanca, in which Victor Laszlo led the people in Rick's Cafe to sing La Marseillaise, flashed through my mind.

PS. It is not book knowledge. I have no doubt these girls have the best-of-ever form of education.

Advice

(My discussion with VW continued.)

"Szeto, if we have to invest for ourselves, do you have any specific advice?" VW was, as always, humble.

"Alas, I suppose you can get much better advice from Warren?" I smiled.

"I'm afraid it is not always easy to follow Warren's footsteps. Many a time I find his approach rather aggressive..." the professor of hepatology murmured.

"That really depends on your point of view. Although leverage is sometimes used, by and large Warren doesn't trade that much; he just buys at a low price and holds. If you follow the definition of Benjamin Graham, Warren is a true investor - and a daring one, too!"

"How about you?"

"I trade - not very often, but I do buy at one time and sell at another. No item is permanent in my portfolio and everything could be given away when the price is good. By Graham's classification, I am unfortunately a speculator - maybe a conservative one, but a speculator all the same."

Fund

Other than the system of examination, VW and I did have some spare time to discuss other casual issues.

For example, investment.

Don’t be surprised. Even genuine academics like VW need savings and investment in order to prepare for the future. Although our professor of hepatology always claims that he is an idiot of finance and stock market, what he does proves that he is the most intelligent amateur.

“I just put my money on index fund.” He said with some hesitation, “Em… I know you are against putting money on mutual funds.”

“Yes and no,” I smiled, “I am against most forms of mutual fund because the management fee is often high, but not many fund managers do consistently perform better than the reference index. In fact, even if we could find a highly capable fund manager, I’m not sure what we should expect from him. It is not a good idea for him to be hard working and keep managing the fund – if the portfolio is a good one to start with, you don’t need to change it very often; every transaction has a cost. But, if he just sits back and spends an hour on the portfolio every month, why couldn’t I take up the task myself?”

VW nodded, and I went on, “But index fund is a different story. The management fee is much lower, and frequent transaction does not exist. I mean, if one has no time to take care of his own money, index fund is probably the best choice. But, I must say I still believe it is better to invest ourselves. After all, if we care to spend time choosing books for our shelf and dresses for our closet, why shouldn’t we spare a trace of effort and decide where to put our money to prepare for our retirement?”

0.36

The very implication of the fact that we do not live in a one (or two) dimension world may skip your eyes.

To put it simply, if each of us have different preferences on various aspects of a topic, a person with a balanced opinion of all individuals on all aspects of the problem (that is, the center of gravity of the system) does not always have at least 50% of the vote when running against someone with an obviously biased opinion. In fact, that person with a balanced mind could only guarantee himself to be supported by at least approximately 36% of the people. (The exact percentage is actually 1/e, where e equals 2.71828.)

In other words, a simple majority is usually biased; a well-balanced opinion is very often objected in various aspects by the majority of people.

Or, as Bill Cosby said: I don't know the key to success, but the key to failure is o try to please everyone.

PS. In the above elaboration, I have done away with all difficult mathematical models and the hypothetical construction of a multi-dimension universe. Interested visitors should refer to Andrew Caplin and Barry Nalebuff’s On 64%-majority rule and Aggregation and social choice: a mean voter theorem, both published in Econometrica.

Side

When I come to think of it, my mistake is all too common and has a much more profound implication than that related to the examination of medical students.

For example, the fact that we are against Party C does not mean we support Party D. Similarly, we do not prefer Part D does not imply we are ally of the mad dog (or Party C!) Contrary to what a so-called great country leader used to say, the enemy of our enemy is not necessarily our friend – they may simply be another type of adversary of us from another angle.

For similar arguments, Hitler and Stalin are two extremes of idea, but one may not always have to find a place in between the two – Winston Churchill was obviously having a very different stand on the other side of the British Channel. Political opinion could be right or left-winged, but it does not necessarily mean that either of them – or the middle of the two – represents the benefit of the general public. As we learn from the French revolution, which was the origin of the terms right and left-winged, both sides had their own agenda on the two sides of King Louis and were both far away from the French people.

Binary

If you think the scenario I put up yesterday simple, consider this one:

There are yet two common suggestions on how we should improve the current system of clinical examination.

1. It should resemble real life clinical practice.
2. It should resemble the membership examination of our College.

Until very recently, my opinion is the above two suggestions are mutually exclusive, because they are, once again, an unfortunate irony. My argument is simple: The membership examination of our College is highly artificial and has very little to do with real life clinical practice.

Alas, my argument was correct (even the College agrees on the problem) - but, my logic of deduction was wrong.

Where's the problem?

The loophole of my logic is: We do not live in a one-dimension world. Although the two suggestions are far away from, and contradictory to, each other, it is possible to improve the system of clinical examination and make it both more close to real life practice as well as more akin to membership examination - as long as the current system is far away from both.

Consistent

As you may expect, during the final examination, we naturally discussed how to modify or improve the format of the examination - at least to cater for the increasing number of medical students.

I shall not elaborate on what was discussed, or what our conclusion was. Nonetheless, the conversations with several persons turned out to be a good lesson on logic, which I may well share with you here.

Let's begin with some simple stuff. There are two common suggestions for our system of clinical examination:

1. The assessment should resemble real life clinical practice.
2. The assessment should avoid variation and be consistent for all students.

My response to the two suggestions is they are an unfortunate irony: Clinical practice is full of uncertainty and nothing could be consistent. An examination that mimics real life practice is always variable, and a consistent method of assessment is by definition artificial.

Simple, eh?

Let me show you the difficult bit tomorrow.

Help

Shortly after I told some stories in Euterpe's kindergarten, we held the final examination for our own students.

I shall not elaborate on the details. The running was as a rule seamless under the meticulous effort of VW, TL and BK. As what VW did (see http://vwswong.blogspot.com/2012/05/examination.html), maybe I should just share with you a few humerus moments:

***********************
(After feeling the pulse and listening to the heart of a patient.)
Examiner: What have you found?
Student: The pulse rate is slow; it is 40 per minute.
Examiner: Are you sure?
Student: Em... no. The pulse rate is 60 per minute.

***********************
(After reading an ECG.)
Examiner: Can you comment on the ECG?
Student: The heart rate is between 60 to 100.

***********************
(During the discussion of a scenario of recurrent bleeding from a peptic ulcer.)
Examiner: What else could you do if the bleeding could not be stopped?
Student: Er....
Examiner: Would you consider calling the surgeon?
Student: I don't think surgeons could help...
Examiner: Do you know who is in-charge of the endoscopy service in our hospital?

(For those who are not working in my hospital, the person in-charge is one of our professors of surgery.)

Allocation

Contrary to my initial suspicion, I shouldn’t worry too much about the workload of the kids. Each task that I mentioned should take no more than 10 minutes – if the child is paying attention on it.

There is no pre-determined sequence of finishing the task, which depends on the preference of each child, as well as the availability of space. For example, there are only eight chairs for the table of arithmatic. If it is full, you’ve got to do something else first.

And, to add to the complexity, there’s one catch: There is an uncle in the classroom who tells story. If a kid finishes everything before the end of that hour, they could spend the rest of the time listening stories (or playing as they like). However, a child could also choose to listen to the story first and then continue with their own work – it’s not a problem as long as they could finish everything on time.

We should really add it to train our medical students.

PS. Of course, as you may guess that much: I was the one to tell stories.

Even Euterpe’s kindergarten knows that I am familiar with playing the devil!

Inspection

Went to the class inspection session of Euterpe’s kindergarten.

(You may not remember when I mean. Please refer to the background of this event that I mentioned in http://ccszeto.blogspot.com/2012/04/preparation.html.)

It was an absolutely eye-opening experience.

No, my princess was just her usual self. In fact, there wasn’t really that much to be observed – but I was thoroughly impressed with what the kindergarten was trying to teach.

Let me tell you in a bit more detail.

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

To begin with, we parents did not just stand there and observe. For each class, there were two parents everyday, and we were each assigned with a specific task in the class.

In that very morning, we were introduced to the class before our session began and being explained what to do: It was supposed to last about an hour. All students of the class (there were 30 of them) had to do four different tasks: writing a tiny page of words, doing a page of simple arithmetic, decorating their own Mother’s Day card (which they made in a previous session), and another cut-and-stick art work (which my partner – the mother of another girl – was assigned to help out).

You may ask: How could those five-year-old kids possibly finish all these in an hour?

Bystander

(Cont'd)

On one occasion, after the mother and the son left, an elective student sitting in my room raised his hand, "May I ask why's she attending the specialist clinic? Her problem is rather simple and could be taken care of by her own family doctor."

“Quite right… but our primary care system may not be very satisfactory…” I smiled and tried to be evasive.

“And, even if that’s the case, why is it necessary for you to see her in the clinic?” The student insisted on his question.

I sighed, “My goodness. I have no interest in this woman what-so-ever. All I wish to see regularly is her son – he has all the features of pituitary insufficiency but refuses to see any doctor. His mother is quite aware of the problem but cannot persuade her son either. All I could do is to see him every now and then and make sure he remains in a reasonable shape – otherwise I would have to find some addition excuse to give him treatment!”

PS. The story I outlined is not common. The more frequent happening is we encounter family members who are obviously psychotic or, even worse, having a personality disorder. There used to be a few incidents that I was about to say, “I shall treat the patient, but, may I refer you to the psychiatrist? Or, is it more appropriate for you to see the psychiatric-hospice – if this specialty really exists?”

Schuld

My recent bedtime reading is Schuld of Ferdinand von Schirach.

The book is a tiny collection of impressive cases of a German lawyer. Most of the stories are very short; the description are sometimes fragmented but always precise - giving me an impression of reading clinical notes written by a sophisticated practitioner.

The last story of this book is, in my opinion, the funniest, and, is indirectly related to medicine. It reminds me of a patient I frequently saw in my general clinic some years ago:

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

(In one of the typical clinic follow up session.)

The patient, an 80-year-old woman, came in with her son - an obviously well-to-do retired man with an obsessively-shaved face.

She sat down humbly in the chair next to me. Her son stood behind her.

"Good morning. How's everything going?" I asked.

In fact I knew the answer. She had diabetes - simple, straightforward, no complication, well controlled with a single tablet each day.

She did not reply - she did not have to. Her son showed me the recent home monitoring, record of symptoms, and other issues that he decided to bring up. The three of us reviewed the result of her recent blood tests. I asked if he had any difficulty taking care of his mother - so much so he might feel stress or other symptoms, or simply be too busy to take care of his beard.

He shook his head and left with his mother and the prescription.

I put down in her appointment sheet that she should have to see me next time.

(To be continued.)

Cash

Although there are good theoretical reasons for a company to keep the earnings for further expansion and pay no dividend, I must say I agree with JW; a growth stock that gives no regular cash to its shareholders is never my cup of tea.

No, that's not because I love the sense of "feeling good" when receiving a tiny sum of money. (For retired persons, however, that consideration may have real importance.) In fact, I have the occasional silly habit of putting the dividend back on the same stock.

My consideration is actually simple: paying a dividend regularly is a good test on the cash flow and healthy running of a company. For visitors with some experience in the stock market, it is easy to appreciate that the reported profit of a company means very little: A company could earn $1 billion by running its business well, but it is equally, if not more, possible, that that $1 billion of profit comes from re-evaluation of the market price of its factory or any other asset. In fact, some companies of a certain strong nation have the habit of reporting that amount of profit without actually receiving it - and the date of payment due may be put down as thirty-first of February.

Of course, there are always hints if you go through the financial report of those problematic companies. But, if you are a busy small investor, a regular and sustained payout is an excellent surrogate test on how robust a business is and, unfortunately, how reliable the financial report is.

Dividend

In my recent outline on JW's investment advice (see http://ccszeto.blogspot.com/2012/04/avoid.html), my friend VW commented that companies that do not pay a dividend may not be excluded. In fact, from the original idea of Benjamin Graham, companies that pay less dividend and use the money for development should be preferred.

I must say that's entirely correct - at least for profitable and efficient business.

For those with some background knowledge in finance and company valuation, let's consider a simple example: If a stock is trading at a price-to-earning (PE) ratio of 10, and the return of equity (ROE) is 20% (implying a price-to-book, or PB, ratio of 2), giving away all profit as dividend means that you get $10 yearly for every $100 of investment. If you put that money back to the stock, the portfolio would be growing at 10% per year, and you own $110 of that stock next year.

However, if the company pays no dividend and keeps the money for expansion of its business, for every $100 of the original investment, the profit next year would be $12 ($60, the new book value, times 20% of ROE). If the PE ratio of this stock stays at 10, the price of the stock would rise to $120 next year.

PS. The method I outlined is a simplified version of the discount cash flow, one of the most commonly used method for company valuation.

Simplified

After my recent discussion on re-creation (二次創作), some of you may think I was extrapolating too far.

Quite true. In fact, there is a strict and confined definition of derivative work. For example, the United States copyright law states that a derivative work is an expressive creation that includes major, copyright-protected elements of an original, previously created first work (the underlying work).

In other words, re-creation, including copying or adapting others' work in a creative mode. It is not plagiarism. In contrast, a derivative work is a project or creation that obviously uses an existing, widely recognized, work for deliberate modification.

***************************
In that case, re-creation should not be banned.

Yes, even re-creation with a malicious intent should not be banned.

It is because, in the history of human beings, the most influential derivative work with, according to Humphrey Appleby, not always an entirely favorable consequence is, I'm afraid, the simplified Chinese.

Choice

Alas, we are coming to the heart of the problem: There are two parameters that a curriculum planner could modify:

1. For each teacher, to cover their own specialty or to go for simple general medicine.
2. For time allocation, to have a few rotations, each for a considerable duration, or to have many touch-and-go encounters.

In other words, we can create a two-times-two matrix for the four possible scenarios:

1. Teach our own specialty and have long rotations - not desirable, as the curriculum would be incomplete and biased.
2. Teach our own specialty and have many short rotations.
3. Teach general medicine and have long rotations.
4. Teach general medicine and have many short rotations - a silly arrangement, of course.

You see? Only options #2 and #3 are sensible - why shouldn't we choose the latter?

Well, I'm not going to discuss should or should not. Unfortunately, the game theory actually predicts that focusing on our own specialty is a dominant strategy in teaching; once some of the academic staff do so, the others would quickly follow, and the few who do not would easily be eliminated by the system (unless, of course, one has won the exemplary teacher award).

I shall leave the logic of deducing such a happening to your imagination.

Collection

You may argue: If every professor teach their own specialty, who is going to cover general medicine?

No one – and, in fact, no need.

The situation is similar to the concept of society or public interest in economy: Although it sounds noble for every individual to pursue the interest of the entire society rather than being selfish, it is not only not practical, but, indeed, as pointed out by Adam Smith, not necessary. Everyone of us could and should focus on our own interest (as long as we are following the rule of the game, that is, the law of our society). The market would work out the rest and the general public would see the benefit. After all, each and everyone of us is part of the society.

By the same argument, every professor should put most of their effort on teaching their own specialty – who else is in a better position to teach that subject? When every professor covers their own territory, when there is a healthy composition of academic staff in a department, and when students have a balanced exposure to each teacher, the result would be an excellent curriculum of general medicine.


Of course, the last pre-requisite that I mentioned above implies each teacher would have to see every student – but only briefly – and it is impossible for them to build up a good mentor type of relationship.

Specialties

You may ask: Should we ask our professors to teach simple general medicine outside their own specialty, or to focus their tutorials on the cutting edge research of their very own super-sub-specialty of interest?

The latter scenario is, of course, not desirable.

But, neither is the former.

And, to go one step further, if we have to choose one side to err on, we should choose the latter.

Why? Because general medicine is, unfortunately, and contrary to the concept of most people, not a subject in its own; it is collection of specialties. (For this reason, neither Harrison’s nor other major textbooks of internal medicine has a section of “general medicine”; each specialty occupies a section of the book.) For example, there are heart or brain or gut problems that are common enough for all physicians to know something about – and these areas are therefore considered to be covered by general medicine. Nonetheless, these topics remain under the territory of one specialty or another, and, these diseases are, at least in theory, better cared and taught by the corresponding specialist.

General

During a recent meeting, KL - our star teacher - made a remarkable comment, "Many of our students reflect that they are taught too much on medical specialties or sub-specialties, but not on general medicine. In fact, many of them know more about cardiology than I do, but, when they are asked about handling some medical emergencies, their response could be horrifying."

"How could that be?" Some of us asked - I suspect many of you many have the same question.

"This is because many of our colleagues are too keen to teach their own specialty and pay little attention on general medicine," our professor of gastroenterology explained, "Of course part of the problem is from our system: Students attend tutorials and seminars, but not morning rounds, out-patient clinics, or emergency takes. Unfortunately, our hospital is too sub-specialized and overcrowded with students. It would be better to send out more of our students to peripheral hospitals so that they could get a better exposure to general medicine!"

I nodded. On the face of it, the blame is entirely legitimate, and, as academic staff, we should try and focus on general medicine in our teaching.

But, when I come to think of it again, I'm not that sure.

Let me explain tomorrow.

幣

(Cont'd)

“Literally you are correct, but, like every economic decision and human activity, the consequence is usually unexpected and often going to the opposite direction,” the seasoned soldier said grimly, “To begin with, if every soldier would surely become a colonel in five years, no one would have the incentive to outshine the others. In fact, the optimal strategy for their military career is to do the bare minimum and wait for the days to pass. After all, no soldier would be dismissed from the army because they do nothing – and, in contrast, they do have a small risk of being fired if they try to have some achievement, and when what they do gets seriously wrong.”

The Cabinet Secretary was speechless; he merely made a grunt.

The General went on, “The next consequence is, none of our soldiers would have the interest of joining the military school. Why should one take up a more difficult post – and a lower pay – when they could become a colonel via a painless way?”

“But, I’m sure in our army, we still have a lot of young soldiers who are energetic and have a good quality!” The Secretary protested.

“That may be true, but they won’t stay long.”

“Why?”

“If our system does not differentiate crème de la crème and scum, the capable ones would leave the system because they are able to find a job elsewhere with a better prospect, while the less competent people would stay – because they have nowhere to go. The end result is, as you should appreciate by your university degree on economics, a classical example of the Gresham's Law: bad money drives out good ones (劣幣驅逐良幣)!”

Colonel

(Meeting between the army general and the cabinet secretary.)

“Our military system is collapsing. Within a few years our army would not be able to defend our country,” the seasoned soldier said.

“I know,” the senior civil servant did not seem surprised, “We do not have enough soldiers and our friends from the Council do not give a green light for employing recruits from overseas. But, don’t worry. Our military school will have a lot more graduates a few years later.”

“No, that’s not what I mean. To say the least, that’s only part of the problem. My real worry is, although we may have many military graduate in the future, our frontline soldiers will have no intention to fight because they do not have to – as long as they would automatically be promoted to colonel in five years.” The General was certainly agitated.

“Why!?” The cabinet secretary did appear surprised this time. After all, he was one of the officials who designed this system. “I suppose a better prospect of promotion would help to keep people from leaving the army?”

(To be continued.)

Anatomy

Since we are talking about practical anatomy, let's focus on cranial nerves and have some more:

• Olfactory nerve comes before the optic - when something is going to happen (that is, when a danger is approaching!) in a primitive world, you should try to smell something before you could actually see any evidence.
• The oculomotor, trochlear and abducens nerves are in that order because you should first open your eyes, then try to make sure where you are standing before looking around and consider what the others are doing.
• Vestibular nerve is, of course, way below the optic - you must depend on what you see rather than what you hear. (Remark for medical students: Therefore, read your textbook rather than listen to what the professor says.)
• Glossopharyngeal nerve is above the hypoglossal - most of the time it is more important to make some noise rather than to express yourself clearly.
• Accessory nerve is also above the hypoglossal - if things go wrong, it is more important to shake your head and shrug your shoulder rather than to give an explanation.

Miscellany

Shortly after I finished with Shinzanmono, I read The Yes Minister Miscellany by Antony Jay and Jonathan Lynn.

It is a gift from my friend KM. In reality, this tiny volume could hardly be regarded as a book, but, rather, represents a handy collection of humorous sayings and conversations from Yes Minister and Yes Prime Minister.

I must confess I am a fan of this series – or, specifically, Humphrey Appleby. If there’s anyone who wants to learn real English, the fictitious Cabinet Secretary was never tired of showing you brilliant demonstrations.

Of course, we may not need a very sophisticated language. For example:

Jim Hacker: But we can’t stab our partners in the back and spit in their face.
Bernard Woolley: You can’t stab anyone in the back while you spit in their face.

The principal private secretary should really come and teach our students anatomy if not practical politics.

Shinzanmono

My recent bedtime reading was Shinzanmono (新參者) of Keigo Higashino (東野圭吾).

AL gave me this book some months ago but I had very little to read it – Higashino is never my favorite author, and the cover appears somewhat hardcore and mechanical.

But, thank goodness, I am happily wrong again. The sordid murder of Mitsui Mineko (三井峰子) turns out to be the best detective fiction I ever read in the past four or five years – and, remind you, I had Byakuyakō (白夜行) and The Confession (告白) during this period. When most of us believe that classical detective stories had died with Agatha Christie and Ellery Queen, Higashino proved beyond doubt that he could do the same – maybe with a little thoughtful trick as well.

*********************
To me, the most memorable scene of the story, however, has nothing to do with logic and deduction. It was the mini-lecture that Kaga Kyoichiro (加賀恭一郎) gave to one of his witnesses:

“The duty of a detective does not only involve solving the case. If there are other people affected psychologically, they could also be considered victims. Exploring all possible means to help victims of this kind is yet another duty of the detective.”

Much substance for a physician to reflect, I’m afraid.

Derivatives

I raised my hands and protested, "My friend, you are going too far."

"You may be right, but, unfortunately, my idea is not very much far-fetched," L put up a bitter smile, "Banning derivative work simply means prohibiting artistic creation of all kinds, for there is actually no music or painting or literature entirely created de novo - and, as an ordinary citizen with an average intelligence, my worry is obviously when and for what reason the government officials would execute the law."

"I know what you mean. It is common sense that a law should be enacted if, and only if, it could be easily executed without bias - and the proposal at hand is certainly not a good example. But, banning derivative work does seem to protect copyright.” I said.

“Yes, but the price is astronomical. As Sherlock Holmes said, there’s nothing new under the sun. Everything we write and all pictures we draw could be considered as modifications of existing work or idea. For example, all Chinese novel and monographs are arguably derivative works of Cangjie (倉頡)!”

“My friend, no one will prosecute us for that, I suppose.” I chuckled.

“No, unless you write something undesirable.” My friend did not smile back.

Second

(The discussion between L and I went on.)

I paused for a moment and said, "My friend, if you were talking about hospital discharge summary, your analogy of Scarlet Heart and Palace doesn't quite fit."

To my surprise, L laughed and shook his head, "You are absolutely right. I was actually thinking of something else. The topic of hospital record documentation came up because it was deep in your head."

I must say I was annoyed by this insightful psychoanalysis of my mind, "Well, then, what's in your mind?"

"Alas, I was pondering about the rights of derivative works (二次創作)," my friend sighed.

"You mean, one of them is copying from the other?" I was curious.

"No, I mean both are copying from a common source - for example, Zhao Erxun (趙爾巽)!" said L.

PS. For those who are not familiar with Chinese history, Zhao is the chief editor of The Draft History of Qing (清史稿).

Audit

After a brief moment of silence, my friend went on, “You know, there’s a deeper water in this matter.”

“What’s that?”

“Let’s take the record of our great historian as an example,” L became serious, “To understand what happened at Changping, it is perfectly acceptable for an ordinary college student to read Sima Qian – and nothing else.”

“I see what you mean. It’s a matter of how deep one should dwell on the problem.” I continued for my friend, “Although reasonable for a college student, we would expect a PhD thesis to cover all first hand material of the Battle rather than simply citing the description from the great historian’s Record. Similarly, it is generally OK to go through the discharge summary alone when we see a simple case in the clinic. However, the consideration is different when we talk about doing a death audit.”

“Your conclusion is correct – but not the analogy,” my friend smiled, “We are not PhD students writing thesis on the Battle of Changping. We are the King of Zhao and wish to find out why our soldiers died – and so many of them, too – and why Zhao Kuo (趙括) failed!”

Summary

(Our discussion continued - after I knew eventually what my friend was talking about.)

"My friend, the discharge summary of our patient is different - there is a specific format to follow and certain things that must be put down." I protested.

"Are there?" L smiled, "In that case, since you are so fond of The Battle of Changping (長平之戰), whose account do you think is better? Sima Qian (司馬遷) or Sima Guang (司馬光)? Similarly, as to the life and time of Jesus, is it Matthew or John?"

I knew my friend meant Record of the Grand Historian (史記) and A Comprehensive Mirror to Aid in Government (資治通鑑), as well as the Holy Bible.

Seeing that I had expressive dysphasia, my friend went on, "You see? To say the least, there is no single ideal format to follow, and, depending on your purpose, the same happenings could be summarized in two disparate ways - with a variety of length."

"I suppose that's the reason why we avoid testing how to write a discharge summary in the final examination!?" I was forced to agree.