24 Sep 2009

Race

To many endoscopists, the colon is like a racecourse.

Some years ago, YT conducted a clinical trial testing the performance of a new colonoscopic technique. As part of the study, the intubation time (from anus to cecum) and extubation time (the way out) were recorded. Soon, endoscopists kept breaking and boasting about their new records. “I reached cecum in less than three minutes!” Of course, people only remembered their triumph and would never mention how long it took to struggle through a difficult case.

At the end of the study, we got a report card. As a whole, all of us did well. If you compare various endoscopists, I was on the slow side. It is hard to uphold self esteem in a place full of virtuosos.

Finally, some sensible people came to my consolation. In an elegant study, Barclay and colleagues demonstrated that the extubation time was proportional to polyp detection rate (NEJM 2006;355:2533-41). In other words, endoscopists who pull out the endoscope quickly are likely to miss important findings. After all, no patient would really mind if the procedure takes five more minutes. Quality is more important than speed.

Just for fun, LL looked at our data again and showed us the extubation time and polyp detection rate of each teammate. This time, I could say that my polyp detection rate was not bad. YT was even slower than me but found more polyps. WK was an outlier. He was fast but also found many polyps. The One whom I dare not name was the fastest. I also dare not report his polyp detection rate.

My memories were brought up by funny stories I heard from endoscopy nurses recently. In a community screening project, we need to record intubation and extubation time again. You Know Who just broke the new record of withdrawing the endoscope in ninety seconds. On another occasion, JL did a rather difficult procedure. After reaching the cecum finally, a nurse said “11 minutes 40 seconds” loudly for recording purpose. The Professor of Surgery did not realize that was a study case and thought the nurse was teasing him. According to the nurse, “he stared at me angrily”.

17 Sep 2009

Typing

On more than one occasion, my patients were impressed by my typing speed.

I have never had any formal typing lesson. My training was from my first computer. I could not recall the model, which was earlier than 80286. Anyway, these early models did not support complicated games. One of my favorite was a typing game. Words fell from the top. If you typed the words correctly, they disappeared. If you were slow and the words touched the bottom of the screen, you lost. With time, I became really good. My mother had to force me to turn off the computer because the game could not kill me even when the words were dropping like thunderstorm.

Recently, my Boss was surprised when I mentioned that my daughter attended piano group lessons. Why did I not teach her myself? Of course I tried. None of the songs I knew attracted her. So we see if others can do a better job.

While Angelina behaved at the lessons, asking her to practise at home remained difficult. One day, I played the DVD provided by the music school. It featured cartoon characters playing music. In one episode, a man hit the low and high keys and showed what they sounded like. Angelina immediately got interested and asked to try on our piano. That marked the beginning of her “do-re-mi” journey.

10 Sep 2009

Housework

My substitution during my domestic helper’s holidays inevitably invited the following comments from my wife. “You did nothing other than playing with Angelina.” I shamelessly referred her to Luke 10:38.

One day, Jesus visited the home of Martha and Mary. Mary listened intently to Jesus, while Martha was busy preparing dinner for the distinguished guest. At last, Martha was fed up. “Bad girl,” she said, “aren’t you going to help me?”

“You are worried about earthly things,” the Lord answered. “Mary just chose what is important, and it will not be taken from her.”

3 Sep 2009

Holidays

My domestic helper had holidays in the Philippines last month. My wife and I took turn to look after our daughter at home.

Not satisfied with watching Mickey Mouse Clubhouse for the whole day, I took Angelina to the country park, had a boat ride, and visited the Museum of History. She was thrilled.

After listening to our report, my wife commented, “You basically did everything I refused to do with you in the past.” Quite true.

One night, Angelina watched the music fountain at the CityOne Plaza with me. “It is like fireworks made of water,” she whispered.