28 Oct 2010


The last few weeks marked a series of anti-Japan demonstrations. I was happy that the Chinese captain was released, but found it difficult to share the strong views of some of my countrymen.

By definition, territorial dispute is a kind of controversy. While I have no hesitation in rising if my people are under attack, the link between fighting for an uninhabited land and patriotism is somewhat fuzzy. Claiming a piece of land because it historically belonged to a country is particularly flawed. The very reason of dispute is because all competing parties can report a period in the past when the place belonged to them.

Some people may say we have no right to express such a weak view because we never went through the war. I agree, but a recent radio interview caught my interest.

That was an eighty-year old lady who served in the local guerrilla during World War II. She has fought with brigands, shot Japanese, but mostly, provided education to local villagers. To avoid being caught and causing trouble to villagers, she never spent the night in villages but instead slept in bushes. During the interview, she let us know much about the lives of different people during the war.

In the midst of the recent rivalry with Japan, the host asked about her view. You may expect she would ask the Chinese government to declare war or at least scold the Japanese.

“Most Japanese did not want to invade us,” she answered. “During the war, people in both countries suffered a lot. The precious thing is not our victory over Japan but peace that we gradually achieved over several decades. It is important to preserve peace.”

To me, acts of hatred between the two nations are simply an insult to all our predecessors who died to create a better world.

21 Oct 2010


Our friend KM mentioned Harper Lee’s Pulitzer Prize winning novel To Kill a Mockingbird recently. (See http://drkmchow.blogspot.com/2010/10/mockingbird.html) In this month’s Reader’s Digest, an article also celebrated the book’s 50th anniversary.

The story took place in Alabama during the Great Depression. A young white girl accused a black man called Tom Robinson for raping her. The court assigned Atticus, a middle-aged lawyer, to represent Tom. During the course, Atticus was under immense pressure from his neighbors and friends. They could not understand why he would agree to represent a black man. His children were also teased by their classmates as ‘nigger-lovers’. At one occasion, other townsmen nearly assaulted Atticus and Tom before the trial.

During the trial, Atticus unequivocally demonstrated that there was no evidence the rape ever occurred. On further questioning, it was clear that the shy and friendless white girl tried to seduce Tom. However, the girl’s father entered the house right at that time. To uphold their own reputation, they decided to make false allegation against Tom.

Despite overwhelming evidence, it was a time when a white person’s testimony was sufficient to condemn the blacks. Tom was convicted, and was later killed when he tried to escape from prison.

Although the novel touches on many serious topics, Lee cleverly used Atticus’ six-year old daughter as the narrator. Viewed from the eyes of a girl, the story had a degree of livelihood and humor. It is touching to see how Atticus was worried about his children and at the same time hoped they would understand why he was doing this.

Much has been said about courage and compassion in this story. To me, Atticus was remarkable for standing up to what is right when he did not have support from his peers. Fighting against enemies without considering their point of view is one thing. Respecting others’ points and at the same time upholding one’s own faith is integrity.

14 Oct 2010


To the student’s question, my simple answer was you need to have priority.

A few years ago, a first-month resident mentioned she could not see all emergency cases at night and had some left unattended for quite a long time. Half jokingly, I told her, “In such situations, you have two choices. You may clerk full history and provide flawless management to some patients and let the rest run their natural course including death. Alternatively, you may provide ‘basic life support’ to all patients and make sure they make it to the next day, when the parent team takes over the care.”

Of course, this deviates from what a sensible person should advise. The textbook answer should be “We work as a team. You should ask your second-call (or consultant, COS, HCE, etc. depending on whether you live in Pluto or outside the Solar System) for help when the case load is high (which literally means every night).” Nevertheless, I mean it. We should not play God. We do our best, but should at the same time understand our own limitations. For one thing, our time is limited. An extra hour spent on one patient means one less for other patients. We spend more time on a patient when necessary, but judicious planning on time and resource allocation is equally important.

This month, a new group of students joined our ward round. Suddenly, AL explained that we were having busy business rounds and sent them away. As a teaching staff, I should have stopped her and encourage students to join clinical activities. However, I was too surprised and became speechless.

Perhaps that was very Freudian.

The spirit indeed is willing, but the flesh is weak.

P.S. Students, ignore the above. Of course you are welcome to join.

7 Oct 2010

Bad News

Most of my close friends know that I am responsible for a tutorial called “When the doctor becomes the patient”. When I was first assigned this topic three years ago, I was horrified. My only experience as an in-patient was when I was five years old, and I mistakenly swallowed a crayon. How can this silly story last for an hour?

After receiving the instructions from the Faculty, I realized I was much mistaken. My job was to play a video clip and lead some discussions. The video was about a consultant surgeon who stressed the importance of surgical skills and despised talks of caring attitude. One day, he attended an ENT checkup for sore throat, and was bluntly told, “Doctor, you have a growth.” He began to view doctor-patient relationship from the other side and was startled by his doctor’s cold attitude and paternal approach. At one point, his doctor offered radiotherapy for the throat cancer and did not allow discussion of alternative treatments. When he asked whether he could have surgery instead, the doctor simply replied, “You will lose your voice.”

Since I took up this tutorial, I have noticed that local students were very shy and felt uneasy about discussing care and emotions. Thus, I took the opportunity to teach both ethics and communication skills. The skill of breaking bad news was discussed and practiced. Instead of spending an hour discussing what one should do, I asked students to convey the same messages themselves in role plays. Through the exercise, they were able to learn the same things.

This year, a student approached me after the tutorial and asked, “It takes much time to explain things to patients. Will we really have time in the future?”