Puzzles

In one chapter, Gladwell described how the US security expert Gregory Treverton distinguished between puzzles and mysteries. Puzzles are there when we lack some essential information to a factual answer. If we obtain that information, we get the answer. For example, Osama bin Laden’s whereabouts are a puzzle. If you hunt down high ranking people in Al Qaeda who knows his hiding place, you find the answer.

In contrast, mysteries require judgments and the assessments of uncertainty. For example, what would happen to Iraq after overthrowing Saddam Hussein was a mystery. You cannot get the answer even if his officials and sons honestly reply to your every question. The major difference between puzzles and mysteries is that in the latter condition, you are not having insufficient information. You just cannot make use of the information at hand.

Of course, not every one would agree to the definitions. However, when you are trying to solve a problem, it is useful to think why you have not got the answer yet and how the answer can be obtained. Without the insight, wrong moves will get you nowhere.

Many medical students spend countless hours reading textbooks and lecture notes without realizing that their future job demands mostly the ability to solve mysteries. If I ask you the tests for diagnosing pulmonary embolism, it is a simple puzzle one can solve by reading a textbook. The trouble is patients never ask you what the diagnostic tests are. They just tell you a symptom and show abnormalities here and there. If you cannot make the diagnosis, it is unlikely because you have not heard of pulmonary embolism before. Instead, you are probably overwhelmed by the information you cannot fully interpret and organize. Simply said, the answer is not in a textbook.

Interesting

My recent bedtime reading is What the Dog Saw and Other Adventures by Malcolm Gladwell. This is a collection of his writing from The New Yorker. I seldom read this kind of recycled publications, but the temptation is too great after enjoying his famous books previously – The Tipping Point, Blink and Outliers.

While flipping through the pages and wondering whether to buy the book, a few lines in the preface touched me. Gladwell mentioned he was often asked where his ideas came from. If you have read his books, you would probably agree that he is a wizard in suggesting interesting answers to explain everyday phenomena. So how did he do it? He explained that most people considered most things uninteresting. What he did was to convince himself everyone has a story to tell.

This is no different from scientific research. At the end of the nineteenth century, scientists have studied thoroughly many areas of the physical world – electricity, optics, kinetics, to name a few. Many wise men held the belief that there was not much left to study in science. Looking back, we of course know how wrong they were. Relativity, quarks and DNA are just some examples of major breakthroughs that they have never imagined.

In clinical medicine, I have repeatedly heard youngsters complaining the ‘big’ questions have all been answered. Their view is certainly shared by many people in history, but so far all of them were proved to be wrong. If you are not satisfied with current beliefs and keep asking questions, well, the world is an interesting place after all.

Coordination

Last week, Angelina had a performance at the Hong Kong Book Fair. After she had told a story, a group of six-year-olds performed a play - Jack and the Beanstalk. The children were cute and spoke excellent English. Unfortunately, one of them forgot a line and the performance became chaotic. Some classmates tried to be helpful and reminded each other what they should say. After a while, they realized none of them really knew where they were and could not go on. They made a bold decision, said ‘thank you very much’ together suddenly, and ended the show.

Once, I was a member of the hand bell team of my primary school. Hand bells sound nice, but each person is only responsible for two bells. Excellent players may be able to control four to five bells if they can change quickly. Thus, each member is like a single finger of a pianist. No matter how musical you are, you have little control over the whole song and rely heavily on your teammates. This is good training of team work.

I remember little about what we really did and the songs we practiced. Nevertheless, we once performed the bridal march at the wedding ceremony of our teacher. A wrong note appeared in the fifth bar. A couple of bars later, everyone played on their own and lost the melody. To her credit, the conductor tried her best to stop the disaster. Instead of keeping the beat with her baton, she repeatedly pointed at each of us like crazy, as if we were giant keys on the piano. We tried to cooperate, but we were so small! How could we know whether we were supposed to strike the bell in our right or left hand? In the end, she closed her fists tightly to end the song. All of us struck both bells together. The ultimate crash chord.

Our conductor was very angry and did not speak to us. On the other hand, the bride was kind enough to offer us cake. We were ashamed and sorry. Now that I have become an adult, I believe the audience really did not mind. At least we were funny.

清

I listened to a radio interview of a famous investigator in Hong Kong recently. It was enlightening.

The details of the project have been described by my friend earlier. [see http://ccszeto.blogspot.com/2010/03/study.html] In brief, the investigator obtained one of the biggest research grants from our Government to study the prevalence of a disease among youngsters that was believed to be both common and important. After screening hundreds of subjects, the investigator failed to find any positive case.

Like many epidemiological studies, this study claimed to select potential subjects randomly. However, the selected subjects had the right to choose whether to proceed to the test. In such a situation, it is of vital importance to compare subjects who agreed to be tested and those who refused. If the two groups had major differences, the data obtained would be inaccurate or even misleading.

If I received a big grant from the Government and got such results, I probably would not be able to sleep. However, that investigator was obviously better than me. “The project is a huge success,” he explained to the host. “If the collaborating parties agree, we would definitely extend the project for another year.”

Somehow my mind drifted to a short story.

One day, Emperor Kangxi (康熙) disguised himself as a commoner and walked around Beijing. He met a crowd and found that a murderer was about to be executed. To his surprise, the poor prisoner looked very young and certainly did not match the description of the middle-age murderer. He put the execution to a halt and confirmed that the rich murderer paid a government official to exchange a young boy for him. Furious, he ordered a thorough investigation of the event and other death sentences in the past.

The Prince who took charge of the investigation was the most likely successor of the Emperor. After discussing with his advisors, he concluded that the investigation would reveal uncountable cases of corruption and mishaps. This would create much trouble among senior officials and he might lose their support. Therefore, he just pretended to do something and held a series of investigations and interrogations.

A few months later, the Prince submitted the final report to the Emperor. “In conclusion,” he described, “no other cases of inappropriate judgments or executions were identified. The judges and officials have done an excellent job and should be commended.”

At this, Emperor Kangxi hit the table and scolded, “What a coincidence! There was just one case of corruption in the whole of China and it happened to be seen by the Emperor!”

Well, our Government is not Kangxi after all. Perhaps the disease really does not exist in Hong Kong.

World Cup

Another year of exciting World Cup games.

To be honest, I am interested in the games but seldom enthusiastic enough to stay up to watch in the middle of the night. The only exception is four years ago, when I worked in a lab in Beijing. When you stay with a group of postgraduate students most of the time, you have to pretend to be a youngster. Nevertheless, that was an interesting experience. I just cannot figure out how the Chinese football team can be so lousy when the whole nation is crazy about the game.

Since the time of Jürgen Klinsmann, I have been a supporter of the German team. Although the team does not have real stars and fails to obtain the trophy again after 1990, their performance and results are always respectable. It certainly reminds me of the importance of team work.

Farewell

In the end, we attended three farewell parties for our Boss. Two parties were for the whole department and our team, and the speeches were very formal. The last one, however, was for his own trainees. Each attendee was asked to say something.

Most of us simply recalled funny occasions in the past. Many talked about how they shared a room with the Boss during overseas conferences and why they could not sleep. Discussing research in a swimming pool was also a collective memory. On the other hand, hardly anyone mentioned anything about success and achievements.

When it was JW’s turn, he boldly discussed built to last. He said few people could remember or cite our finest research papers in 1990s. Although those were great achievements, their importance faded with time. JW concluded that the achievement with really lasting effect was the establishment of a team of people who could continue to serve in different areas.

I cannot totally agree. Each generation has its own problems to solve. A low citation rate of papers on smallpox does not mean the original works were unimportant. Nevertheless, I suppose the point is nothing can substitute for the time you spend with your trainees and children.

P.S. The book we gave Boss contained a poem by Su Shi (蘇軾), <和子由澠池懷舊>. "人生到處知何似？應似飛鴻踏雪泥。泥上偶然留指爪，鴻飛那復計東西。" I am not interested in leaving a name in history. However, leaving a small footprint that may benefit others in the future is always a beautiful thing.

Quotes

The other day, my mentor and I discussed about the speeches made by eminent guests at our Boss’ farewell party. He mentioned some people made good use of quotes, and Szeto probably knew best. (see http://ccszeto.blogspot.com/2010/06/blog-post.html)

Well, I am ashamed to report “The mystery is history” that appeared in my blog last week was from Winnie the Pooh.

You may find this popular quote better: “The clock is running. Make the most of today. Time waits for no man. Yesterday is history. Tomorrow is a mystery. Today is a gift. That’s why it is called the present.” – Alice Morse Earle.

Along the same line, I like the Serenity Prayer by Reinhold Niebuhr.

“God, grant me the serenity
To accept the things I cannot change;
Courage to change the things I can;
And wisdom to know the difference.”