回憶，是一種補償。

年少時，總是暗地裡覺得大人都愛在大時大節中，找點原因聚一聚，人齊就拍拍照這玩意，著實有點無聊。

可是人大了，一個人搬出來住，工作忙碌考試頻繁，發覺原來與家人相聚的時間的確少了許多。時間在不經意間變成了生活上許多事項的函數，工餘時撇除休息，尚且需要時間的地方實在有太多太多。

可能是幹這行活「職業病」的緣故吧，生離死別的事每日上演，加上自己情感泛濫，於是就總覺得自己好像常常為了工作而虧欠了陪伴家人的光陰。再者，久不久身邊便傳來某某親友患病離世等不愉快的消息，教人唏噓之餘，亦不得不提醒自己要好好珍惜生命尚且健康，有家人朋友寵愛的日子。

於是，偶爾某個周末，難得大家有個空，便隨便找個藉口約出來，見見面，吐吐苦水。心情大喜的話，集齊三五知己，按一下快門「戚喳」，然後再把照片鋪上社交網站，指尖輕輕一推就可以與眾生分享實在方便。反正如今數碼相機越出越易用，隨便一按就可以拍出好照片，連沖菲林的成本和等待都免了，多一兩張「回憶」於是就成為了成年人新興的社交禮儀。

有時候一班舊同學聚舊，由於大家工作崗位不盡相同，客套的問候往往很快就告完畢，於是話題便會自自然然帶到以前一些大家共同擁有的回憶裡去 ﹣例如某年某月誰暗戀誰，誰在課室裡喧鬧搞破壞，某年某月大家又曾到過某地旅行的一點一滴，好不容易就變成再一次搭通彼此的橋樑。於是為了在時間的洪流裡保存這份稍瞬即逝的情誼，大家也就更落力地去製造更多的共同回憶，希望到了將來仍能提起一些連結起彼此心裡的話題。

於是回憶，逐漸演變成生命成長𥚃的一種補償。

有人用回憶來冰封某一個特別的時刻，有人憑藉彌留過去逃避將來，有人是為了原諒過去的自己，有人卻是為了緬懷曾經捉緊卻又已經流逝的那麼一點東西。這東西可以是青春，可以是健康，可以是快樂，可以簡單如一小撮年少往事的記憶。正當人意識到自己擁有的時候，就開始害怕失去它的一刻。有人說這是人的愚昧，但無可否認這是一種普遍的人性，而人性就會奠定一個社會的意識形態和基礎，繼而釀成一種文化。

當然亦有人對製造回憶這種事感到嗤之以鼻，我第一個想到的人肯定非我室友莫屬。在我的眼中他的世界很瀟灑，自己以外沒有太多感情空間去容得下其它人和物。這事對他而言，他定必會想封塵的回憶又何來及得上即時行樂重要呢？這是一種截而不同的人生觀，一種以我這種情感主導智慧的人不會領略得到的生活哲學，但我非常地尊重他。因為情感就像是一把雙刃刀，當你試過把痛苦的感覺鑄入回憶的牢裡，那種久久不能忘懷的煎熬，當中的苦只有感受過的人才真正的懂啊。

回憶，是一種補償。

婚姻，就是踩一條鋼線。

剛過去的周末，一對好友結束六年有多的愛情長跑，結婚了。

教堂裡，牧師和眾人分享了一個小故事。

話說1859年，美國曾經有位走鋼索的表演者，當著上萬名觀眾面前，只拿著一支平衡桿就表演穿越尼瓜拉瓜大瀑布。當他走到半途時，風一吹，平衡桿一下子就吹走了，掉進萬尺以下的深淵，無影無蹤。表演者定過神，然後撐開雙臂，就這樣一路平著自己，一步一步慢慢就到終點。

正當群眾都為其完成表演熱烈歡呼的時候，表演者提出了一道叫人驚訝的問題。他問在場的觀眾有誰相信他能背著另一個人走回鋼索另一端的起點。群眾都爭著說相信。但當表演者再問在坐眾人中有誰願意坐上他的肩膀回程的時候，本來雀躍的人們都忽然變得鴉雀無聲。

牧師續道：「這些人口口中中說相信，但其實這根本並非真正的相信。」他又比喻婚姻其實就是這麼的一回事，只要你說一聲願意，跳上肩膀之後，就只能全然交託，完全相信背著你腳踏鋼綫的那個人，今後即使風雨滿道，仍一起面對互相扶持，這正是婚姻的精神。

出名膽小的我聽罷牧師的講道，一股寒意不禁沿著脊椎直竄全身，額頭冒出如豆大的泠汗珠，心有餘悸。別說踩鋼線這麼高難度的動作吧，我連荔園的BB過山車都怕得耍手拎頭。結婚這回事，也就太恐怖了吧！

我記得曾經問過另一對 engaged couple的準老婆一條很不該的問題。皆因她的未來老公是她的初戀情人，是她踏入森林後遇上的笫一棵樹，如今共處只有短短兩三年就毅然訂婚，她又怎能夠肯定準老公就是這片森林裡真正屬於她的 The One？

難怪有人話婚姻是一場賭博，計我話，這分分鐘是一生人中賭最大的一舖。踩鋼線的人尚且看到前面的路，但一對能許下山盟海誓的新人的眼中，就只有對方。當中的恐怖之處，且怕只有局中人才能真正感受啊。

《按：根據Wikipedia引述，1859年踏鋼線橫跨 Niagra Falls 的美藉法裔人名叫 Charles Blondin，當年除了成功其個人表演之外，還完成多個高難度的變奏版本，下圖則是 Charles Blondin 背著其經理人走鋼線的相片。》

Read more about Charles Blondin

Justify

出來社會工作一段日子以後，總有意無意地發現智商越高的人，就越愛在生活上的一舉一動中，努力不懈地去justify 自己。

醫生許多時更是當中的表表者。每個臨床上的決定、每個手術中的步驟，一個動作一個姿勢，背後總有至少一樣值得自己相信的理由，做每件事背後都總希望有點理據理論去支持自己。我以前一位consultant前輩時常掛在口邊的一句話「 Justify yourself. 」正好反映我們作為負責任的醫生，渴望被「 Justified」的例子。

醫生以外，律師亦然。每當發生醫療事故，或是有懷疑醫療疏忽而進行調查程序當中，涉事的醫生的一切記錄舉動，背後的理由動機，都會被查問得一清二楚。倘若端不上合情合理兼夾合時的原因理由的話，分分鐘被冠以Licence to kill的污名，仕途一鋪Game Over。

於是既是因亦是果，日積月累的僭而默化作用底下，人人都學精了，沒辦法Justify的事索性不做不理。這種態度甚至蔓延我們日常生活，彷彿不論你做什麼事，都總要替自己找一個過得到自己又過得人的理由，交代活像一種職業精神病。

我最近經常被問到的就是  「 為什麼你要留鬍子？」

我實在想不到一個人究竟會為了什麼的一件事而走去留鬍子。

留鬍子難道是失戀的Signs and Symptoms嗎？是代表失業嗎？還是為了某某所以才刻意改變自己嗎？

何以連留鬍子這麼一件雞毛蒜皮的小事都要為自己找上一千幾百個藉口？旁人的關心我實在是心領了，筆者留鬍子又實在是沒有什麼富麗堂皇的理由。正如剪個新髮換個顏色，難道又是為了忘記某某嗎？我們做每一件事的背後，真的需要這麼多的動機嗎？我嘗試過問自己，真的有原因有必要留鬍子嗎？沒有，沒有原因，也沒有必要。想留便留，不就已經是一個好好的原因嗎？

可能大家的潛台詞都是一樣：其實你長鬍子的樣子實在太醜了，我想知道你留鬍子的原因，只是希望用理據去說服你別再留下去。

大家的潛心意，我是收到了。

每日工作上已經有夠多的東西要去花心思精神努力地去 Justify，放假的時候何嘗不縱容一下自己，隨心所欲一番？ 人總要有Spontaneous的時候，不然這世界就會變得太繃緊，連呼吸都要精打細算不能好好享受的話，生活又豈能有樂趣呢？這正就是我從室友身上學到的一個道理。

That Thought.

We all had that thought, at some point, when the world seemed crashing into us and darkness befell, there was this irresistible desire to put things behind or out of our minds. We became vulnerable, however hard we camouflage with a fake smile on our face, until that thought became obsessive and a real harm..

•

An old friend attempted to end his life yesterday.

The news struck in the middle of my breakfast while I was reading the papers on my mobile.

The report covered the full story, with kind of a tilted perspective though, yet nothing mattered more than the fact that he survived.

A couple of us went to visit him later, and he seemed pretty upbeat and happy – rather a bit too happy as someone who just attempted to kill himself and got rescued.

It is all common sense that a suicide shouldn’t be taken too light-heartedly. People like him, so highly intelligent and well educated, carrying out such a well-thought plan (instead of an impulsive act) at such hour of the day are determined to die. (N.B.: later on after a brief phone call with a friend in psychiatry, he commented this whole plot could still be a big impulse). And from what I vaguely recalled during the days I studied psychiatry, these are exactly the group of people you need to pay extra attention to, because they are at higher risk of recurrent attempts during the early period after the primary act.

Whatever stressors that pushed him off the edge wouldn’t be cleared after spending a day in hospital – plus there are factors that could hardly be changed by one or two man’s efforts overnight, like the role of family, home environment, personality, coping mechanisms and one’s social circle. For one moment, it was hard for me to believe his elated mood and overjoyed Facebook statuses, but who am I to judge? nobody.

I was worried, and I knew more often than not, that I was over-reacting to it. On one hand I genuinely wish there was something within my capabilities to help – yet on the other I know no earthly being possesses the power of changing another person, not even by a little bit. Like my psych friend says, one must learn to accept the fact that some people just voluntarily choose NOT to live. And as doctors, these are the scenarioes that often prompt you to intervene, but when you come to think about it, the real problem is way beyond the realm of medicine, how far could you actually go?  

My friend gave me an example. He asked, can you detain someone who acts and claims happily alright in a mental ward and observe till the day he feels sad again? Can you force anyone to take happy pills when they deny being sad and while you can’t find any definite psychiatric diagnosis? The answer is no we can’t. Because we aren’t anybody to prevent someone from harming himself if that was in line with his own will.

Don’t get us wrong though, we aren’t cold-blooded animals watchinig people jumping off the bridge. The situation would be similar to people taking down their own houses for whatever sake, and we, as bystanders/bypassers, are in no place nor right to refrain them from doing what they want to their own property. And believe it or not, I had a hard enough time getting over with this fact over the past few years, and one thing I learned from this is we must know where the line is drawn and learn to respect it.

Having said so I was much thankful that a tragedy was prevented so timely and I wish my friend a speedy recovery both physically and emotionally soon in God’s hands. It was, as I said, truly a mistake that shouldn’t be made again, and no one should be proud of it. And for the rest, it would be up to him – to pick himself up, learn the lesson seriously and carry on. This shall take a lot more courage and real bravery than simply putting a big fake smile on one’s face.

Remember, help is always within an arm’s reach. All the best.

You’ve Got Mail

Hi,

I have read your recent post about mainlanders in your blog (well i have to say i am one of your many silent readers lol). I heartfeltly agree, and I felt myself going into a wrong profession as i didn’t expect our society to deteiorate so rapidly. My aspiration of being a doctor came from the perceived satisfaction in helping a patient. But it seems the chance is that when i start my practice, i will more likely see a patient who demands service, than one who seeks help from us with gratitude. That’s sad. What are your ideas towards this? To accept? To get private once one is capable? (i do hope i stay public, to help more patients in need) To emigrate? Any thoughts mind sharing with a puzzled junior?

Cheers,
A

p.s. i was really touched when i saw that thank you note you got from your patient! 萬分佩服! i hope i could get one some day in the future.

—————————————————————————————————————————————————————-

Dear A

Thank you for your letter and this chance to respond to your thoughts. I’m sure as colleagues, we share the same frustration towards the kind of situation that we are facing right now, but more importantly, even more so than finding solutions to these problems, I want you to recognize that you had not entered a wrong profession at all – there is no bigger defeat than abandoning yourself, your faith and your determination altogether too soon, and a career in medicine is almost always rewarding in many sense if only you persist.

Honestly, being a doctor is the merriest thing that ever happened to me, and working in a specialty that I enjoy most is a huge stroke of luck indeed. Although there must be tough moments of disappointment at our current healthcare system, or how our society is changing for better or worse, there are certainly way more fun, satisfaction and meanings in the journey of a doctor.

In my humble opinion, the best solution for me to deal with this is to concentrate on delivering the best, of my capacity and ability, at every opportunity, to help, to be courteous while you learn to serve the sick people. Many a times I’m both humbled and amused by the wealth of stories that I heard from patients who entered my door or whom I met in the wards. My life experience grew enormously with their words of advice and sharing of wisdom, and bearing in mind that as trainees we do learn from our patients – their response and their feedbacks are the best guide to knowing the effectiveness of your treatment, or the surgery that you perform on them – textbooks or papers do not give you this, only real people do.

Remember, in moments of doubts, don’t let anybody else alter your conscience as to who you are and how you value yourself, as a student in medicine or a doctor alike. Yes some patients may not be easy to handle at the first encounter, but if you give them enough time and if you really try to understand their situations, you might realise their attitude would change too.

In fact in Hong Kong, there ARE still many grateful patients around who do not only appreciate what you have done, but also they understand your limitations (of what you COULD NOT have done) too, especially when you are a junior like me. Those are the times that I would wish so badly for an extension in my abilities, instead of worrying about how I am not going to meet their ‘demands’ in providing my ‘services’.

It’s perhaps very hard to describe to you, with my limited English vocabulary, the good feelings of building a respectful patient-doctor relationship, which involves plenty of trust and care. But I guarantee you soon enough you will have a first taste of that pleasant connection during your internship – despite all those sleepless nights and weariness from a hundred calls.

As to public VS private – well like any other relationship, whenever money is involved, it becomes more complicated. As interns, you’ll have your chances meeting some private patients (should you rotate in QM) and you’ll see how different they are from the public group of patients. Mind you, these people are actually paying for your service – they want their money’s worth, at least that is what they think their cash could do. Their tolerance was understandably low in case of things that go against their way, and whoever taking their money are required / expected to give not only an okay outcome, but the most perfect result that is sometimes beyond the power / realm of medicine. It might be too early for you to commit yourself into private practice before you even start your training. Anyhow you are going to spend a few more years in the public (unless you want to become a GP), so why not take the best out of your time in the public sector? and that now the system is crumbling, wouldn’t you want yourself to be the one who stay and fight for the ones who need your help?

Having said that, I do not reject or detest the idea of private practice. I just simply think that for every stage in life, our thoughts and perceptions change and evolve with the environment around us. Our demand for different sorts of experience arises and there are new impulses which will take us to our life’s next arena. But the same principles of who you are should stick. Well let me wish you the strength to find yours in the years to come.

Best regards,

AK

Us in 50 Years?

The Double-Nos & The D&G incident.

For those who know me I’m not into political stuffs, but lately the rising of ‘Double-No’ children and their invasion into our social security system has hit a nerve of many a local Hongkongers including myself, who’d lived our entire lives in this city.

As people now began to realise the aftermath of those once-popular cross-border marriages, they knew that if this matter was not handled well enough, a chain of fierce competitions at every level of resources is bound to follow. Not only are we talking about obstetric services that were already heavily impaired, but parents in China are already brining their double-no children across the border for schooling and education in Hong Kong. Ten years down the road, you could imagine it would become a competition for places in college and finally employment. All these pose great threat to local parents, because judging from what the current government had (not) done, these double no children are certainly going to take up a large amount of society’s benefits without paying much price at all.

The Protest Of The Deprived

Yet political parties fare no better than the silence of our government. The recent incident at the D&G store is the best proof to our citizens that even as daring as some political parties claim to be, none of them was bold enough to even make a tiny noise despite all that injustice and discrimination. None of them dared to make a standpoint on our people’s behalf against the billions of Chinese people, who are waiting (not) in line to cross that Shenzhen river, and who are ultimately backed by the supreme Chinese government.

Same thing happened to the replacement of traditional Chinese with simplified characters on public signposts and official government banners/ posters. Why did we not hear a voice of rejection from Longhair or any of those so-called ‘political activists’ when they were the ones elected by the people to speak for the people?

We all knew the answer, we all knew it too well and for Christ’s sake we are well aware of what is going on and which direction our society is heading. So are we going to be happy about the upcoming transformation? Or is massive rebellion our last weapon? I don’t know.

Is Rebellion Our Last Weapon?

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

From ‘Please Help Me’ To ‘You’d Better Fix This!’ A Paradigm Shift. 

Over the past one year, we’ve heard / read way too many stories on the newspapers about alleged medical negligence, and biased accounts of how patients were being ill-treated by unkind doctors. Many of us, especially junior staff, would feel upset and discouraged by the way the media portrayed our profession in such a unjust way. We were annoyed and angry at how they dismissed our selfless efforts instead of recognizing them.

I don’t know if it’s because we are too young to appreciate the bitterness, or simply we had such a heightened sensitivity towards these unfairness, but certainly the media has done more harm than good by disturbing the society in this vicious cycle. Instead of finding resolutions to conflicts between patients and healthcare professionals, all the media did was keep pushing the line of boundary towards our limits. Their deliberate intention to cross the line oh-so-frequently challenged our tolerance, yet how are we going to defend ourselves even when the government remained silent and powerless.

Whenever there is a medical incident, or a dispute between patients and doctors, doctors are the ones to be blamed. Sooner of later, someone from the administration would come out to apologize in front of the cameras even before they look at the incident, let alone to wait for a thorough investigation. Under the influence of the media, patients nowadays are no longer afraid of challenging their doctors’ professionalism. They become demanding, and they are the ones who request your service, and some of them certainly do not see themselves as the ones who are in need of help. With the encouragement of the media, the culture of filing complaints  grew rapidly among patients who would now rather turn every little hassle into a public judgment instead of working hand in hand alongside their doctors.

So doctors are now MURDERING our patients?

So do I see our future in 50 years, both Hong Kong and our medical community -wise? No, not really. No I can’t. Can you?

 

Because it’s Christmas..

Time to watch it again!

A note on empathy

Symbol of Empathy

I often find it hard for ophthalm doctors to actually understand or appreciate what our patients experience with their illnesses, unlike surgeons who’re treating surgical patients with abdominal pain, our patients complains of symptoms that we have almost no personal experience of, symptoms that are too vague and intangible, and those we do not wish to happen to ourselves.

Each day we see hundreds of sick people who come to seek help for problems that we barely know how they feel. Scotomas, constricted visual fields, metamorphopsia (distorted vision), yes we all learned these scientific terms on textbooks indeed, and we could perhaps recite what are the standard treatments being described by doctors who are very much healthy. But even so, we can hardly describe how exactly it feels to have your eyes lasered, or to actually see through an intraocular lens instead of our own healthy lens. How is it like to read a book when your eyes lose the power to accommodate freely? How are we to cope with life if our vision was reduced to seeing hand movements only? How does it hurt to have a phthisical eye that is shrinking and withering every single day? These are the problems that bother our patients every living day, and they are sitting right across the slitlamp, but we have no access to feel for them. Because if we do — if we start seeing double vision, or any of those debilitating symptoms, it only signals that we are no longer fit to practice, it’s like a stop sign that says, ‘hey you, you should quit working as an ophthalmologist, because you can’t see what your colleagues could see’ It is not only a huge penalty to our entire career, but probably the worst nightmare that an ophthalmologist could ever imagine.

Lately, say two weeks ago, I was approached by a cute drug rep lady outside our clinic, and was handed some samples of artificial tears represented by their company. Personally I never have any dry eye problems but I was curious enough to wonder how it feels to add some extra ‘eye-moisturiser’. So later that night I opened the samples and tried applying to my eyes. Little did I know it’s no easy job getting the exact number of drops into each eye. The moment I uncapped the bottle of fluid and held it up above my eyes, I simply lost control of my eyelids and they couldn’t stop blinking.

Almost instantly I think about my patients who are using 5 to 6 drops many times a day. And those are not lubricants, many of them need these medicinal drops to keep their vision from deteriorating. Imagine you’re working out in the fields under the scorching sun, with all that dirt and sweat, and of course no time for breaks, and your doctor tells you to use a drop every two three hours, how much of a trouble would that be?

Some say empathy is an innate gift, and I do believe majority of doctors are born with quality. Yet as the burdens at work continue to overload and denude our capacities, we become less sensitive to things like these, worse still we become numb towards our patients. To me, empathy is an art that needs constant practice and timely reminders, it also requires an enormous dose of imagination, which regrettably is the only way we could ever come close to how our patients feel.

I once heard someone says, ‘Good doctors treat a disease, Great doctors heal a person.’ and I believe empathy is one of the most important keys to turn one doctor from a med dispenser to a human being. Nowadays, the new medical curriculum is expanding to cover domains of humanities, and there are already lectures at our faculty addressing the theme of ‘making doctors human’, as a young alumnus and a junior doctor, I often find inspirations and energy from interacting with my patients, and I sincerely hope this new programme would serve its well intended purpose and fuel our future doctors with insights beyond physical pain and illnesses.

Sorry guys but just let me put up another off-theme random question of the day here The video was old, and has been put up on Youtube for more than 4 years. It got an awesome 3,794,877 views and the theme of the interview was simple Why Do Asian Girls Go For White Guys? So [...]

Video Of The Week: 記者：「咁你出嚟做乜嘢？」

講多無謂，睇片最實際 ﹣精「警」片段 ﹣由0:47開始

誠然，這個世界上的確存在了許多「出左嚟」但又唔知自己「做乜野」的人，連問問題最利害的記者都忍不佳燥了，枉人家一早set定十幾支咪苦苦等候你出場呢，既然都知道是個不能說的秘密的話，哪麼就乾脆別浪費人家時間吧。