Monday, March 8, 2021

Medical School

 

                            

 

 

 

                      Medical School - The Beginning

 

 

 

 

On a bright Monday afternoon of September in 1963 I queued up outside the Registrar’s Office of the University of Hong Kong to register for medical school admission.  It was still hot at that time of the year in Hong Kong although the temperature was off the peak of the humid summer.

Even in those days the London Examination Boards’ standards were considered at least two notches down and the University of Hong Kong decided in their wisdom to run their own matriculation examinations.  Politicians seem to think that lowering the standards of public examinations to fit their political agenda is enough to fool the unsuspecting voters, who if they happen to have a child sitting the exam are only too pleased to receive the accolade of ever improving grades. The truth is indeed miles away.  The average IQ scores for many populations were rising at an average rate of three points per decade during the 20th century with most of the increase in the lower half of the IQ range: a phenomenon called the Flynn effect. It is disputed whether these changes in scores reflect real changes in intellectual abilities, or merely changes in calibration.

This is not to say that examinations are the be all and end all of all things, although it was generally seen as a major achievement to be one of the sixty or so freshmen admitted at that time to the only Medical School of the colony.  Only a small percentage of those school graduates who aspired to study medicine were lucky enough to get a place. The elite subsidized schools might fare better overall but the variations from year to year were enormous. The year above us in our government grammar school achieved over 50% admission and that was exceptional by any standard.

Of course a bit of luck was involved as well.  Quite a few of our classmates who did not make it have done very well overseas, mainly in U.S. and in Canada.  There were too few places and in a race, someone was going to be left out – loss to Hong Kong but gain for other countries.  With a high concentration of families who had the vision to escape Communist rule, one could expect a higher than average concentration of high achievers amongst their descendents.

So there I was with my classmate.  In our class of twenty two, we were the only two accepted.  Although feeling outnumbered, we were quite excited to meet for the first time our future “window-mates” for the next five years – in Chinese to study together is described as sharing the same windows.  Although time has washed away some less memorable past, my first encounter with some of my fellow medical school students was quite permanently imprinted. The quiet ones would remain the quiet ones and the flamboyant and rather manic ones would stay so. I remember meeting one of them who was very friendly and introduced himself. After a near twenty year gap when I returned to Hong Kong he called to refer a patient to me and he sounded exactly like he was when I first met him.

It was an interesting time. Most of us in Hong Kong were “refugees” from the communist uprising in China.  There were those from families that had recovered quickly through running their own business. There were a few whose families were based in Hong Kong and survived the Japanese occupation. They prospered ahead of those like my family who arrived after 1949. Other families might have been able to get money out of China before the final collapse.  In all it was a curious “mixed up” society where the class structure was quite different to that of say Britain.

Here I was, standing outside one of Hong Kong’s finest examples of colonial buildings, ready to take the first step into a future that I had not even started to imagine.

Unlike some other courses, Medicine was a pretty tough one and required a good deal of difficult memory work for which there was no short cut. Being clever helped but not if you did not work.

The registrar was a most formidable lady and we felt like school boys again. No. Here. No. There. No respect for the future doctors, we all thought.   When I look back now, she was right. We were sky high and someone needed to bring us down to earth and she would not be the last one either.

Now we are ready.

Or are we?

Medical schools around the world at the time were still using traditional methods of teaching, as Problem Based Learning (PBL)[1] was still very much in its infancy.  One of the first rites of passage for any medical student was the cadaver. The very first lesson ever was Anatomy Dissection. To access the dissection room we had to go through the small anatomy museum where partly dissected cadavers preserved in formalin filled casings greeted us as we hurried upstairs. We all tried to put on a brave face although there was no hiding the fact that even for future doctors this was a momentous time. Years of traditional belief in ghosts and after-life in our collective psyche could not help but be at play. We were confident in only one thing. We needed the knowledge to serve humanity better.  The poor souls of these unclaimed bodies that formed the main source of the cadavers were not aware of the critical role they played, but for that we were grateful. At least they would be given a proper burial at the end of our five terms of detailed study.

With hindsight, I cannot be entirely sure that the dissection was an essential part of our medical education.  Could a formalin hardened shrunken cadaver teach us more than a modern computer generated 3-D realisation of human anatomy?  However, I am sure surgeons will agree that there is no comparison with live bodies, even if those of animals, for work like heart transplants or delicate brain surgery.

Soon we got over the initial shock and got on with the cadaver dissection. Fortnightly viva examinations did not allow time for contemplation and then there were the other basic subjects of physiology and biochemistry to learn.

However, for most of us, Anatomy remained the most unforgettable initiation, not least because the professor was one of the most awesome characters we were to meet in our whole study, perhaps equalled only by the professors of medicine and surgery who taught us later on, but the first one was bound to be most memorable.

Our anatomy professor from Cornell was in his senior years by the time we became his students. He had a stony face and wore a pair of old fashioned gold-rimmed eyeglasses that would take another twenty years before being re-popularised by Armani. Then, most of us had fashionable acrylic frames, mostly black for men and fancy coloured ones for ladies.

Early Parkinsonism did not help to soften his formidable look.

His first task in the morning was to lock the lecture room door and then take the roll call.  As far as I knew, no one dared to be late or absent, so no one really knew what he would do if you were – a lesson parents could all learn.

Rumour had it that over the years he had been collecting data on handedness in men and the way the scrotum hang. As we all know, one side of man hangs lower than the other. The subjects were, yes you have guessed right, medical students. More interestingly he had a project on ladies too -  breast asymmetry - which gave rise to his nick name of Zhai Lo, Zhai being the Cantonese slang for breasts, female breasts, not chicken ones.

What was his research tool?  A camera.

We were all resigned to the fact that we would be called to his office and be photographed.  Of course none of that happened and I could not find any of the immediate seniors who had their pictures taken either. The nearest to Zhai I personally witnessed was when he demonstrated the effect of tensing the Pectoris Major on the breast of one fellow female medical student. He never touched her and she complied most gallantly.

All for the sake of science.

Another thing we shall all remember of our anatomy professor was how he arrived at the lecture theatre one Friday morning in 1963. He did not lock the door and did not carry the roll call book. He could hardly hide his emotion when with his crackly voice announced: “The President of the United States has just been killed. There will be no lecture today,” and left the room.

We were all stunned. Some looked tearful. Others were in disbelief. Has the civilised world come to an end? Is there going to be a world war? We looked up to the world’s most democratic country that had hopefully moved on from the Lincoln years. What happened?

Somehow the majority of us survived, and we moved on.

 

 

                                               Morrison Hall

       

 

 

 

Robert Morrison was one of the first non Catholic missionaries in China and the Chinese Missionary Society built a residential hall for the University of Hong Kong in his memory.

For “green horns” (or freshmen, a reference to a young buffalo calf so young that its horns are still green), Morrison Hall was reputed to be one of the toughest in the University. Rumour had it that some left after a month.  Since my seniors from my school all joined the same Hall, I thought what was good enough for them must be good for me.  There was also a matter of economics - it was the cheapest to stay in.

The biggest widely known “secret” was the ragging. Ragging was in every hall and most lasted from a few days to two weeks but ours lasted a full four weeks. It was a way of humbling the new entrants to the university and everybody said it was character building. As it was a voluntary choice to join a hall you more or less agreed to the ragging.   In those days, it was not compulsory for a freshman to stay in a residential hall.

As it turned out, the ragging was not that bad and it is something I remember with a certain degree of fondness. There was, as far as I knew, no physical or sexual side to any of the ragging.

Any senior could summon a junior, who was addressed as Green Horn, to ask him questions. It is in effect a peculiar way for the senior to get to know a junior. In reply, the “Green Horn” could only address himself as “small i” as oppose to the usual “I”.  Anybody who forgot had to eat a square meal, having to make the chopsticks trace a square before the food picked up could reach his mouth. The delay so caused meant that in the communal style of eating, the Green Horn would not get to eat much for that meal.

The other rather major punishment for the Green Horn was to run around wearing his shoes round his neck.

The ragging took place around the dinner table and for about an hour afterwards when the seniors played Bridge. If you were smart enough to answer well, you could get exemptions so that other seniors would not bother you for the rest of the day – a bit like Big Break on the Golf Channel.  The rules of engagement were applied fairly, and juniors and seniors would in four weeks become great friends. That was the theory.

Entering Hall the first time was quite a daunting experience. One of my friends from the village advised that my parents needed not go up as it was near the peak and not accessible by public transport. What was the point of spending on the extra taxi fare that my family could ill afford? So they escorted me to as far as the Star Ferry and then I was put on a taxi to start my life as a medical student.

I did not cry when my father put me, aged four, on the plane to Hong Kong all those years ago, and I did not cry then. You could not if you were going to be a doctor. Other things helped. Hong Kong was indeed a small place so you would not be hundreds of miles from home.  When our daughters went to university, they did not cry either as they had already spent some years at boarding school. Some of the boys, yes boys, were inconsolable.

I was dropped off at the front door where the male servants lined up to help and to welcome the returning Morrisonians and the Green Horns. It was such a majestic building with pillars and an entrance that was very classical English in style. There was a covered veranda all round the building. The Warden had his own flat on the south side of the building over the Chapel. Yes, a Chapel is part and parcel of the college tradition at Oxford and Cambridge, and we were no different.

For me, the contrast in living condition was phenomenal. Most people nowadays go to university to face a spartan room and in the first year you might even have a room-mate. At that time, my family home still had leaking roofs and we did not have a refrigerator, a telephone, or a flushing toilet.  It was the first time in my life that I slept on a mattress. I grew up sleeping on boards with a thin rattan mat, and it was good in the hot summers but rather cold in the winters even with a layer of quilting. It was, I suppose, a welcome change.

We were each assigned our own servant, who each looked after six residents. He carried our luggage and showed us to our room. At meal times he was responsible for refilling our rice bowls or getting extra dishes that we might care to order. Those cost extra though, and the favourites were dry fried pork, beef or chicken. Whatever you ordered you had to share with the whole table of eight. I cannot remember any Green Horn daring to order extras. We kept our secret supply of food in the room such as blocks of Kraft’s Cheddar, which was handy for filling hungry stomachs and required no refrigeration.

The servant also took care of the laundry.  Every other day the laundry would come back nicely folded on your bed and those clothes items that needed hanging would be found hanging in the corner wardrobe.

This was in the early sixties, and there were some strange rules. If any girlfriend wanted to spend the night the mattress had to chapterbe out of the room.  I never saw one in my three years stay. If you actually left your mattress outside your room, you would be inviting an audience and no self-respecting girl would ever agree to that.

In any case, the rooms were not all that private as most were separated by only partial partitions.  We could actually shout to our friend in another room about some study problems. Noise was never a problem.  Most of us in fact studied hard. There were just a few quite private rooms but they were reserved for the most senior at the Hall.

The freshmen stayed mostly on the ground floor and a few rooms were big ones that accommodated up to three. Round by the dining hall, on the shortcut route to the toilet and showers, were four rooms with full walls that went up to the ceiling, as opposed to partial partitions.  That corner was dubbed the Russian Corner, in memory of four Russian students who were unfortunately killed fighting the Japanese during the Japanese invasion.  It was rumoured to be haunted and frequented by tall ghosts - they were tall Russians.

One of the first year Malaysian engineering students managed to get one of the rooms. Within a month he had a severe manic episode. So the ghost story never went away. The student eventually went back to Malaysia. It is surprising that the Chinese philosophy of “if in doubt believe it exists” had such a strong hold even amongst the educated.  Mainly those with strong religious beliefs would agree to stay in these rooms, but most did not stay for more than a year.

The north side faced the games field.  Morrison Hall was located in the upper Mid-levels of Hong Kong Island, where the extreme rich lived. Yes.  One of the then richest men in Hong Kong had his grand villa just opposite our entrance. Now and again we would see his Rolls Royce pull up. Of course quite a few of us would eventually achieve incomes that would put them in the 100 richest in Hong Kong, alas not those of us who went to work for the NHS in U.K.

On the south side the Warden’s flat faced two tennis courts. I had a few lessons from some fellow Morrisonians who had had expensive lessons before coming to university, but never went beyond how to hold the racket and serve.

The rooms were on the west and north side looking into a central garden. The services such as laundry, kitchen and the servants’ quarters were on the east side.  Just at the end of the drive into our Hall was one of the many access paths to Victoria Peak, the small mountain that dominates the small island of Hong Kong. Some weekends when we were tired of studying a few of us would walk up the peak and admire the view of possibly the most beautiful small city of the world. I would not say most beautiful city, but most beautiful small city would guarantee unanimous agreement.

We had a perfect environment for studying. Daily chores were taken care of, and for physical activities there were tennis courts, a football court, and a games field for track running, and long and high jump.

Green Horns had to go into training for the annual Sports Day, one of the key events being the ten mile Inter Hall relay.  Gyms or fitness centres were not widely popular as they are now.  Running had to be practised on the streets. The half way mark where we turned round was the house of one of our medical classmates. They had this prestigious address because his father was a doctor.  Doctors were, and still are, part of the social elite in Hong Kong.  It was a training that I enjoyed and the tough test was at the end, when we had to go up two hundred steps. Nobody was exempt unless they had a medical certificate, and nobody had one.

In the end most of us saw ragging as something positive. There were ridiculous things such as memorising the constitution of the Hall. Personal pride came in and no self-respecting university student would have a problem, except of course we had to recite the first line backwards. To this day I can still remember it even in my sleep: Club Hall Morrison Called Be Shall Club The Of Name The.  You can work that one out.

One of the first year medical students refused to partake in ragging and he was left alone. He did not pass the four weeks interview and left. He still became an accomplished doctor although even in class he did not talk to anyone.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                      Medical School -The Clinical Years

 

 

 

Now that the hard work of memorising where every single bit fitted within our body was over, we thought we would at last get into what we entered medical school for – seeing patients.

Another shock awaited us:

“We are starting medicine at the end,” the Professor of Pathology declared as he held up the scalpel, “and we are the final arbiter!”

It would be another year before we came into contact with live patients. This of course was medicine as it had always been taught. First, dissection of the cadaver; followed by post mortem of dead patients.  It is very different from some modern day medical schools where first year medical students are given an unconscious patient on assisted breathing. I am really not sure which the better way is.  In any case, we did not have a choice then and we were happy for what we got.

Every day at eleven after our various lectures in the morning we were down at the mortuary for the “live” demonstration of post mortem – every day except Saturday and Sundays. Our white coats which used to reek of formalin in the preclinical cadaver dissection days now began to acquire a different stink.

Was it that surprising that whenever we went home our mothers looked worried? “Why are you getting thinner?” Not that we could afford to go home that often, what with studying and the need to grab every spare moment to be with one’s girlfriend. It was a great relief to be able to get home, leaving behind those newly acquired smells and the pages and pages of medical books and graphic images of bodies on stainless steel tables. It was a relief to breathe a different air and taste food that we had taken for granted for years through our childhood.

Then there was Bacteriology at 2 p.m. The Electron Microscope was still in its infancy. The best our microscopes could do was to get to 1000X with oil immersion.  Lectures were conducted with a carbon-arc lantern slide projector with its rather noisy hum. Given the then low profile of Bacteriology and the monotonous delivery of our Professor, only the highly motivated stayed awake during the postprandial period. It was time to catch up with our sleep. It has been suggested since that such cat naps are good for the brain and we started practising young.  Whether it was the effect of sublimal learning that we discovered by chance, most of us managed to pass the Second M.B. examination in the subjects of Pathology and Bacteriology.

It was never my ambition to become a pathologist and be the final arbiter.  Little did I know then that the months spent at the mortuary would pay off later in my career. As on-call Medical Officer at Hong Kong’s only Mental Hospital, we had to perform post mortem on any death that occurred during our duty period. I was only once called to perform the job, and in front of the much experienced technicians I at least knew my way round. I was thankful that was the only time, and it was pneumonia and not something that had to involve forensics. 

On to real patients.

“You might be wearing a white coat. You might look like doctors.  But here you are the lowest worm!”

So our terrifying Professor of Medicine put us on the pecking order, lower of course than the cleaner and the porter.  Fortunately most patients in those days had little understanding of English.

I do not think teachers nowadays can get away with comments ten times milder, not with student assessment through the Internet and unofficial blogs. Yet the few teachers whom we respect and remember most are these formidable non “politically correct” ones. Of course they would not have been respected if they had not been brilliant clinically.

Lectures on Internal Medicine by our Professor overshadowed all other lectures.  First we had to be sure we studied the subject at least the night before the actual lecture. God help the few naïve enough to turn up at a lecture knowing nothing about the topic. You may ask then what the point of the lecture was. Yes, I struggled with that too.  Now I realise that by that stage we were supposed to have moved beyond the spoon feeding days and we were there to interact.

There was a sort of pecking order even on where you sat. The front row was always occupied by the elite of the class, the hopefuls who expected to participate in the Distinction Viva in the finals. However, only about half of them would ever make it. There was the odd one who had little insight. We nicknamed one Dr Keen. He would choose to sit on the front row too and in time the Professor learned to avoid his gaze and ignore his eager hand. He subsequently became a very successful gynaecologist.  His keenness obviously paid off.

There was the hard core who never learned that sitting at the back row was simply an invitation for embarrassment. Did they really think that the Professor in all his wisdom was not going to the back?

The rest of us were happy to take the middle ground, the second row to the last but one. We might still get asked the occasional question by the Professor, but generally it was show-off time for the elite of our class and to be fair we did learn a lot from them. We are forever grateful for that.

Now Surgery was totally different. The flamboyant Malaysian Chinese was more concerned that his students knew the answers, and having very early on identified the few that could provide the answers, he would hardly risk asking the rest of us. His surgical skill was legendary and we tended to forgive him for all his shortcomings. Legend had it that he had sliced a few ulna nerves[2] of his senior lecturers in fits of temper in theatre. I have yet to meet one to confirm that myth. It requires a robust personality to become a surgeon although the financial rewards are high for surgeons in private practice.

Instead of a towering figure, our Professor of Obstetrics and Gynaecology was so short she needed steps specially made for the operating theatre.  She was small in stature but not in any other way. It would be fair to say that almost single-handedly she brought Obstetrics in Hong Kong to lead the world with Japan in terms of low infant mortality, which held true from our medical student days to the present day. From very early days we had a dedicated seven storey maternity hospital that could in an emergency get a baby out by Caesarean in four minutes, five being the acceptable time after which brain damage is considered irreversible. The little glitch in an otherwise exemplary mortality record was due mainly to re-used drip sets.  Their replacement with disposable ones helped bring Hong Kong medicine up to world standard.

Her reputation was way ahead of her and we never realised how small she was until we saw her in person. To fast forward to the end of my story about her, I had the great honour to have her as my finals practical examiner. It was the accepted wisdom that if you got the professor you were either borderline for failure or for distinction.  I never did manage to find out which, though I did not consider that I did badly at all in my Obstetrics and Gynaecology papers. I was given a patient where an internal examination was deemed necessary. Having to discard the Professor’s step platform might have unnerved me, but when I realised we had a cervical polyp of some size, I duly described in metric terms the closest to my estimation, namely 2.5 cm diameter. Horrified, she looked at the notes in front of her from her most trusted senior lecturer – 1 cm. Re-questioning did not change my mind as I was confident of my estimation. With the said Senior Lecturer in tow she put on her glove, dipped into some KY and stepping on the platform that the Senior Lecturer duly replaced, she performed her own examination.

“It must have increased in size overnight.”

Fair was fair, and I was grateful for that.  I was glad I stood my own ground – a lesson I shall always remember for other aspects of medicine. 

Always trust your own assessment.

Tsan Yuk Hospital (the Chinese name meaning promoting birth) was where we learned about venipuncture (drawing blood from the vein) and vaginal examination, and had our other initiation – delivering a baby.

Without much public health education, most mothers in Hong Kong knew the importance of antenatal care, and attendance at antenatal clinics took on a scale that has seldom been seen in the western world. Expectant mothers queued from as early as four in the morning and by the time our little group of ten gathered around 8 a.m. on our first day for the Senior Resident’s briefing, there were already hundreds waiting in the line. By the end of the morning clinic we were experts in venipuncture.  We of course approached vaginal examination in a most doctorly manner and the main surprise was to the female members of our group. They never imagined the variety.

It was only a matter of days before we delivered our first baby and the only words that echoed in our mind were from our Professor of Medicine: we were the lowest life form. There was so much we could learn from experienced mid-wives and so much about humanity from others.

There is of course so much I can write about our clinical days, so much about serious illnesses that seemed to form the main part of our curriculum and so little about mundane day to day colds and illnesses that the majority of us are destined to deal with.

Two important events that I mentioned earlier marked the highlights of our clinical years. It was the era of Love Story and the tragic death from Leukaemia, and I still remember the day my friend came to where I sat in the university library and exclaimed: they found a cure. That was VAMP and what a change it brought! The other was the historic breakthrough of Christiaan Barnard and the heart transplant from South Africa[3], a country shunned by the rest of the world for its apartheid regime. Whatever the merits of what we know of the man later, what he accomplished then was monumental.  It was a good time to be graduating as a doctor.  The new age of Modern Medicine has arrived!

On a lighter note, our final year in medical school also saw the arrival of the mini-skirt.  I could remember one day on the veranda of our library chatting with some of my group before a seminar when the last member of our group walked down the slope leading to our library.

She was wearing a mini-skirt.

There is fun in medicine after all.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                 After the Examinations

 

 

 

The examinations were finally over and I was back home in the village that I had more or less abandoned for the most of the last five years.  I could not remember skies as bright and temperature as high, but it was a nice interlude from the mad preparations and the nerve-wracking examinations.

We had an unusually dry May. The worst of the 1966 rains seemed like a distant memory and the crisp blue skies somehow made the heat tolerable. Even back then we seemed to be complaining of the ever rising temperatures in Hong Kong. The way we had been complaining about the rise every year, the temperature should really have reached 110 or more by now. The air-conditioning of offices, followed by that of private homes, necessarily led to the feeling of higher ambient temperatures in the streets.

The garden was filled with the fragrance of the white tropical jasmines.  That fragrance is only second to that of the Osmanthus (Gui Hua)[4], the flowers of which are tiny and appear more towards winter. We used to collect the Osmanthus flowers, dry them and use them to flavour our best teas.  Jasmine is more a late spring and summer flower and we had a big bush. By nightfall the cooling hill breeze brought with it occasional whiffs that made you want summer to last forever.

It was a peculiar time for those of us who had lived in or around the university for the past five years.  We left home as school children and now we were back, and with any luck the majority of us would in a few weeks become fully fledged doctors ready to apply our skills.

We had changed and the rest of the family probably not as much; and yet it was a time to savour – the last of the old before embarking on the new and brave.

It was good to be reminded of the fine cooking back home, of an older and more sedate time when shopping was done twice a day for fresh ingredients.  This practice of course still continues in some parts of the world.

It was good tasting again eggs that tasted like no others in the five years in between or since. These were expensive eggs as they could have been sold to chicken farms at a premium price. Not only were they free-range but they were extra healthy and fertilised by highly priced chicken of the best Chinese breed. They could fetch upwards of two dollars per egg when one could get a dozen for the same price in the market.

Then there was the chicken, freely running and on a truly magnificent diet that allowed for such fine taste to develop – the original A.C. (Appellation Controlee)[5] chicken of Taipo. These chickens were so special that I used to be given the task of delivering to my father’s retired boss and his family during Chinese New Year two live ones, in double extra strong paper shopping carriers fitted with a bamboo handle. This family lived near the University and I only had to make a special stop on the bus en route. It was more trying and required more skill than you ever imagine, talking to two fully grown chickens to keep them happy on the train and bus journey.

Father’s now retired boss and his wife and two daughters were relatives of the cousin who was brought up by my father. They had done well for themselves and they visited our “village” home quite often. They particularly liked our chicken.  He set my father up to work at the British insurance company where he was the highest ranking Chinese manager. My father eventualy rose to his position before he too retired but that was some years hence.

So when I brought them the two chicken for Chinese New Year I would normally arrive at around five on a Sunday afternoon. There was always some food as I am sure they thought we did not get decent food at the University Hall.  Then true to Chinese custom they would give me a red lucky money package. I am sure they could get a few chickens for the same money.  My mother always assured me that I should use the money for whatever purpose I saw fit.  I suspect she knew I did not get much pocket money and tried my best to skip some meals at Hall in order to get some refund – we could get up to ten percent refund for uneaten meals if we remembered to sign out.  I suspect too that she knew that with a girl friend I should be paying for some of the dates.

The guavas were not quite ready but our own giant papaya tree seemed capable of fruiting through the year.  These were yellow fleshed and delicious though without the special fragrance associated with the red variety.  Bananas too grew wild and bunches were cut when ready and suspended from a tripod for indoor ripening.  It was too risky to let them ripe on the tree as various animals and birds would have had their first claim.

Mother always bought fresh fish from the market, often a Pompano which when fresh has tender flesh with a delicate flavour and makes a popular Teochiu dish. It is perhaps very apt that the first fish I caught in Myrtle Beach some forty-five years later was none other than a Pompano.

I also remember she brought back a huge lobster one day. The fisherman, learning that her son the future doctor was back, gave her a special deal she could not refuse.  The lobster was first steamed and then left to cool before being shelled and presented as cold slices – a different approach to serving lobster.  Some years later I tried serving lobster in the same way to some close friends in England, much to their surprise as it was delicious.

By then we had a fridge, though only a second hand model. My years of medical school had probably drained every cent my father could earn, subsidised by the eggs the hens could lay and hours of sewing my mother could do day and night.  By then hand-stitching of sequins must have been in fashion in the U.S. and a home industry had sprung up in our village.  Each top fetched about the price of ten eggs but any income was income and that was how the likes of our mothers were exploited.  But without this how could she contribute to her own son’s education?

The fridge was a LEC, a good name, I believe. It was green and was rather battered on the outside.  It had the lovely curved door and cooled perfectly.  One of the uncles was getting a new American fridge and decided to give his old one to my father.  He and his family were regular visitors and he liked his beer cold.  Without a fridge it was rather a struggle for my father to keep the San Miguel’s and Carlsberg’s cool. This uncle worked for an aluminium company and one day he had one of his company vans and staff deliver the fridge.

The fridge meant no more bike rides to get ice for jelly and we could even have ice cream in the freezer. It did not change my mother’s habit of food shopping twice a day though.

We still had no phone and I either had to go to the grocery store at the bottom of the hill to buy some groceries and borrow their phone or I had to write, as I was then in love and my future wife was working full time.  Staying in the Cote d’Azur forty years later reminded me of the Basildon Bond Azure paper and envelopes she used.  No land line; no cell phone; and definitely no Email.  Kids nowadays feel so hard done by if they lack even one of these three essentials.  It was as they say and older and more elegant time and I am glad I too experienced a bit of it.

I was given a hardback copy of Gone With The Wind to occupy my mind and keep sane, together with a model of a formula one car to assemble.  Weekends I tried to see her in town.  It was the longest few weeks of my life.  I have a lot of sympathy these days for children waiting for their examination results.

The day the exam results were announced at last arrived.  We passed!  We were the few close friends who studied together. With the results came the scramble for good house jobs.  I had to be on Kowloon side to secure a job at a rather prestigious medical unit at Queen Elizabeth Hospital.  I made arrangements to phone one of the few who went to look at the actual posting of results.  He wanted a job at the University Paediatric Unit and was well placed to scan the results. I cannot remember how we agreed to make contact as mobile phones were not even on the drawing board.  I suspect I called his brother’s office as two of them were Senior Lecturers.  Paediatrics, or more specifically Neonatal Paediatrics, was to be his chosen career, and he rose to become one of the foremost international pioneers in Neonatology.

My other house job was Obstetrics in the University department as I felt that it was one branch of medicine that dealt with the beginning of life and might suit me well enough.   Who was to know at that time that child psychiatry would become my career and in many ways my passion?  The working of the mind fascinates me and the only regret I have in choosing this specialty is how little science we have for it, and that what we do have is often so unreliable.  It is disappointing how, with so little scientific backing, the government and bodies like NICE now see fit to prescribe treatment that is unproven, unsound and often dangerous.  I am sure this is the modern problem with a number of specialties in medicine.  Child psychiatry just has it worst.

 



[2] Ulna nerve - The ulna nerve is a nerve which runs from the shoulder to the hand, at one part running near the ulna bone. It is the only exposed nerve in the human body (it is unprotected for a few centimeters at the elbow)

 

[3] Christiaan Bernard and Heart Transplant: On December 3, 1967, South African surgeon Christiaan Barnard conducted the first heart transplant on 53-year-old Lewis Washkansky. The surgery was a success. Eighteen days after the operation, Washkansky died of double pneumonia.

 

 

[4] Osmanthus (Gui Hua) - Osmthus fragrans is a flower native to China that is valued for its delicate fruity-floral apricot aroma. It is especially valued as an additive for tea and other beverages in the Far East.

 

 

[5] A.C. Chicken - Appellation d’Origine Contrôlée (AOC = Protected Designation of Origin) French designation to protect and therefore guarantee the origin of products. The origins of AOC date back to the 15th century in France, when Roquefort was regulated by a parliament decree. Widely used on wines and now extended to other products including Bresse Chicken. Seen by most as a guarantee of quality.

Friday, February 5, 2021

WSJ: Seeing Things With the Power of Symmetry

 


Group theory studies the symmetrical patterns that underlie everything from Rubik’s cubes to plant biology.



ILLUSTRATION: TOMASZ WALENTA

By 

Eugenia Cheng

Feb. 4, 2021 12:55 pm ET

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Mathematician Eugenia Cheng explores the uses of math beyond the classroom. Read more columns here.

As I gear up for another semester of virtual teaching, one of my invaluable pieces of equipment is a document camera. It is essentially a webcam on a long neck, which I point at my desk to show things I’m writing, drawing or making. The trouble is that if I bend the neck so that the camera faces down toward the desk, the image on the screen is upside down. To make the image appear the right way up, the stand and neck would need to be at the bottom of my page, which would get in the way when I write.

My webcam model is rather basic—that is, cheap—so there is no built-in way to rotate the image on the screen; it can only be flipped horizontally or vertically. However, some mental gymnastics reveals that if I combine those two flips the result is the 180 degree rotation I need. I am familiar with this from group theory, a branch of abstract mathematics that studies symmetry.

 

In everyday life, we typically say an object is symmetrical if we could draw a line down the middle and both sides match up when we imagine folding them over. This is called reflectional symmetry: A human face has it (more or less), but a hand doesn’t. Another type is rotational symmetry, where you can rotate an object and it still looks the same, like a windmill.

 

One of the insights of group theory is that symmetry can be thought of as an action rather than a property—flipping an object over or turning it around. It’s a small shift in perspective, but it means that we can think about combining symmetries by doing one of these moves and then another. 

 

Understanding symmetry via group theory helps us boil down a situation to its fundamental building blocks. 

 

Combining concepts to make new concepts is essentially the purpose of algebra, and rather than trying to visualize the objects it’s dealing with, group theory uses algebraic formulas and techniques. This is beneficial when our ability to form mental pictures of an object runs out, as when we are thinking about a mathematical object in four dimensions, or something with far too much symmetry to keep track of, like a Rubik’s Cube. 

Understanding symmetry via group theory helps us boil down a situation to its fundamental building blocks. For example, by understanding the symmetries of a rectangle, I can start with the flipped reflections of the rectangular webcam image and combine them to produce the rotation I need. This search for fundamental building blocks is central to abstract mathematics.

 

Group theory has many applications because symmetry is so widespread in science. It’s found not just in shapes but also in number systems and systems of equations. Many plant structures in biology and molecular structures in chemistry depend heavily on symmetry. 

One important application in physics is Einstein’s theory of relativity, which conceives our usual 3-dimensional space together with time as a 4-dimensional “spacetime.” Because space and time are related in somewhat counterintuitive ways, spacetime doesn’t behave quite like 3-dimensional space.

 

Of course, sometimes the best abstract mathematical approach is not the most practical. It might have been more helpful if my software had the “rotation” function built in along with the flips. But the abstract approach is better for developing mathematical theories that help us understand more complex phenomena in the world around us.

 

Wednesday, December 23, 2020

Bach and My Musical Advent Calendar


 

·                                                                                                                                                  ILLUSTRATION: TOMASZ WALENTA

By 

Eugenia Cheng

Dec. 23, 2020 5:22 pm ET

·                       

A keyboard masterpiece depends on the complex relationship between sound waves and musical notes.

Along with my usual chocolate Advent calendar, this year I decided to make myself a kind of musical Advent calendar by playing through a book of J.S. Bach’s “The Well-Tempered Keyboard,” a monumental collection of 24 preludes and fugues. Playing one a day made a perfect fit with my chocolates and the run-up to Christmas Eve.

Bach didn’t choose the number 24 arbitrarily. In Western music there are 12 notes in an octave, and for each note there is a major and a minor key, making 24 in total. To understand why there are 12 notes in an octave, rather than 10 or 14, we have to look at the math of sound waves.

The pitch of a note is determined by the frequency of its sound wave—that is, how many identical segments of the wave, or oscillations, pass a fixed point in a given period of time. The higher the frequency of a sound wave, the higher the pitch it produces. Harmony in music involves combining sound waves of different frequencies, making use of the fact that some waves reinforce one another while others interfere. 

For any musical note, the note that goes with it most harmoniously is the same note one octave higher. That’s because the higher note has exactly twice the frequency, leading the two sound waves to oscillate together neatly. The next most harmonious note will be the one with three times the frequency, which in musical terms is a perfect fifth higher—for instance, the jump from C to G, which you can hear at the beginning of “Twinkle, Twinkle Little Star.”

If we keep going up by perfect fifths, we get a sequence of harmonious intervals known as the cycle of fifths. The first five notes in the cycle form the pentatonic scale, which is used in the music of many ancient cultures. If we keep going up to seven notes, we get the notes of the major scale prevalent in Western classical music. Taking 12 notes of the cycle of fifths produces the 12 notes of the piano keyboard.

After 12 steps, something fortuitous happens: We get to a note that is almost the same as the one we started with, but seven octaves higher. The 12 notes of the keyboard essentially come from this numerical coincidence between the frequencies for seven octaves and 12 fifths. But there is still a slight mismatch in the frequencies—less than a quarter of the distance between two adjacent notes. 

Before Bach’s time, the typical approach was to “hide” this error in notes that the music was unlikely to use, like when you stuff your mess in a bedroom before guests come around. For example, if a piece of music is in the key of C major, it’s important for F and G to sound perfectly in tune, since they’re the fourth and fifth notes of the scale; but it’s less important for F sharp to sound right, since it will barely be used.

Musicians eventually had the idea of spreading the mess out more evenly so that no note would sound quite so wrong. This type of tuning of a keyboard is called “well-tempered,” hence the title Bach gave to his work. For the first time it was possible to play music in all the keys without some of them sounding out of tune, and Bach wrote a prelude and fugue in every key to explore and perhaps celebrate this fact.

People celebrate different things at this time of year, and many people have little to celebrate in 2020. But I will at least celebrate the beautiful effect that math can have on unexpected parts of life.