Medical School
On a bright Monday afternoon of September in 1963
I queued up outside the Registrar’s Office of the
Even in those days the London Examination Boards’
standards were considered at least two notches down and the
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
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
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
It was an interesting time. Most of us in Hong
Kong were “refugees” from the communist uprising in
Here I was, standing outside one of
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
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
Somehow the majority of us survived, and we moved
on.
Morrison Hall
Robert
Morrison was one of the first non Catholic missionaries in
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
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
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
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
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
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
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
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
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
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.
Without
much public health education, most mothers in
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
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
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
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
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
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
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
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
[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
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