Doctor - a zigzag journey

Part 27 - 'You see no field (Eosinophil)' "What?"

Background: 2001 - 2003 (Age 34 - 36 years)

Sitting among the younger medical students in the lecture hall, I felt old. The lecturer who taught us anatomy came from India. He left his lecture notes on the front stage. Soon most medical students swarmed to the front stage to grab the lecture notes before the lecture started. I followed the crowd. He lectured in English but in a thick Indian accent. Some of the words were hard to comprehend; I turned to the guy who sat next to me for help.

In a lecture on the respiratory system, I learned that there is an anatomic dead space in the airway from the nose down to the terminal bronchioles (the smallest branch of the airways). The anatomic dead space fills with inspired air that is exhaled unchanged. It is known as a 'dead space' because it does not involve in gas exchange. Simplistically, gas exchange means oxygen diffuses from the alveoli (the tiny air sacs in the lungs) into the blood and carbon dioxide from the blood into the alveoli for exhalation. A 'dead space' within a living body! I reflected this on my past working experience during which I travelled and visited many organizations as an engineering consultant. In some organizations, there was an 'anatomic dead space' in which the unit of a department existed but without participating in an active role. That was a dilemma, perhaps. Now, my mind should be adjusted towards medicine.

I would like to attend an autopsy (dissection of a dead body to discover the cause of death). I was planning to do autopsy during my elective term overseas in my second year. This was something that I was looking forward to.

After attending a few lectures on anatomy, physiology, biochemistry, microbiology, and pathology, the students were to attend a problem-based-learning (PBL) tutorial in small groups. The youngest student in my group, WT, was about 18.

"Should I call you uncle?" WT asked me in the first tutorial class. WT is a courteous person. He can speak Mandarin too.

"Oh, just call my name, Kam Cheong," I replied in an embarrassed voice. I wouldn't like my classmates to call me uncle in a class. Literally, WT was right; he was 15 years younger than me. Since then, WT called my name. We got along well, and the 'generation gap' gradually disappeared.

In a PBL class, a tutor facilitated discussion of a clinical vignette and wrote many learning topics related to the case on a white board. Each student volunteered to take up a few learning topics as homework. We were to search for the relevant information from various sources e.g. textbooks, reference books, medical journals etc. Then, we shall meet again the following week to discuss the clinical case again. In the afternoon, many students attended laboratory-based activities, spent time in the library preparing for the PBL, did self-directed learning (SDL), explored online learning modules and so on.

One afternoon, I attended a "haematology laboratory" session.

"Students, use this sterile needle to prick your finger, squeeze and smear a drop of your blood on this slide, .............and view it under the microscope," the haematology lecturer (Dr. AR), who earned her Ph.D. from the Cambridge University, said in a voice full of enthusiasm. She loved blood.

We did as we were instructed. I tried my best to focus on the field under the microscope to see various types of blood cells. I couldn't see clearly. I was in a panic trying to focus the field! Was I suffering from presbyopia (farsightedness)? I thought it could be a bit too soon to suffer from presbyopia at age 33.

"Hey, 'you see no field'!" the student who sat next to me said in a happy voice.

"What?" I felt embarrassed that he spotted me 'see no field' under the microscope. How did he know that? My body language gave away my ignorance?

"I can see eosinophil, a type of white blood cell!" He articulated clearly this time.

Oh, he said 'eosinophil' which sounded like 'you see no field'! My embarrassment was over.

"Can I view it please?" I asked.

"Sure," he replied.

Wow! I saw the 'bloody' eosinophil that caused the embarrassment – 'you see no field'. Eosinophil plays an important role in killing parasitic worms.

That was my first view of blood cells! We have trillions of blood cells serving us faithfully. If the cells turn malignant, we will be in trouble.

I was exhausted by late afternoon. But, my younger classmates were still full of energy!

"Kam Cheong, do you want to go rock climbing with us?" DL asked. DL seemed to have a 'happy go lucky' personality.

"No, thanks for asking anyway," I turned down the invitation. I have to catch up with my homework and also look for a part-time job.

I walked back to the rented apartment. My apartment-mates and I sometimes took the turn to cook and share dinner, sometimes we went out to the night market to eat. My favourite foods were fried noodle and 'chee cheung fun'. They were relatively cheaper too.

The desk lamp was turned on; a haematology textbook was opened; I was revising the morning lesson.

The chapter read "There are five types of white blood cells in the body: neutrophils, eosinophil, basophil, lymphocytes, and monocytes. Lymphocytes are divided into three types of cells: T cells, natural killer cells, and B cells. All three types of lymphocytes help the body defend itself against disease." Wow, they are the soldiers who defend us! It was pretty exciting to read the chapter on how these cells defend us like in a 'star war'! The cells have various shapes. The neutrophil looks like a 'smiley' cell because it has a multi-lobulated nucleus which makes it look like a smiley face (see the image in this chapter). Well, I felt the 'smiley' cell consoled me. This consolation was much appreciated after the 'ridicule' by eosinophil ('you see no field').