The Diabetes Heroes: Two Patients Who Changed Everything

After five years practicing as a family physician, I thought I had seen it all. From newborns taking their first breath to elderly patients in their final days, medicine had shown me the full spectrum of human experience. Yet among all the conditions I've encountered, diabetes mellitus remained my greatest challenge – common as rain, yet frustratingly difficult to control.

The routine was familiar: explain the diagnosis, order cholesterol and kidney function tests, discuss diet and exercise, prescribe the usual medications – metformin, gliclazide, empagliflozin, or sitagliptin. I'd refer patients for eye exams, check their feet, and hope for the best. Some patients managed well, others showed minimal improvement, and many struggled to meet their targets despite my best efforts.

My goal was always the same: prevent the devastating complications that diabetes can bring – blindness, foot ulcers, kidney failure, heart attacks, and strokes. But I'll be honest: the results were often disappointing, and I sometimes wondered if I was truly making a difference.

Then I met two patients who completely transformed my understanding of what's possible in diabetes care.

Kanthi: Faith, Determination, and a Miracle in Three Months

Kanthi was 60 years old when a routine blood test changed her life forever. The housewife had no classic diabetes symptoms – no excessive thirst, no frequent urination, no unexplained weight loss. She simply felt tired all the time, which she had attributed to getting older.

Her HbA1c result hit me like a thunderbolt: 8.5%. This wasn't borderline diabetes – this was full-blown, established disease. To make matters worse, her blood pressure was elevated at 160/80 mmHg.

When I broke the news to Kanthi, I watched her world crumble. "Am I going to die soon?" she asked, tears welling in her eyes. I spent considerable time that day counseling her, explaining what diabetes meant, and outlining the path forward. I started her on the standard treatment protocol: metformin, gliclazide, blood pressure medication, and a statin for cholesterol protection.

What happened next was extraordinary.

Kanthi became a student of her own disease. She called my clinic regularly with thoughtful questions. She devoured YouTube videos about diabetes management and read everything she could find. But more than that, she drew strength from her deep Catholic faith, viewing her diagnosis as a divine call to transform her lifestyle.

She embraced fasting not just as a medical recommendation, but as a spiritual discipline. She cut her carbohydrate intake to less than a quarter of what she had been eating. At weddings and family gatherings – events where food is central to Sri Lankan culture – she politely declined the rice, sweets, and traditional treats that once defined celebration for her.

Her commitment was absolute. She even explored Ayurvedic remedies alongside her prescribed medications, leaving no stone unturned in her quest for healing.

Three months later, Kanthi returned to my clinic with her follow-up blood work. I stared at the report in disbelief: HbA1c 5.5%. Her blood pressure had normalized to 120/80. She had lost over five kilograms and radiated energy I hadn't seen in her before.

"Is this a miracle?" I wondered aloud. But looking at Kanthi's transformed appearance and hearing her story, I realized it was something even more powerful: sheer human determination.

Ravi: From Crisis to Triumph in 90 Days

A few months later, I received an urgent online consultation request from Ravi, a 50-year-old businessman. His symptoms were textbook diabetes: excessive urination, constant thirst, and debilitating fatigue. As the father of two children with a family history of diabetes and a sedentary lifestyle, he was a walking risk factor.

When his blood sugar results came back, I nearly recommended immediate hospitalization: 450 mg/dl after an eight-hour fast. His HbA1c was 10.8%. This was dangerously high for a first-ever blood sugar reading.

During our video consultation, I could see the fear in Ravi's eyes as I explained the implications. I outlined the usual treatment plan and discussed the serious complications diabetes could bring – heart attacks, strokes, kidney failure, blindness, nerve damage, and sexual dysfunction.

"Doctor," he asked quietly, "is it possible to cure diabetes?"

I paused, choosing my words carefully. "Nothing is impossible if you can stick to the plan. Some patients have achieved remission through lifestyle changes alone."

That conversation sparked something in Ravi that I had rarely seen before.

He transformed his entire household. His wife also had diabetes, so the whole family committed to the lifestyle changes together. Ravi became meticulous about his diet, eating only home-cooked meals and dramatically reducing his carbohydrate intake. Dinner became a light affair. He walked 30 minutes every single day without exception.

Most remarkably, he approached diabetes management with the precision of a professional athlete. He checked his blood sugar regularly, called me twice a week with updates, and consumed educational content voraciously. Within weeks, his fasting blood sugar dropped below 100 mg/dl.

"Can I reduce my medication?" he asked during one of our calls. Given his excellent control, I agreed to discontinue one of his medications while maintaining the lifestyle changes.

Yesterday, I received a WhatsApp message that made my day – a photo of his latest lab report showing an HbA1c of 5.9%, firmly in the non-diabetic range.

The Real Heroes of Healthcare

These two patients fundamentally changed my perspective on diabetes management and healthcare in general. While I provided the medical framework and guidance, the real work – the daily choices, the unwavering commitment, the lifestyle transformation – came from them.

Kanthi and Ravi taught me that patients aren't just passive recipients of medical care; they can be the architects of their own healing. Their success wasn't due to any special medication or revolutionary treatment. It came from something far more powerful: absolute dedication to change.

Their stories challenge the conventional wisdom that diabetes is a progressive, irreversible condition. While not every patient may achieve such dramatic results, Kanthi and Ravi prove that with the right mindset, support, and commitment, extraordinary outcomes are possible.

As I reflect on their journeys, I realize that my role as a physician isn't just to prescribe medications or order tests. It's to inspire, educate, and empower patients to become the heroes of their own health stories.

In a healthcare system often focused on managing disease, Kanthi and Ravi remind us of something profound: sometimes, the most powerful medicine isn't found in a pharmacy – it's found in the human spirit's capacity for transformation.

They are the real heroes of healthcare, and their stories continue to inspire every patient I treat. After all, if they could achieve the impossible in just three months, what might be possible for others willing to take that same courageous journey?

 

When Bones Become Fragile: A Story of Prevention

Kumari was just going about her normal day at her shop when it happened. The 60-year-old woman was carefully climbing down the stairs when she lost her footing and fell. While she was grateful to escape serious head, neck, or back injuries, the sharp pain in her left wrist told a different story.

At the hospital, doctors confirmed what the tell-tale deformity suggested – Kumari had suffered a Colles fracture, where her wrist bone was pushed backward, creating a distinctive "dinner fork" appearance. The medical team quickly applied a plaster cast below her elbow to immobilize the injury and allow proper healing.

But Kumari's story raises an important question that affects millions of people worldwide: Could this fracture have been prevented?

The Hidden Culprit: Osteoporosis

What happened to Kumari wasn't just bad luck. Her fracture was what doctors call a "fragility fracture" – a break that occurs from minimal trauma, like a simple fall from standing height. These fractures commonly affect the wrist, spine, and hip, and they're often the first sign of a silent condition called osteoporosis.

Osteoporosis literally means "porous bones." It's a condition where bones gradually lose their density and strength, becoming fragile and prone to breaking. The frightening reality is that this bone loss happens quietly over years, with no obvious symptoms until that first fracture occurs.

Years earlier, Kumari had fractured her ankle in what seemed like a minor twisting injury. At that time, her doctor had prescribed vitamin D supplements after discovering her bones were "too thin." This was actually an early warning sign that her bone health was already compromised.

A Growing Concern in Our Community

In Sri Lanka, as our population ages, osteoporosis is becoming an increasingly serious health issue. The condition is more common than many people realize, partly because it often goes undiagnosed and untested until after a fracture occurs.

Several factors contribute to weak bones in our population:

Nutritional deficiencies are surprisingly common. Many people don't get enough calcium in their diet, and vitamin D deficiency is widespread – more than we might expect in our sunny climate. Inadequate protein intake also weakens our bones over time.

Lifestyle factors play a crucial role. Smoking, excessive alcohol consumption, and a sedentary lifestyle all contribute to bone loss. Additionally, certain medical conditions like diabetes and rheumatoid arthritis can accelerate the process.

Age-related changes compound the problem. As we get older, we naturally lose muscle mass and balance, making falls more likely. Poor vision and general frailty further increase fracture risk.

The True Cost of Fragile Bones

The impact of osteoporotic fractures extends far beyond the initial injury. These breaks can dramatically reduce quality of life, leading to chronic pain, loss of independence, and significant medical expenses.

Hip fractures are particularly devastating. Many patients become bedridden, leading to complications like blood clots, pneumonia, and muscle wasting. The surgical procedures and prosthetics required are often expensive and may be financially out of reach for many families.

But perhaps most importantly, these fractures are often preventable with the right approach.

Building Strong Bones: Your Defense Strategy

The good news is that there's much you can do to protect your bone health:

Eat for strong bones. Include plenty of calcium-rich foods like dairy products, leafy greens, and small fish with soft bones. Don't forget protein – your bones need it to stay strong. A well-balanced diet with adequate vitamins and minerals forms the foundation of bone health.

Stay active. Regular physical activity, especially weight-bearing exercises like walking, dancing, or climbing stairs, helps maintain bone density. Strength training and resistance exercises are particularly beneficial. Balance exercises can help prevent falls.

Make healthy choices. If you smoke, quit. Limit alcohol consumption. These habits directly damage your bones and increase fracture risk.

Manage your health conditions. If you have diabetes, rheumatoid arthritis, or other chronic conditions, work with your doctor to keep them well-controlled.

When to Seek Help

Doctors can assess your fracture risk using tools like the FRAX calculator, which considers your age, gender, medical history, and lifestyle factors. For a more detailed assessment, a DEXA scan can measure your bone density directly.

If your bone density is significantly low (a T-score of -2.5 or below), your doctor may recommend medications like bisphosphonates. These drugs help prevent further bone loss and can significantly reduce fracture risk. While they require careful administration – some must be taken while sitting upright and on an empty stomach – they can be highly effective.

Vitamin D and calcium supplements may also be prescribed to ensure your body has the building blocks it needs for strong bones. For women after menopause, hormone replacement therapy might be recommended to help maintain bone density.

Could Kumari's Story Have Been Different?

Looking back at Kumari's case, the warning signs were there. Her previous ankle fracture and thin bones should have prompted a comprehensive bone health assessment. Had her fracture risk been calculated and a DEXA scan performed earlier, appropriate treatment could have been started to strengthen her bones before this wrist fracture occurred.

Your Bones, Your Future

Kumari's story serves as a reminder that bone health isn't something to think about only after a fracture occurs. It's an investment in your future mobility and independence.

If you're over 50, have a family history of fractures, or have risk factors for osteoporosis, talk to your doctor about bone health screening. Simple lifestyle changes started today can help ensure that your bones remain strong enough to support an active, independent life for years to come.

Remember: the best time to start protecting your bones was 20 years ago. The second-best time is now.

Silent Burdens and the Power of Listening

 Silent Burdens and the Power of Listening

Today at the Katugastota Family Medicine Clinic was one of those whirlwind days—surgery lists, committee meetings, patients flowing in and out. Family Medicine is like that: one moment you’re removing a cyst or draining an abscess, the next you’re in a hospital boardroom.

Amidst this busyness, my medical attendant rushed in. “Doctor, there’s a patient for you.” I followed her to find an elderly gentleman seated quietly, his wife and niece by his side. His face carried the heaviness of unspoken pain.

As I asked how I could help, his wife answered instead—reeling off a list of complaints: body aches, chest pain, breathlessness. He was diabetic, asthmatic, and by all accounts, a man with multiple burdens. I suspected more than physical illness.

When I gently turned the focus to him, his composure broke. He cried, speaking of how he once lived a life full of activity and purpose, but now felt empty. Once employed in agriculture, he had been let go without a pension. His son had moved away. He felt reduced, invisible.

And then, in a moment of courage, he asked his wife to step outside. His voice dropped to a whisper.

“Doctor… I can’t have erections anymore.”

For six long years, he had carried this secret. He wanted intimacy with his wife but had been too ashamed to speak of it. “Those doctors were big people,” he said, “I couldn’t tell them. But with you… I can.”

It struck me how often patients suffer in silence—not from lack of treatment, but from lack of a safe space to speak.

I examined him, reassured him, and explained how diabetes, hypertension, and cholesterol could all contribute. We spoke about options, and after ensuring safety, I prescribed a medication that could help.

He walked out of my room transformed—his sadness replaced by a quiet smile. His wife, puzzled at first, seemed to sense his relief.

For me, the moment was humbling. Medicine is not only about treating diseases; it is about listening deeply, creating trust, and addressing the unspoken. Sometimes, the most powerful healing begins when a patient feels safe enough to tell you what they’ve never told anyone else.

This is the heart of Family Medicine.

Lessons Learned 🩺

• Men’s health matters: Many men hesitate to share sexual health concerns—clinics must provide safe, non-judgmental spaces.
• Listening beyond symptoms: What begins as “aches and pains” may hide deeper emotional or relational struggles.
• The power of trust: Healing often starts not with a prescription, but with the courage of a patient to share their truth—and the willingness of a physician to listen.

 

🩺 Staying or Leaving: A Doctor’s Reflection in a Time of Exodus 🇱🇰✈️

By Dr. Shane Halpe | The Family Doctor Blog

In clinics and corridors across Sri Lanka, a single question echoes more than any other:
“When are you leaving?”

It’s not about leaving for the day. It’s about leaving the country—for good. The reality is sobering. Over 10,000 doctors, nurses, and allied health professionals left Sri Lanka last year alone, heading to the UK, Australia, the Middle East, or beyond. The result? Public hospitals are overwhelmed. Doctors are burning out. And yet, the exodus continues—forming a vicious cycle that’s hard to break.

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📉 A System Under Strain

As someone still serving in the public system, I see this daily. Wards are packed. Clinics overflow. Patients wait for hours. The load on those who stay behind keeps growing, pushing many to the edge. Burnout isn’t theoretical—it’s real, personal, and creeping into every consultation room.

Government leaders offer mixed messages: On one hand, they speak optimistically at global forums. On the other, they assure us “there are enough doctors” or announce new hospitals in rural areas—plans that sound good on paper, but seem out of step with the shrinking workforce.

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🌍 “When Are You Going?”

As a Senior Registrar in Family Medicine, currently awaiting foreign training, I too hear the familiar questions:

• “Where will you do your training?”

• “Are you leaving for good?”

• “Why stay back when there’s no future here?”

• “Wouldn’t your children be better off abroad?”

It’s tempting. The idea of a more stable income, a predictable future, a comfortable lifestyle for my family—all are powerful draws.

Yet… something in me hesitates.

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🙏 A Bible Study, A Miracle, A Reminder

That hesitation deepened during a recent evening spent with a small group of Christian doctors and medical students. We had gathered for prayer and discussion. The topic? Career decisions and the desire to migrate.

We opened to a well-known passage: The Feeding of the Five Thousand (Matthew 14:13–21). A miracle I’d heard countless times—but this time, it struck a different chord.

“They do not need to go away. You give them something to eat.”
(Matthew 14:16)

The disciples had just returned from their own missions—tired, hungry, seeking rest. Yet, the crowd followed them, pressing in with needs and illnesses. Exhausted, the disciples asked Jesus to send them away. But Jesus, filled with compassion, responded differently. He saw the people. He felt their pain. And He chose to stay and serve.

With only five loaves and two fish, the disciples saw scarcity. Jesus saw abundance.

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🏥 Modern Echoes in Ancient Words

Reading that story again, I saw ourselves. The doctors, nurses, and medical officers working in rural hospitals. The interns stretched beyond limits. The specialists juggling too much with too little. We are the disciples—saying:

• “It’s too late now.”

• “This is a remote place.”

• “We don’t have enough.”

And Jesus still replies:
“You give them something to eat.”

We often focus on the miracle of multiplication. But what struck me this time was the compassion that moved Jesus to act. The same compassion we are called to reflect.

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🇱🇰 What Do We Have?

We may not have high salaries or world-class infrastructure. But what do we have?

• We have freedom.

• We have natural beauty.

• We have communities rich in resilience and heart.

• We have people—our people—waiting to be healed.

Maybe our wants have outgrown our means. Maybe simple living has fallen out of fashion. But as I reflected that evening, one question surfaced:

Is it really about what we lack—or is it about what we’ve lost sight of?

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❤️ I Stay Because of Compassion

In the end, it’s not an economic calculation that keeps me here. It’s a calling.
A pull that’s deeper than convenience.

Yes, I will pursue my foreign training. But not to escape.
Yes, I will go abroad. But I also intend to return.
Because our five thousand are still waiting.
And they are ours.

“What good is it for someone to gain the whole world, yet forfeit their soul?”
(Mark 8:36)

So I stay. I serve.
Not because it’s easy.
But because compassion still compels me.

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📝 If this reflection resonated with you—or if you’re a fellow health professional navigating similar questions—feel free to reach out or share your thoughts. Let’s journey together, with purpose.

A Costly Prescription: A Doctor’s Dilemma in a Broken System

💊 A Costly Prescription: A Doctor’s Dilemma in a Broken System

In clinical medicine, we’re trained to focus on the science—diagnosing the disease, selecting the most effective treatment, and prescribing accordingly. But what happens when the real challenge isn’t the disease, but the system meant to deliver the cure?

A recent encounter in my general practice made me pause and reflect on something I often overlook: the true cost of the medicines we prescribe, and the unseen burden it places on our patients.

The Patient Who Could Afford It—But Still Got Exploited

She’s a 65-year-old patient I’ve known for years—a respected general manager of a leading company. I’ve been managing her chronic conditions: diabetes, hypertension, dyslipidemia, and early renal impairment. She’s intelligent, disciplined, and financially well-off. In short, not someone who would flinch at the price tag of her medications.

But I was the one who flinched.

As a matter of policy and principle, I always prescribe using generic names. For example, I write Metformin, not the brand name. I do this to avoid pharmaceutical influence and to give the patient freedom to choose an affordable option. In my private practice, I usually stock essential medications myself—purchased wholesale from State Pharmaceutical Corporation (SPC) or State Pharmaceutical Manufacturing Corporation (SPMC) at a fair price.

However, this time, I had run out of stock. I sent her prescription—written generically—to a nearby pharmacy. What came back shocked me.

The Price Tag? Rs. 12,000 for One Month

Here’s what the pharmacy provided:

Empagliflozin – Rs. 2,900

Prazosin XL (2.5mg twice daily) – given at Rs. 5,000

Rosuvastatin 20mg – given in a brand name, costing Rs. 132 per tablet, totaling Rs. 3,920 for the month

That’s nearly Rs. 12,000 for just three medications. I couldn’t believe it. Yes, she could afford it. But is this fair? Is this ethical?

I immediately called the pharmacy and asked if they had any SPC or SPMC equivalents. They casually said yes. On requesting a refund and substitution, the Rosuvastatin brand was switched to an SPC version costing Rs. 42 per tablet—bringing the total for that drug down to Rs. 1,260. That’s a Rs. 2,640 difference—for one medicine, over one month.

Pharmacies First Offer the Most Expensive Brands

That experience opened my eyes. Pharmacies, especially when handed generic prescriptions, often offer the most expensive brand available by default. They don’t present options. They don’t explain price differences. They rarely ask if the patient prefers a state-supplied or more affordable version.

In a country where many families struggle to meet their basic needs, this practice is exploitative.

A Doctor’s Dilemma: What Should We Do?

This incident made me question my own approach. Should I start specifying not just the drug, but the manufacturer or brand? Should I write Rosuvastatin 20mg – SPC brand only? But that defeats the purpose of generic prescribing, which was meant to keep us impartial and patient-friendly.

It’s a real dilemma.

Should we prescribe the best-reviewed brand, the cheapest one, or the safest one—even if it's not affordable? When cost becomes a barrier, how do we balance clinical excellence with financial prudence?

The Bigger Picture: System Reform is Needed

This isn’t just a personal frustration—it’s a systemic problem. Without proper regulation, patients are vulnerable to profit-driven pharmacy practices. There must be guidelines requiring pharmacies to:

• Offer patients a choice between branded and generic versions
• Display transparent pricing for alternatives

• Honour prescriptions using state-manufactured medicines if available

Until then, doctors need to be more vigilant. Because not all our patients are company directors. For some, one month of medication is half their monthly income. That’s not just a clinical problem—it’s a moral one.

Prescribing With Heart—and With Eyes Open

Ultimately, this experience reinforced a truth I often forget: Prescriptions must be patient-centred—and pocket-centred. It’s not just about choosing the right drug for the disease. It’s about choosing the right drug for that patient, in that economic reality.

We may not be able to fix the system overnight, but we can start by being mindful, informed, and advocating for our patients at every step of their healing journey.

How Much Should We Help Others? A Reflection on Giving, Sacrifice, and Inner Peace

How Much Should We Help Others? A Reflection on Giving, Sacrifice, and Inner Peace

Growing up Catholic, certain teachings from the Bible etched themselves deep into my thinking. One in particular always stayed with me:

“If someone asks for your shirt, give him your coat as well. If someone forces you to go one mile, go with him two.”

I used to ponder: What does this really mean? Is it a call to blind generosity? To submission? Or something deeper?

For much of my life, I interpreted it quite literally — if someone asks for something I have, and if giving it brings more joy or benefit to them than it costs me, then I should give it. If someone makes my life difficult, perhaps I should still try to walk the extra mile — not because I must, but because choosing peace over resistance might serve me better.

But then I wondered: Is this foolishness? Shouldn’t we protect our time, our energy, our boundaries?

Over the years, I’ve come to understand these verses not as a call to passivity, but as a radical invitation to choose generosity and peace — intentionally. If someone wants to borrow something that still benefits me, yet benefits many others even more, I now try to share it freely. I might even give away the coat too.

And if resisting an unwanted burden only adds more tension and robs me of peace, sometimes it's wiser — and kinder to myself — to shoulder it quietly and move forward. It’s not weakness. It’s wisdom guided by peace.

After all, our journey on this earth is brief. The things we cling to — our possessions, our pride, our power — will not follow us when we go. What truly matters is the good we do, the lives we touch, the suffering we ease. Whatever faith or belief system we hold, if it leads us to love, uplift, and care for others — then it’s pointing us in the right direction.

Jesus made the ultimate sacrifice — not just by dying on a cross, but by choosing to give up what was rightfully His, so that others might live.

“If you want to gain your life, you must lose it.”

To me, that means letting go of our obsession with material things, power, lust, and greed — so we can embrace something deeper, something eternal.

Because in the end,

There is no greater love than to lay down one’s life for a friend.

And maybe, just maybe, the most generous thing we can give is not a coat or a mile — but our time, our presence, our peace.

A Medical Conference… and the Spark of a Story

It was the much-anticipated stroke conference in Jaffna. Our supervisor had encouraged us to attend—not just to stay updated on the latest in stroke care, but also to network with professionals in the field.

I was genuinely excited. It was a refreshing break from the regular rhythm of clinic life. Plus, I couldn’t deny my eagerness for the inevitable conference buffet—the kind of culinary delight that always adds a silver lining to academic events.

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A Chance Encounter in the Lift

The venue was the Thiruvalluvar Cultural Centre, nestled close to the Jaffna Public Library. As we entered and stepped into the lift, just as the doors were about to close, they slid open once more.

A beautiful girl stepped inside.

She gave a shy smile and glanced briefly at the three of us before the lift ascended in silence to the second floor. As we exited, and she was safely out of earshot, my married colleague nudged me and whispered with a grin,

 “Why don’t you consider? She looks pretty.”

This had become a routine jest—the kind of light teasing I often received as the only single one in the group. I laughed it off, as always.

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Lectures, Pharma Stalls, and Dessert

The conference rolled on. Some lectures were insightful, others not so much. We moved in and out of sessions, networked with old friends, and browsed through the pharma company stalls, collecting pens and pamphlets as one does.

Then came lunchtime. We were welcomed by a vibrant spread of curries, salads, and desserts. As we settled in to enjoy our meal, my other colleague—also unmarried—spotted the same girl from the lift now sitting alone at a table nearby.

“She looks nice,” he said thoughtfully. “Feels like talking to her.”

Without missing a beat, our ever-cheerful married friend grinned,

 “Machan, go for it.”

My friend’s eyes lit up. He smiled, nodded, and thanked him for the encouragement.

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A Curious Excuse and a Bold Move

As we were about to leave the dining area and return to the hall, my friend suddenly announced,

“I need to wash my hands.”

I pointed toward the wash basin and continued chatting with my other colleague. A few minutes later, I turned around and—there he was. Not at the wash basin.

He was talking to her.

The two were engaged in conversation, smiling and laughing. And before long, we saw them exchange numbers.

It was only then that I remembered—he had been eating with a fork and spoon.

So why the urgent handwashing?

I laughed to myself. The “handwashing” was merely the exit strategy for something far more interesting.

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The Beginning of a Story?

As I watched them talk, I thought, This could make a good story.

Or maybe, just maybe, it’s the beginning of one.

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Sometimes, the most unexpected moments at a conference have nothing to do with medicine—but everything to do with life.