Monday, October 31, 2011

Deus ex Machina

"We're all puppets, Laurie. I'm just a puppet who can see the strings."

Dr. Manhattan in Watchmen

Names were changed to protect the privacy of the parties involved.

"This is a very severe case of bilateral ventriculomegaly. The atria of the lateral ventricles measure more than 30 milimetres each!" said Dr. Nic. "The thalamus is also absent. I can't say for sure since I am unable to do any 3D scanning with this machine, but I suspect that there is agenesis of the corpus callosum as well."

He was clearly narrating for my benefit rather than for the mother of unborn child he was performing the ultrasound scan on. The woman could neither speak nor understand English, and even if she could, she would still come against the layer of Latin jargon which we medical types use to sound smart and to shield our conversations from lay ears.

"The head is far too big to be delivered vaginally," he went on. "It had to be taken out through a C-sect."

After peering into the Rorschach greys of the monitor to his satisfaction, he hung up the transducer and then went to his computer to compose his report. "There's no way of even knowing how long the baby would live after its birth," he said as he typed. "The prognosis is very bad."

He attempted for a moment to explain to the expectant mother and her mother-in-law who accompanied her about his findings but then gave up before turning to me, asking me for the Malay words for "mental retardation". I supplied them, and he then proceeded to break the bad news to her in his halting, syllabic attempt at our national tongue. It sounded blunt because he had not attained mastery yet over the usual sympathetic inflections. Meanwhile, the woman sitting in front of us was slowly processing the information she just received into tears.

"How do I tell her that the baby might even die in utero?" he asked me next. I took over from there and re-explained everything in the most delicate way I could. But what could I do, really? No matter how soft the words are, the news were still going to crush her like runaway bullet train out of nowhere. Her little babe was more than 30 weeks old, more than three-quarters of the way to the beginning of its new life - and up until that moment, she had been picturing a plump, gurgling, pink-cheeked cherubim in her mind. That picture was shattered in a second. No one expects to give birth to a mistake of nature.

"This is not your fault," I continued in Malay, pulling a few tissue from the dispenser and handing them to her. She eagerly accepted them and buried her face. "It's hard to say at this point what caused this to happen, but the child was probably formed this way from the very beginning." I avoided explaining that it could have been genetic, chromosomal or developmental because these are details she neither need nor understand.

"So, the baby is fated to be this way?" she asked quietly.

"Yes, you can say that," I answered cautiously. Fate to me is just another word for determinism but it probably meant something entirely different to her. Most people ascribed a force of agency to causality; some kind of anthropomorphic decider of destinies that has a Plan all laid out for everyone from the beginning of the universe. God, they call it.

The effect that simple idea had on her was startling. She calmed down visibly. Suddenly, the random, senseless tragedy turned into a scheduled itinerary in her life. I practically saw it clicked into place like a programmed protective subroutine in her brain, and it's uncanny. For a moment, I pierced the illusion and saw what we really are: highly sophisticated biological robots, but robots nonetheless. And we have found a way to short circuit grief.

"It's fate," her mother-in-law said, reinforcing the meme. "This is God's will."

God can mean anything we need. God can mean that there are no accidents. He can mean that all the bad things that ever happened to us are just secret tests of our characters or faith; and that all of it serve some nebulous higher Purpose. He can mean that there's a special place in the hereafter where the woman will reunite with her malformed child who was miraculously made whole and unbroken, along with everyone else she ever loved and lost, while everyone else she dislikes - murderers, paedophiles, rude individuals, or people who simply do not believe in the same beautiful fantasy she does - are summarily excluded from it for eternity. God WILL fix everything in the end, and give us our obligatory happy endings.

"This is God's will," the pregnant woman agreed, drying her eyes. And in them, I saw the invention of God, as He had been invented over and over again since the very first tragedy struck the very first man.

Homo ex machina,
k0k s3n w4i

Saturday, October 29, 2011

The Curse of Epicurus

"Human, I wonder why you’re a better make than I could ever build or create
You know not love or hate
I am so scared of what will kill me in the end for I am not prepared
I hope I will get the chance to be someone, to be human
Look what we’ve done
Look what we’ve done"

Human (2010) by Ellie Goulding

If everything goes according to plan, I'll be graduating my first posting in a fortnight. Ob and Gyn is not my favourite cocktail in the bar but the taste sort of grows on a person, you know?

Recently, I received an insight into how I was selected to be one of the two house officer leaders in the first place. A couple of days ago, I approached the medical officer in-charge of house officers to tell her that I'm leaving soon and that she would have to get another sucker outstanding individual to fill the vacuum. She told me to rattle off a string of names at random but she didn't like the sound of any of them. Then, one of my colleagues happened to stroll by and she decided on the instant that he should be the next HO leader. I half-expected her to holler "Pikachu! I choose you!"

While it's gratifying to know that I was one of the HO's she disliked least, I also know now precisely which of my coworkers she outright disdains - and I'm not quite sure what to do with that knowledge. It also made me wonder: which of my many bosses secretly hate my guts?

In a post-round powwow last Wednesday, a specialist singled me out openly as an example of a good house officer - and that totally made my day. I also secretly hate it that it can make my day. It made me feel like a spaniel pup, ever-eager to please; fetching papers and and bedroom slippers just for that little pat on my foofy head. And I also find his praise perplexing because I don't think I'm cleverer or more hardworking than any other house officer in the department. In my mind's eye, I honestly see myself as a middling worker with no loftier goal than surviving the posting without beeping too loudly on anyone's radar.

On Thursday, said specialist excused me from the afternoon round and summoned me down to his office in the clinic where he had me "chaperone" as he scanned a few patients. To "chaperone" in medical parlance meant sticking around to make sure that nothing sexy happens between a doctor and his female patient - and chaperones are always women. By the virtue (or sin) of being male, I am technically not qualified to do any chaperoning, so his request struck me as being more than a little bizarre. He then proceeded to give me a crash lecture on scanning for fetal anomalies (which I only have a very elementary understanding of) and when he was done with the patients, he proceeded to show me a few 3D sonographs of brain defects in unborn babes in his collection - which I thought were pretty damn neat. In the meantime, my partner had to do all the ward work in my absence while I essentially had a one-on-one teaching session.

I felt out of my depth then; like I'm in a race where which was rigged for me to ultimately disappoint whoever that is fool enough to bet on me. I have no ambitions to speak of. I do not aim to be better than everyone else in anything I do (and frankly speaking, I don't see my destiny in medicine at all). Whatever it is that's the opposite of a go-getter, I'm it personified. I'm so much of a beta male that if I'm a girl, I wouldn't want to fuck me.

My idea of a perfect life is that of a wealthy Victorian highborn lady who does nothing but write, read or paint, and is free to pursue studies in whichever subject she fancies because no one expects her to amount much to anything anyway. In 21st century terms, what I'm saying is that I want to be Paris Hilton, but classy.

Dreaming of pipes,
k0k s3n w4i

Wednesday, October 19, 2011


"For here you are, standing there, loving me
Whether or not you should
So somewhere in my youth or childhood
I must have done something good"

Something Good from The Sound of Music (1965)

I've been gone far too long, I know, but just for the moment, I'm back. I have not written anything that's not a patient report or a discharge summary in an entire month, and I can't imagine that being very healthy for my psyche. Some people meditate or do yoga. Some hang out with friends. My thing is: I write.

I have a hundred specific things I want to write about but I fear I have neither the stamina nor drive to put them in words today. Today, I just want to talk in a vanilla Dear Diary kind of way about nothing.

Recently, I had a rather pernicious duty foisted on me by the boss - I was put in charge of the duty roster and my job is to distribute my department's manpower pool of half a hundred junior doctors to ensure that we remain smoothly operational. It's a much tougher job that it sounds. I receive complaints and demands in all hours of the day (and some hours at night) from the house officers I expected to herd and organise; all of them fighting over valuable operating theatre time which enables them to perform the required procedures which are prerequisites to graduating the posting. I receive a daily stream of complaints and demands ranging in tone from angry to weepy, and let me tell you: I find anyone in tears to be very off-putting. It throws me into traumatic flashbacks of my previous relationship with the Ex-Grrrfriend™.

Yesterday, a specialist texted me and asked me if I would like to participate in the research team of a study he was planning to launch, and I said "I do" and kissed the metaphorical bride. I don't fully know if I should have committed to it but research is something which I find far more fascinating than the care-giving facet of medicine - even if its in OB/GYN a specialty I'm not particularly fond of. But I certainly hunger for the experience. Tomorrow, I'll be meeting said specialist and be briefed on the details and all its devils. We'll see how it goes then.

Currently, I'm quite taken in by the soundtrack to Kari-gurashi no Arietti (or The Borrower Arrietty) which was written and performed by French French-Brettone singer and harper, C├ęcile Corbel, who sang in endearingly broken English and presumably broken Japanese as well. There are very warm and homey Celtic and Oriental fusion tones in the music and I couldn't stop listening to them. Also, after watching Arrietty, I'm increasingly convinced by the inherent advantage animated films have over their live-action counterparts. In live action movies, we see characters being played by recognisable stars we've seen in other works and in their usually very public lives, and the "reality baggage" can sometimes intrude into the performance. With animated films, particularly those voiced by obscure voice actors or seiyuu, the characters lives and breathes only within the movie's universe. In a way, I am far more likely to forget that they aren't real, and that makes me care more about them.

A couple of days ago, I discovered that there's a cineplex located a mere five minutes walk from where I live. I simply went to my fridge, grabbed a bottle of ice-cold ginger beer and a bag of crispy nori snack, walked a block down the street, and saw Warrior (because Tom Hardy ignites my latent homosexuality even more than Michael Fassbender). It's the next best thing to having my own private movie theatre. Sure, it's seedy and looks like one of those places which show nothing but skin flicks to half a dozen furiously-masturbating 40-something lonely dudes per screening, but it's still serviceable. Besides, it's on the 9th floor and has a romantic night view of the city and the river, and that's worth something. I daydreamed for a minute of buying the place, refurbishing it and turning it around - and then the beautiful madness passed.

k0k s3n w4i