Eternal Maternal?

Some things are just not said, just not considered. They fall so far outside of our Weltanschauung they are inadmissible. And we take such comfort in their ubiquity that we no longer feel a need to discuss them. They are so self-evidently true, so axiomatic to our understanding of existence that they seem indispensable. Crucial… Even transcending the need for sentience.

Maternal instinct, for example -the irrevocable compulsion of a mother to protect her offspring even at the expense of her own safety. Characterized as selfless and incorruptible, it often escapes the genetic prison of species boundaries. It is one of those rare attributes that has such survival benefits that it blossomed under the rigorous pressures of evolution. It really is, at least in hominid terms, sacrosanct.

Or is it…? Sometimes there is a need for stepping back from the forever-yawning abyss of unquestioning acceptance. After all, what is instinct? Is it just an under-examined behaviour whose pervasiveness has convinced us of its Darwinian utility? Or is it something else –a hope, maybe? A tachistoscopic view of that which we would like to believe has survived the rigours of the collapse of Eden?

A rather obscure article in the Guardian newspaper –one of many, once I discovered it- attempts a more dispassionate analysis of the universality of maternal instinct: https://www.theguardian.com/commentisfree/2017/may/30/detach-myth-motherhood-from-reality-future-generations?CMP=share_btn_link

It’s addressing the expected attitude of the mother to her baby and the seemingly global societal requirement of her self-effacing altruism towards it –and usually the offspring of others, as well. It’s not attempting to comment on whether or not the woman chose to become a mother –or indeed, whether that might play a major role in her subsequent attitude towards the responsibilities involved. It’s more concerned with the fait accompli.

I have discussed the issues and deeply-rooted cultural assumptions around the decision whether or not to become pregnant in the first place in a separate essay in June 2015: To Have, or not to have ( https://musingsonwomenshealth.wordpress.com/2015/06/02/to-have-or-not-to-have/ ).

No, the Guardian article questions not so much the concept of maternal instinct, as its expanse –or perhaps more accurately, its inexhaustibility. Its sempiternity… ‘[…] maternal instinct is not a switch that exists in every woman, ready to be flipped as soon as she smells a baby. Relationships between mothers and their children are frequently far more fraught than the myth leads us to believe. It shocks us that mothers can be selfish. […]There is scientific evidence to suggest that the maternal instinct may even be contingent on a woman’s circumstances.’

In fairness, I suspect that the article may be a sort of authorial apologia: ‘I myself have had to face down questions from family, friends and even strangers who don’t understand my wish to have only one child. The thought of having more children terrifies me, and has nothing to do with the love I feel for my son. […] a similar argument can be made that maternal instinct may sometimes depend on whether a mother has the support she needs. We’re not a species designed to cope alone. Indeed, we’re at our most social when it comes to parenting, often recruiting many people around us to help. It really does take a village to raise a child. Without any help, it can be desperately tough.’

The author feels that the ‘reasons why women feel the way they do about children is under-studied’ and I certain agree. ‘[…]motherhood is not always an against-all-odds epitome of selfless caring. Sometimes it can involve emotional calculation, weighing the needs of both parent and child. We all assume that a mother always wants the best for her child, above her own needs. What we seem to deliberately ignore is that a child’s welfare can also depend heavily on the mother’s own needs being met.’

Near the end of her essay, I think she makes it clear why she felt it necessary to discuss the topic: ‘For the sake of both mothers and children, we need to begin detaching the myth of motherhood from the reality. It’s unfair of any society to expect women to be the best mothers they can be without economic or emotional support, just because they should love their children.’

I would like to think that as an obstetrician I am not a completely disinterested party in all this –although, of biological necessity, I approach the subject as a non-participant. And now, in retirement, perhaps even more so -I watch from the shadows, as it were, but I’m nonetheless attentive to the roiling milieu. It’s hard to ignore.

I was sitting in the corner of a coffee shop recently, enjoying the relative solitude, when two women sat down at the table next to mine.

“My daughter keeps foisting the kid on me whenever she wants to go out,” one of the women said to her friend.

Emily, you mean?” the friend said with a slow, disapproving shake of her head. “And Jacob…” It was obvious that she objected to a mother –not to mention a grandmother- talking about her family as if they were nameless burdens. Then her expression softened. “My Louise used to do that, I remember. She’d show up at the door unannounced and put Andrew in my arms…”

The first woman took a sip of her coffee and shrugged. “I suppose they all do it, eh Joyce?”

Joyce smiled at the thought. “I used to enjoy the challenge of working Andrew into my day.”

Joyce was a happy person I thought, as I tried to pretend I was reading my book, unaware of their presence. She was probably in her fifties, dressed casually in a grey sweatshirt and dark green track pants, and looking for all the world as if she was enjoying her life.

The woman beside me, however, was tense. I could hear the frustration in the timbre of her words.

“It’s just not fair, though,” she said to Joyce, her voice almost whining.

Joyce’s eyes twinkled even in the soft light of the corner where we sat. “Mothers have to have a break, Mary…”

“Break?” Mary interrupted angrily, “I never got a break, Joyce! I had to bring up two kids all by myself after Ralph left… By myself!”

I could almost feel the exclamation mark slamming onto the table in front of her.

It clearly upset Joyce, and I could see her taking a deep breath before responding. “Wouldn’t you have loved it if you’d had someone to leave them with every once in a while?” Her eyes were spotlights focussed on Mary’s face.

Mary shrugged again. “But I didn’t, Joyce… That’s the point.”

A tenderness suddenly appeared on Joyce’s face and she extinguished the angry glare as she  recalled her eyes. “But Emily does, Mary… And that’s the point,” she said, almost in a whisper.

I’d finished my coffee by that point, so I thought it might seem rude to continue to sit there and listen. But as I l pushed back the chair to leave, I couldn’t help but notice the smile that had finally surfaced on Mary’s face. And something deep inside me smiled, as well; the course of true love never did run smooth

 

 

 

 

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A Plague on Both Your Houses

The plague –nothing conjures up death quite like that word -after all, the bubonic plague wiped out half of Europe in the 14th century. But there have been others of its ilk –and all probably caused by the Yersinia pestis bacterium. Although the yet-unnamed infectious agent was identified in the 1890ies by the bacteriologist Alexandre Yersin -working at the time in the Pasteur Institute on plague samples from an outbreak in Hong Kong- the name was initially misattributed… Never work for somebody really famous when you discover something important. Personally, I preferred its previous name of Pasteurella pestis because that’s the name I was first taught and I liked the alliteration. But never mind.

The plague has three different presentations, depending upon the organs infected: bubonic plague, from infection of the lymphatic system and localized as buboes (swellings of infected lymph nodes which may become necrotic and turn black in their attempt to defend the body); pneumonic plague –infection of the lungs, presumably from aerosolized droplets from coughing or the like; and the rarest and likely most fatal of the three, septicaemic plague, which is an infection of the blood stream. All are carried by fleas, which are carried by rats, which then carry them to us.

Although we tend to associate the word ‘plague’ with the infamous ‘Black Death’ of European fame -not least because of the shock value of its name, I suspect- there have been several plagues throughout history. The first was originally thought to have been as early as 430 BCE in Athens, but a study published in the journal Cell in 2015 suggests that it began long before that –about 5,353 years before, actually. But perhaps a more assimilable article that outlines the background is found in a BBC news report, also in 2015: http://www.bbc.com/news/health-34603116

‘Samples taken from the teeth of seven bodies contained traces of the bacterial infection in the Bronze Age. They also showed it had, at the time, been unable to cause the bubonic form of plague or spread through fleas – abilities it evolved later.’ You have to love this kind of information, eh?

‘In its early days, it could cause only septicaemic or pneumonic plague – which is nearly always deadly and would have been passed on by coughing. By analysing the bacterium’s genetic code through history, the researchers estimate it took until 1000 BC for plague to evolve into its more familiar form. One mutation – acquiring the ymt gene – allowed the bacterium to survive inside the hostile environment of a flea’s gut. […]Developing a separate gene, called pla, allowed the infection to penetrate different tissues and cause bubonic plague.’

But all things change, don’t they? Things fall apart; the centre cannot hold, in the unforgettable words of Yeats. And yet why would a pathogen evolve to destroy the very hosts on which it depends? Why burn the hotel…?

I suppose an easy explanation might be that of a game in which each side –host/pathogen- continually attempts to outsmart the other. More virulence in the invader leads to more defensive mechanisms in the invaded –things as overt as quarantine or antibiotics, to the more subtle, but hopefully preventative development of immune resources by vaccination or over the longer term, adaptation of endogenous immune defenses: survival of the fittest.

But for me, the intriguingly unanswered question still remains: why kill your host? Why not coexist as, say, a parasite –or even a commensal- in the gut, or create a chronic condition that might weaken the owners, but not eliminate them? Of course, some pathogens are just evolutionary dead-ends – fireworks that illuminate the sky briefly and then disappear as suddenly as they appeared, or maybe finally settle into a desk-job and plod along just under the radar. But I suppose even germs want some time on the pedestal, though. Nothing ventured, nothing gained… Ecological opportunities beg for exploitation –leave a window unlocked, and something will find it.

Of course there are other ways of making a living: attack and retreat to fight again… While not strictly analogous, I am reminded of the Champawat tiger of Nepal (and later in the Kumaon district of India) in the late 19th century. She used to attack suddenly and then disappear before anybody could do anything about her. True, she was finally shot, but not before she’d managed to kill almost 450 people in different locations and instilled fear of her return for years. Fear is like that –especially fear of what Donald Rumsfeld (a once upon a time U.S. secretary of Defence, remember?) oxymoronically called the ‘known unknowns’.

The plague has managed a similar trick over the centuries, flaring up in one region, only to hide, then reappear in a totally different region later –often much later. ‘The most recent plague epidemics have been reported in India during the first half of the 20th century, and in Vietnam during wartime in the 1960s and 1970s. Plague is now commonly found in sub-Saharan Africa and Madagascar, areas which now account for over 95% of reported cases (Stenseth, 2008)’ [https://www.cdc.gov/plague/history/index.html]

But, even those of us living in North America are not entirely safe -remember that Hong Kong plague that Yersin was studying in the 1890ies? A ship from there arrived in San Francisco in the summer of 1899 with plague found among some stowaways, two of whom escaped and drowned in the Bay. An epidemic of plague hit San Francisco nine months later. Whether it was from them or from rats that swam ashore, is not known, but the disease has been with us ever since.

http://www.livescience.com/51792-plague-united-states.html  ‘Plague cases occur sporadically in the United States — between 1970 and 2012, an average of seven plague cases occurred yearly […] But plague cases don’t show up everywhere. Rather, most occur in rural areas in western states […] the CDC says. One reason why cases of plague are restricted to the West is that the rodent populations there carry the disease […] “Prairie dogs are one of the major rodent species that serves as a reservoir for plague, and they tend to be west of the 100th meridian” in the United States. For this reason, this line of longitude is sometimes referred to as the “plague line”.’

What, will the line stretch out to th’ crack of doom? asks Macbeth. I suspect that he would have found it fascinating that any of us would think we might be immune from history. And yet, despite all its bad press and the terrifying epithet of ‘Black Death’, plague cases in North America are rare. They can occur when people visit rural areas, says, Dr. Adalja, an infectious disease specialist at the University of Pittsburgh’s Center for Health Security, although ‘people are more likely to be infected with tick-borne illnesses such as Lyme disease, than plague.’

Uhmm, I’d be careful with squirrels in California, though…

 

 

 

 

 

 

 

 

Peekaboo

Seeing is believing, my mother used to say when she saw I hadn’t finished the spinach on my plate despite my protestations to the contrary. But what if the belief were to persist in the absence of visual corroboration? Suppose I simply closed my eyes and pointed at the plate? My mother, no solipsist, would merely laugh and tell me it would still be there if I ever chose to open my eyes again. I could never win at that –her open eyes trumped my temporarily closed ones every time. I tried that ruse so many times, I got so I could actually see the spinach and the plate even with my eyes firmly clamped shut.

Perhaps I was a slow child, but it did make me wonder about what seeing actually meant. Was it something that could continue even when I tried to turn it off? In the bedroom at night when the blinds were drawn and the room was black, I could still navigate fairly well -and if I did bump into something, I could usually sense it just before the collision.

People talked about noticing things out of the corners of their eyes –meaning when they weren’t looking at them, I guess- and when I grew older, I learned about the sensitivities and image resolution of different cells in the retina. The cone cells in the macula –which you use when you are actually looking at something- were good for colour discrimination and fine resolution, whereas the rod cells, peripheral to that, were more sensitive to light, but not at resolution.

That weird sensation of thinking someone is looking at you, I assumed, was something detected in that peripheral part of the retina by the rod cells –noticed, but not readily identified, and maybe, therefore, not consciously processed until you turned to focus your cones cells on it. It made sense, but every so often I am thrilled to find others who continue to be intrigued by the process: http://www.bbc.com/future/story/20170512-what-causes-that-feeling-of-being-watched

I had assumed that it was fairly straightforward –light hits the retinal cells in the eyes, the signal travels to the visual cortex in the brain, and then it makes us conscious of what the signal means. But, of course, it’s not quite as simple as that. ‘Once information leaves our eyes it travels to at least 10 distinct brain areas, each with their own specialised functions. […] The visual cortex supports our conscious vision, processing colour and fine detail to help produce the rich impression of the world we enjoy. But other parts of our brain are also processing different pieces of information, and these can be working away even when we don’t – or can’t – consciously perceive something.’

So what would happen if your visual cortex were destroyed by a stroke or trauma of some sort? You’d lose your conscious vision –your cortical vision… but ‘cortically blind is only mostly blind – the non-cortical visual areas can still operate. Although you can’t have the subjective impression of seeing anything without a visual cortex, you can respond to things captured by your eyes that are processed by these other brain areas’ –Blindsight, as a researcher name Larry Weiskrantz called it.

The BBC article reported on a study of a man with just such a condition. They were able to do a functional MRI to watch his brain while faces were presented to his ‘blind’ eyes. ‘The scanning results showed that our brains can be sensitive to what our conscious awareness isn’t. An area called the amygdala, thought to be responsible for processing emotions and information about faces, was more active when TD [the patient] was looking at the faces with direct, rather than averted, gaze. When TD was being watched, his amygdala responded, even though he didn’t know it.’

Exciting stuff. ‘[…]research like this shows that certain functions are simpler and maybe more fundamental to survival, and exist separately from our conscious visual awareness. Specifically, this study showed that we can detect that people are looking at us within our field of view – perhaps in the corner of our eye – even if we haven’t consciously noticed. It shows the brain basis for that subtle feeling that tells us we are being watched.’

The article reminded me of something that happened long ago in my gynaecology practice. At the time it seemed a rather trivial incident, but I suppose the fact that I can even remember it suggests that I found it intriguing nevertheless.

Prisha –I think that was her name- was a young woman whose baby I had delivered, a few years before. She returned every two or three years for her pap smear but I remember being surprised to see her again only a few months after her last visit. A tall, beautiful woman with what seemed to me to be an exquisite taste in saris, it was hard not to notice her in the waiting room whenever she visited. Long black hair that never managed to hide the large gold earrings, and the red bindi in the middle of her forehead marked her as an immediate attraction for whatever children happened to be playing on the carpet with their toys.

That day, however, their attention seemed to be focused on an older lady sitting beside her like a queen. Regal in bearing and bolt upright in posture, she was wearing a dark blue sari with gold trim, and as I recall her snow white hair was tucked away under a lighter blue scarf. I suppose what drew my attention to it was that she sat beside her daughter with her eyes closed even when she talked. A tow-headed little boy with large, blue, curious eyes was standing a few feet away staring at her. He would have been too young to have been Prisha’s son, so I assumed he was just fascinated, as I always was with the saris that Prisha wore. But it was more the older lady that had captured his eyes. As soon as I walked across the room to greet them, the little boy ran back to his mother who was sitting beside the window, but he continued to watch from the corner.

I was welcomed by a big smile as I approached Prisha. “I’m so happy to see you again, doctor,” she said, “but this time it’s my mother, Lakshmi, who needs your help.”

Her mother pursed her lips, but didn’t extend her hand to shake mine as I had expected. Her mouth drooped slightly on one side, but a smile broke through nonetheless.

“She is blind,” Prisha explained, “So I have come to help her, if that is alright with you. She only speaks Hindi, though, so I will also need to translate…”

As Prisha took her mother’s arm and helped her down the corridor to my office, I noticed a distinct limp and obvious weakness on one side.

“Mother had a stroke and lost her vision,” Prisha explained, when we were in the office. She’d settled her mother in a chair beside my desk and pulled another beside it for herself. The two talked for a moment while her mother fussed in her seat. “She says she is very nervous about consulting a man, doctor, but I have just reassured her that I trust you.” She smiled at her mother. “She can see nothing at all now, and with the continuing bit of paralysis, I think she feels particularly vulnerable.”

They chatted to each other in Hindi for a moment, when suddenly her mother’s face changed and I could see her tightening her grip on Prisha’s arm.

“Is there something bothering your mother?” I asked, wondering if perhaps she’d changed her mind about being examined by a man.

Prisha immediately smiled, but I could sense her tension. “She says someone is staring at her…”

I blushed and looked down at the surface of my desk. “I’m sorry, I didn’t mean…”

Prisha shook her head. “No, it’s not you, she says.”

“But…” I was confused. “Didn’t you say she couldn’t see anything?”

Prisha smiled, embarrassed. “Nothing at all. The neurologist says she’s completely blind… But she says she can sometimes feel things,” she continued and then shrugged.

Lakshmi seemed to be staring at the office door –if ‘staring’ is the right word, so I glanced over at it. The door wasn’t completely closed, and through what little space remained I could see a pair of large blue curious eyes examining us like a visitor in the zoo. And then, realizing they were noticed, they disappeared, and the pounding of little feet echoed down the corridor.

Lakshmi’s face relaxed and she said something to her daughter.

“It’s okay now, doctor,” she said, looking at her mother with a bemused expression. “She says the eyes are gone…”

There are more things in heaven and earth, Horatio… Blindsight? I don’t know, but whatever it was, I think I was privy to something special that day so long ago.

 

 

 

 

 

 

 

She wears her faith but as the fashion of her phone.

Everything is a matter of time, isn’t it? Everything changes. Like the apocryphal monkeys typing away infinitely, everything will be written. Everything will be transmogrified somewhere. Some time. Somehow. I suppose that should be a comfort, but I can’t escape the nagging feeling that there is something unrequited in all that: an imbalance between now and then -no bridge to mediate between what is, and what some nebulous future may unfurl for our children’s children.

And yet, an article I found offers some hope that I might have missed the entr’acte, missed a vital link in the ever lengthening chain of progress –or at least underestimated its importance. I’m talking about the smartphone. I grow old… I grow old… I shall wear the bottoms of my trousers rolled, as T.S. Eliot wrote –that, at least, may be a suitable mea culpa for my inattentiveness, perhaps.

I should have seen that with all of the changes occasioned by the phone, other subtle philosophical alterations might well hide within its shadow. ‘He wears his faith but as the fashion of his hat; it ever changes with the next block’, as Beatrice says in Shakespeare’s Much Ado About Nothing. Who would have thought that religion itself might live the same fate? http://www.bbc.com/future/story/20170222-how-smartphones-and-social-media-are-changing-religion The mobile phone Bible seems to be replacing the book Bible –at least with many of the younger religious crowd. And the result may have been a loss of context –no thumbing through the pages looking for something, just an arrival at whatever nugget was requested –like looking it up in Wikipedia. In other words, an information Christianity, a virtual religion. ‘“A new kind of mutated Christianity for a digital age is appearing,” says Phillips [director of the Codec Research Centre for Digital Theology at Durham University in the UK]. “One that follows many of the ethics of the secular world.” Known as moralistic therapeutic deism, this form of belief is focused more on the charitable and moral side of the Bible – the underlying tenets of religion, rather than the notion that the Universe was created by an all-seeing, all-powerful leader.’

Although I hold neither religious affiliation, nor any particular interest in the Bible, I have to say I am intrigued by the philosophical machinations the smartphone seems to be engendering –the moralistic therapeutic deism, as it is increasingly being referred to. The results of interviews with three thousand teenagers were summarized in (sorry) Wikipedia, and seem to establish the tenets of this theism. First of all, ‘A god exists who created and ordered the world and watches over human life on earth.’ And ‘God wants people to be good, nice, and fair to each other, as taught in the Bible and by most world religions. The central goal of life is to be happy and to feel good about oneself.’ But what I found particularly interesting was the idea that ‘God does not need to be particularly involved in one’s life except when God is needed to resolve a problem.’

And why do I find this  so-called ‘moralistic therapeutic deism’ so interesting? It seems to me it may be the early phases of an evolution of religious thought engendered by the way we are beginning to assimilate information. Or perhaps I should say they are –the millennials. I suspect that we elders –or should I say just ‘olders’- still adhere to the belief that data does not necessarily spell knowledge.

But, as the article points out, ‘[…]a separate strand of Christian practice is booming, buoyed by the spread of social media and the decentralisation of religious activity. For many, it’s no longer necessary to set foot in a church. In the US, one in five people who identify as Catholics and one in four Protestants seldom or never attend organised services, according to a survey conducted by the Pew Research Centre. Apps and social media accounts tweeting out Bible verses allow a private expression of faith that takes place between a person and their phone screen. And the ability to pick and choose means they can avoid doctrine that does not appeal. A lot of people who consider themselves to be active Christians may not strictly even believe in God or Jesus or the acts described in the Bible.’

I doubt that this phenomenon is exclusive to Christianity, either. Any religious doctrine which has a credo that can be digitized, is susceptible -nuggetable into bite-sized digestible portions. Wikipediable.

I think that is what two girls were talking about at the bus stop a few days ago. Both wearing delightfully colourful hijabs, they were huddled around their smartphones giggling.

“Where did you find that?” the taller of the two said shaking her head. She was dressed just like any other teenager –running shoes, jeans, and a bright orange leather jacket- but a dark blue hijab seemed almost tossed onto her head and barely draped over her shoulders. Perhaps it was the wind, but the almost-studied disarray was charming.

The other girl, stouter and wearing a long black coat, also sported a red, hijab-like scarf that barely covered half her head despite her constant readjustments. “It’s Al-Quran [an app, I later discovered],” she answered as if that should have been obvious.

The taller girl tapped on her screen for a moment and then nodded her head. “But, you know that’s not what Abbad said…”

The other girl just shrugged. “He always thinks he knows everything, Lamiya.”

“Well…” I could see Lamiya sigh, even though I was trying not to watch them. “He usually gets it right, Nadirah… I mean, don’t you think…?”

I couldn’t help but smile when Nadirah rolled her eyes. “He only gets it right when you don’t know! If you don’t check on it…”

Lamiya seemed to pout. “I just, like, took his word for it…”

“You can’t do that blindly, Lami… Not anymore.” She made another attempt to readjust her hijab in the biting wind. “Not when you can look it up!” She shivered deeper into her coat and I could see her breath whenever the wind died down. “Things just aren’t what they used to be for our parents… We can actually, like, check,” she said as their bus pulled up and they got on, leaving me still informationless in the cold.