Category Archives: Uncategorized

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Of thinking too precisely on the event

The right not to know -now there’s an interesting concept in today’s competition for instant news, ‘breaking stories’, and the ever present titillation of factoids. It seems almost counterintuitive -why would anyone choose not to know something? Surely knowledge trumps ignorance. Surely Hamlet’s timeless question ‘Whether ‘tis nobler in the mind to suffer the slings and arrows of outrageous fortune or to take arms against a sea of troubles and by opposing, end them?’ has been answered in the modern era: it is better to know what hides behind the door than to turn one’s back… Or is that just naïve? Hopelessly romantic?

And yet, at least in Medicine, there is the potential struggle between beneficence -promoting and advocating for the well-being of others and autonomy -the right of someone to determine their own fate. And when the two are in conflict, there is an ethical dilemma.

But what about the right not to know something? Something that neither party had any reason to anticipate, and of which ignorance could be disastrous? Does the knowledgeable party have an obligation to inform the other, even if they were instructed not to? In everyday affairs, that seems an unlikely scenario, but an interesting article in Aeon by the writer Emily Willingham outlines some examples from medical research that probably cross the line: https://aeon.co/ideas/the-right-to-know-or-not-know-the-data-from-medical-research

A blood sample targeting cholesterol for example, might show another, seemingly unrelated abnormality. Should your doctor tell you about it, even though the cholesterol value was normal? Of course she should, you would assume. ‘But what if the finding turned up in samples donated for medical research instead of taken for medical testing? … [The] UK Biobank offers a case in point. When participants submit samples to be mined for genetic information, they agree to receive no individual feedback about the results, and formally waive their right to know…’ But that seems unethical, does it not? ‘The reality is that the ‘right’ thing to do about these competing rights to know and not know – and to tell what you do know – varies depending on who’s guiding the discussion. For example, a clinician ordering a test and finding something incidental but worrisome is already in a patient-doctor relationship with at least a tacit agreement to inform. But a researcher collecting DNA samples for a big data biobank has formed no such relationship and made no such commitment.’

Still, there should be some way -perhaps a retroactive clause that would enable a researcher to inform. One way, for example, might be to recognize that ‘people who submit samples for research might benefit from the same process that’s provided to people undergoing genetic testing in the clinic. Genetic counselling is strongly recommended before such testing, and this kind of preparation for research participants could clarify their decisions as well. Investigators who engage with these data on the research side deserve similar preparation and attention to their rights. Before getting involved in such studies, they should be able to give informed consent to withholding findings that could affect a donor’s health. Study investigators should also be unable to link donors and results, removing the possibility of accidental informing, and lifting the burden of the knowledge.’

Of course, the problem doesn’t just start and stop with whether the study participant decides she doesn’t want to know, does it? If the problem has a genetic component, ‘what about the people who were never tested but who are genetic relatives to those with an identified risk or disease? … After all, your genes aren’t yours alone. You got them from your parents, and your biological children will get some of yours from you…  in reality, the revelations – and repercussions – can span generations.’

On a lighter note, I can’t help but be reminded of my friend Brien. Readers of some of my more retirement-centered feuilletons will recall that he is a rather eccentric individual who seems to enjoy living on his porch and watching the world go by, no matter the weather. Rain or shine, summer or winter, I see him ensconced in his seat with a beer in his hand and another one on the railing in case I happen by. A harmless sort, and barely noticed by those who amble past, he is not an infrastructure man. His porch ekes out an existence from day to day in terminal decline. Every time I visit, he assures me that because the sidewalk leading to the house is also deteriorating, it discourages unnecessary visitors. And those who brave the path -me, I suppose he means- know and accept the risks -especially of the dangerous and disintegrating steps onto the porch.

But the last time I was over there, I almost put my foot through a rotting board near his chair, and I felt it had gone too far; I thought he should know. “Brien,” I started, somewhat hesitantly, given his explicit instructions to avoid any criticism of his porchdom, “I just…”

But he silenced me with a regal wave of his beer-hand -a sure sign of displeasure. “You’re gonna tell me something bad, I just know it…”

“No… I was just going to suggest that…”

“Remember the rules, eh?”

Brien can be so annoying sometimes. I think he honestly believes that naming a problem -identifying it by whatever means- gives it the right, formerly denied to it -of existence. So I shrugged, and decided to acquiesce and similarly ignore its right to life. Autonomy, after all is a right as well.

I didn’t see Brien for a week or two, but when I next happened by, as I often do on my way to the store, he seemed unusually bulky on his chair. He was covered in a thick Hudson’s Bay blanket, of course, but I assumed the cold autumn wind had made him bring it out early this year.

He waved at me from the porch and told me not to worry about the steps anymore. And as I approached, I noticed they were brand new and ready for painting. In fact, as I neared the porch, I noticed some of the boards near his chair had been replaced as well.

“What’s going on?” I asked as soon as he handed me a beer.

He smiled and pulled back the blanket to show me the cast on his leg. “I decided to take your advice…”

“But, I never…”

He held up his hand to silence me. “Sometimes I can hear what you don’t say, G…” he interrupted, calling me by my nickname. “And just because I don’t want you to tell me, doesn’t mean I don’t want to know about it, eh?”

I’m still not sure I feel good about not telling him, though…

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More than kin and less than kind

Am I really the me I think I am -the cogito ergo sum I have been led to believe? Or have I been naïve all these years in assuming my identity rests solely inside somewhere -in the uniqueness of my brain, maybe, or in the peculiarities of my experiences that no one else could ever hope to share in the same intimate fashion? Am I, in other words, a self-portrait?

I was raised in a society that values self-fulfillment as if were a birthright. Even the motto of my high school was ad maiora natus sum –‘I was born for better things’. Not we, you understand but I… me. And, of course, my teachers were only too happy to inculcate the values of independence and self-reliance in each and every one of us. Competitions on the sports field, and gradations in our marks, only heightened the feeling that each of us was separate, and in charge of our ranking, somehow. It seemed only natural -to some of us, at any rate- to see ourselves as nascent statues seeking our own pedestals.

There’s nothing wrong with that, I suppose, except that as I grew older and gained more experience, I began to realize that I was not alone. Much like my shadow that followed me everywhere, so did the world. Indeed, everything I did, and much of what I thought, was influenced by others -either by assimilation, or unwitting imitation. The opinion of others, although sometimes shunned, was more often modified and subsequently integrated as if by disguising it, I became the author. And yet, deep down, I realized that the parthenogenesis of ideas was largely fictive. I was swimming in the same waters as everyone else…

But it was not as traumatic as I might have predicted in my tutored youth. In fact, on reflection, it has been more affirming than repudiating, more reassuring than discouraging -almost as if I had finally been accepted as a member of something I had unconsciously coveted all along. I had not capitulated to something I had struggled against, but, instead of staring through its windows like a bewildered shopper, I was welcomed through the door.

But why? Why the initial reluctance to accept my membership in something to which I had always belonged? Some of the answers emerged in an online publication, Aeon, from an essay by Abeba Birhane, a cognitive science student at University College Dublin. https://aeon.co/ideas/descartes-was-wrong-a-person-is-a-person-through-other-persons

‘We know from everyday experience that a person is partly forged in the crucible of community. Relationships inform self-understanding. Who I am depends on many ‘others’: my family, my friends, my culture, my work colleagues… Even my most private and personal reflections are entangled with the perspectives and voices of different people, be it those who agree with me, those who criticise, or those who praise me.’

‘The 17th-century French philosopher [René Descartes] believed that a human being was essentially self-contained and self-sufficient; an inherently rational, mind-bound subject, who ought to encounter the world outside her head with skepticism.’ The only thing I can say for certain is that I am, because I am the entity able to conceptualize it. The rest of the world could be a dream -but not the dreamer… So this leaves the effects of anything else on us in a sort of limbo.

Of course others have tried to get around the problem: the 20th-century Russian philosopher Mikhail Bakhtin ‘believed that it was only through an encounter with another person that you could come to appreciate your own unique perspective and see yourself as a whole entity… Nothing simply is itself, outside the matrix of relationships in which it appears. Instead, being is an act or event that must happen in the space between the self and the world.’

I love that. It suggests that we derive our identity -our very existence as that identity- through our interactions, recognition and validation by others. Think of people in solitary confinement in prisons. ‘studies of such prisoners suggest that their sense of self dissolves if they are punished this way for long enough. Prisoners tend to suffer profound physical and psychological difficulties, such as confusion, anxiety, insomnia, feelings of inadequacy, and a distorted sense of time. Deprived of contact and interaction – the external perspective needed to consummate and sustain a coherent self-image – a person risks disappearing into non-existence.’

And it’s not just in prisons we can disappear. I met her at a bus stop -or, rather, she met me. I  happened to be the first person in a lengthy, but orderly queue waiting in the rain for a long overdue bus.

“I was actually first,” she said, staring at me defiantly. She was well dressed in a grey skirt and I could just see a frilly white blouse under her upmarket raincoat. Her short, dark hair was barely mussed in the wind and rain it was now enduring. “I was waiting over there… Out of the rain,” she added, as if to prove her point.

I smiled pleasantly at her as the bus pulled up. “I should have done the same,” I said, furling my embarrassingly inadequate umbrella.

“I didn’t want you to think I just came along, you know,” she persisted. “Sometimes people get really upset when they’ve been waiting in line…”

The way she said it made me think this probably wasn’t the first time she’d crashed a queue. “No, please go in front of me,” I said, trying to show I was not upset. “It’s raining and you don’t have an umbrella.”

She promptly boarded the already crowded bus, then signalled me to sit beside her on one of the only remaining seats. “Do you live in the city?” she asked as soon as I was settled. She looked anxious.

I nodded politely, thinking she was just looking for a way to start a conversation.

“A house…?”

I nodded again, but her eyes immediately landed painfully on my face.

“Landlord, or renter?”

“Excuse me?” It seemed like a trick question, and I was immediately wary.

“You live in a house,” she said slowly and carefully, as if I was hard of hearing.

I nodded, carefully.

“Are you renting it?”

This was getting uncomfortable. “Why do you ask?”

Her eyes scratched at my face for a moment, before flying off again. “Because the city is trying to institute rent controls.” She frowned as she said it.

I brushed her cheek with a quick glance before I stared at my lap. I still wasn’t sure why she was asking. “Do you think that’s a good thing…?” I asked, trying to seem tentative.

“Oh yes!” she hurried to answer. I could almost feel the exclamation mark hovering between us. “Landlords shouldn’t be able to take advantage of their tenants.”

“So, I take it you are a renter?” I said kindly.

“Of course! I’m a single woman now. I’ll never be able to buy a house…”

“Do you like the place you rent?” I asked, trying to change the subject a bit.

She blinked at me, probably wondering if I was trying to trap her, but she relaxed a little. “It’s a bit of a hovel, really. The fridge makes a noise and only one of the burners on the stove works. The walls need some paint, and the rug is frayed…” She sighed and fiddled with a button on her coat. “But it’s the only place I could find.” She looked at the person sitting in front of her for a moment. “I thought it had promise when I first saw it, though…”

I had obviously unleashed something.

“The landlord says he wants to fix it up.”

“Certainly sounds like it could use some work,” I said, smiling.

She glared at me for a moment, and then softened her expression. “That’s exactly what he said.” She glanced out of the window at the rain. “But then he said he would have to raise the rent to pay for it.”

“Do you think that’s fair,” I asked.

I could see she was about to say ‘no’, but she changed her mind and turned her head to look out of the window again. Finally, she shrugged. “We’re both caught, aren’t we? On the one hand, I don’t want to pay more, but on the other, I’d love to see the place fixed up.”

“But if rent controls come into effect, he’s also in a bind, isn’t he?”

She nodded sombrely. “I mean, they’re probably a good idea, but…”

“But they don’t work for you or your landlord…”

She sighed again, and then shrugged.

“Of course there is a way out, isn’t there?” I said, thinking I was just stating the obvious.

She nodded. “Let him fix the place, and pay more rent.”

“Could you not come to a fair compromise with him about the price? Or maybe agree to a gradual increase over, say, a year, or something?” I smiled conspiratorially at her. “After all, rent controls only kick in if you complain.”

I could see her eyes widen as she thought about it. She nodded her head, slowly, and a smile quietly spread over her face. “He’s actually a decent guy…” Suddenly she reached for the pull cord. “My goodness, we’ve been talking so much I almost missed my stop,” she said as she stood and squeezed past me. And then she turned to face me as she struggled through the people standing in the aisle. “I’m so glad I talked to you,” she said. “Thank you,” was the last I heard from her as she disappeared through the sea of dripping coats.

Sometimes it’s good to talk about your problems, I thought and smiled to myself, glad that I might have helped her. ‘A person is a person through other persons’ -wasn’t that the Zulu phrase Abeba Birhane had quoted in that article…?

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Here’s ado to lock up honesty

Sometimes I think we want to simplify things too much; we crave bichromality: on or off, yes or no. We want certainty, not a spectrum. An answer, not another question -a decision, in other words. And yet if we stop to look around, it seems obvious that things are seldom black or white -there are colours everywhere.

Relationships are no different -how could they be when two unique individuals are involved? When evaluated over any period of time, they are in constant flux. Contingent. Their often turbulent waters involve negotiation -one might even say navigation. There are no reliable maps -and unless there is local knowledge, ‘Here be dragons’ like those drawn on medieval charts in areas where there was insufficient information to avoid dangers.

Even initial reassurance may require sudden modification depending upon the conditions -we cannot always know in advance how things will work out. Indeed, the very fragility of the substrate is one of the important reasons why we are so enamoured with fine porcelain, with delicate lacework, with Trust.

But relationships, except in a legal and sometimes transactional sense, are seldom maintained by official written contracts -it’s more of an understanding, verbal or otherwise. This is fine, of course, but susceptible to misunderstanding or deliberate deception. Vulnerable to sudden, unexpected changes in either partner. Difficulties in effective communication…

‘Words, words, words,’ says Hamlet to Polonius. It almost doesn’t need an explanation, does it? Similar to his ‘That one may smile, and smile, and be a villain’ -although admittedly in a different context. But the meaning is clear: one can hide behind a curtain of sound, or a reassuring appearance, so that what is being conveyed may be confusing -purposely, or accidentally.

The problem, I suppose, is in knowing the intent of either one of the participants and its effects on the other. This is especially important in sexual matters where effective communication often lags behind the actions, and frequently is restricted to vague, initial permission followed by hormonal dictates.

It is a subject that people often feel reluctant to talk much about beforehand. Meanings of words and actions can change in the heat of battle, making prior negotiation -setting ground rules, and such- important. Sexual dialogue is not something taught particularly well in School Health Classes, so I was pleased to find an article in Aeon that was willing to tackle it head on. https://aeon.co/essays/consent-and-refusal-are-not-the-only-talking-points-in-sex

The author, Rebecca Kukla, is professor of philosophy at Georgetown University and senior research scholar at the Kennedy Institute of Ethics. She explores the language of sexual negotiation. ‘Philosophers who specialise in what is known as ‘speech act theory’ focus on what an act of speaking accomplishes, as opposed to what its words mean.’ She writes that, ‘all speech acts are governed by what philosophers call ‘felicity norms’ and ‘propriety norms’. Felicity norms are the norms that make a certain speech act a coherent possibility… I can’t name someone else’s baby just because I feel like it, by shouting a name at it. These would be infelicitous speech acts. ‘Propriety norms are norms that make a speech act situationally appropriate. So, although I have the authority to order my son to clean his room, it would be a massive norm violation for me to walk into his classroom at school and shout at him to clean his room in the middle of class.’

‘In public discussions about the ethics of sexual communication, we have tended to proceed as though requesting sex and consenting to it or refusing it are the only important things we can do with speech when it comes to ethical sex… Consenting typically involves letting someone else do something to you. Paradigmatically, consent (or refusal of consent) is a response to a request; it puts the requester in the active position and the one who consents in the passive position. And in practice, given cultural realities, our discussions of consent almost always position a man as the active requester and a woman as the one who agrees to or refuses him doing things to her.’

And yet, ‘Autonomous, willing participation is necessary for ethical sex, but it is not sufficient. We can autonomously consent to all sorts of bad sex, for terrible reasons. I might agree to do something that I find degrading or unpleasantly painful, for instance, perhaps because I would rather have bad sex than no sex at all, or because my partner isn’t interested in finding out what would give me pleasure.’

‘Usually, when all goes well, initiations of sex take the form of invitations, not requests… But when I’m trying to establish intimacy with someone as I am getting to know them, an invitation is more typical and likely more conducive to good, flourishing sex than a request… Invitations create a hospitable space for the invitee to enter.’ An invitation to dinner, for example. And ‘An interesting quirk of invitations is that, if they are accepted, gratitude is called for both from the inviter and the invitee. I thank you for coming to my dinner, and you thank me for having you.’

‘A sexual invitation opens up the possibility of sex, and makes clear that sex would be welcome. Invitations are welcoming without being demanding… Notice that if I invite you, appropriately, to have sex with me, then consent and refusal are not even the right categories of speech acts when it comes to your uptake. It is not felicitous to consent to an invitation; rather, one accepts it or turns it down. So the consent model distorts our understanding of how a great deal of sex is initiated, including in particular pleasurable, ethical sex.’

Kukla goes on to talk about when and if invitations are appropriate, and then about such issues as ‘gifts’ of sex in long-term relationships, as well as the sociology of gifting. But her discussion of ‘safe words’ I think is one of the most important topics she covers. So, ‘Even if we freely consent to a sexual encounter, or otherwise enter it autonomously (for instance, by accepting an invitation), we also need to be able to exit that activity easily and freely. Entering autonomously is not enough; sexual activity is autonomous only when everyone understands the exit conditions and can stop at will, and knows and trusts that they can do this. This requires shared linguistic norms for exiting any activity. Safe words, properly employed, provide a framework that allows everyone to understand when someone wants to exit a sexual activity.’

‘Part of what is interesting about safe words is that they let someone exit an activity at any time without having to explain themselves, or accuse anyone of transgression or any other kind of wrongdoing (although they can also be used when there has been a transgression)… One reason they are important is that inside a sexual encounter, speech is frequently nonliteral… We need very clear ways to be able to tell when someone wants to leave this nonliteral discursive context.’

And, as she suggests, ‘Safe words are powerful discursive tools for enabling sexual autonomy, pleasure and safety, in at least two senses. Most straightforwardly, they offer a tool for exiting an activity cleanly and clearly, with almost no room for miscommunication. But even more interesting to me is the fact that safe words allow people to engage in activities, explore desires and experience pleasures that would be too risky otherwise. When we want to experiment with something that might give us pleasure, but also might make us uncomfortable or put us at risk, we need to be especially sure that we can exit the activity easily.’ But, of course, ‘safe words should never become the only way that someone can exit a scene or activity – all participants need to remain flexibly responsive to other discursive cues as well.’

Unfortunately, the ‘strong social tendency to focus our discussions of sexual negotiation on consent and refusal has resulted in a narrowed and distorted view of the pragmatics of sexual communication. Correspondingly, we have tended to focus on rape and assault, understood as nonconsensual sexual activity, as the only sexual harm we need to worry about. In fact there are many ways in which sex can go ethically wrong, other than by violating consent.’ Kukla feels that ‘sexual autonomy also requires the ability to engage in clear, pragmatically complex, fine-grained sexual communication – including uses of language that go well beyond consenting to and refusing requests for sex.’

There is so much more to communication than words, isn’t there -and so much more to words than meets the ear?  Hamlet again: ‘There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy…’

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Lying down in green pastures

I suppose I should admit something from the start: I’m not particularly religious, and I certainly do not have anything but the most superficial knowledge of Biblical writing. Still, I have come to appreciate the glory of metaphor and how it is able to transmute otherwise ineffable concepts into words. Feelings. Poetry, of course, aspires to that, but so do many of the texts in the Bible -especially the in ‘Old Testament’, apparently.

And yet, except for a very few of the more memorable lines I was taught in Sunday school as a child -parts of Psalm 23 spring to mind- I can’t say I was ever able to differentiate the poetry from the -what?- commands: the instructive reverence with which I was intended to regard the message. But, it seems to me that by its very nature, poetry, through metaphor, simile, and even word play would be particularly helpful for some of the ideas the Bible is trying to describe -things like lamentations, or hymns of praise where it would make sense to draw on the emotive powers of poetry to make a point.

In my adult years, on those rare occasions when the subject of biblical poetry has arisen, I have usually attributed my wonted tone-deafness to translational problems. Cross cultural, not to mention cross-temporal issues mean that some figures of speech, or clever puns in the original language do not have much chance of making the same impact on us as they would have on the recipients when and where they were originally composed.

Even nowadays, the European poems of Schiller (German), or Baudelaire (French), for example, are difficult to translate into English and preserve their same emotional intensity -and they were written as recently as the 18th and 19th centuries, respectively. Imagine the difficulty of attempting to render the writings of people living more than 2000 years ago into meaningful word-pictures that would resonate in today’s modern world. And, given the sacred nature of the Bible, any attempt to change the wording, or render the sentences into something like their original poetry, risks immediate condemnation.

The very idea that someone was willing to take the risk intrigued me. It would require impeccable credentials in ancient Hebrew with an equivalent temporal knowledge of the customs and literary devices used so long ago -and an ability to maintain the intended meaning without trivializing the message.

Of course, I have no way of knowing how well any translational skills succeeded in walking that  obviously difficult path, but some of the word-play involved in the effort was explained in an article in Aeon by Robert Alter, a professor of Hebrew and comparative literature at the University of California at Berkeley: https://aeon.co/ideas/how-translation-obscured-the-music-and-wordplay-of-the-bible

‘An essential fact about the Hebrew Bible is that most of its narrative prose as well as its poetry manifests a high order of sophisticated literary fashioning. This means that any translation that does not attempt to convey at least something of the stylistic brilliance of the original is a betrayal of it, and such has been the case of all the English versions done by committee in the modern period.’ True, the Hebrew Bible is basically a religious text, and yet, ‘If a translation fails to get much of its music across, it also blurs or even misrepresents the depth and complexity of the monotheistic vision of God, history, the realm of morality, and humankind.’

So how, after millennia, can one ever hope to express this language from the depths of time into relevant, let alone evocative English phrases? The accuracy of the message is one thing, of course, but conveying it in anything like the clever style of the original so the reader can still appreciate the poetry is another. ‘One small but telltale manifestation of the artistry practised by the biblical writers is their fondness for meaningful word play and sound play.’ However, ‘translation… entails a long series of compromises because full equivalence is rarely an option.’

For example, ‘The prophet Isaiah, like any great poet, commands a variety of formal tools – powerful rhythms, striking imagery, pointed literary allusions (in his case, to earlier biblical texts). Isaiah is particularly fond of sound play that verges on punning. In order to convey with force the perversion of values in the kingdom of Judah, he often juxtaposes two words that sound rather alike but are opposite in meaning… The Hebrew writers repeatedly revelled in the expressive possibilities of their medium, working inventively and sometimes surprisingly in their stories and poems with rhythm, significant repetition, narrative point of view, imagery, shifts in diction, the bending of language in dialogue to represent actual speech or the nature and location of the speaker.’

The article offers a few examples of Alter’s clever compromises to restore the music of the text, but I suspect it is intended more as a kind of a proof-of-concept than as a detailed slog through each Biblical book and chapter; it was both tantalizing and yet mercifully short. Still, it was enough to alert me to the things I never appreciated in my Protestant Sunday school. In fact, I don’t recall them ever mentioning anything about Biblical writing styles -it was the message they were trying desperately to inculcate in our young minds, I suppose.

But lest readers of my humble feuilleton suspect that in these penultimate years I am finally succumbing to Pascal’s wager and conceding that even though the existence of God may be unlikely -and at any rate unprovable-  and that the potential benefits of belief far outweigh shuffling off unshriven, let me assure them that any quest for hidden beauty need not involve ulterior motives. In the words of the poet Kahlil Gibran, Beauty is life when life unveils her holy face.

Sometimes it’s enough to know what one’s education may have missed without having to read the whole of Tolstoy’s War and Peace. No, Alter stirred my interest enough to allow me to finish his essay, but, sadly, not enough to make me want to retrain as a biblical scholar. I’m happy the Bible is poetic, but not, well, overjoyed, or anything…

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The Begging Bowl

We all have needs; we are all mendicants at some level. Sometimes subtle: a smile that begs response, a look that hopes for more; sometimes obvious: a verbal request, or even a sign that solicits aid. But sometimes it is more blatant. Glaring. Almost rude.

I was once accused of that –of shameless, brazen panhandling. And right in my office. Near my desk.

It started out quite innocently, as I recall. I was given a clay sculpture by a Mexican patient. I don’t encourage gifts -to tell the truth I feel embarrassed by them- but she seemed so grateful for her care, her delivery, and her healthy baby, that I felt compelled to accept. The moment she struggled in with the box unannounced, her eyes shining, and her face a risus sardonicus, paralyzed with joy, I realized I was trapped. No matter the contents, I was meant to appreciate it. My mind returned to Christmases past with presents of socks or itchy home-knit woolen sweaters from my aunts, and how I had to pretend not to be disappointed. So it was not an unfamiliar skill –just long-dormant.

She seemed so pleased with her choice: a poor woman in a shawl sitting on the ground holding a begging bowl. The whole figure was done in a dirty grey clay and fired so it was rough to the touch. The most striking thing about it though was her expression: despite the lack of fine detail, the face commanded attention. The eyes in particular demanded succour -redress for what Life had thrown at them; compensation for the indignity of having to beg.

Whether my patient was concerned for the aesthetic welfare of my office, or the medical system in Canada, she didn’t say. She just watched, beaming and toothful as I opened the box, hugged me, then headed for the door. She hesitated for a moment before leaving, turned her head and pinned me to the spot with her eyes. “I know you understand, doctor,” she said slowly, the smile tucked away somewhere inside.

Well, to tell the truth I didn’t at first. In fact, I didn’t know where to put the begging woman either. Eventually, I brought a little oak table from home and put the two of them in the corner by the window on the other side of my desk. The fact that my patients sit beside the bowl she proffers didn’t strike me as particularly important. In fact, I forgot about it. When you see something every day that neither moves nor changes, it becomes invisible. At least to me.

One day I was talking to an older Asian woman when I noticed her glancing at the bowl whenever I wrote something in her chart. She seemed more troubled each time she looked. At first I thought it was because of the reason for her consultation –an ovarian cyst that looked malignant on ultrasound- but she didn’t sound worried. She didn’t even look anxious. Just perplexed.

“Am I supposed to make an offering?” she said suddenly, in the middle of a question I was asking.

“Pardon me?” It was such a non sequitur, that it threw me off my line of thought.

She reached into her purse and after a moment of scrabbling the depths, her hand emerged with a two dollar coin. “Not much,” she said almost to herself as she placed it carefully in the bowl, “but the poor woman looks so sad with that empty pot.” She stared at me for a while and then smiled. “Maybe it’ll bring me good luck…”

Well, that started the deluge. The coin glinted in the bowl like a flashlight, beckoning. A single offering demanded more: Fill the bowl, it said. The begging woman said -I didn’t; I just watched with fascination each time someone saw it and felt compelled to add something. Just in case. It couldn’t hurt, was written on each face.

Occasionally, I had to empty the bowl when its contents began to spill onto the floor each time someone accidentally touched the table leg with her foot. But an unfilled bowl seemed to spur even more contributions -I used them to fill real begging bowls, though, so I didn’t feel particularly weighed down with guilt.

It was a bowl that fascinated children. Whether it was the money, or the novelty of seeing something like that in a doctor’s office, they used every distracted maternal moment to try to sneak past a knee and grab for a coin. Most mothers are quick, but some are indulgent -trusting the judgement of their experimenting child and assuming that, unlike fire or naked electrical sockets, no harm is likely to come from their curiosity.

I, who watch nervously from the wrong side of the desk, do not trust, however. I am suspicious of every lunge, every mischievous grab. I recognize my younger self and the need, the compulsion, to out-wait the unusually tolerant eye and outwit the momentarily inattentive face.

But sometimes I, too, am preoccupied. Busy with the constraints of medical practice, focussed on mother not child. And so it began –softly at first, of course. A young child I apparently delivered three or four years ago while on call for my colleagues, made it past a set of knees and too-slow hands to reach the bowl. The mother caught the statue before it hit the floor, but not before the coins explored the room and the child screamed in a terrified expectation of retributive justice.

No lasting harm was done, although the little boy wouldn’t stop crying as his mother, down on her knees behind the desk, attempted to refill the bowl. I tried to reassure her, but I could see she was embarrassed and flustered. When the two of them finally surfaced from behind the desk, laden with silver, her mood had changed. She seemed more annoyed than apologetic.

“Why would you put that thing where someone could knock it over?” she said, pointing at the begging lady with anger bordering on litigiousness. “What’s it for, anyway? Bribes?” she added, either in a try for black humour, or more likely, threat.

I smiled in an attempt to diffuse the situation. “It was a gift from a lady I delivered,” I said, trying to remain calm now that the child, recognizing that his mother was mad at me not him, began to cry again.

“Well,” she said, huffiness creeping into her now-trembling voice, “It’s a good thing I didn’t get hurt.”

“Yes it is,” I agreed. Someone had to remain in adult mode. “Maybe I can put it somewhere else…”

Her face immediately softened. She realized she had made her point; I was listening. She lowered her eyes and took a deep breath. “I’m sorry,”she whispered. “I know it was Devon’s fault…” She burrowed into me with sad, repentant eyes. “I always get upset when he cries.” She blushed and immediately reached into her purse and put two coins into the now-overflowing bowl.

Then she looked at me for a moment before speaking. “One coin is for the one I saw him put in his pocket… ” -she glared at Devon briefly- “…the other is a bribe so you don’t tell anybody,” she said chuckling softly. “And,” -she reached across the desk and touched my hand- “I want to thank you for delivering my little boy. You had no way of knowing…”

by

Truth hath a quiet breast

All these years I have been naïve, I suppose; I did not question that democracy entailed giving those governed a say in their fate. Perhaps I was not thorough enough in my analysis of the matter, and assumed that this would be obtained when and if a sufficient majority agreed to a particular proposal. But as I grew older and more contemplative, I recognized that merely acceding to the majority’s decision might leave the remaining minority at a disadvantage – disenfranchise them in a way.

I began to appreciate the wisdom of a tripartite system of governance for at least attempting inclusivity. This consisted of the elected members of government to create and uphold laws, the courts to interpret those laws and ensure they were upheld, and a free and unfettered press to inform the governed whether that was indeed happening -holding truth to power, as we now call it.

The naïveté, though, was in believing that simply informing the public of the state of affairs would be sufficient -that the mere declaration of independently confirmed facts would allow people to decide whether or not things were proceeding as they had believed. But it seems I was wrong -starry-eyed, or at least dangerously innocent of the power of confirmation biases in this era of socially mediated information-bubbles.

I am older now, though; I have been left behind, and perhaps the mist of years is beginning to envelope me like a gauze winding sheet. But, every so often, I find a tear in the fabric so I can see the room in which I lie more clearly. And I can smile, and hope that there is a route from the labyrinth that does not pass the Minotaur -or that there is, somewhere, a modern Theseus…

An essay in the Conversation by Kamyar Razavi, a television news producer and PhD candidate at Simon Fraser University offered me a kernel of hope. https://theconversation.com/how-journalists-can-rebut-trumps-fake-news-claims-110307

He begins by outlining the problem: ‘The news media wield tremendous responsibility over democratic discourse. Yet all too often the media are blamed for fuelling mistrust… News reports typically identify a conflict (a war), diagnose its causes (ISIS) and draw on sources (military analysts) to shed light on what’s going on. But there’s a fourth frame, identified by journalism scholar Robert Entman, that is easy to overlook in news reports — discussing remedies to problems.’ This is so-called ‘solutions journalism’.

‘Solutions journalism tries to change the journalistic equation by giving more prominence to solutions… [but, it] is not about advocating for solutions. It’s about turning a light on the remedies by making them a more prominent part of the narrative… For instance, where a typical climate change story may report on the latest doom-and-gloom statistics about forest fires, a solutions-oriented piece might explore the simple steps you can take to fireproof your backyard and your home. The solutions story still gets you thinking about climate change and forest fires, but in a way that is far more familiar and accessible.’

While disasters capture attention in the news, they seldom help us to think about how they might be avoided -especially if the next day, or even the next column, there are reports of yet another catastrophe. In other words, there seems to be ‘excessive emphasis in news reports on chaos, conflict and all that is wrong in the world —as opposed to what is actually working… It’s this constraining dynamic that can drive people into echo chambers and filter bubbles. It also makes people cynical.’

‘According to McIntyre and Gyldensted [journalism scholars], one of the ways journalists can open up a discussion about solutions is by adding a future orientation to their story — by asking, and trying to answer, the question: “What now? For example, reporters can ask their sources how problems could be solved, how people could collaborate, or what kind of progress their sources envision.” Another technique for drawing out solutions is for reporters to ask questions that get at people’s reasons for thinking a certain way — or that tap into what “the other side” thinks’.

I like this approach, because as Razavi points out, ‘solutions journalism gives people more reasons to think there are ways out of difficult problems — because there usually are.’ Hopelessness does little to encourage solutions -sometimes we need a few flowers.

I will always remember the day that my father died. I was at work at the hospital when my brother phoned, and told me of his not unexpected death at home. I had just delivered a baby, and was sitting in the nursing station writing my notes. Up to then, it had been a wonderful occasion with the husband and their four year old daughter in attendance at the birth. But after the phone call, I found I couldn’t concentrate, and the words I wrote seemed to belong to someone else -seemed, in fact, to describe something that had happened in another life. Another place…

Close to tears, the timing of the two ends of life did not escape me, but the coincidence seemed purposeless. Unfair. The nurses noticed my obvious distress, and smiled encouragingly at me as they hurried about on their never-ending duties. Some of them stopped to ask me why I seemed so sad, but I had trouble answering without giving in to uncontrolled sobs and looked away with a shrug at the questions. I had already told them his death was imminent, so I think they understood.

But as I sat there, staring at the chart with inchoate thoughts swirling about slowly in my head, I felt a tap on my leg.

“Doctor?” a little voice beside me said.

I looked down at the sad face of the little girl who had just become a sister. She was holding a single flower from one of the bouquets in her mother’s room -a white rose, I think. She reached up and handed it to me as a tiny smile crept onto her face. Her eyes twinkled as they locked with mine, and long black curls of hair danced on her shoulders with the movement of her arm. She was dressed in a long white princess dress with silver sparkles that shimmered under the fluorescent lights, and in that moment she reminded me of a latter-day Shirley Temple come to visit.

“Mommy thought you could use this,” she said, the smile growing with each word as the nurses stood around to watch.

And yes, I needed that -it touched me more than I could guess. There is always hope when there is someone to share it with. There is always purpose, even when it seems to arrive like the shadow from a departing cloud.

by

There is nothing either good or bad but thinking makes it so.

If I’m brutally honest with myself, I suspect I side with Goldilocks in her preference for the just-right-baby-bear stance: not too hard, not too soft. I have always been more comfortable in the middle of the Bell Curve with lots of wiggle room on either side; I’m not really cut out to be an extremist. And I was always taught to be sensible and use things wisely: buy good quality and look after whatever I bought so it would last. But times change, I guess, and as the price of goods declined with improved production, and fashion began to favour frequent change, the temptation to buy and replace increased.

Still, making-do was what my parents did, although perhaps it was easier in the days when planned obsolescence was just an economic dream. Unfortunately, now I replace things more often than I reuse them -and more often than I really need to, as well. As the months slip past and the years pile up one upon another on the shelf, I fear I have also become a creature of things. A collector of more than just Time.

And yet I have always harboured a suspicion that new is not necessarily better, nor is more always preferable to less. I would probably make a rather poor salesman, with the menace of the sharp needle of conscience only millimetres away -although I have to confess to feeling the thrill of buying a new and different watch each time the 5 year battery runs out. I justify it by assuming I’m assuring that someone will have a job -and anyway, I’m keeping the economy afloat… Aren’t I?

Dichotomies like these make it difficult to choose sides, though, don’t they? Sometimes it helps to step back far enough to see both sides of the street, and an essay by the author Nick Thorpe in Aeon put things in a rather intriguing perspective for me: https://aeon.co/essays/we-should-love-material-things-more-than-we-do-now-not-less

‘We’ve got used to the transitory nature of our possessions, the way things are routinely swept aside and replaced,’ he writes. ‘It’s one of the challenges facing the UK Department of Energy and Climate Change, whose chief scientific adviser, Professor David MacKay, in January bemoaned ‘the way in which economic activity and growth currently is coupled to buying lots of stuff and then throwing it away’… According to data aggregated by the Global Footprint Network, it takes the biosphere a year to produce what humanity habitually consumes in roughly eight months.’

One could try to avoid consumer goods altogether of course, and yet things do wear out. Things do break. And some things become sufficiently outmoded that they no longer function in the rapidly evolving technosphere. So I suppose we have to persevere ‘with what the British psychologist Michael Eysenck calls the ‘hedonic treadmill’, holding out the unlikely hope that the spike of satisfaction from our next purchase will somehow prove less transitory than the last.’ But as Thorpe observes, ‘If Western consumer culture sometimes resembles a bulimic binge in which we taste and then spew back things that never quite nourish us, the ascetic, anorexic alternative of rejecting materialism altogether will leave us equally starved.’

The answer, as Goldilocks knew all along, lies in compromise. It’s not that we value things too much, but rather that we don’t value them enough. ‘The challenge is to cherish our possessions enough to care about where they came from, who made them, what will happen to them in the future.’

We seem to be innate categorizers, more addicted to the hierarchies of price than cognizant of intrinsic value. And yet, with only a slight shift in perspective, wouldn’t it be valuable to ‘retain the pulse of their making’ as the British ceramicist Edmund de Waal put it? Much as a gift wears a different aura, and adds a different value to the object than is merely contained in its function, consideration of its history and its craft may well do the same.

In the modern world we are too far from the source to marvel at the genius of its production. I am reminded of one of the novels of Mark Twain –A Connecticut Yankee in King Arthur’s Court– in which an American engineer from Connecticut sustains a head injury and awakens in the medieval English court of the mythical King Arthur. It hadn’t developed the processes and gadgets we take for granted nowadays, so it fell to the engineer to develop them from scratch.

I tried to imagine making a working bicycle and the need to fashion it from whatever raw materials were at hand. And had I succeeded -which would have been well beyond my skill- I certainly would have viewed it in a different light than nowadays. The same had I built a clock, or fashioned reading glasses, or even devised a flashlight… My midden would not have required weekly removal.

Still, it’s not just keeping everything you’ve ever bought -that would be hoarding- but in valuing the item enough to repair it and continue using it: Repair, Reuse, then Recycle. Thorpe writes about a growing trend (at least in his part of the UK) of repair shops, and about an absolutely delightfully named social enterprise ‘‘Remade in Edinburgh’ [which] is one of a growing network of community repair shops dedicated to teaching ordinary people to mend and reuse household goods.’

Of course, the ability to avail oneself of this sort of thing is dependent on the initial quality of the item, as well as the opportunity to avoid the planned obsolescence of a technology wrapped in its own hubris. It also requires role models that we can all admire and emulate -people -and things- of proven worth.

Much as we tend to look up to sports heroes, say, or famous scientists, perhaps we need look no further than ourselves, and our biology’s long evolutionary history of successful strategies to reuse what we already have. Sometimes there is no need to develop new genes, or even new organs, to increase our success: existing equipment can be repurposed. Exaptation is the word that the palaeontologist and evolutionary biologist Stephen Jay Gould and his colleague Elisabeth Vrba proposed in 1982 to describe a new function for which an organ, say, was not originally intended. An example might be that of feathers on dinosaurs -in that instance, they may have been helpful for warmth, but were obviously not originally intended for flight as in their later descendants, birds. Or another example, drawn from my own specialty (Obstetrics), but drawn to my attention in an essay in Livescience by Wynne Parry: ‘All vertebrates have sutures between the bones of their skulls to allow for growth, but in young mammals these sutures have acquired an additional use easing birth by allowing the skull to compress as it passes through the birth canal.’

Inventions are seldom wasted in nature; why should we think our own artifacts need be an exception? There are so many obvious precedents that should encourage it -maybe would encourage it- if they were more widely known.

Okay, I’ll admit it’s quite a stretch, and perhaps unduly naïve to think that it would have much of an effect on the average person. But sometimes I think it’s important for us to believe that we have permission to rethink our obsession with novelty, and to realize that we are here today largely because of repurposing. Reusing. And then, ultimately, being ourselves recycled so we can all begin anew…