The Feminist Egg

Once upon a time, I suppose that one of the characteristics of Age was its hubris. After a certain age, it was easy to dismiss most new things as mere variations on time-tested themes –additions, clever perhaps, intriguing even, but still accretions. Ecclesiastes lived in old minds: The thing that hath been, it is that which shall be; and that which is done is that which shall be done: and there is no new thing under the sun. And yet nowadays, even the quickest peek over the shoulder calls that into question. Maybe it always did, but without the publicity it now entertains.

New things –truly new things- are often the hardest to accept, especially if they fly in the  face of cherished beliefs sufficiently entrenched as to be regarded as not merely true, but obviously true -common sense, in fact. It took generations to accept evolution –and now it seems only sensible that the random acquisition of those traits that help survival will be the ones selected for in the next generation. It was not an upwardly purposeful spiral that inevitably led to homo sapiens; evolution doesn’t change cows to humans –it just eventually creates cows better able to survive in whatever milieu they find themselves. And randomly –the unfit are still granted existence, but if they are not suited, they pass on little benefit to their progeny.

It’s true that animals –mammals, especially- do attempt to influence desirable traits in their offspring by choosing healthy partners exhibiting those characteristics. Hence various mating rituals and dominance contests amongst the males; hence elaborate male bird plumage, presumably a proxy, recognizable by a receptive female, as indicative of a primus inter pares. And yet it was probably regarded as curious in premodern societies that a female would be accorded any important choice, let alone that of selecting what she wanted in a partner. Although there has always been a cadre of women who have made their marks throughout recorded history, the examples are sadly limited –curtailed no doubt, because it was usually men writing about what they felt was important to document.

Fortunately, times are changing, as is the realization that each side of the gender divide is equipotent. Just how fluid the roles are is a constant source of wonder to me. Even in these days of Darwin, I am amazed at the still unsuspected porosity of the envelope. And while it no longer seems unusual or unlikely that an information-processing organism like, say, a bird might be able to select an appropriately endowed mate based on observable clues, it is still surprising –to me, at least- that selection duties might be conferred on a more microscopic scale: on an egg, for example.

I first encountered this idea in an article from Quanta Magazine: https://www.quantamagazine.org/choosy-eggs-may-pick-sperm-for-their-genes-defying-mendels-law-20171115/  I have to say it reminded me of Hamlet’s rejoinder to the sceptical Horatio on seeing Hamlet’s father’s ghost: ‘There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.’

The competition in sexual selection was thought to be pre-copulatory –‘After mating, the female had made her choice, and the only competition was among the sperm swimming to the egg. This male-oriented view of female reproductive biology as largely acquiescent was pervasive, argued Emily Martin, an anthropologist at New York University, in a 1991 paper. “The egg is seen as large and passive. It does not move or journey but passively ‘is transported’…along the fallopian tube. In utter contrast, sperm are small, ‘streamlined’ and invariably active,” she wrote.

‘Beginning in the 1970s, however, the science began to undermine that stereotype. William Eberhard, now a behavioural ecologist at the Smithsonian Tropical Research Institute, documented all the ways that females can affect which males fertilize their eggs even after mating.’ For example, ‘Internal fertilizers have their own methods of what Eberhard dubbed “cryptic female choice.” Some female reproductive tracts are labyrinthine, complete with false starts and dead ends that can stymie all but the strongest sperm. Some females, including many species of reptiles, fish, birds and amphibians, that copulate with more than one male (which biologists estimate are a vast majority of species) can store sperm for months, even years, altering the storage environment to stack the odds to favor one male over another. Many female birds, including domestic chickens, can eject sperm after mating , which lets them bias fertilization in favor of the best male.’

The plot thickens. These strategies seem only to select whose sperm to allow access to the precious as-yet unfertilized eggs. But even sperm from the same individual can vary. So, are things just left to chance? Are we still talking Darwin here? And are the combination probabilities proposed by Mendel that depend on randomness still in the picture?

It would seem that the egg itself may have a say in which sperm it uses, and that unlike the voting system in many democracies, it may not be just the ‘first past the post’ -the marathon winner- who gets the prize.

The article presents several theories as to how the egg may be able to ‘choose’, but as yet there seems to be no clear indication as to whether it always happens, or whether it is just able to weed out some potentially damaging or clearly unsuitable ones by the signals they emit –or fail to emit… Sometimes, anyway. Mistakes clearly occur; abnormal genes do manage to slip through, leading to abnormal embryos –some of which are unable to develop enough to survive.

But that there may be yet another layer of protection built into the system –another unsuspected surveillance system- is what intrigues me. And that, once again, it seems to invest the power of a truly critical decision with the female is a cautionary tale for those who cling to the shredding coattails of androcentrism. It is simply another piece of evidence, if more were needed, that Life and all that it enables, is not a zero sum game. It is not a contest between genders, but a journey together. Still…

Let there be spaces in your togetherness.                                                                                      And let the winds of heaven dance between you.
Love one another, but make not a bond of love.
Let it rather be a moving sea between the shores of your souls.
Fill each other’s cup but drink not from one cup.
Give one another of your bread but eat not from the same loaf.
Sing and dance together and be joyous, but each one of you be
alone – even as the strings of a lute are alone though the quiver
with the same music.
Give your hearts, but not in each other’s keeping.
For only the hand of Life can contain your hearts.
And stand together yet not too near together:
For the pillars of the temple stand apart,
And the oak tree and the Cyprus grow not in each other’s shadows. –Kahlil Gibran –

I couldn’t resist.

 

 

 

 

 

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Does the Best Safety Really Lie in Fear?

There are many unheralded benefits of age, one of which is invisibility -changing from a potential threat into a banality. A non-entity for whomever might otherwise be at risk. I can watch from shadows while the world strides past –on the street, in a bus, in a coffee shop. Wherever.

Men, until they age it seems, can be a liability to women –but I never thought of it like that, of course. Few of us ever do. I never thought I was a threat, but now I see I was wrong.

Does danger evolve, or is it the perception? The perceiver? Has its essence been reinterpreted, or merely renamed? Now that I am rapidly becoming a befrailed bystander in my retirement -background noise- I am also subject to harassment I never thought existed.

It’s not the same, I know. It’s not something I have had to endure throughout my life. Something woven into the fabric of each day that hides in the warp and weft of life until the pattern suddenly surfaces from the chiaroscuro like the shark’s fin in Jaws. Knowing the menace is always somewhere beneath the surface, and yet having no choice but to swim above it…

Watching from the shore, where the danger is rarely seen and never felt, it is all too easily dismissed. Maybe that’s why I’m trying to draw a parallel with the tide of years. I’m trying to understand something new to me. Frailty, thy name is Age.

For me, it’s not sexual pestering, of course, and usually not a threat of bodily harm –it’s more of a dominance thing… And yet, isn’t that what the gender divide can be about? Power? Identity insecurity? Role playing…?

I’m not even sure what role hormones play anymore –not all men are provocateurs. Not all men are cursed with the need for entitlement or the fear of losing status . Not all of us are insecure. But I think I can see what is going on –if only through a glass darkly. I think I can understand the gist of the article I found in the BBC news about women worrying about the ‘right’ amount of fear to show in public: http://www.bbc.com/news/world-41614720 The appropriate balance between sensible caution and the avoidance of a perceived threat.

Until I read it, I’m not sure I would have put it as forcefully as Dr. Fiona Vera-Gray, a researcher at Durham Law School, specializing in violence against women, and one of the 100 Women BBC named as influential and inspirational. But, I’m not a woman quietly smothered by the social blanket either thrown over my protests, or wrapped securely around my screams of dissent much as it might around a tired child’s body. It is hard to shift perspective like the article demands.

Dr. Vera-Gray had been speaking to women about how they change their behaviours through fear of sexual harassment and assault for her new book The Right Amount of Panic: How women trade freedom for safety in public. But I have to say that I had never thought about the need for the tactics she has identified that are outlined in the article. 

For example, she outlines conduct I’m sure we’ve all seen in streets and public transit –all seemingly innocuous, innocent, and yet all purposive: ‘Maybe, like Delilah, a black British woman in her early 20s who I interviewed, you stay away from wearing the colour red, to avoid standing out. Or like Shelley, a British Asian woman in her 30s, you’ve developed a death stare, looking tougher than you feel. Maybe like Lucy, a white British woman in her late teens, you’ve pulled out your phone and made a fake call with your battery long dead. Or like Ginger, a white Latvian woman in her 20s, you’ve kept headphones in without playing music so you can hear what they think you can’t.’

The European Union Agency for Fundamental Rights report (FRA) in 2017 on sexual harassment in Europe found that ‘almost half of the 42,000 women surveyed had restricted their freedom of movement based on the fear of gender-based violence.’

‘Liz Kelly, one of the world’s leading sociologists on violence against women, coined the term “safety work”, to describe the habitual strategies that women develop in response to their experiences in public. We perform safety work often without thinking, it becomes part of our habits, or “common-sense”.’ Peeking over my own male-built walls, I had no idea this was going on.

‘The vast majority of this work is pre-emptive, we often can’t even know if what we are experiencing as intrusive is intrusive unless it starts to escalate: he speeds up and crosses the street when you do, he moves from staring to touching. But as this is the very thing safety work is designed to disrupt, success becomes the absence of what might have happened. […] we know that it doesn’t, it simply can’t, always work, and those are the only times we can count. So women are stuck, made responsible for preventing harassment at the same time as unable to know when we’ve been effective.’

But, as Dr. Vera-Gray seems to conclude, ‘[…] there is no “right amount” of panic, there’s only ever too much or not enough. And with no way to know when we’re getting it right, we’ve learnt to just keep quiet.’

I don’t want to seem like a gender apostate, but I find the conclusions very troubling. As Robbie Burns put it O wad some Power the giftie gie us To see oursels as ithers see us! But, alas, we see the world, like we see the reflections in a mirror, only through our own eyes. And that’s not enough –we share the same journey, albeit sometimes on different paths. And that’s why there’s a need for signposts along the way. Conversations about the route. We all have to know where we’re going.

Maybe I will never understand; maybe I can only approach it vicariously, but at least it’s a start. I can stand in shoes that will never fit, even if I can’t walk without discomfort.

But maybe that’s what it takes –a sort of self-empathy, before it finally sinks in…

Presume Not that I am the Thing I Was.

We are all stories, aren’t we? But as I slip further down the years, I wonder about my story. Some of it I suppose I don’t remember, and yet what I do might still be suspect –a revision I make even as I think about it. Memory doesn’t reproduce the past so much as create it. And therein lies the problem. There was a time when historical validity was only accredited to its witnesses –a first-hand account told by someone who was actually there, someone who experienced it. But we’re long past that now…

When we are dead, we become fictions; when we can no longer speak for ourselves, what we might have thought, what we might have been, is merely interpreted, as the historical fiction writer Hilary Mantel has said. And even modern historians, scrutinizing the same evidence, will often differ in their explanations of the past. Who is to choose among them –and why?

So, history isn’t fixed, as we often assume, and it certainly isn’t static –it changes with new evidence, or transmogrifies according to the prevailing Weltanschauung. As Mantel sees it, history is not the past –it’s a method we’ve evolved to organize our ignorance of it. It’s what’s left in the sieve when the centuries have run through it.

I think that what occasioned this reminiscence was a short feature in the BBC news about a fifteen-year old toilet sign found in Italy at a farmhouse B&B: http://www.bbc.com/news/blogs-trending-40936110. The sign was attempting to use emojis to indicate that the toilet was not restricted to any particular sexual orientation. It had three symbols –one of a man, one of a woman, and one of a gay person. Unfortunately, the latter is depicted as a rather flouncy individual who is clearly neither male nor female, but rather an amalgam of them both, I suppose. Why it was felt necessary to suggest that ‘gay’ belonged to neither group is unknown. At any rate, the LGBTQ community reasonably complained of the sign’s confusion of sexual orientation with gender identity and the (new) owners obligingly removed it, even though it had apparently been covered up when they bought the property, and had remained so. They had meant no offence.

Things change. Sensitivities change. And signs are expected to reflect that… I, too, am caught up in the current ethos and find the sign unfeeling, and ill-informed, but things were different then, I think. The world was a different place for sure; the Umwelt itself was less evolved. But nonetheless, it makes me wonder whether we can ever understand the lived-world of another era. Whether even I can ever understand my own historical self, and so continually amend what I can remember of him –and continually rewrite the story…

I was waiting for a bus on the outskirts of town the other day, and sought the tiny shade afforded by a small wooden bench. Two older ladies arrived and seemed more in need of shade and rest than me, so I offered them the only gift I had –the bench. But it was in a covered structure and under a tree, so I stayed nearby in its cooling shadow.

They were both in their eighties, I would think, and both wore loose floral-print cotton dresses like I think my mother would have favoured. They wore their hair like her, too –short and manageable under almost identical blue hats. In fact, the more I looked, the more like her they seemed –they could all have been sisters, although my mother was an only child and died many years ago. It’s strange how often older women seem similar. Men do too, I suppose, but I notice the women more. Age homogenizes their faces, and memory standardizes their appearance… Blends them together into vague familiarity like apples in a crate. Fish in a tank.

I contented myself with leaning against the tree and staring idly down the street lost in thought… Okay, I was listening to them; I can’t resist an argument and they’d been going at it even before they sat down –some sort of family thing.

“You have to admit that father was ahead of his time, though, Thea…” The only difference between them I could detect was the colour of the flower pattern on their dresses. It was the red flower who was talking.

Thea, the blue-flower, sighed loudly. “What on earth makes you say that, Flo?”

Flo promptly crossed her arms and glared at her sister. It was hard to tell from where I leaned, but I think she rolled her eyes because it pulled her lip upwards and something rattled in her mouth. “Remember? He encouraged her to work outside the home, and told everybody about how women should have the same rights as men. Nobody thought like that in those days.”

“What house did you grow up in, Flo? He wouldn’t even let me work in that restaurant, remember?”

Flo shrugged at the memory. “You were too young, Thea. He was protecting you…”

“Then why didn’t he protect Ronny? He had a paper route when he was even younger.” Thea seemed pout for a moment. “And anyway, he didn’t encourage mom to work until he lost his job that time. And even then, she had to clean the house and cook the dinners for us when she got home.”  She stared at Flo. “That’s not equal rights and it’s certainly not ahead of the times…”

Flo stared at her sister with a slight tilt to her head. “Well, how about when Ronny came out? Father welcomed him back into our house…” I could sense that Flo was a bit hesitant to speak about her brother, though.

Thea sighed loudly again, but this time contemptuously. “Only after five years, Flo! And even then, it was because mom kept phoning Ronny and inviting him over. Father had nothing to do with it! And remember, the only reason Ronny agreed to come was because it was a family dinner –their anniversary- and yet, Father wouldn’t even speak to him at first. He totally ignored him at the table.” She shook her head sadly and looked at her sister. “Ronny was so hurt. Remember he even left the table and went to sit in the living room until mom convinced him to come back? And then, years later, Father had the gall to tell everybody that he’d never harboured any grudges against homosexuals? That he’d always accepted them?”

“Father’s last boss was a homosexual, wasn’t he?”

Thea glanced my way and her eyes strayed onto my face for a second, as if fleeing from her sister’s naïveté. “Father always pretended to move with the current, Flo. But deep down, he was a man of his time. That was the way things were when he was growing up. There’s no sense in applying today’s values to another era. It took slow and painful steps to get here…” She touched her sister gently on the shoulder. “It’d be like blaming the doctors in his day for not having discovered penicillin.”

Flo looked down the street and saw the bus approaching. “You certainly remember a different Father from me, Thea…”

Thea shrugged as she fished around in her purse for the fare. “We’ve always seen the world through our own eyes, Flo. It’s a puzzle, eh?” she added as they both boarded a bus that was not mine.

I moved to the bench, now in deeper shade, and thought about what Thea had said about their differences being a puzzle.  I remembered fragments of a thought Alan Watts, had written back in the sixties. It was something about there being a difference between puzzles and mysteries: puzzles are meant to be solved, but mysteries are meant to be enjoyed. Wondered about. Tasted. I think I’d prefer to think of the past as a mystery, you know. That we each taste the world with different eyes; there’s no one history that satisfies us all… And therein lies the wonder.

 

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.

 

Different Flavours

There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy –so says Shakespeare’s Hamlet. I suppose as one ages, there is a tendency to become, if not indifferent, then less surprised at the plethora of variations that exist when they are sought, less amazed at the range of combinations just waiting for discovery. Like ice cream, the world does not come in only one flavour.

But perhaps it is not just the array that so bedazzles, but that we could ever have presumed to define what is normal in anything other than in a statistical way. A Bell Curve distribution confronts us wherever we look –reality is a spectrum no less than the rainbows we all profess to admire. So, then, why is it that in some domains we are less than accepting of mixtures, less tolerant of difference? Why is there the overwhelming need to categorize things as either normal or abnormal? Natural, or unnatural? A macrocosm of only us and them?

Is it just the benefit of retrospection that allows me to notice that no one of us is the same? Or a corollary of Age that lets me thank whatever gods may be that it is like that? That not only do we differ in our tastes and thoughts, but that the discrepancies in our appearance, if nothing else, allow us to recognize each other?

At any rate, I have to say that, as a retired gynaecologist, I was pleasantly surprised to rediscover a world I thought I had left behind –intersex. It was an article in the BBC News that caught my attention: http://www.bbc.com/news/world-africa-39780214 In my day, however, we still hewed to the label ‘hermaphrodite’ if both male and female gonads were present, or even more insensitively, to something like ‘disorders of sex development’, with the medical community taking it upon itself to assign and surgically ‘correct’ the anatomical features at variance with some of the more prominent features of the melange. All this often before the person was able to decide whether or not to identify with either or both traditional sexes. I don’t for a moment believe that this was done malevolently, however, and I think we have to be careful not to apply current sensitivities to another era. Historical revisionism is always a temptation…

But the spectrum of variation is so wide in both anatomy and physiology, not to mention time of discovery, that assignation of gendered roles is fraught. For some, the worry has been that of acceptance –acceptance of any divergent anatomy, any dissonance, by society at large, but also acceptance by the individual themselves (even pronouns become problematic –assigned as they usually are by gender).

It is common nowadays (UN Office of the High Commissioner for Human Rights) to use the (hopefully) neutral term of intersex to define people who ‘are born with sex characteristics (including genitals, gonads and chromosome patterns) that do not fit typical binary notions of male or female bodies. Intersex is an umbrella term used to describe a wide range of natural bodily variations. In some cases, intersex traits are visible at birth while in others, they are not apparent until puberty. Some chromosomal intersex variations may not be physically apparent at all.’

Of course attitudes are as disparate as societies themselves. Not all have been as tolerant or accepting of difference as one might hope. The BBC article, for example, describes the attitude in some rural areas in Kenya that a baby born with ambiguous genitalia should be killed. ‘Childbirth is changing in Kenya. Increasingly, mothers are giving birth in hospitals, rather than in the village. But not so long ago the use of traditional birth attendants was the norm, and there was a tacit assumption about how to deal with intersex babies. “They used to kill them,” explains Seline Okiki, chairperson of the Ten Beloved Sisters, a group of traditional birth attendants, also from western Kenya. “If an intersex baby was born, automatically it was seen as a curse and that baby was not allowed to live. It was expected that the traditional birth attendant would kill the child and tell the mother her baby was stillborn.”’ The article goes on to say that ‘In the Luo language, there was even a euphemism for how the baby was killed. Traditional birth attendants would say that they had “broken the sweet potato”. This meant they had used a hard sweet potato to damage the baby’s delicate skull.’

‘Although there are no reliable statistics on how many Kenyans are intersex, doctors believe the rate is the same as in other countries – about 1.7% of the population.’ But the thrust of the article was really to discuss how  Zainab, a midwife in rural western Kenya defied a father’s demand that she kill his newborn baby because it was intersex. She secretly adopted the baby –and indeed, even a second one a couple of years later. ‘In Zainab’s community, and in many others in Kenya, an intersex baby is seen as a bad omen, bringing a curse upon its family and neighbours. By adopting the child, Zainab flouted traditional beliefs and risked being blamed for any misfortune.’ But she represents a slow, but nonetheless steady change in attitudes in rural Kenya.

‘These days, the Ten Beloved Sisters leave delivering babies to hospital midwives. Instead, they support expectant and new mothers and raise awareness about HIV transmission. But in more remote areas, where hospitals are hard to reach, traditional birth attendants still deliver babies the old-fashioned way and the Ten Beloved Sisters believe infanticide still happens.’ But, ‘It is hidden. Not open as it was before’.

I suppose it is progress… No, it is progress –however slow, and frustrating the pace may be, as long as there are people like Zainab there is hope. But it still leaves me shaking my head.

For some reason Robert Frost’s poem, The Road Not Taken, springs to mind, in a paraphrase of its last verse: I shall be telling this with a sigh somewhere ages and ages hence: two roads diverged in a yellow wood and she, she took the one less traveled by, and that has made all the difference

Please.

The Primrose Path

Age is sometimes mysterious, isn’t it? Despite the experience and occasional brush with wisdom I have encountered, I am still a child in many ways. Naïve -not so much about things I have encountered in my drive through life, but more about those on streets I have not visited. Addresses in the shadows.

I suppose there will always be issues that will never spring to mind in our normal passage through the years and yet, in retrospect, one wonders how they were missed. Or why. What, for example, happens to different populations as they age? And who do we get to care for those who have chosen -or been forced- to walk the darker paths, then fallen neglected and forgotten by the wayside, too old to re-offend? Should we care for those who flout our laws and reject the duty to conform? Are we a family, or just a collection of intolerant strangers easily offended and quick to turn away?

Imponderables, to be sure, and yet, like it or not, there are needs that must be met… by someone anyway. I was intrigued by an article in the BBC News about aging prostitutes in Mexico City: http://www.bbc.com/news/magazine-38677679  One of their members opened a retirement facility for them.

I must admit, that the plight of aging sex workers had never really occurred to me. I’m not sure what I thought would happen as they got old, although, as a gynaecologist, I was certainly aware of their life style risks; their need for consultation in the Emergency Department was a regular and frequent occurrence whenever I was on call. For some reason, I’m reminded of that quote of Queen Katharine buried deep in Shakespeare’s Henry VIII: ‘Like the lily, that once was mistress of the field and flourish’d, I’ll hang my head and perish.’ Is that how they end their days…? I hope not.

But a retirement home –how perfect! The social safety net in Mexico is likely not as comprehensive as that in Canada, and yet even here, I’m not aware of any such facility. Indeed, the oldest profession has undergone other, more callous impediments as I noted in a 2014 blog on prostitution laws: https://musingsonwomenshealth.com/2014/06/12/prostitution-laws/  So perhaps it might be asking too much to wonder if such a facility might be in the offing -if not governmentally sponsored, then perhaps privately funded. Or better still, a legal adoption of  something like the New Zealand model might discourage exploitation and even offer salaries and, who knows, pensions…? Comfort for their end of days?

*

I do not ordinarily sit in malls; I do not ordinarily go to malls, for that matter, but sometimes circumstances foster unexpected opportunities. I was tired that day –tired of fighting through Friday crowds in search of things I probably didn’t need, or at least could likely find with a little effort somewhere else. I had just decided to look for a place to rest and collect my thoughts, when I saw a woman check her watch and stand to leave an uncomfortable-looking wooden seat near where the tide of people was sweeping me. I immediately swam over and moored before the woman right behind me could claim it for herself.

The seat was one of four that served as a kind of breakwater for the waves of people flowing down the shop-lined banks in confused eddies. Bolted to the floor, they were arranged in a little circle, presumably to facilitate conversation, but only two of the occupants seemed to know each other. They were deep in conversation so even an exchange of pleasantries seemed inappropriate, but just before I closed my eyes, I managed to catch their attention and smile at them. In the seat beside me was an old man who also smiled, but seemed more preoccupied with his watch than anything else.

The women were quite old and both looked as if they’d seen better days. Although their clothes were clean and obviously worn with an attempt at style, I could see fraying at the hems, and areas where the patterns were disrupted by attempts at repair. Both their faces were wrinkled, as much by life as age, I suspected, and the one directly across from where I sat, seemed hollow around her cheeks and gummed her words through sparsely distributed teeth. Short and gaunt, she sat proud and straight in her chair, however, her long, greying hair swept back in an elegant ponytail that danced each time she talked. She had dressed that day in a green, fading sweater and black jeans that seemed a bit too large, so the cuffs were carefully rolled to matching folds.

The other was a larger woman with short, ash-white hair that she had scrunched under a blue baseball cap that had some sort of a truck logo on its front. She was dressed in a red and white flower print dress which seemed to hang shapelessly below a tattered and faded nylon jacket that had probably once been totally black. At her feet was a big, stained cloth shopping bag that bulged oddly in places with items too irregular to be just clothes.

Friendly strangers, they both smiled back at me before resuming their conversation.

I closed my eyes and tried to relax into the wooden slats, but their words kept floating over to me during lulls in the storm of voices and accidental elbows hurrying past me. I could tell it was an unsafe anchorage at best.

“Haven’t seen you for a while. You still working, Ethel?” It must have been the pony-tailed woman, because her words seemed strangely distorted and her lips smacked together a little as she spoke.

A gaggle of children passed nearby so I missed some of the response. “… men anymore, Rita…”

“Yeah, I guess, eh?” But I didn’t think Rita sounded very sure. “You still on the…” A demonic laugh surfaced in the crowd for a moment then faded along with Rita’s words.

“Yeah,” Ethel replied. “Hard to get off though, eh?”

I opened my eyes to get a little more comfortable on my seat, and saw Rita nodding in agreement. “Hang out in the same place?”

Ethel shrugged as I closed my eyes again. “They know me there,” she answered.

I imagined Rita nodding in agreement. “Mmmh,” I heard.

School must have ended for lunch, because a group of noisy teenagers rambled past, joking and poking each other. “What shelter you going to nowadays?” Ethel’s words caught my attention, even amidst the confusion of teenage jests and I opened my eyes, pretending to adjust my position again.

I could see the indecision on Rita’s face, and her lips moved as she considered her answer. “Used to go to the one on Main…”

“Yeah, me too,” Ethel agreed, glancing at her. “Got assaulted there, though, so I sometimes try the Sally Ann…”

“Mmmh.”

“What about now, Rita?” She adjusted her baseball cap as she spoke. “Where you headed tonight…?” She sounded suspicious. They were clearly not good friends –just acquaintances, perhaps, who’d found themselves in adjoining seats to shelter from the weather for a while.

Rita stared at Ethel for a moment, obviously uncertain how to answer. Then she ordered her eyes to scan the passing crowd. “Found a new place. Some of the girls got together…” But it wasn’t the noise of passing voices that ended her words.

Ethel tried to find out more, but Rita suddenly stood and waved, as if she recognized someone in the crowd, and dived into a particularly noisy wave and disappeared.

Ethel sighed and then gathered up her things and melted into a similar eddy going another direction. Despite her weight, she seemed frail and aged. Her movements were no longer fluid, her gait was unbalanced and she hobbled with a decided limp. But as she disappeared, her eyes brushed mine -by mistake, I thought at first, but when I remembered it later, I wondered if it had just been habit. A desperate plea for another friend –however temporary.

 

 

 

 

A Flicker of Hope

It’s interesting what catches our attention when we surf the apps on our smartphones nowadays. Some of the more provocative articles have dubious sources, of course, but with a little digging the original study can often be found and the claims checked. The problem, however, is that even these results need to be reproducible in case either the methodology or the results were unreliable –and also the conclusions drawn from them. That’s why it’s often unwise to believe everything you see reported –or, on the other side, to report everything you want to believe… Fear and Hope are wonderful incentives, and so the issues in the study need to be thoroughly researched and vetted for bias and innuendo and references to the original study need to be included.

Perhaps because I am now retired, any article about time-related changes catches my eye more easily. So I find myself particularly interested in studies that suggest progress is being made -not with respect to age itself, but more the evolving process of aging: the gerund. It was with considerable interest that I read the BBC news on the use of flashing light therapy for Alzheimer’s http://www.bbc.com/news/health-38220670

I also attempted to read the original paper from MIT (entitled Gamma frequency entrainment attenuates amyloid load and modifies microglia) published in the December 2016  issue, of the journal Nature should you wish to struggle though it, but I have to confess that for me, even the title was difficult…

At any rate, the article suggested that flashing light in the eyes of mice that were genetically engineered to have Alzheimer’s-type damage in their brain, ‘encouraged protective cells to gobble up the harmful proteins that accumulate in the brain in this type of dementia. The perfect rate of flashes was 40 per second – a barely perceptible flicker, four times as fast as a disco strobe.’ And ‘Build-up of beta amyloid protein is one of the earliest changes seen in the brain in Alzheimer’s disease. It clumps together to form sticky plaques and is thought to cause nerve cell death and memory loss.’ Research has focused on ways to prevent this plaque formation using drugs, but with limited success so far. If a non-invasive method like a flickering light can activate the immune system to do it by itself, so much the better. ‘The researchers say the light works by recruiting the help of resident immune cells called microglia. Microglia are scavengers. They eat and clear harmful or threatening pathogens -in this instance, beta amyloid. It is hoped that clearing beta amyloid and stopping more plaques from forming could halt Alzheimer’s and its symptoms.’ Fine with me.

I did, however, initially wonder about how bothersome the flickering would be –news reports on television usually caution their audience whenever even flash photography is found in the report, presumably because of the risk of triggering epileptic seizures. But, as the article discussed: ‘For the patient, it should be entirely painless and non-invasive “We can use a very low intensity, very ambient soft light. You can hardly see the flicker itself. The set-up is not offensive at all,” they said, stressing it should be safe and would not trigger epilepsy in people who were susceptible.’ Better and better! It’s just preliminary stuff, of course, but at least it opens up new pathways and ideas for further research.

As if even reading about the concept was in itself therapeutic, the article immediately triggered what, at first blush, would seem to be a non-sequitur memory of a patient I saw many years ago. The issue as I recall was not so much about mental aberration -although the patient herself was apparently suffering from paranoid schizophrenia- but more about her speculation on the possible effects of flickering light on mental function.

I was, I think, in my first year of residency training in the gynaecology program and was doing a rotation in one of the older teaching hospitals in the city. In those days, things were very busy on the wards and so our tasks were apportioned according to our seniority, the senior residents doing the lion’s share of new consultations, while we juniors were given those jobs that, while important, required less experience -pap smears, usually.

My senior’s name was Sara, I remember, and she decided I should be the one to go to the psychiatric ward to do a pap smear on one of their more ‘unusual patients’ as she said to tease me.

“What do you mean ‘unusual’?” I asked. Sara didn’t like to go onto that ward, for some reason, so she usually made some excuse.

She stared at me for a moment before answering, I remember. “Oh, you know, she has paranoid delusions and hallucinates, or something…” But it was clear that Sara really had no idea why our department had been asked to do the pap, nor had she any intention of doing it herself.

I was beginning to suspect this was merely another sluff. Sara fancied herself a consultant now and able to delegate things she didn’t want to do. “But if she’s paranoid and hallucinates, wouldn’t it be better if the doctor doing the pap smear was female?”

Her expression turned angry at that point, and I recall her almost attacking me with her eyes. “Oh for god’s sake, there’ll be a nurse there with you the whole time… Or maybe they said two…” she added, uncertainty softening her glare, but not her resolve to send me to that ward.

I showed up at the psychiatric area and was allowed in only after identifying myself via the phone just outside the door. Then I was led to the brightly lit nursing station, and a rather large matronly nurse handed me the chart of the woman needing the pap.

“She hasn’t had a pap smear in years,” the nurse said in a soft voice, so it couldn’t be heard in the corridor outside of the station. “And her voices told her she has cervix cancer…”

“Her voices?” I should have been more professional, but I was already feeling a bit apprehensive about being inside a locked ward. “I mean, shouldn’t we wait until she’s feeling a bit better before we…”

“We can’t seem to find any good medication for her yet,” the nurse interrupted. “The doctor thought that we could at least calm her by checking her cervix.”

Greta –I still remember her name- was already in the examination room, sitting in her gown on a little table that had a set of rickety old metal stirrups at one end. They’d apparently had to borrow everything from another ward for the job. As soon as I entered with the nurse, Greta examined me from top to bottom with suspicious eyes.

“You’re a man,” she said before we were even introduced.

The nurse, whose name I forget, walked over to Greta and held her hand. “You remember we talked about this, Greta,” she said in the same soft voice she’d used before. “And you said it was okay…”

Greta nodded, smiled and lay back to put her feet in the stirrups. “They said I should show you my cervix,” she said, the italics staring at me between her knees. “Not the one with cancer, though…  I’m supposed to keep that one hidden.”

“Her voices,” the nurse quickly whispered in my ear as I sat on a little stool they’d also borrowed for the occasion along with a light on a long, flexible metal pole. It looked as old as the stirrups.

I got the speculum and the pap smear paraphernalia ready as the nurse readied the light. The bulb kept flickering, though. I fiddled with the bulb to see if it was loose, but it seemed tight enough. And it was obviously plugged into the wall. On, off, on, off… the light was beginning to annoy me. I snapped the switch a few times, but still, it insisted on flickering. On, off, on, off…

“I’ve got a flashlight,” the nurse said, but when she turned it on, it was so weak, I knew I wouldn’t be able to see cervix high up in the vagina with it.

“Well, maybe I can do the pap smear with the flickering light,” I said and shrugged.

Suddenly Greta raised her head and stared at me again. “Sometimes the prongs don’t make good contact in the wall. Everything’s so old in this place,” she added, shaking her head. “Take the plug out and squeeze the prongs.”

By this time I had the speculum in my hand, so I nodded to the nurse to try Greta’s suggestion. Sure enough, squeezing the prongs stopped the flickering.

Greta was still staring at me through her legs. “I may be crazy, doctor, but I’m not stupid…”

I put the speculum down on the medical tray I had on my lap. I sensed Greta wanted to explain something. “It’s a signal, you know.” I didn’t think I should reply. “The light’s always trying to tell you something –sometimes it’s angry, but more often it’s just trying to help…” Her feet still in the stirrups, she raised herself onto one elbow and continued. “It gets right into the brain to help, you know. It doesn’t stay there long enough, though, and that’s why it has to keep going in and out, in and out… And each time it tries, it flickers…” Then she stopped talking for a moment and stared at the nurse with an amazed expression on her face. “That’s what the doctors should be trying –not all those horrible pills…”

Maybe that incident stands out because it was the first pap smear I’d ever done. I don’t remember the result in Greta’s case –I was near the end of my rotation in that hospital- but I do remember Sara asking me what I’d done with that patient.

“Why?” I asked, afraid Greta had accused me of doing something improper.

“The ward told me that your patient seemed much calmer after you left and she apparently kept telling everybody you’d come up with a new treatment, or something…” And then I remember Sara smiling condescendingly at me, as if to say that junior residents could never do anything of the sort.