Tag Archives: Hamlet

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Gedankenexperimentophobia

It’s fun to play with thoughts, to riffle through ideas, don’t you agree? Take ‘thought experiments’ for example -think up a problem, set some parameters to confine it and see what your brain, unconstrained by external reality, comes up with. It’s almost akin to the Scientific Method some would argue: ask a question; form a hypothesis about it; make a prediction based on the theory; test the prediction; and finally, come to some conclusion. But is it? Can a mind sitting quietly by itself in an armchair, circumvent the need for external reality?

Ever since I first heard it, I have felt uncomfortable with ‘the Trolley Problem’. There have been several iterations of it over the years, but by and large it consists of a runaway coach on a track that is approaching a switch. Down one track is a single person, whereas down another are several people. The coach cannot be stopped, the person (or people) cannot get out of the way, but the switch can be thrown to direct which track is used. The question, of course, is which track to use -either track will result in death.

What does the choice of one track or the other say about the person who has to decide? About their morality? About ethics? About anything, really? It seems far too monochromal for my liking. And, unlike its real-life cousin, by definition a thought experiment cannot really be subjected to any rigorous objective analysis. It’s more like an experiment done in a lab where all parameters are carefully controlled, unlike what would happen in the real world.

But for years I’ve wondered whether my discomfort was misplaced. After all, Einstein used thought experiments. My concerns, like an unused city lot, lay fallow until I wandered into an essay by James Wilson, a professor of philosophy at University College London: https://aeon.co/essays/what-is-the-problem-with-ethical-trolley-problems

As he writes, thought experiments are ‘short hypothetical scenarios designed to probe or persuade on a point of ethical principle. Such scenarios are nearly always presented context-free, and are often wildly different from the everyday contexts in which ethical sensibilities are formed and exercised… Even when scenarios are highly unrealistic, judgments about them are thought to have wide-ranging implications for what should be done in the real world. The assumption is that, if you can show that a point of ethical principle holds in one artfully designed case, however bizarre, then this tells us something significant.’

Sometimes, however, when considered as things that might happen in the real world, we can envisage other conditions that would invalidate, or at least complicate, any conclusions drawn in the thought experiment. We know too much, as it were. ‘Thought-experiment designers often attempt to finesse the problem through an omniscient authorial voice that… is able to say clearly and concisely what each of the thought experiment’s actors is able to do, their psychological states and intentions. The authorial voice will often stipulate that choices must be made from a short predefined menu, with no ability to alter the terms of the problem. For example, the reader might be presented with only two choices, as in the classic trolley problem: pull a lever, or don’t pull it.’ Exactly.

So constraining the choices limits the possibility of novel approaches to the stated problem. ‘Imaginative ethical thinkers look beyond the small menu of obvious options to uncover novel approaches that better allow competing values to be reconciled. The more contextual knowledge and experience a thinker has, the more they have to draw on in coming to a wise decision.’

But there are at least two other difficult challenges with thought experiments: internal and external validity. ‘Internal validity relates to the extent to which an experiment succeeds in providing an unbiased test of the variable or hypothesis in question. External validity relates to the extent to which the results in the controlled environment translate to other contexts…[but] the very features that make an environment controlled and suitable to obtain internal validity often make it problematically different from the uncontrolled environments in which interventions need to be applied.’ In other words, the world just doesn’t work like that.

I remember trying out the Trolley Problem on the guys who meet for coffee some mornings in the food court. I wondered if they felt the same unease with it as I did.

“So, which track are you going to switch the trolley onto?” I asked, after giving them a brief summary of the thought experiment.

Burt put his doughnut back on the paper plate, and wiped some sugar off his cheek. “It’s so obvious, G -I’d ring the bell. All trollies have bells, eh?”

“But what if the workers on the track don’t hear it…?”

Burt rolled his eyes, as he brushed a lock of his paper-white hair off his forehead. “I’d keep ringing it. The workers would hear it when it got closer…”

“But suppose the workers are tied to the track.”

Burt glared at me for a moment. “You didn’t say that. And anyway, why would they be tied to the track? That’s a bit Little Orphan Annieish, don’t you think?”

I decided to relent a little to make it more -what?- real worldy. “Okay, let’s say they’re just deaf…”

Burt was clearly unmoved by my compromise. “Still…”

Jason, who had been quietly munching on a bagel put his hand up.

Burt sneered at the hand. “You’re not in school, Jas…”

Jason blinked and lowered his hand, and then glared at Burt. “Whatever. Anyway G, you said they were working on the track. They’d be able to feel the vibrations on the rails from a moving trolley, so that would warn them to get out of the way.”

I had to sigh; the guys were not really getting into the spirit of the ethical problem I’d offered. “I don’t know how much warning that would give, but let’s say they weren’t actually standing on the rails…” I had to think quickly here. “Let’s say they were on the ties between the rails then.”

Arthur, who had been teacher before he retired, sighed loudly and shook his head. “You folks are missing the point.”

Burt took a big bite from his doughnut. “The point being…?” It was hard to distinguish word from doughnut, but Arthur ignored the sounds.

“It seems to me the problem is bimodal.”

I smiled and nodded my head at him -finally somebody understood the ethics at stake. “Correct,” I interrupted, “There are two choices: the left track or the right track -several deaths, or one death. Which one would you choose, Art?”

He glanced at me quizzically. “I didn’t say there were two choices; I said bimodal: values occurring most frequently in the data set we were given…”

Jason, Burt and I stared at him, but it was Burt that summed it up. “You had too many cookies, Art…?”

It was Arthur’s turn to roll his eyes. “What I mean is that we have to consider two data streams that affect the choice of track…”

“Too much sugar in his coffee,” Jason whispered to Burt.

Arthur ignored them. “First of all, there’s the trolley driver. He would be ringing the bell, of course, but presumably to be allowed to drive the trolley, he’d have been expected to know about things like the switch signs that indicated which track was open.” He stared at me. “Would that not be the case?”

I shrugged, but I had to agree with him.

Then a wry smile appeared to hover tentatively along his lips. “And then there is the person whose responsibility it is to work the switches.” His smile softened briefly. “A very important job, as you can imagine.”

None of us disagreed. I was more interested in where this was leading, though.

“So,” he continued, “We can assume that the switch person knows that the driver has to have some expertise in reading the switch signs…” He looked at each of us for a second to see if we were following him. Nobody moved. “Therefore, the switchman flags the approaching trolley to let the driver know he understands the trolley is out of control, and then sets the switch only at the halfway position. The driver would see this as an uncompleted switch and realizes it will derail the trolley, so he jumps clear.”

Arthur sat back in his chair this time with a big sloppy grin on his face. “So, nobody dies. Problem solved…”

I suddenly remembered that scene in Shakespeare’s Hamlet: There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.

I wonder if Hamlet could have resolved the Trolley Problem as quickly as Arthur, though.

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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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Should You Wish Upon a Star?

I’m of two minds about magic. On the one hand, it seems too good to be true -too naïve and unexamined, too much like Santa Claus; but there’s a part of me that wants to believe in another world where faeries dance on dew-soaked blades of moonlit grass, and bird song fills the dawn forest as a paean to the aborning light. In a place -or was it a time– where anything was possible, because no one had proven that it wasn’t.

Unfortunately, I grew up and found an adult proof -or thought I had. I suppose most of us do, though. It’s not even a choice -as we wend our ways through the interstices of everyday life, we shed those things which impede our progress -like a shirt on a hot day, unregarded magic is in corners thrown, to paraphrase Shakespeare. Our route is littered with it, if we cared to look. But we don’t anymore. We can’t be bothered.

And yet, in my darker days, when I find myself staring into the ordered chaos that encloses me like a cape, I sometimes wonder if it was all a mistake. Perhaps we were meant to keep a little in reserve. A curtain we could peek behind in times of need. In times when we realize that what we have is not enough… or, rather, too much.

In one such mood, I happened upon an article written by Frank Klaassen, an associate professor of History in the University of Saskatchewan, entitled The Magic of Love and Sex, who characterizes himself as a scholar of medieval magic. I have to admit, that anybody who purports to be able to unmask the most mysterious trappings of an enchanted, faraway age has got my ear -or in this case, at least, my eyes. https://theconversation.com/the-magic-of-love-and-sex-91749

He says that ‘[…] passing the magazine stand at the checkout counter is like stepping back in time.’ Both the men’s and the women’s magazines promise to divulge secret methods of procuring unattainable things we all want, yet could only dream of: sex, power, influence… ‘Bronislaw Malinowski [a Polish-born British social anthropologist] says that the function of magic is to ritualize optimism, to enhance “faith in the victory of hope over fear.” By this he means that when we perform magic, we ritualize our hopes, even if that ritual itself produces no effects.’

‘There is a massive modern industry that leverages our vulnerabilities. Hundreds of scientifically unproven techniques offer not only power over love and sex, but health, wealth, good luck, influence over other people, improving appearance, intelligence and public speaking, assuring happiness and protection of self and family.

‘Modern books on magic like Starhawk’s The Spiral Dance and New Age handbooks like Shakti Gawain’s Creative Visualization have become classics over the past 40 years and have sold millions of copies. They cover pretty much the same ground. With few exceptions, the goals of medieval magic were identical to these personal growth manuals from the 1970s, and fulfilment in love tops the list.’

But interestingly, similar to today, Klaassen says that scholars back then were also critical of magic and superstition. ‘Medieval philosophers expended a lot of ink demonstrating how seemingly miraculous things were just natural effects […] To respond to these attacks, writers of medieval magic books often did exactly what their modern counterparts do —they tried to make them look like they were scientific. They used scientific ideas and language.

‘In comparison, one would think that modern people would be far less interested in magic, particularly given our advanced sense of how the physical world functions and the scientific educations we all get in public school.’

But, I think the crux of his point is to compare the two modes of thinking, and whether things have changed all that much over the years. ‘[…] it challenges the idea that scientific thinking somehow banishes magical thinking. Clearly, it doesn’t.’

‘[…] Modern science may have helped us live longer but it hasn’t made illness and death any less inevitable. It certainly hasn’t made it possible to make ourselves more wealthy, desirable, charismatic, intelligent or successful in love.

From one perspective, love magic is biological. We are biologically programmed to try anything that might help us reproduce ourselves. Skepticism would just get in the way of that. Hope, on the other hand, keeps us creatively trying things out and doing whatever it takes: The perfect clothes, the right music, giving flowers, perfume, beautiful words, … or magic.

From another perspective, as Malinowski suggested, magic springs from human qualities that we all value very highly: Optimism, hope and creativeness. Where would we be without those? If our ancestors only stuck to the tried and true, things they knew would not fail, we’d still be in the trees. We’d certainly have no love songs.’

I like the idea that magic is hope. And hope is no less real because what we wish for hasn’t yet happened; there may not be faeries dancing on the lawn at night, but if I want to believe that if I hid out there under a blade of grass one night I would see them, should you lock me up? Or put me on medication? All of us hear stories, some more fanciful than others -and not all of them are as we remember. We colour our narratives with almosts and often sneak in a few might haves to spice the tales. The rest of us wink at the clever interpolations, and then add our own when it’s our turn to speak. Who’s to say what really happened -what might have happened?

There is a ragged border between fact and fancy sometimes, and maybe your misspeak is my magic -or at least my hope. Would you really want to take that away from me… and should you? Like Shakespeare’s Hamlet, I want to believe there are more things in heaven and earth than are dreamt of in our philosophies…

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Within the Book and Volume of Thy Brain

Is it naive to mention that there is an almost magical bond between a mother and her baby? A bond that, while certainly not less in the father is, well, different? At first, I assumed it was probably related to the closeness of breast feeding –yes, the oxytocin and its effects on bonding, and the magic of skin-to-skin contact- but this seemed to be a very reductionist way of looking at it –a post hoc ergo propter hoc approach. No, the amount of head-swaying I would see, the purring of the sing-song words barely audible from across the room, the eye contact with the bundles in their arms… All this seemed more like the devotion of religious acolytes than could be reasonably reduced to simple biological cause and effect in the little carpeted area where my patients would sit, waiting for their postpartum checkups. I can’t help but think of Shakespeare: There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy, as Hamlet observed under admittedly different circumstances.

I mention this decidedly apostatic thinking because it occurred to me that some things are difficult to fit into a satisfyingly rational, or secular framework. Many years ago, I remember seeing a woman -Lorraine was her name, I think- who, my day-sheet informed me I had delivered 2 or 3 months previously. Anyway, she was coming in to discuss contraception and she had brought her little baby with her. I could see her sitting on the other side of the room talking and nodding rhythmically to the little tyke. Even from a distance, I could see they were locked in ocular embrace. Then, slowly, she reached into a bag at her feet and pulled out what seemed to be a large picture book. She nestled the baby in one arm and held the book open with the other hand so the baby could see it. From where I stood behind the front desk, I couldn’t really tell what pictures the baby saw, but she was naming what I suppose were animals, and whatever else came up from page to page.

Perhaps the baby was paying attention, but it seemed entirely too comfortable in her arms, and her voice far too much like a lullaby for it to keep its eyes open.

When her turn came to talk to me in the office, she told me that she’d noticed me watching her with the picture book.

“I’m a first grade teacher,” she said, showing me a collection of children’s drawings carefully pasted onto stiff pages and stapled into a folder. “And when the kids found out I was going to have a baby, they all decided to draw pictures for me to ‘read’ to it.” She drew little air quotes around the word. “And I thought, why not? It’s sort of like reading, isn’t it? The kids thought so, anyway…”

I have to confess that, although I always loved reading to my children, I enjoyed it more when they seemed to understand the words. When they reacted to my play-acting voice that attempted incarnation of the characters, painting the scene in words, pretending we could see the story. I enjoyed the immersion as much as they did, I suppose –we were the story, in a way. Each of us.

Now that I think of those times, I feel vaguely guilty that the experience was as much about me as it was about the child sitting beside me on the couch, or lying on her bed with saucered eyes in a room lit only by the lamp beside my chair. Each of us was as hungry as the other to discover what the words would tell us, our imaginations primed and insatiably curious as our minds watched the movie being played behind our eyes.

Sometimes, of course, I would read a book of their choosing, but both my son -and later my daughter- seemed to prefer it when I made up stories for them. No pictures –just verbal descriptions that neither of us could guess beforehand. Word riffs.

But Time moves on, and so does our knowledge of developing brains. It would seem that certain content, particular themes and even types of books, may be more helpful at different ages. I can’t say that it came as a surprise that infants, too, benefit from being bathed in words –it’s how vocabulary begins, after all. What I remain somewhat agnostic about, however, is that there might be a preferred order of progression. An article in the Smithsonian Magazine hoped to disavow me of this skepticism, however: https://www.smithsonianmag.com/science-nature/babys-brain-benefit-read-right-books-right-time

For example,  the author, Lisa Scott, Associate Professor in Psychology, University of Florida: ‘[…] found that when parents showed babies books with faces or objects that were individually named, they learn more, generalize what they learn to new situations and show more specialized brain responses. This is in contrast to books with no labels or books with the same generic label under each image in the book. Early learning in infancy was also associated with benefits four years later in childhood. […]These findings suggest that very young infants are able to use labels to learn about the world around them and that shared book reading is an effective tool for supporting development in the first year of life.’

I’m certainly not disputing the findings, nor offering any alternatives –I’m merely wondering whether or not it has that much of an effect on subsequent development of the child as it matures. As she points out earlier in the article, ‘Researchers see clear benefits of shared book reading for child development. Shared book reading with young children is good for language and cognitive development, increasing vocabulary and pre-reading skills and honing conceptual development. Shared book reading also likely enhances the quality of the parent-infant relationship by encouraging reciprocal interactions – the back-and-forth dance between parents and infants. Certainly not least of all, it gives infants and parents a consistent daily time to cuddle.

‘Recent research has found that both the quality and quantity of shared book reading in infancy predicted later childhood vocabulary, reading skills and name writing ability. In other words, the more books parents read, and the more time they’d spent reading, the greater the developmental benefits in their 4-year-old children.’

I suppose what I’m getting at is that perhaps the best message to get across to parents is the importance of reading to their child –interacting with the child- rather than getting them concerned that they’re not doing it the right way. That they’re using the wrong materials, or in the wrong order. Raising a child is hard enough at the best of times. Indeed, the author acknowledges this at the end of her piece: ‘It’s possible that books that include named characters simply increase the amount of parent talking. We know that talking to babies is important for their development. So parents of infants: Add shared book reading to your daily routines and name the characters in the books you read.’

But, then again, maybe this is just preaching to the converted. Mothers already know most of this –Lorraine did, at any rate.

 

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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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Sweet Flowers are Slow

 

 

It never ceases to amaze me what unfettered minds can discover. Sometimes I wonder how they do it. How they set out 180 degrees from the target and still end up hitting it. Of course, the world is full of answers scattered like flowers in a field, in plain sight for anybody who has learned to see them. It’s not the answers that are hidden, just the appropriate questions. But maybe that’s the point –questions are often like detours pointing away from where you think you want to go, and yet arrive you do, having learned unexpected things along the way –Frost’s Road not Taken.

Socrates, although he initially disavowed the Delphic Oracle’s apocryphal pronouncement that he was the wisest man in Athens, knew that Truth, like Wisdom, was slippery. He realized he didn’t possess all the truth and so he asked many questions, whereas others -those who never thought to investigate- were complacent about their knowledge, unpuzzled by what they experienced, content with their grasp, however tenuous.

Maybe that’s just the way we’ve been taught to interrogate reality, though: if A equals C, and B also equals C, then we need look no further –A, B and C are equivalent, or at least interchangeable and otherwise individually uninteresting. Perhaps it takes a Socrates to ask why that is –or at least why we are satisfied with our assessment.

An article in the BBC News about an unusual approach to decreasing the spread of malaria brought this to mind: http://www.bbc.com/news/health-40495958  While researchers are trying desperately to engineer a vaccine, there have been many interesting attempts to ameliorate the prevalence of the disease. Some are relatively high tech –like genetically altering mosquitoes to produce genes to prevent the development of the malarial parasite within themselves and therefore stop its transmission to people when they bite; some are more humble methods, more attainable in the short term -such as pyrethroid-treated mosquito netting around beds. I suppose the boundaries between discovery and invention are fluid, but even so, either of them can lead to uncharted territories. New possibilities.

Still, until we do have an effective and safe vaccine, we need to use as many other methods to decrease the ravages of the female Anopheles mosquito as possible –however indirectly they may achieve this. Sometimes you just have to try stuff. Sometimes, you have to think inside the garden.

‘Gardening could be a powerful weapon against malaria, culling mosquito populations by cutting off their food supply, say researchers.’ The idea is to starve the mosquitoes before they get a chance to pass on the malarial parasite. A pilot project in Mali, West Africa, found that ‘Removing flowers from a common shrub appeared to kill off lots of the older, adult, female, biting insects that transmit malaria. Without enough nectar the “granny” mosquitoes starve, experts believe.

‘These Anopheles mosquitoes carry the malaria parasite in their salivary glands and pass it on to people when they bite and draw blood. The infected person can then infect other younger, biting, female mosquitoes – which are looking for a rich blood meal as they become fertile and make eggs – because their blood now contains the parasite. It takes about 10 days for a newly infected young female mosquito to become contagious to humans. By the time she can transmit malaria, she’s pretty old. Although she will feed on blood, she also relies on flower nectar for energy to stay alive.’

So, ‘Experts in Mali, along with researchers from the Hebrew University of Hadassah Medical School, Israel, and the University of Miami in the US, set up a horticultural experiment to see if removing the flowers from this plant might help kill off local mosquitoes. […]Villages where they removed the flowers saw mosquito numbers collected in the traps fall – the total number of mosquitoes across these villages decreased by nearly 60% after removal of the flowers.’

Admittedly, as the researchers concede, although it was an appropriate technique in a place like Mali, ‘it might not work so well in lush tropical regions where nectar-rich plants are in abundance.’

I suppose one of the reasons why this approach intrigued me so much, was that it seemed like a rather simple –albeit laborious- technique for mosquito control. Much like removing standing water that has collected in puddles or old tires where the mosquitoes can lay their eggs, it could be a community-led project that requires no additional external resources. But even more than that, as Professor Jo Lines, from the London School of Hygiene and Tropical Medicine, has observed, ‘”It appears to show that by changing the landscape, not using insecticides or drugs, we can make a difference.”’

What a thought –changing, not destroying something to achieve an aim. Being clever and asking the right questions about what was already in front of the eyes of anyone inquisitive enough to actually notice. Curious enough to ask ‘what if…?’

So, back to Socrates who, in the end, conceded that perhaps the Delphic Oracle had been right all along about him being the wisest man in Athens. He was still searching for knowledge, still questioning the completeness of what others had already decided was necessary for them to understand. He was still unprepared to pretend that he knew something he didn’t. To the end, he refused to accept that there weren’t always more questions to ask.

After all, it’s not what you look at that matters, it’s what you see; it’s not what you hear, so much as what you understand… The rest, as Hamlet said, is silence.

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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.

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Who Wants a Country of Boys?

We mortals seem to be good at assumptions; they are shortcuts that allow us to function without the requirement of constantly checking the validity of beliefs or items in our environment. Part of it is trust; part of it is process, and yet I don’t want to get into a semantic discussion of the manifold vagaries of the word, nor a tedious list of definitions. I just want to concentrate on that very human characteristic of taking something for granted without the need for proof.

But of course that supposes –okay, assumes– that whatever we are considering has been vetted in a way that we are used to. A way that has the common consent of experts in the field, say, or at least something that accords with our experience. It would be acceptable, for example, to assume that if someone is talking about a bus, that they do not need to define it. They will not likely mean a train or a motorcycle…unless, that is, we include metaphors and their ilk -so let’s not.

I want to keep this simple for now. Some assumptions lead to others and so, like the weak link of a chain, conclusions based solely on a trail of assumptions can be a house of cards. At some stage, it would likely be prudent to search for verifiable sources if the issue is important.

I suspect that the trust with which we clothe assumptions is multi-fashioned. Sometimes it is the source, and sometimes it is the subject. Or the wording. Suppose, as an example, we are reading an article purporting to discuss discrepant sex ratios in a country and there is mention of the ‘sex ratio at birth’. (I have covered sex ratios and their definitions in a previous essay by the way: https://musingsonwomenshealth.wordpress.com/2015/08/25/pregnancy-stress/ ) Would we not be forgiven for the assumption that the definitions used would be the commonly understood ones in this context? And that when the ‘natural sex ratio at birth’ is mentioned in the same breath –or in this case, line- as the World Health Organization, couldn’t we relax. A little?

Well, I have to say I was initially seduced by this notion in an article in the BBC News, and then, intriguingly, disavowed of my naïveté. The article was titled ‘Why does Sweden have more boys than girls?’  http://www.bbc.com/news/magazine-35444173  My first thought, of course, was so what? The normal secondary sex ratio for humans would seem to average out around 5 extra boys, for every 100 girls that are born. Various reasons have been proposed to explain this, and I assumed (there we go again) that the article was reporting a new one –or at least new proof.

And then, when that didn’t prove to be the case in the first paragraph or two, I wondered if there were some hitherto unknown problems with northern sunlight, or perhaps residual effects from Chernobyl…

But I quickly became aware that they were using the term not as sex ratio at birth (the secondary sex ratio), but rather the sex ratio at ages 16 to 17 years of age (which would be closer to the tertiary sex ratio). I hadn’t expected this, and so now I had to again switch assumptions.

First of all, they gave a little background: ‘official statistics show that in 2014, there were 108 boys for every 100 girls among Sweden’s 16 and 17-year-olds.’ Okay, 108 boys per 100 girls is not so far off the 105 boys expected. I almost shrugged and moved on to another article until I read the next sentence: ‘But the country now has 123 boys for every 100 girls in this age group’. Whoa, that woke me up. So, not only do they talk in terms of a specific age group, they also report that in one year it has changed remarkably.

Time to examine my assumptions again, I realized. It turns out that the discrepancy is largely explained by immigration –or more accurately, refugees. But am I also to assume that it would be dominated by males -boys, actually? This requires another assumption: that more young men are able to make their ways through the turmoil and suffering of their native lands than their female counterparts. If the family is in dire need, and has little chance of making it out intact, perhaps it sends out the strongest, in hopes he (or sometimes she) will find refuge and then send for them. But is the male preponderance merely related to societal expectations and socially determined male roles?

The article purports to to explain the preponderance of males over females in that age range:  “If you’re underage, first of all, you get housing, you get more financial resources. You also have a lot of staff around you helping you with different issues,” says Hanif Bali, a member of the opposition Moderate Party in the Swedish parliament – which is on the centre right of the political spectrum. “If you need food, clothing, everything, you can go to the municipality and demand this money.” Presumably a young a young girl could do the same if the family had delegated her as the one to leave -but if you were the matriarch or patriarch of that family, would you send your daughter? Or would fear of the probable fate of a young, unaccompanied girl on a dangerous journey with unscrupulous smugglers likely convince you to send your son?

Of course that survivability benefits the young male asylum seeker all right, but what about the family? Were my assumptions about the strength of family ties naïve? Thankfully not. Fascinatingly not: ‘[…] there is another even bigger benefit, which Bali believes is significant. “You have the right to family reunification. So you can bring all of your family to Sweden, if you are underage.” Under 18, that is… And actually make it to Sweden.

So there are huge incentives for getting to Sweden before you turn 18.’

The article turned out to be thought provoking for me on several levels. One I have to attribute to age-naïveté: how does news of this kind of stuff leak out to people in a war-zone, fleeing for their lives? And secondly, how effectively the refugees have been able to use the Swedish social system to allow something on a scale for which it was likely not intended. But it also speaks volumes about assumptions and where they can lead us. You can almost hear the Hamlet-like defence of those 16-17 years olds when confronted with their manipulation of the system: ‘Why, man, they did make love to this employment, They are not near my conscience.’

 

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The Unfallen Yellow Leaf

‘Age, with his stealing steps, hath clawed me in his clutch,’ as the gravedigger in Hamlet says. I’m not so sure I agree –he was speaking about a skull, after all- but I have to admit there are times when I do feel old, and shipped ‘into the land as if I had never been such’; when I do wonder if whatever I have done has gone as unappreciated as a shadow from the moon, as unnoticed as an owl in the night.

I used to think that ‘Aged’ was just a word –but an adjective, not a noun; a descriptor rather than a described -somebody else, in other words… And that makes a difference, even when it is not mentioned in your CV but, rather, implied in the later stages of your career. I prefer to see the years as a kind of parliament where habits, and opinions and experience, all cohabit equitably, calmly debating the memories they were each elected to serve, sifting through them, perhaps, to decide if any merit publication.

And I’m sure there are some memories out there where my face is almost discernible in the background; where at least my voice was recognizable at the time. ‘What you lose as you age is witnesses, the ones that watched from early on and cared, like your own little grandstand’, John Updike wrote in one of his ‘Rabbit’ novels. He’s right, of course –and yet… Sometimes it can happen that you forget the very ones that watched from early on; you forget they cared.

Janice sat giggling in the corner of the waiting room, watching a little child toddle across the room towards her, his legs bowed around bulging diapers, his progress uncertain but determined. I could see her eyes from the reception desk; they glowed with excitement and her head seemed to bob in time to every tottering step. Her entire face became a smile, an expectation living vicariously as the little boy approached, followed closely by his beaming mother.

The consultation request from her GP said she had been referred for antenatal care -as if the rapture in her eyes, and the glow on her cheeks could be mistaken for anything else. Some people wear their pregnancies like jewels. It’s why I love obstetrics.

As I walked across the floor to greet her, she suddenly jumped up and extended her hand. For some reason I had the impression that she wanted to hug me, and would have under different circumstances. Not that I don’t enjoy being hugged, but it did seem unusual from someone I’d never met before. Pregnancy can be an unpredictable gem, though, and I have learned to appreciate its various rewards over the years.

“I’m so happy to finally meet you, doctor!” she bubbled as we headed down the little corridor to my office. “Pregnancy opens so many doors,” she added, smiling at nothing in particular with her eyes.

Indeed, she spoke as much with her eyes as with her mouth as she glanced around the room like a tourist in Paris. They pointed like children in front of each picture hanging on the walls, flitting from pictures to plants and back to pictures again -excited hummingbirds. They finally came to rest on a little terracotta begging lady I’d placed on an oak table in the corner. Pennies dripped from her little bowl, mute testaments to her longevity in the office.

“Where on earth did you get the pennies?” Janice whispered, this time rolling her eyes.

I had to shrug; it was a long story.

“I Googled you before I came, of course, and all your patients seem to mention the begging bowl… Now I see why,” she added shaking her head with what I took to be admiring disbelief.

“And there’s the carving of the woman holding the child and hiding behind the leaves!” she said, excitedly pointing to the little, pot-bound Areca plant on my desk. I was beginning to feel a bit like an employee at a Disney resort.

But then she calmed a little and instructed her eyes to leave the office thermals they soared and perch on my face. I could actually feel them, heavy on my skin, their prey firmly captured. It was almost as if I should understand that they had come back to roost; that mine was the aerie they had once called home. And throughout that first visit, I thought I felt her disappointment –a father finally seen after many years away, that no longer recognizes his child. I could sense a hope for reminiscence, a need for demonstrating familiarity, sharing secrets I couldn’t possibly possess.

Indeed, I got to know her quite well in that pregnancy, and the initial expectation of acknowledgment she had worn, soon blended imperceptibly into an easy friendship. Who once were strangers, now were allies in the weeks, then days, before delivery. But there was always something in the background that I sensed she was disappointed I hadn’t recognized. Something she was now holding as a surprise; something I should have known from the start.

And then, a week before her dates predicted she should deliver, I saw her sitting in the waiting room with an older woman. She’d told me her mother was flying in for the delivery and seemed excited that I was finally going to meet her. I could even feel the italics in the word.

I saw the two of them whispering excitedly in the corner seats Janice always chose, glancing secretly at me as I greeted other patients with earlier appointments. I thought I heard them snickering once or twice, but sometimes people do that when they’re nervous.

They both stood up and glanced mischievously at each other when I approached them. Her mother was a short matronly woman with greying hair that was precariously balanced on top of her head like a silver hay-stack. Her face, though wrinkled, held a pair of familiar eyes that strained at their cage doors just waiting for liberation.

It’s an interesting thing about faces: no matter how much they change, they stay the same… Or is it just the eyes –roses by any other name…?

The waiting room by then was empty, and there was nothing to stop Denise from hugging me, followed, as if on cue, by her daughter.

“So now do you recognize my daughter?” she said, her face an imp, her eyes laughing silently as they flew towards me.

“She’s changed a bit…” I stammered, still flustered by the secret, and admittedly a little embarrassed at being old enough to deliver a patient I had already delivered so many years before…

 

 

 

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The Grief that does not Speak

How weary, stale, flat, and unprofitable seem to me all the uses of this world!

Like Hamlet, we all recognize this mood: the black dog lying in the noonday sun, the cloud that even hides the moon. It is the tear that defeats the wavering smile –and yet… And yet, there is often something more behind the grief, something that is hidden beneath the first impression. Shakespeare, again, understood this over four hundred years ago: ‘Give sorrow words. The grief that does not speak whispers the o’erfraught heart and bids it break.’

I suppose we all impose our own reality; we all see the world through our own experience. But, sometimes we see through that glass darkly. Things are not always what they seem.

Alethea looked calm and happy as she sat in my waiting room. In fact, she was smiling and talking with a little child who’d toddled over to her in his diapers with a toy. She was bending over in her seat, her long black hair almost reaching the little boy, as she tried to make him laugh. Her full-length black, cotton skirt and her blue silk blouse contrasted sharply with his bulky white diapers –a chiaroscuro worthy of a picture, but he waddled off to another woman as quickly as he’d arrived. The waiting room is like that here: a work in progress; an evanescent scene of fleeting beauty.

Alethea smiled again when I greeted her, and examined me with friendly eyes. I had anticipated avoidance, or at least timidity from a woman referred to me with recalcitrant depression. A woman, according to a rather extensive explanatory note, who seemed refractory to multiple attempts at treatment. But I’m a gynaecologist, and although we’re sometimes involved on the edges of depressive illnesses, most of us lay no claim to the territory. We’re adjuncts –often last-minute guests- invited to the therapy just in case; we’re seldom primaries.

But in my office, she seemed less at ease, her eyes flitting from the plants in their pots to the eclectic pictures hanging on the walls. They spent some time inspecting a terra cotta sculpture of a woman begging with a bowl that I’d positioned on a little oak table.

“You certainly have wide-ranging tastes, doctor.” I don’t think she meant it as a criticism, so I took it as the long missing compliment I have yet to hear from my staff.

I smiled, and opened up the computer.

“I’m afraid my GP wrote a rather long note justifying the referral to you; she seems quite worried –or maybe frustrated with me.” Alethea rested her eyes on me for a few seconds. “I asked to see you rather than a psychiatrist.” And then she chuckled. “She was not happy about that, I’m afraid.”

I pushed the computer to one side and sat back in my chair. “Do you mind if I hear your version, first?” I asked.

“Thought you’d never ask,” she said as she made herself more comfortable in the sturdy, old wooden captain’s chair that I insisted on keeping across from my desk, her eyes twinkling with amusement at my suggestion, but still cautious.

“Well,” she started, obviously trying to place the events in their proper order, “A few months ago, I went to see my GP because of some problems I was having –you know, coping stuff,” she added when I wrinkled my forehead. “Anyway, I was in tears when I sat down in her office and had trouble even talking to her without crying.

“She got very clinical and I could tell she was trying to remain an objective observer.” Alethea rolled her eyes and sighed. “She does that sometimes when all I need is a hug or something.” She risked a quick glance at my expression. “But I realize that’s not what doctors are supposed to do…

“Anyway, she asked me all the usual questions about my work, and my home life…” Alethea blinked and looked away. “I think she felt a bit uncomfortable with that part because my partner also used to go to her.” Suddenly she stared at me and I could feel the anger in her eyes. “I really don’t know why that would matter…”

She quickly snatched a tissue from my desk and wiped her eyes. “I’m sorry, doctor, I guess my GP is not the only one who gets frustrated.” She took a long, deep breath and exhaled it slowly. “She said she’d never seen me like that before, and that whatever might be going on, I was seeing it through the lens of depression.” She glared at the begging lady statue for a moment. “She actually said ‘lens of depression’ for god’s sake! Like no matter what I said, or experienced, it was somehow misinterpreted through that bloody lens, or whatever.”

Alethea seemed uncomfortable and kept readjusting her body on the hard chair so I pointed to a more comfortable one nearby. That got her smiling again, but I could tell she was still angry.

“She insisted I go on one of those new antidepressant medications –you know, the ones that aren’t supposed to make you tired. The ‘no side-effects pill’ she called it. ‘Just try It for a few weeks and let me know if it helps,’ she said and escorted me to the door, all buddy-buddy.”

She brought the comfortable chair close to the desk and helped herself to a handful of tissues. “But it only made things… worse.”

I leaned forward on my chair, detecting something she was implying in the way she said that word. “How do you mean, Alethea?”

A tear rolled down her cheek and she dabbed it with the tissue. “I didn’t feel at all like sex, when I was taking it and…” She hesitated for a moment. “And that really made her mad.”

I was confused. “Made who mad?”

She was staring at her lap, but her eyes wandered up to my face for a brief look before she called them back. “My partner.” She sighed again. “So I decided to go off the antidepressants after a while and went back to the GP. She seemed upset that I had only given them a month, and said I was still acting depressed. At that point she said I needed to see a psychiatrist, but I refused. ‘You have a chemical imbalance,’ she almost screamed at me, and implied that if I didn’t get help soon, there might be dire consequences.” Alethea glanced at me again. “I suppose she thought I might try to off myself or something.” She giggled at the thought and when I looked puzzled, she smiled and continued. “Maybe it’s your birth control pill, Alethea. I don’t know why you insist on taking them anyway.’” Alethea’s face turned mischievous and her eyes twinkled like when she first came in. “Because I’m Bi, you stupid woman!” she said and laughed. “Well, I didn’t actually say that to her, but I felt like it…

“Anyway, I convinced my GP to send me to you.”

I squirmed a little uncomfortably in my own, soft chair. “Why me?”

A playful smile emerged. “My aunt and cousin see you… They said maybe you’d listen.”

I think I blushed. “And what about your partner? Did she think you were… depressed?” I hesitated before using that word. “Did she listen?”

Alethea’s face suddenly tensed. “She was abusive,” she said between gritted teeth, and sent her eyes to scout my face again. “She used to scream at me and throw things around. I hated going home after work.”

“Did you tell that to your GP?”

She shrugged. “I told you, she felt uncomfortable about it. And anyway, she had a diagnosis –and a treatment,” she added, with a wry smile. “That’s what medicine is about nowadays, isn’t it?” The smile disappeared, to be replaced by a sweet grin. “And once you have a treatment, it’s… Next!” she said, rolling her eyes, and we both laughed.

“And so what’s happening now? Are you still with your partner?”

Her face beamed and her eyes sparkled. “Now, I’m back with my old boyfriend -it takes a long time to get in to see you,” she explained with a chuckle. “We’re even planning to have a child soon, maybe.” Her eyes hovered under the ceiling for a second or two. “I guess I wasted your time, doctor, but my aunt was right -it does help to talk about it… And I thought I should meet you anyway,” she added, and decided to make eye contact again. “You delivered my cousin last year…” The twinkle returned. “Care to see me again –in a while?”

I think my smile told her I’d love to see her again.

And as she left, I couldn’t help but think of that wonderful metaphor of Khalil Gibran: ‘Sadness’, he said, ‘is but a wall between two gardens.’

It certainly is.