Hide and Seek

I guess the hunt is never over. Just when you think you’re winning, a sleeper cell surfaces, one you hadn’t even suspected, and closets itself somewhere you’d never think to look –an endless game of hide and seek. A Samsara of possibilities.

An yet, what would be the thrill of exploration if you knew all of the findings beforehand? We all need quests -adventures that uncover the hitherto unexpected, don’t you think? It’s what gets us out of bed in the morning. Me, anyway.

Questions and answers, for example… Let me play the devil’s advocate for a moment. We tend to assume that answers are the result of questions –we ask a question and then search for a correct -or at least appropriate– answer. But are we actually falling into a post hoc fallacy? ‘Post hoc, ergo propter hoc’ –because something occurred right after, or seems to be a response, we assume the initial thing caused the second. That’s just one way to look at it, of course. What if we assume there are answers lying around everywhere, and that the game is to find the appropriate question –the one that fits? A kind of ante hoc approach, I suppose, in which the answers come first.

Okay, try this. Answer: There are significant numbers of bacteria living under, and protected by, the fingernails. Question: Why doesn’t persistent scrubbing eliminate bacteria on the hands? I know this approach is merely a capricious inversion, but sometimes transpositions help us gain an interesting, if not useful, perspective. An article from BBC brought it to mind: http://www.bbc.com/future/story/20160622-what-lives-under-your-fingernails

I’m a surgeon, and early in my career it occurred to me that the water I was using at the scrub sink before an operation was itself not sterile. After a fastidious and lengthy hand and arm scrub with whatever cleansing soap was in vogue, I would then rinse off the soap with what amounted to tap water… And then, yes, I would observe ‘operating room technique’ and don sterile gloves for the procedure, but, apart from perhaps reducing the amount of whatever had been on my hands, what had all that scrubbing accomplished? Was it just a theoretical conjecture that it actually made a difference? A sop to sterile tradition? And if I were required to wear sterile gloves anyway why not just, I don’t know, use the same soap I used in the shower? It would certainly be cheaper. Questions! Questions swirling around hunting desperately for answers…

Had we posed the answer first, though… (Can you pose an answer?) Maybe the answer: ‘there are significant numbers of bacteria in the subungual compartment’ is a perfect fit for the question: why ‘is this hand region […] relatively inaccessible to antimicrobial agents during normal hand-washing procedures’?

Think about it for moment. Isn’t this the classic conundrum of basic science –science that is done for its own sake, science that has no existing practical applications? It consists of a whole platoon of answers to questions that have not yet been framed –or at least questions that were not anticipated at the time, or maybe just not the questions that were asked. A classic example of an answer (observation) looking for the right question was that of the findings of Penzias and Wilson –two physicists working on a new type of antenna at Bell Labs in New Jersey. In the early 1960ies they found a source of noise (the answer) in the atmosphere that they couldn’t explain. Finally, after eliminating other questions, they realized it was the cosmic microwave background (CMB) left over from the Big Bang. They received the 1978 Nobel Prize in physics for finding the proper question: ‘Is there any evidence of the Big Bang still around?’

And how about another answer: DNA is a large double helical molecule containing patterns of paired nucleotides and is found in cell nuclei for some reason. Question: why is it there? Or even: Could it be related to reproduction? Or heredity…?

Okay, I know this is a bit of a cart-before-the-horse stretch, but I think it does make us less complacent and maybe more appreciative of raw data. Details. Complexity. I’m not suggesting that Inductive logic is somehow flawed –it’s one of the fundamental tenets of the Scientific Method which posits using observation (answers) to derive general principles (more answers).

It’s not that confusing, really –it’s actually how things work in Science. The questions often arise because of the observations –after them, in other words- and so require experiments (questions) to see if the observations were indeed the answers…

So, isn’t the world a wonderful place? I ask that question -just one of many- after observing all the answers lying around unquestioned –unbothered, really- on the grass and among the flowers growing outside my window, all the unchallenged clouds in the sky above, and all the sunlight glinting off my polished floor.

I wonder, sometimes, whether the King James translation of the apostle Paul’s letter to the Corinthians was unwittingly prescient: ‘For now we see through a glass, darkly.’ And only when we recognize the importance of the observation, are we encouraged to ask why is that?

 

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Facing up to the Medicine

There is something magical about a face. It is at the same time familiar and yet mysterious. And although it contains many parts with disparate functions, these are somehow secondary. We see the face as a unit, then judge the components; it is a face first, and only subsequently an aggregation of details. It is the whole which imparts meaning, stirs emotion, engenders response. Only then do the ingredients surface. As St. Jerome said: ‘The face is the mirror of the mind, and [the] eyes without speaking confess the secrets of the heart.’ So I suppose it should come as no surprise that development of reliable facial recognition technology is considered so important. http://www.bbc.com/news/technology-33199275

But there are other domains in which it matters, too. Less technical perhaps, and yet more intriguing. Sometimes it’s not just the perpetuation of facial patterns enabling recognition from encounter to encounter that garner attention so much as a metamorphosis of something far more elusive, far more difficult: the ravages of age. There is something about a face that transcends Time itself. We are recognizably who we are despite the years: My comfort is that old age, that ill layer-up of beauty, can do no more spoil upon my face, as Shakespeare has King Henry V say.

Of course we all suspect we have escaped; daily visits to the mirror cannot see the change any more than frequent glances at a clock can spot the hour hand’s slow progress. Whatever we suppose Time to be, and however we conceive of its passage, barring the before and after of catastrophic events, its gait is not fixed, nor its effects on us often noted from day to day. We mostly live our lives in relative time, and adjust our expectations so gradually they are only apparent to others who happen upon us after long and unexpected intervals. And even then, unless confronted, go unspoken by and large -undescribed, unless in favorable terms.

*

The woman on the other side of my desk looked familiar -in the way some new patients seem to do; I could almost place her. Almost… I see a lot of people –some more frequently than others, to be sure- and yet after a few months or years of absence, even those with whom I’ve had extended exposure tend to generify. Recognition often requires initiation on their part. Prodding. Reminiscing… The encounter often ends with embarrassment or pretense on my part, disappointment on theirs, degenerating into an inadvertent charade for both of us. I don’t wish it so, but alas, I have not been blessed with an eidetic memory of faces past.

Of course, it’s easier to recall some people. They adopt a position on a chair that begs for remembrance, or a way of holding their head that is unique. With Sally -the name on my computer daysheet- it was her face. I tried to analyse what made it so memorable, as I sorted through some papers on my desk. Her eyes? They were brown and calm –they did not seem hunters at the moment, nor imprisoned behind long lashes; not deep set in shadows, not  hiding behind thick distorting lenses. In fact they were far from striking or even distinctive. Her nose was neither large nor mishapen, and her mouth seemed to sit comfortably in its alloted place and smiled only when appropriate, if infrequently.

She noticed me sneaking glances at her as I pretended to play with the keys on my computer, and sighed. “You’re trying to remember, aren’t you, doctor?”

Her voice, too, was familiar, and yet only vaguely so. She was like some book I’d read years ago, whose style and mood, were immediately recognizable, and yet the story, and the ending, were obscure. Tantalizingly close, but so far irretrievable.

“You haven’t changed at all from the first time I met you,” she said, painting my face with her eyes. “Hardly any grey in those curls, still no wrinkles, and that unmistakable look of innocent puzzlement whenever the focus is deflected back onto you.”

Why would anybody remember that? I smiled to diffuse my discomfort.

“Same smile, too,” she whispered, sitting back in her chair triumphant in her recollections. I was evidently who she expected to find -the one she had remembered. Her memory had served her well so far and her face was celebrating.

Who was this anyway?

She straightened up in her chair and sat forward slowly. Deliberately. “I know I’m just here for a pap smear, and you’re a busy man, doctor, but given our history, would you mind if I asked you a personal question?”

I hate it when somebody says that. A polite request usually demands a courteous acquiescence -especially when an unrecalled ‘history’ is offered as a reference.

I nodded, but tried to indicate by my expression that I was only doing it to be –what?- polite. My forehead, I’m sure, made my point.

She noticed, and a tiny smile escaped, ran across her lips, and disappeared on the other side. I could see her amending her question on the fly. “I’m sorry, I didn’t mean to embarrass you. It’s just that you look so much the same as I remember from that first time… It’s uncanny, really.” She leashed her eyes for a moment to study my reaction. I could feel them trying to peel information off my face as they sat, hooded and dangerous on the edge of her thoughts. “I’ve been trying to figure out what it is.”

“Probably the scrubs I always wear,” I said, trying to be funny I suppose.

She shook her head and tried out another smile. “No… I don’t think so.”

Something about the varying texture of her smiles and how they each pulled differently at her eyes, caught my attention and a memory –a shadow, really- flitted like a ghost just out of reach.

A new smile, thin and toothless –an unasked question smile- appeared like a figure glimpsed through a thick gauze curtain, only to disappear again before adequate identification. She was beginning to unnerve me. But suddenly, like opening a gate, everything rushed out.

She took a deep breath and straightened herself on the chair as if she were about to answer a question in class. “I… I asked to see you for a reason, doctor. The pap smear was just an excuse…” She looked past me to stare out the window for a moment, obviously uncomfortable. Embarrassed.

“My midwife sent me to you for an urgent consultation twenty-two years ago. It was my first pregnancy and I wanted so much for everything to go smoothly –you know, home delivery, no pain killers… Anyway, one day Maryanne told me I had to see a specialist. I wanted to see a female, but for some reason I ended up with you.” She glanced at me to see how I was reacting, and then, reassured, continued. “I remember you were very nice, but you said there was not enough fluid around the baby and that it wasn’t growing so you wanted to induce labour right away. You asked me if I had any questions, but I was only thirty-two weeks along in my pregnancy then so I panicked and ran out of the office. I phoned the midwife and she assured me you had a great reputation but I didn’t believe her. I couldn’t. I was sure you were a fake, so I drove back to Surrey where I used to live. I wanted to think it over. But that night I went into premature labour and they had to deliver Melissa there by Caesarian section.

“She was quite sick when she was born –she spent more than two weeks in their nursery,” she said, wringing her hands as if it had all happened yesterday. “And you know, for some reason I blamed you. Like, if you’d decided my midwife was wrong, everything would have been okay…” She sighed and wiped away a tear. “Weird, eh? Hormones, I guess, because then they had to hospitalize me for depression. I was so paranoid I couldn’t think straight for months…”

She took a deep breath and another, different, expression surfaced. “Have you read any Oscar Wilde, doctor?” She asked, her eyes suddenly cold.

I nodded –but carefully. I had the uncomfortable feeling I was being led into a trap. “The Portrait of Dorian Gray?” she asked, her voice now soft and apologetic.

I steeled myself. It was the story of a hedonistic and dissolute man who remains handsome and young while his portrait –stored in the attic- ages and reveals all the evil he has committed.

“At the time, I thought of you as Dorian Gray,” she said, now inspecting her hands tightly kneading her lap. “All show, pretending to be kind, but all the while not caring what I really wanted… Really needed.” She shook her head slowly –maybe she did that when I saw her that time so very long ago. I don’t remember. “I apparently phoned all my friends and told them to stay away from your office… I hated you when I was sick… I tried to spread rumors…”

Well, at least it was Dorian Gray and not Jekyll and Hyde she’d read… Small comfort, I suppose.

Suddenly she sat up and leaned across the desk to grasp my hand. “But it was my portrait that was up in the attic, wasn’t it? It was me all along that was the fake.

“You know I’ve waited all these years to tell you about it -to apologize… but I was afraid.”

I squeezed her hand as a tangible acceptance of her apology and sat back trying to think of something to say to diffuse the mood. “And Melissa? How’s she doing now?”

Yet another smile surfaced briefly, changed its mind for a moment, and then re-emerged as a gigantic grin. “You delivered her baby a couple of  years ago, doctor. I was sitting in the far corner of the delivery room in the shadows for most of it, afraid you’d recognize me. I remember you kept looking over at me –wondering why I wasn’t standing beside my daughter. I didn’t quite know what to do. I kept trying to smile, but I was so ashamed, the smile kept disappearing…” She looked at me quizzically for a moment. “Did you recognize me?” Her face knotted up. “I have to know…”

It was my turn to smile this time. “No…” I said slowly, unable to suppress a blush at my failing memory. I hope that made her feel a little better. And yet, although I hadn’t recognized her then, I realized what had puzzled me about her today: she was wearing the face of a woman I’d come to know quite well; she was her daughter but through a glass darklyThe time is out of joint- O cursed spite, that ever I was born to set it right!” said Hamlet. It felt like that…