Saturday, March 17, 2007

And here we go....

Sunday, February 11, 2007

Requiem for A Nobody

Dr. Cai's car silently rolled up to the curb. Surrounding his office was a thin ring of protesters, most of them aged. Evangelicals, Roman Catholics, and occasionally a mosque group - the last throes of the great debate. Two decades ago, vandalism, death threats, even the occasional murder by fanatics were common items in the news. The merger of the abortion clinic and the doctor’s office did much to destroy the upwelling of Fascism in the lower classes. How could you hate the abortionist if he was also your doctor? That, and a general loss of interest in the downside of bioethics had finally collapsed the nascent "pro-life" consensus. As life saving and extending cures tumbled out of East Asia, the largest "pro-life" demographic, the aging leftovers of the twentieth century had changed their tune in favor of another ten or twenty years on this earth.

Dr. Cai turned on his blinker and waited for the line of protestors, about twenty in all, to hobble submissively out of his way. No resistance, no sit-ins. They could no longer heckle the young ladies, who could just as well be coming into the office for a fertility treatment as for an abortion. They would murmur rosaries and occasionally wave signs depicting dismembered fetuses. It was useless to explain to them that no abortions happened past the first trimester, and most happened before the limbs had even formed. The protestors stood, muttering prayers out of unison as his car rolled buy. Ah, a protestant crowd today. They no longer sought victory, after these died out the debate would be as dead as slavery. Dr. Cai had decided that they continued their futile, anachronistic protests seeking a kind of intellectual martyrdom, the only kind achievable in a hyper-tolerant society. He parked his humble compact and headed in the back entrance.

The office glistened with all the Spartan elegance that modern ceramics could muster, a doctor's office of the 21st century. The mess of charts and photographs that used to clutter the desks of every MD had migrated to hard drives decades ago. The numberless drug company trinkets and endorsements had been outlawed, with the exception of pens and computer styli. The whole neat facade set up in opposition to the biological sloppy mess that this building was supposed to care for.
Dr. Cai was a model doctor in that day and age: undergrad at Berkeley, medical school at UPenn, now a practitioner of general medicine. His immigrant parents had been infuriated at his decision to study medicine rather than law. Money was not a problem, but Medicine was not a profession entered into for the cash. The austere office was a reflection of an austere profession. Medicine was the new monasticism. Forsake all to study for ten years of your life, make as much money as a government algorithm thought was appropriate, retire late. Not a bad monasticism, all things considered, but there were no merry monks. They were weeded out of the system very early, leaving only the honor-driven devotees of health. Dr. Cai got his undergrad in psychology, and it was appropriate in a profession devoted to keeping patients in good health in spite of all a-rational passions on their part, as the oath stated. He took himself as seriously as he should. He was not a craftsman or a simple pharmacist. He was a priest of the temple of the human body.

The first order of business for the day was also his most challenging. He sat in his chair, leaned forward, cleared the three styli from his desk and waited for the door to open. It opened and Mr. and Mrs. Mayer walked through the door, a young couple, neither a day over 35. Dr. Cai smiled and motioned for them to sit on the two chairs provided. The husband was antsy and unable to subdue his fidgeting. The wife was the picture of serenity. Dr. Cai smiled again. How to begin this conversation?

"How are you today?" He said.

The husband responded with an enthusiastic "All right!" while the wife smiled and said "Fine, thanks."

"I understand," Dr. Cai began, "that you are having second thoughts about the procedure."

The husband, nervous about the sudden cut to the chase, did not respond, but turned to his wife and waited for the response.

"Yes, I have no problems with an abortion for medical reasons. But what is wrong with my baby?"
The phrase "my baby" could be a boon or a liability, most likely a liability. Millennia of motherly instinct combined with more recent societal constraints made her think herself both the sole possessor of this thing and the protector of a person - her progeny. Dr. Cai could already tell that this one could not be persuaded by personal considerations- the immense pain and suffering brought on her that would come with raising a child with such a genetic defect. Rather, it was necessary to appeal to the pain of the potential child, living in a society that saw genetic problems not as tragedies to be blamed on God or the Devil, but rather as a mistake caused by a sloppy doctor or an idiotic negligence to get a test done. He had to reassure her quickly before she generated the assumption that she was defending her child from men who wanted to destroy it. Where to begin, where to begin?

"Mrs. Mayer, there is nothing wrong with your child. If we did nothing the pregnancy would proceed normally and you would have a reasonably healthy son in about eight months. Unfortunately, though, the conception resulted in a rather acute genetic problem, as the test indicated. I have recommended a termination not because I think it presents any risk to you, or because the future child would die early, but because if that child should exist, his life would be dominated by disappointment, alienation, and profound unhappiness. He would be miserable, even in this society."

"But isn’t there any treatment, any kind of…fix?" Mrs. Mayer asked. Ah, treatment, Dr. Cai thought. People still don't realize that 99% of medicine is preventative.

"Well, the only potential treatments are expensive, generally unsuccessful, and, in fact, illegal in most countries, including this one. The problem your child would have would be so deep-seated that-"

"So there’s no alternative?" the husband asked in that faux seriousness men seem to reserve for the most awkward possible moment.

"Well, the choice belongs to you, Mrs. Mayer, but it is my duty to advise the best possible path for the future health of you and your family."

"What will be done with it afterwards?" Mrs. Mayer asked. A strange question. Afterwards? For one of the few times in his career Dr. Cai was caught off guard by a completely rational question.

"Well, um, we usual- …Well it’s really up to you. We can do whatever you like with the tissue." Was she going to ask to have it buried? He had heard of this kind of thing before. Bizarre! The consequences of some kind of death ceremony after the abortion could be disastrous for her future health! What was the greater good, the abortion or the necessity to keep the death-guilt out of the mind of the mother? Dr. Cai hesitated. What was he to do? How on earth would the department of medicine judge if this case were to be processed? The law stated that he had to do whatever she wanted with the tissue, legally part of her body, but he had never yet been in a situation like this.

"Could it be donated to research?" It took all his discipline to prevent the immense relief from becoming visible on his face. Ah, this was quite a woman. Selfless even in matters as trivial as this.

"Yes, yes, of course, absolutely! I'll see to it." It did not matter if it really was possible or not, he could donate it to the university, and they could do away with it as they saw fit. Disaster averted. Now, if the husband could only keep his trap shut this should go off without a hitch.

"Well, shall we get this over with?" Right on cue, he had to open his big fat mouth. The husband was visibly nervous. Dr. Cai wondered if they had fought about this. Doubtful. Mr. Mayer did not strike him as a man with enough backbone to really fight his wife. But if he was going to delegate the task of convincing his wife to Dr. Cai, the very least he could do was shut up.

After a moment of awkward silence, Dr. Cai drew a long breath, and continued. "Once again, Mrs. Mayer, the choice is yours, but please, do what is best for health."

Mrs. Mayer looked away, blinked, then said "I'll do it."

At last, she had reached decision.

There was one last indignity that he had to submit the poor woman to, the dreadful compromise. While the law removed all holds on a woman's right to do as she wished with her own body, it forbade ignorance or complacency. While Dr. Cai had approved of the compromise when he had first heard of it, the last constitutional provision the so called "right-to-lifers" had slipped in before their base dried up had done more mental damage to his female patients than anything else. He was bound by law to make Mrs. Mayer gaze on a high-quality holographic image of the cells in her womb for fifteen seconds. He removed a small, dime sized, octagonal disk from his lab coat pocket and placed it on the table, without commentary.

"Mrs. Mayer, you are required to look at this image for fifteen seconds." The warmth which had characterized Dr. Cai's speech gave way to a clipped frankness. The decision had already been made, uncoerced by those who would use her animal instincts against her. The small bundle of tissue sat there, attached to the wall of her uterus, the features of the future human being not quite visible. The husband seems slightly disturbed by the show. Mrs. Mayer gazed at it for the required fifteen seconds, a peculiar expression on her face. Was it guilt, mourning? Dr. Cai did not believe so. How could anyone feel a personal connection to a fetus aborted this early? It was barely recognizable, certainly not human. All three kept a shuffling silence, not out of any legal constraint but merely an Anglo-Saxon uneasy silence. The queer stillness always reminded Dr. Cai of the uneasy silence lasting a few seconds between the end of an offertory and the beginning of the sermon in the Presbyterian church his parents had attended. The image flicked off.

"My nurse, Ms. Billet, will perform the procedure."

Dr. Cai tapped the appropriate place on his desk, and shortly Ms. Billet walked through the doorway. She flashed a winning smile and wordlessly invited Mrs. Mayer to an examination room nearby.

Dr. Cai breathed a silent sigh of relief as Mrs. Mayer got up and left the room.

"Excuse me doctor, but if you don’t mind my asking, how did this happen?" Mr. Mayer had a perplexed look on his face.

"How did what happen?"

"How did the baby, er, the, uh, fetus, end up the way it did?" Mr. Mayer was evidently nervous asking this question. He was fiddling with a package of nicotine gum. "Cause my family history goes way back, and there is no mention of anyone being, uh, like that."

"Well, that’s entirely normal." Dr. Cai allowed himself to relax. "It is a recessive trait, and may not have surfaced for generations." Mr. Mayer was justifiably concerned as to how he, a healthy macho man, had managed to create such a thing.

"But doesn't it, you know, prevent-"

"No, not entirely. The trait does not preclude reproduction entirely, it is just extremely difficult, even with treatment."

"But nobody was treated! I don’t even know if they had it back then." This problem had evidently worried Mr. Mayer enough that he had done some basic research.

"Well, the whole society was one huge treatment. They were different times…"

* * * *
As the Mayers walked to their car, the geriatrics glared at them accusingly while they climbed into the van provided by their assisted living home. The Mayers did not even see the glowers. They got into the car and pulled out of the parking lot.

"Well, honey, I guess that tonight we can try to make another!" Mr. Mayer tentatively tried to start a conversation.

"Make another?"

"Well, I mean, we can try to have a baby." Mr. Mayer reached into his pocket and drew out a plastic chit, "the Doctor gave me this prescription. New stuff! It makes sure there is gonna be nothing wrong with the baby!"

"There never was anything wrong, John."

"Yea yea, sure." Mr. Mayer said hurriedly. "But it’s real neat. We can even choose if its gonna be a boy or a girl! And we don’t have to worry at all. The Doctor told me that this pill guarantees that we wont get a homosexual again."