Personal Stories, Philosophy, Simple Explanations

Enter the Tao: A novice’s exploration of Taichi, Taoism, and Traditional Chinese Medicine

The train weaved through the landscape. Buildings turned into farmlands, then into hills, then finally, after a twenty-hour journey from Beijing, I arrived at Wudang Mountain Train Station in Hubei, China. My summer begins here.

Taoists believe that everything in the universe belongs to one of five elements: Fire, Water, Wood, Earth, and Metal. Mt. Wudang is of the Fire element, perhaps owed to the fact that its many peaks lean towards the tallest, giving it the appearance of a flame. Or perhaps it is because Wudang burned at thirty-eight degrees Celsius in the summer months, a feature I’d soon learn to appreciate.

Mt. Wudang is tucked away in an eastern landlocked corner of China. It is not a particularly convenient location. It is not near any major cities or landmarks. It is not very tall, sitting at about sixteen hundred metres in height. But Mt. Wudang is remarkable for a reason: it is one of the centres of origin of Taoism, which, along with Buddhism and Confucianism, form the de facto official religion of China. Out of Taoism came the theory of Ying-Yang, Chinese medicine, and Taichi. In fact, it was in these very mountains that the Taoist monk Zhang San Feng attained enlightenment and created the Wudang martial arts some six hundred years ago. “All Taichi originates from Wudang,” goes a familiar Chinese saying.

Taoist Wuji Kungfu Academy, run by Master Chen Li Sheng, fifteenth-generation disciple of the Xuanwu clan of the Wudang sect, sits quietly at the waist of the leviathan. There are only a few rules to become a student: You must be disciplined. (That’s fine.) You do not have to be a Taoist. (Good.) You must not hold cultish beliefs. (That one sounds a bit odd…)

Despite my slight apprehension, at three o’clock that day I arrived at the school and introduced myself.

Side-note: there are over a hundred martial arts teachers in Mt. Wudang, and not all are created equal.

I heard of a guy, a foreigner, who also trained here.

“Sifu,” he said one day, for that is what we call our Master in Chinese. “Out of everything in the world, what do you wish for most?”

His Sifu  thought about this question. He lowered his eyes and furrowed his wizened brow. His disciples gathered around him. A minute later, he raised his head. His disciples tightened.

“A Porsche,” he said finally.

The guy quit the next day.

I hope the story wasn’t true.

Round, was my first thought when I met Master Chen.

He had a round face, complete with round eyes and a round nose, on top of which sat a
black square hat. He had a round belly, giving him the appearance of a walking cauldron wrapped in white kungfu attire. His full, round lips clasped into a smile as he greeted me.


With Master Chen Li Sheng, fifteenth-generation disciple of the Wudang Xuanwu clan

“This is Wu,” he said, motioning to a lad of about fifteen. “He’ll take you to your room.”

Wu was a lanky teenager with slit-like eyes that made you think he was constantly on the verge of a dirty joke. He and Wen were two of Master Chen’s official disciples. “There’s Wen,” Wu pointed to a short, chubby, bespectacled fifteen-year-old who looked about twelve. Wen wore an expression that made you think he’d just heard a dirty joke and was bursting at the seams.

“Wu means warrior in Chinese. Wen means culture. Here’s your room.”

I was surprised by its cleanliness. Besides a few leaky pipes, everything resembled an honest attempt at creating a hotel atmosphere. I changed into my newly acquired kungfu garbs. I looked into the mirror; a thin, young man in white looked back. “Here we go,” I said to myself.

The Tao in Movement

Bagua, Xingyi, Taichi. These form the pillars of Chinese internal martial arts. They differ from external martial arts, such as Shaolin, in that they emphasize utilizing strength from within to channel to without. Bagua, also known as Eight-Trigrams, uses circular footwork and deceptive movements to confuse the enemy. Xingyi is the most aggressive of the three and was favoured by Yue Fei, a renowned warrior-general from the Song dynasty. Taichi is perhaps the most well-known in the West. Its name consists of two characers: Tai, which means “too much”, and Ji (Anglicized into Chi, not to be confused with Qi), which means “extreme.”

“Most people think of Taichi as a gentle exercise, practiced by the elderly in parks on Saturday mornings,” said Master Chen. “But they forget that it is primarily a martial art and can be used for combat.”

“Taichi moves look gentle. But it hides strength under frailty, toughness under softness. It is like water,” he said, and pushed.

A surging force landed on the Red Beast’s shoulder and uprooted his body. He flew out a few metres and landed on his feet. The crowd clapped enthusiastically. Earlier that evening, a frigate of a man, a tourist, challenged Master Chen. He was tall, a head taller than Sifu, very muscular, and wore a red shirt, hence my appellation. A crowd had gathered during their duel.


Sifu versus the Red Beast

“Try to move me,” said Sifu, taking a stance.

The Red Beast heaved. He lifted. He pulled then pushed. Master Chen would not budge.

“In Taichi, the body exerts force in all directions at once. No matter which direction an attack comes from, the aggressor faces an opposition of equal magnitude.”

Very Newtonian.

“When it comes to attacking, a strike is not just an isolated strike. The hand is connected to the arm, which is connected to the back, which is connected to the legs. The opponent feels the force of your entire body,” he said, then pushed again.

The Beast, presently over-invested in trying to tug Sifu from equanimity, immediately lost his balance and fell backwards into the crowd, which immediately parted like the Red Sea, leaving the Beast on its and his bottom, his face flushed into the colour of his shirt.

“Good skill, good skill,” he said, getting up and clasping his hands into a kungfu sign of respect.

“Cool,” I said.

“We start with the basics,” said Master Chen. “The stance.”

The Wuji Stance (literally meaning “no extremes”), also known as Standing Position or Circular Stance, is sometimes called Standing Meditation. I find this a misnomer. We stand in a quarter-squat with arms in front, as though the entire body is hugging a ball. Within this ball, the head, hips and extremities expand outwards, to be resisted by the tendons and bones. The body is a metal balloon, a series of opposing parts making one consistent whole.


The Wuji stance

My first time holding this position was neither relaxing nor meditative. Five minutes into it, my arms and knees began to ache. Swearing can help one withstand pain, so I began patiently listing expletives in alphabetical order, only to realize how top-heavy the lexicon of rude words is. I got up to “F” before stopping. Ten minutes, I noted pathetically. The other students could stand for an hour.

Over the month, my days would begin at five in the morning. There would be seven to eight hours of practice a day, four of which were spent in the Wuji Stance. The rest were invested in various forms, meditation, and basic training in the thirty-eight degree weather. I would return home sore and worn out. But by the end of it, I would have a beginner’s grasp of the Wuji Stance, and would be able to hold it, albeit imperfectly, for an hour.

The Tao that Cannot be Said

Every morning I wake up groggy, stumble into my uniform, and walk out as though in a trance. There are two paths leading out from the motel. Going down, I will reach a plaza that tourists pass by on the way to the cable cars that carry them to the top. We sometimes practice here to promote the school. But most mornings I go up. I reach a secluded spot, surrounded by mountain-scape. We train facing a monolith imprinted with large red letters: “Di Yi Shan,” First Mountain.

The sun is barely visible at this hour. But soon a bright, red hole sneaks up from the distant hills. It glows from ember-red to golden-yellow in a matter of minutes. At this point, the faraway peaks and valleys become a sea of green and grey that die into a flat line along the horizon. It is a picture of silence. Except it is not. The air is suffused with the sound of bird and bugs. There is incessant chatter, amongst which a single voice rises: the cry of some species of bird that echoes throughout the land. IMG_1431

The day after I arrived, a fog rolled in and ushered us into a classroom. Here, Master Chen, who held what is equivalent to a graduate degree in Taoism, taught us Taoist philosophy.

“Divorced from religion,” he emphasized.

Taoism in China is like Christianity in the West, in that many vaguely believe in it but most do not know what it is about. While practicing the Wuji Stance at the plaza, I sampled the various opinions about Taoism from tourists:

“What are they doing?” said one.

“I think it’s Falun Gong,” said another, referring to an illegal cult that espoused familial sacrifice.

“That’s why Taoism is fading so fast,” said the first.

Taoism holds three works as canonical: The Tao Te Ching by Laozi, the I Ching, and Zhuangzi. The Tao Te Ching is a dense volume of eighty-one passages, each no more than a paragraph long, but its official commentary contains over forty volumes.

“The Tao that can be said is not the Tao. The Word that can be said is not the Word,” runs chapter one, based on my very unofficial translation. In eighty-one cryptic paragraphs, the Tao Te Ching presents the great Tao, or pattern, of the universe. Its central dogma is that everything begins in a state of Wuji (“no extreme”), then enters into a state of Taiji (“too much extreme”), from which the nature of duality, the concept of Yin and Yang, emerges. IMG_1186

The day is Yang and the night is Yin. Front is Yang and back is Yin. Male is Yang and female is Yin. Yin taken to the extreme becomes Yang, and Yang to the extreme becomes Yin. The purpose of life is to return to a state of Wuji, to return to a state of childlikeness.

“Taichi is an embodiment of these principles. The Tao manifests itself in the movements.”

Side-note: If a deal seems too good to be true in a tourist spot, it probably is.

I made a Canadian friend while on the mountain. One day, while taking a trip at the touristy part of the mountains, we came across an herbal store that sold a particular herb at a killer price of five yuan per “ke.” My friend, who spoke some Chinese and studied Chinese medicine, asked for some. He held out his hand in the symbol of five. The shopkeeper nodded. He began heaping handfuls of the herb into a bag, then crushed it into powder. We looked at each other incredulously. Five yuan for this much?

It turned out that every one of us was thinking of something different.

I had a brain-freeze and confused “ke,” which means gram, with “jing,” equivalent to five hundred grams. I thought my friend was asking for five five-hundred-grams.

My friend thought he was asking for five grams.

The shopkeeper thought my friend’s open hand meant keep the goods coming or I’ll slap you silly.

In the farce that followed, I played linguistic and cultural mediator to two increasingly amused foreigners and an increasingly exasperated shopkeeper. We ended up paying a hundred yuan for a bag that cost several thousand.

Taoism as a religion is mired in political and social influences. Chinese religion, if it can be said to exist, is Neo-Confucianism, a hodgepodge mixture of Confucianism, Buddhism, and Taoism. Its gods serve social purposes: Some, such as Huang Di and Yan Di, are credited as Chinese ancestors. Others are deified by emperors to promote particular social values. Thus Guan Yu, the general from the Warring States period known for his fierce loyalty, became the god Guan Gong, protector of households.

“Do Taoists believe in fate?” I asked.

“Chinese folk religion believes that a person’s palm patterns and facial features can be used to predict their future. This was adapted from Taoism,” said Master Chen. “True Taoists believe that one’s physical features reflect one’s health and how others would treat them, which, in a way, seems fatalistic. But they also believe that a person can change their disposition, so in that sense people have control over their own fates.”


The three-point stance is a staple of Xingyi

Taoism is a humanistic religion. Its emphasis on the individual, self-enlightenment, and mastery over one’s own body makes me wonder why Chinese culture is so communal. In my unqualified view, this is due to the overwhelming influence of Confucianism. The latter’s emphasis on social responsibility and accountability must have been auspicious for political figures who would use these to solidify power, and despite Mao’s vilification of Confucius during his reign, large pieces of Confucianism have remained and taken hold on the Chinese soul.

The Tao in Medicine

I am a cultural chimera. Growing up in a Chinese household, I am familiar with concepts such as the body having “too much Fire” or “too little Yin” or “not enough Qi.” Yet, as an aspiring scientist, I identify with the empirical frame of mind. My two worlds have never met. But on this trip, my cognitive dissonance manifested itself in a physical presence.

Jake was a fellow Canadian and student in his mid-thirties. He obtained his high school diploma before going into construction. One day, he “looked at the stars and thought they looked like the meridians in the body” (Meridians are energy channels in Chinese medicine) and enrolled in a Chinese medicine school in Canada. On our first meeting, he annoyed me intensely by suggesting that Western medical doctors were worldly, ineffective, timid money-munchers. Upon further probing, I discovered that his complaint was against the healthcare system, which he lumped together with complaints about the science itself.

I tried to remain objective despite my personal distaste. After all, traditional medicine can be divisive. To the enthusiast, it is a panacea, able to cure anything from the hiccups to cancer. To the dissident, it is a fallacy which, along with homeopathy and ancient Greek theory of the humors, ought to be canned into the past.


We make dumplings and rice pudding for the Dragonboat Festival

Like with most matters, I find myself somewhere in the middle. The theory behind traditional medicine is fundamentally not scientific, by which I mean it is not empirical or mechanistic. As far as I know, no one has measured Qi or observed meridian channels. Nor is there any way to manipulate Qi in a controlled experimental setting and observe its effects. This means there is no objective standard to refute or support parts of the theory. We have in our hands a theory that cannot possibly evolve. Witness this exchange between two fellow students:

“I’ve been trying to open my third and fourth energy gates,” said one.

“I thought there were three energy gates,” said the other.

“No, there are four,” said the first.

“That’s according to Buddhists. Taoists say…”

“Who cares if it’s Buddhists or Taoists? If there are three, there are three,” said the first student flatly.

Furthermore, due to the lack of statistically rigorous study, traditional medical miracles is susceptible to biases. The most obvious is the survivorship bias. Take one doctor with a thousand patients. If half heal just by chance after treatment, they return to the doctor. If half of that half is treated again and heals, again by chance, we are left with a quarter of the original. Five treatment sessions later, we have thirty patients who believe that their doctor has miraculously cured them at a hundred percent success rate. To further complicate matters, many diseases that traditional medicine (and indeed any medicine) purports to cure are self-limiting, meaning that they heal on their own anyway. The doctor would do just as well to tell the patient to eat, rest, and drink plenty of fluids.


We celebrate a fellow student’s birthday. Pictured are Master Chen and his four-year-old son.

That said, one cannot help but admit the effectiveness of certain traditional remedies. I have met people who have been cured of allergies and hormonal problems within weeks of treatment. In 1892, the Anglo-Canadian-American physician Sir William Osler, Father of Modern Medicine and co-founder of Johns Hopkins Medical School, testified to acupuncture’s “extraordinary and prompt efficacy.” The first edition of his essential textbook, the Principles and Practices of Medicine, recommended “needling” as treatment for nerve injury and lower back pain. We now have studies that suggest that acupuncture has beneficial effects on certain types of pain.

As for herbal medicine, in 2015, Tu Youyou became the first Chinese Nobel laureate in physiology or medicine for effectively isolating artemisinin, an antimalarial compound. She was inspired to isolate the substance in low-temperature conditions after reading a traditional Taoist medical text on preparing it.

I conclude that although the theoretical foundation of traditional medicine is not scientific, its apparent effectiveness in particular clinical cases leads to interesting questions that may be brought into the scientific frame of inquiry.

We now shift from the scientific to the social perspective of medicine in China.

Chinese people are suspicious of Western medical doctors, an opinion that I generalize, admittedly, based on only a handful of independent opinions. The healthcare system in China ties physician remuneration with drug sales. Pediatricians earn considerably less than other specialties, since drug dosages are lower for children. Under this system, is there any wonder why physicians lose patient trust?

At the same time, much of the Chinese populace seem to hold a slightly mystical view of Western medicine. During my stay, I discovered that one of my fellow students took ampicillin from time to time “to get rid of inflammation.” He had no idea what inflammation was and what antibiotics did, especially if taken discontinuously. His doctor had no incentive to inform him, and apparently his educational background failed to do so either.

Given these issues, many turn to traditional therapies. But traditional medicine in China faces its own problems, the main one that I see being the lack of consistency from doctor to doctor. This is perhaps the greatest obstacle to the adoption of Traditional Chinese Medicine in North America. In a legalistic environment like Canada and the United States, what constitutes a standard of care in traditional medicine? Maybe the interim solution is a technological one. If opinions on individual doctors is crowdsourced, we might have a platform for indicating standard in an intrinsically heterogeneous field.


The horse stance is our favourite (*sarcasm*) basic training exercise

Personally, all this boils down to one question: would I support Traditional Chinese Medicine as a future physician?

It depends. On the patient, on the disease.

For so-called idiopathic functional disorders, such as irritable bowel disease, for which if I believe Western medicine offer no curative potential, traditional therapies might be tested. For peripheral nerve injuries, acupuncture may be helpful. For more serious afflictions like cancer, conventional treatment is probably wise, at least to avert immediate consequences.

As yet, I am ill-equipped to fully justify my answers. Knowledge, experience, and time will teach me what I need to know.

“You know, it’s all false,” said my French roommate, an osteopathic doctor and one of the few Caucasians in the area.

He knew a bit of English. I knew a very little bit of French. Our conversations were usually brief and cavemen-like:

“No frog tonight.”

“Yes. Oui. No frog.”

“Maybe rest day.”

“Yes, maybe. We rest too.”

“Like frog?”

“Like frog.”

But today his face curled into a serious frown.

“It’s all false, Charlie.”

“What’s all false?”

“Allopathic medicine, osteopathic medicine, Chinese medicine. It’s all false.”

I considered this bit of intellectual nihilism.

“I’ve had fifteen thousand patients. I work with each one with my own hands. They tell me their stories, their troubles. I listen. They speak, I listen. When they speak, I feel change under my hands. The body heals itself. I do nothing. Nothing. The body heals itself. It’s amazing.”

“You go medical school. You learn. It’s good. But remember, you learn a point of view. It’s important to have a point of view, to know that it is false. It’s all false.”

A month passes. Before I realize it, I am once again on a train weaving across the landscape. The mountains flatten into farmlands, then rise back up as buildings. Master Chen set aside seven disciples whom he had given martial art names. Besides Wen and Wu, there were Dao (principle), De (character), Long (dragon), Hu (tiger), and Yun (cloud). Each name was prepended with the character Wei, which means “profound.” He also reserved me a name: Feng, meaning “wind.”

Of course I had to hold in a joke about flatulence.

Next stop: Singapore, again!


In the picture are De, Wen, Dao, Sifu, Wu, Hu, me and my French roommate Long

For information about the Wuji Kungfu School, I’ve made an English website:


The Path We Share: the last stretch towards graduation and goodbye

There is a path behind London Hall that runs around TD Stadium. When I was in second year and living in London Hall, I would spend hours walking along that path, mentally reviewing for an exam or pondering on a particularly tricky problem. This weekend, I went back to that path after a year-long hiatus. I don’t quite know what drew me back. Maybe it was nostalgia. Maybe it was the smell of leaves. Maybe I just wanted to pick up my thoughts from where I left off a year ago.

The path begins at the foot of a small hill. It heads south along the stadium, turns east and then abruptly ends. One moment, you’re part of the Western campus, Frosh week and the class of bleary eyes at 8 AM in the morning. The next moment, you find yourself plunged into a thicket of green. You enter a world of whisperings and soft speeches, full of hidden promises and covenants.

I’d never noticed how beautiful that little patch of forest was. One summer morning, I woke up early after struggling with a research problem all night and decided to take a walk to clear my head. As I rounded the bend on that path, I stopped and stood transfixed at the scene before me. The sun had poured itself through an opening in the trees, diffused through the morning mist and gently fell on the ground. Its glow was gentle yet powerful, like a wave and like a star, like that of music. The rays fell on me and through me, and I could feel the trees rustle to a song that was without sound.

I never saw the sun like that again. I rued the fact that didn’t have my camera on me. If only I’d captured it! Then I could relive that moment forever. But this weekend, as I walked along that path again, the sun ordinary and unimpressive as it always was, I decided that it was better that I did not have my camera that summer morning. After all, that moment was precious precisely because it could not be relived.

Then I remembered why I wanted to walk: Goodbyes. There were many of them this weekend. I met up with friends I’d known over the past four years, some of whom I knew I would never see again, and others whom I knew that, try as I might, I had little chance of seeing. Goodbyes are a tiresome business. It hurt to say goodbye to my classmates when I left Singapore 7 years ago. It wasn’t great leaving Vancouver and saying goodbye to my friends there. Moving through four high schools was another string of goodbyes.

Somewhere along the way, I became pretty good at anticipating what would happen. First, you’re all awkward and fidgety. Then you tell each other of the various odds of meeting again, at which point both of you become crummy statisticians. At last, after a hug, a handshake or a nod, you part ways.

Of course, most of what you say don’t happen. The odds of meeting someone you know are high, but the odds of meeting a particular someone are not. Maybe you’re just casting your net wide, hoping that you’d catch something? “Hey, it’s you! Told you we’d meet again!” (But I told that to everyone else too.) Either way, it seemed pointless to get close to anyone if I knew that goodbye was inevitable.

Once, I made a few new friends who came to Western from Vancouver for a conference. That night, I led them down the path, telling them that it was a shortcut back to campus. We were joking around and laughing until we reached the end of the path and the beginning of the forest. With the bluish tinge of streetlights behind and the deep abyss of the midnight forest before us, they stopped and looked at me apprehensively. “You’re not a psycho-killer, are you?” one of them asked me. He was only half-joking.

I began walking.

“What’s that I’m hearing?” he asked.

“…The river,” I said.

They backed off a few steps.

In the end, I convinced them to follow me into the darkness with the promise of a once-in-a-lifetime-at-Western experience. A few steps in, one of the girls began to scream.

“You know,” I shouted over her screaming. “They say experiencing terrifying events together can make people closer! You guys are leaving tomorrow, so treat this as a speed bonding session!”

She kept screaming the entire way.

“If you ever meet someone, you should bring her here,” the guy said after we emerged from the other side. “That really would have worked.”

I smiled as I remembered that memory. Moments like those have changed my opinion about relating to people. In the past, I wanted to mean something to everybody because that meant I was well-liked and admired. As I grew up, I wanted to mean something to a professional group of people because that meant I was smart and valued. Now I simply want to mean something to a few people, to be there when they needed me, to empathize and to heal without a stethoscope.

As I walked, I realized that human connections are worth the time even though they inevitably end with goodbyes. I realized that we strive and stress so that we may be listened to and loved. I realized that as I develop my identity as a healer, my greatest challenge will be to listen to myself and to those who suffer.

I’ve begun counting my life in four-year blocks. Four years of high school, four years of undergrad and then four more years of medical school. I figured that I have about fifteen more of these. That’s not a lot of time left to do something that’s of worth, or to spend my time wallowing in what would have been, could have been, or should have been.

I tried to recall all my four-year blocks. High school was a blur, new school every year, science fairs, biology class, exams. Undergrad was hazy, frosh week seemed like yesterday, first day of class was intimidating, biology was hard. The more I walked, the more details I remembered, and the more I began to realize that the sun that had seemed so ordinary a moment ago was in fact quite special. It was not the same sun that I saw that summer morning, but it was precious by its own right.

I walked, lost in thought. Look! I’m back where I began.

Personal Stories, Philosophy

A Life Lesson from Professor Tom Haffie

I knocked on the door. There was shuffling on the other side, and a subtle but familiar anxiety rose in my mind. Still nervous, after all these years? I wondered to myself.

The door opened, and Tom Haffie’s face appeared in the crack. He was a late middle aged man whose hair had started turning white, and whose eyes shone with a glint that suggested that he knew more about you than he cared to show. He usually gave a rather serious impression, but he smiled as he greeted me.

“Hi Charlie. Come on in.”

“Hi Tom,” I said as I entered. “These are for you.” I handed him the items in my hands. “Green tea and raisin tea biscuits. Hope you still like them.”

“Always have. Thank you. Have a seat.”

It was three years ago when I first met Tom in this very office. He was my first year biology professor then, but our relationship had progressed over the years. In fact, we recently published a paper together.

Yet in some part of my mind, I still thought of myself as a freshman who wanted to pick his professor’s brains. I remembered the first time I visited, when I’d asked him a question about Okazaki fragments. “Hair splitting” was the phrase he used to describe my question. “You will never have to think in such detail,” he had said.

“How have you been?” I started, watching him break the raisin biscuit into bite-sized pieces.

“Busy, as usual…You remember Elysia?”

“The chloroplast-eating sea slug from first year. How can I forget?”

“New research came out…” he said, gesturing at a paper on his desk. “Turns out it doesn’t actually use the chloroplasts for photosynthesis after all.”

“You’re kidding!”

“And there is no evidence of lateral gene transfer either.”

“You mean to say…”

“The slug just digests chloroplasts for food.”

“So my first year was a lie?”

“I’m hoping you didn’t just learn about the slugs.”

I chuckled, partially at his comment and partially because I imagined myself as a naïve freshman and couldn’t help it. When I stopped, I noticed that a stillness had settled in the room, like time had frozen and there was no one in the world talking except us.

Tom was a master of silence, and maybe that’s why it can be unnerving talking to him. He injected long pauses between sentences, and each word that came out always seemed adamant on asserting its effect on the listener. As a freshman, I’d often wondered what to say to fill in those pauses. But now I steadily met his gaze and waited.

“So…how’s life?” he said ten seconds later.

I updated him on my medical applications. In fact, I’d recently been rejected by McMaster’s medical program. He didn’t have to know that.

“You know, I’ve been reflecting recently,” I said, and I felt his gaze intensify. “I have two competing motivations in me.”

He nodded.

“I am driven by curiosity. I want to try a bit of everything, to learn different things while I’m young. That’s partially why I picked bioinformatics, because I knew I’d learn all the health-related stuff in medical school. But at the same time, I can’t help but be influenced by how everyone around me is doing. Despite all of my achievements, my ego wants to be recognized, and oftentimes it gets in the way of what I really want to do: to learn.”

Throughout my rant, he nodded along with an amused look on his face, like he knew exactly what I meant and maybe a little more. When I finished, he drew a slow breath. Outside, the snow had begun to fall. Flakes of iridescent crystals hung onto the window pane briefly before evaporating into the morning sun.

“Charlie…you have so many expectations, about life, about yourself, about everything,” he said. “…Did you ever question these expectations?”

“Question them?”

“Yes, how do you know that they are the best for you?”

I considered this for a moment.

“For example, your aim is to go to a certain medical school. But maybe that isn’t such a good choice. Maybe you end up hating that school. Maybe you go to that new city, and the second day you get there you get hit by a bus, or maybe you meet some girl there who breaks your heart and destroys your life.”

I’m amused as I write this. For one thing, his bus illustration echoed the one I used in a blog post three years ago. For another, that very evening after my conversation with Tom, my friend and I were walking near my apartment when a car collided into a van, knocked its front bumper off, and skidded onto the pavement where we had been five seconds earlier.

But I was also amused by his girl comment.

“That reminds me of a story I once heard,” I said. “It’s supposed to be about marriage, and I think it works for life too. Do you want to hear it?”

“Sure,” he said.

“They say picking a partner is like picking a corn in a corn field, but you can only walk in one direction, and once you pick a corn, you’re stuck with it. (This analogy probably doesn’t work very well in modern times.) Some people start walking, and they see a pretty large corn. They think to themselves, there’s probably a bigger one up ahead, so they give this one up. But as they keep walking, they realize that the corns get smaller and smaller…”

Tom began to chuckle.

“…until finally they settle for a small one and live their lives in regret.”

At this, Tom let out a long, drawn-out laugh. I’d never seen him laugh like this before, and it was very unprofessorlike. I joined him out of politeness, but I couldn’t see how my story could be that funny.

“No,” he said when he finally stopped laughing. “Marriage is not like that at all.”

“How so?”

“There is no concept of bigger and smaller corns. Plus, what if you’re the type who likes small corns?”

He glanced at his watch.

“Another student is coming in soon. I’m going to have to kick you out for now. We’ll chat again.”

Then he took another slow breath and looked at me intently.

“You’re at an exciting time of your life, Charlie.”

“So are you, Tom.” Then I cast an exaggerated glance at his white hair. “A different kind of exciting,” I said, grinning.

I left his office and entered the snowy world outside, feeling oddly lighter than before.


Dying in the Age of Immortality

He was in his mid-thirties, and was counted successful by any standard. He’d graduated from Harvard, succeeded on Wall Street, and had a family. But on that particular day, a video of him was displayed prominently in the auditorium, his every move scrutinized by a room full of strangers. Outside, the hospital bustled with activity. Tubes of blood shuttled about, microscopes flickered, MRI machines roared to life. The auditorium, on the other hand, was silent; we were all sitting on the edge of our seats, trying to get a better glimpse of the video. The patient had suffered a violent stroke a month earlier. Since then, his personality had become increasingly erratic and violent. He had to quit his job, and was admitted into a nursing home. Shortly afterwards, he began experiencing seizures, and was brought to the epilepsy unit where I am doing my observership.

A week after I saw that case, I received another piece of news. This time it was about Dave*, an employee at the soup kitchen I volunteer for. Dave was in his mid-forties, and confined to a wheelchair. He’d been haunted by drugs and booze for decades, and had gotten in and out of jail several times, each time for increasingly serious misdemeanors. At one point, he decided that he’d had enough. He took adult classes, learned financial accounting, and became a bookkeeper for the soup kitchen, a post that he held for several years until a week ago. He had succumbed to stage four colon cancer. I mourned at the loss of human potential. Why did Dave and the executive have to suffer? Why can’t we do better? Why did medicine fail?

It’s easy to ask these questions given today’s climate around medicine. In the 1920s, life expectancy in Canada was 60 years, lower than today’s age of retirement by five. The discovery of penicillin by Alexander Fleming in 1928, followed by other antibiotics, marked a pivotal point in the history of medicine. Time magazine’s May 15, 1944 cover featured an intense looking Fleming in a white lab coat. The article ran like this:

May 15, 1944 cover of Time

May 15, 1944 cover of Time

“Medical news last week vied with news of the days before invasion. Under the aspect of eternity, the medical news might even be more important than the military. WPB announced that the wonder drug penicillin, for three years practically a monopoly of the Army & Navy, was now being manufactured in such quantity that it can be issued to civilians. Some 1,000 hospitals will be allowed to buy generous monthly quotas for distribution to patients and other hospitals as they see fit.”

Clearly, antibiotics were exciting news, so much so that it vied for headlines with the war effort 3 weeks before D-Day. Scientific discoveries like these, along with increasing public health awareness in the 20th century, led to a dramatic increase in life expectancy. Canada’s rose by 20 years since the 1920s, and it now sits at number thirteen in the world.

With the advancement of medicine came the denial of its potential to fail. As Siddhartha Mukerjee writes in The Emperor of All Maladies, “When a doctor has to tell a patient that there is no specific remedy for his condition, [the patient] is apt to feel affronted, or to wonder whether the doctor is keeping abreast of the times”. Just weeks ago, an article posted on Science Alert ran the sensational headline: “Immortality is one step closer as scientists turn off the ageing process in worms”. (In truth, in the original paper, researchers prevented the decline of heat shock response with age in nematode worms.)

In this climate, it’s no wonder that talking about death, which was once considered bad luck, is now considered taboo. So-called “new-age religions” are more preoccupied with living than with the afterlife. A casual search on Google revealed that the proportion of books mentioning “death” decreased by half since the 1800s. In this “age of immortality”, Hades is no longer a horror; death no longer holds sway in the public imagination.

According to Atul Gawande, a New York surgeon, this has implications for healthcare. In Being Mortal, Gawande argues that ignoring the eventuality of death deters people from discussing about their values. In Canada and the US, if a person becomes legally incompetent because of illness, her Substitute Decision Maker (SDM) makes medical decisions for her. If the patient had not made explicit directives before she became incompetent, the SDM must make judgement calls based on the “patient’s best interest”. If the patient had not made her values clear beforehand, the SDM is left in a grey area. Should the patient remain on life support, if it means more suffering in exchange for a slim chance of recovery? Should a doctor recommend aggressive chemotherapy for an aged patient who might prefer palliative treatment?

On the individual level, forgoing value discussions with ourselves can lead to a feeling of loss and purposeless. In an article published by the New York Times, Julie Lythcott-Haims, dean of freshmen at Stanford, remarked that “[students] could say what they’d accomplished, but they couldn’t necessarily say who they were”. This loss of identity lies at the root of many psychiatric manifestations, according to the psychiatrist and Holocaust survivor Victor Frankl. During his time as an inmate in a concentration camp in Auschwitz, Frankl personally witnessed the disintegration of personhood. He observed that the inmates who had seemed the most carefree were the first to give up hope, whereas those who had been more thoughtful and introspective proved more resilient. His experiences counselling inmates shaped logotherapy, a form of psychotherapy that helps the patient identify his values and meaning in life.

“Death and the Miser” by Hieronymus Bosch

At the end of the day, death is an integral part of our existence. When the sun sets, when the curtain closes, when the hand strikes twelve, how will we face our mortality? How will we measure the life we’ve lived?

Last week, we held a minute of silence for Dave at the soup kitchen. I bowed my head, violin in hand, and uttered a silent prayer. I did not know Dave very well, only that he’d always seemed positive and hopeful, and that he had a glint in his eyes. That light which had inspired so many has faded, its flame now lit elsewhere. Dave’s story was one of ultimate redemption, from a drug addict and criminal offender to a contributing member of society. As I stood in silence, I remembered the video of that Wall Street executive in a hospital wheelchair, and I realized how closely he must have resembled Dave in his last days. In the end, we are all reduced to our insignificant idiosyncrasies. The way we’ve smiled, the way we’ve talked, the private passions that we’ve shared only with our loved ones. Hopefully, when we meet our inevitable end, we would, like Dave, have left behind a courageous life lived according to our values.

*Names and other identifying information are altered in this article.