7/January/2022

The Doctor

by: Edith Choy


Photo by Clay Banks on Unsplash


I was known as the good doctor. People revered and relied on me. I offered them the solution to their significant problem. I kept their secrets, and allowed them to pay back in instalments. I was compassionate and offered them comfort as they made this difficult decision and embarked on this punishing process. I tried to make the process as painless as possible.

In the contract that patients sign before the procedure, there is a clause that warned of the possibility of psychosomatic aftereffects, the degree of which varied from patient to patient. Of course, my practice completely absolved itself of any responsibility in this regard, since this was contingent on the psychological and emotional make-up of the patient.

But I was not absolved from the nightmares. As a man, the power which I wielded over my female patients’ bodies was a responsibility which I took seriously. I only engaged in the safest procedures, my equipment was state of the art and I had very steady hands. That is, until. Of late, these hands trembled at the weight of what they have done and what they have been continually tasked to do.

In my office, over the decade, I have received two recognition certificates from the National Population and Family Planning Commission[1]. The recognition was for being a “Good Doctor” who was in committed service of the Chinese Community Party. The one-child policy[2]would contribute to the country’s economic ascendancy. “计划生育,人人有责.” (“Everyone had a responsibility in family planning.”) Although, the implicit message behind this slogan was that the government had a direct right over each family’s choice in family planning and in women’s bodies.

I had a wife and son of my own. My colleague inserted the IUD[3]into my wife himself. It is the least intrusive measure in my professional opinion, though it could be uncomfortable for my wife, and I recommended that she did a cervical and uterine scan every six months. I could see that she was in pain, especially during her periods, but everyone’s social responsibility was different. We all had our parts to play to protect the development of our Great Nation.

I saw them as floating spectres in my dreams, hung by a thin umbilical thread. Suspended, slightly off-kilter, luminous and slightly neon in a darkened room. I photographed the foetuses with flash. This would cause a noticeable reaction and for a moment, it was as though the foetus looked me right in the eye. Proof of life was not just a series of biological processes and reactions. Within each small body was a will and a soul, helpless and vulnerable, but present nonetheless. This was not my professional, but humane opinion.

That day, a girl barely the age of 20 came to my clinic. Her first pregnancy, but it was a girl. Her in-laws would not have it. She was alone, no husband in tow or sight. Responsibly, I explained the possible immediate complications of the procedure. As she looked terrified, I tried to reassure her with the factual statistics of frequency and the percentage of the risks. But I held my tongue as I thought about how no doctor could assure you that you would not be the exception to the rule. If she were my daughter, how would I speak to her instead? If she were my daughter-in-law, I would treat her like any other female patient. When it came to sensitive things like that, it could be easier to remain professional.

The next week during the procedure, there was excessive bleeding to her womb and she suffered a septic shock.[4]The foetus was removed but the scarring in her uterus was irrevocable. She could still have children in the future, but could she forget the death of this one? “I would have named her 强燕, my strong swallow[5].” she shared with me hours after the procedure, while she was recuperating. I was glad when she returned home. Counselling was not in my skillset and part of my services. Alone in my consultation office later, I could not see how naming a dead child could help this young mother to move forward. She was no longer a mother, at least until she birthed a son. I uttered a secret silent prayer that she would heal well, physically and psychologically. I prayed that she would not have any nightmares.

Prayer was my secret solace that I let in to no one about, including my own wife.

强燕’s name stuck with me. Her form physicalised before me in my dream. Her skin was pink and her veins spread gently across her epidermis. Her chest rose and fell. The umbilical cord was thick and pulsated, it transported nutrients to and nourished her body. Miraculously, she was growing. Resiliently, she defied the odds and survived in my subconscious psyche.

“You are a good man,” my wife would say as we cuddled in the evenings. “and a good doctor. I’m proud of the service you do for the Party and our Nation.” One night, I could not help but cry when she said this. I thought about the oath[6] I had made when I graduated from medical school all those years ago.:

I pledge solemnly-
I will volunteer myself to medicine with love for my motherland and loyalty to the people.
I'm determined to strive diligently to eliminate human suffering…

and uphold the chasteness and honour of medicine.
I will work all my life for the development of the nation's medical enterprise…
[7]

My wife thought that I was moved by her affections and appreciation, and hugged me tighter.

We had considered having a second child to be a companion and playmate to our only son. With our financial situation, we could afford to pay the fine and fees. My good service to the Party granted me some favour in this regard too. We made an application and it was approved. We paid up the hefty fine.

After the removal of my wife’s IUD, we embarked on the task to procreate. Three months later, she conceived. She was a girl. We named her “白燕”, pure swallow. I was fostering a kindred connection between my daughter and the young mother’s sacrificed child. My wife knew nothing about why I had suggested this name. She was overjoyed with the addition to the family, and grateful that we could afford the expenses of a second child. If it were the time of the 70s, she would have wanted four children.

30 years into my practice, the tide began to shift. The Party and its social scientists realised the burgeoning 4-2-1 problem[8]. Two sets of grandparents were supported by a child and child-in-law, who were in turn supported by only one child. In 2015, the Party finally revised the one child policy to a two children[9] one. Thus, we no longer had to pay the fees for 白燕.

But the number of children per family hardly budged. Mothers had taken on greater responsibility in their careers and were flourishing professionally. Parents had invested more into their personal development and growth and fully enjoyed these benefits. The draw of more children and larger families were not as clearly apparent and could not be as easily accepted. This generation beat to a different drum from that of the generations before.

The people responded with their wills to this modern attempt by the government to social engineering. No central authority would have the right to dictate family sizes and have control over female bodies anymore. “一个太少,两个正好,一个嫁人,一个养老. One to marry off, one for old-age caring.”[10]I appreciated the ring to this slogan, but the reverse engineering came too little and too late.

At least it would be a different world for my son and daughter. They would have more options. They would still be told what to do, but is not more better than fewer? I was not too sure. I could encourage them to remember their duty to the Party and the country. They should remember their privileges and seek to serve and give back in the ways that they can. I was uncertain about this. In this day, would I be a good doctor for encouraging this? Would I be a good father? My encouragements sounded stale and outdated in my head. In my private thoughts, I prayed about who my alliance should be with.

In the modern version of the Hippocratic oath, taken by doctors in the Western world, it states:

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being…

I will remember that I remain a member of society, with special obligations to all my fellow human beings…[11]

If the Party could change its mind after 25 years, could I not too? A good doctor does not play God. A good father lets his adult children decide and supports them in their decisions. This was the beginning of my healing. I wanted to begin reversing the overwhelming weight of my actions these past 30 years. Those countless unborn lives, up to the thousands… Every day, I had been praying for forgiveness from these unborn lives. It took time, but the dreams gradually receded.

The Party would have no more hold over my professional practice and I would make my own humane and ethical choices. The 4-2-1 problem was not my problem, and I would ignore the slogans, whatever they were and however catchy. My wife and I would support ourselves in our old age.
In the evenings, when the thought of these unborn lives would rack me with guilt, my wife would hug me and whisper, “You are good husband, for making the choice to obey the Party, and protecting your family in turn. You are a good father, for providing for the family well… I’m proud of you and I love you.” But my tears would not stop falling.

--
About the writer
Edith Choy hopes to be a meaningful voice amidst diverse perspectives, and an ethical writer. She desires to write fiction that makes us reconsider our inherent prejudices and perspectives, poetry that reminds us of heartbreak, hope and healing; and plays that give voice to the forgotten, silent and passive ones. Her poem, "A Silver Lining", was a finalist for Catharsis 2021 of the Poetry Festival Singapore. By day, Edith is an educator who is mostly overwhelmed, but also privileged, at the demands of the teaching endeavour. A teacher may be forgotten at times, but is never silent or passive. Edith can be found in medium.com/@choy_edith




[1] The National Family Planning Commission (NFPC; 1981–2003), was a cabinet-level executive department under the State Council, responsible for population and family planning policy in the People's Republic of China. The commission was dissolved and superseded by the National Health and Family Planning Commission in March 2013, during the first session of the 12th National People's Congress. (Wikipedia)

[2] The one-child policy (Chinese: 一孩政策) was a population planning initiative in China implemented between 1980 and 2015 to curb the country's growth by restricting many families to a single child. China's family planning policies began to be shaped by fears of overpopulation in the 1970s, and officials raised the age of marriage and called for fewer and more broadly spaced births. A one-child limit was imposed in 1980 by a group of politicians including Deng Xiaoping, Chen Yun, and Li Xiannian. (Wikipedia)

[3] An IUD is an intra-uterine device that is placed in a woman’s uterus to prevent pregnancy.

[4] Septic shock is a serious condition that occurs when a bodywide infection leads to dangerously low blood pressure.

[5] It is considered good luck in China to have swallows nest on your roof, for it invites good luck. In addition, the swallow is a bird connected with femininity and beauty.

[6] To cultivate doctors that are competent to the requirements of the 2lst century, the Education Department of the People's Republic of China issued "The Oath of a Medical Student" in 1991.

[7] Excerpt of oath taken from “Chinese Oath of a Medical Student”

- Liu Qing, (7th year class, Grade 96, Harbin Medical University, 54#, Harbin, China 150086) Translator[with proof reader Ruth Asselstine, Reviser Xu Weilian] Eubios Journal of Asian and International Bioethics 9 (1999), 81.

[8] The 4-2-1 problem surrounding the one-child policy means that only children will have to bear the responsibility of supporting both of their parents and, sometimes, all four of their grandparents in their old age, as they cannot rely on siblings to help them care for their aging family. (Wikipedia)

[9] The new policy allowing Chinese couples to have two children was proposed to help address the ageing issue in China. On 27 December 2015, the new law was passed in the session of the National People's Congress Standing Committee, which governs country's laws, effective from 1 January 2016. (Wikipedia)

[10] This is an actual slogan released by the CCP to encourage families to have two children, instead of one.

[11] This modern version of the Hippocratic oath was written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.





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