BY ROBIN CHEAH

The following piece received 3rd place in the Writing (Preclinical) section of The Auricle’s 2021 Writing and Visual Art Competition and is responding to the prompt “the pursuit of knowledge is a quintessential part of medicine, but the benefits and risks sometimes balance treacherously“

When I was a child I visited my great aunt in Singapore – my Yi Poh – and it was an occasion that I’ve always remembered. Despite being in her 90s, my great aunt was as lively as any other friend I would see at the playground. She had made the long trek by foot south from Guangzhou to Malaysia to eke out a better life, living through years of poverty. Yet, when I met her, she was vibrant and cheerful. She seemed unfettered by everything, so much more carefree than my relatives who seemed restrained by family or politics or careers or business. Although the language she spoke with my mother flew over my head, her kindness transcended the language barrier. Her smiling, calm face, the energy with which she spoke to me stood out to me.

When we were leaving her small condominium, she stopped me as we left. She had a gift: a bar of Whitaker’s white chocolate. She put it in my hands and waved bye-bye with a genuine smile — for the first and last time — whilst my mum told her off in rapid-fire Cantonese for spoiling me.   

That bar of white chocolate was destined to sit in the pantry when we arrived home in Australia, a fate best explained by my mum’s hard stance on sugary chocolate. I would occasionally look at it but would never eat it. And so, as it sat on the shelf over time the bar of Whitaker’s white chocolate morphed into a memoir of how kind my Yi Poh across the sea was, even as she faded into a name occasionally brought up over the dinner table.

Years after that visit to Singapore I had somehow found my way into medical school and, anxious about being left behind, soon got caught up in the same academic scramble as my peers. It occurred to me mid-way through first year, though, that what was most important was to make good on a burning desire: the yearning for more knowledge. 

Some pieces of knowledge, though, seemed more important to me than others. Who needed to know the ten steps of glycolysis anyway? Spurred by remarks from older relatives in medicine and clinical-year students, I tried to spend some time interpreting vitals and other test results in preparation for the inevitable clinical years. For a while, it turned out well – I felt more confident, comfortable and knowledgeable whenever relevant scenarios would crop up in tutorials or past exams – and amid medical school’s uncertainty I settled into a state of relief over having studied the “right” things.

This attempt to get ahead of the curve culminated, so coincidentally, in a conversation immediately after I had finished my final written exam last semester. I breathed a sigh of relief, gently closed my laptop and walked victoriously into the living room where I found my mum deeply engrossed in her phone. She was hunched over, staring intently at whatever was on the screen.  

She called me over to her desk and she asked me curiously and quietly: “What do these numbers mean?”

“What do you mean?”

“Here,” she said, as she pulled up a photograph from her family’s Whatsapp group. “What do these numbers mean?”

A very slight, though unignorable uneasiness crept up in me. These were Yi Poh’s vitals, light green numbers juxtaposed on a black screen – her blood pressure was low, maybe even very low, her O2 saturation was below 95%, temperature 37-point-something, heart-rate around 110.  

The kind Yi Poh I had always remembered faded away: my academic instincts kicked in and I was seeing numbers. It felt like an exercise no different from a Friday ICL tutorial. What was the lower limit for normal blood pressure again? In the moment, it occurred to me that maybe I was not as good as interpreting vitals as I thought I was.

I told my mum that Yi Poh’s blood pressure and O2 levels were low, which only opened the gates for a flurry of questions from my concerned parent: “What’s sepsis? Apparently they say she has pneumonia. How did she get it? She also has chole-something, can you read this out to me? Is she going to die?” 

I felt overwhelmed, partly because I couldn’t possibly explain to her what was going on with Yi Poh’s myriad of diagnoses, from her septic shock to hospital-acquired-pneumonia. How could I have forgotten the different gallbladder diseases just a day after the very paper examining them? What seemed like a reasonable amount of knowledge to get me through my exams was barely enough to explain to my mum what Yi Poh was going through. The pursuit of learning had left me with more confidence than the knowledge I thought I wanted and needed. 

“The pursuit of learning had left me with more confidence than the knowledge I thought I wanted and needed”

More importantly though, something felt wrong about how clinical it all seemed to me.

Later that day I came to a realisation: I had spent the entire conversation neglecting the single fact that Yi Poh was simply dying, vitals or diseases be damned. 

Since that afternoon I’ve found it impossible to remember Yi Poh without also recalling that conversation. Perhaps her memory would have found a more peaceful closure in my mind had she simply passed away with my mother telling me in tears, “Yi Poh has passed on”. Maybe it was my oblivious obsession with what was ‘clinically relevant’ and to be so sure of my understanding that quietly relieved her of any humanity in my head. Why didn’t I just let go of my arrogance?

As I write and reflect now, part of me even feels psychopathic for disregarding the fact she was dying in favour of interpreting her vitals like a fictional patient’s. 

Another part of me, living in the present, tells me to move on: there’s no point ruminating on a single afternoon. 

And another part of me, looking pessimistically towards the future, asks me: will this be the way I see future patients? Are they all going to dissolve into a formless series of vitals and test results and differential diagnoses before me?

Medicine, at least its biomedical, academic aspect, is fuelled by the pursuit of knowledge: the acquisition of a neverending repertoire of examinations, histories, differential diagnoses, statistics and parameters. Yet, as important as these are to remember, there’s also another type of knowledge I realise I need sorely. It’s the ability to juggle the interpersonal with the scientific, to recognise that there’s a human being with loved ones and a whole life behind the panel of vitals needing to be interpreted. It’s the ability to just step back and realise that maybe, just maybe, your individual desire for knowledge isn’t always the right one. 

How proud I was; how naïve I am. 

Sometime during the recent July lockdown, my mum threw out the bar of white chocolate as we were cleaning the pantry. It was hiding behind a half-full bag of chips, obscured by to neglected curry packets. As I was making tea for us, she casually remarked: 

“This chocolate’s old. Yi Poh gave it to you, didn’t she?”