Bloodletting and Miraculous Cures

PART I

HOW TO GET INTO MEDICAL SCHOOL,

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DESPERATE STRAGGLERS ARRIVED LATE FOR THE molecular biology final examination, their feet wet from tramping through snowbanks and their faces damp from running. Some still wore coats, and rummaged in the pockets for pens. Entering the exam hall, a borrowed gymnasium, from the whipping chaos of the snowstorm was to be faced with a void. Eyeglasses fogged, xenon lamps burned their blue-tinged light, and the air was calm with its perpetual fragrance of old paint. The lamps buzzed, and their constant static was like a sheet pulled out from under the snowstorm, though low enough that the noise vanished quickly. Invigilators led latecomers to vacant seats among the hundreds of desks, each evenly spaced at the University of Ottawa’s minimum requisite distance.

The invigilators allowed them to sit the exam but, toward the end of the allotted period, ignored their pleas for extra time on account of the storm. Ming, who had finished early, centred her closed exam booklet in front of her. Fitzgerald was still hunched over his paper. She didn’t want to wait outside for him, preferring it to be very coincidental that she would leave the room at the same time he did. Hopefully he would suggest they go for lunch together. If he did not ask, she would be forced to, perhaps using a little joke. Ming tended to stumble over humour. She could ask what he planned to do this afternoon—was that the kind of thing people said? On scrap paper, she wrote several possible ways to phrase the question, and in doing so almost failed to notice when Fitzgerald stood up, handed in his exam, and left the room. She expected to rush after him, but he stood outside the exam hall.

“Are you waiting for someone?” she asked.

Shortly after they arrived at the Thai-Laotian café half a block from campus, Ming said deliberately, “Fitz, I simply wanted to wish you the best in your future endeavours. You are obviously intelligent, and I’m sure you will be a great success.”

The restaurant was overly warm, and Fitz struggled out of his coat, wrestled his sweater over his head, leaving his hair in a wild, electrified state. He ran his hands over his head, and instead of smoothing his hair this resulted in random clumps jutting straight up.

“Same to you,” he said, smiling at her almost excitedly.

She watched him scan the bar menu. When she asked for water, he followed suit. She liked that.

She said, “Also, thank you for explaining the Krebs cycle to me.”

“Any time,” said Fitz.

“I feel guilty that I haven’t been completely open,” said Ming. She considered her prepared phrases and selected one, saying, “It didn’t seem like the right time in the middle of exams.”

“Nothing in real life makes sense during exams,” said Fitzgerald. He tilted in the chair but kept a straight back. Ming reassured herself that he had also been anticipating “a talk,” and so—she concluded with an administrative type of resolution—it was appropriate that she had raised the topic of “them.”

She leaned forward and almost whispered, “This is awkward, but I have strong emotional suspicions. Such suspicions are not quite the same as emotions. I’m sure you can understand that distinction. I have this inkling that you have an interest in me.” She didn’t blurt it out, instead forced herself to pace these phrases. “The thing of it is that I can’t have a romantic relationship with you. Not that I want to.” Now she was off the path of her rehearsed lines. “Not that I wouldn’t want to, because there’s no specific reason that I wouldn’t, but I— Well, what I’m trying to say is that even though I don’t especially want to, if I did, then I couldn’t.” The waiter brought shrimp chips and peanut sauce. “So that’s that.”

“All right,” said Fitzgerald.

“I should have told you earlier, when I first got that feeling.”

“You’ve given the issue some thought.”

“Not much. I just wanted to clarify.”

Fitz picked up a shrimp chip by its edge, dipped it in the peanut sauce with red pepper flakes, and crunched. His face became sweaty and bloomed red as he chewed, then coughed. He grasped the water glass and took a quick gulp.

Ming said, “Are you upset?”

He coughed to his right side, and had difficulty stopping. He reminded himself to sit up straight while coughing, realized that he wasn’t covering his mouth, covered his mouth, was embarrassed that his fair skin burned hot and red, wondered in a panicky blur if this redness would be seen to portray most keenly his injured emotional state, his physical vulnerability in choking, his Anglocentric intolerance to chili, his embarrassment at not initially covering his mouth, his obvious infatuation with Ming, or—worst of all—could be interpreted as a feeble attempt to mask or distract from his discomfort at her pre-emptive romantic rejection.

Ming was grateful for this interlude, for she had now entirely forgotten her rehearsed stock of diplomatically distant but consoling though slightly superior phrases.

“Hot sauce. I’m fine,” he gasped, coughing.

There was a long restaurant pause, in which Ming was aware of the other diners talking, although she could not perceive what their conversations were about.

She said, “I’ve embarrassed us both.”

“I’m glad you mentioned it.”

“So you are interested,” she said. “Or you were interested until a moment ago. Is that why you’re glad that I mentioned it?”

“It doesn’t matter, does it? What you’ve just said has made it irrelevant. Or, it would be irrelevant if it were previously relevant, but I’m glad you brought up your feelings,” said Fitzgerald. He picked up the menu.

“Don’t feel obliged to tell me whether I needed to say what I just said.”

“It was great to study together. You’ve got a great handle on … on mitochondria.”

The waiter came. Ming felt unable to read the menu, and pointed at a lunch item in the middle of the page. She got up to use the bathroom, and wondered in the mirror why she had not worn lipstick—not taken a minute this morning to look good. Then, she reminded herself that she should have actually taken measures to appear unattractive. Nonetheless, Ming examined her purse for lipstick, finding only extra pens and a crumpled exam schedule. When she returned, they smiled politely at each other for a little while. They ate, and the noodles fell persistently from Fitzgerald’s chopsticks onto the plate, resisting consumption. Ming asked if he wanted a fork, and he refused. After a while, as Fitzgerald’s pad thai continued to slither from his grasp, Ming caught the waiter’s eye, who noticed Fitzgerald’s barely eaten plate and brought a fork without Ming having to ask.

Fitzgerald ate with the fork, and craved a beer.

“We’re great study partners,” said Ming, still holding her chopsticks. “I want to clarify that it’s not because of you.” She had to get into medical school this year, and therefore couldn’t allow distraction. Her family, she said, was modern in what they wanted for her education, and old-fashioned in what they imagined for her husband. They would disapprove of Fitzgerald, a non-Chinese. They would be upset with Ming, and she couldn’t take these risks while she prepared to apply for medical school. The delicate nature of this goal, upon which one must be crucially focused, superseded everything else, Ming reminded Fitzgerald. He stopped eating while she talked. She looked down, stabbed her chopsticks into the noodles, and twisted them around.

He asked, “What about you?”

“What do you mean, me?” she said.

“Telling me this. Did you feel … interested?”

“I thought you might be.”

“You might say that I’ve noticed you, but I accept the situation. Priorities.” The imperative of medical school applications carried the unassailable weight of a religious edict.

“Very well,” she said, as if they had clarified a business arrangement.

The bill came. Fitzgerald tried to pay and Ming protested. He said that she could get the bill next time and she insisted that they should share.

She said, “See you in January,” and left. He had not even put his coat on, and afterwards she felt badly, decided she should have been calm and walked out into the street with him. Not just should have. She wanted to have done that, to have at least allowed herself to pretend, for the length of a city block, that there was something between them. Except that her cousins and family’s friends were numerous on campus, and might notice her and Fitzgerald walking together without any academic justification for each other’s company. Not that those of her own age would disapprove, and not that they would do anything less themselves. They would be enthusiastic about such gossip, and it was the talk that could be dangerous.

Fitz struggled into his sweater, took it off again, sat for a little while, and then ordered a pint. There came the relief and ease of the first drink. With this sense of mild well-being, and having abstained completely over the exam weeks, and with no more tests to write and Ming having fled, why not have another? So another beer, and with it the open hurt of feeling sorry for himself. This was the part he liked least, when he wanted to cling to something. This feeling was a lingering shadow of what he had felt when his mother went away, and reminded Fitz of how his father had become cold except when morose in drink. This was the worst part of it, both familiar and unhappy. What was new to Fitz was that he felt a pain at not having Ming. The pain of rejection was a significant shade different from the longing of desire, he noted, although drawn from the same palette. This sombre phase could generally be gotten through with a few more, and therefore justified the third drink. A washroom break. With the third pint came the brink between anger and the careless release that could sometimes be achieved and was the goal of the drinking. Fitz tried to will himself into this easy release, to tip over the meniscus of anger that grew like water perched higher than the rim of a glass, but it didn’t work today. It didn’t spill over so that he could relax, and instead he grew angry at his mother for crashing her car, at the doctors for not saving her, at his father for being his father, at himself for drinking, at Ming for being scared. After a fourth pint, the waiter brought him the bill and Fitz paid it with no tip, angry at the waiter for presuming that it was time for the bill. He told himself not to think about Ming because the anger didn’t help him deal with the hurt of rejection. He let himself out into the street where it was still snowing, that drifting quiet veil that sometimes persists after a storm.

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During the previous month, Ming and Fitzgerald had studied at the same table in the library. For self-identified “med school keeners” (the label was inherently self-designated even for those who publicly denied it), study tables were the monks’ cells of exam time. Adherents arrived early in the morning and sat silently except for whispered exchanges. There was a desperate devotion to the impending sacrament and judgment of the exam. The faithful departed late at night, and returned upon the library’s opening. At first Ming and Fitzgerald sat at the same table coincidentally, but gradually the third table from the corner window became their table. One day they courteously acknowledged that they were studying for the same examinations, and then later that day murmured about phosphorylation reactions.

Sometimes, Fitzgerald closed his eyes and mouthed words while he memorized. Ming pretended to look out the window, allowed herself to briefly watch the half-image of his reflection speaking silently. She could see that he was immersed in the material, that he was trying to get inside it. She admired this, and longed for Fitzgerald because of it. Ming had decided to be occupied primarily with the facts in her textbooks, and less with comprehension. Ionic channels were not a wonderful riddle to her, as she knew they were to Fitzgerald. They were simply a means to an end, that end being a perfect set of grades and a medical school admission letter. Hers was the more common attitude in the life sciences faculty, and so Ming regarded Fitzgerald as being pure and noble, if strategically unwise.

Midway through the exams, they grew into a twice daily session of going through questions. Fitzgerald proposed that they use these question sessions as breaks, and so they visited the library cafeteria twice a day. Ming considered going to the cafeteria to be an indulgent use of time, but she decided that it was acceptable as long as they discussed only academics, and as long as she didn’t spend too much time actually enjoying Fitzgerald’s company.

They ate, clarified the puzzles of cell membrane physiology, and talked about their need to become physicians. Others were not genuine, they agreed, and transparently wanted to become doctors for money and prestige. Ming and Fitzgerald wanted medicine for the right reasons, they told each other: service, humanity, giving. Because their motivations were clean, they were certain they deserved it more than those among them. They did not ask why they wanted to serve, be humane, or to give. These simply felt like the right motivations, and being correctly motivated should improve their chances of success. This was enough, and these sentiments felt easy and immune from questioning. If forced to reflect, both Ming and Fitzgerald would have had to admit that these convictions were, at their core, somewhat improvised. They did not challenge each other, but instead reinforced each other’s sense of moral correctness as a virtuous conspiracy of two.

Their consuming ambition was the same as those of their classmates, but they agreed that most of the people around them were fake. Ming did allow that, although she did not want to pursue medicine for the money, earning a good living was important to her.

“I like being obsessed by things,” said Fitzgerald one day. “It suits me.” He did not tell Ming that he supposed that if his attentions had happened to fall upon something other than medicine, he would have been equally engrossed with it.

Ming paced exams like a marathon. In a three-hour examination, she finished her initial draft within a strictly self-enforced two hours. For twenty minutes, she returned to uncomfortable questions she had indicated with a lightly pencilled star. After reworking her response she erased the star because she didn’t believe in changing an answer more than once. For another twenty minutes, she focused on the crucial phrasing of the questions, ensuring that her answers corresponded. They altered questions subtly from the previous years’ versions in an attempt to throw off those who studied from the prohibited, but widely available, pool of old exams. Ming was vigilant that a four-point question receive no more than four indisputably correct facts in the answer; it was possible to lose marks by including incorrect extra information. She sat straight, with her ankles crossed under her seat.

In her assigned seat behind Fitzgerald, Ming sometimes glanced up at him, saw him curled over his papers. In some sessions he wrote furiously until the invigilator came to take the paper from him. At other times, he finished writing within an hour and then fidgeted while everyone else worked. Fitzgerald constantly slipped his shoes on and off, and once accidentally kicked his right shoe two rows across. The invigilator retrieved it, and pulled out the insole to check for any hidden papers before returning it to Fitzgerald with a recommendation that his shoes stay on his feet.

Ming called Fitzgerald late that night, hours after she had rushed away from her half-eaten pad thai. He woke to the phone ringing, his head pounding with an early evening hangover.

She said, “You’ve been honest, so I should be. I am attracted to you, and now that we both understand this problem, we shouldn’t study together or even see each other.”

“Does that make it more clear?”

“It’s only that the whole thing will go wrong.”

Fitzgerald pointed out the competitively lonely nature of their faculty, spoke in a seemingly spontaneous and heartfelt way about the improbability and importance of human connection, and said, “Why don’t we be friends, of an academic nature.” It was at this moment, as he said this in a comforting manner, that Ming became certain that she was in love with him. They concluded that since they were adults with common priorities, and agreed that a relationship was inadvisable, there was no reason why they couldn’t help each other study. After hanging up, Ming felt pleased in a longing, distanced way. She could be in love with Fitz in this protection of an agreement, with an understanding between them that there would be no romance, and so, she decided, she would not be hurt.

The graded biochemistry finals were the last set to be distributed in the second week of January. Fitzgerald flipped through his paper, adding up the numbers. Ming opened her locker and thrust her own exam into the bottom of her knapsack. She was unsure whether to ask Fitzgerald the sensitive question, the private issue. Some people made a show of displaying their victories, or their self-flagellation at a disappointment. Ming felt that grades were fundamentally secret successes and defeats. On the other hand, Fitzgerald lingered near her. No, she wouldn’t ask. She was not afraid of him doing better than her. It was just that he might feel that she was being nosy in the publicly competitive way that she hated, or would think that she cared, which should be avoided.

“I won’t make the cut-off,” said Fitzgerald. He looked up.

In the way that a mother asks a child to show her a boo-boo she said, “Show me.”

“I needed to ace this,” he said, handing her the paper.

Ming was embarrassed by his grade, by his lower lip drawn tight, and by her own result.

“The cut-off changes every year,” she said. It was believed that a magic grade point average was required in order to get an interview. Ming searched for an error in the addition of marks, hoping to find that ten points had simply not been added. She could give this to Fitzgerald like a gift, although this happening would be like finding a hundred-dollar bill lying in the street. Among the medical school applicants there were theories about MCAT scores, varying schools of thought about curricula vitae, and tales circulated about what so and so’s brother and such and such’s sister were asked in their interviews. Small groups of people who sat shoulder to shoulder in every lecture shared underground treasuries of old exams, but denied their existence to anyone outside their number. It would have been commonly agreed that Fitzgerald’s grade of seventy-eight was a liability.

“How did you do?” asked Fitzgerald.

“Okay.”

“Most people wouldn’t be so modest.”

“I lost two marks, but made them up with the bonus,” she said. She had to tell him. There was an accepted notion of I’ll show you mine if you show me yours, and she felt good telling him. Whenever Ming got her marks, the numbers first gave her a sense of relief, and only once this moment passed did she allow herself to feel some pleasure. Then came the fear that if she became pleased and complacent, she might fail in the future. She reminded herself of the ease with which perfection could be lost, and was wary of being satisfied with her grades. Now, it felt good to tell Fitzgerald that she had received a perfect score. Still looking at his exam, she said, “Get this regraded.”

“Found something?”

“I can’t find marks, but you understand this stuff. You’re losing marks on detail. The Krebs cycle—you know it better than I do. The problem is the way you study and write.” She said this not only to be kind, but because she found his answers elegant and insightful. Ming’s own responses were always factually complete in point form, convenient to check off for a perfect score. Fitzgerald seemed to disregard the assigned value of questions, and in some three-inch spaces he cramped his writing into tiny letters in order to include the essay-length breadth he felt was appropriate. In another section where a page was allotted, he wrote four lines and drew a diagram that, to him, encapsulated the entire issue.

It was Ming’s cousin Karl who had taught her the rules of academic success: be meticulous about details because it’s easier to lose two marks than to earn eight, understand what will be asked and prepare to deliver it, expect that the next test will be harder and that this is your reward for success. When Karl was eighteen and Ming was twelve, it was as a big favour to her father that her uncle had agreed to allow Karl to use some of his valuable time to tutor the B student, Ming. Karl was the shining boy who filled her uncle’s mantelpiece with academic trophies. He was on scholarship in his first year of university biology while Ming blundered through junior high.

Ming’s father impressed upon her the importance of learning from her cousin, of not bringing shame to her parents. She admired Karl’s easy confidence and the way he grasped everything he wanted—each award, each prize. He taught her a system—a way of breaking knowledge into manageable packages that might be related but didn’t have to be, that didn’t even have to matter, but the facts of which must be internalized, mastered, and displayed without so much as a momentary lack of confidence. To lose sight of any of these lists, subjects, or compartments would be to fail, and if you failed any part—whatever else had been learned would not matter when the time came to see if you would be allowed to write the next, tougher test.

“Well, congratulations, Doctor Ming,” said Fitzgerald, his grin too wide. She knew he genuinely intended it, but that it was hard to smile through his frustration.

“That’s a bit premature,” she said. She rolled his biochemistry final into a tube in her hand and said, “How was your Plato?” This was his humanities elective, and she did not take the same course so there could be no comparison.