29 Aug

For my brother’s fund-raiser.


In the upper east side of Manhattan on 69th Street, 20 minutes from the bright lights of Times Square, an imposing gray building stands bordering the East River. It is a quiet and intense spot among the many casual brownstones in the neighborhood; it is the Memorial Sloan-Kettering Cancer Center, home to many of the world’s leading cancer experts.

On the 14th floor is Dr Jedd Wolchok’s office, nexus of a seven-day, 70-hour workweek.

Dr Wolchok, 43, is an associate attending physician in Sloan-Kettering specializing in melanoma, a deadly form of skin cancer. Each morning he arrives at his office before 8am, sometimes even an hour earlier. Then, depending on the day, he consults with patients or tries to further the science of curing melanoma.

The gratifications and disappointments come more immediately in the former. Of the nearly 400 patients on Dr Wolchok’s watch, about half are in deep stage 2, where malignant tumors are present but kept at bay. The other half is in the more advanced stage 4, where life expectancy is predicted in months. The contrast between the two groups is startling, and in a single day Dr Wolchok can turn from savior to bearer of bad news in a matter of minutes.

Each consult follows a three-step protocol: he goes through with the patient his or her most recent CT scans – snapshots of the body interior that reveal malignant presences. Then he discusses with him or her any side effects of current treatments. Finally, depending on his advice and the patient’s preferences, a plan is hashed out for the way forward. In this manner Dr Wolchok sees around 30 patients each consult day, although the process differs for the two to three new faces that invariably punctuate his appointment book.

“People get sick every day,” Dr Wolchok says flatly. Although he devotes two full days a week to patient consultation, his telephone rings the other five. There is a frustration in Dr Wolchok’s voice when he speaks of the prevalence of the disease: a 2000 report by the US National Cancer Institute estimated 160,000 annual diagnoses worldwide. Compared to breast cancer, which is diagnosed 1.3 million times annually, the melanoma incidence rate may not seem staggering, but it is the fastest growing cancer in the US, with total new cases rising 3 per cent every year. More worryingly, the disease is becoming more and more common among the young, with diagnoses almost doubling since 1980 for women in their twenties.

Dr Wolchok is also frustrated because what he can offer in the consults is limited by the current reach of science: of the treatments approved by the US Food and Drug Association, the best is successful only 15 percent of the time, and even then the advance of melanoma is often halted by mere months. So while Dr Wolchok values the work he does in the consults, he values the work he does in the laboratory equally.

Take ‘Ipi’, for example, one of Dr Wolchok’s projects. Short for ‘Ipilimumab’, the experimental drug therapy was invented by Dr Wolchok’s mentor and inspiration, Dr Alan Houghton, and is in the third and final phase of testing. It has shown considerable promise, stopping the growth of melanoma tumors or even shrinking them in roughly 25 percent of test patients. While still far short of a cure, Ipi improves upon current treatments, and is one of the success stories in the fight against melanoma. If all goes well, it will receive FDA approval next year.

Variations on Ipi are also being developed under Dr Wolchok’s care. One of the reasons melanoma is so deadly is that it attacks the body through different avenues, and the hope with these Ipi variations is that they will act as gatekeepers, denying the disease access. According to Dr Wolchok, the long-term goal is to create a combination therapy that will unite Ipi and its cousins, thereby dramatically increasing melanoma patients’ survival rates.

When that might happen, however, is unclear. Although Ipi has sparked interest in the pharmaceutical industry – global company Bristol-Myers is one of Ipi’s investors – melanoma therapy remains a time-consuming and unprofitable venture to possible financiers in the industry, according to industry experts. Ipi itself has been 12 years in the making, and even that is considered speedy. Conception to Phase 3 testing – the final hurdle new drugs have to overcome before they are released onto the market – is traditionally a period upwards of 15 years. Unfortunately, the recent negative outcomes of two major Phase 3 trials – tremelimumab, whose Phase 3 discontinuation in April was a setback for investor Pfizer, and ganglioside GM2-KLH21, whose trial was discontinued in September – have cast a pall over melanoma’s attractiveness to pharmaceutical companies looking to bankroll the next blockbuster drug.

Without Big Pharm behind melanoma research, Dr Wolchok believes that the future of any possible cure is in the hands of ordinary citizens. “At this point, we are more or less dependent on philanthropy,” he said. “Even a dollar or 10 is money toward experimentation.”

_

Save Your Skin, a melanoma fund-raiser in NYC, will have its first event at Tailor on Sunday, October 26. An open bar will be available from 7pm onwards, and guests are invited to RSVP at http://www.yenfeng.com with a minimum donation of $40.

24 Jul

Published in the Straits Times.


The school times, they are a’changin.

Unlike ten or even five years ago, when the model student sat down, kept quiet and took notes, these days that student is more likely to be sitting down, keeping quiet and taking notes – for his eventual petition.

All this begs the question of how much say students should have in their own education.

Four weeks ago, local professor Dr Thio Li Ann was invited to teach a human rights law course at New York University. Some NYU students protested, pointing to her efforts to keep homosexual sex criminalised locally. Dr Thio canceled her visit last Thursday, citing the protest as a reason.

Whether she could have been an effective professor despite her views we will never know. But the tension between office and campus was clear.

Implicit in the students’ stand, after all, was their conviction that they know better than their administration how to run the university.

They’re not alone. Locally, more than 2,000 Republic Polytechnic students petitioned their administration earlier this month. They wanted the school to be shut down for a week in the wake of the H1N1 disease.

And last Thursday, an NTU student made use of his convocation speech to protest his administration’s censorship of his thesis project.

As with other social movements, the questions are how and why now.

The ‘how’ is easy: new technology has given students more platforms, not only to bypass administrations but also to find like-minded people.

Websites like Rate My Professors have long made traditional faculty evaluation forms irrelevant, by allowing students to score and preview teachers according to their own criteria.

Social networking sites like Facebook and Twitter have also made it easier for students to drum up numbers.

In February, 10 Singaporean students wanted lower public transport fares for tertiary students. They created a Facebook group and an online petition.

Some 5,200 signatures later, they got what they wanted.

The ‘why now’ behind this activism, however, is harder to articulate.

A former teacher suggested that students are more vocal now because they can be, with the technological advances.

Whether she is right is a question for anthropologists. More important is how local authorities and organisations will adapt to the idea of students as shareholders in their own education.

After all, Dr Thio’s withdrawal, also spurred by the low enrollment in her classes, show that students are now capable of derailing universities’ plans.

What’s needed is a new agreement, an adjustment to the changing times: where feedback mechanisms are updated to the Age of Twitter, and where discussion replaces and precedes petitions, not the other way round.

This will require effort and open-mindedness on both sides.

But the alternative is much worse: a further souring of relations, and the impeding of what it’s all about – education.

20 Jul

Published in the Straits Times.


For 30 hours last Saturday, I was a suspected H1N1 case.

My very own, personal, ER drama did not start at triage, however, but several thousand metres above ground.

It begins on an airplane – Flight SQ 325.

En route from Frankfurt to Singapore, I develop diarrhoea and then a fever.

At first, I consider toughing it out. In the dark of the cabin, I tell myself: “It’s probably nothing.”

Until a vicious stab of pain has me climbing over my sleeping neighbour for the airplane loo.

That’s when a stewardess catches sight of me and the party in the pantry begins.

She gestures me to a cabin crew fold-down seat and whips out a temperature kit. Another brings in two men in suits. The space begins to feel very crowded and I start to get frightened.

The heat strip in my mouth climbs to 39.1 deg Celsius. When the number is announced, it changes everything.

As I sit in the pantry dictating my particulars, travel history for the last month and future plans, the stewardesses spread into the economy cabin.

They relocate passengers in a one-person square around my seat, tear and disseminate contact sheets to the 45 people closest to me, answer questions and pacify passengers in the inevitable fallout.

A toilet is disinfected and blocked off.

I learn that above the vacancy indicator on the toilet door is a hidden, sliding bolt that unlocks it from the outside.

I am returned to my seat, spotlighted by an empty square. I hide behind my face mask.

For the remainder of the flight, the cabin crew is so solicitous I think I am sitting in first class.

I am embarrassed – mortified – when told that the Ministry of Health (MOH) has been notified. I imagine masked men sweeping through the airport, thermometers holstered.

My fear takes on an added dimension when my fever begins to subside, pressed down by the application of Panadol and cold water.

The thermometer reads 36.8 deg Celsius, otherwise known as normal body temperature.

I have never been so embarrassed to be in better health.

I spend an hour hoping for a resurgence of the fever. That doesn’t happen.

I spend it hoping the ministry will send just one person. That doesn’t happen either.

I am perversely relieved to still have diarrhoea.

The plane is met at the airport by a team of MOH professionals, who take the temperature and contact details of every single passenger.

Needless to say, it takes a long time, during which I sink into my seat and pretend to be asleep.

When I am the only passenger left on board, three blue-smocked women set up command in the business-class cabin.

A tornado of activity ensues, of which I am the eye.

My temperature is taken again. The doctor pokes both ears, one of which registers a more hopeful 37.1 deg Celsius. She records that one.

I am thankful for the small gain and realise I have truly moved to Bizarro Land.

The other two women record my name, address, IC number, home and cellphone numbers, symptoms, travel history and future plans, transmitting all this in a series of overlapping phone calls.

After the storm subsides, despite all likelihood to the contrary, the doctor decides on testing to provide peace of mind.

Because I was in New York a week ago, I may still be a carrier.

My luggage is taken to the tarmac. A Customs official comes on board to process my re-entry into Singapore. My parents are contacted.

A driver parks a tan civic ambulance 15 steps from the plane. I know I am being transferred to a new authority because his smock is green instead of blue.

For the ride to Tan Tock Seng Hospital, a police motorcycle tails us, red and blue lights flashing.

I feel a tiny, private thrill. It is my first time in an ambulance, and my first time being escorted by the police.

How many people can claim to have been escorted by the police?

I mean, besides criminals.

We arrive at a hospital loading bay, its inner end drafted into service as a waiting room. The driver hoists my luggage off the van, chats with the woman on duty and wishes me good luck.

Again, I am asked to disgorge my particulars and travel history. But the woman also wants flight numbers and seat assignments. Considering I have taken seven planes in seven days, this is no small task.

The woman collects what she can and pages the doctor.

He is a hulking young man hidden behind a face mask.

I learn what newspapers mean when they say ‘further assessment at the laboratory’. Three samples are extracted: blood, and throat and nasal swabs.

For the uninitiated, let me say that a nasal swab feels like shoving a pencil up your nose, and then using it to write a novel on your brain.

By the time the doctor withdraws the cotton tip, I am tearing up like a character in a Korean drama. The doctor makes a joke, and I make a joke, and he deposits the tip in a test tube.

I am just getting to like him when he gestures to the other nostril.

An elderly man drops by to hand me porridge and hot Milo while I wait.

Because the analysts have regular working hours except in cases of probable infection, I am to spend the night in one of the Communicable Disease Centre’s isolation wards.

This turns out to be a spacious room, fresh, appointed in soft white, almost friendly but for the biohazard collection box – a bright neon dumping point for the hospital’s toxic chemicals.

Masked and green-smocked women descend on me to show me the toilet, how to carry the saline drip and put on the hospital’s version of pyjamas.

A bulky button is clipped to my groin. It is a thermosensor. It has a bar code and a point of blinking red light.

I imagine an alarm going off when my groin gets overheated. I try not to think about this.

Thankfully the night passes uneventfully. My blood pressure is taken periodically with a wheeled-in machine. Another machine beeps me awake when the saline bags run dry. I thumb the bedside call button and doze while the nurse replaces my drip.

Because of my diarrhoea, I also record my bowel movements through the night, filling up two containers with my watery stool.

Sleep comes easily despite this.

The next morning, refreshed, I have only one thought: When can I go home?

The nurse who takes my blood pressure guesses I will be home within the day. The analysts start work at 8am and the tests take six hours. I do the math and estimate dinner at home.

As I wait for the hourglass to run down, I notice the room across from mine is occupied. The woman in it paces, gesticulating while on her cellphone.

For the first time, I think about the other patients in this place. We are like bees in a hive, each shuttered in our individual cell.

I wonder how long she’s been in hers.

At 3pm, a nurse slips in to tell me I have tested negative. I have to wait for the doctor’s official clearance, but already my spirit is lifting and winging its way home.

The discharge happens in three stages.

The doctor arrives flanked by nurses and a trolley station of blood pressure machine, folders and computer. She pronounces me fit enough to be ‘off-blood, off-drip’, meaning the intravenous contraption on my hand that provides both is removed.

Next, a nurse comes bearing documents. These concern my medical state – ‘Any flu? Any fever? What about tummy aches?’ – at the time of discharge, and I sign them after she completes the checklist.

Finally, the pharmacist comes to give me my drugs. She declines to take a photo with me.

I change back into my jeans and T-shirt, and try to ignore the overnight smell and stickiness.

The floor is busy with people. The woman across the corridor is now looking out of the window.

I say bye to the few faces I recognise. Three nurses, seeing my luggage, take over and escort me to the exit.

My sister called earlier and said she would pick me up at the Emergency Department. I have an hour. I lug my suitcases to a nearby seating area, where people wait for the valet to bring them their cars.

Two teenage girls are there, one of them stabbing a flimsy container of fruit. An N95 mask dangles from her ear like a floppy earring. Her friend is complaining about some feckless friends.

It is a conversation filled with unadulterated ‘wah lao ehs’ and Hokkien.

It convinces me that I am home. Free.

17 May

Wrote this essay for a friend.


Languages are the vehicles to cultures, and I am always interested in traveling. My parents fostered this linguistic and cultural wanderlust: even as a child I spoke Mandarin and English with equal frequency. They wanted me to succeed in an English-dominated society but had seen, at Lunar New Year gatherings, too many nephews and nieces grope for simple Mandarin phrases. Their goal was for me to be effectively bilingual. In the end they achieved so much more: because of them I discovered my love for languages, and that led me to discover my passion for cultures.

The journey from one to the other began in high school. Then I was deemed proficient in my first languages and offered the option of studying a third. French attracted me, with its musicality and promise of Parisian girls. What followed was a four-year pursuit of the perfect French ‘r’, the reward for which was a month-long exchange program in Lyon. One month in France only taught me that a single month was not enough; in 2006 I returned as a college student on exchange in Sciences-Po, Paris.

Between those two French excursions was an undergraduate program in Beijing, China. Having excelled in the Singaporean education system, which is modeled after its British counterpart, I had been offered a scholarship to pursue undergraduate studies at Peking University. China was a transformative experience. Although I am ethnically Chinese, and Singapore a largely yellow-skinned nation, China is decidedly not my homeland on a larger scale.

If my parents and French classes had excited my tongue, Beijing – and Shanghai, and Guangdong, and Hainan – was to move my heart and mind. To one brought up in a city-state barely fifty years old, China was an experience that cracked open worldviews. Here was a country fuelled by its nascent power and yet bogged down by its past. It was culturally diverse and nationalistic, rooted in tradition and ready to take on the reins of the world. My fluency in Mandarin had not prepared me for the sheer history of its birthplace.

In China I began to appreciate the vast, wide world beyond Singapore’s shores. Professor Edwin Thumboo of our National University once said, Singapore internationalized before she nationalized. I saw this in the varied foodstuffs available in our supermarkets, contrasted with our ongoing search for a national identity. But it was not until China that I became aware of our nation’s comparative stature in world affairs. On a map we are the tiny dot easily obscured by breadcrumbs; in the global arena we are the runt that survives by dint of endurance and hard work. There is a manifest interest in our national destiny to understand the world better, to anticipate its crosscurrents of politics and cultures.

When I returned to France I was not the same person. Behind the Parisian flair I grasped the polemics and obsession with ideas that drives French society. China and France combined in me to produce a voracious need to decipher the world: I struggled to understand the reasons behind Macedonia’s suffocated diplomatic space when I lived with my Macedonian friend in Veles; I heard the frustration in my North Korean tour guide’s voice when she described her country’s nuclear policies. I saw the sourness in the eyes of my Tibetan tour guide when I asked about the newly opened Tibetan railway.

And now I am in New York City, pursuing a Master of International Affairs degree at Columbia University’s School of International and Public Affairs (SIPA). I believe learning from my classmates and from my professors, the ranks of which include Anya Schiffrin, will test and sharpen my comprehension of the age. As an aspiring journalist, I would like to engage would-be readers in the same process. I believe enrolling in the Graduate School of Journalism-SIPA dual degree program will empower me to do that, to not only analyze but also explain the troubles that plague so many international issues today.

I can think of no better way to repay the debt to my parents. If my achievements were accomplished through my drive, they are nonetheless the ones who provided me with the keys. I would like to do the same for a future generation through a fruitful career as a journalist.

2 May

This is what they told me, this is what they said:
“Any names you want at all, except every name in red.”
So I looked through all they’d given me, lined and question marked,
And in the end I had my list, composed of thoughts and larks.
But when I brought my list with me, to a meeting with our top,
She looked at it then looked at me, and then the penny dropped:
“I notice that you’ve struck this off, and I’d like to just know why,
Because I’ve seen him work myself, and I do think he’s our guy.”

I should have mused and shrugged and left, I should have bit my lip,
I should have done just anything, but let this winner zip:
“It seems to me that when I pick, I think of work and worth,
But when you look at all these names, you see the last names first.”

So now I sit and file and sneeze, where once I dialed and signed.
Sometimes I type up résumés, but more to pass some time.
It’s hard to get an interview, when bosses recommend:
“This guy has so many honest bones, he’ll never break or bend.”

_

This is what they told me, this is what they said:
“Pick four to five you think are right, but not the names in red.”
So given what they’d given me, I thought and lined and ticked,
And in the end I had my three, the best I could have picked.
But when I brought my list to share, at a meeting with our top,
She looked at it then looked at me, and then the penny dropped:
“I know you’ve struck him off the list, but what about this guy?
I myself have seen his work, and think he’s worth a try.”

I should have mused or shrugged or caved, I should have bit my lip.
I should have done most anything, but let this zinger zip:
“It seems to me that when I picked, I saw their work and worth,
But when you looked at all these names, you saw the last names first.”

So now I sit and file and sneeze, where once I dialed and signed.
Sometimes I type up résumés, but those are wastes of time.
It’s hard to get an interview, when bosses recommend:
“This guy’s a bag of honest bones; he’ll never break or bend.”

30 Dec

Success is in the details at downtown restaurant Tailor. Although it trades in food and not haute couture, the décor of the place might have earned Anna Wintour’s approval. There is a certain meticulousness – even obsession – in its look. Exposed brick walls and parquet flooring provide a foundation, on which are matched the feelings of fall: in the cream and chestnut of the booths; in the muted suns of the hanging Edison light bulbs; and in the old-fashioned sewing machines and dress-fitting dummies repurposed as curios. Even the place mats are large pieces of soft leather, cut to resemble fallen leaves. The overall effect is at once impressive and precious, an effect only compounded by the wait staff’s bespoke uniforms.

Luckily, there is little such ambivalence about the service and the food. Seating is prompt, followed quickly by the appearance of menus. Although orders – depending on the complexity of the dish – may come halfway through the first cocktail, the composition of each is described in a concise manner, such that one is never confused about the ingredients but also never bored. The rigor of the wait staff’s training is perhaps embodied in the way they point: not with the index finger but with the less obtrusive pinky.

The food and drinks are no less considered. The two-storey establishment is divided into food upstairs and drinks downstairs, with surprises at each level. In a city swollen with pork belly, chef Sam Mason’s rendition is among the best. The firm slices melt in the mouth, not on the fork, and are steeped in butterscotch miso, the gooey sweetness of the dish tempered by braised artichokes and oven-dried green apple.

Another unlikely yet winning dish is the appetizers’ escargot. Forget the usual garlic herb butter treatment – these snails are pampered. Each one comes bathed in maple syrup, rested on a bed of toast, and blanketed by bacon and a single leaf of parsley. The result is a medley of sweet and savory, crunchy and tender, with the parsley’s sharp bitterness bringing the flavors together.

Of the dinner menu’s seven appetizers and six entrées, these two come with the staff’s recommendations, but this is by no means a slight on the other dishes. Judging from the reactions of other diners – a white plate crowd – what passes for excellence in a lesser house is merely the standard at Tailor. While the “skate frites” – a play on the more traditional steak and fries – doesn’t electrify, fish have died for lesser causes.

And then there’s dessert. There is no getting around the sometimes bellyachingly small entrée portions, but they do leave room for the sweets. A former pastry chef at New York notable wd-50, Mason has brought his experience there in molecular gastronomy – the use of science to create food – to bear at Tailor.

In one of his seven desserts, a square of coriander cake supports an oval of coconut sorbet, the construction dotted with fennel and accompanied by bursts of orange sections. In another, a Lego brick of soft chocolate leans against a ball of sesame ice cream, the two counterpoints to a Gehry-esque structure of twisted mole. In each and every dessert there is the same sense of architectural carefulness, both in the dishes’ presentation and mix of flavors. There is a saying in the movie business, that the last twenty minutes of any film is what the audience takes home. It is as if Mason has absorbed that principle, because several changes were made to the original dessert menu – including the removal of a critically-detested rum-braised bananas and mustard ice cream concoction – and what remains is a selection at once intriguing and palatable.

Downstairs, famed New York mixologist Eben Freeman takes over. Also an alumnus of wd-50, Freeman has 18 years of bartending experience, evident in Tailor’s expansive list of cocktails. Much ink has been devoted to the Bazooka, an improbable marriage of vodka and Dubble Bubble bubblegum. Although childish in name and girlish in its filmy, pink appearance, the drink is strictly for adults – don’t be misled by its effervescence of nostalgia and childhood memories.

Beyond the Bazooka, other highlights include the trio of “solids”, a series of edible cocktails. The Cuba Libre consists of rum and coke gelatinized into a cube; the Ramos Gin Fizz Marshmallow is exactly as its name suggests; but the crowning achievement is the White Russian Breakfast Cereal. A Rice Krispies treat made by soaking the cereal in Kahlúa, dehydrating it, repeating that process, and then soaking it in vodka, sugar, and half-and-half, it might not be the breakfast rubberstamped by nutritionists, but it’s the perfect breakfast with which to end the night.

Other options at Tailor include seven- and 12-course tasting menus, with optional wine accompaniments, and a three-dessert special. Appetizers mostly run to below 15 dollars, with entrées in the 20 to 30 dollar range, and desserts again below 15 dollars each. Reservations are recommended, although not required, and there is a dress code of smart casual. Lovers will appreciate the intimate ambience, and students with visiting parents the relaxed-collar friendliness, but colleagues and bar buddies might want to decompress elsewhere.

30 Dec

Death comes in many ways, some more polite than others. In its first visitation to me it did me the courtesy of a telephone call. I was 14, my sister 13, and it was six in the morning when the telephone rang, a summons from Death in the calm, clear, and concise instructions of my mother. We were to skip school that day – already then an occasion associated with dread – and go to the hospital immediately. My grandfather had been found dead mid-route of his daily jog, attacked and murdered by his own vagrant heart.

That, however, was not my introduction to the place where life begins and so often ends. Two months earlier, a massive stroke had stolen half of my grandmother’s body, and as I sat once again in the limbo of the hospital’s waiting room I surprised myself with the ability to appreciate the irony: my grandmother slept seven floors above, survivor of her latter dissolute years, while my health-conscious grandfather reposed eight floors below her, felled by a single, severe spasm of chance. Of course, my grandmother did not survive her husband long. A wild confrontation with my father led a relapse, and six lingering months later she gave up the remaining half of her body.

So many visitations in the space of less than a year, but the swing of the sickle was not yet done. Two weeks after my grandmother’s death, my emaciated uncle, my father’s sole brother and remaining kin, announced he would not return to Canada, where he had made his new life. He would, with his Canadian wife and child, remain in Singapore – for chemotherapy.

Imagine then, our family in the seemingly endless moment of grief. My father, who bore each blow and cried only once, in sympathy with my grandmother. My sister, who cried twice and never again, and who quickly became my father’s silent partner in this series of unfortunate events. My mother, whose own parents had died decades ago and who now haggled, with two clear and hard eyes, over peanuts and mineral water for the wakes, who booked the funeral home and hearses and cremation timeslots. And then there was me.

I had not cried when my grandfather died. My eyes were again dammed when my grandmother followed suit, and when my uncle eventually succumbed, defeated, a wreckage of melted flesh and tubes. Why don’t you cry, my sister asked me once. I told her I didn’t know. That, of course, was only a half-truth.

See me now, wandering the precise corridors of the hospital, victim of the illness called a week of compassionate absence. Now blink, and there I am, sitting beside my grandmother, looking at her lain on her side to encourage blood circulation, listening to her thin reedy voice plead for a sip of water, moistening her fractured lips because any more would only dribble out of the corner of her mouth, thinking the frighteningly normal thought that her death would mean freedom from this eternity, and not only for me.

Even before that year of deaths slow and sudden had begun, I had already died a little. Death, after all, comes in many ways, and the living may not be completely alive.