Team Dragon

Hypertrophic cardiomyopathy (HCM) is a disease in which the heart muscle becomes thickened, also called hypertrophied. The thickened heart muscle can make it harder for the heart to pump blood. Many people with hypertrophic cardiomyopathy don't realize they have it. That's because they have few, if any, symptoms.

In the dim and somber light of dawn, the weathered glass of our breakfast table catches the muted amber glow of the rising sun. Its feeble attempt to pierce the worn surface mirrors the weight of my thoughts like light straining through an endless fog. The air feels wet and heavy as if the walls themselves have soaked up my dread. I sit, trapped in routine's relentless grip, in a twilight where morning never truly comes. Laura shakes me from my thoughts. "Lawrence," she whispers, "don’t forget—it’s Mimi’s birthday." At nine and becoming ten, my little Mi fiercely believes promises are sacred, her faith a fragile light amid the constant pressures of work and duty. "Daddy, you’ll come home, won’t you?" she asks, her luminous eyes cutting through my burden and anchoring me, if only for a moment, to an elusive purpose.

"I promise, Mimi," I say, my words hanging fragile yet hopeful against the heavyweight inside me. Her solemn smile graces her delicate face as she places the crimson dragon in my hands, a talisman of faith and childhood magic. Outside, the early morning sky looms grey and heavy, its silence broken by the occasional low whistle of the wind. "There’s an alarm in the dragon’s belly," she murmurs, each word shining with her unshakable belief. "It rings at 6 pm this evening to remind you to go home for my birthday." Her innocence wraps around me, fragile yet grounding, like the soft glow of dawn touching a turbulent horizon. Laura reassures her, "Let him go, darling. He’ll come back and Daddy is about to go to work." With the crimson dragon in hand, I step into the day under a sky brimming with the tension of a pending storm, each step carrying the weight of my promise.

I am Lawrence Shing—a soul ensnared between the complex legacies of gift and burden, shaped by the unyielding call of science and the profound expectations of family. My days unfold within the walls of Queen Mary Hospital, a place that feels less like a destination freely chosen and more like an inheritance bound to my very existence. Its stark corridors echo with the weight of generational duty, each step a tribute to those who came before me. While I am proud to uphold this lineage of healing, I cannot help but feel tethered, navigating a path paved long before I had the chance to choose my own direction.

Fate’s intricate tapestry binds lives with relentless precision, stitching my family’s history into the parched and ancient soil of Qing Dynasty China. My great-great-grandparents—merchants straddling the precipice of despair and opportunity—escaped the waning empire, seeking refuge on the bustling shores of Hong Kong. In an act of both defiance and hope, they pursued sanctuary through education, finding a foothold in the fledgling University of Hong Kong’s medical school. There, my great-great-grandfather encountered the revolutionary Dr. Sun Yat-sen, an intersection of destinies my family reveres as near-sacred. This luminous tale, handed down like a treasured heirloom, carries a solemn resonance—a legacy not of burden, but of purpose, reminding us of the inescapable yet profound duty woven into our lives.

And yet, fate seldom rests its grip lightly upon a family’s history. It yanks, it twists, and it demands. When the Japanese laid claim to Hong Kong during the dark shadow of World War II, my ancestors fled again—this time across the Pacific, where San Francisco’s Chinatown offered a shadowy refuge. There, amidst the whispers of desperation and opportunity, they opened an illicit medical clinic. With scant resources and a reliance on unconventional treatments, it was medicine stripped to its bone—desperate, raw, vital. This crucible reshaped my family, solidifying healing from a profession to a calling, and from a calling into destiny, even as they grappled with the moral weight of their defiance.

Every soul, no matter how bound by legacy and convention, seeks some rebellion. Mine arrives masked as art, an escape from the relentless gravity of expectations. I lose myself in the restless shades of Van Gogh, the dreamscapes of Magritte, and the dramatic ink of Japanese comics. The Team Dragon holds particular sway over my young imagination—its heroic surgeons wield scalpels like warriors, battling despair and mortality with a skill that transcends reality. In their exaggerated movements, I see echoes of my family’s calling, refracted through a parallel lens of creativity and heroism.

And yet, art offers nothing more than a fleeting reprieve from the unshakable weight of my obligations. I choose gynecology, a delicate compromise balancing my passion and my family’s expectations. It lacks the heroic sheen of cardiac surgery, which glorifies my cousin Jonathan at every family gathering. Gynecology is quieter, gentler—creative in its focus on beginnings rather than endings. But when I returned to Hong Kong and became a resident doctor at the Queen Mary Hospital, I realized my choices have always been controlled by forces older and more relentless than I am. Medicine, like my homeland, is never just a calling; it’s a summoning.

Now back on the soil my ancestors fled, I feel their whispers threading through the damp Hong Kong air like restless phantoms, binding me to a destiny I don’t choose. The sky, laden with sullen clouds, mirrors the weight on my shoulders. Medicine, like my homeland, has never been just a calling; it feels like a raging tempest, pulling me deeper into its heart. I imagine freedom in choosing my specialty and place of practice, but I now see those choices as marionette strings, tugged by forces older and more relentless than myself. The rain begins; its cold touch feels like a spectral hand tracing the edges of my resolve.

The corridors of Queen Mary Hospital hum faintly with the steady buzz of fluorescent lights, their static filling the air like an omnipresent whisper. From my office, the cemetery looms through the window, its sprawling stillness a stark counterpoint to the hospital's urgent vitality. Life and death, so palpably close, press against each side of the glass, forcing me to straddle their fragile divide. In this place, duty is a tightrope stretched across the chasm of mortality, a constant reminder of the transience that shadows my every breath. This duality, the ceaseless pulse of life alongside the serene permanence of death, shapes how I see my purpose—an intersection where care momentarily holds the inevitable at bay.

Now, that reminder sits on my desk in the form of Ms. Wai Lin Chan’s chart, which feels unnervingly heavy in my hands. The late 40s, unmarried, 25 weeks first-time pregnant. The details read like lines on a battlefield map: hypertrophic cardiomyopathy (HCM), a condition spelling doom for her overworked heart. Carrying one life within her fragile body feels like a miracle; carrying two borders on defiance of nature. Each beat of her heart is a risk, every moment a negotiation with death.

Hypertrophic cardiomyopathy. The medical jargon almost masked the catastrophe it spelled. A condition where the heart muscle thickens dangerously, impeding its ability to pump blood—here was a textbook tragedy-in-waiting. Especially now, as her heart works overtime for two. Add childbirth into the mix? That’d force any heart into calamity. For both her and her unborn child, this is nothing less than a ticking clock wired to explode without warning.

I push my chair back, feeling the sharp edge of my desk press into my palms as I steady myself. My pulse is quickened, though I mask it well externally. I quickly run through the catalog of knowledge and experiences locked away from years of schooling, training, and practice. But here’s the thing about being a doctor—they never quite prepare you for the edge cases. And this? This is beyond an edge.

For an absurd moment, I think of The Team Dragon, the comics I once devoured. Heroic surgeons slice through peril with unerring precision and bold resolve, as if mortality was merely a narrative beat waiting to be overcome. But reality, I remind myself, was no inked page. There are no clean victories here, only choices—each one etched with potential regrets.

I steady myself against the sharp edge of my desk, its bite grounding me. How many times have I confronted medical impossibilities? Yet each case feels like the first, presenting its unyielding calculus of risks. Textbooks collapse under the weight of reality at this intersection of humanity and uncertainty. Here, the measure of success lies not in outcomes but in navigating this merciless labyrinth.

I meet her later that day at 2 pm. Ms. Wai Lin Chan is a woman dwarfed by the overstuffed hospital chair yet steadfast in her resolve. Her trembling hands work a tissue into shreds, but when her eyes meet mine, they hold no surrender. "Dr. Shing," she begins, her voice remarkably steady despite its faint tremor, "what are my options? For me and my baby?"

That’s the thing about this job. No textbook, no lecture hall, and no hours in medical trenches prepare you for the simplicity—and enormity—of that question. Yet, somehow, you answer. I meet her eyes, summoning every ounce of composure I had. “We will find a way,” I promise.

The words leave my mouth even as my mind pores over the challenges ahead. I don’t fully know the "how" yet. Not even close. But somehow, at this moment, it doesn’t matter. What matters is my promise and the fight I now know I must lead. This isn’t just a case; this is a battle against nature and time itself.”

Ms. Chan is admitted as a patient waiting in the ward. Nurses and Housemen are helping her to prepare for emergency treatment, subject to the decision of the hospital and doctors.

Ms. Chan’s condition demands precision beyond boldness—it requires unity. The room feels submerged beneath a rising tide as the storm outside pounds against the hospital windows. Standard protocol for hypertrophic cardiomyopathy dictates removing the baby early and placing Ms. Chan on ECMO—a machine supporting her fragile heart and lungs. But her case defies standard practice. The baby is far too underdeveloped to survive outside the womb now. Following the procedure risks dooming the infant. Breaking protocol, however, brings its uncharted dangers.

Dr. Eleanor Wu, a pioneer in cardiac surgery, calls an emergency meeting at 5 p.m. Around the oak table, representatives from cardiology, gynecology, anesthesia, and neonatology gather. "This isn’t standard," Eleanor begins, placing her hand firmly on Ms. Chan’s file. Her voice is a scalpel slicing through hesitation. "Hypertrophic cardiomyopathy with a pregnancy this advanced allows no easy solutions. Every move we make will demand precision as sharp as a lancet and teamwork as seamless as sutures."

"The Batista procedure," Eleanor declares, her voice decisive amid the murmurs that ripple through the room. "It’s our narrowest yet most plausible option—one that buys both time and hope." Her plans, outlined with surgical precision, involved excising the swollen walls of Ms. Chan’s heart while it still beats—a procedural rebellion against standard reliance on ECMO. "Fifteen minutes from the moment her rib cage is cut and we open a vision to see the patient's heart directly," she emphasizes. "Every second is borrowed, every misstep a potential catastrophe."

The table's unease is palpable—medical veterans facing uncharted terrain. "Dr. Eleanor Wu," an anesthesiologist begins, "if even a single factor deviates—" Eleanor cuts him off, her voice a sharpened scalpel. "I know the risks," she says, "Better than anyone." Her command is magnetic, her confidence both unnerving and inspiring. Then, she turns to me. "Gynecology needs to be ready for an emergency cesarean at a moment’s notice," she states. I nod, knowing my role in this critical orchestra: a quiet readiness for an emergency born of catastrophe.

Anesthesia gives their hesitant agreement only under the condition that ECMO has to be primed and ready. The gynecology team, led by me, stays on standby in case of cesarean necessity. Eleanor’s success, or failure, decides if the operating room becomes a battlefield. The neonatal team is also stationed—a silent testament to hope, even in the direst uncertainty.

Everything feels taut—every decision, every glance exchanged between the teams. And then, suddenly, it’s 9 pm. The operating theater blazes with light, cutting through the anticipatory darkness of the night. My mind races with worry for my daughter, whose birthday is slipping away without me, and yet here I am, entrusted with the life of a little dragon. This is a different battlefield, one that demands every fragment of focus and resolve I can summon, and I wrestle with the pull of love against the urgency of my duty.

Ms. Chan lies on the table, her tiny frame cradling two fragile heartbeats as the operating theater flares with a stark, unnatural glare. Beyond the windows, flashes of lightning claw through the darkness, echoing the high-stakes tension within these walls. The Batista procedure—unorthodox and daring—offers the slimmest sliver of hope. Performing such a surgery on a beating heart demands skill few possess, and Dr. Eleanor Wu stands as the calm axis of this storm. The layers of strategy and risk swirl around us like an unrelenting tempest.

I stand at the ready, the cesarean instruments laid before me like cold votive offerings. Neonatology hovers close, prepared for an emergency none of us dare to voice aloud. The anesthesiology team keeps ECMO primed—a reluctant safety net should Eleanor falter. Every team member plays their role, and the emotional weight of the moment presses heavily against the walls of the room like the storm clawing to get in.

The stakes are as high as the surgical lights above. Ms. Chan’s blood pressure is monitored with exacting rigor—one slip and it could drop catastrophically, plunging her into cardiac arrest. The anesthesia team hovers closely, prepared to initiate ECMO at the slightest indication of Eleanor’s failure. The gynecology team, under my lead, waits in suspended readiness to perform an emergency cesarean section should the fetus display any signs of distress. Meanwhile, the neonatology team stands ready for a battle of their own—to wrest life from the fragile gasps of an incredibly premature infant, should it come to that.

Eleanor begins. The scalpel gleams like a polished star, its edge tracing precise, exacting lines along the heart’s thickened walls, a cold whisper of defiance against the heat of life. Each cut blends art and defiance, a refusal to yield to inevitability. The minutes tick away, an oppressive reminder of the constraints we labor under.

The heart quivers with fragile rhythm, pulsing beneath Eleanor’s steady hands as she sculpts life from chaos. Monitors beep in frantic counterpoint, warning of vitals teetering on collapse. The seconds feel unbearable, a sequence of endless cliffs. But Dr. Eleanor’s calm never wavers. Every cut defies inevitability, a coaxing function where there had been a failure. Each stroke becomes a testament: despair is not finality.

And here I stand behind the operation table, merely a silent observer transfixed by Eleanor’s brilliance and success. My role tonight—prepared for a cesarean that never comes to pass—feels insignificant under the floodlights of her mastery. Yet it isn’t insignificance I feel. It is something closer to awe, tinged with the humbling realization of how small even the grandest medical strides are against the endless march of time. My tools sit pristine and unused, reminders of a responsibility that, tonight, never arises. The operation is successfully finished. The patient is in the ICU under the care of the nurses and other medical staff. I leave the hospital at 4 am, finally.

The hour's edge into dawn as I return home, weary but intact. Mimi’s collapsed castle of deflated balloons greets me—a silent testament to the time that refuses to wait. Guilt pierces even as relief washes over me. Pausing at her door, I gather breath, then ease it open. Her almond-shaped eyes flutter awake, and in an instant, she leaps into my arms. "Oh, Daddy! You’re late! You didn’t keep your promise!"

“Mimi,” I say, brushing her hair back. "Your dragon keeps me steady tonight—it reminds me that hope is boundless, even when we feel small." My voice wavers as her questioning gaze searches for meaning. "It brings me strength," I add. She clutches the dragon tighter, curiosity flickering in her sleepy eyes. “Daddy, was the baby born?” she asks, her voice trembling. I hold her tiny hands. “No, the baby isn’t born,” I say firmly. "It will stay in its mother’s womb a little longer, where it’s safest. When the waiting is over, it will be born healthy and strong."

As I sit beside her, her hands clutching the dragon tightly, I realize she still believes in me. She knows that my job is about babies and new lives. Her unwavering faith, innocent and steady, tells me to breathe through the doubt and weakness. Tonight, I see that hope isn’t something I grant—it’s something I carry for those who entrust it to me. And in that quiet, as my child's breathing deepens, I know I’ll strive harder to deserve it.