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Tuesday, December 20, 2011 at 10:36AM 
Medical Training
by MAUREEN MILLER
We Need To Talk About Kevin
dir. Lynne Ramsay
112 minutes
An American boy receives his first grade in the first minute of his life. It is the first of innumerable grades he and his mother will receive from then on, and this individual metric of the infant’s health will come into the medical record as a tag team routine following mother and baby throughout the hospital course.
This grade, the Apgar score, is named for the American anesthesiologist Virginia Apgar. It assesses a newborn’s appearance, pulse, grimace, activity, and respiration on a ten-point scale. Blue babies are a bad sign. Robust babies respond. Those who breathe with personality win the first minute of life, if a strong will is the best measure of living. To get full credit on his Apgar's, a good boy must have a pink belly and a “strong, lusty cry.” Good Apgar scores at one and five minutes: nine and eight, nine and nine. He need not be perfect, but effortful. Must a good boy have a good mother? Mommy is spent whether or not she has immaculate spawn.
“Nobody, but nobody is going to stop breathing on me,” Apgar’s aphorism goes.
Yet a new mother, overcome by shaking chills, may not register her boy’s first cries for her attention. Someone, say a scrub nurse, needs to suction his airway so an assisting team can swaddle him away from the cavity. His obstetricians or neonatologists may wrest him away to score him. As the baby completes his first paperwork he and his mother, once together at the chest, lose one another, if briefly, in the process of collating her fingerprints and his footprints. All the while he is crying. She lacks feeling — the epidural! — or she is overwhelmed by feeling — what a boy! What a life! What will life with the boy be like?
And here the mom has an opening: Will she take her boy back right away for breastfeeding, or wait it out a few so they both have another minute to recover? Either way she is his, and he hers, sometimes before he has a name. How they come back together determines a moment in their life, not his whole life, but sometimes we wonder.
I guess I have had babies on the brain lately. For the last six weeks I have been on an OB-GYN clinical clerkship at my medical school. We practice pelvic exams, interview patients, and follow mothers’ labor curves so we can assist with their progression to delivery. One of my classmates with an unusual name (he says it means “strong-rooted”) jokes about coercing the new moms to name their babies after him.
While I’ve been on the labor and delivery floor, I've been thinking about Ezra Miller. Once a child actor from Hoboken, Miller is a gift of a loon, a lanky smirkfest all wide-set eyes and loquacious whacked Zen. He disarms with the jawline of Cillian Murphy and the grave insouciance of a young Steve Jobs. Miller — are these overwrought turns of phrase even things? The Ethan Hawke of it all!
Miller is nineteen now, and apparently an old soul. He's grounded. His friends are older. He occupied Zuccotti. He couches book recommendations in gnomic junket interviews. If Trent Lane from Daria existed in real life, his name would be Ezra Miller (though he’s thinking about changing his name). Beware the gonzo within:
3:33: “I’d say it’s, mmm, not out of bounds, but definitely on the grid.”
Neither Ezra Miller nor I has read Lionel Shriver's 2003 novel We Need To Talk About Kevin.
The film adaptation of We Need To Talk About Kevin casts Miller as Kevin. It starts, however, with Tilda Swinton as free-spirited mom Eva Khatchadourian, resplendent as a madding crowd buoys her to something. It is not the hell, probably, but a hell, maybe. Eva is, at least, supine, and she appears to be crucified upon a field of tomatoes. That much we know. Has she crucified herself, or are we trying to crucify her? And they are bound, eventually, to desaturate during Eva’s depresso phase. One can make no conclusion about what, or who, she was doing to get here, but maybe that’s what director Lynne Ramsay wants. We don’t even know in this scene that Eva is, at the first, a mommy.
A woman first comes to know herself as a mother at the prenatal check-ups. Per Apgar: “Be Good To Your Baby Before It Is Born.” The conversations that go on in them serve as a kind of annunciation narrative. An obstetric history has to be aseptic, which is unfortunate. The history captures a chopped and screwed timeline of the mother’s previous pregnancies, if any, and her gynecologic history, if warty or bloody. Worse, its mandatory and ritual social history of the patient — “Do you smoke? Drink? Use illicit drugs? Have diabetes, high blood pressure?” — may cause the interviewer, who means no harm, to come off as a scold. The physician must counsel the new mother about her “toxic habits” to stratify the risk her womb poses to her child from the time it is conceived. Having done a few now, I imagine it is hard not to blame oneself at least in passing during one of them for existing in this world.
Many mothers I have met whitewash. They mean well. It is better for them, and likely for the baby, than watching us fibrillate at their narrative. Whatever keeps our hands steady as we probe. We then have to smear jelly all over them so mother meets child at the remove of a transvaginal ultrasound.
Like an obstetric history, We Need To Talk About Kevin is scattershot by design. About forty minutes into the film — or around there, did not count — Eva holds a newborn Kevin for the first time as if his pediatrician has given him a five-minute Apgar score of Nein! We do not see his delivery, only Eva’s non-verbal grasps at deliverance. Kevin’s moment of conception appears to have involved his loaded parents lolling around to get out of the rain. Their subsequent life is cushy, if disquieting. Kevin is a pisser from birth, and he grows into a compelling nut who has campy comebacks that he claims he got from his mama. And he’s a damn good shot, so much so that he shoots up everyone in his family but Eva and a bunch of his classmates with a contraband archery set. It’s a feel-weird counterpunch to people who would make glib fun of feel-good movies.
We Need To Talk About Kevin strains to avoid aphorism, because Kevin is a sociopath, and no one knows why. Smart move, maybe. Constraining the inexplicable with a tight one-liner or a forced argument seems wrong somehow. Explaining the malignant behavior of this acerbic little snot is besides the point. He is weird, and we don’t like to think about him. But we don’t like to think of ourselves as weird, which is why we are not sociopaths, who believe themselves to be exceptional.
Virginia Apgar was something of an Eva, which is to say Kevin without the sociopathy, I think. Apgar and Eva would have made good surgeons. They have the disposition and the demanding brain. Apgar found her vocation after her colleagues in surgery at Columbia, wowed by her scientific acumen, said no to her. They identified with Apgar too closely, it seems, and her mentor, Allen Whipple, felt that the disappointments of the economic environment of the Great Depression would warp her chances at a great research career. She was too sharp, and therefore an odd bird.
Whipple, the chairman of surgery at Columbia, nudged Apgar toward anesthesiology after he told her that he feared something might prevent her from hacking it in surgery. And so Apgar made her presence known at 17,000 births over her lifetime, and however many more. She could hack, Whipple knew, but she wasn’t male. So he softened the blow. One might not guess from how she presented herself to the world that she was bothered by the career redirection that defined her as a woman, but the signs were there. It was someone’s cross to bear, anyway, and the parties responsible can’t be sure that it wasn’t theirs.
As medical students consider how to select a specialty for residency, they take pragmatic deciding factors like those Apgar considered into mind. Students who are seriously considering a career in obstetrics and gynecology hear a lot about the high costs of malpractice insurance. Some of them remain swayed in its direction by the thrum they get from the many procedures these specialists get to perform.
C-sections, for one, can be thrilling: for lack of a better word, they throb. The initial incision skims the skin, then the omental fat of the belly, the fascia covering the muscle of the uterus, and the uterus itself. In the ones I’ve seen, the obstetrician cuts the outer layers with a knife, the membranous ones with scissors or the knife handle, then knife again. Two assistants have to retract the abdominal wall with their handgrips to expand the cavity just enough to release the circumference of the baby’s head and nothing else. As is, the digging releases a child coated in fluid and meconium, the waste fluids he expelled in the womb, with the most blood I’ve ever seen in a routine surgery.
To wash away the mess the team irrigates the area with warm saline as best they can, then ties it up nicely, as any suture error sends errors downstream. If you want it to be one, this is an allegory. But it is really just a baby being born. As my classmate with the naming compulsion put it, the takeaway is that you won’t ever be able to understand it fully. At its best it’s a big production and you get a prize at the end. (His dad is an obstetrician.)
At the end of my screening I saw Ezra Miller and Jasper Newell do a Q&A. Newell looks much less like Miller in person than I imagined from his charm-and-a-half turn — really! — as latency Kevin, as A.O. Scott called him. He’s real small, and his hair color is different, and his big eyes are less empty than shining actor-opaque. Newell is a poised sweetheart who wants to work with John C. Reilly, and Ezra Miller wants to be an actor like John C. Reilly. See, they are the same! (John C. Reilly plays Kevin’s enabling dad.) For now, Newell is a fine young man who has not seen this film. I inferred from his repeated insistence about it that his parents may have decided he’s not allowed.
The moderator asked Newell what he will be doing in the meantime. “Einstein on the Beach!” he said. Miller then loped up the aisle in red jeans, immediately pleased to learn Newell is taking after him. Miller’s own earliest role was in a Philip Glass opera. Does Miller see himself in Newell? Who knows. Either way, a terrible cutie is born. Or maybe a child actor just got a career upgrade. Who are we to say? The audience struck me as a little dumbfounded by what they had just seen, and no one was sure what else to ask.
In the final scene of the film Eva and Kevin are together during his prison's visiting hours, seeing themselves in one another without wanting or meaning to. Here Kevin may or may not be evincing remorse. Eva and Kevin not-talk about whether or not it would have been better if either of them decided not to show up. By now Eva is getting on at a travel agency, warding off a wack job colleague when she’s not cleaning vandals’ red paint off the siding of her post-Kevin squatter’s corners. Those red and white waves recur, and they are all guilt and death and symbolism or whatever. Maybe they are nothing but what they are, an accident of paint. Eva eyes Kevin as if she raised him with more of a conscience than she thought. She didn’t, it becomes clear from Kevin’s failure to muster a sincere apology, but that’s Kevin’s mark and not hers. We hope.
Maureen Miller is a contributor to This Recording. She is an MD-MPH student living in New York. She last wrote in these pages about Twelve. She is a founding editor of RapGenius.com. You can find her website here.
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