Ritual Knife

I remember that cold December morning with a lot of nostalgia. My father rose very early at the crow of the first cock. I saw him through the window of my room that was slightly obscured by the dew that covered the panes. He stood at a strategic point in our homestead to ensure that my brother and I didn’t leave. He knew I dreaded this moment. The moment when my blood would be shed to the ground to show solidarity with those who went ahead of us. I had no choice but to submit to the dark forces that had conspired against me.

A black pick-up halted at our gate a few hours later. It was an old Datsun that had covered several miles on the sands of time and I knew for sure that the time had come for us to go. We climbed at the back together with my brother and met a number of other boys in our age group that were sentenced to the same fate as ours. Others by their parents, others by their own will. My father waved as the pick-up fled. I never wanted him to see my face because I was not happy with this.

I wish there was a way in which I could get to the circumcision parlor without using this pick-up. This pick up was known in the entire village to be the initiates’ pick up. Some boys saw it on the way and literally took to their heels leaving us bursting in laughter. We threw them insults that they were not brave enough to face the knife. We even told them never to play with us. This succeeded in distracting me from the impending danger. We passed a few girls on the way. They carried buckets on their heads and without support, the buckets stood steadily on their heads only sometimes swaying slightly at the swinging of their hips. As we passed, they recognized the pick-up and shouted, “Udhi nyange!” this meant we were going for circumcision. It was shouted in a mocking way that I felt embarrassed.

One by one we got into the improvised theatre in a local primary school classroom. We were to get in one at a time because the surgeons were only two against twenty or so boys. Those who went before me came out strong. I admired their courage. I went in. I removed my clothes and submitted myself to them. I felt like I was offering my body as a living sacrifice. The first injection of local anesthesia went deep into the base of my manhood. It was so painful that I protested loudly. In fact I almost kicked one of the surgeons but he moved out of the way of my legs and the legs went into the air. My man felt heavy for the first time, so heavy that if I were to stand, he would have brought me down. At stitching time, the effect of the anesthetic drug was slowly abating and the pain was incredible. I am glad it came to an end fifteen minutes later. Those were the longest fifteen minutes of my life.

Going back home was trouble. People now knew that we had faced the knife but that was none of my problems. The road leading to my village is a loose marram road with a lot of rocks and stones along the way. We sat behind the driver with my brother. The Datsun was a double cab by the way. Whenever it hit a stone, I would literally stand holding my man gently to avoid the impact caused by the rugged terrain. Sometimes I just did not anticipate bumps and the impact would be crazy. My brother was silent all this while, occasionally he would show his teeth when he could not contain the pain. The boy next to him was moaning. You would think it was a lady doing so under intense pleasure from her lover. Oh my! That day I found myself in a pack of cowards, did I show courage myself? No. Why? I don’t know.

Healing was as horrendous as the procedure itself. I had to sit in a particular way or sleep in a particular way to ensure that there was peace between me and this guy of mine. Passing water was hell on earth. I had to wait for several minutes for the water to flow and endure the pain it caused. Afterwards I would gently sink in my bed with a towel around my waist. Mourning. My brother was recovering uneventfully. Once in a while he would shout in the night when the stiches held a piece of cotton and was pulling his flesh as he tried to pull it out. He shouted like a movie star who was destroying his greatest enemy. I laughed. Two days later I suffered the same fate when my towel held the stitch at the upper part of my manhood. I tried to pull gently but the pain was too much. I took a blade, cut the string attached and I was relieved but part of the string remained attached to the stitch. It was supposed to stay there, till the stitches fall off.

Now I took you through all that because last Friday, I was the surgeon passing the rite to a young boy from the street family. It was an experience that reminded me of my very own day. The difference was, this small guy was brave and he came in panting. He was escaping from his colleagues who wanted to circumcise him in the streets using a broken glass as the scalpel and alcohol as the disinfectant. I agreed with Somerset Maugham when he said,

 “For men and women are not only themselves; they are also the region in which they are born, the city apartment or farm in which they learnt to walk, the games they played as children, the old wives tales they overheard, the food they ate, the schools they attended, the sports they followed, the poets they read, and the God they believed in. It’s all in these things that have made them what they are, and these are the things that you can’t come to know by hearsay.

Everything basically went like mine. He was lucky he found a good nurse who gave him a few clothes to carry on with his life in the streets. This was a young man who was a son to none and a brother to many. Life had not prepared him for the dark alleys and cold nights but he seemed to be getting along quite well.

He dressed up in a hurry. I think he was rushing to show his friends that he had successfully become a man. I forgot to tell him that the local anesthesia would soon wear out. He moved out quickly and true to my word he started feeling pain just as he was exiting the door. I used this slow down moment to ask him to come for dressing on the third day.

In Wonder

It has been three years since I joined medical school. I have learnt a lot about the human body. This has made me appreciate art for what it is. For art is art. It is an expression of the ingenuity of the human mind. I have known people who have left everything else to pursue art for the sake of it. When everything else has ceased to matter, art matters.

The human body stands at the center of all creations. The creator looks upon his art and marvels at multiple complexities that have merged into intergrated simplicity. It is intricately woven piece by piece into a masterpiece. Many are the times I have gotten lost in the labyrinth of the human body as I traverse various regions.I have studied it in awe. It could not have happened by chance! The human body was designed by a true designer.

Men have built structures that have amazed them since the beginning of time. Some of these structures have been branded wonders of the world. Talk of the Great Pyramid of Egypt, standing proudly in the middle of Sahara Desert, it has defied the cruelty of the desert and has stood for millenia but still it doesnt surpass the wonder that the human body comes with.The hanging Gardens of Babylon also stood displaying their color in the desert many years ago but the wonder never came close to that of a human brain.even a super computer controlling activities in space can not come close to a human brain! Yet these are just but two of those wonders.

We are entering another age of even more wonder. The quest for knowledge and understanding has brought us back to the cell, the basic unit of life. The human genome has been sequenced. We are understanding diseases better by understanding the cellular language and the cellular way of doing things. It takes me back to the time in history when the missionaries came to Africa, they had to learn the African language to facilitate the spread of the gospel. We have invaded the cell. learning its language is not an option because we are not leaving anytime soon. The cell must give us its secrets that it has kept away from us.

This constant wonder helps me understand the body even in sickness. Disease deranges the human body. Sometimes the derangement goes to the extreme. Sometimes the body says enough is enough. At such times life returns to its Giver. I have heard before that God  pours life into death and death into life without a spill and this is entirely true. I know I will continue in wonder. I may get lost but I will still wonder. I choose to wonder because very soon I will not wonder. So I wonder.

 

 

 

The path of most resistance

27th July 2013 fell on a Saturday. It was a landmark Saturday for me. It brought to an end the bliss that had briefly come into my life. Never before had I felt that grave. I looked again into the eyes of my beloved girlfriend and I knew she was truly going, I could do nothing to bring her back. I questioned life, I questioned my God, “God, why did you let my love for this lady grow so strong when it was never going to last?” she too was looking into my eyes daring me to say the parting words that would end everything. My heart, my fragile heart, was bound to break. I could imagine the left ventricle in pieces, the heart valves ripped apart and the sinoatrial node racing. I wonder how it would sound in a stethoscope. Could it sound like the mid diastolic rumbling of mitral stenosis or the radiating murmur of mitral regurgitation? Perhaps the pulse would even collapse. The collapsing pulse of a broken heart.

It was a few minutes to 4pm. I waited for the clock to struck 4 so that I could break loose. I was breathing fast, the minutes had elapsed quickly and the time had now come. I remembered the preacher’s sentiments “…a time to be born and a time to die…a time to love and a time to hate…’ Was this a time to hate? How could I hate the very person that I had given my heart? Then I encouraged myself that a lot would become available if I let go. “You can go,” I said to her trembling but composed. This was a path of most resistance. It looked like the Spanish soap operas, Alejandro breaking up with Isabella. But this was real, I parting ways with my sweetheart. She took a U-turn and then it was over. ‘Free at last! Free at last!’ but did I really become free?

Three years have elapsed since that day. Exactly three years. A lot has happened in my life. Looking at Akula (not his real name) I can’t help but identify with him. We admitted Akula for attempted suicide. He had taken poison to part ways with this world full of struggles. He was lucky his mum came in time to rush him to the hospital. A stitch in time saves nine. He had been relieved of the poison from a peripheral facility and was referred for further management and psychiatric consult. I quickly took his history. He had lost the girl he had dated for six years to an old man whose only advantage was money. Coupled with a few problems from work, he had so much stress. So much seemed hopeless to him that life was no longer worth living.

I quickly wrote a lab request for liver and kidney function tests as the doctor we were with summarized his report and clinical findings. I was relieved when the tests came back normal. However he was admitted still and a suicide note given to the nurse in charge. These people need close monitoring. One attempted suicide could always lead to another. The mother was happy that the son had not gone so soon and so were we.

Later when he was regaining his normal profile, I asked him to narrate to me the experience of a poison in the belly. “ Hiyo kitu ilinipeleka mbio, “ he said as we both laughed. He meant that the poison had raced with him. He had so much to say. He told me that love is a strange thing. He himself has not understood it in his twenty eight years of life. He has heard of princes leaving kingdoms for the sake of love. When he told me the story of Taj Mahal in India, I knew he had so much knowledge around this thing called love. He took me to Shakespeare’s classics and I sank in. He was willing to do anything he could to prove his love for his girlfriend. What he got in return was betrayal and bitterness.Woe unto those that break the promise of love. None the less, when you find yourself in such a mess, never take the path of most resistance. Remember that you have another story to tell. The story of courage. The story of a better tomorrow.

 

 

Grandeur of Death

That day changed the rest of my life. It gave me a vitality for life that I have never had before. Was it because I was in close proximity to death? Was it because I realized life is shorter than I thought before?

‘Oliver, examine that patient,’ Dr Tembo said expectantly as he always did when there was something for me to learn. Sinclair was by my side. He took the stethoscope that was on my neck and together we went. He was the first one to see the patient and I told him to be silent so that I too could see her then we compare our findings. My patient’s eyes were wide open. Inside them I could only see the reflection of myself and the light that I shone on them.Her hands and feet were cold, no pulse,no breathing, no heartbeat, pupils were unresponsive to light. The patient was dead and Sinclair agreed too.

The doctor looked at us, came and stood between us , held our shoulders and told us the patient is gone. I don’t know where she went to but she was in another world, racing down a tunnel that we only see in movies’ impression of death. The doctor requested me to write down my findings and certify her dead. This was something I never saw myself doing. Paradoxically, I knew at some point in time I will have to do it. I was in the middle of my last sentence when I looked up again to see whether she was really dead. She was terribly dead. There went my last sentence ‘…the patient was declared dead at 4.30pm.’ I signed and my doctor counter signed.

Dr Tembo looked at us again. This time I knew he had something serious to tell us. His eyes could no hide how serious the matter seemed. He took the fatherly role and told us,

‘ Before you die, make a difference in this world, let it be better than it would be without you. Never settle for less in life. Go for all you ever wish for. Whichever talent you have, use it fully to the point where you will stand boldly before God and tell him  “ God you gave me a talent and look, there is none left.” You guys can be great, only make a decision and stick by it. God intended all men to be great but some chose mediocrity. We come unbidden into this world, you are lucky if you find a purpose beyond misery starvation and early death. I am glad I found a purpose and my purpose was to be a doctor.’

I was listening keenly, my heart beating fast. This was a rare kind of a doctor telling us rare kind of things. Sinclair was lost in the world of greatness he foresaw. A moment of silence ensued. The nurses had long left, their shift was over and others had not come in. I felt the words pierce my heart, challenging me to dare great things, to realize my potential and to go beyond my expectations. No one was talking, the silence was becoming noisy, there was no music, there was only a breeze, a gentle breeze and the grandeur of death.

Loyalty Pledge

“John(not his real name), come to consultation room number four,” I heard my voice echoing through the loud speaker. My favorite doctor in the hospital was on call. We had seen a couple of patients that day. Most came with head injuries from traffic accidents or injuries sustained from fights while some came intoxicated with alcohol.

Alcohol is a bad master. I don’t know whether it can be a good servant either. John had served it faithfully for the past thirty years. What did he get in return? A pathetic, sad, tragic and wretched life. At forty, he still lived with his mother. The only friends he knew were those he merried with at pubs and local dens. His wife had long left him because he could not part ways with his bottle. The wife tried the best she could but nothing was forthcoming. This was a species of man he had not seen before. Born and bred in the breweries, how could he deny his roots?

As he sat on the patient’s chair, I could not help but empathize with him. He was wasted in every sense. The cheek bones protruded desperately on his head. He had a few scars on the face, probably sustained from many injuries he got in the line of duty. Duty to alcohol.  He was shaking massively and was anxious about everything. He had gone two days without his drink and he was paying heavily. A price of a choice made. I later learnt from the mother that John could sometimes stand in the middle of the road to pledge loyalty to alcohol. This was akin to the good old days when we pledged our loyalty to the president, ” I pledge my loyalty to the president and the nation of Kenya…” John was pledging it to alcohol.

John’s mother was composed as she talked to us about her son. Behind the composure, were tears that flowed inwards. She was bitter that her son was an embarrassment to her and to her village. His age mates had made huge strides in life while he was struggling to have more and more alcohol at his disposal. Food was not so important to him. He doesn’t remember the last time he did not sleep along the sewage lines. I was happy that he too had got the insight that he needed help as soon as possible. We were more than ready to give him a second chance at life.

“Oliver, we treat alcoholism with high dose diazepam. In that case, we will need to admit him and offer him preliminary treatment before he goes for rehabilitation, ” Dr Mutua was firm and clear. I nodded in agreement. Diazepam was meant to give the same effects as alcohol without the deleterious effect of alcohol. At the rehabilitation centers, they usually give another drug called disulfiram. Disulfiram gives an experience to behold. It makes someone hate alcohol for the rest of their lives. Find out what it does to the body when alcohol greets it in the stomach. Its like finding out that the guy who took away the girl you liked is being beaten somewhere and you join in the beating. we later sent the duo to go open a file to facilitate John’s admission.

John’s mother filled all the necessary documents and paid all the relevant hospital charges. When she finished, John was nowhere to be found. He had discharged himself. Alcohol demanded service. Had he not pledged loyalty? He had to keep his word. I was disappointed that he ran away when the healing process had just started. I hope one day he will give meaning to his life. i hope that he will discover that his purpose is not in the dens of hard drinks but in making the world a better place. He has chewed forty years so far, I hope he gets this message in time to tell a new story. time does not weight nonetheless. His story reminded me of my favorite author, Abraham Verghese, “We come unbidden into this life. You are lucky if you find a purpose beyond misery, starvation and early death.”

 

 

 

 

 

My First Suture

I am walking fast. I am in the middle of a motley of humanity typical of Nairobi City, the city in the sun.Wabera Street. Time 4.30pm. I meet a few children from the street family. Their eyes are inviting me to their world. The tiny little world of uncertainty. One of them stops me, “Uncle, nisaidie.” I bend to her, her eyes are sunken, skin wrinkled and face suggests of nothing but hopelessness and despair. This is what I would clinically call severe acute malnutrition. Oh my ! how unlucky were these children to be born poor. I drop them a 20 shilling coin and my journey continues…

Kenyatta Avenue. My eyes lock themselves up in a man. He is coming my way. He is in tartars but walks majestically defying all odds and believing someday his star is going to shine. You know in my country, poverty is a crime punishable by persecution till death. The poor are getting poorer and the rich richer. In other circles, they call this capitalism. This was a western idea. Nonetheless, life must continue. the guy is getting closer, his eyes are deep yellow in color. Lips tobacco stained and skin wrinkled too. He must have had a little too many. A scar is on the left side of his head. The scar stands prominently above the skin as if it is not part of it. The scar looks like that of a suture done by a medical student. They never look good unless one has gathered a bit of experience. Somewhere in the middle between us, he stops at a book vendor. I stopped too. this time I had a chance to examine him closely. A fairly young man. No obvious respiratory distress. Not so well nourished. Wrinkled skin. Clubbed fingers. Funny nails. In that moment of medical ritual, I get the impression that this guy stands on a time bomb. Alcohol is having a field day in the liver cells. And that guy cirrhosis is coming soon. With the tobacco, lung cancer will even exaggerate the clinical picture. More reasons why i should finish medical school tomorrow. I leave wishing I could warn him of looming danger.

I am running late. I am walking yet am in my clinic. My lab coat is on . Stethoscope completing the picture. I am not a butcher. I am a doctor, yes a doctor. A doctor I shall be. Suddenly, the traffic jam on Kenyatta avenue opens. The first car that passes is a Toyota Mark X, my favorite car. It is branded UN. This guy must be rich, I mean he works at the UN. If he fell under my knife or my care, I would charge him twice the amount of normal consult. This is unethical by the way. However, it is the only way to give a man from Kibera a fair chance to enjoy my clinical expertise. By the time he comes, his bills are already paid. I was doing what nature had unsuccessfully tried to do. Redistributing resources. “We hold together the truth that all men are created equal…” the American creed sounds in my mind, faintly though, obscured by the many other thoughts crisscrossing my mind.

In my reverie, I almost knocked a pregnant woman on the way. This time  it’s on Moi Avenue. Her belly is massively distended. I remember the aphorisms I had been taught by my professor two weeks ago, ” A distended abdomen in a woman is pregnancy unless otherwise proved.” This one needed no proof. Her blouse is tight revealing the contours of her uterine extents. She is at term. Anything can happen anytime. i hope it doesn’t happen here. I would be forced to act in good faith and help her . The umbilicus proudly stands somewhere in the middle of her belly. Life behind it. As we pass each other, I feel proud to be a man. This is what we can do. I am glad her water did not burst suddenly.

Sizzling Grills. This is my favorite restaurant in Town. The security officer is already intoxicated and a bottle half empty is on his right hand. He has prominent veins on his hands. These ones are really good for fixing iv lines. Obesity by the way is not only a patient’s problem but a doctor’s too. Finding a line in this people is like looking for a needle in a stack of hay. Now I know where I would fix a line on this man. If here comes to the casualty intoxicated I would rehydrate him and give him some IV dextrose.

I am coming to the end of Moi Avenue. On the other side towards railway station, two men are fighting. The blows are heavier than those of Mohammed Ali (Tribute) or Mayweather. I am not worried that they are fighting. I am worried because the head injuries that I foresee  would sometimes be severe. So severe that it would change the course of their lives. Have you ever been slapped until some saliva spew out of your mouth with no will of your own but their own? Now these blows came with blood and saliva combined. This picture only reminded me that poverty brings bitterness. Bitterness that you were promised more and not what you have.

Railways Bus Station. The touts are making noise. Their noise effortlessly coalesce with those of hooting cars, hawkers, bitter men, scorned women and mad both to form a condensation of frenzy. This would go till sometime before dawn when they will retreat to their dungeons. I got a bus and am headed to The Hospital. Remember it is a Friday. casualty Friday.

I arrived ten minutes later. City Council ambulance followed later. It has a characteristic wail that is very atypical. Sometimes it exaggerates what is otherwise trivial. Dr Omondi is a bit preoccupied so I received the patients together with the casualty nurse. She is a very beautiful lady. What brings us together most of the time is usually emergencies. I had never found her alone in some alley to wink at her or tell her she was beautiful. I longed for such a moment. The way the caged bird longs for freedom. So like the caged bird, this moment remains a hope rather than a reality.

As I removed the patients from the ambulance, I was taken aback to realize that it was the two men that I had left before in town, thirsty for each other’s blood. One had suffered severe head injuries and the other had a deep cut on his forehead. I felt guilty that I did not stop them from fighting. How could I have done it without a few blows landing on my jaws?

The theatre nurse prepared the minor theatre for suturing. I was going to suture for the first time. I had not learnt of horizontal mattress or vertical mattress but I knew of that simple one that I have forgotten the name. I knew when it was indicated. To do this, I was supposed to go once with the suturing needle, then I pull, afterwards I wind the stitch three times around the needle hold, then I pick the free end of the needle and pull, then wind again twice and pull then once and pull. What else!  I cut. This suture was a magic one. It was the first of the many that I would do. This moment was stored in part of my heart that my mother and that girl, Faith lie.

This event reminded me of the paradox of life. A simple fight in town made me have my first suture. Another fight will soon come and give me another chance to perfect my skills. I don’t know whether to be happy or sad for adversity are the only times that make me thrive. It is certain to me now, that the only certain thing is the uncertainty of life. Life is hard to understand. The more the varied lenses you have, the more obscure reality becomes. What is reality anyway?

 

 

Men Sometimes Do Cry

I come from Nyakach, somewhere at the foot of Nyabondo plateau. We sometimes refer to my village as Got Mesa, meaning table land. In my village, men are not supposed to cry. My father taught me this since I was young and it has become part and parcel of me. I have labored to follow this rule but sometimes i just cant. I remember crying when I could not bear the pain of my broken bones. Sometimes I cry when emotions overwhelm me in medicine, but this i do with tears flowing inwards, deep down into my soul. Sometimes my soul fills to the brim and a few tears drop from my eyes. At such times, I have to wipe the ones that come against my will, but sometimes in the confines of my room I let them flow.

When I was young about five years or so, i remember Otoyo Chiambe undergoing the wrath of a ritual process. He was a teenage boy then. He was tall, hairy and brave.I admired him and often went with him herding along the banks of River Sondu Miriu. One time he had saved a goat from the menacing jaws of  a hungry crocodile. He escaped with a few injuries though but the goat ended up on the dinner table moments later, its injuries were not compatible with life.

On that day when he was being initiated into the ways of our land, his bravery was tested a great deal. the ceremony  started at dawn when the first cock crew. Otoyo’s father had brought in the fattest bull from his herd.There was plenty of food because it was the harvest season. the women had started cooking and some were welcoming guest from other villages. the ritualist was somewhere with the boys teaching them the ways of our land. Oluoch son of Ndonga was nowhere to be found. He could not visualize himself losing his six lower teeth. Seeing him now in medical school, I wonder how he would have looked like had he lost his teeth because even with teeth, he looks like an incarnate of the devil.

The ritual took place at the crack of dawn the next day. The lower teeth were  to be removed by tying them with a special string made from sisal and a heavy stone tied at the other end. At the count of three, the stone would be lifted slightly and jerked, coming down with the teeth and streams of blood. Some initiates shouted in great pain but Otoyo held his peace. I knew he felt pain. He kept  calm as if nothing happened. No tears. This was bravery at its apogee. I admire him  to date.

Almost twenty years have gone since that day. I am in medical school learning how to care for mankind. Whenever I see a man crying, I always know that it is surely something that he can not hold back. My whole purpose is to alleviate pain and suffering. That is exactly what am learning to do and sometimes I actually do it. I remember my professor telling me that “You can have your name in the lights with subordinates hanging around in your lightest world, but as long as you can not relieve pain and suffering, you are as good as nothing.”

The pain of cancer sometimes leave my patients chanting and howling in misery. whenever I think of Otoyo and see my patients especially men crying, things do not add up. Men can contain pain but when it gets to the point when they cant hold back their tears, then it must be real pain. If you haven’t known pain, it can be a simple statement but it isn’t  I tell you.

The other day we received a patient who could not pass urine. This man came writhing and wriggling like a worm. He was crying and calling the name of his forefathers at the presence of his wife and children. This man cursed everything and everyone he thought was responsible for his calamity. He saw me and stopped crying. He said daktari several times and only his eyes invited me to his world, world of misery and suffering. I am happy I was there, to relieve him of this burden that came along in the journey of life. Together with Dr Odhiambo, we inserted a catheter and drained him of urine.in those moments of the convalescent, tears gave way to a smile and great relief. This guy promised me a goat. it was a momentary relief but it meant joy to me and to him.

Otoyo made me believe that when pain is pain, a man will usually cry. Whenever they cry, i am glad I am always there, to relieve the pain, even if for a moment.