Doctor, Examine the Body

Pathology was my last rotation. I dreaded the moments when we would be forced to cut up the dead and find out what killed them. I am of the idea that the dead be left in peace. I hope no pathologist is going to read this. The thoughts made me uneasy, disturbed even. I had to do it, I had no choice. I had chosen to be a doctor. This was part of the deal.

 

Little did I know that the times in pathology were going to be the most life changing moments in my life. You don’t spend time with the dead and come out the same. The dissection ritual in first year is no where close to post mortem examination in the morgue. In first year, the body looked less human, surreal even, you could dismantle it whichever way you chose, you didn’t care who he or he was in life. But in the morgue, you will have a few minutes or hours, you will have a task to find out the cause of death, you will be cutting up someone with a name and with relatives waiting to carry the remains with them after you are done. You will be the last man. You will find out what was hidden in life. The situation is worse if it is a forensic case, worst of all if the government is an interested party.

 

In forensic pathology, you are a doctor and a ‘lawyer’ at the same time. However, you only give expert opinion, you don’t defend anyone neither do you condemn, the lawyers are better at that. Sometimes I think of forensic pathology as something that might seduce me, it is exciting you know. But I fear folks, that I might be too good a detective, that I might be too good for the bad guys, and that I will refuse to be compromised and that they will come after me and they will kill me. You know if they kill me, I will not see my daughter graduate from college and that is a moment that I so long for. Don’t get me wrong, I am not saying that forensic pathology is a dirty game, it is thrilling! After all, when we were young boys, didn’t we all want to be detectives after watching those good movies that exaggerated reality? Again, I cant imagine anything better than the terrible beauty of brain surgery.

 

I was digressing. Back to our subject matter. 3.30pm, a gloomy Thursday, I was coming out of the post mortem room when a body was just wheeled in. A small girl, barely nine years of age. My classmates had already left and I had lagged behind to have a small talk with the pathologist, for today, we shall not mention any names lest it be used against me in a court of law. According to the mortician, the body was brought in last night by the girl’s uncle in the cover of darkness, a few minutes past midnight. Cause of death “Accident.” The mortician was busy sorting out bodies that would be carried by the owners the next day for burial so he did not take keen attention on the girl. Then he saw streaks of clotted blood on the girl’s thighs. His conscience was disturbed, his instincts could not give him peace, and so he ordered for a post mortem, msema kweli.

 

My interest was also drawn to that girl because it is painful to see a young soul, with a whole lifetime ahead dead. The torrid stench of formalin did not deter me from staying behind to find out what had ensued, the circumstances of death, the time of death, the manner of death, the mechanism of death, for a pathologist, you just don’t die, death has many things about it. I had not removed my boots yet and other protective gear were on. The body lay before us, a quick physical examination revealed a helpless girl, with dried tears on the face and patches of dried blood everywhere and particularly the genitals. A huge tear stared at us in the genital area. Accidents never tear up genitals like that. A swab was taken for DNA analysis. You already know where this is going.

 

The pathologist was disturbed, he is always detached but this one case seemed to have taken the better of him. His voice was shaking. Folks, there are some situations in this life that can break you however strong you are. Further examination of the body revealed multiple fractures in both the hands and the legs. It looked horrible how a child could sustain such multiple injuries. This was not only sexual abuse but also physical abuse.

 

It saddens me how the world is often times brutal to its inhabitants. I have always believed that humans are inherently good though. You wonder what would inspire a man to rape a young girl to death.

 

The rest of the post mortem took a quiet course. It was not like the usual times where people talked and laughed even as they did what they had to do. Thirty or so minutes later it was done. We all knew the cause of death, no one had to tell us. The rest was to be taken care of by the pathologist. Probably, he was going to involve the police. 5pm. I left the place with an experience never to forget. The human drama does not leave us in the streets and in the course of our daily interactions, it follows us to death and even to our graves. Well, you have heard of exhumation.

 

 

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The Illusion That is Happiness

Happiness, folks, remains one of the most vague statements that philosophers have never tackled adequately since the beginning of time. I think it is a subject that puzzled even the greatest of minds like Socrates and Plato who seemed to understand human character more than anyone else who has ever set foot on planet earth. For the modern man, happiness remains elusive, pursuing it has become an exercise of futility. But folks, what is happiness?

 
I dont know much about happiness in the manner that Budhist and Diaoists would explain. However I know its not a fleeting set of emotions that comes when we are having our way in whatever engagement we are involved in. It is a state of well being in joy and in sorrow that surpasses human understanding. But may be, just may be, we never find it when we look outside. Its all in the mind. The mind is the most powerful organ. Its better than the brain. Sadly, we dont have surgeons that can operate on the mind. God left that duty to self.

 
Have you asked yourself then, if happiness comes from within, why do people take their lives? Why should someone kill themselves if they can play tricks on their mind and have everything in control? May be the secret to happiness is not found in the grinds of daily life. May be its found in the uncomfortable silence that we are never willing to embrace. May be meditation is missing in the life of a majority of folks. Most people live life without ever experiencing true happiness. Tragedy!

 
I have questioned the essence of life many times folks, especially when I see young people failing and succeding at attempts to end their lives. Some subject themselves to the discomfort of hanging on a rope for several minutes and dying fron the effects of sever deprivation of oxygen, some take rat poison and bleed themselves to death while others take paracetamol or some funny foul smelling agricultural drugs to complete their mission. In attempts that fail, it is usually lack of precision. I have learnt of precision of death in my training as a future doctor. A nice dose of sodium propofol, suxamethonium and potassium chloride can give a peaceful transition to the next life. It gives characteristic ECG patterns which ultimately leads to asystole. Precise, right? That is  what lethal injection consists of in countries where human beings are executed if they are deemed not wise to live. Saddam was hanged on a rope, his was a traumatic fracture of the dens of the axis bone, what is described as the hangman’s fracture. You never live with that kind of a fracture.

 
But folks, you dont use turpentine to kill yourself, it will make you uncomfortable and buy you some time till help comes. It has no precision. It smells bad. You dont want to smell bad in the morgue. But if you want to die, take enough dose of it, like five litres or so. I warn you folks, killing oneself never solves anything, it makes things worse.

 

So last week was a toxicology week for me,. On Friday, a man was brought in, a financial consultant in a huge firm in town. He was brought in by a distressed family that looked so worried that you could tell what their brother or son meant the whole world to them. The family looked well off too, the kind that never goes to public hospitals. So it was a worried well off family.

 

Turpentine poisoning has no specific antidote, you only manage the symptoms as and when they arise. The guy had vomitted quite a huge amount of the poison, so lavage was not going to help him much. We ensured he was breathing properly and that he was well hydrated. Water sorts the kidney pretty well in poisoning. It has a dilutional effect on the toxins. The guy recovered uneventfully. There was more to his life that needed a psychiatrist to sort out. He looked like he had everything that an avergae middle class man would have except joy. His wife was no where around but i was made to understand that they usually fight, fiercely for that matter. In such a case, you can only extrapolate what happens in his life. You can never be sure and you can never believe hearsay.

 
His story was just a digression, happiness does not come with more money, more women or more power. More only brings misery. If you ask me, unhappiness is the side effect of civilization, man has conquered the earth and the stars but has failed to conquer himself. Again folks, lets speak out as i have said time and again in this blog. If we have to die, lets not be guilty of our own murder.

Of Men and Pesticides

Relationships can be very complicated. In fact it is the reason for most human miseries and the unhappiness that fills people’s lives. Most people walking around are putting up with a lot of shit in the name of love. Relationships should be a haven of peace and a place full of laughter. Most of the time, this is not the case. It is all drama. But again folks, you can never understand what goes on between two people who f*ck.

Last Saturday was quite a busy Saturday for me. After revising for my exams that were due for the following week, I passed by casualty to do a little thing here and there to remind me that medicine is not all about books. Dr. Mangar was the neurosurgeon registrar on call. When I walk with Doc Mangar, I always feel like a brain surgeon. He gives me excess charges that may intoxicate you if you are new to his teachings. On that day, I was to learn more than brain surgery.

Just before I got oriented with what was happening at the casualty, a young man was wheeled to resuscitation room B , agitated and with breathing difficulties. The pungent smell of pesticide that emanated from his breath told the tale of a man who was on the brink of tragedy. There was no time to waste folks, we had to do something to stabilise this guy. As a doctor, you just never give up on a young chap. You will never forgive yourself if it is your fault that a young man or woman dies.

The ECG clips were quickly set up on him as the nurse rushed to bring nasogastric tube and everything else we would need to help this young man . Doc Mangar was relaxed. He knew he was in charge and that the boy would walk out of casualty alive. I like the tiny smile he makes when everyone else has no clue what is supposed to be done except him. He reminds me regularly that a brain surgeon ought to know everything. I mean if you can grasp brain surgery, everything else should be simple.

So I put in the nasogastric tube as quick as I could. It was my first NG tube insertion and funny enough, despite my difficulties, he never offered to help. Simple things, he said. We then infused three litres of fluid into the guy’s stomach till you could shake him and hear water move from side to side. After that, we placed a bucket at the foot of the bed and turned him to one side such that the tip of the tube pointed towards the bucket. Lo and behold! Diluted pesticide was flowing from the guy like a tap. He looked at me with mercy written all over his face. He wanted to tell me what happened but he could not. The poison filled the room with the torrid stench. This was what pests had to breath before they die. After the removal of pesticide from his stomach, we ensured he was well hydrated to keep his kidneys protected.

Later when we got the history, this man was in no business to end his life. If he met his death on that day, I don’t know what he would have told God. He had been pinned down by two ladies and the pesticide forced down his throat. The ladies must have been very strong to get the better of this guy. You know you must be fit a lady to force poison down the throat of a man at his prime. What could make two ladies bay for the life of one man? May be the guy was drawing from two wells with impunity. May be he was just not lucky on that day or Karma just carried the fateful day.

His mother looked at him as she shed tears of despondency. She pitied her son. It is always our mothers who stand by us if things get out of hand. If the world turns its back on us. Cheating men don’t deserve to die. They have a right to life. If they have to die, then not like cockroaches and bed bugs.

 

 

The biggest battles are fought in our minds

He hung helplessly on the roof. His tongue was out of his mouth and eyes popped out effortlessly from their sockets. He looked helpless. He looked dead. He was dead. But why did he choose to die this way? Why did he choose to take his own life? That is the sight that tens of people who went to Ayala’s (not his real name) home that Friday night were subjected to; a sight that will forever torment his children.

Ayala was a relatively successful man. He had built his family a decent home on the foot of Nyabondo Plateau a few kilometres from our home. He had a beautiful wife and children like any man would wish. He had a good job at the Ministry of Immigration. He owned two cars, an old Mercedes car that he bought from a former minister and a nice truck that sorted out the needs of his farm. In short he was successful on the various parameters that we would want to use.

However, Ayala seemed to be fighting fierce battles in his mind. His gentle demeanour and winsome smile was hiding a war field that we will never come to know. He never left a suicide note neither did he talk to anyone about it. A few antidepressants found in his private room are the only things that told the tale of a man who was at war with himself. A man who never came out alive in a battle that only he knew. A man who was smiling away his sorrows. A man who is no more.

The situation was not any different when I went to pay my last respects to Adede (not his real name) in Ramogi. Adede was my good friend back then when we were in high school. Adede, like any other student, was so full of life after High School. he joined a local university and passed highly with a second class upper in a business course that he chose after failing to make it to medical school.

Adede however had numerous family problems. He had lost his father to homicide back then when he was in form one. His mother was constantly in and out of the hospital with cancer. His brothers looked up to him because he was the eldest son in that family. His uncles had fought over his father’s wealth till there was nothing left except the little land where their house stood. Adede finished school knowing that he would be the solution to the family’s problems. However he was in for a rude shock, he walked from company to company looking for jobs but to no avail. He tried everything that was within his means but nothing seemed to work. I guess he felt bad that his friends had made it in life and he was left behind. The last time I talked to him, I managed to hustle him a job for project writing that gave him rent for that month.

Before we had time to catch up again, he jumped over a foot bridge and was hit by a driver who I guess is traumatised wherever he is. Adede took his own life. Looking at him in the coffin, he laid gently. Except for a depressed frontal bone fracture and a few dried clots of blood, his face never changed. I will never know what was running in his head. The family did not read the suicide note for fear of being blamed for contributing to the death of their own, for failing to be a good family to him. Wherever he is, I know that Adede wished he found someone to talk to.

I recently read a newspaper article that talked about a young Kenyan lady who had committed suicide in the United states and it saddened me. It pains me that many young people are increasingly committing suicide or battling depression or anxiety or any form of mental illness without any one to talk to or anywhere to turn to.

Well, the society has conditioned us to believe that having a mental illness is a form of weakness, a lack of fortitude or willingness to sort out our own problems. This view should change because it will hinder people from seeking therapy and help before things fall apart. In the last one year, many people who have died that I know have died of suicide than any other cause. So folks, next time you meet your friend and they tell you they are fine, it is a lie, it is a hoax, we say we are fine because we want to be polite. Probe beyond this am fine thing. You just might be the pillar which they need to rise on their feet again and face life with vitality.

As you think about it, remember that the biggest wars are not fought in the worlds’ battle fields, they are fought in the chambers of our souls and deep down in our minds. Lets talk about mental health. Lets STOP the stigma.

 

The Lost Family Touch

It has been long since I put up something on this blog. I have been on a literary dry spell and I hope you my readers will bear with me. Lets break the spell by re-examining the lost family touch.

Being African is not the same as it was many years ago. The togetherness that was the backbone of our ancient self is no longer something we can pride ourselves in. The family is slowly getting disintegrated in our new African self. We often pursue wealth and fame for a large chunk of our lifetime that we forget what really matters. In the end we die miserable people without the wealth and fame that took away the many years of our lives.

The story of Odero (not his real name) breaks my heart. Odero was admitted to our surgical unit in the late months of last year. He was a typical old man from the lakeside region, he had an imposing stature and a calm attitude that was rare to see in our teaching and referral hospital. His face was wrinkled but he still looked strong though his disease seemed to be taking the better of him.

Nothing seemed to scare Odero, even death itself. He had seen everything in the short seventy eight years that he had lived. He talked slowly and all I could smell from his words was, ‘All is vanity!’ After all, what scares you after seventy eight years in the storm that is life? My greatest fear in life is poverty and Alzheimer’s Dementia. Poverty rips you off your dignity and Alzheimer’s leaves you living in the shell of your former self.

Odero had lower urinary symptoms that was consistent with a large prostate. Urinary problems are some of the most frustrating medical problems, you will never have peace. The very moment you get somewhere, you must first identify a washroom because the moment the urine decides it is time, you will not have time to bargain, you must go to the washroom or else whatever you dread most will happen. Now after identifying the small house, your work will be to go there every other time to squeeze a few drops, if you are unlucky, the drops will fall on your shoes or soak your pants. Sexual intercourse becomes a real struggle, actually for some, it becomes a memory. If you have a young horny wife, too bad! Luckily for Odero, the prostate was only enlarged but not cancerous.

He was due for an elective adenomyomectomy (partial removal of the prostate) that Monday morning that I had the opportunity of meeting and talking to him for the second time. That Monday was not a lucky day for him because a lot more emergency cases had come up that weekend and spilled over to the Monday theatre list . He was given one more week.

Considering that he came all the way from Homabay for the procedure, this was going to be a long week in the city. I asked him to go put up with any of his relatives in Nairobi to save him the cost of being in the hospital and for moral support. I seemed to have touched a spot that he never wanted touched, his otherwise flat mood changed and he became gloomy after those words fell on his ears. He held my hands and sat me down on the chair that was besides his bed. He talked to me and these were the words

‘My son, I have sons and daughters here in Nairobi. I also have relatives whom I helped to educate back then when I was a teacher. My relatives here see me as a burden though I pretty much take care of myself. I have urinary problems but I never urinate on their bedding. I usually have a tin by the bedside where I pee to avoid disturbing people when they are having their sleep. For my relatives, I can excuse them because they don’t owe me anything. After all, I helped educate them expecting nothing in return.

My son , my sons and daughters have neglected me and this is what pains me most. I have a disabled daughter around who is quite successful but I cant go to her place. Children will ask me every other time, ”Guka unarudi lini?” I don’t blame the kids, I don’t want to blame them. However my only bitterness is that everybody sees me as a burden. My sons got married and left home, they live good lives in the city but they have forgotten their father. My brothers at home wish me death so that they can forcefully inherit my farm. I am living by the grace of God. Now that the procedure is rescheduled, ask the surgeon to put it three weeks away to give me time to organise funds again. I am going to Homabay!’

Those words pierced my heart like a sharp blade. I am glad he opened up to me. I wish I could do something to make the old man feel better but that was beyond me. All I had were my ears to listen to him. I never asked any questions, I just listened. I hope my parents don’t suffer the same fate. I hope we remember who we are and those who made us who we are. I left him and told the surgeon about his concerns. I never saw him again. He did not show up for the surgery.

Placebo without placebo

Medicine is a brutal science. I have learnt this in the last one and a half years that I have been in clinical years of medical school. Whereas most procedures are done to save the lives of patients, most of them are very invasive. Think of surgery for example, the surgeon gets to explore the parts of the body that even the owner doesn’t know or think about consciously.

If you ask me, I wouldn’t want to be done to the things we do to patients to save their lives. To start with, I fear injections, the thing is just so painful as it sinks in the body. If you get a nurse who doesn’t give a fuck about pain, man, you are doomed. What about the urinary catheter? Oh my! the pain and the discomfort, i don’t even want to think of it.

Somewhere last year I woke up with an awful feeling at two o’clock in the morning, just an hour to the time I normally wake up. I was sweating, nauseated and throwing up like never before. I was all alone in my room, my neighbor was not around, even if he was, I can count the number of times we talked. He was generally a reserved man, always silent. A board made of ply wood separated us. Most of the time, silence reigned supreme. My roommate was a gentle man, something that drew ladies close to him. He had quite a number of them as friends. In my entire stay with him, I never heard his bed shake, squeak or make sounds to that effect. If it ever did, perhaps in my absence.

I went to the student clinic in my campus later that day. The doctor was a female. I was not in the mood of physical examination and giving too much history, I just wanted medication and leave. Actually if it were not for the fact that the school provides the drugs for free, I would have got the drugs from a local store and sorted the situation. The doctor insisted that she had to examine me, so I removed my shirt and lied on the examination table. While she was palpating my abdomen, my stomach rumbled loudly in protest that I felt embarrassed. I felt like asking my stomach, “Hey you, why now? couldn’t you wait till I got out of the clinic?”

I was later sent to the lab for a series of tests including those that I could have never thought of. I wondered what the tests were for. since I was sick, I decided to comply. A blood sample was drawn with ease from my right antecubital vein. I did not even want to look at the needle going in, though it was not as painful as those injections of the buttocks. I was given a stool container to go get stool samples for even more investigations. I insisted that I had to get the results of the blood tests to rule out those weird differentials. I was relieved when the results came out negative.

I took the stool bottle with me to the loo, to get my shit for lab works. When I got into the loo, I found a head staring at me from the space above the toilet door and the roof. No human being can reach that height that he was staring at me from, so it did not take me long to figure out that the guy was standing on the toilet bowl. I just caught him off guard. You know campus toilets can be so dirty, so i guess he was protecting his ass from the dirty water that splashes after shit drops into the bowl. The guy never seemed disturbed, he jumped from the bowl and left as if nothing had happened. He did not give a f***.

I left the loo and never took the stool bottle back to the laboratory. I did even put my shit there to begin with. I decided that if the symptoms persisted, I would treat what the doctor was thinking, after all the weird blood tests were all negative. I left the lab. I have never gone back there again neither have I had any bout of diarrhea. This is what we call placebo without placebo.

 

 

No Higher Honour

My childhood dream of becoming a doctor is almost coming to a reality. Most probably I will celebrate my twenty fifth birthday as an intern in some remote village in a place that I still don’t know. The feeling sets my heart on fire and elicits fear in me in equal measure.

As I come closer and closer to the end of my undergraduate training, I am awed by the fragility of the human body. The human body, as fragile as it is, is also resilient. Before someone dies, the body would have fought against all odds to be alive. Sometimes these odds tilt towards death and sometimes the doctors come in and save the situation.

As days pass by, I am like a groom with so many brides. I am spoilt for choices. The heart and the brain have particularly remained the two organs that I have loved the most. Sitting steadily behind the chest, the heart beats relentlessly to keep us alive. Heart disease remains the major cause of death everywhere in the world. This means as a cardiologist, you will make huge impact in so many peoples’ lives. Treating the heart means you must be a keen listener and hear the  sounds. This I must confess is very thrilling. You could hear something and exclaim, ‘S3 gallop! Patient is going into failure’.

If you think that was beautiful then look at the brain. Physical matter, a constellation of neurons and a home of electrochemical activity holds the conscience, feelings, thoughts and the ‘I’ of a person. This remains a wonder and an awe to neurosurgeons. Consciousness itself could be an illusion, the brain might be playing some tricks on us.

Neurosurgery remains at the realm of the medical world. Neurosurgeons have maintained their pedigree, gathering around the idea that they stand above all physicians. They have embraced a reputation of narcissism and austerity, a historical sameness in which character of neurosurgeons goes unchanged and unchallenged. I don’t care about this, but it is my dream to be part of the medical crème.

I can say that I am the kind of person who loves challenges. I relish emergencies and situations that make me think on my feet. These are the moments that I become the real me. The moments when we are counting minutes without which someone dies or gets morbid. If that is to be combined with awe, then the exhilaration could kill me.

I still have time though, to go round and understand my lovers and finally choose whoever I please. So far neurosurgery  and cardiology are proving too seductive. my experience out there in the wilderness will guide my path. For now general practice stares at me in the face.

Each day I wake up a content man, so eager to learn new things and review old ones. There are nights I never want to end, the Friday nights at Casualty. These are the nights that make me who I am. I am forever indebted to God for this wonderful opportunity to be a doctor. No higher honour.

Acute appendicitis

The first time I made a working diagnosis of acute appendicitis was in third year, a week after I had read the topic. I remember this topic better than any other surgical topic, not because I am a surgical geek, but because of the events surrounding my diagnosis on that particular day.

There was this evening I found myself at the casualty. It was during that time of the year when the sun was blazing hot all the way to dusk. I was not of the idea of learning medicine that evening but I forced myself to go anyway.

The casualty was not unusually busy. The sweltering smell of blood never seems to change. It has been like that since I started school. A few injured people lay helplessly on their stretchers waiting for their turn to be served. I got into one of the consultation rooms and made myself busy looking at the patients’ files to find a good case for revision. I love cardiology cases. I love listening to diseased hearts.  It does not mean that I love when people have sick hearts. People will be sick anyway.

There was this beautiful girl who was brought in by the mum and dad. Her dad was so stressed about her illness that he left almost immediately. I guess he went to drink it down. I don’t remember the name of that girl but at least I remember she was from The University of Nairobi, school of law, second year. She was Luo and she was beautiful. You know those kind of ladies that you would look at and tell God, ‘God, this is good’, yes, she was one of those ones. She looked rich, I wondered what the hell they were doing in a public hospital. Shit happens.

From her history, ruptured ectopic pregnancy and acute appendicitis were high on top of our list. A pregnancy test done before indicated negative, so we remained with acute appendicitis as our most likely diagnosis. I did pretty well examining her abdomen. I loved the whole process. I picked even the minor details that I usually don’t pick in exams. The doctor in charge was happy but I could see he sensed some overenthusiasm in me and moved closer. He took charge and pushed his stethoscope behind her blouse and listened briskly to her heart sounds. Her breasts stood protuberantly on her chest; a sight that every man beholds. He looked like he want to listen to her heart the whole day. Save for the emergency of acute appendicitis, he would have done it. After he was done, I put on my stethoscope and as I was moving my hands under her blouse in the same manner he did, he slid my hands off, gently though, not to raise any alarm. I knew he did not find anything significant, he saw me as a potential threat to scarce resources that nature gives. To console me he simply said, ‘S1, S2 normal’. I didn’t care whether they were normal or not, I wanted to hear them myself. Like hearing is believing. This guy, I mean this doctor who was meant to teach me was out to sabotage my learning.

My ego was bruised. I felt dejected. This was the closest I had come to getting a learned friend. Don’t ask me how. Where there is a will, there is a way. And that moment passed, I moved on as I have always done. She went to theatre almost immediately, the inflamed appendix had to come out. I found no need of staying behind with a man who would take meat from my mouth when I am just about to bite. It doesn’t make sense. Given another chance, he would do it again and again. So I left.

 

Post Exposure Prophylaxis

I wanted to hate that guy. I would have loved to hate that guy. How do you just bump into a consultation room without being called? You know it is unethical, it is lack of courtesy. He looked like the one who knew little about etiquette. I later realized that he was called Omondi (not his real name), Omondi from Homabay. Had he arrived a minute or so earlier, he would have found us examining the breast of a fairly young lady that came in with a lump in the right breast and was very worried. Luckily for her, we had finished the examination and she was dressing up.

Omondi  waited patiently outside till we finished with the lady. Then he got in without waiting for his name to be called. Did we throw courtesy to the jackals? Fortunately, he was next in line. He was a well built man, approximately six feet tall and dark in color. I don’t want to comment on whether he was handsome or not, I just want to tell his story. One thing that I was sure of, Omondi was not sick.

His card was marked very urgent, so we decided to deal with it with the urgency it deserved. I was to have my clinical exams very soon, so the doctor asked me to take the history and present it in a coherent way so that I build my confidence.

“So, what brings you to hospital today?”

”Daktari, you know people like us, we are old men..mmmhhh..“

“ Tell me what brings you to hospital,” I interjected sensing that Omondi was trying to veer off from what I wanted him to tell me. He was not as old as he was trying to insinuate. He was in his mid forties, very energetic and full of life. He leaned forward, I too leaned forward. After reassurance, he decided to hit the point.

“ Daktari, mine is a case of burst condom, I have come for Post exposure prophylaxis, Please give me a prescription. “ I admired his honesty. He looked embarrassed, miserable and so sinful after saying those words. I wanted to remind him that no sin is beyond redemption but time was not on our side, we had so many patients on our list that day. The doctor in charge was so pissed off with the whole idea of a burst condom. What angered him most was that a case like this had to be dealt with at Accident and Emergency, with red color code meaning very urgent. Omondi must have charmed the nurse at the triage. The doctor had no choice but to do the prescription which he did so quickly for that matter, just to have the man leave as quickly as possible. “Next time you go to the outpatient for a similar problem,” he said to Omondi  amidst the many thank yous that Omondi sang. I have never heard that many thank yous from a man.

 

The Wailing Spree

Wailing is one of the ways we Africans express our grief. Whenever I hear a wail at the Casualty, the message is always clear, someone has passed on. The wails however vary from community to community. Let me say with the deepest conviction that Luhya wails are the loudest and the most interesting. I can defend this in a court of law by the way. One time you would think they are laughing, another time they would roll on the ground and cry with mouths wide open but no tears and no signs of tears ever coming out of their eyes. We will get back to this wailing in a short while.

It was one of those Fridays at the casualty. The casualty was busier than usual. You know Friday is that day of the week that doctors dread the most.  A serious case will come just when you are about to leave to go unwind. Often times you would hear the doctors cursing why they got into medicine whenever such situations arise. Some would even try so hard to have the patient fall in the next shift but only after stabilizing them and removing them out of danger.

The Nairobi County Police Land-cruiser halted with a massive screech at the casualty entrance. The screech was so sharp that I felt it in my teeth. Out came two police men who seemingly had no single minute to waste, probably they were in a hurry to get back to the road to collect their dues. I know of a police officer who keeps on foregoing ranks to remain on the road as a traffic police. Damn it! Of what use is a rank when one can earn twice as much standing by the road side?

The policemen had brought in a man who was severely injured and needed immediate medical attention. The man was unconscious. He was drenched in sweat, blood, alcohol, sewage and anything that can run on a drunkard lying on the streets. This combination gave a torrid stench that would be part of us till our shift ends. Poor us!

We took the guy to resuscitation room B and  started him on intravenous drips, put him on oxygen and drew some blood for our investigations. The policemen left without any notice and so the patient was ours, we were the relatives and the care providers. This happens more often than not. after all this is a public hospital for heaven’s sake.

Just then, a wail emanated from outside. It was the typical wail I had mentioned before. It was very loud, so it had to be a Luhya wail. It rose to a deafening crescendo and then silence, only to emerge again at another corner of the casualty. It was a feminine wail but a strong one. It was an afternoon, most probably obusuma was doing the magic, adding strength to the wail. Hungry luhyas wail for a short time by the way, and a hungry wail too can be recognized. It is often sharp and sometimes cut in the middle of wailing. It is like when you want to say Oliver, then you say Oli.. and then hunger bites you so hard that you stop it at that. Mid way.

When another relative joined the wailing, the casualty went into a mess. It was like a wailing spree yet only two people were wailing. In those moments of frenzy, our patient woke up, and remember he could not wake up before to give us a history. Actually the police had thought he was going to die in the next few minutes and was  brought into the hospital to die. To me this was like a resurrection. He managed to open his mouth and asked, “Wameenda?…”