Letting go…

A melanocytic nevus.

I have never had to use the doctor’s room in my ward. Mostly because I never get time to sit down. I am constantly on my toes reviewing a patient or following up with surgery to review their patients who were erroneously admitted to our ward. Ward 3, Female Medical. It’s always tricky dealing with surgery, you all know. They are never commital.

I got into the doctor’s room. Jane, not her real name, was already seated. I had asked her to go in before me as I was finishing a bedside chest tube insertion. She was plump. The kind of plump that is motherly. The kind that you don’t body shame. Probably this was from the many children she had born and bred. She looked exactly like my mother except that she was brown with a conspicuous black dot that stood on her left cheek like a square peg on a round hole. If you zoomed closely, probably you would see some hair coming off the black thing. It’s called a melanocytic nevus. I love the grandeur of Latin. I later learned from our talk that she is an accountant; she didn’t tell me where, but probably with KPMG or Deloitte or one of those monster companies that rake in billions as annual profits.

The atmosphere is tense. Tense and grim. Jane tells me that Juliet is her sister. Juliet is not her real name. Sister from the same womb and balls. The sister you are born and grow with. The one you play hide and seek with. Jane is the big sister. Their mother went to be with the Lord when they were young. The father died of cancer soon after. “Cancer of the throat,” she said. Since then, she has assumed the role of a mother and a father to her little siblings. Being a hard-working woman, she was able to put them through school. She struggled a little, but her siblings went all the way through to the university. She talked like a proud parent, except her eyes were heavy with tears.

“Daktari, I have spent 5 million on my sister’s treatment. She has had countless surgeries. I am tired. I don’t know what else I can do.” Really, there was nothing else she could do or could have done differently. Her sister had been admitted to our unit with an infection. An infection only because the white cells were elevated. Sometimes an elevated white cell count doesn’t mean anything, really. She had lung cancer. Stage IV. With spread to the brain. Now she was mute. The only thing that bore semblance to living was how she closed her eyes when flies landed on them, a primitive brainstem reflex. She was only thirty-seven. Her body was failing her. She had bought a home, and a nice small car like all serious thirty-seven-year-olds do as they anticipate the beginning of life at forty. In her wisdom or lack of, nature was misordering her death. Why not the ninety-two-year-old with stroke in ward 4? In life, you never ask why not. Life has no Fairplay. It beats you when you are at the heart of the game. She had coughed up blood until she could cough no more. The cancer cells had probably depressed the brain’s cough centers. Mortality was imminent. I wonder what people see when they are about to die. Folks, Is it white light that people see? Is it blinding or calming?

A wall separated us from the agony of Juliet.

“You have done your best; there is nothing more you can do. We can’t do much either,” I say to Jane, feeling a little embarrassed. Is that not what we all do to our loved ones? We treat them all the way to death. As a doctor, we must always do something. In her sister’s case, I would probably put her on a short course of antibiotics and call the cancer team to come ‘poison’ her with chemo or radio. I resisted the temptation. It was time for a drug holiday.

The silence that ensued between us was uncomfortably dense. Jane’s tears rolled down her cheeks and then over the black thing to the table that was between us. I got a chance to scan the room again as a means to escape her gaze. The room was disorganized. Unused tubes, catheters, and drugs littered the floor. I sat on a creaky chair close to the door. She occupied the bench on the opposite side. One side of the bench was supported by a carton holding fluids. It was a clear depiction of the appalling state of our public health system. This was the place I was meant to be holding family conferences. I thank God I never had to do it there.

“What do I do, Doc? ” she now burst into a loud cry. She was talking to me like a friend. I realized that because of how she turned her head in a way that people don’t do in a doctor’s office. I felt so sorry for her in those moments. ” Perhaps, you should let go,” I said. I thought she would jerk and stop crying and look at me suddenly. She did not. I don’t know whether I was brutal, but I tried to the best of my ability to let her know the truth. Life was on its way out; it was just a matter of time. Hope is bad. It fuels rage.

I don’t know how long we sat in there, but we agreed that Juliet would not undergo any chemo or radio when we came out. That she would go home with her and watch her die in their home, in a warm blanket, with the aroma of roasted coffee and caring hearts. Jane said that together with her family, they would sing her Christmas carols in the dead of night and early in the morning. She took comfort knowing that even if her sister was not talking, she could see. Do you ever wonder how it is to live in silence? Maybe we should be grateful for the functional state we enjoy. Maybe life is one big pyramid scheme, and you never know when it will crumble.

This holiday season should remind us of how and when to let go. Letting go opens many possibilities; it gives us a chance to die at home with dignity, away from tubes, catheters, fluids, and an overworked medical intern. It also reminds us that the cure of a disease does not have to be more grievous than its endurance. Merry Christmas!


Maranda Blazing!

The great Maranda High School.

Visiting day in Maranda was akin to the day of Pentecost. The wind that blows on visiting day is the same wind that descended on the apostles. The Cold Canary currents. My memory of the Bible is a little hazy there.  Typically the day officially begins at ten. As form fours we would pretend we were reading for the upcoming mock exams. We stay taliban but our real hearts want to be visited.

Deya was always the first to be visited. On days that his grandfather came, he would come before the official time. Other days he would choose land meetings over Deya.  Deya would be called midway from sleep to go see his grandfather. We didnt care so much about his visiting, for his grandfather brought only a newspaper and a single medium sized fish that he had saved his whole life to buy from Nyapiedho. No he didn’t use his whole life savings, he spared sh 300 which he dutifully forced into the hands of Deya. May be he was ashamed that the amount was too little. Deya  would later work hard, and make it to medical school. He scored straight As. 84 points.

Nairobi people would start being visited around tea break. At this time the canteen is always full. People desperately needed mbathi or loaf as we would call our bread. There were no prefects on ‘duty’ during visiting. They all cringed at the gate waiting to be visited. The vulnerability had been passed to them. Cops and civilians alike, we were all waiting for the spoils of visiting day. The uptake of the black mid morning tea would go down tremendously that day. Top layer was however served as usual. It was not uncommon to see students dipping their buggers in top and then squeezing it between their jaws like the world was coming to an end. And the principal would complain in the assembly the next day that they had thrown a lot of food the previous day.

The Nairobi people would drive their parents’ cars around with loud music and windows down. The school captain was  from Ugenya but they resided in Kisumu. He would typically join the Nairobi gang on Visiting day. Some Nairobians  would buy loyalty from him by bringing him a few snacks and sausages. This captain guy once ate back to back sausages in my presence in a manner that no man had ever done before. He was the strictest, most short tempered and yet the most loved. I will not mention his name. Nairobi people loved the hockey pitch. They ate and drunk and enjoyed. Some of them would be seen shirtless throwing around their shirts like slings about to be launched. There was freedom. At least for a while. Mr Airo would look at you with a bad eye when he saw you misbehaving. He would remain silent. Like your mother in a wedding party when you serve a lot of food. Then he would one day bring up the story when you didnt shave over the weekend or when you are late for noc, the morning preps. For some reason, Mr Ahete did not like Nairobians. “You said you are Yobra, and you come from Nai,  ” Mr Ahete would say, even if Brian was not in trouble. There were many Brians. This particular one was in Red. Form Four Red.

The people of Bondo, and Siaya, and Uriri would follow. These people had their proceedings in dholuo. You would hear their parents shouting at them asking them why they did not do well in the mock. You can imagine how it is to hear in the luo language that you did not do well. Irem. Their visitings were however the most thrilling. Relatives of my school mates came with fish from Uhanya, fresh from the lake. The ones that were fried by Anyango in the morning. Anyango had been woken up as a matter of emergency because Opiyo is sitting exams later in the year. Opiyo deserves Omega 3 for KCSE. So she must set at dawn, go to Opija the fishermen and have fish prepared. People of Bondo would share their fish. Actually, by the time we get to the Dorm, the fish is done. Somebody like Opiyo would get sh 500 as pocket money. He would feel better because Deya got only sh 300. Agonda would smell of fish on the third day after visiting. This would be a Tuesday, when there was no assembly. The audacity!

My father would stroll in a few minutes to the assembly time. This would be after I have waited and waited. He would hold The Saturday Standard and some paper bag. The green plastic bag. Plastics were still legal. The bag would smell of fresh fish. I would later be relieved to find out that the fish are actually fried and not fresh. He told me he had passed by Uhanya. He thinks I dont know it but he was late because he went to see his friend from KNUT. He would soften his eyes apolegetically and say, “Omera bisomo koso itugo? ” He asks whether I am reading or playing. I beam with excitement and tell him that I was number one in Bunyore-Maranda. BUMA was hard but not hard hard like Biochemistry.  He would later give me sh 300 for pocket money. I would grunt a little and get an extra sh 150. In any case, I was richer than Deya. We were hiding behind that kasomething that looks like a watch tower close to the gate. The funny thing that we dont know its name. Its near the gate. Visiting was over and Mr Midega could feature anytime and confiscate my food. The word confiscate was popularised in Maranda, on visiting day. Then,  Midega was the deputy boarding master. A shrewd one at that. I would miss supper that day. Because it was visiting day.

I am a doctor because of my old man, and Mr Ouno, and Oduor Obura. These people all taught me English. Because I needed the hand of God to get an A in that subject. Oduor Obura read my first manuscripts and pinned them for students to see how good my writing was. He took me through writing master classes  that I ended up writing something close to what he had taught me when the exams came. Oduor Obura loved Shreds of Tenderness. I loved it too. He taught it so well. From a literary eye, John Ruganda, the author of Shreds was clever. Ouno on the other hand was the God of all creation. Mr. Ouno’s English is from London. London, Colney.  He spoke his way through our hearts to inspire us to greatness.

When I hear that Maranda is ablaze, I am heartbroken. Maranda has been on fire every other time. I am uncomfortable when I meet chaps from Alliance or Ramba or Got Agulu because they all think that all we did in Maranda was to torch the school. I am itching . I wonder why people burn dorms and not classes or toilets or the bursar’s office. I would want to see the marks I left on the walls of Omondi or Owino dormitories. But now Owino was set on fire, carrying with it the memories. Our history will go into flames like we never existed. We must protect our tradition. We must maintain our pride. We must go back to the ways that made us who we are. We must search our souls and solve our problems. But most importantly we must put integrity into practice.

A Decade and a Year on

Disclaimer: All names and identifying details in this story have been changed to protect the identity of those involved.

I would find myself in the ward later that afternoon. I was on call. Exchange had not called yet. I was torn between going for a shave and presenting myself uninvited to the wards. The last time I waited for exchange to call me, I had a rough night. If the mountain won’t come to Muhammad, Muhammad must go to the mountain. I was tired from the many operations that we had performed that week. Being the junior most doctor in the department, there was no rest for me. I was covering the whole surgical and orthopedic unit. Such moments have always prompted me to ask why I was born. It was a weekend. A Sunday.

I started out by discharging patients who I deemed stable enough to go home. You don’t want to add more work to the heap of work that is the daily life of a medical intern. Jane had done her third postoperative day after a hernia repair, she is the first to go. Adequate pain killers, then home. I booked her for our surgical outpatient clinic 2 weeks later. Janet had had a head injury that did not seem to be serious. She had fallen off a motorbike at a roundabout close to the hospital. The motorcyclist, fearing her wrath, sped off without mentioning a word. To hell with the money! June was in the far corner of cube B, she had stage IV colon cancer. When we operated on her to relieve an intestinal obstruction, she said that would be her last. If she ever needed another one, we let her be.

Sister Dorina was on duty with me. Dorina is not her real name. I have never met a nurse called Dorina. She is the fat mean nurse. The nurse whose opinion closes a conversation. Mama yao. Most people complain that she is tough-headed and doesn’t take any sh*t from us doctors. I hold a different opinion about her, she is nice to me. She often tells me how her daughter who lives in the US buys her nice things when she comes home. On several occasions, she has promised me a lady from her village. I am waiting. Dorina thinks I am tough like her. I tell her I try to look tough as a means of survival. The soft ones never leave the ward. There is always work for them. “Daktari, na uone huyo bed 4, siko comfortable na yeye…” she said, looking at my face to see if I would brush off her concerns. Many have done that before. Some, at a costly price. You don’t dismiss Nurse Dorina. She is the last person patients see on their way to heaven, or hell.

Miriam was in bed. Bed 4. When you come to a hospital, you lose your identity. You cease to become a father, brother, sister, or aunt. You become a bed. She had been admitted the previous night with difficulty in breathing. There was no history of an accident or something that would make a thirty-year-old suddenly become short of breath. COVID test was negative. Miriam’s chest x-ray would break my heart. It was not your usual pneumonia or chronic lung disease; she had several loops of bowel on the left side of the chest. I looked for the stomach bubble on the x-ray, it was up there, almost getting to the neck. The diaphragm had been breached. The intestines and the chest became one, at the expense of the lungs and the heart. Tragedy! A CT scan of the abdomen confirmed the same. My afternoon took a different shift. She was for theatre. Emergency explorative laparotomy.  This is a fancy way of saying opening up the abdomen, removing or repairing the damaged organ, and coming out. Si nilienda kujitafutia kazi?

In December of 2010, Miriam would find herself a victim of domestic violence. She was in an abusive marriage. They had both physical and verbal fights every so often. She had slept in the cold of the verandah on several occasions when her house was consummated in a fiery rage. One day, when he could not hold back his anger, her husband stabbed her. She left, with a knife on that part of the chest. Then life happened. She doesn’t remember well what led to the other. All she remembers is that her husband was drunk. That is the injury she remembers on that side of the chest, 11 years later. She says she is lucky to be alive. She was only 19. Nineteen and married.

The theatre was unusually busy. The surgeon on call had finished doing his ‘special cases’ that had spilled over from that week. They were orthopedic operations. Most orthopedic operations are broken bones that need implants. It is the very surgeons that sell the implants. When you sell an implant to a patient, you sell them a promise as well. The promise that you will operate on them. You become a judge in your own case. Worse still, if you get an implant and you get a complication, you will have to wait for the surgeon who did the operation. You can guess what happens when your surgeon is on leave.  I am a junior doctor, so I am talking in a hushed tone. Assume you never heard this. I was not called to theatre for the procedures because I would never have approved of that theatre list.

We started our operation shortly after two o’clock. The abdomen was a familiar territory by now. My heart longed for brain operations. Because neurosurgery is the pinnacle of medicine. We did an upper midline incision and an extension to the left, a few centimeters below the nipple, a left subcostal incision. Loops of bowel pop up carelessly at the incision site as soon as we enter the abdomen. We gently follow the loops from the start to the end. The stomach is a good guide, you leave it and go to the duodenum, then the jejunum, then the ileum. The ileocecal valve marks the beginning of the large intestines. We pulled all these loops of bowel that were fighting for space with the innocent lungs. The shiny central tendon that forms the center of the diaphragm and the distant up and down tapping movement on it reminds you that the heart is close by. Do not disturb. Life in progress. Next to the rib side of the diaphragm, we find a defect, 8cm, running from front to back. The black hole of death.

With a lot of difficulties, we closed the hole with silk. Silk does not get absorbed by the human body. That would reassure us of strength. We inspected the bowel and ensured that they were not dead. A dead bowel would mean life is at stake. To our great relief, the intestines were normal. With that relief came the weight of fatigue. There was no more adrenaline to carry us through. I was hungry. My last meal was the previous night. Ugali and Mala. I was too lazy to fix a proper meal. What a wrong move that was?

Miriam rose from anesthesia at around 5pm. She coughed vigorously as her brain began to reboot. I was writing the operation notes and the post-operative plan. The early postoperative period was promising. Her mother, was outside eagerly waiting for the outcome of the operation. Her daughter had been rescued from the jaws of death and the scars of a painful past. Miriam began a new journey with new scars that remind her, not of a failed marriage but of a fragile existence. I hope life treats her kind.

6pm. I hear my phone ringing. Its Accident and Emergency.

Its a Small World

The smell of fermenting fenesi welcomes you to the old coastal city that is Dar es Salaam. The cool breeze from The Indian Ocean cancels out the heat and humidity that grips the atmosphere of Dar. If Nairobi is the ambitious big brother with big dreams, then Dar is definitely the bubbly child who doesn’t want to be left out. Most buildings in Dar look like they were built by Vasco da Gama himself during his quest to conquer the East African coast. The architecture is mostly ancient Persian except for the newer buildings that have a tinge of modernity. The roads in ‘downtown’ are extremely narrow. They are roads by day and cafes by night. It is not uncommon to find traffic jams in Kariokoo in the evening, only to realize that one side of the road is occupied by food vendors, with tables and seats on the road. ‘Shikamoo kaka, Karibu chai mdalasini kwa mbaazi,” a sonorous voice bickered from the crowd. She spoke in a flashy manner, moving her hips a little sideways like there was more to it than just the food. We were running late so I smiled back at her and rushed to my hotel room. Room 753. Sapphire Hotel. Kariokoo.

We got into a club near our hotel the next day. I checked my wallet and confirmed that I had Tanzanian currency. I had the equivalent of about Kshs. 2000. By Tanzanian standards, this was a lot of money. Enough to party and take us back to our hotel. The nightlife in Dar sharply contrasts the much more conservative coastal life of the day. Sights of sumptuous and curvaceous women skimpily dressed highlighted the night. They danced, slowly, gently, and sweetly as to the tune of every bit. The deejay was playing Maria Salome by Saida Karoli. It reminded me of my father on a cool Sunday morning. Dad loved Saida Karoli and Kofi Olomide. I beamed with nostalgia. I admired the women from a distance as I wet my throat with Serengeti lite. Tourists often frequent this club. They bring along with them the wild party life of Monaco, Milan, Dubai, Moscow, and whatnots. As I took down my last swallow, a petite girl comes over my ears with a little shyness,

 ‘Ukimaliza nina barua yako,’                                                                  


Acha siasa kaka, mengi tutayasema mbele.’ I flinch. I did not go to meet her. You don’t just meet people like that in a foreign land. Your heart can end up in transplant theatre in China and your cornea in Thailand. I later understood that she is a twilight girl who was pitching to a potential client.

 The days we had left were not going to be enough to appreciate the city. Together with one of my team managers, we paid a cab driver a few Tanzanian shillings and had him take us around the city. Unlike Nairobi, Dar is lonely and deserted by night. We ended up in B Max Lounge, on a cliff facing the ocean. It was a favorite of the spoilt students from The University of Dar. Were it not for the early morning we were going to have, we would have ended up in the hands of an overworked medical intern at the Muhimbili National Hospital.

We were having our regional basketball games in Dar. I was on the technical bench of the Equity Bank Basketball team as their team physician. My work was to ensure that the team was well taken care of medically. This was a huge relief from the moans and groans of on-call doctoring. I loved working for the team because of their hunger to win anything. Winning means more traveling.


Golden Jubilee Towers stands tall in the heart of Dar es Salaam. It is surrounded by a few palm trees and other equally tall buildings. On the ground floor, there is a small beautiful mgahawa from which emanates the aroma of roasted coffee. It reminds me of my days in campus when I binged on coffee to stay awake studying. Equity Bank Head Office is on the third floor of the same building if my memory serves me right. We had gone there to pay a courtesy call to the Managing director of Equity Bank TZ. The MD’s office is spacious with a beautiful mahogany desk that has been polished to a fine finish. The wood that forms the desk and the cabinets look heavy. Heavy and expensive. The chairs are made of fine leather.  Not your ordinary leather that peels every so often. Premium leather, tanned with precision. The view of the Indian Ocean from the office is electric. It is a vast blue, with a gentle calming breeze. Therapeutic.

The MD is a light skin gentleman with a broad winsome smile. He wears the signature corporate smile that would have you buy a product you know nothing about. His black pin-striped suit gives him an elegant look, bearing some semblance to Arsene Wenger on the touchline. Our eyes met. We laughed loudly. I was surprised that he recognized me. I thought I would just hide behind the crowd and go unnoticed.

‘How is your girlfriend?” he asked naughtily.

 ‘I guess she is fine, we haven’t talked in a while ‘

‘Where is she?’

’She works as a doctor in some mission hospital back at home. ‘I answered. We laughed again.

I had met the MD previously in Nairobi under very tricky circumstances. I was a little embarrassed on that day. He had summoned me to Equity Center to have a man talk. I had ‘sinned’ and fallen short of the glory of God. I was working for the bank as a teller then. There was this beautiful girl from our class that I admired with the whole of my existence. It was many years back. She had a sweet laugh that I couldn’t get enough of. I often made jokes, just to hear the sound of her laughter. She laughed at even the driest of my jokes. I loved her. She was also working for the bank around the same time. We often used the office email to communicate because it was easy and convenient. I could easily slide a how was your night text while waiting for a client’s receipt to generate from the machine. She always responded within a minute or less. We never blue ticked each other. It was fun while it lasted.

One day my beautiful girl was out of the office. I realized this because my emails had gone without reply. I called her during tea break and requested her to share with me her personal email address. I had written a long mail that I was not willing to retype again on text. I wanted to forward it instead. The email read:

Good morning. I wrote this to tell you how serious I am about the issue we were talking about. In this life, people go through sour love tales. Some even more than you have faced. I have had my fair share of heartbreaks but I still have a tenacious belief in love. I approach you with an open heart and an open mind seeking a chance to love again. I see a lot in you, as a woman, as a doctor, and as a soul mate. You have all that it takes to get to heights that you have always dreamed of. Whenever I saw you in class, I knew that you had something that I needed, something that I could not find anywhere. If you are sure you feel the same for this country boy, am all here ready to welcome you in my little world...and be yours to love and to cherish...

In the process of sending the mail, I forgot to put a full stop in between her names in the email address. I clicked send and boom, the email traveled over the internet to someone else with exactly similar names, except without the full stop. I never knew this till the day that I was summoned by this MD back then when he was working at Equity Center, Nairobi. He had actually been contacted by the recipient of that email. I googled the name and put a face to the recipient. She was the CEO of another company that I knew nothing about up until that moment. I had written a mail to a CEO seeking to be loved. Strange. What if she replied? What if she also wanted to be loved? I would have won myself a sugar mummy. A mama sucrose. Haha. I am joking. The man talk was not as heated as I thought it would be. I was uneasy the whole time though. I was guilty of ‘misusing’ the office mail to advance my own agenda. I did not defend myself whatsoever.

We had our final game on the day we were meeting the MD. We went down to the Mgahawa to grab some bites as we retreated back to our camp to continue with our preparations for the game. We leave it at that folks. It’s a small world!

A Little too Early

Extra-uterine life can be very unforgiving for the preterm neonate. It is like being taken from the shores of Lake Victoria to the heart of The Amazon without warning, without acclimatization. The fragile skin of the preterm baby loses heat to the environment so fast that it puts it at risk of dying from cold. If they are too tiny, their hearts have a hole that ensures blood goes directly to the body with only little going to the lungs. This hole usually closes within the first week of life for the term neonate. The preterm intestines are delicate; so delicate that formula milk can be deleterious to some of them. The blood vessels in their brains are weak; they can bleed without provocation. With an immature immune system, they are at great risk of getting infections, some of which can be life-threatening. The sad part of it all is that preterm neonates can forget to breathe, completely; these ones are given caffeine. Interesting, right? 

The world celebrated World Prematurity Day a few days ago. It will only be just if I share the story of one preterm baby that I took care of, Baby Rose. Baby Rose is not his real name. In the newborn unit, babies are given their mothers’ names. In the confusion and frenzy that comes immediately after giving birth, a mother can forget a new name. The one she gave her newborn. I was born Oliver Reginald Tambo. My father, under pressure to appease the spirits of his dead uncle, changed the name to Oliver Kiaye, and then I changed it to Kiaye Oliver. This confusion is what we don’t want in the nursery, and that is why all babies are called by their mothers’ names.

I am mostly a strict doctor. I am hard on myself and on everyone I work with. If you met me in the nursery then, you would be tempted to ask if it’s a matter of life and death. Yes, it is. I have become more accommodating lately because when you work in a broken system, you can only do and expect so much. Our rounds are ever so full of ‘this is a low resource setting.’ Mpaka lini?

720grams, this was the weight of Baby Rose when his mother had gone into sudden cataclysmic labor that had him come out with twelve weeks to go. Too early. His skin was pink. Pink and fragile. Tiny veins could be seen as dark lines running beneath the thin skin. His heart pounded like a distant train and his pulses were large for his age. He had a patent ductus arteriosus. Kisungu kubwa. Let this pass, I couldn’t avoid the jargon. So I saw him and wrote my notes.

The major challenge I had was putting a line in the baby’s veins so that he could receive medication. Remember at this time, I only had six weeks of experience as a medical doctor. I was not so good with those preterm lines. In my entire life, I have only had two successful cannulations in this population of patients. I called someone to do it for me as I organized other aspects of treatment. On top of antibiotics and caffeine, I did the daily fluid plan, put the baby in an incubator, and left. The next day was uneventful, I did my daily rounds as usual. Baby Rose was doing well as far as I was concerned. She was breathing in short bursts and then stops breathing briefly and then continues. It took time to sink in my head that neonates are periodic breathers.

Talking to Rose, the mother of the baby, this was a special child. She had lost several from similar circumstances before. She was the wife of an ex-army officer who had decided to start a new family after almost losing his life in battle. Battles change men. It makes some men soft and compassionate, while some become shells of their former selves. I gave her the reassurance that we will do whatever it takes to save the life of her baby and bring her joy. Childlessness can be a source of unending sadness. In the grand scheme of things, nature’s most prized characteristic of life is reproduction. She, mother nature, tricked us into mating by making sex a deeply pleasurable experience.  It was not going to be easy for Rose and her baby, I just didn’t know yet. Nobody knew.

The next day was rather uneventful. We had admitted so many babies to our unit. The March sun was blazing above with conviction. It synergized with the newborn radiant warmers to make the unit a furnace. Streams of sweat trickled from my armpit downwards making me uncomfortably wet. The newborn unit was the closest I got to the heat of hell that awaits sinners on the grande finale when the universe will empty into nothingness; when the Good Lord will come for his followers. I was tired. When I was about to leave, Rose called me across the window.

“Daktari, leo nitampea maziwa kiasi gani?”

She was a motivated woman. I told her to take care of the feeding and we would take care of the treatments. The feeding session went just fine. She had enough milk for her baby. Her tits were small though. Small and taut. Her suspensory ligaments were still strong. These ligaments loosen with age, making the breast drop and become pendulous. You would actually doubt if her baby was getting sufficient milk. The size does not matter. I have seen flat-chested mothers take care of twins. To each, their own. The oxygen levels of the baby were acceptable on low flow oxygen.

Fast forward to about ten or so days later, Baby Rose was not gaining weight. As a matter of fact, his weight had dropped significantly to just above 500grams. To put that into context, his legs were the size of an average human thumb. He was spiking fevers occasionally despite being on antibiotics. We went to second-line medication. He had episodes where he stopped breathing and that was worrying me. I was on call that night, I knew I had to make things right lest I stay awake the whole night pacing up and down trying to right every wrong. I had powerful antibiotics on board but again, no intravenous access. I tried every sort of vein that I could see or imagine without success. I called the anesthetist to give it a shot and see if we could get to something lakini wapi? From the way he held the cannula, I knew it would only take the hand of God to get intravenous access. I gave up folks. I went to gather some sleep. Sleep is hard to come by when taking care of babies. They change conditions so fast. I had not discovered my hidden cooking skills by then, so I passed by the cafeteria for some chapo beans.

The next day, we were lucky to get a small vein on the arm, the basilic vein. I cannulated it myself. I wondered where it was hiding all along. He got his meds as was scheduled. I felt like a neonatologist. A few days later, he had started gaining weight. This was promising. At least our efforts were finally yielding something. We optimized his feed and ensured he was warm and comfortable. The incubator was sanitized at least five times a day. That was part of our management plan. We were intentional about it. My consultant was particularly strict on infection prevention and control.

The weekend of Easter had proved very difficult for Rose and Baby Rose. The baby’s oxygen levels were dropping every so often. She was also getting apneic attacks more frequently. We went to the maximum oxygen levels that can be delivered by the special mask we were using. I called the consultant to discuss the state of the baby. I told him that we could be dealing with a spontaneous bleed in the brain that was threatening to reboot the system. The consultant advised me to refer the baby to KNH for more specialized care. Successfully referring a patient to KNH deserves a Grammy award. Dr. Maosa would be a celebrity if that were the case. His referrals are almost always successful. KNH had no space for Baby Rose. The care of Baby Rose belonged to me and my boss. My favorite consultant so far. I will not mention the name. Because I don’t want him or her to thump their chest saying they are Dr. Kiaye’s favorite. The consultant told me to prepare the mother for any eventuality; the chances of survival were diminishing with each passing day. Preparing a family for an impending doom is not easy folks. I have made it a habit not to give strict timelines. I tell people that life is in the balance, get ready. This is different from saying you have six months to live.

We did all we could. I kept updating his treatment and feeding. His oxygen levels were still low. Babies came in and out of the unit leaving him in the incubator in some corner in Cube C. He was proving to be resilient. He had fallen in love with his fate. When nature decides to put its faith in the feeble hands of premature neonates, you don’t give up on them. The baby was gaining weight albeit slowly. We kept our faith alive. As he was growing, we graduated from tube feeding to cup feeding. The hole in his heart was closing as expected after a course of ibuprofen.

One day Baby Rose’s oxygen levels decided to go up and stayed up. I stood by her and looked at the pulse oximeter for close to half an hour on that day. The saturations were constantly above 90%. It took me by surprise that a baby that we had ‘written off’ was starting to show signs of winning. I was happy, my consultant was happy, my nurses were happy, Rose was happy, the heavens were happy. We weaned him off oxygen a few days later. We were not off the hooks yet. We had to ensure that we consolidated our gains.

I left the pediatrics rotation before Baby Rose left the nursery. I was happy I was leaving a fairly stable child. He was at 1350 grams by then. I handed him over to my colleagues who were starting the rotation. I told them of tales and near-death experiences of that baby. And then I forgot about Baby Rose.

A few weeks ago, when we were walking with Dr. Maosa to the medical outpatient clinic, my attention was drawn to a woman who kept waving at me.     She had carried a baby in her arms. You know as a man, you could be shocked with a gift of your own baby without knowing it. You never know and you never trust yourself. Well, I don’t remember going in raw anywhere in the recent past and so I went to her. It was Rose. Rose and Baby Rose. I was happy. The baby had grown so big that I could not recognize him. He had fat cheeks and was bubbly. His mother had brought him to a routine pediatric clinic for regular check-ups. It was marvelous. He had beaten all the odds.