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.

 

 

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.