Monday, May 22, 2017

The Music of Pat Metheny: "He's Gone Away"

Nestled in the eclectic works of Pat Metheny (circa 1997) is a collaborative effort between him and the late Charlie Haden (Rest in Peace) entitled "Beyond the Missouri Sky (Short Stories)". The album is a mix of original compositions and covers, and one of the most beautiful covers that they put down is "He's Gone Away".

He's Gone Away probably ranks up there with great American folk classics. I can't think of this classic without my mind gravitating towards "Shenandoah", probably the next best classic. Seeing as it's quite the old song, its history is mired in some confusion. It is probable that multiple versions exist, with new lyrics added as the song traded hands or traversed generations; be that as it may, it still retains its beautiful ballad quality.

This is one of those quiet ballad pieces where Pat excels. It is also really suited to the "plain" playing style typified by Haden. I'm not trying to Christianize Metheny's version of the tune, but this version feels like it pays homage to "Amazing Grace"; at least, my ears pick an Amazing Grace motif just after the preamble. In much the same manner, the beginning of Lyle Mays solo on San Lorenzo is also capped by an Amazing Grace motif. I don't know whose decision this was (Metheny or Haden), but it makes the rendition that much more soulful.

There is so much meditative "space" in this song. It's as if the silence (and the unsaid) in the song evokes as much passion as that which is actually played. Pat's guitar is most prominent throughout the performance. When they're evenly matching it up, it seems like Pat plays at least 2 notes for every deep note churned by Haden's bass; then they eventually segue into all-Pat. The middle portion of the song actually surprised me today. I've listened to it countless times, and only today did I realize that Pat is overdubbing himself - using the same guitar - to give that impression of a guitar duet. I always assumed the accompaniment was from Charlie Haden, but there is nary a bass note to be heard.

Towards the end of the song, with Haden again on bass, the song is more sonically filled as a result of the overdubs of Metheny's guitar (I have no idea which other one he was playing in this case) that seem to carry the same weight/gravitas that a violin and horn would. It all builds up to this beautiful crescendo conveying the full emotional force of the song, and then magically ends with what you first heard as the preamble.

Some people responded negatively to the overdubbing and feel that perhaps it made the performance less pure. It's sad that we will never get to see a live version of this piece performed. Their tour for this was strictly a duet, and I feel like getting this performance down perfectly would probably have required a second guitar player in tow. Sad! In case you do find any live Metheny/Haden versions that are labelled as "He's Gone Away", they are merely mislabelled versions of Farmer's Trust.

I'm not a purist by any stretch, and I offer this as a definitive 'keeper' from the Metheny songbook. This should appeal to anyone, any age, any leaning. A ballad it may be, but it also captivates the soul like a simple lullaby. The beauty is in the music.

God Bless

Friday, May 12, 2017

The Things That Medical School Won't Teach You (4) - Sometimes, you'll end up hating your patients!




Everyone gets a little tired of their job sometimes, it's about as natural a process as it comes. If someone is enjoying their job 100% of the time, they are probably as rare a commodity as a unicorn. I believe job satisfaction probably lies somewhere between maximizing the "ups" and minimizing the "downs" of your typical work routine.

As a medical practitioner, I can attest that medical school, TV shows and even forerunners and mentors at least gave me the impression that the medical field would be hard. The hours are tedious, the life is downright difficult, and your colleagues and their respective idiosyncrasies will prove to be a challenge. But then, no one ever prepares you for how challenging your patients will actually be; I'm not talking about your patients' illnesses because between your training and your superiors you'll have that covered. I'm talking about those little unexpected moments when your patients (and their relatives) set you up for failure.

Scenario 1: No situation rings truer than the one I so optimally used to introduce this post. If you've managed to go through your internship without your patient turning on you during the ward round, you are one lucky person. Tragically, even very recently as a medical officer, I had taken an extensive patient history that lasted about half an hour in preparation for the major ward round. As soon as the consultant shows up to listen to the history, the patient starts to poke so many holes in my retelling of the history such that even I am left in doubt as to whether I clerked that very patient. However, the embarrassment doesn't stop there; if you have a consultant like mine, you will be berated in front of your colleagues, accused of 'confabulating' (aka LYING) and dismissively asked to return to take a proper history. Lord knows I am not a spiteful human being, but whenever I have been privy to such treatment, I usually give such a patient a wide berth.

Scenario 2: There are probably fewer less comfortable conditions than morbidity. Being stuck in a strange bed, having nurses (and nurses aides) interrupting your rest on a regular basis to take care of you, and last, but not least, having to endure the ward rounds. Granted though, patients will put up with this because they understand that we're trying to get them better. I remember once having a patient in the ward who looked so sickly, like he was on his way out of this world; on the cusp of kidney failure, yellowed eyes and just a generally poor disposition. First time I talked to his family, I basically HAD to reassure them that he would get better. Eventually, we basically discover that he's only suffering from an acute infection, and we're sure that he'll recover full kidney function.

Once the relatives discover he's out of the woods, their true colours come out: complaints and demands galore. Suddenly, it's as if my medical knowledge counted for nothing, and they're the ones who were in charge. Mind you, this happened during the healthcare workers' strike, and it was beyond irritating to have a basically stable patient demand more attention than the less stable sicker patients.  can't lie: I thanked God when we discharged that patient!

Scenario 3:



Speaking of demanding, few things will irk you more than the patient who shows up at the most inopportune moments. As a rule of thumb, kind of like Murphy's Law, a patient is likely to show up needing your help when it's time for you to clock out and head home. Even worse, though, is the scenario where someone shows up at the Casualty (A&E) Department at the oddest hour of the night with an easily treatable malady. If you've been unlucky enough to work the late night shift, you'd understand that you're usually working with a skeleton crew, basically the bare minimum. As if that wasn't enough, the late night clientele can sometimes resemble the idiosyncratic late night Walmart shopper: CRAZY!

I understand that you may have your issues, but it does help if you're considerate about the tasks that we juggle in those circumstances. We operate in triage mode in the Casualty Department, meaning that regardless of the time you set foot in the department, I am going to address the needs of the most severe patient first. I pre-assessed you really quickly and I'm 97% sure you have the flu, so I'm pretty sure that between your headache and chills you're not likely to expire within the next hour. Allow me to attend to this head injury patient who's so banged up that he lacks the capacity to even complain about his situation.

Scenario 4: All hospitals are definitely not created equal! Every person working in a hospital is particularly aware of their hospital's degree of competence, and perhaps more critical of the hospital than an outsider might be. Be that as it may, we are sensitive to being criticized by an outsider. It's very much the same way you might feel comfortable calling your sibling an idiot, but God protect the individual who tries to heap such disrespect on the very same sibling.

As an intern, I once had the misfortune of having the uncle of an MCA (Member of County Assembly) admitted to our hospital to undergo prostate surgery. This was tragic on so many fronts:

  1. An MCA is, for the most part, an overpaid but practically useless political post that we've somehow been saddled with since 2013
  2. Many of the individuals chosen as MCAs take it upon themselves to lord the position over individuals in government institutions, like hospitals.
  3. The limited staff we had in the surgical ward ended up being diverted to the VIP patient's beck and call...and he wasn't even thankful in the least.
In my opinion, if you really can pay for admission at a better hospital, why would you feel the need to game the system, and then mistreat the people who are trying to help you?

Scenario 5: The dysfunctional family. There are few experiences more trying than having to deal with a sick patriarch/matriarch who's admitted in your institution, but is pretty much in the middle of a "custody battle" that gets dragged into the hospital. Sometimes it feels like their relatives are already counting the spoils even prior to the patient's demise. Never have I run into a bunch of entitled individuals who will frustrate your management of the patient, and seem ever eager to drag the hospital into a lawsuit at the slightest perception of an insult.
For your sake (and that of the hospital), make sure to DOCUMENT EVERYTHING! Your notes had better be crisp and concise and up to date. Lord knows you don't want to be sucked into the black hole that this debacle will turn into. On many an occasion, don't forget to emphasize how inadequately your institution is equipped to handle any serious emergencies that may befall the patient, and be on hand to provide them a referral to a top-notch medical facility of their choosing.

There are a myriad of other situations, but this is all I can summon up from memory at this juncture. The commonest string that binds them all seems to be "the demanding patient"; thus, it is in your best interest to always be able to pick out those patients that are likely to be the most demanding.

 Take home message: this life can be hard, but the more prepared you are to face the other awkward stresses that come your way, the more bearable your medical experience will be.

Take care and God Bless.
   

Tuesday, April 18, 2017

Easter 2017

The recently ended season of Easter was quite the enjoyable experience. This time, especially, since I got to spend most of those days away from work. An eclectic bunch of memories from my past cross my mind whenever I think of my past Lents/Easters. In no specific order, I think of

  1. 5-day holidays from being in a Catholic high school (Holy Thursday to Easter Monday)
  2. Easter of 2014, probably the last holiday period I enjoyed before the start of my internship period. (That was an exceptionally hard year)
  3. There was that one Easter in China when the church I used to go to burnt down
  4. Preaching on Psalm 22 one year, only to have someone else preach a totally different (contradictory) message on the same issue a year later.
  5. 2007, my first year in China, when the whole season went by without me even realizing it. 
  6. 2004, Messiah College: choosing an extremely hard challenge in terms of what I gave up for Lent
  7. 2004, Messiah College (redux): having one of my Kenyan colleagues concoct an April Fools' Day joke so hard it rocked the Messiah community to its core. (They were none to pleased with Kenyans for a bit there)
  8. Mr. Creavey (who'd occasionally give me a lift to Elizabeth Ann Seton Church) and his sons playing trumpets during Easter Sunday mass on Patti Drennan's "Sing, O sing a jubilant song."
  9. Cathy Poiesz organizing the small catholic community at Messiah for a lovely night service at a massive church in Harrisburg (possibly Cathedral Parish of Saint Patrick). I remember the choir had balcony seating and sang a haunting rendition of "Remember your love"
Apparently my most vivid memories are associated with my time at school. Seems like I'm itching for the good bit of education 4 years after graduating, but that's a story for another time. Seems like all I do these days is work, and then when I get some time away from work all I want to do is de-stress. I would've loved to indulge myself in all that the season of Lent presents, but with the exception of 2016, my mind can't really be tamed enough to meditate.

I love this season, its sombre tone, the heartfelt music. It is the most appropriate season for me to contemplate "What wondrous love is this" or "God of Mercy and Compassion". Well, in any case, I can't be too hard on myself. This (religion) is more than just the seasons in which I get reminded to reinvest myself in things heavenly. It is an everyday walk that I need to apply myself to. Thank goodness I've got leave coming up in May. I need to find myself some place quiet to just put everything in perspective, and time away from the disillusionment with medicine I've had of late.

I may have barely made anything of myself this season, but I'm hoping to make something of myself starting this week. Feeling doubly blessed after that 3-day weekend (ended up being pulled into work on Good Friday), and this week my boss is at a conference overseas so I get to exercise more control over patient management. Definitely looking forward to shorter ward rounds and more time to myself. This is what dreams are made of.

God Bless.

Thursday, April 6, 2017

The Things That Medical School Won't Teach You (3) - The Giggles



I'd like to start this particular post with a very specific memory: it was circa 1997 and I was in my first year of high school. We were out on the sports field taking part in a class rugby game, and a member of the opposing team tackled me by grabbing me around the waist and swinging me backwards. It was by no means a bad or dangerous tackle (I've taken much worse hits), but unfortunately, I fell awkwardly on my right wrist and experienced excruciating pain.

I dragged myself onto the sidelines and sat out the rest of the game. Despite licking my wounds, the pain had not subsided by the game's end. From there it was off to the high school clinic, then back home, and finally off to the hospital (the former Masaba Hospital, if my memory serves me right). Just as I'd feared, I had fractured my wrist. Was probably a stress fracture because I can recall that, not too far back, one of the poles from a tent had struck that same wrist while we had dismantled a tent at school. At least it wasn't bad enough that it would require an implant; but it did require me to endure a POP cast for a period of 3 months. The worst part of this whole affair was the indignity that I was exposed to at the hospital. I remember the two female nurses taunting me for having the gall to play rugby, me being so spindly and all. Even worse, each of them kept squeezing the wrist to elicit the tenderness. Worst of all was when the doctor showed up and joined in the taunting. I remember that he was a massive fellow, but despite his stature, he claimed that he wouldn't be caught dead trying to play rugby. What on earth made me think I could indulge in the sport? Three taunting medical professionals, a fistful of pain and a dented ego made for one unbearably bad night.

Fast forward to my days as a medical professional, and the experience has been softened in hindsight. This is neither an admission that I have taken up a heavy-handed approach to patient care nor find it acceptable for other practitioners to disregard their patients; it is, rather, an admission that sometimes one person's malady can be another's (comedic) pot of gold.

I've said it once, and I'll say it again: a lot of your friends/family/colleagues who work in the medical field are damaged goods. You can attribute that to years and years of rigorous training, being part of a profession where your superiors have the bedside manner of an army drill sergeant, and impossible situations that everyday practice will throw your way. Like any good professional, we get used to the life....and then we begin to find humour in even the most macabre of situations.

Thus my disclaimer would be, "we're laughing with you, we're not laughing at you!"

Medical personnel's brains are wired a bit different from the rest of the population. In much the same way that firemen (and other first responders) are geared to run towards situations of danger, we actively seek out those situations that we've been trained to handle. A lot of times we're even fascinated by all that strangeness. A lawyer friend of mine was talking about his experiences with helping Key populations (aka people most at risk of contracting HIV - Gay men and IV Drug users). He commented that some gay people feel stigmatized when they show up with anal infections because the nurses start calling each other, "Kujeni muone maajabu!" (come see these wonders!)
Two things are at work here:

  1. Bad PR because sometimes we focus more on the ailment than the person.
  2. Utter fascination at getting to see things that previously we've only ever encountered in our books.
Size, complexity, consistency...really a treasure trove for the senses. If you happen to be at a teaching hospital, you and your "condition" will be celebs for the day.

Thanks to shows like House MD, which exaggerate bits of the medical experience, you can understand that our minds are trained to probe situations, sometimes to extreme lengths. So, for example, when a patient walks into the Emergency Room with a fractured penis, normal minds might stop at merely thinking "Ouch! That must really hurt!" But not your medical friend. His/her mind works a little like this

  1.  "Ouch! That must really hurt!" Let me take care of the patient's discomfort first.
  2. Let me document the patient's account of what happened (Will it be truthful, though? Patients lie, right?)
  3. The likely cause of injury occurred when aforementioned part probably encountered such-and-such in a traumatic clash 
  4. Chances are that the woman that caused this "accident" is not likely to be the man's wife, because statistics show that ...
  5. My colleagues have heard about this case and have come trooping down to see for themselves what's up. Everybody's going to be giving their "2 cents" about this case.
  6. How on earth am I gonna keep a straight face when I have to present this case to my consultant?
If it's a good day, I'd be putting on my stoic face and would succeed in keeping a straight face throughout the whole encounter. If it's a bad day, anything can set you off laughing. Sometimes the patient's voice or demeanor could be a trigger; sometimes the consultant will callously utter such a brash statement that leaves you beside yourself with laughter. At other times, it's just the nature of the situation. I remember getting the giggles when my colleague was presenting a patient history in the ward: this middle aged lady had been walking home in the dark and had, in a stroke of bad luck,  randomly fallen into a pit latrine that was being dug. Don't know what it was about the case, but it left me in stitches. However, God forbid that you should draw attention to yourself by randomly bursting into laughter while you're in a team of 15 conducting a ward round. You suppress that laughter like a boss and ride out the period of mirth.

Sometimes I feel guilty, like I'm headed to hell for finding some of these things funny; but, it is a coping mechanism. I think you'd rather prefer that I find your situation funny and can engage with it 100%, as opposed to fearing it and being overwhelmed by it as most normal folk would. As the disclaimer states, "I'm laughing with you, not at you!" Don't condemn us for our laughter/amusement, but appreciate that it is a joyous part of our day to find amusement in a day's work.

God Bless.    

Saturday, March 4, 2017

Logan Review (spoiler free)


This was an unusual entry into the X-men universe. This finally makes this series a trilogy, which I have thoroughly enjoyed. People give the first entry in the series more grief than it deserves. As I remember it, it had the dubious honour of having a critic review an unfinished leaked copy of the movie, and then it was all downhill from there. Anyway, that's a tangent for another day.

This trilogy has been quite unique; in some ways as unique as the Captain America trilogy. It basically employed the same format, starting with one director, then shifting to a second director(s) who helmed the second and third movies. Despite this being the same director, the 2nd and 3rd movie are stylistically very different. In Captain America, it was because the Russo brothers had morphed "Civil War" into Avengers 2.5; in this case, James Mangold was aiming for a movie straddling multiple genres (Dystopian future/Western/Road Movie).

As you know from all the media hype about this movie, mutantkind has for the most part disappeared. What remains are a few vestiges; what we see of those vestiges are  Wolverine, Caliban and a 90-something Professor X. Logan's invulnerability isn't what it used to be, and the Professor is more liability than saviour at this point in his life, with major repercussions for any humans in his vicinity. Things can only get worse when Laura aka X-23 is introduced into their lives.

It was hard to watch these 2 X-men brought down to this level. Wolverine has always been the Lone Wolf who is sometimes called upon to be the ever reluctant hero. Despite all the bad that humankind has forced upon him, at least he always had invulnerability to rely on, and the choice to hit the road when he so desired. The pillar that was Prof. X is now also a distant memory; in a change of roles, Logan is now tasked with eking out a living to cater for the Prof. and his many special needs. The antagonism between the two of them gives the movie a lot of heart, sometimes intensely engrossing, and at other times hilarious when the Prof. exhibits petulant outbursts.

However, ever the heroes that they are, Laura's needs are a call to action, and even a chance to earn some redemption.

All things considered, this was a great movie, beautifully shot and well paced. I remember the joy of seeing Wolverine break out into a berserker rage in "X-men: Apocalypse", and this movie managed to one-up even that bit of gruesomeness! The R-rating on this movie is definitely used to good effect, whether it's Wolverine or X-23 doing the eviscerating. Though it's set in the near future, the movie is mostly grounded in the present, with the reavers and minor elements reflecting anything of futuristic proportions.

I have to come out and state that this movie is really its own story. Coming into it, there had been talk about them adopting the "Old Man Logan" storyline (definitely a great read if you come across it), but apart from the "Open Road" element of that comic, there isn't much of similarity worth noting.

This is (somewhat) a Marvel movie, so the complaint may arise that the bad guys are not really captivating. I don't think this will be the movie to change your mind about the dearth of characterization for villains in the Marvel stable. On the plus side, though, reflecting on Logan's tribulations will make you understand that the baddies are just an unfortunate hurdle. It could've been anything really. Anything that pushes against him so hard when he's at his most vulnerable seems downright insurmountable.

Hugh Jackman, Patrick Stewart and Dafne Keen are the heart and soul of this movie. What surprised me most was how many times Prof. X dropped the F-Bomb in this outing; all his typical decorum is thrown out the window, and he must've picked up some Wolverine-isms after being cooped up with him. For the most part, Hugh Jackman is reduced to brooding, but his emotions cover the whole range of the spectrum...with the rare smile chipped in. Even though Logan is even more reluctant to be a hero in this outing (Prof. X seems to be the one more concerned with looking out for X-23), Jackman imbues even the neglect with a true humanity. And Dafne Keen will not be afflicted with the "bad child actor who ruins a good movie" title. She has little dialogue for most of the movie, but her facial expressions and physicality convince you that she's more than a little bundle of joy. I look forward to seeing her take her rightful place in the X-men franchise.

I feel like this movie has emotionally drained me; it will take the love you have for these characters and beat you down with it. But, if ever there was a way for the roles of Prof. X and Wolverine to be retired (by their respective actors), this was it. Five star performance that's definitely worth watching. I still feel like there's more left of this story to tell, but maybe the X-men can give us that in a future installment that involves X-23 and Nathaniel Essex (aka Mr. Sinister), who was teased at the end of X-men: Apocalypse, but sadly didn't make it into this movie. Maybe some other day.

God Bless

Saturday, February 25, 2017

Green Thumb

Seems great to finally have some time to just sit back and chill. The whole rigmarole stemming from this whole medical health workers strike is still dominating my whole work life. Can't change anything about that, but I can find something totally different to do on my downtime. 

I've been fascinated with plants for quite some time, but I don't think I've ever intentionally grown something; so I decided to give it a try. For my first bit, it was actually just a small transplant job. The sitting room plants had gotten worse for the wear, so I decided to switch them out for some Monstera deliciosa which is what my Dad usually had growing in the sitting room while I was growing up.  



So this is what the plant looked like after I transferred it. Most of the leaves were quite old and dusty, but these were the best Monstera specimens I could find down at Dagoretti. Shortly after some watering, the middle stalk began to unfurl a new life









And voila! dead centre, we now have the new leaf (proof that I didn't end up killing the plant).

I've also taking to spritzing the leaves from time to time to give them a nice sheen, and maybe keep them from looking so dessicated.










My second foray is more of a long term project. After spotting the above magnificent bloom from the Purple Orchid tree (Bauhinia purpurea) at the PCEA Kikuyu Hospital, I figured that I would take a stab at growing Bauhinia from scratch. From my time at Wenzhou, I'd encountered it as a common avenue tree. Even retracing my steps back to my primary school, I too found it growing vibrantly in the school compound. Thus, I waited for the blooms to give way to precious pods, and then had to wait for them to dry and time things just right before they scattered their seeds to the ground.


And this is the result. Four out of the seven seeds I planted sprouted, bearing the typical bilobed leaves.












I don't know where I'm going to put these plants in the long term, but I feel the urge to continue with the experimentation. At least, I know I'm going to use the next plants I grow for landscaping at our upcoming house. Have an eye on some Agapanthus seeds with a view towards growing up to 100 Agapanthus seedlings. Also want to do some experimentation with some local bamboo, but I want to make sure I can find the "clumping" variety, as opposed to the the friendship-destroying "running" variety.

Other than that, life is just as it should be right now, I guess. Will keep you posted.

God Bless.




Sunday, February 12, 2017

Feb 2017

Dearest me, Smonday is already upon me!

I've gotta say, since the doctors' strike started, last week had to have been one of the worst weeks I've ever faced. For starters, I pretty much put in 60 hours worth of work during the week (...and none of that comes with any overtime). I think the earliest I actually got home might have been 8.20 pm, which coincidentally happened on Friday, the day most people are like to make their exits before 5.00 pm.

I've been so tired lately that I'm starting to embrace the Kenyan culture of not reading. By the time I'm done with my patients and all such related activity, I just want to get home and de-stress. My mind can't be bothered with fanciful thoughts of reading or even trying to keep up with new advances in the medical field...I'd rather just soak in some sensory deprivation and chill.

Last week, I even had the dubious distinction of being tossed under the bus by my consultant for some shenanigans that went down at the hospital. Of course I can't divulge any of the details, but it has got to be one of the most underhanded things that has happened to me while I've worked as a doctor. People don't understand how much medico-legal detail is involved in dealing with patients, and I think a lot more people would steer clear of the medical profession if the actually found out. We may have come along way scientifically, but there's still a lot that we don't know about medical practice. Sometimes it can actually feel more like practising an Art than a Science.

The patients and their relatives will see things differently though. I think medicine is one of the few careers where people feel like they can question your acumen without having even a basic grasp of the concepts involved. Even a primary school teacher is unlikely to get called out on the pedagogy that they employ to teach their students; but a doctor is fair game to everyone. We have moved away from Paternalistic Medicine to a more shared patient-doctor relationship, which I feel is more ideal; if you can understand the disease process and its respective treatment, then I believe the patient can participate more actively in the treatment. Don't get me wrong, if the situation calls for it and either their patient or caregiver is unable to fathom what needs to be done, it is my duty to go "over their heads" and be paternalistic, for the patient's sake.

There is, however, a third patient-doctor relationship that has developed lately that emphasizes Patient Autonomy. If the patient has the necessary education or understanding of their condition, this may be bearable; however, a lot of times you encounter this from a patient who merely wants to be in-charge without a semblance of a clue as to what they actually require. These are the patients (and relatives) that are likely to haul you court for some good old litigation. Thank God I have an extra card up my sleeve for such patients: I can just "Discharge (them) Against Medical Advice" (DAMA), and let them end up being someone else's problem.

I think I'm just a bit disillusioned by the medical field these days. Job satisfaction is at an all-time low, and I don't have the energy to keep myself afloat. I'm beginning to detest some of my patients and the systematic failure at my workplace is just draining. I hate this government for doing nothing to avert or even alleviate the effects of this strike; I'm annoyed at the general public for not having the guts to even try to keep this government accountable despite the egregious missteps that they have committed.

Lord knows I just need a break. Maybe a change in this 10-month routine will do me some good. Something's got to give.