4:27 AM

Becoming a godfather

It has officially been a week and two days since I had the pleasure of becoming a godfather to my nephew, Leo. The baptism was a small intimate ceremony held at my elder brother's & his wife's house in the afternoon. 

The little cherub, Leo, is my elder brother - Emile's - firstborn son, and the last of the five Second generation Araos to be born into the family. At a mere 5.5 months, he's a very vocal baby, and quite outdoorsy - he'd rather go on a stroll outside than remain cooped in the house. He happens to be named after both his grandfathers (Leo, being the name of my father, and Kimani, after Nyambura's father).

The process of stewarding this young lad has been kept an all-family affair: Razia, his mother's elder sister, is his godmother, shouldering part of this great responsibility. I don't currently have any children of my own, but being a godparent is about as close as someone can get, without actually having any kids. I look at him, this great big bundle of possibility and potential, and recognize that I am now tasked with steering him towards the ultimate path his Almighty Father chooses for him. I have to be more than just his uncle.

The godparents

Baby Leo, Razia, Nyambura (Mum), Emile (Dad)

Father Maina wa Flora, Baby Leo, Nyambura

I recognize that there's a lot of work to be done, but I'm happy that I'm not alone in this task. I have his parents, his godmother, and the help of every individual who showed up to celebrate this beautiful start to his life in the Christian faith. I believe that his paternal grandfather is smiling down upon his namesake, and is just as proud of him as we are.

May God guide this beautiful work to its ultimate fruitful end. 
God Bless.

6:44 PM

X-men: Apocalypse Review

I got to watch the lastest instalment of the X-men franchise this past weekend at The Junction (because my procrastination cost me a chance to watch it at The Imax downtown). I must be picking the right times for watching my movies, because the 'free seating' doesn't seem to be limiting my chances of getting great seating.

This chapter starts off with an introduction to Apocalypse (aka En Sabah Nur) during his transferrence/renewal ritual in Ancient Egypt. Suffice it to say, things don't go as planned, so he ends up in stasis until his eventual awakening in the '80s.

Before that, however, we're treated to the roamings of Mystique (going more by 'Raven' in this outing) as a vigilante who helps free and resettle persecuted mutants (enter  Nightcrawler and Angel). We also find Magneto living a new normal life in Poland, with his wife and daughter. Professor X  finally has the school up and running, and Hank McCoy (Beast) is a fellow teacher. Among his students, Jean Grey, Jubilee, and soon a troubled Scott Summers, brought in by his brother, Havok.

Moira MacTaggert unwittingly wakes Apocalypse, and from there all hell breaks loose!

In Days of Future Past type fashion, this movie has a very serious tone. Apocalypse is that archetypical villain who actually wants to see the world burn (cleansed). So he assembles his mythical team of 4 Horseman - Magneto, Storm, Psylocke & Archangel - and sets upon rebuilding the world as per his vision. Like Sebastian Shaw before him, he willingly kill humans with reckless abandon; but he spares most mutants his wrath, even those with whom he finds himself in direct conflict.

Sophie Turner has a very telling line in this movie (albeit it in reference to Star Wars):
"...we all know the third movie's the worst!"
This isn't a bad quality movie, by any means. Magneto has a very deep story arc - even when he does right he can't seem to catch a break. He is an actual villain you can't hate for being a villain...it's as if God means for him to be a villain. I also loved Sophie Turner as Jean Grey. Not only is she feared by humans, but she's also a loner cast aside by her fellow schoolmates at Mutant school. I won't spoil it for you, but, when she's eventually let loose, no one will doubt her full power (a saga that they seem certain to explore in the not so distant future).

Beast, in his Incredible Hulk type incarnation is fine. They definitely improved on that makeup since "First Class". The re-introduced Night Crawler is also a joy. He's portrayed more in Alan Cumming's self aware (comedic) light tone, but as he grows I'd love to see him assume that unstoppable ferocity that we saw at the start of X-Men II.

It is sad, though, that they've decided to buoy this franchise on Jennifer Lawrence's Mystique. She is mostly 'Raven', this time around; justifiably, she's steering clear of the hero worship that arose from the events of DoFP, but casting Mystique in this new light just seems strange. I hope they're preparing her for a true turn of villainy in the next instalment. Sure, people complained about previous outings' Wolverine-centric focus, but I think that was one of Brian Singer's wiser decisions. You could blink-and-miss-it, but Hugh Jackman's cameo (longer than his First Class appearance) is magnificent. You've probably seen iterations of this Weapon X rampage scene in many forms of media, but this one is stunning. It's as close to "Berserker Rage" as they've ever let Wolverine descend. If they eventually plan for an "Old Man Logan" movie, this is the kind of Wolverine we need.

I found nothing wrong with the pacing of this movie, because the exposition benefits from the early layering of the story. I think the small roster of mutant characters facing off against Apocalypse - a la X-men III - is a bit disappointing because it leaves you feeling like there's no way in hell that the X-men should be able to win this fight. (Apocalypse's benevolence regarding mutants is certainly stretched to the maximum). Granted, this time around they brought Quiksilver along. This time they upped the ante with his speed, letting him moonwalk and clown around as he literally salvages the X-men. Seemed silly to leave him out of heroics last time, this time they needed him.

I'm interested to see how this new team evolves into the heroes that we know. McAvoy and Fassbender truly are great emotional anchors for this franchise. Wolverine still has a lot to offer this series. However, I'd love to see more levity returned to this series. Sure, it's hard out there for a mutant, but it doesn't mean you can't have fun while you're at it.

I'd give this movie a B+ (technically, this is already a "B" movie), and would recommend you give it a viewing. I'm going to watch it again today with my bro; let's see if any magic's waiting to be discovered on the second viewing.

Have a great weekend and God Bless.

4:26 PM

Introversion, Medical Practice, Guilt and Penance

Anyone who really knows me knows that I am an introvert by nature. And I've been an introvert since long before it was considered cool or intelligent to be an introvert; I remember that awkward phase where my parents thought it was akin to being anti-social (perhaps in the same way some parents used to actively discourage left-handedness in their kids). However, getting older doesn't fully take the awkwardness away, but it feels good coming into one's own, and especially because I finally gained the words to describe myself - Introvert, Melancholic. Eventually, even parents start to understand their own child's quirkiness, so I now have this beautiful statement that defines me:

"....There is wisdom in your silence...Open up..."
This is actually a compounded statement: first part is from what my mother wrote in a birthday card sometime in my early teens; the second is the last set of words my father said to me. So introversion is my gift, and it's also my burden.

Medical practice, on the other hand, is another part of my world. Medicine, and Science in general, fascinated me from early on in my childhood. I was a bit sickly in my childhood, thus I had more interactions with clinicians than your average kid. Those interactions were a real eye-opener because I became familiar with clinicians' "bedside manners"; hence, I run across people I'd love to emulate, and people I'd rather steer clear off (...and that process has never ended).

A third part of this whole equation is my Christian faith. In detail, particularly, I am Roman Catholic. I've been associated with multiple branches of the faith (some more palatable than others), but I always find myself gravitating towards Catholicism. I love the ritual, the sombre ceremony, its stoic nature, its innate silence and room for meditation, and that it's grounded in a long history of tradition. As my temperament goes, Catholicism is the perfect fit. And, like it or not, I bear my personal guilt like a longsuffering Catholic, so it helps that the rite of Penance is there to help set me straight.

All these things collided when I was doing my medical internship. Medical school teaches you a lot of things (allbeit 'book knowledge'), but there are many areas where you are left to adapt on your own. I could write a whole blog entry on "the things that medical school won't teach you" (probably will in future), but off the top of my head here are a few:

1. It can't teach you how to be a 'good' doctor.
2. It won't prepare you to deal with death, nor will it teach you how to break the bad news to relatives.
3. You will, at some point, develop a case of "the giggles" when dealing with patients.
4. You will undoubtedly cause the death of one of your patients.
5. The system can be very antagonistic, so you spend more time massaging your superiors' egos at the expense of patient care.
6. You will sacrifice a great deal in caring for your patients that will never be compensated.
7. A patient's return to good health and "Thank you" will melt your heart, and make your day.
8. You will run across a myriad of people on the streets who will be happy to see you...and you won't even remember who they are.
9. People will drop their guard around you, and ask your advice on a host of intimate medical maladies.
10. D.A.M.A aka Discharging (someone) Against Medical Advice will sometimes be an infinitely pleasurable experience.
11. Don't mess with the nurses!
12. The system will fail you on many an occasion.
13. Contrary to common thinking, it is a team effort that helps save lives.

For my current story, the more sombre points apply. During my stressful Gynaecology rotation, I was faced with a sickly mother who had recently delivered a baby. In the wards, she was newly diagnosed with HIV, and was deteriorating. She (and her husband) needed to be counselled so she could be started on treatment, but the counselors didn't show up; she had developed an emergent surgical condition, but the surgical team never showed up when asked to review her.

In context, this experience took place when all our clinical officer interns had left, and we were seriously overwhelmed with work. Regardless, our superiors merely expected us to step up our output, and get the work done. In the end, we lost this patient. There are few things that will ravage your soul more than a preventable death. I can still clearly remember her name till today. I carried the guilt of that experience like a heavy yoke, and it killed me a little on the inside.

How does one cope with the knowledge that they directly/indirectly caused a patient's death? My hospital didn't exactly foster a mentorship atmosphere, where you could turn to your superiors for advice; the hospital did have a psychiatrist on staff, but I never felt like I could talk to her without being branded as someone with a "depressive episode", with a corresponding entry being placed in my file.
When it comes down to death, there really aren't that many people who you can talk to about it apart from other clinicians; sadly, I never felt like I could share this with my fellow colleagues, not even the ones to whom I was closest.

I was only able to confess it to a priest a whole 1 year and 4 months after it all went down. I love the Sacrament of Penance; I know that God forgives me for my sins when I genuinely ask it, but it also helps to hear it spoken out loud. It goes beyond just the mere realization of being forgiven, and it assures me that I'm healing the schism my actions might have caused the community.

I am still sad that I can't fully correct this situation. I can't change the life of that aggrieved husband and his child. I have no idea what this course of events had on their extended family. The only thing I can do is to practise my vocation in such a way that this never plays out again. I will continue to voice my concern at the poor path the medical field is taking in my country, and I will mentor my subordinates so that they do not make the same mistakes; and, if they do make mistakes, I can be there to offer them the comfort and understanding that I once needed so badly.

God Bless.

4:43 AM

Captain America: Civil War - Spoiler free review

I'm a bit late to the game due to a fiasco that happened last weekend. This was supposed to be a bonding event for the Arao twin bros, but unfortunately, competing interests forced me to diss my twin (Sorry, Bro!). Anyway, I knew by hook or by crook, I was definitely watching the movie this weekend, especially after my bro let me know he watched it with his wife earlier today; just label it as some much needed R&R from time at the hospital.

Would've preferred watching a 2D version of this movie, but the only theatre showing it in 2D was in Nyali. I'm also a bit sore that post-BvS, both pairs of my 3D glasses have absconded to Burundi in a friend's purse (ahem, Annabelle), so I had to buy another pair. (Bygones).

So the Junction was my choice du jour. Despite them choosing to have us in a free seating arrangement, the theater wasn't too packed, so I got to grab a great seat.

This movie plays out in the same vein as "Winter Soldier", which is a delightful serious tone. The Bucky/Winter Soldier amalgamation is beautifully exposed, allowing us to appreciate his hard path, as well as question how trustworthy he truly is. Captain America goes from strength to strength, and his sense of loyalty continues to evolve. Upon his introduction in "First Avenger", all he wanted to do was serve, protect the ordinary guy from the bullies...as an army man. Events have made him more jaded about authority, and now, more than ever, his moral compass is his true boss.

I don't consider myself a Tony Stark/Iron Man fan, but I must admit this was his best characterization ever: less bravado, more maturity. Gone is the ridiculous PTSD Tony storyline that ruined Iron Man 3 (and Avengers 2), and now we have a Tony with a true motivation behind his guilt, shame and surrender towards authority.

Despite the full gallery of supers in this movie (including Falcon, WarMachine, Black Widow, Hawkeye, Scarlet Witch, Vision, Ant Man, Black Panther & Spiderman), this movie is a well put together tour de force. Thankfully, they get to build on mostly pre-introduced heroes, but in addition they fleshed out the rather scant Scarlet Witch & Vision (who sadly missed out in their Avengers 2 outing), and they built up the new arrivals (Black Panther & Spidey).

The chemistry between the heroes is real, and their interaction generates some great humour: Spidey manages to annoy both his team mates and foes in equal measure, joyless Hawkeye and Bucky make for some welcome dry humour, etc. ...And surprisingly, the issues are real too. Marvel typically shields us from the true cost of the supers' heroics because they keep their footage at the heroes' eye level. This movie shows that something totally different happens at ground level below a raging Hulk (allbeit in the course of protecting you from unfriendly aliens) and then some. Finally, a movie that earns its gravitas without having to look like it was dreamed/inspired by a Nolan.

Even the villain has clear well spelled out motivations. Say what you would about Baron Zemo, but by the end of this movie, you'll appreciate how much collateral damage he is able to create while economizing all his resources. He doesn't best brawn with brawn, but rather chips at cracks in the armour. Truly 'Experience and Patience' can achieve a great many things.

I can't say that this movie switched me from my position on 'TeamCap', but I am a bit more sympathetic towards 'TeamIronMan'. I worried that this outing would suffer from "being too big" (like Avengers 2), but those fears were put too rest. It is well scripted, well paced and elegantly developed. On top of that, it's well shot and the action scenes are beautiful. During my viewing, the theater folk erupted when Bucky reinvented a way to swipe and mount a motorcycle in one swift move. Kudos to the stunt team on this movie: they take home the 6th man award. Everyone really looks good doing their superheroics, and even for those who have to be CG-rendered, they still look real and practical. All the battle royales will impress you to no end. There were moments when the crowd let out peals of joy, especially at the end of the movie. I know it's useless to clap at the end of the movie (no one's there to take a bow), but for the heck of it, there I was, led astray to join in the clapping.

I felt emotionally tied to everyone in this film, invested the way you would be with a good friend. The Russo Brothers definitely earned their money's worth with this movie, and I'm looking forward to what they and their team have in store for us.

This movie will not disappoint. It gets an A+ in my books.

4:55 AM

Where I currently find myself

Hi Everyone.

I figured I'd pen something to let you know how things have been going for a while. To tell you the truth, I had a pretty tumultous latter part of 2015. What should have ended in celebration with an end to my medical internship, instead became a momentous disappointment with an extra punitive 18 weeks added to my internship; that's basically one-and-a-half rotations.

Most of my workmates were surprised at the stiff penalty handed out, which led them to question whether I had been implicated in the death of a patient that mandated such a stiff penalty. And the answer to that is a plain No! This just happened to be one of those situations where some Consultants just wanted to make an example of someone.

I admit, punitive weeks have their place in training interns, particular where lessons needs to be taught; however, they lose their efficacy when obvious bias exists in how different interns are treated; when egregious mishaps are just swept under the rug for some people, and others are treated with heavy-handedness for no reason.

There is an appeal system available at the hospital, but every intern learns very quickly that the same board that sat down to hand out punitive measures is the same one that'll listen to your appeal. An appeal to their previous decision thus constitutes an extreme act of belligerence, and will be followed with a steeper reprimand. So the unspoken rule remains:

"Do your time without incident, and leave when you're done."

As one of my colleagues has reminded me on many occasions, "Life isn't fair!" especially out here in the medical field. I was bitter about the whole experience for holding me back, and for the further manner in which they went out of their way to humiliate me further. Eventually, they commuted about 3 weeks from that stiff sentence, and I finished in late October. By that time I was thoroughly demoralized and just took my time finalizing my documents, during which time I gave myself a generous November and December as a holiday. January finally found me finishing off and handing my documents in for licensure.

Despite what I went through during the internship, I figured I would have an easier time as a qualified medical officer; plus, I had already settld down in Kisii, having already lived there for 1.5 years. Figuring that I had a better chance of being placed in a department of my choice if I started working before my posting was definite - basically volunteering - I made plans to return to the hospital's duty roster. However, my Grandmother passed away late in January, so I had to delay that venture till early February.

So I spent my initial stint working in the Internal Medicine department, but got trucked off unceremoniously to Surgical Casualty because of a Departmental crisis. Needless to say, I was waiting for the county to confirm my posting, but that just turned out to be futile. As March rolled in, things just seemed more hopeless.


Therefore, when I couldn't take it any more, I just packed up and moved back home. Some folks at Surgical Casualty wanted me to be reprimanded for the manner in which I left, but then again, how do you reprimand an unpaid volunteer?

That was basically rockbottom. Worst of all, this dillydallying meant that I've had to go 10 months without a pay cheque, so now I'm flat broke. However, some positive things began to happen: I had my interview for a Medical Officer position at PCEA Kikuyu Hospital on Holy Thursday, and shortly afterwards got the position. Once that hurdle was gone, it basically took me a span of 3 days (Friday - Sunday) to travel to Kisii, pack up my whole life of 21 months, and bring it all back home; and, yeah, rest for 1 day, and be ready for work on Tuesday.

I was surprised how things worked out so well. Makes me wish I'd made the decision to leave Kisii much earlier; I stuck by that place when my family tried to convince me to seek things out here in Nairobi. I'm guessing it became my 'comfort zone', caustic and fear-inducing as it may have been. In any case, I can't change what's happened, but I can learn from it, and grow.
With the ghosts of 2015 behind me, I'm now looking forward to brighter days and new beginnings...and infinite possibilities.
God Bless.

5:16 PM

Batman v Superman (Light) Spoiler Review

I wasn't expecting to be able to review this movie so early - since I had promised to watch it only once it was out on bootleg DVD - however, due to a strange twist of fate I ended up watching it at the cinemas: a friend (lady, no less) was amped about watching a movie at the the theaters before she left, and strangely, this was her choice. In case you haven't read my Man of Steel review (MoS), let me state that I detested that movie, and do not exactly fancy Director Zack Snyder because he had trashed the previous Superman movie lore, whilst not improving on anything beyond visuals.

Anyway, we watched the movie, and I can basically say that I had seen this mess coming from a mile away. I didn't go into the movie expecting to hate it from the get-go (as my twin bro thinks I did); rather, by projection from MoS and the stylistic choices made then, I anticipated an amplification of all the flaws brought out in that movie because of all the new story arcs and heroes that had to be interwoven this time around.

Let me first talk about the positives. Ben Affleck makes a great Batman; surprisingly, the biggest wildcard about this movie ended up being its saving grace. 'Batfleck' should no longer be considered a term of derision, and honestly the 'Sad Affleck' tidings just need to stop...he saved this movie. The whole Batman arc is the best part of this movie (including the cynical take on Alfred Pennyworth delivered by masterful Jeremy Irons). Unlike Nolan's Batman (beyond Batman Begins), this Batman can actually fight. He is a departure from previous Batman incarnations because this time he maims and kills with abandon. Rather than turn me off the Bat, it made me want to see a new standalone Batman movie so they could show what had driven him off the deep end.

This is also a beautifully shot movie, but this is a Zack Snyder movie so it was obvious that it would be a good-looking movie

The negatives abound, though. The same Superman arc that was so lightly fleshed out last time around is sacrificed even further here. Henry Cavill's Supes is as wooden as ever, his and Lois' relationship has grown by leaps and bounds despite not even being organically developed last time around. Lois is annoyingly inserted into situations (again!) this time that are for the most part irrelevant. Lex Luthor, as irritatingly rendered by Jesse Eisenberg, is the literal nail-in-the-coffin for this movie. People had been expecting a Heather Ledger/Joker-esque turn for this character, but it was not to be; the disappointment hinted at in the trailers only got worse the more this movie dragged along.

But honestly, after what Mr. Snyder put on show for MoS, how could people expect anything else? A lot of people wanted a big punch up from MoS, and that was what they got, but at the expense of any sort of useful character building (the big fight was what they said had been missing from Superman Returns, but that movie had character development laid out in spades). I guess once the crowd got that fight-jonesing out of their systems, this time around they wanted something more fleshed out. With this director, that was never going to happen.

So this movie is just MoS pushed to its logical expansion. Ma Kent is rendered more bitterly than previously imagined before, and the movie confuses itself by imagining it made us believe that it was Pa Kent's dream for Clark to be a superhero. (Clarification: that was Jor El's dream). Since MoS, I always wondered why Clark would ever want to be Supes considering this version of Ma and Pa Kent are so bitter, paranoid and cynical. Apart from Jor El, none of them pushed Clark to explore that Christ-like compassion that is a staple of Supes' comic book lore.

Just like MoS, the plot pacing is terrible, and it is built up so that it climaxes in a big final fight; but, I feel nothing for these characters, and I honestly wouldn't care if they were wiped off the face of the earth (maybe with the exception of Batman). And some of the plot points seem downright belittling. Some examples are required:

1. The Africa Desert incident was just poorly played. Supes probably only killed one person in that whole incident; seems rather superflous to blame him for everyone else who obviously died under a hail of bullets. (Heck, Justice League: Gods and Monsters, did a better job of framing Supes)

2. Lois and the Spear: one moment she's tossing it (understandably, to get it away from Supes). Next moment, she knows it suddenly important because she's serendipitously figured out that it'll hurt Doomsday. Then she gets herself trapped, and Supes somehow figures out where the spear is. Lazy writing par excellence!

3. The Batman v Superman fight also feels kinda avoidable. Once it became an issue of manipulation (and not The Dark Knight Rises Again philosophical clash), Supes could easily have let Batman in on Luthor's scheme. The movie setup gives us no indication that Lex is listening in on their conversation  or has them under any surveillance whatsoever. So, they could've convincingly play-acted if they really needed to convince him, while Supes bought some time to track down his Mum (by her heartbeat, voice, etc). If Zack Snyder still wanted to maintain the illusion of the BvS fight, he could later on suggest to us that Bat and Supes were in cohoots at some point in time (beautiful sleight of hand).

4. The Doomsday fight is a waste. It seems like WonderWoman might've actually had more hand-to-hand combat with that brute than Supes did. And then weaving "The Death of Superman" into this movie just kills it for me. As disposable as they made Doomsday, would've been better if they just fashioned him as Bizarro.

5. Lex Luthor is maniacal for the sake of being maniacal. He hated his Dad, he hates God, he hates Supes...full stop. He magically knows secret identities and family ties! This is a Lex who just wants to watch the world burn and we don't know why. I grew up with Power-hungry Lex, so I can relate to that version of him. This new one is a wholly new creation, but still remains a blank slate due to poor characterization.

6. The Justice League: people keep making the same mistakes that made Blade Trinity & The Amazing Spiderman 2 such terrible movies - focusing so much on spin-offs, that you mess up the movie entirely. Those 2 aforementioned terrible movies ended up killing the franchise, and we all know you can't have a spin-off if the franchise is dead. It's elementary! A few people have criticized the 'email-reveal', but what was sillier to me was the build-up. WonderWoman is basically a footnote in this movie, but they weave her in and out of it because...Lex has a dated photograph of WonderWoman and she wants it back. Lex has this photo ONLINE...what is Diana hoping to do...erase it from the cloud?

Using Man of Steel as a launchpad creates the same mess that the disastrous Iron Man 3 (with its terrible PTSD storyline) introduced into the MCU. DC had better work smart and get a new director for its Justice League ideas. Guillermo del Toro gave up on Justice League: Dark, but I'm sure he'd be game to work on Justice League. Also, they need to ditch the Nolanization. I don't want all my superheroes depressed and super serious. It works for Batman, but it could never work for Superman. And I don't forsee it working for Wonderwoman, or, God forbid, The Flash...only, unless you're doing "The Flashpoint Paradox".

In conclusion, just want to say that the lady with whom I watched this movie loved it. She didn't get all of it, she doesn't know much about the heroes, but she liked it. Which was the same point I made about MoS: had it been a story about another hero, a whole new mythos in which I had no prior stake, I would've enjoyed it too. However, this is Superman for goodness sake.

Well, that's my 2 cents for now.
You guys go on and enjoy your movie :)

P.S: Didn't dig the Batsuit. Looks too bulky, plus they've gotten rid of the undies on the outside (MoS style), but heck, they need something to break the dull grey colour scheme. Well, at least they never fully show the costume or focus on it for any long period.

10:25 PM

Internship snippet: Obs/Gyne

I was just thinking about how I never really managed to put out anything concerning my working experience during my medical internship during the time I was actually doing the internship (timing issues and not wanting to unceremoniously leak any confidential issues). Well, now, the internship is all but over, save for the issue of winding up and getting some signatures. I have to say that transitioning and finishing up for me has always been a bit of a difficulty. Anyway, I was talking to a friend the other day, and she asked me whether I had actually done any Caesarean sections. At the time, I told her that I had probably performed close to 100 as the primary surgeon; well, as per the official count in the OR log, it currently stands at 124 as the primary surgeon (there have been quite a number where I was the assistant, then there were also nights when I was just too tired to log in some entries).

It really has been quite the experience: Kisii Teaching & Referral Hospital, where I served my time is a really busy centre and referral cases come in aplenty. Nowhere does this sentiment ring truer than within the Obstetrics/Gynaeceology (Obs/Gyne) Department. I can remember nights when I’d hear an ambulance pull up to the hospital, say a prayer hoping that they were bringing in a case for the Surgical Department to deal with, and then rush up to the ambulance to confirm for myself. (Of course, I prayed the opposite prayer when I was doing my surgical rotation). :(

I must admit that Obs/Gyne is a hustle to deal with: due to Kenya's fascination with the Millennium Development Goals (MDGs), maternal-child health is a big deal; however, we embraced the ideals and goals, but have not exactly put in a step-by-step program to achieve them. What this did was create an untenable work environment where the onus for maternal death is put on the hospital (particularly the intern), regardless of the pregnant mothers' antenatal care history. On top of that, the work is tedious; I actually lost weight during my Obs/Gyne rotation.

Personally, I love practising surgery, and there’s no better teacher than lots of hands-on work. I still feel as excited stepping into the surgical theater as I did almost 10 years ago when I first volunteered at the Harrisburg Hospital. Performing surgery is art and science melded into one, a beautiful dance where everything enriches the experience: the anaesthetist with his/her real-time command of the patients condition, your assistants both at the operating table and those in circulation, and recovery; even the cleaners keeping the place nice and orderly are a massive help.

Obs/Gyne is not as varied a field as General Surgery, so there were very few procedures you get to perform; king of them all is the Caesarean Section. At this hospital, it's pretty much regarded as an Intern's procedure, unless there is a particularly extreme degree of difficulty inherent to a specific pregnancy. That is quite a lot of pressure to place on an intern; consider that (according to my friend in Australia) post-graduate students in other countries ONLY assist with the C-sections! The quicker you learn to be confident at performing a C/S, the better; my immediate superiors - the medical officers - were none too fond of being woken up in the middle of the night by an intern to come assist with a C-section. Knowing how to handle things at night with a skeleton crew is key.

All risks considered, a C-section is a pretty safe standard procedure; I have only had one mother succumb on the operating table (and that was because she had severe antepartum bleeding). I can't forget the near misses, though: on one occasion, a mother developed hypotension as soon as the spinal anaesthesia was injected and she just flatlined (breathing and heartbeat stopped cold)! Hence, before progressing to anything else, we basically started by resuscitating the patient; once the patients vitals were restored, we performed one of my faster C-sections. There doesn't seem to be anything written in literature sources, but it is a startling experience dealing with someone who has flatlined in the course of being anaesthetized: they pretty much seem out of their mind, overly emotional, unsettled, which in turn makes you question whether some sort of brain damage occurred. Thankfully, daunting as the experience is, the patient is in good condition when we review them the morning after.

I don't see a future for myself in Obs/Gyne, but I am at least thankful for the experience. Many a prayer were silently prayed over my patients as they lay on that table; prayers when I was starting out and the thought of being in-charge of systematically slicing someone open weighed heavily on my nerves; prayers when difficulties were imminent, and especially when complications arose. Thankfully, the Lord was faithful.

One downside to this whole experience is the sheer number of patients that we get to deal with. The intensity of the experience, at least on my part, meant that I formed deep relationships with mothers who I had to reassure and counsel on the best course of action for themselves and their unborn children. This occurred day in and day out; sadly, I can scarcely remember many of those interactions; it's as if they were wiped clean from my mind as soon as they were formed to make space for more equally intense versions of the same experience with other emergency patients. Or perhaps I'm just bad at remembering my own patients beyond a certain space of time. Thankfully, the patients never forget: Kisii is a small town, so its not unusual for me to bump into a lady on the street, for her to hail me as "daktari", and then remind me that it was I who helped her with a difficult delivery. It's things like that which make working in the medical profession a blessing, much more profound than anything money could ever offer.

I don't exactly know whats slated to come in the near future, nor where exactly I'll be headed be it another part of Kenya or Post-grad school - but I'm hopeful God will push me in the right direction (because I plain stink at transitioning).

Have a great week. God Bless.