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.

Sunday, January 22, 2017

Memories: A Bad Day at The Office




It's already been quite the tumultous start to 2017 down here in Kenya. The doctors' strike drags on for yet another week, and now, in much the same manner, university lecturers are also on strike due to  talk of yet another unfulfilled Collective Bargaining Agreement (CBA) from 2013. The writing on the wall is obvious: politicians can't be trusted to fulfil any pledges they make in the wake of an election year. Lord knows what other messes they'll be orchestrating in the remaining 7 months of election campaigning.

I feel like the doctors' strike would have ended earlier if we only had a limited number of people taking part in the negotiations, i.e. the president, his ministers of Health and Labour and the doctors' union. In all honesty, other groups like the SRC (Salary & Remuneration Commission) and the Council of Governors have nothing of importance to add to this issue. Devoid of such organization, we are being treated to trivialities that border on the obscene. Social media was ablaze with #IamNotSewage because the Labour Court judge (Wasilwa) hearing the case openly referred to the collective striking medical body as stinking of sewage. (Apparently judges must be skipping Decorum 101 these days). As if that wasn't enough, just recently a 'nominated' Member of Parliament tried to whittle the strike into an issue of tribalism; this earned the ire of the medical fraternity, and now we have #TribelessDoctor trending.

All the wrong people are doing the talking, which is driving the doctors irate. Has any of these sanctimonious individuals ever set foot inside a public hospital, apart from occasions for photo-ops? Can they really sympathize with a general public with whom they have nothing in common? Do they even understand the situations that medical staff have to contend with, especially those that go above and beyond the call of duty? It is probably for these reasons (and many others) that another topic has been trending - #MyBadDoctorExperience. I hear that initially the topic was created to highlight patients' bad experiences at the hands of incompetent doctors; but as later stories will attest, the doctors are currently using it to highlight the traumatic experiences they've experienced at the hands of the healthcare system. It is only a glimpse of what doctors experience, but it is enlightening nonetheless; and I guess it's time to add my experience to the fray.

*Friendly Advisory: beyond this point, some of this gets a little graphic! 

It was about mid-December 2014, and I was knee deep into the 2nd rotation of my internship (Obstetrics & Gynaecology). I believe that at that point, of the 3 interns in the department (Fiona, Lucy and myself), I was 'stationed' in the Labour Ward. I use the word stationed lightly because throughout the course of the day, we all converged at the Labour ward to handle whatever business came up. Considering how overwhelming the work could be for 3 interns, it was very typical for the 2 interns who weren't on duty to end up leaving the hospital after 11.00 pm. Only one of us was ever on night-duty, but we figured that it would be better for us to let the intern-on-duty disappear to freshen up at home; that intern would then report back to the hospital around 7.00 pm, but we'd basically have the intern relax in the call room while we cleared every issue in the wards. Some time before 11pm, we'd join our colleague in the call-room and just debrief each other before we set off. Turns out it was a great way to de-stress and keep ourselves sane.

On this particular day, around 4.00 pm, a patient (about 38 years old) showed up to the Labour Ward; (for my convenience, I'll refer to her as "Edna") by all regards, she was a stable patient, obviously in the 3rd trimester of her pregnancy, and had been admitted because she noted reduced fetal movements in the course of that day. I take down her history, and I find out that this is her 5th pregnancy; all prior pregnancies had ended in normal deliveries, but they had yielded only girls! So here she was hoping that this particular pregnancy yielded a boy so that she could call it quits procreation-wise. By all accounts everything's normal, until I dig out the fetoscope to listen for the fetal heartbeat: not a sound, no matter what position I checked for it. Undeterred, figuring that the problem was my technique, I called in one of the senior nurses to assess for the fetal heartbeat. She too couldn't find the fetal heart.

Unfortunately for us, the fetal doppler probe was not available, so the only way we could confirm the presence of a fetal heart was to perform an obstetric ultrasound. As a double misfortune, the sonographers were also not available at the hospital after 4.00 pm, so we basically had to arrange for her to be transported by ambulance to a reputable external radiology centre to have an obstetric ultrasound done. At this point, I'm really hoping that the ultrasound will prove that there's a fetal heartbeat so that I can schedule her for an emergency caesarean section (C/S) as soon as possible; worst case scenario is that she's had an intrauterine fetal demise (IUFD), and in that case I would not need to saddle her with an unnecessary surgical scar.

We arrange for the ultrasound, but end up having to wait for the ambulance to return from another emergency. Theater staff have been informed about a possible C/S being performed, but we've currently hit the magical hour: 5 - 6 pm...shift change-over time. Basically, nothing gets done during that period, and we end up having to pool our surgical cases until the anaesthetist-on-duty shows up. I keep doing the rounds on the other patients, but also take the time to read the nurses' cardex for Edna's case. During that interview, Edna had reported that she had experienced some vaginal bleeding prior to coming to the hospital (a detail she omitted when I queried her about any danger signs that she may have experienced). Around 5.30 pm, the ambulance becomes available and I'm looking forward to having some clarification on the matter. I've already discussed the option of a C/S with Edna and her husband, and they've suggested that a Bilateral Tubal Ligation (BTL) aka "tying her tubes" be performed; I've even joined up as a member of "Team Edna", and I'm really hoping that the baby is a boy and in optimum condition. And then, it happens!

A sizable amount of blood gushes from her vagina, soaking the sheets! I see the colour disappear from her face, and forget all about the ultrasound; by this point it's very clear that I have to get her into theater immediately. The nurses attempt to stabilize the patient, while we hurriedly prepare blood, get consent, alert the theater, the anaesthetist and my immediate superior (a Medical Officer). The Medical Officer gives me the go-ahead to perform the case and tells me he'll be coming in eventually just in case I might need any help. I counsel Edna's husband again about the emergency situation, and let him know it's the only option that we have left.

Under normal circumstances, I would just perform the C/S myself, but Fiona happens to be around at that moment so she makes the decision to step into theater with me for the case, which affords me several advantages; Fiona and Lucy basically taught me how to perform C/Ss. In addition Fiona is left-handed; basic rule of surgery is that the primary surgeon stands on the side of the patient which allows them the most ease to operate - so, a right-handed surgeon would stand to the right of a patient and vice versa for a left-handed surgeon. Working with Fiona thus felt like having two primary surgeons on the table at the same time, and the responsibility could be shifted without us having to reposition ourselves at the operating table.

Everything is ready for us very quickly. We jump into theater, and in a break from the norm, we are scrubbed in and gowned before the patient has even been wheeled into the theater. Soon as she's placed on the table and anaesthetized we get to work. We sacrifice most of the presurgical skin disinfection for the sake of speed, and start hurriedly. I make a wide incision and slice through skin, fat, fascia and muscle, making my way to the uterus; during this time, she barely bleeds. Once I'm through the peritoneum, I come across a pale white uterus! Gone is the pink colour of the vitalized uterine tissue that I encounter during routine surgery; the inside of her is just as pale as her extremeties.

In one swift move, I'm inside the uterus and we visualize the baby's placenta detached from the uterine wall and accompanied by a massive blood clot...Placental Abruption! Quite the atypical case because the bleeding was concealed and Edna did not experience the usual cluster of symptoms. There was nothing that could be done for this BABY BOY. With one life gone, we concentrate on Edna. With the uterus taken care of, it's time to perform the BTL. All things considered, and with the haste needed post-operatively for the patient (including the most important issue of the blood transfusion), I opt not to perform the BTL, and close her up layer by layer. Soon as we're done, the anaesthetist lets the blood run, trying to reperfuse the patient as quickly as the blood can flow.

Our part as surgeons is done, and we step away from the table to assess the patient whose life entirely relies on the anaesthetist's manipulation. Never would I have thought that the patient I met a mere 3 hours earlier would have taken this eventual turn. As if by design, her breathing ceases, and shortly thereafter her heart stops. We're ready for it when it happens and we jump in to resuscitate her.  We aren't able to achieve anything meaningful, and I lament that her husband isn't around to say any sort of goodbye. A 100% fatality rate in an Obstetric procedure.

We clean her body and place her accordingly. We then silently walk out of the operating room into the adjacent corridor, each one of us pondering the experience. We have theater notes to write, and still have more cases to perform; but more than that, we have to inform the father of four of his wife and child's demise. He's not in the reception area when we come out, but undoubtedly, he'll be arriving soon. I try to organize my thoughts so that I can deliver the news in an informative yet sympathetic manner, but I can't lift my gaze from my hands as they lie idle in my lap. In the end, I'm glad when the anaesthetist picks himself up and ends up relaying the information to the bereaved. I was within earshot of the conversation, but I don't remember hearing any wailing or sobbing from Edna's husband. He calmly stepped out of the reception area, and, as with countless cases, I know nothing more of what happened to him or his family.

With every loss you encounter, you're supposed to be able to detach yourself from the situation enough that you can function adequately come what may. After all, the work never ends and though one person's life has been brought to a standstill, the rest of the world need to move on. Even if it may not be required of you, every death is a chance for you to reflect on what you might have missed, what you might have done wrong and what more you could have done; and after that, the harsh lessons inform your practice in regard to subsequent patients.

Every doctor (/medical practitioner) you've ever met probably has a couple of these jarring experiences that they could quote for you if you gave them the chance. We carry many of these scars with us, but rather than break us, these scars make us resolute. We spend a lifetime poring over our mistakes, so that we don't repeat them to your detriment or that of your loved ones. Us asking for you (through the government) to avail us the tools to stave off death for another day is something that we are duty-bound to do. We would love the chance for every one of our patients to have therapeutic options available to them at a rate that they can adequately afford; that they would stand the same rate of survival regardless of their economic endowment.

As with all things in this life, we do our part, but we recognize that in the end God provides the true healing. In the end, He's all we really have.

God Bless.


Saturday, January 14, 2017

The Music of Pat Metheny: September 15th

The music of  the Pat Metheny Group (PMG) takes my mind back a few years, to a very specific place. The year was 2007 circa April, and the exact venue was the Wenzhou University Library's computer lab. It was shortly after I had moved from Kenya to China, and was slowly but surely getting my bearings in a new land. The computer lab was where I spent most of my time because, conveniently, it had free internet. Thanks to China's love/hate relationship with foreign companies (Google et al.), I was forced to become accustomed to using "Baidu" as my search engine of choice. Great thing about Baidu was that it had an MP3 tab, so I could search for music that crossed my fancy, and a lot of times even listen to it.

The music that resonates most with that time is that of the Pat Metheny Group, specifically "The White Album". I don't know if it's because those were the first songs I played online or perhaps it might be because of that broad Midwestern quality to the music that endears it to someone on a long travel. Whatever the reason, these 2 bits of memories are etched side by side.

The song September 15th is from a whole other different album: As Falls Wichita So Falls Wichita Falls (a mouthful indeed). The album is unique in that it's basically a collaboration between the core of the PMG - Pat Metheny & Lyle Mays. (with a sprinkling of Nana Vasconcelos for good measure).

September 15th is a pure guitar and piano collaboration, and I like to think of it as a song consisting of 3 different songs. That's just how it was written! The first 2 minute portion consists of a preamble contributed by Lyle; with his synth work laying a beautiful orchestral background, Pat is afforded the chance to colour the rhythm with a sparse picking of his guitar strings. There is a tight interplay between their work, but Metheny is clearly allowed to be the front man for this section. Lyle's synths provide a sad solemn undertone, and Pat's guitar adds layers of emotion above it. Despite this song being dedicated to a fallen comrade (Bill Evans), this is not a dirge; it still comes across as a romantic ballad, particularly in its preamble.

The second part, a slight smidgen above 2 minutes, is a waltz piece contributed by Pat. If you've heard his live performance you'd no doubt recognize this part. His solo medley (for the longest time) has consisted of Phase Dance - Minuano - September 15th (Waltz) - Etc. As he tells the story, he actually wrote it specifically for another group, but they didn't end up using it; so he re-purposed it and ended up using it here. Lyle is on the piano in this portion, but does use the synths to lay down a haunting intro to the piece. This is equal parts Metheny and Mays, matching each other note for note, with the strings and keys melded into a unified whole. This is my favourite bit from the song, immediately likeable and invigorating.

The third and final part is a stroke of luck, just pure serendipity. As Pat tells the story, the written portion of the music was over, so this remaining section was open ended and built on the fly. I feel like this segment hands the reins over to Lyle, using Pat's guitar to chime in occasionally to add accents. When they played this live (during the Imaginary Day tour), this third segment actually ended up being a Lyle solo. While the opening seems heavy laden, and the middle a tad whimsical, this latter portion personally resonates with a sort of cautious hope. (I didn't write the music, but it probably inspires me in this specific way...a good piece of music does that!)

I am definitely not gifted with the musical acumen to describe this song; but then again, maybe something this complex doesn't have to be broken down further for it to be enjoyed. Basically, this is one of my Metheny/Mays staples; it never gets old and is sure to please each time. If you're looking for some inspiration or just need to appreciate some impressive artistry at work, this is the track for you.

God Bless

2017

Happy New Year!

As my blog attests, I’ve begun this year with a touch of procrastination 😃. I can sadly attest that despite being employed this year, unlike last year, the workload is quite intense. The doctors’ strike which I thought would be resolved in 3 weeks time is still going strong, and that means that a vast number of patients are headed towards the less price friendly mission hospitals (of which PCEA Kikuyu Hospital – my work station – is a veritable member). Add to that the fact that the Medical Officer interns (paid by the government, but posted to PCEA Kikuyu) have shown solidarity with the medical union and walked out on us, let’s just say I’m busier than I had ever expected to be.

All things considered, I’m very hopeful for this year. I’m going to try and get on the old education horse, and see if I can get into a post-graduate program (in China, perhaps) so I can finally start training as a surgeon. Elections will be coming in August, which presents me with the first chance ever to vote in a Kenyan election. Over the 3 past election periods, during which I was eligible to vote, I’d always been out of the country so I missed my chances to bring about any change. I’m hoping that they don’t postpone the election dates because this time I have a vested interest in tossing out the incumbents; frustration voting all the way.

I’m also hoping to pick up a useful hobby or two. For some time now I have developed an affinity for plants – especially beautiful trees – so now is as good a time as any to develop a ”green thumb”. I hope to start off with some Bauhinia purpurea whose seeds I picked from the trees growing at the hospital grounds. Maybe after that I can move on to Cape Chestnut. With this being the year that the family house finally gets built in Ngong, I would love to add some nice flourishes to the land that will make it more homely.

Lastly, I am hoping to get to write more and read more. I think I’ve hit that dreaded plateau where I can’t seem to pick up a book and get some reading done. I get back so tired from work most of the time, and when I’m home I just want to de-stress by doing absolutely nothing – my own little kind of sensory deprivation. This year things change: I’ve got Wangari Maathai’s "Unbowed" to start with, and I’m sure I’ll pick up something else along the way. As for writing, apart from more blog entries, maybe it’s time for a new independent project; or perhaps I could just flesh out my old papers. I wish I could bootstrap the hell out of "the Hyacinth Economy", but it seems like I have to address my medical career first (wish I had come up with the idea while I was in college, much younger, and with a lot more time on my hands). Time will tell what happens.

Well, here’s to an eventful 2017.


God Bless