Saturday, February 10, 2024

In Memory of Lyle Mays


It has been almost 4 years since Lyle Mays passed away. I knew him as the co-principal of The Pat Metheny Group (PMG), which I happened to delve into deeply towards the end of my (Messiah) college days. In fact 2005 - the year I graduated - stands out to me because as I was preparing to head back home to Kenya, the group released their last album: the magnus opus, "The Way Up". In a strange way, I got acquainted with them in their last iteration, but worked up to discovering a host of other gems that they had made in their long storied careers. Most of the music they made is timeless, classic, so much so that it pretty much stands up to scrutiny till this day. Later on I found out that Lyle - encouraged by Pat - had dabbled as a single artist and had 4 solo albums to his name: his eponymous first album - Lyle Mays, Street Dreams, Fictionary and Solo Improvisations for Expanded Piano

On the day of his passing (10th Feb 2020), I couldn't help but listen to "September 15th", Pat and Lyle's dedication to commemorate the passing of Bill Evans. The beauty and intricacy of the piece speaks to my heart regardless of the season as it wasn't written to be a dirge: it's a ballad, a waltz, a true work of art celebrating an inspiration. It is fitting that the piece that Pat and Lyle crafted together so long ago could provide the solace needed; to calm the waters on his sudden demise. September 15th happens to be the birthday of a very good friend from College (Janice), and I do believe I have tried to have her listen to the piece. 

Lyle was a master of his craft, classically trained but incorporating all the new elements that were being fused into Jazz in those early seminal years. His profile speaks of his excelling in multiple arenas - mathematics, architecture and even computing. As technical an instrument as the piano is, I'm convinced that learning to play and master it just ends up wiring a brain for greater things. I recall that my College Organic Chemistry teacher was a beast on the keys; probably wasn't a coincidence.

I do not have the technical skill to unwind and lay out all the "voodoo" that Mr. Mays was able to convey through the keys, but I think that I can share my passion for his music. What better way really is there for me to introduce anyone to the world of Lyle Mays than to share a few choice songs of his that have impressed me through the years. Now Lyle mixed things up quite a bit; he was the soul of the  PMG, and with his playing he provided a sort of sonic score/scaffolding upon which many of their songs were based. Sometimes the playing was orchestral, straight ahead, "smooth" or downright even avant garde and crazy; there really is something for everyone to appreciate from the easily approachable songs to some of those technique-heavy songs that maybe only true music majors would appreciate.

Here's my list:

  1. September 15th  - Cannot sing enough praise for this song. It just has to be heard for you to understand
  2. Slink - Wonderful jazz bassline, but there is some dissonance between the sax, piano (synth) and guitar. All that notwithstanding, still a very beautiful song with a whole lot of soul.  
  3. Mirror of the Heart - Beautiful ballad which shows off his ability to weave the tapestry of a tune in many directions. I think if you want an idea of what he can do in his longform compositions, this is a good starter. For more obvious longform work there's always Solo Improvisations for Expanded Piano.
  4. Alaskan Suite: Ascent - The Alaskan Suite consists of 3 portions with more shared elements between Parts 2 and 3. I've always gravitated to Part 3: Ascent. Bill Frisell's guitar playing is as dissonant an element as you're ever going to get, but the Sax seems a bit dissonant too. Too go from all that to the beautiful final section is a work of genius that brings this work home.
  5. Close to Home - A song conveying a deep longing, yearning, but he plays it somewhat upbeat. Even without lyrics, he gets the job done. Consequently, even when lyrics are applied to the song (like Milton Nascimento's "Quem é você), the eternal beauty remains. I think we could do it justice with some Kiswahili lyrics.
  6. Ozark - If you ever needed any proof that Lyle was no slouch on the piano! Just listen to him cut loose on that piano.
  7. The Awakening - I'm sad that no live version (by the PMG) of this song exists. Apparently, it was something that they just felt they couldn't get right live. This is a tight structured 9:28 that was built to evoke the hills and nature of Scotland (an aire). The whole group is in on this, but Lyle's piano is the most prominent element. This song is a literal rollercoaster from start to finish and well worth the playing time. They managed to weave a portion of "Imaginary Day" just prior to this song crescendo-ing into heights unknown. This truly was the highlight of "Imaginary Day".
  8. Farmer's Trust - As I've written before, I came across this at the end of the movie "Fandango" (Goodbye Dorman), and I remember thinking that this was probably just a beautiful score element from the movie. It is a beautiful sparse piece that evokes the beauty of a picturesque forlon landscape. Definitely one of my all time faves. 
  9. Travels - Yet another song that I think could benefit from a rendition with added Swahili lyrics. In the vein of PMG songs that convey longing and distant travel through lands unknown, this is your elixir. There are multiple versions of this song, but the best version is indeed the PMG version of the live album. 
  10. Street Dreams (4) - Street Dreams is actually a suite of 4 songs, but I gravitate towards Part 4 because it has this beautiful R&B vibe. For the longest time, I felt like Janet Jackson's "Living in a World (they didn't make)" and it's "Interlude" were in fact built off of this song.
  11. Street Dream (2) is a sweet listen too and quite a riot because its drumline suggests something Brazilian inspired, but the initial piano orchestration seems to do away with that thought; then they cut loose, and show that Brazil/Samba was the plan all along.
  12. San Lorenzo - The longest piece from their White Album (clocking in at 10:14), this is some of the PMG's older work, but it has aged well. The song is built beautifully off of Lyle's playing, and waxes and wanes with a mastery that was proof of what was later to come from the group.
  13. Minuano (Six Eight) - This is one of their longform songs that's easy to miss if you can't sit patiently for the 2nd act to begin. The intro in no way prepares you for where the rest of the song is headed. If you stay the course, the experience is worth it. (Most live performances by the PMG in latter years did away with the intro).
  14. Dream of The Return - Pedro Aznar sings on this song in Spanish no less, but that doesn't diminish this in the least. Lyle's piano lays the soulful base for this song. 
  15. Letter From Home - Equal parts Mays and Metheny giving us a short and sweet 'dirge'.
  16. Badland - I decided to throw in one of their slightly crazy arrangements. When they did this album (Quartet), they sometimes strove for the unusual like Lyle playing on a not-quite properly tuned piano. The strings on this piece get a bit jarring, but this is one of those "you can't appreciate the sweet without the sour" kind of moments; very beautiful resolution.
  17. Language of Time - Don't know why this song struck me as being "mathematical"; the groovy bassline in this, especially the song's resolution casts some very much needed light on Steve Rodby, one of their longterm staples. Straight ahead jazz for those who'd appreciate it. 
  18. Across the Sky - This is a rather subdued song. Don't know what Lyle is playing on those keys, but it is dissonant enough to give this song a rather spooky feel. Note: watching the live version of this is impressive for just how much Pat was shredding through the song, forgoing his subdued playing on the album and just cutting loose.
  19. Proof - The PMG in the start of their last iteration. There are 3 solos in this song, but it takes flight when Lyle is allowed to soar on those keys. A special moment to look out for in the end is the interplay of Pat, Lyle, Cuong Vu accentuated by Antonio Sanchez's cymbal work. Never gets old.
  20. The Way Up - The Magnus Opus. Where they put it all together. Pat always looked at their songs, all the albums they did together as this long continuous work. This is a long suite: 68 minutes to be exact, and some parts of it stand out as easier listening than other; but it is a beautiful cohesive work. It is a work of art
I didn't set out to have the list so long, but I think this is an appropriate start for anyone dipping their toes into the pool of his work. Fortunately, all this stuff is available on YouTube so you can easily check it out when it's convenient. Though he is no longer with us, his great body of work remains, ready to inspire at a moment's notice. 

Rest easy Lyle. You will be fondly remembered.

God Bless

Monday, April 10, 2023

Dungeons & Dragons: Honor Among Thieves "Spoiler-Free" Review

 


Today was a day when I just felt I needed to get out and watch a movie. There's so much at the theaters that I haven't yet watched, but I had a feeling that Mario Bros. was what I was likely to watch, with Dungeons and Dragons as a possible second choice. After only getting to the theater slightly late, I was treated to a fiasco of having so many kids in line before me (which had proved to be an all too aggravating for me during Antman:Quantamania). With the Easter season still in play, it was guaranteed that that entire ensemble of kids was headed to watch Mario Bros., and I wasn't in the mood to deal with shenanigans. So as soon as I got up to the counter (sure that I'd be late to get into the movie), I bought a DnD ticket, and went straight to Screen 3. The room was mostly empty; couldn't have been more than 10 of us in that room. Simply blissful! (and on time!)

Personally, I've never played any DnD. My experience pretty much involves the 80's cartoon version (which saw the heroes dragged into a fantastical world, but never ever managed to return them home), and every once in a while a YouTube vid or some show like Stranger Things regales us with a bunch of nerds taking turns at the tabletop game. Suffice it to say, the movie respects that, and you don't really have to be a diehard DnD fan to get into it. This movie has a lot of exposition, but in much the same way that a Dungeonmaster would build the world of a DnD game, control its pacing, and continuity, etc., this very art of exposition is weaved into the movie. Most of this is done through Edgin Darvis (Chris Pine), a harper; he is the master strategist who is full of bravado and contingency plans to boot, and has a knack for getting the members of his troop in all kinds of mischief and schemes. Though Michelle Rodriguez has played the same mean, gruff character in practically all her movies, here - playing Holga Kilgore, a barbarian - she produces the best permutation of that character. She play second fiddle to Edgin, and the humour that the movie is able to extract from the interplay of the two characters is extremely rewarding.  


Justice Smith plays Simon Aumar, the wizard of the group; he is the most disregarded member of the group, drawing ridicule from other members (Edgin excluded), but still manages to come through for the team when they need him the most. I feel like he excels at playing the bug-eyed hesitant group member (similar to his role from Jurassic World: Fallen Kingdom). Sophia Lillis of IT fame portrays the shapeshifting Doric, perhaps the most versatile member of the group, and its most reluctant. Each of these characters is perfectly cast, and every interaction and line of dialogue melds their relationships even tighter. These are characters that you can, and will fall in love with as the story goes on.

 
The showstopper has to be Regé Jean Page's Xenk Yendar, a paladin. Full of wisdom and an age that is not betrayed by his youthful look, he is the stoic character who contrasts greatly with the skullduggery of Edgin's troop. He is, however, a literalist, immune to sarcasm, irony, cynicism, etc. He plays it off even better than Guardians of The Galaxy alum, Drax the Destroyer.

Hugh Grant as Forge Fitzwilliam is the wily quick-talking scoundrel of the lot; always in for a scheme, and egging Edgin on to even bigger schemes.

The villainous Sofina, (Daisy Head) is the big bad", and doesn't have a single redeeming quality about her; she is evil incarnate, and totally menacing. Her role is somewhat subdued (for the mechanics of the movie), but she is shrouded in a foreboding aura that suggests that there is more darkness  soon to follow where she treads.   

I predict that this movie will be the sleeper hit of the season. The only other time I've been this surprised at the movies is when I RELUCTANTLY got to watch the first "How to Train Your Dragon". It totally caught me by surprise! The pacing is perfect with nary a wasted moment; the humour could very well have gone the Marvel-esque route, but it surprisingly fits so well. The emotional weight that every character is given will have you rooting for the protagonists, and have you invested in each of them. The action is well-choreographed and well weaved into the story, and all the CG and practical effects are a pleasure to watch.

I will definitely be going in for a rewatch. This movie is an A+ in my books.

God Bless



Wednesday, November 16, 2022

Black Panther: Wakanda Forever "Spoiler-Free" Review




After the disastrous Thor: Love and Thunder, an MCU outing so terrible that I've never been able to pen even a decent review for it, this movie was needed as something of a palate-cleanser; there was just no way that it could sink any lower. Low expectations can be a blessing at times. There was a lot of hype surrounding the original Black Panther, some of which it didn't exactly fulfill; being an MCU movie, it fell into the trope of having the Super hero fight an exactly similar super villain, and it also killed off good protagonists who perhaps had more to add to the future of the MCU.

In an case, this movie starts off as a dirge. It is, after all, the first chance that we get to address the passing of Chadwick Boseman on film since his untimely passing. They address this at the start of the movie, and in a very realistic way, the passing of King T'challa hits us like a sledgehammer (an exact replication of the true life event). This movie gives us a chance to grieve in a most colourful celebration only the likes of which Wakanda could provide. With the passing of the King and the vacancy of the Black Panther mantle (thanks to Killmonger's antics from the last film), the world powers continue to antagonize Wakanda sensing that the nation is at its weakest. It is in fact a facet of this antagonism that sets in motion events that reveal to us Namor the Submariner, and his Kingdom of Talokan.

This movie definitely marks a return to form for the MCU. With the new additions of movies and characters that have made their way into the MCU recently, a lot of the recent stories have emphasized the cosmic otherworldly portions of the MCU, and it can become rather easy to get lost in the mix. Here we have a more grounded story, which at its heart is centred on dealing with grief and embracing loss. Angela Bassett steals every scene as the strong Queen Ramonda who has faced more than her fair share of loss, and finds herself having to steer Wakanda's affairs yet again as its leader. She also has to deal with a despondent Shuri (Letitia Wright) who despite probably being the smartest person in the MCU, is unable to reconcile the mixed bag of emotions she's experiencing, tradition and the spirituality that she's grown up with her whole life.

Thrown into the mix to stir things up even more is Namor (Tenoch Huerta), an imposing figure who rues the antics of the colonizer that he has witnessed in a storied life. While the Wakandans chose to reveal themselves to the rest of the world in the last installment (and even played a part in saving the world from Thanos in both Avengers' wars), Namor craves secrecy for himself and his people. He views the rest of the world as an impediment that might eventually bring war to his doorstep, and he is not averse to waging an preemptive strike to quash any such issues. His mythos is really well done (changes from "Atlantis" and all), and well established. He is a complex villain, but this is well balanced with the fact that the world powers are pretty much established to be just another set of villains sitting at the same table, jockeying for position. His love for his people is unquestionable, it's just that his methods are unsavoury. He marks a new start for the MCU as they finally give us Marvel's roster of mutants. 

I really enjoyed this movie. It was tight-knit and cohesive, and never once did my attention wonder. Character favourites like Okoye (Danai Gurira) and M'Baku (Winston Duke) are a joy to watch whenever they're on screen; despite their slightly reduced screen time, they manage to provide both moments of levity and gravitas; and the "colonizer" aka Everett Ross (Martin Freeman) has his story interwoven herein too in a very sensible way, and binds him further to the Kingdom and story of Wakanda. The MCU chose this moment to introduce IronHeart aka Riri Williams, another genius in the vein of Tony Stark. I don't believe she got much love in the comics, but this MCU portrayal might be a chance to update that (just like the Spiderverse did so well for Miles Morales).

Everything fits so well in the story, and it was a joy to watch. I am sad that we lost Chadwick Boseman, and the story had to pivot so much to embrace that. The war between T'challa and Namor is legendary in the comic books, and I think we lost an opportunity to see that fully brought onto the screen; but I have to admit that despite many constraints, this movie made a wonderful soft landing. All thanks to Ryan Coogler and a wonderful cast for a job well done. 

Definitely an A- in my books.


God Bless.

Sunday, January 30, 2022

"My Favorite Things": A Tale of 2 Jazz Renditions



This gem came to me by way of the YouTube algorithm. I have listened to John Coltrane on occasion, and I must admit that "A Love Supreme" is a masterclass in concocting a magnus opus; however, on this occasion, one video recommendation kept on popping up for me: "How Coltrane Broke My Favorite Things" by Polyphonic. It was a mostly technical video that outlined the composition of Rodgers and Hammerstein's song My Favorite Things, which was written for The Sound of Music, initially a  Broadway musical that went on to become a famous movie. I must guiltily admit that I have never watched The Sound of Music (Rest in Peace to Christopher Plummer)...but I got to learn about this particular piece of music. Having never really listened to the song before, I must admit that it was erroneous of me to to be first introduced to the song in this way because I didn't initially hear the original whose runtime is under 3 minutes; imagine how much less I got to hear of Coltrane's rendition which almost clocks in at a staggering 14 minutes!

I did learn a few things though! Being of a melancholic persuasion, I do tend to prefer songs written in darker more solemn tones. I came to find out in my layman kind of way that those are Minor chords; and the joyous, more triumphant tones...those were the Major chords. My Favorite Things had an interesting mix of both major and minor chords that definitely appealed to Coltrane, and thus he translated his version into modal jazz. By the end of the video it was amazing that I knew more about the technicality of the song than I did about the actual song itself; therefore, I had no choice but to actually sit down and listen.



Coltrane's version just grabs you from the start: I initially thought that they were using some sort of reverb effect on the intro, till I watched other live videos on YouTube and found out that it was all done with acoustic instruments. McCoy Tyner on piano plays question & answer by playing out 3 notes, then responding with another set of 3 notes; Steve Davis (Bass) mirrors Tyner, but he only plays one note and sustains it for every 3 that are played on the piano; and Elvin Jones (Drums), well he basically strikes the cymbal once for every 3 - 3 note couplet that Tyner plays. The interplay between piano and bass sets up a very distinct sort of resonance, and then we delve into this very infectious groove.

For the longest time, I was not able to place which specific song this rendition reminded me of; finally, I figured out that it reminded me of Dave Brubeck's Take Five. That infectious groove that permeates this song is what's known as a Vamp (a repetitious progression that sometimes plays as an intro to a solo or can be randomly played as a bookend of sorts; Take Five probably contains one of the most famous jazz vamps on the piano, and on a recent listen I noticed that that vamp basically spans the whole song.

It is Coltrane's tenor sax that actually comes in to remind us that this is actually My Favorite Things, playing the melody from the original composition. He guides us slowly into the mix, first playing the darker chords, lets us get a taste of that infectious vamp, starts off playing the darker chords, then segues into the brighter chords where he lingers for a bit, then takes us back to the dark chords. After this Coltrane takes a seat and McCoy Tyner steps up to take over the reins. I have listened to various Coltrane renditions of this song, and I must say that this studio recording has the best version of the piano solo. In some portions, it sounds so simplistic; Tyner lingers on some note runs like he's letting the tune air out just a bit, and uses this to bookend the more flairy parts of his solo. I was surprised how much he was able to convey by sometimes playing only one note repeatedly (3:42), and there were times when he just went wild (5:08) and I can only imagine the mish-mash his fingers are going through at that moment in time. I love that live versions of a song usually afford an artist a chance for further exploration and the ability to add more flair to a solo; but in this instance, this was the perfect piano solo.

This song is unique for the part that it affords the Bass and Drums. Elvin Jones and Steve Davis are playing a drone that is really only there to support the Piano and Sax. They just sit there providing a "floor" for this performance. This doesn't diminish their skill in the least; in fact, some of the most beautiful moments in this song happen when the Bass & Drums interplay with the Piano: Tyner slowly fades out the piano, and you become more aware of the aforementioned Bass & Drums "floor", then Jones and Davis also fade out to match Tyner. 

Between the two of them, I think Tyner chose to play the more subdued solo so that Coltrane could have the more flourishy solo. Coltrane slowly unpacks his solo over the vamp, conservatively flowing over the minor chord section; he gets flashier when the major chords section comes in, and only really lets up as the song ends. His solo (more conservative than other of his renditions) can really only be appreciated by repeated listening. He has all the notes at his disposal, and he wants to let you see that he can use each and every one of them.             



Granted there are many versions of My Favorite Things by a myriad of artists, but the other version that caught my attention is Brad Mehldau's Jazz a Vienne 2010 (*Note that he also has two other versions: Marciac, which is a wholly sweetly melancholic piece, and a Trio version which sounds very much vamped-up like Coltrane's studio version). Mehldau plays it with darkened abandon. On repeated listening, it sounds to me like he borrowed some inspiration from James Brown It's a Man's Man's Man's World or Alicia Key's Fallin'. Unlike Coltrane, he sticks close to the melody of the traditional recording, but he does one helluva job exploring and re-interpreting it. After a very beautiful 2 minute 6 second prelude, he settles down and delves into a classical music exploration, which is at times done in a very dissonant manner that I've noticed some people have said is off-putting. It does appear to be the maestro showing us his chops (which some people may say that Jazz artists do at the expense of sacrificing the enjoyment of their music to a general audience), but I must say that there is a method to the madness. He uses all that dissonance to set up a dramatic conflict which crescendos at the 6:00 - 6:50 mark in a stunning bridge section. After 6:50, he just flies off the hinges, and it actually sounds like it's 2 people playing the piece on the piano. I'm not sure if I have him timed right, but he could possibly be playing in the range of 350 bpm. For him to basically be freestyling, developing the motifs on the fly, and playing that fast is just insane. What's more impressive is that he's playing 2 different melodies simultaneously: one is set to a rapid-fire pace, and the second is slower, measured, only a fraction as fast, and acting as a counterpoint (sounds like the tolling of a bell). I only wish there was a live video so I could see what playing this really looked like. After all the excitement, he brings things full circle with the re-introduction of the sweet melody that started it all; he then slows things down and guides us home.

Really don't know how many times I've listened to both these pieces, but each time it brings me immeasurable joy. The Coltrane rendition, while being quite a long piece, is the more approachable of the two, the easy listen (in the vein of Take Five). Mehldau's rendition seems to meander a bit, at first being easily approachable, then seeming to lose its way; in my opinion, he actually enhances the song by having the "bitter" middle section break apart the "sweet"; the sweet never is quite as good without the sour. It might not be the easiest of listens, but it is well worth the patience.

Take a chance on listening to these two contrasting renditions. You won't be disappointed.

God Bless.

  






Monday, January 10, 2022

Spider-Man: No Way Home "Spoiler-Free" Review


This is my first foray into anything MCU this whole year. I missed out on "Shang Chi" while it was in theaters, and I still haven't yet managed to watched the prolific "What if..." anthology yet. Anyway, I am glad to say that "No Way Home" reflects a return to form for this Spider-Man series. I had honestly had this series pegged as yet another "Iron Man" trilogy where it was just a case of diminishing returns with each returning installment. The underwhelming "Far From Home", which basically played like a bootleg "If Looks Could Kill", certainly filled me with a whole lot of doubt, but I'm glad that my doubts were eventually cast aside.

Far From Home starts off right where No Way Home ended: Mysterio, in a last ditch attempt at revenge, outs Spider-Man's secret identity, and now the whole world is suddenly aware that he's Peter Parker. Unlike the usual peril for his loved ones that tends to be occasioned by such a reveal in the comics, here it just proves to be an unbearable nuisance to those associated with Peter. 

People familiar with the comics will be aware that the MCU has attempted to adapt the much maligned "One More Day" storyline for the big screen. In that outing, Peter in his ever self-sacrificing way makes a deal with the Devil (Mephisto) in order to save Aunt May's life. The MCU doesn't typically translate these storylines to screen verbatim, and in this case, Dr. Strange is used as a welcome substitute for Mephisto. Dr. Strange, appearing to be of a more mellow demeanour towards Peter since Infinity War (& Endgame), opts to help him out by basically making the world forget about the secret identity. The MCU's Spidey is still pretty much a child, so of course he tries to throw all kinds of caveats at Dr. Strange about people who should be unaffected by the "forgetting spell", and this ultimately messes the spell and throws his reality into disarray.

This is a return to form for Spider-Man; the "home" series has been lacking that Je ne sais quois of what we've come to expect from Spider-Man. This was basically spelled out in Captain America: Civil War where during our introduction to Peter, in his first talk with Tony Stark, he basically stumbled over the "With great power comes great responsibility" pitch. They then proceeded to basically write out Uncle Ben and handed over this surrogate parent role to Tony Stark. Spider-Man is a great hero because he's basically had to handle most of his adversity by himself, and the MCU basically knee-capped him by making him a Tony Stark fanboy. In Homecoming, he spends his time trying to earn Tony Stark's favour; in Far From Home, he finds himself living in Tony's shadow, and still ends up making the biggest rookie mistake. And why on earth are they referring to his Spidey sense as "the Peter tingle"? (Most annoying change ever!)

The great thing this time around is that there isn't a single mention of Tony Stark. Sure enough Stark-Tech is still involved in the MCU, but even the memorial murals that seemed to permeate Far From Home are gone now. After Peter makes his debacle, he goes about fixing it in the most adult pragmatic fashion possible with the best outcome for everyone involved. From the trailers, you'd know that the mechanics of this story involve "The Sinister Five" - Doc Ock, Sandman, Electro, Lizard, and Green Goblin - drawn in from their different corners of the Spiderverse, and ensuring good outcomes for this disparate group of villains poses a high stakes game that will take everything in Spidey's arsenal and more. A superhero is only as strong as his rogues gallery, and the foil against which he is compared. Alfred Molina's "Doc Ock" and Willem Defoe's "Green Goblin" are the standouts in this movie. Both of them are tragic figures born of intellectual hubris; where they differ is that "Doc Ock" is still fixated on his goals, whilst "Goblin" is psychotic and vengeful. These two provide the most poignant moments and it really is great to see them rehash their performances from the Raimi side of the Spiderverse. 

The villain who really gets the biggest makeover is Jamie Foxx's "Electro". The all-rage-all-the-time demeanour of a fanboy turned villain from The Amazing Spiderman II was a rather poor take on the character; this time around he's played as a straightforward snide character with an unfortunate penchant for being literally power-hungry. He doesn't get too much time in the movie, but every bit of it is deeply redeeming.

I have to say that the most beautiful elements in this movie was the addition of Dr. Strange. His mysticism is such an eclectic bag that allows him to fit in well within any portion of the MCU; the addition of the trippy Inception-esque visuals also manages to seemlessly fit in to the story, and always enthrall.  With the events that this story sets into motion, the MCU have done more than enough to whet our collective appetites for the Dr. Strange sequel that's due to come out later this year.

The story is very well written and fast-paced, and the action is top-notch. The only gripe I had with the movie is that Marvel can sometimes be indisciplined when it comes to lingering over their jokes. One time during the finale, it got so bad that it took me out of my suspension of disbelief. Shaving out a few minutes of this indiscipline could very well have given us a tighter story; other than that, there was a great deal of fan service draped out for all the fans on this outing. Truthfully, you can't please everyone, but I think you can achieve a fine balance that caters to the masses. 

The trailers managed to keep most of the story under wraps, so I will end the review here, and save the rest for a "Spoiler" review; but suffice it to say, this is the strongest Spidey offering that the MCU has ever put together. This is the most mature presentation of Spider-Man thus far, and a delight to watch. Definitely gets an "A" grade from me.

God Bless.

Sunday, April 26, 2020

Not All Doctors Are Created Equal!

From "The Fourth Plane"

I remember that it was a day much like any other at my first job as a Medical Officer. Internal Medicine ward round, longer and more nerve-racking than it ought to have been. My Consultant was a Nephrologist of some renown, but she had a peculiar bedside manner for a practising physician: she could be dismissive, condescending, insensitive or downright incendiary as we went about the business of assessing the patients. As we got towards the last room in the female ward that day, we had a new unclerked patient (let's call her "*Eunice") before us who appeared otherwise normal. Lately, she had been experiencing a recurrent localized right lower abdominal pain; her past medical history was hitherto unremarkable. My Consultant had me assess Eunice briefly,  and the only symptom she had was marked tenderness in the lower right abdominal area of her abdomen. I remember suggesting that it seemed likely that this patient might have been suffering from appendicitis, and that she might actually be more of a surgical patient. The Consultant wasn't having any of it and proceeded to berate me in front of the team, which included medical and clinical officer interns, nurses, physiotherapists, nutritionists and a counselor (and let's not forget the patients that were within earshot):
  1. Why would I think it was an appendicitis yet the patient did not have the typical "septic" look of an appendicitis patient?
  2. Wasn't her abdominal pain localized, and without the typical progression seen in appendicitis? Where are the other signs suggestive of appendicitis? 

I halfheartedly remember suggesting that perhaps it was an atypical case, but she was having none of it; I was summarily told to stop jumping to conclusions (known more technically as "confabulating") and a plan was made to work up the patient in terms of lab work and some imaging studies.

Getting insulted was usually par for the course, so I just took it in stride. Apart from that slight, nothing else really stirs in my memory from that day. Anyway, the ward round - which spanned 2 wards, and sometimes involved consults in other areas of the hospital - took so long such that the rest of the day typically involved drawing samples and tending to other ward procedures. I was also charged with attending to the Outpatient dialysis patients. A lot of the time, you would end up getting the results the next day, so it wasn't something that you could respond to too quickly. Provided the patient wasn't knocking on death's door, a little waiting wasn't really going to hurt.

The next morning was joyously a Thursday. Thursday was the one day in the week that I got to lead the ward round because it was the day when my Consultant was otherwise occupied running the Medical Outpatient Clinic (MOPC). This meant that we usually finished the ward round a lot faster. As I was conducting a preliminary assessment of patients prior to the ward round, I remember asking one of the clinical officer interns for the list of our patients. When I received the list, I noted that Eunice was unceremoniously missing. When I inquired why, I was told that she had been handed over to the Surgical Team. My interest was piqued and I decided to glance in her file to find out what had happened. The sonographer who performed her abdominal ultrasound had detected a mass in the tender part of her abdomen - an appendiceal abscess. What appeared to be more likely is that Eunice had probably suffered from chronic appendicitis; this inflammation was eventually "walled off" by the body, protecting her from the more adverse effects associated with a leaking/burst appendix.

The irony of it all is that a crowd was present for my ridicule, but my moment of vindication was mostly a private affair. Dear God life can be so unfair!

I must admit that I have been reading and watching a lot of news concerning Covid-19 lately. Part of the reason for this is that so many medical updates keep on arising concerning testing, and many of my colleagues on the front-line worldwide are providing a lot of useful advice that might prove helpful in our local battle with the disease. Another reason is to see how countries are dealing with the economic push-back from the virus, and to get a sense of what stimulus measures might be needed to protect the citizenry from the economic ravages of the virus. However, the last bit consists of the debacle-prone US response (with all its bells and whistles) and, surprisingly, tales of conspiracy theories and what not. Just recently, I caught a segment on Fox News whereby Dr. Oz was talking about possibly getting children in the US back to school after a Lancet (Medical Journal) study had shown that such a move came with a 2-3% chance of increasing the total US mortality statistics. This is of course par for the course when it comes to Fox News recently, and though they keep on emphasizing how precious human life is, it a repetition of their stance that some amount of human life sacrificed for the sake of the economy might not be such a bad thing. However, policing a news media outlet is not my duty; as a trained medical practitioner, my job is to at least make sure that people are getting sound medical advice wherever they choose to consume it from, and especially that is being delivered by a sound medical professional.

Now, rightly so, Dr. Oz drew a lot of condemnation for his comments and ended up having to apologize. This is not the first time that he has been forced to walk back his comments as he was actually brought before a congressional hearing to account for claims he had made on his television show about certain weight-loss regimens. For those who may not know it, Dr. Mehmet Oz is a renowned Cardiovascular Surgeon who is a media sensation who got a big push by being endorsed by Oprah Winfrey. His skill is unquestioned in the field of cardiovascular surgery where he is known to be an innovator; however, it is his media sensationalism that typically gets him into a lot of trouble.

I remember chatting with a group of my high school alums on Whatsapp and I remember being peeved at a suggestion by one of my friends that they needed to be hearing more from doctors in the national discourse during this period of Covid-19. That remark set of a powder keg in the group that drew the ire of the health practitioners. This came against the background of disdain and distrust that Kenyans have continued to hold towards doctors and nurses since a massive 100+ day strike in 2017 which was meant to address issues of poor renumeration and working conditions, and inadequate functional capacity. The politicians of course turned things around and made it seem like it was purely a salary push by a money-hungry lot, and consequently medical professionals and institutions were lambasted by the citizenry. Long story short, hearing my friend calling on the medical professionals to start waxing lyrical was like opening up an old wound. In retrospect though, having had some time to calm down, I can admit that my friend was right. People do need to be hearing from sensible medical professionals at a time like this. The amount of sensationalism, hoaxes, "miracle-cures" and conspiracy theories is proof of that.

I think that people understand even less about the practice of medicine these days. In the old days, people were awed about the profession, but nowadays the prevailing sentiment might be that the internet has bridged the divide between clinicians and patients. It is therefore useful to understand the typical career path of your typical medical doctor. In Kenya, there'll be 5-6 years of medical school (post-secondary), followed by a 1 year internship rotating in 4 major departments; from there you can expect 3 - 5 years of specialty training, and after that you add on as many Fellowships as you want, and you can aim towards being a professor, etc.
Now, since I am going to discuss Dr. Oz, I'll give you a glimpse into the American path of ascension.
  • 4 years of a pre-medical degree
  • 4 years of a medical degree
  • *Residency Program
  • Fellowships
*The 1st year of the residency is pretty much just an "internship" (semantics). Unlike the Kenyan experience, American doctors do their internships specifically in their field of interest. Surgeons have a surgical internship, physicians do an Internal Medicine internship, etc.   
    

The aim of medical training is to start you off with as wide a base of medical knowledge as possible, and then whittle that down to the things required only for your area of specialty. Back in the day there were people who dabbled across the field of medical specialties, but nowadays - short of someone being a genius - such broad focus is discouraged. True Story - I remember being blasted for showing lack of focus during a surgical specialty interview at a local medical university. Why? you might ask. Because I had listed that I had performed independent research on Phytoremediation on my curriculum vitae (CV); the same CV further states that
"I aim to become an experienced doctor specializing in surgery, with a view towards
practicing and teaching medicine while infusing my practice with environmental
consciousness to enhance the focus on preventive medicine."

The Plastic Surgeon on the panel had a look of disbelief on his face; it was like this was blasphemy!

Therefore, applying this logic to Dr. Oz, who got his joint MD and MBA degree in 1986, the man has been a PURE SURGEON since 1986! This is not the kind of individual you want to be getting your principal Covid-19 findings from (media sensation or not).





The above 2 images have been part of a meme sent out by many of my medical colleagues, but I think that only the medical field is in on the joke. This is the grim reality: most of the specialist medical professionals do not have the skills to deal with this Covid-19 pandemic; but if we cannot keep the numbers of severely sick down to a level where the healthcare system can adequately handle the numbers, then every medical practitioner will eventually need to be drafted to help with the situation. They'll just have to be retrofitted and adapted to the situation.

If this post wasn't already too long I would've delved into the reasons why medicine is not the homogeneous field most people tend to think it is. There is a lot of direct antagonism going on that is the subject of much comedic gold.
  • Surgeons vs. Anaesthetists, where surgeons believe it is the joy of an anaesthetist's day to cancel a scheduled surgery for the flimsiest of excuses. Anaesthetists in turn believe that surgeons will steam-roll through any procedure without considering the risks. (It's the relationship portrayed in the title cartoon!)
  • Orthopedic surgeons being of questionable IQs (despite the research)
  • Those who are not good enough to be surgeons become... (I once remember a surgeon toss this gem in jest at his accompanying scrub nurse)
  • Doctors vs. nurses
  • A surgeon only sees a surgical solution to a problem. A physician only sees a medical solution to a problem (typified by my experience with my Consultant)
All this aside, the best results in our profession (and its allied fields) are usually achieved when we have a healthy dose of respect for everyone and their training. The best approaches are always multi-disciplinary. Therefore, next time your relative with Diabetes/Heart Disease/Lung Disease etc. shows up for an elective surgical procedure and another doctor gets called in for a specialized consult, please understand that the hospital is not simply trying to pad your hospital bill; what they are trying to ensure is that the elective surgical procedure doesn't end up degenerating into a complicated affair with death as an outcome.

This pandemic is stressful for everyone, more so the medical fraternity which finds itself faced with a new enemy for whom our typical treatment regimens don't seem to be working. Despite that, we are soldiering on, and we are looking for our fellow (not-so-flamboyant) colleagues to provide answers. We are listening to the Researchers (Virologists, Pathologists, Epidemiologists, Biotechnologists), Infectious Disease Specialists, Intensivists, Critical Care nurses, Respiratory Therapists, Psychiatrists/Counselors etc. to help us chart the way forward. Their work will eventually filter down to the other medical professionals and inform our practice, and finally down to the general population.   

Now, more than ever, it is important for people to interrogate their sources of information. It has taken the medical field forever to get down to the level of Evidence Based Medicine wherein we have to let the efficacy of the science guide our practice. We are not witch-doctors after all! This level of supervision has not made its way to streaming and social media, and thus all manner of dubious claims are being made about this disease and its treatment. We have no way of policing all these dubious claims, but I would ask people to exercise restraint in dispersing all this pseudo-science. Sars-Cov-2 is out in the open and it will be studied intensively for many years to come, then we will finally have the truth; until then, for all these medical pundits making all these claims, remember to assess their backgrounds with the following lens

  1. Researchers trump Classical Doctors
  2. Internal Medicine specialists trump Surgical Specialists
  3. Alternative Medicine specialists are pretty much at the same level as the typical civilian
  4. Not every PhD has the acumen to discuss medical issues
  5. Always look for conflicts of interest. The person is certain to be selling their dubious miracle cure as they tear into the conventional medicine, i.e. Miracle Mineral Solution (MMS) which is just INDUSTRIAL BLEACH; otherwise, look for them to be espousing a particular agenda
  6. Check for reports about them being called out by their professional peers or censured by medical regulatory boards. This kind of behaviour is always a continuum       
This current sensationalism of medicine reminds me of that time when "The DaVinci Code" movie graced the movie screens. I remember that it was touted to have made a lot of people lose their Christian faith, and I wondered if watching it would have been detrimental to my own; then I watched it and I felt bamboozled. I remember at one point the author (Dan Brown) randomly included "The Peace of Westphalia" and used it to make a nuanced argument. I wouldn't have known anything about that incident if it hadn't been for the boring "Church History" lessons (my apologies Mr. Borruso) that I'd had to take while I was in High School, and thus I could see that the author was merely sensationalizing historical incidents that most people are not aware of.

The same exact thing is playing out with medicine right now. To tell you the truth, medicine - just like History - is very boring! Let me clarify, studying/reading medicine is extremely boring! You better thank a scientist who is able to take the time to truthfully summarize a lengthy research paper into snippets that you can digest because reading them is hard work! Being boring notwithstanding, it does not give us practitioners of science the right to mislead people. Always remember that

"The most dangerous untruths are truth slightly distorted." 

Therefore, as a medical practitioner, I will do right by my patients or anyone who needs some clarification. Honesty, Discipline, Empathy and fortitude will get us through the rigours of this pandemic. However, despite the readily available stream of information from social media and video streaming services, we all still have a responsibility to practise patience and critical thinking. There is no need for panic.

God Bless



 
 

Sunday, April 19, 2020

Empathy




As far removed as I am from my internship days, every once in a while a specific memory pops into my mind from way back then. This one specific memory has been popping up from time to time; perhaps it's relevant for the times we're in. So here goes.

During the latter part of the Internal Medicine rotation, I remember early one evening, as I was almost leaving, I ended up being called to attend to a patient. This patient was neither in the ward nor in the casualty area; rather, he was at the TB clinic area, which was an Outpatient clinic where TB patients usually showed up for follow-up as they went about taking their medication. This was something that the clinic was able to handle so well without involving the other doctors, so it was something of a novelty for me to be called in to the clinic. I got there to find a young man - probably in his early 30s - flanked by another gentleman who looked to be in his 60s.  The elderly gentleman then proceeded to tell me a story. The young man was his son (I'll refer to him henceforth as *ALEX), and was a prospective patient; having been diagnosed with Pulmonary Tuberculosis (PTB) a while back, Alex had been started on treatment for the condition. Unfortunately, he was also an incorrigible drunkard, and his usual modus operandi had consisted of initially taking the TB medication (which doctors refer to as RHZE) then somewhere along the way - probably once his symptoms would subside - he would go back to his drunken ways and stop taking the medication.

Let's get a little technical here: the treatment for TB consists of 4 medications: Rifampicin (R), Isoniazid (H), Pyrazinamide (Z) and Ethambutol (E). You start off taking all 4 for 2 months (RHZE), then switch to 2 drugs - Rifampicin and Isoniazid (RH) for the remaining 4 months. There are variations to this dosing, but this is the simplest one for run-of-the-mill PTB. People should be aware that these drugs do have a whole bunch of side effects, most common of which is liver toxicity and injury.

So, by the time I encountered the young man, he had basically defaulted on taking his medication on 4 separate occasions. During that time, he had gone on to infect 3 other people in his village area; thus, he had been served with an eviction notice by his chief (and the villagers) that if he was found within the village, he would basically be beaten and burned to death! Father and son had thus ended up moving to the township area to stay with a relative as a stop-gap measure, and they had come to the TB Clinic in order to get him started on treatment. Because Alex was a serial defaulter, an option that has usually existed is for such patients to be institutionalised in a prison facility where it can be ensured that they take the full course of their medication. I remember making a call to the nearest prison facility, but they insisted that they were in no position to accept such a risky individual; the prison was already overcrowded, and imprisoning someone suffering from TB was a recipe for disaster.

With that option off the table, I called the Internal Medicine Consultant. He was very categorical that the patient was high risk, possibly suffering from MDR (Multi-Drug Resistant) TB, and thus there was no way he could be placed in our regular ward. I broached the idea that perhaps the patient could be placed into our TB isolation ward (our old Amenity Ward) while we tested him to confirm that he was in fact suffering from MDR-TB, but my consultant categorically refused. "Send him to Homa Bay" was the only solution I was given.
Now Homa Bay does in fact have a facility that can serve MDR-TB patients, but you needed to first have a confirmatory test (Gene Xpert) which confirms infection with a drug resistant strain of TB. Without that confirmatory testing, I worried that I would be sending the patient on a long journey only for him to be turned away once he arrived at the Homa Bay facility. In addition, if he was in fact infectious, he risked infecting an even larger number of people if he used public means to travel to that same facility.

My hands were tied in the matter, and I remember relaying this to Alex's father. This had been a surreal experience, sometimes so comical that a chuckle almost escaped my lips (damn that morbid medic sense of humour!). I was not expecting to see his elderly father almost break down into tears at the hopelessness of the situation! Contrasting that with Alex's laissez-faire attitude, this felt like a case where a careless man deserved to get his comeuppance. Sadly though, there was a family that was being inconvenienced by this man's carelessness, and that had to factor in there somewhere. Eventually, in contravention of my consultant's advice and against my better judgment, I ended up having Alex housed at the amenity ward so that he could have Gene Xpert testing early the next morning. I think my stomach was in knots that night as I thought about the prospect of having admitted a high-risk patient; worse still, if my consultant had found out, my goose would have been cooked. 
My elation was palpable on the next day when I eventually found out that he was suffering from "garden variety" TB. This meant that he could be treated at our facility. I hoped that the idiot would finally stick to his treatment for the prerequisite 6 months this time around, but, alas, I don't know how the story ended.
Seems like ever since this COVID-19 popped up, it really is the only infectious disease that's being talked about. In a most ironic twist, it has thankfully reminded people that hand hygiene and cough etiquette are matters of utmost important. You'd have thought that a high prevalence of TB and Cholera (among other things) would already have clarified that fact! After this is all said and done, we'll probably have the most hygiene-conscious generation of individuals ever.

The sad thing about being smack in the middle of this pandemic is that we can't even be 100% sure of the transmissibility of this virus. The asymptomatic carrier may have an extremely large role to play in spreading Covid-19. An oft-quoted line of wisdom with regards to Influenza used to suggest that you are most infectious before you start to show flu symptoms (might be more true for Influenza B than A). This same line of reasoning seem to hold true for Covid-19, and a pre-symptomatic or asymptomatic carrier might just go about shedding a lot of viral particles without being any the wiser.

I keep thinking back to how my response to this virus changed as the situation has evolved. Even while at the clinic, initially I wasn't afraid to shake hands. At that point, before seeing a patient, I would casually glance at their notes and only don a surgical mask if the patient exhibited respiratory symptoms. From there, it evolved to no handshaking, having the surgical mask on at all times, and eventually progressed to preferentially donning the N95 mask. I went from looking at my scrubs as benign items that I was confident to walk into the house while wearing (at the end of a shift), to germ-infested items that are tracking this nasty virus to my humble abode each day.
In case you might not have guessed it, a lot of your doctors and nurses are the biggest hypochondriacs out there. It started out during medical training when we were exposed to a whole bunch of medical conditions in the literature. Sometimes we could feel the lecturer diagnosing us with the rarest conditions on the spot; but because we stoically kept quiet, I think we eventually just overcame our worries and fears to continue with our chosen careers. It does of course help that once we begin actually practising medicine, we discover that "Common things occur more commonly"; and in case something uncommon jumps out at us, between our hands-on practice and help from peers and superiors, we can usually fashion a suitable response to the task at hand. Truthfully speaking, Covid-19 has a lot of us worried. There are no standard treatment regimens as of today for the disease, and there is no vaccine in sight until next year (at the most optimistic estimate). The disease remains a really theoretical concept for the ordinary mwananchi, but we in the medical field can physically visualize the downward spiral for an affected patient. We've encountered these effects with other diseases, but never on scale that's potentially this massive!

I also keep thinking back to a few of the patients that I'd been encountering in the previous months. I was - initially - particularly annoyed at the patients who'd travelled from hotspots; instead of quarantining themselves off for the agreed 2 week period, they were breaking quarantine to come into the clinic to seek reassurance. Practically all of them were asymptomatic, but they still worried that they had possibly put their families/loved ones in danger and worried about the fallout. They wanted to have themselves tested, but the truth of the matter was that only government labs were conducting the testing, and due to scarcity they were only really testing patients with marked respiratory symptoms coupled with a positive travel history or contact with a Covid-positive individual.

I can understand their fears. For the longest time I have had 2 fears concerning this condition:
  1. Suffering the most severe symptoms
  2. Unwittingly spreading it to others
I daresay that if all I was going to encounter was the typical flu symptoms - with the assurance that I'd be immune thereafter - I'd rather get it over with (same way parents used to opt for their kids to get exposed to Chicken pox). All I could do was reassure them that they had an 80% chance of being on the good end of this condition. Until such time as they would develop severe symptoms, I advised them to simply continue with their quarantine schedule whilst monitoring themselves.

Lately, however, I've developed a 3rd fear that stems from our government's response. As a matter of policy,

"Until the Ministry of Health establishes the existence of sustained community transmission, all confirmed positive Covid-19 cases identified should be monitored closely at a HEALTH FACILITY ISOLATION ROOM...Once sustained community transmission has been established, home management of mild cases should be encouraged."
 *Interim Guidelines on Management of Covid-19 in Kenya (PDF Page 13) - Available for Download here


I'm of the opinion that because we have under-tested thus far, we have already reached the level of sustained community spread. This is the reason that I'm all for random mass testing of the general population because it will push the number of confirmed cases up exponentially, which will in turn escalate the government's response; ideally, this should mean home care for Covid-19 positive individuals with mild symptoms.

The government's understanding of the situation and its "playbook" keeps changing as time goes on. After a recent webinar by medical professionals, I feel like the government might choose to accommodate a Chinese solution, meaning isolation of POSITIVE people, whether they might be asymptomatic or mildly symptomatic. If that's the course they follow, picture a whole bunch of people who might at most only require Paracetamol, cough syrup and bed rest being isolated away from the general population in designated facilities like hospitals, stadiums and high schools.

I also appreciate that the government also needs to do contact-tracing of those individuals that have possibly been exposed to a confirmed Covid-19 patient. Defining the extent of the disease's spread is important, but I believe that we also need to safeguard the dignity of our citizen's who've been inadvertently exposed to this disease. These contact-tracing officials riding gung-ho into a neighbourhood in the name of carrying out their duties risk panicking residents, or even worse turning the infected/affected into pariahs within the community (like Alex in my initial story). Ironically, to quote Donald Trump,

We cannot have the cure be worse than the problem
    
Life will go on for most of us beyond this virus. We cannot afford to "burn" people in the community in the name of protecting everyone else. Despite how crazy things might be around us, we must retain our humanity through the whole experience.

I really sympathize with the government as well. It can't be easy charting a course in the chaos with all the differing opinions about their approach (though I suspect they're having a much easier time than the United States). I can respect that they've chosen to have people wear masks like the CDC recommended (but not the WHO), but hate that they've left us at the mercy of hoarders and quacks supplying the goods. Have they even stockpiled enough masks for healthcare (and affiliated) workers in this same period? Then there's the problem of indiscipline among Kenyans. In much the same way that overseas travelers failed to self-quarantine, it can be postulated that Covid-19 positive patients are unlikely to self-isolate of their own volition (as recent reports of mischief would suggest).

We have a powder-keg of a mess on our hands, but there is always hope if we empathize with those that we mean to protect. Worldwide, Covid-19 is showing us that traditional inflexible systems cannot work. Just like the fictional human society in Star-Trek, we might be forced to abandon concepts like "profit" and "individualism", and just work together to confront a common unseen enemy, if at least only for the moment at hand. At a countrywide level, our politicians need to make sensible policies for the citizens they govern. Despite all the buzz about Kenya being a middle-income country, they know that we are still a fledgling developing country with a vast vulnerable population. Their policy needs to acknowledge that and put in place measures to safeguard the most vulnerable; ignoring this will only lead to revolt.

At the local level, there needs to be public health education on a massive scale. People need to feel entrusted with the knowledge and acumen to fight this disease. They also need to be reminded that with all the RIGHTS that they exercise there are also congruent RESPONSIBILITIES. The only way we come out of this any better is by abandoning the inefficiency and bad habit that have failed us in the past; we need to empathize and we have to be better. Our very survival depends on it.

God Bless