Wednesday, October 25, 2017

The Music of Pat Metheny - Minuano 6/8

Eventually, it had to happen. I had to dig up one track that is quintessentially a Pat Metheny Group number. This is typically the 2nd part of his famous "Metheny Medley" (Phase Dance - Minuano (6/8) - September 15th - First Circle...), and even continues to maintain that position in his newest Sessions rendition.

It certainly was a hard track to come by because this is one of those long form songs, which begins one way, and midway transforms into a whole other creation. I was lucky to run across it as a snippet from a fan's playlist on Pat Metheny Radio on the PMG website. (Un)fortunately, the snippet was from the second portion of the song past the 2:45 mark - similar to what he uses in his medley - thus, it is one that you're likely to miss unless you're patient enough.

Coming from the "Still Life (Talking)" album of 1987, this song reflects some of the group's earlier Brazilian influence from around the period; it also includes the incorporation of wordless vocals in its composition. The song starts off with an eerie portion of humming set against a nondescript instrumental background that steadily increases in complexity; there is an ebb-and-flow of the guitar, piano and other percussion elements as something buoying the humming, but not entirely sounding unified at first; this then builds up around the 2:45 mark, where we swing from the crescendo of the humming into a beautiful samba bass line.

From here, the guitar, piano and whistling spell out the Minuano melody, and in the next line the vocals reiterate the same phrasing. This is the preamble to Metheny's tasteful solo (more restrained in the album version, but a tad more explosive in varied live playings of this song). We then delve back into the minuano melody, which is used as a bridge to a delightful percussion breakdown: the Marimba stands front-and-centre with notable backing from castanets and the piano; for its second spin, the drums are brought in and the bass accent a few notes, and lastly, third time around, they are joined by Metheny's guitar which seems to resonate exactly with Steve Rodby's Bass playing. With the whole band back in play, Lyle Mays builds up the next bridge section to sound like a brass heavy affair, and then we find ourselves back in the Minuano melody proper till the song's conclusion.

Clocking in at a decent 9:28, this song is a masterpiece. It actually seems much shorter when you play it out, but it is immensely enjoyable through and through. Many versions of it abound, especially some live versions (We Live Here & Imaginary Day DVDs) where the intro session is cut out and they just get down to business. Also available is the Pat Metheny + Metropole Orchestra version adapted by Pat for a massive ensemble.

Whichever version you view, I hope it proves as much a feast for your senses as it has for mine over the years.

God Bless



Monday, October 23, 2017

Discipline

I have been mulling over this topic for a while, and now it's just something I have to get out there. However, for the sake of making a few things clear in this post, I need to juxtapose 2 memories (for the first time no less) to serve as a useful reference point.

The first memory is pulled from 'orientation week' at Daystar University in late 2001. Now, I've called upon that time period once before, but I think it is begging for a revisit. On one of the allotted days, the University Registrar - Mrs. Arao (my very own mother) - addressed us. Granted, she did address us on more than one occasion that week, I am reminded of the first speech that she prepared for us. I can't really remember the specifics, but I'll never forget the topic: Discipline. Discipline was supposed to make all the difference between how we utilized our time, all the resources our parents (guardians) had invested into our studies, etc to make our stay at Daystar, and our time beyond university fruitful. From what I know of my mother's professional demeanour, she's never been one to take an authoritarian stance; but students rued having to meet up with her in her office if it involved academic missteps. Turned out to be many a trepid time for a few students, but it was merely her enforcing her guiding principle of discipline, which, suffice it to say, if you didn't learn it at school, you'd eventually have to learn from the world.

The second memory comes to you courtesy of an annoyance that I'm sure many a Kenyan faced in the 90s: dealing with KPTC (Kenya Posts & Telecommunications Corporation). This was before the advent of mobile telephony, so the best way to stay connected was by having a landline. This came with a few problems, one of which was problematic connectivity, and even worse than that was that the billing proved to be a huge nightmare. I remember there being times when our phone would be out of service for huge swathes of time, yet come month's end we would receive an astronomical bill. I remember once going to their offices to protest an unjust bill, and all they could tell me was that the system recorded us as having used the specific amount of units, and there was no way to verify those units. My pleas that the phone had not been working for most of the month, and that barely anyone was in the house making calls to rack up such a high bill fell on deaf airs. In the end, they concluded that we just pay the bill or risk having our phone service terminated.

This whole year has been an irritating reminder of how bad politics is for the Kenyan psyche. Not that it's restricted to this year alone; rather, it has come to a head this year. Constant electioneering at the expense of development, and now, after a bungled election which has put us on the world map, there continue to be shenanigans aplenty that threaten to draw us towards a dangerous stalemate in the course of the week. In my experience, I believe that all Kenya's woes boil down to one thing: Discipline, or rather, lack of it.

There seems to be a rather prevalent rallying cry these days (not exactly sure when it became so fashionable), but if you live here, you've probably become accustomed to it by now:
"Accept and Move on!
As it has been used for the current political situation, people will tell you that it is to ensure the safety and integrity of our country; things may not be perfect, but we can eventually work on resolving them later.

On the surface, it might appear that it's a well meaning sentiment, but at its core it's just a call for Kenyans to settle down and accept the current mediocrity. If you pressed people further, they'd probably regale you with a sentiment along the lines of,

"Y'know, Kenya is a very stable place; things could always be worse...it's not like we're in Somalia or something of the sort!" 
First off, Kenya has enjoyed a favourable position for the longest time, but laxity and indiscipline could knock it off its high perch at any point if we're not careful. Next, I don't get why there's so much panic about our current situation. People are acting as if not having a president will doom us to extinction. Short of going to war, or some dastardly terrorist emergency that would require the imposition of Martial law, this country  and its people will live very peacefully. The inauguration of a prior president under the cover of dusk in 2007 is something that is still fresh in many of our minds. I didn't have the option to watch that particular inauguration because I was in China at the time, and I believe it also coincided with the "Media Blackout of 2007/08", but it is a very shameful part of our collective history.

I'm tired, as are many Kenyans, of the constant politicking that never really came to a close after the last election in 2013. I was hoping to have some semblance of peace, maybe even return to reading newspapers and watching News after the August 8th elections, but that was not to be. Our Independent Electoral & Boundaries Commission (IEBC) presided over an election whose results it cannot defend, and which summarily ended up being annulled by the Supreme Court. I just wish the Supreme Court hadn't been hasty in deciding that we needed to have another election a mere 60 days after they tossed out the previous election's results because I am pretty sure that the IEBC has not resolved the issues that characterized the last fumble. I'm also pretty sure that a whole host of people are criminally liable for some things that went down, and now we're merrily sailing in the same boat with those very same individuals who have atoned for nothing.


People might suggest I am being outright political because of partisan issues, but that is far from the truth. I can't lie: the current administration has nothing to offer me (as a medical professional) as it has single-handedly bungled the handling of the medical crises that have befallen the country (which is a treatise for another day); other than that, their record on handling corruption is deplorable. But there's something more: like it or not, every one of us is a political being because we contribute a fair amount of our income to this country in form of our taxes. None of this is by choice (the money having already been taken right out of our cheques and factored into the goods we purchase), but it is a necessity we bear understanding that the money will be put towards doing something useful for our society; something, which, neither of us could achieve on our own. Therefore, to paraphrase the old saying,
"I pay taxes therefore I am political"
Politicians are probably the most selfish class of individual we have, but they are human beings after all. I don't subscribe to the school of thought that suggests we have to have good people/Christians/angels etc. in power so that we can have good governance; rather, I believe in a system of checks and balances that makes it so hard for people to act in their usual selfish ways, such that it actually forces them to be good. Lord knows here in Kenya we've done our fair share to put in these checks and balances: a new constitution, Devolution, and plethora upon plethora of commissions and bodies that are supposed to protect the common mwananchi. Best intentions notwithstanding, we really have very little to show for all these measures, and I'm including the recent decision from the Supreme Court as one of the saving graces.

What irks me the most is the amount of money that has been wasted. The IEBC went through a huge sum of money to guarantee us a credible election via high tech servers, tamper proof ballot papers, biometrics and top notch communication; to find ourselves befuddled by the end results really calls into question whether we wouldn't better off just using the old manual system. It was actually easier to rig the old system, but at least it saved us all an enormous expense. And to add insult to injury, the reconstituted IEBC stands accused of shenanigans the likes of which brought down its previous occupants: purchasing a whole bunch of satelite phones (none of which worked, and probably at rates more exorbitant than the basic market rate) and single tender sourcing.

The IEBC might look like a culprit, but it is not alone; our commissions and statutory bodies remain unable to shield us from Kenyans without any moral authority whatsoever to rule over us. Hate speech runs unabated, with serial offenders strutting across the land guilt-free, even when televised recordings of their utterances exist for all to see. The Salaries and Remuneration Commission (SRC) sits impotent as the Members of Parliament (MPs) will most likely undo recommendations that the SRC put in place to harmonize runaway salaries and benefits, and tame the wage bill. I don't even have a clue who is supposed to represent the mwananchi when state machinery is blatantly used in campaigns

Like it or not, this indiscipline (fiscal or otherwise) is the cancer that eats away at the soul of the republic day after day. A mere fraction of the money whittled away by corruption could easily have addressed the medical crises, providing enough money to adequately compensate all medical staff cadres...even Teachers and the Police ; more money could be used to cushion the majority of our vulnerable population who are merely one medical emergency away from being rendered bankrupt. The same money could also be plowed into industries (novel, struggling or thriving) to guarantee that the youth of this country could be involved in some form of gainful employment. Our politicians seem overjoyed at being able to drum up massive crowds of people for mid-week rallies, but all I see is a ticking time bomb. The same people who have all that time to sit at rallies and soak up the "doctrine of the day" are for the most part impressionable and have nothing to lose. When all that desperate energy is whipped into a frenzy, we will all reap the whirlwind. With nothing to lose, they will turn on the very business folk, businesses, factories, etc. that are meant to help us put food on the table.

There are no easy fixes for the mess that we've gotten ourselves into, but there is a path back from the precipice: we have no choice but to become disciplined. I wish our leaders could be the ones to lead the way, but it seems like even in times of crises they still do not feel the need to make the hard decisions. Which pretty much just leaves it up to us, the common folk, to take up discipline as our mantra. It has to be something that we strive for and render unto our children, or those over whom we have influence. We need to make it something that can strongly be associated with being Kenyan as we oft romanticize "Bushido" with Japan or "Excellence" with German machinery. We have already tasted mediocrity in our past; it's finally time to embrace our greatness.

God Bless.

 





Sunday, October 15, 2017

The Music of Pat Metheny: Sueño con México (Orchestrion Edition)



Time to delve into another gem from the masterful Pat Metheny. This is from one of his solo albums (New Chautauqua) released in 1979, and as the story goes, the song was something he wrote up quite hurriedly as he became aware that he was one song short for the record. The original recording is an outstanding piece of work, wrapped around this beautiful weaving of music against a baseline arpeggio that is hypnotizing to say the least.

However, I will not be focusing on the original recording. In 2010, Metheny exposed the world to his idiosyncratic labour of love: Orchestrion. Sure, this was yet another of his solo albums, but one with a twist: he had the backing of a whole slew of musical instruments, specifically designed for the endeavour, that he was able to activate at will. He used this to good effect, and came up with 5 original compositions to showcase this project. However, after going on tour, he would dabble in some improv work using the orchestrion instruments, and he even gave some of his old tunes a fresh spin. This is of course what led to his spin-off album, The Orchestrion Project, which dropped in 2012. This album, inspired by his Orchestrion tour, was an expansion of his original orchestrion work featuring aforementioned new improv material and a few of his old hits.

And this is where we pick up things with his new rendition of Sueño con México. This rendition breathes a whole new life to the original (similar to what happened with The Way Up); the palette has been expanded greatly for this song. We end up going from the whimsy of a piece designed last minute in a Stuttgart hotel, to an even more tightly hemmed piece of music; whereas the original composition is a more nuanced quiet piece, this time around it's more full blown and expressive. The arpeggios underlying the song are more vibrant, and the extra percussion from cymbals, piano, bass, etc., used sparingly in bursts, amplifies the emotiveness of the piece.

Within this soundscape, Metheny still stands front and centre with his guitar and this time around he has a true semblance of a solo (which the original recording never really had). The solo has two distinct parts: at first he plays all his flourishes accompanied chiefly by the underlying arpeggio, and adds splashes of the orchestrion to accent his work; the second part is more subdued with just a bit more yearning conveyed by his guitar. Perhaps his finest moment comes in a roughly 1 minute stretch starting from the 6:40 mark; and within that stretch, 7:19 to 7:44 consists of some of the finest notes I've heard committed to music. So much elation, it just sounds like a stairway to Heaven. 

I enjoyed the original Sueño con México, but I adore the reinvented edition of the song, and I can truly call it one of my favourites. I love that he can still reinvent his classics anew, and use them to inspire a new generation. Thank God for such blessings. 

Saturday, October 7, 2017

The Things That Medical School Won't Teach You (6) - Don't be afraid to diagnose death



It has been one of those trying weeks at the office. Lately it just feels like I'm stuck in a rut and the job isn't fulfilling. Even worse is the loss of patients; seems likes it's more traumatizing in these past few days. Despite working at a hospital, it's still easy to take it for granted that these vulnerable souls could just up and expire on you at a moment's notice. Makes you think twice about that expression "Sleep is the cousin of Death!"

With all the death we encounter, you'd think that there would be some special training to help us steel our nerves and encourage us despite the amount of loss we witness; training that would keep our minds at peace, so that we could be able to impart some form of closure and finality to the grieving relatives that we interact with on a regular basis. The answer to this is, of course, a big resounding NO!

I honestly can't recall any of my med school classes that evenly remotely mentioned the concept of death (beyond the usual sterile "cessation of all bodily functions" package). In fact, it's only been earlier this year in a Counselling CME (Continuous Medical Education) seminar when this issue was really broached for the first time. However, as in all things medically-related, we just have to make do with on-the-job training, usually carried out on your own. So next time you get a doctor with a questionable bedside manner delivering bad news to you, it might not entirely be his/her fault. Blame the profession.

I'm reminded of one experience that occurred during my internship while I was in the middle of my surgical rotation. On that particular day, I was manning my casualty post when an ambulance pulled up to the adjacent parking area. Convinced that an ambulance pulling up most likely signified either an Obstetric/Gynecology (Obs/Gyne) or Surgical emergency, I silently prayed that this was one for the Obs/Gyne team. (...and of course when I was in my Obs/Gyne rotation, I prayed the opposite prayer).
In a departure from the norm, the ambulance just sat there parked without anything apparently meaningful happening. I took a walk down to the Nurse-in-Charge's office so I could get some idea of what was going down. Turns out that the EMTs/Paramedics had ferried a victim (elderly adult male) of a road traffic accident that occurred in an adjacent county to our facility. This irked us to no end for a couple of reasons:

  1. There is a protocol in place to follow when referring/bringing patients to our facility, which usually involves communicating with the Nurse-in-charge so that proper preparations can be made. Many people tended to ignore this common courtesy.
  2. More often than not, some counties are particularly notorious for off-loading their workload by referring patients that they could satisfactorily deal with within their own county facilities.
  3. With the advent of devolution, multiple county heads had acquired ambulances at a rate incongruent to the money they had invested in medical facilities. What this meant was that (as mentioned above), it was easier to handle an emergency situation by just dumping a patient at another hospital's doorstep.
So what we had was an actual stalemate. The ambulance had ferried an accident victim who was in urgent need of an ICU, but all our ICU beds were occupied (which they would have found out if they had bothered to inquire first); they were, of course, unwilling to transport the patient to another hospital or return him back from whence he came; our Nurse-in-Charge was sticking to her guns, and as per protocol, was not going to take responsibility for the patient.

I figure the ambulance had been parked for 30 minutes while this whole scenario played out. Finally, I made the decision to examine the patient within the ambulance to find out exactly what we were dealing with. So I step into the ambulance and the patient is eerily quiet; all I get from him is seriously laboured breathing. He's neither responsive to my voice or painful stimuli of any sort, and his eyes are closed shut; once pried open, his pupils are slightly dilated and not responding to a light stimulus. On the plus side, he did have a steady pulse. Thus, on the Glasgow Coma Scale (GCS), this patient registers an all-time low of "3".


Now any medic knows that this patient's breathing is going to be the next thing to go; devoid of an ICU with ventilatory support when that happens, death will most definitely ensue.
I relayed my findings to the Nurse-in-Charge, and we shared an ominous silence between us. The patient had no relatives/guardians that could organize for him to be taken to another facility, so he was stuck either way. Seeing as we really had no good choices, we opted to keep him in our casualty area, providing supplemental oxygen and as much supportive management as we could muster under the circumstances.

He lasted a good 2 days in that state (longer than I had actually anticipated), but in the end he passed away.

Despite all my experiences with death, even I fail to see how I would prepare a lesson to adequately prepare fledgling colleagues for what awaits them in the field. Every death encountered is as diverse as every life lived. You will watch some lives snuffed out within the few minutes you encounter them, and yet with others it will be a "slow burn" where you will get to experience the patient's life and those of their relatives for a prolonged period. And in itself, this notion of time is certainly a fluid concept: you could live a lifetime in the few minutes that you spend trying to resuscitate a newborn child, or, as in my experience with Edna, the 5 hours you spend with a practical stranger.

In my experience, I have found that you shouldn't be afraid to diagnose death! I'm not talking about that morbid movie-type experience where a doctor says something along the lines of you having 6 months to live (nothing is ever really that clear-cut); rather, you need to develop an acumen for seeing it coming. After being around death for such a long time, you and your colleagues develop a knack for predicting it (especially the nurses); in my Paediatrics rotation, I discovered that mothers are very good at sensing minute changes in their children's state, so when a mother asks you to check up on her child, kindly do it.

Any well trained health worker knows that recognizing the GCS will steer you right (except maybe in the tricky case of career alcoholics!). Thus, as a matter of fact, impending death is easy to predict in most cases, but occasionally it just sneaks up on you; I've had cases where we've fought out the worst of the patients' battles, and just as it appeared they were on the road to recovery, the war ended. So, in essence, the work of medical staff truly is that arm-wrestling match immortalized in my intro illustration. And in the end, we always lose!(...it is appointed for all men to die once, and after that comes judgment...).

Morbid as that may sound, death is not always the grim experience we all imagine; if handled correctly, it can provide closure to those left behind, a culmination of a life well lived. Pair that with the belief that people have of the afterlife, and you end up understanding that death is not the "be all and end all" of everything; it's just a phase.

I remember that during my first few months in China, I struck up a friendship with a young practising doctor from Mauritius named Javed. In the course of mentoring me, he gave me one quote that's stuck with me till today:
We treat, but God provides the healing!
There's only so much that you can be expected to achieve by the instruments and measures of your time/era, and death is always an inevitability, so be humble in your practice. A 'God Complex' is a liability to any true health worker worth their salt; do not give people false hope, but neither should you aim to dash their hopes underfoot; always do your best for your patients, and rely on all members of your team to get you through all eventualities. None of us is perfect, but as I've mentioned before, working with this segment of society is a privilege (despite its taxing nature); therein lies a blessing and a daily perfecting grace.

God Bless