Spider-Man: Far From Home "Spoiler Free" Review

Time for yet another MCU adventure after the massive event that was the Infinity saga came to a close. This sees a return to some light fanfare with the latest Spidey installment. As per the after effects of the events known as "The Snap" and "The Blip" (which is what they now call the moment that the other 50% of people reappeared thanks to the Professor Hulk's use of the Infinity Gauntlet), our team of high school comrades find themselves back in school with a bit of a twist: they haven't aged at all, but the people that remained aged a natural 5 years in their absence. And, as per where we left off in "Homecoming", Michelle is going by MJ now. In true comic book fashion, Peter is now enamored with her, and romantic shenanigans ensue. It seems like the European tour the school has scheduled will provide the perfect opportunity for Peter to step up to the plate and ask her out.

Unfortunately, Nick Fury has other plans for Peter. Substituting for Tony Stark, this is Nick's first "true" introduction to Tony's protégé. The MCU has thus far only paired Nick with the older superheroes, so it is interesting to see him paired up with the inexperienced needy teenager. This thus makes Fury appear more ornery as he serves as the annoyed mentor who feels he should be dealing with a lot better than this. In true MCU fashion, the Avengers are "off-world" or incommunicado, so Spidey is really the only one that he can count on. Well, with the exception of Jake Gyllenhall's "Mysterio", who appears as a response to the Multiverse's Elementals threat who happen to be this outings "creature-feature".

This movie made me nostalgic for 1991's "If Looks Could Kill". In that movie, a high school slacker basically got confused for a secret agent, and he ended up thrust into larger-than-life espionage scenarios. Pretty much the same thing happens here, especially once Nick Fury starts to meddle with Peter's Euro Trip, and once Happy (Hogan) entrusts Peter with the E.D.I.T.H artificial intelligence system that was handed down from Tony Stark.

Unfortunately, the movie falters in terms of its story mechanics at times. To explain this, I need to contrast MCU/Tom Holland Spidey with Sam Raimi/Tobey Maguire Spidey. People complained that Tobey Maguire seemed too old and didn't portray the young Spidey too well, but he was ultimately self-sufficient. This is in fact what made the adaptation of the "Spider-man No More!" storyline possible. His biggest debt is the death that he cannot undo: Uncle Ben. However, as overwhelming as things may get and the chips may be stacked, he continues to prevail as a solo hero. This is why "Spider-Man II" prevails as one of the best superhero movies ever made.
Tom Holland's Spidey is cast in the mold of the animated "Ultimate Spider-man". A teenager who is basically a Tony Stark fanboy. In "Civil War", we get a glimmer of his homage to Uncle Ben as his justification for donning the suit; however, by the time of "Homecoming", he's in full Tony Stark hero-worship mode, and comes to rely on his augmented suit as a crutch. Sadly, "Far From Home" propels us farther down this path with the notion that Spidey is in some way supposed to take up the mantle of Iron Man. This overwhelmed teenager storyline thus becomes the reason for some of the dumbest decision-making ever committed to screen time.

This is an MCU movie, so it definitely looks good. The SFX department dedicated to Mysterio really did a top-notch job; seemed like they were channeling their inner Dr. Strange. The action and comedy blends in very well, and this will definitely be an enjoyable time at the movies. However, the high school gimmick abounds in this movie. I'm looking forward to seeing an older Peter Parker put to screen so that eventually we might even be able to have the "Spider-Totem" story made for the big screen. Mayhaps the MCU needs to finally divorce this convoluted Iron Man - Spidey relationship and let him stand on his own two feet as the true hero that he can be. Only time will tell.

I give this move a B+.

God Bless

X-Men: Dark Phoenix "Spoiler-Free" Review

If it isn't news to you, you'd already know that this movie has faced quite a thumping from the critics. One of my favourite Youtube reviewers - Jeremy Jahns - even found it fit to rate the movie as "Dog Sh*t", a rating that's been preserved for the like of "The 50 Shades of Grey" trilogy and other similar cinematic failures. I get it! Sometimes it can be so much fun to rail on a movie. I've seen a comparison to Wolverine: Origins, and I remember how that movie was similarly savaged; however, I remember the genesis of that movie's bad luck was a movie critic's review of an unfinished version of the movie and similar bad happenings for the production studio. Contrary to public opinion, I enjoyed Wolverine: Origins, so I was willing to give this movie a chance to prove itself.

In a unique twist of events, there are showings of both the 2D and 3D versions of this movie right now. I ended up watching the 2D version...no biggie. First off, I was astounded by how beautiful this movie looks. The cinematography is simply astounding with colours so vibrant that especially pop out at you in the space scenes. The scenes remain crisp and clear no matter which era they're representing.

There are similar beats in this movie to the last "Phoenix" iteration from The Last Stand. As usual, it explores Jean Grey's fractured psyche once she begins to be inhabited by the powerful "Phoenix Force". The Last Stand broke with tradition and sought to make the Phoenix a darker identity that always resided in Jean; Dark Phoenix takes the more traditional approach and renders the Phoenix as a visceral cosmic force capable of both creation and destruction in equal measure. Hand-in-hand with Jean's struggle is Professor X's conundrum at trying to match his good intentions with his methods. This time around there's been a quantum leap and the X-men are considered fully fledged superheroes that the public is very much aware of. In a series that has given us the delightfully dystopian "Days of Future Past", it is not lost on the Prof. that the mutants are really one bad day from going back to being characterized as a danger to society. This movie mixes in these 2 stories quite well, and it forces these two characters to handle a very murky progression of events while coming to terms with their shortcomings.

As usual, Magneto is never too far behind. As if on cue, he's found some semblance of peace, but as usual, he's pulled back into the fray again; really any excuse to have Magneto in these movies is worth it. Michael Fassbender (and Ian McKellen before him) has always managed to make him a relatable "Villain" with questionable actions that are not too far-fetched in the scheme of things. He always leaves us wondering whether he can ever really become a force for good after all the bad things that he's faced in his past.

Running parallel to the Jean Grey - Phoenix storyline is the story of the mysterious white haired stranger played out in ever ethereal fashion by Jessica Chastain. In The Last Stand, the Phoenix was pretty much a sideline character that Magneto had sitting on the wings as he took his fight to the humans; this time around, the nature of the Phoenix force propels this movie into the cosmic realm, and with that comes the arrival of other "players" into the mix. The trailers don't really divulge anything about this storyline, and since this is a spoiler-free review, neither will I. Suffice it to say, I had expected her to be a different character from X-men lore, but she adds another nice bit of layering to this tale.

The acting is top-notch, and Sophie Turner is all over the place with Jean's frenetic changes in emotion; she is all at once this scared frail figure, and then the embodiment of power personified. James McAvoy's Prof. X is the heart of this movie, anchoring all elements in place. He is the figure that has to balance peaceful coexistence betweens humans and mutants, worry about protecting both sides and sometimes to the detriment of his own charges by placing their lives in danger; and he is Magneto's foil, thus despite the fact that benevolence is at their heart of their actions, he has to sometimes straddle a thin line that could easily cause him to become just like Magneto.

There was one death that was teased from the trailers, but I don't think it had quite the emotional punch that they were expecting. This character has been "overplayed" throughout the series, was also responsible for the most cringe-worthy line in this whole movie, and it just felt better that the character was done away with. The death and its aftermath get a less than fully realized set of plot points, and this was one of the weaker parts of this movie.

The action set pieces look good, but one city street battle was particularly hard to follow. This may have been a casualty of the darkness involved and the pacing. Unfortunately, like in some bad WWE fights, the extent of some injuries is overplayed and some characters can end up unfairly counted out from subsequent fights. They borrowed some elements from The Last Stand, like the Phoenix's ability to obliterate her enemies, and even some of the interactions. This serves as some very good misdirection because they subvert your expectations and show you that this is a very different movie from its predecessor.

This movie has disappointed quite a number of people because it perhaps didn't turn the Phoenix saga into the full-blown spectacle that it was in the comics and animated series. However, truthfully, we'd need about 2 full length movies (3 hours each) or one season of a television series for that to happen, so I'm glad with what they've given us onscreen this time around. I think this is a great open-ended send-off for this set of characters, and look forward to what the MCU will add to it now that they've gotten back the rights to the X-men.

I give this movie a B+ and guarantee that it's a good time at the movies.

God Bless.


P.S: Now that I've finally watched this movie, I can give my definitive ranking for all the X-Men movies.

1. Logan 
2. X-2 
3. X-Men Days of Future Past 
4. X-Men
5. X-Men: Dark Phoenix
6. The Wolverine 
7. X-Men: First Class 
8. Wolverine: Origins 
9. X-Men: Apocalypse
10. X-Men: The Last Stand

Survivor's Guilt

I was at the clinic the other day, and I was finishing up the evening shift. A female patient showed up for a review with regards to lab test results. It isn't uncommon for us to end up reviewing a patient on behalf of one of our fellow doctors because their shift might have ended before investigations they'd ordered were complete. I honestly don't mind because it is usually a case that can be handled quickly.

In this case, it turns out that the lady was the one who had specifically asked for the tests. We get this from time to time too: some individual may have suffered from a specific malady in the past, thus they come in on a regular basis just to check on that specific parameter - Lipid profiles (cholesterol), Liver Function Tests, Blood pressure or sugars, Clotting profiles, etc. I pored through the lady's results and everything was essentially normal, which is the best kind of news - no management needed whatsoever.

At that point, the lady decided to let me know what had occasioned the testing. She had lost her last pregnancy in her 3rd trimester, and was considering getting pregnant again. I decided to question her further, and asked her if the baby had any identified malformations; she answered no. Next, I asked her if there were any problems with her blood pressure during the pregnancy; Yes, she answered.

So my mind pretty much knew what the diagnosis had been: Preeclampsia. So I continue to peel away the layers, finding out that she had very elevated blood pressures which had worsened towards the end; she had also developed generalized oedema. With blood pressures towering above the 170/100 mmHg mark at some point, she had generally crossed over into the realm of Severe Preeclampsia. She had been admitted for monitoring, but somewhere along the way foetal movements ceased and the baby passed away - an IUFD (IntraUterine Fetal Demise) at 32 weeks of gestation. To make matters worse, the lady ended up needing to undergo a Caesarean Section to deliver the recently deceased baby.

The hits had just kept on coming during that pregnancy, and almost 2 years down the line, this lady was still coming to me with questions. In some regards, as usual, she still felt that the doctors were at fault and didn't do enough to save her pregnancy; she was obviously hoping that the same thing wouldn't happen in this subsequent pregnancy attempt. In the course of the conversation, I also got the impression that she felt that things would have turned out better if it had been her life lost in the pregnancy and not that of the unborn child.

Being blunt
I had tried to be compassionate and offer up as much empathy as I could while we talked, but at some point it became necessary to give her the cold hard facts.

1. She had experienced preeclampsia in her very first pregnancy; it had been a mild case that had developed in her 3rd trimester, but that was evidence enough that she'd be at risk of suffering preeclampsia in subsequent pregnancies. For this (fateful) pregnancy, the preeclampsia had started earlier (in the 2nd trimester) and progressed even faster. She definitely should have been booked into a High Risk Pregnancy Clinic for her 2nd pregnancy; but I let her know that it was imperative that she start any future new pregnancies with prior visits to her Ob-Gyn before conception.
   
2. Preeclampsia/Eclampsia is no joke. It's one of those conditions that gives doctors nightmares because we don't fully understand its cause, but we have dealt with its ramifications many times. Any organ damage that happens during the pregnancy stands the chance of being irreversible! Let me mention a few of my fine examples
   
   
   • Pre-internship (KNH) 
   • A mother shows up after a normal delivery in Kibera. She seems to be acting particularly aggressive and out of sorts, so we assume it is a case of puerperal (post-partum) psychosis. Only thing gleaned from her discharge notes was that she's had a BP of 160/100 mmHg at one point. 2 weeks into her stay we end up performing a Head CT scan which shows a massive bleed into her brain. A few days later, she's gone.
   • A mother is 20 weeks pregnant, but her whole body is swollen like a grapefruit. We have a special term for this kind of oedema: Anasarca. I have never seen a case of preeclampsia progress this fast! Coming this early in the pregnancy, my consultants have no choice but to terminate the pregnancy to save the mother's life.
     
   • Internship 
     
     • My introduction to the Obs/Gyne Department: a mortality debriefing. Mother had suffered kidney failure and basically had blood streaming into her urine bag instead of...well, urine. Patient succumbed soon after.
     • A mother had developed seizures in the course of her delivery, and thus ended up being taken to ICU for further treatment.
     • Typical night in the labour ward. Mother transferred in from Lord-knows-where in need of a Caesarean Section (CS). Mother hasn't really had any sort of antenatal clinic visits, so there isn't much for us to glean in terms of past medical history. Anaesthetist hopes to perform a rapid sequence induction using Ketamine, but, with the patient already on the operating table, finds out that the patient's blood pressure is at the 180/100 mmHg. Ends up having to switch to more traditional agents, which have a pressure lowering side effect, and as the surgeon I have to perform as quick a CS as I possibly can, and hope for no complications.
        
   • Post-Internship - a relative comes down with a case of AntePartum Hemorrhage (APH) just 4 weeks prior to her official due date. Investigations prove that she's developed HELLP syndrome, and ends up needing a CS one week later to avoid any further complications.
     
   • Most preeclampsia pregnancies -  with regular doctor's visits and appropriate medication, we are able to ensure a smooth pregnancy. Delivery of the placenta usually results in normalization of blood pressures for the mother; an unlucky few go on to develop chronic hypertension.
     
3. A doctor will NOT risk the life of the mother for the sake of the child. This is not some form of Roe v. Wade permissiveness - this is a real question of life and death where the pregnancy places the pregnant mother's life in immediate harm, possibly of imminent death. We don't particularly like sacrificing the life of an unborn child, but in terms of priorities, it is basically
   

   Save the Mother first; if possible, save the Mother AND Child.

   I do not hesitate in this matter in light of my experience losing Edna. I have been adequately prepared to answer this question by a Philosophy 101 class from my first semester of (Daystar) University. The justification for this is strangely Utilitarian: the mother is a microcosm - she has built up a wealth of relationships, and has very many people who actively depend on her; the foetus is wholly potential. Thus, as a doctor, in weighing the scales, it is more ideal for you to save the mother's life, preserving the already intricate web of relationships that she is a part of.
   
   But then again, life is not so clear-cut and absolute. I remember hearing about the case of a mother who delayed chemotherapy treatment so that she could have a normal pregnancy, and give her unborn baby a fighting chance at a normal birth and life. This was wholly a mother's choice and sacrifice, and a reminder that mothers (and fathers) will on many an occasion make the ultimate sacrifice for their children.
   
   
4. Hindsight is 20/20. Doctors usually get asked to review situations where things have gone wrong, and asked to chime in our thoughts. This is why we typically have Morbidity and Mortality (M&M) meetings, which give us a chance to backtrack and see how things could have been done better. However, we are not always so quick to assign blame because there is the realization that every health situation evolves along a vast array of lines. In this case in particular, someone may argue that the baby should have been delivered earlier. Theoretically, I can think of 2 reasons why the doctor might have chosen not to.
   
   
   • The mother's blood parameters might have been with normal ranges, and it was hoped that adjusting the set of medications that she was on should have allowed the doctors to prolong the pregnancy.
   • It might also have been possible that the baby was considered "small for gestational age". Preeclampsia is one of a host of conditions that can cause Intrauterine Growth Restriction (IUGR), so prolonging the pregnancy would offer a better post-delivery outcome for the foetus.
     
   It is no mere coincidence that I am emphasizing prolongation of pregnancy. Some people may remember a Christian song by the name "Better is One Day". One lyric in that song is particularly poignant

   Better is one day in your house...than thousands elsewhere

The songwriter was referring to being in God's presence...but he might as well have been talking about a foetus in the womb. Nothing we scientifically possess is capable of mimicking the fine-tuned conditions that exist in the womb; thus, as normal a progression of pregnancy is one of the main aims of any OB-Gyn. We usually find that it is ideal to let nature take its course as much as it possibly can.

Conclusion
I think it's worth noting that the patient described me as being "very blunt" at the end of our talk. I don't regard that as a worthy hallmark, nor is it representative of my typical bedside manner. However, she was thankful that I had taken the time to explain things to her in a manner she hadn't experienced before.

In hindsight, it is possible that we sometimes mentions these things to our patients, but they fly right over their heads if they're not yet ready to hear them. Sometimes, we really don't have that much time: I had the chance to go over the situation with her because it was a slow evening at the clinic; I can't guarantee I would've had the same outcome on a busy day. This is why it's probably a good reason to readily recommend some counseling for such patients. Allowing them to talk about the experience often provides more relief than merely doping them up for their depression.

I am thankful for opportunities to practice medicine, and chances like this to clarify things to my patients. I hope this patient gets the outcome that she desires, and can get the true healing that she needs from the events in her past.

God Bless.

The Huduma Number Fiasco

You can obviously tell that I'm already peeved about this Huduma Number registration exercise. Just the manner in which it has been rolled out amid mystery and mistrust, and the immediate threats that have followed is an immediate cause for concern. However, before you go on to condemn me as some unpatriotic critic whose only intent is to curtail development, let me give you some reference for my misgivings.

Let's take it back to my medical internship, circa mid 2014. The government had suddenly become overwhelmed by its "ghost worker" problem, so they had decided that they would conduct a biometric registration program of its civil servants to fix the issue. So summarily, they decide that within a small window of time (~2 weeks in my recollection), all civil servants would have to be registered, or run the threat of not getting their salaries.

In my mind I'm thinking "what the hell is this?" I had been posted to Kisii Hospital in May that year, reported on June 1st, received my paperwork that I needed to present to the Ministry of Health (at Afya House) on June 2nd; after making all the submission of the required data, I had reported back to my work station on June 8th and started working. So they basically had all my fresh data,  but now we were going to add biometrics. Well, when threats abound, you just make your peace with the situation and try to find time in your schedule for such things.

This registration turned out to be a little tricky. The hospital served as a registration centre for some days (not given out in advance), then there was the functionality of the biometric registration kits (questionable), and the speed of the exercise. I remember that the most convenient time for me to register fell on the morning right after I had been on the night shift during my surgical rotation; hence, I made up my mind to show up for the registration early the next morning before I departed for home. Morning rolls in and I get down to the designated area (close to the cafeteria), and I find a large line has formed. There are some clinical and other hospital staff in the queue, but, surprisingly, the bulk of the people in line are other county workers from Lord knows where.

The registration workers arrive and the exercise starts. It moves slowly: only 2 of the 3 biometric registration kits are working. Then the usual tomfoolery ensues with grown men and women just cutting in line or being mysteriously moved ahead of others unceremoniously. By 12pm, I still wasn't any closer to being registered, and I was basically running on fumes from a busy night shift. I cut my losses and decided to head on home, and try my luck on a different day. The rest of the day turned out to be a similar nightmare: lights went out, meaning I couldn't charge my phone which also dabbled as my alarm; I thus overslept past my reporting time of 8pm, waking up to multiple missed calls from fellow interns once I eventually plugged in and charged my phone. (In retrospect, this might be one of the reasons that I had supplementary weeks added to my surgical rotation).

I eventually had to get myself registered at the county offices some time later (as usual, the date for the exercise had had to be extended), and life went on as it should...but I was pretty sure that the ghost worker issue would rear its ugly head again

All of a sudden, in 2019, we apparently have ghost workers in the Police Force. I'm not exactly sure if Police count as civil servants, and neither am I sure whether they were expected to be registered during that last (eventful) program of 2014, which was of course run under this same Jubilee Administration. This all boils down to the same thing: we have a mediocre set of systems that have been set up to manage us. A proper management system would register employees, make regular updates to cater for changes in their status/upgrades, and lastly account for attrition in the work force, occurring through resignation, dismissal or retirement. The fact that we have ghost workers masquerading in the system merely means that the system is not being regularly updated (to weed out past employees), or someone with a higher level clearance is introducing bogus data into the system. Needless to say, the majority of the good hardworking people will suffer for problems originating from levels that are "way above our pay grades."

So now we have the Huduma Number, our Saviour-du-jour. As with all things of this generation, we are first reminded that it is digital and biometric; in addition, it is meant to bring together all disparate data and numbers that are essentially tied to each Kenyan, and basically make life easier. This isn't really anything new. I remember that some time before the most recent elections, some government spokesperson had shown up on TV and spoken of the need for a new card (and number) to oversee our other numbers. And even then I had still thought it was a ridiculous idea.


I actually managed to get my hands on one of the forms in advance, and I was able to start filling it out, but the only details I was missing were the expiry date of my passport and my driving license number. Looking at the form is simply infuriating because it just makes you realize that you've already filled in these details on multiple prior occasions when registering for your NSSF, NHIF, KRA and even driving license. And here's the kicker: you needed your ID card to register for all those other cards!

Anyway, filling out the form was easy enough, with the exception of these administrative divisions (county, sub-county et al.) which are pretty much a foreign concept to me. After it's all filled out, you have to sit and wait in line for your turn to be registered using the biometric capturing kits. Fortunately, I was being registered at my place of work and did not have to face the prospect of standing in a ridiculously long queue. Understand that the time it's taking for people to be registered is more along the average mark of 15 minutes, and there are some outliers that are even exceeding 30 minutes. That means that for every 4 people ahead of you in line, you should expect to wait about 1 hour if only one registration officer is working, or 30 minutes if you have 2 registration officers on duty. And that's hoping that the machines work the way they are supposed to! Rumours abound of the biometric kits being unable to capture biometric data if their battery charge dips below the 40% mark. Forget about that ease of registration display they show you when they register the President and other high ranking politicians. That is the demo version. You, on the other hand, are guaranteed to have a more tedious and nerve-racking time when you settle down for the process.

However, since this is Kenya, more frustration abounds when people fail to show common courtesy. How on earth do people grow up to be full blown adults and never ever learn to queue properly? People are already on edge because of the length of time the whole process takes, and the usual bunch of hiccups that ensue. Nothing grates the nerves more than seeing someone mosey up to the front of the line like they're entitled royalty. At our registration centre, someone had the foresight to draw up a register to keep track of people's order of arrival. This came in handy because we ended up switching to a larger room, and that kept things from devolving into free-for-all chaos.

The process itself merely consists of having everything transferred from the form to the Biometric kit, having your picture and finger prints taken, and also having pictures taken of some of the documents that you bring along with you. I think it only took 10 minutes to have my stuff over and done with. I can attest that my registration officer was a pretty stand-up guy...but then they did show up at 8.30 am instead of the previously stated 7.00 am.

Anyway, I have a little acknowledgment slip as proof that I've actually gone through the process. It still doesn't change my misgiving about the whole process. I don't really think this will improve anything. Sure there's all that talk of improved service delivery and rooting out ghost workers, but if this was something that was meant to be taken seriously they'd have started out with some civic education. Some people might try to explain it as the Kenyan citizenry being propelled into the future with a new digital number; this will basically save us the hustle of needing a whole bunch of other cards and numbers that are currently part and parcel of our daily lives. In theory, that would seem intelligent...if it weren't for the fact that our ID cards are already a key field item: they are basically the singular item tying us to our passports, KRA pins, NSSF and NHIF cards, and even our driving licenses. Someone may argue that the IDs may not be digital, but then the simpler solution would be for them to issue a New Generation ID card, and make sure that this time it is machine-readable. (the last generation ID card already included capturing of biometric parameters).

The common mwananchi is even more confused about what this new number will be able to do. Thanks to threats from government allied officials, people basically think that they won't be able to get bank cards, or perhaps that they may lose their cell phone numbers, or that they won't be able to register for things like passports (my personal fear). Sometimes in this country, unfounded fears can be something you should really consider seriously. I'm just thinking of the government clerks who will unduly frustrate people using this Huduma number as some sort of sifting criteria. These Hudumu Number cards won't even be ready for the next foreseeable couple of months (at least 3 - 6), and we will still need to use our IDs for most things, but one should never assume government offices are places where sound reason abides.

It's business as usual in this country. We haven't even passed legislation that's guaranteed to protect our data and honour our privacy. The politicians wrongly think that this matter is handled with as much carelessness as they form their political vehicles of the day: come up with the party first, then eventually tack some sort of manifesto and meaning much later on. Too much politics and tenderpreneurship has seen us sacrifice the soul of this nation for the vested interest of a few individuals. Politicians the world over are more likely to implement something new (affording them the chance to attend lavish ceremonies with ribbon-cutting theatrics) rather than retooling or fixing an old FUNCTIONAL system. The wisdom of the old saying still stands:

It is better to measure ten times and cut once than to measure once and cut 10 times

Any sort of critical thinking would convince anyone that this operation is half-baked; why else would they need to resort to the lowest form of manipulation  - intimidation - to get this pushed through? Kenyans are not an abrasive bunch of folk who merely routinely oppose the government for kicks - we can be reasoned with. The courts have tried to protect us from this hasty government decree, but this current government is renowned for ignoring court orders and bulldozing their way forward. The likelihood is that reason and justice will not prevail here.

However, there just might be some light at the end of the tunnel. I believe that the veracity of the data can be maintained beyond this exercise. This Huduma Number can eventually be written out of our collective consciousness, and we can get the ideal ID card we've been longing for. Fundamental to all this would be the fact that we build up a foundation of institutions and systems of integrity that will safeguard the dignity of the people of Kenya, and root out all the "conflict of interest" that is sucking our lifeblood dry. The land and people of Kenya will outlive the prevailing politics and trends of the day, and thus, we owe them something congruent to that. The glow and trappings of new technology will not be our saviour: a culture of integrity and respect for justice is all we really need, and something we will eventually get.

God Bless

 

Avengers: Endgame - "SPOILER" Review

By Eileen Steinbach

SPOILER ALERT!





This movie is a work of art! The Russo Brothers certainly have made some of the best MCU installments to date, but the soul sapping Infinity War was an extremely horrendous gut-punch that left the world (both real and MCU) in a dark place. We just needed to see how things were meant to end. They had to tie up a lot of loose strings.

Gladly, they followed up with Endgame. I am not going to do a blow-for-blow recap of the movie, but I will address some salient points that really stood out to me. I am happy that they put us in the thick of things, pretty much shortly after Thanos' snap: the world was awry, and the Avengers were still scrambling to make some sense of the world, finding some sort of solace in heroics. By the time that arc is resolved (shortly afterwards), they are plunged into true despair, and it is only then, after a well placed time jump (ahem... "Venom") that the mechanics for righting the world finally show up with the appearance of Ant-Man (yep, the Quantum Realm).

The seamless integration of all the various MCU characters started earlier, but cemented in Infinity War, continues to shine through in this movie: the Guardians of the Galaxy (GoTG) roster is basically only Rocket and Nebula, Tony's basically retreated into family life and has abandoned the Avengers (specifically Captain America); Black Widow is basically running point for Avengers operations, Hawkeye has become the anti-hero Ronin, and Bruce Banner has managed to bring forth the Professor Hulk identity thanks to some Gamma experimentation.

Thor has a really sad arc to his story (it's just been a steady decline), but the Russos can't resist the urge to poke more fun at the character, in much the same way that Taika Watiti started off in "Thor: Ragnarok". After the jump, Thor pretty much turns into "The Dude"from "The Big Lebowski" (I managed to catch the "On your left..Lebowski" on rewatching the movie). I haven't even watched that particular movie yet, but I recognized the character immediately he strapped on some shades and a cardigan. They really did Thor dirty!

The movie is not as fast paced as Infinity War in the beginning, but that is certainly not a weak point; Infinity War was pretty much a heist movie that was moving to the beat of Thanos' frenetic plans. This movie is a character study of the survivors, many of whom are dealing with "Survivor's Guilt", the pain of loss, and ultimately DEFEAT. People need to pick up the pieces before they can really become the heroes that we need them to be. Thor is about the worst possible manifestation of how far someone can fall; however, wise words from his mother Frigga end up putting him on the right track.

"Everyone fails at who they're supposed to be. The measure of a person, a hero, is how they succeed at being who they are"

The trippy mechanics of the Quantum Realm gave the directors a wonderful opportunity to reinsert future characters into a lot of past moments with future hindsight as something of a boon. It was also a chance to flesh out some going-ons that were merely glossed over/ segued out of in prior MCU installments. It was great to see that the Ancient One (Tilda Swinton) did her part to protect NY during Loki's siege. It was also a joy to see the Shield/Avengers politics that played out regarding Asgard's jurisdiction with regards to Loki's judgment. All in all, it was just wonderful to see the vast roster of characters - villainous and heroic - that have been a part of this MCU-world reprise their roles, even if only for short cameos. Not only was it great fan service, but any excuse to heap more layers on already developed characters is a worthy endeavour in my books.

As with any movie that focuses on time travel, this movie sought to put its own spin on the time travel trope and put a lot of previous time travel movies on blast (usually through Ant-Man/Scott Lang). It did set us down some confusing paths in the process. I can understand that they returned the Infinity Stones back to the past from which they stole them to preserve the timelines as the Ancient one had hoped. (Definitely couldn't have Dr. Strange "bargaining" with Dormammu without the Time Stone!) But what about them taking Mjolnir away from Thor in his Dark World outing. Mjolnir was pretty important in Thor's battle against an overpowered Malekith. Or are we just meant to consider that Odin might have commissioned "Storm Breaker" to be made earlier in the new setting?

(Addendum: Cap just returned Mjolnir when he went back in time. Y'know, for a moment there, I'd thought that Mjolnir had become his new weapon of choice, but in all likelihood, he returned it just like he did the Stones.) 

Also, they never let us know how Valkyrie, Korg, Miek and the other Asgardians were able to escape from Thanos' clutches between the events of Thor: Ragnarok and Infinity War. I mean, I knew New Asgard was definitely going to be included in this continuity, but they owe us a resolution to that little missing bit of info (along with the whereabout of Lady Sif). It is plausible that he could've just killed half of them and let the other half go, but if they could show us that for Gamora's world, they could certainly have shown it for Thor and the Asgardian remnant. Another thing that was also glossed over was how Thanos was able to steal the Power Stone from the Nova Corps. Infinity War just had a Power Stone wielding Thanos show up to obliterate Thor's ship, and Thor - while talking shop with the GoTG crew - mentioned that the Power Stone was stolen from the Nova Corps and that Thanos would be headed for Knowhere to get the Aether (Reality Stone). It seemed sad that this important event was relegated to the realm of exposition in such a summary fashion. I had hoped that this movie's time travel plot would at least have given us a glimpse into the raid on the Nova Corps

The Black Order is also a very overlooked element; their role was even smaller this time around (though Ebony Maw is an enticing character no matter how little screen time he receives). It would have been insightful to see how they came to serve the mad Titan, but that would have taken this movie beyond the epic length it already had. We know what their final destiny is, but I hope that there are plans to continue to use them in MCU stories about the past - similar to what was done with Capt. Marvel - and that way a full story can be told about the denizens of the Black Order.

Anyway, these few questions/ruminations aside, this movie remains a work of art. We have received fitting ends to the character of Tony Stark and Steve Rogers. Tony suffered character assassination under the reins of Shane Black, but his appearances in Russo movies (Civil War, Infinity War) and Spider-man: Homecoming actually made him a more well-rounded and likeable character; and here, he shines like never before. Cap finally got his last dance, and to live a fully realized and enriched life - no longer that fish out of water. He's handed the Capt. America mantle over to Falcon, but it could just as easily shift over to Bucky (something that's already happened in the comics). It seems like it was curtains for Black Widow, but then we know she has a solo movie in the works; I pray that it contains a team-up between her and Hawkeye, and we can finally get to see the "Incident at Budapest" that they've been referring to since the very first Avengers movie.

Hawkeye and Nebula got the biggest character boosts from this movie. On a team of superpowered individuals, having someone who's merely an olympic-level athlete at peak fitness with no other augmentation means that Hawkeye typically has gotten overshadowed. However, as Ronin, he was very much in his element, taking the fight to street level thugs and handing out summary justice on the fly. Just like Age of Ultron, he now has another death on his hands, and it'd be interesting to see how things progress;  he probably will name one of his children after Natasha...but first we need to see him in a Widow movie. Nebula on the other hand usually had limited range as an angry sneering individual. This time around we see the full switch with her bonding with Tony, and then Rocket, and even becoming part of a team. Everything comes full circle when her present self is juxtaposed against her subservient past. I think she will make a great anti-hero.

As for Hulk, the MCU needs to do him justice. The Professor Hulk is interesting, but he is not the strongest Hulk incarnation there is. Louis Letterier's Incredible Hulk was a travesty to the character, and managed to do much less with the character than Ang Lee's seminal Hulk movie. (Besides have Hulk utter the line "Hulk Smash!"). Perhaps they should consider a similarly serious approach to the character as was the case with Ang Lee; they could always throw in Joe Fixit for added measure. There's a lot to unearth here, and I'm sure the MCU could do it right.

In summary, my biggest highlights from this movie:

1. "On your left"
2. "Avengers assemble"
3. Captain America is worthy!
4. "Hail Hydra"

Strange that they all involved Capt. America. From the applause that rocked the cinema during the first three of these, I think that everyone else in attendance also agreed.

Here's to the close of one chapter, and the promise of a new and better lineup of movies with great stories to tell.

God Bless

Avengers: Endgame - Spoiler-Free Review

By Eileen Steinbach

One does not merely watch Avengers: Endgame and leave without having a life altering experience. This movie has touched my heart so much so that this time around I made sure that I'd have both a Spoiler-Free and Spoiler review for this movie...and I basically ensured this by writing the Spoiler version first. But you need not worry, I won't be spoiling the Endgame for anyone: I would love for everyone to walk into this movie with the little info gleaned from the trailers (trust me, it is very little) and walk out of it with a sense of utter joy and satisfaction.

This was a great companion piece to Avengers: Infinity War. After all the darkness that Thanos' snap introduced into the universe, we needed a whole lot of light to put things right again. Infinity War was basically Thanos 1.0; it was really astounding how a villain who had only previously appeared in a handful of cameos was able to steal the show so easily. In fact, Thanos as a villain is such a complex and compelling character. Similar to a character like the Joker, he is deeply invested in his villainy: in the Joker's case, there is obvious insanity tied to the character, but Thanos comes off as an Obsessively Compulsive individual who fully embraces his psychosis, and takes it as serious business. No laughs are to be had where Thanos is involved. The way they continue to evolve him this time around is as logical a progression of his madness as you'd expect.

This movie is the flip side to the chaos of Infinity War. For this reason, the pacing is slightly slower (only slightly). I couldn't even really call it a "slow burn" because every little bit of the heroes coming to terms with their vulnerability, loss and previous defeat is an interesting character study. You get to see the whole spectrum of reactions from ambivalence to obsession. However, once the pieces start to fall into place, the heroes rise up to the task and make us proud. I guess coming from all those previous wins that they'd had in their careers, it always seemed like winning was an inevitability. Thanos thus became the true litmus test for what it means to be a hero when you are brought down to your lowest point. I guess the best summation for this sentiment comes from one of my favourite movie quotes:

"Why do we fall? So that we can learn to pick ourselves up!"

There is a growth to all these characters that have come to be a part of our lives in this 11-year journey, and that is palpable throughout the course of the movie. I daresay that Hawkeye, who hasn't had that much to do since they introduced him in the first Thor movie, gets the biggest character development from this movie. It is good to see him getting the respect that he deserves, and I've always felt that he should definitely be a big supporting character in the Black Widow movie that will definitely be getting off the ground in the coming future.

The epic 3-hour runtime felt well earned for this movie. If you can sit back long enough to enjoy excellent world-building and storytelling, the time will pass by very quickly. From my previous Infinity War experience, I was peeved about having to watch this type of movie in a theater where kids are in attendance. As if fate was trying to spite me again, there were even more kids in attendance this time around; but, to my shock, they kept it together for the whole show. Their parents must've threatened to disown them if they embarrassed them in public! (Or maybe the movie was just that compelling!)

However, in that last hour, when the action goes down...it goes down (Russo style). Scores in attendance became child-like again, and people were cheering wildly. (When you do watch the movie, you'll understand what I'm talking about!). Having watched this movie twice, I can definitely tell you that it pays to be watching it with a "good crowd". The enjoyment level will be infinitely better for the action scenes. And they bring things to a good conclusion, that'll have you leaving the theater and feeling very satisfied, whether you're slightly teary-eyed or holding those tears on the inside.

I highly recommend this movie as a wonderful time at the theaters for the whole family. A+ movie making and storytelling. It feels just like catching up with an old friend.

God Bless

Us: "Spoiler Free" Movie Review

I'd been waiting to check out this movie since last week, and I only just happened to make it today; however, shockingly, they only had 2 shows - 10.30 am and 12.30pm at Prestige Cinema. I made the 12.30 showing, and surprisingly, I was the only person in the whole theatre. The only other time that's ever happened was, coincidentally, during a screening of The Grudge II in 2006. That was one hell of a scary movie, and I sat in there alone for about 70% of the movie before another soul just randomly popped in. I figured this would be a different experience, so I just braced for the movie.

First off, I was really fascinated that a big part of this movie revolves around the Santa Cruz Beach Boardwalk. My brother and sister only lived a short 15 minute walk away from that beach and I got to visit them on holidays, and consequently visited that boardwalk once; 

It's really hard to explain this movie without getting into spoiler-territory, but I can at least explain some beats alluded to in the trailers. The story spans 2 periods - 1986 and present day. Adelaide Wilson (Lupita Nyong'o) is vacationing with her husband, Gabe (Winston Duke) and her children: Zora (Shahadi Wright Joseph) and Jason (Evan Alex) in the vicinity of the Santa Cruz area. Things seem to be normal for everyone but Adelaide, who has a strange sense of foreboding about the area. Soon enough, her fears are shown to be correct and she and her family encounter their doppelgangers - the tethered - who, as can be expected, are rather malevolent.

Just like "Get Out" before it, "Us" is an amalgamation of many genres. It has a Sci-Fi angle just like its predecessor, and also elements of thriller and horror; unlike "Get Out, however, this movie straddles the "spiritual horror" line a bit more. This movie is a bit of a slow burn, taking its time to build the elements of its story. The most interesting element - the tethered - remains something of a mystery throughout, with its exposition crippled by the dynamics of the story.

The scope of this story is a lot bigger than the trailers would have led you to believe. I don't know if bigger was necessarily better, because at the end of it all, like many other movies that have come out recently, a lot of questions remain unanswered. I'm talking "Bird Box" or even "A Quiet Place" unanswered. It might leave a lot of fertile ground for a future sequel, but in the here and now, it feels like something is missing.

Lupita Nyong'o and her co-stars do a great job of portraying a terror-stricken family that goes from being wholly unprepared to evolving into a fully battle-ready unit when disaster strikes. Their performance as their doppelgangers is also exemplary, with most of their menace being physically portrayed. In the case of Adelaide, her doppelganger - Red - is both physically and mentally menacing.

This is not a particularly scary movie; I am not a horror-buff by any means, and if I was able to watch this alone at the theaters, anyone can. There is some bloody gore, but it is tastefully done. There's even comedy here, occurring in the weirdest of situations; strangely though, it lands each time. (Kudos to Mr. Peele). This being a horror movie, there are of course some questionable decisions made by these characters (I thought black people have always made the case that they would never do half the stuff that white people get caught doing in horror movies).

Personally, I wasn't really surprised by the twists and turns of the movie. I could see them coming from a mile away. I don't consider it being exactly intuitive on my part, neither do I feel that the movie was telegraphing everything; I guess I just synced with the director's thought patterns for this story. That being said, it still feels like something is missing in the translation of this family's plight to the larger scale of the situation, and the movie suffers for it.

You're welcome to watch it and see what you come away with. I'm 50/50 about whether this needs to be watched at the cinema or within the comfort of your home. I think this deserves a B.

God Bless    

Medicine: The Gift of Giving

 For the first time in my life I had the opportunity to do some CSR (Corporate Social Responsibility) at a "medical camp". I remember I had initially witnessed a couple of those clinics run at my local church (St. Elizabeth Ann Seton) while I was still doing my Pre-Med in Grantham, PA, and hoped it  was something I could do once I obtained my medical degree. Well, truth be told, it's been almost 6 years and a month between actually getting the degree and me doing the CSR. Part of that might be down to procrastination, but the bigger portion probably has to do with my proclivities towards giving. I'm not saying that I'm stingy, but I always feel like I never give enough...like I never can give enough. With such an internal monologue going on in my head, it's very easy to psyche myself out of giving. I appreciate the chance to give money when the occasion calls for it, but even more than that, I prefer to give my time. I don't put a premium on my time, and I'm still relatively young and devoid of any major commitments, so I have time to spare. 

I used the Bill Cosby pic at the start despite all that's happened with him lately because you can't knock the humanitarian work that he did. That little pic was a big part of my past because it was something I remember encountering in the back of Marvel comics. It is also my own personal mantra because I feel more comfortable donating my time more than anything else.

It turns out that you can achieve a lot if you have the right team, and in this regard I have to thank the Nairobi Hospital team that put it together. We had nurses, nutritionists, Lab techs, doctors, marketers and customer service reps working to make the whole experience seamless. It was my day off, but I was glad to be using all this knowledge I've accumulated to give back to the community. The medical CSR opportunity gave me the chance to interact with a bigger subset of the Kenyan populace than I have of late. It serves to remind me of the need that exists at the grassroots level. 

My most defining experience of the day was actually a paediatric case.

A grandmother shows up with her 7-year old granddaughter who is having a fit of coughing. So as I do the history taking, it turns out that the cough basically kept her up through the night; the cough has a diurnal variation (worse in the early morning and late evening), and it is worsened by cold weather. The child has been taken to hospitals, and usually receives a bunch of medications (last one being an antibiotic - Septrin), but the condition still recurs.

Off the bat, I'm pretty sure that the child is asthmatic, and on auscultating/listening to her chest, I hear the telltale rhonchi (wheeze); clearly she just needs an inhaler (Ventolin/Salbutamol), and measures need to be taken to ensure she's kept warm to avoid the cold, which is a trigger for her asthma. This is where things start to get interesting: turns out that when the girl was younger, she had been given an inhaler, but the clinician had given it with the caveat that she not use the inhaler so much because she would eventually get "hooked" on it. (The clinician must've been missing from class when they discussed ATOPY 101).

To add insult to injury, we have the child's mother who ascribes to a "name it and claim it" brand of religion. I initially thought that this specific mantra only worked for drawing blessings to oneself. Turns out there's an extension to that kind of thinking: basically the mother felt that if she "named" the ailment, then that would be her accepting the devil's curse upon her child's life. So she just wanted to live life as if her child's condition didn't exist.

I hold myself from going off on a tirade about the double dose of ignorance, and ask my superiors to arrange for the child to be nebulized (they were able to do this at no charge to the patient). However, this was only one mere battle to be fought; since asthma is a recurrent condition, this child needed an inhaler, and occasional follow-ups to assess the adequacy of the treatment. The grandmother already understood the importance of the inhaler, but it was the mother - the principal guardian - who needed some kind of counselling to come to terms with her child's condition. Unfortunately, the mother could not be reached at that moment, which was sad because she could also have received the counselling for free.

I ended up giving the grandmother a prescription for the inhaler, and hoped that she would at least succeed in convincing the child's mother that asthma is a common condition that has reversible symptoms, and can usually be managed with medication; and importantly, the patient can live an essentially normal life. Sadly, this is a case which will undoubtedly be lost to my own personal follow-up.

All in all, it was quite a long day, but it was worth it. I at least saved people some money and time in terms of consultation, and as doctors often do, provided reassurance about benign symptoms that may have troubled their minds. I think I might just actively seek out more chances to volunteer in the days to come. It might be a token effort in the end, but it probably makes a world of difference to lots of people out there. So if you're still sitting on the fence about volunteering, despite how much you feel you have to offer, take the leap and do whatever small part you can.

God Bless

Shazam: "Spoiler Free" Movie Review

After recently regaling you with the information concerning the "Captain Marvel" moniker, and all the controversy attached to it, it is fitting that I would be reviewing a movie from yet another of the characters to have used that name...this time from the DC stable.

Now, personally, I'm old school, and this was actually the first Captain Marvel I knew of. I even remember his old cartoon adventures that I got to watch, an episode of which I found on Youtube.

Right off the bat, choosing to name him Shazam seems like a very silly idea. It was always understood that that specific title belonged to the wizard that bestowed his powers upon Billy Batson, turning him into Captain Marvel. Because he is unable to say the name without undergoing transformation into or out of the Captain Marvel persona, he basically remains unnamed throughout the whole movie. Sure, they'll play it for laughs: his hype man, Freddie Freeman (Jack Dylan Glazer) gets in a truckload of silly sounding facetious names before the movie's through ("Thundercrack" was probably one of the worst of them).

All that aside, this is DC's foray into the realm of magic. They do have a couple of characters who straddle that line - John Constantine, Dr. Fate, etc - but Shazam is cut from a mould similar to Wonder Woman's, though he is skewed more towards the magical spectrum. This is an origin story, so it takes up the story of the wizard Shazam as he looks for his successor: a human who is pure of heart. (If you get a chance, watch the DC animated short "Superman/Shazam!: The Return of Black Adam", which is a barebones compact version of this story).

The villain in this scenario is Dr. Thaddeus Sivana played to maximum bad guy effect by quintessential bad man Mark Strong. I will not spoil his origins for you because it initially just hits you in the face, but his fate and that of Captain Marvel are deeply intertwined. This is quite a serious take on the character, because, if (like me) your experience with Dr. Sivana doesn't stretch beyond "Batman: The Brave and The Bold", you'd probably just think of him as a very comical villain. He got away with insulting Captain Marvel by calling him "The Big Red Cheese"; he even upped the ante when he met the Marvel Family, and referred to them as "The Big Red Cheese and his two Gorgonzolas."

  
This is certainly a dark take on the character, but it is developed organically throughout the film. In essence, he doesn't feel Nolanized. Surprisingly, one moment in which he settles family business will definitely produce a jump scare.

Changes have been made to more than just Dr. Sivana. They significantly darkened Billy Batson's backstory. I feel like they could've still gotten the family message across without changing his past so significantly...but at least they make it work by fleshing out the underpinnings of this re-imagining. Previous animated versions portrayed Billy as more innocent and naive; totally worthy of the "Pure of Heart" descriptor. This time Billy is streetwise, a bit of a smart ass, and displaying a singular drive towards a mission that puts him at odds with the foster families he's usually placed into. He basically isn't much of a team player, but the last foster family he's placed into is more than up to the task of dealing with his character quirks.

I'd have to say that with few exceptions, this movie was well done. They nail the dual personality of Billy Batson/Shazam thanks to great performances from Asher Angel and Zachary Levi. Zachary Levi channels that confusion that he did so well in his "Chuck" appearances so at this point he plays someone out of his depth quite well; and in a similar vein to that show, he has a sidekick who he can at once threaten, and also look to for advice on his unique situations.

Mark Strong can basically do no wrong as a bad guy; case closed. The foster family truly brought a lot of heart to the movie. All actors - adult and children included - did a stellar job concocting an environment where Billy could feel accepted without needing to conform to a set standard. Each of the foster children is unique, and the family dynamic works.

Also have to give props to the world building, and I'm focusing on the magical portion of it, because some of the real world portion is set in Philadelphia, and they even reference Rocky in one scene when they're seated on the "Rocky Steps"at the Philadephia Museum of Art. (Note: a lot of the movie was actually filmed in Canada). They tackle the magical realm in the "magic as a form of science" method that you've usually seen in the Thor movies. One scene in particular, which I cannot spoil, references this very well; mind you, the scene is not original (you'll get the animated reference when you see it), but it's no less creatively done.

Unfortunately, this movie has a less than stellar third act, and this comes down to that final fight. First off, since this is the Shazam universe, there's already an understanding that he comes laden with some baggage. I feel like it was a poor choice by the producers to include that this early in the game. All the seriousness (shrouded by all the comedy) built throughout the earlier two-thirds of the film is sacrificed for a comicky more childish finale. The fight choreography is also subpar, too busy, and lacking a crisp finish. It could have benefited from better editing.There is also something lost in the works about how Shazam finds Billy worthy of his powers; there is a dynamic that was set up by the story itself, and as the story proceeded this gimmick got written out, so something just felt amiss when Shazam chose Billy.

All in all, I had a great time with this movie, and it is definitely one worth watching at the cinemas. I'm tied between grading this as an A- for the first two-thirds, and a B+ or B for the finale. You be the judge.

God Bless 

P.S: Kindly desist from staying till the end for the end credits scene. Nothing new about it. It is that same Aquaman-esque scene already shown in the trailers where Shazam tests his ability to talk to fish. Stay for the mid-credits though.

The Things That Medical School Won't Teach You (10): [Good] Leadership

"Thrown under the Bus" by Jason Jones

My (Kenyan) medical internship was a treasure trove of experiences, and thus on this fine day we will be revisiting one of those many formative experiences.

So I'm in the Obs/Gyne department (little surprise), and it was one of our elective theater days (either Monday or Thursday if memory serves me right), and I was assisting a consultant as he performed a TAH (aka Total Abdominal Hysterectomy). We've gotten through the relevant set of procedures, cut what needs cutting, and tied off any bleeders that need to be tied off. All this was done with very little blood loss all around.

So, now comes the moment of truth. Patient has been adequately hydrated by the anaesthetists and it's time to make sure that the patient is able to produce urine. So the patient gets a dose of a diuretic (Lasix/Furosemide), and we keep our eyes on the catheter that's been shoved up their urethra waiting to see some magic happen. Unfortunately, after about 10 minutes of watching, nary a drop of urine has collected in the urine bag. Basically, my consultant ended up tying up the patient's ureters during the procedure - the most common complication your medical school teachers would warn you about concerning this procedure.

So, it's back to the drawing board, or the chopping block as luck would have it. We proceed to backtrack trying to figure out at which point the ureters have been tied, and undo the damage. What should have been a 1 - 2 hour procedure ended up being a 5 hour long procedure with not so much as a break taken in-between; however, we came out of it thinking that we had at least salvaged the situation.

We skip forward to her time in the ward, and it becomes painfully obvious that the patient still isn't out of the woods. Her urine still isn't making it through the catheter, but, it is now draining through the incision scar in her abdomen. On the one hand, we're glad that she won't be developing kidney failure; on the other hand, we still have a veritable mess and our patient's dressing and bedding keep being stained with urine.

Worst of all was my consultant's decision to go AWOL and leave me "holding the hot potato". Imagine having to explain that stuff to the patient and her exasperated relatives day in and day out. At this point, the consultant is only addressing the issue via phone conversations with me. Eventually, plans ended up being made to transfer her to a bigger hospital to address the issue, but then some haggling over the issue of footing the ambulance bill to get her there broke out and threatened to lengthen her stay at our hospital. I don't remember how things finally got sorted out, but eventually she left, and I had never been so glad to see a patient leave.

Medicine in its most classical form is learned through apprenticeship. Some teachers might go a bit overboard with the "See one, do one, teach one" approach to learning procedures, but at the end of the day you need to be learning the nitty-gritty from someone else. With that in mind, when you're starting out you benefit from having a good leader who can impart useful knowledge, teach you the complexities of patient care, and even act as a mentor. Some of these people will actually sway you towards choosing which field to specialize in if you come into the game unsure of which direction you feel called in.

However, as I was recently reminded by a friend of mine, a "God Complex" almost certainly seems to be associated with doctors. I did take some time to correct the misconception though; just like I had been reminded by my friend Javed (circa Wenzhou, 2007), people have multiple reasons for choosing to become doctors. The way he broke it down for me, there were basically about 10 reasons, but the more common ones (of the top of my head) are as follows:

1. Prestige
2. Feeling called to help in society
3. Prior interaction with medical professionals due to your own/relative's illness
4. Money
5. Following in a parent's footsteps.

If "Prestige" is someone's driving force, you shouldn't really be surprised if patients, colleagues and juniors end up being used like mere stepping stones. You've probably been in the presence of doctors who made you feel like they were only interacting with you for the purpose of making a pay cheque - unnecessary tests, needlessly excessive repeat appointments, excessive medication, aggressively scheduling you for surgical procedures, etc. If we are looking to put a dent in your wallet, or take advantage of your insurance, many are the ways that we could make that happen. Truthfully, any doctor worth their salt should be able to explain their reasoning and justification for everything they subject you to, and you can always seek a second opinion if you're not convinced.

Medical school does not endeavour to develop people's character. They might sneak in an Ethics class or two, but character formation is really up to the individual and those that you choose to mentor you. So when it comes to "God Complexes", that was probably the default baseline setting of the respective individual. They would have ended up being a difficult lout regardless of whether they had chosen Business, Engineering, Politics, Fashion or Teaching.   

I have interacted with many doctors in my time who were very humble and willing to show me the ropes. My most vivid memory was working with Dr. Onkunya who showed me how to perform an excision of a breast fibroadenoma when I told him I had never performed one before. It was my first day in the Casualty, and one of my initial interactions with Dr. Onkunya, and I really didn't know what to expect. Fortunately, he was so concise and precise about the whole thing, and encouraging as he tutored me such that I was able to flawlessly replicate his technique and perform the next one on my own, and eventually teach the technique to others.

Unfortunately, I have also interacted with a lot of doctors that are a disservice to the profession. Some doctors merely see the practice of medicine as a power play and a chance to browbeat you into submission. You'd think you were in a boot camp, and they were drill sergeants. These doctors are usually short-tempered, prone to chastising and insulting you at the drop of a hat. Learning from them is also a task as they can opt to show you up in public (among your colleagues during ward rounds), and without remedying your ignorance, simply tell you to go read a book. Seems like their amount of bravado is inversely proportional to their actual skill. These doctors encourage you to basically hide your imperfection and basically "fake it till you make it", which, in light of rampant medical errors and malpractice, is about the worst thing you could ever do. Even at a basic level, doctors are tasked with repairing/fixing the human body and its processes after things have obviously gone awry; and we are expected to do it to such an extent - whether by surgery or drugs, physical therapy, etc - that the verisimilitude would approach that of a normal functioning body. You can't really fathom how much things can go wrong until you have to "undo" the work of one of your colleagues. This could range from poorly placed implants, poorly sutured wounds, erroneous drug prescriptions, missed diagnoses and misdiagnoses, etc.

A good practitioner will teach you to own up to your mistakes early, and to fix them as soon as possible; if that entails getting help, then get the aforementioned help; in retrospect, my Obs-Gyn consultant did just that - I just wish he had had the guts to actually talk to the aggrieved family face-to-face. A poor practitioner, however, is likely to be averse to admitting fault and/or blame others or systems for their failings. When that happens, you best be prepared to have yourself thrown under the bus for someone else's follies. I remember so vividly being tossed under the bus by my Director of Medical Services last year for something that was obviously a systemic issue that stemmed from poor management practices at the hospital, one of which they immediately course-corrected after this particular misfortune. (I cannot divulge any further information because that specific case might be undergoing some active litigation). If you haven't been thrown under the bus a couple of times in your career, then you've probably had a hallowed existence...like a unicorn. Since it is such a common evil, you should make it a point to cover yourself accordingly:

1. Document, document, document!  (Rule of thumb: if it isn't written down, assume it wasn't done!)
2. Be careful about anything that you end up signing
3. Be careful about being sent to witness a post-mortem. If litigation ensues (and court cases can last a really long period - years), you will find yourself sitting in court because of just one case.
4. Don't assume that the hospital has your back during a court case. It would be great to assume that this great community of individuals that you spend so much time with is your family, but such sentiment can turn in a minute. Distinguish yourself as a consummate professional, but always remember, "it's everyone for him/herself and God for everybody!" 

On a more positive note, remember that the vast majority of doctors actually joined the service for more philanthropic reasons. In a world this crazy, there are still good people trying to make things work; and the best of them can teach all these skill and experiences, and can inspire a whole host of people in the process.

As a parting shot, I remember that during my pre-internship at Kenyatta National Hospital (KNH), an Obs-Gyn consultant was walking though the maternity ward, and he was giving this rousing speech in order to let people know what was up. Can't remember most of it, but this little snippet (paraphrased) stuck in my mind,

"We are here to do a job. If you do not know what needs to be done, kindly make yourself known to us so that you can be taught what that involves; but if you feel like you don't need to know, then keep yourself out of our way so that we can still do effective work"

Very blunt and straight to the point! This hallowed profession demands that we always propel it forward, and check ourselves if our egos or other shortcomings are an impediment to its practise. We should remember that we are called upon to lead, as much as to be led. Therefore, invest yourself in learning to lead as much as you hit the books to improve your skills; and always remain teachable - the effort will never be wasted.

God Bless.

 

Captain Marvel: "Spoiler Free" Review

The Captain Marvel character is something of an enigma, having a complex history that has involved many different characters inhabiting the role, and let's not forget that little Marvel-DC tussle over the rights to use the name (The DC character "Shazam" who has a new movie coming up was for all intents and purposes known as Captain Marvel, but they switched his name to Shazam as of the New-52).

This version of Captain Marvel (aka Carol Danvers) was initially known as Ms. Marvel, receiving her powers from the original Captain Marvel (Mar-Vell), and has a very interesting history that intimately includes the X-Men character Rogue.

Anyway, nostalgia aside, the Marvel team has made some changes to her already pre-established history in order to bring her into the MCU. The story is a non-linear affair, basically starting off in her time spent among the Kree. Suffering from amnesia concerning most of her life - save for a few segments she glimpses in recurring dreams - she is trained to be a member of StarForce (which just happens to include a Pre-Guardians of the Galaxy (GoTG) Korath, reprised by Djimon Honsou). It is during one of her missions that she encounters the Skrulls, a race of shape-shifting aliens, who happen to have more than a passing interest in the fledgling Kree soldier whose past may pose some special significance for their futures.

As far as non-linear histories go, this one isn't too hard to follow. Pretty quickly she ends up thrust into 90s-era Earth, and runs across Pre-MCU versions of Nick Fury and Phil Coulson (wonderfully and seamlessly de-aged for this movie). Amid the throwbacks to that era, she has to make sense of her past memories, come to terms with her unexplained and mysterious powers, and basically figure out what her place is in this universe.

The look of this movie is a bit different from other MCU movies; I think this is as a result of the 90s aesthetic, and the fact that this is all happening pre-MCU (the only prior glimpses we've had of that thus far have been from Peggy Carter's initial SHIELD adventures). This makes for an interesting dynamic. One pleasant surprise occurs at the very start of the movie. The current Marvel Logo Intro consists wholly of Stan Lee imagery. It was a beautiful dedication to a wonderful icon.

As far as origin stories go, this is not one of the MCU's strongest efforts. As Marvel builds up this character as probably its most powerful superhero in the MCU, with a big stake to play in the upcoming Avengers: Endgame, they definitely have to present her history to us to at least get us invested in the character. Brie Larson is serviceable as the character, building up quite a good rapport with Nick Fury that makes this play out like a "Buddy-Cop" film. The addition of Goose, the orange tabby cat, will definitely be a treat for movie lovers. He actually has quite a fleshed out role in this movie (one of which will likely produce a what-the-hell-were-they-thinking moment for many a movie fan), and it will be great to see how the MCU uses him in future installments.

The movie producers play it by the numbers, ticking off respective checkboxes for building up this portion of the MCU, but there is something seemingly "alien" about this effort; don't get me wrong, I see none of the feminism that was supposedly meant to make this movie a "Social Justice Warrior"(SJW) darling; rather, it feels like the stakes aren't that high in the end. There's a segment with a Pre-Guardians of the Galaxy (GoTG) Ronan the Accuser - reprised by Lee Pace - but even he is unable to breath more depth or risk into this movie.

Marvel has taken a non-traditional route in covering Captain Marvel's story, and this leaves me optimistic that there is a lot to mine in this vein in order to give us compelling stories. They've also provided surprises aplenty that might digress from the lore of other characters, and I would love to see how that plays out.

When all is said and done, it's a good-looking movie, but it would definitely have benefited from a more invested story.

I unequivocally  give this movie a B-, but that still shouldn't stop you from checking it out.
God Bless

P.S: How on earth is Djimon Honsou being allowed to do all this Marvel-DC crossing over?     

The Music of Hans Zimmer and James Newton Howard: Batman Begins Soundtrack

Christopher Nolan's Dark Knight Trilogy has earned much praise for the amount of realism that it was able to inject into the iconic character of Batman. Don't get me wrong, I grew up on Tim Burton's Batman and Batman Returns, and these were both great takes on Batman lore. Batman Forever (sans Jim Carrey's overacting) is also an enjoyably watchable movie. Unfortunately, Joel Shumacher took the comic gimmick to ultimate extremes with Batman & Robin. Batman Begins thus served as a course correction.

In my opinion, Batman Begins is the best installment in the whole trilogy because it shows Nolan's most seamless uncluttered vision for the project. The Dark Knight might have wowed us with an incredible joker, but it also offered us a terrible Rachel Dawes whom I was overjoyed to see killed off in the same installment. The Dark Knight Rises was a travesty and a cash-grab, worst entry in the trilogy hands-down.

As I've mentioned on more than one occasion, the musical score of a movie is in itself a character within the movie. This score was a collaboration by Hans Zimmer and James Newton Howard with Zimmer taking care of scoring the action scenes and Howard scoring the emotional scenes. Initially Zimmer may have come under fire for not using elements of Danny Elfman's score for prior Batman movies, but I can't argue with the finished product.

There is something somewhat "industrial" about some of the music. The heroic theme "Molossus", which plays when Bruce suits up for action, is one such example of this; set to a rapidly pulsing drumbeat that sounds like the heart of a gigantic mechanical beast (that meshes well with the "Tumbler"), it also consists of quickfire strings that are used to convey a sense of urgency. Some tunes are also rather "airy": the very first track, "Vespertilio" mimics the sound of Batman unfurling his cape. The effect is used on other occasions to make us feel like we're in the depths of a cave, or within the recesses of "the Narrows", the seedy underbelly of Gotham.

"Nycteris" sounds like something from a James Bond-esque movie, and it should really because it matches up with a very "Q" type of moment when Lucius Fox leads Bruce Wayne through R&D, showing him the ins and outs of the armoury. Portions of some songs trail of into the most dissonant weird sections in order to mimic the effects of the Fear Toxin or as a representation of the villainous Scarecrow.

"Lasiurus", which is the last track, is probably what I would classify as Ra's Al Ghul's theme. It is a sombre piece that enlightens the moment in which Ra's teaches Bruce about the nature of criminals, and the League of Shadows. It perfectly signifies the heavy loss that is at the heart of this dark character, which becomes the driving force for his resolution to enforce balance by any means necessary.

The heart and soul of this movie is the elegiac Wayne Theme sprinkled in multiple songs but chiefly found in "Macrotus" and "Corynorhinus". Corynorhinus is remarkable for having the most beautiful intro of this particular theme; Macrotus, on the other hand, is the full examination of the theme. Starting off beautifully with a melodic string portion playing a very striking opening motif, then sinks into the theme proper, and at the midway point it slows down and acquires that "airy" tone I previously spoke off, perhaps harkening back to "the Narrows"; then with a lick very much reminiscent of The Lord of the Rings (Sauron-esque), it segues into the Adversity Theme - a booming brass section that conveys the very insurmountable weight of Gotham's problems, and the arduous task of trying to fix it. A choir boy's shrill voice then pierces the background, and provides a scaffold for the strings section to be built upon. The piano then leads us back into the beautiful Wayne Theme motif, joined in by strings and the brass, and buoyed by that haunting shrill voice. The song then slowly winds down as the brass section crescendos.

One piece that they failed to name (nor does it appear in the score) makes a very prominent appearance during the burning down of Wayne Manor at the 2:21 - 3:57 mark. (prior to that, you can definitely notice Lasiurus playing).

 

The same unnamed tune is also part of the final credits suite and is an action-oriented version of the Wayne Theme. It's a pity that they omitted it from the score, but fortunately you can still get it on Youtube.

As far as soundtracks in this trilogy went, this eclipsed all other entries, and is the most emotionally vibrant of them all. The Dark Knight's soundtrack is particularly unpleasant to listen to because the grating strings that are used for the Joker's theme are like nails on a chalkboard; they may be fine for adding suspense within the context of the movie, but the music cannot be enjoyed on its own; and as for the Dark Knight Rises, it's all Zimmer with none of Howard's redeeming qualities.

Take some time to listen to this wonderful soundtrack and bask in its beauty. I recommend starting with Corynorhinus, Macrotus and Lasiurus.

God Bless

Driving Peeves

Driving in Kenya really isn't for the faint of the heart. Between the roads, motorized vehicles and pedestrians, circumstances conspire to give you an enraging experience on a regular basis. Matatus are obviously top on my list in terms of irritants with their devious ways, but it seems like everyone and anything can ultimately surprise you at any time. Here's just a list of some of my current peeves

1. Matatus stopping on the road
   This literally just happened to me today: I'd just made it up a precipitous hill, and was balancing my car as I waited for my chance to branch right onto the road. A matatu driver pulls off to my side of the road to drop people, blocking my view of oncoming traffic! It's hard enough trying to balance a manual car up a hill that steep, and be able to get enough thrust to gun it; however, doing this without a clear view of oncoming traffic (sometimes very fast approaching) is insane!
   
   Somewhere along the line, it became acceptable for matatus to just stop in the middle of the road, park on the side road preventing you from merging onto a road, or even just pull off ever slightly off the road but have enough of the vehicle jutting onto the road to cause some concern (or even an impending accident).
2. Grandfather with wheelbarrow on the road
   This particular entry is so specific, I just had to highlight it. The other day as I was driving to Kiserian, this (perhaps senile) old man was just standing square on the edge of tarmac in my lane, and he was just totally oblivious. There was an oncoming car in the opposite lane, and I'm pretty sure if I'd driven on I would've hit the man. I actually had to come to a complete standstill, wait for the other vehicle to pass, then maneuver past the idiot. I pray that he learns better road etiquette or he won't have many more days on this earth with that kind of behaviour.
3. Pedestrians crossing at idiotic places
   I have previously been accused of being very hard on pedestrians, perhaps signifying that I am a vehicle-snob. Granted, most of Kenya is a walking-nation (I would actively eschew driving for a walk or a decent bus ride), but none of that excuses rank idiocy on the roads. I once drove through Kawangware (hopefully never again), and it was a nerve-racking experience trying to steer clear of pedestrians who'd invade the road any chance they got.
   
   The sheer lunacy from pedestrians is mind-boggling. Some people have gotten into the habit of pointing their open palms at you to stop as if they're the police; others simply walk so slowly once they plant their feet onto the tarmac, it's as if they assume they have bragging rights to the road. I once saw a man walk directly into a roundabout (with freely flowing traffic mind you) in much the same way that a car would!
   
   Some of these pedestrians are just begging to get hit. Sad reality is that people think that if you hit them you owe them a ride to the hospital, and a responsibility to pay for all their medical procedures. If only people really understood the amount of convalescence and rehab associated with ghastly road accidents (in addition to expenses and lost productivity time), they might try to be more careful on the roads. I feel sad for all the children who have to learn to cross roads from these obviously deficient adults, because they'll end up making the same mistakes
4. Poorly marked/maintained roads
   It always astounds me how many bodies are charged with taking care of our roads, but then they seemingly can't get some simple things fixed. It's already a nightmare driving on roads with people from oncoming traffic veering into your lane on occasion, but this is magnified further by failing to mark roads with the occasional fresh coat of paint.
   
   Then there are those times when you encounter massive potholes that are literally craters. Sometimes you just find yourself waiting for the other shoe to drop, because in the back of your mind you're pretty sure that the pothole will undoubtedly end up being a "widow-maker". Don't the employees of these road maintenance bodies drive through these very roads everyday?
   
   With all the money we pay in form of taxes (particularly those tacked onto already inflated fuel prices), you'd think that we could get well marked and maintained roads. This isn't brain surgery!
5. Non-standardized bumps
   I remember that while I was learning to drive in the US, when it came to something like honking/hooting/beeping it was understood that it was something you did to warn people; thus it need not be used punitively. I imagine the same principle stands for putting bumps on the road. I can't understand why for the life of me some of the bumps on the road are erected so tall; there are some bumps so high, that they scrape the base of your car on the regular. Then there are those irritating bumps which you have to slow down to a measly 8 km/h to climb them, or face the prospect of a jolt in your ride.
   
   This, however, isn't the norm; there are some elegantly designed sections of road (both old and new) that get their bumps right. As a plus, they actually mark them so that you can be aware of the bumps much earlier. Can't we just aim for the best standards in our roads instead of playing russian roulette with quality?
6. People not using their turn signals appropriately
   Sometimes I wonder how many people actually passed their driving tests without having to pay a bribe to get the requisite pass. According to the way some people drive, you'd think that turn signals are just an unnecessary accessory on their vehicles. Many a time, I've had to employ defensive driving because someone randomly just slows to a complete standstill without any warning; there is nothing more insulting than seeing them then turn on their turn signal, as if that was enough prior warning that you required. Worse still, there are people who would never make any indication at all
7. People driving on unpaved shoulders
   Save for the few rains that have quenched the scorched earth in most of the country, it has been really hot and dusty outside. Of course I'd like to keep my windows open and soak up the breeze, but that becomes impossible when matatus, bike riders and cars resort to using unpaved shoulders to beat traffic. They kick up so much dust that is immediately suffocating, but ultimately also a nuisance because they make my car interior and exterior look like I've taken a drive through the Sahara.
8. Impatient idiots
   Sunny Bindra once remarked that Kenyans talk so much about (traffic) jams that you'd assume that it was our staple food! Granted, we do spend a lot of time sitting in traffic jams, but nothing stirs up my gall more than watching drivers jump onto the oncoming traffic lane to avoid the jam. Sometimes they even end up making the situation worse. It's as if they think they're better or more intelligent than everyone else.
   
   You can add self-important politicians and like-minded individuals to the list. I long for the days long gone of President Moi when there were minimal motorcades on the road. Nowadays you could even see run-of-the-mill diplomats with chase cars, and they're driving on the wrong side of the road. If our politicians don't have the decency to fix the underlying causes of the traffic jams (very well within their domain of responsibility), then by God they should have the decency to sit in traffic jams like the rest of us.
9. Roundabouts
   Lord knows I didn't get much experience with roundabouts during driving lessons, but with a little practice and attention to the rules it's a skill that you can easily acquire. I do have an issue with the people that don't understand that you can't use the 1st lane (right outermost lane) to make a 270 or 360 Degree turn about the roundabout. I almost had my car T-boned by someone as I was basically driving straight through the 2nd lane; similarly, my mother almost found herself between a rock and a hard place when her car was almost sandwiched between a lorry making such a maneuver in the 1st lane, and a bus in the 3rd lane. 
10. Motorcycle (boda boda) riders riding aggressively
    As if it wasn't bad enough that a huge number of motorcycle riders are unlicensed and poorly taught, they have the gusto to ride extra aggressive on the roads. I recall that once I was driving in Kileleshwa, and this lorry driver gave me way so that I could merge onto his lane. Would you believe that NOT one, BUT two motorcycles (with passengers in tow) came up from behind me, and without slowing down squeezed into the small gap between myself and the lorry. If I hadn't slammed on the brakes, I'm pretty sure I would have crushed those people to death.
    
    Now I've been around an orthopaedic ward or two, and could regale you with the variations of fractures and soft tissue injuries that I've come across when it comes to boda boda riders. The worst thing about these injured riders is that their friends visit them while they're in hospital, see the horrific injuries, dastardly surgeries and long recovery times that their colleagues undergo, but learn nothing from the experience, and go on to perpetuate the carelessness.

I'm pretty sure there's more I haven't highlighted, but that's enough for now. Just better make sure you say your prayers before getting on these roads because it's the rule of the jungle on these streets.

Stay safe.