Old Age is Coming, Soon Enough

At the end of an impromptu upcountry visit, I was quite reluctant to get back to the mental drudgery of medical school. The serene countryside ambiance was naturally invigorating and enlivening, a stark contrast to city life. I had neither heard the disturbing, piercing cry of a woman who had lost her loved one nor encountered any tinge of hospital funk for the past approximately forty six hours. Two days! That was quite something.

So here I was again on a vehicle heading back to the city. I was waiting for other passengers to board so we could get moving. My mind drifted off to some obscure thoughts. The amount of mental clutter running to and fro in my cranium is sometimes enough to trigger an absence seizure. Anyway, my thought train ground to a startling halt when a boarding passenger heaved themselves on the seat right next to mine pushing me right up against the window.

I was forced to turn to get a glimpse of this person who lacked the decency to stick to the code of personal space. My stare landed on the plethoric face of a young, short and plump woman. She was panting a little. I guess the effort spent to defy gravity for a good thirty centimeters as she was hauling her body into the vehicle had left her lungs bereft of air. As I was settling from the sudden discomfort, she flung a flabby arm in my direction beckoning me to open the window a bit more. I did it reluctantly, after which she beckoned a hawker and asked for two cold Fanta Orange sodas. She then stuck her hand in a fittingly fat purse and after rummaging for several seconds, she dug out some archaic note to pay the peddler. With the drinks clamped under her arm, she proceeded to uncork one bottle, swung her head back and generously bathed her buccal cavity and throat with this cold, orange, fizzing, calorie rich liquid. I watched in bewilderment as the events unfolded almost hitting her with the cliche ‘food is not your friend!’ but I knew one better.

She was a young woman, the type that are laden with volatile emotion. Such comments no matter how sincere or true have the propensity to culminate in word battles, physical exchanges, gore or even burials in unmarked graves. You may call me timid all you want to. In my defence, I chose to stand for my pacifist beliefs. World peace shalt not be compromised by things as meagre as medical students telling fierce looking obese damsels to watch what they eat. I sat tight, plugged in my earphones and got my thought train chugging away once again. It was going to be a long two hour travel to Nairobi.

Back at home three weeks later, I am now trying to enjoy my holiday and feeling happy that my junior medic years are officially over. I suddenly realize something: this is my third last holiday at home as a dependent. I have mixed emotions about it. Before I even get my mind to think it through, I am jolted back to reality. My mum has just sat next to me letting out the ‘grunt’. You know, that noise old people make when they sit down? I call it the indicative ‘noise of senescence’.

Again it hits me. My mum has indeed aged. I joke to her about it. She laughs and blushes then resolves to renew her gym membership. Her face is not wrinkled, just treaded with womanly and motherly experience. Expounding that is beyond me. A lot has changed about her. She neither even shouts as loud nor as long as she could do when my brother and I were younger. That is when we would know that we were in real trouble. The days when mothers would yell at you to go to your room, not so that you can have some time to introspect about your latest breach of the family protocol, but to have limited space to manoeuvre during the inevitable whooping.

Isn't it interesting how certain ages, men and women look pretty much the same?
Isn’t it interesting how certain ages, men and women look pretty much the same?

My father walks in at that convenient moment. His physique too has borne the brunt of time. His stifled limp, a consequence of osteoarthritis of the hip. It pains him sometimes. His demeanor, however, is that of a young man. He too sits down with the ‘grunt’ and proceeds to sip his tea slowly. He takes the remote control and flips channels hoping to catch the news. He then relaxes on his seat and strikes me with some intriguing parlance, the kind that is intellectually erotic. Politics of the day, sports, relationships, philosophy, random people on the streets: topic after topic, we wear down the clock as conversation is intermittently punctuated with humor. My dad never holds  his laugh. He takes it from deep within his diaphragmatic recesses laughing heartily like a wild lad. His somewhat large belly trembles in unison to his guffaws. I often find myself in a dilemma on whether to laugh at his jokes or to  laugh at him. It is always a good evening when he is around.

I now fathom how the youth of the physique lasts only for a while.  For different reasons and at different rates, we all age gradually. How well that happens, depends on our genes and our bodies. Both my grandfathers lived to a century plus. I am not sure how much longevity or immortal blood runs in my veins. I do, however, believe in the need for us to take care of ourselves. I admit that I probably should have found a way to talk to our ‘passenger-friend’ about her weight ‘problem’. Maybe some carefully delivered counsel on obesity predisposing to a poor quality of life, restrictive respiratory diseases and heart attacks at a young age would have worked. I wouldn’t know.

I also think that young people should not despise their friends who don’t drink as much, party as hard, and who adhere to some structured diet. There sure is a chance that, at some point in life, we could all get hit by the proverbial ‘bus’ or be a casualty statistic to some unforeseen cataclysmic event. But if such morbid things don’t come to pass, some of us may end up taking our grand children for walks in the park while the rest are restricted to their wheel chairs, passing urine via a catheter, wearing an uncomfortable adult diaper, inhaling from an oxygen mask and frequently cursing the grim reaper’s poor swing of his scythe. It’s rather obvious who falls in which category. After all, you don’t really only live once now do you?

 

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An Encounter with a Silent Killer

For most people, the word tumor is synonymous to cancer: the diagnosis of which is likened to a ‘gift’ delivered from the grim reaper himself, with not-so-much love. Medical truth however suggests otherwise. From it, we know that benign and malignant tumors exist. It is the malignant ones that most doctors dread: and the doctors who (as it seems) don’t are called oncologists. I wouldn’t wish a malignant tumor on my worst enemy, nor advise them to pursue oncology. The latter is indeed (and infamously) the most depressing specialty in medicine, reasons behind this being rather obvious. Some encounters with malignancies however, are worth recounting.

Now, for many a student there are those moments when your conscience tells you that you would rather sit out a class than attend and let yourself down. This happens to me sometimes: after all, some classes can be quite a task! On this particular day, I was with a close friend of mine. We made our way to the hospital’s casualty where after entering the consultation area, a familiar voice caught our attention. It was one of my good doctor friends who I am tempted to describe as follows. He is an ample guy; indeed, an aspiring epitome of the consequences of unhealthy eating. He is a jolly one too; often punctuating his sentiments with billows of chesty, heartfelt laughter. He even lightly comments how the KNH Trauma department is a refuge center for thugs whenever we assist him in the minor theater. In essence, he has a contagious personality- an infrequent thing from a doctor working in this particular hospital.

He beckoned us into his consultation room.

There, we found a half dressed sexagenarian lady on the examination table. Many similar scenarios had trained us to put professionalism and deep respect for the patient before shyness or lad-ish mischief. Our host immediately got to work on our now eager minds. He pointed at a swelling on the lady’s right loin, asked us to examine her and make a diagnosis. My friend and I asked for consent then got to work- inspecting keenly for color changes, deformities, scars or swelling then palpating for tenderness, lymph nodes, edema and any other notable things as per protocol. All we detected were the inguinal lymph node swellings the doctor had earlier pointed, a mildly edematous right leg and a dark, irregular patch on the heel of her foot on the same leg. The patient was not in pain. This, in our naïve minds was puzzling.

We got to thinking and mumbling guesses that sometimes screamed loudly of our ‘ignorance.’ The doctor however exuded a fatherly sense of patience. He guided and probed us further, merely asking us to dig deep into what I would consider our ‘shallow lakes’ of knowledge. In a last and almost desperate attempt, I uttered- ‘Melanoma.’ He smiled at me, a gesture which he complemented with a solid affirmative ‘YES’. At last I had gotten it. He then produced a chest X-ray of the same patient. Her lungs’ morphology was uneven with rounded zones of what the doctor told us were metastases. I then turned to the patient, curious for a brief history.

Her foot had started hurting five months earlier as she was working on her farm- a pain which receded after a short while. It was only after she had experienced repeated episodes of coughing that she sought treatment from a local healthcare centre; a journey which ended at our teaching and referral hospital. She was not in pain. However, her body was now an unwilling host to a fast spreading, inconspicuous yet lethal tumor- a malignancy called Melanoma. We let her dress as I exchanged ideas with my classmate. And when she rose to receive her documentation and advice from the doctor, I trained my eyes on her yet again.

She was a simple country woman. Her headscarf had slipped further back now perhaps from her prolonged recumbent position on the examination table. Her hair was jet-black, plain and kinky, few streaks of grey standing out augmenting the subtle creases on her face. Her eyes were sunken, whether because of worry or the disease creeping upon her- I couldn’t quite tell. There was a slight aura of hope on her demeanor though. This hope, I thought, was founded on ignorance. Her lack of knowledge about her current predicament was her shield; a weak one, but a shield nonetheless. As expected, her body looked fairly healthy: save for the X-ray images we had just seen. Our conclusion; she was sitting on a ticking time bomb. Prognosis is guarded.

I pitied her. Deep down, I wanted to give her the benefit of doubt. But I knew a tad better. If not by the disease, chemo-radiation and depression would take its toll on her. There was little chance that she would live through it. The outcome however is always in the hands of a Higher power. Having learnt something new though, we left hoping that whatever her fate was, she would dig deep into her soul and find the courage to face it all.

Sitting Duck

A general practitioner, a pediatric physician, a psychiatrist, a surgeon and a pathologist set out for duck hunting one day. Shot guns in hand, they found a nice spot to lay in wait.

 

As the first duck flew within range, the GP trained his gun then hesitated saying, “Wait a minute, is that a duck? I need a second opinion…” The duck flew away.

 

A second duck approached the range. This time the pediatrician called dibs. He took aim but just before firing, he noted, “It sure does look like a duck, but what if it has babies?” As he contemplated, the duck flew past.

 

Another duck came in sight. The psychiatrist who was next in line took aim then hesitated as he thought out loud, “I know that is a duck, but does it know that it is a duck?” Before he could make up his mind, the duck was gone.

 

After a while, another duck flew within range and this time the surgeon took aim. ‘BOOM!’ and the duck fell into the ground. As the ringing noise in their ears died out, the surgeon nudged the pathologist saying, “Go confirm what it is.”

The Immaculate Conception

A mother and her daughter were at the gynecologists office. The concerned mother asked the gynecologist to examine her daughter. “She has been having strange symptoms for the past few weeks and I’m worried about her,” she said.

The doctor examined the daughter carefully then announced, “Madam, I believe your daughter is pregnant.”

The mother was flabbergasted. “That’s nonsense! I know my daughter, she has nothing whatsoever to do with men.” She turned to the daughter and asked, “you don’t do you dear?”

“No mum,” she said, “you know that I would never so much as kiss a man!”

The doctor looked at the mother, then at the daughter and back again. He then silently stood up and stood next to a window staring out. He continued staring until the silence compelled the mother to ask, “Doctor, is there something out there?”

“No, madam” he said. “It’s just that the last time something like this happened a star appeared in the East. I was looking to see if another one was going to show up.”

Why I want to be a Doctor

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The moment right after passing my high school entry examinations remains nostalgic. If I’d travel back in time and passed my exams well enough to get the media scurrying home, I’d wait for that ‘What would you like to be when you grow up?’ question and promptly answer, ‘Adult’. Yes I said it, -Adult. Here is why…

My take is that people have rather deluded ideas of what being a doctor is. The society and even some doctors think that being in the medical field is a calling. I used to think the same till I asked myself; ‘who really called me?’ If it even was a message -let alone a calling, me thinks it was hand written, in hieroglyphics; slit into a split stick and sent to me via the fastest runner within a hundred mile radius. Seldom, I think he only got to deliver that message because I wasn’t running fast enough in the opposite direction. That happens when I am on a low run of course.

The process starts with being a medical student. This is where you are confined to Med School Maximum Security Prison. They pressurize you with all the medical jargon here. The more you learn, the more you realize how much more you do not know and the more you forget. You even forget yourself. In fact, your social circle is relegated to your loved ones, a few like-minded friends with whom you share ‘sick’ jokes, and many more sick ‘friends.’ You appreciate what it really means to be sick get well and accept that people die. Your responsibility- to be seen and not heard… and when it’s required that you be heard, it should mostly be the sound of your tongue diligently licking your consultants boots and making sense while you are at it. Once your saliva is exhausted and your seniors can see a vague reflection of your face on their shoes, they may let you graduate.

Being a doctor is enjoyable. We derive satisfaction from fixing people. It is that rush of solving the mysteries of body versus disease that pushes us forward. The times we are able to cheat death and bargain with life for a little more time on behalf of our patients. Those amazing moments we venture even deeper to do ‘repair’ and ‘replacement’ as in surgery. Believe me, it takes people with more guts than a kid with mega colon. We feel like demi-gods while we are at it. Not many have the privilege to do that after all, let alone the balls. That is what our profession is about. Restoring life, health and purpose where it was dwindling. But then again, it is never that simple.

The world embraces you in its stony arms. Society thinks you are a miracle worker on a path to riches. You have a sworn duty to your patients, and you must keep abreast with new information to stay sharp. You lose sight of what is important. It all is anyway. They miss you at home, you are never there. You console yourself that you are going out life and limb for others, for humanity. Even the closest to you never seem to understand you. You got used to this in med school. Since then, there was never enough of you to go around. This either distracts you, or you resign to forgetting yourself all the more.

 At the hospital, you have many lives to save. Depending on how good you are, you save most and lose a few. Sometimes it is your fault, other times it is beyond you. It’s unfortunate that you can’t save them all. It hurts deep, this realization. You could sit down and wallow in glum; they call it being human. I’ve learnt to square my jaw and forge ahead like it never happened; I call it protecting my heart. Despite all that’s on your shoulders, you tell yourself that you have to do better next time. You don’t have a choice, you simply have to.    

‘Why did I want to be a doctor?’ I ask again. Too many times I have answered this question a little too hastily. I made a choice… No, I love it all. But once in a while, I am not so sure. I could do business, disaster management, or try physical education. Simple things to do, albeit you make way more than your input accounts for. Maybe I should find a better answer to this question. Until then, let’s have a moment of silence, I need to introspect: play me some good music, to whose lyrics I can relate: as I flip through a book, coarse enough to sharpen my intellect: just understand me for being me, that, I’ll truly appreciate.