3:00 hours. The extension phone in theatre rings once. The theatre nurse stirs, but continues resting her head on the table. Her breaths are coming out in shallow regular spurts. She looks peaceful, comfortable even. The extension phone rings again. This time, the ringing is continuous. The harsh krr, krr, krr of the phone jolts her awake. She lifts her head. She is disoriented for a minute or two. she looks around, yawns, stretches her arms then stifles another yawn as she picks the receiver and places it next to her right ear.
“Theatre”, she croaks into the phone, then listens. “Okay”, she says and replaces the receiver. She has an operation to prepare for. She walks into the operation room and taps the other nurse. He is seated on a theatre stool, head resting against a wall. She taps him on the shoulder. He wakes up immediately. They start preparing the operation room for surgery. Then the extension phone on the nursing station starts ringing again. He goes to receive the call. He comes back just as the surgeon walks in. the anesthetist also walks into the changing room soon after the surgeon.
The second phone call is from maternity ward. They have two emergencies; two cases of fetal distress. The theatre nurse informs the surgeon about the maternity cases and the surgeon knows that his patient will have to wait and probably lose one testicle in the process. He has reviewed this particular patient. An eighteen-year old male with scrotal swelling and severe scrotal pain, admitted about an hour ago, a condition called testicular torsion. It is a surgical emergency. The earlier the operation is done, the higher the chances of saving the testicle. At the entrance to theatre, the patient from maternity and the young male patient arrive at the same time, both wheeled in by nurses. they are both wailing in pain. One from labor, the other from a rotated testicle. Both of them have emergency conditions. But because there is only one theatre bed, only one of them can be saved first; the pregnant lady. She is carrying a life. So she gets in as the young man is wheeled back to the ward. He will be taken to surgery alright, but then he will lose his testicle. Because the longer the time taken to operate on a testicular torsion, the higher the chances of losing that testes.
Because of severe shortage of theatre staff and equipment, doctors every day have to make tough decisions. Every time you get three pregnant women in need of emergency cesarean sections, you have to decide who to take in first amongst the three. You are therefore indirectly deciding whose child to save now and whose to save later, something that doesn’t always work well. When you have done your best assessment, you might as well save all of them. But sometimes, “shit happens”. If you have a mother in labor who requires a c- section and a young man with a rotated testicle that needs to be fixed urgently, you will of course decide to save the mother and the baby and lose the testicle! Doctors are always playing god, not only on which patient who gets admitted into an intensive care unit, but also on who to be saved and who to deal with consequences.
When Gabriel walks into the gynecology clinic, I am expecting that his wife will follow him into the consultation room. But he closes the door behind him and takes a seat . And no, he doesn’t have any problem really, just a small question though; “daktari, they say that my wife has an incompetent cervix“, he begins tentatively. So I look up at him and wait for him to ask his question. He regards me for a moment then goes on, “tell me daktari, how can a cervix be incompetent?’ I look at him closely for the first time, he looks like one of those men who go to beauty parlors for a facial. He has the smoothest face south of Sahara, and for a minute, I almost pass a hand over my own face. “cervical incompetence’, I begin, “means that during pregnancy, the cervix dilates and becomes thin before the pregnancy reaches term. The effect of this is pregnancy loss or a miscarriage”. He exhales visibly and I almost chuckle. I mean what did he think after seeing the diagnosis? I want to explain further but he is ready to take his leave. He extends his hand and I shake him while he mutters his thank yous then quickly leaves closing the door behind him. I try to imagine what he saw written on his wife’s consultation card. The correct term is “cervical incompetence” how did it become incompetent cervix? As the next patient walks in, I decide doctors should just stick with bad hand writing. Writing in a legible hand writing that patients and their relatives can easily read might give someone a heart attack soon. Imagine that man seeing incompetent cervix as his wife’s diagnosis? What was the first thing that came to his mind? Now imagine if that man decided to be unreasonable, arrived at his own conclusions and confronted his wife about it? Maybe he might have included it in his list of abuses; good for nothing woman, lazy, incompetent cervix, idiot.
NB; always ask your doctor to explain everything, you can’t form an opinion based on what you see. Sometimes, a list of words written side by side don’t mean what you think. Adios
If your hand or arm is going to “accidentally” brush against my ample bosom once, I will turn my eyes the other way and let you be. While I agree that accidents will always happen no matter what; I will not be looking forward to similar accidents from you ever. Which is why I am taking time off to inform you that accidents that involve you touching my body parts are not going to be forgiven twice. And since there is no way I am going to shrink my bosom, please learn to keep your distance, your roving eyes and arms slash hands to your space.
Dear colleague, note that I prefer shaking hands than hugging, for the simple reason that hugging is informal and is preserved for my close friends and relatives not colleagues. But if you ever find me crying and feel the urge to hug me as a way of comforting me ( we all have those moments when all we need is a hug), please don’t press your body so much into mine, because well, then you will not be hugging me but trying to squeeze air from my lungs! A hug doesn’t have to be full body to work. The Cambridge dictionary defines hug as to hold someone close to your body with your arms to show that you like, love or value them. Please put emphasis on “hold” and ignore the rest of the definition from love onwards.
Dear colleague, on behalf of those colleagues who are well endowed posteriorly, butt groping will never ever be treated as an accident! As a matter of fact, butt groping is a form of sexual assault. So don’t go grabbing buttocks that you have no right over and think you are better than rapists. If you are going to grab buttocks or thighs for fun, then you can wait and go to be sorry in court because there is no way in hell I am going to stand and wait for you to apologize to me for “accidentally” feeling my ass or thighs or any part of my body for that matter!
And finally colleagues, when it comes to sex, there is no such a thing as implied consent. We have far too many bosses assuming that a worker who stays late in the office is sending them some message. How they assume it is sexual, I am yet to find out. Someone cannot work late and have peace, dear colleagues. The moment some of you discover a colleague is staying late, you start staying late too, time your toilet breaks with theirs, somehow find yourselves in their offices for no intelligent reasons at all and before long, your thrusting your hands into places you should never touch in the first place. And you will think of yourself differently from a rapist, accuse your victim as a pretender and of passing mixed signals. Mixed signals my left foot! Why on earth don’t you just man up or woman up and ask for sex.
If you are going to have sex with someone, the least you need is a consent. Sneaking up to your colleagues and assuming that given your familiarity with them you can try grabbing their breast then hopefully end up laying them doesn’t make you any different from a rapist. Rape isn’t having sex with an unfamiliar person, it is having sex with someone who has not consented!
There are loads of relatives surrounding bed twenty three, all in various stages of grief. In the six and a half days that I have been a doctor, I have learnt a great deal about people. The overriding lesson has been; people are different. While it will take some people several years to finally accept and move on with their lives, some will get stuck at sorrow and depression for years. Still, others will go from shock, to denial to anger, then guilt and to the final stage of acceptance in just six minutes!
I move to the bed and as if on cue, they all move away to a safe distance, the strong ones drag the really grief stricken away with them. For the thousandth time, I wish this hospital had curtains. Life has literally stopped. The chatter that is characteristic of the visiting hour is dead. I can feel the weight of eyes on my back as I bend over (pun) to examine her. The tell tale rise and fall of the chest is absent. She is still warm. Her limbs are still flexible, and her eyes are not glassy. Not yet. I put the stethoscope over her chest and listen keenly. I hold my breath and try slowing the thud thud of my own heart. No heartbeat. I shift the stethoscope to the next place on her chest and listen again, nothing. I shine the torch into her eyes; the pupils are large black rounds against a white background. She is dead. I hang the stethoscope around my neck and feel the neck. No pulses. She is dead. I pull the upper and lower lips together in a desperate attempt to close her mouth, there are many things that people try to tolerate, and a corpse with an open mouth is definitely not one of them.
As I pull the white sheet over her face, fresh wails begin. It is as if I have given them a go ahead to wail, inform other relatives, type long rest in peace-you fought so hard-messages on the face-book wall of the deceased go ahead, and plan for a burial. At this point, some of those who were stuck at shock move on the next stage, to denial.
I walk to the doctor’s room, clutching the ends of my stethoscope, wearing an expression that I cannot name. It is sadness and a determination to hold it together. You don’t need to know the patient at a personal level to feel sad, because sorrow floats. It is the tears of a the newly widowed wife that brings your own, the wails of a mother that makes you clench your teeth, the cries of a child who has lost a mother that makes you walk with your eyes wide open, unblinking for fear the tears will flow down your cheeks, and the patients will stop “respecting you”. So I push these feelings to the back of my mind. I will deal with it later. I know sooner or later this sadness will descend on me, meanwhile, I will write the death summary, then I will see the next patient. I will answer my phone with a smile.
I am jolted awake by the loud and harsh vibration of my phone. I jump with a start sending papers flying all over. It hadn’t occurred to me just how harsh that vibration can be especially at the wee hours of the morning. It vibrates again. The caller ID reads “call room”. It is 3:36 am, twelve minutes since they last called. I had told them I would be in the ward in five minutes. I was just finishing off with the notes. I must have fallen asleep ….. I gather the papers and put them back in the file. My eyes land on the last sentences and I shrug and chuckle at the same time. Even I can’t read what I have written. The notes seem like they are ascending to heaven. The doses of the drugs are all mixed up. My phone starts vibrating once again. I thrust it in my pocket and dash to the changing room as I tear up the notes. In the changing room, I strip off my trouser scrubs leaving beneathmy pencil trouser change into my rubber shoes and run off.
It is business as usual in the maternity ward. All curtains are drawn. The lights are on. There is a nurse at the admission desk and a line of women seated with their legs apart, waiting for their turns. He lifts his head as I enter, I nod at him. He looks at me for a few seconds then continues writing in a yellow file. I walk towards the beds. Most beds are shared. Some women are sleeping on their sides, their backs against each other, bellies protruding before them, beyond the edges of the beds. Some are dancing on the spot, some standing with their fists at their hips. There is a nurse on the second bed, trying to get an IV access on a patient who looks like she should be soundly asleep in some dorm room, except for her bulging stomach that is threatening to rip her dress at the seams. The nurse is struggling. I move to her side. But she continues slapping the hand of the patient, a desperate attempt to make the veins more visible. she is obviously ignoring me. I walk away to the delivery room.
All three delivery beds are occupied. There is only one nurse standing on the foot of bed three. She is shouting commands to the three patients. “Bed one I said push only when there is pain!” “Bed three sleep on your left, and you in the middle can you open your thighs and then hold your legs! I know this nurse, all interns who have been through maternity call her Faya- she is fire, literally. I sigh, and then walk towards her! She sees me and turns to face me. I am prepared for whatever, so I look at her, eyeball to eyeball. She looks at me, shakes her head. Un-gloves, throws the gloves on a receiver attached to the delivery bed. I half expect her to walk away, or maybe slap me. But she just stands there unmoving, quiet, studying me from forehead to big toe. Then she speaks, ” nobody forced you to go study medicine young girl, here, people work”. Pause. “ We called almost thirty minutes ago. Thirty freaking minutes.” pause. “Explain to that patient what happened to her baby. I am not hearing the heartbeat.” I look at the patient and swallow as panic grips my whole being. “Hello,” I mumble. She doesn’t answer and I can understand. “What is your name? “ I ask, ‘”Grace Ngina,” she shouts, as a contraction starts. She sits down, forgetting she was supposed to be lying on her left side and starts rubbing her lower back furiously. I walk out to go and look for her file as she starts to invoke her mother’s name together with the names of all her female relatives.
She is a primigravida (pregnant for the first time). From the notes, her baby is in breech position! I walk back to her and coax her into an examination which she half heartedly accepts. Her fundal height is at term, the presenting part is the breech or buttocks if you may, aaand, there is a fetal heart, a very faint one. ” You are going in for a CS, “I inform her. She looks at me and shakes her head so vigorously that I move a step away from her involuntarily. “But there is a fetal heart. And your baby is in breech” I try an explanation. She will have none of it. I glance at my watch 4:02am. My phone vibrates, it is the call room. I am needed in the gyne ward, a ruptured ectopic with a hemoglobin level of four, bleeding. I summon Mrs Faya. By good luck she listens, agrees that the fetal heart is present. She talks Ngina into signing the consent forms. I drop the theatre list in theatre, and then run to the gyne ward before I get a second call from them.
It is a ruptured ectopic pregnancy, confirmed by an ultrasound. The lady is white from bleeding. I draw her blood samples and rush them to the lab, calling my senior on the way. In six and a half minutes, I am back in theatre, scrubbed. The patient is quietly lying on the operation table, under spinal anesthesia. With my assistant standing on the left side of the patient, we clean and drape her quietly. Everyone is lost in their own thoughts, or too sleepy for small talk. I pick the scalpel and make a bikini incision, fighting the fatigue in my eyes. Seven minutes later, the baby is out. She gives a fierce cry and I hear myself say; ‘that is an apgar score of ten, ten and ten”. I catch the smile on her mother’s face momentarily as I pull out the placenta and start repairing the uterus. Twenty three minutes later, she is wheeled to the recovery room, with her baby safely tucked between her legs. I yank off my gloves, throw my gown to the pile of gowns and drapes on the floor and run to the changing room once again and this time without even removing my scrub bottoms, rush to the lab. “Blood will be ready in ten minutes”, the lab tech tells me over her shoulder and continues scrolling on her phone. I collapse to the nearest seat and stare at her. She is angry for being awake doing a job she voluntarily trained for. My phone vibrates once again, and then goes off. Crap, it has been warning me constantly that the battery is low. I just got too engaged to even connect it to a charger!
I walk out of the lab for a sec and walk back in to find the three blood bags on the table. I sign off in the dispatch book and run back to theatre with the blood. Back in theatre, my senior greets me with a battery of questions, why is your phone off? Why is the patient not in theatre already? Have you found blood? ‘Yes, I answer to the last question, than run off. Back to the gyne ward. The patient is ready except there is no one to wheel her to theatre. I wheel her to theatre, stopping to catch my breath twice. Even I am shocked that I did it. The operation ends at six. My senior walks away. He will probably sleep away the whole morning. I switch on my phone and sit down to write all the notes on the last two patients.
At six fifteen, I walk back to the maternity ward. I finish my pre-round an hour later , rush to the doctor’s room wash my face, brush my air, empty my now threatening to burst bladder and rush back to the ward just in time for the daily ward round. I will have breakfast at eleven , maybe.
I haven’t seen flowers or peonies being sold outside hospitals. Perhaps this is the reason why I haven’t seen any of my patients being brought a bouquet in the hospital. Or perhaps the real reason why my patients are never visited with flowers is because they have no healing value (shrugs shoulders). Perhaps it is because their family and friends have a large list already and flowers will never make it.
Where I work, people are visited with food containers, jerry-cans of water, blankets, bed sheets and drugs. Hospital food is horrible, and when it is not horrible, it is too little. I have seen a man’s eyes water after being served a river of soup, a handful of Sukuma wiki and ten to thirty grains of rice. This is a man taking care of his sick son wondering just how many spoons of that food he is allowed to eat before feeding his son. Hospital water is unreliable. Most times, there is never drinking water, let alone some for flashing poop down the drain. So you can imagine how a latrine will look like in a ward that has three patients with diarrhea and vomiting, patients who visit the toilet every seven minutes and in the twenty-first minute, they’ll all clash at the toilet door.
Many times, hospitals don’t have linen. There is always a different reason each day. Some days it is the water, no water in the hospital and so dirty linen wasn’t washed. Other days it is the patients who are too many, more than the number of beds, bed sheets and blankets. I have seen patients sleep on cold mattresses because the hospital had no extra linen, and so relatives have to carry blankets to come cover their sick.
Where I work, there is no such fantasy as privacy. Doctors have to discuss a patient’s condition as the others listen. Because when two sick people share a bed, then you have no option. In a public hospital, you choose between letting the doctor and whoever is close enough to have a good look between your legs and privacy. When it comes to discussing your problems as a patient, then it is never between you and your doctor, it is between you, your doctor, your bed mate, and the four patients sleeping next to your bed, the two on your right and two on your left.
New mothers are never congratulated. We are always anxious to whisk them away from the delivery couch so we can deliver the next mother. A labour room is little worse than hell. Up to three very pregnant women share a bed that is meant for one person. Each woman is always lamenting and cursing and wailing in tongues. That, mixed with the cries of newborns makes every labour ward a little worse than a hell on fire.
After we certify death, we move swiftly to the next patient. There is never time to recover from a loss that is a luxury which we can’t afford in a public hospital given the large number of people who die and the equally large number of the living who are waiting for you to attend them. So we move very swiftly from among the dead to the living. We leave from the dead to the living even before we erase the evidence of death from our eyes and hearts. Duty always demands. You cannot afford to take a break, not even mortality. No matter how shaken you are, you must be strong enough not to let tears pool in your eyes, and if they pool in your eyes, then you must never let them fall, and if they fall, then you must be quick to dash them away soon enough .
Planting seasons are the saddest. Mother and father leave very early. When I am awake, I milk the cows then let the calf loose. Sometimes I feel sad for the calf. It only feeds for ten minutes two times in a day. So unfair. I make tea while the calf finishes suckling. I tie it under the avocado tree and leave while the morning dew is still on the grass. Sometimes I wear my black rubber shoes, but not on days like today. The heavens wept yesterday. The path is too muddy; there are pools of water all over. My black rubber shoes are still by the fire, wet.
I slide my way to school. Then there is the usual sweeping. This day is for fetching water out though. The rain water turned our class into a swamp, and we have to sweep the water out, then arrange stones under our desks. This is where we will rest our feet. Classes begin at eight, Mathematics mostly. The teacher walks in and we have moments of multiplication, addition and subtraction. By ten, the clouds are already hanging too low, a strong wind blows, the door is slammed open, and some liquid flows into the class through the openings on the walls. These were supposed to be windows (the openings I mean).
It starts raining. Then we begin our migration. All people move to the centre of the classroom. People pull their sweaters over their hands and heads. Heads rest on desks.
Outside, all hell breaks loose. Lightning flashes. Thunder storms, hard pellets of hails hit the roof.
The business of the day closes. The rains stop in time for lunch. Small bodies scramble for the door. There is some pushing and pulling, there is lots of sliding too. Some fall. One girl falls buttocks fast. Her legs up. She has no inner wear. The others laugh. She cries. Then stands up
Some distance away from school, the rain starts again. A light shower first. Then heavy rain drops. Paper bags of books are placed on heads. Then a tall tree comes to sight, ten children run for its shelter. Then as if sent, lighting flashes and descends down. Ten little bodies fall to the ground.
Day and night don’t alter a programme in their shifts. Sun no longer rises. Clouds will gather during the mornings. The sky will be forever dark. By noon, the clouds will be hanging loosely from the sky. They will be dark rainy clouds. Nimbus.
It will rain, in torrents. The first few drops will hit us hard on our faces. A raindrop will land on my neck then slide down on my back. I will run faster and open the classroom door. The rain will increase in intensity. More and more students will keep running into the classroom. Moments later, a strong wind will blow, forcing the door open.
We made it with pieces of clothes stuck between our legs to absorb our blood. We will make it through this elnino
We will give up our shoes. We will only walk barefoot. That way, we will cross the overflowing rivers better.
During the nights we will hang our uniforms by the fire to let them dry. No one will complain about the smell of smoke. All of us will be smoky come the following morning.
The procedure room is not technically a room, calling it a room is a misnomer. If you doubt it, then you can come and see for yourself. It is just a space with an examination bed that can be transformed into various shapes, three large bins; a red, yellow and a black one labeled highly infectious, infectious and non-infectious respectively, a white bucket containing a jik solution, and a large table holding stitching packs, an emergency kit, needles, branulas, syringes and bottles upon bottles of drugs. It basically contains a doctor’s paraphernalia. The ‘room’, is delineated from the rest of the ward by two almost blue or green (I don’t know colors) curtains that are stained by the brown of rust. The curtains only cover the front part, the part where people pass when they want to get to side A of the ward, or to the nursing station or the doctor’s admission desk. It is open on the part that faces my bed.
The bed next to mine is occupied by a small boy, about fifteen. He walks around wrapped in two lesos, with blood trickling down his legs, discoloring the tiled hospital floor. You would be forgiven if you asked him, “why don’t you get a pad for your menses?” but he is a boy. His bleeding is a result of circumcision gone wrong. The doctor, the big one says that he needs to be referred to a bigger centre, like Kenyatta National, otherwise, he will bleed out all he’s got( God grant him life). He has hemophilia, hemophiliacs should NEVER be circumcised.
I have been here for six weeks, six and a half days now. When I look to my left, my eyes lock with those of the young man. It is boring watching him. He is so young, and helpless. He should be in some forest picking berries, or herding cattle, not seated in hospital thinking about life. But now he is stuck here, his old man cannot afford the money to transfer him.
When I look to my right I see the whole procedure room. Sometimes, there is nothing going on in the procedure room. Sometimes I look as doctors suture (fancy name for stitching) patients. Other times I see them inserting their index fingers up the anuses of old men with large prostates, I watch as they close their eyes trying to estimate the real size of the damn prostate, and finally as they withdraw the finger and give it one long look, to see if it is blood or stool that stains their glove. Watching, you would think they enjoy doing it. I see as the nurses dress the young man who is burnt all over his body. I listen to the way he keeps screaming as layer after layer of gauze is brought out of his body. I hear the way the nurses tell him to behave or they will leave. I hear the “shit” of the nurse when he accidentally steps on her. I even heard when one nurse told him, “but I never sent you to steal”. So he is a thief, he could have died, he didn’t. He cheated death. I always close my eyes as the last layer of gauze is pulled off his body. His screams become continuous at this point. I guess real tears flow down his cheeks. I never look until after twenty minutes when the last layer of gauze is being applied.
The air is no longer acrid. The tablets don’t even nauseate me these days. I am used to the retching, and the bilious smell of vomits. It is not cold any more, not even when windows are left open. I have learnt to ignore the dark tall nurse who acts as if she is in her periods forever. I have stopped feeling ashamed of my frame. I have resigned to the fact that I no longer have dignity. I don’t even tell people about four years ago. I don’t tell them that once there was fat and flesh under my cheek bones. I don’t even tell them that there was a time when my collarbone couldn’t be felt let alone being seen. I don’t even bother to tell them that once, my ribs were deep inside me. I no longer have a private part. The doctors have seen my body as many times as I have seen it in these four years that have passed. I don’t find it shameful to be stripped in front of thirty pairs of eyes. I have become used to the fact that I am special. I don’t squat to poop. That, I used to do four years ago. I miss walking to the toilets. I miss sitting on the toilet seat; I miss flushing water down that seat. I no longer use my ass hole. Colon cancer took that away from me as well. The surgeons said I had an inoperable tumor. It was too large that it blocked the intestines. That explained the long, long calls that I used to have before diagnosis, and the bleeding per rectum. I didn’t know. I should have sought treatment early, when the tumor could be operated.
I don’t know how I never thought about cancer. My grandfather had colon cancer. He even died of it. It should have been a learning process. It wasn’t. We buried him and thought we were done with cancer. “But these things run in families,” I remember a young doctor telling me. I wonder why it picked on me, at twenty. It stripped away my youth, the fat from below my cheeks and all my dreams. I wonder why it came again after claiming my maternal grandfather. Why it came when my life was just beginning, when I was just waking up to live my dreams, when I was plunging myself to the business of living. I wonder why it is claiming me this early, even before I leave any seeds here.
Every time I fall asleep, I just want to wake up and live. I think of all the dreams I had and tears drip down my face. I have spent a fair share of my cancer life in hospital. I no longer feel the pain of the injections. I should be used to the hospital by now, it has been my home for long, long enough to last me another life time. I am used to the sighing of pain, and to the cries of distress. I even don’t mind the attitudes of the nurses and the cleaners and the doctors.
The cancer has been progressing over the four years, in two years it had already spread to the liver, making my eyes yellow. Over four years, it has converted me from an independent man to almost a toddler. The change has been a drastic one, but now it has paused. Now I am suffering the effects of radiotherapy. I got a perforated gut and fecal matter dripping from below my umbilicus. I have lived for three weeks on some fluids but no food. I have not been able to move. The doctors don’t know what to do yet. Miraculously, the perforation stopped draining, and I am eating again. A lady from the palliative care came to see me and we talked about end of life. I am reading two leaflets now, entitled light and darkness, they are about heaven and hell.
I know where the journey comes to a close, but I still hate the sound of a trolley being pulled over concrete. I hate the masked be-gloved men in green. I hate the way they look and how they handle the dead. I hate fridges and I don’t want to be in one any soon. I hate yellow and white roses. I hate my mother’s tears, and my father’s long depressed face. I still want to drink my mother’s home made carrot juice. I still want to be held. I want to watch one more sun-rise. I am not ready yet. Heaven please, wait. I will be on my way soon. Grant me another day God, that I may see the white that’s my mother’s teeth one more time. Until then, it is not over yet.