4:55 AM

Where I currently find myself

Hi Everyone.

I figured I'd pen something to let you know how things have been going for a while. To tell you the truth, I had a pretty tumultous latter part of 2015. What should have ended in celebration with an end to my medical internship, instead became a momentous disappointment with an extra punitive 18 weeks added to my internship; that's basically one-and-a-half rotations.

Most of my workmates were surprised at the stiff penalty handed out, which led them to question whether I had been implicated in the death of a patient that mandated such a stiff penalty. And the answer to that is a plain No! This just happened to be one of those situations where some Consultants just wanted to make an example of someone.

I admit, punitive weeks have their place in training interns, particular where lessons needs to be taught; however, they lose their efficacy when obvious bias exists in how different interns are treated; when egregious mishaps are just swept under the rug for some people, and others are treated with heavy-handedness for no reason.

There is an appeal system available at the hospital, but every intern learns very quickly that the same board that sat down to hand out punitive measures is the same one that'll listen to your appeal. An appeal to their previous decision thus constitutes an extreme act of belligerence, and will be followed with a steeper reprimand. So the unspoken rule remains:

"Do your time without incident, and leave when you're done."

As one of my colleagues has reminded me on many occasions, "Life isn't fair!" especially out here in the medical field. I was bitter about the whole experience for holding me back, and for the further manner in which they went out of their way to humiliate me further. Eventually, they commuted about 3 weeks from that stiff sentence, and I finished in late October. By that time I was thoroughly demoralized and just took my time finalizing my documents, during which time I gave myself a generous November and December as a holiday. January finally found me finishing off and handing my documents in for licensure.

Despite what I went through during the internship, I figured I would have an easier time as a qualified medical officer; plus, I had already settld down in Kisii, having already lived there for 1.5 years. Figuring that I had a better chance of being placed in a department of my choice if I started working before my posting was definite - basically volunteering - I made plans to return to the hospital's duty roster. However, my Grandmother passed away late in January, so I had to delay that venture till early February.

So I spent my initial stint working in the Internal Medicine department, but got trucked off unceremoniously to Surgical Casualty because of a Departmental crisis. Needless to say, I was waiting for the county to confirm my posting, but that just turned out to be futile. As March rolled in, things just seemed more hopeless.


Therefore, when I couldn't take it any more, I just packed up and moved back home. Some folks at Surgical Casualty wanted me to be reprimanded for the manner in which I left, but then again, how do you reprimand an unpaid volunteer?

That was basically rockbottom. Worst of all, this dillydallying meant that I've had to go 10 months without a pay cheque, so now I'm flat broke. However, some positive things began to happen: I had my interview for a Medical Officer position at PCEA Kikuyu Hospital on Holy Thursday, and shortly afterwards got the position. Once that hurdle was gone, it basically took me a span of 3 days (Friday - Sunday) to travel to Kisii, pack up my whole life of 21 months, and bring it all back home; and, yeah, rest for 1 day, and be ready for work on Tuesday.

I was surprised how things worked out so well. Makes me wish I'd made the decision to leave Kisii much earlier; I stuck by that place when my family tried to convince me to seek things out here in Nairobi. I'm guessing it became my 'comfort zone', caustic and fear-inducing as it may have been. In any case, I can't change what's happened, but I can learn from it, and grow.
With the ghosts of 2015 behind me, I'm now looking forward to brighter days and new beginnings...and infinite possibilities.
God Bless.

5:16 PM

Batman v Superman (Light) Spoiler Review

I wasn't expecting to be able to review this movie so early - since I had promised to watch it only once it was out on bootleg DVD - however, due to a strange twist of fate I ended up watching it at the cinemas: a friend (lady, no less) was amped about watching a movie at the the theaters before she left, and strangely, this was her choice. In case you haven't read my Man of Steel review (MoS), let me state that I detested that movie, and do not exactly fancy Director Zack Snyder because he had trashed the previous Superman movie lore, whilst not improving on anything beyond visuals.

Anyway, we watched the movie, and I can basically say that I had seen this mess coming from a mile away. I didn't go into the movie expecting to hate it from the get-go (as my twin bro thinks I did); rather, by projection from MoS and the stylistic choices made then, I anticipated an amplification of all the flaws brought out in that movie because of all the new story arcs and heroes that had to be interwoven this time around.

Let me first talk about the positives. Ben Affleck makes a great Batman; surprisingly, the biggest wildcard about this movie ended up being its saving grace. 'Batfleck' should no longer be considered a term of derision, and honestly the 'Sad Affleck' tidings just need to stop...he saved this movie. The whole Batman arc is the best part of this movie (including the cynical take on Alfred Pennyworth delivered by masterful Jeremy Irons). Unlike Nolan's Batman (beyond Batman Begins), this Batman can actually fight. He is a departure from previous Batman incarnations because this time he maims and kills with abandon. Rather than turn me off the Bat, it made me want to see a new standalone Batman movie so they could show what had driven him off the deep end.

This is also a beautifully shot movie, but this is a Zack Snyder movie so it was obvious that it would be a good-looking movie

The negatives abound, though. The same Superman arc that was so lightly fleshed out last time around is sacrificed even further here. Henry Cavill's Supes is as wooden as ever, his and Lois' relationship has grown by leaps and bounds despite not even being organically developed last time around. Lois is annoyingly inserted into situations (again!) this time that are for the most part irrelevant. Lex Luthor, as irritatingly rendered by Jesse Eisenberg, is the literal nail-in-the-coffin for this movie. People had been expecting a Heather Ledger/Joker-esque turn for this character, but it was not to be; the disappointment hinted at in the trailers only got worse the more this movie dragged along.

But honestly, after what Mr. Snyder put on show for MoS, how could people expect anything else? A lot of people wanted a big punch up from MoS, and that was what they got, but at the expense of any sort of useful character building (the big fight was what they said had been missing from Superman Returns, but that movie had character development laid out in spades). I guess once the crowd got that fight-jonesing out of their systems, this time around they wanted something more fleshed out. With this director, that was never going to happen.

So this movie is just MoS pushed to its logical expansion. Ma Kent is rendered more bitterly than previously imagined before, and the movie confuses itself by imagining it made us believe that it was Pa Kent's dream for Clark to be a superhero. (Clarification: that was Jor El's dream). Since MoS, I always wondered why Clark would ever want to be Supes considering this version of Ma and Pa Kent are so bitter, paranoid and cynical. Apart from Jor El, none of them pushed Clark to explore that Christ-like compassion that is a staple of Supes' comic book lore.

Just like MoS, the plot pacing is terrible, and it is built up so that it climaxes in a big final fight; but, I feel nothing for these characters, and I honestly wouldn't care if they were wiped off the face of the earth (maybe with the exception of Batman). And some of the plot points seem downright belittling. Some examples are required:

1. The Africa Desert incident was just poorly played. Supes probably only killed one person in that whole incident; seems rather superflous to blame him for everyone else who obviously died under a hail of bullets. (Heck, Justice League: Gods and Monsters, did a better job of framing Supes)

2. Lois and the Spear: one moment she's tossing it (understandably, to get it away from Supes). Next moment, she knows it suddenly important because she's serendipitously figured out that it'll hurt Doomsday. Then she gets herself trapped, and Supes somehow figures out where the spear is. Lazy writing par excellence!

3. The Batman v Superman fight also feels kinda avoidable. Once it became an issue of manipulation (and not The Dark Knight Rises Again philosophical clash), Supes could easily have let Batman in on Luthor's scheme. The movie setup gives us no indication that Lex is listening in on their conversation  or has them under any surveillance whatsoever. So, they could've convincingly play-acted if they really needed to convince him, while Supes bought some time to track down his Mum (by her heartbeat, voice, etc). If Zack Snyder still wanted to maintain the illusion of the BvS fight, he could later on suggest to us that Bat and Supes were in cohoots at some point in time (beautiful sleight of hand).

4. The Doomsday fight is a waste. It seems like WonderWoman might've actually had more hand-to-hand combat with that brute than Supes did. And then weaving "The Death of Superman" into this movie just kills it for me. As disposable as they made Doomsday, would've been better if they just fashioned him as Bizarro.

5. Lex Luthor is maniacal for the sake of being maniacal. He hated his Dad, he hates God, he hates Supes...full stop. He magically knows secret identities and family ties! This is a Lex who just wants to watch the world burn and we don't know why. I grew up with Power-hungry Lex, so I can relate to that version of him. This new one is a wholly new creation, but still remains a blank slate due to poor characterization.

6. The Justice League: people keep making the same mistakes that made Blade Trinity & The Amazing Spiderman 2 such terrible movies - focusing so much on spin-offs, that you mess up the movie entirely. Those 2 aforementioned terrible movies ended up killing the franchise, and we all know you can't have a spin-off if the franchise is dead. It's elementary! A few people have criticized the 'email-reveal', but what was sillier to me was the build-up. WonderWoman is basically a footnote in this movie, but they weave her in and out of it because...Lex has a dated photograph of WonderWoman and she wants it back. Lex has this photo ONLINE...what is Diana hoping to do...erase it from the cloud?

Using Man of Steel as a launchpad creates the same mess that the disastrous Iron Man 3 (with its terrible PTSD storyline) introduced into the MCU. DC had better work smart and get a new director for its Justice League ideas. Guillermo del Toro gave up on Justice League: Dark, but I'm sure he'd be game to work on Justice League. Also, they need to ditch the Nolanization. I don't want all my superheroes depressed and super serious. It works for Batman, but it could never work for Superman. And I don't forsee it working for Wonderwoman, or, God forbid, The Flash...only, unless you're doing "The Flashpoint Paradox".

In conclusion, just want to say that the lady with whom I watched this movie loved it. She didn't get all of it, she doesn't know much about the heroes, but she liked it. Which was the same point I made about MoS: had it been a story about another hero, a whole new mythos in which I had no prior stake, I would've enjoyed it too. However, this is Superman for goodness sake.

Well, that's my 2 cents for now.
You guys go on and enjoy your movie :)

P.S: Didn't dig the Batsuit. Looks too bulky, plus they've gotten rid of the undies on the outside (MoS style), but heck, they need something to break the dull grey colour scheme. Well, at least they never fully show the costume or focus on it for any long period.

10:25 PM

Internship snippet: Obs/Gyne

I was just thinking about how I never really managed to put out anything concerning my working experience during my medical internship during the time I was actually doing the internship (timing issues and not wanting to unceremoniously leak any confidential issues). Well, now, the internship is all but over, save for the issue of winding up and getting some signatures. I have to say that transitioning and finishing up for me has always been a bit of a difficulty. Anyway, I was talking to a friend the other day, and she asked me whether I had actually done any Caesarean sections. At the time, I told her that I had probably performed close to 100 as the primary surgeon; well, as per the official count in the OR log, it currently stands at 124 as the primary surgeon (there have been quite a number where I was the assistant, then there were also nights when I was just too tired to log in some entries).

It really has been quite the experience: Kisii Teaching & Referral Hospital, where I served my time is a really busy centre and referral cases come in aplenty. Nowhere does this sentiment ring truer than within the Obstetrics/Gynaeceology (Obs/Gyne) Department. I can remember nights when I’d hear an ambulance pull up to the hospital, say a prayer hoping that they were bringing in a case for the Surgical Department to deal with, and then rush up to the ambulance to confirm for myself. (Of course, I prayed the opposite prayer when I was doing my surgical rotation). :(

I must admit that Obs/Gyne is a hustle to deal with: due to Kenya's fascination with the Millennium Development Goals (MDGs), maternal-child health is a big deal; however, we embraced the ideals and goals, but have not exactly put in a step-by-step program to achieve them. What this did was create an untenable work environment where the onus for maternal death is put on the hospital (particularly the intern), regardless of the pregnant mothers' antenatal care history. On top of that, the work is tedious; I actually lost weight during my Obs/Gyne rotation.

Personally, I love practising surgery, and there’s no better teacher than lots of hands-on work. I still feel as excited stepping into the surgical theater as I did almost 10 years ago when I first volunteered at the Harrisburg Hospital. Performing surgery is art and science melded into one, a beautiful dance where everything enriches the experience: the anaesthetist with his/her real-time command of the patients condition, your assistants both at the operating table and those in circulation, and recovery; even the cleaners keeping the place nice and orderly are a massive help.

Obs/Gyne is not as varied a field as General Surgery, so there were very few procedures you get to perform; king of them all is the Caesarean Section. At this hospital, it's pretty much regarded as an Intern's procedure, unless there is a particularly extreme degree of difficulty inherent to a specific pregnancy. That is quite a lot of pressure to place on an intern; consider that (according to my friend in Australia) post-graduate students in other countries ONLY assist with the C-sections! The quicker you learn to be confident at performing a C/S, the better; my immediate superiors - the medical officers - were none too fond of being woken up in the middle of the night by an intern to come assist with a C-section. Knowing how to handle things at night with a skeleton crew is key.

All risks considered, a C-section is a pretty safe standard procedure; I have only had one mother succumb on the operating table (and that was because she had severe antepartum bleeding). I can't forget the near misses, though: on one occasion, a mother developed hypotension as soon as the spinal anaesthesia was injected and she just flatlined (breathing and heartbeat stopped cold)! Hence, before progressing to anything else, we basically started by resuscitating the patient; once the patients vitals were restored, we performed one of my faster C-sections. There doesn't seem to be anything written in literature sources, but it is a startling experience dealing with someone who has flatlined in the course of being anaesthetized: they pretty much seem out of their mind, overly emotional, unsettled, which in turn makes you question whether some sort of brain damage occurred. Thankfully, daunting as the experience is, the patient is in good condition when we review them the morning after.

I don't see a future for myself in Obs/Gyne, but I am at least thankful for the experience. Many a prayer were silently prayed over my patients as they lay on that table; prayers when I was starting out and the thought of being in-charge of systematically slicing someone open weighed heavily on my nerves; prayers when difficulties were imminent, and especially when complications arose. Thankfully, the Lord was faithful.

One downside to this whole experience is the sheer number of patients that we get to deal with. The intensity of the experience, at least on my part, meant that I formed deep relationships with mothers who I had to reassure and counsel on the best course of action for themselves and their unborn children. This occurred day in and day out; sadly, I can scarcely remember many of those interactions; it's as if they were wiped clean from my mind as soon as they were formed to make space for more equally intense versions of the same experience with other emergency patients. Or perhaps I'm just bad at remembering my own patients beyond a certain space of time. Thankfully, the patients never forget: Kisii is a small town, so its not unusual for me to bump into a lady on the street, for her to hail me as "daktari", and then remind me that it was I who helped her with a difficult delivery. It's things like that which make working in the medical profession a blessing, much more profound than anything money could ever offer.

I don't exactly know whats slated to come in the near future, nor where exactly I'll be headed be it another part of Kenya or Post-grad school - but I'm hopeful God will push me in the right direction (because I plain stink at transitioning).

Have a great week. God Bless.

9:37 PM

Memories: A "Buddy" Pass

Well, a picture really is worth a thousand words. The picture above is actually the conclusion to this whole fiasco after it had come full circle. So let's take a trip down memory lane.

This story starts in November 2003, during my days at Messiah College in Central PA. My elder brother, Nguza, who at that point lived at Daytona Beach, Fl., invited me over to spend the Christmas vacation at his place. He had come across a few Delta Airlines 'Buddy passes', and he sent me one of them so that I could use it to get a deal on a ticket. I'm not exactly sure about the specifics of the deal...but I do remember till today that I only ended up paying $88.00 for a Harrisburg (Pennsylvania) - Orlando (Florida) roundtrip.

Best way I could describe the Buddy Pass is to say that you were basically flying on the cheap, but you were flying 'Standby' the whole time; this meant I had to wait at the counter, get listed as a 'potential' for a specific flight, and hope that the flight either hadn't been overbooked or that everyone didn't make their flight. Oh, there was that one extra added stipulation that I had to be formally dressed...so no jeans and comfort on that trip.

The trip to Florida was for the most part uneventful. My boss, Elick Yeadon, got me to the airport safe and sound (though I remember him having to rush me back home when we pulled over to PNC Bank about 1 mile out from Messiah to get some money; serendipitously, it was then that I realized that I' d forgotten my passport). Apart from that, and maybe being passed over 2 times for a potential flight, I got to Orlando in one piece, and had a great vacation in Daytona.

When it was time to get back home, again I had to depart from the airport at Orlando. However, this time it proved to be quite the hustle to find a set of flights that would get me back to Harrisburg; it was peak season for travel, which basically meant I was stuck. Finally, someone manning the counters told me that instead of hustling to use 2 flights to get to Harrisburg, I had the infinitely easier option of taking 1 flight to New Jersey and after that taking 2 buses to get to Downtown Harrisburg.

I don't tend to hear many positive things about New Jersey, but on that day I felt New Jersey was just the Godsend that I'd been looking for. As soon as I set my sights on that NJ trajectory, everything just seemed to flow perfectly; I got the standby flight immediately, and I was headed back home. Soon as I landed in Jersey, I got the information for my buses. Turned out the first bus would get me to Allentown, PA at about 11pm, and I would have to take my bus to Harrisburg later in the morning. I surmised that I could just spend the night at the bus station.

Allentown, PA was like no other town I'd come across until then (at least nowhere in the continental US). It was only 11pm when the bus rolled into town, but everything was shut down! All businesses, even the bars: the town was dead and lifeless! Oh, as for that bus station where I'd planned to stay the night...well, it was literally just a small one-person ticketing stall set up next to a bus stop where the bus could pull over. I was basically stranded!

But then again, 'when it rains, it pours'. To add insult to injury, it had snowed earlier that night and the temperatures were frigid. So I found myself trudging through the snow with my luggage in tow, formally dressed, but not appropriately layered and stuck in a strange new town at the worst possible time. I remember walking those streets and coming across some homeless guy who looked like he was balled up in a sack and sleeping in the street. The guy was snoring so loudly, so you knew he had to be comfortable. At that point, I even considered sleeping underneath someone's porch if it was all I was gonna get.

At my wits end, I just walked up to a payphone and figured I'd call 9-1-1. I remember thinking I'd better give the police officer (dispatcher) the correct impression about my situation; didn't want him to think I was pranking him and find myself unceremoniously locked up in jail. He understood my predicament, and gave me directions to a nearby 'Halfway' house. (maybe he was new to Allentown and didn't know of any other options...or he knew how dead the place was and gave me the best option).

I got to the halfway house after a short walk, and I rang the bell. The Supervisor showed up and let me in; unfortunately, he couldn't let me sleep in one of the rooms because I had shown up too late. The best thing he could do was to let me sleep in the lobby, and attend to me later in the morning. It was a chilly place, and not the most comfortable of places to sleep, but it was better than my other options. In the morning, I got to eat breakfast with some of the residents, and by 8.30 am I was already down at the ticketing office finalizing my bus ticket. Long story short, I got home safe.

Fast forward to the end of J-Term 2004, at which point we were done with our classes, and some mission trips had been set up by the school. My good friend, Collins Mwangi, and I ended up going on one of the trips together. I don't remember if we had a choice concerning the area we were posted to, but suffice it to say we ended up in Allentown

I don't remember majority of what transpired on that Mission trip, but I do remember helping to stock food products for the Soup kitchen store; I also remember that we were hosted by the kindly Mr. Garcia and his family, who took us out for a basketball game at LeHigh University (...still have the entrance ticket stub till today). And, last but not least, we ended up at the Halfway house...Yes! The same Halfway house where I'd holed up that one eventful night.

To capture the event for posterity, on January 31st 2004, I had Collins take a picture of me seated in the very same lobby chair where I slept that night - the very same picture at the start of this post. So there you have it: finally come full circle. Memories indeed!

God Bless!

1:05 AM

Just a snapshot

I've neglected to write anything for quite sometime, and that was mainly because of all the stress that I went through during my stint in the Obstetrics/Gynaecology Department, but I've finally moved on to a slightly less hectic department: Internal Med.

Suffice it to say, the experience did nothing to sway me away from considering a specialty in Surgery. (I've only just managed to get over the episode of PTSD induced by the whole experience.

While I have been neglecting the blog, I managed to finally open a Tumblr account - http://wmu1ah.tumblr.com - and started to do something I should have done 2 years ago: putting the 'Compendium' pictures of the 1st Affiliated Hospital online (similar to the one shown on this post). During my last year at Medical school, a group of us invested hours and hours of our time putting together this massive project that would highlight the new 3,300 bed hospital and, in turn, bring much need attention to our medical school.

Personally, that project is all at once one of my greatest accomplishments and greatest failures. At this point, it's easier to ruminate on the failure, because, honestly, these pictures are coming out 2 years too late; I can't even begin to think of all the other compiled work that is sitting on multiple computers, idle, serving no useful purpose. Whatever the long story behind the whole process, I'm glad that I still have Tumblr to show some semblance of what we hoped to achieve.

My most heartfelt thanks go to all members of Compendium who helped with all the major lifting, particularly Hafiz, our trusty photographer, whose great skill shines through in this particular Tumblr.

Now that I have this bit of work off my chest, I can find another hobby to occupy my mind.

God Bless.

3:36 PM

The Music of Pat Metheny - Everyday, I Thank You

I had usually skipped this piece whenever I came across it in my playlist. The long drag from Michael Brecker's sax usually implied to me that this would be a depressing piece (...and this one certainly is long, coming in at a full 13.5 minutes).

Thankfully, one day I just let the shuffle button do its thing in my PMG playlists, and I had a chance to listen to the piece in its entirety. It is by all means exquisite; a ballad perfectly crafted. Starting out with the song's chorus framed by an ethereal pipe synth portion, Michael Brecker paints us an eloquent picture, and in a quickening of pace, Mr. Metheny adds yet more pastels to the song. (Love that rubato!)

If memory serves me right, it was Pat who wrote this song, but from listening to it, it's clear that the good relationship he had with his late friend allowed them to concoct pure magic. Mike Brecker is front-and-centre on this tune, but Pat is never far behind - each of them coming in to accentuate different portions of the song. Every bit of this song just works. If the title of the song is anything to go by, they really expressed their gratitude as sincerely as could possibly be done. And in turn, I thank God, everyday, for this music which conveys sentiments that cannot be described adequately through wording.

 Everyday, Father, I thank you.

1:03 AM

Rant: The Registrar of Companies

This is the second time I'm having to deal with the Registrar of Companies at Sheria House, and I cannot claim that the experience is any less painful than the last time. In my previous post, I had mentioned that I already knew the necessary steps required to initiate my business. As usual, the lynch pin was the people manning the counters at Sheria House.

This past Monday, armed with a new name for the business - "Aykornia" or "Aykornium" - I wanted to run the prerequisite name search. Would you believe the Registrar has only one desk dedicated to this process (Counter 1 - File Perusal/Name Preservation); to cap it off, at 10.30am the employee-in-charge of the counter just got up and left, leaving a growing number of us in a queue stranded! And these things aren't complete unless they come in a
trifecta: some of the employees from the other counters who glanced at my desired company name told me that my company name HAD to consist of at least 2 words.

 My complaint concerning these 3 issues remain unchanged from my last post, and I'll put them down here again. First, Counter 1 is redundant and can literally be manned by even a trained high school student who would only be required to receive your application and give you a slip allowing you to pay for the transaction. It would even be more effective to actually digitize the procedure to ease the whole process and decongest the registration hall. These two mere measures would free up the people manning the counter to 'possibly' make themselves useful somewhere else.

And I've said it once,and I'll say it again: some sort of guide needs to be published to assist fledgling entrepreneurs concerning the idiosyncratic rules governing setting up businesses. I am tired of having random clerks randomly chipping in with ad hoc rules that complicate an already complex and infuriating process. I would like to think that any worker worth their salt would strive to improve the processes associated with thir work stations, but it is becoming clear that some of these civil revel in the confusion; others just do not care enough to want to change anything.

 The last time I went to Sheria House, a guard at the gate approached me and basically offered to 'expedite' the process if I basically 'greased his fingers'. The corollary is that if his fingers are 'greased', someone else on the inside is also having their fingers 'greased'. The only other option is to have a lawyer bulldoze through this process for you, and that certainly doesn't come cheap.
So for the clerks, the modus operandi is just frustrate! frustrate! frustrate! the common mwananchi.

 I hear people talk about how easy it is to start a business in Rwanda - a maximum 3 days (even for foreigners) to have the legal documentation in their hands. I compare this to Kenya and think that there's nothing really special involved here. Just Discipline and the ability to understand that allowing business to flourish in Kenya is good for the country as a whole. However, if the current civil servants can't understand that, they need to be sent packing instead of positioning themselves as stumbling blocks in everyone else's path.

That's my 2 cents for today. God help us all (especially if we have to go to the Registrar of Companies offices)