Curses, porridge and other cases stranger than fiction

There is never a dull moment for a surgeon in the village as there are happy and crazy hilarious days. Some border on the criminal, other patients are just mischievous, some are prisoners of their beliefs. 

Take the octogenarian who consented to amputation but could not allow the trimming of his overgrown beard that had his mouth under ‘lockdown’.

His mouth is more of an ostium only accessible by him to eat or talk. When he takes tea or porridge, gray skid marks colour his hair around the mouth. When he showers it returns to black. Growing young and old in short cycles! His denomination, he said, did not allow shaving the beard.

Then there was the 60-year-old man who checked in suffering from Fournier’s gangrene, a flesh-eating bacterial infection that attacks the private parts, starting around the genitals and quickly creeping up the crotch to the lower belly. Often it can go as up as the collar bones.

At first look, my medical officer and I shouted ‘debridement’ in unison. He needed urgent surgical source-control before he could collapse into an overwhelming infection. The damage is best assessed after surgery. Usually, the patient will get several trips to theatre, every time the surgeon removing the dirty tissue in addition to the tons of antibiotics.

Being fully alert, I did not expect any challenges with obtaining informed consent for the second surgery. Yet it did not come. The patient sent for the relatives first: “Hata mwîchiaro alikuja na wakamaliziana sasa tunaweza kuendelee na surgery.”

I was taken aback with this update that a villager had come to ‘lift the curse’ before I could proceed with the surgery. The patient was convinced he suffered this tormenting disease because he had wronged someone who had cursed him. His family had just brought the aggrieved person to lift the curse.

Having gotten this clearance, now the anesthetist was allowed to review and ‘clear’ him for surgery.

Another memorable case was the male patient with a clot pressing on his brain. Epidural hematoma it is called. The patient was fairly stable awaiting surgery. There was an NPO (Nil per Os) meaning ‘nothing by mouth’ notice board next to his bed meaning he could not have breakfast. When we got to the cube, he had left his bed and moved to another two beds away. He stood next to the other patient (already a discharge-in awaiting evacuation), drinking his porridge. The other patient looked on uncomplaining. It was a debt he was paying, I learned.

The patient had felt pain at night and sent this younger and stronger one to the nursing station to call for a nurse to bring him pain killers. In return he would sacrifice his early morning mug of porridge.

“Will you go back to your bed,” we reprimanded the porridge-chugging lad. He immediately cleared it and wiped his lips then went back to his bed.

That is when it dawned on us. He could not be accused of drinking or eating next to the NPO board. Of course, his surgery was cancelled.

Exit the porridge patient and enter the guy brought in after a road accident. He could not talk. So his family decided to “play rough” with our admission staff. They registered him using his brother’s details so that he could benefit from insurance. For a whole week we knew him by his brother’s name!

For head injury patients, you have to give a score called the Glasgow Coma Score (GCS) daily. It entails giving instructions to patients, some in the form of questions, and then assessing how they respond. The better the response, the better the GCS and by extension, the condition of the patient.

Of course, his GCS remained low because of how he answered us if we addressed him by his brother’s name. We were the ones confused, not him. We kept wondering why he would be this “low” even when the scans did not reveal a high grade of injury. Until the day their mischief was caught out and the file corrected. Next day he would not only answer my question but strike a clear conversation.

“It seems the drug we added is working miracle,” I nodded to my team. “No doc. We have been using an alias!”

Other patients, also suffering head injuries, were basking in the sun. Well, that meant they were doing really well for their grades of head injury. The nurse summoned them all onto their beds. It was time for the ward round. They all got onto their beds, or so I thought. Until the nurse told me that almost all three of them had changed beds. I confirmed by looking at corresponding files and bedside charts. We tried to move them and the ward round came to a halt. Everyone stood their ground, arguing that they were in their beds. Well, it was better than keeping quite.

Dr Aruyaru Stanley Mwenda’s book “The Chronicles of a Village Surgeon” is available on Rafubooks and Amazon.