Sunday, 25 March 2012

A SURGICAL APPROACH TO THE KENYAN POLITICIAN

My general surgery rotations in med school are so far quite something. This is one field of medicine that I piously revere. See, the job here is straight forward; see a patient, deliberate their fate with other intelligent colleagues, open them up and fix whatever is wrong and hope nature will handle the rest. Sounds pretty simple doesn’t it? Well, even with my meager background of medicine, I can tell you; it’s not all that simple. That’s why surgeons are revered as demi-gods by laymen and envied by their other less daring counterparts. One thing that I have learnt though is that surgical patients need to be overly analyzed if treatment is to work. And to put my newly acquired skills into action, I will present to you a very familiar surgical case: the Kenyan politician.

Typically, this patient is a geriatric male presenting with an overly distended abdomen, verbal diarrhea and mild kleptomaniac tendencies. This clinical condition is called politicsitis. All cases have a history of election to parliament as the predisposing factor. The onset of these symptoms is insidious, with the acute phase coming soon after election and chronicity kicking in as little as four months later. The disease escalates from a mere infection to a premalignant condition known as a politicytoma about four years later. This may graduate to a malignant condition that will be illustrated below.

The pathophysiology of this condition is as intriguing as the politician himself. I will therefore try to illustrate each symptom according to the latest medical findings. The distended abdomen is usually the earliest symptom. Due to exposure to the ‘greed atmosphere’ of parliamentary quarters, the average politician tends to gormandize on public funds. This directly impacts on their gastrointestinal system culminating to constipation. The adynamism of their intestines culminates into an infective process: politicsitis.

Acute politicsitis rapidly turns into a chronic systemic complication. While the politician seems healthy to the ordinary mwananchi, he is suffering inside. Consequently, the incumbent becomes rare to the electorate to nurse a disease process that is now a vicious cycle. This phase of the disease is the longest, lasting from the sixth month to the fourth year of the electoral term. During its active phase, it is a vicious cycle that presents with kleptomaniac tendencies and hypersomnia especially in parliamentary proceedings. Absconding of duties is also observed and when the politician makes a show, verbal diarrhea is very evident. The three symptoms i.e. kleptomania, absconding and verbal diarrhea are collectively known as the Vulture’s Triad. If they are not well monitored (as happens in most cases) the premalignant phase is imminent.

The premalignant condition, politicytoma, is a benign tumor that affects the frontal and temporal lobes of the brain. Its cause is unknown though Evidence Based Medicine suggests that tribalism, greed for re-election and corruption are predisposing factors. It starts late in the electoral term. The gross presentation of its onset includes holding irrelevant prayer gatherings and paranoia with formation and disbandment party and tribal alliances. This phase is also characterized by a lot of verbal diarrhea secondary to severe cognitive embarrassment. It is no wonder that a brain biopsy analyzed microscopically reveals very few normal neurons strangulated by large tumor cells; the Cells of Idiot. This is a pathognomonic feature of this stage. Where a biopsy test is unavailable, one can conduct an easy ‘Lame Joke Test’ where in his attempt to please everyone in exchange for votes; the politician will blatantly laugh at the lamest of jokes. This characteristic howling laughter is known as the Howling Hyena Syndrome abbreviated as HHS.

Its prognosis is poor as it turns into a malignant condition (Politicytosarcoma) just before elections. The chief site of metastasis is the electorate via 'pouring of money', cheap liquor and false promises. The symptoms of metastases may range from mild e.g. nominating the politician as a ‘tribal figure head’; moderate e.g. soliciting for signatures to postpone Hague trials; to severe ones like the post election violence (how fast we forget).

Unfortunately (very unfortunately indeed), this nagging condition is rarely fatal. Its management is also challenging due to poor compliance and high recurrence rates. In an ideal situation however, radical management is prime. Patients should be exterminated from the larger society and completely forgotten about. Those in advanced disease stages should be deprived of palliative sympathy and any vote treatment. The latter drug is known to aggravate the disease. Prevention is by isolating and electing leaders with a strong immunity and a will to work with relevant stakeholders to cure society of this disease. Otherwise, I know I would be speaking on your behalf by saying that we are all getting sick of this, wouldn't I?

Sunday, 4 March 2012

ON CLERKSHIP AND DRY BONES

The epitome of a medical student’s life is clerkship: that’s before graduating from med school of course. My clerkship started on a rather interesting note. My first rotation was in Orthopedic Surgery. Orthopedics is basically the medicine of the musculoskeletal system; at least in theory it is. Where I was, things roll a little bit differently.



The wards:

I learnt to locate these by my sense of smell, which (I must say) was bad for most of the rotation owing to the weekly visits to the Ear Nose and Throat clinics. Most of the cases there are trauma. Unfortunately, trauma cases are on the increase. In fact, road traffic accident victims occupy most of the beds. The rest are victims of burglar attacks, ‘Nyerification’, survivors of a ‘Wanjiru episode’ or those who believed they could fly, actually tried it and lived to tell the story. And after the trauma of natural and not so natural causes, they are all bundled up in the ward (that explains the stench). Their fate: a simple recovery or, being victims of malpractice, a long uncomfortable and complicated hospital stay and an even longer hospital bill.

The consultant:

My admiration of our consultant knows no bounds. A simple hulk of a man, a frame built well enough to break a bone and fix it. He has this gorilla-esque demeanor, an ever twisted neck-tie and an uncanny sense of sarcasm that only ages of practice can justify. And he knows his stuff too. His teaching techniques, rather unorthodox I must say. He keeps pinging very open ended questions: like telling you something about a fracture and asking you what you should tell the anesthetist (like it’s him who broke a bone). He likes concise answers, very military of him I should add. In fact, all he needs is a stolen war medal to make a fool proof alibi of his being a veteran war medic.

The practice:

You know those moments when you are about to do something then your friends tell you to break a leg? Well, it’s not that easy. Neither is fixing a broken one. Actually it depends. The simple ones just need a cast, but when surgery is required the game changes. A chisel, a hammer, some screws and plates, nails, tape measure and other things to measure angles, bolts to mention but a few… those are the essential tools of carpentry, erm, sorry: orthopedic surgery. So similar are these two that one famous orthopedic surgeon wrote, “To operate on the bone requires the tools of a carpenter, yet orthopedic surgery is not carpentry; the biological imperatives ensure that it can never be.”

The lessons:

Other than the simple straight forward concepts, there are a few other bizarre ones I have to mention. First, the indications for limb amputation of are better known as the 3 ‘D’s : Dead /Dying, Dangerous, or Damn nuisance (that’s how they wrote it I swear). Secondly, a boner is not a bone: just plenty of blood in erectile soft tissue. The hydrostatics behind it is plain to the eye. The paradox is that one can get a fracture of the penis. Let’s leave the cause of that to doctor-patient confidentiality and its management to your imagination.

What next?

Next on my plate is general surgery. Before that, I hope none of my friends will ever say that they have a bone to chew with me because from then onwards, I will assume they are talking hyenas. As for my new rotation, I'm mostly looking forward to it. I must say though that I associate it with a lot of alliteration: Surgery, Surgeon, Scalpel, Sear, Suction, Scaffold, Suture, Strap… Sigh; let me display my ignorance no further.
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