SURGEON'S DIARY: He swallowed bottle cap and forgot about it

A few years ago, I lost my briefcase while I was waiting for my flight at Johannesburg airport. I had gone there to attend a Rotary meeting, which was convened to see how we could increase Rotary membership in Africa.

The project, still flourishing, is called “Reach out to Africa”, with a catchy acronym ROTA. The meeting had gone on until late and the next morning, I was due to catch a flight home. After checking in, I was waiting in the departure lounge for my flight to be called. I must have dozed off briefly because when I woke up, my briefcase had vanished. Luckily, my passport and boarding pass were in my pocket and so I could fly after reporting the incident at the airport police station. Otherwise I would still be loitering there!

Few months later, I was flying to Maputo along with three colleagues, to attend a council meeting of College of Surgeons of East, Central and Southern Africa (COSECSA). Our flight was delayed and while we were waiting at JKIA, I related the incident to my friends just to fill time. To my surprise, I discovered that we all have been stung in a similar manner.

“I lost my briefcase in the surgeons’ changing room at the Westminster Hospital in London.” One of my colleagues narrated his experience. “I left it in the locker and went to assist my boss in the main theatre. When I came back and opened the locker, it had disappeared. I reported it to the hospital security officer.”

“And?” I asked.

BAD REPUTE

“He said he would try, though he held no hope of finding it. “In London”, he added. “if you don’t fasten your shoe laces tight, they will steal your shoes from your feet.’”

“At this rate we might have to start wearing chastity belts.” Suddenly, I heard the feminine voice of a lady plastic surgeon, travelling with us.

“My friend, the provost of a famous cathedral in Nairobi was praying at Schiphol airport in Amsterdam.” Another surgeon lamented.

“He did so with his eyes closed, his briefcase tightly gripped between his feet. When he finished, he looked down and found that though his feet were nailed to the ground, his valise had vanished.”

“And what did he do?” One of us asked.

“As per the precept of his faith which proffers the other cheek,” replied the surgeon in his usual funny way. “He closed his eyes and prayed again, this time to invoke forgiveness for the culprit!”

Eventually our flight took off but at Maputo airport, we faced another  challenge. The vagaries of communication in our continent surfaced and there was nobody at the airport to receive and help us with immigration formalities and escort us to our hotel.

DEAD END

We did not even know at which hotel we had been booked for the night. We tried to use our mobiles to contact our hosts but realised that neither Safaricom nor Airtel extended their network to Mozambique then and none of us carried an international roamer. To make matters worse, after having managed to obtain local currency at very unfavourable rates, to enable us to use the landline in the airport building, we found that it was out of order.

Eventually, we hired a cab and since I knew the city, I asked the driver to take us to hotels I knew. Hotel Pollana, Tourismo, Cardozo and Santa-Cruz — we visited them all and they were all full.

There was an international conference going on to promote tourism in the country and all hotels were fully booked. My Portuguese was worse than the driver’s English but I managed to convey to him that he could take us to any hotel of his choice. He did so and in the process, showed us all the ill-reputed back streets of the city including the red light district and finally dropped us at a hotel which rented rooms by the hour and allowed one companion of the hotel guest to stay with him!

Long night

I lay awake the whole night, listening to doors opening and shutting every hour, crunching sound of brothel creepers, whispered intimate conversations, laughter, moans and groans, all of which I could only connect to one human activity!

There were profuse apologies the next morning when we managed to contact our Mozambican colleagues, who having missed us at the airport were frantically ringing the hotels the whole night. Understandably, the hotel we were staying at was not on their list!

The quarterly Council meetings of COSECSA usually take place in district towns to promote rural surgery where majority of our people live and this meeting was organised at a beautiful beach side town, called Chai-Chai, where we drove.

It was the first meeting presided over by the newly elected president and he carried on the happy tradition of starting with a couple of light hearted remarks before embarking on the serious part of his discourse.

“You know,” he said. “We belong to a very privileged profession, because as surgeons, we can undress a woman and send a bill to her husband for doing so!”

He then told us about the new batch of freshly qualified doctors the university had sent as interns, to the teaching hospital.

“I must have got the worst of the lot, because every time I asked my new intern to make a diagnosis on the case he had presented on my teaching ward rounds, he was wide off the mark.

FATHERLY ADVICE

“So when he finished his term and came to collect his testimonial, I gave him fatherly advice. I told him, “Son, have you ever considered taking up meteorology and weather forecasting as a career?”

On the flight back to Nairobi, my surgical colleague, Prof Ocholla and I got adjacent seats and we took the opportunity to do a postmortem on the Council meeting. He particularly picked up on the subject of making wrong diagnoses.

“It is not only interns who make mistakes,” he said. “It sometimes happens to the most senior among us.”

He then proceeded to relate his own experience. “Not so long ago, I had this male teacher from Kisumu come to see me, complaining of difficulty in swallowing, initially solids and lately liquids. As you know anyone from there, suffering from dysphagia is diagnosed as a case of cancer of the oesophagus, unless proved otherwise.”

He was referring to cancer of the gullet. He took a swig of the pre-lunch Tusker which had been served and continued.

“Barium swallow X-rays showed an irregular rat tail narrowing of the oesophagus, typical of cancer. So I decided to do an endoscopy and saw what looked like a tumour. As I was taking a biopsy with my punch forceps, I thought I heard a metallic clang and concluded that the growth was calcified, which often happens in this disease.”

He said, “The first doubts about my clinical and endoscopic diagnosis were cast by the pathologist whose report said, ‘No malignant cells seen in the specimen sent.’”

By now the pretty, coastal Arab air hostess had placed two meal trays in front of us. Eating his salad, my friend continued.

“Meantime, the patient was experiencing increasing pain and difficulty in swallowing and so I talked to him. ‘Occasionally, we fail to take a representative part of the lesion. That is why the lien by our pathologist. By mentioning in the specimen sent, she is safeguarding her position. Your symptoms, however, are so typical of cancer of the oesophagus and the dangers of delay are so dire that in my view, we should at least explore it’,” said Prof Ocholla who was now cutting into his tilapia.

HIS CONFIDENCE

“The man complied straight away after paying me a handsome compliment. ‘I have come all the way from Kisumu and put my life into your hands because I know you are the best chest surgeon in the country,’ he said.

With a glow of pride on his face, the professor went on. “As I was dissecting the oesophagus and separating it from important structures, trying to get above and below the lesion, I heard the same metallic sound. So I decided to open the gullet before removing part of it, which I reckoned contained the malignant growth.”

He suddenly darted the question: “Can you guess what I found?” I had no clue. Fortunately, I couldn’t speak with my mouth filled with food and so he continued.

“Top of a beer bottle!”

“The mystery was solved the next day when I handed the bottle top to its rightful owner. Mwalimu looked at it for a few minutes and after scratching his bald pate said. ‘I had forgotten all about it. Long time ago, my colleagues and I went for a head-masters’ meeting to Homa Bay. In the evening there was a koroga. Lots of beer and nyama choma was consumed. At the end of the long evening we found a lot of beer tops missing, but were too drunk and drowsy to worry about them.’”

“Did you do anything about it?” the doctor asked.

And the patient replied. “Not really. After discomfort for a few days, it all settled down, so I didn’t bother.”

“Did not the Barium swallow X-rays, which you mentioned you took while you were investigating the man, show any radio-opaque material or metal?” I asked.

“No,” replied Prof Ocholla. “Bottle tops contain so little metal, mostly tin and don’t show a significant opacity. Without a prior history, we did not have a high level of suspicion either.

“In this case, it just burrowed in the wall of the food-pipe and caused irregular narrowing, mimicking cancer of the oesophagus.”