Student battling vengeance, HIV and acute appendicitis

At the end of this sad but fascinating session, I thanked Damaris for relating her autobiography so lucidly and candidly. I said with religious fervour, searching for positive points. ILLUSTRATION | JOHN NYAGAH

What you need to know:

  • If I had to sum her up in two words, I would have labelled her as a rough diamond, unpolished and weathered by merciless storms in her life.
  • I was a precocious girl for my age and my uncle sexually abused me. It became a regular occurrence and first I thought of informing my aunt, but I decided against it for two reasons. One was that she wouldn’t believe me, the other being that it would create a rift between a happily married couple with children of their own.
  • “Oh yes,” she replied with a naughty glint in her eyes.”I have had the last laugh, for I must have transmitted HIV to all those 20 rogues, who gang-raped me!”

It was a call from the university medical clinic. “I have a young lady here with acute appendicitis,” Dr Kajwang, the senior medical officer on the campus said.”

Then to justify his cocksure diagnosis he added. “Damaris started with central abdominal pain last night after dinner. Thinking that it was a tummy upset, she drank soda-water and tried to sleep with it. This morning, she found that her pain had settled in the RIF.”

RIF stands in our jargon for Right Iliac Fossa, which in a layman’s language means the right lower corner of the tummy. “She managed to have a little breakfast this morning but threw up soon after and decided to attend our morning clinic. On examination, she looks ill and is extremely tender and rigid in the RIF. She will benefit by your intervention.”   

“Please send her to the hospital,” I advised.

Soon, I was rung by the Sister of the female surgical ward: “Your patient with acute appendicitis is here.”

As soon as I finished what I was doing, I went to see Damaris. Since I had been given her medical history by Dr Kajwang, I asked her two questions. “How old are you?” was my first question.

“Twenty-two,” she replied.

“And what are you studying at the university?”

“I am doing business management and finance,” Damaris replied.

“Good,” I remarked.

All the time, I was assessing my patient, both with surgical eyes and a psycho-social lens.

Her face belied her young age. She was at once saucy and subdued and there was some mystery about her which made my analysis both intriguing and fascinating. If I had to sum her up in two words, I would have labelled her as a rough diamond, unpolished and weathered by merciless storms in her life. It did not escape my notice that as I was studying her, she was assessing me. Why not? After all she was putting her life in my hands. But, more than that, I suspected that there was another subtle reason; she did not trust my gender and I was a suspect in her eyes.

I proceeded to examine her. I confirmed the diagnosis of Dr Kajwang because when I palpated her RIF, she almost shot out of bed. That was the easy part but her general examination revealed a few puzzling points. On her abdomen there were a few linea gravidarum lines left behind repeatedly by a fully pregnant uterus, as the name implies.

SHOCKING REVELATION

“Have you been pregnant before?” I asked.

“Yes,” she replied nonchalantly, “A couple of times.”

“Both times full-term?” I asked because linea gravidarum are stretch marks, left behind by full-term pregnancies. As she nodded her assent, I asked. “Where are the children?”

“In a children’s home,” she replied.

Being a breast surgeon, my eyes and hands travelled there in a reflex action. Though I did not feel any lumps there, their general configuration once again puzzled me. They were sagging and lacked support and were not as upright as her age warranted. They belonged to an older age group and looking at them, a naughty but appropriate thought crossed my mind. “Life should not be judged by years alone but by the intensity at which the life has been lived!”

Finally I looked at the throat to see the state of her tonsils. They were alright but as I was slowly drawing the spatula out, I saw a suspicious sore on the inside of her right cheek which impelled me to ask Damaris. “Would you mind if I did a HIV test on your blood?”

“Not at all,” she sounded brazen. “It is positive and I am on Anti-Retro Viral (ARVs) drugs.”

Shocked with her revelations, I did not think this was the right time to pursue my inquiry further. I had an urgent task on my hands, which was to take her appendix out. It had been well established by now that HIV positive patients should receive the same treatment as the rest.

We had already adopted a protocol to operate on patients since the advent of this new disease. We as surgeons put a waterproof gown on top of our green gown and wear two pairs of gloves, in case one set had undetected holes in them. The nurses took extra care when dealing with sharp instruments and never handed them to us with their sharp ends pointing towards us, as they did in the good old days.

They now presented them in a kidney dish and we picked them up from there. Everyone knew what measures to take in case of an accidental prick to the hands of the surgeon, the assisting doctor and nurse.

At operation, I was glad to see that though the appendix was on the verge of bursting, it was still intact, because the resultant peritonitis is more difficult to treat in HIV positive patients. Even so, the post-operative recovery was very slow in the case of Damaris, which necessitated her stay in the hospital for almost a week. It was during that period that she gave me an account of her short, sad but eventful life. It came out in bits and pieces, sometimes interrupted by questions and exclamations from me.

To make it a coherent presentation however, I will give her verbatim account.

“My problems started when I lost my parents to HIV and Aids. I was just 11. I had passed my KCPE with good marks and was waiting to join a leading secondary school, when this calamity descended. My siblings and I were distributed to various relatives, as per our tribal custom. I ended up in Nairobi with an aunt. I was a precocious girl for my age and my uncle sexually abused me. It became a regular occurrence and first I thought of informing my aunt, but I decided against it for two reasons. One was that she wouldn’t believe me, the other being that it would create a rift between a happily married couple with children of their own.”

She added: “I don’t want to blame my uncle, who is a good man. He simply couldn’t resist a dish, easily available to him to ravish! I just left the house, in search of a job, not realising that jobs are not easy to come by for a girl of 11. So I ended up as a street girl. I learnt to sniff glue, scavenge for food and found a corner to put my head down at night. The problem was fighting off street boys and other men who were after my body, some of whom wouldn’t take No for an answer. What they couldn’t take by seduction, they grabbed by force. I knew that I had picked up the virus and the test at a government clinic confirmed it.”

LAST LAUGH

At that point, she didn’t know she could get free ARVs at a government hospital. 

“I lived that life for almost three years, until an elderly Asian couple rescued me and gave me job on their shamba.  It was timely because just before they ‘adopted’ me, I had a terrible experience one night, when I was gang-raped by almost 20 louts. The good-hearted couple soon realised that I was over-qualified for the job asked me to give them details of my background, which I did. Surprise! Surprise! They approached the secondary school to which I was admitted before and paid for my education. I found a street-girl in similar circumstances and to take my job,” Damaris said

She continued: “I justified their faith in me by coming in the top ten in my school and obtained admission at the university as a regular student in the subject of my choice. That is when I went on ARVs, as advised by the doctor at the  clinic.”

At the end of this sad but fascinating session, I thanked Damaris for relating her autobiography so lucidly and candidly. I said with religious fervour, searching for positive points.

“I am neither wearing priestly robes, nor a clerical collar and we are not in the confessional, but I want to pose this question to you couched in canonical terms. ‘My child, can you recall any silver linings in this dark cloud?’”

“Oh yes,” she replied with a naughty glint in her eyes.”I have had the last laugh, for I must have transmitted HIV to all those 20 rogues, who gang-raped me!”

As I drove home that evening, I realised that in all the many years, I have practised as a surgeon, I haven’t heard of an experience which Damaris narrated.

I wondered at the human body and mind, riddled with contrary emotions like fortitude, determination, compassion, generosity and resilience, but also vengeance, as that light-hearted remark by Damaris indicated!